HELE 55

FOOD AND NUTRITION

COURSE DESCRIPTION:

Seeks to change attitudes and to improve the health status of both the individual and the
community. In addition, the syllabus seeks to provide additional opportunity for access to, and
advanced standing in existing tertiary level education programmes. Students will be exposed to
the main aspects of food science, including safety practices, standards, purchasing, planning,
preparing, storing and serving.

SUBJECT TEACHER
CHRISTINA C. MALAYAO
WEEK 7

LEARNING OUTCOME

 develop the skills to plan and prepare nutritious meals for all stages of the
life cycle and for various occasions;
 develop the skills to plan and prepare nutritious meals while maintaining the
safety and aesthetic value of food;
 understand the role of protection agencies and governmental
organisations in maintaining acceptable food standards.

Food, Nutrition, and Meal Preparation

Introduction

Proper nutrition is important for all of us. Home Health Aides/Personal Care Aides have very
important roles to fill with regard to helping their patients obtain proper nutrition. This module
will explore the basics of nutrition. We will discuss all the important types of food that should be
in a patient’s diet. We will also talk about the type of food that should be avoided. We will learn
how to use the USDA’s nutrition guidelines by learning how to plan meals using ChooseMyPlate
guidelines. We will talk about food preparation and safe food handling. We will also explore
what different types of diets mean and what foods should and should not be included in those
special diets.
Unit A: The Basics Of Nutrition

The Major Nutrients

All living things require nutrients in order to survive and to grow and develop
normally. Nutrients are components (parts) of food that provide nourishment in order for us to
survive. Nutrients provide our bodies with energy, help build and maintain body tissues, organs,
bones, and teeth, and help regulate body functions such as metabolism and blood pressure
(Lehman, 2014). Nutrients include protein, carbohydrates, fats, vitamins and minerals.

The Care Plan will direct a HHA/PCA as to what the patient’s dietary requirements and
restrictions are. Home Health Aides/Personal Care Aides should always be sure to follow these
as they are in place to best promote good health for the patient. If they are ever in doubt about
whether a patient can have a certain food, they should seek guidance from their supervisor.

Protein

Proteins are the essential (necessary) building blocks that our body needs in order to properly
function. We need protein in order to build and repair body tissues, such as muscles, organs, and
skin. Sources of protein include poultry, meat, fish, eggs, milk, cheese, nuts and nut butters, peas,
dried beans, and soy products. Our bodies can also use protein as an energy source or convert it
to fat (Lehman, 2014). The amount of protein that a person needs depends on their body size,
age, activity level, and their general well-being (U.S. Department of Agriculture, 2015a). People
who are sick, undernourished, and healing generally require higher amounts of protein in order to
help the body’s tissues heal.
Sources of Protein:
 Poultry (chicken, turkey)
 Beef (steak, ground beef, stew meat, hamburgers, hot dogs)
 Fish (tuna, salmon, trout, bass, cod)
 Shellfish (shrimp, lobster, crab)
 Milk
 Eggs
 Soy products (tofu, tempeh, veggie burgers)
 Legumes (beans such as white beans, kidney beans, chickpeas)
 Peas
 Nuts (almonds, pistachios, walnuts, cashews, peanuts)
 Seeds (pumpkin, sunflower, squash seeds)
  Peanut butter and other nut butters

Carbohydrates

Carbohydrates are the essential nutrients our body needs in order to provide us with energy.

Carbohydrates are the major way our body gets energy in order to effectively function.
Carbohydrates provide our body with sugar, starch, and fiber. Starches include grains, potatoes,
beans, and peas. Sugars include fruits, vegetables, and sweeteners. Foods that have fiber in them
include whole grain foods such as cereals and breads, fruits, and, vegetables. Fiber is important
as it helps aid in digestion, helps to lower cholesterol, and helps us to feel fuller longer. Fiber is
also necessary to aid with bowel elimination (Leahy, Fuze & Grafe, 2013).
There are two basic types of carbohydrates: complex and simple. Complex carbohydrates are
found in grain products such as bread, cereal, pasta, rice, and
vegetables. Simple carbohydrates are foods found in sugars, sweets, syrups, and jellies. Complex
carbohydrates have more nutritional value than simple carbohydrates.
The body uses sugars and starches for energy. Extra carbohydrates or carbohydrates that we take
in but do not need at the time, are converted to fat, which are then stored (Lehman, 2014). A diet
in excess of carbohydrates can lead to obesity (being over the ideal weight for a person’s body
size).
Sources of Carbohydrates:
 Grains
 Breads of all kinds
 Potatoes
 Beans
 Peas
 Oatmeal
 Rice (white, wild, brown)
 Breakfast cereals
 Tortillas
 Grits
 Pasta, noodles
 Popcorn
 Quinoa
 Crackers (all kinds)
 Couscous
 Muesli
Fats

Fats are essential nutrients in our diets. Even though we tend to think of fats as bad for us, we do
need a certain amount of fat in our diets. Fat helps to protect our organs, is necessary for all the
membranes in most the cells in our body, for brain and nerve function, is used to insulate the
body and help us prevent heat loss, and is a carrier for other nutrients ((Leahy, Fuze & Grafe,
2013; Lehman, 2014). Extra fat can also be used as energy for the body, or it can be stored.

While we need a certain amount of fat in our diet, caution must be taken to not eat too much fat.
A diet high in fat can lead to serious complications such as high cholesterol, myocardial
infarction (heart attack), coronary artery disease, and cerebrovascular accidents (strokes).
Sources of fat include oils, butter, margarine, salad dressings, and animal fats found in meat,
fish, and milk.

Some fats are healthier options than others. For example, choosing to eat a handful of nuts is a
healthier option than choosing to eat a handful of potato chips. There are three main types
of fats: monounsaturated fats, polyunsaturated fats and saturated fats (Leahy, Fuze & Grafe,
2013). Monounsaturated fats include vegetable fats such as olive oil and canola
oil. Polyunsaturated fats include corn, soy, safflower, and sunflower oils, and omega-3-fatty
acids. Saturated fats include butter, bacon, lard, coconut oil, and peanut oil. Saturated fats are
less healthy options than monounsaturated and polyunsaturated fats. They should be consumed
in limited quantities.
Sources of Fat:
 Oils (all kinds)
 Butter
 Milk
 Eggs
 Fish
 Meat
 Nuts and seeds
 Avocados
 Margarine
 Salad dressings
 Olives
 Peanut butter
 Animal fats found in meat
Vitamins

Vitamins are essential to help our body use other nutrients we take in, and they also help to
promote tissue growth. There are several kinds of vitamins, all of which have a specific purpose
and which we need every day. With the exception of Vitamin D and Vitamin K, our body needs
to obtain vitamins through our diets. We make a certain amount of Vitamins D and K within our
bodies. While most people who eat a well-balanced diet do not need to take vitamin
supplements, other people may need a daily supplement in order to meet their nutritional needs.
The patient’s physician will discuss the specific vitamin supplements the patient needs, if any. If
the patient has a question about a vitamin, Home Health Aides/Personal Care Aides should
inform their supervisor about the patient’s question.
Vitamin A is necessary to help keep the skin in good condition and also supports eye health.
Vitamin A can be found in dark green, yellow, and orange vegetables.
Vitamin B is needed to help the nervous and digestive systems function properly. It also is
important for protein, carbohydrate, and fat metabolism. Metabolism is the process by which the
body converts (changes) what we eat and drink into usable energy. Foods high in vitamin B are
those found in animal products such as meat, milk and milk products, green leafy vegetables,
and fortified grain products. When foods are fortified, they have nutrients added to them in order
to make them more nutritious. For example, many grain or bread products are fortified, or
enriched with extra minerals and vitamins for extra nutrition.
Vitamin C helps to strengthen blood vessel walls and aids in the healing of wounds and bones. It
also helps the body to absorb iron. Foods rich in vitamin C include fruits such as oranges,
strawberries, grapefruit, and vegetables like broccoli, Brussel sprouts, and green cabbage.
Vitamin D is needed for our body to build strong bones and teeth. Sources of vitamin D include
milk, butter, salmon, sardines, tuna, liver, fish liver oils, and fortified orange juice. We also
synthesize (make) our own vitamin D when we get sunlight on our skin.
Vitamin E is an antioxidant, which is a substance used to remove potentially damaging agents
called free radicals. This helps to promote a good immune system. Sources of vitamin E are
wheat germ, fish, fruits, vegetables, cereals, and nuts.

Minerals

Our bodies also require a number of minerals in order to best function. Minerals are compounds
that our body needs in order to perform a variety of functions. There are a number of essential
minerals that our bodies need. For example, we need calcium, which is a mineral, in order to
help keep our bones and teeth strong. There are a number of minerals that we need to take in
through eating a well-balanced diet. Calcium, potassium, chloride, sodium, phosphorus, and
magnesium are known as major minerals (Lehman, 2014). Iron, fluoride, zinc, copper, selenium,
chromium, and iodine are known as minor minerals (Lehman, 2014). Whether a mineral is major
or minor has to do with the amount we need in our diets. We need a greater amount of calcium
within our diet as compared to zinc, for example.
Calcium: is a mineral that is needed for bone and teeth strength, blood clotting, proper muscle
contraction, and a healthy heart. Milk and milk products such as cheese, ice cream, yogurt, leafy
green vegetables, and canned fish, such as sardines (which have soft bones) are good sources of
calcium.
Potassium: helps the heart to function properly, helps muscles to contract, and is necessary for
good nerve conduction. Foods high in potassium include tomatoes, potatoes, squash, dried
apricots, yogurt, and bananas.
Iron: iron combines with protein to make hemoglobin, which is a part of our red blood cells that
carries oxygen. Good sources of iron include red meat, chicken, pork, dark green leafy
vegetables such as spinach, iron fortified cereals and grain products, and dried fruits such as
raisins.
Iodine: is needed for proper functioning of the thyroid gland. The thyroid is important for our
body’s metabolism. Sources of iodine in the diet can include cod, shrimp, canned tuna, iodized
table salt and even milk and yogurt.
Sodium: helps our body to maintain normal fluid balance. Foods high in sodium include most
processed food, many canned food such as meats and soups, olives, pickles, packaged mixes, and
canned foods such as vegetables. While we need sodium in our diet, we should limit the amount
of sodium we take in.

Water

Water is essential to all life, including human life. Without it, we cannot survive. We could only
live for a few days without water. We need water for digestion, elimination, and control of our
body temperature. The majority of our body is made up of water. We need about 8 glasses, or 64
ounces, of water each day to stay adequately hydrated. Liquids such as coffee, tea, juices, milk,
and soda also provide us with fluid we need. However, it is healthier to select drinks such as
water, milk, or juice rather than soda.

It is important to remember to keep a patient hydrated. Some patients may not be able to or may
forget to ask for a drink of water. It is a good idea for Home Health Aides/Personal Care Aides to
offer a drink of water at least once every two hours. When turning and positioning a bedridden
patient, offer them a glass of water at that time.

Nutrients Work Together

It is important to have a well-balanced diet. While each of the individual nutrients discussed

above are important, it is important that a person take in a combination of all of them to make
a well-balanced diet. Together they work to keep the body working at its optimum (best) level.

Unit B: Meal Planning

Well-Balanced Diet

A well–balanced diet means a diet in which all the nutrients our body needs for proper

functioning and energy are taken in. A well-balanced diet contains a variety of foods from all the
food groups, as well as all the necessary vitamins and minerals we need. It also means taking in
an adequate supply of water for adequate health. A well-balanced diet can be planned by
selecting healthy foods from each of the food groups.

Milk Group

When selecting foods included in the milk group, low fat and fat-free choices should be made to
promote good health. In general, 1 cup of milk, soy milk, yogurt, and 1 ½ ounces of cheese are
considered a serving size (U.S. Department of Agriculture, 2015a).

Milk Sources:

 Milk (low fat, fat free, whole)

 Lactose-free and lactose-reduced milk
 Yogurt
 Pudding
 Ice cream
 Frozen yogurt
 Calcium fortified soy milk
 Hard cheeses (cheddar, mozzarella, swiss, parmesan)
 Soft cheeses (ricotta, cottage cheese)
 Calcium fortified juices and cereals

 Recommended daily servings of milk products:

Children 2-3 years old 2 cups

 4-8 years old 2 ½ cups

9-18 years old 3 cups

Women 19 + years old 3 cups

Men 19+ years old 3 cups

 Source: U.S. Department of Agriculture (2015a)

Fruit Group

Most fruits are low in fat and all fruits have no cholesterol (U.S. Department of Agriculture,
2015a). Fruits are considered an important part of our diets and have many protective health
benefits. Eating a diet high in fruits has been shown to reduce the risk of heart disease, some
types of cancer, obesity, and type 2 diabetes (U.S. Department of Agriculture, 2015a). In general,
1 cup of fruit or fruit juices or ½ cup of dried fruit is considered a serving size from the fruit
group (U.S. Department of Agriculture, 2015)

Fruit Sources:

 Apples
 Apricots
 Bananas
 Blueberries
 Cantaloupe
 Cherries
 Fruit juices (100% fruit juice, all varieties)
 Grapefruit
 Grapes
 Kiwi
 Lemons
 Limes
 Mangoes
  Nectarines
 Oranges
 Papayas
 Peaches
 Pears
 Pineapples
 Plums
 Raisins
 Raspberries
 Strawberries
 Watermelon

Recommended daily servings of fruit:

2-3 years old 1 cup

Children
4-8 years old 1-1 ½ cups

Girls 9-18 years old 1 ½ cups

9-13 years old 1 ½ cups

Boys
14-18 years old 2 cups

19-30 years old 2 cups

Women
31 + years old 1 ½ cups

Men 19-51 + years old 2 cups

  Source: U.S. Department of Agriculture, 2015a

Oils

Oils are NOT a food group, although they provide essential nutrients we need for our body (U.S.
Department of Agriculture, 2015a). Oils include items such as butter, oils, margarine,
mayonnaise, salad dressings. These food items should be used sparingly. Foods such as fish,
nuts, and avocados are good choices of fats. Many foods we eat, especially those that are
processed, often are high in fat. This should be considered when planning meals. In general, 1
ounce of nuts, 1 tablespoon margarine, mayonnaise, or oils, and 2 tablespoons of salad dressings
count for one serving of oils (U.S. Department of Agriculture, 2015a). You can view sources of
oils by visiting choosemyplate.gov at http://www.choosemyplate.gov/oils

Recommended daily servings of oils:
2-3 years old
Children
4-8 years old

Girls 9-18 years old

9-13 years old

Boys
14-18 yrs. old

19-30 years old

Women
31+ years old

19-30 years old

Men
31+ years old

Source: U.S. Department of Agriculture (2015a)

Using ChooseMyPlate in Meal Planning

Creating a basic menu plan involves selecting a food from each food group. To help create well-
balanced meals, it is helpful to follow the ChooseMyPlate food guidelines. ChooseMyPlate.gov
suggests the following key points:

 Focus on fruits
  Vary your vegetables
 Make half your plate fruits and vegetables
 Make at least half your grains whole grains
 Go lean with protein
 Get your calcium rich foods

Dietary Guidelines

In addition to taking in well-balanced foods and creating healthy meal plans, it is important for
Home Health Aides/Personal Care Aides to keep the following in mind when planning and
preparing meals to serve their patients:

 Consume a variety of foods within and among the basic food groups. This ensures meals
are well-balanced and interesting.
 Control caloric intake in order to maintain an optimal weight.
 Be physically active every day. Even people who have physical limitations can engage in
exercise within the constraints of their limitations. For example, people who have limited
mobility can do leg and arm exercises independently or with help, rock in a rocking chair,
turn side to side, and do simple exercises. Follow the guidelines set forth in the Care Plan
that will detail the kind of activity the patient can engage in.
 Increase daily intake of fruits, vegetables, whole grains and nonfat or low fat milk
and milk products.
 Switch to fat free or low fat milk and milk products.
 Choose fats wisely.
 Choose carbohydrates wisely. Select complex carbohydrates rather
than simple carbohydrates which tend to have more sugar content in them.
 Choose and prepare foods with little sodium (salt). Read labels to check for
sodium content and avoid prepackaged and boxed foods.
 Switch to water and reduce consumption of sugary drinks.
 If the patient drinks alcohol, they should do so in moderation. Guidelines suggest
that women should consume no more than 1 drink per day and men no more than 2
drinks per day.
 Keep foods safe to eat and follow good hygiene practices during food preparation.
Other Considerations

Home Health Aides/Personal Care Aides should involve their patients in meal planning. Use the
communication skills learned throughout this course to educate patients about healthy food
choices. When planning meals, they must take into consideration their patient’s food preferences,
cultural and or religious background, eating habits, ability to chew and digest food, convenience
of preparation, and calorie and special nutrient needs. Food preferences are determined by our
family, culture, religious beliefs, foods we may choose not to eat, such as animal products for
vegetarians, and the area we grew up or in which we live. There may be regional or ethnic
differences in food preferences. Talk to the patient about their food preferences and beliefs.
Watch the types of foods they eat. Make suggestions and ask for feedback. Ask them to share the
foods they most enjoy. Always also assess for any allergies to foods, as these would be items to
avoid purchasing or preparing in the patient’s home.

Unit C: Food Preparation And Serving

Food Preparation

When selecting foods to plan a menu and foods to offer a patient, Home Health Aides/Personal C
are Aides should use the basics of good nutrition and follow the ChooseMyPlate guidelines foun
d at www.choosemyplate.org

 Choose a variety of foods to keep it interesting.

 Choose foods that are low in fat, low in saturated fat, and low in cholesterol
 Select lean meats, fish, and poultry. Avoid fatty cuts of meats. Remove the skin from
poultry to reduce fat.
 Use sugar and salt in moderation.
 Herbs and spices can be used to help flavor food and according to the patient’s
preferences.
 Choose plenty of fruit, vegetable, and grain products for snacks and meals.
 Avoid frying foods as this adds extra calories, fat, and cholesterol.
 Steam vegetables to maintain the most flavor and nutrition.
 Bake, broil, or microwave foods rather than frying or sautéing in butter or oil.
 Avoid convenience foods such as those that are pre-made or prepackaged. When foods
are prepared fresh, you always know the ingredients and there will be less preservatives,
sodium, fat, and calories.

Patient Involvement
It is very important for Home Health Aides/Personal Care Aides to involve their patient in the
planning and preparing of meals. Not only is the patient more likely to eat foods if they choose
them, but it also helps to promote independence and self-determination. Working with a patient
to plan meals and prepare foods can also help to strengthen the relationship. Share tasks of food
preparation, keeping in mind any physical or cognitive limitations a patient may have.

Home Health Aides/Personal Care Aides should not allow their patient to perform unsafe tasks if
they are unable to do so. For example, young children should not be allowed to use sharp knives
and dangerous equipment. A person with dementia who may forget what they are doing should
be closely supervised while using knives or the stove. If adaptive equipment is available, teach
and encourage the patient to use it. If they can assist to provide their own care, this will help
promote self-esteem and independence.

Getting involved in meal planning and preparation can also provide mental and physical
stimulation, as well as relaxation and distraction. It can be a time where patients are encouraged
to be creative and draw upon their strengths and talents, especially if they enjoy cooking. Many
people enjoy food, either cooking or eating it. Home Health Aides/Personal Care Aides can make
this time fun and relaxing by going through cookbooks and magazines with attractive pictures to
help stimulate interests in food. Make a list of items that are on hand and Home Health
Aides/Personal Care Aides can even make planning a meal with on-hand ingredients a fun game.

Available Cooking Equipment

While preparing food in a patient’s home, Home Health Aides/Personal Care Aides may only
have access to the available equipment they have on hand. There may not be a lot of equipment
to choose from. They may need to get creative in order to adequately meet their patient’s
nutritional needs. Discuss ideas with a supervisor about how to best do this.

Serve Quality Food

 Purchase food that will not expire soon. Check expiration dates on all food in order to
ensure it is fresh. Discard food that is past its expiration date.
 Select fresh fruits and vegetables. Don’t select those that are overripe, bruised, or have
brown spots.
 Cook foods only until tender, unless the patient’s preferences and diets state otherwise.
Overcooking foods destroys good nutrients.
 Serve food that is eye-appealing. Food that looks attractive will more likely be eaten and
could help stimulate a person who has a poor appetite to eat.

Serving Meals

Mealtime is an excellent time to spend with a patient and their family. Home Health
Aides/Personal Care Aides can use it as a time to talk, to learn more about their patient and to
allow their patient time to socialize with them and others. Make sure to always plan for extra
time during meals so the patient does not feel rushed. Sit next to or across from them whenever
possible. Avoid doing other tasks while the patient is eating. Instead, use this time to socialize
with them, unless they do not prefer it.

If the patient has a swallowing problem, remember not to ask them questions while they are
trying to chew or swallow, as this could lead to choking. Plan conversation for the time in
between bites. If the patient requires assistance to eat, sit next to them. This will allow Home
Health Aides/Personal Care Aides to be close enough so they do not have to overextend their
back while feeding the patients. Be patient as they chew and do not rush them by trying to give
them another bite of food while they are still chewing the first.

Food Appearance, Texture, and Portion Size

Select nutritious foods that are contrasting colors and textures. This adds to visual and chewing
appeal. Try to vary the colors of the foods being served. Avoid serving foods that are all one
color. Even for people who must have a mechanical diet, which is a diet that is altered in texture,
such as food that is pureed or finely chopped, different colored foods can be selected. For
example, select a green, soft vegetable (spinach), a red, crunchy fruit (an apple), and colorful,
chewy wild rice to go along with a piece of chicken and a glass of milk. This lends visual and
chewing appeal as the patient can see different colors and feel different textures as they chew.

Home Health Aides/Personal Care Aides should be observant about changes in their patient’s
appetite, and report any significant decreases of appetite to their supervisor. A poor appetite
should be investigated.

Some  possible  explanations of a  poor appetite are:

 Illness or depression. When we do not feel well or are depressed, our appetite is
diminished.
 Dissatisfaction with the food. If a patient does not like the food, they will be less likely to
eat. Find out their preferences and plan meals accordingly.
 Improper mouth care. A poorly cared for mouth can lead to chewing problems.
 Loose or broken teeth or problems with the gums or tongue. This makes chewing
difficult.
 Chewing difficulties. It is difficult to eat if chewing is painful.
 Improperly fitting dentures. Poorly fitting dentures makes eating difficult and painful.
 Patient fear of choking. Patients who are afraid to choke may hesitate to eat.
 Patient has confusion. Patients who are confused may forget what they are doing. They
may need to be encouraged to eat.
 Side effects of medications. Some medications decrease a person’s appetite.
Unit D: Food Shopping, Storage, Handling, & Food Safety

How to Save on Food Costs

Food can be expensive. Families on a tight budget may have trouble purchasing food. If Home
Health Aides/Personal Care Aides ever observe that a patient does not appear to have enough
food in the house, they should discuss this concern with their supervisor.

Here  are some tips for  Home Health Aides/Personal Care  Aides to keep in mind to help  cut f

ood  costs:

 Use coupons
 Look through weekly store circulars for items on sale
 Avoid convenience foods such as those that are pre-made, pre-packaged, or that come
from sections of the grocery store such as the deli, bakery, or salad bar. These items tend
to be much more expensive than if you purchased the ingredients and prepared it yourself.
 Check food labels for nutritional value.
 Purchase items such as produce when it is in season. It will be less expensive and fresher.
 Purchase items in bulk, but be aware of storage space. If it can’t be stored or used up
before it expires, you will not be saving money.
 Plan meals for a week at a time. Make a grocery list and stick to it.
 Use meat and protein substitutes that tend to be less expensive. Canned tuna, dried beans,
yogurt, and eggs are excellent sources of protein.
 When buying meat, check the expiration date to ensure you are buying the freshest meat
possible. Spoiled meat is wasted money.
 When possible, buy meat in bulk as costs tend to be lower. Cutting up a whole chicken or
cutting a pork roast into chops tends to be less expensive than buying individual pieces of
chicken or pork.
 Always stick within the allowed food budget. Never buy more than you are told or that
the patient can afford.

Food Storage

It is important to properly store food. Food that is improperly stored can lead to illness and is
also a waste of money as it will have to be thrown out. You can read more about refrigeration
and food safety at the United States Department of Agriculture
website: http://www.fsis.usda.gov/wps/portal/fsis/topics/food–safety–education/get–
answers/food–safety–fact–sheets/safe–food–handling/refrigeration–and–food–safety/ct_index
Here  are some things for  Home Health Aides/Personal Care  Aides to keep in mind, based on 
recommendations from  the United States Department of Agriculture (2015b):

 Buy cold foods and get them home quickly to avoid spoilage.
 Keep eggs in their original packaging on a shelf, not the door in the refrigerator. Since the
door is opened often, it risks the eggs becoming spoiled or cracked.
 Immediately refrigerate all meats, fish, poultry, eggs, milk, and milk products.
 Store dry food in covered containers. For example, dried beans, lentils, pasta, and rice
should be stored in clean, closed containers such as plastic storage containers. Ensure pests
cannot get to packaged food.
 Rotate stock. Use older items first. Make it a point to rotate cans and boxes before putting
away newly purchased items.
 NEVER store food with cleaning supplies.
 NEVER store food beneath plumbing, such as beneath a sink.
 Eggs, milk, milk products (cheese, yogurt), salad dressings, and mayonnaise should be
refrigerated.
 Always read the label to see if the product should be refrigerated once it is open. Items
such as ketchup can be kept stored in a cupboard BEFORE it is opened. Once it has been
opened, it must be stored in the refrigerator.
 Refrigerate fresh fruit only after it is ripe.
 Refrigerated food should always be covered or placed into a closed container and dated.
 Label items to be stored in the freezer with the name of the item and date if you
repackaged it. Once food is frozen, it can be difficult to tell what it is.
 Use frozen foods within six months.
 NEVER thaw frozen food on a counter at room temperature. This allows bacteria a
chance to multiply. Thaw food in a refrigerator overnight.
 Ensure refrigerators and freezers are in good working order. Keep a thermometer in each
to ensure the temperature is correct. Refrigerators should be kept at or below 40 degrees F.
Freezers should be kept at 0 degrees F.
 Cooked foods and leftovers should be used within 4 days.
 Raw meat, poultry, and fish should be used within 1-2 days.
 Keep refrigerator shelves clean and wipe up spills using hot soapy water immediately.
 Clean the refrigerator once per week and discard perishable items. Ensure there is enough
space between items in the refrigerator so that air can circulate and keep foods properly
chilled. Avoid overcrowding the refrigerator or freezer.

Safe Food Handling

When handling food, it is important to keep safety at the forefront of food preparation. You can
read more about safe food handling guidelines developed by the United States Department of
Agriculture at: http://www.fsis.usda.gov/wps/wcm/connect/18cece94-747b-44ca-874f-
32d69fff1f7d/Basics_for_Safe_Food_Handling.pdf?MOD=AJPERES#page=2

Home Health Aides/Personal Care Aides should follow these guidelines for safe food handlin
g:

 ALWAYS wash your hands before and after food preparation. Follow proper hand
washing guidelines. Always wear gloves when handling food.
 ALWAYS wash your hands after handling raw meat, poultry, fish, or eggs.
 Use one cutting board for raw meats, poultry, and fish. Use another one for vegetables,
fruits, and foods that are ready to eat, such as bread.
 Wash cutting boards in hot soapy water or run them through the dishwasher.
 Non Porous acrylic, plastic, glass, or wood cutting boards can be safely washed in the
dishwasher. Discard cutting boards that are worn or that have a lot of grooves where
bacteria can hide and contaminate food.
 Immediately wipe up spills from raw meat, poultry, and fish using an antibacterial
cleanser or a diluted bleach solution.
 Clean the workspace before and after food preparation using hot soapy water. Clean the
workspace and wash your hands after handling raw meats, poultry, or fish before moving
on to the next step in food preparation.
 Cutting boards and work surfaces can be sanitized using an antibacterial cleanser or a
homemade solution of 1 tablespoon liquid chlorine bleach to 1 gallon of water. Spray
solution onto surface, allow a few minutes to work, rinse, and then let air dry or pat dry
with a paper towel.
 Keep raw meat, poultry, and fish separate from other items in your food cart to avoid
juices contaminating other food. Place these items in plastic bags separate from other food.
 When storing raw meat, poultry, and fish in the refrigerator, place them in containers or
on a dish to prevent juices from dripping on other foods. Store these items on the lowest
shelf in the refrigerator to prevent dripping from higher shelves onto food stored on lower
shelves.
 Your clothes and apron should always be clean.
 Avoid coughing or sneezing during food preparation. If you cough or sneeze, step away
from the food preparation area and wash your hands immediately afterwards.
 Use clean dishes, bowls, pots, and dish towels.
 Use hot, soapy water to wash dishes.
 Never taste food and stir food with the same spoon. If you need to taste food, or the
patient would like to taste the food during food preparation, use a clean spoon to remove
some from the pot or pan, and then discard that spoon into the sink to be washed.
 Hot foods can be placed in the refrigerator immediately. Do not let them sit on the stove
or counter for several hours. This encourages bacteria to multiply.
 NEVER use a damaged can or a can that is bulging or dented. It could be spoiled and you
risk food poisoning.
 Do not eat raw eggs or use eggs that have cracks in them. Never undercook eggs. You
risk salmonella if you do so. Store eggs in their original container in the refrigerator.
 Use a food thermometer to ensure that meat is cooked to the proper doneness.
 When using a microwave, rotate the dish while cooking to avoid cold spots where
bacteria may live and multiply.
 When reheating food, bring it up to proper temperature. Sauces, gravies, and soups
should be brought to a rolling boil before eating.
 NEVER use foods that are moldy or have a bad smell to them.
 Keep hot foods hot (above 140 degrees F).
 Keep cold foods cold (at or below 40 degrees F).
 Do not refreeze food that has already been frozen.
 Always use food within the recommended time and by the expiration date. When in
doubt, do not use it and ask a supervisor for guidance.
Consumers have a right to expect that the foods they purchase and consume will be safe and of high
quality. They have a right to voice their opinions about the food control procedures, standards and
activities that governments and industry use to ascertain that the food supply has these characteristics.
While consumers, governments and others play an important part in ensuring food safety and quality, in
free-market societies the ultimate responsibility for investing the physical and managerial resources that
are necessary for implementing appropriate controls lies with the food industry - the industry that
continuously oversees the manufacture and processing of foods, from raw ingredients to finished product,
day in and day out.1

1
 Although in the broadest sense the food industry encompasses all those who are involved in growing,
processing, manufacturing or distributing food, from the farm to retail shops and restaurants, this article
focuses on manufacturers of packaged food products who have clearly identified products and a long
history of outreach to consumers.

While this is true, private enterprise recognizes that its success - measured in terms of profitability - is
completely dependent on consumer satisfaction. A reflection of consumers' satisfaction is their continuing
purchase of the same products. Food manufacturers and marketers thus have an investment in their
product identities (brand names) that they naturally wish to protect. It is in their interest, therefore, to
establish and administer the controls that ensure that their products do indeed meet consumer expectations
of safety and quality.

Food industry's view of food control

The food industry takes a broad view of the term food control, which includes a large number of factors
such as:

· safety - setting standards for toxicological and microbiological hazards, and instituting procedures and
practices to ensure that the standards are achieved;

· nutrition - maintaining nutrient levels in food ingredients and formulating foods with nutritional profiles
that contribute to consumer interest in healthful diets;

· quality - providing sensory characteristics such as taste, aroma, palatability and appearance;

· value - providing characteristics of consumer utility and economic advantage, involving attributes such
as convenience, packaging and shelf-life. Some of these factors, such as value, are exclusively in the
domain of industry and consumers; while others, such as safety, are shared interests of government,
industry and consumers.
Setting and implementing food standards
At the heart of all food control activities is the establishment of safety, quality and labelling standards.
These should be established on the broadest possible scale, in the recognition that food production and
marketing is truly a global industry. Governments and intergovernmental organizations such as the Codex
Alimentarius Commission have the principal role in establishing certain food control standards. It is the
role of national governments to establish uniform safety standards so that

· all consumers receive equal levels of protection;

· all food producers, whether domestic or foreign, are equitably treated through application of the same
levels of safety;

· consumers are informed about the standards of protection that are being applied.

In establishing safety standards, it is important that governments allow industry, the scientific community
and the public to contribute information and ideas. Standards and guidelines should be sufficiently
flexible to meet the needs of changing technology. At the same time, governments should apply those
controls that will assure real and meaningful safety benefits rather than merely perceived benefits.

Any safety standards that are developed have real costs for governments, industry and consumers.
Governments bear an obligation to monitor and enforce safety standards. Imposing stringent standards
usually increases the government's need for resources to enforce those standards; therefore standards must
be carefully set to take enforcement costs into account. Industry bears the primary responsibility for
implementing safety standards and must invest the resources such as staff time, systems, training and
equipment required to put the standards into practice. Ultimately, consumers will pay the costs for food
safety standards both through taxes to pay for the government control authorities' activities and through
food prices, which must reflect all the costs of production, including the cost of quality assurance.

Control of food safety and quality encompasses a broad number of factors, and governments must
carefully select the areas in which they will set standards. In particular, quality includes attributes of food
that are market concerns rather than public health matters. Governments should focus their attention and
resources on the public health aspects of quality and on those market-related aspects of quality and
labelling that will protect consumers against fraud and misleading claims.

Governments have three additional responsibilities related to the establishment of food controls. First,
they should conduct research into testing and evaluation methods for determining the safety of food
ingredients and processes. Governments need to have a good research base because food controls should
only be imposed on a sound scientific basis. Second, governments need to audit industry performance to
ensure that companies are complying with standards and that standards are being uniformly applied. This
involves training inspection personnel so that they have a good understanding of the technologies and
processes involved, as well as conducting inspections in an even-handed and fair manner. Third,
governments must communicate with industry and consumers about food controls. It is important that all
affected industry members know their obligations so that they can comply. It is also important that
consumers know what steps are being taken on their behalf to prevent misconceptions. Further,
consumers make a contribution to food safety in handling food after purchase and need to be informed
about proper procedures. Consumers and industry must have an opportunity to raise questions and
comment about the appropriateness of food control standards. In those areas in which governments
exercise premarket approval,2 this should be done in a timely manner in order to facilitate the application
of new technology.

2
 In the United States and a number of other developed countries, food ingredients that are regulated as
food additives, e.g. preservatives, emulsifiers and colours, require government approval before they may
be used in foods. The manufacturers of such food additives must submit scientific data that demonstrate
that these;: substances are safe. The standards of safety are established by laws and regulations and include
considerations of various types of toxicity, ranging from carcinogenicity and reproductive effects to
effects on digestion. According to Title 21, Part 170 of the United States Code of Federal Regulations, a
substance may be termed safe when there is "a reasonable certainty in the minds of competent scientists
that the substance is not harmful under the intended conditions of use". Once a food additive is
determined to be safe, it may be used in any food application for which it is approved.

Industry's efforts to ensure quality

Because of their necessarily intimate involvement with the science, technology, logistics and management
disciplines required to make the food supply system work, food manufacturers must be involved in the
standard-setting process at both the national and international levels. They are obliged to lend their
knowledge of the food supply system to this process to help guarantee its efficiency and effectiveness and
to ensure that it results in a supply of safe products. This involvement is beneficial to consumers and
governments as well as to industry, and this exchange of information should be facilitated by
governments.

To provide safe products, food industry management requires an organized way of defining and
controlling the relationships of critical factors in the complete food supply system, including product
conception, manufacturing and distribution and customer satisfaction. Quality assurance encompasses the
development, organization and implementation of a variety of activities directed at maintaining and/or
improving the safety and quality of products. It begins when the product is conceived and continues in the
selection and purchasing of raw materials and in processing, packaging, distribution and marketing.

It is axiomatic that safety and quality must be designed into a product; they cannot be achieved by end-
product testing. Therefore, quality assurance begins with the design and development of food products.
This is not only a laboratory or conference-room process; it also involves consumer participation in
evaluating new products. Before making a commitment to produce and market an important new product,
a manufacturer introduces it to small groups of consumers to obtain their reactions to a wide range of
matters, for example, usage and packaging as well as sensory satisfaction. Even after deciding to proceed
with the marketing of a product, a manufacturer will often introduce it in a limited, regional market to
obtain more widespread consumer reactions.

Quality assurance programmes are designed today with particular emphasis on the use of hazard analysis
and critical control point (HACCP) techniques, an approach that the food industry developed and has
voluntarily adopted on a broad scale for the past 20 years. This approach consists of several elements:

· conducting a hazard analysis to identify hazards and the needed controls;

· identifying the critical control points;
· establishing critical limits for each control point;
· establishing monitoring procedures;
· establishing corrective action procedures;
· establishing verification procedures to ensure that corrective steps have been taken;
· establishing appropriate documentation procedures to ensure that the control system is defined and that
records will be maintained to permit auditing and verification that the system is properly applied.

Training is an essential element of HACCP and of all the operating activities involved in producing safe,
high-quality food. All those employed in food production must be thoroughly trained in their
responsibilities to achieve this result. Indeed, manufacturers are providing extensive employee training, as
no HACCP programme could function without it.

Similarly, supplier and distributor controls are essential to the production and marketing of safe, high-
quality foods. Manufacturers must ascertain that the suppliers of their ingredients comply with strict
specifications. This is done by contractual arrangements, with verification by a strong system of testing
and, in many instances, on-site inspections of suppliers.

The objective of all quality assurance systems used by food manufacturers and processors is to produce
safe products that meet manufacturer's specifications, including the requirements established by
governments. The corollary is to prevent unsafe or poor-quality products from reaching the marketplace.
In the event that a system failure occurs, procedures should be in place for removing products from the
market as expeditiously as possible so that the health of consumers and the reputation of the brands
affected are protected to the greatest possible extent.

Communication between industry and consumers

An especially important activity of industry is communication with the consumers of its products.
Important and widely used methods of integrated communication are advertising, marketing and product
promotions, in which mass media and specialized media are used to secure consumers' attention and to
advise them about the availability of products and their uses and advantages.

Another important means of communication is product labelling, i.e. information that appears on the
product package or that accompanies it at the point of purchase. Labelling enables consumers to make
informed decisions and is intended for careful reading and understanding. It identifies the manufacturer
and provides instructions for safe and effective use of the product, as well as providing information about
contents, ingredients, health and safety features, preparation and storage.

Labelling and advertising that provide information about the health benefits of food products are
important and effective means of communicating with consumers about diet. A study by the United States
Federal Trade Commission (Ippolito and Mathios, 1989) concluded that health information in cereal
labelling and advertising achieved two important effects; it added significant amounts of information to
the market and changed people's eating habits; and it reached population groups that were not well
covered by government and general information sources.

Although advertising and labelling are perceived as one-way communication with consumers, in fact they
provide the basis for eliciting informed consumer responses to manufacturers about products. Consumers
frequently take the initiative to communicate with manufacturers and to ask questions about products as a
result of information they have seen in advertising or labelling or because of their experience in using the
item. Manufacturers also directly solicit consumers' reactions in advertising. In the United States, for
example, many manufacturers encourage communication by providing toll-free telephone numbers on
product labels and in advertising so that customers can call the company free of charge.
Indeed, consumer communication with manufacturers is so frequent and important that most
manufacturers have consumer affairs departments headed by a company officer to provide appropriate
attention to this function. This approach is used mainly in developed countries, particularly the United
States, Canada, the United Kingdom and some other European Community countries. It has two purposes:
first, to provide an active outreach programme to seek out consumers and provide information to them
about the company and its products; second, and most important, to obtain information and ideas from
consumers.

It is not uncommon for a single company in the United States to be contacted by consumers literally
hundreds of thousands of times each year through telephone or mail communications. These contacts are
carefully analysed and evaluated, for they are an important source of information about consumer
concerns and interests and provide useful insights about products. As a result of this communication with
consumers, manufacturers will modify products, provide new information or otherwise respond to
consumer interests.

Manufacturers conduct other outreach programmes for consumers in addition to those specifically
intended to test new product acceptability and those intended to inform consumers about product usage.
Many initiatives are undertaken voluntarily each year by individual companies and by industry
associations to provide the public with useful information about food safety and nutrition. These
initiatives are a valuable public service; they carry effective messages to consumers, educators, health
workers and others, and thus support and complement the efforts of national governments to fulfil their
public education responsibilities. Dissémination of brochures and other promotional literature, media
campaigns and interaction with local government officials and schools are among the techniques used to
educate consumers about food safety and nutrition. Often these activities are undertaken in association
with governments, professional groups and consumer organizations. In addition, informing consumers
about proper food handling should be a high priority for both government and industry.

Conclusion
A number of food control issues are currently being debated at the national and international levels,
regarding for example pathogenic microorganisms, allergens, genetically modified foods, contaminants
(including pesticides), irradiation and nutrition labelling. These are important and complicated matters
that require attention. The control issues are at various stages of resolution and considerable effort will be
required to resolve them in a scientific, practical and uniform manner. Industry recognizes that consumers
play an active, important role in the food control process through their participation in the standard-
setting process and discussions on scientific and technical issues. International bodies such as the Codex
Alimentarius Commission can contribute to understanding the issues and to achieving rational standards.
The food industry has an essential role in the resolution of these food control issues because of its vested
interest in the safety and marketing of foods. Further, because of its extensive scientific and technical
resources and experience with these issues, the food industry can make important contributions towards
their understanding and resolution. Lastly, for the same reasons, the food industry's communications
capabilities can benefit public understanding of the complex nature of the many issues that arise.

Clearly, food control involves many difficult issues. Some of these are highly technical, while others are
partly technological and partly political. The mutual goal should be to resolve these questions in a way
that takes into account the needs of governments, consumers and industry. For governments, there is the
need for enforceable standards that are convincing to both consumers and industry. For consumers, food
control systems must provide meaningful protection against real and important hazards. Finally, industry
needs standards that permit flexibility and efficiency in producing and marketing foods that will serve
their customers - the world's consumers.
 References:

FAO/WHO. 1991. Report of the FAO/WHO Conference on Food Standards, Chemicals in Food and

Food Trade. Rome.

Hotchkiss, J.H. 1992. Pesticide residue controls to ensure food safety. Critical Reviews in Food Science
and Nutrition. 31(3); 191-203.

Principles of nutrition, nutritional surveillance and assessment in specific populations including

its short and long term effects

Health and Social Behaviour: Principles of nutrition, nutritional surveillance and assessment in

specific populations including its short and long term effects
Principles of nutrition

Definitions
Nutrition is the study of the influence of food intake on health and wellbeing.
Public health nutrition involves studying the relationship between dietary intake and disease
(nutritional epidemiology) and applying the knowledge gained to help prevent disease in the
population (nutrition intervention).
Dietetics is the application of nutritional knowledge particularly tailored to individual needs. It
generally involves the use of diet in the treatment and management of disease.
Energy
 Energy is needed by the body for a number of functions.
 Energy is provided by the diet (food and drinks) in the form of carbohydrate, proteins,
fats and alcohol.
 Energy can be measured in either joules (J) or calories (cal). One calorie is equivalent to
4.184 joules or one kilocalorie (kcal) is 4.184 kilojoules (KJ).
 The amount of energy made available to the body by carbohydrates, proteins, fats and
alcohol varies: per gram of carbohydrate (starch and sugar) provides 16KJ (3.75 kcal), per
gram of protein provides 17KJ (4 kcal), per gram of fat provides
37KJ (9kcal), and per gram of alcohol provides 29KJ (7 kcal). Summary provided in table 1.
Table 1: Amount of energy made available by different sources of energy 

Energy Source (per gram) Kilojoules Kilocalories

(KJ) (kcal)

Carbohydrate 16 3.75

Proteins 17 4
 Fats 37 9

Alcohol 29 7

 
 Energy balance occurs when energy intake (food and drinks consumed) equals energy
expenditure. An individual in energy balance will maintain their weight. Increases in energy
intake/decreases in energy expenditure will lead to weight gain and
decreases in energy intake/increases in energy expenditure will lead to weight loss.
 Energy expenditure is primarily determined by body size, body composition and physical
activity.
 The actual amount of energy needed will vary from person to person and depends on
their basal metabolic rate (BMR) and their level of activity.
 Energy requirements increase by approximately 800 KJ/day in the last trimester of
pregnancy, and by about 2100 KJ/day during full lactation.
Carbohydrate
 Carbohydrate is needed by the body’s tissues for energy.
 There are two main types of carbohydrates: sugars and starch. Both sugars and starch
provide energy.
 Sugars can be subdivided into intrinsic and extrinsic. Intrinsic sugars are those that are
part of the cellular structure of foods e.g. sugars in fruits and vegetables. Extrinsic sugars are
those that are not part of a cellular structure e.g.
lactose in diary products, or honey, fruit juices and confectionary (also known as non-milk
extrinsic sugars).
 Complex carbohydrates include starch and non-starch polysaccharides. Starch is found in
potatoes, bread, rice and pasta and non-starch polysaccharides are found in fruits, vegetables,
legumes and whole-grain cereals.   
 Fibre is a type of carbohydrate found only in plants. Fibre cannot be digested so it does
not provide energy but is needed for a healthy digestive system.
 At least half the energy in our diets should come from carbohydrate, mostly as starchy
carbohydrates.
 Frequent consumption of food and drinks containing non-milk extrinsic sugars can
increase risk of tooth decay.
Protein
 Protein is needed by the body for growth and repair and is able to provide energy when
the diet is low in carbohydrate.
 Protein is found in animal and plant cells in a variety of foods e.g. meat, fish, eggs, dairy,
cereals, nuts and pulses.
 Proteins are made up of amino acids. There are approximately 20 different amino acids
found in foods.
 Amino acids are broken down into 2 groups: essential and non-essential.
 Essential amino acids are those that must be supplied by the diet: Leucine, Isoleucine,
Valine, Threonine, Methionine, Phenylalanine, Tryptophan, and Lysine.  Histidine is an
 essential amino acid for children (not adults) because
children are unable to produce enough to meet their needs.
 Non-essential amino acids are those that the human body is able to make itself (by
breaking down amino acids in protein that are eaten and absorbing them to make other
proteins in the body).
 Different foods contain different amounts and combinations of amino acids.
 Vegans and vegetarians can get all the protein they need by combining different plant
sources of protein, e.g. pulses and cereals.
Fat
 Fat is needed by the body for energy, for providing essential fatty acids, and for carrying
and absorbing fat-soluble vitamins (A, D, E and K). 
 Fat is found in meat/meat products, dairy products, fish, eggs, fruit, vegetables, nuts,
cereals and cereal products (including cakes and biscuits), savoury snacks and oils.
 Fats are described as either saturated or unsaturated depending on the proportions of fatty
acids present. Butter is described as a saturated fat because it has more saturated fatty acids
than unsaturated fatty acids.  Olive
oil is described as an unsaturated fat because it has more mono- and polyunsaturated fatty
acids than saturated.   
 Saturated fats are usually found in animal products and unsaturated fats in vegetable
sources. There are exceptions to this rule.  Unsaturated fats may be converted into saturated
fatty acids by hydrogenation.
 Essential fatty acids (EFAs) are those that must be supplied in the diet because the body
is unable to make them. There are two essential fatty acids: alpha linolenic acid (n-3) and
linoleic acid (n-6). The body is able to
synthesise other fatty acids from these two essential fatty acids.
 Fat should not exceed more than one third of a human being’s energy intake and a high
intake of saturated fat can have adverse effects on health.
Vitamins
 Vitamins are nutrients that are needed by the body in very small amounts for a variety of
functions carried out by the body e.g. co-factors in enzyme activity and antioxidants. 
 Different foods supply different amounts of vitamins.
 Vitamins needed by the body include: vitamin A, D, E, K (fat soluble vitamins), C, B1,
B2, Niacin, B6, B12, Folate (water soluble vitamins).
 Vitamins, except vitamin D, have to be provided by the diet because the body is unable to
make them.
 Vitamin D can be produced by the action of sunlight on the skin.
 Each vitamin is required in different amounts for a number of different processes in the
human body.
 The amount of each vitamin needed by the body changes during a person’s lifetime.
Minerals
 Minerals are nutrients that are needed by the body for a variety of functions e.g.
formation of bones and teeth, as an essential constituent of body fluids and tissues, for nerve
function and components of enzyme systems. 
 Different foods supply different amounts of minerals.
 Minerals needed by the body include: calcium, magnesium, phosphorus, sodium,
potassium, chloride, iron, zinc, iodine, fluoride, selenium, copper, chromium and manganese. 
 Each mineral is required in different amounts for a number of different processes in the
human body. Some minerals are needed in large amounts (e.g. calcium, phosphorus,
magnesium, sodium, potassium and chloride) and others in smaller amounts
(e.g. iron, zinc, iodine, fluoride, selenium and copper).
 The amount of each mineral needed by the body changes during a person’s lifetime.
Water
 Over half the human body consists of water, and regular fluid intake is essential for the
correct functioning of the body.  For example, it acts as a lubricant for joints and eyes, helps
for swallowing, provides a medium in which most
reactions in the body occur, helps eliminate waste, helps regulate body temperature. 
 The amount of fluid needed varies between people and according to age, time of year,
climatic conditions, diet and levels of physical activity.
 Water can be obtained from the direct consumption of water and other drinks (e.g.
squash, tea, coffee) and through the consumption of food (e.g. fruits and vegetables).
The Eatwell Plate, formerly the Balance of Good Health, has been designed by the Food
Standards Agency to make healthy eating choices easier to understand for individuals
(http://www.food.gov.uk). 
The plate is a visual representation of the five types and proportions of food people need to
maintain a healthy and balanced diet.  The five types are broken down into the following
categories:
1. Fruit and vegetables
2. Bread, rice, pasta, potatoes, and any other starchy foods
3. Milk and dairy foods
4. Meat, fish, eggs, beans, and any other non-dairy sources of protein
5. Foods and drinks high in fat and/or sugar.
Food that represent the largest groups/proportions in the Eatwell Plate should be eaten most
often, and food from the smallest groups/proportions should be eaten least often.
Nutritional surveillance and assessment in specific populations including its short and long term
effects
Nutritional surveillance involves the routine collection and collation of data which inform us
about the nature and causes of nutritionally related disease. Initially, these were diseases arising
from nutritional deficiencies (e.g. anaemia,
rickets, and osteoporosis) but they now include a whole range of conditions (e.g. obesity,
hypertension, cancers, coronary heart disease, and dental caries).
Nutritional surveillance traditionally involved only dietary surveillance by evaluating national
food productions, household expenditure on food, household studies of food purchases and
consumption and occasionally studies of individual
consumption. These contribute to the Food and Agriculture Organisation’s data on national food
balance sheets. A surveillance system that links dietary and health surveillance (using indices of
health such as weight, blood pressure, serum
cholesterol and anaemia) allows more effective evaluation of the dietary contributors to diseases
 such as obesity, diabetes, hypertension and cardiovascular disease. In the UK, the National Diet
and Nutrition Survey (see Markers of nutritional
status, nutrition and food) links diet with indices of health. It was established to compare current
intakes of nutrients with the various Dietary Reference Values (DRVs) to assess where problems
exist in the population (e.g. high salt intake and low
consumption of fruit and vegetables) and to assist with informing government policy.
Surveillance can identify short-term nutritional effects which includes those conditions that are
responsive to acute changes in diet:
 High intake of sugary foods – increased dental caries
 High intake of salt – increased blood pressure
Surveillance can also identify long-term nutritional effects, which includes those conditions that
may not occur for several decades:
 Lack of fruit and vegetable intake – colon cancer
 High and prolonged intake of alcohol – colon cancer
 Lack of breastfeeding – breast cancer
 Central obesity – type 2 diabetes
 Lack of dietary calcium – osteoporosis

References
 British Nutrition Foundation http://www.nutrition.org.uk/ [accessed 01.08.08]
 Food Standards Agency http://www.food.gov.uk/ [accessed 01.08.08]
 Food and Agriculture Organisation of the United
Nations  http://faostat.fao.org [accessed 01.08.08]
 Garrow J., James W. and Ralph A .Human Nutrition and Dietetics (10th Edition)
 Lewis, G. Sheringham, J. Kalim, K. Crayford, T. Mastering Public Health: A
postgraduate guide to examinations and revalidation. The Royal Society of Medicine Press
Limited.

https://www.healthknowledge.org.uk/public-health-textbook/disease-causation-diagnostic/2e-
health-social-behaviour/principles-nutrition