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KNOWLEDGE REGARDING PROPER NUTRITION AND DIETARY PRACTICES

AMONG MEDICAL AND PARAMEDICAL STAFFS OF GMC KOLLAM

INVESTIGATORS

FACULTY: Dr. Ratheesh

Associate Professor

Department of community medicine,

GMC KOLLAM

Co-investigators:

Anmol Vij

Annie A Ninan

Ann Maria Pattery

Ansa Alex
INTRODUCTION

The ICMR -NIN 2024 guidelines emphasize a balanced diet that supports overall health and prevents non-
communicable diseases (NCDs). The National Institute of Nutrition (NIN) under the apex body, said that healthy
diets and physical activity can reduce the amount of coronary heart disease (CHD) and hypertension (HTN) and
prevent 80% of 2 types of diabetes

BALANCED DIET - Balanced diet is defined as a diet which contains a variety of foods in such quantities and
proportion that the need for energy, amino acids, vitamins, minerals, fats, carbohydrates and other nutrients are
adequately met with for maintaining health, vitality and general well-being and also makes a small proportion of
extra nutrients to withstand a short duration of leanness.

A balanced diet is a wholesome and nutritionally adequate diet. It provides calories, proteins, vitamins, minerals
and adequate fiber to perform wide range of functions in the body.

Malnutrition- It refers to deficiencies, excesses or imbalances in a person’s intake of energy and nutrients. It
encompasses both undernutrition and overnutrition. Undernutrition denotes insufficient intake of energy and
nutrients, it can lead to wasting and stunting, whereas overnutrition is the excess intake of macronutrients and
micronutrients leading to obesity and diet related non-communicable disease. E.g. Heart disease, stroke, diabetes,
RATIONALE –

Our food choices have an unparalleled impact on our health, and we can make better choices when physicians become more
effective advocates for proper diet and nutrition. Making it easier for doctors and their patients to discuss nutrition in practical
terms is one of the best methods we have to improve public health.According to NATIONAL FAMILY HEALTH SURVEY 5,
in India 35.5% of children under five years are stunted, 19.3% are wasted, 32.1% are underweight

As per WHO, in India, there are estimated 77 million people above the age of 18 years are suffering from type 2 diabetes and
nearly 25 million people are pre-diabetic. More than 50% of people are unaware of their diabetic status.

As per Lancet new study 44 million women and 26 million men aged above 20 in India were found to be obese.

As per ICMR INDIA 2023 study, prevalence of diabetes in adults Kerala is overall 23.6 %, including 24.7% in urban
population, 23% in rural population, 18 % are pre diabetic overall.

Estimates show that 56.4% disease burden in India is due to unhealthy diets. Healthy diets and physical activity can reduce a
substantial proportion of coronary heart disease (CHD) and hypertension (HTN) and prevent up to 80% of type 2 diabetes.

According to WHO, a healthy diet helps protect against malnutrition and diet-related noncommunicable diseases such as
diabetes, heart disease, stroke and cancer.
REVIEW OF LITERATURE

The dietary guidelines for Indians by ICMR-NIN 2024 states guidelines to be followed for a healthy lifestyle. It states the
problem of malnutrition i.e. overnutrition and undernutrition and the increased number of cases of non-communicable
diseases among children and adults. The guidelines give information about the ideal dietary habits along with special
consideration for different food groups to different age groups and pregnancy along with dietary preference in diseased
state.

According to cross sectional study conducted in Kerala from September 2010 to January 2011 in rural areas of
Thiruvananthapuram in food decision making the most crucial decision point was affordability. Also associated with
social interactions, media advertisement and health, local availability, any chronic disease in family.

As per cross sectional study conducted in Lucknow, Nagpur, Hyderabad and Bangalore including urban and rural
workers found that animal food related diet has increased anthropometric risk factors and cereal-savory foods (cooked
grains, rice-based dishes, snacks, soups, nuts) related diet reduces the risk.
OBJECTIVES

PRIMARY OBJECTIVE
 To estimate the knowledge regarding proper nutrition among medical and
paramedical staffs of GMC Kollam
 To find out the dietary practices among medical and paramedical staffs of GMC
Kollam

SECONDARY OBJECTIVE

To determine factors influencing knowledge of proper nutrition and dietary


practices
METHODOLOGY

Study design- cross sectional study

Study setting- Government Medical College, Kollam

Study period: 6 months after getting the approval from Human Ethics Committee

Study population: Medical and paramedical staffs of GMC Kollam

Inclusion criteria: All medical and paramedical staffs who are willing to participate

Exclusion criteria: Staffs who are not willing to participate

SAMPLE SIZE

Sample size will be fixed after pilot study

SAMPLING TECHNIQUE

Medical and paramedical staffs of GMC Kollam satisfying inclusion criteria and exclusion criteria will be involved in

to the study till the sample size is satisfied.


DATA COLLECTION-

Tools:

1)pre-tested semi structured interview schedule: The data collection will be started after obtaining permission from
institutional review committee and Human Ethics Committee of the institute and from Superintendent. The pre-tested semi
structured interview schedule will be used to interview the study participants to gather information regarding the factors
affecting dietary practices.

2)Structured questionnaire: Knowledge score will be determined through a structured questionnaire which has items
adapted from newly released DIETARY GUIDELINES FOR INDIANS by ICMR – National Institute of Nutrition
2024. We will be using a 25-item questionnaire for the study.
Study variables:

Outcome variable: Knowledge and practices- Analyzed using structured questionnaire prepared from DIETARY
GUIDELINES FOR INDIANS by ICMR-NIN 2024

Exposure variables:
 Age
 Gender
 Education
 Occupation
 Health status
 Genetic factors related to nutrition
 Physical activity
 Socio-economic status
 Source of awareness
 Kitchen gardening
DATA ANALYSIS
After the completion of data collection, it will be properly coded and entered in the MICROSOFT -EXCEL.
The compiled data will be analyzed using Statistical Package for Social Studies (SPSS) trial version 24.
Qualitative variables will be expressed as proportion and quantitative variable will be expressed as mean + SD.
Appropriate statistical tests like Chi-squared test and T-test will be used to assess the statistical significance.

ETHICAL CONSIDERATION
The participation in the study is voluntary, informed and safe for research subjects. The study will be undertaken
only after the approval of Human Ethics Committee. The confidentiality and anonymity of data will be maintained.
Informed consent will be obtained from each participant.
REFERENCES-
1. Meena Daivadanam, Rolf Wahlström, KR Thankappan, TK Sundari Ravindran.Balancing expectations amidst
limitations: the dynamics of food decision-making in rural Kerala.
BMC Public Health 2015;15: 1-13

2.Ambika Satija, Frank B Hu, Liza Bowen, Ankalmadugu V Bharathi, Mario Vaz, Dorairaj Prabhakaran, K Srinath Reddy,
Yoav Ben-Shlomo, George Davey Smith, Sanjay Kinra, Shah Ebrahim.Dietary patterns in India and their association with
obesity and central obesity.
Public health nutrition 2015;18 (16): 3031-3041
3. Yingting Cao, Quan Huynh, Nitin Kapoor, Panniyammakal Jeemon, Gabrielli Thais de Mello, Brian Oldenburg,
Kavumpurathu Raman Thankappan, Thirunavukkarasu Sathish.Associations between dietary patterns and
cardiometabolic risk factors—a longitudinal analysis among high-risk individuals for diabetes in Kerala, India.
Nutrients 2022;14 (3): 662
4. Carolyn I Auma, Rebecca Pradeilles, Megan K Blake, David Musoke, Michelle Holdsworth.Factors influencing
dietary practices in a transitioning food environment: a cross-sectional exploration of four dietary typologies among
rural and urban Ugandan women using Photovoice.
Nutrition journal 2020;19:1-15
5.
https://www.google.com/amp/s/indianexpress.com/article/health-wellness/obesity-lancet-study-india-cause-9188931/
lite/
6.https://www.google.com/amp/s/www.thehindu.com/news/national/kerala/non-communicable-diseases-to-be-the-
biggest-health-challenge-of-the-state-indicates-icmr-indiab/article66951283.ece/amp/
7.https://www.indiatoday.in/amp/health/story/india-has-67-million-zero-food-children-going-without-food-harvard-
study-2513449-2024-03-

8.https://main.icmr.nic.in/sites/default/files/upload_documents/DGI_07th_May_2024_fin.pdf
QUESTIONNAIRE (1 to 15 questions estimate knowledge)

1)How much fruits and vegetables are taken in MY PLATE FOR THE DAY?

a) 150g and 350g

b) 50g and 450g

c) 200g and 300g

d) 100g and 400g

2) What is the recommended daily intake of water for adults?


a) 1 L
b) 2 L
c) 3 L
d) 4 L

3)Daily requirement of dietary fibre per 2000kcal is considered

a) 30g b) 25g c) 35g d) 40g


5)How does excessive consumption of sugary foods and drinks impact health?

a) It can lead to iron deficiency.

b) It can lead to obesity and diabetes

c)It can lead to dehydration

d)It can cause vitamin C deficiency.

6)Which of the following is a healthy cooking method that helps retain the nutrients in food?

a) Deep frying

b) Boiling in excessive water

c)Microwave cooking

d)Overcooking
7)What is the main function of dietary fibre?
a) Energy production
b) Building and repairing body tissues
c) Regulating bowel movements
d) Protecting against heart disease

8)What is the approximate body mass index (BMI) range for healthy weight?

a)8.5 to 15

b)15.5 to 20

c)18.5 to 25

d)25.5 to 30

9)Which of the following is the best way to increase one’s fibre intake?

a) By eating variety of whole grains, vegetables, legumes and fruits.

b) By consuming at least 3 servings of low-fat milk products every day.


c)By making dietary supplements a part of one’s diet.

d)By decreasing one’s intake of red meat.

10)Select the group rich in vitamin C

a) broccoli, soyabeans, pepper

b) guava, amla, orange

c) milk, strawberry, lemon

d) strawberry, orange, soyabean

11) It is recommended that babies should be exclusively breastfed till ……

a) 3months

b) 4months

c) 5months

d) 6months

12) For how much duration folic acid supplement should be taken in pregnancy?
a) 1 month before conception and continued till 1st trimester i.e.12 weeks
b) No problem if not taken
c) 1 month after pregnancy
d) Before conception only

13) At what time after birth breastfeeding should be started?

a) Within 24 hours
b) Immediately after birth within 1 hour
c) Within 6 hours
d) Within 12 hours

14) What is the right time for starting complementary feeding along breastmilk?

e) As soon as possible after birth


f) After 6 months
g) After teeth come
h) After 3 months

15) Which foods should be fed to infant after 6 months?


a) The same food family is eating
b) Only liquids
c) Semisolid foods and mashed food the family eats
d) Commercial foods like cerelac, lactogen etc

Above 60% - Good

40- 59% - Average

Less than 40% -Poor


17) Do you wash vegetables before or after cutting?

a) Before cutting (3)


b) After cutting (0)
c) Both (0)
d) Do not wash(0)
18) How often do you eat fast foods, bakery foods and processed foods?

a) Daily (0)
b) Once weekly (1)
c) Occasionally (2)
d) Never (3)

19) Do you reuse vegetable oils for cooking?

e) yes (0)

f) no (3)

20) How much sugar do you consume per day? (25g=5teaspoons)

g) <25g (3)
h) > 25g (1)
21)How much salt do you consume per day? (5g=1teaspoon)

a) <5g (3)
b) > 5g (1)
22) Do you heat refrigerated food before eating?

a) Yes (3)
b) No (0)

23) In which form do you prefer fruits or fruit juices?

c) Fruit Juices (1)


d) fruit (3)

24) In which container do you store pickles, chutneys, sambar?

e) Earthen pots/ stainless steel (3)


f) Aluminium/copper (0)
g) Plastic (0)

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