Pharmacy Level III

Learning Guide -16

Unit of Competence: Provide Information on Nutritional Supplement
Module Title: Providing Information on Nutritional Supplement

LG Code: HLT PHS3 M04 LO2- LG16

TTLM Code: HLT PHS3 TTLM 0919

LO 2: Provide information on nutritional products.

Learning Guide #-1

Instruction Sheet
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This learning guide is developed to provide you the necessary information regarding the
following content coverage and topics –
 Product information (name, strength, use, precautions, storage condition,
direction for use and possible adverse drug reactions) are accurately conveyed
to customers
 Complementary products are recommended to clients
 Products are correctly identified to assist customers' purchase decisions.
 New products are promoted to customers according to promotional guideline

This guide will also assist you to attain the learning outcome stated in the cover page.
Specifically, upon completion of this Learning Guide, you will be able to:
o Assess nutritional status and nutritional requirements
o Select nutritional product
o Provide relevant nutritional product information
Learning Instructions:
1. Read the specific objectives of this Learning Guide.
2. Read the information written in the information Sheet
3. Accomplish the Self-check

INFORMATION
Learning Guide #16 Provide information on nutritional products
SHEET #1

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 2.1. Assessment of nutritional status and
Topic
nutritional requirements

2.1.1. Nutritional Assessment

Definitions:
 Refers to the interpretation of information obtained from anthropometric, dietary,
biochemical, clinical signs/symptoms and socio-demographic information.
 The nutritional status of an individual is often the result of many inter-related
factors.
 The spectrum of nutritional status spread from obesity to severe
malnutrition
 The purpose of nutritional assessment is to:
• Identify individuals or population groups at risk of becoming
malnourished
• Identify individuals or population groups who are malnourished
• To develop health care programs that meet the community needs
which are defined by the assessment
• To measure the effectiveness of the nutritional programs &
intervention once initiated
What does good NS mean?
• Good status of health;
• Good supply of energy to perform daily activities;
• Good cognitive and analytic skills;
• Speedy healing process of injuries & recovery from illness .

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 Forms of Nutritional Assessment:

1. Surveys (a cross-sectional assessment of nutritional status of a selected

population group)

2. Surveillance (Continuous monitoring of the nutritional status of selected

population groups)

3. Screening (Identification of malnourished individuals requiring intervention)

N.B: each of the above has been adopted in clinical medicine as well as preventive
medicine.

Methods of Nutritional Assessment

• Nutrition is assessed by two types of methods; direct and indirect.

The direct methods deal with the individual and measure objective criteria, while indirect
methods use community health indices that reflects nutritional influences. In this
learning module, you will see only Direct Methods of Nutritional Assessment.

Direct Methods of Nutritional Assessment

These are summarized as ABCD
• Anthropometric methods
• Biochemical, laboratory methods
• Clinical methods
• Dietary evaluation methods
N.B: The ABOVE methods can be used either alone or more effectively in combination

INDIRECT
• Morbidity & mortality data,
• Assessment of dietary intake,
• Food balance sheet

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2.1.1.1. Anthropometric Methods

Measurements of the physical dimensions and gross composition of the body – vary
with age and degree of nutrition. Particularly useful when chronic imbalances of protein
and energy are likely. Provides information about past nutritional history.

Two types:

Growth Body composition

Height/length Body fat
Body weight Fat-free mass
Head circumference Skeletal & non-skeletal muscle
Soft lean tissues
Skeleton

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Fat-free mass
• Mid-upper-arm-circumference
• Mid-upper-arm muscle circumference
• Mid-upper-arm muscle area

Anthropometric indices
• Assess growth and body • Anthropometrist trained
composition until acceptable level of
• Used extensively precision and accuracy are
• Can be performed in a obtained
quick easy and reliable • Measurement procedures
way reviewed periodically
• Use portable equipment • Accurate measurement of
• Standardized methods and  Age
calibrated equipment are  Birth weight
used (infant)
 Birth length
 Gestational
age
If unknown, build locally relevant
community specific calendar.

Growth indices based on:

• Length/height-for-Age and
• Weight- for-length
Are recommended by WHO for evaluating impact of nutrition intervention on children.
• Length-for-age: more sensitive for measuring the impact of nutrition
intervention strategy.
In stunted population with normal weight-for-length/height, nutrition intervention may
have no impact on wasting indicators. Despite WHO recommendation weight expressed

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in relation to age is the most widely used anthropometric index because of difficulty of
measuring length. Weight-for-age does not discriminate between wasting and stunting,
and underestimate malnutrition in stunted population.
Body composition indices derived from:
• Skin fold thickness
• Mid upper arm circumference
Mid upper arm fat area
• Derived from triceps skin fold using standard equation
• Provide indirect estimate of total body fat
• Monitor alteration in body fat
Mid upper arm circumferences
• Derived Mid upper arm circumferences using standard equation
• Provide indirect estimate of lean body mass
• Monitor alteration in protein reserve of the body
I. Weight-for-age:
• identifies the condition of being underweight, for a specific age.
• reflects both past (chronic) and/or present (acute) undernutrition (although
it is unable to distinguish between the two).
• Prevalence of underweight is a Millennium Development Goal Indicator.
II. Height-for-age:
• identifies past undernutrition or chronic malnutrition.
• For children below 2 years of age, the term is length-for-age; above 2
years of age, the index is referred to as height-for-age.
• Deficits in length-for-age or height-for-age is referred to as stunting.

III. Weight-for-height:
• identify children suffering from current or acute undernutrition or wasting
• useful when exact ages are difficult to determine.
• Appropriate for examining short-term effects such as seasonal changes in
food supply or short-term nutritional stress brought about by illness.

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 Anthropometric Indices

Indicators Indices
Wasting
Weight/Height
(Acute malnutrition)

Stunting
Height/Age
(Chronic malnutrition)

Underweight
Weight/Age
(Acute and/or chronic)

• To determine the nutritional • Anthropometric surveys based on

status of an individual, ALL those three indices:
variables are necessary:
• Weight/height index
• Weight (W/H)
• Height
• Height/age index (H/A)
• Presence of bilateral
edema • Weight/age index (W/A)
• Age, Sex

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MUAC Tape
This arm circumference insertion tape measures mid-upper arm circumference of
children, up to 25 cm. Colour-coded in red/yellow/green, non-tear, stretch-resistant
plasticized paper. Supplied in pack of tapes together with written and pictorial
instructions for use.

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2.1.1.2. Biochemical /Laboratory Methods

In primary and/or secondary deficiencies, the tissue stores become gradually depleted.
This may result in reductions in the levels of nutrients or their metabolic products in
certain body fluids and tissues, and/or in the activity of some nutrient-dependent
enzymes. Biochemical and/or physiological/behavioural function tests could detect
these states.

Types of Biochemical Methods

a. static: detected by body fluids (invasive)
Examples: Hb, UIE, Serum retinol, Albumin etc
b. functional: detected by abnormal test results

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 Examples of functional test:
• Dark adaptation test (VAD)
• Taste acuity (Zinc)
• Capillary fragility (Vit C)
• Cognitive function (iron)
Functional tests provide a measure of the biological importance of a given nutrient
because they assess the functional consequences of the nutritional deficiency.

2.1.1.3. Clinical methods

A medical history and physical examination are used to detect symptoms and signs;
These Signs and Symptoms are often non-specific and only develop during the
advanced stages of nutritional depletion. Table 1. summarizes the major clinical findings
of clinical importance.

Micronutrient Malnutrition – Detection, Measurement and Intervention

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2.1.1.4. Dietary methods

First stage of any nutritional deficiency identification. It Can be because of primary

deficiency or secondary deficiency.
 Primary deficiency: low level of nutrient in the diet
 secondary deficiency:
 dietary intake may appear to meet nutritional needs
 Factors interfere with ingestion, absorption, transportation,
utilization or excretion of nutrients
 certain drugs, dietary component, disease state.
Several dietary methods are available
 The choice depends on the primary objective of the study
 Information of proportion of the population “at risk” of inadequate intake
of nutrient is required
 Used to ascertain whether assessment using more invasive laboratory
methods is warranted in a specific population or subgroups.
 Nutritional intake of humans is assessed by five different methods. These are:
1. 24 hours’ dietary recall
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 2. Food frequency questionnaire
3. Dietary history since early life
4. Food dairy technique
5. Observed food consumption
1. 24 hours Dietary Recall
A trained interviewer asks the subject to recall all food & drink taken in the previous 24
hours. It is quick, easy, & depends on short-term memory. It may not be truly
representative of the person’s usual intake.
2. Food Frequency Questionnaire
 In this method the subject is given a list of around 100 food items to indicate his
or her intake (frequency & quantity) per day, per week & per month.
 inexpensive, more representative & easier to use.
• Limitations:
 long Questionnaire
 Errors with estimating serving size.
 Needs updating with new commercial food products to keep pace with
changing dietary habits.
3. Dietary history
 Interview method consisting of a 24-h recall of actual intake, plus information on
overall usual eating pattern, followed by a food frequency questionnaire to
verify and clarify initial data. Usual portion sizes recorded in household
measures. Nutrient intakes calculated using food composition data
 It is an accurate method for assessing the nutritional status.
 The information should be collected by a trained interviewer
 Details about usual intake, types, amount, frequency & timing needs to be
obtained.

 Used to describe
 food and/or nutrient intakes over a long time period
 can be used to estimate prevalence of inadequate intakes.

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  information used for national food policy development, food fortification
planning,
 Limitations
 Labour-intensive, time-consuming and results depend on skill of
interviewer.
4. Food diary
 Food intake (types & amounts) should be recorded by the subject at the time of
consumption. The length of the collection period ranges between 1-7 days.
 Reliable but difficult to maintain.
5. Observed Food Consumption
 The most unused method in clinical practice, but it is recommended for research
purposes. The meal eaten by the individual is weighed and contents are exactly
calculated. The method is characterized by having a high degree of accuracy but
expensive & needs time & efforts.

2.1.2. Calculating nutritional requirements

2.1.2.1. Methods of calculating normal nutritional requirements
Calculators are available to help you determine your nutritional needs, BMI, body fat,
food plan, point converter (for Weight Watcher's), and activity calorie assessments.
Macronutrients are eaten in large amounts and include the primary building blocks of
your diet — protein, carbohydrates, and fat — which provide your body with energy.
Vitamins and minerals are micronutrients, and small doses go a long way. There are six
main groups of essential micronutrients and macronutrients.
2.1.2.2. Influence of age, sex and other factors

The factors that affect the nutritional requirements of an individual are the quality and
quantity of the food they eat, the efficiency of their digestive system in absorbing and
utilizing eaten food and biochemical availability. Biochemical availability is the optimum
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range of intake of a person essential nutritional requirement. This nutritional
requirement is influenced by age, growth, sex, pregnancy and breastfeeding, illness,
psychological and emotional stress, activity level and other factors like smoking and
drinking.

Nutritional requirements change as a person gets older, because the elderly use a lot of
medication their absorption, excretion and utilization of nutrients can be affected.
Growing children have different nutritional needs to that of adults. For example, a
growing infant requires a higher intake of essential fatty acids than that of an adult. In
the same way there are different nutrition requirements for young and old there are also
very different requirements between the sexes. For example, a woman's nutritional
requirements can vary throughout her menstrual cycle, also a woman who is pregnant
or breastfeeding has different nutritional requirement to that of one who is not.
Nutritional requirement vary depending on whether someone is healthy or ill. As
diseases are unique so are the nutritional requirements needed whilst that person is ill.
The same applies to psychological and emotional stress. When people are affected by
stress their appetite is affected, this results in less intake of food which in turn results in
less nutrients being absorbed.

A person activity level will affect their nutritional requirement. An athlete will need a
different nutritional requirement to that of an office worker. Exercise improves metabolic
efficiency in some people and increases nutrient requirement.

2.1.2.3. Nutritive value of common foods

It relates to carbohydrates, fats, proteins, minerals, additives, enzymes, vitamins, sugar intake,
cholesterol, fat and salt intake. Nutritive value is essential in maintaining performance of
neonatal, growing, finished and breeding animals. In general food label gives nutritional
values to consumers.

Self-check 1:
1. Which of the following methods of nutritional assessment is concerned the
measurement of variations of physical dimension and growth compositions?
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 A. Anthropometric method
B. Biophysical method
C. Clinical method
D. Dietary intake method
E. Ecological method
2. Which of the following indices of growth shows chronic nutritional deficiency?
A. Stunting B. wasting C. underweight D. BMI
3. The purpose of nutritional assessment is to:
A. Identify individuals or population groups at risk of becoming malnourished
B. Identify individuals or population groups who are malnourished
C. To develop health care programs that meet the community needs which
are defined by the assessment
D. To measure the effectiveness of the nutritional programs & intervention
once initiated
E. All

Learning Guide #16 Provide information on nutritional products

INFORMATION
SHEET #2 2.2. Selection of nutritional product
Topic

 Your nutritional needs depend on:

 Your age
 The types of foods you eat 
 Any medical conditions you have
 What health problems you’re likely to get.

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For instance, if an individual at risk for osteoporosis, calcium and vitamin D may
recommended. Or for a woman who might get pregnant, it’s important to take folic acid,
which helps prevent certain types of birth defects. Or if an individual is working on better
heart health, his/her plan might include omega-3s.
To ensure food safety and nutritional quality throughout the entire food supply chain,
“from field to consumer”, establishing a new concept capable of consolidating safety
and quality benefits at the level of consumer health was necessary. The main purpose
of all good practices in the food safety circle is to provide consumer with safe, healthy,
and high-quality food.

Self-check 2:
 List the criteria to select nutritional product

Learning Guide #16 Provide information on nutritional products

INFORMATION
2. 3. Providing relevant nutritional product
SHEET #3
information
Topic

Providing nutrition counseling in health and disease; developing, implementing, and

managing nutrition care systems; and. evaluating, making changes in, and maintaining
appropriate standards of quality in food and nutrition care services.
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Nutrition education is an essential component in improving dietary habits and food
choices, in order to reverse the under nutrition and improve the nutritional diagnosis.
Nutrition education presents general information related to health and nutrition, often to
groups in clinic waiting rooms or community settings. Educators may be trained
counselors or health volunteers who deliver prepared talks on specific topics, often
using visual aids. They should encourage clients to ask questions and direct them to
additional information as needed.

Nutrition counseling is an ongoing process in which a health professional, usually a

registered dietitian, works with an individual to assess his or her usual dietary intake
and identify areas where change is needed. The nutrition counselor provides
information, educational materials, support, and follow-up to help the individual make
and maintain the needed dietary changes. The goal of nutrition counseling is to help a
person make and maintain dietary changes. Nutrition counseling aims to help clients
understand important information about their health and focuses on practical actions to
address nutrition needs, as well as the benefits of behavior change.

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Nutrition can affect the body’s response to drugs; conversely, drugs can affect the
body’s nutrition. Foods can enhance, delay, or decrease drug absorption. Foods
impair absorption of many antibiotics. They can alter metabolism of drugs; e.g., high-
protein diets can accelerate metabolism of certain drugs by stimulating cytochrome P-
450.
Self-Check 3:
 Discuss Nutritional education and counseling

References
 https://www.boxingscene.com/nutrition/56270.php
 https://www.bapen.org.uk/members/pdfs/conf_presentations/2010/symposium4-
chris-slater.pdf
 American Dietetic Association and Dietitians of Canada. Manual of Clinical
Dietetics. 6th edition. Chicago, Illinois: American Dietetic Association, 2000
 Food and Nutrition Technical Assistance III Project (FANTA). 2016. Nutrition
Assessment, Counseling, and Support (NACS): A User’s Guide—Module 3:
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 Nutrition Education and Counseling, Version 2. Washington, DC: FHI
360/FANTA.
 Human Nutrition A Health Prospective, Mary E. Barasi, Second Edition in 2003
Hodder Arnold, 338 Euston Road, Landon NW1 3BH.
 Nutrition A Health Promotion Approach, Geoffrey P Webb. Third Edition, in 2008
Hodder Arnold, UK, 338 Euston Road, Landon NW1 3BH.
 Essentials of Human Nutrition, Jim Mann and A. Stewart Trus well, Second
Edition in 2002, Oxford University Press.
 Human Nutrition for Health science students, Tefera Belachew, Jimma
University, 2007.
 Gibson, Principles of nutritional assessment oxford 1990.

 FMOH, protocol for the management of severe acute malnutrition 2004, 2007
and 2013.
 FMOH, National guideline for control and prevention of micronutrient deficiency,
2004

Prepared By
Educational
N LEVE Regio Phaone
Name Backgroun College Email
o L n Number
d
1 Nagelle [email protected] 092179872
Debisa Taressa Pharmacy B Oromia HSC m 8
Nagelle 093067505
2 Tamene Galchu Pharmacy B Oromia HSC [email protected] 5
3 091048018
Ebrahim Dawud Pharmacy A Somali Jigjiga HSC [email protected] 6
Alemseged 091373979
4 Workneh Pharmacy A Harari Harar HSC [email protected] 2
5 091750409
Habtamu Tarekegn Pharmacy B BGRS Pawi HSC [email protected] 4

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