LESSON 1:

Lesson Objective

By the end of the lesson, you will be able to: -

a) Familiarize yourself with the unit

b) Comprehend topics and subtopics to cover

Introduction

This module unit is intended to equip you with skills, knowledge and attitude to enable you
understand the principles of nutrition and behaviour.

General objectives

At the end of the unit you will be able to: -

a) Appreciate the importance of nutrition and behaviour studies

b) Understand the relationship between nutrition and behaviour

c) Understand behaviour aspects related to nutrition and dietary intake

d) Comprehend influence of nutrition on behaviour

Topics to Cover

1. Introduction to Nutrition and Behaviour

 Meaning of terms

 Introduction to nutrition and behaviour

 Historical perspective

2. Concepts and models in nutrition behaviour

 Scientific method

 Ethical issues

 Nutrition quackery and psychological misconduct

3. Research methods and analytical strategies

 Experimental approaches

 Correlational approaches

4. Direct effects of nutrition and behaviour

 The central nervous system and behaviour

 The role of nutrients in brain development

 Breastfeeding versus formula feeding

 Cholesterol and adult behaviour

 Cholesterol and antisocial behaviour

 Cholesterol and cognitive function

5. Nutrients, the central nervous system and behaviour

 B vitamins, the central nervous system and behaviour

 Minerals, the central nervous system and behaviour

6. Short term and long-term effects of malnutrition

 Short term effects of nutrition and behaviour

 Acute forms of malnutrition

 Chronic forms of malnutrition

7. Dietary supplements, mental performance and behaviour

 Dietary supplement and cognition

 Herbal supplements and behaviour

8. Bio-behaviour and psychological influences on nutrition

 Bio-behaviour influence on nutrition

 Psychological influence on nutrition

9. Stimulants, depressants, sweeteners and food additives

 Dietary sugar and behaviour

 Caffeine, methylxanthines and behaviour

 Food additives and behaviour

10. Alcohol brain functioning and behaviour

  Interaction between alcohol and nutrients

 Alcohol consumption, brain functioning and behaviour

 Fetal alcohol syndrome

11. Eating disorder syndrome

 Anorexia nervosa

 Bulimia nervosa

12. Behaviour aspects of overweight and obesity

 Social cultural correlates and physiological consequences

 Biological and behaviour influences

 Restrictive feeding practices

 Treatment and preventive approaches

ASSIGNMENT

1. What’s your general overview of this unit?

2. State the advantages of breastfeeding over formula feeding.

3. List the functions of food additives.

Till next time, thank you and stay safe.

Bye!
LESSON 2:

Lesson Objectives

By the end of the lesson, you will be able to: -

a) Define terms used in nutrition and behaviour

b) Explain nutrition and behaviour

c) Explain the historical perspective of nutrition and behaviour

1.1 Meaning of terms

Abnormality – something deviating from normal, or differing from normal or differing from the
typical. It is subjectively defining behavioural characteristics assigned to those with rare or
dysfunctional conditions.

Behaviour – this is the way in which one act or conducts themselves especially towards others.
It is the way in which an animal or person acts in response to a particular situation or stimulus.

Cognition – refers to mental processes involved in gaining knowledge and comprehension.

These processes include: thinking, knowing, remembering, judging and problem solving (the
higher-level function of brain). It also encompasses language, imagination, perception and
planning.

Cognitive functions – they are cerebral activities that lead to knowledge, including all means
and mechanisms of acquiring information. They include reasoning, memory, attention and
language and leads directly to attainment of information of information and that is knowledge.

It not only refers to influencing factors but also to health, environmental, social and economic
implications along the entire product chain from the farmer to the consumer.

Lethargic - low in activity or display of energy, disinterested in the environment and flat in
affect.

Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy

and/or nutrients.
Normal – the word is used to describe individual behaviour that conforms to the most common
behaviour in a society. Definitions of normal will vary depending on person, time, place and
situations. It also changes along with changing society standards and norms.

Nutrition behaviour is framed by biological, anthropological, economic, psychological, socio-

cultural and home economics related determinants and it is shaped by the individual situation.

Nutritional behaviour is the sum total of all planned, spontaneous or habitual actions of
individuals or social groups to procure, prepare and consume food as well as those actions
related to storage and clearance.

Quack - derived from quacksalver, an archaic term used to identify a salesman who quacked
loudly about a medical cure such as salve, lotion.

1.2 Introduction to nutrition and behaviour

Recently, knowledge from three different lines has together illuminated the complex interactions
between nutrition and related environmental factors, on one hand, and behaviour on the other
hand. The three advancing areas are the behavioural sciences, knowledge of the effects of
specific nutrients on the brain function and the study of gross malnutrition in underdeveloped
regions of the world and its impacts on behaviour.

The study of human behaviour is one of the major advances of the 20thcentury starting with
Freud’s discovery of the importance of early traumatic experiences in the development of
neurotic disorders in adulthood. He tried to bring to understanding the interaction between nature
and nurture i.e. to recognize the multiple determinants of human behaviour ranging from genetic
to environmental.

As the above developments were being made, in the understanding of behaviour, important
discoveries were being made in the field of nutrition. Goldberger was the first to observe that a
specific nutritional deficiency could cause marked behavioural abnormalities. Through
epidemiological studies, he discovered the causal relationship between nicotinic acid deficiency
and deficiency and pellagra, which is characterized clinically by diarrhoea, dementia and
dermatitis. This helped to lay the foundation for understanding the role of specific nutritional
factors in behavioural functions.

Although the behavioural effects of concurrent infantile malnutrition were recognized early in
populations living in poverty, it is only recently that the long-term effects of early malnutrition
have been identified. it has been concluded that early malnutrition is responsible for long-term
behavioural changes, many of which limit a child’s ability to adapt successfully
Diet affects our quality of life and impacts behaviour affecting our emotions and maybe even
how we think for example hunger will cause discomfort, while a full stomach brings
contentment. From the beginning of recorded history right up through the present, humans have
believed that the food they eat can have a powerful effect on their behaviour. Currently
thousands still believe that a type of diet or a particular nutrient can help to achieve sexual,
emotional or cognitive equilibrium.

Numerous fads, statements are increasingly being circulated in the press, sometimes marketed to
sell a product. Fortunately, unlike in past centuries, a lot of research has been carried out to
distinguish fact from fiction on the diet and behaviour connection.

A phenomenal amount of research on feeding behaviour and the effects of nutritional deprivation
has been conducted using animal models, as there are certain manipulations that cannot be done
with humans.

The area of nutrition and behaviour is interdisciplinary in that, in order to provide objective data
and verify some of the claims, information is borrowed from various disciplines such as
anthropology, psychology, biochemistry, medicine, public health and sociology. How or what a
person eats obviously determines nutritional status, but our approach to behaviour will consist of
far more than the behaviour of eating. This includes looking at factors that determine food
selection, behaviour how it affects diet selection. Global, cultural and familial factors may
influence food preferences, how income determines food choice.

1.3 Historical perspective

Ancient Egyptians, for example, believed that salt could stimulate passion, onions induce sleep,
cabbage prevents a hangover, and lemons protect against ‘the evil eye’.

The ancient Greeks also thought that diet was an integral part of psychological functioning, but
added a personality component to the process. They conceived of four temperaments, that is,
choleric, melancholic, phlegmatic and sanguine, that were responsive to heat, cold, moisture and
dryness.
Choleric – ‘the achiever’. Short tempered and irritable. Tends to like hot food.

Melancholic – ‘the naturally gifted’. Analytical and quiet. Tends to like cold food.

Phlegmatic – ‘the loyal friend’. Relaxed and quiet. Tends to like moist food.

Sanguine – ‘the life of the party’. Social and optimistic. Tends to like dry food.

During the middle ages, the view that food and health were connected as medieval men and
women used food in an attempt to both encourage and restrain their erotic impulses. Figs,
truffles, turnips, leeks, mustard and savoury were all endowed with the ability to excite the
sexual passions, as were rare beef in saffron pastry, roast venison with garlic, suckling pig,
boiled crab and quail with pomegranate sauce. To dampen sexual impulses, foods such as
lettuce, cooked capers, rue and diluted hemlock-wine concoctions were sometimes employed,
though seldom as often as the stimulants.

The French philosopher and gourmand Jean Anthelme Brillat-Savarin wrote ‘Tell me what you
eat, and I will tell you what you are’ in his treatise, The Physiology of Taste, first published in
1825. He postulated a number of direct relationships between diet and behavioural outcomes,
being among the first to document the stimulating effects of caffeine. He also believed that
certain foods, such as milk, lettuce or rennet apples, could gently induce sleep, while a dinner of
hare, pigeon, duck, asparagus, celery, truffles or vanilla could facilitate dreaming.

In the early years of the last century a diet was believed to affect mental health, intelligence,
spirituality and sexual prowess. One of the most prominent leaders of this movement was John
Harvey Kellogg – known best for introducing breakfast cereals who lectured widely throughout
the USA, promoting the use of natural foods and decrying the eating of meat, which he believed
would lead to the deterioration of mental functioning while arousing animal passions. He further
claimed that the toxins formed by the digestion of meat produced a variety of symptoms
including depression, fatigue, headache, aggression and mental illness, while spicy or rich foods
could lead to moral deterioration and acts of violence.

In the later centuries, the interaction between nutrition and behaviour have led to numerous
claims such as monosodium glutamate (MSG) causes headaches and heart palpitations, refined
carbohydrates cause criminal behaviour in adults, bee pollen has been advocated as a means to
enhance athletic prowess, garlic as a cure for sleep disorders, ginger root as a remedy for motion
sickness, ginseng as an aid to promote mental stamina, and multivitamin cocktails as a tonic for
boosting intelligence. This is why well controlled studies are essential to validate or discredit
such claims. Since some may be based on anecdotal evidence, insufficient observations,
misinterpretation of findings or just poor science.

Whether concerned with ensuring our mental health, reducing our levels of stress or simply
losing weight, most of us share a belief that diet and behaviour are intimately relate e.g. eating an
energy bar yourself in the belief that it helps in concentration, or consumption of herbal
supplements by the elderly to slow aging. it would help you concentrate, while you observe your
parents attempting to slow the aging process by trying the herbal supplement they see advertised
on a nightly infomercial. While we may not think we are exactly what we eat, we nevertheless
seem predisposed to accept claims about nutrition and behaviour that promise us whatever we
think is desirable, no matter how improbable. Our task throughout this book will be to help you
recognize the associations that current scientific evidence suggests are most likely true, given our
current understanding of work that bridges nutrition and behaviour.
Check your understanding

1. Differentiate between normal and abnormal.

2. How does your behaviour affect nutrition?

3. What claims have you heard about nutrition and behaviour?

LESSON 3: CONCEPTS AND MODELS IN NUTRITION BEHAVIOUR

Lesson Objectives

By the end of the lesson, you will be able to: -

a) To explain concepts and models in nutrition and behaviour

b) To describe the scientific method

Introduction

The relationship between nutrition and behaviour is circuitous i.e. nutrition affects, modify or
influences behaviour e.g. affecting performance, but that behaviour can be just as powerful in
determining nutritional status or diet quality. In most cases the relationship between nutrition and
behaviour is not as direct as it involves other variables. Behaviour can influence nutritional status
or diet quality. For example:

 A malnourished person is likely to be lethargic. An adequate diet is necessary for the

individual to exhibit a reasonable amount of activity therefore under nutrition is having
an effect on active behaviour. Severe malnutrition can greatly depress physical and
cognitive functioning.
 Conversely, an individual who participates in exercise and body building to regain
muscle tone may find themselves hungry more often. This means that the active
behaviour is having a direct effect on the nutritional status of that individual i.e. increase
in energy intake as a result of increase in physical activity
  From a behavioural perspective, an attention seeking individual tends to enjoy hot, spicy
foods like chilli peppers.
 An insecure individual may starve themselves to fit into a group or join a sports team.
 Individual who have experience happy childhoods may cook more unhealthy food.
 Skipping a meal such as breakfast can reduce a child’s attention span on a learning task
while substances such as caffeine, a natural ingredient of coffee but an additive to certain
soft drinks, will boost attention and arousal. In contrast, a high-starch meal may serve to
calm a stressed adult just as much through its perception as a comfort food as by it
facilitating the release of neurotransmitters.
 An overweight or obese child may not be physically active at school and maybe due to
bullying by peers the child may snack excessively, spend more time indoors, further
leading to less activity.
 Phenylketonuria (PKU) is an inborn error of metabolism that results in mental retardation
in childhood if unidentified and left untreated. In infants with the disorder, the absence of
a single enzyme – phenylalanine hydroxylase – prevents the conversion of the amino acid
phenylalanine into tyrosine. The ingestion of a normal diet, containing typical amounts of
protein, results in the accumulation of phenylalanine, which in turn exerts a toxic effect
on the central nervous system. The effects are manifested in the form of severe mental
retardation, decreased attention span and unresponsiveness. Fortunately, the early
detection of PKU, through a new born screening test, can allow for immediate treatment
through a low protein diet, which avoids the certain likelihood of any brain damage.
Nevertheless, this example shows the powerful effects that diet can impose on a
developing infant. Mental development can also be impaired due to derivational
dwarfism is a condition of retarded growth and mental directly attributable to a
caregiving environment that is characterized as emotionally detached and lacking in
normal affection. Infants reared by hostile parents, or by caregivers that are emotionally
unavailable and who do not respond to the infant’s signals for attention, often fail to
thrive and show stunted growth with little interest in their environment. Despite regular
feedings, adequate nutrient intake, and no metabolic irregularities, a lack of
environmental stimulation in infancy will here have as powerful an effect on the
developing infant as did undetected PKU in the previous example. It is almost certain that
a normal diet for a PKU baby will have devastating consequences, no matter a good
caregiver–infant relationship. But an infant deprived of appropriate behavioural
interaction with a caregiver will also be delayed, no matter how optimal the nutrition.

Scientific method

The scientific method is the approach used by all scientists despite their background in their
efforts to identify the truth about relationships between natural events.

It comprises of the following series of steps:-

1. State the research question – scientists can build upon a theory they encounter, personal
observation or on previous research and will pose a research question that has a relevance to the
phenomenon of interest.

2. Develop a hypothesis – the researcher formulates the research question into a hypothesis that
can be tested.

3. Test the hypothesis– a systematic plan is designed, implemented by conducting the study,
appropriate date is collected and then analysed. This can be done by conducting a survey, using
questionnaires that demographic information is included.

4. Interpret the results – Based on the results of the study, the scientists either accepts or rejects
the hypothesis and have the research question answered. Conclusions are then derived solely
from the data.

5. Disseminate the findings–this can be achieved through publishing the results, presentations
such that others may replicate, learn from or constructively critique the results.

Reviewing the literature on a topic is a critical phase of the research process to identify whether
the research has already been done, current gaps or to compare findings from similar findings
which can be obtained from a wide array of sources such as books or internet.

Summary

 The relationship between nutrition and behaviour is bi-directional and complex

 Research is undertaken using the scientific method for both nutritional and behavioural
sciences
Check your understanding

1. Explain the bi-directional relationship between nutrition and behaviour.

2. Define the terminology Scientific methods.

3. Expound the steps involved in Scientific methods.

LESSON 4: CONCEPTS AND MODELS IN NUTRITION BEHAVIOUR

Lesson Objectives

By the end of the lesson, you will be able to: -

a) understand the ethical issues in nutrition and behaviour

b) discuss the nutrition quackery and psychological misconduct

c) identify ways of spotting nutrition quacks

Ethical issues

The formal codification of ethical guidelines for the conduct of research involving humans, at
least in the USA, began well over 50 years ago in the aftermath of the Second World War. In
1946, a number of Nazi physicians went on trial at Nuremberg because of research atrocities they
had performed on prisoners as well as on the general citizenry. For example, dried plant juice
was added to flour fed to the general population in an experiment aimed at developing a means
for sterilizing women, while men were exposed to X-rays without their knowledge to achieve the
same effect. In another experiment, hundreds of prisoners in the Buchenwald concentration camp
were injected with the typhus fever virus in an effort to develop a vaccine.

After the trial and through the efforts of the Nazi War Crimes Tribunal, fundamental ethical
principles for the conduct of research involving humans were generated and made part of the
Nuremberg Code, which sets forth 10 conditions that must be met before research involving
humans is ethically permissible. Primary conditions being:

 Voluntary consent
 Benefits should outweigh the risks
 The subject should be in a position to terminate participation at will.

Despite these rules being in place, numerous instances of abuse of human beings have occurred
after 1946 incidences all in the name of research.

Examples of research atrocities

- Tuskegee Syphilis Study where black men with syphilis were left untreated to track its effect.
The study was started in the 1930s with men had not given their informed consent. However,
when penicillin became available in the 1940s the men were neither informed of this nor treated
with the antibiotic

- From 1946 to 1956, mentally retarded boys at the Fernald State School in Massachusetts who
thought they were joining a science club were fed radioactive milk with their breakfast cereal.
The researchers were interested in how radioactive forms of iron and calcium were absorbed by
the digestive system.

- In 1963, studies were undertaken at New York City’s Chronic Disease Hospital to gather
information on the nature of the human transplant rejection process. Patients who were
hospitalized with various debilitating diseases were injected with live cancer cells, with the
rationale that the patients’ bodies were expected to reject the cancer cells.

- From 1963 to 1966 ‘mentally defective’ children at the Willowbrook State School in New
York were deliberately infected with the hepatitis virus, drawn from the infected stools of others
or in a more purified form. The investigators argued that since their contracting hepatitis was
likely to occur anyway, much could be learned by studying the disease under controlled
conditions.

This prompted the need to design comprehensive systems for research involving humans. In
1974, the National Research Act (PL 93-348) was signed into law and established the National
Commission for the Protection of Human Subjects of Biomedical and Behavioural Research to
identify the ethical principles that should guide the conduct of all research involving humans.
The Commission’s efforts resulted in a document called The Belmont Report – Ethical Principles
and Guidelines for the Protection of Human Subjects, which was published in 1979.

This report outlines three basic ethical principles:

1. Respect for persons. This principle requires that researchers acknowledge the autonomy of
every individual, and that informed consent is obtained from all potential research subjects (or
their legally authorized representative if they are immature or incapacitated).
2. Beneficence. This principle requires that researchers treat their subjects in an ethical manner
not only by respecting their decisions and protecting them from harm, but also by making efforts
to secure their wellbeing. Risks must be reasonable in light of expected benefits.

3. Justice. This principle requires that selection and recruitment of human subjects is done fairly
and equitably, to ensure that a benefit to which a person is entitled is not denied without good
reason or a burden is not imposed unduly. It is clear then that all researchers have a fundamental
responsibility to safeguard the rights and welfare of the individuals who participate in their
research activities. In addition, government regulations require that any institution that conducts
federally-funded research must adhere to the principles of The Belmont Report.

Nutrition quackery and psychological misconduct

Professional conduct should always be adhered to in any field. Confidential information should
not be disclosed unless to a professional also handling the case. Any consulting or clinical
relationship by a psychologist should be terminated if it is found not to be beneficial to the client.
A professional should have a licence after completion of internship and training as per their field
of study. Suspension or termination can occur due to violation of any of the above.

For the most part, individuals do not have to possess particular credential to call themselves a
nutritionist. They may have had some nutrition coursework, or may have had none at all. They
may have an advanced degree, or may not have diploma from an accredited college. Even if they
have an advanced degree, however, it need not be in nutrition, medicine, or even science.

In the same manner, a nutrition credential exists in the form of the Registered Dietitian (RD).
The designation indicates that the individual has completed at least a Bachelor’s degree from an
accredited college/ university, has mastered a body of nutrition related courses, has successfully
completed a supervised work experience and has passed a national qualifying exam.

For example, an individual could claim to be a nutritionist, nutrition expert, nutrition consultant
or nutrition counsellor armed only with the confidence of having taken some nutrition courses.

Nutrition quackery occurs mainly due to the broad nature of nutrition presenting both financial
and physical danger. Lack of laws preventing selling dietary supplements. Lack of credentials for
nutritionists. Finding that go public before publication

Certain populations are particularly target for quackery e.g.

- Those who believe testimonials that they hear regarding health claims of supplemental
products.

- Those suffering from incurable diseases and are desperate for a cure

- Those who may simply mistrust the medical or scientific establishment and services offered
therein.

- Athletes who want to boost their performance

- Teenage girls

How to spot nutrition quacks

 They display credentials that are not recognized by a credited institution

 They promise quick, dramatic and miraculous cures
 They use disclaimers filled with medical jargon
 They claim that most of the population is poorly nourished.
 They advise that supplements offset a poor diet
 They state that research is ‘currently underway’ indicating that there is no current
research.
 Lists ‘good’ and ‘bad’ foods.
 Nonscience-based testimonials supporting the product, often from a highly satisfied
customer.
 They allege that modern processing removes all nutrients from foods
 They claim that everyone is in danger of food poisoned by our food supply chain
 They recommend that everyone should take nutrients and food supplements
 They promise quick and easy weight loss for individuals
 They advise people not to trust conventional medicine

ASSIGNMENT

1. Explain the ethical principles to be observed when undertaking research.

2. Outline standards of professional conduct a nutritionist should observe.

3. Highlight ways of identifying nutrition quacks.

LESSON 5: RESEARCH METHODS AND ANALYTICAL STRATEGIES

Lesson Objectives
By the end of the lesson, you will be able to: -

a) to describe experimental approaches in research

b) to differentiate between independent and independent variables

Experimental approaches
Experimental designs have the potential to identify causal links between diet and behavior.
Where a co-relational study may include a number of variables, equivalent in value until
associations are determined, an experimental study includes two specific types of variables i.e.
Independent and dependent variables
An independent variable is that which is manipulated in the experiment and constitutes the
treatment that the subjects receive e.g. a nutrient may be added to subjects’ diets or a nutrition
lesson is applied to a given class.
A dependent variable refers to the outcome, measure or observation which results from the
manipulation of a specific dietary component.
If the manipulation significantly alters the form or magnitude of a behavioural measure, a causal
relationship can then be suggested.
Elements of sound experimental nutrition-behavior studies

1. A minimum of two groups of subjects i.e. the treatment group (those to which the
manipulation is subjected) and the control group (those which receive no treatment. Serve
as a standard on which comparisons are made). Using a control group makes it possible
to eliminate alternative explanations for changes in the dependent variable, such as
maturation, history or other experiences aside from the treatment. Any difference that is
seen between the treatment and control groups at the end of the experiment can therefore
be attributed to the independent variable therefore groups should similar in all respects
prior to the application of the treatment.
2. Random assignment – the subjects are randomly assigned to one group or the other.
3. The placebo effect –this refers to the phenomenon that when human beings take any
treatment that they believe will be beneficial, their chance of improving are increased. It
is particularly relevant when carrying out studies where subjects have reason to expect
that by receiving a treatment, their behavior or feelings of well-being will change. If this
is applied, the researcher will have 3 groups of subjects i.e. control group (given no
treatment), treatment group (receive the treatment) and placebo group (receive a mock
treatment).
 4. Double blind conditions- neither the individuals who are collecting data nor the subjects
know whether the subjects are receiving the treatment or placebo

Limitations of experimental studies

 The sample should difference randomly distributed

 The duration of treatment matters when determining behavioural effects; one treatment
cannot provide information about chronic or long-term exposure
 Variables such as timing of the experiment may influence behavioural effects

Examples of experimental studies

1. Dietary challenge study
Behavior is usually evaluated for several hours after the subjects have consumed either the
substance being studied or a placebo. This approach is also referred to as a between subject’s
design. An advantage of this approach is that double-blind procedures are usually easy to
implement, as the food component can be packaged so that neither the subjects nor the
experimenter can detect what is being presented
2. Crossover design
Half of the subjects are given the food component on the first day of testing and the placebo on
the second, while the other half are given the placebo on the first day and the treatment on the
second. In this manner each subject experience both the treatment and serves as his or her own
control, and the N-size has in effect been doubled. This approach is also referred to as a within
subject’s design.
3. Dietary replacement studies
Behavioural effects of two diets – one containing the food component of interest and the other as
similar as possible to the experimental diet except for that component – are compared over a
period of time. For example, regular tub margarine could be replaced with a fat substitute in
order to determine if subjects will compensate for the reduction in calories by eating more food.
Such a manipulation would be relatively mild if done over a day or two, but differences in
energy intake could be attributed to a change in perceived hunger due to the experiment. An
obvious advantage of dietary replacement studies is that chronic dietary effects can be examined.
However, it is often difficult to make two diets equivalent except for the food component that is
being studied, making double-blind techniques relatively hard to employ. Furthermore, it is
usually not feasible to test more than one dose of the dietary variable, and replacement studies
are usually expensive and time consuming.
Independent and Dependent Variables
Independent variables

 Organismic or individual characteristic e.g. weight, gender, personality and diet history
 Social and cultural factors- common types of food originating and eaten in a region
 Setting and context e.g. phenomenon of people eating and drinking more when they are
in a social situation like a party
 External cues – eating regulated by external cues e.g. time as opposed to feelings of
hunger
 Cognitions about food – ideas about food
 Palatability of food – refers to ease in acceptance of food e.g. eyeballs, dog meat may be
palatable in some countries
 Nutrient-related or energy density of food – eat because of a deficiency or for energy
 Food characteristics e.g. texture, volume, liquid or solid and its influence on consumptive
behaviour

Dependent variables

 Amount consumed or rate of eating- the manner in which the subject approaches the meal
e.g. eating vegetables first
 Manner of eating
 Frequency of ingestion –how the meals or snacks are spaced
 Motivation for food – reason for eating a particular food e.g. an advert on ice cream may
make you want to eat it
 Physiological responses e.g. increase in heart rate after ingesting caffeine or sweating
after eating chilly
 Judgement of food quality – how factors such as taste and texture determine food
enjoyment
 Hedonic ratings – an individual perception on food feeling of hunger or satiety.

ASSIGNMENT
1. Differentiate between in between independent and independent variables
2. Explain 3 experimental studies.
3. State the limitations of experimental studies.
LESSON 6: RESEARCH METHODS AND ANALYTICAL STRATEGIES
Lesson Objectives
By the end of the lesson, you will be able to: -
a) understand what are the correlational approaches
b) identify the designs of correlational approaches

Co-relational approaches
Co-relational studies determine whether or not two or more variables are correlated. This means
that an increase in one variable corresponds to either increase or decrease on another variable.
They are used to identify associations between variables and in nutrition research to generate
hypothesis about the manner in which certain nutrition and behavior variables are related. For
example a relationship between diet and certain behavior; Low iron intake leads to low
concentration, fatigue.
The linkages between two or more variables are determined by use of statistical procedures that
produce an index of association known correlation coefficient which reflects the strength as well
as the direction of relationship.
Nothing is manipulated in a co-relational approach; the investigator observes or measures a
number of variables of interest. Observation is the primary means of obtaining data which is then
analyzed.
Example 1:
In a study done to ascertain whether the intake of chocolate reduces depression in women. An
inverse relationship was shown to exist between chocolate and depression meaning there was a
negative relationship between chocolate consumption and depression and conclusion can be
made that; those that consume chocolate or at high intake scored low in depression.
Example 2:
Suppose a researcher wants to study the relationship between sugar and hyperactivity, researcher
might ask a group of children to complete a diet record of everything they ate over a weekend
and request the parents to report how active their children were using a standardized activity
rating scale. The researcher then determines the total sugar content of children’s diet using
dietary assessment methods.
Similarly, the children’s score on the activity scale could be tabulated with higher scores
indicating higher activity levels i.e. is it really the case that children who ingested more sugar
also displayed higher activity? Let us assume that the study concluded that it is indeed found that
there was significant positive relationship between sugar intake and activity level. It might be
easy to conclude that consumption of sugary food causes hyperactivity but that conclusion may
not be necessarily true because there are several conditions that affect behavioural outcomes.
The following therefore are conditions that must be met before such results can be accepted as
valid:

 Obtain valid measures of nutrient intake i.e. use accepted dietary assessment methods e.g.
the 24-hr recall method
 Use appropriate sampling technique, a larger sample size is preferred since if the sample
is too small the probability of observing relationships between a nutrient variable and
particular behaviour is reduced thereby leading to establishment of non existing
relationships. Very large samples lead to many false positives
 Consider sampling of behaviour e.g. rating of activity levels, sociability and aggression
will be rated
 Co- relational studies cannot establish causality (cannot show cause).

Co-relational designs
Epidemiological studies - It include large sample sizes as well as large numbers of variables.
Observation is the main method of data acquisition.
The retrospective approach consists of obtaining data on a pool of subjects, but instead of
linking nutritional status to certain behaviours by drawing on an array of concurrent measures,
efforts are made to identify relevant variables from the past that may help to inform the present
circumstances. E.g. a psychologist handling a client with anorexia nervosa will identify factors in
the individual’s family history relevant to his/her condition.
The cross-sectional approach- a crosssection of the population with diverse income, ethnicity, or
geographic region are of interest are surveyed. In the behavioural sciences, however, the cross-
sectional design refers to a study in which subjects of different ages are observed in order to
determine how behaviormay change as a function of age e.g. the use of supplements across
different age groups
The longitudinal design- the investigator would identify a group of subjects, observe them in
regards to a variable of interest and study them on separate occasions. This design is time
consuming and expensive. It is primarily for this reason that longitudinal studies of adults are
conducted by research groups at institutes or universities, where several investigators (with a
large budget) can arrange for their successors to continue to gather the data. For example, the
Fels Research Institute began the Fels Longitudinal Study in 1929 in Yellow Springs, Ohio, in
order to study the effects of the Great Depression on child development. Psychological data were
collected for well over 40 years, with a switch to physical growth measures in the mid-1970s.
Dozens of individuals are enrolled every year, with data now available on the children,
grandchildren and great-grandchildren of the original volunteers.
Similarly, the Framingham Heart Study was started in Framingham, Massachusetts, by the
National Heart Institute in order to identify the general causes of heart disease and stroke. A
cohort of 5209 adult men and women were enrolled in 1948, with the subjects returning every 2
years for extensive physical examinations. A second generation of enrollees began participating
in 1971. Since its inception, over 1000 research articles have been published using this database,
with much of our present knowledge of cardiovascular risk factors derived from the study.

Food selection behaviour

The food choice will depend on three factors:
Who? The characteristics pertaining to an individual be it descriptive (age, sex), biological
(hereditary, health) or personality based (activity, mental state)
Where? It relates to the physical environment e.g. (place, time of food choice, socio-cultural
norms and context that influence the individual decision making.
Why? Food perceptions that relate to the individual’s food choices based on belief or sensory
attributes as opposed to hunger cues. E.g. familiarity, taste, cost, convenience, prestige,
cognitions

Summary

 The proper way to establish validity of claims about nutrition

 Co-relational approaches are useful in identifying associations between different

variables

 Experimental approaches are useful in determining causality

Check your understanding

1. State the advantages and limitations of co-relational studies.
2. Dose response is an example of experimental studies. Explain how a dose response experiment
is carried out.
3. Describe two studies done using co-relational and experimental approaches respectively.
LESSON 7: DIRECT EFFECTS OF NUTRITION AND BEHAVIOUR

Lesson Objectives
By the end of the lesson, you will be able to: -
a) describe the central nervous system
b) discuss the relationship between central nervous system and behaviour

The central nervous system and behaviour

The brain-behavior connection
In humans, changes in behavior are ultimately as a result of changes in the functioning of the
central nervous system (CNS) i.e. whatever affects the brain affects behavior. Diet exerts an
effect on both the developing and mature brain.
Constituents of the diet i.e. minerals, vitamins and macronutrients have been shown to influence
brain function.

Structure and development of the central nervous system

It is composed of two major components i.e. the brain and the spinal cord. The brain and spinal
cord are completely surrounded by three layers of tissues known as meninges.
The brain weighs about 1.4kg and lies within the cranial cavity. Some parts of the brain are
cerebrum (largest part of the brain), hypothalamus (controls appetite and satiety, control thirst
and water balance, regulate body temperature), and thalamus (centre of recognition, process of
some emotions and complex reflexes), mid brain, pons, medulla oblongata and cerebellum.

Neurons/nerve cells comprise about half of the volume of the brain and form the structural
foundation of the organ.
Neurons – are the information processing and transmitting elements of the CNS. Their capacity
to perform this function depends on their ability to generate and conduct electrical signals as well
as to manufacture and transmit chemical messengers.
No two neurons are identical. However, most share certain structural features i.e. the soma, the
dendrites and the axon. Their special properties allow them to function as the components of
rapid communication network.
LESSON 8

Lesson Objectives
By the end of the lesson, you will be able to: -
a) identify the nutrients that have a role in brain development
b) discuss the role of various nutrients in brain development

The role of nutrients in brain development

The chemistry and function of the developing and mature brain are influenced by diet. Large
gaps exist at the biochemical, physiological and behavioural levels in terms of our knowledge of
the precise effects of nutrition on brain functioning.
Vitamins, minerals and macronutrients, have long been shown to influence brain function. In
recent decades research has further determined that essential fatty acids, as well as certain amino
acids, also play a role in brain development and function.
All life processes are subjects to the influences of biological and nurturing factors and ultimately
to their interaction. These include brain growth and development, and their function outcome
(behavior).
Nutrition is an environmental factor as it represents access to resources from the environment
(i.e. food and water). However, unlike other environmental resources like medical care,
education or experiences, nutrition can directly modify gene structure and mediate the expression
of gene factors by providing the specific molecules that enable genes to exert their potential or
targeted effects on brain growth and development.
The brain is a specialized tissue in which functionality depends on generation and conduction of
gene impulses. These special functions of brain are reflected in a higher need for certain nutrients
such as choline, zinc, vitamin A, folic acid, iron and special fats i.e. essential fatty acids
(docosahexaenoic acid, arachidonic acid, gangliosides and sphingolipids).
Therefore, poor nutrition contributes to delays in intellectual development by causing “brain
damage, enhancing the risk of illness, inducing lethargy and withdrawal or delayed physical
growth”. Brain “damage” refers to relatively straightforward nutrient-induced structural or
biochemical alterations.
Illness delays the development of motor skills (e.g. crawling and walking) thus limits the child’s
exposure to and exploration of the external environment. Similarly, delayed physical growth,
lethargy and withdrawal would limit the child’s exploration of the external environment and
incorporation of new knowledge from external stimuli.
Lipids and fatty acids
Nutrition during the first year of birth is also important as the brain continues to develop. Up to
about 60% of an infant’s total energy intake during the first year of birth is used by the brain in
constructing neuronal membrane and disposing myelin. Most of this energy comes from dietary
fat. Lipids account for over half the dry weight of the brain. Lipids found in the brain include:
cholesterol, phospholipids, gangliosides and other fatty acids.
Cholesterol is a key component of neuronal plasma membrane and regulates and maintains
internal environment of the nerve cell.
During intra-uterine growth, the fetus synthesizes its own cholesterol but at birth most of the
plasma cholesterol comes from the high-density lipoproteins.
Cholesterol appears to be involved in regulation of brain function as it modulates the activities of
neurotransmitter receptors.
Macro and micronutrients
Macro and micronutrients largely affect brain behavior in that, deficiency and inadequate intake
of various nutrients manifest in different behavioural outcomes. For example:

 Under nutrition during development adversely affect the growth of the brain e.g.
production of myelin.
 General reduction of nutrient intake e.g. protein impairs brain growth and lipid deposition
altering the composition of myelin.
 A deficiency in niacin impairs myelination and vitamin B6 deficiency reduces the levels
of myelin lipid and polyunsaturated fatty acid in cerebellum hence affecting movement
and coordination.
 Folate deficiency in mothers appears to have a greater likelihood of delivering of infants
who display malformations of the CNS.
 Zinc and copper deficiency are damaging to the maturation of the brain.
 Sodium and potassium are necessary for electrical activities, fluid balance and synaptic
communication.
 Selenium facilitates antioxidant activities.

Polyunsaturated and fatty acids

PUFAs, that are located on the cell membrane phospholipids serve as important structural
components of the brain. The major brain PUFAs are docosahexaenoic acid (arachidonic acid
and adrenic acid).
PUFAs sources are prevalent in green plants, algae, and phytoplankton on which fish feed, fish
oils are a rich source of docosahexaenoic acid (or DHA), while egg lipids can provide both DHA
and arachidonic acid (AA).
linoleic acid (omega-6) and alpha linolenic acid (omega-3) are precursors of these PUFAs and
must be obtained from the diet because they cannot be synthesized. They are termed essential
fatty acids (EFAs) and if provided by the diet, the CNS and liver have enzymes that can convert
them into the longer chain PUFAs.
Vegetable oils are a rich source of both linoleic and alpha linolenic acids. The long-chain DHA
and AA fatty acids are believed to be critical components of membrane phospholipids and major
constituents of the nervous system.
DHA is present in high concentrations in the retina. In the brain, DHA is most abundant in
membranes that are associated with synaptic function, and is accumulated in the CNS late in
gestation and early in post-natal life.
Breastfeeding versus formula feeding
Breast milk contains DHA which is essential in nerve functioning.
There have been frequent claims that breastfed infants tend to be smarter than those who are
formula fed. Research done earlier indicate that children who are breastfed for ten months or
more have higher IQ scores than those who are formula fed or weaned by four months of age.
From a scientific standpoint however, breastfeeding is not the only factor that favours breastfed
infants since many studies have also shown that, breastfeeding is also associated with higher
social-economic status, maternal IQ and maternal education though this is still subject to ongoing
research.
Higher social-economic status is a marker for more involved parenting which translates into
more attention being paid to infants either into reading, playing and an all-round caregiving all of
which facilitate cognitive development.
A major difference between breast milk and commercial formula is the absence of certain fatty
acids in the latter, notably DHA.

Cholesterol and adult behaviour

Research has shown that there is a link between cholesterol and behavior in that, new-borns
exposed to higher levels of cholesterol through breastmilk are better able to cope with dietary
cholesterol as adults.
Lowering cholesterol levels in adults to reduce risk of cardiovascular diseases can be achieved
through improving the diet, increasing level of physical activity and not necessarily through
intake of antilipidemic drugs. Since a lower than optimal cholesterol has been associated with
mortality. This mortality is related to behavioural factors resulting from depression e.g. suicides,
homicides and accidents. Statins is a class of drugs that inhibit the enzyme that controls the
metabolic pathway that provides cholesterol in liver. They are particularly effective and much
prescribed. More evidence exists that statin use may reduce the risk of depression although some
research suggests that results may differ by sex, with fewer depression symptoms in women and
more in men.
Cholesterol and antisocial behaviour
The relationship between cholesterol and non-illness-related deaths remains controversial as
contrary data exists. A small body of literature links low serum cholesterol levels (i.e. below
160-180mg/dl) to psychiatric and behavior manifestations of effective disorders and violence.
For example, individuals with antisocial personality disorder whether psychological or social,
have been shown to have lower levels of cholesterol.
Lower cholesterol concentrations have also been observed in prisoners, homicidal offenders,
patients hospitalized for violence, and those who attempt suicide
Violent suicide attempters were found to have the lowest total cholesterol (140mg/dl), followed
by non-violent suicide attempters (165mg/dl), followed by non-suicidal healthy control group
(194 mg/dl).
Low cholesterol may therefore influence mood and suicidal behavior, but perhaps as likely,
mood and medication, via their influence on eating and exercise, may serve to reduce cholesterol
levels.
It has therefore been concluded that a low fat or low-cholesterol diet results in a variety of anti-
social behavior.

Cholesterol and cognitive function

Following animal studies, dietary manipulations may modify behavior by changing brain
cholesterol levels and the fluidity of neural membranes
However, in humans, almost no research has been conducted on the role of cholesterol and
learning ability, although some other aspects of cognitive functioning have been explored such as
memory. For instance, a study on some elderly individuals found high total cholesterol or high-
density lipoprotein (HDL) to be associated with better memory function.
Others have found the opposite patter; that higher total cholesterol may be associated with higher
rates of dementia in elderly.
Another study of the possible effects of cholesterol on children found no associations with their
cognitive academic performance. Beyond childhood, however, the current assessment shows that
higher levels of cholesterol are the most detrimental in middle-age adults and most beneficial in
the elderly.
Numerous studies though need to be done before a conclusion is reached on cholesterol directly
affect cognitive functioning.
ASSIGNMENT
1. What is the role of breastmilk in brain development?
2. Discuss the relationship between cholesterol and cognitive.
3. Giving examples, explain how macro and micro nutrients affect brain behaviour.

LESSON 9

NUTRIENTS, THE CENTRAL NERVOUS SYSTEM AND BEHAVIOUR

Lesson Objectives

By the end of the lesson, you will be able to: -

a) identify the B Complex vitamins involved in the central nervous system and behaviour

b) identify the deficiencies, signs and symptoms of various B complex vitamins

C) discuss the relationship between minerals and behaviour

B Vitamins, central nervous system and behaviour

Vitamins are organic compounds essential for metabolism of other nutrients and maintenance of
a variety of physiological functions. The primary function of vitamins is catalytic i.e. they serve
as co-enzymes which facilitate action of enzymes involved in essential metabolic reactions.

The common causes of nutrient deficiencies are: -

 Inadequate intake
 High nutrient demand e.g. due to infections or physiological states such as pregnancy
 Low bio-availability e.g. anti-nutrients such as tannins, phytates, goitrogens, oxalates
may affect bio-availability of some nutrients, the cooking and preparation method may
also impact on loss of nutrients
 Malabsorption
Thiamin (vitamin B1)

It is a co-enzyme in metabolism of carbohydrates and branched chain amino acids. It is also

important for membranes functionality and conduction of electric impulses. It is also involved in
utilization and turnover of neurotransmitters e.g. acetylcholine.

Alcohol consumption also contributes to thiamine deficiency because it leads to degeneration of

the intestinal wall thus impairing the absorption of the vitamin. Wernicke-Korsakoff syndrome
characterized by neurological and psychological deficits may also be present in alcoholics due to
thiamine deficiency.

Since thiamine plays a role in energy metabolism at cellular level, its deficiency may result into
depletion of central glucose metabolism leading to energy depletion and neuronal death.

The early stages of deficiency are featured by anorexia, weight loss, short term memory loss,
confusion, irritability, muscle weakness and enlarged heart.

The common conditions from a deficiency of thiamine are: -

 Dry beriberi (no edema) – which affects the nervous system and causes damage to the
nerves, decrease in muscle strength and muscle paralysis.
 Wet beriberi (edema is present) – which affects the cardiovascular system.

Thiamine deficiency is associated with lesions in the brain particularly the thalamus,
hippocampus, brainstem and cerebellum. Damage to these parts of the brain result in memory
deficit and ataxia or loss of full control of bodily movements.

Niacin (vitamin B3)

It is an important component of co-enzyme nicotinamide adenine dinucleotide (NAD) which is

important for intracellular respiration and oxidation of fuel molecules such as lactate and
pyruvate.

A deficiency in niacin causes neurological symptoms like dizziness, sleepiness, irritability, loss
of memory, confusion and emotional instability.

In advanced cases it causes hallucinations, delusions, severe depression and catatonia

(abnormality of movement and behavior arising from disturbed mental state).

Catatonia is a typical symptom of schizophrenia.

The condition that results from niacin deficiency is referred to as pellagra. It is characterized by
the four (4) D’s i.e. dermatitis, diarrhea, dementia and death. It is particularly prevalent in
populations that heavily rely on maize as its staple food since the nicotinic acid in maize is in its
bound form and the body cannot utilize it much.

Signs of pellagra include:

 Fatigue
 Lack of appetite
 Muscular weakness
 Anxiety and irritability

Pyridoxine (vitamin B6)

It serves as a co-enzyme involved in the metabolism of protein and carbohydrates, participates in

the production of insulin, production of red and white blood cells, synthesis of neurotransmitters
and enzymes. A deficiency results in dermatitis, microcytic anemia (formation of small and
immature red blood cells), convulsions, depression and confusion. Supplementation with vitamin
B6 is recommended to Tuberculosis patients who are treated with isoniazid.

Cobalamin (vitamin B12)

It is significant in the functioning of the central nervous system and formation of red blood cells.
It is involved in metabolism of every cell in the human body especially affecting DNA synthesis
and therefore its deficiency can potentially cause severe and irreversible damage to the central
nervous system.

At levels slightly lower than normal range, symptoms like fatigue, lethargy, depression, poor
memory, breathlessness, headaches and pale skin may be present.

Absorption of cobalamin requires intrinsic factor which is made by the stomach. A few people
have inherited a defect in the gene for intrinsic factor, which results in abnormal absorption of
cobalamin beginning in mid-adulthood. Anemia resulting from lack of intrinsic factor is known
as pernicious anemia. Pernicious anemia causes fatigue, decreased tolerance to exercise,
shortness of breath and palpitations. Neurological signs of deficiency are: tingling of hands and
feet and poor motor coordination.

With continued deficiency, demyelination progresses gradually to include damage to the spinal
cord and eventually to the brain.
Cognitive changes include: -

 Moodiness
 Loss of concentration
 Memory loss
 Confusion
 Depression
 Insomnia
 Dementia
 Visional disturbances

Folate (vitamin B9)

It is necessary in metabolism for energy production. It plays a significant role in synthesizing

proteins, genetic material, building muscles, making new cells particularly the red blood cells,
transmission of nerve signals. It also prevents changes in the DNA.

Several studies have shown that patients with folate deficiency also have psychiatric symptoms
which include; irritability, paranoia and hostility.

Dietary deficiency of folic acid at the time of conception is also associated with occurrence of
spina bifida. Spina bifida is a developmental abnormality of the nervous system. It is the
congenital malformation of the embryonic neural tube and spina cord.

In addition, these neural tube defects may be of genetic origin or due to environmental factors
e.g. irradiation and maternal infection (rubella).

Minerals, central nervous system and behaviour

Biological functions of minerals

 They are necessary constituents of a number of enzymes e.g. iron is necessary for
catalases and cytochromes, iodine is necessary for production of thyroxin, calcium and
phosphorus are important for bone and teeth health.
 Minerals act as catalysts or co-factors for biological reactions e.g. the absorption of
nutrients in GIT and uptake of nutrients by cells.
 Minerals help to maintain acid-base balance in the body as well as to regulate the
physiology of cell membranes.
Iron

Iron deficiency anemia occurs in individuals with dietary inadequacies and other health problems
e.g. malaria, malabsorption and parasitic infections. In children, IDA is strongly associated with
impaired cognitive development and intellectual performance.

The behavioural disturbances in both adults and children are:

 Irritability
 Mental fatigue
 Short attention span
 Impaired memory
 Anxiety
 Depression

Studies have shown that infants with iron deficiency tend to have poor motor ability during the
first two years of life. Additionally, developmental test scores for these children are lower than
those of non-anemic infants. They also have behavior characteristic of ‘functional isolation’.

Functional isolation – limits infants’ stimulation and learning from the environment because
anemic infants are less likely to explore their environment and are more likely to stay close to
their caregivers.

In school going children, iron deficiency results in poor academic performance which may lead
to anxiety, depression and social problems especially since learners lag behind their peers on
cognitive and motor tasks.

Brain iron is involved in neurotransmitter metabolism and therefore has a role in nerve
conduction.

Iron is a cofactor for enzymes such as tyrosine hydroxylase and tryptophan hydroxylase which
are essential for the synthesis of dopamine and serotonin.

Since dopamine is involved in perception, memory, motivation and motor control, the
behavioural symptoms of iron deficiency can be explained by this connection. Many studies have
shown that iron deficiency is significantly associated with behavioural alteration.

Zinc

It is a mineral that is important for growth and development. It is widely distributed in foods and
is particularly important in protein metabolism in tissues that undergo rapid turnover as well as
in immunity.

Deficiency of zinc is associated with

 Growth retardation
  Behavioural abnormality
 Negative pregnancy outcomes
 Abnormal CNS development
 Attention is affected in zinc deficient infant
 Poor taste perception

Zinc deficiency results in infants are irreversible but the results are reversible in adults.

Iodine

The thyroid hormone has multiple functions as a regulator of cellular metabolism and growth.

Reduced metabolic rate is the principal biological consequence of iodine deficiency.

Other manifestations are:

 Impaired physical growth and immaturation

 Slowness of movement
 Impaired reflexes
 Hoarseness of voice
 Skin changes
 Cardiac insufficiency

The symptoms of deficiency can be classified as mild, moderate or severe.

Moderate iodine deficiency: associated with reduced visual and motor performance, perceptual
abnormality and reduced intellectual capabilities.

Severe iodine deficiency: during infant development stage, both physical and mental
abnormalities are manifested e.g. in neurological cretinism, mental retardation, poor display of
spastic movement and gait as well as deaf and mute situations are reported. These are
irreversible.

Iodine deficiency can be avoided by fortification of salt with iodine.

In conclusion, intake of essential minerals is important for normal brain development and
functioning. In adults, mineral deficiency can lead to a variety of alteration in behavior,
unfortunately, the consequences of mineral deficiency are most often irreversible if they occur
during s critical stage of brain development.

Iodine and zinc deficiency during fetal development can lead to permanent impairment of brain
function and behavior.

Summary
  Vitamins and minerals play a significant role in the functioning role of the nervous
system and behaviour
 Vitamin deficiencies can result in neurological and psychological problems e.g. sensory
or motor functioning.

ASSIGNMENT

1. State the factors contributing to nutrient deficiencies.

2. Explain the conditions resulting from deficiency of thiamine.

3. State the effects of zinc deficiency.

LESSON 10

SHORT TERM AND LONG-TERM EFFECTS OF MALNUTRITION

Lesson Objectives
By the end of the lesson, you will be able to: -
a) identify and discuss Protein Energy Malnutrition (PEM)
b) discuss the relationship between PEM and behaviour
Protein Energy Malnutrition (PEM)
The condition we are going to talk about first is the one brought about by shortages(deficiencies)
of proteins and energy giving foods. This leads to “protein energy malnutrition,” or PEM. This
includes the following range of conditions:

 Underweight
 Marasmus
 Kwashiorkor
 Marasmic kwashiorkor.

1) Underweight: This mildest form of PEM can be detected only by checking the weight of the
child and plotting it on the weight for age (or growth) chart. In “underweight” the child has an
expected weight for age of 60-80%. There are no other remarkable signs, but the child may look
thinner and smaller than other normal children. These children need special attention because:

 There are very many underweight children in the community. Most are between 1 - 3
years of age.
 Underweight children grow and develop more slowly than well-nourished children.
 They are considered "at risk" for illness. Underweight children are always in danger of
picking up infections very easily. These infections are more serious and more prolonged
than in well-nourished children and are more likely to cause death.

Management of the underweight child:

 Look for the primary causes of the child’s undernutrition.

 Advise on good mixed diets.
 Follow up those children under the age of five years and observe their growth line. If
there is no catch up in weight or if the weight stays the same or is lost, then refer the child
for further examination and treatment.
 Carry out comprehensive immunization.

2) Marasmus: Marasmus literally means “starvation.” Marasmus can occur at any age but is
more commonly found in infants who do not get enough breast milk, or who during the weaning
period are not given adequate food. Infections are often contributing factors.
Clinical features:

 The weight is below 60% of the standard weight for age.

 Lack of subcutaneous fat. Legs and arms are thin.
 The skin is thin, wrinkled and seems to be large for the body it covers.
 Child looks anxious and has a face like that of an old person.
 The child is usually hungry, suckling at his/her fingers.
 There may be constipation or diarrhoea, which is often the reason why the mother brings
the child for medical care.

3) Kwashiorkor: Kwashiorkor is a word from a Ghanaian language that means “illness of the
displaced child.” Displaced in this context means that a younger brother or sister has displaced
the child from her/his mother’s breast. Many local languages describe the presence of oedema in
this disease, and for that reason it is sometimes called “wet malnutrition.”

Kwashiorkor can come on rather quickly over a few weeks. It often follows infections like
measles or diarrhoea, and may suddenly develop in a child who is underweight, failing to thrive
or marasmic.

LESSON 11

Lesson Objectives
By the end of the lesson, you will be able to: -
a) understand the relationship between malnutrition and behaviour
b) discuss the malnutrition and behaviour cycle

Malnutrition effect cycle

Malnutrition leads to brain damage, brain damage leads to lowered IQ and low IQ leads to
impaired behavior. This is best demonstrated using the diagram below.
The PEM-Behavior Cycle

Severe protein malnutrition in early development results in failure to maintain embryonic

implantation resulting in spontaneous abortion. Moderate acute malnutrition throughout
pregnancy may permit continued development of the foetus but will lead to changes in growth of
both the placenta and the foetus. If the placenta is poorly developed, it cannot deliver adequate
nourishment to the foetus and the infant may even be born prematurely, small for their gestation
age and with reduced head circumference. Small head circumference is a clear indication that
malnutrition has occurred and results in permanent head damage. Since marasmus develops at
young ages compared to kwashiorkor, a marasmic child is more likely to have reduced head
circumference than that with kwashiorkor.

Post-natal brain has its development impaired in those cells and regions that show maximum
growth at the time of nutrition deficiency. Therefore, postnatal malnutrition is usually associated
with reduction in the number of glial cells and not neurons. Glial cells regulate homeostasis by
offering support and protection to the functioning of neurons. Neurons on the other hand transmit
signals between themselves and from one part of the body to another.
In adulthood, malnutrition impairs biological functions related to the reproductive system. In
men, the ability to produce viable sperm is affected and in women, amenorrhea occurs and may
result in infertility.
If a malnourished woman gets pregnant, the pregnancy outcome is unfavourable i.e. spontaneous
abortion may occur or they may give birth to infants with congenital malformations.
Behavioural Effects of Severe Malnutrition
Lower IQ scores and school performance has been reported in impoverished children who
experienced early clinical malnutrition.
Behavioural symptoms of marasmus include irritability and apathy. Those of kwashiorkor
include anorexia and withdrawal, whimpering and monotonous cry.
Lethargy and reduced activity are the most commonly observed in the two forms. This reduced
motor activity may help to isolate malnourished infants from their environment, resulting in
limited opportunities for learning and thereby depressing mental development. Malnourished
new-borns may be poor in their taste organisation, low in social responsiveness and not very
adapt at orienting to visual stimuli.
Although apathy and reduced activity are characteristics of malnourished infants, many
behaviours of infants failing to thrive cannot be attributed to malnutrition alone. Instead, the
infant’s irritability may discourage social interactions, which the mother may be interpreted as
personal rejection.
Effects on children and adults
Cognitive deficits
Severe malnutrition before three years of age leads to low IQs (below 70) even after two or more
years of recovery. Malnutrition may have been confounded with poor parenting (e.g. mothers
being less sensitive, verbally communicative, emotionally involved or interested in their child’s
performance relative to their behavior with the unaffected child).
Motor delays
Motor skills are delayed in children with PEM, although this is not always the case. School age
children who are only mildly undernourished can have their activity level reduced. High activity
positively correlates with protein-calorie intake and vice-versa.
Behavioural problems
A study done among Kenyan children found that energy intake was positively associated with
observed happiness and leadership, and was negatively associated with observed anxiety.
Formerly malnourished children show less emotional control, are more distractible, have lower
emotional spans, and develop poorer relationships with their peers and their teachers.
Food insecure families have children who are rated as higher in hyperactivity and other
problematic behaviours.
Despite cultural differences in expectations for behavior, malnourished children generally seem
to have more behavioural problems than normal children e.g. being aggressive and hyperactive at
ages eight and eleven, and higher in conduct disorders and excessive motor activity at age
seventeen.
School performance
Those who were malnourished during infancy tends to earn poor grades than matched controls
(those who were well nourished then), although it is not obvious.
NB: there has not been much research conducted on school-age children with respect to long-
term effects of malnutrition on their school performance.

Effects in Adults
Adolescents from low-income households that experience food insufficiency report higher levels
of mild depression, suggesting that persistent food deprivations may affect mental health.
Lethargy and reduced activity are also observed. Apathy, social isolation and impairments in
memory also occur.
Decreases in activity, motivation, self-discipline, sex drive and mental alertness with increase in
apathy, irritability and moodiness are also common.
ASSIGNMENT
1. Discuss the effects of malnutrition on children and adults.
2. Briefly describe the PEM-Behaviour cycle.
3. Highlight the behavioural effects of severe malnutrition.

LESSON 12
DIETARY SUPPLEMENTS, MENTAL PERFORMANCE AND BEHAVIOUR

Lesson Objectives
By the end of the lesson, you will be able to: -
a) To define dietary supplements
b) To explain the relationship between dietary supplements and cognition

Dietary supplements and cognition

According to the US Dietary Supplement Health and Education Act (DSHEA) of 1994, the term
dietary supplement refers to a product (other than tobacco) that is intended to supplement the diet
that bears or contains one or more of the following ingredients; vitamins, minerals, amino acids,
herbs or other botanical and dietary substance for use by man to supplement the diet by
increasing total dietary intake e.g. enzyme or concentrate, a metabolite a constituent or an
extract.
It is intended for ingestion in the form of pills, capsules, gels, tablets or powders and is not
recommended for use as conventional food or as sole item of meal or diet.
Under DSHEA, it is the manufacturer who is responsible for determining that its supplements are
safe and that claims made about them are supported by scientific evidence that is not false or
misleading. Dietary supplements are marketed as food and therefore their regulation has not been
developed. These products cannot be removed from the market unless there is evidence that they
can cause harm to the public.

The public perceives these products as ‘natural’ and healthy and therefore without health risks.
However, some products can have side effects or can interfere with action of other medication.
Interactions between medicinal herbs and common medications can pose serious health
problems. For instance, consuming Gingko biloba with anticoagulants, vitamin E or even aspirin
can cause internal bleeding
The long-term use of these products is leads to effects that are largely unknown as they are not
subjected to the rigorous safety standards that apply to the manufacture and sale of
pharmaceuticals.
There are several clinical studies conducted on dietary supplements but the bulk of this is flawed
by the use of inappropriate study designs. Clinical studies should be randomized, placebo-
controlled, double-blind trial.
Dietary supplements are one of the most common forms of Complementary and Alternative
Medicine (CAM) that patients use.

Examples of supplements with beneficial health claims

Vitamin E
Vitamin E is a fat-soluble vitamin that primarily functions as chain-breaking antioxidant in
lipids. Vitamin E prevents the propagation of free-radical reactions. Specifically, the vitamin
protects polyunsaturated fatty acids from attack by peroxyl radicals. This protection derives from
the fact that peroxyl radicals react 1000 times more rapidly with vitamin E than with PUFAs.
Vitamin E deficiency is extremely rare in humans and is only associated with malabsorption of
the vitamin (as in cystic fibrosis) or inborn errors in vitamin E metabolism. Vitamin E
supplements are sold as esters (to protect the shelf life) of the natural form or as the synthetic
mixture. When α tocopherol is derived from vegetable oils it is labelled as a natural source of
vitamin E.
There are few adverse effects of consuming large doses of α-tocopherol as dietary supplements.
High doses of the vitamin lead to hemorrhage in experimental animals, but large studies in
humans showed no evidence of hemorrhagic stroke.

Vitamin C
Vitamin C is a broad-based, water-soluble antioxidant that quenches a variety of reactive oxygen
and nitrogen species. In addition to its own antioxidant activity, Vitamin C can also regenerate or
spare α-tocopherol. When α-tocopherol intercepts a radical, a tocopheroxyl radical is formed.
This radical can be reduced by vitamin C (or other reducing agents), thereby oxidizing vitamin C
and returning vitamin E to its reduced state. Thus, vitamin C has the capacity to recycle vitamin
E.
Vitamin C is also highly concentrated in the central nervous system (CNS) and local brain
concentrations change rapidly with neuronal activity. Moreover, brain pools are relatively
resistant to vitamin C depletion. Together, these observations suggest a major role for vitamin C
in CNS functioning. The protective effects of vitamin C in the brain may arise from its free-
radical scavenging ability.
In the periphery, vitamin C has vasodilatory and anti-clotting effects, and is thought to play a
role in the reduction of cardiovascular disease by inhibiting plasma low-density lipoproteins
(LDL) cholesterol oxidation. Oxidized LDL tends to aggregate on vascular cell walls resulting in
the accumulation of plaques that narrow blood vessels. Since senile dementia and other
neurodegenerative diseases may involve narrowing of cerebral blood vessels, vitamin C may
serve similar functions in the brain.
Dietary supplements containing vitamin C are popular, but estimated intakes from both food and
supplements rarely exceed 200 mg/day. Although serious risk of adverse effects from excess
vitamin C intake from food and supplements is low, some individuals experience gastrointestinal
disturbances such as nausea, cramps and diarrhea from large oral doses. The UL for vitamin C
for adults is 2000 mg/day.
Beta-carotene
Although consumption of β-carotene and other carotenoids has been linked to reduced risk of
chronic diseases such as cancer and cardiovascular disease, these effects have not been firmly
established. It is however believed to be an emulsifier and therefore stabilizes the lipid profile at
present, there is no dietary reference intake for carotenoids, per se since the biological functions
of these compounds are diverse and are poorly understood. However, several carotenoids
including α-carotene, βcarotene and β-crytoxanthin have well-known pro-vitamin A activity.
β-carotene from supplements has a much higher bioavailability than from foods. This is because
the β-carotene from supplements is not bound to proteins and has been solubilized with
emulsifiers. There are no health risks from consuming large amounts of carotenoids from foods
or supplements except for carotenoiderma, a yellow discoloration of the skin that is not harmful.
No upper limit has been set for β-carotene or other carotenoids.
Selenium
Selenium principally functions as selenoproteins. Two classes of selenoproteins are known.
i. glutathioneperoxidase enzymes whichserve as the body’s primary defense mechanism
against oxidative Glutathione peroxidase is widely distributed in the body but is highly
concentrated in the brain where it is localized in glial cells in central gray matter, hippocampus
and temporal cortex. Decreased activity of this enzyme has been documented in patients with
Alzheimer’s and Parkinson’s disease which could imply a general increased level of oxidative
stress in these individuals.
ii. iodothyronine deiodinases regulate thyroid-hormone metabolism. These enzymes play a role
in iodine deficiency disease and cretinism. Many dietary supplements also contain selenium.
However, the risk to the general population of adverse effects from high doses appears to be low.
The UL for selenium is 400 µg/day

Vitamins B6, B9 and B12

Elevated homocystein levels have been associated with an increased risk of dementia. The most
common causes of homocyteine elevation are deficiencies in Vitamins B6, B9 and B12.
Therefore, enhanced homocysteine metabolism through B-supplementation may have a
beneficial effect on reducing risk of dementia.

 Vitamin B6 is an essential cofactor in homocysteine metabolism

 Vitamin B9 acts as a donor of methyl groups for the methylation of homocysteine to
methionine
 Vitamin B12 is also required in the methylation of homocysteine to methionine.

Essential fatty acids

The mechanisms for their benefit in cognition and dementia include reduction in cardiovascular
diseases and stroke, reduction in synthesis of pro-inflammatory cytokines implicated in the
development, maintenance of brain cell membrane integrity and neural function.

Herbal supplements and behaviour

Ginkgo biloba
It is an herb derived from the leaves and nuts of the ginkgo or maidenhair tree. It has been used
to treat asthma and chilblains (sores of the hands and feet from exposure to the cold) in Chinese
medicine for thousands of years. Pharmacological studies suggest that this herb has anti-edemic,
antihypoxic, free radical scavenging, antioxidant and anticoagulant activity. Ginkgo has been
used experimentally to protect against myocardial reperfusion injury, depression, brain trauma,
memory impairment, dementia and intermittent claudation. Extracts contain the active
ingredients, flavonoid glycosides and terpene lactones.
NB: despite the theoretical basis of ginkgo biloba in the prevention of cognitive decline, there is
no convincing evidence that it’s efficient in preventing dementia of delaying cognitive decline
among older adults.

Ginseng
The roots of Asian ginseng (Panax ginseng) are believed to have sedative, hypnotic and
antidepressant properties. Ginseng extract also acts as a CNS stimulant and potentiates the
stimulatory effects of caffeine from coffee, tea and cola. The herb is used in traditional Chinese
medicine to improve cognitive performance, vigilance, stamina and concentration.
 It has been investigated as a therapeutic agent for improving cognitive performance, memory
and mood.
Side effects include insomnia, nausea, diarrhea and headache. It also lowers blood glucose. Thus,
the use of this herb might be counterindicated in individuals taking anti-diabetic medications.
Ginseng is also reported to interact with monoamine oxidase (MAO) inhibitors, used in the
treatment of depression, and anticoagulants such as warfarin.

St. John’s Wort (Hypericum perforatum)

It is a wild-growing herb with yellow flowers. It has been used since ancient times to treat mental
disorders and nerve pain. When applied topically as a balm, it was used to treat insect bites,
wounds and burns. Currently it is used primarily to treat mild to moderate depression. However,
it is not effective in treating major depression. The main active constituents of SJW (St. John’s
Wort) are hypericin and hyperforin, although other components may be active as well. More
research needs to be done to determine precisely how SJW counteracts depression.
St. John’s Wort has fewer side effects than conventional antidepressants which make it an
attractive treatment alternative. Side effects may include a dry mouth, dizziness, gastrointestinal
effects, increased sensitivity to light and fatigue.
It adversely reacts with medication; SJW rapidly deactivates several classes of drugs by inducing
liver detoxifying enzymes. Serious interactions are known to occur with protease inhibitors used
to treat HIV infection, immunosuppressant drugs, birth control pills, cholesterol lowering drugs,
cancer and antiseizure medications and blood anticoagulants therefore SJW should not be
combined with other medications.
Kava
Kava is made from the dried rhizome of the plant Piper methysticum and was traditionally used
as a recreational drink in the South Pacific. Kava has anxiolytic properties and also acts as a
muscle relaxant, mood enhancer, analgesic and sedative. It is generally used to treat seizures and
psychotic illnesses. The active compounds are a family of kavapyrones, the anxiolytic actions of
which are complex.
Kava should be avoided in individuals taking psychotrophic medications. Long-term use has
been associated with yellow discoloration of the skin, hair and nails, visual disturbances,
dizziness, ataxia, hair loss, hearing loss, appetite loss and weight loss. It severe cases it may
induce toxic liver damage.

Oxidative damage in the CNS

The brain has high energy needs and has a high rate of oxygen utilization which makes it highly
susceptible to oxidative damage.
It also has high content of fatty acid incorporated into neuronal membrane and much of it are
unsaturated fatty acids that are vulnerable to oxidation.
Oxidative damage to the brain cells result in occurrence of disease like Alzheimer’s disease and
Parkinson disease.
1. Alzheimer’s disease
It is the most common form of dementia. There is continuous atrophy of the cerebral cortex
accompanied by deteriorating mental functioning e.g. reasoning.
The etiology is unknown. However, genetic factors may be involved. Females are affected twice
as often as males and it usually affects those over 60 years of age.
Alzheimer’s disease and deficits associated with it

 Cognitive - Forgetfulness, loss of memory, memory distortions. Deficits in concentration,

attention, learning and problem solving. Language deficits and the ability to draw figures
 Functional – loss of motor skills including the ability to walk and talk, incontinence,
emergence of primitive reflexes such as grasping and sucking
 Behavioural – mood swings, apathy, depression, irritability, restlessness. Delusions and
hallucinations

2. Parkinson’s disease
It is a disease in which there is gradual degeneration of dopamine-releasing neurons in the
extrapyramidal system.This results to lack of control and coordination of muscle movement
leading in fixed muscle tone and muscle tremor of extremities.The cause is unknown but some
cases are associated with repeated trauma.Onset is usually between 45 and 60 years.
There is progressive physical disability but intellect is not impaired.

ASSIGNMENT
1. Define oxidative stress.
2. Discuss oxidative stress.
3. Giving examples, differentiate between dietary and herbal supplement.
LESSON 13
BIO-BEHAVIOURAL AND PSYCHOSOCIAL INFLUENCES ON NUTRITION

Lesson Objectives
By the end of the lesson, you will be able to: -
a) To explain bi-behavioural and psychosocial influence on nutrition
b) To outline psychosocial health and psychosocial determinants

Bi-behavioural influence on nutrition

The effect of nutrition on behavior is bidirectional. On one hand, nutritional state can have a
profound effect on our mental state, the state of our well- being and our responses to physical
and emotional stress. On the other hand, certain aspects of our social or physical environment
such as cultural and family background, where we live and our educational and income level
affect our attitudes towards foods. This combination of social and environmental variables can
have several consequences for eating behavior, mediating both the types and amounts of foods
we choose to consume, ultimately influencing nutritional state.
Therefore, bio-behavioural and psychological influence on nutrition explores how major
biological variables like sex, age, genetic background and disease influence nutrition- behavior
paradigm/ pattern. Certain variables such as the presence of disease can directly alter nutritional
state hence influence eating behavior. On the other hand, other variables such as genetic
variation in taste do not affect nutritional state directly, but exert a strong influence on eating
behavior which subsequently influences nutrition and health.
Social and environmental variables (psychosocial variables) can operate in a similar manner.
Psychosocial variables can mediate or modify behaviours which have a subsequent effect on
nutritional state.

Genetic and Biological Determinants of Nutrition- Behavior Paradigm

a) Taste perception and preference
Taste is the most important determinant of food choices. It encompasses several of food
dimensions such as aroma, flavour and texture.
Aromas and flavours are complex mixtures of volatile odour compounds. Taste buds respond to
the four classic basic tastes including sweet, salt, bitter and sour.
b) Neophobia and familial interactions
Food selection by young children is strongly determined by familiarity with and exposure to
specific foods.
Since the consumption of a varied diet is consistent with good health, repeated exposure to new
foods during childhood could promote diversity in children’s food choices and ultimately lead to
the selection of healthiest diets. Studies have shown that children can overcome neophobia with
repeated exposure to the taste of a novel food.

Disease, Aging and Other Physiological Differences

a) Disease
A variety of systemic diseases can influence food and fluid appetite. Aging may reduce the
quality of life e.g. aromas are 2-15 times harder for elderly to detect, and when detected, they are
weaker to them than the young. Age decline in taste perception is much more modest than for
aroma perception
NB: All taste qualities are not equally affected
b) Aging
The elderly are more likely to experience a decline in bitter taste than in sweet taste; decreased
sour and salty taste has been reported in some studies on aging but not others.
Diminished appetite may be a risk factor for weight loss, poor nutritional status and other health
consequences in genetic population.
The sources of appetite changes in the elderly are many but can be grouped into three major
categories:

Functional changes to the taste/ smell system- the causes of taste/ smell loss include reduction
in the number or activity of taste buds or olfactory receptors, changes in conduction along nerve
pathways, or reduced activity at higher brain centers.

Physiological changes associated with the diseases of aging and their treatment

Demographic/ psychosocial factors

Other changes associated with the aging process include dry mouth and changes in dentition
which affects the ability to chew and swallow food, and also functional changes in the GIT that
affect absorption and utilisation of nutrients.
c) Pregnancy
Appetite changes are common in pregnancy and are generally of two types:
i) Food aversions- usually experienced during early stages of gestation
ii)Food cravings- usually experienced later in gestation
Food aversions are closely associated with nausea and vomiting (due to gestational hormones).
Commonly associated foods are salty and spicy foods (including meats and shell fish), alcohol
and coffee. The coffee and alcohol are of particular concern because of their toxic effects that
increase the risk of miscarriages and still births.

Psychosocial health and psychosocial determinants

Psychosocial means something relates to one's psychological development in a social
environment and interaction with a social environment. It relates social condition to mental
health.
Mental Health
The thinking portion of psychosocial health is known as mental health. Your beliefs and values
in life, as well as how you relate to others and respond to situations in your life, are a reflection
of mental health, which overlaps with the other aspect of health. When something happens to
you that you don't like and you respond in a positive manner by accepting your mistake and
looking forward to its correction, then that is good and healthy.
Emotional Health
The feeling part of psychosocial health is called emotional health. This includes things like
anger, love, hate, and happiness. Everyone, even the most optimistic people, have their ups and
downs. But an emotionally unhealthy person is one that responds to a situation in a manner that
is uncontrollable, out of proportion, and extreme.
Emotional intelligence is also an important aspect of psychosocial health. It is the ability to
understand and manage your emotions and those of others. It can be broken up into five main
parts:

 Know your emotions: Are you able to quickly recognize your feelings?
 Manage your emotions: Can you express those feeling appropriately? Are you able to
cope with them well?
 Motivate yourself: The more you can do this independently in order to achieve more in
your life, the higher your emotional intelligence.
 Recognize the emotions of others: The more you can empathize with others, the better.
 Handle your relationships: The better you are at navigating conflict in life and building a
good social network, the higher your emotional intelligence.
Social Health
This refers to the ability to create and maintain healthy relationships with others.
Social health goes beyond having appropriate emotional health and intelligence. A person with
good social health:

 Recognizes the importance of social engagement. We are not supposed to live alone
 A person with good social health is able to support their friends in a time of need and ask
for their help when they need it themselves.
 They are not biased, prejudiced, racist, or sexist.
 Listens to others well, expresses their feelings just as well, and acts in a responsible
manner around others.

As an example of a person with good social health is someone who has close friends that they
enjoy listening to and feels close enough to share important feelings with.
Spiritual Health
The final aspect of psychosocial health is spiritual health, a belief in a force that gives meaning
to life. For some, it is nature or something else that is bigger than them. Regardless of where a
person's ethics, morals, values, and beliefs come from, they should give them a sense of purpose,
awareness, and community.

Psychological Determinants of Nutrition

Stress
Psychological stress is a common feature of modern life and can modify behaviors that affect
health such as physical activity, smoking or food choice. The influence of stress on food choice
is complex because of the various types of stress that one can experience. The effect of stress on
food intake depends on the individual, the stressor and the circumstances. Generally, some
people eat more and some eat less than normal when experiencing stress.
Mood and emotions
Mood and emotions could influence food choice via physiological effects that change appetite, or
by changing other behavior that constrains or alters food availability.

ASSIGNMENT
1. Explain the psychosocial determinants affecting nutrition.
2. Discuss 3 Physiological influencing nutrition of an individual.
3. How does stress, mood and emotions affect nutrition?

LESSON 14
STIMULANTS, DEPRESSANTS, SWEETNERS AND FOOD ADDICTIVES

Lesson Objectives
By the end of the lesson, you will be able to: -
a) discuss the dietary sugar and behaviour
b) explain the interaction between caffeine, methylxanthines and behaviour

Dietary sugar and behaviour

Sugar belongs to a group of foods known as carbohydrates that are composed of the elements
carbon, Hydrogen and oxygen. Carbohydrates, in human nutrition are classified as sugars,
starches and fibres.
Food manufacturers add a variety of sugar-containing products to our foods – often referred to as
‘hidden sugars’. Most of these products are added to enhance the sweetness of the food,
however, these products also can extend the shelf life of a product, promote browning in foods,
help to retain moisture in bakery items, and improve food consistency.
Nutritive sweeteners refer to sugar-containing products used for their sweetening capacity. For
many years, sucrose was the most commonly added nutritive sweetener, however, in the mid-
1980s corn sweeteners became the product of choice for many food manufacturers. Corn
sweeteners are produced by the enzymatic breakdown of maize starch. They are similar in taste
to sucrose, but are significantly less expensive to produce. Corn sweeteners are now the
predominant sweeteners in a number of foods
Examples of nutritive sweeteners

 Cane and beet sugar Corn

  Cane and beet sugar and corn sweeteners are subsets of total nutritive sweetener
consumption.
 High fructose corn syrup (HFCS) is a subset of corn sweeteners.
 Low-calorie sweetener data consist of saccharin and aspartame.

The WHO recommends a diet that contains no more than 10% dietary sugars for the prevention
of obesity, diabetes and dental caries.Nutritive sweeteners are found in ice cream, gelatin
desserts, cereals and cookies and other baked goods, we may not be as aware that sweeteners are
added to foods as varied as pizza, hot dogs, lunch meats, soups, spaghetti sauce, ketchup, salad
dressings, boxed rice mixes and canned vegetables.

The past few decades have seen an explosion of sugar-containing foods including soda, high-
fructose corn syrup flavored fruit beverages and low-fat snacks. Lowfat foods are often a
surprising source of sugar for consumers. Fat carries flavor in foods, and when fat is removed,
more of other ingredients need to be added to boost flavor. Since sugar is a relatively
inexpensive and flavor-enhancing ingredient, these foods have more added sugar than their
higher-fat counterparts.

Metabolism of sugar
All carbohydrates are ultimately broken down into glucose. The body treats sugars added to
foods the same way as it treats the sugars found naturally occurring in fruits and other foods.
Therefore, natural are not any better or worse for the body than added sugars. Fructose is rapidly
metabolized to glucose in the intestinal mucosa hence the metabolism of sugar basically refers to
sugar metabolism.
After absorption, glucose is carried in the blood stream to the liver, brain and other tissues.
Glucose is removed from the blood stream to the liver, brain and other tissues. Glucose is
removed from the blood stream by insulin, and stored in the liver as glycogen. The liver can
store glycogen, sufficient for use through ten (10) hours fast; any excess that it cannot
accommodate is converted into fat and stored in adipose tissue in fat cells.
When needed, glycogen is retrieved and broken down into glucose by glucagon. Glucose is the
primary fuel for the brain, though it is not stored in there. In addition, the brain lacks the
enzymes present in the liver for converting amino-acids Sugar and cognitive behavior
There is a link supported by research between sugar consumption, blood glucose levels and
cognitive abilities. Because glucose is the primary fuel for the brain, the availability of glucose to
the brain may influence the performance of mental tasks. Specifically, glucose intake can
facilitate cognitive behavior while impairment in glucose metabolism can negatively impart
cognitive performance.
The positive effects of acute sugar consumption on cognition have been demonstrated in all age
groups, as well as people with Down syndrome and Alzheimer’s disease. For example, in infants,
it is argued that the preference for sweet foods and for faces develops early in humans to help an
infant for a bond with the mother, thus increasing survival.
Young children perform significantly better on vigilance task shortly after consuming a sugar
containing product.
Adults working memory is significantly improved in college-students given a glucose drink (if
measured by a listening span test). Poor glucose regulation has been associated with poorer
performance in cognitive tests. Typically, the intake of glucose improves cognitive performance
more on difficult than easy cognitive tests.
In addition, blood glucose falls more sharply following more demanding tasks than for easier
ones. This mental work leads to a depletion of glucose which is reflected in falling blood glucose
levels. Therefore, by consuming a food or a beverage containing sugar, the resulting elevation in
blood glucose levels enhances cognitive performance.
NB: decrements in cognitive functioning are common in people with diabetes hence in
improvements in glycemic control leads to enhanced cognitive performance.

Sugar and mood

Culturally, people have a belief that sugar intake enhances mood and decreases fatigue. The
intake of pure carbohydrates can lead to an increase in the neurotransmitter serotonin which may
then improve mood. e.g. some researchers found that people who reported greater levels of
anxiety, depression, and fatigue also reported greater cravings for high carbohydrates/ high fat
foods than people who craved protein-rich foods.
Carbohydrates intake increases blood glucose levels which in turn elevates mood. However,
foods consumed to enhance mood are typically highly palatable and contain not only sugars but
also fats.
Therefore, some of the effects of sweet foods on mood may be attributed either to other
components of the food itself or to sensory characteristics including taste, mouth feel and smell,
although such foods would generally be sweet.

Sugar and hyperactivity

Many parents and teachers believe that the intake of sugary foods lead to an increase in activity
in children in general and specifically, an aggravation of attention deficit hyperactivity disorder
(ADHD) symptoms in children with the syndrome.
There has however been no scientific evidence to support the myth. ADHD presents with
symptoms ranging from inattention to the stereotypical restlessness. Diagnosed children have
difficulty coping with overstimulation, changes in daily routine and periods of concentration
focus.
Some researchers have shown that sugar consumption has little or no effects on behavior.
Clinical investigations have demonstrated a significant effect of sucrose on aggressive or
disruptive behavior, motor activity, or cognitive performance in children.
Caffeine, methylxanthines and behaviour
While coffee, tea and soft drinks differ widely in taste and nutrient composition, they share an
important characteristic- they all contain chemicals called methylxanthines. There are several
types but only three are commonly found in foods:

 Caffeine- naturally sound in coffee, kolanuts, tea and chocolate and is an added
ingredient in over 70% of soft drinks
 Theophylline- commonly found in tea
 Theobromine- commonly found in chocolate

The three of them have significant physiological action. However, it is an action of these drugs
on the central nervous system, which contributes most significantly to their use. As a group, they
are the most commonly consumed psychoactive substances in the world.
Caffeine helps in:

 Boosting physical performance especially in athletes both during training and

competition. It is also common in the military where sustained operations are a necessity.
 It increases heart rate, respiration, blood pressure and blood glucose levels which together
contribute to the positive effects of the day on physical performance
 When taken, it also increases the energy derived from fat and decreases energy from
carbohydrates hence allowing the individual to sustain physical activity for longer
periods of time.
 It may also reduce the perception of the pain resulting from rigorous activity- this is
partly because of its ability to stimulate the release of beta-endorphin (the body’s natural
‘pain killer’)

Caffeine and sleep

Caffeine can delay sleep onset, shorten sleep time, reduce the average depth of sleep, and worsen
the subjective quality of sleep. At high doses, it can cause insomnia.
However, these negative effects do not apply to all individuals. Those who regularly consume
caffeine have fewer problems with sleep after an evening cup of coffee or tea than those who
abstain from it. Moreover, the effects are also dose-dependent.

Caffeine and cognitive behavior

In regular caffeine users, cessation of use is associated with mild withdrawal symptoms such as
headache, irritability, mental confusion and fatigue symptoms would begin 12-24 hours after the
last caffeine intake.
There is little evidence that it improves intellectual abilities except when normal performance
has been lowered by fatigue.
Those who develop sleep-deprivation are disadvantaged because they often suffer from
impairment in cognitive functioning including a decreased ability to concentrate and subsequent
decrements in tasks requiring sustained attention, logical reasoning and perceptual skills such as
driving a car. To reverse these adverse effects, one should sleep even if it is a short nap (15-30
min).

ASSIGNMENT
1. Discuss ways in which the dietary sugar affect behaviour.
2. Highlight ways in which caffeine help in the body.
3. Briefly describe the relationship between caffeine and cognitive behaviour.

LESSON 15

Lesson Objectives
By the end of the lesson, you will be able to: -
a) explain the addiction of caffeine and physiological effects of methylxanthines on the body
Systems
b) discuss the food additives and behaviour
Caffeine and Addiction
Caffeine is a drug that produces physiological, psychological and behavioural effects. There has
been a debate of whether caffeine is a drug of abuse such as heroine, nicotine, alcohol and
cocaine.
The drugs of abuse usually produce pleasurable or reinforcing effects. Caffeine’s reinforcing
properties are similar in characteristics (but not in magnitude) to psycho stimulant drugs such as
cocaine or amphetamine. Caffeine’s reinforcing effects are also relatively weak. Moreover,
individuals do not normally need to consume increasing amounts of caffeine (characteristic of
drug abuse), but rather use it at consistent and moderate levels (drug use).
Caffeine users develop tolerance to some of the physiological effects of caffeine such as elevated
heart rate and blood pressure, but typically do not show tolerance to the mood elevating and
sleep-delaying effects.
Withdraw from caffeine can be accompanied by headache, fatigue, depression, difficulty
concentrating, irritability and sleepiness. For those trying to abstain from caffeine, symptoms of
withdraw normally are relatively mild and subside within a few days. However, in some
individuals, withdrawal symptoms can lead to impairment

Physiological Effects of Methylxanthines on Body Systems

Cardiovascular system
The actions of caffeine and other methylxanthines on cardiovascular system are complex and
sometimes antagonistic. This is because the drug’s effects depend on an individual’s history of
consuming methylxanthines, the dose of the drug and the route of administration.
Caffeine intake is associated with a rise in blood pressure and increase in heart rate especially
intake >250mg. its effect on blood pressure is more pronounced among the elderly.
Smooth muscles
The methylxanthines relax a variety of smooth muscles including those found in the bronchi of
the lungs. Therefore, theophylline is used in making the drugs for asthma (prophylactic therapy).
They are also used widely prescribed to prevent episodes of the loss of effective breathing (sleep
apnea) in pre-term infants.
Gastrointestinal system
Caffeine stimulates the secretion of gastric acid and pepsin. Consequently, coffee intake is often
considered detrimental to individuals suffering from gastric ulcers. However, both caffeinated
and decaffeinated coffee have similar effects of gastric secretions, meaning that additional
components in coffee are responsible to its actions on the system.
Renal system
The diuretic action of caffeine and other methylxanthines has long been recognized. Acute
ingestion results in the short-term stimulation of urine output and sodium excretion in individuals
deprived of caffeine for days or weeks.
Regular intake of caffeine is however associated with the development of tolerance to the
diuretic effects of the drug so that its actions to the renal system are reduced in such individuals.
Reproductive system
The potentially harmful effects of caffeine intake during pregnancy has long been known. Intake
has been blamed for infertility, miscarriage, low birth and birth defects. Research has shown that
lower doses have negligible effects on fetal development. Heavy caffeine (> 700mg/day) may be
associated with a decreased probability of pregnancy and an increased probability of miscarriage
or having a preterm delivery. It also increases the risks of an infant suffering from sleep apnea or
sudden infant death syndrome

Food additives and behaviour

Food additivesare the substances added to the products in order to improve the properties such as
taste, smell, flavour, appearance, nutritional value and shelf life of foods.
The relation between food additives and behavior is evaluated rather considering the effects of
additives increasing hyperactivity- attention, Deficit Hyperactivity Deficit Disorder (ADHD).
This disorder is the most common disorders of childhood and affects approximately 3-10% of the
children during the school terms and is more frequent in boys.

Characteristics of ADHD
ADHD often begins to reveal itself with findings such as inattentive, hyperactivity, impulsivity,
intolerance against obstacles, ill humour, aggression, adjustment difficulties, emotional lability,
and impulsive behavior after 3 years old.
In the first years of school, findings such as incapability of learning, perceptional problems and
school failure are prominent.
Although the causes of the disorder are unknown, genetic and environmental factors play a role
in the formation of the disease.
Some studies have shown that there is a significant decrease in the hyperactive behaviors with
the withdrawal of chemical/ artificial colorants and preservatives from the diet; and there was a
significant increase with the addition of these substances in the diet, and this changing was
independent of the underlying disease.

The Additive-free Foods

A study conducted among 17 nuns fed with organic foods for a month and physiological and
psychological effects were evaluated. Decrease in blood pressure, strengthening in the immune
system, physical fitness and an increase in mental clarity were observed. In addition, they were
also found to suffer from fewer headaches and could cope better with stress.
Another study was also conducted to investigate whether nutrition in childhood is associated
with the tendency to violence in adulthood. Those who ate foods like chocolate, cake, candy, etc
every for 10years in their childhood were assessed when they attained 34 years and it was
determined that they were sentenced from violence significantly more than those who had not
eaten them. Therefore, food additives in foods consumed might increase aggression.

Food additives and the impact on mood and behavior

 Aspartame can trigger migraines in adults who suffer from migraine. in addition, there
are many reports of headaches and other neurological symptoms from people who drink
aspartame containing drinks.
 People suffering from depression become more depressed when they take aspartame
containing drinks. It can also inhibit an enzyme called acetyl choline esterase, which
plays a role in memory and learning.
 A study on children without ADHD (or any other diagnosed difficulty) found that food
colours and sodium benzoate have a significant impact on attention and hyperactivity
scores.
 Artificial food colours E102 and E110 have been shown to cause deterioration in
behavior and zinc status in children with ADHD, but not in children without ADHD.

NB: None of the additives provide any nutritional benefit, and their removal from the diet is
realist and practical.

Examples of food additives

 Artificial yellow colours: E102 tartrazine, E104 Quinone Yellow, E110 Sunset Yellow
(sweets, jelly, soft drinks)
 Artificial red colours: E122 Carmoisine or Azorubine, E123 Amarinth, E124 Ponceau 4R
or Cochineal Red A, E127 Erythrosine, E128 Red 2G, E129 Allura Red AC (soft drinks,
sweets, meat products, jelly)
Other artificial colours: E132 Indigo Carmine, E133 Brilliant Blue, E142 Green S, E151 Brilliant
Black, E155 Brown HT. (sweets, cake mixes, jelly)

 Preservatives: E210-E219 Benzoates (most commonly used: E211- Sodium benzoates)

(soft drinks)
 Artificial sweeteners: E951 Aspartame (sugar free gum, diet yoghurt, instant drinking
chocolate, soft drinks)
 Flavour enhancers: 621 Monosodium Glutamate (stock cubes, packet soup, flavoured
crisps, some Chinese take-aways, some sausages and pies)

ASSIGNMENT
1. Explain the physiological effects of methylxanthines on the body Systems.
2. Discuss the impact of food additives on mood and behavior.
3. List down the examples of food additives.
LESSON 16
ALCOHOL BRAIN FUNCTIONING AND BEHAVIOUR

Lesson Objectives
By the end of the lesson, you will be able to: -
a) explain the interaction between alcohol and nutrients
b) discuss the alcohol effects on digestion and absorption of essential nutrients
c) describe the metabolism of Alcohol and it's effects

Interaction between alcohol and nutrients

Many alcoholics are malnourished either because they ingest too little of the essential nutrients
or because alcohol and its metabolism prevent nutrients from properly absorbing, digesting and
using these nutrients.
Consequently, alcoholics tend to experience deficiencies in protein and vitamins particularly
vitamin A, which may contribute to liver disease and other serious related disorders.
In addition, Alcohol breakdown in the liver both by the enzymes alcohol dehydrogenase and by
an enzyme system called the microsomal ethanol-oxidising system (MEOS) generates toxic
products such as acetaldehyde and highly reactive and potentially damaging oxygen-containing
molecules. These products can interfere with the normal metabolism of other nutrients and
contribute to liver cell damage.

Nutritional value of alcoholic beverages

Alcoholic beverages primarily consist of water, pure alcohol (ethanol) and variable amounts of
sugars (carbohydrates). Their content of other nutrients (e.g. proteins, vitamins and minerals) is
usually negligible. They are therefore considered as “empty calories”.
Alcohol effects on digestion and absorption of essential nutrients
Even if an alcoholic ingests sufficient nutrients, deficiencies may develop if those nutrients are
not adequately absorbed from the GIT into the blood, are not broken down properly and / or are
not used effectively by the body cells.
The two types/ classes of nutrients highly affected are vitamins and protein.
Amino-acid and protein
Alcohol can interfere with the uptake of essential amino-acids. Patients with chronic liver failure
(many cases are alcoholics) also exhibit a number of defects in protein metabolism with
consequences. These include:

 Decreased production of protein in the liver: (e.g. Albumin and blood-clotting factors).
Decreased production of albumin may lead to abnormally low levels of it in the blood.
Albumin helps maintain normal blood levels and also the blood’s concentration of
minerals and other dissolved molecules. Excessively low albumin levels may cause or
exacerbate the abnormal accumulation of fluid in the abdomen (ascites) of patients with
cirrhosis, which may worsen the impaired blood slow through the patient’s already
damaged liver.
 Reduced levels of blood-clotting factors- may predispose patients to the risk of internal
bleeding in the GIT which can have serious health consequences
 Decreased urea synthesis: urea synthesis serves to remove from the body (by excreting it
in the urine) the toxic ammonia that is generated during various metabolic reactions
(including the breakdown of protein). Decreased urea production (results in excessive
ammonia levels in the body) may increase the likelihood that patients develop altered
brain function (hepatic encephalopathy).
 Decreased metabolism of a group of amino-acids called aromatic amino-
acids: abnormalities of the normal balance of various types of amino-acids such as
increased levels of aromatic amino-acids, also can increase the risk of hepatic
encephalopathy.

Vitamins
The vitamins that are particularly affected by alcohol consumption include: thiamin (B1),
Riboflavin (B2), pyridoxine (B6), folic acid (B9) and ascorbic acid (C). The fat-soluble vitamins
are also affected but not as much as the water-soluble vitamins.
the severity of these deficiencies correlates with the amount of alcohol consumed and with the
corresponding decrease in vitamin intake.
Deficiencies are especially common in patients with cirrhosis and from reduced intake with the
diet and for some vitamins, from reduced absorption such as vitamin A.
Fat-soluble Vitamins and Alcohol
Alcohol inhibits the absorption of fats, which in turn inhibits the absorption of fat-soluble
vitamins.
Alcohol’s effect on vitamin A levels
  Liver disease alters the liver’s ability to take up beta carotene and / or convert it into
vitamin A. Therefore, patients with liver disease especially cirrhosis would have
decreased levels of beta-carotene in the blood. This occurs because of the impaired
conversion of ingested beta-carotene to vitamin A in the liver due to the alcohol
consumption especially at advanced stages of alcoholic liver disease.
 Alcohol also promotes the secretion of vitamin A from the liver, thereby enhancing its
decline in the liver.
 It also increases the vitamin A content of some tissues and decreases vitamin A in other
tissues.
 It can speed up or alter the conversion of vitamin A to other compounds which may
contribute to alcohol’s toxic effects on the liver and to the development of liver fibrosis.

NB: on the other hand, excess vitamin A levels can promote the formation of scar tissue
(fibrosis) which is worsened by concurrent alcohol use.

Metabolism of Alcohol
Once alcohol enters in the stomach, up to 20% of it can be absorbed and get directly into the
bloodstream. Within minutes, it will reach the brain and give a feeling of being a stimulant. The
remaining goes to the intestine for absorption with other nutrients.
A small amount is excreted through sweat, saliva, urine and breath.
Metabolism occurs in the liver hence liver problems may occur following excessive alcohol
consumption.
Negative effects of too much alcohol include:

 reduced inhibitions
 slurred speech
 motor impairment
 death
 confusion
 memory problems
 concentration problems

Long-term alcohol consumption can cause problems related to the brain, liver (cirrhosis,
steatosis, alcoholic hepatitis, fibrosis) heart (high blood pressure, cardiomyopathy, arrhythmias
is, stroke), pancrease (pancreatitis), and immune system.
It can also put one at a risk of certain cancer, including those of the mouth, esophagus, throat,
breast and liver. It can also cause fetal alcohol syndrome- currently there is no known safe level
for alcohol consumption in pregnancy and lactation.
ASSIGNMENT
1. Explain the interaction between alcohol and nutrients
2. Discuss the alcohol effects on digestion and absorption of essential nutrients
3. Describe the metabolism of Alcohol and its effects

LESSON 17
ALCOHOL BRAIN FUNCTIONING AND BEHAVIOUR

Lesson Objectives
By the end of the lesson, you will be able to: -
A) explain alcohol consumption and its effect on brain functioning and behaviour
B) describe fetal alcohol syndrome

Alcohol consumption, brain functioning and behaviour

Alcohol and the Brain
Alcohol is a central nervous system depressant. It acts on the receptor sites for the
neurotransmitters (chemical messengers) known GABA, glutamate and dopamine. Its activity on
the GABA and glutamate sites results in the physiological effects associated with drinking such
as slowing down of movement and speech.
Alcohol’s activity on the dopamine site in the brain’s reward center produces the pleasurable
feelings that motivate many people to drink
The degree to which alcohol impacts a person’s mood, behavior and neurological functioning
depends in part on whether the Blood Alcohol Content (BAC) is elevated or decreasing.
NB: At the beginning, alcohol acts as a stimulant, but as consumptions tapers off, it acts as a
sedative.
The following factors directly influence how alcohol affects a person’s brain function besides
BAC:

 The volume of alcohol consumed

  How often a person drink
 The age at which drinking began
 The number of years a person has been drinking
 The person’s sex, age and genetic factors
 Whether the person’s family has a history of alcoholism
 Whether the person was exposed to alcohol as a fetus
 The person’s general health condition

Heavy and chronic drinkers

A person who drinks heavily over an extended period of time may develop deficits in brain
functioning that continue even if sobriety is attained. The cognitive problems do not arise from
drinking alcohol but from brain damage that prior drinking caused.
Most heavy long-term alcohol users will experience a mild to moderate impairment of
intellectual functioning and diminished brain size. The most common impairments relate to the
ability to think abstractly and the ability to perceive and remember the location of objects in two-
and three-dimensional space (visuo-spatial abilities).
In addition, there are numerous brain disorders associated with chronic alcohol use such as
thiamin deficiency which results to Wernicke Korsakoff Syndrome (WKS). WKS is a disease
that consists of two separate syndromes:
- A short-lived and severe condition called Wernicke’s encephalopathy characterized with
mental confusion, paralysis of nerves that move the eyes (oculomotor disturbances), and
difficulty with muscle coordination
- A long-lasting and debilitating condition known as Korsakoff’s psychosis characterized by
persistent learning and memory problems. Patients will be forgetful and quickly frustrated and
have difficulty in walking and coordination. They will also have problems in remembering old
information (retrograde amnesia) and also “laying down” new information (anterograde
amnesia).
NB: Cognitive impairment can be reversed through abstinence from alcohol
Occasional drinkers: in this case alcohol can produce one or more short-term effects after one
or more drinks. Namely memory impairment can begin after a few drinks and can increase as the
consumption increases or a high volume of alcohol consumption especially on an empty stomach
can result in a blackout
Moderate drinkers: it refers to a person who consumes one drink (applies to women) or two
drinks (men) per day. It has negative associations such as increasing the risk of breast cancer and
causing violence, falls, drowning and car accidents. It is associated with cognitive impairments.
Alcohol, gender and cognitive behavior
Blackouts refer to an interval of time for which the intoxicated person cannot recall key details or
events, or even entire events.
Women are at greater risks than males for experiencing blackouts. The difference is due to the
way in which men and women metabolize alcohol. Women are prone also to milder forms of
alcohol-induced memory impairments than men.
Women are also more vulnerable to developing medical consequences than men e.g. liver
cirrhosis, alcohol-induced damage of the heart muscles (cardiomyopathy) and nerve damage
(Peripheral neuropathy) after a few years of heavy drinking than do alcoholic men.
Both males and females have similar learning and memory problems from heavy drinking. Both
actually show significantly great brain shrinkage, a common indicator of brain damage.
Women’s brains are more vulnerable to alcohol-induced damage than men.

Alcohol consumption and pregnancy, fetal alcohol syndrome

Women who drink alcohol during pregnancy can give birth to babies with Fetal Alcohol
Spectrum Disorders (FASDs). The disorders can be mild or severe and can cause physical and
mental birth defects. They include:

 Fetal alcohol syndrome (FAS)

 Partial fetal alcohol syndrome
 Alcohol-related birth defects
 Alcohol-related neurodevelopment disorders
 Neurobehavioural disorder associated with prenatal alcohol exposure

FAS is a severe form of the condition. It is generally characterized by problems with vision,
hearing, memory, attention span, abilities to learn and communicate.
While the defects vary from one person to another, the damage is often permanent

Causes of FAS
When a pregnant women drinks alcohol, some of that alcohol easily passes across the placenta to
the fetus. The body of a developing fetus doesn’t process alcohol the same way as an adult does.
The alcohol is more concentrated in the fetus, and it can prevent enough nutrition and oxygen
from getting to the fetus’ vital organ.
Damage is most likely to occur in the first few before the mother can realize that she is
pregnancy. The risk increases if the mother is a heavy drinker.
Although alcohol appears to be most harmful during the first trimester, consumption any time
during pregnancy can be harmful.
Symptoms of FAS
Severity of symptoms ranges from mild to severe and can include:

 A small head
 A smooth ridge between the upper lip and nose, small and wide-set eyes, a very thin
upper lip, or other abnormal facial features.
 Below average height and weight
 Hyperactivity
 Lack of focus
 Poor coordination (ataxia) occurs when there is a disruption in communication between
the brain and the rest of the body. This causes jerky and unsteady movements. Commonly
characterized by loss of balance and coordination.
 Delayed development and problems in thinking, speech, movement, and social skills.
 Poor judgment
 Problem seeing or hearing
 Learning disabilities and low IQ
 Intellectual disabilities
 Heart problems
 Problems with sleep and suckling as an infant
 Deformed limbs or fingers
 kidney defects abnormalities
 Mood swings

Treatment of FAS
There is no cure for FAS or FASDs. Children can however benefit from services and therapies
such as:

 Speech therapy- language, occupational and physical therapy

 Early intervention education
 Adult classes that help parents and other caregivers handle problem behavior or other
issues
 Classes that teach kids social skills
 Counseling with a mental health professional

ASSIGNMENT
1. Explain alcohol consumption and its effect on brain functioning and behaviour.
2. Describe fetal alcohol syndrome.
3. Highlight the symptoms of fetal alcohol syndrome (FAS).
LESSON 18
EATING DISORDER SYNDROME

Lesson Objectives
By the end of the lesson, you will be able to: -
a) introduce eating disorders
b) describe anorexia nervosa
c) describe bulimia nervosa disorder

Introduction
Eating Disorders describe illnesses that are characterized by irregular eating habits and severe
distress or concern about body weight or shape.
Eating disturbances may include inadequate or excessive food intake which can ultimately
damage an individual’s well-being. The most common forms of eating disorders include
Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder and affect both females and
males.
Eating disorders can develop during any stage in life but typically appear during the teen years or
young adulthood. Classified as a medical illness, appropriate treatment can be highly effectual
for many of the specific types of eating disorders.
Although these conditions are treatable, the symptoms and consequences can be detrimental and
deadly if not addressed. Eating disorders commonly coexist with other conditions, such as
anxiety disorders, substance abuse, or depression.
tics frequently come from backgrounds that are characterized by puritanical attitudes,
particularly toward female sexuality. Self-esteem can also be a factor in individuals who become
anorexic.

Risk factors for eating disorders

Individual risk factors:

 Biology- early maturation, overweight

 Personality- Low self-esteem, impulsiveness, inadequate coping skills, body
dissatisfaction, perfectionism.
  Behavior- Dietary restraint, initiation of dating, weight concerns.

Family risk factors:

 Parental- Obesity, overprotection, loss or absence, psychopathology, neglect, physical or

sexual abuse.
 Familial- Conflict, concerns about shape or weight, immediate relative with eating
disorder.
 Sociocultural risk factors:
 Peer - Weight concerns among peers, teasing by peers, thin ideal for by in-group or
sorority, thin ideal for sport or team membership.
 Societal - Thin beauty ideal by dominant culture, emphasis on physical appearance for
success, gender role conflict and media influences.

Anorexia nervosa
Anorexia nervosa, is an eating disorder, characterized by low weight, food restriction, fear of
gaining weight, and a strong desire to be thin. Many people with anorexia see themselves
as overweight even though they are, in fact, underweight.
Individuals with this disorder do not suffer from a loss of appetite rather they suffer from an
intense fear of gaining weight.
Anorexia nervosa occurs most frequently in females, with some 85–95% of the reported cases
occurring in adolescent girls. The remaining cases are in prepubertal boys and older women. The
mean age of onset is 17 years of age, with peaks at 14 and 18 years, ages that would seem to
correspond to the girls’ transitions to high school and college, respectively. Self-esteem can also
be a factor in individuals who become anorexic.
Diagnostic criteria for anorexia nervosa

 Refusal to maintain body weight at or above a minimally normal weight for age and
height. A weight of 85% or less than what an individual’s minimal body weight should
be, given their frame and height. For example, a 20-year-old woman of medium build
who is 5 feet 4 in tall (1.63 meters) would satisfy this criterion if she dropped to a weight
of 105 lb. (48 kg) or less.
 Intense fear of gaining weight, even though underweight.
 Disturbance in the way in which one’s body weight or shape is experienced, undue
influence of body weight or shape on self-evaluation, or denial of the seriousness of the
current low body weight. Body image distortion in terms of self-perception (the
individual cannot see that she/he is underweight but perceives themselves as still being
overweight) and body image (perception of physical appearance).
  In postmenarcheal females, the absence of at least three consecutive menstrual cycles. In
the restricting type, the individual restricts food without regularly bingeing or purging. In
the bingeing/purging type, the individual severely restricts food and binges or purges.

Physiological consequences
It affects all major organ systems of the human body, most notably the cardiovascular,
dermatological, gastrointestinal, skeletal, endocrine and metabolic systems. Many of the medical
complications are similar to those that accompany other forms of starvation with the severity of
the physiological changes that occur in anorexia nervosa varies directly as a function of the
degree of reduced food intake and body weight.

 Gastrointestinal: Delayed gastric emptying, bloating, constipation, abdominal pain.

 Haematological: Iron deficiency anemia, decrease of white blood cells.
 Cardiac: Loss of heart muscle, cardiac arrhythmia, increased risk of sudden death.
 Osteopathic: Decalcification of bone, premature osteoporosis.
 Neuropsychiatric: Abnormal taste sensations, depression, mild cognitive disorder.
 Other: Growth of fine hair on trunk, loss of fat stores and muscle mass. Reduced thyroid
metabolism and difficulty in maintaining body temperature.

Anorexia Treatment
Medical: The highest priority in the treatment of anorexia nervosa is addressing any serious
health issues that may have resulted from the eating disordered behaviours, such as malnutrition,
electrolyte imbalance, amenorrhea and an unstable heartbeat.
Nutritional: This component encompasses weight restoration, implementation and supervision
of a tailored meal plan, and education about normal eating patterns.
Therapy: The goal of this part of treatment is to recognize underlying issues associated with the
eating disorder, address and heal from traumatic life events, learn healthier coping skills and
further develop the capacity to express and deal with emotions.

Bulimia nervosa
Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge
eating followed by purging.

 Binge eating refers to eating a large amount of food in a short amount of time.
 Purging refers to the attempts to get rid of the food consumed. This may be done
by vomiting or taking laxatives. Other efforts to lose weight may include the use
of diuretics, stimulants, water fasting, or excessive exercise.

Diagnostic criteria for bulimia

1.Recurrent episodes of binge eating, characterized by one or both of the following:
- Eating, in a discrete period of time, an amount of food that is definitely larger than most
people would eat during a similar period of time and under similar circumstances
- A sense of lack of control over eating during the episode.
2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-
induced vomiting; misuse of laxatives, diuretics, enemas or other medications; fasting; or
excessive exercise.
3. The binge eating and inappropriate compensatory behaviours both occur on average at least
twice a week for 3 months.
4. Body shape and weight unduly influence the person’s self-evaluation.
In the purging type, the individual uses regular purging behavior. In the non-purging type, the
individual uses other inappropriate compensatory behaviours, such as fasting or excessive
exercise, but does not regularly engage in purging.

Psychological characteristics of bulimic individuals

 They have a distorted view of their own weight and shape, and desire to weigh much less
than they do.
 Obsession with controlling their food intake though for bulimic this proves to be
unsuccessful as they binge eat and then purge.
 Bulimics are more likely to display symptoms of depression and show greater changes in
mood.
 Bulimics tend to engage in more sexual behavior.

Bulimia nervosa Treatment

Since negative body image and poor self-esteem are often the underlying factors at the root of
bulimia, it is important that therapy is integrated into the recovery process. Treatment for
bulimia nervosa usually includes:

 Discontinuing the binge-purge cycle: The initial phase of treatment for bulimia nervosa
involves breaking this harmful cycle and restoring normal eating behaviours.
 Improving negative thoughts: The next phase of bulimia treatment concentrates on
recognizing and changing irrational beliefs about weight, body shape, and dieting.
 Resolving emotional issues: The final phase of bulimia treatment focuses on healing
from emotional issues that may have caused the eating disorder. Treatment may address
interpersonal relationships and can include cognitive behavior therapy, dialectic behavior
therapy, and other related therapies.
ASSIGNMENT
1. Distinguish between anorexia nervosa and bulimia nervosa.
2. Explain the risk factors for eating disorders.
3. Discuss the Physiological consequences of anorexia nervosa.

LESSON 19
BEHAVIOURAL ASPECTS OF OVERWEIGHT AND OBESITY

Lesson Objectives
By the end of the lesson, you will be able to: -
a) understand the etiology of obesity
b) explain social cultural correlations
c) determine biological and behavioural influences
d) outline physiological consequences

Introduction
Over nutrition is an ever-increasing phenomenon of significant concern resulting from a myriad
of causes such as overeating as it leads to health problems and psychological distress. Excessive
body weight has been demonstrated to increase the risk of various diseases and disabilities and is
associated with a number of adverse social and psychological consequences.
Obesity is a clinical condition characterized by the excessive accumulation of body fat.

Aetiology of obesity
The reason for gaining of excess weight is that over an extended period of time an individual’s
energy intake is greater than his or her energy expenditure. A positive energy balance occurs
when energy intake exceeds energy expenditure and weight gain is promoted. Conversely, a
negative energy balance results in a decrease in fat stores with subsequent weight loss. Body
weight is regulated by a series of physiological processes that have the capacity to maintain a
stable weight within a narrow range, or set point.

Social cultural correlates

Many socio-cultural variables are associated with the tendency for increased body fat. The socio-
cultural factors may be broken down into:
1. Social characteristics
- Fatness increases over the course of adulthood
- Fatness declines in the elderly
- Obesity rates are higher for women than men.
2. Social contexts
- Obesity rates are higher in developed countries than developing countries
- Obesity rates are higher for rural women than urban women
- Obesity rates are higher for married men than single men.
- Older people living with others have a higher rate of obesity than those who live alone.
3. Socio-economic status
- Obesity rates are higher in people with less prestigious jobs
- Obesity rates are higher in low-income women
- Obesity rates are higher in less educated women
- Obesity rates are higher in women who are not employed outside the home.

Physiological consequences
Heart disease is associated with a BMI ≥ 30, as are hypertension, stroke, diabetes, gallbladder,
joint diseases and some forms of cancer. For men, obesity in early adulthood has been linked to
cardiovascular disease, while for women weight gain during mid-adulthood has shown a stronger
association. Hypertension is higher in the overweight than in those who are not overweight. In
combination with high blood cholesterol and high serum triglycerides, which are also linked to
being overweight, hypertension contributes to atherosclerosis and coronary heart disease. Adult
onset diabetes (Type 2) appears to have the strongest association with obesity. Obesity
compromises glucose tolerance, increases insulin resistance and diabetes in turn may cause heart
disease, kidney disease and vascular problems.

The location of fat is a risk factor for disease;

Apple’ shape or android where fat is collected in the belly. the ‘apple’ shape is associated with
greater health risks than the ‘pear’ shape pattern more often seen in women since excess fat in
the abdominal region appears to raise blood lipid levels, which then interfere with insulin
function.
Visceral fat (that fat which surrounds the organs of the abdominal cavity) is linked to
hyperlipidemia, hypertension, heart disease and diabetes. Several types of cancer are associated
with being overweight and possessing excess abdominal fat. Overweight men are at heightened
risk for developing cancer of the prostate, colon and rectum. Overweight women are at greater
risk for developing cancer of the colon, gallbladder, uterus, cervix, ovary and breast.
‘Pear’ shape or gynoid where fat collects in the hips and buttocks.

Consequences of being overweight or obese

Physical risks: hypertension, heart disease, stroke, diabetes, cancer, sleep apnea, osteoarthritis,
gout and gallbladder disease.
Psychosocial risks: Depression about weight and eating, susceptibility to hunger, disinhibition
toward eating when stressed, target of prejudice, viewed as less attractive, industrious,
intelligent.

Biological influences
Genes do not cause obesity, although they may influence certain processes that may help lead to
it. Indirect evidence has stated heredity plays a part in excess weight gain. If both parents are
obese, for example, it is estimated that the probability that their children will be obese is 80%,
whereas if neither parent is obese the chances of an obese child are less than 10%. Research
suggests that a large number of genes may play a role in the development of obesity.
The development and metabolism of fat cells themselves may also contribute to overweight and
obesity. The amount of fat in a person’s body reflects both the number and size of the fat cells
that he or she possesses. The number of fat cells increases most rapidly during late childhood and
early adolescence and more rapidly in obese children than in lean children. As fat cells fill with
fat droplets they increase in size, and may also divide if they reach their maximum. Obesity can
develop when a person’s fat cells increase in number, size or both. With weight loss, the size of
fat cells will reduce, but not their number, and with subsequent weight gain they will readily be
refilled.

Behavioural influences
Energy expenditure
Lack of physical activity due to advances in technology and labor-saving devices
Television watching increases the likelihood of obesity because it is a sedentary activity, replaces
time for activities requiring movement, minimal attention is given to food ingested, food
advertised may motivate purchase or fast food consumption
Energy intake
Energy intake refers to the food we eat, or caloric intake; energy expenditure is comprised of
BMR, diet-induced thermogenesis (the body’s generation of heat), and physical activity. Energy
intake does not entirely explain why some people become fat while others seem resistant to
weight gain as other factors such as genetics may play a role.
The dietary component of what is eaten matters:

 Fat - too much fat promotes obesity. Dietary fat provides more kilocalories per gram and
requires less energy to be metabolized, relative to protein and carbohydrate.
 Total calories consumed e.g. larger portions at restaurants, fast food joints.
 The price of food, greater variety at a low price.
 Where the food is consumed also matters, people tend to overeat at restaurants.
 Stress may lead to overeating or binge eating.
 Overeating in children may be due to parents who attempt to control their children’s
eating by rewards or threats to coerce children to finish their meals may lead to the
unintended effect of increasing the child’s tendency to be overweight. This is because
such actions inadvertently interfere with their child’s ability to self-regulate energy
intake, by forcing them to ignore internal feelings of satiety.

ASSIGNMENT
1. Explain social cultural correlations to overweight and obesity.
2. Identify the physiological consequences of obesity.
3. Discuss biological and behavioural influences of overweight and obesity.
LESSON 20
BEHAVIOURAL ASPECTS OF OVERWEIGHT AND OBESITY

Lesson Objectives
By the end of the lesson, you will be able to: -
a) discuss the restrictive feeding practices
b) identify preventive approaches
c) discuss the treatment of obesity

Restrictive feeding practices

a) Very low calorie diets
Very-low-calorie diets (VLCDs), an approach deemed suitable for individuals who are
moderately obese, that is, from 41% to 100% over their ideal weight. The typical VLCD plan
provides no more than 800 kcal, at least 1 g of high-quality protein per kg of body weight, and at
least 50 g of carbohydrate, which may not be enough to spare protein.

b) Yo-yo dieting
Many individuals who diet will successfully lose weight, but very few are able to maintain their
loss for an extended period of time. Nevertheless, they are likely to repeat the strategy of dieting
to lose weight, regaining the weight and dieting again, a behavioural pattern known as weight
cycling or ‘yo-yo dieting’

Preventive approaches
Preventing excessive weight gain in the first place is a sensible approach to lifelong health and
well-being. At an individual level the following strategies are recommended:
  Eat regular meals and limit snacking
 Drink water instead of high kilocalorie beverages
 Regularly select low-fat foods
 Limit dietary fat to 30% of daily kilocalorie intake
 Become physically active
 Limit television-viewing time

Weight management
This refers to striving for a healthy weight. Modest weight loss, even if a person remains
overweight, can reduce the risk of heart disease and improve control of diabetes. A loss of just
10 to 15 lb (4.5–6.8 kg), for example, can lower an individual’s BMI by two units, which will
significantly improve his or her health. However, experts recommend a loss of no more than 5%
to 10% per year.

Diet composition
A small change in energy intake, such as a reduction of 200–300 kcal/day, is more successful in
long-term weight control than is trying to subsist on a daily regimen of 1000–1200 kcal.
Adequate intake will ensure more successful weight loss than a severely restrictive plan that
induces starvation and deprivation, which can lead to bingeing.
A low-fat diet will more readily satisfy their hunger and eat less food but it must be high in
carbohydrate and adequate in protein. Even low-fat foods provide excessive calories if eaten in
mass quantities.
Complex carbohydrate foods such as fresh fruits, vegetables, legumes and whole grains are low
in fat but also rich in vitamins, minerals and fiber.
Highfiber foods are also beneficial because they require more effort to chew, in effect slowing
down intake while having a strong satiety effect.
Drinking water frequently is therefore a useful strategy in maintaining weight.
Physical activity
Regular physical activity is an essential component of weight management. Aerobic activities
such as walking or jogging burn calories directly, while anaerobic activities such as sit ups or
lifting weights serve to build muscle mass. In addition, regular exercise can discourage
overeating by reducing stress, can produce positive feelings that reinforce a sense of well-being,
and will often promote positive social interactions. Overweight individuals who combine diet
and exercise may be more likely to lose fat, retain more muscle and regain less weight than those
who only diet.

Behaviour change
Behavioural programs designed to facilitate weight management typically include a number of
strategies that rely on cognitive-behavioural change. These include self-monitoring, goal setting,
stimulus control, problem solving, cognitive restructuring and relapse prevention.

Stimulus control involves managing the near environment so as to avoid cues that encourage
inappropriate eating, or to institute new cues that elicit desirable behaviors. This may include the
individual being instructed to place energy-dense foods out of sight and to set up visible
reminders to exercise.
Cognitive restructuring refers to eliminating rationalizations for inappropriate eating, as well as
countering negative thoughts with positive statements that build self-acceptance.
Stress management involves identifying cues that trigger overeating is a useful way to avoid
temptation. Among binge eaters, in particular, chocolate is often eaten under the mistaken belief
that it will help to alleviate stress.

Treatment
1. Surgery
The use of surgery as a treatment for weight loss is clearly the most radical form of therapy for
the obese. For individuals who are morbidly obese (i.e. 100% or more overweight), this approach
has been shown to help those with a severe weight problem to maintain large weight losses for
an extended period.
Types of surgery
a) Jejunoileal bypass
The absorptive surface of the small intestine is reduced in length.
b) Vertical banded gastroplasty surgery that reduces the stomach’s capacity.
c) Gastric bypass surgery routes food almost directly to the jejunum, bypassing the duodenum
and most of the stomach.
d) Intragastric balloon approach involves a balloon being inserted into the stomach to reduce
gastric capacity. Besides complications such as vomiting, ulcers and intestinal obstructions,
weight gain typically returns when the balloon is deflated.
e) Jaw wiring, the patient can be expected to lose 4–5 lb (2 kg) per month because of the inability
to ingest solid foods and masticate.
f) Liposuction, which consists of suctioning off subcutaneous fat, has been employed by many to
remove targeted fat deposits. This procedure can alter body shape slightly, but has little effect on
weight as the body still has billions of fat cells that can store extra fat.
2. Drugs
Early drugs acted to reduce hunger, trigger satiety or stimulate energy expenditure, the newer
drugs serve to block the absorption of calories from fat. The current focus is on drugs with
distinct mechanisms of action that can be used in conjunction with proper diet and exercise.
Anti-obesity drugs may inhibit energy intake, inhibit fat absorption, enhance energy expenditure
or stimulate fat mobilization.
An ideal anti-obesity drug should meet the following criteria:

 A sustained loss of weight though a reduction in body fat with a sparing of body protein
 Maintenance of the weight loss once a desirable body weight has been achieved
 Absence of side effects or abuse liability when the drug is chronically administered
 Improved compliance with a weight reduction program of diet and exercise

Examples of drugs used in obesity:-

 Phentermine (Fastin™ or Phentrol™) - Suppresses appetite

 Mazindol (Sanorex™) - Suppresses appetite
 Diethylproprion (Tenuate™) - Suppresses appetite
 Clortermine (Voranil™) - Suppresses appetite

NB: TM – Stands for Trade Name

ASSIGNMENT
1. Explain 3 ways of weight management in obesity.
2. Discuss the treatment of obesity.
3. Highlight the Preventive approaches for obesity.