1.

BALANCED DIET AND DIET

PLANNING

2. NUTRITION EDUCATION AND

COUNSELLING

DR. MARY KAMAU

UNIVERSITY OF NAIROBI
BALANCED DIET
AND DIET
PLANNING
DR. MARY KAMAU

UNIVERSITY OF NAIROBI
BALANCED DIET AND DIET PLANNING
Define Balanced Diet:
• One that has all nutrients required by the body in the right
amounts.
• A balanced diversified diet is more appropriate i.e. intake of a
varied kind of foods regularly and in each meal all nutrients
required by the body in the right amounts.
• A balanced diversified diet increases chances of obtaining all
nutrients including the nutrients required in small amounts
(trace) since each food item contains several nutrients in
varying amounts.
 Diet/Meal Planning:
Definition:
• Making a plan of meals with adequate nutrition (for meeting the nutritional
requirements) for every member of the family within the available resources.

• Food choices especially over many years influence the health and consistently
poor choices increases the risks to developing chronic diseases.
• Currently the prevalence of lifestyle diseases such as cardiovascular diseases,
diabetes mellitus and cancers is alarmingly high.
• This calls for need to be informed of healthy eating habits.

Assignment:
• Food Pyramid - allow people to make healthy choices of food in various quantities
Importance of Diet Planning

Meal planning helps us to:

1. Fulfill the nutritional requirements of the family
members
2. Make the food economical
3. Address the food preferences of individual members
4. Save energy, time and money
5. Avoid wastage of leftover food
Factors Influencing Diet Planning
• Nutritional Adequacy: Most important factor - nutritional
requirements of all the family members are fulfilled. While
planning meals, balanced diversified diets based on food
pyramid proportions should be considered.
• Age: People normally eat according to their age e.g.
differences among newborn, adolescent, elderly
• Gender: Dietary requirement of adolescent and adult males
are more than their female counterparts.
• Physical Activity: The kind of work a person does affect the
kind and amount of food they need to take.
Ctd. Factors Influencing Diet Planning
• Household Income: Money available to the family to be spent on food
is another major factor. Some foods are expensive but alternative
sources are less costly and at the same time nutritious. Thus, a
balanced diet should suit the family budget.
• Time, energy and skill considerations: Consider the resources like
time, energy and skill available to the family. Meals can be elaborate
with different dishes, but you can simplify them by cooking a simple
but nutritious dish.
• Seasonal availability: The off-season foods are expensive and
sometimes less nutritious, while those in season are fresh, nutritious,
tasty and cheap. Hence, while planning seasonal foods should be
used.
Ctd. Factors Influencing Diet Planning
• Religion, region, cultural patterns, traditions and customs: Regional
factors influence meal planning. Staple food differs in different localities.
Religious beliefs prevalent in the family also have an influence. For
example, if you are a vegetarian, your diet will not have any meat or meat
product, Hindus do not eat beef and Muslims do not eat pork.
• Variety in colour and texture: This implies food which has variety in terms
of colour, texture, flavor and method of preparation - helps make meals
more appealing, attractive and hence more acceptable.
• Likes and dislikes of individuals: It is often better to change the form of
some particularly nutritious food item, rather than omitting it completely.
• Satiety Value: Meals which produce inadequate satiety value (the feeling
of being satisfied). , will lead to onset of hunger pangs, which in turn will
affect the working capacity and efficiency of a person
Principles in Diet Preparation
• Adequacy: Diet provides all the essential nutrients, fiber and energy in amounts
sufficient to maintain health.
• Balance in the diet: Helps to ensure adequacy. This involves consuming enough
food and not too much or too little of each type of the food groups in the food
pyramid.
• kCalorie Control: Amount of energy consumed should balance with the amount
of energy used by the body to sustain its metabolic and physical activities. To
maintain a healthy weight one should select foods of low energy density; this is
the amount of energy in kilocalories in a food compared with its weight. Low
energy density foods include fruits and vegetables and any food that incorporates
a lot of water during cooking. They contribute to satiety without giving many
calories.
• More energy (calories) than it’s expedited
• Burns more calories than they eat
Ctd. Principles in Diet Preparation
• Nutrient density: Means eating foods containing a high ratio of nutrients
to food energy. This promotes adequacy and kCalorie control. Foods that
are low in nutrient density such as potato chips, candy and sodas
sometimes referred to as empty-kCalorie foods; deliver energy from
sugar, fats, or both with little, or no, proteins, vitamins and minerals.
• Moderation in the diet: Refers to portion sizes. It contributes to
adequacy, balance and kCalorie control. Plan the entire day’s diet so as
not to under or over consumes any food.
• Variety in food choice: Choosing different food items within each food
group or class rather than eating the same food daily.
Food Hygiene
• Food hygiene helps to prevent food from going bad or becoming
contaminated at any stage of production, collection, storage, sale,
preparation or consumption.
• Food can cause the spread of disease
• Contamination is through the 6 Fs:
• Food
• Fluids
• Fingers
• Flies
• Faeces
• Fomites
Food Borne Illnesses
• Food borne illness can be caused by either an infection or
intoxication.
• The most common food borne pathogen is Salmonella which
causes symptoms such as abdominal cramps, fever, vomiting
and diarrhea.
• Food intoxications are caused by eating foods containing
natural toxins or, more likely, microbes that produce toxins.
• A common source of food toxin is Staphylococcus aureus,
others include Clostridium botulinum.
Concepts of Food Preparation and Handling:

Measures to Control Food Borne Illnesses

1. The Hazard Analysis Critical Control Points (HACCP) - this is a
food industry control system.
• It is systematic plan to identify and correct potential microbial
hazards in the manufacturing, distribution, and commercial
use of food products.

2. Use of food preservation methods is important: these include

smoking, drying, saturation, refrigeration and canning/bottling.
Control Measures at a Household Level
• Keeping a clean and safe kitchen
• Avoid cross- contamination; the contamination of food by bacteria that
occurs when the food comes into contact with surfaces previously
touched by raw meat, poultry, or sea food.
• Keep hot foods hot; served food and leftovers should be reheated.
• Keep cold foods cold. Refrigerate perishable groceries
• Throw out foods with danger signaling odour.
• Follow label instructions for storing and preparing packaged and frozen
foods.
• Discard food that are discolored, moldy, or decayed or that have been
contaminated by insects or rodents.
Assignment:
• Discuss the Food Pyramid

• Discuss the major determinants of food choice and categorize them into
their different categories

• Maximizing the value of nutrients from each food in handling and

preparation

• (Form discussion groups and send the names to me)

• (Discuss in groups and write notes in your books)
NUTRITION EDUCATION,
COUNSELLING AND
REFERRAL
 COUNSELLING VS. EDUCATION VS. ADVICE

 Giving advice is directive.

 Educating is conveying information from an expert
to a group of people.
 Counselling is non-directive, non-judgemental,
dynamic, empathetic, interpersonal communication
to help someone use information to make a choice
or solve a problem.
 CRITICAL NUTRITION ACTIONS

1. Get weighed regularly and have weight recorded.

2. Eat a variety of foods and increase intake of nutritious
foods.
3. Drink plenty of boiled or treated water.
4. Avoid habits that can lead to poor nutrition and poor health.
5. Maintain good hygiene and sanitation.
6. Get exercise as often as possible.
7. Prevent and seek early treatment of infections and advice
on managing symptoms through diet.
8. Manage medication-food interactions and medication side
effects through diet.
 SKILLS THAT FACILITATE COUNSELLING
 Using helpful non-verbal communication
 Showing interest
 Showing empathy
 Asking open-ended questions
 Reflecting back what the client says
 Avoiding judgement
 Praising what a client does correctly
 Giving a little relevant information at a time
 Using simple language
 Giving practical suggestions, not commands
 ETC ETC ETC
GATHER COUNSELLING STEPS

G – Greet
A – Ask
T – Tell
H – Help
E – Explain
R – Reassure/Return date
 CHALLENGES IN COUNSELLING ON NUTRITION

1. Inability to find or buy nutritious foods

2. Feeling that nutrition is not important compared
to other problems
3. Inexperienced counsellors
4. Stigma related to HIV
5. Belief that illness is caused by supernatural forces
 ADDRESSING COUNSELLING CHALLENGES

1. Refer clients to food or economic support.

2. Counsel on the importance of nutrition to prevent and
recover from illness, perform better at school and work and
help medicines work effectively.
3. Learn more about nutrition and counselling methods.
4. Counsel people living with HIV in private and assure them
that their information will be kept confidential.
5. Show evidence of improvement from nutrition interventions.
 THE IMPORTANCE OF SAFE FOOD AND WATER

 Food- and water-borne illness can decrease appetite and

nutrient absorption, lower resistance to infections and
increase the body’s need for nutrients to fight infection.
 People living with HIV are at high risk of infection, have more
severe symptoms of food- and water-borne illnesses and can
have a hard time recovering from diarrhoea.
 Good sanitation and hygiene can prevent infections that cause
malnutrition.
 MEDICATION-FOOD INTERACTIONS

 Medication side effects can reduce appetite, nutrient

absorption and medication adherence.
 Some foods can reduce the effectiveness of medications.
 Antiretroviral therapy (ART) can cause changes in body
composition (haemoglobin, lipodystrophy, fat
redistribution).
 Long-time use of ART can result in diabetes,
hypertension, osteoporosis or dental problems.
 EXAMPLE:
FALSE ADVERTISING OF HIV CURES

Nutrition
supplements sold
as HIV treatment Photo: wb3.indo-work.com

Photo: positivenation.co.uk

False claims that a

Photo: Avert.org
compound called
Rooperol in the African
potato can fight HIV
 AIMS OF COMMUNITY OUTREACH

 Find malnourished people early and refer them for

treatment before they develop serious complications.
 Increase awareness of the importance of nutrition and the
causes, signs and treatment of malnutrition.
 Increase awareness of available nutrition services.
 Increase coverage and follow-up of clients.
 Link prevention and treatment of malnutrition.
 CHANNELS OF COMMUNITY OUTREACH

 Home-based care (HBC) and most vulnerable children (MVC) services:

Measure MUAC to screen for malnutrition, refer malnourished people
to health facilities and counsel people on the Critical Nutrition Actions
(CNAs).
 Local leaders: Mobilise communities to seek Nutrition Assessment and
Counselling Support services.
 Networks and support groups for people living with HIV: Encourage
members to practice the CNAs, measure MUAC and refer members to
NACS services.
 Local media: Inform communities of NACS services and entry and exit
criteria.
 COMMUNITY CASE-FINDING OF
SEVERE ACUTE MALNUTRITION (SAM)

 Growth monitoring and promotion

 MUAC measurement during home visits
 MUAC measurement in meetings with MVC as they
come for other services
 MUAC measurement as part of home-based care
 MUAC measurement in support group meetings
 NUTRITION SERVICES IN HOME-BASED CARE
AND CARE OF MOST VULNERABLE CHILDREN
 MUAC measurement
 Dietary assessment
 Assessment of food availability and use
 Demonstration to caregivers of how to prepare
locally available foods to make nutritious meals
 Demonstration to caregivers of how to prepare and
feed specialised food products
 School feeding
 School gardens
 ASSIGNMENT:

 Discuss the following:

• Principles of nutrition education
• Teaching methods in nutrition education
• Hint: one on one; group health talks in form of lectures,
discussions, demonstrations, practicals, digital space use, etc etc
THANK YOU!