THE HEALTH .c\SPECTS OF FOOD AND NUTRITION (Tidad Edition) (J f I 1 woaw BBALTS oaGANJZATJON BllloMioalal ................,.. THE HEALTH ASPECTS OF FOOD AND NUTRITION (Third Edition) CORRIGENDA Page 5, Introduction. Add Ref. No. (6) to the end of the first paragraph. Page 71, References. Add: 16. Cook, J.D., D.A. Lipschitz, L.E.M. Miles, and C.A. Finch. 1974. Serum ferritin as a measure of iron stores in normal subjects. Amer. J. Clin. Nutr. 27:219. 17. Bainton, D.F., and C.A. Finch. 1964. The diagnosis of iron deficiency anaemia. Amer. J. Med. 37:62. 18. Langer, E.E. 1972. Erythrocyte protoporphyrin. Blood. 40:112. 19. Morley, D. 1973. Paediatric priorities in the developing world. Butter­ worths, London. 20. WHO. 1972. Nutritional anaemias. WHO Tech. Rep. Series No. 503, Geneva. 21. Sood, S.K. et al. 1975. WHO sponsored collaborative studies on nutri­ tional anaemia in India. Quart. J. Med. New Series. 44:241. 22. Layrisse, M., C. Martinez-Torres, M. Renzy, F. Velez, and M. Gonzales. 1976. Sugar as a vehicle for iron fortification. Amer. J. Clin. Nutr. 29:8. Page 125, References. Add: 10. Mata, L.J., J.J. Urrutia, and J.E. Gordon. 1967. Diarrhoeal disease in a cohort of Guatemalan village children observed from birth to age two years. Trop. Geogr. Med. 19:247. Page 133, Add Ref. No. 11) to the end of the following: - Maternal diet ... weight. (There is ... kcal/day). Page 137, Number 2, first paragraph, add Ref. No. 15 to third sentence. Page 151, ;ntroduction. Add Ref. No. (1) to the end of the first sentence. Page 203, b. Standard deviations or centile groups. Add Ref. No. (3) to the end of the first sentence. Page 230, Annex 3 to Chapter 19. Add Ref. No. (6) to the end of Foodstuffs which are Rich Sources of Specific Nutrients. Page 309, Number 17, second line. Sp. "Interpret". Page 348-349, Table 3, Reference Weights for Age, 0-72 months, Sexes com­ bined. Change "em" to "kg". THE HEALTH ASPECTS OF FOOD AND NUTRITION A manual for developing countries in the Western Pacific Region of the World Health Organization Printed and distributed by the Regional Office for the Western Pacific of the World Health Organization Manila Pcice~ ~.Fr. 16.- Prices are subject to change without notice. First edition, Manila, 1969 Second edition, Taiwan, 1972 Third edition, Manila, 1979 World Health Organization 1979 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Con­ vention. For rights of reproduction or translation of WHO publications, in part or in toto, application should be made to the Office of Publications, World Health Organization, Geneva, or to the WHO Regional Office for the Western Pacific, Manila, Philippines. The World Health Organization welcomes such ap­ plications. The designations employed and the presentation of the material in this pub­ lication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the deli­ mitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Or­ ganization in preference to others of a similar nature that are not mentioned. PRINTED IN MANILA ii ACKNOWLEDGMENTS The first edition of this manual was produced by the WHO Re­ gional Office for the Western Pacific in 1969 and was revised in 1972. Both the first edition and the revision were financed by UNICEF. For this edition the contents were extensively rewritten, reor­ ganized and updated by the Department of Nutrition, and other de­ partments of the Institute of Public Health, University of the Philip­ pines who consulted with, and received contributions from many health and nutrition workers both inside ond outside the Western Pacific Region of WHO. B.C. Barbers, S.B. Bibera, J. Bulatao- Jayme and other staff of the Food and Nutrition Research Institute, A.P. Burgess (editor), H.J.L. Burgess, V.F. Chan, H.K. Chang, A. Chia, Y.H. Chong, S.K. Chun, E.S. Constantino, I.T. Cruz, N.T. Estrada, R.F. Florentino, L.U. Uabut, V.B. Guzman, M. Kacic-UimHri, .l:t. Kamkllakai, 8.Y. Kim, J. Lambert, T.C. Lopez, C.S. Loyola, M. Lubis, S. Menon, LB. Mutuc, H.N. Navarro, P.O.D. Pharoah, L.B. Rabuco, ~.M. Reyes, N.P. Salazar, L.C. Somera, C. Sundram, B.S. Tchai, J.{ Thompson, T.V.Tiglao, J.I. Yabes. I iii TABLE OF CONTENTS Page Acknowledgments Chapter 1 Introduction......................... 1 Part I. FOODS AND NUTRIENTS Chapter 2 The principal foods used in the Region . 5 Chapter 3 Nutrient requirements and recommended intakes 27 Part II. NUTRITIONAL DISORDERS Chapter 4 Protein-energy malnutrition. 43 Chapter 5 Nutritional anaemias . 61 Chapter 6 Xerophthalmia and vitamin A deficiency. 73 Chapter 7 Endemic goitre . 87 Chapter 8 Other nutritional deficiencies. 99 Chapter 9 Nutrition and dental health. 105 Chapter 10 Nutritional disorders associated with affluence . 109 Chapter 11 Nutrition and infection. 119 Chapter 12 Malnutrition and mental development. 127 Part III. NUTRITION OF THE POPULATION Chapter 13 Nutrition of the mother and infant. 133 Chapter 14 Weaning and the nutrition of the preschool age child . 151 Chapter 15 Nutrition of the school age child and adult. 163 Part IV. NUTRITIONAL SURVEILLANCE Chapter 16 Nutritional surveillance of the community . 169 Chapter 17 Nutrition surveys. 183 Chapter 18 Nutritional.anthroppmetry . 201 Chapter 19 Food consumption surveys . • 221 Part V. NUTRITION INTERVENTIONS Chapter 20 Nutrition policies and programmes. 235 Chapter 21 Nutritional rehabilitation ....... \ . 247 Chapter 22 Nutrition education . 253 Chapter 23 Supplementary feeding programmes . 273 Chapter 24 Food fortification . 281 Chapter 25 Food surveillance . • . 285 Chapter 26 Nutrition training . 305 Chapter 27 Role of the international agencies. 315 v CONTENTS Part VI. REFERENCE DATA Appendix 1 Food Composition table for the Western Pacific Region. 323 Appendix 2 F AO/WHO recommended intakes of nutrients . 337 Appendix 3 Oral rehydration . 339 Appendix 4 Anthropometric reference values . 343 Appendix 5 Recipes suitable for young children. 361 Appendix 6 Useful conversion figures . 367 Appendix 7 Useful publications, journals and sources of educational aids . 369 Index 373 vi CHAPTER 1 INTRODUCTION Hiroshi Nakajima Director, Regional Office for the Western Pacific, World Health Organization In the Western Pacific Region of the World Health Organization malnutrition remains a scourge, particularly affecting mothers and their children. In some countries, as many as 30% of preschool children exhibit moderate to severe growth failure; indeed in some areas the prevalence is even higher. Anaemia is found in every coun­ try, developing or developed, especially associated with pregnancy. While we still grapple with these deficiency diseases, "malnutrition of affluence" in the form of obesity and degenerative disease, in­ creasingly emerges as a problem. In the past, the importance of malnutrition has not been fully appreciated because, except in its severest forms, it does not present dramatically. Often a more obvious infection is superimposed, before the case comes to the notice of health personnel. However, with the emphasis given to preventive medicine over the past few years, health authorities have come to recognize its importance, not only in terms of human suffering and morbidity but as a hindrance to national development. This realization culminated in a strongly worded reso­ lution adopted by Member States at the Thirtieth World Health As­ sembly in 1977 ,a the operative paragraphs of which are given below: "The Thirtieth World Health Assembly ..... 2. URGES governments: (1) to give higher priority to food and nutrition problems within their health programmes; ( 2) to further develop multisectoral programmes specifically oriented to improve the nutritional situation of the population, and to improve the quality of food; aSee resolution WHA 30.51, WHO Official Records, No. 240, pages 31-32. 1 2 THE HEALTH ASPECTS OF FOOD AND NUTRITION (3) to consider the food and nutritional implications of their development policies and plans; ( 4) to give to these actions greater political, technical and finan­ cial support than heretofore; (5) to pay attention to both qualitative and quantitative aspects of nutrition; 3. REQUESTS the Director-General: (1) to take the additional necessary steps to strengthen the WHO nutrition programme in order that the Organization may play its legitimate role in the development and implementation of na­ tional and international food and nutrition policies and plans, with the aim of: (a) providing the necessary stimulus and technical co-opera­ tion to Member Countries for improving the efficiency and effectiveness of their health services in health-related nutri­ tional programmea; (b) strengthening the research capacity and education and training in nutritional programmes, with priority in the devel­ oping countries; (c) eliminating the florid forms of malnutrition such as kwash­ iorkor, marasmus and keratomalacia as public health prob­ lems at least by the turn of this century; (d) identifying problem areas such as the interaction be­ tween malnutrition on the one hand and infection and pro­ ductive capacity on the other, and hence integrating relevant action programmes; (e) determining the most vulnerable population groups (groups at