Introduction to nutrition

Hippocrates of Kos, also known as Hippocrates II, was a Greek physician of

the classical period who is considered one of the most outstanding figures in
the history of medicine. Connections between nutrition and health have
probably been understood, at least to some degree, among all people of all
places and times. For example, around 400 BC Hippocrates said, "Let food be
your medicine and medicine be your food." Understanding the physiological
needs of the cells helps one understand why food has such an impact on
overall health. The nutritional status of people in the communities is a
concern not only for quality of life, but also for economics (treating illness
costs far more than preventing it). Various public health agencies are striving
to prevent nutritional deficiencies and improve overall health.

The human body has certain nutritional needs and if they are not met will
cause catabolism of its own fats, carbohydrates and proteins. Molecules are
continuously broken down, so they must be replaced. Food molecules,
essential fatty acids and essential amino acids are particularly important in
replacing these molecules. Vitamins and minerals are not used as energy,
but are essential in enzyme reactions. Living tissue is kept alive by using the
expenditure of ATP, found in the breakdown of food. Food energy value is
measured in kilocalories. 1 kilocalorie is equal to 1000 calories.

A Clinician is in a unique position to assess people’s nutritional status and

provide information on proper nutrition. They can reinforce positive
nutritional patterns, identify people at risk for malnutrition, and encourage
more healthful eating habits.

The goal of eating is to supply body cells with necessary nutrients. Ingestion,
digestion, absorption, and metabolism are the processes that normally
accomplish this goal. Interference with any of these functions can contribute
to nutritional problems.

Concepts, principles and requirements in human nutrition

Definition of terms

Nutrition

It is the process by which the body obtains and uses certain components of
food. The process includes digestion, absorption, transportation, and cell
metabolism. Nutrition is also the evaluation of food and drink requirements
for normal body function.
The biochemical and physiological process by which an organism uses food
to support its life. It provides organisms with nutrients, which can be
metabolized to create energy and chemical structures. Failure to obtain the
required amount of nutrients causes malnutrition.

-The process of providing or obtaining the food necessary for health and
growth.

-The taking in and use of food and other nourishing material by the body.

-The relative state of balance between nutrient intake and physiological

requirements for growth and physical activity. Optimal nutrition helps protect
against disease, facilitates recovery, and decreases complications during
illness. Good nutrition helps people stay healthy.

Nutrition is also about why people choose to eat the foods they do, even if
they have been advised that doing so may be unhealthy. The study of food
habits thus overlaps with the social sciences of psychology, anthropology,
sociology and economics.

Food

Any substance, solid or liquid consumed to provide nutritional support for the
body. It is usually of plant or animal origin, and contains essential nutrients,
such as carbohydrates, fats, proteins, vitamins, or minerals. The substance
is ingested by an organism and assimilated by the organism's cells to
provide energy, maintain life, or stimulate growth.

Nutrient

A substance that provides nourishment essential for the maintenance of life

and for growth.

Nutrients

Substances contained in food that are essential for optimal body

functioning.

The chemicals taken into the body that are used to produce energy, to
provide building blocks for new molecules and to function in other chemical
reactions. Some important substances in food, such as non-digestible plant
fibers, are not nutrients.

Malnutrition
Deficiencies or excesses in nutrient intake, imbalance of essential nutrients
or impaired nutrient utilization. The double burden of malnutrition consists of
both undernutrition and overweight and obesity, as well as diet-related
noncommunicable diseases.

Traditionally it has been defined as a deficit of appropriate nutrients.

However, it literally means bad nutrition and can encompass any situation
that contributes to an imbalance in nutrient intake relative to actual needs.
Therefore, malnutrition can mean a nutrient deficit or excess. Although
nutritional deficits remain a significant health problem in Third World
countries, the major problem in the developed countries is nutritional excess,
as is shown by the rising rates of obesity in all age groups.

Balanced Diet

This means eating a wide variety of foods in the right proportions, and
consuming the right amount of food and drink to achieve and maintain a
healthy body weight.

A balanced diet contains an adequate amount of all the nutrients required

by the body to grow, remain healthy and be disease-free. In addition, a
healthy, balanced diet provides the necessary energy requirement, protects
against vitamin, mineral, and other nutritional deficiencies, and builds up
immunity.

Community Health

It encompasses a broad set of activities designed to provide access to safe,

adequate, healthful diet to a population living in a particular geographical
area.

Health is a state of complete physical, mental, and social well-being, and not
merely the absence of disease or infirmity.

Principles of community nutrition

The goal of community nutrition is to educate individuals and groups so that
they adopt healthy eating habits and to emphasize a preventive approach in
educating individuals on how a change in dietary habits will reduce the risk
of illness. Community nutrition focuses on all age groups.

Principles of Community Health (Alma Ata Declaration - WHO

1978)
•Availability of health care for all people and at a cost they can afford.
•Promotive and preventive aspects of health care.
•Integration of curative and preventive services.
Program Plus (NHPplus) in Kenya

Nutrition and Health Program Plus (NHPplus) is designed to increase access

to and demand for quality nutrition services, to improve food and nutrition
security, and to provide commodity management support. NHPplus will buy
and distribute fortified blended foods and ready-to-use therapeutic foods to
address severe acute malnutrition. Funding for this project is provided by the
U.S. Agency for International Development (USAID).

NHPplus uses a service model with three components.

1. Nutrition Assessment Counseling and Support (NACS) at the

national level. This component includes providing technical
assistance for NACS activities, as well as fortified, blended and ready-
to-use therapeutic foods for people living with HIV/AIDS, individuals
with tuberculosis, and orphans and vulnerable children. NHPplus will
also strengthen the skills and knowledge of health care workers in
nutrition and community management at all levels.
2. Maternal and newborn child health programs at the county
level. This component includes a comprehensive scale-up of high-
impact nutrition interventions and social and behavior change, as well
as support for the implementation of integrated and community-based
management of acute malnutrition at community and facility levels, an
approach that enables community volunteers to identify and initiate
treatment for children with acute malnutrition before they become
seriously ill.
3. Strengthening nutrition in Feed the Future priority regions.
This component includes providing technical assistance for food
fortification and increased household production and consumption of
nutritious foods, as well as social behavior change communication in
dietary adequacy and diversity. Additionally, NHPplus will help to link
vulnerable communities with resilience-focused activities to support a
value chain approach to the

Laws governing community health provision

Each county government shall take all necessary measures to build the
capacity of community health promoters for the proper and efficient
implementation of this Act. A community health promoter shall be
selected by the community through a public participation forum and
appointed by the county government.

Health Act No 21 of 2017 Kenya

 An Act of Parliament to establish a unified health system, to coordinate the
inter-relationship between the national government and county government
health systems, to provide for regulation of health care service and health
care service providers, health products and health technologies and for
connected purposes.

Public health law in Kenya

This Act concerns the protection of public health in Kenya and lays down
rules relative to, among other things, food hygiene and protection of
foodstuffs, the keeping of animals, protection of public water supplies, the
prevention and destruction of mosquitos and the abatement of nuisances.

Primary Health Care Act in Kenya

AN ACT of Parliament to provide a framework for the delivery of, access to

and management of primary health care; and for connected purposes.

Legal framework on the right to health in Kenya

The right to health is a fundamental human right guaranteed in the

Constitution of Kenya. Article 43 (1) (a) of the Constitution provides that
every person has the right to the highest attainable standard of health,
which includes the right to health care services, including reproductive
health care.

Role of the Clinical Officers in community health provision

Co-ordinating the clinical services function by formulating, developing,
implementing and reviewing policies, procedures and guidelines for clinical
services, setting standards, ethics and quality assurance systems in the
provision of clinical services, ensuring proper provision of clinical and family
health and implementing Community Health Care activities.
.
The role of nutrition in health
Nutrition is a critical part of health and development. Better nutrition is
related to improved infant, child and maternal health, stronger immune
systems, safer pregnancy and childbirth, lower risk of non-communicable
diseases (such as diabetes and cardiovascular disease), and longevity.

The science of human nutrition deals with all the effects on people of any
component found in food.

This starts with the physiological and biochemical processes involved in

nourishment, how substances in food provide energy or are converted into
body tissues, and the diseases that result from insufficiency or excess of
essential nutrients (malnutrition).

The role of food components in the development of chronic degenerative

disease like coronary heart disease, cancers, dental caries, etc., are major
targets of research activity nowadays.

The scope of nutrition extends to any effect of food on human function: fetal
health and development, resistance to infection, mental function and athletic
performance.

There is growing interaction between nutritional science and molecular

biology which may help to explain the action of food components at the
cellular level and the diversity of human biochemical responses.

Dietetics and community nutrition are the application of nutritional

knowledge to promote health and well-being. Dietitians advise people how to
modify what they eat in order to maintain or restore optimal health, and to
help in the treatment of disease. People expect to enjoy eating the foods
that promote these things; and the production, preparation and distribution
of foods provides many people with employment.

A healthy diet means different things to different people. Those concerned

with children’s nutrition—parents, teachers and paediatricians aim to
promote healthy growth and development. For adults in affluent
communities, nutrition research has become focused on attaining optimal
health and ‘preventing’—which mostly means delaying—chronic
degenerative diseases of complex causation, especially obesity.

Essential nutrients

Essential nutrients have been defined as chemical substances found in food

that cannot be synthesized at all or in sufficient amounts in the body, and
are necessary for life, growth and tissue repair.

Essential nutrients must be ingested because the body cannot

manufacture them or adequate amounts of them. The essential nutrients
include certain amino acids, certain fatty acids, most vitamins, minerals,
water, and a minimum amount of carbohydrates. The term essential does
not mean, however, that the body requires only the essential nutrients.
Other nutrients are necessary but, if they are not part of the diet, they can
be synthesized from the essential nutrients. Most of this synthesis takes
place in the liver, which has a remarkable ability to transform and
manufacture molecules.

Macronutrients:
Energy-yielding nutrients. Macronutrients are those nutrients that together
provide the vast majority of metabolic energy to an organism. The three
main macronutrients are carbohydrates, proteins, and fat.

Micronutrients:

Micro minerals or trace elements are dietary minerals needed by the human
body in very small quantities (generally less than 100mg/day) as opposed to
macro minerals which are required in larger quantities.

Factors that influence nutritional status

Developmental, Cultural, and Ethnic Variations and drug therapy,

medical/surgical condition.

As people grow and develop, their nutritional needs change. Developmental

groups especially at risk for nutritional problems include pregnant and
lactating women, infants and children, adolescents, and older adults.

Components of the diet

Diets are composed of nutrients: macronutrients (protein, fats,
carbohydrates, and alcohol) and the micronutrients (vitamins, minerals, and
trace elements). Food also contains many non-nutritional, but biologically
active substances. These include toxins and contaminants, such as alkaloids
and aflatoxins, that are detrimental to health as well as constituents, such as
phytochemicals, that may be health-promoting. As consumers we do not eat
nutrients, but meals and foods. These are the components of diet most
meaningful to the public and usually the basis of food choice.
Food groups
Foods vary in their energy and nutrient content. Food groups are a
classification of foods on the basis of the nutrient profile. Commonly used
food groups are:
- high protein foods, e.g. meat, fish, eggs, pulses/legumes;
- carbohydrate-rich foods, e.g. cereals, roots, and tubers;
- dairy foods;
- fruit and vegetables;
- foods rich in fat or oil.

Bread, Cereal, Rice, Pasta, roots and tubers Group

The largest section of MyPyramid is made up of the grains—the bread,
cereal, rice, and pasta group. The number of servings from grains is
established with the recommendation that at least half of the servings
should be whole grains. Whole grains provide dietary fiber, B vitamins, iron,
and magnesium. Enriched products also contain B vitamins and iron, but if
they are not made from whole grains, they contain little dietary fiber.

Vegetable Group
The food intake patterns have established the number of daily servings per
calorie level of vegetable. All vegetables are included in the vegetable group:
green and leafy, yellow, starchy, and legumes. Vegetables provide
carbohydrates; dietary fiber; vitamins A, B-complex, C, E, and K; and iron,
calcium, phosphorus, potassium, magnesium, copper, manganese, and
sometimes, molybdenum. This guideline, if followed, also guarantees that
one will receive a variety of nutrients, phytochemicals, and flavonoids. One-
half cup of cooked or chopped raw vegetables or two cups of uncooked, leafy
vegetables is considered one serving.

Fruit Group
All fruits are included in the fruit group. They provide vitamins A and C,
potassium, magnesium, iron, and carbohydrates, including dietary fiber. It is
recommended that one eat a variety of fruit daily, following the food intake
patterns for quantity, and go easy on the fruit juice. The calories in fruit juice
add up quickly, especially if one is thirsty and drinks large amounts of juice.
One serving is three-quarter cup of fruit juice; a half of a grapefruit; one
whole raw medium apple, orange, peach, pear, or banana; a half cup of
canned or cooked fruit; and a quarter cup of dried fruit.

Milk, Yogurt, and Cheese Group

Milk, yogurt, and cheese are excellent sources of carbohydrate (lactose);
calcium, phosphorus, and magnesium; proteins; riboflavin, vitamins A, B12,
and, if the milk is fortified, vitamin D. Unfortunately, all contain sodium, and
whole milk and whole-milk products also contain saturated fats and
cholesterol. Fat free milk has had the fats removed. It is recommended that
two to three servings of these foods be included in one’s daily diet. The
serving size is one 8-ounce glass of milk or the equivalent in terms of
calcium content.
Children 2 servings
Adolescents 3 servings
Adults 3 servings
Pregnant or lactating women 3 servings
Pregnant or lactating teens 4 servings
The following dairy foods contain calcium equal to that found in one 8-ounce
cup of milk. The best choices would be low fat.
{11⁄2 ounces cheddar cheese
{ 2 cups cottage cheese
{ 13⁄4 cups of ice cream
{ 1 cup yogurt

Milk used in making cream sauces, gravies, or baked products fulfills part of
the calcium requirement. A cheese sandwich would fulfill one of the serving
requirements, and a serving of ice cream could fulfill half of one of the
serving requirements. Obviously, drinking milk is not the only way to fulfill
the calcium requirement. Some clients suffer from lactose intolerance and
cannot digest milk or milk products. If they eat or drink foods containing
untreated lactose, they experience abdominal cramps and diarrhea. This
condition is caused by a deficiency of lactase. In such cases, milk that has
been treated with lactase can be used, or commercial lactase can be added
to the milk or taken in tablet form before drinking milk or eating dairy
products

Meat and Beans Group

All meats, poultry, fish, eggs, soybeans, dry beans and peas, lentils, nuts,
and seeds are included in this group. These foods provide proteins, iron,
copper, phosphorus, zinc, sodium, iodine, B vitamins, fats, and cholesterol.
Caution must be used so that the foods selected from this group are low in
fat and cholesterol. Many meats contain large amounts of fats, and egg yolks
and organ meats have very high cholesterol content. Let the food intake
patterns be the guide for the number of ounces one should eat daily. In
general, 1 ounce of lean meat, poultry, or fish, 1 egg, 1 tablespoon of peanut
butter, 1⁄4 cup of cooked dry beans, or 1⁄2 ounce of nuts or seeds can be
considered as a 1 ounce-equivalent from the meat and beans group.
Fats
This group contains butter, margarine, cooking oils, mayonnaise and other
salad dressings, sugar, syrup, honey, jam, jelly, and sodas. All of these foods
have a low nutrient density, meaning they have few nutrients other than fats
and carbohydrates and have a high calorie content. One’s limit for fat will be
figured and listed as oils in accordance with the food intake patterns. It is
recommended that the fat sources be from fish, nuts, and vegetable oils. The
following dietary guidelines are recommended:
1. Eat the majority of food from plant sources, such as potatoes, grains and
breads, beans, fruits, vegetables, nuts, and seeds.
2. Eat minimally processed foods, with an emphasis on fresh, locally grown
foods.
3. Replace other fats and oils with olive oil.
4. Keep total fat in a range of less than 20–35% of energy. Saturated fat
should be no more than 7–8% of energy.
5. Eat low to moderate amounts of cheese and yogurt (low fat and fat free
preferable).
6. Eat low to moderate amounts of fish and poultry and from zero to four
eggs per week (those used in cooking need to be counted).
7. Eat fruit for dessert; desserts that contain a significant amount of sugar
and saturated fat should be eaten only a few times per week.
8. Eat red meat a few times per month, not to exceed 12–16 ounces per
month.
9. Engage in regular exercise to promote fitness, a healthy weight, and a
feeling of physical well-being.
FOOD LABELING
The resulting food labels provide the consumer with more information on the
nutrient contents of foods and how those nutrients affect health than former
labels provided. Health claims allowed on labels are limited and set by the
Food and Drug Administration (FDA). Serving sizes are determined by the
FDA and not by the individual food processor. Descriptive terms used for
foods are standardized. For example, “low fat” means that each serving
contains 3 grams of fat or less.
Current Label
The nutrition label has a formatted space called Nutrition Facts that includes
required and optional information. The items, with amounts per serving, that
must be included on the food label are the following: Total calories, Calories
from fat, Total fat, Saturated fat, Trans fat, Cholesterol, Sodium, Total
carbohydrates, Dietary fiber, Sugars, Protein, Vitamin A, Vitamin C, Calcium,
Iron.
The food processor can voluntarily include additional information on food
products. If a health claim is made about the food or if the food is enriched or
fortified with an optional nutrient, then nutrition information about that
nutrient becomes required. The standardized serving size is based on
amounts of the specific food commonly eaten, and it is given in both English
and metric measurements.

Daily values on the label give the consumer the percentage per serving of
each nutritional item listed, based on a daily diet of 2,000 calories. For
example, total fat shows 3 grams, which represents 5% of the amount of fat
someone on a 2,000-calorie diet should have. The label also shows the
maximum amount of a nutrient that should be eaten (for example, fat) or the
minimum requirement for specified nutrients (for example, carbohydrates)
based on a daily diet of 2,000 calories and another based on 2,500 calories.

Health Claims
because diet has been implicated as a factor in heart disease, stroke, birth
defects, and cancer, the following health claims linking a nutrient to a health-
related condition are allowed on labels. They are intended to help consumers
both choose foods that are the most healthful for them and avoid being
deceived by false advertisements on the label. The allowed claims are for the
relationship between the following:
{ Calcium and osteoporosis
{ Sodium and hypertension
{ Diets low in saturated fat and cholesterol and high in fruits, vegetables,
and grains containing dietary fiber and coronary heart disease
{ Diets low in fat and high in fruits and vegetables containing dietary fiber
and the antioxidants, and vitamins A and C and cancer
{ Diets low in fat and high in fiber-containing grains, fruits, and vegetables
and cancer
{ Folic acid and neural tube defects
{ Soy and reduced risk of cardiac heart disease
Two additional criteria must also be met:
1. A food whose label makes a health claim must be a naturally good source
(containing at least 10% of the daily value) of at least one of the following
nutrients: protein, vitamin A, vitamin C, iron, calcium, or fiber.
2. Health claims cannot be made for a food if a standard serving contains
more than 20% of the daily value for total fat, saturated fat, cholesterol, or
sodium.

Terminology
The FDA has also standardized descriptors (terms used by manufacturers
to describe products) on food labels to help the consumer select the most
appropriate and healthful foods. The following are examples:
{ Low calorie means 40 calories or less per serving.
{ Calorie free means less than 5 calories per serving.

{ Low fat means a food has no more than 3 grams of fat per serving or per
100 grams of the food.
{ Fat free means a food contains less than 0.5 gram of fat per serving.
{ Low saturated fat means 1 gram or less of saturated fat per serving.
{ Low cholesterol means 20 mg or less of cholesterol per serving.
{ Cholesterol free means less than 2 mg of cholesterol per serving.
{ No added sugar means that no sugar or sweeteners of any kind have been
added at any time during the preparation and packaging. When such a term
is used, the package must also state that it is not low calorie or calorie
reduced (unless it actually is).
{ Low sodium means less than 140 mg of sodium per serving.
{ Very low sodium means less than 35 mg of sodium per serving.
Obviously, the information on food labels is useful to all consumers and
especially to those who must select foods for therapeutic diets. Health care
professionals should become thoroughly knowledgeable about the labeling
law. On request, many food manufacturers will provide the consumer with
additional detailed information about their products.