Chapter 2: Achieving Healthy diet

What is a healthy diet?

Fulfills energy needs (macronutrients)
Provides sufficient amounts of essential nutrients
(micronutrients)
Reduces risk of disease
Is safe to consume (low contaminants or potentially
harmful added substances)
 A healthy diet is a diet that maintains or improves
overall health

 It provides the body with essential nutrition: fluid,

macronutrients such as protein, micronutrients such
as vitamins, and adequate and adequate fiber and
food energy

 A healthy diet may contain fruits, vegetables,, and

whole grains, and may include little to no ultra-
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processed foods or sweetened beverages
 Characteristics of healthy diet….

Eating a variety of foods from every food group, such as fruit, vegetables,
legumes, nuts, whole grains, lean protein, and healthy fats

Eating at least 400 g (five portions) of fruit and vegetables per day,
excluding starchy roots

Balancing the calories you take in from food with the calories you spend
each day through physical activity

Choosing nutrient rich foods that have more nutrients and fewer calories.
 Healthy diet….

The nutritional value of a food is only one of many factors that

affect the dietary choices individuals make

• There are five key factors that make up a healthy diet:

1) An adequate diet
2) A balanced diet,
3) Calorie control,
4) Moderation, and
5) Variety
 Healthy diet...
 Is essential for good health and nutrition
 It protects you against many chronic non-communicable diseases, such as
heart disease, diabetes and cancer
 Eating a variety of foods and consuming less salt, sugars and saturated
and industrially-produced trans-fats, are essential for healthy diet

 A healthy diet comprises a combination of different foods like:

Staples like cereals (wheat, barley, rye, maize or rice) or starchy
tubers or roots (potato, yam, taro or cassava).
Legumes (lentils and beans).
Fruit and vegetables
Foods from animal sources (meat, fish, eggs and milk)..
Oils and
 Healthy diet...
• Breastfeed babies and young children:
 A healthy diet starts early in life - breastfeeding fosters healthy growth, and may have longer-term
health benefits, like reducing the risk of becoming overweight or obese and developing
noncommunicable diseases later in life.
 Feeding babies exclusively with breast milk from birth to 6 months of life is important for a healthy diet
 It is also important to introduce a variety of safe and nutritious complementary foods at 6 months of
age, while continuing to breastfeed until your child is two years old and beyond

• Eat plenty of vegetables and fruit:

• They are important sources of vitamins, minerals, dietary fibre, plant protein and antioxidants
• Diets rich in vegetables and fruit have a significantly lower risk of obesity, heart disease, stroke,
diabetes and certain types of cancer.

• Eat less fat:

• Fats and oils and concentrated sources of energy, and eating too much, particularly the wrong kinds
of fat, like saturated and industrially-produced trans-fat, can increase the risk of heart disease and
stroke.
• Using unsaturated vegetable oils (olive, soy, sunflower or corn oil) rather than animal fats or oils high
in saturated fats (butter, ghee, lard, coconut and palm oil) will help consume healthier fats.
• To avoid unhealthy weight gain, consumption of total fat should not exceed 30% of a person's overall
energy intake.
 Reduce less fat…
• Moderate amounts of fats and oils are part of a healthy diet
• Fats and oils are concentrated sources of energy, and eating too much fat,
particularly the wrong kinds of fat, can be harmful to health

• For example, people who eat too much saturated fat and trans-fat are at higher
risk of heart disease and stroke
• Trans-fat may occur naturally in certain meat and milk products, but the
industrially produced trans-fat (e.g. partially hydrogenated oils) present in various
processed foods is the main source.
• Use unsaturated vegetable oils (e.g. olive, soy, sunflower or corn oil) rather than
animals fats or oils high in saturated fats (e.g. butter, ghee, lard, coconut and palm
oil)
• When possible, choose white meat (e.g. poultry) and fish, which are generally low
in fats, rather than red meat
• Eat only limited amounts of processed meats because these are high in fat and
salt
•
Healthy diet...
• Limit intake of sugars
 For a healthy diet, sugars should represent less than
10% of your total energy intake
 Reducing even further to under 5% has additional
health benefits
 Choosing fresh fruits instead of sweet snacks such as
cookies, cakes and chocolate helps reduce
consumption of sugars
 Limiting intake of soft drinks, soda and other drinks
high in sugars (fruit juices, and syrups, flavoured milks
and yogurt drinks) also helps reduce intake of sugars

• Reduce salt intake:

 Keeping your salt intake to less than 5g per day helps
prevent hypertension and reduces the risk of heart
disease and stroke in the adult population
 Limiting the amount of salt and high-sodium
condiments (soy sauce and fish sauce) when cooking
and preparing foods helps reduce salt intake.
 Choosing a balanced diet

• Optimum for nutrient-dense whole foods that provide the most

nutritional value for the number of calories created.
• It ensures that your body processes high-quality components and fuels
you for the long term.
• High-quality foods have a variety of nutrients:
• Vitamins
• Minerals
• Fiber
• Healthy fats
• Carbohydrates
• Protein
• Other components such as antioxidants
 Foods to Avoid or Limit

• To avoid empty calories, limit your intake of foods considered

nutrient-poor Examples of this broad range of foods include:
• Highly processed foods
• Refined grains
• Refined sugars
• Sweetened drinks
• Red and processed meats
• Saturated and trans fats
• High-glycemic foods
 Healthy Diet: Key Principles
• 1. Balanced Nutrition
• Macronutrients: Ensure a balance of carbohydrates, proteins, and fats.
• Carbohydrates: Prefer whole grains, fruits, and vegetables.
• Proteins: Include lean meats, fish, beans, and nuts.
• Fats: Focus on healthy fats like those from avocados, nuts, and olive oil.
2. Micronutrients
• Vitamins and Minerals: Essential for body functions.
• Sources: Fruits, vegetables, dairy products, and lean meats.
3. Hydration
• Drink plenty of water throughout the day.
• Limit sugary drinks and excessive caffeine.
4. Portion Control
• Be mindful of portion sizes to avoid overeating
• Use smaller plates and bowls to help control portions
 Key Principles….

5. Regular Meals
Eat at regular intervals to maintain energy levels.
Avoid skipping meals, especially breakfast.
6. Limit Processed Foods
Reduce intake of processed and high-sugar foods.
Opt for fresh, whole foods whenever possible.
7. Special Considerations
Dietary Restrictions: Be aware of any allergies or intolerances.
Cultural Preferences: Incorporate culturally relevant foods.
8. Physical Activity
Combine a healthy diet with regular physical activity.
Aim for at least 150 minutes of moderate exercise per week.
The rate of uptake of glucose (and other sugars) from the gut is determined
by the rate of hydrolysis of oligosaccharides and polysaccharides that are
susceptible to pancreatic and brush border enzymes

• Food factors
- particle size
- macrostructure & microstructure of food, especially whether cell walls are
intact
-amylose-amylopectin ratio of starches
- lipid content of food
-presence (or otherwise) of enzyme inhibitors
Consumer factors
- degree of comminution in the mouth
- rate of gastric emptying
- small bowel transit time
 Achieving a healthy diet….
It is a matter of balancing the quality and quantity of food that is
eaten. There are five key factors that make up a healthful diet:
1.A diet must be adequate, by providing sufficient amounts of
each essential , as well as and adequate calories.
2.A balanced diet results when you do not consume one nutrient
at the expense of another, but rather get appropriate amounts of
all nutrients.
3. diet control is necessary so that the amount of you get from
the nutrients you consume equals the amount of energy you
expend during your day’s activities.
4.Moderation means not eating to the extremes, neither too
much nor too little.
5.Variety refers to consuming different foods from within each of
the food groups on a regular basis.
 Achieving a healthy diet….

 A healthy diet is one that favors whole foods.

 As an alternative to modern processed foods, a healthy diet focuses on

“real” fresh whole foods that have been sustaining people for generations.
 Whole foods supply the needed vitamins, , , , fats, and fiber that are
essential to good health.

 Commercially prepared and fast foods are often lacking nutrients and often
contain inordinate amounts of sugar, salt, saturated and trans fats, all of
which are associated with the development of diseases such as , heart
disease, stroke, cancer, obesity, diabetes, and other illnesses.

 A balanced diet is a mix of food from the different

 food groups (vegetables, legumes, fruits, grains, protein foods, and dairy).
 Nutrient and diet adequacy

 An adequate diet is one that favors nutrient-dense foods.

 Nutrient-dense foods are defined as foods that contain many
essential nutrients per calorie.
 Nutrient-dense foods are the opposite of “empty-calorie”
foods, such as sugary carbonated beverages, which are also
called “nutrient-poor.”
 Nutrient-dense foods include fruits and vegetables, lean
meats, poultry, fish, low-fat dairy products, and whole grains.
 Choosing more nutrient-dense foods will facilitate loss, while
simultaneously providing all necessary nutrients.
 Moderation
 Moderation is crucial for optimal health and survival.
 Eating nutrient-poor foods each night for dinner will lead to health
complications.

 But as part of an otherwise healthful diet and consumed only on a

weekly basis, this should not significantly impact overall health.

 For optimum weight maintenance, it is important to ensure that

energy consumed from foods meets the energy expenditures
required for body functions and activity. If not, the excess energy
contributes to gradual, steady accumulation of stored body fat and
weight gain.
 In order to lose body fat, you need to ensure that more calories are
burned than consumed. Likewise, in order to gain weight, calories
must be eaten in excess of what is expended daily.
 Variety
 Variety involves consumption of different foods from all the food
groups, helps to ensure that you consume and absorb adequate
amounts of all essential nutrients required for health.
 One of the major drawbacks of a monotonous diet is the risk of
consuming too much of some nutrients and not enough of others

 Introducing variety in your diet can still result in the consumption of

too many high-calorie, nutrient poor foods and inadequate nutrient
intake if you do not also employ moderation and calorie control
 Using all these principles together will promote lasting health
benefits.
 Nutrition Requirements
Introduction and Historical Overview

“The problem of assessing the calorie and nutrient requirements of human beings, with
the greatest possible degree of accuracy, is of basic importance to FAO" (FAO, 1950).

The first attempt to establish human energy requirement at population level was carried
out by FAO in 1950

Essential Nutrients
Chemical substances found in food

Necessary for life, growth, and tissue repair

Cannot be synthesized

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 Principles and Definition of nutrient requirement
• Requirement
• Minimum amount of a nutrient needed to sustain a physiological state,
function, or structure in an individual

• Recommendation
• Normalized estimate of nutrient needed to cover most individuals in a
population group

 Human energy requirements are estimated from measures of energy

expenditure plus the additional energy needs for growth, pregnancy and
lactation.

 Energy balance is achieved when input (i.e. dietary energy intake) is equal to
output (i.e. total energy expenditure), plus the energy cost of growth in
childhood
12/17/2024 and pregnancy, or the energy cost to produce milk during lactation
19
 Nutrient requirement definitions…

 The dietary requirement for a nutrient is an intake level which meets a specified
criteria for adequacy, thereby minimizing risk of nutrient deficit or excess

 These criteria cover a gradient of biological effects related to a range of nutrient

intakes which, at the extremes, include the intake required to prevent death associated
with nutrient deficit or excess
 The assumption is that requirements for energy will be fulfilled through the
consumption of a diet that satisfies all nutrient needs

• An adequate, healthy diet must satisfy human needs for energy and all essential
nutrients

• Furthermore, dietary energy needs and recommendations cannot be considered in

isolation of other nutrients in the diet, as the lack of one will influence the others
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 Principles and definition of nutritional requirement

• The dietary requirement for a micronutrient is defined as an intake level

which meets specified criteria for adequacy, thereby minimizing risk of
nutrient deficit or excess

• These criteria cover a gradient of biological effects related to a range of

nutrient intakes which, at the extremes, include the intake required to
prevent death associated with nutrient deficit or excess

• However, for nutrients where insufficient data on mortality are available,

which is the case for most micronutrients discussed in this report, other
biological responses must be defined
• Measures of nutrient stores or critical tissue pools may also be used to
determine nutrient adequacy
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Principles & definition of nutritional requirement…..
 These include clinical disease as determined by signs and symptoms of nutrient
deficiency, and subclinical conditions identified by specific biochemical and
functional measures

 Measures of nutrient stores or critical tissue pools may also be used to

determine nutrient adequacy

 The choice of criteria used to define requirements is of critical importance, since the
recommended nutrient intake to meet the defined requirement will clearly vary,
depending, among other factors, on the criterion used to define nutrient adequacy

 Unfortunately, the information base to scientifically support the definition of

nutritional needs across age ranges, sex and physiologic states is limited for many
nutrients

 Where relevant and possible, requirement estimates presented here include 22

12/17/2024 an
Estimated average requirement

 Estimated average requirement (EAR) is the average daily nutrient intake level that
meets the needs of 50% of the healthy individuals in a particular age and gender
group

 It is based on a given criteria of adequacy which will vary depending on the specified
nutrient

 Therefore, estimation of requirement starts by stating the criteria that will be used to
define adequacy and then establishing the necessary corrections for physiological
and dietary factors

 Once a mean requirement value is obtained from a group of subjects, the nutrient
intake is adjusted for inter-individual variability to arrive at a recommendation

 50% of subjects would not have their needs met

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 Recommended nutrient intake (RNI)
• Recommended nutrient intake (RNI) is the daily intake, set at the EAR plus 2
standard deviations (SD), which meets the nutrient requirements of
almost all apparently healthy individuals in an age- and sex-specific
population group

• If the distribution of requirement values is not known, a Gaussian or normal

distribution can be assumed, and from this it is expected that the mean
requirement plus 2 SD will cover the nutrient needs of 97.5% of the population

• If the SD is not known, a value based on each nutrient’s physiology can be

used and in most cases a variation in the range of 10–12.5% can be assumed
• Because of the considerable daily variation in micronutrient intake, daily
requirement refers to the average intake over a period of time

• The cumulative risk function for deficiency and toxicity illustrates that as
nutrient intake increases the risk of deficit drops and at higher intakes the risk
of toxicity
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 Recommended nutrient intake (RNI)

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 Upper tolerable nutrient intake level
• Upper limits (ULs) of nutrient intake have been set for some micronutrients
and are defined as the maximum intake from food, water and supplements
that is unlikely to pose risk of adverse health effects from excess in almost all
(97.5%) apparently healthy individuals in an age- and sex-specific population
group

• ULs should be based on long-term exposure to all foods, including fortified

food products

• For most nutrients no adverse effects are anticipated when they are
consumed as foods because their absorption and/or excretion are regulated

• The special situation of consumption of nutritional supplements which, when

added to the nutrient intake from food, may result in a total intake in excess
of the UL
• The12/17/2024
range of intakes between the RNI and UL should be considered sufficient
26
 Recommended daily Allowances (RDAs)
• “. . . levels of intake of essential nutrients considered, in the
judgment of the Food and Nutrition Board on the basis of
available scientific knowledge, to be adequate to meet the known
nutritional needs of practically all healthy persons.”

• RNI = RDA as used by the Food and Nutrition Board of the United States
National Academy of Sciences

 Sufficient to meet the daily nutrient requirements of most individuals in a

specific life stage and gender group

 Set at a level that is at the top two to three percent of the requirement
distribution

 Intended
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 Energy requirement
• Is the amount of food energy needed to balance energy expenditure in order
to maintain body size, body composition and a level of necessary and desirable
physical activity consistent with long-term good health

• Estimates of energy requirements are derived from measurements of individuals

• Measurements of a collection of individuals of the same gender and similar age, body
size and physical activity are grouped together to give the average energy
requirement – or recommended level of dietary intake – for a class of people or a
population group

• These requirements are then used to predict the requirements and recommended
levels of energy intake for other individuals with similar characteristics, but on whom
measurements have not been made

• However, there remain unknown factors that produce variations among individuals
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 Energy Vs Nutrient requirements
 For most specific nutrients, a certain excess of intake will not be harmful

 Thus, when dietary recommendations are calculated for these nutrients, the variation among
individuals in a class or population group is taken into account, and

 The recommended level of intake is an amount that will meet or exceed the requirements of
practically all individuals in the group
 This approach cannot be applied to dietary energy recommendations, because intakes that
exceed requirements will produce a positive balance, which may lead to overweight and
obesity in the long term

 A high level of energy intake that assures a low probability of energy deficiency for most
people (e.g. the average requirement plus 2 standard deviations) also implies a high
probability of obesity for most people owing to a dietary energy excess

 The dietary energy intake that could be safely recommended for a population group is the
estimated average energy requirement of that group
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 Dietary Reference Intakes (DRIs)
• DRIs- are a set of reference values used to plan and assess nutrient intakes
of healthy people
They are widely used in:
1. Designing and evaluating research studies and results
2. Developing dietary guidelines and food guides
3. Planning and tracking nutrition-related public health programs and diets for
military personnel
4. Creating patient and consumer counseling and educational programs

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 Adequate Intake/AI/

• AI- is the recommended average daily intake level based on observed

or experimentally determined approximations or estimates of nutrient
intake by a group (or groups) of apparently healthy people that are
assumed to be adequate- used when an RDA cannot be determined

• An AI is established when there is insufficient scientific evidence to

determine an Estimated Average Requirement (EAR)

• AI is expected to meet or exceed the amount needed to maintain a

defined nutritional state or criterion of adequacy in essentially all
members of a specific apparently healthy population

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 Dietary Guidelines Versus DRIs
 Dietary Guidelines
• Qualitative advice to the public about diet and chronic disease prevention (e.g., the
Food Pyramid)

 Dietary Reference Intakes (DRIs)

Quantitative advice to professionals about amounts of nutrients found to
be of benefit

Fig. Food Pyramid

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 Dietary Reference Intakes (DRIs)
Estimated Average Requirement (EAR)
Recommended Dietary Allowance (RDA)
Adequate Intake (AI)
Tolerable Upper Intake Level (UL)

 Scientific Basis for Establishing DRIs

 Observed intakes in healthy populations
 Epidemiological observations
 Balance studies(measure input and output)
 Depletion/repletion studies
 Animal experiments
 Biochemical measurements

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 Sources of Dietary Energy

• Energy for the metabolic and physiological functions of humans is derived

from the chemical energy found in food and its macronutrient constituents,
i.e.
• carbohydrates,
• fats,
• proteins and
• ethanol, which act as substrates or fuels

• Fats and carbohydrates are the main sources of dietary energy

• Proteins also provide important amounts of energy, especially when total

dietary energy intake is limited

• Ethanol is not considered part of a food system, but its contribution to total
energy intake cannot be overlooked, particularly among populations that
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Components of Energy Requirements
Human beings need energy for the following:
• Basal metabolism: comprises a series of functions that are
essential for life, such as cell function and replacement; the synthesis,
secretion and metabolism of enzymes and hormones to transport
proteins and other substances and molecules; the maintenance of body
temperature; uninterrupted work of cardiac and respiratory muscles;
and brain function

• Depending on age and lifestyle, BMR represents 45-70 percent of

daily total energy expenditure, and it is determined mainly by the
individual’s age, gender, body size and body composition.

• Metabolic response to food: Eating requires energy for the

ingestion
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and digestion of food, and for the absorption, transport, 35
interconversion, oxidation and deposition of nutrients
Components of Energy Requirements…

• Physical activity. This is the most variable and, after BMR, the second largest
component of daily energy expenditure. Humans perform obligatory and discretionary
physical activities

• Growth. The energy cost of growth has two components: 1) the energy needed to
synthesize growing tissues; and 2) the energy deposited in those tissues.

• Pregnancy. During pregnancy, extra energy is needed for the growth of the foetus,
placenta and various maternal tissues

• Lactation. The energy cost of lactation has two components: 1) the energy content
of the milk secreted; and 2) the energy required to produce that milk

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 Components of Energy Expenditure
Energy is expended by the human body in three forms:
1. Resting energy expenditure (REE),
2. Thermic effect of food (TEF), and
3. Energy expended in physical activity (EEPA)

These three components make up a person's daily total energy expenditure (TEE) .
• Except in extremely active subjects, the REE constitutes the largest portion (60% to 75%)
of the TEE.
• The TEF represents approximately 10% of the total daily energy expenditure.
• The contribution of physical activity is the most variable component of TEE, which may be
as low as 100 kcal per day in sedentary people or as high as 3000 kcal per day in very
active people.

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 Factors Affecting Resting Energy Expenditure

• Major determinants are body size and composition.

• In addition, age, sex, and hormonal status affect REE as well.
• BODY SIZE. Larger people have higher MR than smaller size.
• A difference in weight of 10 kg would lead to a difference in RMR of
approximately 120 kcal per day in adult men or women.
• BODY COMPOSITION. The major single determinant of REE is fat-free mass
(FFM) or lean body mass(LBM).

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 Cont… Factors Affecting Resting Energy Expenditure

• Age: The loss of FFM with aging is associated with a decline in resting
metabolic rate (RMR) , amounting to about a 2% to 3% decline per decade
after early adulthood.
• As a child becomes older, the caloric requirement for growth is reduced to
about 1% of the total energy requirement.

• Sex: Sex differences in metabolic rate are primarily Attributable to differences

in body size and composition.

• Women, who generally have more fat in proportion to muscle than men, have
metabolic rates that are around 5% to 10% lower than men of the same weight
and height
• Hormonal Status: Hormonal status can impact metabolic rate, particularly in
endocrine disorders, such as hyperthyroidism and hypothyroidism, when
energy expenditure is increased or decreased, respectively.
• Other hormones, such as cortisol, growth hormone, and insulin, also influence
12/17/2024 39
 Cont…
• Resting metabolic rate (RMR) seems to decrease in the early stages of
pregnancy, AND later is increased by the processes of uterine, placental, and
fetal growth and by the mother's increased cardiac work

• Other factors affecting metabolic rate include Fevers (increase the metabolic
rate by about 13% for each degree above 37°
• RMR is also affected by extremes in environmental temperature.

• People living in tropical climates usually have RMRs that are 5% to 20% higher
than those living in a temperate area.
• Exercise in temperatures greater than 86° F also imposes a small additional
metabolic load of about 5% owing to increased sweat gland activity.
• The extent to which energy metabolism increases in extremely cold
environments depends on the insulation available from body fat and
protective clothing.
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Cont…
• Athletes with greater muscular development show approximately a 5%
increase in basal metabolism over that in nonathletic individuals owing to
their greater FFM

• Habitual exercise does not cause significantly prolonged stimulation of

metabolic rate per unit of active tissue, but it does cause an 8% to 14%
higher metabolic rate in men who are moderately and highly active,
Therespectively,
energy expended in physical
owing activity LBM.
to increased
(EEPA)
 EEPA is the most variable component of total energy expenditure.
It may range from as little as 10% in the bedridden person to as much as 50% of total energy
expenditure in the athlete

EEPA includes energy expended in voluntary exercise, as well as the energy expended involuntarily in
activities like shivering, fidgeting, and postural control.

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 Uses of Human energy requirements and recommendations

 Assess the adequacy of food supplies to meet population nutrients needs

 Assessing the proportion and absolute number of undernourished people

worldwide

 Setting targets for food production

 Monitor nutrition programs and plan development activities

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