Adequate diet:
A mixture of food stuffs selected to satisfy the nutritional requirements of the body in quality and quantity. It should be safe and of good taste and smell. It should be suitable for weather age, effort and physiological status of every one.
Introduction of Nutritional requirements ( according to RDA data ), different methods for assaying nutritional requirements, interaction with other nutrients and Antagonists & Analogues of vitamins.
Introduction of Nutritional requirements ( according to RDA data ), different methods for assaying nutritional requirements, interaction with other nutrients and Antagonists & Analogues of vitamins.
Concept of nutrition, Food, nutrition, malnutrition and balanced dietkumkumpandey4
concept of nutrition: definition of food, nutrition, malnutrition, overnutrition, under nutrition, optimum nutrition, balanced diet, its components and importance
Nutrition is the study of the nutrients in food and how they nourish the body.
Nutrients are components of food that are needed for the body to function
what is a balanced diet ?
Sources, RDA & Deficiency symptoms associated with- Carbohydrate
Fat
Protein
Vitamin
Minerals
and Fibers
IRON, SODIUM, POTASSIUM, CALCIUM, IODINE, COPPER & WATER
Unit 1 (introduction to food nutrition & dietDhaka Gaurav
Introduction to Nutrition & Diet
About Calories & Balance Diet
Daily Caloric Requirements for different age of groups
Food Groups & their Roles in balance diet.
Concept of nutrition, Food, nutrition, malnutrition and balanced dietkumkumpandey4
concept of nutrition: definition of food, nutrition, malnutrition, overnutrition, under nutrition, optimum nutrition, balanced diet, its components and importance
Nutrition is the study of the nutrients in food and how they nourish the body.
Nutrients are components of food that are needed for the body to function
what is a balanced diet ?
Sources, RDA & Deficiency symptoms associated with- Carbohydrate
Fat
Protein
Vitamin
Minerals
and Fibers
IRON, SODIUM, POTASSIUM, CALCIUM, IODINE, COPPER & WATER
Unit 1 (introduction to food nutrition & dietDhaka Gaurav
Introduction to Nutrition & Diet
About Calories & Balance Diet
Daily Caloric Requirements for different age of groups
Food Groups & their Roles in balance diet.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
The WDF mission:
Proc.02 and 03: Body Weight, and Intake & Outputjhonee balmeo
Daily weights provide a relative accurate assessment of a client’s fluid status.
while all routes of fluid intake and all routes of fluid loss or output are measured and recorded
Healthcare organizations including hospitals were founded to give care to those who need it and to keep patients safe.
It is generally agreed upon that the definition of patient safety is…
"DO NO HARM"
Diet does not substitute drugs but it is considered a complementary therapy.
The goals of dietary advice are:
To prevent or manage some medical conditions
To maintain or improve health through the use of appropriate and healthy food choices
To achieve and maintain optimal metabolic and physiological outcome
Malnutrition is poor nutrition due to an insufficient, poorly balanced diet, faulty digestion or poor utilization of foods. (This can result in the inability to absorb foods).
Malnutrition is not only insufficient intake of nutrients. It can occur when an individual is getting excessive nutrients as well.
Nutrition: it is the dynamic processes by which the body can utilize the consumed food for energy production, growth, tissue maintenance and regulation of body functions.
Is the ability to access, assess and apply the best evidence from systematic research information to daily clinical problems after integrating them with the physician's experience and patient's value.
Sample is Group of individuals or things selected from the entire population to be representative to this population.
Each member of the population is called the sampling unit.
Workplace Mental Health (WMH) is a sub-discipline concerned with psychological illness, injury and disability and the role of work as a causal or contributing factor. But, unfortunately, WHO announced that WMH is a ‘Cinderella’ subject. So, it is one of the most urgent demands facing the occupational health services (OHS).
Environment
Any things surrounding us & can affect health
Environmental sanitation
Properties & requisites of clean environment.
Environmental health
Protection of human health from hazards of unsanitary environment.
A training workshop that assists researchers in dealing with statistics throughout the research.
It is the science of dealing with numbers.
It is used for collection, summarization, presentation & analysis of data.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. Dr. Dalia El-Shafei
Assoc. prof., Community Medicine Department, Zagazig University
http://www.slideshare.net/daliaelshafei
2. LEARNING OBJECTIVES:
Identify sources, functions, effect of deficiency of nutrients.
Understand the characteristics of adequate, balanced diet.
Develop a diet plan by using the dietary guides and nutritional pyramid.
Describe diets for vulnerable groups.
Understand the causes, manifestations and control of malnutrition problems.
Explain methods of assessment of nutritional status.
Describe diet plans for selected chronic diseases (therapeutic diet).
4. FACTORS AFFECTING ENERGY REQUIREMENTS
Physical activity
• Type & duration of activity and
size of the person.
Lean body mass (LBM)
• ↑LBM →↑Metabolic activity
→↑Energy requirements.
Age
• ↑BMR & energy requirements
during periods of growth then ↓ at
older age.
Climate
• ↑Energy requirements in low
atmospheric temperature to
maintain body temperature.
Fevers
• ↑BMR by 7% for each ↑0.83°C in
body temperature.
Pregnancy & lactation
• ↑BMR & energy requirements.
5. ESTIMATION OF ENERGY REQUIREMENTS
BMR
• 1.0 K.cal/kg BW
/h (for men)
• 0.9 K.cal/ kg BW
/h (for women)
• BMR/day = 1.0 or
0.9 x BW x 24
Physical activity
requirements
• Sedentary life =
20% of BMR
• Very light activity
= 30% of BMR
• Moderate activity
= 40% of BMR
• Heavy activity =
50% of BMR
Specific dynamic
action of food
(S.D.F)
• Energy needed for
digestion
absorption &
metabolism of
food) = 10% of
BMR.
Energy requirements = BMR + Phys. Activity + S.D.F.
7. A serving of a high-fiber food, such as backed beans
results in lower blood glucose levels compared to the
size serving of mashed potatoes which results in a
higher blood glucose level.
Why are we concerned with the effects of various foods
on blood glucose? Foods that result in a high blood
glucose level elicit a large release of insulin from the
pancreas which chronically will lead to many bad
effects on the body.
8. Two food measurements have been developed which are
useful in predicting the blood sugar response to various
foods and in diet planning to avoid hyperglycemia.
9. GLYCEMIC INDEX (GI)
It is a measure of how quickly foods that contain
carbohydrate raise blood glucose levels.
Some foods cause a rapid rise in blood glucose (with a high
GI) while others cause a gradual rise (with a low GI).
This depends on starch structure, fiber content, food
processing and other food contents as fat.
10.
11.
12. GLYCEMIC LOAD (GL)
• Another way of describing how different foods affect
blood glucose levels
• More useful because it considers the glycemic index &
the amount of carbohydrate consumed.
Glycemic load = Glycemic index X Grams of CHO serving /100
16. A mixture of food stuffs selected to satisfy the nutritional
requirements of the body in quality and quantity.
It should be safe and of good taste and smell.
It should be suitable for weather age, effort and
physiological status of everyone.
17. DIETARY GUIDELINES
Every day, food must contain all nutritional elements (all levels
of the guide pyramid).
Eat nutritionally adequate food “Variety of foods; 20% of total
calories from proteins, 25% from fats & the rest from
carbohydrates (55%)”.
Drink plenty of water.
Don't eat between meals (snacking only by fruits & vegetables).
Eat 5-6 small meals instead of 3 huge meals & last-meal must
be before 9 PM.
18. DIETARY GUIDELINES
↓ Salt & refined sugars intake (white poisons).
↓ Intake of canned, preserved, smoked and salted foods.
Check for expired dates for canned & frozen foods and do not
eat nuts stored for long periods (contain aflatoxin).
↑ Consumption of fresh fruits & green leafy vegetables.
↓ Intake of ready-made foods (fast foods) and too much
processed foods “full of saturated fats & cholesterol”.
19. DIETARY GUIDELINES
↑ Consumption of dietary fibers & complex
carbohydrate (whole grain bread).
↑ Consumption of calcium containing foods
(green leafy vegetable, fish with bones and milk).
↓ Consumption of total fats especially saturated
fats and cholesterol containing foods.
Use vegetable oils instead of margarine (trans-
fats) for cooking
21. In (2011) the Nutritional Guide Pyramid was replaced with a new
and simpler icon, My Plate. It is based on how our food, drink, and
activity choices affect our health.
22. Make most of your meal
vegetables & fruits – ½ of
your plate:
• Aim for color and variety
• Potatoes don’t count as vegetables
because of their negative impact on
blood sugar”.
Go for whole grains – ¼ of
your plate:
• Whole and intact grains—whole
wheat, barley, oats, brown rice, and
foods made with them,
• Milder effect on blood sugar &
insulin than refined grains.
Protein power – ¼ of your
plate:
• Fish, chicken, beans, and nuts.
• Limit red meat and avoid processed
meats such as hamburger and
sausage.
Healthy plant oils – in
moderation:
• Healthy vegetable oils like olive,
canola, soy, corn, sunflower, peanut
• Avoid partially hydrogenated oils
“contain unhealthy trans fats”.
• Low-fat does Not mean “healthy.”
Drink water, coffee, or tea:
• Skip sugary drinks
• Limit milk & dairy products to 1-2
servings per day
• Limit juice to a small glass per day.
Stay active:
• The red figure running across the
Healthy Eating Plate’s placemat is a
reminder that staying active is also
important in weight control.
23.
24. ARE THE RELATIVE SIZES OF THE HEALTHY EATING PLATE
SECTIONS BASED ON CALORIES OR VOLUME?
The Healthy Eating Plate does not define a certain number of calories or servings
per day from each food group.
The relative section sizes suggest approximate relative proportions of each of
the food groups to include on a healthy plate.
They are not based on specific calorie amounts, and they are not meant to
prescribe a certain number of calories or servings per day, since individuals’
calorie and nutrient needs vary based on age, gender, body size, and level of
activity.
26. Nutrition plays a major role throughout each stage of the life cycle.
There are nutritionally vulnerable groups who are at risk due to
increased physiological needs to certain nutrients.
Infants &
preschool
children.
School
children.
Adolescents. Pregnant(s)
&
lactating(s).
Elderly
group.
28. FEEDING OF INFANTS “BREAST FEEDING”
Advantages of breast milk
• Secreted in the first 3-4 days in small amount.
• High contents of carotene, maternal antibodies, digestible proteins, less sugar and fat and
more sodium, potassium and chloride.
Colostrum
• Rich in proteins, vitamins, mineral, IgA and galactolipid (for brain growth).
• Contains hormones, growth factors & anti-bacterial factors as lysozymes, macrophages.
• Contains lactoferrin which binds iron for absorption and prevents bacterial multiplication.
• It is bacteriologically safe, ready made, sterile always fresh and of suitable temperature.
• Its amount regulated by baby suckling according to his need.
• It reduces risk of infections, allergy and obesity of infants.
Mature breast milk
29. Advantages of breast-feeding process
Has good psychological
effect on baby & mother and
initiating early mother baby
bonding.
Promotes development of
jaws, teeth and speech
pattern of baby.
Helps uterine involution.
↓ Risk of post partum
hemorrhage.
↓ Risk of cancer breast &
ovarian cancer.
Easier for mother and saves
her money that paid in bottle
feeding.
30. Requirements of breast feeding
After birth
• Start as early as possible to stimulate milk
secretion.
1st 6 months • Exclusive "No other food”.
After 6th month
• Weaning started by introduction of other foods
with breast milk
• To face the rapid growth & development of baby
and compensate some deficient nutrients in milk
as iron.
• Start is with fluids, semisolid and solid foods.
• Use spoon or cup not bottle before breast
feeding.
• If diarrhea occurs, stop this food and replace by
another gradually.
31. FEEDING OF PREGNANT & LACTATING MOTHERS
They need more nutritional elements because of:
Growth of the
fetus &
placenta.
↑ Mother
weight.
↑ BMR. Production of
milk.
32. FEEDING OF PRESCHOOL & SCHOOL CHILDREN
Characterized by
rapid growth &
development.
↑ Need of food rich
in proteins, calcium,
iron, vit.D, vita.C,
vit.B complex and
calories.
33. FEEDING OF ADOLESCENTS
During adolescence
period body mass ↑
by 35% in boys &
20% in girls.
Dramatic physical,
biochemical and
emotional changes.
34. FEEDING OF THE ELDERLY
↓ Requirements of all nutrients
due to ↓ BMR, & ↓ activities.
36. Methods of Nutritional Assessment
Relevant data
Food data
Availability
Prices
Production
Importation
Vital indices
Morbidity rates
Mortality rates
Investigation of the nutritional status
National food
consumption
Dietary survey Health appraisal
Dietary history
Medical history
24-hours recall
Clinical
examination
Anthropometric
measurements
Weight & height
Skin fold
thickness
Mid-upper arm
circumference
Waist
circumference
Laboratory
investigations
Blood Hg
Serum or urine
Stool analysis
Physiological
tests
37. Food data
Availability Prices Production Importation
Vital indices
Morbidity
rates
Diarrheal
diseases among
children
L.B.W.
Parasitic
infestations
T.B.
Mortality rates
Stillbirth
Perinatal
mortality
Neonatal
mortality
Infant &
preschool
mortality rates
Relevant data
38. National food
consumption
Dietary survey Health appraisal
Dietary
history
Medical
history
24-hours
recall
Clinical
examination
Anthropometric
measurements
Weight &
height
Skin fold
thickness
Mid-upper
arm
circumference
Waist
circumference
Laboratory
investigations
Blood Hg
Serum or
urine
Stool analysis
Physiological
tests
Investigation of the
nutritional status
39. NATIONAL FOOD CONSUMPTION
For estimation of the average food consumption (the
national diet) the food-balance sheet technique is used.
40.
41. Food balance sheet technique
Aim
• Determining the individual share from different foods assuming
that the available foods are distributed equally among the
population.
• It is used for the community as a whole
Steps
• The different foods are divided into “11” similar groups as
cereals, starchy roots, pulses and legumes, sugar and honey, fresh
vegetables, fruits, meat and poultry …etc.
• Calculation of local production of these food groups plus the
amount of foods imported or donated.
• From the above calculation a subtraction of the amount of food
exported plus that not used by human beings (not-edible) is done.
• The difference is called the “Balance” which is the amount
consumed by the population. It is then divided by No. of
population and by 360 to get the individual share in grams from
the national foods per day.
42. The consumption of different
food items as milk, meat, eggs
….etc are analyzed into their
nutrients and energy to give the
individual consumption of
each nutrient (as protein, fats,
vitamins, iron …etc) and
energy per day.
43. Advantages
• Explores the national food
consumption & the main defects
in it.
• Used to compare between average
food consumption in successive
years to show the trend of
consumption.
• Used to compare between different
countries.
• By using it, we can identify the
main sources of different
nutrients in the national diet as
protein & iron contents in Egyptian
diet are mainly from plant sources.
Disadvantages
• Assumes that the food is
distributed equally throughout the
year among the population which is
not true due to different socio-
economic conditions and seasons.
• Ignores differences in
requirements of people regarding
age, sex, occupation, physical
activity …etc.
44. Pattern
of
food
consumption
in
Egypt
Cereals (especially bread) & legumes form the main bulk of diet.
“Supply the greater part of energy, proteins, iron, vit. B & fibres”
Energy is in excess than required (high carbohydrates & fats).
The protein content is mainly from the plant sources (low
biological value).
Moderate consumption of vegetables & fruits.
Low consumption of meat, milk & eggs.
Iron intake is high but mainly from plant sources (cereals) which
is of low absorbability.
45. Impact on nutritional status of Egyptians
Iron & B12
deficiency anemias
Protein deficiency
among children
Obesity
46. DIETARY SURVEY
• Carried out to find out if the food intake satisfies the individuals’
requirements.
• Can be done on individuals or homogenous groups (families, camps,
patients in a hospital) provided that these groups of population eat from
a common kitchen. It is more precise and feasible.
• All foods used in preparing meals are weighing every day with
subtracting the unused parts and wastes. The actual amount of food
which eaten/day are calculated for a special period (one week) then
the end amount divided/No. of individuals in the group/No. of days
(7) to get the actual individual share in food consumption/day.
The method
47. Limitations
• Concerned with what
people are eating which
considered a private
issue.
• Its occurrence by itself
might involuntarily
change the pattern of
food consumption.
Advantages
• More accurate &
feasible (represents the
food actually eaten).
• Suitable for nutritional
experimentation e.g., to
test variations in diet or
the effect of introduction
of new foods.
48. HEALTH APPRAISAL (COMPREHENSIVE CLINICAL
EXAMINATION)
Health
appraisal
Dietary
history
Medical
history
24-hours
recall
Clinical
examination
49. Dietary
history
• Comprehensive nutritional interview
to detect living conditions, habits, culture
and economic & psychological factors ...
etc.
Medical
history
• Malnutrition, parasitic & chronic
diseases.
24-hours
recall
• Simple & cheap method “Recall of all
foods consumed the previous day to the
test but it is not suitable for old
persons”.
50. HEALTH APPRAISAL
(COMPREHENSIVE CLINICAL EXAMINATION)
It is done to detect physical signs of nutritional deficiency.
However, this will be somewhat late as against every case
showing frank clinical manifestations at least there are
“10” cases in the subclinical (biochemical or functional)
stages.
51. Defect in body functions and frank manifestations of malnutrition
Detected by clinical examination and anthropometric measurements.
↓Enzymatic activity and physiological functions
Detected by biochemical and physiological testing
↓Plasma levels of some nutrients
Detected by biochemical testing
↓Food intake or ↑loss
Detected by dietary history, survey.
Effect of nutritional deficiency passes into stages:
52. Skin, hair & nails
• To detect manifestations of vit. A,
B1, B3 & protein deficiencies
Head & neck
• To detect signs of iron, Ca,
iodine, vit.B2, C & fluorine
deficiencies.
Muscles & skeletal system
• To detect P.E.M. & rickets
manifestations.
Nervous system
• To detect signs of vit. B1, B3,
B12 & Ca deficiencies.
Cardiovascular system
• To detect vit. B1 deficiency.
53. Clinical signs & symptoms are not often specific.
Body can adapt to very low intake especially with
sufficient body stores.
Clinical signs take long period to be manifested
“young women having deficient intake of Ca & vita.D
often suffers no ill effects in young age, but they face ↑
risk of osteoporosis after many years”.
Limitations of clinical examination method:
55. Weight & height
They are used mainly
to evaluate nutritional
status of children.
Each of them is
plotted on growth
charts against age for
growth monitoring.
56. Height for age
• <5th percentile of the
reference population
→ Stunted child
(short for age) in
chronic under-
nutrition.
Weight for height
• <5th percentile of
the reference
population →
Wasted child (thin
for age) in acute
under-nutrition.
Weight for age
• <5th percentile of the
reference population
→Underweight child
for age in both acute
& chronic under-
nutrition.
WHO indices for growth monitoring of children:
59. Body Mass Index (BMI)(Quetelet's index):
Good measure of overweight not obesity as weight may increase due to
excess muscularity or oedema not always due to excess fat deposition.
60. Skin fold thickness (S.F.T.)
Skin thickness over mid-
triceps or mid biceps
muscles or subscapular
or suprailiac regions are
measured by certain
caliber in millimeters.
It is used in infants &
children to assess obesity
(fat deposition).
61.
62. Mid-upper arm circumference (MUAC)
Measuring the circumference of mid-non dominant upper arm by
using non-stretchable tape.
Readings are measured in centimeters and compared with standard
reference tables.
It provides a good measure of the subcutaneous fat reserve as S.F.T.
63.
64. Waist circumference
Should not exceed 88cm for females & 102 cm for males.
Waist hip ratio (WHR): Should be <1, if above denotes android obesity.
65. Laboratory
investigations Blood Hg Detection of iron
deficiency anemia
Serum or urine
Assess the level of the different nutrients
“amino acids, serum retinol, iodine,
some vitamins & alkaline phosphatase
enzyme level to diagnose vit. D
deficiency”
Stool analysis Intestinal parasites
Physiological
tests
Dark adaptation test &
muscle activity test
66. THESE METHODS OF ASSESSMENT CAN BE USED:
On the community level
• National food consumption
method.
• Dietary survey.
• Relevant data & vital indices.
On the individual's level
• Dietary survey.
• Clinical health appraisal.
• Anthropometric measurements.
• Laboratory investigations.