1

Course : Nutrition
Course code፡ COMH 503
Credit hours: 2

By:Kassahun K. (BSc. MPH, Assistant Professor)

 E-mail:- kasyon33@gmail.com

Addis Ababa, Ethiopia

8/21/2020
 Objective
2

At the end session, students should be able to:

 Define common terms in nutrition

 Discuss history of nutrition

 Understand and explain why nutrition matters

 Explain changes in concepts of nutrition

 Discuss causes of malnutrition

 Explain the basics of metabolism

8/21/2020
3
Common Terms
 Public health nutrition: Deals with the promotion
of good health (the maintenance of well being or
wellness, quality of life) through nutrition and the
primary and secondary prevention of nutrition
related illnesses in the population.
 It has established itself as a major branch of
nutrition which draws on the science of nutrition,
of epidemiology and public health to help deal
at population level with major nutritional issues

3/19/2017
 Continued
4

 Human nutrition “The science of foods, the

nutrients and the substances therein, their
action, interaction and balance in relation to
health and diseases.
 Nutrition science is the area of knowledge

regarding the role of food in the maintenance

of good health. Thus nutrition is the study of
food at work in our body‖
 Staple food: Food which form largest part of
nation’s diet(staple crops-rice, wheat, maize …)
3/19/2017
 Continued
5

 Food is anything solid or liquid that has a chemical

composition which enables its life function.
 Nutrient is ―Fully characterized (physical, chemical,
physiological) constituent of a diet, natural or designed,
that serves as a significant energy yielding substrate, or
a precursor for the synthesis of macromolecules and or
of other components needed for normal cell
differentiation, growth, renewal, repair, defense and/or
maintenance or a required signaling molecule, cofactor
or determinant of normal molecular structure/function
and/or a promoter of cell and organ integrity‖.
3/19/2017
 Continued
6

 Essential(indispensable) : those substances absolutely

necessary for growth, development, and maintenance
and are not made in the body either at all or in
sufficient quantity to meet physiological needs (45).

 Non-essential(dispensable): those substances that are

either synthesized in the body in adequate quantity
or not necessarily essential for growth, development
and maintenance

3/19/2017
 Continued
7

 Macronutrients: are nutrients that are required by

our body in large quantities on a daily basis.
 Micronutrients: are nutrients that are required in
smaller quantities by the body.
 Nutritional status: the nutritional health of a
person as determined by nutritional assessment.
 Nutritional assessment is an interpretation of
anthropometric, biochemical (laboratory), clinical
and dietary survey data.
3/19/2017
 Continued
8

 Diet is a pattern of food consumption which is

followed by a population or an individual.
 Balanced diet: All essential nutrients in right
proportion. Optimal for long time survival and
health.
 Nutritionist: A person who advises about
nutritional and/or works in the field of food and
nutrition
 Malnutrition is the condition that results from an
imbalance between dietary intake and
requirements.
3/19/2017
 Continued
9

 Dietetics: ―The integration and application of

principles derived from several disciplines—
including nutrition, biochemistry, physiology, food
science and composition, management, food service,
and the behavioural and social sciences—to
achieve and optimize human health. Dietetic
professionals translate the scientific evidence
regarding human nutrition and use that information
to help shape the food intake or choices of the
public‖ (American Dietetic Association, 2002)
8/21/2020
 Continued
10

 Metabolism is the sum of all the chemical

transformations taking place in a cell or
organism, occurs through a series of enzyme-
catalyzed reactions that constitute metabolic
pathways.
 It is transformation of the macronutrients in

food to energy and other physiological

processes are parts of the metabolic process.

3/19/2017
 Continued
11

 Roughage: It enables the body to get ride of

waste products, which would other wise
become poisonous to the body.
 It prevents gastro intestinal and metabolic
disorders. Gastrointestinal disorders include the
following:
•Gastritis • Appendicitis •Gallbladder stone •
Constipation

8/21/2020
 Continued
12

 Metabolic disorders include: Diabetes mellitus,

Hypertension, Ischemic heart disease, Colon
cancer
 Diets in clinical practice

 Accurate prescribing of diets containing known

amounts of some of the important nutrients is

essential for the treatment of certain diseases

8/21/2020
 Continued
13

 Diets low in calories for obese patients

 Diets containing known amounts of protein, fats and
carbohydrates of diabetic patients
 Diets rich in protein for convalescents
 Diets with low sodium content for patients with
congestive heart failure are well known example

8/21/2020
 Historical Development of Nutrition
14

 Nutrition evolved from chemistry, physiology,

and medicine
 Hippocrates is a famous for having said "Let thy
food be thy medicine and thy medicine be thy food."
(400BC)
 In 1674, a British physician named Sydenham
showed iron filings in wine can treat anemia
 In 1740s, a British naval surgeon named Dr.
James Lind found consuming limes and lemons
cured scurvy in sailors
8/21/2020
 Continued
15

 Antoine Lavoisier (France, 1743-1794) -

became known as the father of chemistry and
also the father of nutrition.
 He became famous for the statement "Life is a
chemical process".
 He also designed the "Calorimeter", a device
which measured heat produced by the body
from work and consumption from different
amounts and types of foods.
8/21/2020
 Continued
16

 In 1816 a German physician named Magendie

showed that dogs fed only on cabs rapidly lost
body weight and died in a few weeks
 By 1830, it was known foods contain carbs, protein
and fats
 By 1850, six minerals had been identified that
were required for survival- Ca, Na, K, P, Cl, & Fe
 In the 1890s Rubner and Atwater established the
kilocalorie (kcal) as the energy content contained
in proteins, fats, and carbs
8/21/2020
 Continued
17

 1938 - Erhard Ferhnholz discovered the structure of

Vitamin E, which was later synthesized by Paul Karrer.
 1940s- The water soluable B and C Vitamins were
identified.
 In 1943, the Recommended Daily Allowance (RDA)
was published in response to poor diet in many
Americans
 1992 - The Department of Agriculture (USA) set up the
Food Guide Pyramid, which was to be subsequently
criticized by nutritionists throughout the world for
different reasons. 3/19/2017
 Continued
18

 1992 - Integrated Development Foundation (IDF)

was formed.
 2002 - A link between violent behavior and
nutrition was revealed in a Natural Justice study
(USA).
 2005 - Researchers found that the adenovirus is a
cause of obesity, as well as bad nutrition.
 In the last 30 years, the science of nutrition has grown,
and much new research is done every year, revising
what we know about healthy eating.
8/21/2020
 Changing Concepts of Nutrition
19

 The essential nutrients, proteins, fats and

carbohydrates have been recognized in the early
19nth century.
 Specific nutritional disorders were identified such
as protein energy malnutrition, Vitamin A
deficiency, Endemic goiter, Nutritional Anemia, etc.
and
 Measures were found to prevent and control these
disorders.
 The science of nutrition was extended to other
fields like agriculture, animal husbandry, economics
and sociology.
3/19/2017
 Continued
20

 This led to ―green revolution‖ and ―white revolution‖

and increased food production.
 During recent years the science of nutrition has
extended to nutritional epidemiology.
 The old concept of ―the health sector alone is
responsible for all nutritional problems‖
 Is now realized that a broad multi factorial and
integrated approach of sectors is essential to solve
today’s nutritional problems.

3/19/2017
21

8/21/2020
 Classification of Nutrients
22

 Water
 Proteins
 Fats
 Minerals
 Nucleic acids
 Carbohydrates

8/21/2020
23

8/21/2020
 Classification of Foods
24

 Based on origin: plants and animal

 Based on chemicals: Carbohydrates ,Proteins ,Fats
,Vitamins ,Minerals
 Based on pre- dominant functions :
o Energy supplying food: cereals, sugars, roots, tubers,
fats and oils.
o Body building foods: milk, meat, poultry, eggs, fish,
pulses and groundnuts.
o Repairing and maintenance foods: Vegetables, fruits,
milk.
8/21/2020
25

8/21/2020
 Function of Food
26

8/21/2020
 Balance Between Intake and Required
27

8/21/2020
 Who has more water, fat M or F?
28

8/21/2020
 The first four of the five levels of human body
composition
29

(From Bistrian BR, Blackburn GL, Vitale J et al. JAMA 1976;235:1567–70, with permission.)
8/21/2020
 continued
30

 Approximately 50 (11 major) elements in the body

are organized into:
 100,000 chemical compounds,
 About 200 cell types and 4 main tissues.
 The—oxygen, carbon, hydrogen, and nitrogen—
make up greater than 96% of body mass.
 The major elements are linked to higher level
components.
 Other important elements are calcium, potassium,
phosphorous, sulfur, sodium, chlorine, 8/21/2020
and magnesium.
 Why Nutrition Matters ?
31

 It is known that nutrition cuts across many

development sectors
• The role of nutrition in development goes far
beyond providing an indicator of progress towards
the SDGs.
• Good nutrition is an essential building block for
development and it supports efforts to generate
new resources and technologies and to imagine,
create, and nurture new institutions and
partnerships to improve global welfare.
3/19/2017
32

3/19/2017
 What are SDGs?
33

3/19/2017
 Nutrition and Health
34

–It is known that undernutrition affects both the body’s

immunological and non-immunological defense.
– Good nutrition is critical to preventing not only diseases
of deprivation, but also chronic diseases that afflict
affluent and non-affluent populations
– Nutrition as a promoter of good health:
• Modest increase BF rates alone has the potential to
prevent up to 10% of deaths among children under five.
• Improving the vitamin A status of vulnerable populations
can reduce < 5 mortality rates by at least 23 percent
• Iron interventions can also be expected to reduce
maternal mortality considerably (PAR= 20%)
3/19/2017
 Continued
35

 Prevention of IUGR decreases later onset of chronic

degenerative diseases ( syndrome X).
– Incorporating nutrition interventions into health
sector programs
• Programs that address malnutrition offer not only
direct benefits for the well-being of participants,
but also benefits for future generations and
remarkable synergies with other types of
interventions.
 e.g. The integration of high-dose vitamin A
supplementation with National Immunization
Days(NIDs)
3/19/2017
 Malnutrition and Infection
36

 The interaction or synergism of malnutrition and

infection is the leading cause of morbidity and
mortality in children in most countries in Africa,
Asia and Latin America
 The simultaneous presence of both malnutrition

and infection results in an interaction that has

more serious consequences for the host than the
additive effect would be if the two worked
independently
8/21/2020
 Why Nutrition is Important in Ethiopia ?
37

 There is recurrent food insecurity at the national and

household level
 There is high rate of macro and micronutrient
deficiency
 There is intergenerational link of the undernutrition
 The impact of such high rate of undernutrition was
estimated to be huge in terms of:
 Increased susceptibility to infection (diseases)
 Poor physical and mental capacity
 High cost for care of those affected by malnutrition
3/19/2017
 Underdevelopment of the country
38

•Mortality
• Illness
• Intelligence loss
• Reduced productivity 3/19/2017
 Causes of Death among Ethiopian Children 0-5
Years Old
39

Other 2%
Measles 4%
AIDS 1%
Neonatal 25%
Diarrhea 20%

Malnutrition
53%

Malaria 20%
Pneumonia
28% 3/19/2017
40

The Ugly Face of

“Hidden Hunger”

Folic Acid Deficiency

Iron Deficiency

Vitamin A Deficiency Iodine Deficiency Zinc Deficiency

3/19/2017
41

8/21/2020
 Continued
42

 Protein-energy malnutrition (PEM), vitamin A

deficiency, iodine deficiency disorders (IDD) and
nutritional anaemias are the most common serious
nutritional problems in almost all countries of Asia,
Africa, Latin America and the Near East.
 In addition, diet-related non-communicable diseases
such as obesity, cardiovascular disease, stroke,
diabetes and some forms of cancer exist or are
emerging as public health problems in many
developing countries.
8/21/2020
 Important cause of malnutrition in Ethiopia
43

 Lack of knowledge in selecting foodstuff with high

nutritive value
 Poverty and infectious diseases
 Drought
 Insufficient supply of the necessary food
 Uneven distribution of the available foods
 War, Poor sanitation/hygiene, Transport, problems ,
Increased populations, Inadequate weaning

8/21/2020
44

 Poor management
 Topographical differences in different regions
(variation in productivity)
 Social problems
 Loss off food through destruction by insects
 Exploited land due to planting the same type of
food crop for many years, erosion because of over
grazing and moreover the farmers could not use the
fertilizer due to many reasons.
8/21/2020
 Hormones
Hormones
45

Anab
olism

Anabolism
Anaboli
sm

What no energy
needed?
46
47

3/19/2017
 48

3/19/2017