Nutrition Advice and

Health Education
Session 11
Learning Objectives

By the end of this session, students are

expected to be able to:
 Explain the meaning of nutritional advice
 Explain nutrition recommendations for

pregnant women, children under five years,

adolescents aged 10-19 years, adults aged
20-59 years, and elderly adults 60 years
and older.
Nutritional Advice
 Giving nutrition advice is when a more
experienced or knowledgeable person is
telling a less-experienced or less-
knowledgeable person what to do.
 Nutrition advice is necessary if the client

cannot make decisions about a food or

nutrition problem
 Before delivering nutrition advice to family
members, do the following:
 Ask questions about medical history,

lifestyle, and current eating habits

 Formulate diet plan tailored to the family’s

needs. Consider locally available foods

because they are cheap and easily
accessed.
 Involve family member in the diet plan.
Balanced Diet
 Consider balanced diet whenever possible.
A balanced diet should provide the body
with all of the substances necessary to
maintain growth, good health and repair
damaged tissues.
 One should not eat too much or too

little of food from one food group, or

one food item only.
 A balance between food intake and the
body’s energy expenditure is important for
prevention of excess weight gain or loss. No
single kind of food contains all the nutrients
and fiber needed, so it’s important to eat a
range of foods.
 Eating the right balance from the main food

groups will ensure that the body gets all it

needs to stay healthy.
There are five main food
groups
 In addition to food, drinking plenty of clean
and safe water is very important in cell
metabolism and transportation of nutrients.
Drink two litres of water or more a day
depending on the weather.
 High intake of saturated fat can increase
the amount of cholesterol produced in the
liver and therefore the amount in the blood.
A high level of cholesterol in the blood is
associated with increased risk of coronary
heart disease.
 In general terms, to improve your diet there

are certain foods you should aim to eat

more or less of.
Foods which Improve Diet
Eat more Eat less
Lean meat Fatty meat products
• Skin and extra fat • Sausages, meat
removed pies, red meat

Fruit and vegetables Salty foods

• Eat vegetable • Salted peanuts,
abundantly crisps
• Eat fruits • Processed foods
generously such as ready meals
• Steam rather than andsauces, burgers
boil vegetables and sausages
• Eat when fresh and
 Eat Eat less
more
High-fibre foods Sugary foods
• Wholegrain (or • Sweets, chocolate,
brown) bread or rice, cakes and biscuits
beans

Low-fat dairy High-fat dairy products

products • Full-cream milk, full-
• Skimmed or semi- fat cheese and yogurt,
skimmed milk, low- cream and butter
fat cheese, spreads
and yogurts
 Eat more Eat less

Starchy foods Starchy foods

• Whole grain,roots • Processed cereals
and tubers, and potatoes
brown bread

Pulses/lentils and Poultry and poultry

nuts products
Nutrition Throughout the Life
Cycle
 Nutrition is one of the key factors that can
affect the health of an individual at any
particular stage throughout the life cycle.
 Nutrients and energy requirements differ

with age, sex, level of physical activity and

physiological status.
Below are the groups/categories
 Pregnant women
 Under five
 0-six months
 six months–two years
 two- five years
 School age children (five-nine years)
 Adolescents (10-19 years)
 Adults (20-59 years)
 Elderly (60 years and above)
Nutrition Recommendations for
Pregnant Women
The physiological changes that occur during
pregnancy require extra nutrients and
energy to meet the demand of:
o An expanding blood supply
o The growth of maternal tissue
o The developing foetus
o Preparation for lactation
Poor Nutritional Status during
Pregnancy
• Directly affects women’s health status
 Has a negative impact on birth weight,

growth and development of the infant

 May lead to increased risk of foetal,

neonatal, and infant death

 Contributes to the occurrence of intra-

uterine growth retardation, low birth weight

and prematurity
 A child might be born with defects such as
cretinism, spinal bifida and brain damage
 There is also increased risk of maternal

death due to anaemia, infection, labour and

delivery complications, which occur as a
result of other forms of malnutrition
 The most visible measure of inadequate

nutrition during pregnancy is the lack of

maternal weight gain
 Overweight women entering pregnancy
should gain 7.0 – 11.5kg during pregnancy.
 Obese women with lower weight gains can

have successful pregnancies and healthy

babies. It is recommended that their
gestational gain to be limited not more than
7kg.
 An obese pregnant woman requires
individual nutrition counselling to insure
adequate nutrient intake and regular
physical activity, and to discourage them
from inappropriate attempts to lose weight
during pregnancy
 Young adolescent and pregnant women are

advised to gain at the upper end of their

recommended range for their BMI. Short
women (157 cm) should strive for gains at
the lower end of the range.
 Excessive weight gain is also a concern
because it may lead to post-partum obesity
which might be difficult to lose after
delivery
 Excess weight increases the risk of

developing a number of nutrition-related

complications including heart diseases,
stroke, diabetes, depression, cancer and
high blood pressure
 Some women develop gestational diabetes.
 This means that they had high blood sugar

levels during pregnancy.

 After delivery those women could have
normal blood sugar levels; however, some
of them have a greater chance of
developing diabetes in future.
 Gestational diabetes is associated with

abnormal increase in foetal weight and

deaths.
 The known risk factors of gestational

diabetes are obesity and family history of

diabetes.
Recommendations for Healthy
Eating During Pregnancy
 Pregnant women need to choose nutrient-
dense foods to insure an adequate nutrient
intake (i.e. carbohydrates, proteins, fats,
vitamins and minerals).
 For many women this requires some

changes in their current eating habits.

Therefore pregnant women need to:
Increase the amount and varieties of foods
they eat:
 Eat starchy foods, such as maize, rice, wheat,

millet, sorghum, yams, potatoes and potato

products. These foods items should form the
main part of the meal.
 Pulses, nuts, fish, meat, poultry, milk or eggs,

should accompany these foods.

 In addition fruits and vegetables should be

available for every meal.

 Drink enough safe and clean water at least

two litres a day.

Eat frequently
 Eating five meals a day is recommended

(three main meals plus two snacks).

 Eating only one or two meals a day can

inhibit weight gain because the large

amount of food consumed distends the
stomach and makes you feel full.
 Eating smaller meals frequently will prevent
you from over consuming calories in one
sitting, at the same time your body cannot
utilize all the nutrients at once.
 Therefore eating frequently smaller meals

and healthy snacks throughout the day can

allow for a greater overall food intake.
Eat sensibly
 Oil from plant origins such as corn,

sunflower, olive,cottonseeds, peanut butter,

avocados and nuts are nutritionally good
compared to fats from animal products such
as butter, cheese and meat which raise
cholesterol level and increase the risk of
cardiovascular diseases.
 Consuming a lot of fatty (deep fried foods),
sweetened (cakes, sweets, ice-cream) foods
and carbonated drinks (coca cola) will not
be helpful in terms of health since these
foods contain little amount of other
nutrients besides energy.
 Though general increase in fat intake is

beneficial for gaining weight and making

food more appetizing; replacing with foods
of higher nutritional value such as fruit
juice, starchy foods and nuts will be ideal.
 Avoid caffeine and nicotine because they are
detrimental to the health of the foetus
 Limit the use of salt to about a table spoon a
day (i.e. six grams)
 Restrain from alcohol intake - consumption of
alcohol during pregnancy can damage unborn
child. Since alcohol is quickly absorbed into
the bloodstream, it circulates in the blood until
it is completely broken down by the liver then
passes through the placenta to the baby,
possibly resulting in several mental disabilities
including mental retardation, a short attention
span and behavioural problems.
 Get enough physical activity to keep fit.
Walk or do light physical activities every
day.
 It is recommended to have enough rest

during pregnancy and to avoid heavy work

load because of risks of spontaneous
abortions, miscarriage, or stillbirth, as well
as low birth weight babies.
 Take supplements (e.g. folic acid and iron)

as advised by the health worker

Feeding of Children Under Five
(0-5 years)
 Children aged below five years are at high
risk of morbidity and mortality.
 Malnutrition is the underlying causes of

about 50 percent of the child deaths which

is often associated with inappropriate
feeding practices.
Other contributing factors are:
 Malaria
 Diarrhoea
 Measles
 Neonatal sepsis
 Upper respiratory tract infection/acute

respiratory tract infection (ARI)

 Urinary tract infection (UTI)
 Prevention of malnutrition in children aged
below five years requires appropriate
feeding practices which include:
 Breastfeeding
 Complementary feeding
 Growth monitoring

In addition, prevention and management of

early childhood illnesses are important, and
appropriate feeding of the child is an
important component of this
Feeding Children Aged 0–6 Months

 During the first six months of life, infants

should be exclusively breastfed.
 Exclusive breastfeeding means feeding the

baby with breast milk only, with no added

food or supplements, not even water.
 Breast milk contains 100% of nutrient

requirements of the child. It also contributes

to antibodies, and more social bonding
between the mother and child.
Recommendation for
Successful Breastfeeding
 Breastfeed the baby within the first hour
after birth
 Give the baby the first yellowish milk

(colostrum) which is very important for the

baby as it is rich in nutrients and
strengthens the baby’s immune system.
 Continue feeding the baby with only breast

milk until the baby is six months of age.

 Breastfeed as often as the baby wants (‘on
demand’) day and night.
 Breastfeed for at least 10–15 minutes to

allow the baby to empty the breast before

switching to the other breast.
 It is not advisable to give the baby other

foods or fluids. Breast milk quenches the

baby’s thirst and satisfies the baby’s
hunger.
 Ensure proper positioning and attachment
of the baby so as to get enough milk.
 Express the milk whenever you have to

leave the baby for long.

 The expressed breast milk can be stored in

a cool dry place under room temperature

for up to eight hours or can be refrigerated
for 72 hours.
 If the baby on breast milk is not growing
well or refuses to breastfeed, seek
appropriate advice from a healthcare
provider.
 For those who cannot breastfeed for

whatever reason, seek advice from a

healthcare provider.
Feeding Children Aged 6–24 months
 Complementary feeding is the giving extra
food to the child to fill the gap between the
increased nutrient needs of the child and
what the breast milk can provide.
 After the first six months, adequate

complementation should be introduced,

however,breast milk remains important for
at least two years and beyond.
 At age 6–12 months breast milk can provide
up to 50% of the nutrient requirements for
the child while at the age of 12–24 months
breast milk can provide only 35% of the
requirements.
 During complementation critical nutrient

gaps are energy, iron, Vitamin A and Zinc.

Issues to be observe during
complementation
 Nutrient density to be met
 Frequency of feeding: at least four to five

times a day
 Adequate amount of feeding
 Safety in terms of hygiene and free from

contaminants.
Other Factors for Consideration
 Introduce one type of food at a time start

with staple foods, which provides energy to

the baby
 Staple foods include cereals (maize, millet,

rice) roots and tubers (cassava, yams, Irish

potatoes) and cooking bananas.
 Add foods rich in protein from plant and

animal origin such as milk, eggs, meat,

beans,pulses/lentils and nuts. Increase the
quantity of food gradually as the baby
grows.
Introduce foods which are rich in vitamins
and minerals such as:
 Green leafy and yellow-coloured vegetables

(e.g. amaranths, sweet potato

leaves,pumpkin leaves, carrots, pumpkins,
tomatoes and egg plant), and also fruits
such as papaya, bananas, oranges,
mangoes avocado and pineapples.
 Improve the quality of food by adding oils
and fats such as vegetable oil and butter.
 Ground nuts, cashew nuts, Kweme, sesame

and sunflower seeds can also be used.

 Use little amount of iodated salt during

cooking
 If the baby shows any kind of allergy, seek

medical advice
 Offer clean and safe drinks preferably water
 Avoid spices and sugary foods
 Maintain adequate feeding frequency
 Do not force child to eat
Food Preparation Recommendations
 Ensure safe preparation and serving of food
 Peel carefully and remove pips/pits, stones,

and stings
 Cook, steam or boil
 At first chop to small pieces, mince or mash,

and later on puree and sieve

 Remove all bones
Feeding Techniques
 Feed the baby by cups and spoon and not

by bottle because bottles are hard to clean

and can be easily contaminated with germs
that can make your baby sick.
 Let the child try to feed themselves starting

from six months

 Give chewable food of different textures as

they age
 Offer finely chopped or mashed foods and
food that the baby can pick up such as
carrots by the age of eight months
 Introduce chunkier textures at 8–10 months
 At age one, the baby should be able to eat

almost everything the family eats

 Continue to give three to four nutritious

meals and one to two nutritious snacks

(fruit, mashed nuts and yogurt) between
meals depending on the child’s appetite
Feeding Children Ages 2-5 years
 Children aged two to five years have high

nutritional requirements because they are

still growing fast, increasing in weight, and
their immunity continues to develop.
 At this age a child can be withdrawn from

breastfeeding and continue with family

foods, especially greater quantities of staple
food includes cereals (e.g. rice maize and
wheat) and legumes (e.g. beans and
cowpeas) and foods of animal origin to
meet the body’s nutritional requirements.
 It is strongly recommended that milk from
other sources should continue to be
included in the child’s foods.
Recommendations
 Offer a variety of foods, taking into

consideration the five food groups

 Feed family foods for three meals per day
 Feed a healthy snack in between meals

twice a day (e.g. porridge, milk and boiled

or sweet potatoes)
 Do not force a child to eat
 Make sure children are adequately fed
 Care must be taken to ensure that there is

no contamination of foods
 The child should be taken to the clinic for

growth monitoring, supplementation and

deworming
Feeding of the Sick Child
 When a child becomes sick nutrient
requirements usually increase.
 This might be due to fevers caused by

infections, loss of appetite, loss of nutrients

that might be due to diarrhoea or vomiting
etc.
 In order to meet the increased nutrient
requirements for the child and replace the
lost nutrients, it is important to:
 Continue breastfeeding particularly for

young children 0–24 months.

 Increase intake of nutrient dense foods
 Increase feeding frequency
 Provide soft foods which are easy to swallow
 Increase intake of fluid to prevent

dehydration
School-Age Children, 5-9 Years
 School age children have high nutrient
needs because they are growing, highly
active and still depend on other people to
provide their basic needs including food.
 These children have high incidence of

diseases including worm infestation and

malaria.
 They also suffer from under nutrition and

currently increasingly over nutrition.

Recommendations
 School children should be given breakfast at

home before going to school.

 Provide child with available fruits or cooked

potatoes, cassava or porridge.

 Encourage parents to send their children to

school with some food to be eaten at mid

day
 Organise community school feeding
 Healthy snacks should be encouraged
 Regular deworming is essential
 Nutritional status monitoring and physical

activity should be promoted

Adolescents Aged 10-19
Years
 Adolescence is the second most critical
period of physical growth starting from the
beginning of puberty until maturity when a
person becomes physically able to
reproduce.
 During this time, physical changes affect

the body’s nutritional needs, while changes

in one's lifestyle may affect eating habits
and food choices.
 At this stage 25% of an adult’s height is
attained.
 Nutritional health during adolescence is

important for supporting the growing body

and for preventing future health problems.
Teenagers need additional:
o Calories: More energy is needed because
they are highly active.
o Protein: Protein is important for growth and
maintenance of muscles.
o Calcium: Calcium is essential for
development of strong and dense bones.
 Iron: Iron is an essential nutrient needed to
help new muscle cells to obtain oxygen for
energy production.
 Deficiency of iron causes anaemia which

leads to fatigue, confusion, and weakness

 During the adolescent growth spurt, milk,
yogurt and cheese are good sources of
calcium.
 Inadequate calcium intake during

adolescence and young adulthood puts

individuals at risk for developing
osteoporosis later in life
Nutritional and Health Problems
Facing Adolescents
 Undesirable food habits (less fruits,
vegetables, depend too much on snacks/junk
foods and sweetened coloured drinks)
 Alcohol abuse and drug use
 High morbidity and mortality due to HIV/AIDS
 High incidences of diseases, and anaemia
due to worms
 Early adolescent pregnancies increase
maternal deaths
Recommendation
 Promote nutrition education with the focus
on healthy eating and lifestyle in primary
and secondary school
 Promote eating of healthy snacks and drinks

by adolescents
 Supplementation with iron and folic acid
 Encourage health-seeking behaviours on

general health, HIV and AIDS prevention

and management.
 Promote deworming of adolescents within
and outside schools
 Sensitise adolescence on risks of early

pregnancies, alcohol and drug abuse

 Promote and support establishment of

social/recreation centres
Adults Aged 20-59 Years
 Generally nutritional needs for the adults
are mainly for maintenance.
 At this stage most adults have stopped

growing. However, most adults remain

physically active due to their involvement in
production and reproduction.
 Within this group there are people of active

reproductive age (20–45).

 Pregnant and lactating women have
increased nutrient needs and tend to be
anaemic.
 Inadequate child spacing, poor

immunization and pregnancy weight

monitoring contribute to high maternal
mortality.
Recommendation
 Promote nutrition education among adults
on health and lifestyle
 Supplementation with iron and folic acid
 Promote use of reproductive and child

health (RCH) services for reproductive age

groups
 Monitor dietary habits and physical activity

due to risk of nutrition-related chronic

diseases (NCDs)
 Discourage alcohol consumption and

smoking
Elderly Adults, Aged 60 Years and Above

 After the age of sixty people are recognized

as elderly, whereby there are many
metabolic and physiological changes which
have an impact on their nutritional needs.
 At this stage, metabolic rate slows and

decline to about thirty percent over a

lifetime. This results in:
 Decreased caloric needs which can be
complicated by changes in an older
person's ability to balance food intake and
energy needs
 Increased nutritional requirements such as

calcium, magnesium, antioxidants and

vitamin B6
 Mostly they have reduced immunity and

metabolic functions which leads to low

appetite poor digestion and absorption
 Elderly are often plagued with chronic
diseases that have nutritional origins or
associations.
 These diseases include arteriosclerotic

heart diseases, hypertension, diabetes,

osteoporosis and dental carries
 Healthy lifestyle during elderly age is very

important as it is associated with greater

chances of living longer.
 Healthy lifestyles should include weight

management, exercising regularly, not

smoking and alcohol in moderation
Recommendations
 At this stage professionals should promote:
 Foods rich in calcium and vitamin B
 Care and support for the elderly
 Accessibility of quality health services for

the elderly
 Monitor- dietary habits, physical active
 Key Points
 Eating the right balance from the main food
groups will ensure that your body gets all it
needs to stay healthy.
 The most visible measure of inadequate

nutrition during pregnancy is the lack of

maternal weight gain.
 Pregnant women need to choose nutrient-
dense foods to assure an adequate nutrient
intake (e.g. carbohydrates, proteins, fats,
vitamins and minerals).
 Prevention of malnutrition in children aged

below five years requires appropriate

feeding
 practices, including breastfeeding,

complementary feeding and growth

monitoring.
 School children should be given breakfast at
home before going to school.
 Provide children with available fruits or

cooked potatoes, cassava or porridge.

 Teenagers need additional calories, protein,

calcium and iron for supporting the growing

body and for preventing future health
problems.
 Elderly people’s metabolic rate slows and

declines about thirty percent over a lifetime.

 This results in decreased caloric needs,

increased nutritional requirements and

reduced immunity and metabolic functions.
 Evaluation
 What nutritional advice would you give to a
mother who has a sick 0-24 month old
child?
 What useful nutrition advice will you give to

adolescent pregnant woman?

 References
 Institute of Medicine (1990). Nutrition
during Pregnancy. Part I: Weight Gain, Part
II: Nutritional Supplements. Washington DC:
National Academies Press.
 King, F.S. & Burgess, A. (2000). Nutrition for

Developing Countries. (2nd Ed.) USA:

Oxford University Press.
 Stanfield, P. & Bwibo, N. (2005). Child

Health: A Manual for Medical and Health

Workers in Health Centres and Rural
Hospitals. (3rd Ed.) Nairobi, Kenya: AMREF
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