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Course Description:
This human nutrition course is designed to prepare Bachelor of pharmacy students in order to be competent in nutrition related to health and disease. The
course is designed to introduce students to normal nutrition, diet therapy, infant & child and maternal nutrition. It helps the students to identify different
nutrients and to be competent in assessing and managing nutrition and nutrition related problems in the community and for women, children . It also
helps students to recognize public importance of ensuring food safety and quality.
Course Objectives:
After completion of this course, the student will be able to recognize essential nutrients for life function, develop skill on nutritional assessment
methods, recognize nutritional intervention methods and also able to apply them in promotion of health and in the care of the sick in an effective and
integrated manner.

At the end of this course, the students will be able to:

 Explain the historical development of nutrition
 Describe the characteristics and types, physiological functions, and food sources of essential nutrients
 Explain recommended intakes and the adverse effects of both inadequate and excessive intake of nutrients
 Describe the epidemiology, population at risk, classification, clinical feature and management of malnutrition
 Analyze and develop skill on the major nutritional assessment methods
 Discuss infant and young child feeding options
 Describe the public health importance nutritional deficiency states in Ethiopia
 Integrate maternal nutrition with other programs band services
 Describe the management algorithm for HIV patients with malnutrition
 Describe the importance and application of nutritional surveillances
 Prevent micronutrient deficiencies through active participation in micronutrient supplementation programs and control of common infections
such as malaria and helmenthiasis
 Control micronutrient deficiencies through proper therapeutic supplementation with micronutrients
 Discuss the public health importance of ensuring food safety and quality in terms of protection from microbiological hazards, pesticide
residues, misuse of food additive, chemical contaminants, biological toxins (national toxins in foods), and adulteration

Mode of delivery:
Illustrated and interactive lectures
Group discussion
Case study
Brain storming
Individual and group exercises
Seminar/ presentation
Mode of Assessment:
Quizze?
Atendance_______________________________10%
Group assignment_________________________30%
Final examination_________________________60%
 Objective written exam 40
 Short answer 20
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Day 1&2-beyene  Introduction to nutrition .Historical development of nutrition

March 31- April 1/2022  Terminologies
 Growth and development

Day3&4 Abonesh  Ma.N (Carbohydrates, Proteins, Lipids)

April 4-6/ 2022  Mi.N (Vitamins, Minerals Functions, Types, Food Sources, Digestion, Absorption, metabolism, RDA
Nutritional deficiency states
 Micronutrient deficiencies
 Chronic energy deficiency
 Consequences of malnutrition
 Major factors contribute to malnutrition.
 Nutrition requirement:
 Methods of calculating normal food requirements
 Influence of age sex and occupation
Day 5-7 Nutritional assessment:
Beyene  Anthropometry
April 7-8/2022  Biochemical method
 Clinical method
 Dietary survey method
 Prevention and control

Day 8-9 Nutritional deficiency states

Beyene  Diet as therapeutic agent
April 11-12/2022  Diet and the patient
 • Hospital diets
Day 10-13 Nutritional interventions for major nutritional problems in Ethiopia
Abonesh  Methods, mechanisms and criteria,
April 13-14/2022  Essential Nutrition Actions(ENA)
 Teaching Good nutrition
 Nutritional care and support for PLHIV
Day 14- 15 The quality and safety of nutrition related products
Beyene
April 15-17
References:
1. Dudek S.G., Nutrition hand book for nursing practice, third ed Lippincott, Newyork, 1997
2. FMOH: Protocol for management of sever acute malnutrition(SAM) in Ethiopia, 2007
3. Human energy requirements Report of a Joint FAO/WHO/UNU Expert Consultation Rome,October 2001
4. Management of severe Malnutrition: A manual for physicians and other senior health Workers
WHO,Geneva,1999
5. FMOH: National guidelines for HIV/AIDS and Nutrition,2008
6. Nutrition and HIV/AIDS A Training Manual For Nurses and Midwives, updated on 2010
7. National nutrition guideline ,Ethiopia
8. ENA counselor guide, FMOH, revised January 2005
9. National guideline for control and prevention of micronutrient deficiency ,FMOH, June 2004
10. Gibson, principles of nutritional assessment ,oxford,1990
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History of Nutrition science

Nutrition as a science was found by Lavoisier (France, 1743-1794) (the father of chemistry and
also the father of nutrition) towards the end of 18nth century. 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.

Changing concepts of nutrition

• 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, Nutritional blindness 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. This led to “green revolution”= (crop production) and “white
revolution”= (milk production) there by to increase food production and elevate poverty

• 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.

 In pre-agricultural era, entire mankind consumed meat as early man was a hunter. Possibly he
ate from plants sources which grew in the wilderness.

• With the advent of agriculture as an outcome of civilization, man acquired the ability to
cultivate what he wanted, as by now he was influenced to some extent by the selection of the
food that he wanted to eat.

 400 B.C: Hippocrates “Let thy food be thy medicine and thy medicine be thy food."
Foods were often used as cosmetics in the treatment of wounds
 1500’s: Scientist and artist Leonardo Da Vinci compared the process of metabolism of the
body to the burning of a candle.

• Modern nutrition science is young: It is less than one century since the first vitamin was
isolated in 1926

• The first half of the 20th century focused on the discovery, isolation, and synthesis of essential
micronutrients and their role in deficiency diseases
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• This created strong precedent for reductionist, nutrient focused approaches for dietary research,
guidelines, and policy to address malnutrition

• This reductionist approach was extended to address the rise in diet related non-communicable
diseases— eg, focusing on total fat, saturated fat, or sugar rather than overall diet quality

• Recent advances in nutrition science have shown that foods and diet patterns, rather than
nutrient focused metrics, explain many effects of diet on non-communicable disease

• Lower income countries are recognizing a growing “double burden” (combined undernutrition
and overnutrition)

• Nutrition policy should prioritize food based dietary targets, public communication of trusted
science, and integrated policy, investment, and cultural strategies to create systems level change
across multiple organizations and environments

Pharmacology and nutrition science

Food and nutrition play an intimate role in all aspects of drug metabolism, safety, and effectiveness.

The processes of nutrition consist of ingestion, digestion, absorption, metabolism, use, and excretion. All
these processes are integral to how the body takes in and uses therapeutics/drugs

Our body response, to either therapeutic or toxic, or any foreign substance is subject to numerous factors
that include stage of development, genetics, general health, and nutritional status.

Within the context of pharmacokinetics and pharmacodynamics several pathways exist by which
nutrition could affect drugs and vice versa

Drug-nutrient interactions

Mechanism Description

Ingestion Both drugs and disease can cause changes in appetite (dysphagia/anorexia/testlessness) and nutrient intake; so
malnutrition can affect drug efficacy.

Absorption Drugs and foods can have a mechanical effect, via binding or adsorption, that can increase or decrease drug and
nutrient absorption. Some drugs can increase or decrease gastrointestinal motility, which may result in
increased or decreased nutrient absorption. Chemical factors, in particular the pH of the stomach contents and the
influence of foods therein, can affect the subsequent absorption of drugs.

Nutritional status, infection, and inflammation can cause homeostatic responses, which lead to increased or
decreased nutrient absorption.

Gastrointestinal The ability of drugs and nutrients to be transported can depend on factors such as lipid solubility and competition
transport for amino acid transport systems.
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Mechanism Description

Metabolism MFO (Mixed-function oxidase) and conjugase systems that convert drugs and nutrients into their active and
excretory forms are nutrient/cofactor dependent. Certain drugs can increase the activity of the MFO systems
required to convert nutrient precursors into their active forms. Nonnutritive components in foods/supplements can
induce MFO activity and thereby affect drug metabolism.

Distribution The use of both drugs and nutrients depends on body composition, the availability and functional integrity of
transport proteins, receptor integrity, and intracellular metabolic machinery, all of which are sensitive to nutritional
status and the impact of disease (inflammation and infection via the acute-phase response).

Elimination Drugs and nutrients can synergistically and competitively interact to cause increased or decreased excretion.
Systemic factors such as pH and physiologic state (eg, sweating) can dictate whether a drug or nutrient is excreted
or resorbed.

Direct Action The effectiveness of some drugs is directly related to their impact on nutrient metabolism (eg, antimalarial antifolate
drugs, isoniazid, and vitamin B-6)

Pharmacology and nutrition

Nutraceutical:The term 'nutraceutical' was coined from 'nutrition' and 'pharmaceutical' in 1989 by
DeFelice and was originally defined as a food (or part of the food) that provides medical or
health benefits, including the prevention and/or treatment of a disease

They are food or part of food playing a significant role in modifying and maintaining normal
physiological function that maintains healthy human beings. They are categorized as

1. Dietary Fiber: non-digestible carbohydrates and lignin that is intrinsic and intact in plants.

2. Probiotics: Lactobacillus, Bifidobacterium

3. Prebiotics: non-digestible, fiber compounds that pass undigested through the upper part of the
gastrointestinal tract and stimulate the growth or activity of advantageous bacteria that colonize
the large bowel by acting as substrate for them

4. Polyunsaturated fatty acids:omega-3(α-linolenic acid) and omega-6 (linoleic acid)

5. Antioxidant: first line of defense against free radical damage to our cells.

Nutrient-derived- ascorbic acid (vitamin C), tocopherols and tocotrienols (vitamin E),
carotenoids, glutathione and lipoic acid.

Antioxidant enzymes- superoxide dismutase, glutathione peroxidase, and glutathione reductase

Metal binding proteins- ferritin, lactoferrin, albumin, and ceruloplasmin

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6. Polyphenols : micronutrients that naturally occur in plants.

7. Spices

8. different types of herbal natural foods.

These nutraceuticals used in various diseases such as obesity, cardiovascular diseases, cancer,
osteoporosis, arthritis, diabetes, cholesterol etc.

Nutraceutical‟ has led to the new era of medicine and health, in which the food industry has
become a research oriented sector.

 Some Antibiotics + Dairy >>>Cipro. Amoxa.Tetra

 Calcium Channel Blockers and Statins + Grapefruit>>> inhibits a common drug-metabolizing enzyme
called CYP3A4 .The drug can be accumulated in the body>dangerous
 MAOIs + High-tyramine foods (Aged Cheeses, wine…)>>>hypertensive crisis
 Hypothyroid Drugs + with Food>>>Food can block absorption of the drug in small intestine,
 Antidepressants + Alcohol>>>stomach or gastrointestinal bleeding,
 Warfarin + V-K rich food (broccoli,Kale) ,green leafy vegetables >>>vitamin K negates what warfarin
is trying to do
 Metronidazole + Alcohol>>>severe vomiting
 Insulin, Oral Diabetic Agents + Alcohol>>>alcoholic can increase or prolong the effects of insulin or
oral diabetic agents (pills) and thus lead to hypoglycemia
 Antihistamine, NSAIDS,Corticosteroids, Narcotic Analgesic ,Bronchodilators>>>take with food
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Introduction to nutrition

Humanity has existed as a genus for about 2 million years with exponential growth

Until 1850 population grow to one billion persons. In 1930 increased to two billion. By 1960
risen to 3 billion and in 1976 there were four billion people. In1986 >5 billion. This population
growth becomes a Potential problem for food supplies and other essential resources?

Natural selection has provided us with nutritional adaptability. Sufficient quantity of food is
produced to feed the world population. Genetic improvements in the grains planted, fertilizers,
pesticides, and energy subsidies that drive the farm machinery created a situation of abundance
but the poor distribution of food products is the problem, not because of any absolute shortage of
food. The distribution problems are not caused by technical problems in transportation but rather
by economic and political systems, disparity between our technological and social evolutions.

Primitive cultures who survive to the age of 60 years or more remain relatively free from health
disorders, unlike their civilized counterparts.

Food Quality/adequacy, Quantity/Density and safety for the several stages of the life cycle and
for special conditions of pregnancy and various diseases and optimal health are intimately
interdependent.

Modern Dietary habits over the past 100 years make an important etiologic contribution to
coronary heart disease, hypertension, diabetes, and some types of cancer.

The word nutrition first appeared in 1551 and comes from the Latin word nutrire, meaning “to
nourish.” Today, we define nutrition as the sum of all processes involved in how organisms
obtain nutrients, metabolize them, and use them to support all of life’s processes. Nutritional
science is the investigation of how an organism is nourished, and how nourishment affects
personal health, population health, and planetary health. Nutritional science covers a wide
spectrum of disciplines. As a result, nutritional scientists can specialize in particular aspects of
nutrition such as biology, physiology, immunology,biochemistry, education, psychology,
sustainability, and sociology.

Health is defined as “a state of complete physical, mental, and social well-being and not merely
the absence of disease or sickness. “WorldHealth Organization.“WHO definition of health.”

Disease is defined as any abnormal condition that affects the health of an organism, and is
characterized by specific signs and symptoms.

Diet-related conditions and diseases include obesity, Type 2 diabetes, cardiovascular disease,
some cancers, and osteoporosis. Good nutrition provides a mechanism to promote health and
prevent disease.
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Human Growth and development

Human development is a multifaceted process and involves different stages and aspects

One aspect involves biological and physical development. The size and complexity of the human
body change dramatically between conception and maturity.

Second aspect involves cognitive or intellectual abilities and processes. What children know,
learn and can remember changes greatly as they grow with the time.

A third aspect involves social behavior and relationships. A newborn has limited ability to
participate in social interactions but before reaching adulthood the child forms many
relationships and knows how to behave appropriately in a variety of social situations.

All the different facets of development are interrelated. Life-course nutrition approach that
captures both the cumulative risk and the many opportunities to intervene

Growth refers to quantitative changes (physical) - increase in structure and size; measured with
some degree of reliability in terms of weight, hight,bone age , etc.

Development refers to both qualitative changes of progressive series of orderly, coherent

changes

The period of human growth and development

Pregnancy- Prenatal Development (IU)

 Embryonic stage: day 15 to the 8th week

 1st trimester: conception to 13th week

 2nd trimester: 14th to 27th week

 3rd trimester: 28th to 40th week

 A full term pregnancy lasts 38 – 42 weeks:

 Fetus After the 3rd month

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 After Birth

G&D Stages with *Erikson (1902–1994) was a stage theorist who took Freud’s
Erikson’s psychosocial controversial psychosexual theory and modified it into an eight-stage psychosocial theory of
stages development.

• Infancy: From birth to weaning (up to 2yrs) ===== Trust vs.. Mistrust
• Childhood: weaning ->end of brain growth (2-8yr)
Toddler: 2-4 yrs.) ======Autonomy vs. Shame & Doubt
Preschools: (4-5 yrs.)===== Initiative vs. Guilt
School age/ Juvenile: end of childhood >adolescence. (8-12)====Industry vs. Inferiority
• Adolescence: puberty until sexual maturity (12-18) ===== Ego Identity vs. Role Confusion
• Adulthood (18-45) ====== Generativity vs. stagnation
• Elderly :> 45 =====Integrity vs. Despair
Some research evidences About nutrition importance
Early life nutrition disparities are likely to explain, at least in part, higher risks for
maternal disease (e.g., gestational diabetes) and childhood obesity
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The sterile period (in the human life cycle) is during the gestation, remains tolerant to maternal
antigens.

Gut microbial diversity declines with age and its function in metabolism and regulation of the
immune system is reduced. This provides a chance for opportunistic pathogens to invade and
inflame the gut giving rise to various diseases ranging from low-grade chronic ill health to those
causing hospitalization and even death.

Antibiotics use and diet play a major role in the gut microbial colonization during breast fed.
Changes occur to gut colonization after introduction of solid foods

Despite significant research on gut microbiota, the optimal therapy to reduce/prevent the
dysbiosis in the older adults is yet to be identified. Diet plays a role as a manipulator of the gut
microbiota throughout life and this may be particularly important in the older adults. The use of
broad spectrum antibiotics almost certainly has an adverse effect on gut bacteria. Probiotic
supplementation has significant potential to restore the diversity of the gut microbiota and
improve immune function. More well-conducted randomized studies on
probiotics/prebiotics/synbiotics in the older adults are needed.

The establishment and alteration of gut microbiota, with ageing.The potential role of gut
microbiota in regulating the immune system, together with its function in healthy and diseased
state are important discoveries

Qualities of good food

Nutritious/ nourishing,

Satiety value

Produced, stored, transported, delivered, Prepared …under sanitary condition

Palatability [color, aroma, flavor, texture]

Within budget

Exchange, substitute, choice

Suitable under the condition

Classification of foods

By origin:

- Foods of animal origin

- Foods of vegetable origin

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By chemical composition:Proteins, Fats, Carbohydrates, Vitamins ,Minerals, water/// organic;

inorganic

By predominant function:

Body building foods:(meat, milk, poultry, fish, eggs, pulses)

Energy giving foods : cereals, sugars, fats, oils etc.

Protective foods: vegetables, fruits, milk, etc

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Measurements of nutritional status (individual, household or community)

1. Anthropometric measurements
***There is no standalone medical profession. Reminding practice of clinical
Pharmacotherapy.Therapeutic plan with no or minimal side effects.Body composition monitor BMI, bone
mass, level of visceral fat, body fat percentage etc

Compared to other methods Anthropometry is the single most universally

applicable,inexpensive, and non-invasive method available to assess the size, proportions, and
composition of the human body. Moreover, since growth in body dimensions at all ages reflect
the overall health and welfare, of individuals and populations,valuable tool for guiding public
health policy and clinical decisions anthropometry may also be used to predict performance,
health, and survival.
Height—measured with stadiometer. The measurement of the maximum distance from
the floor to the highest point on the head when the subject is facing directly ahead, with
shoes off, feet together, arms by the sides, and heels, buttocks, and upper back in contact
with the wall

Recumbent length—as infants under 2.0 years old cannot stand erect sufficiently well
for a useful measure of height, body length is measured lying down (recumbent). A
measuring board is used, normally with a fixed headpiece and an adjustable footpiece
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Body mass/weight—the person stands (or sits) on the balance with minimal movement
and with hands by their side, or a young child can be placed in a sling attached to a
hanging spring scale. Shoes and excess clothing should be removed so that the subject is
dressed in light gown, bathing suit, or minimal clothing acceptable for the.
Arm circumference–the person stands with their back to the examiner and the right arm
flexed. The examiner locates the acromion process of the scapula (tip of the shoulder)
and the olecranon process of the ulna (tip of the elbow) and measures the distance
between these two points.

Skinfolds—the measurement of skinfolds can be performed at three to nine different

standard anatomical sites around the body. For consistency, only the right side of the
body is usually measured. The tester pinches the skin at the appropriate site to raise a
double layer of skin and the underlying adipose tissue, but not the muscle.
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The WHO publishgrowth references for over the age of 5.0 years
Z scores:way to express the distance between an individual child's weight and the average weight of comparable children in the reference
population is by z-score.

Weight-for-height
• Moderate acute undernutrition (wasting) ≤ –2SD > –3SD(B/n)
• Severe acute undernutrition ≤ –3SD
.Normal >-2SD
Height-for-age
Chronic undernutrition (stunting) ≤ –2SD > –3SD
Severe chronic undernutrition ≤ –3SD
Weight-for-age
• Overweight ≥ + 2SD and < + 3SD
• Obesity > + 3SD
BMI-for-age
• Overweight > + 2SD and < + 3SD
• Obesity > + 3SD

2. Biochemicalstatus indices
We must consider choices of tissue and body fluid samples (human body fluidsand tissues such
as blood, urine, breast milk, fat biopsies, hair, and nails, which can be used as predictors for the
different levels of nutrient intake and tissue status adequacy that occur in human individuals and
Populations
It is part of a coordinated set of the other nutritional investigations
It is essential to have access to suitable analytical equipment, suitable laboratory facilities, and
relevant expertise for sample collection, storage, sample analysis, and interpretation
Protein and essential amino acids-
Albumin-Function → transport molecule, plasma oncotic pressure. Low levels correlate with
chronic malnutrition
*Immunologic markers
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Total lymphocyte count (TLC)-Reflective of total number of circulating lymphocytes and

evaluates cellular immunity
*Transferrin- Function → Binds and transports ferric iron to the liver for storage.Reflective of
acute protein deficiency
*Nitrogen balance- Measurement of amino acid metabolism. Allows for baseline assessment of
patient’s metabolic state
Prealbumin (transthyretin) - Function → Transports thyroxine and retinol-binding protein
Essential fatty acid status (and fatty acid profiling)-
Fat-soluble vitamins= Vitamins A(retinol) and E(tocopherol), D(calciferol),K(phylloquinone) are
commonly measured in serum or plasmaby high performance liquid chromatography (HPLC).
Water soluble vitamins-Vitamin B1 (thiamin),Vitamin B2 (riboflavin),Vitamin B6
(pyridoxine),B9(Folate),Vitamin B12(cobalamin),B3(Niacin),B7(Biotin),B5(Pantothenate),Vitamin
C (ascorbic acid)
Non-vitamin dietary organics- polyphenols, phytoestrogens, pterins, carnitine, choline,
flavonoids, etc.)
Mineral nutrients=Macro-essential elements include sodium, potassium,calcium, phosphorus,
magnesium, and chlorine (Na, K,Ca, P, Mg, and Cl).,Selenium, Iodine, Copper, Zinc, Iron, Toxic
elements-Some elements, including aluminium, mercury, lead, and cadmium (Al, Hg, Pb, Cd),
but are of interest and concern because of their toxicity if present as contaminants in food or
from other environmental exposure.
3. Clinicalevidence of adequacy(sign and symptoms)
A medical history and a physical examination are the clinical methods used to detect signs
(observations made by a qualified examiner) and symptoms (manifestations reported by the
patient) associated with malnutrition. These signs and symptoms are often nonspecific and only
develop during the advanced stages of nutritional depletion; for this reason, diagnosis of
nutritional deficiency should not rely exclusively on clinical methods.
 History
Social → income, activity level, living situation
Surgical/Medical → sugical procedures, chronic diseases, dietary supplements
Dietary → food/drug interactions, food intolerance, drug/alcohol abuse
 Physical exam
General → edema, ascites, obesity, alopecia
Skin/mucus membranes → decubitus ulcers, poor skin turgor, dermatitis
Musculoskeletal → muscle atrophy, retarded growth
Neurologic → ataxia, night blindness, encephalopathy
Hepatic → jaundice, hepatomegaly
4. Dietary survey (intake) estimation
Dietary assessment involves the collection of information on foods (and drinks) consumed over a
specified time period.
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The choice of dietary assessment method will be largely influenced by the answers to the above
questions—why? What? Who? When?
What to measure:
 The collection of information on the quantity, and frequency, of foods, drinks over a
specified time
 Nutrientscontent and drink consumed over a specified time ; single nutrients,macronutrients,
and/or micronutrients.
 Using food composition tables, a calculation of energy and nutrient intakes
 Patterns of food consumption
Dietary assessment can be used at national, household, and individual level.In a given culture, it
is essential to know which substances constitute food or drink and which are taboo or
unacceptable.
When to measure:
There are seasonal variations in food availability in every country: wet and dry seasons or
variations in employment and income, weekends…
Different types of measurements have their usefulness, reliability/Validity (measures the
closeness of the estimate to the true value (its accuracy), Reproducibility (measures the spread
(or precision) of the individualestimates). They have different strengths and weaknesses.
Measurements can be performed at different levels.

These measurements are valuable as they may be predictive of health outcome.The practical
requirements for assessment of nutritional status and adequacyarise from the need to intervene,
by.

 Actions, to improve the nutritionof individuals or populations,

 To reduce therisks and the burdens of those diseases that have, a nutritional component.
Suchas ‘single-nutrient’ deficiency diseases (beriberi or scurvy, Goiter, Anemias…)
multifactorial diseases (vascular diseases, cancer, Hypertension, diabetics… where nutrition
could play a modulating role as one of many etiological factors).

Methods of dietary assessment

Weighed diary or record:Each item is weighed prior to consumption using portable food
weighing scales. Left-over itemsare also weighed.Or respondents are provided each day with a
preprinted list of foods and drinks and asked to ticka box each time an item is consumed

24-hour recall:interviewer asking subjects to recall and describe every item of food and drink
consumed over the previous 24 hours (usually midnight to midnight).

Food frequency questionnaire:FFQs are preprinted lists of foods and drinks (or foods and
drinks from given groups) on which subjects are asked to indicate the typical frequency of
consumption over a specified time period in the past. Frequency responses are usually multiple
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choice, and may range from several times per day to number of times per year, depending on the
item and the time period that the FFQ covers. The number of foods on the list varies from a few
questions on selected items (e.g. 20 items) to a fully comprehensive list of items (e.g. 200 items)
to assess total diet. Many FFQs enquire about frequency of consumption over the past year or
previous six months.

Diet history:The oldest approaches for assessing individualdiet. It is mostly used in clinical
practice to assess ‘usual diet over the recent past

Food balance sheets:Compilation of a selected country's food supply during a specific time

period. The food balance sheet shows the food items for human consumption, along with how it
is produced, used, imported/exported, and how it benefits the society (per capita supply).

Household food consumption survey (expenditure surveys (HCES): Surveys that are

routinely conducted to collect data on household food consumption and availability in many
countries. It is an important and variable component of the quantity of food consumed or
available in a household to prioritize the global agenda for support of evidence-based nutrition
policy making.

Assessing the food intake of population subgroups, such as minority ethnic groups, low income
groups, pregnant women, or those at either endof life’s spectrum, childrenoften presents specific
problems.

5. Functional evidence of adequacy of nutrients(casual links)

Biochemical functional assays are measures of the functional integrity of nutrient-dependent
biochemical pathways, as distinct frommicronutrient concentration assays. As noted in
theprevious section, there is considerable interest in nutrient-sensitive functional status indices
such as plasmahomocysteine(responsive to variations in folate, vitaminB12, and vitamin B6
status), plasma methylmalonic acid(responsive to vitamin B12 status), and oxidative
damagemarkers (such as malondialdehyde or F2 isoprostanes)which can be modulated by the so-
called ‘anti-oxidant’(or redox modulatory) nutrients (e.g. vitamins E andC, the carotenoids, and
selenium).
6. Ecological factorsassessment:
Nutritional assessment methods often include thecollection of information on a variety of other
factors known to influence the nutritional status of individuals or populations, including any
relevant socioeconomic and demographic data. Variables may include household composition,
education, literacy, ethnicity, religion, income, employment, material resources, water supply
and household sanitation, access to health and agricultural services, as well as land ownership
and other information.
7. Additional data
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On food prices, the adequacy of food preparation equipment, the degree of food reserves, and
the percentage of household income spent on certain foods such as animal foods, fruits, and
vegetables can also be collected.

Nutritional requirement
A requirement is an intake level, which will meet specified criteria of adequacy, preventing risk
of deficit or excess.
The relevance of the biological effects starts with the prevention of illness and death. For
nutrients where sufficient data on mortality are not available, the nutrient intake that prevents
clinical disease or sub-clinical pathological conditions, identified by biochemical or functional
assays, is used. Biomarkers that are used to define requirements include measures of nutrient
stores or critical tissue pools.
Presently, approaches to define requirements of most nutrients use several criteria. Functional
assays of sub-clinical conditions are considered the most relevant. If sufficient time is provided
balance can be achieved at multiple levels of intake. Nutrient blood levels, they usually will
reflect level of intake and absorption rather than functional state. Where relevant, requirement
estimates should include allowance for variations in bio-availability.
Recommended nutrient intake
Recommended nutrient intake (RNI) is the daily intake, which meets the nutrient requirements of
almost all (97.5 percent) apparently healthy individuals in an age and sex-specific population
group.
The average requirement value obtained from a group of individuals is adjusted for inter-
individual variability. If the distribution of values is not known, a Gaussian distribution is
assumed, that is, a mean plus 2 SD is expected to cover 97.5 percent of the population. If the SD
is not known, a value based on each nutrient’s physiology is used. In most cases a variation in
the range of 10-12.5 percent was assumed; exceptions are noted within chapters.
Upper tolerable nutrient intake level
Upper tolerable nutrient intake levels (ULs) have been defined for some nutrients. ULs are the
maximum intake from food that is unlikely to pose risk of adverse health effects from excess in
almost all (97.5 percent) apparently healthy individuals in an age and sex-specific population
group. ULs should be based on long-term exposure from food, including fortified food products.
For most nutrients no adverse effects are anticipated when they are consumed as foods, because
their absorption and or excretion are regulated.
The range of intakes encompassed by the RNI and UL should be considered sufficient to prevent
deficiency while avoiding toxicity. If no UL can be derived from experimental or observational
data in humans, the UL can be defined from available data on upper range of observed dietary
intake of apparently healthy populations.
Protective nutrient intake
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Refer to an amount greater than the RNI, which may be protective against a specified health or
nutritional risk of public health relevance (e.g., vitamin C intake with a meal to promote iron
absorption or folic acid to lower the risk of neural tube defects).

For many years the basic assumption - on which nutritionists make their projections has been
that all nutrients can be obtained from a diet containing a variety of foods from a variety of
sources. Some of the challenges to this assumption rest in the complexities and diversity of
worldwide realities, culture, and traditions. For many people with access to an adequate energy
intake, an extensive freedom of choice exists in the selection of food. However, the existence of
widespread poverty in the majority of countries precludes the opportunity to consume adequate
energy let alone a diet balanced in micronutrients.
In different parts of the world and in different segments of society within the same countries,
there are broad ranges of life spans in part due to nutritional adequacy. Especially in urban
populations, as lifespan increases as a result of nutritional adequacy and despite improved access
to health care, an increase in obesity, diabetes, some forms of cancer, and cardiovascular disease
has been recorded in all regions of the globe.
Dietaryenergydensity(ED,kcal/g)
ED is calculated by dividing the energy content (in kilocalories) by weight of foods (or foods
+ beverages in g) consumed. Dietary EDfood+beverage = Total energy (kcal) / total weight (g)
Calculating calories from fat in food
Divide a food or drink's calories from fat by total calories (this information is on the product's
food label) and then multiply by 100. For example, if a 300-calorie food has 60 calories from
fat, divide 60 by 300 and then multiply by 100.

Recommended daily calorie intake is 2,000 calories a day for women and 2,500 for men.As a
general rule, people need a minimum of 1,200 calories daily to stay healthy.

Daily Intake Levels for nutrients

Protein 50 grams
Fat 70 grams
Saturated Fatty Acids 24 grams
Carbohydrates 310 grams
A serving size is a measured amount of food—1 cup, 1 slice, 1 teaspoon, etc. It's the amount
you'll see on a food label
Dietary guidelines provides advice on what to eat and drink to meet nutrient needs, promote
health, and prevent disease.
 Eat a variety of foods.
 Maintain ideal weight.
 Avoid too much fat, saturated fat, and cholesterol.
 Eat foods with adequate starch and fiber.
 Avoid too much sugar.
 Avoid too much sodium.
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 If you drink alcohol, do so in moderation.

A balanced diet or healthy diet may be defined as that diet which contains all the nutrients in the
correct amount. In other words, "a diet which consists of all the essential food elements e.g.
proteins, carbohydrates ,vitamins, fats, minerals and water in correct proportion is called
balanced diet."The ratio between proteins, fats and carbohydrates should be 1:1:4 respectivel
Balanced diet chart must contain proper combination of everything essential for body. It should
contain adequate sources of fats, carbohydrates, proteins and minerals. So it is possibleto prepare
balanced diet chart by understanding following table.

Qty. What to eat serving Example

High Raw Vegetables and Fruits 8-10 per day Apple, Mango, Bananas, pineapple, Lettuce, Carrot,
Raddish, Tomato, dried fruits

High Grains 7-8 per day Bread, cereal, cooked rice, Pasta,

Medium Low fat dairy Products 2-3 times per day Milk, yogurt, cheese

Medium Poultry, Sea food, Lean 1-2 times per day Skinless poultry,roasted seafood or lean meat
meat

Medium Dressing Mayo, salad 1-2 times per day 1/2 cup mayo salad, raw veg. salad, fruit chat

Low Beans, Nuts and Seeds 1 time daily 1/2 cup beans, 1/2 cup nuts, 2 tbsp. sunflower seeds

Very Low Sweets 5 per week 1 cup low fat fruit yogurt, 1 tbsp. maple syrup, sugar or
Jam

Factors affecting balanced diet

 Age
 Occupation
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 State of health
 Climate
 Gender
 Pregnancy or Feeding mother

Importance of balanced diet

 It helps in disease prevention.
 Helpful in meeting nutritional needs of a person.
 It also help in controlling weight of a person.
 Makes immune system stronger.
 Help in proper sleep.
 Support good mental health.

Food safety
Foodborne illness (FBI); Infection or intoxication caused by transfer of microbial or
chemical contaminants from food or drinking water to a human
Microbes grow, multiply and survive in different environment and condition
Factors affecting growth and/or illness
 Nutrients
 pHAll microorganisms prefer a neutral pH for optimum growth, but ( acidophilic
grow best at pH < 5, neutrophilic at pH between 5 and 9, and alkaliphilic grow
fastest above pH 9 )
 Oxidation-reduction potential. Electrons altered by cooking
 Water activity aW. It is a measure of available water, how the water in  food will
react with microorganisms(0.6-1is favorable for microbial growth).It is affected
by temperature. A water activity of 1 means the vapor pressure is 100% of that of
pure water. butMoisture content is the amount of water in food and
ingredients.water activity lowered by:drying, addition of salt or sugar
 Temperature(Danger zone 40-140°F(4.5-60 C))Bacteria grow most rapidly in the
range of temperatures between 40 °F and 140 °F, doubling in number in as little as 20
minutes. This range of temperatures is often called the "Danger Zone."used for surfaces
of food-handling equipment
 Atmosphere(pressure)osmophilic microorganismsprefer high osmotic pressure,
xerophilic microorganismsprefer low water activity
 Time.one bacteria can multiply to more than 30,000 in five hours and to more
than 16 million in eight hours
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 Minimal air(aerobic, anaerobic, facultative aerobe/anaerobe)

 Physical structure; grinding and mixing increase surface area and distribute
microbespromotes microbial growth. outer skin of vegetables and fruits slows
microbial growth
Food safety can be affected from production to consumption process
 Pre-harvest, harvest and post-harvest contamination
 Water contamination
 Manure and municipal biosolids
 food manufacture
 Microbiological Spoilage of Fruits and Vegetables
 Worker health and hygiene
 Sanitary facilities
 Field sanitation
 Packing facilities sanitation
 Transportation and the changing world =>International trade
 Raw foods and also prepared foods are distributing internationally.
 Food industries expanded all over the world >>distribution of local
foods>>exporting foods containing pathogens
 Fast-food chain service systems=Consumers’ trends and communication
 Foodservice operation from home to restaurants
 Residues, cholesterol, salt, sugar, artificial coloring, pigments,
additives,chemicals, GMOs, enzymes, aromatic and flavor compounds, non-
caloric sweeteners, colors, low-calorie oils, antimicrobials>intensive agriculture
 Prepared refrigerated/frozen foods which are usually made of mixed meats,
seafood, vegetables and other raw materials>>risk of mixing bacteria from
different origin and spreading of certain pathogens.
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 Development of new technology [Biosensors , Kits , DNA probes ,PCR,

Nanotechnology…] are developed to potential threat of bioterrorism and
emerging diseases in food industry
 Development of new ingredients =food ingredients (>bacteria may be altered
 Change the constituents of food crops (bio fortification, add on soil, add on plates,
food fortification…)

Food borne illness is caused by

1. Food spoilage :results from ingestion of microbes in food and their byproducts.
Toxins
 Ergotism:toxic condition caused by growth of a fungus in grains
 toxic condition caused by growth of a fungus in grains
 aflatoxins:carcinogens produced in fungus-infected grains and nut products
 fumonisins:carcinogens produced in fungus-infected corn
2. Food-Borne Intoxications
Bacterial toxins are typically classified under two major categories: exotoxins or
endotoxins. Exotoxins are immediately released into the surrounding environment
whereas endotoxins are not released until the bacteria is killed by the immune system.

Ingestion of toxins in foods in which microbes have grown include staphylococcal food
poisoning, botulism, Clostridium perfringens, and Bacillus cereus food poisoning

Food can get toxic-metal poisoning (aluminum, mercury, lead, and cadmium (Al, Hg, Pb,
Cd))
Food Allergens (Milk and Dairy products, Eggs, Fish and shellfish, Wheat, Soy
products, Nuts)

Over 250 different foodborne diseases are constantly changing due to emerging
microorganismsCampylobacter
 Salmonella
 Mycobacterium bovis
 Staphylococus aureus
 Escherichia coli O157:H7
 Clostridium perfringens
 Listeria monocytogenes
 Viruses (Norovirus, Hepatitis A)
 Protozoa (Cryptosporidium, Cyclospora, Toxoplasma)
 Known: Enteropathogenic E. coli, Campylobacter, Yersinia, Clostridium botulinum,
Staphylococcus aureus, Salmonella, Shigella, Bacillus cereus,
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 Emerging: Aeromonas. hydrophila, A. sorbria and A. caviae, Edwardsiellatarda, Enteric

Viruses(hepatitis A, non-A, non-B hepatitis, Norwalk, Snow Mountain agent,
astroviruses, caliciviruses and small round viruses.), Plesiomonasshigelloides, Vibrio
species, Enterobacter sakazakii
 Antimicrobial resistance=Impaired uptake, modification or overproduction of the target
site, bypass of sensitive steps, absence of enzymes or metabolic pathways, efflux,
enzymatic degradation, receptor alteration, and change in membrane permeability, cross-
resistance,
 antibiotic use in food animals
Food borne disease Symptoms
Acute symptoms is common
Often self-limiting
Chronic sequelae iscommon
Cramps, nausea, fever, vomiting, body aches
Diarrhea, >3 or 4 loose stools within a 24 hour period Warning sign is bloody diarrhea
 Factors contributing to outbreaks
Improper holding temperature Danger zone 40-140°F
Inadequate cooking
Improper cooling
Improper reheating
Poor personal hygiene
Cross-contamination
Poor storage practices
Measures:
 Pasteurization,
 Fermentation; bear, wine(Malted grain: Grain that has been allowed to germinate,
then dried in a kiln & perhaps roasted)
Dairyproducts (Yogurt Milk is fermented by a mixture of Streptococcus
salivariussspthermophilus and Lactobacillus bulgaricus. Often these two are co-
cultured with other lactic acid bacteria for taste or health effects (probiotics).
These include L. acidophilus, L. casei and Bifidobacterium species. Acid
produced from the fermentation causes the protein in the milk (casein) to
coagulate into a semisolid curd),
bread (growth of Saccharomyces cerevisiae (baker’s yeast) under aerobic
conditions
 canning,
 refrigeration at 5°C,
 Chemical-Based Preservation,
 ultraviolet (UV) radiation,
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 radappertization-use of ionizing radiation (gamma radiation) to extend shelf life

or sterilize meat, seafoods, fruits, and vegetables
 drying, addition of salt or sugar
 intact outer skin of vegetables and fruits
 Microbial Product-Based Inhibition. Bacteriocins: bactericidal proteins active
against related species
 HACCP(HazardAnalysis and Critical Control Points) A system used to control
risks and hazards throughout the flow of food.It is based on identifying significant
biological, chemical and physical hazards at specific points within a products
flow.
Detection of Food-Borne Pathogens
 culture techniques
 immunological techniques - very sensitive
 molecular techniques; probes used to detect specific DNA or RNA