Nutrition Health Education Tobacco Intervention Program in Nepal

Nutrition Health Education & Tobacco Intervention Program in Nepal 2010 Aune Greggas

Nutrition • Digestive system • Organic compounds • Chemical elements: basic elements, minerals, trace elements • Vitamins Aune Greggas

• Biologically food, water and air are the physical requirements of all the living organisms. • Food is processed in the digestive system. http: //en. wikipedia. org/wiki/Digestive_system DIGESTIVE SYSTEM

http: //fi. wikipedia. org/wik i/Hammas Aune Greggas Teeth People have 32 teeth (radiograph) • The teeth cut up and grind the food fine. • They have a very strong white enamel (mica). • Sugars and acids can break it. • This kind damage is called dental caries. http: //fi. wikipedia. org/wiki/Hammas

• Dental caries is also known as tooth decay or a cavity. • It is a disease where bacterial processes damage hard tooth structure producing dental caries (cavities and holes in the teeth). • Washing teeth decreases it. http: //en. wikipedia. org/wiki/Dental_caries Dental caries

Gingivitis • The gingivitis is a usual disease among those whose teeth hygiene is low. • However, the gums can be healed if they are treated in the right way. http: //en. wikipedia. org/wiki/Gingivitis

Hideo Ichiki, D. D. S. , Smoking spoils health • Inflammatory diseases in the mouth and in the gums are common with smokers and those who tug tobacco or betel nuts. • They can lead to cancer. Hideo Ichiki, D. D. S. , Smoking spoils health Cancer in the mouth

Mouth • When the food is grinded the saliva glands of the mouth adds to the crunch enzymes needed to break up the food into that kind of chemical compounds which can be used by the body. http: //en. wikipedia. org/wiki/Mouth Salvary glands http: //en. wikipedia. org/wiki/Salivary_gland

• When the food is swallowed, there are muscles which take it all the way through the esophagus to stomach by peristaltic wave. http: //fi. wikipedia. org/wiki/Ruokatorvi http: //en. wikipedia. org/wiki/Peristalsis Esophagus

• The use of alcohol, even in smaller amounts, increases the possibility to get cancer. • Most it increases cancers in the mouth, esophagus, stomach, liver, pancreas and intestines. http: //en. wikipedia. org/wiki/Esophageal_cancer Cancer in Esophagus Cancer in the esophagus.

• In the stomach the chemical process to break up the food compounds continues with the enzyme pepsin (pepsinogen). • On the walls of the stomach there also millions of gastric glands which secrete gastric juice. • It is mainly hydrochloric acid. http: //www. biohit. com/upload/dia/img/gastr opanel/stomach_med. gif Stomach

Peptic ulcer http: //en. wikipedia. org/wiki/S tomach_cancer • 70 - 90% of stomach ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach. • Aspirin might make it worse. • Peptic ulcer precedes often stomach cancer. http: //en. wikipedia. org/wi ki/Peptic_ulcer Stomach cancer

Liver • The liver collects nutrients from the blood and stores them in the liver. • Among those nutrients are carbon hydrates, minerals, trace elements and vitamins. http: //en. wikipedia. org/wiki/Liver

Glykogen store • If the blood sugar is high, the glucose in it is changed to glycogen and stored in the liver. • If the blood sugar is low, glycogen is released from store areas and broken to glucose. This keeps blood sugar level even. Schematic 2 -D cross-sectional view of glycogen. A core protein of glycogen is surrounded by branches of glucose units. The entire globular granule may contain approximately 30, 000 glucose units http: //en. wikipedia. org/wiki/Glycogen

Detoxifyer • The liver is also a detoxifyer. • It breaks down or transforms substances like metabolic waste, ammonia, alcohol, nicotine, caffeine, drugs and chemicals, so that they can be excreted. http: //www. liverdoctor. com/index. php? page=liv er-detoxification The liver of a child is not able to detoxify alcohol.

• The hepatitis is the inflammation of the liver. • Symptoms are jaundice, fatigue, fluid accumulation in the abdominal cavity, and brain dysfunction due to liver failure. • Severe cases have a high risk of death. http: //en. wikipedia. org/wiki/Alcoholic_hepatitis Hepatitis Alcohol hepatitis is due to the use of excess alcohol. Hepatitis is common also among drug users.

Liver cirrhosis http: //www. fotosearch. com/LIF 127/3 d 714002/ • The cirrhosis is characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules leading to loss of liver function. • Cirrhosis is most commonly caused by alcoholism, hepatitis or fatty liver disease. Clip Art - Cirrhosis versus normal liver 3 D 714002 Life. ART Medical Illustrations Royalty Free Photograph

Pancreas • The pancreas is a gland which extracts insulin. • Insulin is a hormone which helps to transfer glucose to cells in the liver, muscles and fat tissue. • The disease which results of the lack of insulin is called the diabetes. http: //en. wikipedia. org/wiki/Pancreas

Blood sugar & insulin • A daily schedule (3 meals) and how it affects the blood sugar and insulin levels. http: //en. wikipedia. org/wiki/Insulin

• There are two types of diabetes. • Type 1 diabetes is inherited and begins already in the childhood. • Type 2 diabetes is found in adults with abdominal fatness and metabolic syndrome background. http: //en. wikipedia. org/wiki/Diabetes_mellitus Diabetes Polydipsia = excess thirsty Polyhagia = excess hunger Polyuria = excess urination

Gallbladder http: //en. wikipedia. org/wiki/Pancreas • The gallbladder stores bile. • Bile is released when food containing fat enters the digestive track. • Bile emulsifies fats in partly digested food to help their use. http: //en. wikipedia. org/wiki/Bile

Gallstones • Bile sometimes crystallizes to gallstones. • Especially foods with lots of fats can invite intense abdominal pain, when the gallstones begin to move. http: //en. wikipedia. org/wiki/Gallstone

Intestines • After the food has been processed in the stomach, it enters through duodenum to small intestine (7 - 8 meters). • From the cecum it continues through the colon to the rectum and then to the anus. Stomach Duodenum Small intestines Cecum Colon Rectum Appendix Anus http: //www. terveyskirjasto. fi/xmedia/ldk 00247. jpg

• Many infections in the intestines are due to contaminated food. • To protect against Salmonella infection, it is recommended that food be heated at least ten minutes at 75 °C (167 °F). http: //en. wikipedia. org/wiki/Salmonella infection Salmonella bacteria causes typhoid fever, paratyphoid fever and diarrhea.

Rotavirus http: //en. wikipedia. org/wiki/Rotavirus • Round rotavirus is the most common cause of severe diarrhea among infants and young children. • Good hygiene, washing hands and giving the child enough liquids is the best way to treat it at home. • Severe cases need hospital. http: //en. wikipedia. org/wiki/Rotavirus

• Constipation is usual with older people. • Depression and lack of activity makes is worse. • Food with lots of fibers (oat, whole meal cereals, vegetables) and seeds can help to keep the bowel active. http: //en. wikipedia. org/wiki/Flax Constipation Linen seeds have been commonly used to help in constipation.

ORGANIC COMPOUNDS • All the main organic compounds in the living organisms are made of water, carbohydrates, proteins (amino acids) and lipids. • Most of our food is also made of them. http: //www. food-faq. net/food_pyramid. gif

Water H 2 O • 50 - 70 % of human body is water. • People with strong muscles have most water in their body. • If you are not sure that your drinking water is clean, it is best to boil it first and drink then. Aune Greggas

• A carbohydrate is an organic compound which consists of carbon, hydrogen and oxygen. • To them belong sugars (glucose and sucrose and lactose) and larger polysaccharides (starch, glycogen, cellulose, ribose). http: //en. wikipedia. org/wiki/Carbohydrates Cm(H 2 O)n In food science carbohydrate means any food that is rich in starch (cereals, bread and pasta) or sugars.

Lipids • The main biological functions of lipids include energy storage. • Their caloric content is about 9 kcal/g compared with 4 kcal/g for carbohydrates and proteins. • Lipids in the food can be liquid (vegetable oils) or hard (butter, animal fats). • Liquid fats are better than hard. Mustard field Aune Greggas

• Proteins (also known as polypeptides) are organic compounds made of amino acids. • Examples of high-protein foods are tofu, dairy products, fish and meat. • Soya beans has high amount of proteins and amino acids. http: //en. wikipedia. org/wiki/High-protein_diet Proteins Tofu is made of soya beans.

Amino acids • Amino acids are critical to life, and have many functions in the body, in metabolism, as a neurotransmitter etc. • Also the genetic code is based on amino acids (DNA and RNA). • Amino acid molecules contain the carbon, hydrogen, oxygen and nitrogen. http: //en. wikipedia. org/wiki/Amino_acid H = Hydrogen N = Nitrogen C = Carbon O = Oxygen R represents a side chain specific to each amino acid (the amount of amino acids is 22)

CHEMICAL ELEMENTS • There about 120 known chemical elements in the world. • In nutrition some of them are called basic elements, some of them minerals (macronutrients) and some of them trace elements (micronutrients). • In all the living organisms, the most important chemical elements are hydrogen, carbon, nitrogen and oxygen (96 %).

Periodic table of elements Basic elements: Hydrogen 1, Carbon 6, Nitrogen 7, Oxygen 8

Hydrogen (H) • Hydrogen is a gas. • It is the most abundant element in the universe. • Water (H 2 O) has two hydrogen atoms and one oxygen atom. • 70 - 90 % of fruits (oranges, apples) and vegetables (tomatoes, cucumbers) and 50 - 70 % human beings is water.

Carbon (C) • Carbon is a nonmetallic black chemical element. • Its name comes from coal. Coal has usually been made of old forests. • Carbon (carbohydrates) can be found in cereals (rice, wheat), vegetables (potatoes, corn, carrots) and in fruits (bananas). • Also diamonds are of carbon. http: //en. wikipedia. org/wiki/Carbon

Nitrogen (N) • Nitrogen is a colorless, odorless and tasteless gas. • 78 % of the air in the atmosphere is nitrogen. • Nitrogen is present in all living organisms, in proteins, nucleic acids and other molecules. It makes up around 4 % of the plant matter, and around 3 % of the weight of the human body. • It is a large component of animal waste.

Oxygen (O) • Oxygen is a very important gas. • In living organisms oxygen inhaled in the air is needed for energy production. • Also other energy production, burning trees, fuel, gas etc. are dependant on oxygen. • In the air there is about 20 % oxygen. • Oxygen is released to the air by photosynthesis in the green leaves and algae.

MINERALS • There are chemical elements which are needed only some grams. • The most important of them are sodium (natrium), magnesium, phosphor, sulfur (sulphur), chlorine, potassium (kalium) and calcium. • Of the living organisms these macronutrients represent 1 - 1, 5 %.

Periodic table of elements Minerals: Natrium 11, Magnesium 12, Phosphor 15, Sulphur 16, Chlorine 17, Kalium 19, Calcium 20

Sodium, also called natrium (Na) • The most well known food product which includes sodium is salt. • In one gram salt there is about 0, 4 g sodium. • Need for day is 1, 5 g. • Too much salt increases the blood pressure. http: //fi. wikipedia. org/wiki/Ruokasuola Salt (Na. Cl) is used to give taste and to preserve food.

Magnesium (Mg) • Whole grain cereals, spices, nuts and vegetables are rich sources of magnesium. • Green leafy vegetables, such as spinach, are rich in magnesium as they contain chlorophyll. • Low levels found in asthma, diabetes, osteoporosis. http: //en. wikipedia. org/wiki/Magnesium

Phosphorus (P) • Phosphorus is a key element in all known forms of life. • It is found in the cells (DNA, RNA), used in body energy production (ATP) and in the bones (calcium phosphate). • Whole grain cereals and fishes include phosphorus. Aune Greggas

Sulfur or sulphur (S) • Sulfur is a bright yellow crystalline solid element. • It is an essential element for life and is found in two amino acids. • It is used as a fertilizer. • It can be found in lentils, beans, eggs, animal products. http: //en. wikipedia. org/wiki/Sulfur Lentil soup Aune Greggas

• As the chloride ion chlorine is abundant in nature and necessary to most forms of life, also to human beings. • Common salt is Natrium chloride (Na. Cl). • Iodine is often added to salt to prevent struma. http: //fi. wikipedia. org/wiki/Ruokasuola Chlorine (Cl) In the picture salt stored in Trapan, Sicilien. Salt has been one of the first merchandizes.

• Potassium is an essential mineral macronutrient in human nutrition. • It is important in maintaining fluid and electrolyte balance in the body. • Fruits and vegetables rich in potassium include citron fruits, potatoes, bananas, avocados, Potassium is abundant in most broccoli, soybeans, tomatoes, fruits and cantaloupes, garlic etc. vegetables. http: //en. wikipedia. org/wiki/Orange_juice Potassium of kalium (K)

Calcium (Ca) http: //en. wikipedia. or g/wiki/Sesame http: //en. wikipedia. org/ wiki/Almond • Calcium is essential for living organisms, particularly in cell physiology. • It is a major material used in mineralization of bones. • A diet high in fruit, vegetables and cereals has been demonstrated to Almonds sesame seeds are a good source for result in greater femoral bone calcium. It is also in mineral density to other diets. milk products,

TRACE ELEMENTS • Some chemical elements are needed maybe only for some milligrams or micrograms. • They are called trace elements or micronutrients. • The most important of these are chromium, manganese, iron, cobalt, copper, zinc, selenium and molybdenum, fluorine and iodine.

Periodic table of elements Trace elements: Chromium 24, Manganese 25, Iron 26, Cobalt 27, Copper 29, Zink 30, Selenium 34, Molybdenum 42, Fluorine 9, Silicon 14 and Iodine 53.

Iron (Fe) • The most important of the micronutrients is iron. • It is very important part of the blood cells. • Iron can be found in whole grain cereals, soya, peas, beans, seeds, meat. • Deficiency: anemia. http: //en. wikipedia. org/wiki/Anemia Main symptoms that may appear in anemia.

Zink (Zn) • Zinc is very important when healing scars. • It is also needed in stress situations and infections. • Zink is found in wheat (germ and bran) and various seeds (sesame, sunflower, mustard), beans, nuts, almonds, whole grain cereals, blackcurrant. Blackcurrant Aune Greggas

Copper (Cu) • The human body contains about 1. 4 to 2. 1 mg for each kg of body weight. • It is needed when blood cells are developing and in many other functions in the human body. • It can be found in mushrooms, bran, spinach, nuts, sesame and sunflower seeds, avocados, peas. Avocado Aune Greggas

Manganese (Mn) • Manganese is needed when children are growing and it has to do with the fat metabolism. • It is also needed in physical activity. • Manganese is found in berries, carrots, nuts, soya flour, whole grain cereals. Physical activity Aune Greggas

• Lack of chromium might be reason for childlessness. • Lack of chromium is also often connected with defects in sugar metabolism. • Chromium is found in sesame seeds, whole grain cereals, mushrooms, honey. http: //en. wikipedia. org/wiki/Honey Chromium (Ch) Honey http: //en. wikipedia. org/wiki/Honey

• Selenium is an antioxidant and helps muscles to get oxygen and keep the body cells in good condition. • It is found in whole grain cereals, mushrooms, seeds, lentils, soya Mushrooms s products, fish, meat, milk, eggs. Learn which are and which • Lack of it increases the possibility eatable are not eatable to get infections, even cancer. mushrooms. Aune Greggas Selenium (Se)

Molybdenum (Mb) • Molybdenum helps copper in its work. • Molybdenum is found in peas, soya products, whole grain cereals, green vegetables, eggs, potatoes. Potatoes Aune Greggas

• Cobalt is an essential trace element for all animal organisms as the active center of coenzymes. • Cobalt is a part of B 12 vitamin which is needed to make blood cells. • Cobalt is found in germ and bran. http: //en. wikipedia. org/wiki/Bran Cobalt (Co)

Iodine (I) • Iodine is needed for cell metabolism and lack of it hinders both intellectual and body growth. • It is found in milk, salt with iodine, sea fishes, sea algae. Breast milk is the best food for babies. http: //en. wikipedia. org/wiki/Breastfeeding

Fluorine (Fl) • There is fluorine in bones and teeth, especially on the teeth mica, the hard cover which shields the teeth. • Fluorine is found in whole grain cereals, potatoes, green vegetables, berries (strawberries) and some fishes. Strawberries Aune Greggas

• Most silicon in the human body is in hair, skin and nails. • It is also needed when bones are growing. • Silicon is found in whole meal cereals and vegetables. Aune Greggas Silicon (Si)

VITAMINS • Vitamins are organ compounds which are needed only micro- or milligrams per day. • The most important of them are A-, B-, C-, D-, E- and K-vitamins. • B- and C-vitamins are water soluble and they are needed every day. • A-, D-, E- and K-vitamins are fat soluble and they can be stored in the body for later use.

A-vitamin • A-vitamin is needed for growth, growth of bones, skin and mucous membranes and for immunity. • It is found in vegetables which include carotenoids: carrots, parsley, spinach, nettle, paprika, tomatoes, rose berries. It is also found in meat, cheese, eggs. http: //en. wikipedia. org/wiki/Vitamin_A http: //en. wikipedia. org/wiki/Parsley

B-vitamins • There are several B-vitamins. • Best known are thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, biotin, folic acid. • They are important for the nerve functions, in the stress situations and in the metabolism. • They are found in whole meal cereals, peas, beans, nuts and almonds. • B 12 (cobalamin) is found in milk products, eggs, fish and meat (as wells as also riboflavin).

B-vitamins according to numbers • • B 1 = thiamine. . B 2 = riboflavin…………………. B 3 = niacin…. . B 5 = pantothenic acid. . . B 6 = pyridoxine……. B 7 = biotin… B 9 = folic acid…………. . B 12 = cobalamin………. . .

• C-vitamin is an antioxidant. • It is needed to resist diseases, to keep the skin in good order, when healing scars and in growth of bones and tissues and to absorb iron to the body. C-vitamin (ascorbin acid) is needed to • C-vitamin is found in fruits, absorb iron to the specially in citrus-fruits, berries, body. It is also often used to resist common flu. potatoes, cabbage, garlic. http: //en. wikipedia. org/wiki/Vitamin_C C-vitamin

D-vitamin Aune Greggas • It is important for the metabolism of calcium and phosphor (bones and teeth), and also to keep the resistance against different diseases high. • It is synthesized by sunlight. • It is also found in fishes, fish oils, soya beans, eggs, butter, cheese, mushrooms. Fishes and fish oils

E-vitamin • E-vitamin is an antioxidant and it is needed to keep up the cell functions and good skin. • It also shields the cells from damage and of heavy metals and toxins. • It is found in vegetable oils, soya beans, cereals, mangos, papayas, almonds, nuts, sesame seeds etc. http: //en. wikipedia. org/wiki/Soybean Soya beans, soya flour and soya milk have E-vitamin.

K-vitamin • K-vitamin is needed for blood coagulation. • It is made in large intestine. • To make it will be needed: bran, potatoes, green vegetables, especially cabbages, spinach, soya flour. http: //en. wikipedia. org/wiki/Cabbage http: //en. wikipedia. org/wiki/Potato

Recommended http: //www. faqs. org/photodict/photofiles/list/2781/3702 whole_grain_bread. jpg • Whole grain cereals Choose always bread where all the macro- and micronutrients are still left. X http: //meghantelpnerblog. com/megblog/wpcontent/uploads/2010/03/Bread. White. jpg http: //www. grainsessential. ca/english/grains/h ealthylifestyle. html

Recommended • Fruits http: //www. allindiaflowers. com/flowers-to-calcutta. htm

Recommended • Vegetables http: //www. virginmedia. com/homefamily/fooddrink/food-poisoners. php? ssid=9

Not recommended Uma Thapa http: //en. wikipedia. org/wiki/Candy • Lots of candy and sweet drinks http: //en. wikipedia. org/wiki/Candy http: //en. wikipedia. org/wiki/Lollipop

Not recommended • Alcohol (ethanol) http: //en. wikipedia. org/wiki/Alcohol

Not recommended • Tobacco http: //www. nlm. nih. gov/medlineplus/ency/imagepages/17193. htm http: //healthguide. howstuffworks. com/tobacco-and-chemicals-picture-a. htm

Not recommended • Smoking http: //listsoplenty. com/blog/archives/8901 http: //listsoplenty. com/blog/wp-content/uploads/2010/06/Cigarette_Inside. jpg

http: //en. wikipedia. org/wiki/Tobacco_smoking Not recommended

Cancer

Cardiovascular diseases

Brain bleeding

Emphysema

Nutrition is full of manifold. There are so many things we can safely drink and eat and feel well. But not everything. Choose always what is best for health!.

We thank • Ministry for the Foreign Affairs, Finland • ETRA–liitto ry, Finland, Aune Greggas • Scheer Memorial Hospital, Banepa, Kavre, Sundar Thapa, Pratigya Ranjit, HETIP team • Wikipedia, A. D. A. M. , Life. ART Medical Illustrations, Fixmedia, Biohit, Healthylifestyle, Liverdoctor, Food-faq, University of Minnesota, Hideo Ichiki, Federal State and Territory Health Initiative, Australia (videos)