Health and Wellness | Unit I | PDF

Established as per the Section 2(f) of the UGC Act, 1956 Approved by AICTE, COA and BCI, New Delhi Health and Wellness Department of Biotechnology School of Applied Sciences Dr. R.Senthilkumar  Semester III...

Established as per the Section 2(f) of the UGC Act, 1956 Approved by AICTE, COA and BCI, New Delhi Health and Wellness Department of Biotechnology School of Applied Sciences Dr. R.Senthilkumar  Semester III Unit I Health Determinants and Standards; Individual health parameters, Determinants of Health. Future challenges in public health. Daily nutritional requirements. Deficiency diseases (Malnutrition); Iron deficiencies (Anemia), Vitamin A deficiencies (Blindness), Vitamin B1 deficiencies (Beriberi), Vitamin B3 deficiencies (Pellagra) 2 Determinants of Health  Health and disease lie along a continuum, and there is no single cut-off point The lowest point on the health-disease spectrum is death and the highest point corresponds to the WHO definition of positive health The health of an individual is not static; it is a dynamic phenomenon and a process of continuous change There are degrees or "levels of health" as there are degrees or severity of illness. As long as we are alive there is some degree of health in us. Spectrum of Health { 1 } Definitions: Health, Disease, Illness, Sickness, Wellbeing Health is a relative concept! It is relative to Where on the spectrum of health the person is. The health dimensions (physical, mental, social, spiritual, emotional, vocational dimensions) Local conditions and health standards. Definitions: Health The oldest definition is that health is the "absence of disease". World Health Organization (1948): "Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity" In recent years, this statement has been amplified to include the ability to lead a "socially and economically productive life" Definitions: The trilogy of Disease, Illness, Sickness Disease Illness Sickness a condition that is ill health that the person social & cultural diagnosed by a physician identifies themselves conception of a person’s or other medical expert. with, often based on self condition. reported mental or physical symptoms. It can be Acute or Chronic (Physician) (Patient) (Society) Example: Flu diagnosed Example: Flu reported by Example: Missed class or by a physician the patient work due to Flu There is no satisfactory definition of the term well-being!  Wellbeing Objective Components Subjective Components Standard of Level of Quality of Life Living Living PQLI HDI  Physical Quality of Life Index Human Development Index (HDI) (PQLI) Indicators used in 1. Infant mortality 1. Life expectancy at birth (longevity) calculating this 2. Life expectancy at age one 2. Mean years of schooling (knowledge) index 3. literacy 3. Expected years of schooling (knowledge) 4. GNI, gross national income, per capita (income/ decent standard of living) Scale From 0-100 Values from 0 to 1 0 is worst performance and 100 is best performance It measures The results of social, economic, It reflects achievements in the most basic and political policies. human capabilities Does NOT measure economic growth Both allow for National and International Comparison { 3 Determinants of Health: } & 4 Definition, Types, and Levels “Many factors combine together to affect the health of individuals and communities.” 1. 1) Biological: Genetic predisposition 1. 2) Behavioral and socio-cultural: Cultural and behavior patterns, life long habits developed from socialization (eg: smoking, staying up late!) 1. 3) Environment: Internal – internal medicine! / external (macro-environment: things you’re exposed to after conception) 4) Socio-economic: Economic status: Education, Employment, Housing 1. 5) Health services: Services for treatment of disease, prevention, and promotion of health. 1. 6) Aging population: Increased burden of chronic diseases 1. 7) Gender: Women's health covering nutrition, reproductive health, the health consequences of violence, ageing, lifestyle related conditions and the occupational environment. 8) Other: Information technology, health related systems like agriculture and food Type of Determinant Analysis 1) Biological: Genetic predisposition / Obese parents 2) Behavioral and High TV, computer, electronic entertainment use socio-cultural: Sedentary lifestyle Car-only mode of transportation 3) Environment: Internal: Hypothyroidism, Syndromic / External: High consumption of fatty takeaway foods / Low consumption of fruits, vegetables and fiber rich foods / Poor walkable environment / Easy access to convenience stores / Extensive unhealthy food marketing 4) Socio-economic: Unemployment / Low disposable income / Rural area 5) Health services: Limited preventive services / Delayed access to treatment 6) Gender Male obesity is more prevalent than females in Saudi Arabia 7) Others Weak food policy & pricing High Cost of organized physical activity programs/sport { 5 “Right to Health” “Health for All” } Right to Health Historically, the right to health was one of the last to be proclaimed in the Constitutions of most countries. Universal Declaration of Human Rights (1948): "Everyone has the right to a standard of living adequate for the health and well-being of himself and his family..... ". WHO Constitution introduction affirms that it is one of the fundamental rights of every human being to enjoy "the highest attainable standard of health". Health for all Decided by the 30th World Health Assembly in year 1977. They decided that the main social target of governments and WHO in the coming decades should be "the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life"  HEALTH INDICATORS  Health Health is defined as “a state of complete physical, mental & social wellbeing, and not merely an absence of disease or infirmity” This statement has been amplified to include the ability to lead a “socially and economically productive life” Health cannot be measured in exact measurable forms Measurement have been framed in terms of illness (or lack of health), consequences of ill-health (morbidity, mortality) & economic, occupation & domestic factors that promote ill health  Indicators of Health Indicator also termed as Index or Variable is only an indication of a given situation or a reflection of that situation Health Indicator is a variable, susceptible to direct measurement, that reflects the state of health of persons in a community. Indicators help to measure the extent to which the objectives and targets of a program are being attained. Health Index is a numerical indication of the health of a given population derived from a specified composite formula. Indicators WHO defines Indicators as “variables which measure change”  Uses of Indicators of Health Measurement of the health of the community. Description of the health of the community. Comparison of the health of different communities. Identification of health needs and prioritizing them. Concurrent evaluation and terminal evaluation of health services. Planning and allocation of health resources. Measurement of health successes. Characteristics of Indicators Valid - They should actually measure what they are supposed to measure Reliable – The answers should be the same if measured by different people in similar circumstances Sensitive - They should be sensitive to changes in the situation concerned Characteristics of Indicators Specific - They should reflect changes only in the situation concerned Feasible - They should have the ability to obtain data needed Relevant - They should contribute to the understanding of the phenomenon of interest Challenge to measure health Measurement of health is not simple:- There is no criteria for measuring health As happiness health cannot be defined in measurable terms. Its presence or absence is subjective matter of judgment. So the measurement of health has been framed in terms of illness ( or lack of health), the consequences of ill health ( morbidity, mortality) Factors influencing health Indicators Health is multidimensional Each dimension is influenced by numerous factors Economic, occupational, cultural, educational, social  Health Indicators 1. Mortality indicators 2. Morbidity indicators 3. Disability rates 4. Nutritional status indicators 5. Health care delivery indicators 6. Utilization rates 7. Indicators of social and mental health 8. Environmental indicators 9. Socio-economic indicators 10. Health policy indicators 11. Indicators of quality of life 12. Other indicators  Mortality Indicators ❑ Crude Death Rate Is considered a fair indicator of the comparative health of the people. It is defined as the number of deaths per 1000 population per year in a given community, usually the mid-year population The usefulness is restricted because it is influenced by the age-sex composition of the population, socioeconomic and socio-cultural environment of the communities. Current CDR is 7.2 deaths/1,000 population CBR 27.2  Mortality Indicators ❑ Expectation of life is the average number of years that will be lived by those born alive into a population if the current age specific mortality rates persist. It is a statistical abstraction based on existing age-specific death rates. Estimated for both sexes separately. Good indicator of socioeconomic development Positive health indicator of long time survival Life expectancy at birth: Total population: 65.2 years Male: 64.3 years Female: 66.1 years  Infant mortality rate ⦿ The ratio of deaths under 1yr of age in a given year to the total number of live births in the same year, usually expressed as a rate per 1000 live births ⦿ Indicator of health status of not only infants but also whole population & socioeconomic conditions ⦿ Sensitive indicator of availability, utilization &effectiveness of health care, particularly perinatal care. ⦿ Current IMR – 67/1000live birth (69)  Child Mortality Rate The number of deaths under 5yrs in a given year, per 1000 children in that age group at the mid-point of the year. Correlates with inadequate MCH services, malnutrition, low immunization coverage and environmental factors Current rate – 86/1000 Other indicators are Perinatal mortality rate, Neonatal mortality rate, Stillbirth rate, etc. Correlates with inadequate antenatal care and perinatal care  Mortality Indicators ❑ Maternal Mortality Rate Ratio of number of deaths arising during pregnancy or puerperal period per 1000 live births Accounts for the greatest number of deaths among women of reproductive age in developing countries Current MMR – 276/100000 live births  Mortality Indicators ❑ Disease Specific Death Rate Mortality rate which is computed for specific diseases. E. g. TB mortality is 23 per 100000 population per year. ❑ Proportional Mortality Rate Proportion of all deaths attributed to the specific disease E.g. Coronary heart disease causes 25 to 30 % of all deaths in developed world.  Morbidity Indicators ❑ Morbidity Indicators reveal the burden of ill health in a community, but do not measure the subclinical or inapparent disease states. 1. Incidence The number of new events or new cases of a disease in a defined population, within a specified period of time. E.g. Incidence of TB is 168 per100000 population per year. 2. Prevalence The total number of all individuals who have disease at a particular time divided by population at risk of having disease at this point of time Reflects the chronicity of the disease E.g. Prevalence of TB (sputum +ve in population) is 249 per 100000 population  Morbidity Indicators 2. Notification rates is calculated from the reporting to public authorities of certain diseases. yellow fever , poliomyelitis, cholera, plague They provide information regarding geographic clustering of infections, quality of reporting system 3. Attendance rates at OPDs and at health centers. 4. Admission, Readmission and discharge rates. 5. Duration of stay in hospital – reflects the virulence and resistance developed by the etiological factor 6. Spells of sickness or absence from work or school. - reflects economical loss to the community 7. Hospital data constitute a basic and primary source of information about diseases prevalent in the community. Disability rates The disability rates are based on the premise or notion that health implies a full range of daily activities. This rate are group in two 1. Event type indicator: i. Numbers of days restricted activity. ii. Bed disability days iii. Work loss days 2. Person- type indicators:- 1. Limitation of mobility 2. Limitation of quality  Disability Rates ❑ Sullivan’s Index refers to “expectation of life free of disability”. Sullivan’s Index = life expectancy of the country - probable duration of bed disability and inability to perform major activities It is considered as one of the most advanced indicators currently available. ❑ HALE - Health Adjusted Life Expectancy. It is based on the framework of WHO It is based on life expectancy at birth but includes an adjustment for time spent in poor health. It is the equivalent number of years in full health that a newborn can expect to live based on current rates of ill- health and mortality.  Disability Rates ❑ DALYs: Disability Adjusted Life Years. It is defined as the number of years of healthy life lost due to all causes whether from premature mortality or disability. It is the simplest and the most commonly used measure to find the burden of illness in a defined population and the effectiveness of the interventions Two things needed to measure DALYs are - Life table of that country, to measure the losses from premature deaths - Loss of healthy life years resulting from disability; the disability may be permanent (polio) or temp(TB, leprosy), physical / mental.  Disability Rates ❑ Uses of DALYs To assist in selecting health service priorities To identify the disadvantaged groups Targeting health interventions Measuring the results of health interventions Providing comparable measures for planning & evaluating programs To compare the health status of different countries ❑ DALY express years of life lost to premature death and years lived with disability for the severity of the disability ❑ One DALY is one lost year of healthy life  Disability Rates ❑ Premature death – defined as one that occurs before the age to which a dying person could have expected to survive if he or she was a member of a standardized mode population with a life expectancy at birth equal to that of world longest surviving population e.g. Japan ❑ QALY- Quality Adjusted Life Year It is the most commonly used to measure the cost effectiveness of health interventions. It estimates the number of years of life added by a successful treatment or adjustment for quality of life.  Nutritional Status Indicators ❑ Nutritional Status is a positive health indicator. ❑ Newborns are measured for their i. Birth–weight ii. Length iii. Head circumference ⦿ They reflect the maternal nutrition status ❑ Pre-school children Anthropometric measurements i. Weight – measures acute malnutrition ii. Height – measures chronic malnutrition iii. Mid-arm circumference - measures chronic malnutrition ❑ Growth Monitoring of children ❑ Measuring weight-for-age, height-for-age, weight-for- height, head & chest circumference and mid-arm circumference. Adults Underweight, Obesity and Anemia are generally considered reliable nutritional indicators. Nutritional status indicators Anthropometric measurement of children Prevalence of low birth weight >2.5 Kg (24%)  Health Care Delivery Indicators These indicators reflect the equity of distribution of health resources in different parts of the country and of the provision of health care Doctor – population ratio :-1 : 1222 Doctor – Nurse ratio:- 2.2 : 1 Population – bed ratio:- 1:1701 Population per dentist:- 16,854 Population per nurse:- 2,501 Population per health centre:- 5000-10000 Population per TBA :- 0.47/1000  Utilization Rates ❑ Utilization Rates is expressed as the proportion of people in need of a service who actually receive it in a given period, usually a year It depends on availability & accessibility of health services and the attitude of an individual towards health care system 1. Proportion of infants who are fully immunized 2. Proportion of pregnant women who receive ANC care or have institutional deliveries 3. Percentage of population who adopt family planning 4. Bed occupancy ratio, bed-turn over ratio, etc.  Indicators of Social and Mental Health Rates of suicide, homicide, other crime, road traffic accident, juvenile delinquency, alcohol and substance abuse, domestic violence etc. These indicators provide a guide to social action for improving the health of people. Social and mental health of the children depend on their parents. E.g. Substance abuse in orphan children, smoking  Environmental Indicators These reflect the quality of physical and biological environment in which diseases occur and people live. The most important are those measuring the proportion of population having access to safe drinking water and sanitation facilities. These indicators explains the prevalence of communicable diseases in a community The other indicators are those measuring the pollution of air and water, radiation, noise pollution, exposure to toxic substances in food and water  Socio-economic indicators These do not directly measure health but are important in interpreting health indicators. Per capita income Level of unemployment Literacy rate Per capita caloric availability Population Total Fertility Rate (TFR) Family size Population increase rate Contraceptive use  Health Policy Indicators ❑ The single most important indicator of political commitment is allocation of adequate resources ❑ The relevant indicators are Proportion of GDP spent on health services- 0.27% (2011-12) Proportion of GDP spent on health related activities like water supply and sanitation & housing and nutrition Proportion of total health resources devoted primary health care  Indicators of Quality of Life ❑ Life expectancy is no longer important ❑ The Quality Of Life has gained its importance Physical Quality of Life Index It consolidates Infant mortality, Life expectancy at age of 1yr and Literacy. For each component the performance of individual country is placed on a scale of 1- 100. The composite index is calculated by averaging the three indicators giving equal weight to each The resulting is placed on the 0 to 100 scale. The PQLI does not consider the GDP. Indicators of Quality of Life Human Development Index Life expectancy at birth Literacy rate Income- GDP per capita income The resulting is placed on the 0 to 1 scale  Other indicators Social indicators Population, families, educational, earning Basic Needs indicators Calories consumption, access to water, illiteracy, Dr per population Health for All Indicators  Summary Health is not measured directly but using indicators Indicator should be valid, sensitive, specific, reliable, relevant and feasible Used in measuring, describing, comparing, identifying health needs and planning and evaluation of health services Determinants of Health  What are the Determinants of Health? Determinants of Health are all factors that influence the state of health of the population, without necessarily being the direct causes of particular problems or diseases. The Social Determinants of Health are associated with individual and collective behaviors, living conditions, and environments. According to the WHO definition The Determinants of Health are the “personal, social, economic and environmental factors that determine the state of health of individuals or populations”. In 2007, some organizations proposed a list of 12 Social Determinants of Health. They are, Income Level and Social Status  Social Support Networks Education and Literacy Employment and Working Conditions Social Environments Physical Environments  Personal Health Habits and Adaptability Early Childhood Development Biological and Genetic Heritage Health services Gender  Culture and ( food fads likes and dislikes, in some culture men eat first and women eat last with small quantity leading to malnutrition) Religious factors Traditional factors Food production and distribution Lifestyle habits(cooking practices, child rearing practices, alcoholism  1. Income Level and Social Status The level of income of individuals, households, or the family was the classic indicator used in the first investigations on social inequalities and their effect on health, however, several studies have discredited its validity to sufficiently explain this relationship. Some studies show that, after a certain level of average income per person, increases in income do not seem to improve the health level of the population, at least significantly. Social status determines significant health inequalities in the population. These inequalities are often evident, especially in clinical practice. However, defining and measuring these inequalities is not always easy. Social status can be defined as access to power, prestige, wealth, etc. 2. Social Support Networks The social environment, the support of relatives and family, and the help of friends make it possible to overcome health-related difficulties and thus contribute to better health. A quite influential area is that of the family. A person with family problems tends to be more emotionally unstable, as well as people with few, less sociable friends who live in toxic relationships. 3. Education and Literacy Education is another widely used material factor for the study of health inequalities. The educational level has direct and indirect repercussions on people’s health status, by operating as an element of reinforcement and protection throughout their lives. As a reinforcement, education contributes to the choice of lifestyles and behavior favorable to health and, simultaneously, it enables access to better jobs and life opportunities that protect people from health risks. Education is a relatively easy factor to measure through indicators such as the number of complete years of study, the maximum level of study achieved, or the degrees obtained.  4. Employment and Working Conditions The fourth material factor used is the occupation of the people, that is, the position of the individual within the social structure, which contributes to protect him from certain occupational risks, facilitates access to health resources, contributes to producing different levels from psychological stress and can influence their behavior or the adoption of healthy lifestyles. In advanced societies, occupation is the main criterion to explain the social stratification and categorization of the different socioeconomic groups, where esteem and social approval depend, to a large extent, on the type of work that people have, as well as on their professional training and achievements. However, the certain analytical utility of this determining factor, its measurement faces difficulties to consider in all research work, among others: classifying those who are engaged in domestic work or are in retirement condition and and also, the existing differences in the compensation paid for the same job and often due to gender or race. 5. Social Environments People with an unfavorable socioeconomic position are in poorer health than people whose socio-economic position is favorable. Since the mid-nineteenth century, numerous investigations revealed the significant impact that the conditions of the environment where they live, study, work, or age have on the health of individuals, which they concern elements such as access to basic services in the field of sanitation, clean water, and waste disposal. To measure environmental factors, a very broad set of useful indicators is used such as measures related to air quality (quantity of suspended particles of lead, ozone, or carbon dioxide, for example), water quality (from access to piped water to measurement of the turbidity or pH of the liquid); the number of road accidents and mortality from this cause, an average value of homes, number of cases of family violence, percentages of unemployed in the study area, among others. It is also related to the socio-economic factor since it is said that unemployment and poverty can cause social disintegration, which would increase the risk of suffering stress, depression, and anxiety. 6. Physical Environments The good health of a population depends on the quality of the air, water, homes and infrastructure, and public roads. Physical factors encompass everything that refers to the environment that surrounds a person to pollution. Among them we can mention the following: The use of aerosols. Noise: a factor that is not considered, but has a relevant influence e.g. the excessive presence of noise, whether at work or home, can cause stress, anxiety, insomnia, and, consequently, hearing problems. Atmospheric pollution. 7. Personal Health Habits and Adaptability Although it is not taken as something so necessary, physical exercise is very important since it not only prevents obesity but also protects cardiovascular health. Therefore, the general recommendation is to lead an active lifestyle, not only incorporating exercise routines, but increasing movement, both in the workplace and at home. In the same way, eating unhealthy foods (such as saturated fat) could increase the risk of heart problems. People with risky behavior (tobacco, alcohol, drugs, etc.) are at risk of developing more disease and have poorer health than people without risky behavior. People with coping skills in the face of stressful situations and/ or obstacles in life enjoy better health than people without good coping skills.  8. Early Childhood Development The development of the child and the situations lived or not, have repercussions on the state of health of the adult person. The study by stages of life, more than a dimension, is a useful approach for the investigation of social inequalities since it covers social facts outside the individual, which can affect their health condition throughout life, for example, the effect of socioeconomic status during childhood, the presence of specific health conditions upon reaching adulthood. It is obvious that this approach requires very extensive studies, with a great variety of indicators and, above all, precise and continuous monitoring of the data. The usefulness of the results of this type of work concerns the design of public policies that can influence the future of the health of individuals.  9. Biological and Genetic Heritage Biological factors are inherent to each individual being and in most cases cannot be controlled. They can make an individual more or less prone to presenting a certain disease and are considered to influence up to 20% in the general state of health. Genetics heritage is one of the most difficult to change, since it is directly related to each individual, so it is different in each case. While it is true that there are factors that predispose to suffering a disease, lifestyle also influences. Specifically, it is about 20%; therefore, it is very important to maintain a good diet and exercise. The healthier you try to be, the less risk there is of suffering from any ailment.  10. Health Services People with easy access to health services have better health than people with difficult access to health services. In recent years, barriers to access to health services appear as one of the causes of greater explanatory interest about the differences in health between social groups, mainly because to eliminate them, consistent public policies are established. Although the level of income is adequate, one has sufficient knowledge and lives in a healthy environment, the effect of access gaps is true, if medical services are not available or these are deficient when diseases appear. Not only will social groups see their good health diminish, but they will also live in an environment much more risky for life. The indicators used are the number of doctors and nurses available in the study area, as well as the number of countable beads or the percentage of social security beneficiaries. 11. Gender Men and women are not subject to the same risk of disease depending on their age. Beyond the specific ailments of each gender, common diseases do not always occur equally if the person is of one or the other sex. Neither drugs have to act the same in a man as in a woman. Recent research has revealed the crucial differences between men and women in cardiovascular disease, cancer, liver disease, osteoporosis, and in the area of pharmacology. Medical science still knows very little about gender-specific differences in disease, particularly when it comes to symptoms, their link to social and psychological factors, and the implications of these differences for treatment and prevention.  12. Culture and Lifestyle Cultures, customs, traditions, and beliefs influence values and feelings about health. The behavior of people throughout their lives, faced with different risks to their health, is one of the most studied determining factors since the second half of the 20th century. Smoking, consuming alcohol, eating poorly nutritious food, or maintaining low levels of physical activity are practices that directly damage the health and life perspective of individuals and that they freely choose, hence the importance of their knowledge in predicting the future state of their health and the implementation of appropriate prevention and cure policies. This factor is usually measured through indicators such as consumption or not of cigarettes or alcohol, the number of cigarettes or the daily amount of drink consumed, the level of caloric consumption, or the time devoted to physical activities. And it is said that leading a healthy lifestyle is individual and, accounts for approximately 45% of the factors. What Is Nutrition -Nutrient: A chemical substance in food that helps maintain the body. -Nutrition: The study of how your body uses the food that you eat. -Malnutrition: is the lack of the right proportions of nutrients over an extended period  What is a Nutrient (A nutrient is a chemical substance in food that helps maintain the body.) Some provide energy. All help build cells and tissues, regulate bodily processes such as breathing. No single food supplies all the nutrients the body needs to function. Deficiency Disease: failure to meet your nutrient needs. Carbohydrates The body’s chief source of energy Sugar Simple Carbohydrates Glucose: Blood Fructose: Fruit Galactose: Milk Sucroce: Table sugar Starches Complex Carbohydrates Fiber  Fats Important energy source Lipid family which includes fats and oils Hydrogenation: adds hydrogen atoms to unsaturated fatty acids (liquid) turning them into more saturated solid fats Crisco and margarine sticks Cholesterol: fatlike substance found in every cell in the body Important… found in skin tissue, produces hormones Two types: Dietary and Blood Fat Molecules Fats are large molecules made up of elements - Carbon, Hydrogen, Oxygen Fatty acids found in animal triglycerides are saturated ones Fatty acids found in plant triglycerides are unsaturated ones ( exception - tropical oils)  Proteins Provide energy, encourage growth and tissue repair Made up of small units called amino acids 20 important to the human body: 9 your body can’t make and 11 it can Complete protein: animal foods and soy Incomplete proteins: plant foods Must pair 2 foods together: beans and rice Vitamins Are complex organic substances Normal growth, maintenance, and reproduction Your body cannot produce all vitamins you can get those by eating a nutritious diet. Fat-soluble vitamins: carried in fatty parts of foods and dissolve in fats (body stores them in fat... build up can be dangerous) Water-soluble vitamins: dissolve in water (body does not store them)  Fat-Soluble Vitamins Vitamin A Vitamin D Vitamin E Vitamin K  Water-Soluble Vitamins Vitamin B-Complex Thiamin (vitamin B1) Riboflavin (vitamin B2) Niacin (nicotinamide, nicotinic acid) Vitamin B6 (pyridoxine, pyridoxal, pyridoxamine) Folacin (folic acid) Vitamin B12 Vitamin C Minerals In addition to vitamins your body also needs 15 minerals that help regulate cell function and provide structure for cells. Major minerals, in terms of amount present, include calcium, phosphorus, and magnesium. In addition, your body needs smaller amounts of chromium, copper, fluoride, iodine, iron, manganese, molybdenum, selenium, zinc, chloride, potassium and sodium. Amounts needed for most of these minerals is quite small and excessive amounts can be toxic to your body.  minerals Calcium:A mineral important for strong teeth and bones and for muscle and nerve function. The major mineral constituent of bone. sources: milk and milk products, fish with bones that are eaten, turnip and mustard greens, tofu, almonds and broccoli. Chloride: A mineral that regulates body fluid volume, concentration and acid-base balance. Balance intertwined with that of sodium Chromium: A mineral important in regulating blood glucose. sources: brewer's yeast, whole grains and meats Copper: A mineral that is important for nerve function, bone maintenance, growth, blood formation and utilization of glucose. sources: organ meats, sea foods, nuts and seeds Fluoride: A mineral that is important to dental and bone health. Greatly improves resistance to cavitites sources: fluoridated water, foods cooked in or containing fluoridated water, fish with bones that are eaten, and tea Phosphorus: A mineral essential to bone formation and maintenance, energy metabolism, nerve function and acid balance. sources: meat, poultry, fish, eggs, dairy products and cereal products. Potassium: A mineral that is essential for nerve function, muscle contraction and maintenance of normal blood pressure. sources: fruits and vegetables.  minerals Iodine: A mineral essential for the production of thyroid hormones. sources: sea foods, iodized salt and foods containing iodized salt Iron: A mineral that is an essential constituent of blood and muscle and important for the transport of oxygen. Certain groups can be at risk of having low iron levels. These include young children and early teens, women with heavy menses, women with multiple pregnancies, and people with conditions that cause internal bleeding, such as ulcers or intestinal diseases. sources: liver, red meat, egg yolk, legumes, whole or enriched grains and dark green vegetables. Magnesium: A mineral found mainly inside muscles, soft tissues and bone. It functions in many enzyme processes. sources: nuts, legumes, whole grains and green vegetables Manganese: A mineral that is important for growth, reproduction, formation of bone, and carbohydrate metabolism. sources: whole grains, fruits, vegetables and tea. Molybdenum: A mineral involved in many enzyme processes, nerve function and protein metabolism. sources: milk, beans, breads and cereals. Minerals Selenium: A mineral associated with antioxidant properties and fat metabolism. It has been claimed to help prevent cancer and cardiovascular disease sources: seafoods and organ meats. Sodium: A mineral that regulates body fluid volume, concentration and acid-base sources: table salt (sodium chloride), foods processed with table salt, milk, milk products, eggs and seafoods Zinc: A mineral involved in wound healing, taste sensation, growth and sexual maturation and part of many enzymes regulating metabolism sources: meat, liver, eggs and seafood (oysters). Water Water is your body's most important nutrient, is involved in every bodily function, and makes up 70- 75% of your total body weight. Water helps you to maintain body temperature, metabolize body fat, aids in digestion, lubricates and cushions organs, transports nutrients, and flushes toxins from your body. Everyone should drink at least 64 ounces per day, and if you exercise or are overweight, even more. Your blood is approximately 90% water and is responsible for transporting nutrients and energy to muscles and for taking waste from tissues.  Nutrients that have Calories: ✔ Proteins ✔ Carbohydrates ✔ Fats  Definition of a Calorie: o A unit of measure for energy in food Calories per gram: Protein 1 Gram = 4 calories Carbohydrates 1 Gram = 4 calories Fat 1 Gram = 9 calories Variables which affect nutrient needs: 1. Age 2. Gender 3. Activity Level 4. Climate 5. Health 6. State of nutrition Aim for Fitness 1. Aim for a healthy weight 2. Be physically active each day Build a Healthy Base 3. Let the pyramid guide your choices 4. Choose a variety of grains daily, especially whole grains 5. Choose a variety of fruits and vegetables daily. 6. Keep food safe to eat. Choose Sensibly 7. Choose a diet that is low in saturated fat and cholesterol and moderate in total fat 8. Choose beverages and foods to moderate your intake of sugars 9. Choose and prepare food with less salt 10. Individuals over 21 who drink alcoholic beverages should do so in moderation OVERVIEW OF PEM The majority of world’s children live in developing countries Lack of food & clean water, poor sanitation, infection & social unrest lead to LBW & PEM Malnutrition is implicated in >50% of deaths of