An Introduction to Concepts of Nutrition: Facilitator’s Handbook

NUTRITION AND AN INTRODUCTION TO THE ESSENTIAL NUTRIENTS Nutrition is currently a hot topic and has been the subject of TV programmes, radio talks, chat shows and even a movie! It has hit the media in magazine articles, books and celebrity diets. However how much do we really know and how do we know that what we are being told is right or not? Knowledge abounds on the internet and in popular fad diet books but what we do with it and how we wade through the plethora of information to find out what we can apply and how requires perhaps a little guidance. This course aims to provide the necessary knowledge you require alongside encouragement and assistance from your programme facilitator. The Importance of Nutrition in Our Lives As far back as 1978, the Declaration of Alma-Ata challenged the world to embrace the principles of primary health care as the way to overcome gross health inequalities between and within countries. “Health for all” became the slogan for a movement, in which it was recognised that everybody needs and is entitled to the highest possible standard of health. All countries of the world have pledged to reach the Millennium Development Goals (MDGs) set at the United Nations Summit in 2000. These include ambitious targets for nutrition and we now have an opportunity to gain the knowledge we need for longer, healthier lives and to lay the foundations for improved health for generations to come 1. Health is not simply the absence of disease or of infirmity but has been defined as a state of complete physical, mental and social well-being. The health of any group of people is both a goal in itself and a key development input towards other goals. This is because health contributes crucially to economic and social well-being. More recently, health has not been seen in isolation but in conjunction with human wealth and the lack of health, therefore, is viewed alongside the issue of human poverty. This term refers to deprivation of the means to achieve capabilities, for example, physical access to health care in addition to the lack of basic factors that facilitate this achievement such as social access to health care. Human development refers to processes that enlarge people’s choices to enable them to achieve capabilities, for example, the freedom to choose a healthy lifestyle and the information with which to make a genuinely informed choice about one’s lifestyle (such as engaging with this programme). This more complex concept of poverty, wealth and development takes account of the interactive processes that are crucial to the social dynamics of health improvement, significantly, ill-health limits people’s ability to earn higher incomes 1. When we discuss health, we are in fact discussing how not to develop a disease or illness. Two types of disease have been identified; those which are communicable and those which have previously been known as non-communicable diseases, now more often termed chronic diseases. Communicable diseases are those which are infectious and are spread from person to person, or via other vectors such as infected food, or water. The previously termed non-communicable diseases are those generated most often through a combination of hereditary tendencies and lifestyle factors, (not necessarily in equal measure). It has, however, been argued that these are also ‘communicable’, not so much as by human contact, but by the person to person transmission of certain social habits and lifestyles. Inappropriate lifestyle is still communicable; however, the vectors (means of spreading disease) are not skin contact or coughing but peer pressure, marketing pressure and family habits that continue from generation to generation. Also, inadequate access to information with which to make informed decisions comes into the equation. We no longer, therefore, refer to these diseases as non-communicable but as chronic disorders most of which are lifestyle and diet-related and in addition preventable 2. The burden of chronic disorders is increasing, accounting for nearly half of the global burden of disease. While the proportion of burden from chronic diseases in developed countries remains stable at over 80% in adults aged 15 years and over, the proportion in middle-income countries has already exceeded 70%. Surprisingly, almost 50% of the adult disease burden in the high mortality regions of the world is now attributable to chronic diseases. Cardiovascular diseases account for 13% of the disease burden among adults over 15 years of age. Ischaemic heart disease and cerebrovascular disease (stroke) are the two leading causes of mortality and disease burden among older adults (over age 60). In developed countries, ischaemic heart disease and cerebrovascular disease are together responsible for 36% of deaths. The mortality and burden resulting from cardiovascular diseases are rapidly increasing in developing regions as well. Of the 7.1 million cancer deaths estimated to have occurred in 2002, 17% were liver and colon/ rectum cancers which are the third and fourth leading causes of death 1. All the chronic diseases mentioned previously are preventable, and the main source of prevention is the improvement of healthy eating and physical activity. These are the two goals of the World Health Organisation (WHO) global strategy on diet, physical activity and health 4. One of the most effective tools of preventative medicine is nutrition education and intervention. Changing the eating habits of a group of people would cut the figures for heart disease, diabetes and some of the preventable cancers along with the misery that comes with them. Many chronic diseases are not only preventable but, if caught in time, can be dealt with solely with a change in diet. Unfortunately, it sometimes takes a crisis in a person’s life for them to begin looking at ways to help themselves out of a chronic ill-health problem and to look at ways to prevent further degeneration 7.