FOOD AND NUTRITION

Dr. K.L.M.D. Seneviwickrama

MBBS, MSc, MD
Consultant Community Physician
Nutrition Coordination Division
Ministry of Health

What is NUTRITION?

A PROCESS OF
INGESTION

DIGESTION

of food

ABSORPTION

UTILIZATION

of nutrients

Importance of Nutrition
Adequate nutrition, which is best
achieved through consumption of a
balanced diet, is vital for health &
survival for individual

Effects of Malnutrition on Life Cycle

Child
growth
failure

Low weight &

height in
adolescence

Low birth
weight babies

Small adult
women

What are the Causes of

Malnutrition?

Multifactorial

Refer UNICEF frame work on Malnutrition

Functional Consequences:

mortality, morbidity, educability,

and productivity

Nutritional Status

Diet

Household
Food Security

Health

Care of Mother
and Child

Environ. Health,
Hygiene & Sanitation

Immediate
Causes

Underlying
Causes

Human, Economic, and

Institutional Resources
Political and Ideological Structure
Ecological Conditions
Potential Resources

Basic
Causes

Multi sectoral Approach

Nutrition Needs Identification

INTERVENTIONS

Importance of Nutrition
Poor nutrition during the first 1,000 days (from
pregnancy through a childs second birthday)
can cause
life-long and irreversible damage

with consequences at the

individual, community, and national level!

Why investing in nutrition?

Poorly nourished children are more likely to
complete fewer years of school
have lower productivity as adults
10% lower earnings over their lifetime
Hunt, J. M.(2005); Horton, S. (1999)

Why investing in nutrition?

poor nutrition can reduce a nations economic
advancement by at least 8%
due to direct productivity losses, and
losses due to reduced schooling and poorer
cognition
Horton, S., & Steckel, R. H., (2013)

Role of balanced nutrition for

healthy life
HEALTHY LIFE

Nutrients Balanced and Adequate

Nutrients in diet

Nutrients Imbalanced and Inadequate

Diseases

What is Malnutrition?
Improper nutrition

Over-nutrition
Under-nutrition (nutritional deficiencies
Macronutritents
Micronutritents (hidden hunger)

Is Nutrition a problem in Sri Lanka?

Triple Burden of Malnutrition

Major problems among children less

than five years

LBW rate static

Static Protein Energy
Malnutrition status
Iron deficiency anemia
Vitamin A deficiency

Gross district disparities

Major Nutrition Problems Among

pregnant/Lactating Mothers
Protein Energy Malnutrition

Anaemia

Nutritional Problems among Adults

31.5%

26.2%

14%

16.2%

What is FOOD?
Something to satisfy our hunger & appetite?
More than that!
Fuel for our body
Contains nutrients that has a specific
purpose and meets specific needs of our
body

Main Nutrients
Six main nutrients in Food
Carbohydrates
Protein

Fat
Vitamins
Minerals
Water

Types of Nutrients
Macronutrients
Carbohydrates

Proteins
Fats

Micronutrients
Vitamins
Minerals

- A,B,C,D,E,K

- Fe, Zn, Ca, P, Mg, I, etc

Functions of Food
Energy giving

Carbohydrates & Fats

Body building

Proteins

Body protective
Vitamins & Minerals

Vegetables and fruits

Provide vitamin and

minerals (iron, calcium)
Antioxidants
(Vit A,C,E)

Dietary fibers

Protect body
from diseases
Prevent diseases
(stroke, cancer, arthritis, hypertension)

Prevent constipation/
bowel cancers
Reduce absorption of
cholesterol
Reduce dietary intake
(increase satiety)

Protein

Animal sources High quality protein

(Fish, meat, eggs, dried fish)
Plant sources- pulses & legumes
(soya beans, dhal, chick pea, cowpea, green
gram)

bean or winged bean (dambala)

pods are Not a good source of prote

Protein

Growth & maintenance of the body

Provide energy
As hormones, enzymes
Transportation (Hb) and storage (Ferritin) of
molecules
Antibodies- prevent infections

Main Food Groups

Cereals & yams
Vegetables, Fruits & greens

Milk & milk products

Fish, pulses, meat and poultry
Nuts and oil seeds

Main food groups

Food group

Food

Grains(cereals) & Rice, wheat, kurakkan, maize, rice & wheat flour preparations
tubers (yams)
(bread, string hoppers)
Tubers manioc, potatoes, sweet potatoes, Jak, breadfruit
Fruits

Plantains, mango, papaya, pineapple, oranges, guava, avocado

Vegetables

Leafy vegetables- kankun, spinach, gotukola, mukunuwenna

Root & fruit vegetables- gourds, brinjals, ash plantains, ladies
fingers, tomato, carrot, beet

Fish, pulses,
meat & eggs

Fish- fresh water fish, sea fish, sprats, dried fish

Pulses- chick pea, green gram, cowpea, soy bean, dhal,ulundu
Meats- chicken, beef, pork, mutton
Eggs- hens, duck

Milk and milk

products

Milk, curd, yoghurt, cheese

Nuts & oil seeds

Coconut, peanut, cashew, gingelly and palm oil

Main Food Groups

Cereals & yams

Vegetables, Fruits & greens

Fish, pulses, meat

and poultry
Nuts and oil
seeds

Milk & milk

products

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Why Do We Need to
Eat Healthy ?
To enjoy good health
To prevent diet related chronic
diseases (NCDs)

Emerging Diet related Diseases

Non Communicable Diseases (NCD)

Obesity

Hypertension

Ischemic Heart Diseases

Diabetes

Cancers

Non-communicable Diseases (NCD)

What is a healthy diet?

A diet that include a variety of food from each

of the main food groups in recommended
proportions

Basic principles of healthy diet

Eat at least two varieties of vegetables, one

variety of green leave and two varieties of
fruits (400 g/five portions) per day

Basic principles of healthy diet

Eat variety of full grains and starchy foods

Basic principles of healthy diet

Minimize sugar consumption as

much as possible.
Limit to less than six teaspoons
(including hidden sugar) per day

Basic principles of healthy diet

Limit salt intake to one teaspoon (5 g) per day

per person

Basic principles of healthy diet

Consume moderate amount of fat (less than

30% of total energy)
Consume more unsaturated fat (fish, avocado, nuts,
canola & olive oil). than saturated fat(meat, butter,
coconut & palm oil, cake, biscuits,)

Saturated fat

Mono unsaturated

Poly unsaturated (omega 3 & 6)

Sunflower seeds, oil

Soybean oil

Basic principles of healthy diet

Avoid trans fat containing foods (processed food,

fast foods, fried food, pies, margarine, spreads and
some bakery items)

Basic principles of healthy diet

Consume milk (fresh milk) and milk products

(curd, yoghurt) once or twice daily

Basic principles of healthy diet

Take healthy snacks in between meals (fruits,

yoghurt, curd, home made cereal based products,
boiled tempered grams, boiled cob of corn, helapa)

What is a healthy plate?

National Nutrition Month 2016

Recommendations:

Half of the plate (1/2)

Food containing carbohydrate (Rice, Bread, Rice/

Wheat flour products, Yam" Jack" Breadfruit,
Etc&
Remaining Half (1/2)

2$3 Vegetables
1$3 Animal & Plant Proteins (Fish,
Meat, Eggs, Pulses, etc)

National Nutrition Month 2016

Healthy Food Plate

Importance of healthy plate

Intake of carbohydrate and fat (energy) is more
than the need

Excess deposit as fat

Obesity/ Overweight

Increase risk of Non communicable diseases

(diabetes, hypertension, IHD, stroke)

Intake of carbohydrate and fat (energy) is less

than the need

Muscle wasting
Wasting/ underweight/low BMI

Dietary Intake = Need of person

How Much Should We Eat from

Each of These Food Groups?
Refer Food Pyramid

Food Pyramid

Recommended Number of Servings/day

What are serving sizes?

Rice, bread, other cereals and yams:
1 cup of cooked rice
1 slice of bread (450g bread into 9 slices)
Fruits:
1 medium banana, orange
3/4 cup of fruit juice
Vegetables:
3 tablespoons of cooked fruit vegetables
1/2 cup of cooked leafy vegetables

What are serving sizes?

Milk or milk:
200ml of milk
1 cup of yoghurt or fermented milk (curd)
2 tablespoons of milk powder

Fish, pulses, meat and eggs:

25-50g of cooked fish, chicken, lean meat
3 tablespoons of cooked dhal
1 hens egg 1/2 duck egg

What are serving sizes?

What are serving sizes?

Serving Size

RDA chart

(MRI 2007)

How to Identify Healthy Food?

Nutrition Information Panel
Health Star Rating (HSR) system

Ingredients List
Nutrition content claims
Health claims

Percentage Daily Intake

How to Identify Healthy Food?

Traffic light

Vegetarian diet
For Adults, Vegetarian diets are healthy and
nutritionally sound if they are carefully
planned !
Common Nutritional deficiencies

Protein
iron

vitamin B12
calcium & zinc

Vegetarian diet
Can be overcome by including a wide variety of
foods into daily diet

Plenty of cereals, pulses, seeds and nuts

Fruits, vegetables and dark green leaves

Milk & milk products and eggs - growth and

maintenance of body, healthy bones and teeth

Strict Vegetarian diet- Vegans

High risk of Nutritional deficiencies!
Needs vitamin supplementations

Ex: vit B12

Fast food
Feel fun
& thrill
But
it is a trap
It will kill you

Hamburger

Quarterpound Cheeseburger, Large Fries, 16 oz. soda

This meal
Recommended daily intake

1,166 calories
2,000-2,700 calories

51 g fat
No more than 50-80 g

95 mg cholesterol No more than 300 mg

1,450 mg sodium
No more than 1,100-3,300 mg

Pizza
4 slices Sausage and
Pizza,

Mushroom
16 oz. soda

This meal
Recommended daily intake

1,000 calories
2,000-2,700 calories

28 g fat
No more than 50-80 g

62 mg cholesterol No more than 300 mg

2,302 mg sodium
No more than 1,100-3,300 mg

Fried Chicken
2 pieces Fried Chicken (Breast and Wing),
Buttermilk Biscuit, Mashed Potatoes and Gravy,
Corn-on-the-Cob, 16 oz. soda
This meal
Recommended daily intake

1,232 calories
2,000-2,700 calories

57 g fat
No more than 50-80 g

157 mg cholesterol No more than 300 mg

2,276 mg sodium
No more than 1,100-3,300 mg

Concern if you eat frequently

Too much fat:
Contributes to high blood cholesterol levels
Too much fat

High blood cholesterol

Risk for breast

& colon cancers
Hardening of the arteries
coronary heart disease
& stroke

Concern if you eat frequently

Too much cholesterol & saturated fat:
Recommendation

Too much cholesterol

High blood cholesterol

Risk for heart diseases

no more than 300 mg per day

(American Heart Association)

Concern if you eat frequently

Too much trans fat:

Increase bad cholesterol (LDL) & lowers good cholesterol

(HDL)
It is carcinogenic

5g per day

Increase heart disease risk by 25%

Per gram risk, it is more harmful than any other kind of fat

Large fries-and-chicken-nuggets combo : 10.2 g of trans fat

Large hot wings-and-fries order : 19 g of trans fats or more

Concern if you eat frequently

Too many calories:
Extra calories
3500 calories = one pound
Increase weight

Obesity

Heart attack, high blood

Pressure, diabetes & death

Concern if you eat frequently

Too much sodium:
Recommendation

2,400 mg of sodium per day

Approximately 1/2 - 1 1/2 teaspoons of salt

We consume at least twice than that

High sodium

High blood pressure

Thirst
Shortness of breath
Water retention

Concern if you eat frequently

Too much sodium:
Fast foods are loaded with sodium
Serving size is very important...
Recommendation : 2,400 mg of sodium per day
One teaspoon : >2300 mg of sodium

Food Item

serving size

Sodium (mg)

Chicken hot dog

755

Lean ham

3 ounces

1,025

For healthy life

Do stress relief
activity
music..
exercise..
Meditation..
Stop smoking
Stay away from alcohol

For healthy life

Drink plenty of water

Double burden of Malnutrition

Change of dietary pattern ?

(high energy, fat, free sugar, salt)

Increase production & availability of processed

foods
Rapid urbanization
Changing life style
Marketing strategies

Factors influence the dietary pattern

of people

Availability
Affordability
Individual preferences
Cultural context
Socio-economic factors
Environmental factors

Calories and weight loss.

kg (1 lb) of body fat = 3,500 calories
To lose kg a week

Eat 500 calories less each day

Or add enough exercise to burn an extra 500
calories each day
Or combine them both, by walking 30-45
minutes each day (burning approximately 250
calories) and eating 250 calories less each day

For Weight loss.

Realistic healthy targets

500g/wk

Do Not skip meals/ fast

Reduce energy intake gradually

Sugar, carbs, oil/fat

Replace starchy/oily foods in meals with nonstarchy veggies & fruits

Take Healthy snacks

For Weight loss.

Grains (rice)

Non-starchy
Vegetables

Protein Food

Calories do add up.

Just an extra 100 calories per day

= 5 kg weight gain in a year!

OR

Eating 100 calories less per day

= 5 Kg weight loss in a year

100 calories is equal to:

20 minute brisk walk
10 minute run at 5mph
(8kmph)
15 minutes of swimming
15 minutes of cycling at
10mph (16kmph)

240ml of carbonated
drink
2 chocolate biscuits

1 large Chinese roll

piece of icing cake

35g French fries

4 pieces of Chocolates
115ml Cola drink

Liquid Calories
Lite
Beer
360ml

Alcohol
45ml

Wine
180ml

Beer
360ml

100
calories

110
calories

124
calories

150
calories

Hamburgers

Regular
340
calories
30 g fat

80%
lean
270
calories
21 g fat

85%
lean
230
calories
16 g fat

92%
lean
145
calories
8 g fat

Parties
Did you know
2 Tbsp icing=150 calories

Tbsp=tablespoon

The Consequences of
Snacking
Watch what you and your children eat
before or after the main meal
For example, look at what was consumed:
Regular cola /
carbonated drink

150 calories

0 g fat

1 pastry

180 calories

14 g fat

Handful of chips
(30g)

155 calories

10 g fat

Biscuits 1 small
pack

140 calories

4.5 g fat

Sweetened milk

150 calories

0 g fat

TOTAL 775
calories

28.5 g
fat

Can you burn it off?

How long would you have to walk briskly to burn
about 550 calories*?

1 hour and 40 minutes

450 calories

Physical Activities

For Adults

At least 30 min of Moderate intensity Aerobic PA

per day - 5 days/ week
Walking, cycling, jogging

For Children

1 hour daily

Activity pyramid

Sedentary life style

Watching TV
Computer
games

Video games

Tuition

How to assess your nutritional

status
Anthropometric measures

Weight
Height,
Body Mass index (BMI)
Waist circumference,
Waist to hip ratio (WHR),

Bio chemical measures

Haemoglobin,
Vitamin levels
Serum protein,
urine iodine,
serum ferritine

Body Mass Index (BMI)

BMI charts 5-18yrs

Adults
Weight (kg)
Body Mass Index (BMI)=
Height2 (m2)

Healthy Food Plate

Waist circumference

An approximate index of intra abdominal fat

mass and total body fat

Waist circumference
> 90cm (36) male
> 80 cm (32) female

Increase risk of Non communicable diseases

Waist to hip ratio (WHR)

Waist to hip ratio (WHR)
>0.85 for females
> 0.9 for males

Abdominal obesity
Increase risk of Non communicable diseases

What is your body shape?

(Upper Body Obesity /

Android Obesity)
Health risks +++

Lower Body Obesity /

Gynoid Obesity)
Health risks +

96

Complications of over nutrition

Increase risk of Non communicable diseases

(Diabetes, hypertension, stroke, cancer )
Loss of body shape
Increase risk of joint problems
Psychological distress

Thank You!

26.07.16

Shape Your Meal to Shape Your Body

98