N u t r i t i o n for Rural Health

1. NutritionforRural Health Mukesh Vats

2. Topics covered • Introduction • Food, nutrition and relation with health • Nutritional status of rural India • Key issues related to nutrition • Macronutrients • Carbohydrates • Proteins • Fats • Water • Micronutrients • Vitamins • minerals • Nutrition related issues of rural women

3. Topics covered (contd..) • Nutrition related issues of rural children • Planning nutrition for rural india • Simple techniques to get nutrients • Mid day meal scheme • Nutrition and organic farming • Role of schools & parents • Role of government • Way ahead

4. INTRODUCTION • Nutrition is widely ignored problem when we discuss the issues related to rural development. • The nutrition directly affects the health of the rural masses thereby has a direct role in productivity of human resources . • The nutrition in rural context is also important from the point of view that the entire sources of nutrition come from rural areas and the rural people are most deficient in the nutritional status. • The rural women folk is mostly suffering from nutritional problems and need more attention.

5. Food, Nutrition and Relation with HEALTH • We define food as anything that provides nourishment to the body. • Food is important for sustaining the life itself. • Food has nutritional and non nutritional components. • The various function of food are, 1. Providing energy 2. Body building 3. Building resistance 4. Regulating body functions • Other than the above bio chemical functions, the food is also performing social and psychological functions.

6. Food, Nutrition and Relation with HEALTH (contd..) • We wonder how the food can perform non bio-chemical functions. Can we recollect the joy of having same food at picnic or during holi festival ! We know the satisfaction derived by a mother when her child likes the food prepared by her and eats it properly. • Nutrition is nothing but the study of food after consumption. • Our body requires the micro and macro nutrients in specific quantity. • Therefore it is not only important to have all nutrients but also in correct quantity.

7. (contd..) During Vedic period the food was classified into three categories i.e. rajsik, tamsik and satvik. The nutritional value of the food is sometimes linked to the market price of the food. It is incorrect to do so. The cheaper source of food could be much nutritious than the costly fast food. The fresh guava provides better nutrient than a stale apple. Rural set up in India provides better avenues for having cheaper nutrients . Proper design of meals can offer economical solutions if local needs and traditions are taken into consideration.

8. (contd..) • The concept of health not only includes the physical health but also the mental health and spiritual health. • Though the nutrition takes care of the physical health and to some extent the mental health, it can not deal with the spiritual health, which, however, should not be confused with the religious practices.

9. NUTRITIONAL STATUS IN RURAL INDIA • The nutritional status refers to health issues related to proper or improper use of nutrition. • The nutritional status is determined by study of diet pattern, study of illness suffered in the past and some pathological tests. • In case of studies related to populations, the statistical techniques are used for determining the nutritional status. • Some facts about nutritional status of rural india will be discussed now.

10. (contd..) • More than 20% rural children suffer from malnutrition. • About 40% children under five years are underweight. • Underweight among children is associated with illiteracy of their mothers. • Schedule tribe children have lowest nutritional status. • Highest number of children with low birth weight are in India. • About 60% children are anaemic and about 50% have access to iodized salt.

11. Malnutrition –a common problem of rural India

12. Key issues related to nutrition • Under nourished children can not become healthy citizens and will add to problems for rural India. • Resources meant for development will have to be diverted for providing good health. • The problem is generally not visible and not covered by press etc. • Poor nutritional status of mother affects the children also. • The illiteracy is attributed to be the root cause of all the problems.

13. (contd..) • Breast feeding of new born is still not followed in some sections of society, which can reduce infant mortality. • Colostrum provided to the infant by breast feeding ensures natural immunization. • Iron deficiency and mineral deficiency is very common among rural women and children. • Vitamin A deficiency is affecting vision of children in rural areas. • Iodized salt is still not so popular, resulting in Iodine deficiency whichcauses hormone related problems like mental retardation.

14. (contd..) • The girls of growing age requires folic acid supplements along with iron supplement. • The nutritional status of the pregnant women and lactating mothers in rural areas is cause of concern.

16. Should we ignore this ???

17. Macronutrients - Carbohydrates • The carbohydrates are the major components of food and classified as organic compounds. • The carbohydrates are made up of three elements i.e. carbon, hydrogen and oxygen. • All plant based foods are sources of carbohydrates. • The plant based carbohydrates are further classified as available or non available. • The human digestive system can not digest all types of carbohydrates therefore some are classified as non available i.e. fibres.

18. (contd..) • The various sources of carbohydrates are 1.sugar (gur, cane sugar or honey) 2.cereals(wheat, rice, barley, pulses, millets) 3.roots(potato, tapioca) 4.fruits(banana, mango etc.) • The above list is only indicative, almost all fruits, vegetables are sources of carbohydrates. • Carbohydrates are not temperature sensitive. • The carbohydrates can be stored for a long time without deterioration in quality.

19. Functions of carbohydrates • The carbohydrates are primarily energy giving foods. One gram of carbohydrate gives 4 calories of energy to the body. • Carbohydrates are cheapest sources of energy for our body. • The sufficient amount of carbohydrates are required for proteins to do the function of body building. • Similarly, insufficient carbohydrates in the diet will result in breaking of the fats for giving energy, which is also not good for health in excessive quantities.

20. (contd..) • Extra amount of carbohydrates consumed is stored in the form of glycogen but in limited quantities, afterwards it is stored in form of fat. The extra amount of fat accumulated in the body contributes to extra weight. • The non available carbohydrates are fibres since the enzymes present in the intestine are not able to digest the same. • Fibres are important for our body in many ways; 1. They absorb water and give a feeling of fullness .

21. (contd..) 2. They help in the elimination of the non useful part of the food out of the body. 3. The fibres save us from many disease like heart problems, cancer and diabetes. • The whole grains, fruits and vegetables are important sources of the fibres. • We must avoid the refined food to get good quantity of fibres. • Animal products generally do not contain fibres.

22. Sources of Carbohydrates

23. Proteins - macronutrient • Proteins are also organic compounds like carbohydrates. • The proteins are made up of Carbon, Hydrogen, Oxygen and Nitrogen. • There are hundreds of types of proteins but they are made up of 22 amino acids in different combinations. • There are 8 amino acids which can not be manufactured by our body. • These amino acids are called essential amino acids and should be supplied by food only.

24. (Contd..) • The quality of proteins depend on the number of amino acids present as also in proper proportion. • Vegetarian and non vegetarian food both supply us the proteins. • The plant based proteins lack in one or two amino acids. • Pulses and the grains have different types of amino acids, therefore the traditional Indian foods like dosa, dalia with milk or dal with rice or roti are good combinations for proper absorption of proteins. • The combination of plant and animal based proteins make very good combination.

25. (contd..) • Soyabean, rajmah, lobia, blackgram etc. are good sources of protein. • The oil seeds like groundnuts, til etc. also contain good amount of proteins. • Milk, Paneer and Khowa are good sources of animal based proteins acceptable to vegetarians. • Meat, fish and eggs are non vegetarian sources of proteins.

26. Nutrition values of common food items

27. (contd..) • While planning a balanced diet we have to consider the cost vs. availability of protein and its acceptability to the consumers. • The scenario of rural India is different from the urban areas as there may be excess production of some thing and some required source may not be available at all. • Functions of protein are as under, 1.First and most important function is body building. (requirement of proteins reduces with the age) 2.Proteins also act as carriers of essential things like hemoglobin.

28. (contd..) • The proteins also give energy when the carbohydrates are not sufficient. • Some of the essential substances for body like enzymes and antibiotics are also proteins. • The digestion of proteins is dependent on enzymes present in gastric juices. • Only good quality protein( rich in all types of amino acids) is used by body for the formation of tissues. • A balanced diet is important for proper utilization of protein.

29. Complementary proteins

30. Protein sources

31. Fats • Fats are organic compounds made up of carbon, hydrogen and oxygen. • Fats are made of fatty acids and glycerol. • Like amino acids there are two essential fatty acids which can not be produced by body. • Fats and oils are triglycerides chemically but fats contain more saturated fatty acids and the oils contain less saturated fatty acids. • Main sources of fats are milk and other animal products like eggs. • The sources of oil are oil seeds, dry fruits, coconut and soyabean etc.

32. (contd..) • Generally we think that fats are harmful substances and may be avoided to the extent possible. In fact the fats are essential part of the nutrition if taken in moderation. • The energy supplied by fats is highest i.e. 9 cal per gram. • Fats take much time in digestion and give the feeling of satisfaction for long time. • The layers of fats stored under skin provide insulation to the body. • Fats are carriers of fat soluble vitamins.

33. Sources of Fats

34. Water • Water is most important nutrient for all living creatures. • The water in natural form contains various minerals which are required for human body. • The water is major content of our body and it acts as a medium for all fluids. • It regulates our body temperature. • Water acts as solvent for most of the nutrients for the body. • Our body receives water either directly or with other foods like vegetables and fruits.

35. Micronutrients- Vitamins • Vitamins are organic compounds with complex chemical structure. • Our body requires vitamins in very small quantities. • The vitamins have been classified as fat soluble or water soluble. • Vitamin A is found only in foods of animal origin, however some vegetables with yellow or orange colour have compounds that can be converted to vitamin A by the body. • As the conversion of vegetable source is not efficient, vegetarians should consume the foods containing beta carotene in large quantities.

36. (contd..) • Vitamin A is useful for maintaining normal vision. • It supports growth of the bones and protects the body from diseases and infections. • Vitamin D can be manufactured by our body in the presence of sunlight. • Main sources of vitamin D are animal based - fish oil is best source of vitamin D. • It helps in building bones and helps in absorption of the minerals.

37. Vitamin sources

38. (contd..) • Vitamin E is fat soluble and is found in small quantities in all vegetarian sources of food. • It saves the other important sources of nutrition from destruction. • Vitamin K is found in some of the vegetables and also in animal foods. • This vitamin is also manufactured in the body. • This vitamin is fat soluble and helps in clotting of blood.

39. (contd..) • Vitamin B complex refers to a group of water soluble vitamins & acts like coenzymes thus helping enzymes to perform their role. • Vitamin B1 is found in all types of foods except fats and sugars. Refined flour like Maida and polished rice contain little amount of vitamin B complex. • The sprouted and fermented food are good sources of this vitamin. • This vitamin is very important for various metabolic activities of body.

40. (contd..) • Vitamin B2 is also found in all types of food and increases with sprouting & fermentation. • This vitamin also helps in metabolism of macro nutrients. • Folic acid is found in all types of foods. • This is very important for formation of blood cells. • Vitamin B12 is found only in non vegetarian food but can be manufactured in the body. • This vitamin is important for functioning of nervous system and bone marrow.

41. (contd..) • Vitamin C is found in fresh fruits and green vegetables. • Animal foods are deficient in supply of vitamin C. • It is distributed in various important organs of the body. • It is helpful in healing of wounds. • It is a known anti-oxidant and helps in absorption of iron. • It protects some important substances from destruction.

42. CITRUS FRUITS FOR VITAMIN C

43. Micro nutrients - Minerals • Our body requires some inorganic compounds for proper functioning in small quantities but some of these minerals are required in comparatively larger quantity such as calcium, phosphorus, sodium, potassium, chloride and magnesium. • Minerals like iron, iodine, zinc and copper are required in still smaller quantities. • There are some trace elements which are required in negligible quantities.

44. (contd..) • Calcium and phosphorus account for 75% of mineral contents of our body. • Calcium and Phosphorus are required for development of bones and teeth. • Calcium helps in functioning of muscles and cells. • It is also required for proper functioning of nerves and clotting of blood. • Phosphorus is important for metabolism and formation of genetic material.

45. MINERAL SOURCES

46. (contd..) • Milk and milk products are good sources of calcium. • Some pulses and beans also contain good amount of calcium. • Sodium is present in our body in the extra cellular fluids. • It helps in regulating alkalinity and acidity of fluids found in body. • It also helps in functioning of nervous system and cells.

47. (contd..) • We get maximum sodium from common salt. However, excess consumption is bad for body. • Iron is required in very small amount, it helps in transport of oxygen in the body and helps In oxidation within the cells which in turn is responsible for release of energy for work. • It helps in functioning of the brain. • Absorption of iron is promoted by vitamin C. • Iodine is very important in nominal quantity and is required for proper functioning of thyroid glands. It is found in sea food.

48. (contd..) • Only some of the very important minerals and vitamins have been discussed here. • In fact the food contains large number of known and unknown sources of nutrition which are very important for our body.

49. Nutrition related issues of rural women • Macro indicators: • Life expectancy is lower than males, much lower than urban women and below developed nations. • Sex ratio is declining slowly but rate is less than the urban counterparts. • The average height and corresponding weight is below the standards . • Anaemia is main problem of the rural women due to deficiency of iron and folic acid.

50. (contd..) • The women require more quantities of iron as compared to men. • At least 50% rural women and girls are suffering from anaemic conditions. • This is also one of the reasons of maternal mortality in India. • The main reason of poor nutrition among rural women is early marriage. • The other reason is repeated child birth.