KENYA MEDICAL TRAINING COLLEGE

NUTRITION

NOTES

MOLEX
2-7-2020

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Nutrition
Broad objective
To equip the leaner with knowledge, skills and attributes. So as to be able to apply the basic
principles of nutrition and the prevention of nutritional disorder.
Specific objectives
1. Define terms used in nutrition
2. Explain principles of nutrition
3. Classify groups of nutrients
4. Identify sources of nutrients
5. Explain balance diet
6. Identify nutritional disorders and relate them to causative factors
7. Identify vulnerable groups and specify their nutritional requirements
8. Carry out health education on nutrition.
Contents
1. Terminologies
2. Classification of foods
3. Balanced diet
4. Nutritional disorders
5. Vulnerable groups
6. Factors influencing nutrition
7. Nutritional survey
8. Communication skills

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Table of Contents
1 Principles of nutrition................................................................................................................................................................4
2 Role of PHO / PHT in Nutrition................................................................................................................................................4
3 Nutrients their sources and functions.........................................................................................................................................5
3.1 Carbohydrates..................................................................................................................................................................5
3.1.1 Available or soluble carbohydrates........................................................................................................................5
3.1.2 Sources of Carbohydrates.......................................................................................................................................7
3.1.3 Functions of Carbohydrates....................................................................................................................................8
4 Fats and Other Lipids (OILS)...................................................................................................................................................8
4.1 Kinds of fats and their characteristics..............................................................................................................................9
4.2 Classification of Fats........................................................................................................................................................9
4.3 Sources of fats..................................................................................................................................................................9
4.3.1 Cholesterol and Ergosterol...................................................................................................................................10
5 PROTEINS.............................................................................................................................................................................. 12
5.1 Classification of Amino acids........................................................................................................................................12
5.2 Sources of proteins.........................................................................................................................................................13
6 WATER.................................................................................................................................................................................. 16
6.1 Extra cellular fluid..........................................................................................................................................................16
6.2 Intercellular Fluid (ICF).................................................................................................................................................16
6.3 SOURCES OF WATER................................................................................................................................................16
6.4 FUNCTIONS OF WATER............................................................................................................................................16
7 VITAMINS............................................................................................................................................................................. 17
7.1 FAT SOLUBLE VITAMINS.........................................................................................................................................17
7.2 SOURCES OF VITAMINS...........................................................................................................................................17
7.3 DEFIENCY....................................................................................................................................................................18
8 FACTORS INFLUENCING NUTRITION............................................................................................................................18
8.1 ROLE OF WOMEN IN FOOD PRODUCTION...........................................................................................................18
8.2 ROADS TO HEALTH CHARTS..................................................................................................................................19
8.2.1 Importance............................................................................................................................................................19
8.3 BALANCED DIET........................................................................................................................................................19
8.3.1 FOOD PATH........................................................................................................................................................19
8.4 STARVATION..............................................................................................................................................................19
8.4.1 Causes...................................................................................................................................................................20
8.5 FAMINE........................................................................................................................................................................ 20
8.5.1 Causes...................................................................................................................................................................20
8.5.2 Effects of famine..................................................................................................................................................21
8.5.3 Prevention and control..........................................................................................................................................21
8.6 OBESITY....................................................................................................................................................................... 21
8.6.1 Causes...................................................................................................................................................................21
8.6.2 Clinical Picture.....................................................................................................................................................21

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 8.6.3 Prevention and control..........................................................................................................................................21
8.7 Protein Energy Malnutrition (PEM)...............................................................................................................................21
8.7.1 Prevention of PEM...............................................................................................................................................22
9 Nutritional Survey...................................................................................................................................................................22
9.1 Purpose........................................................................................................................................................................... 22
9.1.1 Requirements........................................................................................................................................................22
9.1.2 Methods of Survey...............................................................................................................................................22
10 Preliminaries Considered in Dietary Preparation of the Old..................................................................................................22

9.

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Terminologies
1. Nutrition – the science of food and its relationship to the health, disease and the processes
by which the body ingests, absorbs, transports, uses and excretes food substances.
2. Health care – the prevention and the achievement of good health as well as care provided
during illness.
3. Nutritional care – the abrogation of the science of nutrition to the care of people.
4. Health care delivery system – an organization of functions and services by which health
care is made available to persons: the manner of financing, place of care and types of
services provided.
5. Obesity – excessive deposit and storage of fat in the body.
6. Nutrients – chemical substances supplied by food for body growth, repair and general
functioning.
7. Nutritional assessment – the evaluation of a person’s nutritional well-being by the
collection of data such as nutritional history, physical examination, laboratory evaluation/
exam, X-Ray studies.
8. Culture – beliefs arts and customs that make up a way of life for a people.
9. Nutritional survey – the sampling of a population covering an area for the purpose of
studying or determining its nutritional status.
10. Food group plan – is a diet planning that sought foods of similar origin and groups. It also
specifies that a person eat a certain number of foods from each group to ensure adequacy
and balance.
11. Essential nutrients – necessary nutrients that the body cannot make for itself.
12. Balanced diet – a sufficient measure of a regularly order system of nourishment
consisting of carbohydrates, proteins, fats, mineral salts, vitamins and water according to
the requirement of the body.
13. Food taboos – strong social customs forbidding eating or touching certain foods.
14. Mal-nutrition – the process where one does not get one or more of the nutrients required
for the proper functioning, growth and repair of the body.

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1 Principles of nutrition
 Food (diet) planning
 Food should be adequate
 Diet should contain / provide adequate essential nutrients
 The diet should be balanced
 The food should provide the required amount of energy
 The diet should be moderate and not to provide excess intake of a particular constituent
 The diet must be varied by use of different foods to provide needed nutrients
 The consumers must be informed in nutritional health
 Food should be prepared and handled carefully to preserve nutrients
 Food should be stored, prepared and served under clean environmental conditions
 Prevention and control of diseases
 Diagnose and effectively treat diseases

2 Role of PHO / PHT in Nutrition

1. Offer sound nutritional information by educating families, schools, children and the
community
2. Promote good health
3. Refer clients to the physicians, dieticians, nutritionists and other resource person to assist
4. Carry out nutritional survey
5. Asses nutritional needs of the community
6. Ensure food safety
7. Participate in nutritional programs
8. To initiate, implement, monitor and evaluate nutritional program
9. Prevention and control of communicable diseases
10. Ensure food quality control
NB /
The PHO/PHT as an effective promoter of nutritional health requires:
a) Knowledge of the science of nutrition
b) Knowledge of body requirements of food
c) To understand the cultural, social, psychological and economic factors that
help in shaping a person’s food habit
d) To understand the lifestyle of individuals or communities

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3 Nutrients their sources and functions
3.1 Carbohydrates
A major source of energy in human diets. Are chemical compounds of carbon, hydrogen and
oxygen. It is divided into:
i. Available or soluble carbohydrates
These the sugars (monosaccharides, disaccharides and some polysaccharides). Digestion takes
place in the upper gastrointestinal tract of man, absorbed and utilized.
ii. Insoluble carbohydrates
These are polysaccharides e.g. cellulose with large molecules than the monosaccharides and
disaccharides.
3.1.1 Available or soluble carbohydrates
Categorized into two
a) Monosaccharides (Single Sugars)
The simplest sugars and smallest carbohydrates molecules. No digestion is required. Are readily
absorbed from the intestine directly into the blood stream. They include glucose, fructose and
galactose found in foods and from other carbohydrates during digestion.
i. Glucose (C6H12O6) or Dextrose
Is available in fruits, especially grapes and vegetables. All other forms are converted into glucose
for transport in the blood and for utilization by body tissues.
ii. Fructose (laevulose or fruit sugar)
Is food associated with glucose in many fruits, e.g. figs, vegetables and honey. It is slightly
sweeter than glucose and has the same empirical formula, C6 H12O6, as glucose, but structurally
different from glucose.
iii. Galactose
Is a constituent of lactose (milk sugar) and plant polysaccharides.
b) Disaccharides (double sugars)
Those commonly encountered in foods are sucrose, maltose and lactose. The double sugars are
split by acid hydrolysis outside the body or by specific enzymes in the digestive tract into single
sugars.
i. Sucrose (Cane & beet sugars)
Is the familiar sugar in com
mon domestic use. It may be granulated or powdered white or brown sugar.

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 ii. Maltose (malt sugar)
Is manufactured from starch by the action of diastase in the molting (sprouting) of grains such as
barley, finger millet and sorghum. Is easy utilized by the body.
iii. Lactose (milk sugar)
One of the sugars not found in plants. It is formed in the mammary glands of lactating mammals.
It is less soluble and digested slowly.
c) Oligosaccharides
Includes the following:
i. Trehalose (mushroom sugar)
Is present in many fungi, bacteria and insects such as white ants, locusts, grasshoppers, etc.
ii. Raffinose
Is found in molasses. It is a tri-saccharide of glucose, fructose and galactose.
iii. Starchyose
Is a tetra-saccharide present in beans.
d) Available Polysaccharides
i. Starch – is insoluble in water. Heat promotes a stable solution but gels on cooling.
Utilizable carbohydrate solution is stored in the form of starch with grain and root
granules of a variety of plants. Cooking renders the starch in vegetable foods more
available for digestion.
ii. Dextrins - are degradation products of starch with varying numbers of glucose per
molecule liquid glucose in a mixture of dextrins, maltose, glucose and water. These are
given to seriously ill patients and totally drunken people. Carbohydrates since they are
easily absorbed and assimilated. Dextrins are less sweet than glucose.
iii. Glycogen – the animal equivalent of starch. Natural sources are animal liver, shell fish.
Unlike starch, glycogen readily dissolves in water. Its readily broken down by the
appropriate enzyme to yield glucose.
e) Insoluble (Unavailable Carbohydrate dietary fiber or roughage)
They include:
i. Pectin – are amorphous but not fibrous. Are found in fruit and vegetable soft tissue. Is
insoluble in hot water.
ii. Hemicellulose – small intestines do not digest it, but are broken down in the colon by
microorganism.
iii. Cellulose – it is the framework of plants. It is the chief constituents of wood, stalks and
leaves of all plants and of the outer coverings of seeds. No enzyme secreted in the human
intestines can digest cellulose. Indigestibility of cellulose furnishes the bulk required for

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 efficient and normal peristaltic action. Ruminants can digest cellulose because their
bacteria have the enzyme cellulase.
3.1.2 Sources of Carbohydrates
1) Plant sources
a) Cereals grains and their products
 Maize
 Millet
 Sorghum
 Wheat
 Orts
 Rice
 Barley

b) Fruits and their by-products

 Bananas
 Mangoes
 Pineapples
 Pears
 Guavas
 Pawpaws
 Passion
 Watermelon
 Citrus fruits
 Apricots
 Dates
 Prunes
c) Roots, tubes, and their by-products
 Cassava
 Turnips
 Coco-yam
 Beets
 All kinds of potatoes
d) Stems
 Sugarcane and its by-products
 Maize stems
 Sorghum stems
e) Flowers
 Flower nectars
f) Beverages
 Non-alcoholic drinks e.g. Coca-Cola, Fanta etc.
 Malt liquors e.g. beers, ale, pombe etc.

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  Ciders e.g. sweet cider
 Wines e.g. red or white, port, sherry, champagne etc.
 Cocktails e.g. martini
g) Vegetables
 Pumpkin
 Vegetable marrow
N/B
Most vegetables have low concertation of carbohydrates.
2) Animal sources of carbohydrates
Most animal foods contain traces of carbohydrates in the form of: glycogen the liver contains
appreciable amount.
i. Meats, fish, poultry
ii. Eggs
iii. Liver (6%)
iv. Milk sugar lactose (5%)
Glycogen stored in the liver and muscles is a temporary reserve for body use when need arises in
the muscles and blood. Surplus carbohydrate is transformed into fat and stored as adipose tissue.
Oversupply of carbohydrates in the diet leads to obesity. Excessive intake of sugars causes rise in
blood sugar leading to a slight appearance of glucose in urine.
3.1.3 Functions of Carbohydrates
Each gram of carbohydrates supplies 4.5 calories of energy.
1) Provides the body with the most efficient energy.
2) For proper use of fats – in order to avoid incomplete burned fats in the blood
3) Provide energy quickly to spare protein for building and repairing tissues
4) Are important components of certain body substances required for the regulation of body
processes e.g. heparin (a substance that prevents blood from clotting), nervous tissue,
connective tissue, hormones, enzymes ribose (is part of deoxyribonucleic acid DNA and
RNA).
5) Encourages growth of useful bacteria: these are beneficial
6) To promote normal functioning of the lower intestine tract – cellulose make up the
dietary fiber, fiber absorbs and holds water, resulting in a softer bulgious stool and faster
movement of the lower intestinal tract.

4 Fats and Other Lipids (OILS)

Are an important form of stored energy in animal’s lipids (fats, oils and fat-like substances) are
composites of carbon, oxygen and hydrogen in different to carbohydrates.
Fats act as carries of essential fat acids and vitamins gives flavor to food. A gram of fat supplies
a calorie of energy.

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4.1 Kinds of fats and their characteristics
Characteristics of fat include melting point, flavor, texture and ignition point etc.
1) Saturated fatty acids – means that each carbon atom caries all the hydrogen atoms
possible e.g. butter, lard, tallow and coconut oil, palm oil
2) Unsaturated fatty acids – means one or more carbon atoms possible e.g. oleic acid (mono
- unsaturated) poly-unsaturated fatty acid has more than one bond: found in seed oils, fish
maize, cotton seed, sunflower, simsim and soya beans.
4.2 Classification of Fats
a) Hydrocarbon
Are not foods and are derived from petroleum e.g. lubricating oil or purified mineral oil. They
contain carbon and hydrogen but not oxygen. Mineral oil is indigestible in the animal body and
interferes with the absorption of fatty soluble vitamins.
b) Invisible fats
Include milk, cheese, nuts, cereals, fats of meat and eggs.
c) Visible fats
Include salad oil, butter, cooking fat, margarine and lard.
d) Essential fat acids include
Arachidonic acid present in animal tissue
Linoleic acid present in animal fats and plants.
4.3 Sources of fats
Animals – bacon fat, beef fat, mutton fat, chicken fat, fish fat, butter, cheese and cream milk.
Plants – avocados, palm oil, coconut oil, cotton seed oil, maize oil, sunflower seed oil, simsim
Margarine and cooking fat are made from vegetable oil.
Other fats include
1) Phospholipids which consist of a fat to which is attached phosphoric acid vadicid and a
nitrogen-containing base e.g. lecithin found in eggs, cephaline found in brain tissue,
sources of fat include egg yolk, brain, liver, kidney, heart, lungs etc.
2) Cholesterol and Ergosterol
Sources include liver, blood, nerve and glandular cells.
N/B
i. Ergosterol is present in plants
ii. Cholesterol present in animal tissues

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 3) Lipoproteins – are compounds of fat and proteins some are fat-soluble and transport
lipids e.g. cholesterol in the blood stream.
4.3.1 Cholesterol and Ergosterol
Present in foods of animal origin, while Ergosterol is present in food of plant origin. Cholesterol
is also manufactured in the body from acetate via mevalonate, squalene in the liver and intestinal
wall respectively.
Cholesterol and Ergosterol are both sterols. They are not essential nutrients since; the body is
capable of synthesizing them for its own use. Sterol is one of the tree main classes of lipids.
These lipids have a structure similar to that of cholesterol. The lipid is a family of compounds
(soluble in organic solvents) namely
i. Triglycerides (commonly called fats and oils)
ii. Phospholipids
iii. Sterols
Pancreatic juice contains phospholipase and cholesterol esterase whose function is to split
triglycerides into fatty acids, diglycerides, monoglycerides and glycerol during fat metabolism.
In the liver cholesterol is oxidized to primary bile acids, colic and chenodeoxycolic acids (CDO)
acids that mixes with glycine or taurine and excreted in the bile.
The bile cholesterol that is in solution micelles formed with bile salts and bile acids in small
intestines. The micelles are important moot of the bile acid later reabsorbed from the lower ilium
and recycled several times after each meal.
Biliary and dietary cholesterol mix and are partly absorbed. Triglycerides enter the lacteals and
mesenteric lymph vessels of small intestine and chylomicrons. The large intestine the
cholesterol that passes here in transformed by bacterial flora to coprostanal. Fecal coprostanal,
cholesterol and related compound constitute the fecal neutral sterols.
Cholesterol and Ergosterol
There are four classes of lipids in the blood
a) Cholesterol
b) Triglycerides
c) Phospholipids
d) Fatty acids
Fatty acids are divided into three types
Saturated fatty acids
Mono-unsaturated fatty acids
Poly-unsaturated fatty acids
Cholesterol, triglycerides and phospholipids are insoluble in saline solution of plasma. They are
in cooperated in three types of lipoproteins. Are divided into four main types
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 1. Very low-density lipoproteins (VLDL) – are made in the intestine and the liver they
transport to other body organs including triglycerides.
2. The liver makes low-density lipoproteins (LDL) –. They transport lipids including
cholesterol from the liver to other body tissues. A high blood cholesterol level usually
reflects a high LDL. Dietary factors that raise LDL are total fat intake, saturated fat and
high calories. Dietary factors that lower LDL are monounsaturated fats and
polyunsaturated fats. Dietary cholesterol raises LDL depending on the amount eaten.
3. High-density lipoproteins (HDL) - Are formed by body cells and return remnants of
unused cholesterol from storage (depots) places to the liver for recycling or dismantling
and disposal. The cardiovascular disease (CVD) – a disease of the heart and blood vessels
(atherosclerosis and hypertension)-risk s predicted by the HDL level. The HDL can be
raised by regular exercises, none smoking loss of weight etc.
N/B Triglycerides (food fats) raise blood cholesterol.
4. Chylomicrons- is lipoprotein very low in density (VLDL) made by the cells of the
intestinal wall. They transport lipids from intestine through lymph and blood to all body
cells these carry mainly triglycerides remnants of the lipids are cleared from blood by
liver cells.
N/B.
The protein component consists of peptide chairs known as a proproteins. The main consistent of
a poprotein are A, B and C. the plasma contains non-esterified fatty acids or free fatty acids
(FFA) which serve as food for the tissues. Plasma cholesterol falls when humans take a diet very
low in cholesterol.
Functions of Cholesterol & Ergosterol
1. Both cholesterol and Ergosterol are precursors of vitamin D 2 and when the skin is
exposed to sunlight, they are converted into vitamin D.
2. Essential constituent of cell e.g. nerves, glands
3. Serves to transport fat
4. Formation of hormones
5. Used as a source of energy by muscles and other tissues.
Functions of fats
1. Major energy source
2. Cushions the vital organs
3. Insulates the body
4. Transport some vitamins (A, D, E and K) and essential fatty acids to body’s cells
5. Are part of cell membrane structure
6. Serve as raw materials for synthesis of other needed products.
7. Part of bile
8. Are essential form of material from which hormones are made
9. Precursor of vitamin D2 in skin with the help of ultraviolet light.

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 10. A major part of plagnes that narrow the arteries in killer diseases C.D.V
11. Part of pancreatic juices
12. Return lipids from storage depot to liver for recycling or disposal
13. Attach to proteins to form complex lipoproteins & carried to body cell
14. Attach to phosphorous to form complex phospholipids one of the three main classes of
lipids.

5 PROTEINS
Carbon, hydrogen, oxygen and nitrogen. Also, contain phosphorous and Sulphur. Other elements
contained in proteins are, iron and iodine 1gm of protein yields 4.0 calories of energy. On
digestion of proteins, nitrogen compounds are released in the blood stream as amino acids.
5.1 Classification of Amino acids
i. Essential amino acids
ii. Non-essential amino acids

a) Non-Essential amino acids

Synthesized by the body to meet its needs. They include
Glutamine
Alanine
Cysteine
Arginine
Tyrosine
Glutamic acid
Aspartic acid
Cysteine
Asparagine
Glycine
Hydroxyglutamic acid
Citrulline
Noslencine
Praline
Hydroxpraline
Serine

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 b) Essential amino acids
These are the amino acids that cannot be synthesized by the human body but must be obtained
from food. These are 8 essential amino acids for the adult body. And 9 essential amino acids for
infants
They include
i. Histidine vi. Threonine For adult human body
ii. Isoleusine
vii. Tryptophan
iii. Luesine
iv. Methionine viii. Valine
v. Phenylalanine

For infant human body

5.2 Sources of proteins

Animal source
Group I
Milk and milk products such as:- milk, cheese, ice-cream, dried (skimmer) milk, butter, yoghurt,
cream etc.
They contain a good balance of amino acid.
Group II
Animal and animal products:- for example: meat, poultry meat, Fish. Eggs, variety meats e.g.
organs and glands of animals. They are much rich in proteins.
Eggs are protein food of high value, egg protein contain the essential amino acids nearly ideal.
Plant sources
Group III
Vegetables and nuts
Vegetables in general are poor sources of proteins except legumes. Legumes provide better plant
protein and are meat alternatives. Soya beans are the highest in protein content of the legumes.
Other legumes include:- beans, cow peas, lentils etc
Nuts are a good source of protein of a high quality. These include:- cashew nuts, monkey nuts,
grounds nuts etc.

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Group IV
Cereals and cereal products
Grain proteins are low in one or more essential amino acids. They include:- wheat (low in
lysine), maize (low in tryptophan),rice (low in tryptophan, cysteine and methionine)
Other sources of protein
Texture vegetables proteins (positive)- are manufactured by extraction of protein from oil seeds
e.g. soya beans, groundnuts cotton seeds they are low in saturated fats.
The TVP are combined with flarous, colour, starch and other ingredients that include:-chicken
flarous, beef flarous, fish flamous etc TVP are analogs because they resemble other foods by
their flarous.
Single-cell protein- are from microorganisms and algae
Leaf-proteins- are extracted from leaves of food crops as beans, peas, cowpeas etc.

FUNCTIONS OF PROTEINS
Tissue maintenance and growth.
i. Tissues growth-in infancy and child hood, pregnancy and lactation requires extra a micro
acids above those required for tissues maintenance. Additional proteins is required to
build new tissue for wound healing and for recovery from surgery, burns, fever etc
ii. Formation of regulating compounds. Regulatory material in the body are protein
substances e.g. hormones (such as insulin, thyroxine, and adrenaline.
Enzymes hemoglobin.
iii. Antibody formation
These are proteins that assists the body in fighting infection and other toxic conditions.
iv. Fluid balance
Protein assist in regulating the fluid balance of cells the plasma protein moleances in the
blood vessels creates the required pressure to remove fluid from cells so that it does not
accumulate causing edema.
v. Maintenance of body neutrality
The blood must be maintained at nearly neutral or basic state for the body to function
well. The presence of proteins in the blood prevents the accumulation of too much acids
or base in blood.
vi. Provision of energy
Proteins provide energy when kilo calories from carbohydrates and fats are too low.
Proteins in excess is not stored, but is converted to energy, which if not required is then
converted to fat.

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 ASSIGNMENTS
MINERAL ELEMENTS
These are micronutrients involved in human nutrient. Their metabolic roles are as varied
as the element themselves. They fulfill a variety of metabolic functions.
They are active participants in the overall metabolic process
Major minerals- they are minerals elements which the requirement is greater than
100mg/day.
Trace elements- they are needed in much smaller amounts
Major minerals – calcium
Phosphorous
Magnesium
Sodium
Potassium
Chlorine (chloride)
Sulfur
Trace minerals- iron
Iodine
Zinc
Copper
Manganese
Cobalt
Selenium
Molybdenum
Fluoride
MAJOR SOURCES OF MINERALS
Bread cereal, rice, pasta

Vegetables
Artichoke (boiled)
Avocado (raw)
Carrots (raw)
Collards (boiled)
Kale (chopped)
Peas green (boiled)
Potato (baked with skin)
Tomato (raw)

Fruits
Apricots (raw)
Banana (raw)
Figs (dried)
Orange juice (fresh)
Papaya (raw)

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 Meat:- poultry, fish, eggs, milk, dairy products, milk, skim, yoghurt, whole fats, oils
SOURCES OF MINOR ELEMENTS
Food sources:-
Liver, meat, eggs, whole grains, enriched breads, cereals, dark green vegetables, legumes,
nuts.

6 WATER
Is the one nutrient’s most vital to human existence. We can survive for longer without
food then without water only our constant need for is more demanding.
For our body water balances a state of dynamic equilibrium-, homeostasis is constantly
involved.
There are two compartments of body water, this are-
1. Extracellular fluids (ECF)- this is made up of all water outside the cells and
2. Intercellular fluids (ICF)- this is made up of all water inside the cells
6.1 Extra cellular fluid
Is the collective water outside the cells and makes up about 20% of the body weight. It contains
of four parts
a. Blood plasma – accounts for approximately 25% of ECF and 5% of the body weight
b. Interstitial fluid – accounts for water surrounding the cell
c. Secretory fluid- accounts for water in transit
d. Dense fluid – accounts for water in dense connective tissue, cartilage and bone.
6.2 Intercellular Fluid (ICF)
The total water inside the body cells and makes about 40% to 45% of the total body weight.
Since the body, cells are sites for vast basic metabolic activity. It is no surprise that the total
water inside the body cells is about twice the amount outside the cells.
6.3 SOURCES OF WATER
a. Water in liquids- (preformed water in liquids) water and other beverages are the main
sources of ingested daily fluid. About 1200ml liquid are ingested daily in this form.
b. Water in foods- foods vary in their water content the water ingested in the foods we eat
contribute about 700 to 1000ml daily.
c. Water from oxidation- when nutrients are oxidized in the body, one of the end products in
water, the amount of metabolic water produced varies with different nutrients. About 200
to 300ml of water is contributed daily from the body’s metabolic activity. This brings
daily water intake to about 2100 to 2800ml.
6.4 FUNCTIONS OF WATER
1. Cell water and its contents in solution provide a normal turgor in fullness to the tissue.
Without this normal tissue turgor that cell water makes possible, the body form would not
exists.

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 2. Water provides the necessary chemicals solvent on which body tissue solutions are based.
This provides the base of tissue fluid circulations that supply nutrients to cells and is
essential for multitude of cell chemical reactions that fulfill the body’s life needs.
3. Water provides the means of maintain a stable body temperature. The skin water loss
adjusts to help maintain a steady body temperature.
4. Cushioning and lubrication- protects sensitive organs and tissues
5. It facilitates digestion
6. Cleansing and waste removal

7 VITAMINS
Water-soluble vitamins:-
These are the B vitamins.
Which include:-
1) Thiamine
2) Riboflavin B2
3) Niacin B3
4) Pyridoxine (Vit B6)
5) Pantothenic acid
6) Biotin
7) Folate
8) Cobalamin (Vit B12)
9) Ascorbic acid (Vit C)

7.1 FAT SOLUBLE VITAMINS

Vitamin A, D, E, K
7.2 SOURCES OF VITAMINS
Food sources: - bread, cereal, rice, pasta
Vegetables: - asparagus (boiled), spinach (boiled), mushrooms
Fruits: - blueberries (raw), figs (dried) peas (raw), prunes (raw),
Meat: - poultry, fish, dry beam, eggs,
Nuts: - almonds, beef liver, chicken liver, egg( fresh), kidney beans, soybeans.
Fats: - oils, sugars, is not an important source of vitamins
FUNCTIONS OF VITAMINS

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 1. General antioxidant capacity - vitamin C is an antioxidant i.e. it takes up free oxygen in
the cells resulting from cell metabolism.
2. Intercellular cement substance - Vit C cures scurry by developing an intercellular
cementing substance to build strong connective tissues Vit C.
3. Carbohydrate metabolism. Thiamine is rapidly absorbed. .e the first part of the small
intestine and combined with phosphorous is the jejuna mucus to form the active co-
enzyme TPP
4. Vitamin K helps in blood clotting; it catalyzes the synthesis of blood clotting factors by
the liver.
5. Vitamin A plays a role in visual adaptation to light and dark. It also plays general roles
that influence vision, the health of body covering and lining the process of growth and
reproductive function.
6. Synthesis of vitamin and hormone.
7. Vitamin C helps in wound healing.
7.3 DEFIENCY
a) Extreme defiance of Vit A causes Exophthalmia, affects the children annually and
leaving them blind in its wake. Depletion of Vit A also causes death among young
children especially those under 3 years of age
b) When the body is deficient in vitamin A many epithelial tissues may undergo
keratinization (day and flat and gradually harden to form keratin)
c) Lack of vitamin D results into bore mineralization and rickets.
d) Defiance of thiamin (Vit B) causes beriberi- a disease of the peripheral nerves,
characterized by pain (neurites) and paralysis of the extremities, cardiovascular changes
and edema.
e) Lack of vitamin C leads to scurry.

8 FACTORS INFLUENCING NUTRITION

a. Poverty
b. Lack of knowledge
c. Disease leading to lower appetite
d. Allergy
e. Alcoholism and drug abuse
f. Lack of sufficient food or no food at all
g. Customs and behaviors
h. Family size
i. Lack of physical exercise
j. Food distribution
k. Soil erosion
l. Climate condition
m. Age and sex
n. Type of activity
o. Prescription of drugs

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 p. Political instability

8.1 ROLE OF WOMEN IN FOOD PRODUCTION

1. Take care of domestic animals that include sheep, goat and chicken.
2. Fetch water for house hold/domestic use
3. They work in the farm
4. Breast feeding of the young ones
5. Help in food preparation
6. Play a role in food hygiene
7. Cooking of food and serving
8. Do shopping and buy foods in the markets
9. They milk, collect eggs
8.2 ROADS TO HEALTH CHARTS
Basic idea of growth chart is to promote growth rather than just malnutrition. It is done by
plotting children weight monthly on one card yielding to growth curve, the curve that reveal any
significance
8.2.1 Importance
1. One can easily know the weight of a healthy child
2. One can easily know of the child is in her or his right weight for his right age.
3. One is able to know is the child
4. Assist in knowing the immunization status of a child.
8.3 BALANCED DIET
Definition
A sufficient measure of regularly ordered system of nourishments consisting of carbohydrates,
proteins, fats, mineral salts, and H2O according to body requirements.
8.3.1 FOOD PATH
Clearing planting growing harvesting

Farming w/selling Transporting Strong

Budgeting retailing and shopping cooking

Using Eating Sharing

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N/B Anything that blocks the food path influences nutrition.
8.4 STARVATION
Growth under nourished
8.4.1 Causes
- Famine
- Diseases e.g. intestinal tract infection
- Illness e.g. cancer and T.B
- Occasionally due to unemployment and poverty
- Insanity
8.4.1.1 CLINICAL FEATURES
1. Person becomes thin
2. Skin becomes dry and loss
3. Hair loses
4. Pulse slow
5. Reduced blood pressure
6. Hormonal disturbances
8.4.1.2 COMPLICATION
1. Edema
2. Anemia
3. Diarrhea nearly almost
4. Psychological and mental disturbances
5. Tropical ulcers commonly occur
8.4.1.3 PREVENTION AND CONTROL
Prompt treatment is necessary.
8.5 FAMINE
Refers to lack of access to food due to manmade and natural disasters.
8.5.1 Causes
 Climatic conditions e.g. floods, volcanic eruption, etc.
 Manmade causes e.g. wan, urbanization and migration
 Unequal distribution of food
 Lack of time / being lazy
 Infestation of food crops by insects e.g. locusts
 Farmers spending more on cash crops than on food crops
 Poor transport and communication system
 Lack of knowledge on agriculture

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  Poor storage of foods
 Disease outbreaks
 Poverty
 Culture
 Ignorance
8.5.2 Effects of famine
 Causes death
 Causes malnutrition diseases
 Affects the country’s economy
 Changes the government’s programs
 Increases illiteracy
 Low conception in women
 Causes underweight in pregnant mothers and children
8.5.3 Prevention and control
 Introduce and use irrigation methods
 Build dykes to control floods
 Construct dams for water catchment
 Improve on transport and communication systems
 Introduce drought resistance crops
 Improve storage facilities
 Health education on balanced diet
8.6 OBESITY
Any excessive deposit and storage of fat in the body.
8.6.1 Causes
Consumption of more food than the body needs more energy is ingested in food than is exploited
in exercise.
8.6.2 Clinical Picture
 Increase in weight and fatness
 Psychological upset people do not like and be conspicuous or thought to be ugly
 Difficult in moving about, tiredness etc.
 Arthritis in weight baring joints
 Skin infections are common in hot humid climate
 High blood pressure
 Diabetes mellitus, verso in vein and coronary arteries
 Overfeeding of infants and young children may lead to production or increased number
of fat cells in the body.
8.6.3 Prevention and control
 Reduce intake of energy foods and increase

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  Lower / reduce the size of seeming at each meal
 Increase the amount of exercise taken.
8.7 Protein Energy Malnutrition (PEM)
A group of diseases caused by deficiency by both protein and
Protein calories malnutrition
8.7.1 Prevention of PEM
 Educate individuals, families and community on good nutrition
 Early diagnosis of diseases and treatment
 Provision of better farming methods
 Encourage school feeding programs
 Deworm children frequently.

9 Nutritional Survey
Population covering an area for the purpose of studying or determining its nutritional station.
9.1 Purpose
Determines nutritional status of a community. Assesses the influence of soar economic,
agricultural status and climatic factors on nutritional status
9.1.1 Requirements
Weighing scale
Measuring board
Charts
Pens / notebooks
9.1.2 Methods of Survey
Road to health chart
Arm circumference
Physical examination
Lab tests
Discussion on food eaten etc.
Personal observation

10 Preliminaries Considered in Dietary Preparation of the Old

Elderly people present dietary problems because they place many social, physical and economic
difficulties. They can be isolated in ill health so as not to eat adequately to fulfil their nutritional
needs. Balanced diets for them require special attention, which is nonexistence in developing

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countries. Their calorific needs are lowered due to reduced activity; light to moderate activity
should be encouraged to maintain muscles well-being.
Diet should be varied and planned to secure nutritional balanced diet. Meals should be adequate
in quality and quantity. There need for vitamins, minerals and proteins should be. Many elderly
people are anemic and should have iron supply. They may suffer from astir malaria and should
be given foods rich in calcium and Vitamin D.
1. Carbohydrates
Supply of calories and Vitamin D should be to 50% of total number of calories daily. Reduce the
consumption of sugar and products of sugar.
2. Fat
Reduce consumption to 40% of the total number of calories. Reduce use of saturated fats and
raise the consumption of wholly unsaturated fats.
3. Proteins
Should not be less than 0.8g/kg body weight. Animal source should contribute 25 – 50% the
reminder be plant source. Protein to supply 15 -20 % of a day’s calories.
4. Minerals
These remain vital especially iron and calcium
5. Vitamins
More is required especially Vitamin D. Supplement Vitamin D intake, give plenty of fruits and
vegetables.
6. Water
Be adequate or xerostomia may occur due to less flow of saliva. Other sources of fluid intake
include cocoa, milk, fresh fruit juice. Nutritional supplement in illness or debilitated state are
required to replenish losses.
Importance of Road to Health
 Easily find the weight of a healthy child
 Tells if the child is the right weight for his/her age or if he is under weight
 Tell the growth of a child
 The nutritional status of the child
 Assists to know the immunization status of a child

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