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APPLIED NUTRITION Definition of terms Applied nutrition: Is the science and art of administering the principles of nutrition so that an individual/family/community receive and utilize food necessary for healthy growth and development, maintenance and building the body Food budgeting: Systematic way of planning of how o purchase food Meal planning: Process of arranging family meals so as to prevent malnutrition and it involves the pattern of eating Diet therapy: The use of food as a factor in the treatment of disease or the control of the type of food eaten so as to promote health for instance use to protein to treat or prevent kwashiorkor Food budgeting: Systematic way of planning how to purchase food Factors which influence food budgeting 

Composition of family, size, health status, sex, age, activities of members

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Income of the family, amount of money available as this tend to influence planning

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Family values and goals, likes and dislikes

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Cost of nutrients, availability of food and food prices

Meal planning Process of arranging family meals systematically in a way so as to meet nutritional needs of the family and prevent malnutrition It entails cooking oneself, questions on what you want you want to buy and if these are convenient to buy within your locality Factors that affect meal planning 

Resources available: Utilizing what is locally available is affordable i.e. what is found at home and market, the mother considers what food she has on store or garden and how much she has for a meal

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Family values: This takes into account which food the family members like most. Different individuals in a family differ in size and preferences

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Family composition: Determine the quantity, type of food as well as time of preparation

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Family goals: Health states of family members should be considered in meal planning. One need to know which food is good for family and which constitute a balanced diet

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Time factor: Take in to consideration type of food/meal for various time of the day, breakfast, lunch, supper

Factors that affect buying and costing of food 

Price: Different foods have different prices which apply to foods in the same class e.g. price of meat is high compared to price of beans

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Food supply: At times there is shortage of nutritional important food for sale and this lead to fluctuation in prices

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Quantity: Cost of food depends on how much you want to buy

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Income: Low income is the most common reason for not buying enough food

Process of meal planning

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Plan which food are eaten in the family and how often the food are eaten

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Plan the different amount of food you have and how to prepare them

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Find out if the family needs to improve their meals by checking if they eat enough food to cover their needs and if they eat variety of nutritious food

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Analyze from your finding which food could be used for preparing meals at various times of the day

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Discuss with family and friends and find out their own views

Preparing and cooking food This usually causes loss of vitamins e.g. vitamin C and folic acid The loss can be minimized by: 

Buy or harvest vegetable on the day of use

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Clean and cut vegetables, fresh starchy roots just before cooking

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Cook vegetables in little water/stew until is just tender

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Cover food with lid while cooking

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Do not keep cooked food for too long before eating

How to save fuel 

Soak legumes

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Cut food into small pieces

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Use fuel efficient stoves

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Put a lid over the pot

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Use dry firewood or charcoal

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Prepare food in an attractive way and maintain hygiene

Diet therapy Principles of diet therapy 

Therapeutic diet should vary from normal diet as little as possible

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Diet should meet daily requirement from essential nutrients as much as it may permit

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Diet should cater for the patients food habits, economic status, religious beliefs or practices or environmental needs provided they are not threatening the condition of the patient

The role of KRCHN in diet therapy 

Advise on EBF up to 6months

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Emphasize on nutritional value of many local and traditionally available foodstuff especially on their mixture so that an adequate balance diet is got

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Identify food values of locally growth food and encourage their production and use

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Advise on proper storage and preservation of local foodstuff

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Calculate the cheapest sources of vitamins, proteins, carbohydrates on local market and advice on their use

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Organize and conduct nutritional education in schools, clinics, community on what is available

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Prepare and demonstrate weaning food recipes made from locally available foods

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Start demonstration shambas at the health center

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Advice on food to be given at a day care center, villages and food requirements

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Try to improve nutrition through ward development committee

Examples in diet therapy Anemia Patient has low Hb, give food rich in iron like liver, spinach Malnutrition Its lack of food in both quality and quantity, give food rich in protein and calorie Liver disorder Give diet low in saturated fats, restrict amount of protein. Ensure food rich in fibre and ensure gut emptying Gout Ensure diet low in purines Advice patient to avoid red meat, coffee Diabetes mellitus Food low in carbohydrates but rich in fibre Avoid refined sugary foods Obese patients Diet low in calorie to reduce weight Prescription of low diet therapy Prescription of nutrition in treatment 006F f a particular disease and it saves some purpose as medical Calory allowance Necessary to keep body warm, provide energy and muscular activity, hence a patient in bed with a minor illness can be maintained on low calorie diet. Very sick patients however need additional energy because of the increased metabolic rate that results for instance to fever Protein allowance Patient hospitalized for more than ten days as well as losing protein from either burns exudates of renal disease should increase their protein intake Modification of diet therapy Adequate normal diet can be modified to become a specific therapeutic diet Any substitution or modification can be made to compensate the dysfunction of the affected body part Modification can occur in any of the following forms 

Changes in the consistency of the food e.g. liquid diet, solid diet etc

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Increase of decrease in value in energy

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Increase or decrease in type of food e.g. sodium restricted diet

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Omitting specific food e.g. that causing allergy

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Adjusting the ratio of food constituents

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Rearrangement of the number and frequency of meals

Food hygiene Preventing food from going bad i.e. decay and contamination at any stage of production

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Areas to be considered include 1.

Food handlers: people who handle food at any stage should be free from infectious disease at any stage. They should go for routine check up, 6 monthly test fr TB, cholera, typhoid

Practice personal hygiene and they should be clean always: they should practice good habits like hand washing and wearing hats 2.

Premises e.g. restaurants, hotels and abattoirs: they should be inspected regularly by public health officer for standards of hygiene

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Foodstuffs sold should be inspected before selling food, unfit food should be destroyed

Get food from reliable source Government policy regarding food hygiene It is a document which contains food act cap 254 It is an act of parliament regarding food that control the purity if food and other substances Food regulation It deals with food premises Licensing and inspection Licensing and inspection of food additives in factories and control of food additives used in chemical industry Licensing of bakeries and dairies Licensing of supermarkets Licensing of food stores Control of hawkers of uncooked food Registration of hawkers Inspection of market stores Ban and control of roadside cooks Organization and control of animal husbandry Control and inspection of imported food Provision of adequate medical facility Control of food advertisement Nutritional education program for all and issuing of certificate Inspection of public laboratory Food habits Is acquired/learned food preferences If refers to why people eat which food, which people they eat with as well as the way food is stored or the way people obtain food or discard food They are developed over many years and they strongly influence our first test as babies and dietary habits formed in early childhood They are reinforced as we grow which make them difficult to change They are can either be bad or good Assignment: list examples of good and bad food habits

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Food habits have a bearing on 1.

Growth and development : food habits not only impact on physical but also intellectual development

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Resistance to infection: malnutrition which can occur as a result of ineffective food habits can predispose to infections like TB,

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Mortality and morbidity: malnutrition lead to high death, high infant mortality rate, high illness rate and lower expectancy Over nutrition is responsible for obesity, diabetes

Factors influencing food habits 

Culture

In every community of people, customs influence the food that would be eaten and those that should not be eaten Certain food area regarded as taboos and assignment of society e.g. based on sex, age etc The taboo may have little or no scientific base but people rigidly adhere to them so that any kind od change is resisted Religious beliefs prohibitions for instance of pork, beef 

Geography

In olden days men would eat whatever was available to satisfy their hunger, food eaten was the type found in there locality hence it became their stable food 

Income

Influences largely the type of food consumed depending on affordability. People from lower class eating food they can easily afford regardless of their nutritive value Where income is substantial, one can choose food from all the groups irrespective of the season 

Social value of food

Family events like birthdays, anniversaries, festivals, weddings. During these occasions food play an important role as good food is served 

Sex/gender

In most communities in the past, men were given preference over women and children regarding the quality and quantity of food served to them In such setting women and children were prone to deficiency states like anemia 

Disease and illness

Certain food types are used during illness so as to control and treat diseases 

Sociological factors

Eat of already made food e.g. canned is rampant in urban area, working parents prefer to eat what is easy to make The media also promote the eating of junk foods 

Age

People take food according to body requirement especially during period of growth and development 

Family size

Big families have difficult time preparing food compared to small family size 

Emotional state of a person

Others use food to reduce tension, stress and anxiety may inhibit one from taking certain food. Other takes food for enjoyment and taste not for their nutritive value

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BREASTFEEDING The Global Strategy for Infant and Young Child Feeding The Global Strategy for Infant and Young Child Feeding was developed by WHO and UNICEF jointly, and launched in 2002, to revitalize world attention to the impact that feeding practices have on the nutritional status, growth, development and health, and thus the very survival of infants and young children. Malnutrition has been responsible, directly or indirectly, for over 50% of the 10.6 million deaths annually among children under five. Well over two-thirds of these deaths, which are often associated with inappropriate feeding practices, occur during the first year of life. The Global Strategy was built on previous initiatives such as the International Code of Marketing of Breast-milk Substitutes in 1981, the Innocenti Declaration in 1990 and the Baby-friendly Hospital Initiative in 1991. The Global Strategy is designed for use by governments and other concerned parties, such as health professional bodies, non-governmental organizations, commercial enterprises and international organizations. The Strategy lists the WHO/UNICEF recommendations for appropriate feeding of infants and young children, explains the obligations and responsibilities of governments and concerned parties, and describes the actions they could take to protect, promote and support mothers to follow recommended feeding practices. Global strategy for infant and young child feeding summary of operational targets All governments are urged to: A. Follow up previous targets from Innocenti Declaration: 1.

Appoint a national breastfeeding coordinator with appropriate authority, and establish a multi-sectoral national breastfeeding committee

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Ensure that every facility providing maternity services fully practises all the ‘Ten steps to successful breastfeeding’ set out in the WHO/UNICEF statement on breastfeeding and maternity services

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Implement the International Code of Marketing of Breast-milk Substitutes and subsequent resolutions

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Enact imaginative legislation protecting the breastfeeding rights of working women and establish means for its enforcement

B. Introduce these five NEW targets: 5.

Develop, implement, monitor and evaluate a comprehensive policy on infant and young child feeding

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Ensure that health and other relevant sectors protect, promote and support exclusive breastfeeding for six months and continued breastfeeding up to two years of age or beyond, while providing women access to the support they require

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Promote timely, adequate, safe and appropriate complementary feeding with continued breastfeeding

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Provide guidance on feeding infants and young children in exceptionally difficult circumstances

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Consider what new legislation or other suitable measures may be required to implement the International Code of Marketing of Breast-milk Substitutes and subsequent resolutions

Breastfeeding for the first six months of life Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants. As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health.

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Exclusive breastfeeding means giving a baby only breast milk, and no other liquids or solids, not even water. Drops or syrups consisting of vitamins, mineral supplements or medicines are permitted. Assignment: list the advantages breast milk List the advantages of breastfeeding Explain differences between breast milk, cow milk and goat milk Nutrients in human and animal milks Formula milks are made from a variety of products, including animal milks, soybean, and vegetable oils. Although they have been adjusted so that they are more like human milk, they are still far from perfect for babies.

This chart compares the nutrients in breast milk with the nutrients in fresh cow's and goat's milk. All the milks contain fat which provides energy, protein for growth and a milk sugar called lactose which also provides energy. The animal milk contains more protein than human milk. It is difficult for a baby's immature kidneys to excrete the extra waste from the protein in animal milks. Human milk also contains essential fatty acids that are needed for a baby's growing brain and eyes, and for healthy blood vessels. These fatty acids are not present in animal milks, but may have been added to formula milk.

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The protein in different milks varies in quality, as well as in quantity. Whilst the quantity of protein in cow’s milk can be modified to make formula, the quality of proteins cannot be changed. This chart shows that much of the protein in cow's milk is casein. Casein forms thick, indigestible curds in a baby’s stomach. Human milk contains more whey proteins. The whey proteins contain anti-infective proteins which help to protect a baby against infection. Artificially fed babies may develop intolerance to protein from animal milk. They may develop diarrhoea, abdominal pain, rashes and other symptoms when they have feeds that contain the different kinds of protein.

Variations in the composition of breast milk Colostrum is the breast milk that women produce in the first few days after delivery. It is thick and yellowish or clear in colour. It contains more protein than mature milk. Mature milk is the breast milk that is produced after a few days. The quantity becomes larger, and the breasts feel full, hard and heavy. Some people call this the breast milk ‘coming in’. Foremilk is the milk that is produced early in a feed. Hindmilk is the milk that is produced later in a feed. Hindmilk looks whiter than foremilk, because it contains more fat. This fat provides much of the energy of a breastfeed. This is an important reason not to take a baby off a breast too quickly. The baby should be allowed to continue until he has had all that he wants. Foremilk looks thinner than hindmilk. It is produced in larger amounts, and it provides plenty of protein, lactose, and other nutrients. Because a baby gets large amounts of foremilk, he gets all the water that he needs from it. Babies do not

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need other drinks of water before they are six months old, even in a hot climate. If they satisfy their thirst on water, they may take less breast milk. Other variations occur depending on maternal health and the food the mother eats Colostrum Properties and their Importance 

Antibody rich - protects against allergy & infection

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Many white cells - protects against infection

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Purgative - clears meconium, helps to prevent jaundice

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Growth factors - helps intestine to mature, prevents allergy, intolerance

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Rich in Vitamin A - reduces severity of infection

Assignment: discuss the control of breast milk production within the breast Positioning of baby Four key points about positioning are: 

Baby’s head and body in line

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Baby held close to mother’s body

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Baby’s whole body supported

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Baby approaches breast, nose to nipple

Attachment to the breast The 4 key points of attachment are: 

More areola above baby’s top lip than below bottom lip

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Baby’s mouth wide open

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Lower lip turned outwards