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Abstract
To show that nutrition science, with its application to food and nutrition policy,
now needs a new conceptual framework. This will incorporate nutrition in its
current definition as principally a biological science, now including nutritional
aspects of genomics. It will also create new governing and guiding principles;
specify a new definition; and add social and environmental dimensions and
domains. Method: A narrative review of nutrition science, its successes and
achievements, and its dilemmas, paradoxes, shortcomings, dissonances and
challenges. Reference is made to 16 associated papers. Equal use is made of
continuous text and of boxed texts that extend the review and give salient
examples.
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Introduction
We have now entered a new era of human history. We are moving out of the period
in which human activity has been mainly concerned with exploitation, production
and consumption, into a new period in which our main concerns are and will
remain ones of preservation, conservation and sustenance. This is inescapable, and
has the greatest significance for those human activities with the greatest impact
on the living and natural world. The implications for all sciences and technologies
are profound. There is in any case imperative need for nutrition science to gain a
new definition, new governing and guiding principles, and extended dimensions
and domains. The science, with its application to food and nutrition policy, is
already breaking out of its original physiological, biochemical and medical frame,
and is extending into other dimensions and domains; but it has not yet gained the
overall conceptual framework needed by all sciences and indeed by all structured
and sustained human activity
Nutrition is the study of food and how it works in your body. Nutrition includes
all the stuff that's in your food, such as vitamins, protein, fat, and more. It's
important to eat a variety of foods, including fruits, vegetables, dairy products,
and grains, so you have what you need to grow and be healthy.Nutrition is defined
as the processes by which an animal or plant takes in and utilises food
substances. Essential nutrients include protein, carbohydrate, fat, vitamins,
minerals and electrolytes. Normally, 85% of daily energy use is from fat and
carbohydrates and 15% from protein.
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Balanced Diet
A balanced diet is one which includes a variety of foods in adequate amounts and
correct proportions to meet the day’s requirements of all essential nutrients such
as proteins, carbohydrates, fats, vitamins, minerals, water, and fibre. Such a diet
helps to promote and preserve good health and also provides a safety margin or
reserve of nutrients to withstand short durations of deprivation when they are not
supplied by the diet.
Fig-1:Nutrition
The safety margin takes care of the days we fast, or the short-term deficiency of
certain nutrients in the daily diet. If the balanced diet meets the Recommended
Dietary Allowances (RDAs) for an individual, then the safety margin is already
included since RDAs are formulated keeping extra allowances in mind.
Recommended Dietary Allowances = Requirements + Margin of safety A
balanced diet takes care of the following aspects.
1. Includes a variety of food items
2. Meets the RDA for all nutrients
3. Includes nutrients in correct proportions
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Health and Fitness
According to World Health Organisation (WHO) ‘‘Health is the state of complete
physical, emotional, and social well-being, not merely the absence of diseases or
infirmity.’’ This definition has remained unchanged since 1948. All of us want to
maintain positive health, i.e., a perfect blend of physical, social and mental. Taking
adequate amounts of essential nutrients in our diet is necessary to maintain positive
health.
Physical health is probably the most easily understood aspect. Mental health can be
defined as a state of emotional and psychological well-being in which an
individual is able to use her or his cognitive and emotional capabilities,
function in society, and meet the ordinary demands of everyday life. In other
words, the absence of a recognised mental disorder is not necessarily an indicator
of mental health. One way to assess mental health is to see how effectively and
successfully a person functions. Feeling capable and competent, being able to
handle normal levels of stress, maintaining satisfying relationships, and leading an
independent life; and being able to ‘bounce back’ or recover from difficult
situations are all signs of good mental health.
Thus, health is a state of complete mental, physical and social wellbeing whereas
fitness is the ability to meet the demands of a physical task. A well-nourished and
fit person is better able to learn and has more energy, stamina, and self-esteem. A
healthy eating pattern along with regular exercise will certainly help to remain fit.
Teenagers between the ages of 12 and 18 who have unhealthy eating behaviours
and are undernourished develop eating disorders.
Using Basic Food Groups For Planning Balanced Diets
One of the simplest ways to plan a balanced diet is to divide foods into groups and
then make sure that each group is included in the meals. A food group consists of
different foods which have common characteristics.
These common features may be the source of food, the physiological function
performed, or the nutrients present. Foods can be grouped on the basis of the
predominant nutrients present in them.
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This classification varies from one country to another depending on many factors.
The five food group classification is used in India as a guide to meal planning.
Many factors have been considered while compiling these groups such as
availability of food, cost, meal pattern, and deficiency diseases prevalent. Not all
foods in each group are equal in their nutrient content. That is why a variety of
foods from each group should be included in the diet.A classification based on
nutrients present will ensure that all nutrients are made available to the body and
offer greater variety within the group.
Fig-2:Body diet
There are five basic food groups suggested by the Indian Council of Medical Research
(ICMR). These include:
• Cereals, grains and products
• Pulses and legumes
• Milk and meat products
• Fruits and vegetables
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Vegetarian Food Guide
Vegetarian diets rely mainly on plant foods: grain, vegetables, legumes, fruits,
seeds, and nuts. Some vegetarian diets include eggs, milk products, or both. People
who do not eat meats or milk products can still use the daily food guide to create
an adequate diet. The food groups are similar and the number of servings remains
the same. Vegetarians can select alternatives to meat such as legumes, seeds, nuts,
tofu and for those who eat them, eggs. Legumes, and at least one cup of dark leafy
greens, help to supply the iron that meats usually provide. Vegetarians who do not
drink cow’s milk can use soy ‘milk’ – a product made from soyabeans that provides
similar nutrients if it has been fortified with calcium, vitamin D, and Vitamin B12
(i.e., these nutrients are added). lower sections of the pyramid. Each of these food
groups provides some,but not all of the nutrients you need. Foods in one group
cannot replace those in another. No one food group is more important than another
– for good health you need all of them.
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The pyramid is an outline of what to eat each day.
4.1.Dietary Patterns in Adolescence
Healthy eating is vital for the teenager’s health and well-being. The nutritional
needs of adolescents vary tremendously, but generally increase due to rapid growth
and changes in body composition that occur during puberty. Adequate nutrition is
vital for ensuring overall emotional and physical health. Good eating habits help
prevent chronic illness in the future, including obesity, heart disease, cancer and
diabetes. Studies of nutrient intakes have shown that adolescents are likely to obtain
less vitamin A, thiamine, iron, and calcium than recommended. They also ingest
(consume) more fat, sugar, protein, and sodium than is currently thought to be
optimal.
Irregular meals and skipping meals: The numbers of meals teenagers miss and
eat away from home increases from early adolescence to late adolescence,
reflecting the growing need for independence and time away from home.
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Fig-4:Unhealth Food
Snacking: Snacking is probably a survival technique for teens. Snacking does not
have to be a bad habit. It can help maintain energy levels, particularly in active and
growing adolescents.
Fast foods: Adolescents, particularly in urban areas, are more apt to eat fast food
because it is convenient and typically a social affair, and they may believe it is the
fashion of the day.
Dieting: Obesity is becoming a crucial problem among adolescents. Intervention is
needed to maintain ideal body weight among the entire population. If this is not
maintained, 80 per cent of them will stay overweight as adults.
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Nutritional Limitations of Fast Foods
The following factors appear to be the major nutritional limitations of fast-food
meals. Calcium, riboflavin, vitamin A: These essential nutrients are low unless
milk or a milkshake is ordered.
Folic acid, fibre: There are few fast food sources of these key factors.
Fat: The percentage of energy from fat is high in many meal combinations.
Sodium: The sodium content of fast food meals is high, which is not desirable.
Energy: Common meal combinations contain excessive energy when compared
amounts of other nutrients provided.
Although fast foods can contribute nutrients to the diet, they cannot completely
meet the nutritional needs of teenagers. Both adolescents and health professionals
should be aware that fast foods are acceptable nutritionally when they are
consumed judiciously and as a part of a well-balanced diet. But when they become
the mainstay of the diet there is cause for concern. A nutrient imbalance may not
appear to be a problem until a number of years have gone by, unless some specific
problem such as a chronic disease exists. However, evidence is accumulating to
show that food intake patterns of teenagers affect their health in later life.
A healthy diet is essential for good health and nutrition. It protects you against
many chronic noncommunicable diseases, such as heart disease, diabetes and
cancer. Eating a variety of foods and consuming less salt, sugars and saturated and
industrially-produced trans-fats, are essential for healthy diet.
However, adolescents with normal weight often diet because of the perception that
“thin is in”. Girls are bombarded with messages from the media about thinness,and
body weight
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Modifying diet related behaviour
As you have read in the chapter on ‘Self ’, adolescence is a time when an individual
begins to question authority and tries to establish her/his status. Eating behaviour
is one of the mediums through which individuality may be expressed by
adolescents. Thus, rejection of routine home food (which may be healthy) and
eating outside (not so healthy), sometimes in order to conform to peer preferences,
is not uncommon in adolescence.
It is easier for us to change lifestyle and diet patterns if we are convinced that we
want to do so. What are the ways in which adolescents can modify their own
behaviour? The next section tells us more about how to adopt healthy dietary
practices.
Limiting television viewing: Television viewing should be limited to about one
or two hours each day (this includes playing video games or using the computer).
Watching television does not use up many Calories and it encourages eating
erratically, since it is common to eat while watching TV. Overeating and
undereating is common among those who do it.
Healthy eating habits: Eat three balanced meals One must try not to skip meals.
Snacks: Snacks should be limited to two each day and they can include low calorie
foods, such as raw fruits or vegetables. Avoid using high calorie or high fat foods
for snacks, especially potato chips, biscuits and fried foods. Of course, favourite
snacks can be consumed once in a while, but this should not be made a habit.
Drinking water: Drinking four to six glasses of water each day, especially before
meals is a good habit. Water has no calories and it will create a feeling of fullness.
Avoid drinking soft drinks and fruit juices too frequently, as they are high in energy
(150-170 calories per serving).
Diet journal: It helps to keep a weekly journal of food and beverage intake and
also of the amount of time that is spent in watching television, playing video games
and exercising. Recording body weight each week is a good practice.
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Fig -6: benefits of nutrition food
Exercise: This is essential for healthy life. helps to keep activity levels high.
Some tips to increase physical activities include:
• Walk or ride a bicycle for short distances.
• Use stairs instead of elevators in a building.
• Do regular exercise for 20-30 minutes, 3-4 times each week.
• This can include walking, jogging, swimming or bike riding.
• Playing games and sports, such as skipping and doing yoga are also advisable
Substance use and abuse: Substance use and abuse in adolescence is a public
health problem of major significance and concern. The substances most widely
abused by adolescents are tobacco, alcohol, and marijuana and other addictive
drugs. The abuse of drugs and alcohol has a harmful effect on the nutrition and
health status of adolescents. Nutrition intervention, support, and counselling would
play a major role in the physical and psychosocial rehabilitation process.
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Girls and boys doing these tasks will have high activity levels and therefore, their
energy needs will be higher. Protein needs are also higher due to the high growth
rate at adolescence. The chances of adolescents being malnourished are, therefore,
very high in rural areas among the poorer communities. Girls in particular are
known to be anaemic (low iron in blood) and require iron rich foods to be healthy.
Adolescents from rich families in rural areas would face many of the same
problems as those in urban areas in the higher income groups. They would tend to
be sedentary and enjoy rich food having plenty of fat and carbohydrate
Factors influencing eating behaviour
By the time a person reaches adolescence the influences on eating habits are
numerous and the formation of those habits is extremely complex, as shown in
Figure 3. The growing independence of adolescents, increased participation in
social life, and a generally busy schedule of activities have a definite impact on
what they eat. They are beginning to buy and prepare more food for themselves
and they often eat rapidly and away from home.
In order to encourage adolescents to form reasonably healthy eating habits parents
should give their children the opportunity to choose from a range of nourishing
foods as they are growing up. By the time they are teenagers they will need some
freedom to use the kitchen; this is true for boys as well as for girls.
Fig-7:bad habit while eating
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Eating disorders at adolescence
Adolescence is associated with rapid physical growth and body-image
development eating disorders are of special concern at this time. These changes
intensify associated selfesteem problems. Anorexia nervosa, for example, is a
disorder so tied to body image distortion that it is most commonly seen in
adolescence, the period when a person is struggling with self- identity and most
vulnerable to body image problems. Progress in adopting a normal adult body
image will be interrupted for the teenager with an eating disorder.
To understand anorexia nervosa let us take the example of Sonam. She aspires to
have a perfect body. She has been ignoring the advice of her parents and teachers
and almost stopped eating. She has become obsessed with having a very thin body.
Although her current weight is normal, she feels pressured to be “ideally” thin like
some actresses in movies or models in magazines. She has a low self-esteem and
remains depressed, and this has resulted in her withdrawing from her family and
friends. She is unaware that she is undernourished and insists that she is fat. She is
a clear case of the eating disorder called anorexia nervosa. She is unaware that
drastic loss of weight can even lead to death.
Bulimia is another type of eating disorder. Bulimia often begins in late adolescence
or early adulthood after a series of various unsuccessful weight reduction diets.
Those with bulimia indulge in bingeing (overeating) and inducing purging by
vomiting or using laxatives. Although more common in females, about five to ten
per cent of all eating disorders occur in males too. Anorexia and bulimia can have
serious consequences such as convulsions, renal failure, irregular heartbeats and
dental erosion. In adolescent girls, anorexia can delay the onset of menstruation,
permanently minimise stature and result in osteoporosis (weakening of bones).
Perhaps a person’s best defense against these disorders is to learn to appreciate
one’s uniqueness. Respecting and valuing oneself will certainly be life saving.
Important dietary interventions include ensuring balanced diets, enhancing
dietary fibre intake and using nutrient/food supplements to make up losses. To
sum up, physical, social and emotional changes experienced during adolescence
can profoundly impact the adolescent’s nutritional status and eating patterns.
Although young people are rarely motivated to learn about nutrition for the sake
of longevity, learning how to apply sound dietary .
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Challenges for nutrition science
Below are some of the questions now increasingly being asked by and also of
nutrition scientists, with a sense of urgency and anxiety. They are uncommon
topics for themes of conferences or presentations within scientific meetings. But
they are in the air. Here they are phrased in the form of ‘how?’ questions. There
are also plenty of ‘what?’ and ‘why?’ questions to be asked.
Fig-9:Challenges Of Nutrition
• How can the science maintain its prestige and justify its existence,
when global rates of classical malnutrition are decreasing slowly or
erratically?
• How can the science claim to prevent food-related diseases, when
global rates of childhood obesity and diabetes in young people are
now rocketing?
• How can genomics be a global solution to diseases caused by
unhealthy foods, when most people have no access to sophisticated
health care?
• How can the benefits of local fresh agricultural produce be
advocated, when governments are shifting their rural populations
into big cities?
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Activity Conducted
Nutrition is a critical part of health and development. Better nutrition is related to
improved infant, child and maternal health, stronger immune systems, safer
pregnancy and childbirth, lower risk of non-communicable diseases (such as
diabetes and cardiovascular disease), and longevity. Healthy children learn better.
Biological determinants such as hunger, appetite, and taste. Economic determinants
such as cost, income, availability. Physical determinants such as access, education,
skills (e.g. cooking) and time. Social determinants such as culture, family, peers
and meal patterns.
Nutritional awareness is also related to knowledge of the interrelationships between
nutritional matters and human life, which may have an effect on a person's life. In
the present study, nutritional awareness entails being cognizant of the kind of
foods an individual eats and the reasons for eating such foods.
Fig-10:AwarenessConductedOn bandipallem Village
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Fig-11: Explaining About Nutritions In Fruits
three levels of nutritional awareness. Higher proportions of women and
individuals living above poverty threshold were nutritionally aware (attached a
higher importance to eating balanced meals). Participants who attached little
importance to eating balanced meals were considerably younger and consumed
more energy-dense and less diverse foods
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conclusion
The authors developed the conceptual framework of this paper jointly. The text is
also the result of iterations between the authors and other authors of papers
published in this issue of Public Health Nutrition,referenced below, and also
reflects discussions and findings of the Giessen workshop whose conclusions are
stated in The Giessen Declaration. Thanks are also due to Catherine Geissler and
Boyd Swinburn. Initial drafts were prepared by Geoffrey Cannon; subsequent
drafts were worked on by Claus Leitzmann and Geoffrey Cannon. Thanks are
given to those who have influenced the thinking of this paper, and associated
papers written by the authors, in the general introductions preceding this paper.
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