Nutrition and Food

Security
Shomik Maruf
Lecturer
Department of Public Health North
South University

slide courtesy: MHHN

Content

• Nutrients and its classification

• Function of different nutrients
• Classification of malnutrition
• Nutrition interventions
• Food safety (food contamination and
adulteration)
• Food security and its dimensions
Nutrition and Nutrients

▶Nutrition is the process of utilizing nutrients from food

for growth and maintenance of our body. Nutrients
are chemical substance found in food that are used for
growth and maintenance of our body

▶Good nutritional status means having all the required

nutrients in right balance, as both deficiency and
excess of nutrients can cause disease

▶Poor/Deficienct nutritional status is associated with

reduced immunity, impaired physical and mental
development, and reduced productivity. Excess of
nutrients like fat can result in non-communicable
diseases
Classification of
nutrients

Macronutrients Micronutrients
Nutrients that are required in large amount in our Nutrients that are required in small amount in
body our body

These are utilized to produce energy These are necessary for metabolism and other
body functions like growth and development
immune system

Examples: Carbohydrate, protein, fat Example: vitamins and minerals

Macronutrients

Name Function Source Good/Bad

Carbohydrate Energy production Cereals, legumes, grains etc. Glycemic index (low), high
Glucose, Fructose, (4 kCal/gm) dietary fiber
Lactose

Protein (made up of Growth and repair, energy production Pulses, meat, fish, egg, milk, Animal source are considered
amino acids) (4kCal/gm) better (complete protein)

Fat (Lipid) Energy storage (9kCal/gm), insulation, Milk and milk products, nuts and Unsaturated fats are
shock absorption, vitamin metabolism seeds, meat, fish, egg good/saturated and trans-fat are
bad
Vitamins and minerals are considered as micronutrients, they perform wide range of
functions, but do not produce energy in our body

Minerals are inorganic substances and can be classified into major mineral (Calcium,
Sodium, Potassium, Phosphorus, Magnesium, Chlorine, Sulfur) and trace minerals (Iron,
Zinc, Iodine, Copper etc.) based on their abundance in our body and requirement

Vitamins are organic substances can be classified into fat-soluble vitamins (Vitamin A, D,
E, K) and water-soluble vitamins (Vitamin B complex and Vitamin C) based on their
solubility. Fat-soluble vitamins are stored in liver

Micronutrients
Micronutrients – minerals
Name Function Source Deficiency syndrome

Calcium Bone and teeth formation Milk and Milk products Thinning of bones, Fracture, tooth erosion,
Blood Clotting Green leafy vegetables Heart rhythm problems, rickets (in children)
Normal Heart Function (Spinach)
Small fishes (fish bone)

Zinc Enzyme activities (~300) Meat, Nuts and seeds Growth faltering, loss of taste, immune
Healing of wounds, Proper immune Shellfish, Cereal products impairment, loss of reproductive functions
functioning, Taste sensation, Growth Dairy products
Animal > Plant (phytate)

Iron Transport of O2 and CO2 around the Dark green vegetables Anemia, Neurocognitive impairment
body (hemoglobin), Enzyme function Legumes, whole grain
cereals, Liver
Animal > Plant (phytate)

Iodine Used to make thyroid hormone, that Iodized salt (fortification), Goiter, Mental and physical growth retardation
regulates metabolism in the body nuts and seeds, seaweed, in children (Cretinism), lack of thyroid function
cereals and grains (Hypothyroidism)
Micronutrients –
vitamins

Name Function Source Deficiency syndrome

Vitamin A Helps in vision (night vision), Liver, milk, cheese and Blindness, night blindness,
Fights infection butter, Carrots & dark increased infection
Anti-oxidant (against ROS), vegetables, fortified oil
epithelial integrity
Vitamin C Anti-oxidant (against ROS) Citrus fruits, green Scurvy (joint pain and bleeding
Wound healing (synthesis of vegetables, peppers and gum)
collagen), Iron absorption tomatoes
Vitamin D Calcium distribution in bones Sunlight (our body can make Poor bone growth, Rickets in
own vitamin D) can be from children
fortified food, fish, eggs
Balanced diet
▶ We need to “mix and match” different food items in right
proportion to ensure all essential nutrients are consumed

▶ A balanced diet should contain required energy adjusted

for the age, sex, body weight and physical activity of an
individual (energy balance). On average a male should
consume 2,500 kcal/day and a woman should consume
2,200kcal/day

▶ Consuming extra calories will result in weight gain

through deposition of fat, consuming less will not allow
body function optimally

▶ When the diet of a community is not balanced, they suffer

from micronutrient deficiency, a condition known as
“Hidden Hunger”
Classification of malnutrition

Abnormal Nutrition
Normal Nutrition
(Malnutrition)

Under-Nutrition Over-Nutrition
Overweight and Obesity,
Hypervitaminosis A

Protein Energy Micronutrient

Malnutrition Deficiency
Wasting Vitamin A deficiency
Stunting Zinc deficiency
Underweight Iodine deficiency
Iron deficiency
Protein Energy Malnutrition
ACUTE ACUTE AND CHRONIC

MILD MODERATE SEVERE

CHRONIC

To detect these, you need to know – Age, Weight and Height/Length

Overnutrition

▶Overnutrition is commonly used for the conditions

overweight and obesity, a condition where there is
excess fat accumulation in body that poses health risk

▶BMI is commonly used to determine overweight and

obesity. BMI is calculated by dividing weight in kg by
squared height in meter square. A BMI of ≥25 kg/m2 is
considered as overweight and a BMI of ≥30 kg/m2 is
considered as obese

▶Obesity and overweight are strongly associated with

more than 40 diseases including all major NCDs.
Nutritional
Transition
▶ When both undernutrition and over-nutrition prevails
in the same community/country that country is
considered to be going through “nutritional
transition” phase

▶ It can be also family level or even at individual level

▶ Developing countries are mostly affected

▶ Increases the risk of non-communicable disease in the

future generation

▶ Once an individual is affected, s/he carries it

throughout the life and passes to next generation
National prevalence
of malnutrition

WOMEN IODINE DEFICIENCY 2011 42%

SCHOOL AGE CHILDREN IODINE DEFICIENCY 2011 40%
WOMEN ZINC DEFICIENCY 2011 57%
UNDER 5 ZINC DEFICIENCY 2011 45%
WOMEN VITAMIN A DEFICIENCY 2011 5%
UNDER 5 VITAMIN A DEFICIENCY 2011 21%
WOMEN ANEMIA 2011 26%
UNDER 5 ANEMIA 2011 33%
WOMEN HIGH BMI (25.0 OR MORE) 2014 24%
WOMEN LOW BMI (LESS THAN 18.5) 2014 31%
UNDER 5 UNDERWEIGHT 2014 33%
UNDER 5 STUNTING 2014 36%
UNDER 5 WASTING 2014 14%
0% 10% 20% 30% 40% 50% 60%
Nutritional interventions
Nutrition Specific Interventions Nutrition Sensitive Approaches
(targets individual or families) (targets community or nation as a whole)

• Promote breastfeeding and IYCF* • Agriculture

practices
• Clean water and sanitation
• Fortification of Food Iodine Salt

• Education and Employment

• Micronutrient supplementation Protein shakes,
full cream milk
• Healthcare

• Treatment of Severe Acute Malnutrition • Women empowerment

*IYCF – Infant and Young Child Feeding Practices

Fortification Supplementation

Fortification refers to the process by which nutrients are

Supplementation refers to providing concentrated
added to usually staple foods to maintain or improve the
sources of nutrients (i.e. mineral and vitamins) that is
quality of the diet of a group, a community or a
meant to supplement nutrients in the diet
population

Long term preventive approach Short term corrective approach

Fortification cost is low Supplementation is expensive

Fortification covers the whole population Supplementation targets a specific groups of people

Example of Supplementation are Micronutrient

Examples of Fortification are Salt Iodization, Vitamin A supplementation for children (MoniMix), Iron-Folic Acid
fortification of edible oil supplementation for Pregnant women, Vitamin A
campaign for children

Fortification vs Supplementation
Food Safety and Food
Security
Food safety

▶ Food Safety refers to handling, preparing and storing

food (from farm to fork) in a way to best reduce the
risk individuals becoming sick from foodborne
illnesses (e.g., diarrhea, cholera, typhoid, hepatitis)

▶ Lack of food safety or “unsafe food” affects 1 in 10

people every year and children are the worst sufferer
because it initiates a vicious cycle between infection
and malnutrition

▶ Among the factors that affect the safety of our food,

contamination and adulteration are of prime
importance
Food contamination
Food contamination refers to food that has been corrupted by another substance – either physical,
biological or chemical (Usually done unintentionally)

Biological Contamination Physical Contamination

• Refers to food that is contaminated by • Physical contamination is when a foreign object
organisms or substances they produce contaminates food
• This includes biological matter produced by • This can happen at any stage of the production
humans, rodents, insects and microorganisms process and could include Band-Aids, steel wool or
• Bacteria and viruses are typically the two pieces of plastic
biggest causes of biological contamination • Physical contamination can cause injury to an
and can result in some of the most common individual who inadvertently consumes the foreign
types of food poisoning including salmonella, object
E.coli, listeria and Norovirus • The added risk associated with physical contamination
is that the foreign object could be carrying biological
contamination
Food contamination
Chemical Contamination
• Chemical contamination refers to food that has
been contaminated with a natural or artificial
chemical substance.
• These contaminants are particularly dangerous as
they expose people to any number of toxic
substances, some of which can be fatal.
• Chemicals can also contaminate food at any time
of the food process, whether by pesticides
transferred from the soil the food is grown in or
during the manufacturing process Cross Contamination
• Cross-contamination is when biological, physical or
chemical contaminants get into food, making it unsafe
to eat and putting people at risk of food-borne
diseases
Examples of Contamination
Microbiological: Bacteria, Virus, Prion, Parasites and their toxins

Physical: Hair (most common food contaminant), Jewelry, Glass or metal,

Pest drippings or pests itself, Dirt, Fingernail . Physical contamination most
of the time indicates microbiological contamination as well

Chemical: Kitchen cleaning chemicals, Pesticides and fertilizers, Non-food

grade plastics, Heavy metal (Lead, Cadmium, Mercury)
Food Adulteration
Food adulteration is the act of intentionally debasing the quality of food offered for
sale either by the admixture or substitution of inferior substances or by the removal of
some valuable ingredient
Food is adulterated if
• The food sold does not meet the nature of the substance or quality as per the demand of
consumer
• The food contains inferior or cheaper substance
• If the food’s original nature is substituted wholly or partially by abstracting a portion of vital
substance from food
• If it is an imitation of some other food substance
Food safety
challenges in
Bangladesh

Food samples tested from 2001 to 2009 by IPH

Food safety challenges
in Bangladesh
Food safety challenges
in Bangladesh
Food safety challenges
in Bangladesh
Contamination vs
Adulteration

Contamination Adulteration

Food contamination happens when “something” (contaminant) Food Adulteration refers to the process by which the quality or
gets into food that shouldn’t be there the nature of a given food is reduced through addition of
adulterants or removal of vital substance

Contaminant can be physical, chemical or Biological Adulterants are non-nutritious or even harmful substances

Contamination is usually done unintentionally Adulteration is done intentionally for more profit (by increasing
shelf-life, increasing the weight or improving the texture of
food items)

Examples of contaminants are hair, dust, pest or pest dripping Example of adulterants are carbide (to ripen fruit) formalin (to
(physical), heavy metal, non-food grade plastic, dishwasher, increase shelf-life), textile color (to make vegetable more
insecticide (chemical) bacteria, virus, prion, parasite (Biological) attractive), stone-chips (to increase weight of rice or other
grains)
 Causes Prevention

Cause and ▶ Profit motive of traders: ▶ Individual level: Consumers

Done as a part of the should be aware of
prevention of business strategy adulteration and avoid

Adulteration ▶ Scarcity of food and high

adulterated food/food
items
population demand
▶ Policy level: Government
▶ Lack of consciousness of
should make strict law
proper food consumption
against adulteration.
Regular monitoring should
▶ Lack of effective food laws
be done along with proper
and government initiative
implementation of law and
harsh punishment for those
who are involved in it
Effect of contamination
and adulteration

Contamination Adulteration

▶ Food borne disease(cholera, typhoid, hepatitis, food ▶ Acute problems like food poisoning
poisoning). Often these diseases are characterized by:
▶ Abdominal cramps ▶ Long term use can cause problems in heart, liver, kidney,
stomach and cancers in different parts of the body
▶ Nausea
▶ Vomiting ▶ Chronic consumption of non-nutritious adulterants can
lead to malnutrition, especially in children.
▶ Diarrhea – dehydration
▶ Fever

▶ Allergic reactions

▶ Poisoning from chemical substances, e.g. Mercury

Prevention of food contamination

Wash your hands before handling food, after going to the toilet. Wash and sanitize all
Wash surfaces and equipment used for food preparation

Separate raw and cooked food, use separate equipment and utensils such as knives and
Separate cutting boards for handling raw foods and store separate containers for raw and prepared
food

Cook food thoroughly, especially meat, poultry, eggs and seafood. Bring foods to boiling to
Cook make sure that they have reached 70°C. Reheat cooked food thoroughly
Prevention of food contamination

Keep food at safe temperatures, do not leave cooked food for more than 2 hours.
Refrigerate promptly (preferably below 5°C).Keep cooked food piping hot (more than
60°C) prior to serving

Use safe water(or treat it to make it safe) and raw materials. Choose foods processed
for safety, such as pasteurized milk. Wash fruits and vegetables, especially if eaten raw.
Do not use food beyond its expiry date

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Prevention of
Adulteration
Proper implementation of food law under continuous
surveillance

Regular monitoring of the activities with periodical records of

hazards regarding food adulteration.

Periodical training programs for workforce ensuring food safety

Existence of consumer awareness programs

Strict actions regarding the punishment for food adulteration

Food Security

▶Food security means ensuring (securing) food for

everyone in the population for all the time. It is usually
measured at the household level.

▶Food security exists when all people, at all times, have

physical, social and economic access to sufficient, safe and
nutritious food that meets their dietary needs and food
preferences for an active and healthy life

▶Absence of food security (food insecurity) can be due to

many reasons, almost all of them affecting the agricultural
production (water crisis, climate change, land degradation,
urbanization). It can also be due to natural disaster or
humanitarian crisis
Classification ▶Transitory: short term/temporary, usually
unpredictable (appears suddenly). Might occur
of Food due to sudden fluctuations in the food market

insecurity - ▶Chronic: long-term/persistent. Usually predictable

duration and occur due to more sustained causes like

poverty.

▶Seasonal: Another subdivision of chronic food

insecurity as it is predictable (or can be viewed as
recurrent transitory food insecurity). There is a
cyclical pattern of inadequate availability and
access to food. This is associated with seasonal
fluctuations in the climate, cropping patterns,
work opportunities etc.
Classification of Food
insecurity – severity
Dimensions of Food security

Availability: Physical availability of food from the “supply side” and is determined by the level of food
production, stock levels and net trade

Accessibility: Physical and Economic access to food and determined by incomes, expenditure, markets
and prices

Utilization: Biological aspect dealing with the way the body makes the most of various nutrients in the
food which is determined by good feeding practices, food preparation, diversity of the diet and intra-
household distribution of food

Stability: Refers to the importance the other three dimensions “at all times”
Impact of Food Insecurity in Public Health
Thank You