312 NTUN-2018.pdf

NUTN 312: FOOD AND SOCIAL FACTORS IN NUTRITION The main function of food is to nourish the body. The benefits can be obtained only when food is eaten in the right proportion and in the right environment. Our nutritional status and health depends on the kinds of foods we eat. Kinds of...

NUTN 312: FOOD AND SOCIAL FACTORS IN NUTRITION The main function of food is to nourish the body. The benefits can be obtained only when food is eaten in the right proportion and in the right environment. Our nutritional status and health depends on the kinds of foods we eat. Kinds of food eaten are however affected by many social, physiological and geographical factors. Naturally people show food preferences, which is the particular type of food a person likes or dislikes. This food preference could develop from many prevailing factors. At any particular time, the food choice of a person is based on the food preference from which the food habit is developed. The food habit of a person is the total food choice that will constitute the diet over a period of time. Our food habit can therefore determine to a large extent our nutritional status (how healthy we are). The type of food habit adopted by a person, an ethnic group, a tribe, a religious group, or a community determines their nutritional status. This in turn gives hint of the type of nutritional problems likely to occur in that group. The availability of food in one area does not mean people in that area will eat that food, if that is not their preferred food. Inappropriate food habits most often leads to undernutrition or over nutrition. Diet-related disorders such as goitre, anaemia, underweight, stunting, rickets, scurvy, pellagra, vitamin A deficiencies, blindness, protein deficiencies, obesity etc. Many influential factors, conditions, circumstances and environments operate together to determine the food preference and hence the food choice of a person from which the food habit is formed. The factors that operate to determine food habits are many but the common ones that are applicable to our social setting include: ❖ Food availability/ Climate ❖ Parental influence ❖ Economy ❖ Ethnic group or tribe ❖ Religious factors ❖ Taboos ❖ superstition ❖ prejudice ❖ Celebrations /festivals/funerals ❖ Institutionalization ❖ Physiological/Age related ❖ Health status ❖ Travelling/migration ❖ Social prestige, etc. Food Availability and Climatic Influences: These factors contributes to development of food habit because in general what is available in a place is what people adapt to eat. The types of food crops grown also depend on the local climate such as the local pattern and amount of rainfall, the temperature, wind and soil types. It is common knowledge that whiles some food crops grow well in hot humid tropical climate; others grow in cold temperate climate. The different kinds of cereals and tubers that grow in different zones around the world have always been our best examples (Table 1). Thus the food habit of those in the different zones will be formed around the foods grown there. 1  Table 1: Zones around the World and Common Food Crops that Grow Well Zone Food crop crown Temperate southern hemisphere Wheat Northern hemisphere – Asia through to Russia Wheat South America and across Africa Maize South-eastern Asia – China, Japan Rice Southern hemisphere including Australia Wheat Northern hemisphere Potato Southern hemisphere Cassava Parental Influence: Children are exposed to food prepared by their parents and that is the food they learn and grow up to eat. This influence breeds familiarity and a food habit is developed according to what parents provide. In this case, the household that is financially endowed is likely to expose the young to a kind of food preparation (canned fish, meat, other processed foods, biscuits, candies and beverages like tea and milo) different from the household that is less financially capable (usually settling for vegetables, tubers and legumes mixed diets as well as roasted corn, cassava and cereal porridges). Hence depending on what parents provide, people grow up to acquire particular food habits. Also the food habit of the parents affects the food habit of the children. Economic Factors: It is reasonable to think that what people can afford is what they will obtain to eat. This is especially so in the urban areas where food is usually obtained from the market. This means that the purchasing power of a person would determine the food choice and hence the food habit that will develop. An individual of low socio-economic class may avoid the expensive foods such as meat, fish, milk, eggs, cabbage etc. These will be minimized from the diet. Unfortunately the high protein foods tend to be expensive. For such a person the food habit will be formed around the relatively inexpensive legumes, cereals, vegetables, starchy roots and tubers. In some cases the natural food habit is modified because of economic reasons. If at a particular time the purchasing power is low, the expensive foods cannot be bought. This means that foods different from what were consumed previously will be consumed and thus the food habit is modified. The economic factor could be one of the reasons why many people are turning to certain food habits such as the consumption of diets made up solely of vegetables and fruits: e.g. some vegetarian. Ethnic Group, Tribe or Race: In Ghana and many other places in the world, there are certain food preparations that have been associated with certain tribes or ethnic groups. The moment the name of that food is mentioned the name of the tribe or race or ethnic group comes in mind. This “ethnic diet” forms part of the main meal regularly. In many Akan rural settings for instance, people do not conclude that they have any good dinner if the ethnic diet (fufu) is not part of the meal. Few examples of ethnic diets in Ghana include: Ethnic group Ethnic diet 2 Fante: Fufu, etsew, fante-kenkey. Ashanti: Fufu, ampesie (boiled yam or plantain) Ga: Ga-kenkey, kpokpoi Northern Ghana descents: Tuozafi, kafa Ewe: Akple (from dough and or flour) eg gari kple, ayi etc Ada/Krobo/Ningo: Kokonte (black beauty or face the wall) Nzima: Akyeke Wasa: fomfom, pusa (boiled rice) Some of these ethnic diets are ceremonial diets, e.g. kpokpoi used to celebrate “homowo,” a festival celebrated by the Ga tribe. Religious Factors: The religious group one belongs to can markedly influences the food choice and hence the food habit. Food restrictions and avoidance because of religious reasons are common and it plays important role in the development of food habits. For examples, it is claimed that Muslims do not eat pork because, pig is considered to be unclean animal; People belonging to the Roman Catholic Church or live in Roman Catholic homes, on Easter Friday, do not eat meat because Jesus Christ was believed to be crucified on that day. Those belonging to SDA (Seventh Day Adventist), Hindu, Rosicrucian and similar groups practice vegetarianism. Hindus do not eat meat because it is against their religion to take life of any kind even an ant because they all have souls. During fasting days members of many religious groups may develop new food habits. In some cases a town or a community occupied by a religious group, for example, Mosama Disco Christo Church (MDCC founded by Prophet Jehu Appiah) at Mosano near Cape Coast has fasting days, and inhabitants of Shalom Village near Accra, belonging to the SDA, are known for their vegetarian habit. In such cases the whole community has a food habit developed from religious beliefs and may exhibit nutritional problems common with most the members. Taboos, Prejudices and Superstition: In Ghana and many other countries, certain foods have been associated with strength, sexual potency or virility, heroism, childbirth or disease etc. A food habit controlled by these perceptions could be formed. Never the less, most of these beliefs and prejudices are due to ignorance and someone's experience about the said food. Even though the experience may be due to food contamination and other causes, the experience with the food breeds prejudice against it. On the other hand, some beliefs and prejudices tend to promote good nutrition. ❖ Certain foods are claimed to have magical powers. It is believed if one eats such foods he would have extra powers or strength. For example, the flesh or bones of a wild animal like a lion or a tiger, as believed in Northern region of Ghana. Thus one's belief or superstition encourages him to eat such foods. ❖ Certain foods have been associated positively or negatively with sexual capability. For instance many Ghanaians claim eating tiger-nut or fresh groundnut improves sexual capability while frequent eating of sugar lowers this capability (diabetes). ❖ In certain parts of Nigeria, eating snail is alleged to lower sexual prowess (for snail is soft and cannot stand and can’t fight). ❖ In Madagascar, soldiers are not to eat the flesh of the hedgehog because it is said to be timid and may influence their performance. ❖ In parts of Northern Ghana, a woman who has a first child is forbidden to eat eggs because if she does she would become barren. 3 ❖ In some parts of Eastern Region of Ghana, (e.g., areas around Kokorantumi) pregnant women are not to eat ripe plantain because it would cause weak girdles. ❖ In certain area around Keta in the Volta region, pregnant women are forbid from eating egg because the hen labours excessively before it lays eggs for this reason, they believed that women who eat eggs will have difficulty with child birth. ❖ Beef is not eaten by Buddhist and Hindu in Indians because the cattle is regarded a holy animal. ❖ In some parts of the Western and Greater Accra Regions of Ghana, garden egg is not eaten because it is believed that it causes skin rash. ❖ In Northern Ghana, especially among the Kusasi tribe, their belief forbids them from eating pawpaw and thus this vitamin A rich food is not grown and not eaten. ❖ In the Volta Region of Ghana, especially areas around Angloga, mushroom is not eaten because it resembles umbrella which they believe has been produced by the ghost. ❖ In many Ghanaian communities, (e.g. in some Ga communities) children are prevented from eating eggs because they would produce foul-smelling faeces. They also believe artificial milk causes diarrhea so should not take it. ❖ In many communities in Ghana, when a child begins to develop the first set of teeth, he is given an egg. In this way, the child is initially introduced to a high protein food. ❖ During puberty rite for adolescent girls (i.e. passage to womanhood, called 'dipo' by the Adas /Krobos and 'bragro' by the Ashantis) in Ghana the young girl is fed with nutritious diet for some days and she is groomed before she is presented for the final puberty rites. ❖ In Ghana, highly nutritious diets are prepared for women who have successfully given birth to a child. The special food is believed to improve her ability to produce enough breast milk. Such as groundnut soup, special palm soup (abedru) with fufu or banku, tiger-nut, mixture of roasted corn and groundnut, soups made from melon seeds ('Akatoa'), 'prekese' fruit. ❖ In areas around Jirapa in the Upper West Region of Ghana, the Muslim community donates a sheep to the woman who has successfully delivered. In this case she is expected to eat the best part of the meat to enhance her lactation ability. ❖ Among the Ga tribe of Ghana, special dish is prepared for the husband of the woman who has successfully given birth to a child. ❖ In most northern part of Ghana, most traditional herbalists accompany their prescriptions with a chicken which is eaten solely by the patient being cured. Even though the emphasis is to sacrifice the blood of the fowl for the gods and the ancestors, it nevertheless, improves the protein nutrition of the patient (contrary to what mostly happen in the southern part of Ghana). ❖ In the Northern part of Ghana, the predominant traditional religious prayer is to prepare highly nutritious mixed diet, rich in protein, for children and women on that occasion, especially if one thinks she is in crisis. ❖ In parts of the Eastern Region of Ghana (the Akim traditional area) lactating mothers are forbidden to eat together with anybody this is to enable her to sleep well (without strange dreams) at night, this if done, it is believed enhances breast milk production very well. ❖ In the Central region of Ghana, specifically around Dunkwa-on-Offin, a child is rewarded with an egg when he or she begins to walk. This practice is widespread in many parts of Ghana. 4 Celebrations, Festivals and Funerals: In Ghana, food is associated with almost all festivals. There are thus different food habits that develop at the period of such festivals. ❖ Yam festivals are associated with harvesting and eating of yam, e.g., Odwira festival by Akwapem tribe? ❖ Homowo festival by the Ga 'kpokpoi' is prepared using fish, corn and palm oil. Prior to the day of the grand durbar, all twins in the Ga community are given an egg each for a period of three days. ❖ Akwasidae by the Akim involves feasting. During this time, protein-rich foods are prepared using domestic animals for the occasion. ❖ Christian festivals e.g. Christmas, Easter etc.; the Muslim festivals e.g. Id-Ul-Adha, Id- Ul Fetre etc. are not an exception. During these religious festivals, domestic animals like goat, sheep, and cow are slaughtered and used to prepare food to feast. Each year, these festivals are celebrated and thus contribute to the development of a food habit of that group of people. This pattern of food intake becomes part of the general food habit of the people. In recent times, food has become a major component of funeral celebrations in Ghana and many other places. Interestingly feasting has taken a greater proportion of the funeral activities and the type of meal served is said to portray the social status of the deceased. In many places after burial chief mourners and the family serve food to those who attend the funeral. In most cases dancing, feasting and merry making are common on the funeral ground. When this pattern of food intake becomes frequent, it forms part of the food habit of that community. Institutionalization: In various religious institutions, camps, schools and work places, the kind of food prepared at the canteen or cafeteria or dining or hall is what is available for inmates. The people in the institution learn to eat these foods which most often are different from what they used to eat at home. If this happens for a long time, a food habit is formed. Physiological, Age and Health State: The food habit portrays by a person is also dictated by the physiological and health status. Any attempt to improve nutritional status must include a study of the food habits of the people involved. ❖ During pregnancy and lactation (breastfeeding), there are increased nutrients requirements that must be met. This necessitates the preparation, modification and the demand of existing foods. ❖ The aged individual makes food selection such that the final diet can be managed; bearing in mind denture problems. In this group, certain foods easily cause diarrhoea and are thus avoided. In these physiological states therefore new food habits are formed. ❖ In disease and injury conditions, the kinds of foods eaten are related to the type of disease and can have a link with the curative measures being used. There would diet modification of quality, quantity, rate of diet to promote management of diseases which differ e.g. diabetes, hypertension, jaundice, cancer, gout, ulcer, fever, obese which patient must all adhere to. Generally there is food for the sick and food for the healthy. The person suffering from heart disease or hypertension may not be allowed to eat foods containing high fat, salt, high cholesterol and condiments. At the end of the condition, there would be a fixed pattern of food habit. 5  In general, the food habit formed is usually passed on to other members of the household especially if the household head is the one affected. The Role of *Ostentation, Prestige and Social Significance Certain foods have acquired certain higher social values or prestige and perceived to be for the rich and important personalities in society and contribute to the development of food habit of such people. These foods, however are not always true that the food believed to have a higher social value or prestige would be of a better nutritional quality than the alternative or may not be related to their nutritional value. ❖ For example, rich people may like white bread instead of brown bread, which tends to be more nutritious than the white. ❖ People may favour white (polished) rice and look down on brown rice, although the latter is more nutritious. ❖ Yellow corn which is richer in vitamin A and protein as compared to white corn; however, some people may look down on yellow corn but prefer white corn. ❖ It is a well-known fact that apple is perceived to be food for the rich while butter; tea and milk are qualified as luxury foods for the opulent in society. ❖ In some cases, just changing the name of a food to an attractive one makes it becomes food for the wealthy in society. For example when the name of local toasted sauced meat, “kyikyinga”, was changed to “Khebab”, it instantly caught on with the well-to-do in our society and since then it has continued to attract high patronage. *(Ostentation= showiness: conspicuous or vulgar display of wealth and success, especially designed to impress people) Factors that affect or alter Food Habits: Foods habits are dynamic in nature and are not static. In fact, food habits keep on changing according to the existing conditions that shape food intake of people. All the factors that contribute to the development of food habits are also involved in their change or modification. Among the noted factors, that contribute to or modify food habit include: ❖ Improvement in socioeconomic status: People who gain promotion in their work places or who gain new post may have their socioeconomic status improved. They may change their ways of eating or their food choices and hence their food habits. For example, such a person may now begin to consume high proportion of refined foods, milk, sugar, cheese, biscuits, bread, increases both alcoholic and non-alcoholic drinks. The food habit would be changed and diseases of the affluent may begin to appear in such people. ❖ Education: General education may contribute to alteration of food habits, most often for the better. It is perceived that most educated tend to have particular food habits. Nutrition education makes people aware of the nutritional value of foods and may modify their food selection to achieve optimum health. However some may not because habits are difficult to change. ❖ Travelling: Leaving your comfort zone may have profound effect on the food habits of people. What food is served by the host or what is available is what we eat. We therefore cannot adhere, at this stage, to our original food habit and in time we are bound to adapt and change our food habits. ❖ Innovations/ inventions of food products: When food environment is studied and new ideas are introduced that either improves the acceptability or the quality of a particular food it improves the consumption of that food by the general population. In some cases the promotion involves just changing the name of the product from a local name to an exotic one (e.g., kyikyinga to khebeb), in other cases it involves the processing technique of the crude products to new easy to use ones. For instance the invention of fufu flour (cassava flour) eliminated the pounding aspect of preparation. There are 6  also plantain chips, groundnut paste, cowpea flour etc. These are easy to use products which promote their patronage and alter food habits. ❖ Advertisements: Advertisement in the media (television, radio, newspapers, magazines, newsletters and posters) has an important contribution to modification of food habits. The catchy words and nice human bodies, including infants, shown attract and encourage people to consume the said foods. ❖ Food shortage caused by say drought, natural disasters, wars etc. Social uses of food In addition to providing nourishment for the human body which ultimately will ensure good health, food also plays many important social roles in our society, spanning many ethnic lines. In all cases, the success of the occasion is linked to the extent of feasting that accompanies it. The various uses of food in society include: ❖ Ceremonies: Marriage, Naming, ❖ Displays social status: The type of food one eats may be associated with one's social status, even though such foods may not guarantee good health and nutrition. Also the kinds of food found in the fridge, the shelves, or elsewhere may show the social status of the person. ❖ Festivals: Religious, traditional etc. ❖ Funerals celebrations etc. ❖ Maintenance of health and cure of disease, for fertility etc. ❖ Pacification: A wife may pacify a husband with a specially formulated diet after a conflict between them has been resolved. ❖ Promotion: e.g. business promotion, food fairs, bazaars and Dinner-dances ❖ Puberty rites, circumcision. ❖ Remembrance days e.g. Jubilee, Anniversaries, Birthday ❖ Show compassion, Show love ❖ Show Encouragement/ Appreciation, Celebration of success: Special dishes may be prepared e.g. by parents to show appreciation, for a child who has excelled e.g. in an examination or other achievements and gains the chance to progress in life. ❖ Social structure: The social structure is sometimes depicted by the part of the household dish served to a person. Thus there is food for children and food for adults. The part of the food dish served to the household head may be different from what the others in the household may get. But education is fast changing this phenomenon. ❖ Socialization / entertainment/ sign of welcoming: the first thing one thinks of welcoming guests in your home are foods and drinks. ❖ Special occasions: special dishes are prepared for lovers on special occasions (e.g. Valentine day) or gifts to strengthen the ties or bonds. ❖ To satisfy the human body: Certain foods are said to cool the human body in hot weather e.g. cold drinks, cold water, chilled yoghurt etc. usually refer to as cold foods. On the other hand, sauced meat, grilled meat, fish, eggs, and soups are said to be hot foods and are preferred when the weather is cold. Food Faddism / Nutritional Quackery Any information that is out of line with current scientific evidence but propounded with emotional appeal is a fad, so when it concerns food it is termed food fad and one who does that is food faddist (myth, craze). Misrepresentation and fraud for financial gain by those who claim authority in nutrition but have little or no background can be called as nutritional quackery. 7 The dramatic but misleading manner in which fads are propounded with zip and emotional appeal, shrouds the falseness. Food quacks use a lot of scientific jargon that seem important to the layperson. Operators in trying to persuade people to take up the food, faddists use such descriptions as “special diet”, “special food”, “special regime”, “weight reducing agent”, “special diet preparation”, “athletic diet”, “health foods” “weight reducing food” “food supplement” etc. It is difficult for the layperson to differentiate between the accurate and the unsound information. ❖ The food faddist pretends to be a specialist in the field of nutrition, food or medicine. ❖ No single food is essential to health. All the over 60 different nutrients required cannot be obtained from one food. However, the food faddist think elimination or excessive intake of a particular food is the panacea to your nutrition problems e.g. garlic, moringa, alovera, mahohani, and a lot more. ❖ Food faddist makes exaggerated claims for the value of certain foods to suit his aim and condemn others which might even be better. ❖ They advocate the omission of other foods from the diet due to harmful properties some foods have. ❖ They sometimes use special devices (book, symbols, TV’s, radio, exhibition boards, etc.) to propagate their ideas with or without an accompanying food fad in the attempt to mislead people. ❖ False ideas about food are also used by the food faddists. For instance, myth that all diseases are due to faulty diet. ❖ Fads about health foods, organically grown foods are nutritionally superior Foods used in their natural state (without refinement) Weight reducing foods Extreme vegetarianism Megadoses of nutrients Soil depletion causes malnutrition etc. There are many different patterns of food consumption worldwide. Some are based on sound nutritional principles while others lead to a variety of nutritional problems. In general, the fewer the varieties of food that a person feeds on, the greater the possibility of nutritional inadequacies. The list is constantly changing but the motivation remains the same, which is to take advantage of supposedly special health-giving properties of some foods or to boost well-being by eliminating certain foods. These diets are not necessarily inadequate. As the range of foods we feed on decreases, it becomes more important to choose with a full "knowledge" of the nutritive value of foods and the human nutritional requirements. Among the various diet patterns, particularly popular in the West are: ❖ Vegetarianism: ❖ Macrobiotic diet ❖ Single-food diets ❖ Liquid protein diets ❖ Natural or Health-food diets, etc. Vegetarianism: It is estimated that millions of persons, most of whom are young and from the middle and upper class backgrounds in America espouse it to varying degrees. To some, it is tied up with religion or a means of purifying the body. To others e.g. Hinduism, vegetarianism represents a form of rejection of many aspects of their affluent 8 society. Something similar to the stand taken by the three Jewish men - Daniel, Shaderach, Meschach and Abednego in the court of the king of Babylon (Book of Dan..) ❖ Ovo-lactovegetarian, through consumption of eggs and milk in addition to vegetables he would be nutritionally adequate. ❖ The pure vegetarian (Vegan) may be susceptible to nutritional inadequacies, particularly Vit B12. Adult vegan may obtain some Vit B12 from GIT micro-organisms. Quality proteins for a child, recuperating adult, expectant and lactating mothers may be compromised. Calcium, haem Iron and vitamin D for vulnerable group may be inadequate. Young VEGANS are also more prone to development of rickets because of Vit D and Ca++ deficiencies. Since vegetarian diets, being mostly of plant origin have high in fibre and don't provide as much energy as an equivalent low-fibre diet. ❖ High fibre diets are in fact recommended for obese people who need to lose weight because of their lower energy content. ❖ It is also to be remembered that above a certain level of fibre intake, Ca, Fe and Zn can be lost from the diet because of binding property of fibre. Poor availability of dietary iron because of inhibitory factors in plant foods (eg. fibre, phytate, tannin etc) which interfere with iron absorption. Although there is no Vit B12 in the foods of plant origin, vegans are really not at severe risk of B12 deficiency, probably because of the provision of Vit B12 by intestinal micro-organisms in the colon. ❖ There are apparent health advantages of vegetarian diet: Consumption of low fat and low cholesterol which reduce their chances of developing atherosclerosis and hyper-lipoproteinaemia disorders. It lowers the risk of developing colon cancer. Low fat and low bile acids are potentially convertible to carcinogens The fibre produces a rapid transit time so lower risk of constipation Lower rate of obesity, hypertension, diabetes, gout, etc. ❖ Protein: Legumes and cereals should be consume simultaneously to get balance complete quality protein comparatively. ❖ Lactovegetarians: who allow milk, cheese, yogurt, and vegetables ❖ Ovovegetarian, who allow eggs as their only source of animal protein. ❖ Lactoovovegetarian: who consume milk and milk products as well as eggs ❖ Pescovegetarian: permit fish as the only animal product in their diets. ❖ Pollovegetarian who allow poultry as the only animal product in their diets. ❖ Red-meat abstainers, who eat any animal product except red meat but still consider themselves vegetarians. ❖ Fruitarians, who eat only fresh and dried fruits, nuts, honey. Reasons given for becoming a vegetarian are varied. Many desert the traditional meat and other animal source food for several reasons: Religion: religious communities, such as the Seventh Day Adventists, use vegetarianism as a means of self-discipline, as well as to promote good health. Other vegetarians may or may not be religious but feel it is ‘sinful’ to kill a living animal for food (all living things have souls). Ecology: approximately half of the world’s grain output is used to feed livestock. Some vegetarians feel that, faced with diminishing agricultural land and an increasing population, grain would be better used to feed people, so less land would be used to meet the world’s protein needs. Some also feel that using less land would result in a reduction in the use of pesticides that are now used to ensure large crops. 9  Economic: beans, grains and vegetables are cheaper that meat. Some vegetarians are concerned not only with saving money for themselves but also with finding a way to meet world food shortages in the poor nations of the world. Health: another common reason for selecting vegetarianism is to achieve good health. By avoiding animal products or in some cases only meats except fish, vegetarians manage to reduce their intake of cholesterol and saturated fats, thus gaining some protection against heart diseases. Some vegetarians also feel protected against cancer and other degenerative diseases because they are avoiding hazardous additives (such as nitrites added to meats to improve their colour), pesticides, and lack of dietary fibre (meat has none). Vegetarian can meet the RDAs for most major nutrients without taking supplements. However, a few nutrients create problems if the vegetarian is not careful. Vitamin B12: this vitamin is found only in animal products (and in small amount in seaweed, supplements often seen in health food stores but not considered reliable sources of vitamin B12). People who follow vegetarianism or the extreme macrobiotic diets are at the greatest risk for deficiency. Vegans may be at special risk because they take in a large amount of folacin, another B vitamin that can mask signs of vitamin B12 deficiency. A deficiency can be avoided, however, by including fortified foods or by taking a vitamin B12 supplement. Vitamin A: vegetarians tend to get more pro-vitamin A (carotene), than they need. This usually is not a problem. Iron: Grains and legumes have fibre and other inhibitors that prevent absorption of Fe in the gut. Absorption can be enhanced by including a good source of vitamin C in the same meal. Pregnancy: Supplement is recommended for such hard-to-get nutrients as iron. Children: Children manage to grow fairly well on a vegetarian diet. They tend to be little shorter than average. Vegetarian children also tend to be mildly anaemic, probably because of the poor availability of iron from grains and legumes. Again, including a source of vitamin C with meals may be helpful. The vegan and macrobiotic diets are too poor in require nutrient to sustain childhood growth needs. Eliminating meats automatically removes a major source of fat in the diet. Since fats provide more than twice the number of kcalories per gram than carbohydrate or protein, the vegetarian diet is usually much lower in kcalories. Some vegetarian have to be careful to get enough kcalories, especially pregnant women, children, and athletes. Thus the well-planned vegetarian diet can be nutritious. If used wisely, it can offer many advantages in terms of health, economy, and ecology. There are groups that would call themselves the only true vegetarians because they allow no animal products in their diets. In some cases their highly restrictive dietary laws have caused serious malnutrition. These problems are found among the following: ❖ Zen macrobiotics, who eat only brown rice and herb tea. This is done to achieve a perfect balance of yin and yang to fend off disease and reach a higher spiritual state. They also follow restricted fluid intake, apparently with the intention of sparing the kidneys. This however poses an additional hazard, since this diet is high in Na+, which increases thirst and the need for fluid. Their use of sea water to alleviate thirst only worsens the problem. 10 ❖ Single-Food Diets: "Anchimolus and Moschus, they drink water all their lives and though they eat nothing but figs, they enjoy robust physique as anyone else; but their sweat is ill-smelling that everyone avoided them at the public places". ❖ Natural or Health Food Diets: They eat only foods they believe have been grown on soil either unfertilized or fertilized with organic manures and have not been subjected to any chemical treatments during growing or processing. The animals must not have been given any antibiotics, hormones or other growth-stimulating hormones during breeding. Eggs should be fertile; milk should not be pasteurized. Eating Disorders An eating disorder is defined as a gross disturbance in eating behaviour that jeopardizes a person’s physical or psychological health. It refers to any abnormal eating, handling, or eating of non-food substances. The commonly document eating disorders are: Anorexia nervosa, Bulimia, Bulimarexia, Pica and Rumination disorder of childhood. ❖ Anorexia nervosa: It is distinguished from the other eating disorders by a weight loss of at least 25% of the pre-morbid (normal/expected weight) weight. This results in severe adult protein energy malnutrition, usually adult marasmus. In fact, the disorder is 20 times more prevalent among young females than males. It appears to affect mostly persons of middle to upper socio-economic strata. The characteristics of patients presenting with anorexia nervosa include: Extreme thinness, psychologically related loss of eating control and appetite, perfectionist behaviour, desire for thin body and obsession of overweight and low self-esteem with features of depression and anxiety. Health Complications The anorexia patient exhibits certain medical complications such as: protein-energy malnutrition, cardiac malfunction, amenorrhoea, electrolyte imbalances, fainting, and hormonal problems. ❖ Bulimarexia (bulimia nervosa): This is an eating disorder characterized by chronic binge-purge episodes and progressive physical and psychosocial deterioration. Individuals who have this habit, practice it in secrecy and this makes it difficult for diagnosis. Bulimarexia is definitely diagnosed when the binge eating is combined with purging. Mostly, the purging is done to counter the overindulgence. Abuse of cathartic and diuretic drugs and self-induced vomiting are common with the bulimarexic patient. In all cases of bulimarexia, binges occur episodically with variable pattern. It is characteristic of the bulimarexic patient to follow the binge with self-imposed starvation. Because of this habit, they have variable body weight and the near-ideal body weight may fluctuate by about ±15% the ideal body weight. During binging a large assortment of easily ingested high-calorie foods such as biscuits, pastries and ice cream are consumed within a short time. Assorted foods containing over 15,000 to 20,000 kilocalories may be consumed at one time. One study found 19% prevalence among college students. In a study, over 40% of college females and 10% of college men were found to have bulimarexia. The patient with bulimarexia has the following clinical characteristics: Hypocalcaemia, hypokalaemia, hypernatraemia, kidney problems, heart failure and heart-burn, Gastric and oesophageal dilation or rupture, Lack of rapid eye movement, Piles, anaemia, Abdominal pain, and Diarrhoea. 11 ❖ Bulimia: refers to binge eating without purgation. This eating disorder is similar to bulimarexia but the patient does not purge. However the patient may self-induce vomiting and do all the other odd things done by the bulimarexic one. Thus we distinguish bulimarexia from bulimia by the purging accompanying bulimarexia. The patient with bulimia suffers from constipation as an additional clinical feature. ❖ Pica: Pica is an eating disorder that is characterized by the eating of a non-food substance or the eating of a food substance that is unusual in kind or quantity. Thes may include chalk, slate, pencils or clay, salt or sand. These substances are usually non-nutritious. There are two types of pica. The benign pica has no clear association with undernutrition, though clay pica has been linked to anaemia and intestinal worms infestation. The factors that have been associated with pica include periods of stress such as in pregnancy and lactation among illiterate individuals, sheer hunger and psychological upsets. The habit is observed chiefly in poorly fed individuals in the lower socio-economic groups in developing nations. There are various forms of pica depending on the type of material ingested. Geophagia: the consumption of earth materials, usually clay substances. It is mostly seen during times of stress such as pregnancy and lactation and may probably be due in part, to natural craving for trace minerals, especially iron. Plasticophagia the ingestion of plastic materials like pen tip etc. Amylophagia the ingestion of raw uncooked starch and other carbohydrates Pagophagia; the excessive eating of iced water or ice-block and cold substances In general, some of the medical implications of pica include: anaemia, colon blockage, teeth discoloration and wear, worm infestation, diarrhoea (e.g. starch ingestion) and other infections, and Constipation (e.g. clay eating). ❖ Rumination disorder of childhood: It involves a chronic regurgitation of nutritive substances from the gut. Such children vomit back food from the stomach into the mouth to re-chew it in a manner similar to what cattle do. There is no anatomic defect of the gastrointestinal tract has been observed to be the cause of rumination of childhood. It is just a bad habit that the child has. Medical implications: Weight loss, Failure to thrive, Electrolyte imbalance, Epigastric hernia and Foul mouth World Population and Food Resources In 1798 Malthus published his famous essay on the principles of population. His augment was that any temporary increases in human living condition would increase the population faster than corresponding food production. He proved correct in this. He also believed that if population grows, wars, famines and *pestilence could reduce population significantly and slow down the growth. In this latter expectation he was proved wrong. Because the population of the world is constantly increasing in addition to natural and manmade disasters. *(epidemic of disease: an epidemic of a highly contagious or infectious disease such as bubonic plague; serious infectious disease) Cause of Population Growth: ❖ Fall in death rate due to: Wide spread use of insecticide and antibiotic that protect many people from early death. effective immunization programme Introduction of oral dehydration salt that help 1000s of children from death. 12 ❖ When mothers don’t suffer many infant mortality they are likely to reduce the number of babies they choose to have. ❖ Population has grown because of decrease in civil wars. This may be credited to increase religious tolerance. ❖ Population has grown because of increase maintenance of law and order. ❖ Populations have grown because of decrease in frequency of famine. New improve agricultural methods greatly abolished famine. The Search for Solution to The Population and Food Crisis: Conferences were organized and some of the decision taken in the first one were: ❖ Help should be given to 3rd world nations to improve their food production. ❖ Effort should be made to improve food distribution system in the world over. ❖ That food security system that is food stock against emergencies should be established. ❖ To enable developing nations modernized their agriculture. It was decided that an international fund for agriculture development (IFAD) to be set up to grant soft loan to the needy nations. ❖ Trade barriers should be removed to enable developing nations to freely export their produce in order to buy their agriculture equipment and market the produce. ❖ Non-agricultural food sources should be developed e.g. fish farming also protein extraction from leaves should be developed. ❖ More land should be cultivated but only about 3% was under irrigation in Africa by 1987. ❖ Crop yields per acre should be increased with modern agricultural techniques using high yielding varieties of seeds ❖ Post-harvest losses must be. In Ghana about 43% of post-harvest losses were recorded in 1976. ❖ In 1962, between 5-35% of the population in developed nations were agriculturists. In UK only 5% were in agriculture. 1967 about 8% of the population in US were farming producing enough to feed them with high surpluses as left over for storage. They owe all these to efficient and modern farming methods. World Efforts to Control Population Growth United Nations Fund for Population Activities (UNFPA) to help countries set up an effectively run family planning programme. ❖ Ghana the first country in Africa to start its family planning programme in 1970 under Busia’s regime, despite the early beginning of Ghana’s family planning programme much impact has not been made in the control of population. In Ghana, tradition, religion and economic considerations have given resistant to attainment of Ghana family goal. ❖ The Acheapong government embarked on series of irrigation programme in 1977 e.g. the Tono, the Akumadan, Asituare, Dahwenya, Bui, Okyereko and Afram plain irrigation programmes. ❖ International Food and Agriculture Development programme (IFAD) has given loan and supporting projects. ❖ Universities and research institutes in search for solution embark on may activities: The Kuadaso agricultural research station on improved seed varieties Food Research Institute and FAO jointly developed Chorkor Smoker helping to make fish smoking easy and reduces losses. 13  Department of Nutrition and Food Science has been on reduction of post-harvest losses addressing the processing marketing and storage of cereal and legumes, The Population Impact Project (PIP) of the Department of Geography UG Legon keeps the issue of uncontrolled population growth and its harmful consequences alive in the minds of Ghanaian policy makers, opinion leaders and researchers aware of the impact of uncontrolled population growth on our development. PIP emphasizes the value of education both in improving living standard and keeping the population growth controlled. ✓ They claimed that, Female education has been shown to particularly ▪ Promote proper health ▪ Advance further nutrition ▪ Ensure desirable family size that they can adequately carter for ▪ Reduce infant mortality. ✓ Their 1987 booklets offers the following analysis. The present fertility rate in Ghana averaged 6.7 children per family. ✓ If this fertility rate is allowed to decline steadily reaching an average of 2.8 children per family by the year 2020 our population will be 33 million. ✓ If the rate of decline is only moderate given us 4.8 children per family by 2020 our population will be about 46 million ✓ If nothing changes and we maintain the 6.7 children per family until 2020 our population will be 53 million. ✓ Unless we work hard in improving agriculture and economic we can be sure that at 53 million our standard of living will be very low. 14 15