COMMUNITY NUTRITION

INTRODUCTION
Adequate food and water are basic human needs. Sufficient energy (measured in calories), protein, fat,
carbohydrates, water, vitamins, and minerals are necessary for preventing deficiencies, allowing proper
growth, maintenance of body weight, and physiological function. Nutritional status is a significant
determinant of health status.

NUTRITION
Nutrition is the science that interprets the interaction of nutrients and other substances in food in relation to
maintenance, growth, reproduction, health and disease of an organism. It includes food intake, absorption,
assimilation, biosynthesis, catabolism and excretion.

Nutrient is a substance that provides nourishment essential for the maintenance of life and growth.

COMMUNITY NUTRITION
Community nutrition is a discipline that strive to prevent diseases and to improve the health, nutrition and well
being of individuals and groups within community. Public health nutrition is the application of nutrition and
public health principles to design programs, systems, policies and environments that aims to improve or
maintain the optimal health of populations and targeted groups.

Its practitioners develop policies and programs that help people improve their eating patterns and health.
Indeed these three arenas- people, policy and program- are the focus of community nutrition.

 PEOPLE:
*Individuals who benefit from community nutrition programs and services.
*They have access to food in times of need or learn skills that improve their eating patterns.

 POLICY:
*A course of action chose by public authorities to address a given problem.
*What governments and organizations intend to accomplish through their laws, regulations and programs.

 PROGRAMS:
*The instruments used by community nutritionists to seek behavior changes that improve nutritional status
and heath.
*May target small groups or large groups of people.

WHY IS IT IMPORTANT TO KNOW ABOUT PUBLIC HEALTH NUTRITION?

1. Adequate nutrition for all is the goal: Adequate food and balanced nutrient intake are basic necessities for
life, health and well being. Nutrition affects health from conception to old age. Adequate nutrition is

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 especially important in periods of rapid growth and development. Poor nutrition during pregnancy, infancy,
childhood and adolescence can mean stunted physical, mental and social development with lifelong
consequences. Chronic dietary deficiency, excess or imbalance predisposes individuals to or aggravates a
spectrum of disease conditions, and ultimately affect the quality and length of life.
2. Dietary factors are associated with five of the ten leading causes of death: Coronary heart disease, some
types of cancer, stroke, non-insulin dependent diabetes (type 2 diabetes), and atherosclerosis are
associated with dietary factors. Dietary excesses and imbalances contribute to the development of these
diseases.Currently attention is focused on total caloric intake; amount and type of fat; vitamins such as folic
acid and the antioxidants of vitamins A, C and E; minerals such as calcium; and other nutritive substances
such as fiber and flavonoids.Overweight and obesity which are estimated to affect over a third of the
population is also an important contributing factor for disease and disability.
3. Maternal and child nutrition sets the stage for life: The health of mothers and infants has historically been
a focus of public health and public health nutrition. Balanced diet and appropriate weight gain have
received attention in the past.Now attention is also directed to preconceptual concerns such as folic acid
intake and its association with neural tube defects. Recent research links factors in the fetal environment to
risk for adult diseases including diabetes and cancer.Breastfeeding for the first year of life is recommended
because of its many benefits to infants and their mothers.Childhood is a time when food preferences and
habits are shaped.Childhood nutrition affects growth and development, immune status, and social and
cognitive ability. The nutritional intake of children with special health care needs also requires close
scrutiny. Low calcium intake of girls and young women sets the stage for osteoporosis in later years.
4. Vulnerable subgroups are at high risk for nutritional problems: Some subgroups of the population,
including people with low incomes, some racial and ethnic minority groups, and people with disabilities
(defined as functional impairments) experience a disproportionate amount of preventable illness and
premature death. Nutrition is an important contributing factor.Some groups, especially those who are
economically disadvantaged or isolated, experience periodic or chronic hunger (also called food insecurity)
resulting in undernutrition.Reaching these groups with accessible, culturally-relevant, nutrition programs
and services presents aspecial challenge to public health agencies and all community nutrition
providers.Targeting vulnerable subgroups and designing programs to meet their special needs is a strategy
used by public health to attempt to reduce disparities in nutritional status and health among population
subgroups.
5. Behavior change is challenging: Nutrition behavior (including food selection, preparation and consumption)
is the product of culture, education, economics, food availability, social strata, family position and health
status. Nutritional status depends on all those factors plus biological and genetic factors.Guiding all
members of the population toward more healthful food choices and optimum nutritional health is a great
challenge. And doing so early enough to prevent the development of disease is a goal of public health
nutrition.Meeting this challenge requires the use of multiple, reinforcing behavior change strategies,
including food and nutrition information and education.

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NUTRIENT

A nutrient is a component in foods that an organism uses to survive and grow.Nutrients that we obtain through
food have vital effects on physical growth and development, maintenance of normal body function, physical
activity and health. Nutritious food is, thus needed to sustain life and activity. Our diet must provide all
essential nutrients in the required amounts. Requirements of essential nutrients vary with age, gender,
physiological status and physical activity.

The human body requires seven major types of nutrients

A nutrient is a source of nourishment, a component of food, for instance, protein, carbohydrate, fat, vitamin,
mineral, fiber, and water.
 Macronutrients are nutrients we need in relatively large quantities.
 Micronutrients are nutrients we need in relatively small quantities.

Macronutrients can be further split into energy macronutrients (that provide energy), and macronutrients that
do not provide energy.

Energy macronutrients
 Carbohydrates

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Carbohydrates - 4 kcal per gram
Carbohydrates, also known as saccharides or carbs, are sugars or starches. They are a major food source and a
key form of energy for most organisms. Most carbohydrate-rich foods have a high starch content.
Sources: Bread, cereal, rice, pasta, beans
Deficiency: ketosis, excessive breakdown of protein, fatigue and a decreased energy level, hypoglycemia.

 Fats

Fats - 9 kcal per gram

Fats are triglycerides - three molecules of fatty acid combined with a molecule of the alcohol glycerol. Fats are
required in the diet for health as they serve many functions, including lubricating joints, helping organs produce
hormones, assisting in absorption of certain vitamins, reducing inflammation, and preserving brain health.
Sources: Avocados, Cheese, Dark Chocolate, Whole Eggs, Fatty Fish, Nuts etc.
Deficiency: fatty acid deficiency disease.

 Proteins

Proteins - 4 kcal per gram

There are 20 amino acids - organic compounds found in nature that combine to form proteins. Some amino
acids are essential, meaning they need to be consumed. Other amino acids are non-essential because the body
can make them. They do most of the work in cells and are required for the structure, function, and regulation
of the body’s tissues and organs.
Sources: chicken, lean pork, fish, lean beef, tofu, beans, lentils, low-fat yogurt, milk, cheese, seeds, nuts, and
eggs.
Deficiency: protein energy malnutrition (kwashiorkor)

Macronutrients that do not provide energy: These do not provide energy, but are still important:

 Fiber

Fiber consists mostly of carbohydrates. However, because it is not easily absorbed by the body, not much of the
sugars and starches get into the blood stream. Fiber is a crucial part of nutrition, health, and fuel for gut
bacteria.
Sources: Split Peas, Broccoli, Brussels Sprouts, leafy vegetatbles.
Deficiency: constipation
 Water

About 70 percent of the non-fat mass of the human body is water. It is vital for many processes in the human
body.We do know that water requirements are very closely linked to body size, age, environmental
temperatures, physical activity, different states of health, and dietary habits; for instance, somebody who
consumes a lot of salt will require more water than another similar person.

Micronutrients: Micronutrients are required in smaller quantities:

MINERALS

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In the context of nutrition, a mineral is a chemical element required as an essential nutrient by organisms to
perform functions necessary for life.

MINERALS FUNCTIONS
Potassium What it does - a systemic (affects entire body) electrolyte, essential in co-regulating ATP (an
important carrier of energy in cells in the body, also key in making RNA) with sodium.
Deficiency - hypokalemia - can profoundly affect the nervous system and heart.
Excess - hyperkalemia - can also profoundly affect the nervous system and heart.
Chloride What it does - key for producing stomach acid, important in the transport of molecules
between cells, and vital for the proper functioning of nerves.
Deficiency - hypochloremia - low salt levels, which, if severe, can be very dangerous.
Excess - hyperchloremia - usually no symptoms, linked with excessive fluid loss.
Sodium What it does - a systemic electrolyte, and essential in regulating ATP with potassium.
Important for nerve function and regulating body fluid levels.
Deficiency - hyponatremia - causes cells to malfunction; extremely low sodium can be fatal.
Excess - hypernatremia - can also cause cells to malfunction, extremely high levels can be fatal.
Calcium What it does - important for muscle, heart, and digestive health. Builds bone, assists in the
synthesis and function of blood cells.
Deficiency - hypocalcaemia - muscle cramps, abdominal cramps, spasms, and hyperactive
deep tendon reflexes.
Excess - hypercalcemia - muscle weakness, constipation, undermined conduction of electrical
impulses in the heart, calcium stones in the urinary tract, impaired kidney function, and
impaired absorption of iron, leading to iron deficiency.
Phosphorus What it does - important for the structure of DNA, transporter of energy (ATP), component of
cellular membrane, helps strengthen bones.
Deficiency - hypophosphatemia, an example is rickets.
Excess - hyperphosphatemia, often a result of kidney failure.
Magnesium What it does - processes ATP; required for good bones and management of proper muscle
movement. Hundreds of enzymes rely on magnesium to work properly.
Deficiency - hypomagnesemia - irritability of the nervous system with spasms of the hands and
feet, muscular twitching and cramps, constipation, and larynx spasms.
Excess - hypermagnesemia - nausea, vomiting, impaired breathing, low blood pressure. Very
rare, but may occur if patient has renal problems.
Zinc What it does - required by many enzymes. Important for reproductive organ growth. Also
important in gene expression and regulating the nervous and immune systems.
Deficiency - short stature, anemia, increased pigmentation of skin, enlarged liver and spleen,
impaired reproductive function, impaired wound healing, and immune deficiency.
Excess - suppresses copper and iron absorption.
Iron What it does - required for proteins and enzymes, especially hemoglobin, the oxygen-carrying
compound in blood.
Deficiency - anemia.
Excess - iron overload disorder; iron deposits can form in organs, particularly the heart.
Manganese What it does - a cofactor in enzyme functions.
Deficiency - wobbliness, fainting, hearing loss, weak tendons and ligaments. Less commonly,

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 can be a cause of diabetes.
Excess - interferes with the absorption of dietary iron
Copper What it does - component of many enzymes.
Deficiency - anemia or pancytopenia (reduction in the number of red and white blood cells, as
well as platelets) and neurodegeneration.
Excess - can interfere with body's formation of blood cellular components; in severe cases,
convulsions, palsy, and eventually death (similar to arsenic poisoning).
Iodine What it does - required for the biosynthesis of thyroxine (one type of thyroid hormone).
Deficiency - developmental delays, enlarged thyroid gland (in the neck), and fatigue.
Excess - can affect the function of the thyroid gland

Vitamins: These are organic compounds we require in tiny amounts.

VITAMIN FUNCTION
Vitamin A Chemical names - retinol, retinoids, and carotenoids.
Deficiency disease - Night-blindness.
Overdose disease - Keratomalacia (degeneration of the cornea)
Vitamin B1 Chemical name - thiamine.
Deficiency disease - beriberi, Wernicke-Korsakoff syndrome.
Overdose disease - rare hypersensitive reactions resembling anaphylactic shock when an
overdose is due to injection.
Vitamin B2 Chemical name - riboflavin.
Deficiency disease - ariboflavinosis (mouth lesions, seborrhea, and vascularization of the
cornea).
Overdose disease - no known complications. Excess is excreted in urine
Vitamin B3 Chemical name - niacin.
Deficiency disease - pellagra.
Overdose disease - liver damage, skin problems, and gastrointestinal complaints, plus other
problems.
Vitamin B5 Chemical name - pantothenic acid.
Deficiency disease - paresthesia (tingling, pricking, or numbness of the skin with no apparent
long-term physical effect).
Overdose disease - none reported.
Vitamin B6 Chemical names - pyridoxamine, pyridoxal.
Deficiency disease - anemia, peripheral neuropathy.
Overdose disease - nerve damage, proprioception is impaired (the ability to sense where parts
of the body are in space).
Vitamin B7 Chemical name - biotin.
Deficiency disease - dermatitis, enteritis
Vitamin B9 Chemical name - folic acid.
Deficiency disease - birth defects.
Overdose disease - increased risk of seizures

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Vitamin B12 Chemical names - cyanocobalamin, hydroxycobalamin, methylcobalamin.
Deficiency disease - megaloblastic anemia (a defect in the production of red blood cells).
Overdose disease - none reported.
Vitamin C Chemical name - ascorbic acid.
Deficiency disease - scurvy, which can lead to a large number of complications.
Overdose disease - vitamin C megadose - diarrhea, nausea, skin irritation, burning upon
urination, depletion of copper in the body, and higher risk of kidney stones.
Vitamin D Chemical names - ergocalciferol, cholecalciferol.
Deficiency disease - rickets, osteomalacia (softening of bone), recent studies indicate higher
risk of some cancers, autoimmune disorders, and chronic diseases
Overdose disease - hypervitaminosis D (headache, weakness, disturbed digestion, increased
blood pressure, and tissue calcification).
Vitamin E Chemical name - tocotrienols.
Deficiency disease - very rare, may include hemolytic anemia in newborn babies.
Overdose disease - dehydration, vomiting, irritability, constipation, build up of excess calcium.
Vitamin K Chemical names - phylloquinone, menaquinones.
Deficiency disease - greater tendency to bleed and bruise.
Overdose disease - may undermine effects of warfarin.

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 NUTRITION FOR INFANTS
WHO and UNICEF recommend:

 early initiation of breastfeeding within 1 hour of birth;

 exclusive breastfeeding for the first 6 months of life; and

introduction of nutritionally-adequate and safe complementary (solid) foods at 6 months together with
continued breastfeeding up to 2 years of age or beyond.

Breastfeeding: Exclusive breastfeeding for 6 months has many benefits for the infant and mother. Chief among
these is protection against gastrointestinal infections which is observed not only in developing but also
industrialized countries. Early initiation of breastfeeding, within 1 hour of birth, protects the newborn from
acquiring infections and reduces newborn mortality. The risk of mortality due to diarrhoea and other infections
can increase in infants who are either partially breastfed or not breastfed at all.Breast-milk is also an important
source of energy and nutrients in children aged 6–23 months. It can provide half or more of a child’s energy
needs between the ages of 6 and 12 months, and one third of energy needs between 12 and 24 months.
Breast-milk is also a critical source of energy and nutrients during illness, and reduces mortality among children
who are malnourished.Children and adolescents who were breastfed as babies are less likely to be overweight
or obese. Additionally, they perform better on intelligence tests and have higher school attendance.
Breastfeeding is associated with higher income in adult life. Improving child development and reducing health
costs results in economic gains for individual families as well as at the national level.

Complementary feeding: Around the age of 6 months, an infant’s need for energy and nutrients starts to
exceed what is provided by breast milk, and complementary foods are necessary to meet those needs. An
infant of this age is also developmentally ready for other foods. If complementary foods are not introduced
around the age of 6 months, or if they are given inappropriately, an infant’s growth may falter. Guiding
principles for appropriate complementary feeding are:

 Continue frequent, on-demand breastfeeding until 2 years of age or beyond;

 Practise responsive feeding (for example, feed infants directly and assist older children. Feed slowly and
patiently, encourage them to eat but do not force them, talk to the child and maintain eye contact);
 Practise good hygiene and proper food handling;
 Start at 6 months with small amounts of food and increase gradually as the child gets older;
 Gradually increase food consistency and variety;
 Increase the number of times that the child is fed: 2–3 meals per day for infants 6–8 months of age and 3–4
meals per day for infants 9–23 months of age, with 1–2 additional snacks as required;
 Use fortified complementary foods or vitamin-mineral supplements as needed; and
 During illness, increase fluid intake including more breastfeeding, and offer soft, favourite foods.

Low-cost food supplements can be prepared at home from commonly used ingredients such as cereals (wheat,
rice, ragi, jowar, bajra, etc.); pulses (grams/ dhals), nuts and oilseeds (groundnut, sesame, etc.), oils (groundnut
oil, sesame oil etc.) and sugar and jaggery. Such supplements are easily digested by all infants, including those
with severe malnutrition. The impression that only the commercially available supplementary foods are

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nutritious is not correct Since infants cannot consume bulky complementary food, in sufficient quantities,
energy-rich foods like fats and sugars should be included in weaning foods. Infants can also be fed green leafy
vegetables (GLVs), which are rich, yet inexpensive, sources of vitamins and minerals. However, greens should
be well cleaned before cooking lest the infants develop loose motions. Dietary fibre in green leafy vegetables
can, by itself, promote the bowel movements leading to loose motions in infants. Since GLVs are rich in dietary
fibre, it is advisable to initially feed only the juice of the GLVs after cooking them properly. Infants should be
introduced to different vegetables and fruits gradually. It should, however, be remembered that these dietary
articles should be thoroughly cooked and mashed before feeding. In families which can afford egg yolk and
meat soup can be introduced. At about one year of age, the child should share the family diet.

Basic principles
The basic principles of weaning are:

 At the start of the process the baby is allowed to reject food, and it may be offered again at a later
date.
 The child is allowed to decide how much it wants to eat. No "fill-ups" are to be offered at the end of
the meal with a spoon.
 The meals should not be hurried.
 Meals should be offered at times when parents are also eating, to set example and aid in learning
through behavior mirroring.
 Sips of water are offered with meals.
 Initially, soft fruits and vegetables are given. Harder foods are lightly cooked to make them soft
enough to chew on even with bare gums.
 Non-finger-foods, such as oatmeal and yogurt, may be offered with a spoon so the baby can learn
to self-feed with a spoon.

Feeding in exceptionally difficult circumstances: Families and children in difficult circumstances require special
attention and practical support. Wherever possible, mothers and babies should remain together and get the
support they need to exercise the most appropriate feeding option available. Breastfeeding remains the
preferred mode of infant feeding in almost all difficult situations, for instance:

 low-birth-weight or premature infants;

 mothers living with HIV in settings where mortality due to diarrhoea, pneumonia and malnutrition remain
prevalent;
 adolescent mothers;
 infants and young children who are malnourished; and
 families suffering the consequences of complex emergencies.

HIV and infant feeding: Breastfeeding, and especially early and exclusive breastfeeding, is one of the most
significant ways to improve infant survival rates. While HIV can pass from a mother to her child during
pregnancy, labour or delivery, and also through breast-milk, the evidence on HIV and infant feeding shows that
giving antiretroviral treatment (ART) to mothers living with HIV significantly reduces the risk of transmission
through breastfeeding and also improves her health.WHO now recommends that all people living with HIV,

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including pregnant women and lactating mothers living with HIV, take ART for life from when they first learn
their infection status.

CHILDREN AND ADOLESCENT

Appropriate diet and physical activity during childhood is essential for optimum body composition, BMI and to
reduce the risk of diet-related chronic diseases in later life and prevent vitamin deficiency. Common infections
and malnutrition contribute significantly to child morbidity and mortality

Owing children and adolescents require more calcium. Though recommended dietary allowances for calcium
are about 600-800 mg/day, it is desirable to give higher quantities of calcium for adolescents to achieve high
peak bone mass. To achieve optimal peak bone mass, it is recommended to consume calcium rich foods like
milk and milk products, fox tail millet (Ragi), til etc. Young children below the age of 5 years should be given less
bulky foods, rich in energy and protein such as legumes, pulses, nuts, edible oil/ghee, sugar, milk and eggs.
Vegetables including green leafy vegetables and locally available seasonal fruits should be part of their daily
menu. Snacks make a useful contribution to the nutrient requirements, particularly in older children and
adolescents. Frequent changes in the menu are often liked by children.

ELDERLY
As people grow older, they tend to become physiologically less active and therefore need fewer calories to
maintain their weights. The daily intake of oil should not exceed 20 g. Use of ghee, butter, vanaspati and
coconut oil should be avoided. They need foods rich in protein such as pulses, toned milk, egg-white etc. The
elderly population is prone to various nutritional deficiencies. Therefore, the elderly need nutrient-rich foods
rich in calcium, micro-nutrients and fibre. Apart from cereals and pulses, they need daily at least 200-300 ml of
milk and milk products and 400 g of vegetables and fruits to provide fibre, micro-nutrients and antioxidants.
Inclusion of these items in the diet improves the quality of the diet and bowel function. The diet needs to be
well cooked, soft and less salty and spicy. Small quantities of food should be consumed at more frequent
intervals and adequate water should be consumed to avoid dehydration, hyponatraemia and constipation

PREGNANCY / LACTATION
Pregnancy is physiologically and nutritionally a highly demanding period. Extra food is required to meet the
requirements of the fetus. The daily diet of a woman should contain an additional 350 calories, 0.5 g of protein
during first trimester and 6.9 g during second trimester and 22.7 g during third trimester of pregnancy. Some
micronutrients are specially required in extra amounts during these physiological periods. Folic acid, taken
throughout the pregnancy, reduces the risk of congenital malformations and increases the birth weight. The
mother as well as the growing fetus needs iron to meet the high demands of erythropoiesis (RBC formation).
Calcium is essential, both during pregnancy and lactation, for proper formation of bones and teeth of the
offspring, for secretion of breast-milk rich in calcium and to prevent osteoporosis in the mother. Similarly,
iodine intake ensures proper mental health of the growing fetus and infant. Vitamin A is required during
lactation to improve child during lactation to improve child and C need to be taken by the lactating mother.

The table below shows the daily requirements of some important nutrients in pregnancy and lactation. The
data shown is for women between 19 and 30 years of age. Some variations in daily requirements may be seen

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outside of that age bracket. During breastfeeding, more energy and vitamin a are required compared to during
pregnancy. Additional increases in calcium during pregnancy and lactation are not needed in women whose
usual diet is rich in dairy products and other good sources of calcium.

Normal Recommended Recommended

recommended intake during intake during
nutrient
intake pregnancy lactation
Energy (kcal) 2,000 2,450 2,500
Protein (g) 46 71 71
Vitamin a (μg) 700 770 1,300
Iron (mg) 18 27 9
Folic acid (μg) 400 600 500
Iodine (μg) 150 220 290
Calcium (mg) 1,000 1,000 1,000
Zinc (mg) 8 11 12
Vitamin b12 (μg) 2.4 2.6 2.8

The pregnant/lactating woman should eat a wide variety of foods to make sure that her own nutritional needs
as well as those of her growing foetus are met. There is no particular need to modify the usual dietary pattern.
However, the quantity and frequency of usage of the different foods should be increased. She can derive
maximum amount of energy (about 60%) from rice, wheat and millets. Cooking oil is a concentrated source of
both energy and polyunsaturated fatty acids. Good quality protein is derived from milk, fish, meat, poultry and
eggs. However, a proper combination of cereals, pulses and nuts also provides adequate proteins. Mineral and
vitamin requirements are met by consuming a variety of seasonal vegetables particularly green leafy
vegetables, milk and fresh fruits. Bioavailability of iron can be improved by using fermented and sprouted
grams and foods rich in vitamin C such as citrus fruits. Milk is the best source of biologically available calcium.
Though it is possible to meet the requirements for most of the nutrients through a balanced diet,
pregnant/lactating women are advised to take daily supplements of iron, folic acid, vitamin B and calcium.

DIETARY GOALS (by national institute of nutrition)

1. Maintenance of a state of positive health and optimal performance in populations at large by maintaining
ideal body weight.

2. Ensuring adequate nutritional status for pregnant women and lactating mothers.

3. Improvement of birth weights and promotion of growth of infants, children and adolescents to achieve their
full genetic potential.

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4. Achievement of adequacy in all nutrients and prevention of deficiency diseases.

5. Prevention of chronic diet-related disorders.

6. Maintenance of the health of the elderly and increasing the life expectancy.

DIETARY GUIDELINES FOR INDIANS (by national institute of nutrition)

Right nutritional behavior and dietary choices are needed to achieve dietary goals. The following 15
dietary guidelines provide a broad framework for appropriate action:

1. Eat variety of foods to ensure a balanced diet.

2. Ensure provision of extra food and healthcare to pregnant and lactating women.

3. Promote exclusive breastfeeding for six months and encourage breastfeeding till two years or as long as
one can.

4. Feed home based semi solid foods to the infant after six months.

5. Ensure adequate and appropriate diets for children and adolescents, both in health and sickness.

6. Eat plenty of vegetables and fruits.

7. Ensure moderate use of edible oils and animal foods and very less use of ghee/ butter/ vanaspati.

8. Avoid overeating to prevent overweight and obesity.

9. Exercise regularly and be physically active to maintain ideal body weight.

10. Restrict salt intake to minimum.

11. Ensure the use of safe and clean foods.

12. Adopt right pre-cooking processes and appropriate cooking methods.

13. Drink plenty of water and take beverages in moderation.

14. Minimize the use of processed foods rich in salt, sugar and fats.

15. Include micronutrient-rich foods in the diets of elderly people to enable them to be fit and active.

NUTRITIONAL PROGRAMS IN INDIA

The government of India have initiated several large scale supplementary feeding programmes aimed at
overcoming specific deficiency diseases through various Ministers to combat malnutrition.

1. Vitamin A prophylaxis program: One of the components of National Programme for control of Blindness is to
administer a single massive dose of an oily preparation of Vitamin A orally to all pre-school children in the
community every 6 months through peripheral health children in the community every 6 months through
peripheral health workers.

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2. Prophylaxis against nutritional anaemia:In view of its public health importance, a national programme for
the prevention of nutritional anaemia was launched by the Govt. Of India during the fourth five year plan. The
programme consists of distribution of iron and folic acid tablets to pregnant women and young children.

3. Special Nutrition Programme: This special programme was started in 1970 for the nutritional benefit of
children below 6 years of age, pregnant and nursing mothers and is in operation in urban slums, tribal areas
and backward rural areas.

4. Balwadi Nutrition Programme:This programme was started in 1970 for the benefit of children in the age
group 3-6 years in rural areas. It is under the overall charge of the Department of Social Welfare. Balwadis also
provide pre-primary education to children.

5. ICDS programme:Integrated Child Development Services(ICDS) programme was started in 1975 in pursuance
of the National Policy for children. The workers at the village level who deliver the sevices are called Anganwadi
workers. Each Anganwadi unit covers a population of about 1000.

6. Mid-day meal programme:The mid-day meal programme(MDMP) is also kown as school launch programme.
This programme has been in operation since 1961 throughout the country. The major objective of the
programme is to attract more children for admission to schools and retain them so that literacy improvement
of children could be brought about.

7. Mid-day meal scheme: Mid-day meal scheme is also known as National Programme of Nutritional Support to
Primary Education. It was launched as a centrally sponsored scheme on 15th August 1995 and revised in
2004.Some suggestions for preparation of nutritious and economical mid-day meals are as under:Parboiled rice,
single dish meals, cereal pulse combination, sprouted pulses, leafy vegetables, fermented food items etc. Only
'iodised salt' should be used for cooking mid-day meals.

CONCLUSION

Translation of knowledge into action calls for the coordinated efforts of several government and non-
government organizations. Effective IEC strategies and other large-scale educational campaigns should be
launched to encourage people to follow the dietary guidelines. Such efforts should be integrated with the
existing national nutrition and health programs. Effective IEC strategies and other large-scale educational
campaigns should be launched to encourage people to follow the dietary guidelines. Such efforts should be
integrated with the existing national nutrition and health programs.

BIBLIOGRAPHY:
1. Brar NV, Rawat HC. Textbook of advanced nursing practice. New Delhi: The health sciences publisher;
2015. p. 376-404.

2. Park K. Park's textbook of preventive and social medicine. 22nd ed. India: M/S banarsidas bhanot; 2013.
Chapter 11; p. 571-603.

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3. Infant and young child feeding [internet]. 2017 July [cited 2017 Nov 15]. Available from:
http://www.who.int/mediacentre/factsheets/fs342/en/

4. Nordqvist C. Nutrition: What is it and why is it important? [internet]. 2017 Sep [cited 2017 Nov 15].
Available from: https://www.medicalnewstoday.com/articles/160774.php

5. India. National institute of nutrition. Indian council of medical research. Dietary guidelines for Indians- A
manual, 2nd ed. India: Indian council of medical research; 2011.

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