Paper 1

Section A
1. State five factors that determine dietary modifications.(5 Marks)
- Age and life stage (e.g., childhood, pregnancy, elderly)
- Medical conditions (e.g., diabetes, heart disease)
- Nutritional deficiencies (e.g., iron deficiency)
- Cultural and religious practices (e.g., vegetarianism, fasting)
- Lifestyle factors (e.g., physical activity level, occupation)
2. Enumerate five symptoms of iron deficiency anaemia.(5 Marks)
- Fatigue and weakness
- Pale skin and mucous membranes
- Shortness of breath
- Dizziness or light headedness
- Cold hands and feet
3. State five reasons why exercise and physical activity is an important component in
diabetes management. (5 Marks)
- Improves insulin sensitivity
- Aids in weight management
- Lowers blood glucose levels
- Reduces the risk of cardiovascular disease
- Enhances overall physical fitness and well-being
4. State five qualities of a good nutrition diagnosis statement.(5 Marks)
- Clear and specific
- Based on reliable assessment data
- Addresses the root cause of the nutrition problem
- Measurable and outcome-focused
- Feasible for intervention within the healthcare setting
5. State five reasons when calorie-restricted diets may be necessary. (5 Marks)
- Weight loss in obesity
- Management of type 2 diabetes
 - Reducing cardiovascular risk factors
- Preventing or managing metabolic syndrome
- Pre-surgical preparation to reduce operative risks
6. List five indications for enteral nutrition. (5 Marks)
- Inability to swallow due to neurological disorders
- Severe burns or trauma requiring increased nutritional support
- Malabsorption syndromes where oral intake is insufficient
- Chronic illnesses like cancer with inadequate oral intake
- Critical illness in patients who cannot meet their nutritional needs orally
Section B
2. a) Explain six principles which should be considered when planning diets. (10 Marks)
Balance: Ensure a variety of nutrients are consumed in the correct proportions.
Adequacy: Provide all essential nutrients in sufficient amounts to meet the body’s needs.
Moderation: Avoid excessive intake of any single nutrient or food group to prevent
imbalances.
Calorie Control: Manage caloric intake to maintain a healthy weight.
Variety: Include a wide range of foods from all food groups to ensure a comprehensive
nutrient intake.
Nutrient Density: Focus on foods that provide the most nutrients relative to their caloric
content.
3. b) Explain five risk factors for cardiovascular diseases.(10 Marks)
High Blood Pressure: Increases the force of blood against artery walls, leading to heart
disease.
High Cholesterol Levels: Contributes to the build up of plaques in arteries, leading to
atherosclerosis.
Smoking: Damages blood vessels and raises blood pressure, increasing the risk of heart
attack and stroke.
Obesity: Excess body weight increases the risk of hypertension, high cholesterol, and
diabetes.
Physical Inactivity: Lack of exercise can lead to weight gain, high blood pressure, and
increased risk of heart disease.
4. a) Explain five pregnancy-related complications and state their management. (10
Marks)
Gestational Diabetes: Managed with dietary modifications, blood glucose monitoring, and
possibly insulin therapy.
Preeclampsia: Managed with blood pressure control, bed rest, and sometimes early delivery.
Hyperemesis Gravidarum: Managed with hydration, anti-nausea medications, and
nutritional support.
Preterm Labour: Managed with medications to delay labour, bed rest, and close monitoring.
Anaemia: Managed with iron supplements, folic acid, and a diet rich in iron-containing
foods.
5. b) Explain the relationship between nutrition and a healthy immune system.(10
Marks)
Proper nutrition is essential for maintaining a healthy immune system. Key nutrients like
vitamins A, C, E, and zinc play vital roles in immune function. Malnutrition or deficiencies
in these nutrients can impair immune response, making the body more susceptible to
infections. Conversely, a well-balanced diet rich in fruits, vegetables, whole grains, and lean
proteins supports immune health by providing the necessary vitamins, minerals, and
antioxidants to protect the body against pathogens and promote recovery from illness.
Paper 2
Definitions
Balanced Diet (2 Marks)
A balanced diet is a diet that includes a variety of foods in the right proportions, providing the
necessary nutrients—carbohydrates, proteins, fats, vitamins, and minerals—required to
maintain health, energy, and well-being.
Nutritional Status (2 Marks)
Nutritional status refers to the condition of an individual’s health as determined by the intake
and utilization of nutrients. It is often assessed through indicators such as body weight,
height, dietary intake, and biochemical measures.
Health (2 Marks)
Health is a state of complete physical, mental, and social well-being, and not merely the
absence of disease or infirmity, according to the World Health Organization (WHO).
Vicious Cycle of Malnutrition and Disease (5 Marks)
Malnutrition and disease are interrelated in a vicious cycle where one condition exacerbates
the other:
Malnutrition weakens the immune system, making individuals more susceptible to infections
and diseases.
Infections and diseases further impair the body’s ability to absorb and utilize nutrients,
leading to worsening malnutrition.
This cycle continues, often leading to chronic health problems, delayed recovery, and
increased mortality, particularly in vulnerable populations such as children and the elderly.
Glycaemic Index (4 Marks)
The glycaemic index (GI) is a measure that ranks foods according to their effect on blood
glucose levels after consumption. Foods with a high GI cause a rapid increase in blood
glucose levels, while those with a low GI result in a slower, more gradual rise. For example:
High GI foods: White bread, potatoes, sugary drinks.
Low GI foods: Oatmeal, lentils, most fruits and vegetables.
Types of Nutrition Assessment (4 Marks)
Four types of nutrition assessment are
Anthropometric Assessment: Measures physical dimensions such as weight, height, and
body mass index (BMI).
Biochemical Assessment: Involves laboratory tests of blood, urine, or tissue samples to
assess nutrient levels and metabolic status.
Clinical Assessment: Involves a physical examination to detect signs of nutritional
deficiencies or excesses.
Dietary Assessment: Evaluates an individual’s dietary intake through methods like food
frequency questionnaires, 24-hour recalls, or food diaries.
Functions of Nutrients (6 Marks)
Vitamin A
Vision: Essential for maintaining normal vision, particularly in low light conditions.
Immune Function: Supports immune system function, helping the body fight infections.
Iron
Oxygen Transport: Vital for the production of haemoglobin, which carries oxygen in the
blood.
Energy Metabolism: Involved in energy production within cells and overall metabolic
processes.
Calcium
Bone Health: Crucial for the development and maintenance of strong bones and teeth.
Muscle Function: Plays a role in muscle contraction and relaxation, including heart muscle
function.
Section B
Increased Nutrient Requirements Associated with Pregnancy (12 Marks)
During pregnancy, several nutrients are required in higher amounts to support the health of
both the mother and the developing foetus:
Folic Acid (Vitamin B9)
Essential for DNA synthesis and cell division, folic acid helps prevent neural tube defects in
the foetus.
Iron
Required to support the increased blood volume in the mother and to ensure adequate oxygen
supply to the foetus. Iron also helps prevent maternal anaemia.
Calcium
Necessary for the development of the fetal bones and teeth, calcium also supports the
mother’s bone health as fetal calcium needs increase.
Protein
Crucial for the growth of foetal tissues, including the brain, protein also supports the mother’s
increased blood volume and maintains maternal muscle mass.
Vitamin D
Helps in the absorption of calcium and phosphorus, essential for foetal bone development
and immune function.
Omega-3 Fatty Acids (DHA)
Important for the development of the foetal brain and eyes, omega-3 fatty acids also support
the mother’s mental health during and after pregnancy.
Harmful Effects of Excessive Intake of Dietary Fiber (8 Marks)
While dietary fiber is important for digestive health, excessive intake can lead to:
Gastrointestinal Discomfort
High fiber intake can cause bloating, gas, and abdominal pain due to increased fermentation
of fiber in the gut.
Nutrient Absorption Interference
Excessive fiber can bind to minerals like calcium, iron, and zinc, reducing their absorption
and potentially leading to deficiencies.
Diarrhoea
Large amounts of fiber can increase stool bulk and frequency, leading to diarrhoea and
dehydration.
Constipation
If fiber intake is not accompanied by adequate fluid intake, it can lead to constipation by
hardening the stool.
Stepwise Approach to Providing Nutrition Education to Mothers in a Child Clinic (6
Marks)
Assessment of Needs
Determine the specific nutritional knowledge gaps and needs of the mothers, possibly
through surveys or interviews.
Planning the Education Session
Develop a structured plan outlining the key topics to be covered, such as breastfeeding,
weaning, and balanced diets for children.
Implementation
Deliver the education using simple language, visuals, and interactive methods like
demonstrations. Ensure the session is engaging and allows for questions and discussions.
Evaluation
After the session, evaluate the mothers’ understanding through feedback or a brief quiz to
ensure the information has been effectively communicated.
Follow-up
Plan for follow-up sessions to reinforce learning and address any new concerns or questions.
Factors Considered in Designing the Approach (4 Marks)
Cultural Sensitivity
Consider the cultural beliefs and practices regarding nutrition and health among the mothers
to ensure the information is relevant and respectful.
Literacy Levels
Tailor the educational content to the literacy level of the audience, using simple language and
visual aids for those with limited literacy skills.
Time Constraints
Design the session to fit within the time mothers have available, ensuring the information is
concise and focused on the most important topics.
Relevance to the Audience
Ensure that the topics covered are directly relevant to the needs of the mothers and their
children, focusing on practical advice they can apply in their daily lives.
Paper 3
Explanation of Terms
i) Nutrition (2 Marks)
Nutrition is the science of how the body uses food to obtain essential nutrients necessary for
growth, energy, and maintaining overall health. It involves the study of how different foods
contribute to the physical, mental, and social well-being of an individual.
ii) Diet Modification (2 Marks)
Diet modification refers to the alteration of an individual’s regular diet to meet specific
health needs, such as managing a medical condition (e.g., diabetes) or addressing nutritional
deficiencies. This may involve changes in the type, quantity, and frequency of foods
consumed.
iii) Lactose Intolerance (2 Marks)
Lactose intolerance is a digestive condition in which an individual is unable to fully digest
lactose, the sugar found in milk and dairy products, due to a deficiency of the enzyme lactase.
This can result in symptoms such as bloating, diarrhoea, and abdominal pain after consuming
dairy products.
iv) Micronutrients (2 Marks)
Micronutrients are vitamins and minerals that the body requires in small amounts to carry
out various physiological functions. They are essential for processes like immune function,
bone health, and energy production. Examples include vitamins A, C, D, and minerals like
iron and zinc.
Critical Nutrition Practices for People Living with HIV/AIDS (5 Marks)
Maintaining a Balanced Diet: Ensuring a diet that includes a variety of foods to provide all
essential nutrients.
Adequate Protein Intake: Consuming enough protein to help repair and build tissues,
support the immune system, and prevent muscle wasting.
Regular Meals and Snacks: Eating regular, well-balanced meals and snacks to maintain
energy levels and prevent weight loss.
Food Safety: Practicing good food hygiene to avoid infections, as people with HIV/AIDS
have compromised immune systems.
Hydration: Drinking plenty of fluids to stay hydrated and support overall health.
Modifiable Risk Factors in the Management of Heart Diseases (5 Marks)
Smoking: Quitting smoking reduces the risk of heart disease significantly.
Diet: Adopting a heart-healthy diet low in saturated fats, trans fats, and cholesterol.
Physical Activity: Regular exercise helps maintain a healthy weight, lowers blood pressure,
and reduces cholesterol levels.
Alcohol Consumption: Limiting alcohol intake can help prevent high blood pressure and
heart disease.
Weight Management: Maintaining a healthy weight reduces the strain on the heart and
lowers the risk of heart disease.
Effects of Diseases on Nutritional Status (4 Marks)
Malabsorption: Diseases like celiac disease or Crohn’s disease can impair the body’s ability
to absorb nutrients, leading to deficiencies.
Increased Nutrient Needs: Illnesses such as infections or chronic diseases can increase the
body’s demand for certain nutrients, exacerbating deficiencies if not met.
Loss of Appetite: Conditions like cancer or depression can reduce appetite, leading to
insufficient nutrient intake and weight loss.
Metabolic Changes: Some diseases alter metabolism, causing increased energy expenditure
or changes in how nutrients are processed, which can affect nutritional status.
Roles of Nutrients in the Human Body (4 Marks)
Energy Production: Carbohydrates, fats, and proteins provide the energy required for all
bodily functions and activities.
Tissue Growth and Repair: Proteins and certain vitamins and minerals are essential for the
growth, repair, and maintenance of body tissues.
Immune Function: Micronutrients like vitamins A, C, and zinc support the immune system,
helping the body fight infections.
Bone Health: Calcium and vitamin D are crucial for the development and maintenance of
strong bones and teeth.
Conditions Requiring Parenteral Nutrition (4 Marks)
Severe Malabsorption Syndromes: Conditions like short bowel syndrome where the
intestine cannot absorb nutrients effectively.
Gastrointestinal Obstruction: When there is a blockage in the digestive tract that prevents
food from being absorbed.
Severe Pancreatitis: Inflammation of the pancreas that requires the digestive system to be
rested.
Prolonged Ileus: A condition where the intestine does not function properly, requiring
nutrition to be given intravenously.
Describe TWO types of dietary fiber and explain their role in the human body. (10
Marks)
1. Soluble Fiber
Description: Soluble fiber dissolves in water to form a gel-like substance. It is found in foods
such as oats, barley, nuts, seeds, beans, lentils, peas, and some fruits and vegetables (e.g.,
apples, citrus fruits).
Role in the Body:
Blood Sugar Regulation: Soluble fiber helps slow down the absorption of sugar, which
helps in stabilizing blood sugar levels and reducing the risk of type 2 diabetes.
Cholesterol Management: By binding to cholesterol and bile acids in the digestive tract,
soluble fiber can lower blood cholesterol levels, reducing the risk of heart disease.
Gut Health: Soluble fiber is fermented by bacteria in the colon, producing short-chain fatty
acids that promote gut health and may reduce inflammation.
Insoluble Fiber
Description: Insoluble fiber does not dissolve in water and adds bulk to the stool. It is found
in foods such as whole grains, wheat bran, vegetables, and legumes.
Role in the Body:
Digestive Health: Insoluble fiber helps to add bulk to stool and promotes regular bowel
movements, preventing constipation and promoting digestive health.
Weight Management: By adding bulk and promoting a feeling of fullness, insoluble fiber
can help control appetite and manage body weight.
Prevention of Diverticulitis: Insoluble fiber may reduce the risk of developing diverticulitis,
a condition where small pouches form in the colon wall and become inflamed.
Factors Determining Dietary Modifications in Disease Management (10 Marks)
Nutritional Requirements of the Disease
Certain diseases increase the body’s need for specific nutrients. For example, protein needs
are higher in patients with wounds or infections, while carbohydrate intake may need to be
monitored in diabetes management.
Symptoms and Tolerance:
The presence of symptoms such as nausea, vomiting, diarrhoea, or difficulty swallowing can
dictate the type of diet modifications needed. For instance, a patient with difficulty
swallowing may require a pureed or liquid diet.
Stage and Severity of the Disease
The progression and severity of the disease can influence dietary modifications. In chronic
kidney disease, for example, dietary restrictions become more stringent as the disease
progresses.
Medication Interactions
Some medications interact with nutrients, necessitating dietary adjustments. For example,
patients on blood thinners may need to monitor their vitamin K intake, as it can affect the
efficacy of the medication.
Cultural and Personal Preferences
Cultural food practices and personal preferences must be considered when planning dietary
modifications to ensure the patient is more likely to adhere to the dietary plan.
Nutritional Status
The patient’s current nutritional status, including any existing deficiencies or malnutrition,
will determine the dietary changes needed to meet nutritional needs.
Metabolic Changes
Diseases that affect metabolism, such as hyperthyroidism or diabetes, require specific
dietary modifications to manage the altered metabolic state.
Psychosocial Factors
The patient’s mental and emotional state, socioeconomic status, and ability to obtain or
prepare food can influence dietary modifications. For example, depression may decrease
appetite, necessitating more frequent, smaller meals.
Dietary Restrictions
Some diseases require the restriction of certain nutrients, such as sodium in hypertension or
phosphorus in chronic kidney disease, to prevent further complications.
Clinical Goals
The primary goals of disease management, such as weight loss in obesity or glycaemic
control in diabetes, guide the dietary modifications needed to achieve these outcomes.
Basic Causes of Malnutrition in Your Country (12 Marks)
Malnutrition is a multifaceted issue with various underlying causes:
Poverty
Poverty is a significant contributor to malnutrition, as it limits access to nutritious food,
clean water, and healthcare. Families living in poverty often rely on inexpensive, nutrient-
poor foods, leading to malnutrition.
Food Insecurity
Inadequate food availability due to factors like drought, poor infrastructure, and conflicts
can lead to malnutrition. Inconsistent food supply affects both the quantity and quality of
food intake.
Poor Agricultural Practices
Inefficient farming techniques, lack of access to modern technology, and poor soil
quality can reduce crop yields, leading to food shortages and malnutrition.
Lack of Education
A lack of knowledge about proper nutrition, especially among mothers and caregivers,
contributes to poor dietary practices, which can result in malnutrition, particularly among
children.
Inadequate Healthcare Services
Limited access to healthcare services means that malnutrition-related illnesses are often
untreated, exacerbating the problem. This is particularly problematic in rural areas.
Cultural Practices
Cultural beliefs and practices may influence dietary choices and food distribution within
households, sometimes leading to malnutrition, especially among women and children.
Infectious Diseases
Diseases like HIV/AIDS, tuberculosis, and malaria increase the body’s nutritional needs
while reducing appetite and nutrient absorption, contributing to malnutrition.
Political Instability and Conflict
Wars, political unrest, and displacement can disrupt food production and distribution,
leading to widespread malnutrition in affected regions.
Environmental Factors
Climate change, droughts, floods, and other environmental factors can reduce agricultural
productivity, leading to food scarcity and malnutrition.
Urbanization
Rapid urbanization has led to lifestyle changes, including increased consumption of
processed foods that are high in calories but low in essential nutrients, contributing to
malnutrition.
Gastrointestinal Complications of Enteral Feeding (8 Marks)
Aspiration Pneumonia:
Aspiration of enteral feeding formula into the lungs can occur if the feeding tube is
improperly positioned or if the patient has impaired swallowing, leading to pneumonia.
Diarrhoea:
Enteral feeding, especially if given too rapidly or with a high-osmolality formula, can
cause diarrhoea due to the malabsorption of nutrients or intolerance to the feeding formula.
Constipation:
Lack of fiber in enteral feeding formulas or inadequate hydration can lead to constipation,
which can be uncomfortable and further complicate the patient’s condition.
Nausea and Vomiting:
Improper tube placement, delayed gastric emptying, or feeding too quickly can cause nausea
and vomiting, which can lead to discomfort and potential aspiration.
Tube Displacement
The feeding tube may become dislodged or blocked, leading to inadequate nutrition and the
potential need for re-insertion, which can be uncomfortable and pose additional risks.
Electrolyte Imbalances
Enteral feeding can cause electrolyte imbalances, particularly if the patient has renal issues or
the feeding solution is not properly balanced. This can lead to complications like
hyperkalaemia or hyponatremia.
Managing Gastro-Intestinal Discomfort During Pregnancy (5 Marks)
Eating Small, Frequent Meals
Smaller, more frequent meals can prevent overloading the digestive system and reduce
discomfort such as bloating and heartburn.
Avoiding Trigger Foods:
Pregnant women should avoid foods that are spicy, fatty, or highly acidic, as these can
exacerbate gastrointestinal discomfort.
Staying Hydrated:
Drinking plenty of water helps to prevent constipation, which is a common cause of
gastrointestinal discomfort during pregnancy.
Elevating the Head During Sleep:
Sleeping with the head elevated can help reduce acid reflux and heartburn, which are
common during pregnancy.
Engaging in Light Exercise:
Light physical activity, such as walking, can help stimulate digestion and alleviate discomfort
such as gas and bloating.
Definitions and Management
i) Toxaemia (Pre-eclampsia) (2.5 Marks)
Definition: Toxaemia, also known as pre-eclampsia, is a pregnancy complication
characterized by high blood pressure and signs of damage to other organ systems, often the
liver and kidneys, typically occurring after 20 weeks of pregnancy.
Management:
Regular Monitoring: Blood pressure and urine should be regularly monitored to detect pre-
eclampsia early.
Medications: Antihypertensive medications may be prescribed to manage high blood
pressure.
Bed Rest: In some cases, bed rest is recommended to reduce stress on the body.
Dietary Adjustments: Reducing salt intake and ensuring adequate protein intake can help
manage the condition.
Delivery: In severe cases, early delivery may be necessary to protect the mother and baby.
ii) Kwashiorkor (2.5 Marks)
Definition: Kwashiorkor is a severe form of protein-energy malnutrition commonly seen in
children, characterized by oedema, an enlarged liver, thinning hair, and skin changes due to
protein deficiency.
Management:
Nutritional Rehabilitation: Gradual introduction of protein-rich foods such as eggs, milk,
fish, and legumes.
Energy-dense Foods: Providing high-calorie foods to meet the energy needs of the child.
Micronutrient Supplementation: Vitamin and mineral supplements, especially zinc,
vitamin A, and iron, to address deficiencies.
Hydration: Ensuring adequate hydration to manage edema and prevent dehydration.
Monitoring and Follow-up: Regular monitoring of growth and nutritional status to prevent
relapse.
Reasons Why Mixed Feeding (Breastfeeding and Introduction of Other Foods) Is
Discouraged (5 Marks)
Increased Risk of Infections:
Introducing other foods too early can expose the infant to pathogens, increasing the risk of
infections like diarrhea.
Reduced Breast Milk Supply:
Mixed feeding can lead to reduced demand for breast milk, thereby decreasing the mother’s
milk supply.
Nutrient Imbalance:
Breast milk provides a balanced nutrient profile, and introducing other foods may lead to an
imbalance and inadequate nutrient intake.
Interference with Digestive System:
An infant’s digestive system is not fully developed to handle solid foods, leading to potential
digestive issues like constipation or allergies.
Weaning Difficulties:
Mixed feeding can lead to early weaning from breast milk, depriving the child of its benefits.
Effects of Drugs on Nutrient Excretion (5 Marks)
Diuretics:
Increase the excretion of potassium, magnesium, and calcium, which can lead to deficiencies
if not managed.
Antibiotics:
Some antibiotics can cause the excretion of essential nutrients like vitamin K, leading to
deficiencies.
Laxatives:
Chronic use of laxatives can lead to the loss of electrolytes and minerals like potassium,
sodium, and magnesium.
Steroids:
Steroid medications can increase calcium excretion, potentially leading to bone loss and
osteoporosis.
Chemotherapy Drugs:
Chemotherapy can increase the excretion of certain vitamins and minerals, leading to
deficiencies and requiring supplementation.
Three Goals of Nutrition in the Prevention of Disease (10 Marks)
Maintaining Optimal Health and Function:
Proper nutrition helps maintain the body’s overall health and function by providing essential
nutrients that support bodily processes, immune function, and energy levels, which in turn
helps prevent chronic diseases such as diabetes, heart disease, and obesity.
Preventing Nutrient Deficiencies:
Ensuring an adequate intake of all essential nutrients helps prevent deficiencies that can lead
to various health problems, including anemia (due to iron deficiency), osteoporosis (due to
calcium and vitamin D deficiency), and scurvy (due to vitamin C deficiency).
Reducing the Risk of Disease Development:
A balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can
reduce the risk of developing chronic conditions such as cardiovascular disease, type 2
diabetes, and certain cancers. Nutritional strategies such as limiting sugar, salt, and unhealthy
fats can significantly lower the risk of these diseases.
The Nutrition Care Process: Four Distinct Steps (8 Marks)
Nutrition Assessment:
The first step involves collecting and analyzing data related to the individual’s health and
nutritional status, including dietary intake, medical history, biochemical data, anthropometric
measurements, and psychosocial factors. This helps identify any nutritional problems and
serves as the basis for the entire care process.
Nutrition Diagnosis:
Based on the assessment, the nutrition professional identifies specific nutrition-related
problems or diagnoses, which are categorized as intake, clinical, or behavioral-environmental
issues. The diagnosis provides a clear direction for intervention.
Nutrition Intervention:
In this step, the nutrition professional develops and implements strategies to address the
diagnosed problems. This may include dietary modifications, education, counseling, and
monitoring. The intervention is tailored to the individual’s needs and circumstances and aims
to achieve specific goals and outcomes.
Nutrition Monitoring and Evaluation:
The final step involves tracking the patient’s progress and evaluating the effectiveness of the
nutrition intervention. This may include reassessing the patient’s nutritional status, adjusting
the care plan as needed, and ensuring that the goals of the intervention are being met.
Six Principles to Consider When Planning Meals (12 Marks)
Balance:
A balanced meal plan includes appropriate proportions of different food groups, such as
carbohydrates, proteins, fats, vitamins, and minerals, to ensure that all essential nutrients are
consumed in the right amounts.
Variety:
Including a wide range of foods in the diet helps provide all the necessary nutrients and
reduces the risk of nutrient deficiencies. It also makes meals more enjoyable and interesting.
Moderation:
Moderation involves controlling portion sizes and not overconsuming any one type of food,
particularly those high in sugars, fats, or salt, to maintain a healthy weight and prevent
chronic diseases.
Adequacy:
Ensuring that the diet provides sufficient energy and nutrients to meet the individual’s daily
needs, based on their age, gender, activity level, and health status, is essential for maintaining
health and preventing malnutrition.
Caloric Control:
The total caloric intake should match the individual’s energy expenditure to maintain a
healthy weight. This involves choosing nutrient-dense foods that provide maximum nutrients
for the calories consumed.
Nutrient Density:
Prioritizing foods that are high in nutrients relative to their calorie content, such as fruits,
vegetables, lean proteins, and whole grains, ensures that the diet provides all necessary
nutrients without excessive calorie intake.
Five Factors Contributing to Overweight and Obesity in Children (5 Marks)
Poor Dietary Habits:
Consumption of high-calorie, low-nutrient foods, such as sugary snacks, fast food, and sugary
beverages, contributes significantly to excessive weight gain in children.
Lack of Physical Activity:
Sedentary lifestyles, characterized by minimal physical activity and excessive screen time,
reduce calorie expenditure, leading to weight gain.
Genetic Predisposition:
A family history of obesity can increase a child’s likelihood of becoming overweight or obese
due to inherited traits that affect metabolism and fat storage.
Socioeconomic Factors:
Limited access to healthy foods, education, and recreational activities in low-income families
can lead to poor dietary choices and inactivity, contributing to obesity.
Psychological Factors:
Emotional eating, where children eat in response to stress, boredom, or depression, rather
than hunger, can result in overeating and weight gain.
Health Benefits of Dietary Fiber (5 Marks)
Improves Digestive Health:
Dietary fiber helps maintain bowel regularity by adding bulk to the stool, reducing the risk of
constipation, haemorrhoids, and diverticular disease.
Helps Control Blood Sugar Levels:
Soluble fiber slows the absorption of sugar, helping to improve blood sugar control, which is
particularly beneficial for individuals with diabetes.
Reduces Cholesterol Levels:
Soluble fiber binds to cholesterol in the digestive system and helps remove it from the body,
which can lower total cholesterol levels and reduce the risk of heart disease.
Aids in Weight Management:
High-fiber foods are more filling and take longer to eat, which can reduce overall calorie
intake and support weight management.
Supports Gut Health:
Fiber serves as a prebiotic, feeding beneficial gut bacteria, which promotes a healthy gut
microbiome and may protect against certain diseases.
Nutrient Deficiencies Associated with the Following Disorders (5 Marks)
i. Neural Tube Defects:
Deficiency: Folate (Folic Acid)
ii. Osteomalacia:
Deficiency: Vitamin D
iii. Cretinism:
Deficiency: Iodine
iv. Beriberi:
Deficiency: Thiamine (Vitamin B1)
v. Scurvy:
Deficiency: Vitamin C
Main Types of Lipids of Nutritional Importance (6 Marks)
Triglycerides:
These are the most common type of fat in the body, made up of three fatty acids attached
to a glycerol molecule. They are the primary form of stored energy and provide insulation
and protection for organs.
Phospholipids:
These lipids contain a phosphate group and are a major component of cell membranes,
playing a crucial role in cellular structure and function. Phospholipids also help in the
transportation of lipids in the blood.
Sterols:
Sterols, such as cholesterol, are essential for the formation of steroid hormones, vitamin D,
and bile acids, which are vital for digestion and absorption of dietary fats.
Five Advantages of Using Anthropometry to Assess Nutritional Status (5 Marks)
Non-Invasive:
Anthropometric measurements, such as weight, height, and body circumference, are non-
invasive and easy to obtain, making them a practical tool in various settings.
Cost-Effective:
Anthropometry requires minimal equipment and is relatively inexpensive, making it
accessible for widespread use, particularly in low-resource settings.
Can Be Used Across All Age Groups:
Anthropometric methods are applicable to individuals of all ages, from infants to the elderly,
making them versatile for assessing nutritional status across the lifespan.
Tracks Growth and Development:
Anthropometry is useful for monitoring growth in children and adolescents and identifying
potential nutritional problems early.
Estimates Body Composition:
Certain anthropometric measures, such as skinfold thickness and waist-to-hip ratio, can
provide estimates of body fat distribution and overall body composition, which are important
indicators of health.
WHO and UNICEF’s Global Recommendations for Optimal Infant Feeding (4 Marks)
Exclusive Breastfeeding for the First Six Months:
WHO and UNICEF recommend that infants be exclusively breastfed for the first six months
of life, meaning no other foods or liquids, including water, should be given during this period.
Continued Breastfeeding Alongside Complementary Foods:
After six months, appropriate complementary foods should be introduced while continuing
breastfeeding up to 2 years of age or beyond.
Initiation of Breastfeeding Within the First Hour:
Breastfeeding should be initiated within the first hour of birth to take advantage of the
nutrient-rich colostrum and to establish breastfeeding early.
Responsive Feeding:
Caregivers should practice responsive feeding, paying attention to the infant’s hunger and
satiety cues, and provide a variety of nutrient-rich foods as the child grows.
Five Functions of Carbohydrates in the Body (10 Marks)
Primary Source of Energy:
Carbohydrates are the body’s main source of energy. Glucose derived from carbohydrates is
used by cells to produce ATP (adenosine triphosphate), the energy currency of the body.
Sparing Protein:
Carbohydrates prevent the breakdown of proteins for energy by providing a readily available
source of glucose, thus allowing proteins to be used for their primary functions, such as tissue
repair and enzyme production.
Regulation of Blood Sugar:
Complex carbohydrates, particularly those high in fiber, help regulate blood sugar levels by
slowing the absorption of glucose, preventing spikes and crashes in blood sugar.
Supporting Brain Function:
The brain relies almost exclusively on glucose for energy, making carbohydrates essential for
cognitive function, concentration, and overall mental performance.
Promoting Digestive Health:
Dietary fiber, a type of carbohydrate, promotes healthy digestion by adding bulk to the stool
and feeding beneficial gut bacteria, which supports a healthy gut microbiome.
Five Common Nutrition-Related Problems Among the Elderly (10 Marks)
Malnutrition:
Due to factors like reduced appetite, difficulty chewing or swallowing, and limited access to
nutritious foods, elderly individuals are at high risk of malnutrition, which can lead to weight
loss, muscle wasting, and weakened immunity.
Vitamin D Deficiency:
Older adults are often at risk of vitamin D deficiency due to decreased skin synthesis and less
outdoor activity, leading to weakened bones and increased risk of fractures and osteoporosis.
Dehydration:
The elderly may have a diminished sense of thirst, leading to inadequate fluid intake and
dehydration, which can cause confusion, urinary tract infections, and kidney stones.
Anaemia:
Iron deficiency or poor absorption of vitamin B12 can lead to anemia, resulting in fatigue,
weakness, and decreased cognitive function in the elderly.
Obesity:
Reduced physical activity combined with unchanged eating habits can lead to weight gain
and obesity, increasing the risk of chronic conditions such as diabetes and cardiovascular
disease.
Digestion and Absorption of Protein from an Egg (10 Marks)
Mouth:
Digestion of protein begins in the mouth, where the egg is mechanically broken down into
smaller pieces by chewing, mixing it with saliva.
Stomach:
In the stomach, the acidic environment denatures the proteins, unravelling their structure. The
enzyme pepsin, secreted by the stomach lining, begins breaking down the proteins into
smaller polypeptides.
Small Intestine:
The partially digested proteins enter the small intestine, where they are further broken down
by pancreatic enzymes, such as trypsin, chymotrypsin, and carboxypeptidase, into smaller
peptides and amino acids.
Absorption:
The small peptides and free amino acids are absorbed by the intestinal lining through active
transport mechanisms and enter the bloodstream via the portal vein.
Six Signs and Symptoms of Kwashiorkor (6 Marks)
Oedema:
Swelling, particularly in the legs, feet, and sometimes the face, caused by fluid retention in
the tissues.
Distended Abdomen:
A protruding belly due to weakened abdominal muscles, enlarged liver, and fluid
accumulation.
Skin Changes:
Dark, patchy, and peeling skin, often referred to as “flaky paint” dermatitis, due to protein
deficiency.
Hair Changes:
Hair becomes thin, brittle, and may change color, often turning reddish or lighter due to lack
of melanin.
Fatigue and Irritability:
General tiredness, lack of energy, and increased irritability due to insufficient calories and
protein.
Growth Retardation:
Stunted growth and poor weight gain, especially in children, due to inadequate protein intake.
Five Risk Factors for Coronary Heart Diseases (5 Marks)
High Blood Pressure (Hypertension):
Increased blood pressure can damage arteries, making them more susceptible to plaque
buildup and leading to coronary heart disease.
High Cholesterol Levels:
Elevated levels of LDL cholesterol contribute to the formation of plaque in the arteries,
narrowing them and increasing the risk of heart disease.
Smoking:
Tobacco use damages the lining of blood vessels, raises blood pressure, and reduces oxygen
in the blood, all of which can contribute to coronary heart disease.
Diabetes:
High blood sugar levels associated with diabetes can damage blood vessels and the nerves
that control the heart, increasing the risk of coronary heart disease.
Obesity:
Excess body fat, particularly around the abdomen, is associated with higher levels of blood
pressure, cholesterol, and the risk of developing coronary heart disease.
Description of Terms (6 Marks)
(i) Malnutrition (2 Marks):
Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy
and/or nutrients. It includes undernutrition (wasting, stunting, underweight), inadequate
vitamins or minerals, overweight, obesity, and diet-related noncommunicable diseases.
(ii) Nutrition (2 Marks):
Nutrition is the science that studies the interactions between living organisms and the
nutrients and other substances in food, and how these nutrients are absorbed, digested,
metabolized, and utilized by the body.
(iii) Nutritional Disorders (2 Marks):
Nutritional disorders are medical conditions that occur due to either a lack or an excess of
certain nutrients in the diet. These disorders can manifest as undernutrition, overnutrition, or
specific deficiencies such as vitamin or mineral shortages.
Key Function of Thiamine (Vitamin B1) in Our Bodies (4 Marks)
Energy Production:
Thiamine is essential for converting carbohydrates into energy. It acts as a coenzyme in the
metabolism of glucose, which is crucial for producing ATP, the body’s energy currency.
Nervous System Function:
Thiamine plays a vital role in nerve function by supporting the synthesis of neurotransmitters,
which are chemicals that transmit signals between nerves and muscles. It helps maintain the
health of nerve cells and contributes to proper brain function.
Nutritional Requirements for Infants and Justifications (10 Marks)
Energy:
Requirement: Infants need approximately 100-120 calories per kilogram of body weight per
day.
Justification: Rapid growth and high metabolic rates require substantial energy for proper
development, including physical growth and brain development.
Protein:
Requirement: Infants require about 1.5 grams of protein per kilogram of body weight per day.
Justification: Protein is essential for growth and development, including the development of
tissues, muscles, and enzymes.
Fat:
Requirement: About 40-50% of an infant’s total caloric intake should come from fats.
Justification: Fats are crucial for brain development, absorption of fat-soluble vitamins (A, D,
E, K), and providing a concentrated source of energy.
Carbohydrates:
Requirement: Carbohydrates should make up about 40-50% of total caloric intake.
Justification: Carbohydrates provide a primary source of energy and support the development
of the nervous system.
Vitamins:
Requirement: Adequate intake of vitamins such as A, D, and C is necessary.
Justification: Vitamins support various physiological functions, including vision (Vitamin A),
bone health (Vitamin D), and immune function (Vitamin C).
Minerals:
Requirement: Key minerals include iron, calcium, and zinc.
Justification: Iron is essential for preventing anaemia and supporting brain development;
calcium is crucial for bone development; zinc supports immune function and cell growth.
Water:
Requirement: Infants need sufficient water intake, though this is generally met through breast
milk or formula.
Justification: Water is vital for maintaining hydration, facilitating digestion, and supporting
metabolic processes.
Role of Food Fortification and Nutrient Supplementation in Controlling Malnutrition
(10 Marks)
Food Fortification:
Example: Iodized salt.
Role: Iodizing salt helps prevent iodine deficiency disorders, such as goiter and
hypothyroidism, by ensuring adequate iodine intake through a commonly used food product.
Example: Iron-fortified cereals.
Role: Fortifying cereals with iron helps combat iron deficiency anaemia, particularly in
populations with low dietary iron intake.
Nutrient Supplementation:
Example: Vitamin A supplements for children.
Role: Supplementing vitamin A helps prevent and treat vitamin A deficiency, which can lead
to blindness and increase susceptibility to infections.
Example: Folic acid supplements for pregnant women.
Role: Folic acid supplementation reduces the risk of neural tube defects in newborns by
ensuring adequate folate levels during pregnancy.
Combining Fortification and Supplementation:
Example: Combining fortified foods with targeted supplementation programs (e.g., iron
supplements for pregnant women).
Role: This approach addresses both general and specific nutritional needs, improving overall
health and preventing deficiencies.
Public Health Impact:
Example: National fortification programs.
Role: Large-scale fortification programs can significantly reduce the prevalence of
micronutrient deficiencies across populations, improving public health outcomes.
Digestion, Absorption, and Assimilation of Carbohydrates in the Human Body (10
Marks)
Digestion:
Mouth: Carbohydrate digestion begins in the mouth with salivary amylase breaking down
starches into maltose and dextrins.
Stomach: Digestion continues in the stomach, though the acidic environment temporarily
halts amylase activity.
Small Intestine:
Enzyme Action: In the small intestine, pancreatic amylase further breaks down starches into
maltose, isomaltose, and dextrins.
Disaccharides to Monosaccharides: Enzymes such as maltase, lactase, and sucrase on the
intestinal lining convert disaccharides (maltose, lactose, sucrose) into monosaccharides
(glucose, galactose, fructose).
Absorption:
Transport: Monosaccharides are absorbed through the intestinal villi into the bloodstream
via active transport mechanisms and facilitated diffusion.
Glucose and Galactose: Absorbed through sodium-dependent transporters (SGLT1).
Fructose: Absorbed via facilitated diffusion (GLUT5).
Assimilation:
Liver Processing: Monosaccharides are transported to the liver via the portal vein, where
they are processed. Glucose is used for energy, stored as glycogen, or converted into fat if in
excess.
Utilization: Cells throughout the body take up glucose from the bloodstream, utilizing it for
energy or storage.
Nutrition Challenges of HIV/AIDS Patients and Implications (10 Marks)
Increased Nutrient Requirements:
Challenge: HIV/AIDS increases the body’s need for nutrients due to higher metabolic
demands and frequent infections.
Implication: Nutritional deficiencies can worsen health outcomes, accelerate disease
progression, and reduce the effectiveness of antiretroviral therapy.
Appetite Loss and Weight Loss:
Challenge: Loss of appetite and chronic diarrhoea can lead to significant weight loss and
malnutrition.
Implication: Weight loss weakens the immune system and increases susceptibility to
infections and complications.
Increased Risk of Micronutrient Deficiencies:
Challenge: Malabsorption and higher nutrient needs can lead to deficiencies in vitamins and
minerals such as A, C, and zinc.
Implication: Deficiencies can impair immune function, increase infection risk, and hinder
overall health.
Food Insecurity:
Challenge: Economic hardships and increased medical costs may limit access to nutritious
food.
Implication: Poor nutrition can further compromise immune function and overall health,
leading to a cycle of malnutrition and illness.
Drug-Nutrient Interactions:
Challenge: Antiretroviral drugs may affect nutrient absorption and metabolism.
Implication: These interactions can lead to nutrient imbalances and affect the efficacy of
treatment.
Key Strategies in Prevention and Control of Food Insecurity (12 Marks)
Improving Agricultural Productivity:
Strategy: Implementing advanced farming techniques, providing access to quality seeds, and
improving irrigation systems.
Impact: Increases food availability and reduces reliance on imported food.
Strengthening Food Distribution Systems:
Strategy: Enhancing infrastructure for transportation and storage of food to reduce post-
harvest losses and ensure timely delivery.
Impact: Ensures that food reaches those in need and reduces waste.
Supporting Local Food Production:
Strategy: Encouraging urban and rural community gardens, and supporting local farmers
through subsidies and training.
Impact: Reduces food dependency and boosts local economies.
Enhancing Social Safety Nets:
Strategy: Implementing food assistance programs, cash transfers, and school feeding
programs.
Impact: Provides immediate relief to vulnerable populations and reduces food insecurity.
Promoting Sustainable Practices:
Strategy: Encouraging sustainable agricultural practices and reducing food waste.
Impact: Ensures long-term food security and environmental protection.
Educating Communities:
Strategy: Providing education on nutrition, food preparation, and healthy eating practices.
Impact: Increases awareness and empowers individuals to make better food choices.
Factors and Lifestyle Challenges Contributing to Increasing Obesity Cases in Modern
Society (8 Marks)
Increased Caloric Intake:
Factor: Rising consumption of high-calorie, processed foods and sugary beverages.
Challenge: Excess caloric intake contributes to weight gain and obesity.
Sedentary Lifestyle:
Factor: Reduced physical activity due to increased screen time and sedentary jobs.
Challenge: Lack of exercise reduces calorie expenditure and promotes weight gain.
Urbanization:
Factor: Busy lifestyles and convenience foods lead to poor dietary choices.
Challenge: Urban environments often provide easy access to unhealthy food options.
Marketing and Advertising:
Factor: Aggressive marketing of unhealthy foods to children and adults.
Challenge: Influences food preferences and consumption patterns.
Economic Factors:
Factor: Lower-cost, energy-dense foods are often more affordable than healthier options.
Challenge: Limited financial resources lead to the purchase of cheaper, less nutritious foods.
Stress and Emotional Eating:
Factor: Increased stress levels and emotional eating as a coping mechanism.
Challenge: Emotional eating can lead to overeating and weight gain.
Lack of Awareness:
Factor: Insufficient knowledge about healthy eating and the risks of obesity.
Challenge: Lack of awareness can lead to poor dietary choices and obesity.
Genetic and Biological Factors:
Factor: Genetic predispositions and metabolic conditions.
Challenge: Some individuals may be more genetically prone to weight gain and obesity.
Explanation of Terms (8 Marks)
Food Security (2 Marks):
Definition: Food security refers to the condition in which all people, at all times, have
physical, social, and economic access to sufficient, safe, and nutritious food to meet their
dietary needs for an active and healthy life.
Justification: It ensures that individuals can obtain and afford enough food to maintain their
health and well-being.
Nutrient Density (2 Marks):
Definition: Nutrient density refers to the amount of essential nutrients provided by a food
relative to its calorie content. Foods that are nutrient-dense provide a high level of vitamins,
minerals, and other beneficial nutrients per calorie.
Justification: Nutrient-dense foods are important for achieving optimal nutrition without
excessive calorie intake.
Trans-Fat (2 Marks):
Definition: Trans-fat is a type of unsaturated fat that has been artificially hydrogenated to
make it more solid at room temperature. It is commonly found in processed and fried foods.
Justification: Trans-fats are associated with increased risk of heart disease and other health
issues, making them a target for reduction in diets.
Stunting (2 Marks):
Definition: Stunting is a condition where a child’s height is significantly below the average
for their age, typically due to chronic malnutrition or insufficient nutrient intake during
critical growth periods.
Justification: Stunting reflects long-term nutritional deficiencies and can impact physical and
cognitive development.
Clinical Manifestations of Protein Energy Malnutrition (5 Marks)
Oedema:
Swelling in the legs, abdomen, or face due to fluid retention, often seen in Kwashiorkor.
Wasting:
Severe loss of muscle mass and body fat, resulting in a very thin and frail appearance, typical
of Marasmus.
Growth Retardation:
Significantly slowed growth in height and weight compared to age-matched peers.
Delayed Development:
Developmental delays in motor skills, cognitive abilities, and social interactions.
Weak Immune System:
Increased susceptibility to infections and illnesses due to compromised immune function.
Nutrition Disorders Common During Pregnancy (5 Marks)
Anaemia:
Description: A condition characterized by a low level of haemoglobin in the blood, often due
to iron deficiency.
Impact: Can lead to fatigue, weakness, and complications during childbirth.
Gestational Diabetes:
Description: A form of diabetes that occurs during pregnancy, characterized by high blood
sugar levels.
Impact: Increases the risk of complications for both the mother and baby, such as
preeclampsia and birth defects.
Preeclampsia:
Description: A condition marked by high blood pressure and protein in the urine.
Impact: Can lead to severe complications for both mother and baby if not managed properly.
Morning Sickness:
Description: Nausea and vomiting that typically occurs in the early stages of pregnancy.
Impact: Can affect nutrient intake and hydration.
Calcium Deficiency:
Description: Insufficient calcium intake, which is crucial for bone development.
Impact: May lead to bone density issues and increase the risk of hypertension.
Routes of Feed Administration During Enteral Feeding (5 Marks)
Nasogastric Tube:
Description: A tube inserted through the nose into the stomach.
Usage: Short-term feeding; suitable for patients with normal digestion but unable to eat.
Orogastric Tube:
Description: A tube inserted through the mouth into the stomach.
Usage: Typically used in infants or in situations where nasal placement is not possible.
Gastrostomy Tube (G-Tube):
Description: A tube inserted directly into the stomach through the abdominal wall.
Usage: Long-term feeding for patients with chronic conditions or those who cannot use a
nasogastric tube.
Jejunostomy Tube (J-Tube):
Description: A tube inserted directly into the jejunum (part of the small intestine) through the
abdominal wall.
Usage: Used for patients who have difficulties with gastric feeding or digestion.
Nasojejunal Tube:
Description: A tube inserted through the nose and into the jejunum.
Usage: Short-term feeding for patients who need enteral nutrition past the stomach.
Two Immediate Causes of Malnutrition (2 Marks)
Inadequate Food Intake:
Description: Not consuming enough food to meet the body’s energy and nutrient
requirements.
Justification: Leads to deficiencies in essential nutrients and energy, causing malnutrition.
Poor Nutrient Absorption:
Description: Conditions that impair the body’s ability to absorb nutrients from food, such as
gastrointestinal disorders.
Justification: Even with adequate food intake, poor absorption can lead to malnutrition.
Section B
Purpose of Community Nutrition Assessments (10 Marks)
Identifying Nutritional Needs:
Purpose: To determine the nutritional status of a community and identify specific needs and
gaps.
Impact: Helps tailor nutrition interventions and programs to address prevalent deficiencies
and health issues.
Assessing Food Security:
Purpose: To evaluate the availability, access, and utilization of food resources within the
community.
Impact: Identifies areas with food insecurity and helps in planning targeted food assistance
programs.
Monitoring Health Outcomes:
Purpose: To track changes in nutritional status and health outcomes over time.
Impact: Provides data for evaluating the effectiveness of nutrition interventions and policies.
Guiding Policy and Planning:
Purpose: To inform policymakers and public health officials about the community’s
nutritional needs.
Impact: Supports the development of evidence-based nutrition policies and programs.
Educating the Community:
Purpose: To raise awareness about nutrition and healthy eating practices.
Impact: Enhances community knowledge and empowers individuals to make better dietary
choices.
Effects of Illness on Nutritional Status (10 Marks)
Increased Nutrient Requirements:
Effect: Illness can increase the body’s need for certain nutrients due to heightened metabolic
demands.
Impact: Can lead to deficiencies if dietary intake does not meet increased needs.
Altered Nutrient Absorption:
Effect: Some illnesses can impair the digestive system’s ability to absorb nutrients effectively.
Impact: Results in malabsorption and potential deficiencies, even with adequate food intake.
Reduced Appetite:
Effect: Illness often leads to decreased appetite or food aversions.
Impact: Reduced food intake can contribute to weight loss and nutritional deficiencies.
Increased Nutrient Loss:
Effect: Certain illnesses and treatments can increase the loss of nutrients through vomiting,
diarrhoea, or medication.
Impact: Leads to imbalances and deficiencies if not managed properly.
Increased Metabolic Rate:
Effect: Illnesses like infections can raise the body’s metabolic rate.
Impact: Higher energy and nutrient requirements can exacerbate malnutrition if intake is not
adjusted.
Complications Associated with Enteral and Parenteral Feeding (12 Marks)
Infection:
Complication: Risk of infection at the feeding tube insertion site or from contaminated
feeding solutions.
Management: Strict aseptic techniques and proper tube care.
Gastrointestinal Issues:
Complication: Problems such as diarrhoea, constipation, or nausea may occur with enteral
feeding.
Management: Adjusting the feeding formula and rate; using medications if necessary.
Tube Displacement or Blockage:
Complication: Tubes can become dislodged or blocked, causing feeding difficulties.
Management: Regular monitoring and maintenance of tube position; ensuring proper
flushing.
Nutrient Imbalance:
Complication: Risks of over- or under-supplementation of nutrients.
Management: Regular monitoring of nutrient levels and adjusting the feeding formula
accordingly.
Hyperglycaemia:
Complication: High blood sugar levels can occur with high-carbohydrate enteral formulas.
Management: Monitoring blood glucose levels and adjusting the formula as needed.
Liver Dysfunction:
Complication: Parenteral feeding can lead to liver problems due to prolonged
1a) Definition of Concepts in Nutrition and Health (8 Marks)
Food Intolerance (2 Marks):
Definition: Food intolerance refers to the difficulty in digesting certain foods, leading to
adverse physical reactions that do not involve the immune system. Unlike food allergies,
which trigger immune responses, food intolerances are generally less severe and may cause
symptoms such as bloating, gas, or diarrhoea.
Example: Lactose intolerance, where individuals cannot properly digest lactose, a sugar
found in milk and dairy products.
Essential Nutrients (2 Marks):
Definition: Essential nutrients are compounds that the body cannot synthesize or produce in
sufficient quantities, and therefore, must be obtained through the diet. They are crucial for
maintaining health, supporting growth, and preventing disease.
Examples: Essential amino acids, vitamins, minerals, fatty acids, and water.
Limiting Amino Acid (2 Marks):
Definition: A limiting amino acid is the essential amino acid that is present in the lowest
quantity in a food protein, relative to the body’s needs. This amino acid limits the body’s
ability to synthesize complete proteins, which can impact growth and repair.
Example: In cereals like wheat, lysine is often the limiting amino acid.
Bland Diet (2 Marks):
Definition: A bland diet consists of foods that are soft, low in dietary fiber, and not spicy. It
is designed to minimize irritation to the digestive tract and is often recommended for
individuals with gastrointestinal conditions or recovering from surgery.
Examples: Foods like bananas, applesauce, plain rice, and boiled chicken.
Conditions Requiring a Fat-Restricted Diet (5 Marks)
Gallbladder Disease:
Fat restriction helps reduce the risk of gallstone formation and eases the burden on the
gallbladder.
Pancreatitis:
A fat-restricted diet minimizes pancreatic stimulation, helping manage the inflammation.
Liver Disease:
Fat restriction supports liver function by reducing the metabolic load on the liver.
Hyperlipidemia:
Reducing fat intake helps manage blood cholesterol and triglyceride levels.
Steatorrhea:
Fat malabsorption conditions like steatorrhea benefit from a fat-restricted diet to prevent
excessive fat loss in stools.
Advantages of Using Biochemical Tests in Nutrition Assessment (4 Marks)
Objective and Quantitative Data:
Biochemical tests provide precise and measurable data on nutrient levels, such as blood
serum levels of vitamins or minerals, offering a clear indication of nutritional status.
Early Detection of Deficiencies:
Biochemical tests can detect nutrient deficiencies before clinical symptoms appear, allowing
for early intervention and prevention of more severe health problems.
Factors Affecting Bioavailability and Utilization of Nutrients (4 Marks)
Nutrient Interactions:
Some nutrients can inhibit or enhance the absorption of others, such as calcium inhibiting
iron absorption.
Food Preparation Methods:
Cooking methods can affect nutrient availability; for instance, boiling can leach water-soluble
vitamins like vitamin C from vegetables.
Digestive Health:
Conditions like celiac disease or Crohn’s disease can impair nutrient absorption in the
intestines.
Presence of Anti-Nutrients:
Compounds like phytates and oxalates in certain foods can bind to minerals and reduce their
bioavailability.
Functions and Rich Dietary Sources of Zinc (4 Marks)
Functions of Zinc:
Immune Function: Zinc plays a critical role in maintaining a healthy immune system and
helps the body fight off infections.
Cell Growth and Repair: It is essential for DNA synthesis, protein production, and cell
division, which are crucial for growth and healing.
Rich Dietary Sources of Zinc:
Animal Sources: Red meat, poultry, and seafood (especially oysters) are rich in zinc.
Plant Sources: Legumes, seeds, and nuts are good sources, though the bioavailability of zinc
from plant sources is lower due to the presence of phytates.
Dietary Management of Cancer (10 Marks)
High-Calorie, High-Protein Diet:
Purpose: To combat weight loss and muscle wasting (cachexia) often associated with cancer
and its treatment. Protein supports muscle maintenance and repair, while calories provide
energy.
Nutrient-Dense Foods:
Purpose: Patients with reduced appetite should consume small portions of nutrient-rich foods
that provide essential vitamins and minerals.
Anti-Inflammatory Foods:
Purpose: Incorporating foods like fruits, vegetables, and omega-3 fatty acids to reduce
inflammation and support overall health.
Hydration:
Purpose: Ensuring adequate fluid intake to prevent dehydration, which is crucial for patients
experiencing side effects like vomiting or diarrhea.
Dietary Modifications Based on Treatment:
Purpose: Adjusting the diet to manage side effects from treatments, such as nausea from
chemotherapy or difficulty swallowing from radiation.
Dimensions of Food Security (10 Marks)
Availability:
Definition: Ensuring sufficient quantities of food are available on a consistent basis.
Impact: Focuses on food production, stock levels, and trade.
Access:
Definition: Having sufficient resources to obtain appropriate foods for a nutritious diet.
Impact: Relates to economic and physical access to food.
Utilization:
Definition: Proper use of food based on knowledge of nutrition and care, as well as adequate
water and sanitation.
Impact: Ensures that food consumed is properly utilized for growth and health.
Stability:
Definition: Access to adequate food at all times, without risk of losing access due to sudden
shocks (e.g., economic crisis) or cyclical events (e.g., seasonal food shortages).
Impact: Focuses on consistent access to food over time.
Sustainability:
Definition: Long-term ability to maintain food production and access without compromising
the environment or future food needs.
Impact: Ensures that food systems are resilient and sustainable over the long term.
Underlying and Basic Causes of Malnutrition (10 Marks)
Underlying Causes:
Inadequate Dietary Intake: Insufficient food consumption in terms of quantity and quality.
Poor Health Services: Lack of access to healthcare, leading to untreated illnesses that
exacerbate malnutrition.
Unhealthy Environment: Poor sanitation, lack of clean water, and exposure to diseases that
hinder proper nutrition.
Basic Causes:
Poverty: Economic deprivation that limits access to food, healthcare, and education.
Social and Cultural Factors: Gender inequality, cultural practices, and lack of education
that affect food distribution and health practices.
Political and Economic Structures: Weak governance, conflict, and economic instability
that disrupt food systems and health services.
Risks and Strategies to Reduce Salt Intake (10 Marks)
Risks
Hypertension: High salt intake is a major risk factor for high blood pressure, leading to
cardiovascular diseases.
Kidney Damage: Excessive salt can strain the kidneys and lead to kidney disease.
Osteoporosis: High salt intake can increase calcium loss in urine, contributing to bone
density loss.
Strategies to Reduce Salt Intake:
Reducing Salt in Processed Foods: Encouraging food manufacturers to lower the salt
content in processed foods.
Public Education: Raising awareness about the health risks of high salt consumption and
promoting alternatives like herbs and spices.
Labeling Regulations: Implementing clear labeling on food products to help consumers
make informed choices about their salt intake.
Promoting Home Cooking: Encouraging people to cook at home using fresh ingredients to
control the amount of salt added.
Setting National Salt Targets: Governments can set and enforce salt reduction targets for
the food industry.
Determinants of Dietary Modification in Disease Management (4 Marks)
Disease Type and Severity:
The specific condition and its severity dictate the dietary changes needed to manage
symptoms and promote healing.
Nutritional Requirements:
Adjusting nutrient intake to meet the increased or altered nutritional needs due to the disease,
such as increased protein for wound healing.
Metabolic Changes:
Diseases may alter metabolism, requiring modifications in macronutrient distribution, such as
reducing carbohydrates in diabetes management.
Medication Interactions:
Some medications can affect nutrient absorption or metabolism, necessitating dietary
adjustments to prevent deficiencies or adverse effects.
Roles of Vitamin C in the Human Body (4 Marks)
Antioxidant Protection:
Vitamin C acts as a powerful antioxidant, protecting cells from damage by free radicals.
Collagen Synthesis:
It is essential for the production of collagen, a protein that helps maintain the integrity of
skin, blood vessels, and bones.
Immune Support
Vitamin C strengthens the immune system, enhancing the body’s ability to fight infections.
Iron Absorption:
It enhances the absorption of non-heme iron from plant-based foods, helping to prevent iron-
deficiency anaemia.
Reasons the Elderly Are Considered a Vulnerable Group (4 Marks)
Decreased Appetite:
Age-related changes often lead to a reduced appetite, increasing the risk of nutrient
deficiencies.
Chronic Diseases:
The elderly are more likely to suffer from chronic diseases that affect their nutritional status,
such as diabetes or heart disease.
Physical and Cognitive Decline:
Declines in physical ability and cognitive function can make food preparation and
consumption challenging, leading to malnutrition.
Social Isolation:
Many elderly individuals face social isolation, which can result in poor eating habits and
inadequate nutrition.
Classification of BMI to Categorize Nutrition Status in Adults (5 Marks)
Underweight:
BMI < 18.5 kg/m²
Indicates insufficient body weight relative to height, associated with a higher risk of
malnutrition.
Normal Weight:
BMI 18.5 – 24.9 kg/m²
Represents a healthy weight range with the lowest risk of developing weight-related health
issues.
Overweight:
BMI 25 – 29.9 kg/m²
Indicates excess body weight relative to height, increasing the risk of cardiovascular
diseases and other health problems.
Obesity Class I:
BMI 30 – 34.9 kg/m²
Represents a moderate level of obesity, associated with a higher risk of chronic diseases like
diabetes.
Obesity Class II and III:
BMI ≥ 35 kg/m²
Represents severe obesity, with a significantly increased risk of serious health complications.
Principles to Guide Family Diet Planning (10 Marks)
Balance:
Ensuring that the diet includes a variety of foods from all food groups to provide a balanced
intake of essential nutrients.
Adequacy:
Making sure the diet provides sufficient calories, proteins, vitamins, and minerals to meet the
family’s nutritional needs.
Moderation:
Including treats and indulgent foods in moderation to maintain a healthy diet without
excessive intake of unhealthy foods.
Variety:
Incorporating a wide range of foods to prevent monotony and ensure a broad spectrum of
nutrients is consumed.
Cultural and Personal Preferences:
Considering the family’s cultural practices and individual food preferences to ensure the diet
is enjoyable and sustainable.
Dietary Management of Cardiovascular Disorders (10 Marks)
Low Sodium Diet:
Reducing salt intake to manage blood pressure and prevent fluid retention.
Increased Fiber Intake:
Consuming more fruits, vegetables, and whole grains to lower cholesterol levels and improve
heart health.
Healthy Fats:
Replacing saturated and trans fats with unsaturated fats from sources like olive oil, nuts, and
fish to reduce cholesterol and inflammation.
Limited Sugar and Refined Carbohydrates:
Reducing intake of sugar and refined carbs to manage blood glucose levels and prevent
obesity.
Adequate Omega-3 Fatty Acids:
Including sources of omega-3s like fatty fish to reduce the risk of arrhythmias and lower
triglyceride levels.
Distinguish between Enteral and Parenteral Nutrition (10 Marks)
Enteral Nutrition:
Definition: Nutrition provided through the gastrointestinal tract via a tube when oral intake is
inadequate but the GI tract is functional.
Indications: Applicable in patients who cannot eat by mouth due to conditions like stroke,
neurological disorders, or head and neck cancers but have a functional digestive system.
Types: Nasogastric tube, gastrostomy, and jejunostomy.
Parenteral Nutrition:
Definition: Nutrition provided intravenously, bypassing the gastrointestinal tract, used when
the GI tract is non-functional.
Indications: Applicable in patients with severe gastrointestinal disorders like bowel
obstruction, severe pancreatitis, or short bowel syndrome.
Types: Total parenteral nutrition (TPN) and peripheral parenteral nutrition (PPN).
Strategies for Addressing Micronutrient Deficiencies in Emergency Situations (5 Marks)
Micronutrient Supplementation:
Providing supplements such as vitamin A, iron, and iodine to vulnerable populations to
quickly address deficiencies.
Fortified Food Distribution:
Distributing foods fortified with essential vitamins and minerals, such as fortified cereals or
cooking oils, in emergency food aid.
Nutrition Education:
Educating the affected population on the importance of consuming a varied diet to prevent
deficiencies.
Emergency Rations:
Providing specially designed emergency food rations that are rich in essential micronutrients.
Health and Nutrition Surveillance:
Implementing systems to monitor the nutritional status of the population and identify
micronutrient deficiencies early.
Changes in the Gastrointestinal System of the Elderly (5 Marks)
Reduced Saliva Production:
Decreased saliva production can lead to difficulty in swallowing and poor digestion of
starches, increasing the risk of malnutrition and dental issues.
Slower Gastric Emptying:
The stomach empties food more slowly, which can cause feelings of fullness, reduce appetite,
and increase the risk of indigestion.
Decreased Digestive Enzyme Production:
The production of digestive enzymes decreases, leading to impaired digestion and absorption
of nutrients, particularly fats and fat-soluble vitamins.
Reduced Gastrointestinal Motility:
Slower movement of food through the intestines can lead to constipation, which is a common
issue in the elderly.
Altered Gut Microbiota:
Changes in the gut microbiome may affect nutrient absorption, immunity, and overall
gastrointestinal health.
Characteristics of Malnutrition in Adults Identified During Clinical Examination (5
Marks)
Muscle Wasting:
Loss of muscle mass, particularly in the arms, legs, and face, is a common sign of
malnutrition.
Unintentional Weight Loss:
Significant and unplanned weight loss over a short period is a key indicator of malnutrition.
Poor Wound Healing:
Slow or impaired wound healing may be observed due to protein or micronutrient
deficiencies.
Hair and Skin Changes:
Brittle hair, dry skin, and the presence of dermatitis or sores can indicate nutritional
deficiencies.
Oedema:
Swelling, particularly in the lower extremities, may be a sign of protein deficiency or severe
malnutrition.
Purpose of Nutritional Management for Burns Patients (5 Marks)
Promote Wound Healing:
Adequate nutrition is essential to support tissue repair and regeneration, which is critical in
the healing of burns.
Prevent Muscle Wasting:
Providing sufficient protein and calories helps prevent muscle loss due to the increased
metabolic demands of burn injuries.
Support Immune Function:
Proper nutrition boosts the immune system, reducing the risk of infections in burn patients.
Maintain Fluid and Electrolyte Balance:
Nutrition management helps restore and maintain fluid and electrolyte levels, which are often
disrupted in burn patients.
Provide Energy for Recovery:
High-calorie diets are necessary to meet the increased energy requirements for recovery and
to prevent further weight loss.
Factors Influencing Calcium Absorption in the Body (5 Marks)
Vitamin D Levels:
Adequate vitamin D is crucial for calcium absorption in the intestines; low levels can impair
absorption.
Dietary Intake:
The presence of dietary factors such as oxalates and phytates (found in spinach, nuts, etc.)
can bind calcium and reduce its absorption.
Age:
Calcium absorption decreases with age, making it more difficult for the elderly to maintain
adequate calcium levels.
Stomach Acidity:
Sufficient stomach acid is required for calcium absorption; conditions that reduce stomach
acid can impair absorption.
Hormonal Balance:
Hormones like parathyroid hormone (PTH) and estrogen play a role in regulating calcium
absorption; imbalances can affect absorption.
Functions of a Health Project Leader (5 Marks)
Planning and Strategy Development:
Creating a clear plan and strategy for the health project, including setting goals, timelines,
and resource allocation.
Team Management:
Leading and managing the project team, assigning tasks, and ensuring that all members are
working effectively toward the project objectives.
Monitoring and Evaluation:
Overseeing the progress of the project, evaluating outcomes, and making adjustments as
needed to meet objectives.
Stakeholder Communication:
Maintaining clear and consistent communication with stakeholders, including project funders,
community members, and government agencies.
Budget Management:
Managing the project’s budget, ensuring that resources are used efficiently, and adhering to
financial constraints.
Strategies for Addressing Micronutrient Deficiencies in Emergency Situations (5 Marks)
Micronutrient Supplementation:
Providing supplements such as vitamin A, iron, and iodine to vulnerable populations to
quickly address deficiencies.
Fortified Food Distribution:
Distributing foods fortified with essential vitamins and minerals, such as fortified cereals or
cooking oils, in emergency food aid.
Nutrition Education:
Educating the affected population on the importance of consuming a varied diet to prevent
deficiencies.
Emergency Rations:
Providing specially designed emergency food rations that are rich in essential micronutrients.
Health and Nutrition Surveillance:
Implementing systems to monitor the nutritional status of the population and identify
micronutrient deficiencies early.
Biofortification:
Developing crops with enhanced nutritional profiles, such as vitamin A-enriched sweet
potatoes, to improve intake through commonly consumed foods.
Dietary Diversification:
Promoting the consumption of a variety of foods to ensure a balanced intake of
micronutrients.