The document presents comprehensive insights into nutrition and health, defining key concepts such as health, disease, illness, and wellness, while detailing the human dimensions of health including physical, emotional, and environmental factors. It explores various health and illness models, the chain of infection, and the determinants of health, highlighting the roles of nutrition and dietetics in maintaining and promoting health. Additionally, it discusses types of illness, methods of disease prevention, and the responsibilities of dietitians in managing nutritional care.

1. NUTRITION AND HEALTH
MR.ANTHONY MATU. RN. BScN. KEMU

2. Basic Health Concepts

3. Health & Disease
• Health
• State of complete physical, mental, social and spiritual well-being and
not merely the absence of disease or infirmity (WHO)
• Disease
• Deviation from physical, social, mental and spiritual well-being

4. Illness & Wellness
• Illness
• A subjective state of the person feeling awareness of not
being well
• The unique response of a person to a disease
• Wellness
• An active state, oriented toward maximizing the potential
of the individual

5. The Human Dimensions of Health
• Physical dimension
• Genetic inheritance, age, developmental level, race, and gender
• Emotional dimension
• How the mind affects body function and responds to body
conditions
• Intellectual dimension
• Cognitive abilities, educational background, and past experiences
• Environmental dimension
• Housing, sanitation, climate, pollution of air, food, and water
• Sociocultural dimension
• Economic level, lifestyle, family, and culture
• Spiritual dimension
• Spiritual beliefs and values

6. The Human Dimensions
Composing the Whole Person

7. Types of Illness
• Acute illness
• Generally has a rapid onset of symptoms and lasts only a relatively
short time
• Examples: appendicitis, pneumonia, diarrhea, common cold
• Chronic illness
• A broad term that encompasses many different physical and mental
alterations
• Examples: diabetes mellitus, lung disease, arthritis, epilepy, lupus

8. Characteristics of a Chronic
Illness
• It is a permanent change
• It causes, or is caused by, irreversible alterations in
normal anatomy and physiology
• It requires special patient education for
rehabilitation
• It requires a long period of care or support

9. Health– illness models

10. Models of Health and Illness
• The agent-host-environment model
• The health–illness continuum
• The high-level wellness model
• The health belief model
• The health promotion model

11. The Host-Agent-Environment Model
• Host – a person or other living animal,
including birds & arthropods, that affords
subsistence or lodgment to an infectious
agent under natural conditions
• Agent – a factor, such as a
microorganism, chemical substance, or
form of radiation, whose presence,
excessive presence, or (in deficiency
diseases) relative absence is essential for
the occurrence of a disease
• Environment – all that which is external
to the individual human host. This can be
physical, biological, social, cultural, etc,
any or all of which can influence health
status of populations

12. Chain of infection
• Communicable diseases occur as a result of the interaction
between:
• The infectious agent
• The transmission process
• The host
• The environment
• The control of such diseases may involve changing one or
more of these components

13. The infectious agent
• A large number of microorganisms cause disease in humans
• Infection is the entry and development or multiplication of an
infectious agent in the host
• Infection is not equivalent to disease
• Some infections do not produce clinical disease
• The specific characteristics of each agent are important in
determining the nature of the infection

14. Transmission
• The second link in the chain of infection is the transmission or
spread of an infectious agent through the environment or to
another person
• Transmission may be direct or indirect

15. Direct transmission
• Direct transmission
• The immediate transfer of the infectious agent from an
infected host or reservoir to an appropriate entry point
through which human infection can take place
• This may be by direct contact such as
• Touching, kissing, sexual intercourse, sneezing,
coughing

16. Indirect transmission
• Indirect transmission may be vehicle-borne, vector-borne or
airborne
• Vehicle-borne
• Occurs through contaminated materials such as food, clothes, bedding
and cooking utensils
• Vector-borne
• Occurs when the agent is carried by an insect or animal (the vector) to
a susceptible host
• Airborne
• Occurs when there is dissemination of very small droplets to a suitable
point of entry, usually the respiratory tract

17. Modes of transmission of an
infectious agent
Direct transmission
• Touching
• Kissing
• Sexual intercourse
• Other contact
• e.g. childbirth, medical
procedures, breastfeeding
• Airborne, short-distance
• Droplets, coughing, sneezing
• Transfusion (blood)
• Trans placental
Indirect transmission
• Vehicle-borne
• Contaminated food, water,
towels, farm tools, etc
• Vector-borne
• Insects and animals
• Airborne, long-distance
• Dust, droplets
• Parenteral
• injections with contaminated
syringes

18. Host
• The third link in the chain of infection
• Defined as the person or animal that provides a suitable
place for an infectious agent to grow and multiply under
natural conditions.
• The points of entry to the host vary with the agent
• Include the skin, mucous membranes, and the respiratory
and gastrointestinal tracts.

19. Host
• The reaction of the host to infection is extremely variable
• Determined by the interaction between host, agent and mode of
transmission.
• The spectrum of this reaction ranges from no apparent signs or
symptoms to severe clinical illness
• The incubation period
• The time between entry of the infectious agent and the appearance of
the first sign or symptom of the disease varies
• Few hours (staphylococcal food poisoning) to years (HIV/AIDS).
• The consequences of infection are largely determined by the
host's resistance.

20. Environment
• The environment plays a critical role in the
development of communicable diseases
• General sanitation, temperature, air pollution and water
quality are among the factors that influence all stages in
the chain of infection
• Socioeconomic factors are also of great
importance
• Population density, overcrowding and poverty

21. The health–illness continuum
• Measures a person’s level of health
• Views health as a constantly changing state with
high-level wellness and death on opposite sides of
a continuum
• Illustrates the dynamic (ever-changing) state of
health

22. The health–illness continuum

23. Natural history of disease

24. Natural history of disease
• Process by which diseases occur and progress in
the human host
• Process is not regular and depends on whether the
disease is chronic or acute
• Illustrates the dynamic (ever-changing) state of
health

25. Stage of Susceptibility
• Stage during which conditions for disease occurrence exist
• Conditions that favour disease occurrence are referred to
as risk factors
• Risk factors may be subject to change e.g. unhygienic
conditions while others are not flexible e.g. age, gender,
race
• All individuals with risk factors will not develop disease
and absence of risk factor does not ensure absence of
disease
• Not possible to identify all risk factors and the extent to
which they contribute to disease occurrence

26. Sub clinical stage/pre-
symptomatic
• No signs or symptoms of the disease
• The person doesn’t know any presence of disease
• The sub clinical stage may lead to clinical stage or
an individual recovers without developing any
signs or symptoms

27. HEALTHY PERSON
SUB – CLINICAL DISEASE RECOVERY
CLINICAL DISEASE
Sub clinical stage/pre-symptomatic

28. Clinical stage
• Person has signs and symptoms of disease
• Symptoms become severe and the person may seek
medical attention
• Clinical stage of different diseases may differ in
duration, severity and outcomes.
• Outcome of a clinical disease include
• Full recovery, Disability and Death

29. HEALTHY PERSON
SUB – CLINICAL DISEASE RECOVERY
FULL
RECOVERY CLINICAL DISEASE
DEATH
DISABILITY
Pathway of health and illness

30. Assignment
• Choose a disease and discuss all the stages: from
susceptibility, sub-clinical, clinical and
recovery/disability/death

31. The High-Level Wellness Model
• Wellness is not just the absence of disease, illness, and
symptoms, but the presence of:
• Purpose in life
• Joyful relationships
• A healthy body and living environment
• The presence of happiness
• An integrated way of living, oriented toward maximizing the
potential of the individual, within the environment
• The integration of the whole being of the total individual—
body, mind, and spirit—in the functioning process
• There is not an optimal level of wellness, but rather that
wellness is a direction in the progress towards ever-high
potential of functioning.

32. The Health Belief Model
• Concerned with what people perceive to be true about
themselves in relation to their health
• Modifying factors for health include demographic,
socio-psychological, and structural variables
• Based on three components of individual perceptions of
threat of a disease
• Perceived susceptibility to a disease
• Perceived seriousness of a disease
• Perceived benefits of action

33. Premise of the HBM
• Individuals will take action to ward off, to screen
for, or to control an ill health condition if:
• They regard themselves as susceptible to the condition
• They believe it to have potentially serious consequences
• They believe a course of action can reduce the
susceptibility and seriousness
• They believe the costs of the action are outweighed by
its benefits

34. Components of the HBM
• Perceived Susceptibility
• An individual’s perception of her or his risk of contracting
a health condition
• Perceived Severity
• An individual’s perception of the seriousness of a health
condition if left untreated
• Note: the combination of these is the perceived threat of the
health condition (emotive response is fear)

35. Components of the HBM
• Perceived Benefits
• The perceived effectiveness of taking action to
improve a health condition
• Perceived Barriers
• The perceived impediments to taking action to
improve a health condition
• Cues to Action
• Body or environmental events that trigger the HBM

36. Health Belief Model
INDIVIDUAL PERCEPTIONS MODIFYING FACTORS
LIKELIHOOD OF ACTION
Perceived Susceptibility
to Disease “X”
Perceived Seriousness
(Severity) of Disease “X”
Demographic variables
(age, sex, race,
ethnicity, etc.)
Socio-psychological variables
Perceived Threat of
Disease “X”
Cues to Action
Mass media campaigns
Advice from others
Reminder postcard from physician/dentist
Illness of family member or friend
Newspaper or magazine article
Perceived benefits of
preventive action
minus
Perceived barriers to
preventive action
Likelihood of Taking
Recommended
Preventive Health Action

37. The Health Promotion Model
• Illustrates the “multidimensional nature of persons interacting
with their environment as they pursue health”
• Incorporates individual characteristics and experiences and
behavior-specific knowledge and beliefs, to motivate health-
promoting behavior
• Personal, biologic, psychological, and sociocultural factors are
predicative of a certain health-related habit
• Health-related behavior is the outcome of the model and is
directed toward attaining positive health outcomes and
experiences throughout the lifespan

38. Preventive & Curative Health

39. Levels of Disease Prevention
• Primary prevention (Preventive)
• Prevents the occurrence of disease in persons who are well through specific
protective measures e.g. immunization, good diet, exercise, envt hygiene
• Secondary prevention (Curative)
• Early detection and treatment to prevent severe consequences of disease e.g.
screening, mammography, family counselling
• Tertiary prevention (Rehabilitative/Palliative)
• Refers to taking action to prevent further deterioration and disability, alleviating
suffering and slowing progression, in situations where disease cannot be cured
e.g. medications, surgical treatment, modification of work/home environment

40. Levels of Prevention in Malaria
• The three levels of prevention may be applicable in
many diseases
• Some of the diseases are only amenable effectively
to one form of prevention
• Malaria provides a good example of a disease
where all three levels of prevention may be
applied.

41. Primary prevention
• Primary prevention
• Use of insecticide treated bed nets
• Prophylaxis applied to non-immune persons
• In-door spraying with insecticide

42. Secondary prevention
• Secondary prevention
• Includes early diagnosis and treatment of malaria in
persons who have clinical signs and symptoms of the
disease and those identified through blood tests

43. Tertiary prevention
• Tertiary prevention
• Some cases of malaria progress to severe forms leading
to brain and other organ damage. In this case effort is
made to minimize losses and reduce suffering among
victims who may be left bedridden or even comatose.

44. Factors that influence Health

45. The determinants of health
• Different factors combine together to influence the health
of individuals and communities
• Health of people, is determined by their circumstances
and environment
• To a large extent, factors such as where people live, the
state of the environment, genetics, income and education
level, and our relationships with friends and family all
have considerable impacts on health
• Access and use of health care services by individuals also
have an impact on health

46. Determinants of health
Broadly they include:
1. The physical environment
2. Biological environment
3. Economic and political environment
4. The social and cultural environment
5. Individual characteristics and behaviors

47. Determinants of health Cont’
• Physical environment
• Made up of all the geographical, physical & chemical
features
• safe water, clean air, soil, healthy workplaces, safe houses,
roads
• Biological Environment
• Made up of all the living things
• People, Vegetation, Animals, Insects, Infective organisms

48. Determinants of health Cont.’
• Economic
• Income and social status - higher income and social status are linked
to better health. The greater the gap between the richest and poorest
people, the greater the differences in health
• Education – low education levels are linked to poor health, more
stress and lower self-confidence
• Political
• Leadership systems, Health policies, Regulation
of health care, Financing health care,
Development of infrastructure

49. Determinants of health Cont’
• Social
• Support networks – greater support from families,
friends and communities is linked to better health
• Religion, Individual and community attitudes, Health
seeking behavior
• Cultural
• Customs and traditions, beliefs of the family and
community all affect health

50. Determinants of health Cont’
• Personal behaviour and coping skills
• Balanced eating, keeping active, smoking, drinking, and how we
deal with life’s stresses and challenges all affect health
• Genetics
• Inheritance plays a part in determining lifespan, healthiness and
the likelihood of developing certain illnesses
• Gender
• Men and women suffer from different types of diseases at
different ages

51. Common Health Problems /
Challenges
• Poor environmental conditions leading to rampant
communicable disease
• Changing lifestyles leading to increasing non-
communicable diseases
• Low access to health care due to poverty and poor health
infrastructure
• Low capacity for improvement of community health
status due to inadequate investment in health and poor
social support

52. Group assignment
• Discuss
• Physical environment – safe water, clean air, healthy workplaces, safe houses
and roads all contribute to good health
• Customs and traditions, and the beliefs of the family and community affects
health
• Using examples, discuss how politics in Kenya has impacted on provision of
health services
• People in different communities always have perceptions (whether right or
wrong) on what causes different diseases. The community’s perceptions may be
in conflict with those of health professionals. Using a disease of your choice
discuss how you would handle a patient who holds a different opinion

53. Nutrition
• • Nutrition is the process by which organisms utilizes the nutrients
in food through digestion, absorption, transportation, storage,
metabolism and elimination; for the purpose of maintaining life, growth,
normal functioning of organs and the production of energy.
• Nutrition science studies the relationship between diet and states of
health and disease.

54. Dietetics
Dietetics is the practical application of nutritional science to persons
and groups of persons in various states of health and disease; the
practical application of diet in relation to health and disease.
The science of applying nutritional principles to the planning and
preparation and storage of foods and the regulation of the diet in
relation to both health and disease

55. What is Nutrition?
• The study of the relationship between
food and health
• Exploration of how food is:
• Digested
• Absorbed
• Transported
• Metabolized
• Used or stored in the body

56. What is Nutrition?
• Good nutrition
• Reduces the risk of the leading causes of death
• Helps prevent harmful diseases and conditions
• Reduces the risk of developing obesity, diabetes, and
high blood pressure

57. Dietetics
• Dietetics is the study of diet and nutrition in relation to
health and disease
• Dietitians apply the art and science of human nutrition to
help people understand the relationship between food and
health and make dietary choices to attain and maintain
health, and to prevent and treat illness and disease
• Dietitians work in a variety of settings, mostly hospitals,
chronic care/long term care facilities, private practice and
‐ ‐
counseling and public health
• All dietitians are considered to be nutritionists however,
nutritionists without a dietetics qualification cannot take
on the specialized role of a dietitian

58. Roles & Responsibilities of a Dietitian
• Collecting, organising and assessing data relating to
the health and nutritional status of individuals, groups
and populations
• Interpreting scientific information and communicating
information, advice, education and professional
opinion to individuals, groups and communities
• Managing client centred nutrition care for individuals
by planning appropriate diets and menus and
educating people on their individual nutritional needs
and ways of accessing and preparing their food

59. Roles & Responsibilities of a Dietitian
• Planning, implementing and evaluating nutrition
programs with groups, communities or populations
as part of a team. This may be in a community
health, public health or food industry setting
• Managing food service systems to provide safe and
nutritious food by designing nutritionally appropriate
menus and designing and implementing nutrition
policies
• Undertaking food and nutrition research and
evaluating practice

60. Basic nutrients

61. What Are Nutrients?
•Compounds in foods that sustain
body processes
•Substances found in food that keep
your body functioning
•The food you eat is the source of
nutrients

62. Essential Vs. Nonessential
Nutrients
• Essential nutrients
• Must be consumed from food
• Cannot be made in the body in sufficient quantities to
meet its needs and to support health
• Nonessential nutrients
• Can be made in sufficient quantities in the body to meet
the body’s requirements and to support health

63. Macronutrients & Micronutrients
• Macronutrients
• Nutrients the body needs in large amounts
• Include the energy-containing
carbohydrates, lipids, proteins, and water
• Micronutrients
• Essential nutrients the body needs in
smaller amounts
• Vitamins and minerals

64. Calories
• Unlike micro-nutrients, macro-nutrients are broken in the body to
provide energy
• Energy intake and expenditure is measured in Kilocalories (Kcal)
• Alcohol
• Provides more energy than carbohydrates but it is not a nutrient
• Modifies body functions and is referred to as a drug
• Affects functions of the liver because the liver prefers it as a source of
energy and this results to a fatty liver

65. Classes of nutrients

66. Classes of nutrients
• Six classes of nutrients that are found in foods
• Carbohydrates
• Proteins
• Fats (lipids)
• Vitamins
• Minerals
• Water

67. Macronutrients

68. Carbohydrates
• Carbohydrates
• Body’s main source of energy and provide the body’s
need for dietary fiber
• Provide energy quickly and efficiently
• Supply glucose to body cells e.g. brain and red blood
cells
• Some forms of complex carbohydrates may
reduce cholesterol which is beneficial for health

69. Food sources
• Found in most foods
• Breads, cereals, pasta, nuts, fruits,
tubers, starchy vegetables, dairy
products, sugars, sweets.

70. Types of Carbohydrates
• Simple Carbohydrates (Sugars)
• Monosaccharaides
• Are the simplest form of carbohydrate molecules, e.g. glucose,
fructose and galactose
• Disaccharides
• Formed when two sugar molecules join together, e.g. sucrose
(glucose and fructose), lactose (glucose and galactose) and maltose
(2 molecules of glucose).
• Polysaccharides (Complex carbohydrates)
• Made up of many monosaccharide's molecules joined
together, e.g. starch, glycogen & cellulose (Fiber)
• Stored in the body as glycogen

71. Simple Carbohydrates
• Food Sources:
• Fruits, juices, milk, and yogurt.
• Candy, soda, and jelly.
• These simple carbohydrates have a
bad reputation because they are high
in calories and low in nutritional
value.

72. Complex
Carbohydrates(Starches)
• Food Sources:
• Whole grain breads and cereals,
pasta, vegetables, rice and legumes.
• Function in the Body:
• An excellent source of fuel (energy)
for the body.
• Rich in vitamins, minerals and fiber.

73. Fiber/Roughage/Cellulose
• A complex carbohydrate that does not provide energy
• The plant material that doesn’t break down when you digest food
• Many, but not all, complex carbohydrates contain fiber.
• Food Sources:
• Oatmeal, rice bran, corn, whole grains, legumes, fruits, vegetables

74. Functions of Fiber
• Gives food satiety value due its bulk
• Aids in digestion by moderating movement of food
along the gastro-intestinal tract (Gut motility)
• Reduces the risk of developing some diseases like
heart disease, diabetes and obesity, diverticulosis and
certain types of cancer.
• Helps lower blood cholesterol levels
• Increases fecal weight which is necessary for bowel
movement

75. Negative effect of Fiber
• Reduces nutrient density of food which may cause
deficiencies esp. in people with small eating capacities
• Abrupt increase in fiber consumption will lead to
discomfort e.g. Flatulence
• Excess fiber binds other nutrients and reduces their
bioavailability esp. incase of insoluble fiber whereby
the body cannot detach nutrients from the fiber
(Complexing effect of fiber)

76. Excessive consumption of carbohydrate
• Increased body weight
• When too much carbohydrate is consumed and not
used for energy over an extended period of time, it is
stored as fat. Building up too much fat will increase
body weight
• Increase dental caries
• It is important that teeth are brushed twice a day and
foods high in sugar should be eaten with main meals,
rather than in between snacks to prevent dental caries

77. Lack of Carbohydrate
• The short term effects of a lack of carbohydrates
are weight loss and lethargy
• Kwashiorkor and Marasmus are two forms of
deficiency disease which can develop in extreme
conditions.
• These occur where energy and protein are lacking in the
diet over an extended period of time

78. Protein
• Proteins are made up of chemical compounds called
amino acids
• These are the building blocks of protein.
• There are 20 amino acids
• The human body is capable of producing 11 of them (Non-
essential amino acids).
• The other 9 (Essential Amino Acids) must be supplied by food
sources
• The body’s protein requirement is dependent on the diet
• You cannot obtain proteins from carbohydrates and
fats
• About 20% of the body weight consist of proteins

79. Food sources
• Good food sources
include: meat, fish, eggs,
poultry, dairy products,
legumes, nuts and seeds
• Lesser food sources
include: cereals, bread
vegetables, fruits

80. Types of protein
• Complete proteins
• A protein containing all the 9 essential amino acids
• They are found in animal sources
• Examples: fish, meat, eggs, milk, cheese
• Incomplete proteins
• A protein that lacks one or more of the essential amino
acids
• They are found in plant sources
• Examples: Legumes, nuts, whole grains

81. Types of amino Acids

82. Essential/indispensable Amino Acids
• These are amino
acids that the
body cannot
synthesis
• Must be provided
by the diet
• Valine, Leucine,
Isoleucine, Lysine,
Methionine,
Phenyalanine,
threonine, tryptophan,
Histidine

83. Non-essential/dispensable Amino Acids
• These are amino acids that the
body can synthesis using other
amino acids
• Need not be supplied in the diet
• Can become conditional
essential
• If body lacks essential amino acid
from which it is synthesised
• Body cannot synthesis because of
sickness
• Glycine, glutamic acid,
arginine, aspartic acid,
proline, alanine, serine,
tyrosine, cysteine,
asparagine, glutamine

84. The body’s needs for protein
• Babies and children have a high need for protein
because they are growing
• Adolescents need protein for their rapid growth
spurt
• Pregnant women need more protein than other
adults because of the growing baby
• Nursing mothers also need more protein for
lactation

85. Biological value and complementation
• It is not just the amount of protein, but the quality or
biological value of the protein that needs to be
considered
• If a protein contains all the essential amino acids it is
said to have a high biological value
• If a protein does not contain all the essential amino
acids it is said to have a low biological value
• The amino acid that is present in smallest quantity in a
food is called the limiting amino acid

86. High and low biological value
• High biological value (HBV) proteins include:
meat, fish, eggs, cheese, and milk
• Low biological value (LBV) proteins include:
cereals, pulses, some nuts and vegetables
• In general, animal protein sources have a higher
biological value, than vegetable sources
• Vegetarians and vegans need to eat wisely to ensure
they are getting all the indispensable amino acids

87. Protein complementation
• Complementation of LBV protein sources ensures
that all essential amino acids are consumed
• Amino acids of one protein source can compensate
for the limitations of the other, resulting in a
combination to create a high biological value meal

88. An example of protein complementation
• Methionine is the limiting a.a in legumes while tryptophan is the
limiting a.a in cereals. In a mixture of cereals and legumes
complementation occurs to give a protein whose profile closely
resembles that of animal proteins
• The amino acids of one protein compensates for the limitations of the
other
• This results in a combination of higher biological value
• It is necessary to use a variety of plant proteins to improve a.a
profile esp. for vegetarians

89. Functions of Proteins
• Growth, development and repair of the body
• Play a role in the immune system
• Antibodies which help to fight against diseases are made of protein
• Manufacture of enzymes
• Catalysts and control chemical reactions
• Production of hormones
• Nervous impulse transportation (neurotransmitters)
• Fluid balance-Control amount of fluid in the body
• Explains presence of Oedema in Kwashikor children

90. Functions of Proteins
• Transportation of various chemical substances in
the body e.g. hemoglobin
• Muscular contraction and body’s structural support
• Primary source of tissues in muscle, bones, and skin
• Serve as a source of energy when body is deficient
of carbohydrates and fats

91. Protein deficiency
• Leads to a condition called Protein Energy
Malnutrition (PEM)
• The body adapts to the shortage of energy & nutrients.
• All energy stores are depleted as it is used to supply
vital organs
• This can be seen in infants with stunted growth or thin
arms and legs, and large distended abdomens
• Types
• Marasmus
• Kwashiorkor

92. Symptoms of PEM
• Marasmus
• Severe weight loss
and wasting
• Limbs Emaciated
• Muscle Wasting
• Old mans face
• Big Head
• Appetite loss
• Kwashiokor
• Oedematus
• Round swollen cheeks
moon like face
• Distended stomach
• Pigmented and very light
hair
• Pale sore skins that peels
off easily
• Inactive and irritable

93. Lipids
• A group of organic compounds that do not dissolve in water
• Refers to fats and oils
• Fatty acids are the building blocks of lipids
• There are essential and nonessential fatty acids
• Different fatty acids are found in nature and are responsible
for the wide diversity and chemical specificity of lipids
• Lipids provide a more concentrated source of energy than
carbohydrates

94. Types of Lipids

95. Triglycerides
• Main form of lipids in food stuffs and storage deports of
animals
• Consist of a three carbon molecules called glycerol to which 1-
3 fatty acids are attached
• Triglycerides make up 95% of total body fat
• Source of energy during rest and sleep
• Storage form for excess energy
• Adipose tissue beneath the skin and around several organs
• The majority of lipids we eat
• Found in margarine, butter, oils, and animal products

96. Phospholipids
• One of the fatty acids is replaced by a phosphate group
• Therefore they consist of glycerol, fatty acid and phosphate
• Major component of cell membrane which control what gets in
and out of the cell
• Relatively soluble in water which gives them the emulsifying
characteristics e.g. lecithin found in egg york

97. Cholesterol
• Belongs to a group of lipids called sterol
• Necessary for formation of bile salts
• Not a dietary essential since liver and body cells can
manufacture up to 90% of amount needed
• Excessive amount is associated with cardiovascular heart
diseases
• Occurs when the body is unable to clear excess cholesterol
which gets deposited in major blood vessels
• Cholesterol balance in the body is not dependent on the amount
taken in diet but its transportation from tissues to liver for
breakdown

98. Unsaturated fats
• Contain fatty acids that are missing hydrogen atoms
• Liquid at room temperature
• They are less harmful to the circulatory system than saturated
fats
• Come from plants
• Foods sources:
• Canola, sanflower, and peanut oils

99. Saturated fats
• Contain fatty acids with the maximum number of hydrogen
atoms
• Solid at room temperature
• Diets with too much saturated fat have been known to cause
heart disease
• Mainly from animal sources
• Foods sources
• Beef fat, egg yolks, dairy products

100. Trans Fatty Acids
• Created by process of making liquid oil into a
solid
• Increases Low Density Lipoprotein (LDL ) levels
while lowering High Density Lipoprotein (HDL)
levels
• Ratio of cholesterol HDL/LDL helps determine
risk for heart disease
• Found in many margarines, baked goods and
restaurant deep-fried foods

101. Lipid Transport
• Lipid transport in the body is complicated by the
fact that it is insoluble in water (major medium of
transport)
• Lipids are carried in blood bound to protein into
complex micro-molecules referred to a lipoproteins

102. Types of Lipoproteins

103. Chylomicrons
• Formed on the intestinal wall
• Main vehicle for carrying triglycerides from elementary canal
after digestion
• Also carry phospholipids, cholesterol and fat soluble vitamins
from elementary canal to the liver
• Reduced in the liver into very small particles known as Very
Low Density Lipoproteins (VLDL)
• VLDL carry endogenous triglycerides from the liver to the peripheral
body tissues

104. Low Density Lipoprotein
(LDL )
• Main carrier of cholesterol in the blood
• Distributes cholesterol to various parts of the body
to serve its functions
• It is therefore considered a mobile reserve for
cholesterol in the blood
• Deposit cholesterol in body tissues and is
responsible for heart diseases/sudden cardiac death

105. High Density Lipoprotein (HDL
• Collects cholesterol from peripheral tissues and brings it back to
the liver
• In the liver it is incorporated into the bile through which excess
cholesterol is excreted from the body
• Its efficiency in clearing cholesterol determines
whether one suffers from cardiovascular heart
disease

106. Functions of Lipids
• Energy source for the body
• Help protect and cushion vital organs as well as
joints
• Maintain body temperature (Insulate the body)
• Formation of cell membrane and regulation of what
goes in and out of the cell
• Give food satiety value –digested slowly
• Carry fat-soluble vitamins A, D, E, and K
• Improve physical and sensory value of food

107. Obtaining Essential Lipids
• Still need essential fatty acids
• Eat fatty fish
• Use healthier oils (including olive oil)
• Eat green leafy vegetables
• Walnuts, walnut oil

108. Obtaining Essential Lipids
• Use moderation with fat intake
• Read food labels
• Use olive oil for cooking
• Avoid margarine with trans fatty acids
• Choose lean meat, fish, poultry
• Eat less bacon, sausages, hot dogs, organ meats
• Choose nonfat dairy products
• Use substitutes for higher-fat products

109. Vitamins
• Organic substances that assist in the chemical reactions that
occur in the body
• Required in small amounts
• Unlike carbohydrates, fats, and proteins, vitamins DO NOT
provide energy (calories)
• Involved in numerous key functions in the body e.g. growth,
metabolism, body structure
• Deficiencies lead to: Fatigue, stunted growth, weak bones,
organ damage

110. Vitamins
• Divided into two types:
• Fat Soluble & Water
Soluble Vitamins
• Food Sources:
• Fruits, vegetables,
milk, whole-grain
breads, cereals and
legumes.

111. Vitamins
Water Soluble Vitamins
• Vitamins C and B-complex
• Not stored in the body
• Consumed daily
• Require water for absorption
• Easily absorbed and passed
through the body as waste
• Affected by cooking
methods
Fat Soluble Vitamins
• Vitamins A, D, E, K
• Require fat to allow them
to be carried into the
blood stream for use
(absorption).
• Stored in the body
• Not destroyed by ordinary
cooking methods

112. Water Soluble Vitamins

113. Vitamin C
• Food Sources
• Citrus fruits, strawberries, kiwi,
broccoli, tomatoes, and potatoes
• Function in the Body
• Helps heal wounds
• Helps maintain healthy bones
teeth and blood vessels.
• Helps body fight infection

114. Vitamin B-complex
• Food Sources
• Whole grain and enriched breads and cereals; dry bean
and peas; peanut butter; nuts; meat; poultry; fish; eggs;
milk
• Function in the Body
• Helps the body use the energy
from the foods we eat.
• Helps brain, nerves, and muscles function

115. Types of Vitamin B-complex
• B1: (Thiamine)
• Assists with conversion of carbohydrates to energy
• B2: (Riboflavin)
• Assists with nerve cell function
• B3: (Niacin)
• Maintenance of normal metabolism
• B12: (Cyanocobalamin)
• Necessary for formation of red blood cells and normal cell function

116. Types of Vitamin B-complex
• B6: (Pyridoxine)
• Necessary for normal carbohydrate, fat and protein
metabolism
• Folic acid (Folate)
• Necessary for the production of genetic materials (DNA & RNA
• Deficiency linked to neural tube defects – Spina Bifida
• Biotin
• Necessary for metabolism of carbs. and other B vitamins
• Pantothenic Acid
• Used to produce some hormones and assists with the
release of energy

117. Fat Soluble Vitamins

118. Vitamin A
• Food Sources
• Dark green, leafy vegetables, deep yellow and orange fruits and
vegetables, liver, milk, cheese, and eggs
• Function in the Body
• Helps keep skin and hair healthy
• Aids in night vision
• Plays a role in developing
strong bones and teeth
• Keeps the lining of digestive track resistant to infections

119. Vitamin D
• Food Sources
• Vitamin D fortified milk, egg yolk, salmon,
and liver
• Nonfood Source: the sun
• Function in the Body:
• Helps the body use calcium and phosphorus
• Plays a role in building strong bones
and teeth
• Promotes normal growth

120. Vitamin E
• Food Sources
• Whole-grain breads and cereals; dark green leafy vegetables; dry beans
and peas; nuts and seeds; vegetable oils; margarine; liver
• Function in the Body
• Helps form red blood cells, muscles, and other tissues.
• Prevents the destruction of red blood cells

121. Vitamin K
• Food Sources
• Dark green and leafy vegetables (such as spinach,
lettuce, kale,) and cabbage
• Function in the Body
• Helps blood to clot
• Deficiency leads to haemorrhage

122. Minerals
• Inorganic substances that are generally absorbed to form
structural components of the body
• Functions in the Body:
• The body depends on minerals for practically every process necessary
for life.
• Minerals actually become part of the body.
• Impact hardness to bones and teeth
• Cofactors in enzyme reactions

123. Minerals
• Divided into
• Macro-minerals (required
in large amounts
• Micro-minerals (required
in small amounts
• Food Sources
• Meats, beans, nuts, fruits,
vegetables, dairy
products, and grains.

124. Macrominerals

125. Calcium & Phosphorus
• Food Sources
• Dairy Products: milk, cheese, ice cream, green leafy vegetables, Fish,
nuts, legumes
• Function in the Body
• Helps build and maintain healthy bones and teeth
• Helps heart, nerves, and muscles work properly
• Deficiency (lack) of calcium & phosphorus leads to
osteoporosis

126. Sodium
• Food sources
• Processed & prepared foods: Canned vegetables, soups,
pickles, ham, bacon, sausage, hotdogs, and frozen foods.
Salt/sodium is used to preserve food and improve the taste
and texture of food.
• Condiments: Table salt, soy sauce, ketchup, mustard, BBQ
sauce, steak sauce…
• Natural sources. Some meats, poultry, dairy products (esp.
cheeses) and vegetables

127. Sodium
• Function in the Body:
• Helps maintain the right balance of fluids in your body.
• Helps transmit nerve impulses
• Influences the contraction and relaxation of muscles.
• Excess sodium can lead to hypertension (high blood pressure),
a condition that can lead to cardiovascular and kidney diseases

128. Other macrominerals
• Magnesium
• Bones, metabolism, nervous transmission...
• Deficiency-muscle pain, poor cardiac function
• Potassium
• Nerve and muscle function, acid-base balance…
• Deficiency-muscle cramps , irregular heart rate
• Chlorine
• Maintenance of water balance
• Sulphur
• Found in amino acids

129. Microminerals

130. Iron
• Food sources
• Liver, kidney, heart, meat, egg yolk, dried beans and peas, spinach,
dried fruit, whole-grain & enriched breads & cereals, nuts
• Function in the Body
• Helps make hemoglobin in red blood cells
• Helps cells use oxygen.
• Antibody production
• Deficiency leads to anemia

131. Causes of iron deficiency
• Dietary deficiency
• Low bioavailability
• Complexing factors e.g. in fiber
• Increases demand e.g. during pregnancy and
lactation with inadequate supplementation
• Parasitic infections e.g. hook worms
• Blood loss due to injuries, ulcers, menstruation

132. Other microminerals
• Zinc
• Growth and wound healing, maturation of sexual organs, taste and
smell, tissue growth and repair, cell reproduction, functioning of
immune system
• Deficiency- Hypogonadism (retarded dev. of sexual organs)
• Fluoride
• Stability of teeth/bones structure…
• Deficiency- dental carries and osteoporosis
• Excessive amount leads to browning and mottling of teeth

133. Other microminerals
• Iodine
• Production of thyroid hormones…
• Deficiency causes goiter/cretinism
• Manganese
• Normal function of nerve cells
• Copper
• Dev of connective tissue and blood vessels
• Skin and hair pigmentation
• Melanocyte responsible for pigmentation is highly controlled by copper

134. Water
• Makes up the majority of all body fluid
• Part of every cell in the body
• Cannot be stored, must replenish daily
• Essential component in you diet
• About 2/3 of body weight is water

135. Functions
• Essential during metabolism
• Digestion and absorption
• Transport medium that delivers nutrients and oxygen
to cells and excretes waste products through urine
• Maintenance of body temperature
• Lubricant for joints, eyes, mouth, and intestinal tract
• Cushions vital organs
• Helps maintain acidity at the proper level so the chemical reactions
can occur

136. Water Balance
• Water balance exists when water intake equals water output.
• Water Intake
• The volume of water gained each day varies from one individual to the next.
• About 60% of daily water is gained from drinking, another 30% comes from
moist foods, and 10% from the water of metabolism.
• Regulation of Water Intake
• The thirst mechanism is the primary regulator of water intake.
136

137. Water Balance
• Water Output
• Water is lost in urine, feces, perspiration,
evaporation from skin and from the lungs during
breathing.
• The route of water loss depends on temperature,
relative humidity, and physical exercise.
137

138. Dehydration
• A state which the body has lost more water than
has been taken in
• Can occur as a result of:
• Heavy physical activity
• Illness that includes vomiting, diarrhea, fever or a
situation that cause you to sweat profusely
• Happen if you are not drinking enough water

139. Electrolytes
• Electrolytes are molecules that release ions in
water
• To be in balance, the quantities of fluids and
electrolytes leaving the body should be equal to
the amounts taken in
• Anything that alters the concentrations of
electrolytes will also alter the concentration of
water, and vice versa

140. Electrolyte Balance
• An electrolyte balance exists when the quantities of electrolytes
gained equals the amount lost.
• Electrolyte Intake
• The electrolytes of greatest importance to cellular metabolism are sodium,
potassium, calcium, magnesium, chloride, sulfate, phosphate, bicarbonate, and
hydrogen ions.
• Electrolytes may be obtained from food or drink or produced as a by-product
of metabolism.
140

141. Electrolyte Balance
• Regulation of Electrolyte Intake
• A person ordinarily obtains sufficient electrolytes
from foods eaten.
• A salt craving may indicate an electrolyte
deficiency.
• Electrolyte Output
• Losses of electrolytes occur through sweating, in
the feces, and in urine.
141

142. Digestion and absorption

143. Digestion
• Digestion
• The process of changing food into simple components which the body
can absorb
• Digestive tract or Gastrointestinal tract is a long tube
surrounded by muscles - where digestion & absorption take
place
• Mouth->esophagus->stomach->small intestine->large intestine
• The muscles alternate contracting and relaxing pushing food
along

144. Organs involved in digestion
Mouth
Stomach
Oesophagus
Small intestine
Colon
Anus
Rectum
The gastrointestinal
(GI) tract involves
the stomach, small
intestine and colon.

145. Mouth
• Teeth grind food to reduce the size
• Saliva released to help moisten food
• Some carbohydrate digestion begins
• The tongue and cheeks help to shape the food into a ball or
bolus before being swallowed
• The bolus is passed through to the oesophagus and enters
stomach

146. Saliva
• Saliva contains the enzyme amylase which breaks down starch
into simple sugars
• It also moistens the food allowing easier passage through the
GIT
• Saliva is secreted from glands found under the tongue and at
the back of the mouth
• The sight, smell, taste or even the thought of food will start to
increase the amount of saliva secreted

147. Oesophagus
• The oesophagus is similar to a conveyor belt as it transfers the
food from the mouth to the stomach in 3-6 seconds
• Circular muscles in the wall of the oesophagus relax contract,
pushing the bolus onward
• This is called peristalsis
• People do not have conscious control over the muscles in the
oesophagus.

148. Stomach
• Distended pouch made up of three different layers of muscles
where the bolus will be churned for a few minutes or up to 2 or 3
hours
• Mixes food by muscular contractions causing food to break up
further
• Secretes hydrochloric acid (mixes with bolus)
• Begins protein digestion
• Kills microorganisms in food
• Nutrients not absorbed except water & alcohol

149. Stomach
• The enzyme pepsin is also active in the stomach
• It starts to break down protein to form peptides and amino acids
• When the food has been churned into a creamy mixture known
as chyme, the pyloric sphincter (a ring of muscles) opens and
chyme is released gradually into the small intestine

150. Small intestine
• The small intestine is a tube about 6 metres long
• The small intestine is divided into three sections,
• The duodenum, jejunum and the ileum
• The first section of the small intestine is the
duodenum

151. Small intestine
• Most digestion and absorption occurs in small intestine
• Bile released to emulsify (break up) fat.
• Pancreatic enzymes released to digest carbohydrates, proteins
and fats
• Final digestive enzymes in intestinal lining break down
carbohydrates, proteins and fats into absorbable units

152. Duodenum
• The duodenum receives about 12 grams of chyme
each time the pyloric sphincter opens
• The duodenum is about 25 centimetres long and in
the shape of a horse shoe
• In the duodenum, chyme is diluted with bile salts
(from the gall bladder) and pancreatic juices (from
the pancreas)

153. Bile
• Bile is produced in the liver and stored in the gall bladder. This
contains bile salts which emulsify fat
• Fat is normally insoluble in water. The bile salts are released
into the duodenum making it easier to break down fat
• The bile allows the fats to mix in with the watery digestive
juices, and allows the enzyme lipase to digest the fats
efficiently
• Fat can take from 3 to 5 hours to be broken down and absorbed

154. Pancreatic Juices
• The pancreas provides alkaline pancreatic juices
• These juices contain sodium bicarbonate to neutralise
the hydrochloric acid mixed into the chyme from the
stomach
• Pancreatic juices also contain digestive enzymes such
as
• Trypsin and chymotrypsin – break down protein to peptides
and amino acids
• Pancreatic amylase – breaks down starch and glycogen to
maltose
• Lipase – breaks down fat to fatty acids and glycerol

155. Peristalsis
• Peristalsis is the action of waves of muscular contractions
which moves food along the digestive system
• Dietary fibre aids peristalsis because it increases the bulk of
the bolus or chyme being moved along

156. Wall of the small intestine
• The inner surface of the small intestine is folded into
finger-like structures called villi, which greatly
increase the surface area available for absorption.
• The villi have a surface area of about 30m2
, this is
equivalent to the size of a tennis court!

157. Digestion in the wall of the small intestine
• Protease breaks down peptides to amino acids
• Maltase breaks down maltose to glucose.
• Sucrase breaks down sucrose to glucose and fructose.
• Lactase breaks down lactose to glucose and galactose.
• Lipase breaks down fats to fatty acids and glycerol

158. Substances absorbed in the small intestine
• Water
• Alcohol
• Sugars
• Minerals
• Water soluble vitamins
• Peptides and amino acids
• Fatty acids, glycerol and fat soluble vitamins

159. Absorption
• The villi in the small intestine have a high blood supply.
• Nutrients pass through the wall of the small intestine and into the
blood supply.
• Once in the blood, the nutrients are transported to the liver via
the hepatic portal vein. The liver filters, converts the nutrients
into substances that can be used by the body’s cells for energy
and growth.

160. Absorption
• Most fatty acids and glycerol pass into the lymphatic system, and
then the bloodstream
• Once in the blood, nutrients are carried to all the cells of the
body. Some are oxidised to produce energy and other are used to
repair the cell or to build new cells
• Once the nutrients have been absorbed, the remaining chyme
passes into the large intestine or the colon

161. Colon
• The colon is a tube just over one meter long, which is
inhabited by bacteria.
• The main function of the colon is to absorb water into
the bloodstream.
• Bacteria in the colon ferment dietary fibre and produce
fatty acids and gas.
• Other bacteria produce vitamin K, which is also
absorbed.
• The products of bacterial digestion, along with water

162. Colon
• The watery residue moves along the colon, and the faeces are
formed and stored in the rectum before being excreted through
the anus
• It may take 12-24 hours for the faeces to pass through the
colon. This time can be reduced if the diet is high in fibre

163. Summary of the phases of digestion
• Ingestion
• This is the physical intake of foodstuffs into the gastrointestinal
tract.
• Digestion
• A series of physical and chemical processes which begin in the
mouth, but take place mainly in the stomach and small intestine
• Absorption
• The passage of the digested food substances across the gastro-
intestinal lining, or mucosa, into the blood and lymph
• Elimination/Egestion
• The excretion, or elimination, of those food substances that
cannot be digested (such as cellulose) or without any
nutritional value in the faeces

164. Factors that affect Health & Nutrition Status

165. Nutritional status
• Nutritional status
• Physiological state of an individual, which results from:
• The relationship between nutrient intake and requirements,
and
• The body’s ability to digest, absorb and use these nutrients
• It is influenced by multiple and interrelated
factors:
• Food intake, quantity & quality, & physical health.
• The spectrum of nutritional status spread from
severe malnutrition to obesity

166. What is malnutrition
• The term malnutrition indicates a bad nutritional
status
• Distinction btwn Malnutrition & Under-nutrition:
• Malnutrition
• It arises either:
• From deficiencies or excesses of specific nutrients, or
• From undiversified diets (wrong kinds or proportions of foods)
• Under-nutrition
• It is the outcome of insufficient food
• It is caused primarily by an inadequate intake of dietary or food energy

167. What is malnutrition
• In many developing countries, under and
overnutrition are occurring simultaneously among
different population groups.
• This phenomenon is referred to as the “double
burden” of malnutrition.

168. Causes of malnutrition
• Poverty is the root cause of malnutrition
• The underlying causes are
• Food security, health and care
• However, over-nutrition and dietary imbalances cut across many
socio-economic boundaries

169. Conceptual frameworks
This is the most
commonly used
framework for
understanding
the causes of
malnutrition.
(adapted from
the UNICEF
conceptual
framework).
Causes of malnutrition

170. Another conceptual framework for malnutrition:
the Food Insecurity and Vulnerability Mapping System
(FIVIMS) framework for food security, livelihoods and nutrition.
Socio-economic
and political
environment
Performance of the
food economy:
• availability
• access
• stability
Care practices
Health and
sanitation
Nutritional
status
Food
consumption
Food
utilization
Conceptual frameworks
Causes of malnutrition

171. Nutritional and health status
NUTRITIONAL STATUS
HEALTH STATUS
This can eventually lead to severe
malnutrition and death
Nutrition and health are closely linked:
Disease contributes to malnutrition
While malnutrition makes an individual
more susceptible to disease

172. Nutritional and health status
INADEQUATE
DIETARY
INTAKE
Weight loss, growth faltering and reduced
immunity, which lower the body’s ability to
resist infection.
leads to
this causes
Longer, more severe and more
frequent disease episodes.
Loss of appetite, malabsorption
of nutrients, altered metabolism
and increased nutrient needs.
leads to
this results in
This ‘vicious cycle’ is known as the “malnutrition-infection cycle”:

173. Nutritional and health status
• Certain diseases are particularly frequent causes of
poor growth
• Diarrhoea
• Respiratory infections
• HIV/AIDS
• Malaria

174. Nutritional and health status
• The relationship between nutrition and disease
• Can be observed in the seasonal changes in nutritional status
• Many communities experience periods in the year
when malnutrition levels are higher
• These are influenced by seasonal patterns such as:
• Cropping patterns
• Food availability
• Disease
• Child care
• Income sources
• Price of foods
• Labour demand

175. Summary of factors affecting Nutrition & Health status

176. Poor diet
• A poor diet can be due to:
• Eating too little or too much
• Not having a varied diet
• Not eating enough fruits, vegetables, and milk products

177. Physiological changes
• As we age, changes in our body composition, systems,
and organ function can affect our food choices, and
ultimately our health and nutritional status.
• A decrease in lean body tissue, reducing energy needs
• A loss of bone mass, increasing the risk of osteoporosis
• A decline in immune function, enhancing the risk of
infection
• Reduced taste and smell, contributing to lack of
appetite
• Tooth loss and dry mouth, compromising food intake
• Decreased esophageal and colonic peristalsis

178. Chronic illness
• Many chronic conditions can make it difficult to swallow
properly, which interferes with food intake
• Cancer, thyroid disorders, diabetes
• Mental illness impairment
• Result in decreased food intake and contributes to social withdrawal.
• Depression is the most common cause of weight loss and anorexia

179. Medications
• The more medicines you take, the greater the chance for side
effects from drug interactions
• The side effects (loss of appetite, nausea, vomiting, diarrhea)
• Affect our ability to consume food and our body’s ability to retain the
nutrients from food
• Nutrients most at risk include
• Folic acid, vitamins B12, B6, C, D, and K,
• Phosphorus, potassium, calcium, magnesium & zinc.
• Prescription drugs and over-the counter remedies may also
interact with certain foods

180. Alcohol consumption
• Consuming more than 1-2 drinks per day can
significantly impair the appetite
• Alcohol contains “empty calories”.
• Chronic alcohol consumption can damage vital
organs such as the brain, heart & liver
• Alcohol can also interact with medications

181. Low income
• Having a low income can make it difficult to obtain
the foods required for a healthy diet
• The cost of transportation prohibits seeking of
health care

182. Social isolation
• Eating is a social event and social isolation can
have a negative effect on our nutritional health.
• The loss of a loved one through death, indifference
or separation can also impair food intake
• Being with people has a positive effect on morale,
well-being, and eating

183. Physical disability
• People with physical disability, have trouble
walking, shopping, buying & cooking food
• They need support from friends, family, or social
services in order to achieve good nutritional health

184. Other factors
• Lifestyle
• Gender
• Ethnicity & culture
• Food beliefs
• Food preference
• Religion

185. Socio-culture Influence on Food

186. What is Culture?
• Refers to human behaviour that is not biologically determined.
The traditional way of doing things in a society which makes
it different from other societies
• It differentiates societies e.g. mode of dressing, cooking, eating
• The unique way in which a group of people live
• Generally refers to the patterns of human activity

187. What is Culture?
• The total, generally organized way of life, including values,
norms, institutions, and artifacts, that is passed on from
generation to generation by learning alone
• A system of thoughts & behaviors shared by a group of people
• Our cultural backgrounds have tremendous impact on our lives
• Culture contributes to the richness of human experience

188. What is Culture?
• Ways of living, built up by a group of human beings, that are
transmitted from one generation to another
• Culture has both conscious and unconscious values, ideas,
attitudes, and symbols
• Culture is acted out in social institutions
• Culture is both physical (clothing and tools) and nonphysical
(religion, attitudes, beliefs, and values)

189. Characteristics of culture
• It must be learnt
• Not inborn
• It is shared by a group of people
• No individual has his/her own culture
• Must be transmitted from generation to generation
• Vertical transmission
• Must have a language for communication in order to be
transmitted

190. Characteristics of culture
• Differs from society to society
• Keeps on changing - It is dynamic
• This dynamic way of culture is known as acculturation
• Due to external influences
• It resists change
• Despite external influences a society seeks to maintain its
culture

191. Material and Nonmaterial Culture
• Physical component or
physical culture
• Clothing
• Tools
• Decorative art
• Body adornment
• Homes
• Subjective or abstract
culture
• Religion
• Perceptions
• Attitudes
• Beliefs
• Values

192. How culture shapes us
• Everyone has a culture. It shapes how we see the
world, ourselves, and others
• How does my culture shape me?
• How does culture shape the way we see ourselves,
others, and the world?
• Why is it important to understand culture?

193. Question
• You’re providing health care in a low-income community. You
learn that mothers in the community eagerly participate in
nutrition classes but will not stop feeding their babies junk
food.
• What do you need to consider in order to effectively improve
nutrition for children in this community?

194. Social & Cultural Factors in
Healthcare
• In order to be an effective provider, you must
understand:
1. The ways people think about health and illness
2. Individual behaviors and habits that influence health
3. How you and your actions are perceived by the
community where you work
4. How culture interacts with environment, economy, and
politics to affect health

195. Social function of food
• Cultural identity
• Religious/magic function
• Communication function
• Expression of economic status
• Exercising influence and power

196. Food Habits and Cultural Patterns
• Personal food habits develop as part of one’s social and cultural
heritage, as well as individual lifestyle and environment

197. Cultural Development of Food
Habits
• Food habits grow from many influences
• Personal
• Cultural
• Religious
• Social
• Economic
• Psychological
Slid
e
197

198. Cultural Development of Food
Habits
• Food habits are learned through everyday living
and family relationships
• Food habits are primarily based on food
availability, economics, personal food beliefs
• Cultural background and customs largely determine
what is eaten
• Foods may take on symbolic meaning

199. Religious Dietary Laws
• Muslim
• Dietary laws dependent on restriction or prohibition of some foods,
promotion of other foods
• Ramadan: 30-day period of daylight fasting
• Milk products are permitted at all times
• Fruits, vegetables are permitted unless fermented
• Breads, cereals are permitted unless contaminated
• Seafood, land animals are permitted
• Pork and alcohol are prohibited

200. Asian Food Patterns
• Chinese
• Use a wok for quick stir-frying with little fat
• Vegetables and rice are staples
• Meat, eggs, tofu are sources of protein
• Japanese
• Rice is basic grain
• Many varieties of fish and shellfish are used
• Vegetables are usually steamed
• Diet is high in sodium, low in milk

201. Asian Food Patterns
• Southeast Asian: Vietnamese, Indonesian, Cambodian,
• Rice is a staple
• Soups are common
• Fish, shellfish, pork, chicken, and duck are common
• Red meat is eaten only once or twice a month

202. Key Concepts
• Social and economic change usually results in
alterations in food patterns
• Short-term food patterns, or fads, often stem from
food misinformation that appeals to some human
need

203. Social Influences
• Social structure
• Groups may be formed by economic status, education, residence,
occupation, family
• Group affiliation influences food attitudes and choices
• Food and social factors
• Food symbolizes acceptance and warmth in social relationships
• Certain foods trigger childhood memories

204. Psychological Influences
• Diet patterns
• Food has many personal meanings
• Many psychological factors rooted in childhood
• Food and psychosocial development
• Food relates closely to psychosocial development
• Toddlers may become “picky eaters” in order to control parents
• Food neophobia (fear of unfamiliar foods) is normal developmental
factor

205. Economic Influences
• Family income
• Low-income families suffer extreme needs
• Illness, hunger, and malnutrition are more common in this group
• Food habits more likely to be manipulated by media
• Food assistance programs can help low-income families develop better
food habits

206. Food Misinformation and Fads
• Fad
• Any popular fashion or pursuit without substantial basis that is
embraced passionately
• Food fads
• Scientifically unsubstantiated beliefs about certain foods that may
persist in a given time or community
• Unscientific statements may mislead consumers and contribute
to poor food habits

207. Food Fad Claims
• Food fad claims may center on
• Food cures for specific conditions/illnesses
• “Harmful” foods to be omitted from the diet
• Certain food combinations may promote health, weight loss
• “Natural” foods can prevent disease
• Food fad claims tend to focus on foods, not the specific
nutrients in food

208. Dangers of Food Fads
• Danger to health/failure to seek appropriate medical care
• Money wasted on fad supplements
• Lack of sound knowledge that counteracts scientifically based
health information
• Distrust of the food market/unwarranted rejection of all
modern food production

209. Factors Determining Food
Choices
• Physiologic factors
• Allergy
• Disability
• Health-disease status
• Heredity
• Needs, energy, or nutrients
• Therapeutic diets

210. Factors Determining Food
Choices
• Psychological factors
• Habit
• Preference
• Emotions
• Cravings
• Positive or negative experiences/associations
• Personal food acceptance

211. Diet Myths

212. Food Faddism
• A dietary practice based upon an exaggerated belief in the
effects of food or nutrition on health and disease
• Such thinking leads people to overestimate the beneficial
effects of some foods (e.g. organic food, raw food, whole
grains) and condemn others (e.g. sugar and white flour)
• It can have serious consequences e.g. nutritional deficiencies

213. What is a fad?
• A fad as “a short-lived fashion or craze”
• So fad diets are short-lived, crazy diets!
• These diets do not work for many reasons – one
reason being they are SHORT-LIVED

214. Examples of fad diets
• High Protein/ Low Carbohydrate Diets
• Low in calories and exclude grains and other important high-
carbohydrate foods
• Important nutrients and fiber are being limited in
the diet
• Higher in protein than recommended = stress and
injury to the kidneys
• Some are also high in fat which can raise the risk
of developing heart disease
• Majority of weight loss is muscle and water loss, so weight
will be regained as soon as normal eating resumes

215. Examples of fad diets
• Elimination Diets
• Demonize one or more foods or food groups
• Sugarbusters!”– calls for elimination of sugar in
the diet
• This includes carrots and beets since they are naturally
high in sugar
• Very low in calories/ high in fat – people do see
temporary weight loss

216. Examples of fad diets
• Single Food Diets
• Examples: the grapefruit diet, the rice diet, the cabbage
soup diet
• Variety of foods not being eaten so nutrients are
missing from the diet
• Usually low in calories

217. Examples of fad diets
• Blood Type Diets
• Eat foods based on your blood type
• Thinking is that by eating certain foods, the body will process
them more efficiently because they are for your blood type
• Processing food more or less efficiently does not result
in weight loss
• Again, it eliminates foods, therefore; one would be
missing important nutrients

218. Examples of fad diets
• Liquid Diets
• Simply drink just liquids
• It is possible to consume just as many calories through liquid as through
food
• May be easier to consume more because food contains more
fiber that can help you feel full
• Some may replace one or two meals with liquids
• Most provide few calories per day
• Claim to provide everything in a drink but they are missing
nutrients and phytochemicals that can only be found in food

219. Examples of fad diets
• Skipping Meals
• It is a myth that skipping meals will result in weight loss
• Going several hours without eating will more than
likely cause one to overeat when they have their
next meal
• It is healthier for the body and appetite to eat
regular meals when hunger strikes instead of
skipping

220. Examples of Fad Diets
• Fasting or Near Fasting
• Also called “crash dieting”
• Lacking in nutrients required for normal functioning of the body
• Weight loss is a result of water and muscle loss
• Side effects include
• extreme fatigue, constipation, nausea, diarrhea, and even gallstone
formation

221. Examples of Fad Diets
• Detox Plans
• Several diets claim the body is full of toxins which are stored in body
fat and need to be cleansed regularly to avoid illness
• Plans include fasting, liquid dieting and/or use of herbal teas
• No scientific basis that supports this type of plan
• Substances stored in mobilized body fat would reenter the
bloodstream and be recirculated through the liver and
throughout the body and would not necessarily be excreted or
“flushed out”

222. Examples of Fad Products
• Laxatives
• Induces bowel movements
• Myth that taking laxatives promotes weight loss
• Laxative-induced diarrhea does not significantly reduce the number of
calories absorbed from the food you have eaten
• Laxatives do not work on the small intestine – where calories
are absorbed, but on the colon
• Use can promote cramping, nausea, diarrhea, vomiting,
constipation, dehydration, fainting, irregular heartbeat and
electrolyte imbalances

223. Examples of Fad Products
• Teas
• Several teas on the market: dieter’s tea, slim teas, fat-burning teas
• Likely contain a form of a laxative but it may not be listed on the label
• If the tea contains: aloe, rhubarb or castor oil – it contains a
laxative
• Use can promote cramping, nausea, diarrhea, vomiting,
constipation, dehydration, fainting, irregular heartbeat and
electrolyte imbalances

224. Examples of Fad Products
• Herbs, Hormones, Minerals
• Marketed as weight loss aids
• None have been proven to promote weight loss, build muscle,
or anything beneficial
• Some have been found to be dangerous and can cause death

225. Examples of Fad Products
• Drugs
• Dexatrim, prescription drugs
• Not been proven effective in long-term weight control
• In some cases, medication is appropriate as part of a
doctor prescribed plan
• Other Gimmicks-
• Cellulite creams, fat-burning sweat suits, vacuum pants
(claim to suck the fat out of your body while you are
hooked up to a vacuum cleaner)
• Slimmer shorts claim to melt unwanted fat away from hips,
stomach, buttocks, and thighs

226. Identify a Fad Diet or Product
• Promise quick weight loss
• Flaunt famous names
• Limit foods to eat
• Use testimony instead of science
• No sweat
• Sell something – like food or pills
• Have “secret Ingredients”
• Short-term
• Disbelieve doctors

227. Potential Health Problems
• Loss of energy – almost all fad diets call for less calories to
promote quick weight loss
• When this happens, body tries to conserve energy by burning fewer
calories, making you feel tired
• Dehydration- electrolytes sodium and potassium are dissolved
in body water
• When one is dehydrated, an imbalance of electrolytes occurs causing
constipation, slowness of thought, labored breathing, dim vision, and
can result in death
• Electrolytes conduct nerve transmissions and muscle contractions,
including heart rhythm – an imbalance can cause cardiac arrest

228. Potential Health Problems
• Loss of muscle – when the body does not have adequate CHO
intake it is forced to perform gluconeogenesis (glucose
formation) for energy
• Source of this glucose is mostly protein, or muscle tissue
• More muscle you have – the higher your metabolic rate
• By losing muscle- metabolic rate is slowed
• Muscle holds water so weight loss will actually be occurring
• However, person is not losing fat and weight gain will occur when old
habits return

229. Potential Health Problems
• Vitamin & Mineral Deficiencies
• Iron deficiency is prevalent among young women of childbearing age
and causes one to feel fatigue, cold, and unable to concentrate
• Majority of teens do not meet recommended calcium intake and
deficiency can lead to sub-optimal bone formation and osteoporosis later
in life

230. Other Problems
• False hope
• Fad diets make promises they can’t keep by offering “magic bullets”
• Feeling of failure
• When the diet doesn’t work or the dieter eats a forbidden food, he/she
may feel failure or guilt
• Loss of money
• Many products are expensive
• Avoiding real change
• By trying fad diets, person who really wants or needs to lose weight is
avoiding making the changes that will promote real weight loss for
good

231. Sensible Weight Control
Guidelines
• Do you really need to lose weight?
• Recent study showed that more than 33% of high school girls in USA
considered themselves overweight compared to 15% of the boys
• More than 43% of the girls reported they were on a diet
• Lose the quick-fix mentality
• Losing weight is a lifetime commitment, not meal-long, day-long, or
even month-long
• THERE ARE NO QUICK FIXES!

232. Sensible Weight Control Guidelines
• A healthy Diet
• Use the word diet as a noun not a verb
• A healthy diet is what you eat; you no longer “diet” to lose weight
• A healthy diet follows the food pyramid format
• Honor your hunger
• If your stomach is growling – feed it!
• If you wait too long, you will probably overeat
• Stop eating when you feel like you have had enough – forget the clean
your plate mentality

233. Sensible Weight Control
Guidelines
• Forget perfection
• Accepting our bodies and loving them is enough to want to care of
them and give them all the healthy fuel and exercise they need to stay
healthy
• Don’t deny yourself –
• Don’t make certain foods “illegal”
• Just make sure it is once in a while, and the rest of your diet is low-fat
• Remember it is the overall diet you eat week to week, month to month
that makes up the cells in your body, not one dessert

234. Sensible Weight Control
Guidelines
• Get sweaty
• Try to do something active everyday
• Don’t focus on a certain number of minutes, just become a more active
person
• Monitor how you feel
• Using the scale to determine whether you are at a healthy weight can
be deceiving
• Monitor how you feel, do you have energy when you are done, do you
sleep well, do you feel fit and strong?

235. Food Distribution in the Household

236. Food Distribution in the Household
• Approximated that food in the world is capable of
feeding everybody
• Food is unevenly distributed between
• Different regions of a country
• Rural and urban areas
• Different social economic groups
• Members of same household

237. Food Distribution in the
Household
• Food access to a household member comprises
• physical, social and financial accessibility
• A household is said to be food secure
• When it has access to food that is adequate in quantity
and quality to meet nutritional needs of members at all
times
• Food supply is stable and sustainable

238. Food Distribution in the
Household
• Household food consumption and availability is
influenced by:
• Food production for home use
• Household expenditure on food
• Nutritional knowledge
• Food availability

239. Factors influencing food
production for home use
• Type of crops grown
• Balance between food and cash crops
• Access to land for food crops
• Division of family labour for farm work
• Harvest size and quality
• Crop sales-How much is sold/ Retained
• Pre and post harvest losses

240. Determinants of Household
expenditure on food
• Total Household income
• Market supply of acceptable foods
• Prices food in the market
• Amount and variety of food bought

241. Determinants of amount/type of
food served to household members
• Fuel availability
• Time available for food preparation and service
• Amount and variety of food to be prepared
• Food avoidance
• Temporary e.g. sickness, pregnancy, lactation
• Permanent e.g. allergies, religion
• Traditional eating habits
• Who is responsible for portioning

242. Preparation and handling
• Food Handling
• Any operation in growing and harvesting, preparation, processing,
packaging, storage, transport, distribution and sale of food
• Food safety
• Safety refers to freedom from spoilage or toxic agents
• Food hygiene
• Measures necessary to ensure safety and wholesomeness of food at all
stages
• The processes and procedures necessary to prevent contamination of food
by pathogenic micro-organisms, chemicals and physical agents such dust,
sand, hair

243. Preparation and handling
• Food spoilage
• Deterioration of food quality aspects such as nutritive
value and sensory quality (Colour, texture, flavour
• Contamination
• Presence of harzadous substances in food
• Food Poisoning
• Presence of toxic substances in food which can injure a
consumer’s health

244. Objectives of food Hygiene
• To
• Ensure wholesomeness in appearance, aroma and other
desirable characteristics
• Prevent entry of poisonous substances and other toxic
substances into food
• Prevent invasion of food by rodents, insects and other
vermin
• Reduce contamination of food by spoilage micro-
organisms

245. Food processing chain
• To prevent contamination, sanitary practices are vital and
they must be adhered to from production to consumption

246. Food security

247. Food Security
• Access by all people at all times to enough food for an active
healthy life (World Bank)
• When all people at all times have both physical and economic
access to sufficient food to meet their dietary needs for a
productive & healthy life (USAID, 1992)
• Food security exists when all people, at all times, have physical
and economic access to enough safe and nutritious food to
meet their dietary needs and food preferences for an active and
healthy lifestyle (World Food Summit, 1996)

248. Dimensions of food security
• Food security depends on five key components
• Food availability
• Food accessibility
• Food stabilty
• Food utilization
• Food safety

249. Food Availability
• Food is said to be available when there are adequate quantities
of good quality food
• It describes both quantitative and qualitative (nutritional adequacy and
safety)
• It addresses the supply side of food security
• Determined by the level of food production and stock levels
• Total availability
• Combines both foods available from production and food bought from
markets including imports at national level
• Food is consistently available to the individuals or is within reasonable
proximity to them or is within their reach

250. Factors Affecting Food Availability
(Locally, Nationally & Globally)
• Climate-Rainfall
• Disasters
• War
• Civil unrest
• Environment
• Size of land
• Population size & growth
• Trade
• Inadequate agricultural
inputs
• Marketing and transportation
systems
• Political choices by
governments
• Lack of foreign exchange
• Agricultural practices,
knowledge & technologies

251. Food Accessibility
• Ability to either produce own food, purchase the food or
exchange assets for food
• Food can be available but not accessible
• All individuals and families need to have access to food both
physically & economically
• Individuals have adequate incomes or other resources to
purchase or barter to obtain levels of appropriate foods needed
to maintain consumption of an adequate diet

252. Food Accessibility
• All stages of the food chain supply system have
some influence on physical accessibility
• Transportation, storage, transformation and marketing of
food commodities
• Economic accessibility or purchasing power
• Household income is the most important factor affecting
people’s accessibility to food

253. Constraints to individual food access
• Economic growth that is inequitable
• Leads to a lack of job opportunities or lack of incentives to become a
productive participant in the economy
• Inadequate training and/or job skills
• Lack of credit or other means to exchange assets
• Food losses associated with ineffective and inefficient
harvesting, storage, processing and handling
• Political decisions favoring one group over another

254. Factors Affecting food
accessibility
• Reduced purchasing power at household level
• Geographical barriers to the market
• Culture
• Prohibits consumption of some foods as a result of
taboos
• Conflict
• Creates insecurity hence people cannot access farms and
market

255. Food Stability
• Refers to the capacity of individuals, households or
government to cope with food crises in case of
unpredicted emergency
• Times of drought, conflict and crop failure
• If food intake is adequate today, but one is exposed
to unpredicted shocks on a periodic basis, then one
is considered food insecure

256. Factors that affect food stability
• Storage capacity at household level
• Drought
• Flooding
• Fluctuation of prices or the stability of the market
• Depends on the balance between supply and demand
• Seasonal unemployment
• Adverse weather conditions
• Political and economic instability

257. Food Utilization
• Refers to how the human body makes maximum use of various
nutrients available in food
• Sufficient energy and nutrient intake by individuals is the
result of:
• Good care and feeding practices, food preparation, diversity of the diet
and intra-household distribution of food
• Distribution of food within a household does not always reflect
individual’s food needs
• Food practices are governed by religious taboos, food preferences and
cultural influence

258. Food Utilization
• Food is properly used for instance
• There is proper food processing and storage techniques
• Adequate knowledge of nutrition and child care techniques exists and
are applied
• Adequate health and sanitation services exist
• At the household level
• Sufficient and varied food needs to be prepared safely so that people
can grow and develop normally, meet their energy needs and avoid
disease

259. Factors affecting food utilization
• Nutrient losses associated with food preparation
• Inadequate knowledge and practice of health techniques,
• Those related to nutrition, child care, and sanitation
• Health status like malfunctioning of digestive system
• Unable to eat due to sickness
• Age
• Children and elderly may not be able to consume some foods

260. Food Safety
• Refers to availability of food that is fit for human
consumption
• Food might be there in plenty but not safe
• Unsafe food when consumed will lead to illness,
malnutrition or death
• Example aflatoxin in maize

261. Factors affecting food safety
• Storage to avoid food spoilage which may lead to destruction
of food
• Methods of food processing, preservation, cooking
• Might introduce microbes thus reducing the nutritional quality of food
• Packaging with materials that have carcinogenic additives like
plastic containers
• Transportation where the food is destroyed or gets spoilt

262. Consequences of Food
Insecurity
• Ill health
• Shorter life expectancy
• Poorly developed children
• Stunted, underweight, weak physically & intellectually

263. Factors influencing food security
• Climatic factors
• Drought
• Floods
• Government factors
• Political instability
• Government policy
• Economic factors
• High food prices
• Transport cost
• Social cultural factors
• Cultural practices
• Food taboos and believes

264. Why is there food insecurity?
• Poverty
• Poor people lack access to sufficient resources to produce or buy
quality food
• Health
• Poor health affects food production and food utilization
• Without sufficient calories and nutrients, the body slows down, making it
difficult to undertake the work needed to produce food
• Without good health, the body is also less able to make use of the food
that is available
• Contaminated food and water can cause illness, nutrient loss and often
death in children
• Water and the environment
• Food production requires massive amounts of water

265. Why is there food Insecurity?
• Gender equity
• Women play a vital role in providing food and
nutrition for their families through their roles as food
producers, processors, traders and income earners
• Yet women's lower social and economic status limits
their access to education, training, land ownership,
decision making and credit and consequently their
ability to improve their access to and use of food
• Food utilization can be enhanced by improving
women's knowledge of nutrition and food safety and
the prevention of illnesses

266. Why is there food insecurity?
• Disasters and conflicts
• Droughts, floods, cyclones and pests can quickly wipe out
large quantities of food as it grows or when it is in storage
for later use.
• Conflict can also reduce or destroy food in production or
storage as farmers flee to safety or become involved in the
fighting
• Population and urbanization
• Population growth increases the demand for food.
• Expanding cities spread out across productive land, pushing
food production further and further away from consumers.
• Trade barriers

267. What can be done to improve food security?
• Helping people improve their farms and productivity
• Constructing food stores
• Improving roads so that food can be moved to where it is
needed or where it can be sold
• Promoting national and international trade to encourage
economic growth and poverty reduction
• Health education on strategies of enhancing good nutrition and
health

268. What can be done to improve food security?
• Improving the status of women and girls so they have more
control over the areas in which they have traditionally been
involved and can access new areas
• Ensuring that people, and especially children, receive food in
emergency situations (food aid)
• Promoting rural development, including sustainable
agricultural, fishery and forestry production and management
of natural resources

269. Question
• There is a lot of maize that is normally produced in Kitale. At
the same time in Turkana the population is more often food
insecure. Explain this case scenario.

270. Assignment
1. Using a perishable food of your choice, describe how it is
produced, priced, marketed and distributed
2. Using a non-perishable food of your choice, describe how it
is produced, priced, marketed and distributed
3. Plan a three course meal, purchase the ingredients, prepare
and market the food
• Menu planning, Budgeting, Food safety, Hygiene,Marketing
4. Is Kenya a food secure country? Discuss giving examples