Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
1
Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
NUTRITION FOR YOU!
A GUIDE TO NUTRITION AND HEALTH
AWARENESS IN SCHOOLS
Written by:
Ms. Emma Collins, UNICEF Intern
Edited by:
Ms. Aishath Shaaheen Ismail and Hussein Rasheed Moosa
School Health & Safety Section
Ministry of Education
Male’
Republic of Maldives
ISBN: 99915-0-561-X
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School Health & Safety Section, ESQID, Ministry of Education
Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
All Rights are reserved by School Health and Safety Section, ESQID, Ministry of
Education, Male’, Maldives. The document may, however, be freely reproduced or
translated, in part or in whole, for educational use only.
Written by:
Ms. Emma Collins (UNICEF Intern)
Technical and Professional Support by: Ms. Unni Silkoset (Assistant Program
Officer, UNICEF – Maldives) Ms. Nina Jutila (VSO Volunteer for School Health Unit,
EDC) and Ms. Ella Smith.
Edited & proofread by: Aishath Shaaheen Ismail (Ma. Bougainvilla)
Hussein Rasheed Moosa, MOE
Published by:
School Health and Safety Section, ESQID
Ministry of Education,
Male’,
Republic of Maldives
2010
Layout and Design by: Mariyam Maalika Assistant Illustrator, EDC, Maldives
Financial Assistance by:
ISBN:
99915-0-561-X
Printed by: M- Print
Faraway Holidays Private Limited
Male’, Maldives
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School Health & Safety Section, ESQID, Ministry of Education
Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
Foreword
Nutrition is important for our existence, why it is important is not always selfexplanatory. Good nutrition is important for growth and development of the body and
the brain. Nutrition is the power source that enables the body to function properly and
keep its healthy. Nutrition is important for children as their bodies are in the growing
and developing stage. Children who do not take enough food, or take non-nutritious
food, have poor physical and mental development compared to children who take
nutritious food.
Following a series of School Health Assessments conducted in Male’ in September 2002
it was clear that one of the primary gaps in educating children was lack of resources and
knowledge among School Health Assistants and Teachers. Many of the staff who
interviewed in the assessments procedure responded that they need additional
resources and information. Specifically, an information guide for School Health
Assistants, Teachers, Parents and also Students would be of help.
This guide, as a result, is targeted towards those who work with and have a direct
impact in the lives of children and their education. The guide is designed in a way that
can be facilitated by health Personals across the Maldives and those working to expand
and promote health within the country. It is hoped that this guide will prove a useful
resource for all those who read and use it, providing knowledge and encouragement to
make a difference in the community within which they work.
We would like to extend a very special thanks to Ms. Emma Collins, (UNICEF Intern) for
her untiring effort and support rendered in making this document a reality. We owe a
big thanks to Dr. Heidi Brown, Ms. Nina Jutila,( VSO Volunteer), Ms. Unni Silkoset,
(UNICEF Maldives) and Ms. Aishath Shaaheen Ismail for their contributions. Last but not
least, a special thanks goes to Ms. Zahiya Zareer, former Director General, EDC for her
guidance and Support.
And also a very special thanks to Dr. M.J. Luna, WHO
Representative to Maldives and other Staffs from WHO Country Office.
Hussain Rasheed Moosa
Senior Co-ordinator, School Health Programmes,
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
ACKNOWLEDGEMENTS
Health and nutrition information and education has made great improvements over the
last few years in the Maldives. However, it is an area which still has far to go in terms of
further developments.
The focus of the guide is targeted towards those working with children as teachers and
school health personnel who can have a direct impact in the education and lives of the
children with which they work.
I am grateful for the following people who have helped me in the various stage of the
development of this booklet:
Ms. Zahiya Zareer
former Director General, Educational Development
Centre (EDC), Ministry of Education, .
Mr. Hussein Rasheed
Senior Co-ordinator, School Health Programmes,
School Health Unit, EDC.
Ms. Unni Silkoset
Assistant Programme Officer, UNICEF, Maldives
Ms. Nina Jutila
School Health Officer, School Health Unit, EDC.
Ms. Nina Kolbjornsen
UNICEF Intern, Educational Development Centre.
Mr. Ahmed Salih, Mr. Ahmed Affal and The Health Information and Research
Unit, Ministry of Health.
Ms. Ella Smit for her professional help, support and guidance.
Mariyam Maalika, Assistant Illustrator, EDC.
The Staff of School Health Unit, EDC, Ministry of Education.
Emma Collins,
UNICEF Intern,
2005
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School Health & Safety Section, ESQID, Ministry of Education
Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
CONTENTS
Part 1
Introduction
3
Nutrition throughout the Lifecycle
3
Nutrition and Health Matters in the Maldives
5
Aims and Objectives of the Guide
7
Who Can Use the Guide?
8
How Do I Use the Guide?
8
Nutrition Basics
9
What Are Nutrients?
9
Carbohydrates
11
Fats
12
Proteins
13
Vitamins and Minerals
15
Water
31
Nutrition Requirements
32
Healthy Meals
36
Nutrition Requirements at Different Ages
38
Clinical Nutrition
44
Protein Energy Malnutrition
44
Obesity
46
Diabetes
47
8B
Part 2
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
Part 3
12B
13B
Diseases of the Heart and Circulation
49
Iodine Deficiency Disorders
50
Iron Deficiency – Anaemia
50
Eating Disorders
52
Food Safety
54
Using Your Knowledge
57
Activity Ideas for Children
58
Grades 1-3
58
Grades 4-6
61
Grades 7+
63
Ideas for Schools
65
How to Plan and Hold a Workshop
66
Appendices
References
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
PART 1 INTRODUCTION
Nutrition throughout the Lifecycle
The importance of nutrition starts even before we are born. A pregnant woman has a
responsibility to have a healthy diet that meets the requirements of a growing foetus.
Pregnant women also need to ensure that they have a healthy body weight. Being
underweight can increase the risk of having a low birth weight baby and increase the
likelihood of ill health to both the mother and the child. However, it is important not to
be overweight as this can increase the risks of high blood pressure and diabetes during
pregnancy.
Low birth weight (LBW) is defined as weight at birth of less than 2500 grams and is
caused either by intrauterine growth retardation or pre-term deliveries. In developing
countries, most of the LBW babies are caused by growth retardation which means that
they are born undernourished. LBW babies have 40-fold risk of dying in the neonatal
period and 50% greater risk of serious developmental problems where impaired mental
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
development is the most serious. A low-birthweight infant is thus more likely to be
underweight or stunted in early life.
The consequences of being born undernourished extend into adulthood. Studies from
both developing and industrialized countries suggest a link between foetal undernutrition
and increased risk of various non-communicable diseases like diabetes, high blood
pressure and coronary heart disease later in life.
During infancy and early childhood, frequent or prolonged infections and inadequate
intakes of nutrients - particularly energy, protein, vitamin A, iron and zinc - exacerbate
the effects of foetal growth retardation. Most growth faltering, resulting in underweight
and stunting (low height-for-age), occurs within a relatively short period, from before
birth to about two years of age.
Undernutrition in early childhood has serious consequences. Underweight children tend
to have more severe illnesses, including diarrhoea and pneumonia. There is a strong
association between the severity of underweight and mortality. The capacity to learn
and thrive will also be reduced due to reduced mental development.
A long-standing assumption has been that by school age a child has survived the most
critical period and is no longer vulnerable. However, many of the infectious diseases
affecting preschool children persist into the school years. In addition, rates of
malnutrition are still increasing in many countries. These problems adversely affect
school attendance, performance and learning.
In adolescence, a second period of rapid growth may compensate for early childhood
growth failure, although the potential for catch-up growth is limited. The effects of early
childhood undernutrition on cognitive development and behaviour may not be fully
restored. A stunted girl is thus most likely to become a stunted adolescent and later a
stunted woman. Apart from direct effects on her health and productivity, adult stunting
and underweight increase the chance that her children will be born with low birthweight.
And so the cycle turns…
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
Nutrition and Health Matters in the Maldives
9B
The health and nutritional status of children in the Maldives is one, which is in constant
need of improvement as children are torn between the influences of Western cultures
and the practicalities of living in the Maldives where food sources are limited and
unpredictable.
The Health Master Plan 1996-2005 highlights a number of objectives concerning
childhood nutrition. It states that the nutrition programme will “sustain food security and
ensure that people are made aware of the value and importance of a balanced diet”
(Health Master Plan 1996-2005, p 103). The importance of nutritional education is
prioritised and strategies include the identification of “specific nutrition education
projects implemented based on modern techniques of behaviour modification” (Health
Master Plan 1996-2005, p 104). This proposal has been formulated on the basis of these
strategies to meet the stated objectives.
The Multiple Indicator Cluster Survey 2001 (MICS) when examining the nutritional status
of children, states that malnutrition “is mainly due to the lack of a well balanced diet”
(MICS 2001, p 39). The knowledge and awareness of nutritional concerns among
Maldivians are generally poor especially on small community islands where both health
facilities and health workers are lacking.
Under-nutrition continues to be a problem in the Maldives, shown in the high levels of
stunting, wasting and micronutrient deficiencies that are shown in many national reports
and surveys. Despite a reasonably high level of food security, Maldivians suffer due to
the problems that are associated with a limited diet and lack of access to fruits and
vegetables. The geographical nature of the country and its problems with transportation
mean that many communities lack access to good food and nutrition knowledge.
The National Nutrition Strategic Plan aims, amongst others, to improve access to
nutrition and health information and provide guidance on specific nutritional deficiencies
highlighting and increasing the awareness of the values and importance of a balanced
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
diet. In this way, the problems of children attending school without breakfast, food
choices being limited, and nutrient deficiencies, will be tackled.
However, in addition to the problems of under-nutrition, Maldivians are also facing the
pressure associated with the Western influence. Companies such as Coca Cola, Mars,
Nestle, and Apollo target groups of people especially children and adolescents by
utilizing the fact that these groups of people can be influenced and through advertising
means can be pressurized into choosing to consume junk food rather than making
sensible eating choices.
Dieting is a very common practice among both girls and boys all over the world. The
desire to be thin prompted by what is seen in the media is thrived after in all countries.
It is important that the children and adolescents develop healthy eating habits and
approach dieting in the right way. This is an issue in the Maldives as in most other
countries and improved awareness is needed to allow eating problems to be dealt with
and guidance given to individuals.
Improving diets and preventing under-nutrition is focused around working together to
identify problems and establishing initiatives that will be effective in the community
through the sharing and exchange of knowledge. The more involved the community in
the identification and planning of activities the more effective and sustainable the work
will be in solving specific problems.
The term ‘community’ can be applied not only to large groups of people but can be used
in the context of the school community, local parenting community, families, health
centre patients and government officials. Working together to tackle problems avoids
duplication of ideas and effort and ensures that ideas, skills and information are shared
among a wide range of individuals.
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
Aims and Objectives of the Guide
The aim of this information guide is to provide those employed in and related to the
health and education sector with a solid background knowledge of nutrition and health
and to make recommendations as to how this knowledge can be used to educate and
raise awareness about issues that are cause for concern in the Maldives.
The objectives of the guide are as follows:

To highlight the nutrition related problems of children that exist in the Maldives
in terms of health and nutrition

To give a basic knowledge of nutrition

To enable users to clearly:
 be able to identify a healthy diet
 to feel confident about giving advice to others on healthy lifestyles
and nutrition
 have a basic understanding of how to communicate health messages
to students
 be equipped with activities to be used when teaching nutrition
 to identify problems and solutions for the problems that are faced by
individual schools and communities
 to make suggestions to programmes that can benefit the school or
community in terms of health and nutrition

To aid the formation of a network of School Health Assistants, Health Workers
and those interested in nutrition and health who can work together and learn
from each other

To enable a greater understanding of professionals working in the field of health
and nutrition through the network, and to have a greater knowledge about
different programmes being conducted in different areas i.e. schools and
communities
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
Who Can Use the Guide?
The Guide is designed and targeted towards those working as School Health Assistants
and Community or Family Health Workers who require a more detailed knowledge and
understanding of health and nutrition in order to work more effectively.
How Do I Use the Guide?
The Guide is designed to provide basic nutrition information for those working in the
area and also to provide a selection of ideas and activities that could be used in the
communication of this knowledge.
It is divided into two sections, one containing the information and the other activity
ideas, workshop plans and additional information.
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
PART 2 NUTRITION BASICS
0B
What are nutrients?
Nutrients are the substances in food that our bodies need to produce energy, growth
and maintain and repair the body. Nutrients can be grouped into different types:
carbohydrates, fats, proteins, vitamins, minerals and water.
One simple way of approaching nutrition is to think of the body as a car. The car needs
six nutrients to maintain in good condition and they are all equally important.
Vitamins
Water
Carbohydrates
and fats
Proteins
Minerals
Figure 1: Your Body Is Like A Car
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
Nutrient
Function in the body
Function in the Car
Carbohydrates
Provide the energy to work The
fuel
used
for
rapidly. Give glucose to the acceleration and short trips.
brain.
Fats
Keep the engine running.
Provide energy for strenuous The fuel used on long drives.
work. Maintain the body.
Proteins
Build the body. Protect the The
body.
Vitamins
Keep the car running.
Help
frame
of
the
car.
Protects the car.
the
systems
body
work
and
its The parts of the car needed
properly. for
Protect the body
start
up
and
maintenance. Keep the car
in shape.
Minerals
Aid and maintain correct The accessories of the car
functioning of body systems that helps it run smoothly.
and protect the body
Water
Vital for life. Required in all The cooling system of the
cells and fluids.
car. Needed for the car to
work.
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
Carbohydrates
This group is made up of sugars, starch and dietary fibre.
Sugar is the simplest form of carbohydrate. There are many different types of sugar that
are found in different types of food. Sugar is found naturally in foods such as milk, fruit
and vegetables but is added to jams, soft drinks, biscuits, cakes and sweets.
Sugars are simple molecules that are digested and absorbed easily by the body.
Starch is made up of chains of glucose sugar molecules. Starches are more complex
molecules that are broken down by the body into glucose before they can be digested.
Starch foods must be cooked before they can be eaten. When cooked with water
starchy food absorbs the water and swells.
Starch products include potatoes, bread, rice, pasta, taro, wheat, and millet.
Dietary fibre is the term given to a number of complex carbohydrates, which cannot be
digested. Fibre is found primarily in the cell walls of plants. These starches pass through
the small intestine and are broken down by bacteria in the large intestine before being
excreted from the body together with other waste products.
Fibre helps to prevent constipation, and can prevent heart disease as it alters cholesterol
levels in the blood. Fibre is important in keeping the digestive tract healthy and working
properly. However, fibre can reduce the absorption of minerals such as iron and zinc.
Sources of fibre are fruit, vegetables, beans and whole-grains.
Carbohydrates have important functions in the body.
1. They provide energy
U
1 gram of carbohydrate provides 16kJ or 4 Kcal
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
2. If carbohydrates are lacking, protein will be used for energy by
the body and wasting (acute malnutrition) can occur as protein is
used for energy rather than its growth and repair functions
3. Fibre can reduce blood cholesterol levels, and prevent heart
disease
4. Fibre can reduce the risk of cancer
Fats
Fats are made up of chains of fatty acids. Fatty acids can be either saturated or
unsaturated. Saturated fats are solid at room temperature and include butter, lard, and
ghee. Unsaturated fats are liquid at room temperature and are mainly vegetable and
animal based oils.
Functions of fat in the diet;
1. The most energy dense source in the diet
U
1 gram of fat provides 37kJ r 9 Kcal
2. They are an essential component of cell membranes
3. They are needed for the absorption and function of vitamin A, E, D,
and K
4. Essential fatty acids are needed for cell membranes and nerve tissue
5. Fat makes meals more tasty and satisfying
Rich sources of fat are oils, meat products, butter, margarine, fish, nuts, soya beans,
potato crisps and chocolate.
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
Fat is an important nutrient in the diet. However, it is important to regulate fat intake. A
diet high in saturated fat is associated with high blood cholesterol levels, which can lead
to coronary heart disease.
It is recommended that no more than 35% of total energy intake comes from fat, with
no more than 10% from saturated fat.
Proteins
Proteins are complex molecules made up of chains of smaller molecules called amino
acids. These are the primary building blocks of the body. Chains of amino acids together
form proteins. When proteins are eaten and digested they are broken down into their
amino acids, which are then absorbed and used to build new tissues.
Amino
Acids
A
B
C
E
= Proteins
D
F
B
E
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
Proteins are needed to build and maintain muscle, blood, skin and bones together with
tissues and organs of the body. They also make hormones and enzymes and provide
energy.
Good sources of protein are:

Fish

Meat

Dhal curries

Beans

Eggs

Milk

Cheese

Yoghurt
Protein is found in a wide variety of animal and plant based foods, however, the amount
and quality of the protein varies. The quality of the protein depends on the amino acids
that are present. Amino acids can be classified into essential and non-essential amino
acids. Essential amino acids cannot be made by the body, thus they are required from
the diet.
If a food contains more than one of the essential amino acids required by the body it is
said to be of high biological value. If low in essential amino acids it is said to be of low
biological value. In general, animal sources of protein have a higher biological value
than plant sources.
However, proteins can complement each other if eaten together and thus give a meal of
high biological value. This complementary function of proteins plays an important role in
meeting people’s nutritional requirements.
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
Vitamins and Minerals
Vitamins and minerals are called micronutrients. They are needed in much smaller
amounts than protein, fat and carbohydrate but are essential for good nutrition. They
help the body work properly and stay healthy. Some minerals also make up part of
many of the body's tissues, for example, calcium and fluoride are found in bones and
teeth and iron is found in the blood. Without vitamins and minerals your body will fail to
function properly and diseases occur.
Vitamins
Vitamins are complex substances that are needed in small amounts for specific body
processes. Only a few milligrams are needed per day but vitamins are essential to
health. Most vitamins cannot be made by the body and so are required from the diet. If
vitamin requirements are not met due to a poor diet or medical condition specific
symptoms will appear and a deficiency disease may develop.
A
Vitamin A is needed for building and maintaining healthy tissues throughout the
body, particularly eyes, skin, bones and tissues of the respiratory and digestive tracts. It
is also very important for effective functioning of the immune system. Vitamin A
deficiency can lead to poor night vision, severe eye diseases and in severe cases
permanent blindness. This occurs mainly in undernourished children, especially those
with measles and other infections. Vitamin A deficiency can also lead to increased illness
and death from infections.
Vitamin A is found in two forms; as retinol in animal food sources and carotenoids in
plant sources. Carotenoids are converted to retinol by the body. The most common
carotenoid is beta-carotene.
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
Retinol is found in breast milk, liver, eggs, and milk. Foods rich in carotene include
carrots, dark green leafy vegetables, deep yellow and orange sweet potatoes, pumpkins,
mangoes, papaya and red palm oil. Vitamin A is not found in oranges.
B
Vitamin B complex consists of 8 individual B vitamins, which have a unique
structure and function in the human body.
The B-vitamins are necessary for converting carbohydrates, fat and protein into energy
and for using them to build and repair the body's tissues. Requirements for B vitamins
vary greatly and it is important to remember that because the different vitamins have
different functions, they are not all needed at the same time as they are used at
different rates for different functions.
B vitamins are classified using numbers, but they also have chemical names. The 8 B
vitamins are:

Thiamine (B1)

Riboflavin (B2)

Niacin (B3)

Pantothenic Acid (B5)

Pyridoxine (B6)

Biotin

Folic Acid

Cobalamin (B12)
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
Thiamine
Thiamine is needed to release energy from carbohydrate. The amount required is
related to the amount of carbohydrate eaten in the diet. It also aids blood formation and
circulation. Good sources of thiamine are whole grains, liver, nuts and seeds.
Deficiency of thiamine causes a disorder of the nervous system called beri-beri.
Characteristics include fatigue, nerve degeneration, poor coordination, oedema,
constipation and irritability. Loss of appetite and difficulty in breathing may also
occur. Deficiency is common in populations where refined white rice is a staple
food.
Riboflavin
Riboflavin is required to release energy from protein, carbohydrate and fats. It is also
important for red blood cell production and growth.
Good sources of vitamin B2 include meat, poultry, fish, dairy products and green
vegetables.
There is no known deficiency disease for vitamin B2. However low intakes result in skin
problems, namely dryness and cracking around the mouth and nose.
Niacin
Niacin has a function in the digestive system, skin and nervous system. It is also
suggested that it has the ability to lower the level of fat in the blood thus aiding
treatment of a condition known as hyperlipidaemia in which blood fat levels are too
high.
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
Niacin is made by the body from an amino acid called tryptophan and is found in the
following sources: meat, milk and eggs.
Niacin deficiency results in a disease called pellagra. This is characterized by inflamed
skin, digestive problems and mental difficulties.
Pantothenic Acid
Pantothenic acid works closely with the vitamin Biotin. It is important in the release of
energy from carbohydrates and fatty acids and in the synthesis of hormones.
Pantothenic acid is found in a wide range of foods with meat, whole grains and legumes
being especially rich.
Pyridoxine
Vitamin B6 is needed to release energy from protein. It also is involved in the regulation
of fluid levels in the body and aids red blood cell production.
Vitamin B6 is found in a variety of foods: chicken, fish, liver, eggs, whole-wheat
products, peanuts and walnuts.
Deficiency may occur as a complication of disease and drug effects.
Biotin
Biotin is very similar to Pantothenic acid in its functions and sources. It is needed for the
breakdown and synthesis of carbohydrates, fat and protein. Biotin is found in liver, eggs,
cereals and yeast.
A lack of biotin can cause fatigue, loss of appetite, muscle pain, dry and scaly skin.
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
Folic Acid (Folate, Folacin)
Folic acid is needed for the formation of red blood cells. It is especially important during
periods of growth such as pregnancy and childhood. It is also important in the
production of DNA, which is essential for the growth and reproduction of normal cells.
Inadequate intake of folic acid during pregnancy can result in birth defects as a result of
cells not being produced properly. Neural tube defects are common in babies where
pregnant mothers have had a diet low in folate.
Low intakes of folic acid can cause diarrhoea, loss of appetite, and weight loss. Other
signs of deficiency include weakness, headaches, and a sore tongue. In children, low
folate levels can slow growth rates and result in complex medical conditions. Anaemia is
a sign of advanced folate deficiency in adults characterized by fatigue and lethargy.
Sources of folic acid include green leafy vegetables, nuts, grains, liver and yeast.
Cobalamin
Vitamin B12 maintains healthy nerve cells and red blood cells. It is also needed to make
DNA.
Deficiency is rare, however it is often seen in individuals who exclude animal produce
from their diet. Deficiency causes a type of anaemia known as megaloblastic anaemia
where the red blood cells become enlarged and damage the nervous system. Typical
signs of deficiency are therefore numbness and tingling of the hands and feet.
Cobalamin is found naturally in animal foods including milk, milk products, eggs, meat
and poultry. Fortified breakfast cereals and canned tuna also contain vitamin B12.
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
C
C
Vitamin C (or ascorbic acid) has many functions. It is necessary in the
formation of collagen (connective tissue) which binds the body’s cells, in immune
responses, wound healing and allergic responses. Vitamin C increases the absorption of
iron in the gut, and due to its properties as an antioxidant it plays a protective role in
the body.
Prolonged vitamin C deficiency can lead to scurvy. The signs of scurvy are bleeding
gums and sore, swollen joints, poor wound healing and damage to bone and body
tissue. In serious cases it can lead to death.
Most fruits, especially citrus and guava, and many vegetables, including fresh potatoes,
are good sources of vitamin C. Eating fresh fruit and vegetables is important for both
adults and children.
Stress and strain on the body, like smoking, increases the amount of cellular byproducts called radicals. Antioxidants counteract the radicals and transform them into
non-damaging products. They can therefore reduce the risk of developing cancer and
heart disease. Other antioxidants are vitamin E, carotenoids and selenium.
Vitamin D is the one vitamin that is made by the body. When the skin is
D
exposed to sunlight, the ultra violet rays stimulate the production of vitamin D.
This is therefore an important source as vitamin D is found in few food sources.
Vitamin D is particularly important for the use of calcium by the body. It works as a
hormone to control the amount of calcium that is absorbed by the intestines. It is
therefore essential for bone structure, as the more calcium that is absorbed by the body
the stronger the bones and teeth will be.
Vitamin D is found in fish oils, eggs and milk. Lack of vitamin D can lead to rickets, a
disease, which causes soft and deformed bones in young children.
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A prolonged lack of vitamin D can result in pain and muscle weakness in adults (a
disease called osteomalacia) and bone degeneration (osteoporosis).
E
Vitamin E consists of a group of compounds that are called tocopherols and
tocotrienols. Vitamin E is an antioxidant and consequently protects the body against
harmful radicals.
Sources of vitamin E are vegetable oils, nuts and green leafy vegetables.
K
Vitamin K is made by bacteria in the gut. However, it is also required in the diet
and is found in the following sources;

Cabbage, spinach and green leafy vegetables

Cereals

Soybean
Vitamin K is essential for blood clotting. A lack of vitamin K results in the blood failing to
clot properly, which can be fatal. It is also found to have a role in maintaining strong
bones in the elderly.
How Much of the Vitamins Do We Need?
The body requires different amounts of each vitamin because each of them has a
different function. Many factors influence the amount that each individual needs. It
depends on age, gender, level of activity, state of health. Certain people may have
higher requirements for specific vitamins, for example, those suffering or recovering
from illness, smokers, athletes and pregnant women.
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Daily Reference Values (DRV’s) exist to give guidance for daily intakes of each vitamin.
However, these values are estimates and take into account that vitamins and minerals
are consumed over a period of days and weeks rather than each and every day. The
Reference Nutrient Intake (RNI) is given for some vitamins and represents the amount
of each nutrient that the general population requires for good health.
The Availability, Absorption and Loss of Vitamins
The availability of a vitamin for absorption and use in the body is affected by a number
of factors. The amount absorbed by the body can be influenced by other substances
such as minerals and natural chemicals found in foods. For example iron can reduce the
absorption of vitamins A, D and E whereas the absorption of vitamin B12 can be helped
by increased folic acid.
The amount that each individual absorbs will depend on their needs, ability to absorb
nutrients and the amount available in their diet.
Some vitamins are damaged easily by heat, light, preparation and storage. Losses can
occur during food preparation and cooking which in turn can affect the amount of a
vitamin that is consumed and therefore absorbed. For example, when green vegetables
are boiled, vitamin losses occur whereas cooking carrots allows the vitamin A to be
made more available for absorption by the body.
Minerals
Phosphorous
Iron
Calcium
Potassium
Magnesium
Iodine
Sodium
Trace
Elements
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Minerals are inorganic substances that are required by the body for a wide range of
functions. They are needed in varying amounts depending on their functions in the
body. Those that are required in smaller quantities are called trace minerals. However,
these minerals are just as important as others despite being needed in smaller amounts.
The best way to ensure that all mineral requirements are met is to eat a varied diet
including a wide range of foods from all food groups.
Calcium
Calcium is a mineral that works with vitamin D to build strong bones and teeth. Ninety
nine percent of calcium is stored in the bones and teeth. The remaining 1% is found in
the blood and soft tissues. This is just as important as it controls muscle contraction and
aids blood clotting.
A lack of calcium can cause growth problems in children. Calcium deficiency may cause
bone abnormalities. Rickets occurs in children who have calcium deficiency. Rickets
affects the structure of growing bone. A lack of calcium stored in the bone results in the
bones becoming soft and weak and unable to bear the weight of the child. Symptoms
include bone pain, delayed teeth formation, curvature of the spine and legs, and poor
muscle strength.
Calcium deficiency in childhood can lead on to osteomalacia in adulthood. As with
rickets, a prolonged calcium deficiency causes the bones to be weak and prone to
fractures. Pain and muscle weakness is experienced.
The density of the bone mass gradually builds up and reaches a peak between the ages
of 30 – 35. After this the bones begin to gradually degrade as less bone is made to
compensate for the bone losses. It is therefore important to ensure an adequate calcium
intake. Severe bone loss results in bone becoming weak and brittle in adulthood, a
condition known as osteoporosis. Osteoporosis results in repeated bone fractures and
general bone pain.
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The above diagram shows how the condition affects bone, causing a thinning of the
bone tissue. This causes fractures to occur more easily. Bone degradation may also
results in poor spinal support (see picture on page 25).
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Calcium absorption depends on vitamin D and so the two nutrients are dependent on
each other. This explains why calcium and vitamin D deficiency show similar signs.
Rich sources of calcium are dairy produce, together with pulses, nuts, dried fruit and
green vegetables. Many foods are also fortified with calcium. Calcium availability,
however, can be affected by substances in other foods that bind to the calcium and
prevent absorption. Wholegrain cereals and pulses contain a (natural) substance called
phytate and some green leafy vegetables contain another called oxalate that decrease
the absorption of calcium.
Iron
Iron is a major part of red blood cells and is necessary to keep all of the body's cells
working properly. Iron is needed for the substance in red blood cells called
haemoglobin, which is needed to transport oxygen around the body. A lack of iron leads
to iron deficiency anaemia. Iron deficiency anaemia is the most widespread nutritional
problem in the world. It can be very serious in children and women of childbearing age,
especially during pregnancy. It is also common in teenage girls and in those who have
suffered severe blood losses such as through injury or menstruation. Iron deficiency
anaemia causes tiredness, irritability, low attention span, learning difficulties, poor
growth and development, and increased illness and maternal mortality, especially at
delivery.
There are two types of iron available from the diet:
1. Haem iron
which is found in meat, fish, poultry and liver. It is absorbed easily
by the body.
2. Non-haem iron
found in dark green leafy vegetables, dried fruits and whole
grains. This form of iron, however, is not absorbed as easily by
the body, and its absorption is affected by other foods.
Substances as phytates and tannins restrict the absorption of nonhaem iron. Phytates are found in cereals and pulses and tannins
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are found in tea and coffee. It is therefore recommended that tea
and coffee are not consumed at meal times as they can inhibit
absorption by up to 40%. Vitamin C however increases the
absorption of non-haem iron and if consumed together with iron
rich foods iron absorption will be significantly increased.
Phosphorous
Phosphorous is a component of bones and teeth and is present in all animal and plant
cells. It is also involved in enzymes and is needed for the metabolism of energy from
glucose.
Phosphorous has an important role in maintaining healthy bones and teeth as 80% of
phosphorous is stored as calcium salts in the skeleton. Phosphorous therefore works
closely with calcium and vitamin D. It is essential that all three nutrients are available in
adequate amounts to work together to ensure healthy bones and teeth.
Good sources of phosphorous tend to be those rich in protein and include milk, meat,
nuts, whole-grains and green vegetables. Pumpkin and sunflower seeds are very rich
sources.
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Iodine
The primary function of iodine is to make thyroid hormones. Thyroid hormones are
made in the thyroid gland and are essential for controlling metabolism and therefore
proper growth and development. A lack of iodine in the diet results in lethargy and
mental retardation.
The characteristic sign of iodine deficiency is a swollen thyroid gland in the neck, known
as goiter.
Iodine deficient mothers can bear children who are severely iodine deficient, and the
infant suffers from mental disability known as cretinism. This condition causes mental
retardation and dwarfism.
Iodine is restricted to only a few sources. Seafood is a rich source of iodine as is iodized
salt. Foods such as vegetables grown in iodine rich soil may contain iodine but not in
significant amounts. In the Maldives tuna fish contain iodine but levels are reduced
significantly after prolonged periods of cooking. Reef fish is a far better source of iodine.
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Potassium
Potassium is found in all body fluids and has many functions;

It is needed for normal muscle tone and function

Keeps heartbeat regular

Needed for a healthy nervous system

Maintains normal blood pressure

Regulates the transfer of nutrients to cells
Potassium is found in almost all foods but rich sources include dairy products (except
cheese), green leafy vegetables, apricots, fish, bananas, and brown rice. Raw foods are
a better source of potassium as losses occur during processing.
A lack of potassium in the diet causes fatigue, muscle weakness and cramping, and
rapid heartbeat.
Sodium
Sodium, together with potassium, helps regulate the water content of the body. Like
potassium, sodium is present in all body fluids and is essential for hydration as it
controls the amount of water in cells. In contrast, potassium functions to carry waste
products out of the cells.
BODY
CELL
Potassium
takes
waste products out of
the cell
Sodium takes water
into the cell
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It is therefore important that the balance of potassium and sodium in the body remains
constant and equal. If imbalanced, waste products can accumulate inside the cells and
healthy nutrients and water remain outside the cells.
In addition, sodium is required to regulate nerve impulses and muscle contractions.
Although sodium chloride (salt) is found in few foods naturally, all processed refined
foods contain added salt ensuring that deficiencies are rare. Salt is also used in cooking
and added as table salt supplying adequate amounts from the diet. In hot climates, it is
necessary to ensure that sodium levels do not deplete as sodium is lost through sweat
and can destroy the potassium/sodium balance in the body. Care must be taken
however, not to consume excess sodium as salt, as this can result in high blood
pressure (hypertension) and further complications.
Magnesium
Magnesium is needed for muscle contraction, nerve impulses, bone mineralization and
energy metabolism. It is present in all body cells. It also forms part of enzymes involved
in energy transfer from fats, proteins and glucose.
It is also important in regulating the amount of calcium in the blood.
Magnesium deficiency is rare, and is usually a result of a clinical condition rather than a
deficient diet. However symptoms include muscular weakness, confusion, tremors and
difficulty in swallowing.
Magnesium is present in dark green leafy vegetables, nuts, seeds, soybeans and wheatgerm.
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Trace Elements
Trace elements is the term used to describe minerals that are essential for good health
but are needed in very small quantities. Trace elements include zinc, fluoride, selenium,
copper, and chromium. See Appendix for information on these nutrients.
Fortification and Supplements
Many foods are fortified with vitamins and minerals due to the losses that occur in
processing and the rise in concern over adequate dietary intake of nutrients. Foods that
have had vitamins and minerals added to them are called fortified foods. An example of
a fortified food is iodised salt. Iodine is frequently added to salt to produce iodised salt
for use in cooking. Cereals and dairy products are also commonly fortified with vitamins
and minerals to enhance their nutritional content.
Additional mineral supplementation in the diet is unnecessary provided the individual
eats a varied and balanced diet. However, in developing countries where food variety
and shortages exist it is sometimes necessary to have a supplement in the diet. The
sick, pregnant and young who have higher nutrient requirements should ensure that
they eat foods rich in vitamins and minerals before resorting to additional tablet
supplementation. It is important that supplementation is prescribed by a doctor only, as
excess vitamin and mineral stores can cause toxicity and illness.
The amount of a particular vitamin or mineral that an individual absorbs will vary
depending on their needs and body stores. Together with other influencing factors such
as age, gender and health these factors require serious consideration before
supplementation is advised.
Water
Our bodies are over 70% water. Water is a major part of all body fluids; blood, digestive
juices, urine, tears, saliva and sweat. It is therefore involved in all body functions;
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circulation, digestion, absorption, getting rid of waste substances, cell production and
metabolism, and chemical reactions. It is essential for the body.
The amount of water that we need depends on many different factors such as age, job,
climate, activity levels and diet. It is essential however that an adequate intake is
maintained to replace the water lost from the body. Excessive loss of water can cause
dehydration. Hot weather, physical activity and sickness (such as diarrhoea, vomiting
and fever) can all cause increase fluid losses, which need to be replenished through
drinking clean water.
Nutrition Requirements
All nutrients have different roles and functions in the body, some of which are needed in
larger amounts than others. The nutritional requirements for nutrients vary among all
individuals and depend on a number of different factors:

Age

Gender

Level of physical activity

State of health

Environment
Due to individual needs being different, different types and amounts of foods are
needed for a balanced diet. For example a balanced diet for an athletic man will not be
the same as that of a young child.
Nutritional requirements are based on values known as Dietary Reference Values
(DRVs). These are estimates for different groups of people and should not be viewed as
goals for individuals. DRVs include three different estimates:
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Estimated Average Requirement (EAR)
This is an estimate of the average requirement for energy or a nutrient for a group of
people.
Reference Nutrient Intake (RNI)
The RNI is the amount of a nutrient that is enough to ensure that the needs of the
group (97.5%) are being met.
Lower Reference Nutrient Intake (LRNI)
The amount of a nutrient that is enough for only the small number of people that have
low requirements (2.5%). This is the minimum requirement for a nutrient.
This can be shown on a graph.
The graph shows how the
majority of people consume
average requirements.
The daily diet should be made up of all nutrients to achieve a healthy balanced diet.
Energy should be derived from all nutrients of the daily calorific intake;

Fat should provide 30-35% of calories

Protein should provide 15%

Carbohydrate should provide 55%
The Balance of Good Health is a symbolic representation of the proportions and types of
foods that should be consumed in order to achieve a balanced diet.
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This is not a requirement for every meal however, but a guide for daily and weekly
intakes. This is also shown using the food pyramid (see Appendix v)
It is based on eating a selection of foods from the five food groups (see Appendix vi).
The Balance of Good Health
As the diagram shows, bread, cereals and potatoes and fruit and vegetables should
make up the main part of the diet, with sugar and fatty foods being only eaten in small
amounts.
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It is also important to remember that nutritional requirements increase when the body is
not functioning properly or is under stress or strain. It is therefore important that
nutritional intakes increase during sickness and during recovery.
Certain groups of people may have higher requirements for a specific nutrient such as a
vitamin or mineral if suffering from a medical condition. For example, an elderly woman
suffering from osteoporosis may require a higher calcium intake than a healthy woman
of the same age.
Children also require more energy per kilogram of body weight and nutrients than adults
as it is necessary to meet the nutritional demands made by phases of growth and
development.
The graphs below highlight how nutritional requirements vary.
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Healthy Meals
A balanced diet must consist of balanced meals. A balanced meal consists of different
foods that provide a variety of nutrients. Different types of food should be combined to
give a balanced meal.
Ingredients for a balanced meal:
1. Staple
This provides the most calories, together with protein and
some minerals and vitamins. Staples are starchy foods and
cooked cereals such as bread, pasta, potato, rice, and
roshi.
2. Meat, fish, or legumes
These provide calories, protein, fibre and some vitamins
and minerals. Iron is supplied from this group. Legumes
include dhal, beans and nuts.
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3. Vegetables and/or fruit
These provide vitamins and minerals such as vitamin A, C,
folic acid, and iron.
4. Fat rich foods
Vegetable oils, margarine, coconut, milk and cheese supply
fat. Children need more fat than adults.
Children require less food than adults and should be given small regular meals rather
than a few big meals because of smaller stomachs. The diagrams below show balanced
meals for children and adults.
Adult
Child
Snacks may also be eaten as part of a balanced diet but care should be taken to ensure
that these do not interrupt the pattern of regular meals and that they are nutritious and
not high in saturated fat and sugar.
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Good value snacks include:

Pieces of cooked cassava, potato, or breadfruit

sandwich

Milk, cheese or egg

Fruits such as mangos, bananas, oranges and apples
Bad value snacks are:
High sugar foods such as sweets, chocolate, biscuits
Foods that are high in fat and give few nutrients such as crisps,
ice-cream and fried short eats
Sugary drinks such as sweet tea, coffee and fizzy drinks
Nutrition Requirements at Different Ages
Infants, 0 – 6 months
Breast milk provides all the energy and nutrients a baby needs
for growth and development. It also contains antibodies,
hormones, enzymes, growth factors and other substances
needed for a healthy development. A healthy baby does not
need any food or drink other than breast milk for the first six
months of its life. The composition of breast milk changes over time, in accordance with
the changing needs of the growing baby.
Babies are born with appetite control which matches their bodies' needs. However,
babies have different feeding patterns. Some babies need to feed 12-15 times while
others 6-8 times during 24 hours. Putting the baby to the breast whenever it shows
signs of hunger during the day and night is the key to establishing good milk supply and
good growth.
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Young Children, 7 months - 2 years
While breast milk is the basic food of the baby, it is not enough
to meet the increased nutritional needs as the baby grows older.
By six months babies should be introduced to other foods to
supplement the energy, protein, vitamins and minerals provided
by breast milk.
This process of introducing new foods into the baby’s diet is
called complementary feeding. This will also accustom the baby to varieties in food
flavours and textures and establish good food patterns from an early age.
Breast milk should continue to be the main ingredient of the diet, but different types of
complementary foods should be introduced gradually. Foods for babies require special
preparation to make sure that they are soft, clean and easy to digest. Food can be
softened by cooking and then pureed, mashed or chopped.
To meet all of the baby’s nutritional needs it will be necessary to add foods high in
energy and other nutrients (oil, fruit, vegetables, legumes, animal products) to the
family’s staple food. Once the baby is accustomed to liquid and soft foods, and as the
teeth appear, semi-solid and then solid foods can gradually be introduced to the diet.
Preparing safe and nutritious complementary foods can take time and effort. Many
parents need practical advice and assistance to help them provide their babies with the
foods they need. Introducing the baby to family food instead of ready-made packets is
preferred as the baby will be introduced to different tastes and textures and she/he will
be used to the tastes of the food she/he will eat when older. One of the most common
first foods for babies is rice based porridge.
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Children, 3 – 12 years
10B
The food and nutrition of a young child is important, as this is the time when food
preferences and habits will be established. It is also an important period in life as it is
when a child grows and develops. Young children are often the most at risk of being
malnourished. They have very high energy and nutrient needs for their body size in
comparison to adults. Proper care and feeding is essential for their normal growth,
development and activity.
Energy requirements increase dramatically as a child grows rapidly and becomes more
active. Foods must therefore be high in energy but also rich in nutrients. A good supply
of protein, calcium, iron, vitamin A and D are also of primary importance. Childhood is
the most important time for the development of bones and teeth. Milk is therefore an
important part of the diet.
Iron is important during this phase of life. A lack of iron can cause poor weight gain,
poor development and frequent infections. Meat, liver and eggs are rich sources of iron,
and can be given to children. Iron should therefore be consumed from alternative
sources such as green vegetables and pulses. Iron absorption can be increased by
consuming vitamin C, for example, having orange juice at meal times.
It is necessary to ensure that a child’s diet is not too high in fibre as this will restrict the
absorption of other nutrients and will fill the child up so that fewer nutrient rich foods
are consumed. It is important also that the sugar and salt content is controlled.
Consumption of foods high in sugar such as drinks with added sugar can result in dental
problems. Also consumption of high caffeine foods such as coca cola and black tea
reduces iron absorption and should be avoided as much as possible.
Children cannot eat the same amount of food in one meal as adults. Active children also
spend a lot of energy and should sustain energy requirements by eating small meals and
snacks spread over the day. Children should be encouraged to exercise and stay active
in order to become healthy adults and avoid obesity.
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Sick children must be encouraged to eat and drink, even if they have little appetite.
They should be offered softer textured foods. Lots of fluids, like milk, fruit juice, soups
and clean water, are especially important when a child has diarrhoea. Children
recovering from fevers and sickness should also be given plenty of energy and nutrientrich foods to eat as well as liquids such as juices.
The focus should be on developing healthy eating habits of children at this age. Children
can eat many of the same foods as their parents. The importance of a healthy balanced
diet should be reinforced by guiding food choices and feeding patterns and highlighting
the importance of avoiding foods that are high in fat and sugar, in favour of nutrient rich
fruit and vegetables.
Adolescents, 13 – 18 years
11B
Adolescence is a period of rapid growth and development and thus, adolescents have
very high energy and nutrient needs. They need adequate intakes of vitamins and
minerals, especially iron, calcium, vitamins A, C and D. In addition, adequate amounts of
energy and protein are needed to sustain growth and development. Teenagers usually
satisfy this increased need by snacking in between meals. Teenagers should therefore
be encouraged to choose healthy snacks in order to avoid excess weight gain, which can
lead to obesity.
Special attention should be given to adolescent girls who begin menstruation and need
to be well nourished both for their immediate development and the future stresses of
childbearing. Anaemia and calcium deficiency are common problems so foods rich in
calcium and iron should be encouraged.
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Further concerns for teenage girls are focused around the issues of slimming and eating
disorders. Teenage girls are likely to adopt low energy diets and habits such as smoking
in an effort to control weight. This can lead to nutrient deficiencies and problems in later
life.
Adolescent girls who become pregnant are at particular risk and must have
additional nutrients for their baby’s growth as well as for their own.
Adulthood
It is important during adulthood to maintain a healthy diet that
provides adequate vitamins and minerals. Diets should be
balanced, and saturated fat, salt and sugar intakes monitored so
as not to increase the risk of becoming obese, developing heart
disease, and diabetes.
Food is the body’s fuel and consequently the more active people are the more food is
needed whereas less active people will need less food. Having a proper body weight is
important to good nutrition and can also affect the happiness and enjoyment of life.
Being underweight can lead to malnutrition.
Malnutrition often results in lack of energy, reduced ability to work and other nutritional
problems. Being very overweight (obese) is also a form of malnutrition and can lead to
serious health problems including cardio-vascular disease, diabetes and hypertension.
Overweight people often find it harder to do physical work, exercise and stay fit.
Whilst it is common that the body weight will fluctuate to a certain extent, it is advisable
to avoid extreme weight loss or weight gain. Diets that promise rapid weight loss
normally only make you loose water and as soon as you start eating normally again, the
weight gets back to what it was before you started the diet.
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If you want to gain weight

If you want to loose weight

Eat more of your regular foods
Eat
less
energy-dense
foods,
especially ones high in fat

Eat
more
frequent
meals
and

snacks
Eat more foods rich in fibre, e.g.
fruit, vegetables and whole grain
products

Eat a greater variety of food

Eat regular meals; constantly going
hungry is not the answer

Make sure you are eating enough

protein and energy
Drink water before eating; it will
“fill up” your stomach so you eat
less

Increase the energy content of
your food by adding fats, oils and
sugar

Increase exercise level; be more
active in everyday life and more

Keep fairly active as exercise helps
vigorous exercise sessions can be
stimulate appetite and is important
gradually introduced
for good health

Avoid
or
minimise
stressful
situations as worry and stress can
cause weight loss
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Pregnant and Breastfeeding Mothers
Women need to eat enough before, during and after pregnancy to
deal with the extra strain that pregnancy puts on the body. When a
woman is pregnant or breastfeeding, she must meet the baby’s
nutritional needs as well as her own.
If the mother’s diet does not satisfy the needs of her body, the baby
will draw on, and reduce, the mother’s own stores of nutrients. This puts the mother at
increased risk of illness and can affect the baby’s development.
The additional needs can generally be met by eating a wide variety of foods including
fresh fruits and vegetables.
Pregnant women should be encouraged to have regular medical checks to ensure that
they are keeping themselves and the developing baby well nourished. In some cases
vitamin and mineral supplements might also be recommended, but these should be
taken only as advised by a doctor. During pregnancy the requirement for iron is
particularly high and supplements are often needed. Folic acid is another common
supplement.
The Elderly
As people begin to feel the effects of old age, illness and loss of taste and thirst
sensation can reduce appetite. Further, loss of teeth can make chewing difficult and a
variety of stomach and intestinal disorders can lead to digestive problems.
Disabilities and infirmities, coupled with poverty, loneliness and depression can make
acquiring and preparing food difficult. All older people should therefore pay attention to
their nutritional needs.
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Even though most people need less energy as they get older, the elderly need adequate
amount of protein, carbohydrates, fat, vitamins, minerals and dietary fibre. Women
should have an adequate calcium intake throughout life to reduce bone loss.
Consumption of high energy foods may be particularly important if appetite falls and
overall food intake is limited. Maintaining adequate fluid intake is also important.
Clinical Nutrition
Malnutrition is a clinical diagnosis which includes several overlapping syndromes. They
are due to inadequate supply, relative to demand, of energy or essential nutrients.
Malnutrition is more common and obvious in young children than in adults, as they
require extra food for growth. They also have little control over the supplies of food
offered to them and have far smaller stores for coping with the setback of food shortage
and infection.
Protein Energy Malnutrition
First recognized in the 20th century, the full impact of protein energy malnutrition (PEM)
has been revealed only in recent decades. Infants and young children are most
susceptible to PEM’s characteristic growth impairment because of their high energy and
protein needs and their vulnerability to infection. The term protein-energy malnutrition
has replaced a group of related disorders that include marasmus, kwashiorkor, and
intermediate states of marasmus-kwashiorkor.
There are several indicators to detect PEM:

Low weight-for-height or wasting is a measure of acute malnutrition caused by a
sudden change in the diet e.g. during a serious disease.

Low height-for-age or stunting is a measure of chronic malnutrition or consistent
under-nourishment over a longer period.

Low weight-for-age or underweight is an overall measure of malnutrition.
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• Protein-energy malnutrition (PEM) affects every fourth child world-wide: 150
million (26.7%) are underweight while 182 million (32.5%) are stunted
• Geographically, more than 70% of PEM children live in Asia, 26% in Africa and 4%
in Latin America and the Caribbean. Their plight may well have begun even before
birth with a malnourished mother
Varying degrees of PEM require varying treatment methods. Ideally, each child should
be examined to exclude the possibility of underlying disease, such as bacterial or viral
infections. The management of a malnourished child often also requires an improvement
in the child’s environment – family’s income, knowledge of child care and stimulating
play as well as improvements in hygiene, diet and feeding practice are all important.
These measures should be linked to a systematic community involvement in health
promotion aimed at enhancing exclusive breastfeeding, improving hygiene, increasing
rates of immunisation and organising systems for child health care, with regular weight
monitoring and help parents with family planning.
Serious cases of PEM need hospital treatment where first the child’s acute problems are
diagnosed and treated including antibiotic therapy, maintenance feeds and supplements.
The second stage ‘high-quality’ feeds are offered in increasing amounts to permit rapid
catch-up growth. In the last stage, the child is weaned to home feeds.
Obesity
Obesity has been identified as one of the most important public health problems of our
time. No single disease accounts for all the excess mortality among obese people, but
cardiovascular disease is the main cause of increased mortality. The mortality from
coronary heart disease, congestive heart failure, stroke and hypertension all increase
with age, but within any age group the mortality among obese individuals is greater
than among lean ones. Obesity is an important risk factor for gallstone formation.
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Obese men have an increased risk of cancers of the colon, rectum and prostate,
whereas in women the increased risk involves the breast, ovary, endometrium and
cervix. Other penalties of obesity include osteoarthritis of the weight-bearing joints
(especially back, hips and knees) and social discrimination. All of these penalties
decrease with weight loss, with the exception of the risk of gallstone formation.
One way to measure desirable range of weight for height for adults is to calculate the
Body Mass Index (BMI). The index is calculated by dividing the individual’s weight (in
kg) by the square of his or her height (in metres). Thus a person who weighs 55 kg and
who is 1.60 m tall would have a BMI of 55/(1.60 x 1.60) = 21.5 , which is in the
U
U
desirable range.
Body Mass Index
kg/(m2)
>40
obese, class III
35-40
obese, class II
30-35
obese, class I
25-30
overweight
18.5-25
normal/desirable
16.5-18.5
moderately underweight
<16.5
severely underweight
The best strategy to treat obesity depends on the ability, inclination and degrees of
obesity of the subject. Some factors which influence appropriate advice are:
1. Age and BMI of person.
2. Person’s target weight and expected benefits from weight loss.
3. Previous attempts at weight loss.
4. Domestic circumstances.
5. Other diseases and medication.
Appropriate rate of weight loss also depends on the age and grade of obesity. For the
first month of dieting the rate of weight loss is more rapid due to loss of water. The
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optimum rate of weight loss is 0.5-1.0 kg per week which corresponds to an average
energy deficit of 500-1000 kcal (2-4 MJ) per day.
The disadvantage of losing more are that there may be excessive loss of lean tissue, it
becomes difficult to provide the essential nutrients in such a restricted diet, it is
unnecessary unpleasant, and that there will have to be large adjustments when the
target weight is achieved to find a suitable weight-maintenance diet.
Diabetes
There are several types of diabetes, all characterised by a failure to maintain the
concentration of blood glucose within the normal range.
Type I diabetes mellitus or insulin dependent diabetes mellitus (IDDM) presents with
acute symptoms induced by a high blood glucose. The classic symptoms of IDDM are
thirst and weight loss. The patient becomes dehydrated because of water loss as water
is excreted with glucose by the kidneys.
The patient may appear very ill, dehydrated and unconscious with a sweet breath of
acetone being excreted via the lungs. Rehydration, electrolyte replacement and insulin
therapy is required. In such patients’ education with regard to insulin therapy, diet and
modification of lifestyle are the major considerations.
Type II diabetes or non insulin dependent diabetes mellitus (NIDDM) is characterised by
the development of progressive insulin resistance. About 2-3% of the population has
type II diabetes, but the rate is increasing as adults become more overweight and live
longer. The risk of developing diabetes in adults with a body mass index (BMI) >30 is
five times that of adults with a BMI <25. The cause of type II diabetes is unclear, but
involves both an impaired secretion of insulin by the liver and the development of tissue
resistance to insulin. Frequent urination and thirst are early symptoms of diabetes.
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Blindness and kidney failure are particular problems in the long-term management of
type I diabetes whereas cardiovascular disease including coronary heart disease and a
severe form of atherosclerosis are seen in both types.
Dietary Management of Type I Diabetes
Education is the cornerstone of modern diabetic management. People with diabetes
need to be taught the practical skills of insulin administration and blood testing and have
the knowledge to deal with different day-to-day situations and activities. Normal weight
individuals have to receive daily injections of insulin, but the amount required depends
on several factors.
Dietary Management of Type II Diabetes
The education and management of people with NIDDM depends on their individual
needs. The aim is to relieve the symptoms of diabetes and to minimise its impact on
diseases caused by diabetes. First, dietary methods are used to reduce weight and the
intake of quickly absorbed carbohydrates. If dietary measures fail to control blood
glucose levels, drug therapy is prescribed in addition to diet.
Diseases of the Heart and Circulation
Diseases of the circulatory system account for a great number of total morbidity and
mortality in adults throughout the world. The basic pathology underlying coronary heart
disease is the plaque, which is a build-up of fatty deposits within the wall of an artery
that narrows the artery thus reducing blood flow. Two major clinical conditions are
associated with these processes: angina pectoris is characterised by pain and discomfort
in the chest which is brought on by exertion or stress, and which may also radiate down
the left arm and to the neck.
It results from a reduction or temporary block to the blood flow through the coronary
artery to the heart. The pain usually passes with rest and seldom lasts for more than 15
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minutes. A coronary thrombosis or heart infarction results from prolonged total
obstruction of the artery, which causes infarction or death of some of the heart muscle
and is associated with prolonged and usually excruciating central chest pain.
There is no single cause of coronary heart disease but a number of risk factors including
lifestyle, behaviour, physical and chemical characteristics influence the likelihood of
developing
coronary
heart
disease.
High
cholesterol
and
triglycerides
levels,
hypertension, type II diabetes, obesity and low birth weight may increase the risk of
coronary heart disease.
Nutritional recommendations for high-risk populations include reduction in saturated
fatty acids found in butter, margarine, full-fat milk, cheese and red meat. Further,
increase in fibre, fruits and vegetables intake.
Iodine Deficiency Disorders
The importance of iodine arises from the fact that it is a constituent of the thyroid
hormones which are essential for normal growth and physical and mental development
in humans and animals.
The most familiar iodine deficiency is goitre – swelling of the thyroid gland in the neck.
However, the understanding of iodine deficiency now concerns all effects of deficiency
on growth and development and is denoted iodine deficiency disorders (IDD). Severe
iodine deficiency leads to severe retardation of growth and maturation of almost all
organ systems. Body weight does not increase and there is retardation of bone growth.
The brain is especially susceptible to damage during the foetal and early postnatal
period.
Marine fish and shellfish are the best sources of iodine in nature. Eggs, milk and meat
also contain iodine whereas plant foods are likely to have reduced iodine content in
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iodine deficient soils. Cooking reduces the iodine content of foods with over half of the
iodine escaping during boiling.
Iodisation of salt has been the most common way of correcting IDD and it has proven to
be successful in many countries. However, there is still the problem of distribution and
the iodine content will fall if the salt is left uncovered or exposed to heat. Iodised oil
either by injection or orally is also being used in areas where IDD is considered a major
public health problem.
Iron Deficiency – Anaemia
Iron deficiency is the most common nutritional deficiency in the world today. The World
Health Organization estimates that as many as 4-5 billion, 66-80% of the world’s
population, may be iron deficient. About 2 billion people are anaemic, mainly due to iron
deficiency, and in developing countries, frequently exacerbated by malaria and worm
infestations. Symptoms of iron deficiency are lack of energy, tiring easily, shortness of
breath, palpitations, headache, weakness, dizziness and irritability. Other symptoms are
sore mouth and tongue, sensation of a lump in the throat with difficulty of swallowing,
nails breaking easily and eating of materials such as ice, clay, paper, dirt etc. occurs
particularly in children.
The most common indicator for iron deficiency is haemoglobin below the level that is
normal in that individual and, in time, below 13 g/dl in men and 12 g/dl in women.
Other indicators are the size of red cells, mean corpuscular haemoglobin, serum iron
level and serum ferritin level. A firm diagnosis of iron deficiency requires a blood count
testing for the indicators mentioned above.
To establish that iron deficiency is due to nutritional deficiency requires an assessment
of the subject’s diet and the exclusion of blood loss. Foods rich in iron are meat and
meat products, cereals, vegetables, beans and fruits.
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Treatment of iron deficiency is usually done by oral iron salts, like ferrous sulphate.
Dietary treatment is desirable but economic, traditional or religious situations may make
this difficult.
Anaemia with small red blood cells also occurs in thalassaemia syndromes and in the
anaemia of chronic disorders. These are different from iron-deficiency anaemia.
Thalassaemia is a heterogeneous group of disorders of haemoglobin synthesis.
Eating Disorders
Eating disorders are a complex combination of physical and psychological aspects of
shape and weight and are usually divided into anorexia nervosa and bulimia nervosa.
Anorexia Nervosa
Anorexia nervosa is a state in which the sufferer, usually female, refuses to eat enough
to maintain normal body weight for height. Usually she claims to want to lose weight to
be slimmer; sometimes she says that she does not feel hungry or that it is
uncomfortable to eat. The current definition of anorexia nervosa has four criteria:
1. Refusal to maintain body weight over a minimal normal weight for age and
height
2. An intense fear of gaining weight or becoming fat, even though underweight
3. A disturbance in the way one’s body weight, size or shape is experienced
4. In females, absence of at least three consecutive menstrual cycles when
otherwise expected to occur
All anorexics refuse food and count calories and many eat as little as 200-300 calories
per day. They may also take strenuous exercise and take an immense interest in
cookery and cooking for other people, although they will avoid eating the food they cook
themselves.
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The disorder takes a physical toll on sufferers in that they may have dry skin, excessive
growth of dry brittle hair over the nape of the neck, cheeks, forearms and thighs. They
often have cold hands and feet. They can develop cardiac abnormalities and suffer from
constipation. Long-term absence of menstruation may lead to premature bone loss and
place sufferers at risk of osteoporosis later in life.
Bulimia Nervosa
Bulimia nervosa patients have powerful urges to overeat, which they alternate with
periods of starving themselves. Like anorexics, they have a ‘morbid fear’ of fatness and
some develop the habit of vomiting or purging in order to control their weight. There are
five main criteria:
1. Recurrent episodes of binge eating
2. Experience of lack of control over the binges
3. Attempts to prevent weight gain by the regular use of self-induced vomiting,
laxatives, diuretics, or strict dieting or fasting, or by vigorous exercise
4. A minimum average of two binge-eating episodes per week for at least 3 months
5. Persistent concern over body shape and weight
Typically, bulimics start the day by eating nothing or very little, then possibly are ‘good’
at lunchtime with a yoghurt or fruit, after which eating may escalate to include several
meals or several items of food, typically high in calories, fat and carbohydrates. Bulimics
usually eat in private, hiding the problem from other people. Often they do not eat
normal meals, and have difficulty in experiencing hunger or knowing when they have
reached ‘fullness’ at the end of a meal. After an eating binge they will experience
extreme guilt and desolation. Days of binge-eating may alternate with several days of
strict dieting or starving.
Like anorexia nervosa, bulimia nervosa can take its toll physically on the health of the
sufferer. Some experience amenorrhoea, oedema and possible kidney dysfunctions. The
vomiting results in symptoms of muscle weakness, constipation and headache.
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Palpitations, abdominal pains, easy fatigue, sore throat and swollen salivary glands are
other symptoms. The disorder leads to a predisposition to cardiac arrhythmias. Many
bulimics have dental problems.
Treatment of eating disorders normally includes hospitalisation, drug treatments and
psychological treatment. Given that it is extremely difficult to persuade a determined
anorexic to put on weight in hospital, many programmes have adopted a behaviour
modification approach with close follow up by a psychological consultation. Family
therapy and attitude change are also common in treatment programmes of sufferers of
eating disorders.
Food Safety
Five keys to safer food:
 Keep clean

Wash your hands before handling food and often during food preparation

Wash your hands after going to the toilet

Wash and sanitise all surfaces and equipment used for food preparation

Protect kitchen areas and food from insects, pests and other animals
Why?
While most micro-organisms do not cause disease, dangerous micro-organisms are
widely found in soil, water, animals and people. These micro-organisms are carried
on hands, wiping cloths and utensils, especially cutting boards and the slightest
contact can transfer them to food and cause food borne diseases.
 Separate raw and cooked

Separate raw meat, poultry and seafood from other foods

Use separate equipment and utensils such as knives and cutting boards for
handling raw foods

Store food in containers to avoid contact between raw and prepared foods
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Why?
Raw food, especially meat, poultry and seafood, and their juices, can contain
dangerous micro-organisms which may be transferred onto other foods during food
preparation and storage.
 Cook thoroughly

Cook food thoroughly, especially meat, poultry, eggs and seafood

Bring foods like soups and stews to boiling to make sure that they have reached
70°C. For meat and poultry, make sure that juices are clear, not pink. Ideally,
use a thermometer.

Reheat cooked food thoroughly
Why?
Proper cooking kills almost all dangerous micro-organisms. Studies have shown that
cooking food to a temperature of 70°C can help ensure it is safe for consumption.
Foods that require special attention include minced meats, rolled roasts, large joints
of meat and whole poultry.
 Keep food at safe temperatures

Do not leave cooked food at room temperature for more than 2 hours

Refrigerate promptly all cooked and perishable food (preferably below 5°C)

Keep cooked food piping hot (more than 60°C) prior to serving

Do not store food too long even in the refrigerator

Do not thaw frozen food at room temperature. Thaw the food in the refrigerator

Do not re-freeze food once it is thawed.
Why?
Micro-organisms can multiply very quickly if food is stored at room temperature. By
holding at temperatures below 5°C or above 60°C, the growth of micro-organisms is
slowed down or stopped. Some dangerous micro-organisms still grow below 5°C.
 Use safe water and raw materials
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
Use safe water or treat it to make it safe

Select fresh and wholesome foods

Choose foods processed for safety, such as pasteurised milk

Wash fruits and vegetables, especially if eaten raw

Do not use food beyond its expiry date
Why?
Raw materials, including water and ice, may be contaminated with dangerous microorganisms and chemicals. Toxic chemicals may be formed in damaged and mouldy
foods. Care in selection of raw materials and simple measures such as washing and
peeling may reduce the risk.
PART 3 USING YOUR KNOWLEDGE
This part of the guide is designed to help you use the knowledge you have gained from
the previous section, in order to communicate and educate others about health and
nutrition.
It contains ideas for activities to do with different groups of children and ways in which
you can hold workshops and sessions to educate people about health and nutrition.
The previous section provides you with all the information and knowledge you require to
successfully teach others about health and nutrition, and as an individual who works
within the field of health or education for children you have the responsibility to pass on
what you know to your colleagues, peers, family and friends.
Use your knowledge and help make a difference!
Activity Ideas for Children
Grades 1-3
14B
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Healthy foods
 Healthy food collages using rice, pasta, beans
 Give
each child in the class a different type of
food packaging, then with the help of the
students split them into two groups – food that is
good for us and food that is bad for us. Why is it
good or bad? Discuss reasons with the group
 Food necklaces. Have a selection of healthy food
shapes cut out of paper or card, with a hole
through the middle. Give each child a piece of
string and allow them to make their own healthy
necklace.
 Painting
with vegetables. Use potatoes, carrots
and any vegetable or fruit that can be used to
print. Cut out shapes, dip them in paint and use
them to create pictures.
 Our
favourite foods. Ask each member of the
class what their favourite food is and plot the
results on a display graph for the children to see.
What is the most popular food in the class?
What is the healthiest food? How many children
prefer the healthy food?
Class Activities
 Fruit tree. Have a large tree shape cut out from
paper displayed on the wall. Next to the tree
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have a number of apple shapes cut out in paper.
Each time a child eats an apple, banana, mango
or other fruit allow the child to write their name
on a shape and pin/tac the shape to the tree. At
the end of the week see who has eaten the most
fruit and award them a prize.
 Fishing
game. Using food shapes made out of
card/paper. Attach paperclips to the shapes and
place them on the floor. Give each child a fishing
rod made out of sticks with string on the end. At
the end of each piece of string attach a magnet.
The aim of the game is to fish for food. Time the
game for a few minutes. The children must then
separate the foods they have caught into good
and bad foods. The child with the most good
foods wins!
 Healthy
party. Hold a class healthy party. Each
child must bring something that is healthy to eat
to share with class members. Talk about why
each food is healthy and enjoy the fun!
 Growing grass. Each child requires one foot of an
old pair of tights, marker pens, grass seed, sand,
water and a pot. First place the grass seed in the
tight and then fill with sand to make a round
head shape. Using markers give the head a face.
Stand the head in a pot and water well. Water
daily and watch the hair grow. Talk to the
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children about growing plants. What could they
grow that they can eat?
 Nutrition Olympics. An outdoor athletic event that
reinforces eating five fruits and vegetables a day.
Children complete five activities each with a
different fruit or vegetable at the centre of the
activity.
1.
Coconut bowling (children bowl with coconuts)
2.
Papaya weight lifting (two papayas at the end of a
stick/branch form the weights)
3.
Mango relay (relay with mango instead of baton)
4.
Apple throw (throw apple up and catch as many times as
possible)
5.
Potato sack race (stand inside sack and jump the race)
 Finally
the last event is the Food Pyramid
challenge where children have to assemble the
food pyramid in the shortest time possible from
the packets and food displayed on the table.
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Grades 4-6
Games
 Unscramble words game
 Word search
 Crosswords
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 What am I? Game involving children in pairs. One child has a piece of paper with
the name of a healthy food put on their backs. The child has to guess what they
are by asking their partner a series of questions. For example:
Q. Do I grow on a tree?
A. Yes
Q. Do I grow in Maldives?
A. Yes
Q. Am I green in colour?
A. No
Q. Am I round?
A. No
Q. Am I orange?
A. Yes
Q. Am I a mango?
A. Yes
 Bingo. Have sheets with foods listed on them. Call out random foods from the
sheets. The first person to have five healthy foods is the winner. Bingo!
Fun Stuff!
 Poem writing. Write a poem about your favourite healthy food. Why is it healthy
and good for you?
 Food
Pyramids. Create your own food pyramid using foods (i.e. rice, pasta,
beans) and packaging from food.
 Create a class cookbook. Each child brings in their favourite recipe from home.
On each page of the book for each recipe include what is healthy and what is
unhealthy about that dish.
 Eating diary. Complete an eating diary for one/two days. Compare the diaries
with friends. Create a chart with three categories: Good food I ate, bad food I
ate, foods I avoided. Graph the results and compare what they have eaten as a
class with the food pyramid. How healthy are they? How can they be healthier?
What changes do they need to make to their diets?
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Grades 7+
15B
Health and Nutrition
 Collect magazine articles about health and nutrition. Group the class and give
each group a different article. Is it correct in what it claims? Discuss the article as
a group and report back to the class. Is the information correct? What messages
does it portray? Who is it aimed at? Is it successful? As an extension activity
children can design and create their own magazine/paper articles.
 Make posters about health and nutrition.
 Exploring the long term negative health aspects of some foods. Give each group
a different unhealthy food. Ask them to discuss and come up with a number of
problems that can result from long term consumption. Create and perform a
short play/drama based on these problems and their consequences. Focus on
diet related diseases such as stroke, heart disease, diabetes, and osteoporosis.
 One
week exercise plan. Plan an exercise regime for one week. Discuss the
benefits of exercise. How do you feel after exercise? Do you notice any
difference as the week progresses?
The Body
 Body Picture. Have a life sized picture of the body on the wall. What do we need
for different functions? Have the names of vitamins and minerals written on
pieces of card. Stick them where they are needed, for example, vitamin A at the
eyes and on the skin.
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Group Tasks
 Group children. Give them a scenario. Someone is ill and suffering from a diet
related disease. Give the children the full details of this person, i.e. their name,
age, date of birth, occupation, family, habits (smoker/exercise etc). The task for
the group is to construct a diet and exercise plan for the patient. What must they
eat more of and why? How will this help? An extension exercise is to perform a
short role play/drama to display their knowledge on the subject. How can the
patients help themselves?
 Timeline Challenge. Construct a timeline which shows the relationship between
the health issues of adults and the eating habits of children
 Eat Smart Hotaas! The children are the new recruited task force to improve the
health and nutritional status of locals in their area. Their guidelines are to design
and develop signs for local tea shops/restaurants and shops that are healthy in
terms of nutrition, food safety and hygiene.
Children must create a checklist of points and then visit local teashops and have
a forum to decide which tea shops/restaurants will be awarded the award. This
could also be conducted in school canteens. Children must think about what
makes a teashop healthier than another? Is it clean and hygienic? Why? How?
For those that do not receive the award, design and distribute a leaflet
explaining how they can be made healthier, more nutritious and more aware of
food safety.
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Ideas for Schools
Select one day a week to be a fizz free day where no fizzy drinks are allowed to
be brought to or consumed in schools.
Fizz free schools. Promote the consumption of healthy drinking by only selling
juice, un-carbonated soft drinks, milk and water.
Start breakfast clubs in schools. Encourage children to bring breakfast with them
to school and allow a ‘breakfast break’ during the morning at approximately 8
o’clock to allow children to have breakfast before their lessons continue. Children
are required to bring to school roshi, mashuni, or sandwiches for breakfast
together with water, milk or juice to drink.
Parents
Day. Parents are invited to come to school with children without
breakfast and experience a day in the lives of their children. The aim being to
make parents/guardians aware of a day in school and how children cope with the
school day on an empty stomach, what they eat, and how this affects their
health and academic ability.
How to Plan and Hold a Workshop
Follow these simple guidelines to plan an effective workshop:

Know your target audience

Have an understanding of the level of the group’s knowledge. It is
unrealistic to hold a detailed workshop for young children who do not
have a strong knowledge of the subject

Set realistic aims and objectives

Set targets and expected outcomes

Plan your workshop in detail
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
Ensure your workshop has a structure

Try to use a variety of methods, for example, interactive activities as well
as lectures

Always start by introducing yourself and the topic

Have an icebreaker at the start to help the group relax and get to know
each other

Use ideas from workshops that you have attended

Always spend time at the end of the workshop evaluating the success
with the group

Use the feedback to write a report on the workshop giving details of what
activities were successful and those, which were not.

Use this report for future reference
APPENDICES
i.
Daily energy and nutrient needs
ii.
Nutrients
iii.
Vitamins
iv.
Minerals
v.
Food pyramid
vi.
The five food groups
vii.
8 Guidelines to a healthy diet
viii.
Workshop plan
ix.
Simple meal plan – for use in workshops
x.
Case studies – for use in workshops
xi.
Website wonders
xii.
Cartoon characters – aids to health promotion
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Nutrients
Sources
Carbohydrates
Fats

Rice, maize, wheat and
other cereals

All types, but brown varieties
are better than white as they
are whole-grain and
therefore more nutritious



Root crops
Legumes
Roshi, bread and rolls




Fruits and vegetables


Soft drinks, drinks with
much sugar like jelly
juice, cakes and
chocolates
Potatoes, yam and cassava
Such as peas and beans
All types but brown,
wholegrain varieties are
healthier as they contain
more fibre
Contain fibre and natural
sugar providing long term
energy
 Oils






Meat and meat products
Butter, margarine
Milk products
Fish
 Nuts




Protein





Seeds
Soya beans
Popadoms
Chocolate, crisps
Supply immediate short-term
energy release but no other
nutrients
Sunflower, vegetable and olive
oil
Chicken, beef, and mutton
Milk, cheese and yoghurt
Oily fish such as fresh
tuna, swordfish, baitfish,
sardines, mackerel
All types, particularly coconut
Especially sesame seeds and
groundnuts



Fish
Meat
Dhal curries



All types
All types
Chick peas have a higher
protein content but lentils are
also good



Beans
Eggs
Dairy

Milk, cheese, yogurt
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A Guide to Nutrition and Health Awareness in Schools, 2005
Simple Sugars
(monosaccharides)
(disaccharides)
Glucose
Sucrose
Starch
Glycogen
Dietary Fibre
Cellulose
Fructose
Lactose
Pectin
Galactose
Maltose
Hemicellulose
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Table 1: Fat soluble vitamins
Vitamin
Main functions
Sources
Deficiency
Excess
A
Essential for
vision especially
in dim light.
Needed for
healthy skin and
growth.
As retinol in milk, fortified
margarine, butter, cheese,
egg yolk, liver and fatty fish.
As carotenes in milk, carrots,
tomatoes, dark green
vegetables.
Reduced night vision; loss of
sight through gradual damage
to the eyes. Lowered resistance
to infection.
Vitamin A is stored in the liver
and when an excess is consumed
toxicity can occur.
D
Promotes
calcium and
phosphate
absorption from
food and is
essential for
bones and teeth.
Sunshine, fortified
margarine, oily fish, egg
yolk, fortified breakfast
cereals.
Failure of bones to grow and
calcify leading to rickets in
children and osteomalacia in
adults.
Vitamin D can be toxic.
E
Protects cell
membranes.
Vegetable oils, nuts,
vegetables and cereals.
Deficiency may occur in
premature infants or due to
malabsorption.
Not known.
K
Essential for
blood clotting.
Made by bacteria in the gut.
Dark green leafy vegetables,
e.g. cabbage and spinach.
Deficiency leads to an increased
clotting time.
Not known.
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A Guide to Nutrition and Health Awareness in Schools, 2005
Table 2: Water soluble vitamins
Vitamin
Main Functions
Sources
Deficiency
Excess
Ascorbic
acid
(vitamin C)
Involved in the
production of
connective tissue
and bone. Aids
wound healing
and iron
absorption.
Fresh fruits especially citrus
fruits and green vegetables.
Also found in potatoes.
Scurvy. Poor wound healing
and bleeding gums.
May lead to kidney stones.
Thiamine
Involved in the
release of
energy from
carbohydrate. It
is important for
the brain and
nerves, which
use glucose for
their energy
needs.
Cereals, nuts and pulses are
rich sources. Green
vegetables, and fruits and
fortified cereals contain
thiamine.
Deficiency leads to beriberi.
The body excretes excess
thiamine.
Riboflavin
Involved in
energy release,
especially from
fat and protein.
Rich sources are liver, milk,
cheese, yogurt, eggs, green
vegetables and yeast
extract, and fortified
cereals.
Deficiency includes changes to
the mucous membrane and skin
around the mouth and nose.
The body excretes excess
riboflavin.
Niacin
Involved in the
Rich sources include liver,
Deficiency leads to pellagra.
High doses cause dilation of
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A Guide to Nutrition and Health Awareness in Schools, 2005
release of
energy.
beef, mutton and fish. Most
breakfast cereals are
fortified.
B12
Necessary for
the proper
formation of
blood cells and
nerve fibres.
Rich sources are offal and
meat. Eggs and milk also
contain B12. Almost no plant
foods contain B12. Fortified
breakfast cereals are a
useful source.
Deficiency leads to pernicious
anaemia.
No toxic effects known.
Folate
Involved in the
formation of
blood cells.
Reduces the risk
of birth defects
in babies.
Liver, (and orange juice,
dark green vegetables) are
rich sources.
Deficiency leads to
megaloblastic anaemia.
No known toxic effects.
Source: www.nutrition.org.uk
HU
arteries and reduction of blood
lipids. Excess can cause kidney
damage.
UH
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A Guide to Nutrition and Health Awareness in Schools, 2005
Table 1: Major Minerals
Mineral
Calcium
Main Function
Main Sources
Deficiency
Excess
Formation and maintenance
of bones and teeth.
Milk, cheese, yogurt and
canned fish are rich
sources. Also dark green
leafy vegetables.
Bone weakening- rickets
and osteomalacia. Linked
to vitamin D deficiency.
Not known in adults.
Blood clotting and nerve
functions.
Sodium
Regulation of body water
content. Nerve functions.
Salt - either added to foods
during processing or at
home in cooking or at the
table.
Fatigue, nausea, cramps.
Thirst is experienced.
Excess sodium has
been linked to high
blood pressure.
Potassium
Functioning of cells. Part of
body fluids.
All foods except sugars, fats
and oils.
Weakness, mental
confusion and, if extreme,
heart failure.
Excess is dangerous.
Magnesium
Involved in energy transfer
in the cell, in enzyme
activity and muscle
functioning.
Widespread but wholegrain
cereals, nuts and spinach
are good sources.
Depression, irritability,
fits, tiredness and, if
extreme, heart attack.
Excess magnesium is
not absorbed.
Phosphorus
An essential component of
all cells and present in
bones and teeth.
Milk, cheese, meat, fish and
eggs are good sources.
Dietary deficiency
unknown.
Not known in adults.
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Table 2: Trace Minerals
Mineral
Main Function
Main Sources
Deficiency
Excess
Iron
Formation of haemoglobin in
red blood cells.
Red meat and offal are rich
sources. Cereals, bread,
and vegetables contain
some iron. Breakfast cereals
may be fortified.
Iron deficiency anaemia.
Excessive absorption
may be due to a rare
genetic disorder.
Zinc
Essential for growth, and
sexual maturation. Involved
in enzyme activity and taste.
Milk, cheese, meat, eggs
and fish, wholegrain cereals
and pulses.
Dietary deficiency is rare;
may cause delayed
puberty and retarded
growth.
Interferes with copper
metabolism.
Iodine
Formation of thyroid
hormones.
Milk, seafood, seaweed.
Iodised foods such as salt.
Goitre and cretinism.
Excess iodine is not
absorbed.
Fluoride
Increases the resistance of
teeth to decay.
Fluoridated water, tea, fish
and toothpaste.
Tooth decay more likely.
Fluorosis.
Copper
Forms part of many enzymes
and needed for iron to
function.
Green vegetables, fish and
liver
Rare
Not known
Chromium
Involved in the action of
insulin, controlling glucose
levels of the blood
Found in a variety of foods
Not known
Not known
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Selenium
As an antioxidant it protects
cell membranes.
Source: www.nutrition.org.uk
HU
Cereals, meat, fish, offal,
cheese and eggs.
Keshan disease (a type of
heart disease).
Excess selenium is
toxic.
UH
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A Guide to Nutrition and Health Awareness in Schools, 2005
The Food Pyramid
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A Guide to Nutrition and Health Awareness in Schools, 2005
The Five Food Groups
1B
Bread, cereals and
potatoes
Fruit and
vegetables
Milk and dairy
foods
Meat, fish and
alternatives
Meat, poultry,
fish, eggs,
nuts, beans
and pulses.
What’s included
Breakfast cereals,
pasta, rice, oats,
noodles, maize,
millet and
cornmeal.
Fresh, frozen
and canned fruit
and vegetables
and dried fruit.
A glass of fruit
juice can also
contribute.
Beans and
pulses can be
eaten as part of
this group.
Milk, cheese,
yogurt.
This group
does not
include
butter, eggs
and cream.
Meat includes
meat products
such as beef
burgers.
These are all
relatively high
fat choices.
Beans, such
as canned
baked beans,
and pulses are
in this group.
Fish includes
reef and tuna
fish, frozen
and canned
fish such as
tuna.
Carbohydrate
(starch)
Fibre
Main nutrients
Some calcium and
iron
B vitamins
Recommendations
Eat lots
Foods containing fat
and/or sugar
Foods containing fat:
margarine, butter,
other spreading fats
and low fat spreads,
cooking oils,
mayonnaise, cream,
chocolate, crisps,
chips, biscuits,
pastries, cake,
puddings, ice-cream,
rich sauces and
gravies.
Foods containing
sugar: Soft drinks,
sweets, jam and
sugar as well as
foods such as cake,
puddings, biscuits,
pastries and icecream.
Iron
Vitamin C
Calcium
Protein
Carotenes
Protein
Folic Acid
Vitamin B12
Fibre and some
carbohydrate
Vitamins A
and D
B Vitamins,
especially B12
Zinc
Fat, including some
essential fatty acids.
Carbohydrate
(sugar). Some
products also provide
other nutrients e.g.
fat soluble vitamins
and some contain
salt.
Magnesium
Eat lots
Eat or drink
moderate
amounts and
choose low
fat versions
whenever you
can.
Eat moderate
amounts and
choose low fat
versions
whenever you
can.
Eat foods containing
fat sparingly and look
out for the low fat
alternatives.
Foods containing
sugar should not be
eaten too often, as
they can contribute to
tooth decay.
Source: www.nutrition.org.uk
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U
8 GUIDELINES TO A HEALTHY
DIET








Enjoy your food
Eat a variety of different
foods
Eat plenty of foods rich in
starch and fibre
Eat plenty of fruit and
vegetables
Don’t eat too many foods
that contain a lot of fat
Don’t have sugary foods
and drinks too often
Eat the right amount to be
a healthy weight
Exercise regularly
Taken from: www.food.gov.uk
HU
UH
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WORKSHOP PLAN
Activity
2B
Length of session
Specific tasks
Your role
Target
3B
Introduction

15 minutes



Ice breaker

15 minutes
Introduce yourself
to the group
Introduce the
topic
Explain the plan of
the day i.e. what
you will do, how it
will work etc
Explain the aims
of the day
Introduce and
oversee an activity
that integrates all
members of the
group






Morning session
Introducing Nutrition
82
To ensure that all
members
understand the
aims and
objectives of the
day and what they
will be doing
To introduce
yourself
To introduce all
members of the
group to each
other
To relax those
attending
To create a relaxed
pleasant
atmosphere
To educate the
group about health
and nutrition
Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
Nutrition Basics
30 minutes
A Healthy Diet
30 minutes
Balanced Meals
30 minutes
Using the food pyramid as
a guide, split the group into
5 groups each representing
a different food group. Ask
the group to discuss what
nutrients that food group
contains. Circulate around
the groups and give advice
where necessary. Get the
groups to report back to
the rest of the group.
A healthy diet should
contain all food groups in
the proportions
demonstrated in the food
pyramid. Split the group
into 2 groups and give each
a case study, stating the
diet of an individual. The
groups must assess the
diets and make suggestions
as to how the diet could be
improved. What is healthy
about the diet? What needs
improvements? What may
the consequences be if
unhealthy habits are
continued? What are the
individuals needs?
Show using plate
presentations how different
groups of people need
different proportions of
foods. Explain the reasons
for differences.

To give an
overview of basic
nutrition

To explain a
balanced diet, and
clarify how it
varies between
individuals

To establish what
healthy meals are,
how they differ for
different people

To establish a level
of knowledge
among the group
that is sufficient to
use to educate
others
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A Guide to Nutrition and Health Awareness in Schools, 2005
Lifestyles
30 minutes
Relate nutrition to lifestyle.
Smoking, activity levels,
and state of health all affect
nutrition and requirements.
Educating Others
Adolescence
Explain nutrition in
relation to
lifestyles and how
different factors
affect each other

Afternoon session
Young children

30 minutes
30 minutes
Choose an activity from the
guide and allow the group
to play the game/do the
activity. Spend 5 minutes
after the activity assessing
how useful it was. How is it
best used? What situation
would it be most relevant
to? What did they learn
from the activity?
Brainstorm activity. Split
the group into 2 groups and
ask each group to come up
with issues that are of
concern with teenagers.
Ask them to think back to
there own experiences.
After discussing issues that
are of concern during
adolescence, ask each
group to come up with 3
ways in which these issues
could be tackled with the
children.



To show how
working together
can make small yet
significant changes
to the lives of
others and their
health.
To emphasis how
simple activities
can be used to
educate using key
ideas.
To come up with
innovative ideas
for tackling
nutrition and
health issues
To encourage
members to have
the confidence to
plan and conduct
simple workshops
and education
based sessions
using their
knowledge
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A Guide to Nutrition and Health Awareness in Schools, 2005
Adults
30 minutes
Planning and conducting
workshops
30 minutes
Final Activity
30 minutes
Opinions and habits are
hard to change in adults.
However, focus on
educating them and
offering alternatives to
what they already do. Ask
each member to write
down a recipe that they use
regularly. Then work in
pairs. Swap recipes and
make recommendations on
how that can be improved
and made more nutritious.
Split the group into smaller
groups and give each group
an age range and a topic.
The groups must then
come up with a simple 20
minute session, complete
with aims and objectives
and expected outcomes.
Share ideas with the other
groups, discussing good
and bad points about each
one.
Ask the members to get
into small groups and
discuss what they have
learnt and achieved from
attending the day.
In what ways can they use
their knowledge?

To let the group
establish and
understand how
habits can be
changed by simple
changes.

To encourage the
group to assess
ways in which they
can easily educate
others

To allow members
of the group to
assess what they
have learnt and
achieved.

To prepare to
conclude the
session
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A Guide to Nutrition and Health Awareness in Schools, 2005
Conclusion
15 minutes
Discussion with the group,
recapping on what has
been learnt during the day.


Assess the day’s activities,
what was enjoyed and
successful? What requires
improvement?
To finalise the
topics covered
during the day
To tackle any
questions and
queries




To ensure all
members leave on
a positive note
To recap on the
days activities,
what has been
learnt
Assess the day in
terms of its
strengths and
weaknesses
To cover any
questions that the
group may have
**This plan is based on a session for school health assistants/teachers.
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Simple Meal Plan
4BU
Meal
U
Mashuni, roshi, black tea
Fish curry, roshi, black tea
Omelette and bread, black tea
Short eats, black tea
Curry and rice, black tea
Noodles
Short eats, black tea
U
Changes
U
Breakfast
Drink milk, juice or water instead of tea
Drink milk, juice or water instead of tea
Drink milk juice or milk tea instead of black tea
Add ingredients such as tomato, and cheese to
omelettes to make them more nutritious
Tea
Try fruit instead of short eats
Lunch
Drink water or juice with meal
Add chicken, tuna and vegetables to noodles
Tea
Try fruit instead of short eats
Noodles
















Dinner
Curry and rice, black tea
U
Drink water or juice instead of black tea
Make salads from leaves to add vitamins and
minerals
Add chicken, tuna and vegetables to noodles
87

General Advice
Try to eat food low in fat and
high in carbohydrates
Cereals with milk
Toast
Yogurt and fruit
Boiled egg and toast/bread
Choose short eats which are
not fried
Go for a portion of fruit
instead
Crackers
Sandwich
Add vegetables to curry to
increase the nutrition content
Have fruit as a desert
Choose short eats which are
not fried
Go for a portion of fruit
instead
Crackers
Sandwich
Try having additional
vegetable dishes i.e. boiled
carrots, potato, cabbage
Try new meals such as dhal
curries, salads, pasta and
potato and vegetable dishes.
Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
Case Study 1
5B
Hassan Yasir is 10 years old. He was born with a birth weight of 2.3 kg. He was
breastfed until the age of 4 months exclusively and then weaned quickly onto
foods such as crackers and fruits. His mother stopped breastfeeding Hassan at
the age of 6 months, after which water and juice became typical daily fluids.
A typical day’s meal for Hassan is:
Breakfast
A cup of Milo
Interval
Coke and biscuits
Lunch
Rice and Rihaakuru
Afternoon Tea
Black tea and short-eats
Dinner
Curry and rice
What improvements can be made to Hassan’s diet?
What food groups are included in his daily diet?
What may the consequences be if Hassan’s eating habits do not change?
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A Guide to Nutrition and Health Awareness in Schools, 2005
Case Study 2
6B
Aminath Ali is a busy working woman. She is 27 years old. She is married with
one child aged 7 months who she is breastfeeding at least twice a day. Aminath
works between 7.30 am and 2.30 pm every day and sometimes at the weekends
also. She also goes running twice a week. Aminath prepares meals for her
family.
A typical days meals for Aminath are:
Breakfast
Not eaten
Tea
Black sweet tea and shorteats
Lunch
Curry and rice, water
Afternoon Tea
Black sweet tea and shorteats
Dinner
Noodles, water
What improvements can be made to Aminath’s diet?
What food groups are included in her daily diet?
What may the consequences be if Aminath’s eating habits do not change?
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A Guide to Nutrition and Health Awareness in Schools, 2005
Website Wonders
7B
Check out the following websites for help, advice and information:
HU
HU
HU
HU
HU
HU
HU
HU
HU
HU
HU
HU
HU
HU
HU
HU
HU
HU
HU
HU
www.nutritionexplorations.org
www.wiredforhealth.gov.uk
www.nutrition.org.uk
U
U
U
www.navigator.tufts.edu/
UH
www.kidfood.org
U
www.healthyfridge.org
www.dole5aday.com
U
U
www.ific.org
U
www.kidshealth.org
U
www.nlm.nih.gov/medlineplus
www.education-world.com
U
www.betterhealth.vic.gov.au
www.anyvitamins.com
www.milk.co.uk
U
U
U
U
www.breakfastforlearning.ca/english/resources
www.breakfast-club.co.uk
www.welltown.gov.uk
www.galaxy-h.gov.uk
www.lifebytes.gov.uk
U
U
U
U
U
www.mindbodysoul.gov.uk
U
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A Guide to Nutrition and Health Awareness in Schools, 2005
Ideas behind the ‘Eat Right’ Family
The basic ideas lying behind the development of food based characters is to develop a
group of cartoon characters that can then be facilitated to be used for a wide range of
health and nutrition promotion activities.
The concept of a family was decided on as the family forms an important part of
Maldivian life and culture and to involve all members of a family means that people of all
ages will be able to relate to the characters.
Therefore the ‘Eat Right’ family can be used to target people of all ages, from young
children to the elderly. In this way, it is also able to tackle the lifecycle nutrition
components.
The food types on which the characters are based were chosen with relation to foods
that are commonly eaten by the Maldivians as well as trying to incorporate different
food groups. The names were similarly chosen as names with which Maldivians are
familiar with, and are easily recognisable.
By using a family based idea, many different groups can be targeted:
Mas
Men of all ages including teenage boys, how to eat healthily etc,
and aspects of sport and exercise nutrition could be implemented.
Roshi
Women’s health matters, importance of nutrition for themselves
as well as their children. Nutrition during pregnancy and
breastfeeding.
Falho
Elderly nutrition and the importance of caring for an aging body.
Subjects surrounding lifelong nutrition. Children may also be
taught about the effects they have on their future health.
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A Guide to Nutrition and Health Awareness in Schools, 2005
Ambu
Teenagers and older children will benefit from advice on healthy
eating habits and nutrition. Aspects of eating disorders and dieting
could also be approached.
Dhonkeyo
Childhood nutrition, breastfeeding, introducing complementary
food and nutrition during growth phases. The importance of
different nutrients and why they are of importance in the diets of
children, Parents may also be targeted through this.
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A Guide to Nutrition and Health Awareness in Schools, 2005
The father, head of the house. He keeps his family healthy by making sure
that they eat fish everyday to provide essential vitamins and minerals which
help them grow and keep them strong.
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A Guide to Nutrition and Health Awareness in Schools, 2005
Mohammed’s wife is Rasheeda Roshi. She is busy with her family feeding
them all and taking good care of them. Together she and Mohammed make
the perfect team! Roshi is part of a meal that tastes great with fish.
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A Guide to Nutrition and Health Awareness in Schools, 2005
The oldest member of the family, the Grandmother. Her name is Fathmath
Falho. As an old lady, Fathmath knows how important it is to eat the right
foods and stay healthy so she makes sure that her grandchildren eat papaya
as often as they can to give them plenty of vitamin C to fight infections, and
vitamin A for good eyesight and healthy skin.
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A Guide to Nutrition and Health Awareness in Schools, 2005
Dhiyana’s older sister is called Aisha Ambu and enjoys looking after her baby
sister. When old enough to eat solids, Aisha is looking forward to feeding
mango to baby Dhiyana.
Aisha has grown up healthy and strong following a healthy lifestyle of
exercise and good food. Her parents, Mohammed and Rasheeda have always
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A Guide to Nutrition and Health Awareness in Schools, 2005
made sure that she has eaten fruit and vegetables everyday, and only had
snack foods as a treat on special occasions.
The baby of the family is Dhiyana Dhonkeyo. She is only a few months old
but already full of life as she has been fed properly on breast milk. With
Mohammed, Rasheeda and Fathmath looking after her, she is sure to grow up
fit and healthy with a well balanced diet.
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Nutrition For You!
A Guide to Nutrition and Health Awareness in Schools, 2005
REFERENCES
Burgess, A., Maina, G., Harris, O. and Harris, S., (2000), How To Grow A
Balanced Diet: A Guidebook for Community Workers, VSO Books, The Chameleon
Press, UK
Food Safety (poster), WHO, 2003
Multiple Indicator Cluster Survey, (2001), Ministry of Health, Male’, Republic of
Maldives
National Nutrition Strategic Plan 2002 – 2006, (2003), Department of Public
Health, Male’, Republic of Maldives
Seres, Nina (2000), Nutrition throughout the Life Cycle, 4th Report on the World
Nutrition Situation, UN ACC Sub-Committee on Nutrition, Jan 2000
The Health Master Plan 1996 – 2005, (1998), Ministry of Health, Male’, Republic
of Maldives
HU
HU
www.food.gov.uk
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www.nutrition.org.uk
UH
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School Health & Safety Section, ESQID, Ministry of Education