Data sources and methods

Biological Nutrition Indicators

Childhood diarrhoeal deaths in seven low- and middle-income countries
The indicator refers to resources collected and pooled by public agencies including all the revenue modalities. Landscape analysis on countries' readiness to accelerate action in nutrition , Blaine committed suicide by jumping off a parking garage in ; Scott was charged two years later with racketeering, and prosecutors called his tribal arrangement a sham. The following are the sources of current non-income measures data reported in New Zealand: According to a study by the International Agency for Research on Cancer , "In the developing world, cancers of the liver, stomach and esophagus were more common, often linked to consumption of carcinogenic preserved foods, such as smoked or salted food, and parasitic infections that attack organs. An introduction for students and health professionals Cambridge: Scott pioneered what he thought was a clever legal loophole that would give him access to that market:

Nutrition Landscape Information System (NLiS)

Water fluoridation

IN addition, this study also assesses brominated fire retardant concentration and toxicity of breast milk collected from a subsample lactating firefighters. Alexandre Laudet is an internationally recognized expert in addiction recovery.

A social psychologist, her main goals are to build the science of recovery and to help translate findings into services and policy that create opportunities for long-term recovery and improved quality of life for people with substance problems. She leads the Center for the Study of Addictions and Recovery and provides training and consultancy to government and community-based agencies on promoting opportunities for sustained recovery.

She regularly publishes in peer-reviewed journals, presents at national and international conferences, and serves on the editorial board of several scientific publications. At the Vera Institute, Dr. Mateu-Gelabert was lead researcher of a National Institute of Justice grant that focused on adolescent violence, gangs, and immigration. Mateu-Gelabert has over fifty peer-reviewed publications and has given numerous scientific presentations throughout the world.

He was visiting professor at Hunter College School of Public Health and has provided seminars at several universities. In addition to his research and teaching experience, he is also a founding member of the Social Art Collective, a group that merges artistic and professional expertise using art as a conduit to generate social change. Matusow served as the Project Director on a nationwide survey of US Drug Courts on barriers, attitudes, and availability of medication assisted treatment in drug courts.

The results of this survey are cited in the National Association of Drug Court Professionals Best Practice Standards of as a rationale for a policy statement that Drug Courts learn about medication assisted treatment and obtain expert consultation from addiction physicians. As chair of the symposium entitled Drug Court Perspectives: Matusow moderated the discussion of evidence-based practices in Drug Courts with colleagues from the field and conducted a Webinar on MAT for the Center for Court Innovation, on which he serves on the Advisory Committee.

Other research interests include dual focus mutual aid for those with co-occurring mental health and substance use disorders. Larry Nuttbrock earned a PhD in sociology from Case Western Reserve University, specializing in medical sociology, and completed three years of post-doctoral training in psychiatric epidemiology from Columbia University.

His research focuses primarily in the areas of obesity, tobacco control, and cardiovascular disease prevention with an emphasis on minority populations and military and first-responder health. Poston has published over peer-reviewed journal articles and book chapters and has presented at numerous national and international conferences and meetings on the etiology, assessment, and management of obesity, cardiovascular disease, and tobacco use.

His research includes studies of mental disorders, substance use, and transmission of infectious diseases, such as HIV and hepatitis C, through social networks and populations. He is an experienced methodologist and quantitative analyst, with expertise in clinical assessment, scale development, clinical trials, survival analysis, mixed effects modeling, meta analysis and agent-based modeling.

Pouget is currently funded by the National Institute on Drug Abuse as a Principal Investigator of a study to develop new measures of the pathways between social structural changes and HIV epidemics, and as a Co-Investigator of a study to assess change over time in risks of opioid misuse and overdose among recent US military veterans.

She is currently working on a project that examines co-parenting among cohabiting low-income black couples with children who live in high poverty areas in New York City R01HD , PI: The study seeks to examine how the family formation paradigm of transient domesticity influences parenting decisions, parental responsibilities, and child development.

It employs the mixed-methods approach of a longitudinal panel study and an embedded ethnography over a five year period. Reid received her PhD in sociology from the University of Texas at Austin, where she focused on social inequalities, family, and social policy.

His research addiction-related interests include development and evaluation of psychosocial interventions, eLearning and eTherapy applications, and prevalence studies. Most of his research activities have been funded by the NIH. Rosenblum is also PI on a Health and Human Services grant designed to develop policy recommendations for emergency preparedness and response for opioid treatment programs and, is a Co-investigator Dr.

Alexander Bennett is PI on a prospective longitudinal study that is examining factors contributing to overdose among young veterans. She has worked extensively with people who use drugs heroin, opioid analgesics, cocaine and been involved in research in the following topic areas: Simmons is co-editor and co-author with Drs. She has also expanded her advocacy and training interests.

She has developed two computer-based, overdose-prevention training modules with funding from NIDA: Simmons is working with Dr. She broadly identifies as a health and social geographer. Her research interests include infectious disease, women's health, political ecology of health and disease, disease surveillance, health policy and global health. Her research expertise lies in studying the distribution of HIV and identifying the sociopolitical and structural responses to these distributions.

Her current research investigates injection drug use-related HIV, and measuring the need for service provision and availability of services to this highly stigmatized and largely hidden population. This research focuses on the nexus of health, social, and political geography in measuring the geographic distribution of services, response and prevention of HIV among injection drug users. She has conducted reproductive health research in Nepal focusing on use of condoms and HIV knowledge among Nepalese women, and how physical landscape bears on this knowledge.

Tempalski earned a Ph. She earned an M. H in Community Health Education at the same institution in She completed a B. NDRI , a private, not-for-profit c 3 organization, has conducted substance use and other bio-behavioral research nationwide and throughout the world.

Drawing on the expertise of our interdisciplinary professional staff and our partners such as medical centers, treatment and prevention programs, universities, CBOs, industry and government NDRI has advanced public health across diverse populations including high-risk and underserved persons, uniformed services, youth and veterans. In addition to its focus on addiction, NDRI, organized under specialized institutes, has generated scientific discoveries associated with infectious diseases particularly HIV and Hepatitis C , overdose, chronic pain, prevention of cardiovascular disease and cancer, tobacco control and criminal justice.

Children's growth and immunisation can be readily monitored in schools. Partnerships between health workers and agencies can provide access to children and needed support to all participants.

Other potentials include involvement in teacher training and medical doctor training programmes, where the schools invite students into their classrooms to learn as well as teach.

Libraries can also provide important links between the school and the larger community. Volunteers can be trained in, and work with schools to broadcast programmes, motivate audiences, and coordinate nutrition and other health-related messages to children and the broader community.

Implementing special or system wide promotions Linkages that occur at the local level can be extended to district, regional or system-wide programmes as well, especially in the area of nutrition surveillance and child growth monitoring programmes, other Ministry of Health programmes, child care centres, women's development programmes, home economics training for women's groups, or any programme that promotes home food production or home consumption.

In fact, linkages should be systematically promoted at all levels, from local community administrators and extension workers to district committees, provincial government officials, and high level government officials. Such linkages should be used to frame and institute policy changes at each of these levels to assure that nutrition education and communication programmes, especially highly successful efforts, are sustained over time.

Facilitating policy development There are many areas where government policy has an impact on nutritional status, food security, and nutrition education at national, regional, and local levels.

Some of these areas include agriculture, including animal husbandry, crop production, fisheries, and forestry; health; environmental policy; women's development; population; urbanisation; international economics; and trade agreements policy. Education, advertising and consumer policies are discussed less often in terms of their interaction with nutrition, but are probably as important.

Policy is inalienably a matter of politics. At the same time, the school system is charged with a custodial responsibility for children. It therefore seems that schools should also be involved in policy development to protect and sustain children's development. Food and nutrition policies are integral to that interest. It should be recognised that the strategies for poverty alleviation have changed significantly in the past decade or so. It is now accepted by experts in behaviour change and nutrition communication that people's participation is fundamental for any sustainable improvement in the welfare of the poor.

Participation means local people organising to shape the terms of the social, political, and economic processes that affect them. In other words, the people create organised demands upon governments and agencies as well as private and commercial bodies to meet their needs using indigenous expertise and technologies.

Participation also implies capacity building and the strengthening of local institutions Haralambous, Naturally, agenda-setting and policy formation play an important role in this effort. Food and nutrition policy may be among the most important and most obvious to people at the local level and local schools may be a natural focal point for such organization and participation.

However, in some countries, the style of government does not permit the type of citizen participation discussed here. Mass media and social communication Using mass media to increase awareness The mass media were not used widely in nutrition communication until the s. Before then, nutrition communication relied almost entirely on face-to-face instruction in health clinics Lediard, Many early efforts using mass media in nutrition communication yielded disappointing results.

This was often because the quality of many past programmes was inferior due to a lack of training or preparation, inadequate resources, or because it was used for inappropriate purposes. Media cannot, for example, cure poverty Lediard, But, neither can media be relied upon to change behavioural patterns by itself. Media-based nutrition education projects are now legion.

Some have produced changes in behavioural practices, such as campaigns for oral rehydration salts in Egypt, the Honduras, Gambia, and Swaziland, but changes in nutritional status are rare Hornik, It is now known that the best use of media, particularly for stand-alone media campaigns, is to build public awareness about a new issue, problem, or resolution.

One of the most powerful aspects of the media is its ability to set the public's agenda. That is, media shapes what people view as important in the world, and it identifies and defines concerns, issues and problems. This is another form of building awareness. Other forms of two-way communication may be needed to persuade the public to adopt a different behavioural approach, for example, to infant feeding.

Developing single message strategies Today, the strategies used to develop mass media communications in nutrition are taken from social marketing literature. Several sources provide good descriptions of how to plan persuasive messages such as Andrian , Rasmuson et al. Generally, four questions are posed at the beginning stages. Who is the target audience or consumer for the communication? What is the product?

What is the message? What are the channels of communication? Market research is used to answer these questions and the media messages and campaign are designed accordingly.

There are four elements involved in designing an effective single message Hornik, Some of the key points include creating messages that are clear, concise, credible, and easy to remember, all from the target audience's perspective. Above all, the messages need to appeal to the target audience's perceived need for information. The most effective messages include a precise behaviour change recommendation, use a memorable slogan or theme, and are presented by a credible source in a positive, uplifting style that is not offensive to any member of the target audience US Department of Health and Human Services, Finally, a focus on motivation, not just information, is needed.

Of course, all media should be thoroughly pre-tested with members of the target audience, as described earlier in this chapter. A variety of media may be used to communicate a single message, including bulletin boards, booklets, pamphlets, posters, radio and television messages, newspapers, community bill boards, and promotional give-aways to name just a few.

Promotional give-aways are products that carry slogans or short messages including calendars, T-shirts, caps, vests, ball point pens and pencils, notepads, pins, and bags. Effective promotionals are items that are regularly used by the recipients, routinely reminding them and those with them, of the message. Print messages should specifically avoid jargon and technical terms, abbreviations and acronyms, small type, and long words, sentences, and paragraphs.

Text should be written in an active voice and use organising headers, bold print and "boxes" to highlight important points. Graphics should be immediately identifiable to the target audience, relevant to the subject matter, and kept as simple, but up-to-date, as possible. Short second public service announcements, spots, or plugs on radio or television should also recommend a specific action, make a positive not a negative or fearful appeal to the audience in simple language with a memorable theme, music, visual, or character to deliver the message.

Even the best designed message needs to be repeated many times if it is to build general public awareness or accomplish any other outcomes. Any form of mass media has a limited effect when it is delivered only once or for a short period of time. The audience needs frequent exposure to the message, even if it is familiar, but especially when it is new or novel to them. The greater the reach, frequency, and duration of a mass media message, the greater the number of people who will be reached and the greater the likelihood that change will occur.

Using mass media as the centre piece for a multi-channel campaign A fundamental dilemma in nutrition communication is that interpersonal communication may be more effective at promoting behaviour change, but its reach, and ultimate impact, is limited by the size of the audience Gillespie, The mass media reach far more people in far less time. However, single messages are unlikely to change strongly held attitudes or behaviours. Mass media campaigns are defined as planned, large scale, multimedia efforts to communicate a single concept idea to a target population s in a prescribed amount of time Wallack, Generally, mass media campaigns: Mass media campaigns may speed the rate of behaviour change, but rarely initiate it.

They can also play a role in facilitating one or more steps in the behaviour change process. They work best, however, in synchrony with other intervention components. Several family members should be targeted by messages in order to facilitate a supportive home environment for the desired behavioural changes. Different media have different effects on different people. Heavy users of the media react differently to media messages than light users.

Heavy users those who listen to or watch media for four or more hours a day tend to rely on the media for information about their community and the larger society. Some people are interested in certain topics e. A multi-channel nutrition communication campaign that introduces new messages with star personalities drawn from these interest areas can take advantage of this. For example, in Brazil, the captain of Brazil's World Cup football team, a well-known male musical entertainer, and three well-known television actresses were used in second television commercials to support breast-feeding ad Kahn, Alternatively, nutrition messages can be incorporated into pre-existing heavily watched media e.

Other communication channels can then be used to reinforce these messages and stimulate behaviour change, especially at the local level.

In Thailand, for example, Buddhist monks were very influential within communities, but mass media was useful for initiating community campaigns for change Smitasiri et al. Facilitating pro-active use of mass media Several factors contribute to the potency of any media campaign. Media effects are limited when interpersonal relations and prior beliefs conflict with the message. Media effects can be powerful when they coincide with interpersonal relations. When the public hears a message that makes them uncomfortable, they may selectively pay no attention to it, misinterpret it, fall back on their own rationalisations, disbelieve it, or attack the source's credibility to reduce their discomfort with the message.

People will be less resistant to a new message if it is introduced by opinion leaders in the local community or general society. Only sound market research prior to message development can anticipate and accommodate the conflicts the target audience might have with the messages.

Because multi-channel media campaigns are by definition complex, partnerships are highly recommended to facilitate their development, implementation, and evaluation. Nutritionists need to form partnerships with social scientists and communication or media specialists. In addition, multi-sectoral partnerships are also routinely required. They may involve private industry, non-governmental agencies, government agencies, religious leaders, and grassroots participation at the local level.

Policy-makers should, in particular, be thought of as a target audience and be included in communication design. Desired changes are most likely to occur within a supportive environment for change. Only broadly based partnerships can create that context. Authoritarian-type governments may provide a better context for a co-ordinated, multi-sectoral communication programme than more democratic-type governments where communication industries are independent, commercially oriented, and owned by many different people.

In recent years, innovative mass communication approaches have been effectively integrated into mass media campaigns to create widespread attention, interest, motivation, and recall for particular nutrition, health and population messages. One approach has been called "enter-educate.

The enter-educate productions are aired over radio and television, featured in magazines and newspapers, and even through live shows in shopping malls. A similar approach, "info-tainment", combines the objectives of informing while entertaining the public via comedy and drama programmes over radio, television, and comics.

Info-tainment has also been used by community development workers to reinforce their interpersonal approaches. Using mobile audio-visual vans, they present certain video documentaries on agricultural technology, alternating with a full length movie of the audience's choice. The advertising industry has also introduced "values advertising" and "development plugs" to inject messages with developmental value in their advertisements.

Enter-educate, info-tainment and developmental plugs are unlikely to work effectively unless they are created by a team of nutrition educators and mass media specialists. Inter-sectoral partnerships can accomplish two objectives. They may increase the broadcast of more positive nutrition messages, and thereby change the communication mix. They may also decrease the broadcast of negative messages as partners recognise the number and kind of negative messages already broadcast in the mass media.

They may then voluntarily withdraw certain negative messages or work to change some of those messages. Training media journalists There is a shortage of media specialists in developing countries, especially those associated with ministries of health or education. In some cases, a ministry of agriculture may have access to communication expertise.

Health ministries and education ministries should be encouraged to create positions for media specialists and include them in the earliest stages of programme development. They should also try to work inter-sectorally to support training for media specialists and create an infrastructure to support their activity. Media journalists tend to be trained as generalists.

Few have the expertise to correctly communicate health and nutrition information to the public. Therefore, multiple training programmes are necessary to promote effective nutrition communication campaigns: This will require training on how to incorporate innovative technologies into programme planning as well as the use of traditional communication modalities.

This will require additional training in the behavioural and social sciences. Training of media journalists and communication experts can be costly in itself, but the Union of National Radio and Television Organisations of Africa URTNA has developed an effective model that may be appropriate in many parts of the world. URTNA has 48 member countries that team together to sponsor training sessions and an exchange of programmes and teachers across international boundaries.

In a three year period, they have graduated technicians from their training programmes and have exchanged over 2, radio and television programmes for broadcast. Regular meetings held every two weeks between communicators from national broadcast organisations and experts in family planning and maternal and child health are considered a key element in this programme's success. The meetings foster open communication between these two fields and stimulate teams in different countries to produce higher quality programmes Demena, Effective training programmes are needed, but are not sufficient, for the creation of successful communication programmes.

Successful programmes require not only the incorporation of communication technologies, but also institutional infrastructure and a supportive policy and philosophy to sustain such communication efforts across a region or country. Work-site programmes Establishing the benefits to employers and employees Healthy work-site programmes became popular in the s and nutrition education is a common component of these interventions. They have been reported in telephone companies, police departments, Fortune companies, and small local businesses.

Healthy work-site programmes emphasise disease prevention or health promotion. For example, it is less costly to prevent hypertension via education than it is to treat it via medication. Some of these chronic diseases are related to food habits and choices. Since these food-related behaviours are not fixed, communication and other interventions designed to modify these behaviours may decrease the risk associated with these diseases, and presumably increase worker productivity, decrease company costs and improve the company's public image.

Work-site nutrition education programmes are appealing for many reasons. From the employer's perspective, they may increase workers' productivity, decrease absenteeism and turnover, improve recruitment of personnel, and generally improve company morale.

From the health-care provider's perspective, work-site nutrition education programmes provide access to workers who may not otherwise be served by the health-care community, enable cost-effective and efficient screening opportunities, provide a forum where nutrition information can be efficiently disseminated, and an environment where behaviour can be monitored and social or peer influences can be used to reinforce behaviours.

From the employees' perspective, work-site nutrition education programmes may be attractive because they are convenient, meaningful, credible, and ongoing. If successful, they can decrease health-care costs and improve the happiness, health, and quality of life for individual workers and their families Johnson, et al. Screening and needs assessment Groups of participants can be screened, counselled, and followed in a time-efficient and cost-efficient way Johnson, et al.

These screening data should be used to design appropriate interventions and communication campaigns for the company as a whole and possibly, for individuals within the company. Baseline data should be collected about the individual workers, their home and community environment, and their employers and work environment before a work-site programme is designed and implemented. Assessment of the work-site should include management style e.

Some of these variables are important in order to determine how to introduce and sustain a work-site programme in the most acceptable manner to both workers and management. Catering programmes, nutritional improvements of food services, and point of sale promotions Many family members, including school children, spend a major part of their day in the workplace or in school. This means that they must eat at least one meal and about two snacks outside the home.

This has led to the growth of the food service industry, particularly street-food vending in developing countries. The street-food trade is a source of livelihood for many people among the low income group, and is a source of cheap food for low to middle income people. Recognising the need to protect consumers against unhygienic and low quality street-foods, FAO supported pilot projects on the improvement of street-food safety and quality in several developing countries in Asia and Latin America.

An education and communication component was built into the projects, addressing consumers on one hand, and educating street-food vendors on the other, on topics like basic nutrition, food preparation, hygiene, and sanitation. Seminars and training in the workplace had been successfully carried out for both groups, reinforced by well researched and properly designed print and audio-visual media such as posters, flyers, brochures, flipcharts, and training modules.

In these programmes, employers offer their workers choices of nutrient-dense foods e. These foods may or may not be offered along with other less desirable choices. Often nutrient information in the form of labels or posters accompanies the foods in the cafeteria environment. Entrepreneurial lunch wagons can offer nourishing food to field work-sites that are remote from feeding facilities.

Facilities for washing before eating are also important. Some companies subsidise in-plant food services partially or totally, making them nutritious, attractive and convenient to employees. Some employers have also added nutrition awareness games and incentive raffles e. Research studies have generally produced positive trends in dietary intake but often only outcomes over a short period of time are evaluated.

Most of the catering programmes reported in the literature have concentrated on heart health issues, but other issues that could be considered include use of fluoridated water, iodised salt, adequate protein, clean water, and iron. Nutrition education as a stand-alone work-site programme Nutrition education that is not connected to any other form of health education at the work-site can be described as a stand-alone programme.

Carefully targeted materials and classes can have a significant impact on nutritional status, not only for employees, but for their family members as well.

The success of stand-alone programmes depends on how supportive the company environment is of the recommendations. Stand-alone programmes are unlikely to work if they include only information dissemination. Generally, work-site nutrition education programmes require supportive environments such as cafeteria or food catering programmes as described above. It is essential that employees have access to appropriate food choices.

Release time from work and employer commitment to the programme are also viewed as important to success. Employees respond best to healthy work-site programmes that are simple, practical, and relevant and that allow them to participate actively in the learning activity during work time.

Eating pattern messages which include specific foods or brand names and behaviourally oriented programmes are better accepted than messages containing medical jargon and lengthy background explanations McCarthy et al. Nutrition education as part of an integrated health programme Nutrition education can also be integrated into a more comprehensive health programme at the work-site that might include, for example, smoking cessation programmes, drug and alcohol education, stress management, child-care education, and breast-feeding support.

It may be combined with an exercise or fitness programme or more often, a weight control programme. Work-site nutrition education programmes can also be integrated into the broader community. Community-based wellness councils, for example, team non-profit health organisations with small businesses and vendors within and across communities. The councils do not compete.

Rather, they bring together local providers with common interests to share ideas and resources to offer healthy work-site programmes that they cannot afford themselves. Often they share newsletters and strategies with one another.

Wellness councils may publish "how to" guides, hold delegate meetings and annual meetings, or share the cost of bringing in an outside consultant or nationally known speaker Kizer, Ideally, community-based wellness councils match local expertise to local needs and help small businesses lever their limited resources for maximal impact.

Together, they may also affect an entire community to create a more healthful and supportive environment for its citizens. Number of work-site programmes Given the advantages of, and opportunities for work-site nutrition education programmes, it is interesting to note their small number, especially in developing countries.

This may, in part, be due to the lack of an infrastructure for these programmes, but there are several other considerations as well. Work-site programmes have been criticised because many tend to serve only healthy workers or well-paid, professional employees, neglecting those in greatest need. They may increase personnel costs to the company, at least initially, and they may subject a company to liability concerns Ostby, Relatively little attention has been given to developing methods for institutional commitment, and this seems critical to programme success.

Conclusions This review has led us to draw four broad conclusions: These conclusions are further developed below. Nutrition education and communication should be thought of as an integral part of a country's development plan. The nutritional status of a country's population is an important indicator of national development.

The causes of poor food habits are complex. The simple provision of food or supplements does little to resolve long-term nutritional problems. Nutrition education and communication can have a significant impact on a population when there is political stability, social coherence, and a favourable economic climate. Nutrition education and communication provide people with the knowledge, know-how, motivation, and reinforcement to empower them to effectively address their own long-term food and nutrition problems.

Changing food and nutrition behaviours to improve nutritional status at a country level is a long process comprising many steps in many sectors at many levels. Recognition of this fact may call for a reorientation in thinking about nutrition programmes. A long-term, holistic view of nutrition education and communication is needed, with nutrition education seen as a central component, not merely as a tool to use on occasion.

This holistic view may also require a re-examination of the philosophy, processes, strategies, messages, and methodologies used in nutrition interventions. It involves many actors including policy makers, planners at community and national levels, educators and communicators, NGOs and other providers of resources, field support staff and service delivery personnel, community leaders, and finally, mothers, children, and other family members.

Nutrition education and communication programmes need to be comprehensive and coordinated for effectiveness. Mass media messages, although cosmetically perfect, will be ineffective as stand-alone interventions. Rather, several communication channels should be used. At least some of these channels should involve two-way communication. These activities require an administrative infrastructure, including organisational structure and managerial mechanisms to support a coordinated effort.

Usually these efforts will have to be multi-sectoral in nature. Commitment to the programme effort at all levels is needed for sustained programmes. Nutrition education and communication programmes need to be participatory in order to effective.

Interventions should be problem-solving, decision-making and action-oriented. Some of the structural material can be used to generate energy internally, and in either case it is measured in Joules or kilocalories often called "Calories" and written with a capital C to distinguish them from little 'c' calories.

Vitamins, minerals, fiber, and water do not provide energy, but are required for other reasons. Molecules of carbohydrates and fats consist of carbon, hydrogen, and oxygen atoms. Carbohydrates range from simple monosaccharides glucose, fructose and galactose to complex polysaccharides starch. Fats are triglycerides , made of assorted fatty acid monomers bound to a glycerol backbone. Some fatty acids, but not all, are essential in the diet: Protein molecules contain nitrogen atoms in addition to carbon, oxygen, and hydrogen.

The fundamental components of protein are nitrogen-containing amino acids , some of which are essential in the sense that humans cannot make them internally. Some of the amino acids are convertible with the expenditure of energy to glucose and can be used for energy production, just as ordinary glucose, in a process known as gluconeogenesis.

By breaking down existing protein, the carbon skeleton of the various amino acids can be metabolized to intermediates in cellular respiration; the remaining ammonia is discarded primarily as urea in urine.

Carbohydrates may be classified as monosaccharides , disaccharides , or polysaccharides depending on the number of monomer sugar units they contain. They constitute a large part of foods such as rice , noodles , bread , and other grain -based products, also potatoes , yams, beans, fruits, fruit juices and vegetables.

Monosaccharides, disaccharides, and polysaccharides contain one, two, and three or more sugar units, respectively. Polysaccharides are often referred to as complex carbohydrates because they are typically long, multiple branched chains of sugar units. Traditionally, simple carbohydrates are believed to be absorbed quickly, and therefore to raise blood-glucose levels more rapidly than complex carbohydrates.

This, however, is not accurate. Dietary fiber is a carbohydrate that is incompletely absorbed in humans and in some animals. Like all carbohydrates, when it is metabolized it can produce four Calories kilocalories of energy per gram. However, in most circumstances it accounts for less than that because of its limited absorption and digestibility. Dietary fiber consists mainly of cellulose, a large carbohydrate polymer which is indigestible as humans do not have the required enzymes to disassemble it.

There are two subcategories: Whole grains, fruits especially plums , prunes , and figs , and vegetables are good sources of dietary fiber. There are many health benefits of a high-fiber diet. Dietary fiber helps reduce the chance of gastrointestinal problems such as constipation and diarrhea by increasing the weight and size of stool and softening it.

Insoluble fiber, found in whole wheat flour , nuts and vegetables, especially stimulates peristalsis ;— the rhythmic muscular contractions of the intestines, which move digest along the digestive tract.

Soluble fiber, found in oats, peas, beans, and many fruits, dissolves in water in the intestinal tract to produce a gel that slows the movement of food through the intestines. This may help lower blood glucose levels because it can slow the absorption of sugar. Additionally, fiber, perhaps especially that from whole grains, is thought to possibly help lessen insulin spikes, and therefore reduce the risk of type 2 diabetes.

The link between increased fiber consumption and a decreased risk of colorectal cancer is still uncertain. A molecule of dietary fat typically consists of several fatty acids containing long chains of carbon and hydrogen atoms , bonded to a glycerol. They are typically found as triglycerides three fatty acids attached to one glycerol backbone. Fats may be classified as saturated or unsaturated depending on the detailed structure of the fatty acids involved.

Saturated fats have all of the carbon atoms in their fatty acid chains bonded to hydrogen atoms, whereas unsaturated fats have some of these carbon atoms double-bonded , so their molecules have relatively fewer hydrogen atoms than a saturated fatty acid of the same length.

Unsaturated fats may be further classified as monounsaturated one double-bond or polyunsaturated many double-bonds.

Furthermore, depending on the location of the double-bond in the fatty acid chain, unsaturated fatty acids are classified as omega-3 or omega-6 fatty acids. Trans fats are a type of unsaturated fat with trans -isomer bonds; these are rare in nature and in foods from natural sources; they are typically created in an industrial process called partial hydrogenation.

There are nine kilocalories in each gram of fat. Fatty acids such as conjugated linoleic acid , catalpic acid, eleostearic acid and punicic acid , in addition to providing energy, represent potent immune modulatory molecules.

Saturated fats typically from animal sources have been a staple in many world cultures for millennia. Saturated and some trans fats are typically solid at room temperature such as butter or lard , while unsaturated fats are typically liquids such as olive oil or flaxseed oil.

Trans fats are very rare in nature, and have been shown to be highly detrimental to human health, but have properties useful in the food processing industry, such as rancidity resistance. Most fatty acids are non-essential, meaning the body can produce them as needed, generally from other fatty acids and always by expending energy to do so.

However, in humans, at least two fatty acids are essential and must be included in the diet. An appropriate balance of essential fatty acids— omega-3 and omega-6 fatty acids —seems also important for health, although definitive experimental demonstration has been elusive. Both of these "omega" long-chain polyunsaturated fatty acids are substrates for a class of eicosanoids known as prostaglandins , which have roles throughout the human body.

They are hormones , in some respects. The omega-3 eicosapentaenoic acid EPA , which can be made in the human body from the omega-3 essential fatty acid alpha-linolenic acid ALA , or taken in through marine food sources, serves as a building block for series 3 prostaglandins e. The omega-6 dihomo-gamma-linolenic acid DGLA serves as a building block for series 1 prostaglandins e. An appropriately balanced intake of omega-3 and omega-6 partly determines the relative production of different prostaglandins, which is one reason why a balance between omega-3 and omega-6 is believed important for cardiovascular health.

In industrialized societies, people typically consume large amounts of processed vegetable oils, which have reduced amounts of the essential fatty acids along with too much of omega-6 fatty acids relative to omega-3 fatty acids. Moreover, the conversion desaturation of DGLA to AA is controlled by the enzyme deltadesaturase , which in turn is controlled by hormones such as insulin up-regulation and glucagon down-regulation.

The amount and type of carbohydrates consumed, along with some types of amino acid, can influence processes involving insulin, glucagon, and other hormones; therefore, the ratio of omega-3 versus omega-6 has wide effects on general health, and specific effects on immune function and inflammation , and mitosis i.

Proteins are structural materials in much of the animal body e. They also form the enzymes that control chemical reactions throughout the body. Each protein molecule is composed of amino acids , which are characterized by inclusion of nitrogen and sometimes sulphur these components are responsible for the distinctive smell of burning protein, such as the keratin in hair.

The body requires amino acids to produce new proteins protein retention and to replace damaged proteins maintenance. As there is no protein or amino acid storage provision, amino acids must be present in the diet.

Excess amino acids are discarded, typically in the urine. For all animals, some amino acids are essential an animal cannot produce them internally and some are non-essential the animal can produce them from other nitrogen-containing compounds. About twenty amino acids are found in the human body, and about ten of these are essential and, therefore, must be included in the diet. A diet that contains adequate amounts of amino acids especially those that are essential is particularly important in some situations: A complete protein source contains all the essential amino acids; an incomplete protein source lacks one or more of the essential amino acids.

It is possible with protein combinations of two incomplete protein sources e. However, complementary sources of protein do not need to be eaten at the same meal to be used together by the body. Water is excreted from the body in multiple forms; including urine and feces , sweating , and by water vapour in the exhaled breath.

Therefore, it is necessary to adequately rehydrate to replace lost fluids. Early recommendations for the quantity of water required for maintenance of good health suggested that 6—8 glasses of water daily is the minimum to maintain proper hydration. Most of this quantity is contained in prepared foods. For healthful hydration, the current EFSA guidelines recommend total water intakes of 2. These reference values include water from drinking water, other beverages, and from food. The EFSA panel also determined intakes for different populations.

Recommended intake volumes in the elderly are the same as for adults as despite lower energy consumption, the water requirement of this group is increased due to a reduction in renal concentrating capacity.

Dehydration and over-hydration - too little and too much water, respectively - can have harmful consequences. Drinking too much water is one of the possible causes of hyponatremia , i. Pure ethanol provides 7 calories per gram.

For distilled spirits , a standard serving in the United States is 1. A 5 ounce serving of wine contains to calories. A 12 ounce serving of beer contains 95 to calories. Alcoholic beverages are considered empty calorie foods because other than calories, these contribute no essential nutrients. The micronutrients are minerals , vitamins , and others.

Dietary minerals are inorganic chemical elements required by living organisms, [70] other than the four elements carbon , hydrogen , nitrogen , and oxygen that are present in nearly all organic molecules. The term "mineral" is archaic, since the intent is to describe simply the less common elements in the diet. Some are heavier than the four just mentioned, including several metals , which often occur as ions in the body.

Some dietitians recommend that these be supplied from foods in which they occur naturally, or at least as complex compounds, or sometimes even from natural inorganic sources such as calcium carbonate from ground oyster shells. Some minerals are absorbed much more readily in the ionic forms found in such sources. On the other hand, minerals are often artificially added to the diet as supplements; the most famous is likely iodine in iodized salt which prevents goiter.

Many elements are essential in relative quantity; they are usually called "bulk minerals". Some are structural, but many play a role as electrolytes. Many elements are required in trace amounts, usually because they play a catalytic role in enzymes. Vitamins are essential nutrients, [70] necessary in the diet for good health. Vitamin D is an exception, as it can be synthesized in the skin in the presence of UVB radiation , and many animal species can synthesize vitamin C.

Vitamin deficiencies may result in disease conditions, including goitre , scurvy , osteoporosis , impaired immune system, disorders of cell metabolism, certain forms of cancer, symptoms of premature aging, and poor psychological health , among many others. Phytochemicals such as polyphenols are compounds produced naturally in plants phyto means "plant" in Greek. In general, the term is used to refer to compounds which do not appear to be nutritionally essential and yet may have positive impacts on health.

To date, there is no conclusive evidence in humans that polyphenols or other non-nutrient compounds from plants have health benefit effects. While initial studies sought to reveal if nutrient antioxidant supplements might promote health, one meta-analysis concluded that supplementation with vitamins A and E and beta-carotene did not convey any benefits and may in fact increase risk of death.

Vitamin C and selenium supplements did not impact mortality rate. Health effects of non-nutrient phytochemicals such as polyphenols were not assessed in this review. Animal intestines contain a large population of gut flora. In humans, the four dominant phyla are Firmicutes , Bacteroidetes , Actinobacteria , and Proteobacteria. Bacteria in the large intestine perform many important functions for humans, including breaking down and aiding in the absorption of fermentable fiber, stimulating cell growth, repressing the growth of harmful bacteria, training the immune system to respond only to pathogens, producing vitamin B 12 , and defending against some infectious diseases.

There is not yet a scientific consensus as to health benefits accruing from probiotics or prebiotics. Carnivore and herbivore diets are contrasting, with basic nitrogen and carbon proportions vary for their particular foods. Many herbivores rely on bacterial fermentation to create digestible nutrients from indigestible plant cellulose, while obligate carnivores must eat animal meats to obtain certain vitamins or nutrients their bodies cannot otherwise synthesize. Plant nutrition is the study of the chemical elements that are necessary for plant growth.

Some elements are directly involved in plant metabolism. However, this principle does not account for the so-called beneficial elements, whose presence, while not required, has clear positive effects on plant growth. A nutrient that is able to limit plant growth according to Liebig's law of the minimum is considered an essential plant nutrient if the plant cannot complete its full life cycle without it.

There are 16 essential plant soil nutrients, besides the three major elemental nutrients carbon and oxygen that are obtained by photosynthetic plants from carbon dioxide in air, and hydrogen , which is obtained from water. Plants uptake essential elements from the soil through their roots and from the air consisting of mainly nitrogen and oxygen through their leaves.

Green plants obtain their carbohydrate supply from the carbon dioxide in the air by the process of photosynthesis. Carbon and oxygen are absorbed from the air, while other nutrients are absorbed from the soil. These hydrogen ions displace cations attached to negatively charged soil particles so that the cations are available for uptake by the root. In the leaves, stomata open to take in carbon dioxide and expel oxygen. The carbon dioxide molecules are used as the carbon source in photosynthesis.

Although nitrogen is plentiful in the Earth's atmosphere, very few plants can use this directly. Most plants, therefore, require nitrogen compounds to be present in the soil in which they grow. This is made possible by the fact that largely inert atmospheric nitrogen is changed in a nitrogen fixation process to biologically usable forms in the soil by bacteria.

Plant nutrition is a difficult subject to understand completely, partially because of the variation between different plants and even between different species or individuals of a given clone. Elements present at low levels may cause deficiency symptoms, and toxicity is possible at levels that are too high.

Furthermore, deficiency of one element may present as symptoms of toxicity from another element, and vice versa. Canada's Food Guide is an example of a government-run nutrition program. Produced by Health Canada , the guide advises food quantities, provides education on balanced nutrition, and promotes physical activity in accordance with government-mandated nutrient needs.

Like other nutrition programs around the world, Canada's Food Guide divides nutrition into four main food groups: Dietary and physical activity guidelines from the USDA are presented in the concept of MyPlate , which superseded the food pyramid , which replaced the Four Food Groups.

Department of Health and Human Services provides a sample week-long menu that fulfills the nutritional recommendations of the government. Governmental organisations have been working on nutrition literacy interventions in non-primary health care settings to address the nutrition information problem in the U. The FNP has developed a series of tools to help families participating in the Food Stamp Program stretch their food dollar and form healthful eating habits including nutrition education.

It is designed to assist limited-resource audiences in acquiring the knowledge, skills, attitudes, and changed behavior necessary for nutritionally sound diets, and to contribute to their personal development and the improvement of the total family diet and nutritional well-being. Launched in , this program promotes lifelong healthful eating patterns and physically active lifestyles for children and their families.

It is an interactive educational program designed to help prevent childhood obesity through classroom activities that teach children healthful eating habits and physical exercise. Nutrition is taught in schools in many countries.

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