2.

1  Classification of essential nutrients

Based on the amount of the nutrients that each person needs to consume on a daily
basis, these nutrients are categorised into two groups. These are macronutrients,
which should be consumed in fairly large amounts, and micronutrients, which are
only required in small amounts.

2.1.1  Macronutrients

‘Macro’ means large; as their name suggests these are nutrients which people need
to eat regularly and in a fairly large amount. They include carbohydrates, fats,
proteins, fibre and water. These substances are needed for the supply of energy and
growth, for metabolism and other body functions.

Metabolism means the process involved in the generation of energy and all the
‘building blocks’ required to maintain the body and its functions.

Macronutrients provide a lot of calories but the amount of calories provided varies,
depending on the food source. For example, each gram of carbohydrate or protein
provides four calories, while fat provides nine calories for each gram.

2.1.2  Micronutrients

As their name indicates (‘micro’ means small) micronutrients are substances which

people need in their diet in only small amounts. These include minerals and
vitamins.

Although most foods are mixtures of nutrients, many of them contain a lot of one
nutrient and a little of the other nutrients. Foods are often grouped according to the
nutrient that they contain in abundance (see Box 2.1).

Box 2.1  Nutrient types and their names

Foods that contain a lot of protein are called body-building foods or growing foods.
Foods that contain a lot of fat or carbohydrates and perhaps only a little protein are
called energy-giving foods.
Foods in which the most important nutrients are vitamins or minerals are
called protective foods.

 What are some of the common foods consumed in your community? Make a list in
your Study Diary.
Reveal answer

If people are to stay healthy they must eat a mixed diet of different foods which
contain the right amount of nutrients.

2.2  Macronutrients in detail
You are now going to look at the different macronutrients in more detail.

2.2.1  Carbohydrates

Carbohydrates are referred to as energy-giving foods. They provide energy in the

form of calories that the body needs to be able to work, and to support other
functions.

Carbohydrates are needed in large amounts by the body. Indeed, up to 65% of our
energy comes from carbohydrates. They are the body’s main source of fuel because
they are easily converted into energy. This energy is usually in the form of glucose,
which all tissues and cells in our bodies readily use.

For the brain, kidneys, central nervous system and muscles to function properly,
they need carbohydrates. These carbohydrates are usually stored in the muscles
and the liver, where they are later used for energy.

The main sources of carbohydrates are bread, wheat, potatoes of all kinds, maize,
rice, cassava, ‘shiro’, pasta, macaroni, ‘kocho’, banana, sweets, sugar cane, sweet
fruits, and honey. Other foods like vegetables, beans, nuts and seeds contain
carbohydrates, but in lesser amounts.

2.2.2  Classification of carbohydrates

Based on the number of sugar units, carbohydrates are classified into three groups;
these are monosaccharides, disaccharides and polysaccharides. You need to know
the classes of carbohydrates to enable you to give relevant advice to patients with
special needs like diabetes (when someone has problems regulating the amounts
of glucose in their body).

Monosaccharides and disaccharides are referred to as simple sugars or simple

carbohydrates that our body can easily utilise. For this reason, people with
diabetes mellitus shouldn’t eat too many of these carbohydrates. Examples include
 sugar, honey, sweet fruits and sugar cane. Polysaccharides are called complex
carbohydrates and they need to be broken down into simple sugars to be used by
our body. They can be consumed by diabetic patients without restriction. Examples
include starch and cellulose.

 Can you think of examples of foods that are sources of carbohydrate?

Reveal answer

 Which of these foods are simple sugars and should not be eaten in large quantities
by patients who have diabetes?

Reveal answer

2.3  Proteins
About 10–35% of calories should come from protein. Proteins are needed in our
diets for growth (especially important for children, teens and pregnant women) and
to improve immune functions. They also play an important role in making essential
hormones and enzymes, in tissue repair, preserving lean muscle mass, and
supplying energy in times when carbohydrates are not available.

Pregnant women need protein to build their bodies and that of the babies and
placentas, to make extra blood and for fat storage. Breastfeeding mothers need
protein to make breastmilk.

2.3.1  Sources of protein

The main sources of proteins are meats, chicken, eggs, breastmilk, beans, ground
nuts, lentils, fish, cheese and milk.

All animal foods contain more protein than plants and are therefore usually better
sources of body building foods. However, even though plant proteins (see Figure
2.1) are usually not as good for body-building as animal proteins, they can become
more effective nutritionally when both are mixed with each other.
 Figure 2.1  Meat is a good source of protein. (Photo: Dr Basiro Davey)

 Look again at the list of foods you wrote in Section 2.1.2. Which of these foods are
sources of protein? Which of these food groups have good quality protein?

Reveal answer

2.4  Fats and oils

Fats and oils are concentrated sources of energy and so are important nutrients for
young children who need a lot of energy-rich food. Fats can also make meals more
tasty and satisfying. Fat is found in meat, chicken, milk products, butters, creams,
avocado, cooking oils and fats, cheese, fish and ground nuts.

2.4.1  Classification of fats

Fats are classified into saturated and unsaturated fats. The classification is
important to enable you to advise your community about which fats can be
consumed with less risk to people’s health. Saturated fats are not good for a
person’s health.

Saturated fats are usually solid at cool temperatures. Eating too much saturated fat
is not good for a person’s health, as it can cause heart and blood vessel problems.

Unsaturated fats are usually liquid at room temperature. These types of fats are
healthy fats. Examples include fats from fish, oil seeds (sesame and sunflower),
maize oil and ground nut oil and breastmilk.

As a general rule, plant sources of fats are better for a person’s health than the
animal sources, because animal fats contain more saturated fats.

 Look at the list of foods you wrote in Section 2.1.2. Which of these foods are
sources of fats? Which of these fats are not healthy fats?
Reveal answer

2.5  Water
You may remember from Study Session 1 that a 50 kg adult contains about 31 litres
of water and a one year old, 10 kg child contains nearly 8 litres of water. Almost
every part of the body contains large amounts of water.

People can live without solid food for a few weeks, but we cannot live without water
for more than a few days. An adult needs about 2–3 litres of water each day. That is
why giving drinks are so important when people lose a lot of water, such as when
they have diarrhoea.

Water is essential for life. We need water for a number of reasons:

 For the body to make cells and fluids such as tears, digestive juices and
breastmilk
 For the body to make sweat for cooling itself
 For essential body processes — most take place in water
 For keeping the lining of the mouth, intestine, eyelids and lungs wet and healthy
 For the production of urine, which carries waste from the body.

2.6  Fibre
Fibre is a mixture of different carbohydrates which are not digested like other
nutrients but pass through the gut nearly unchanged. Foods rich in fibre are ‘kocho’;
vegetables like cabbage, ‘kosta’, carrots, cassava; fruits like banana and avocado;
peas and beans; whole-grain cereals like wheat flour and refined maize or sorghum.

2.6  Including fibre in the diet

Fibre should be included in the diet for the following reasons:

 Fibre makes food bulky or bigger — this can help a person who is overweight to
eat less food
 Fibre makes the faeces soft and bulky; this can help prevent constipation
 Fibre slows the absorption of nutrients, so it helps nutrients to enter the blood
stream slowly. This is important for patients with diabetes mellitus.
In this section you have learned about the macronutrients: carbohydrates, fats,
proteins, water and fibre, and how they nourish the body. You are now going to learn
more about vitamins and minerals, the important micronutrients.

2.7  Micronutrients in detail
2.7.1  Vitamins

Vitamins are groups of related substances present in small amounts in foodstuffs

and are necessary for the body to function normally. Vitamins are also called
protective foods. They are grouped together because, as their name implies, they
are a vital factor in the diet.

Classifications of vitamins
Vitamins are classified into two groups:

Fat soluble vitamins (vitamins A, D, E and K) are soluble in fats and fat solvents.
They are insoluble in water. So these are utilised only if there is enough fat in the
body.

Water soluble vitamins (vitamins B and C, and folic acid) are soluble in water and
so they cannot be stored in the body.

The best sources of micronutrients in our diets are fruits and vegetables. These two
food groups contain essential vitamins and minerals. Animal sources of foods are
also both good sources of micronutrients. However, an adequate micronutrient
intake can only be achieved through sufficient intake of a balanced diet that includes
plenty of fruits and vegetables. Table 2.1 overleaf sets out the functions of some of
the important vitamins and examples of sources of food for each of these.

Table 2.1  Functions and sources of vitamins.

Vitamins Function Food sources

Vitamin A Night vision Breastmilk, tomatoes, cabbage, lett

Healing epithelial cells Mangoes, papaya, carrots

Normal development of teeth and bones Liver, kidney, egg yolk, milk, butte
Vitamin D Needed for absorption of calcium from small intestines Ultra violet light from the sun

Calcification of the skeleton Eggs, butter, fish

Fortified oils, fats and cereals

Vitamin K For blood clotting Green leafy vegetables

Fruits, cereals, meat, dairy product

B complex Metabolism of carbohydrates, proteins and fats Milk, egg yolk, liver, kidney and h

Whole grain cereals, meat, whole b

Vitamin C Prevention of scurvy Fresh fruits (oranges, banana, mang

Aiding wound healing Breastmilk

Assisting absorption of iron

Epithelial cells form the thin layer of tissue lining the gut, respiratory and
genitourinary systems.
Calcification refers to the hardening of bones by calcium deposits.
Scurvy is a disease caused by vitamin C deficiency which leads to sore skin,
bleeding gums and internal bleeding.
2.7.2  Minerals

Minerals are the substances that people need to ensure the health and correct
working of their soft tissues, fluids and their skeleton. Examples of minerals include
calcium, iron, iodine, fluorine, phosphorus, potassium, zinc, selenium, and sodium.
Table 2.2 outlines the functions of some of these important minerals and examples
of sources of food for each of these.

Table 2.2  Functions and sources of common minerals.

Minerals Function F
Calcium Gives bones and teeth rigidity and strength M

F
 Iron Formation of haemoglobin M

E
Iodine For normal metabolism of cells I

F
Zinc For children to grow and develop normally; for wound healing M
Fluorine Helps to keep teeth strong W
 What are the main sources of micronutrients and why are they important as part of a
healthy diet?

Reveal answer

You will learn more about micronutrients in Study Session 7, in particular the impact
of deficiencies in vitamin A, iron and iodine on individuals and communities.

2.8  A balanced diet

You have already come across the term ‘balanced diet’ several times in this Module.
In this section we’ll discuss what a balanced diet is and the benefits of a balanced
diet. It is important that you know enough to be able to recommend a balanced diet
for the people in your community.

Eating a balanced diet means choosing a wide variety of foods and drinks from all
the food groups. It also means eating certain things in small amounts, namely
saturated fat, cholesterol, simple sugar, salt and alcohol. The goal is to take in all of
the nutrients you need for health at the recommended levels and perhaps restrict
those things that are not good for the body. Figure 2.2 shows you some good
sources of micronutrients in a selection of food at a market.

Figure 2.2  Good sources of micronutrients (Photo: Dr Basiro Davey)

To know if the diet is balanced and to plan a balanced diet you have to think about
two things: the mixture of foods and the amount of food a person eats.

2.8.1  Helping families to have good balanced diet

The best way to help individuals in your community prepare a balanced diet is to
learn which foods people use, the amount of different foods available, and how they
prepare their meals. Then you can decide if people need help or further support or
information to improve the balance of things they eat.

Fat and added sugars come mostly from fats, oils and sweets, but can be part of or
added to food from the other food groups as well.

Figure 2.3 shows a food pyramid. It helps us identify the food groups people should
combine in order to make a balanced diet. The food groups at the top of the pyramid
should be eaten in moderation (small amount) but food groups at the bottom of the
pyramid should be eaten in larger amounts.

View larger image

Figure 2.3  Food pyramid
2.8.2  The mixture of foods to use

The staple food is the common type of food that is consumed by the community. It
should be part of a balanced diet because it’s the main part of most meals. The
staple diet may vary from region to region. For example, ‘injera’ is the staple diet in
many sites, maize in other areas, and ‘kocho’ in the southern part of the country.
These foods are usually cheap, and provide most of the energy, protein and fibre in
a meal, as well as some vitamins.

2.8.3  Adding other foods to the staple food

 In order to have a good balanced diet, people in your community will need to eat
other foods in addition to the staple foods. The additional foods are important
because they:

 Provide nutrients that may not be available in the staple food. For example,
legumes such as peas, beans and lentils add protein, iron and other minerals
and fat; green and yellow vegetables and fruits add vitamins A and C, folate,
and fibre
 Make the food less bulky
 Make the diet more tasty and interesting to eat.

A diet which is composed of staples, legumes and vegetables or fruits is a good,

balanced diet because this combination of foods will provide most of the nutrients
that the people in your community need. The problem with the diet above is a lack of
animal sources of food. Animal sources are good because they contain plenty of
protein, have high energy (due to the fats), and the iron is easily absorbed compared
with the iron sourced from plants. Therefore adding small amounts of animal
products like meat, milk and eggs to staples, legumes and vegetables will improve
the balanced diet. As well as protein, animal foods will also provide fat (for energy)
and vitamins (especially vitamin A and folate), iron and zinc. But these foods may
not be easily available and even if they are, they are usually expensive.

 Think about the types of foods usually consumed by your community and write a list
of two groups of balanced diets, one with presence of animal foods and the other
without animal foods.

Reveal answer

Summary of Study Session 2

In Study Session 2 you have learned that:

1. Carbohydrates, proteins, fats, vitamins, minerals, water and fibre are the main
groups of nutrients which together, but in variable amounts, make up a
balanced diet.
2. Nutrients are grouped into macronutrients and micronutrients. Carbohydrates,
proteins, fats and water are macronutrients, and vitamins and minerals are
micronutrients.
3. Although most foods are mixtures of nutrients, many of them contain a lot of
one nutrient and a little of the other nutrients. Foods are often grouped
according to the nutrient that they contain in abundance.
4. Unsaturated fats are healthy fats; saturated fats are unhealthy fats. Therefore
people in your community need to eat more of the unsaturated fats and try to
reduce their intake of saturated fats.
5. Vitamins are substances present in small amounts in foodstuffs and are
necessary for the body to function normally. Vitamins are also called protective
foods.
6. Minerals have a number of functions in the body including developing body
tissues and supporting metabolic processes. The minerals that are of most
importance are calcium, iron, iodine, zinc and fluorine.
7. In order to have a healthy life and good nutritional status, a person needs to eat
a balanced diet. You need to know the commonly used food groups in order to
advise the people in your community on how to have a balanced diet.