Prepared by: Judith P.

Antonino

judithantonino@clsu.edu.ph

CENTRAL LUZON STATE UNIVERSITY

Science City of Muñ oz 3120
Nueva Ecija, Philippines

Instructional Module for HE2110

(Food and Nutrition)

MODULE 2: Food choices and its impact on health and wellness

OVERVIEW

In this module, you will learn why individuals have certain food preferences or
choices and how food choices affect health conditions for better or for worse. Knowledge
from this lesson will make you wiser in selecting the food that you eat.
I. OBJECTIVES

Upon completion of this module, you should be able to:

1. Identify the different factors that influence food choices

2. Discuss the consequences of food choices to one’s health and wellness
3. Value the importance of the right food choice in achieving healthy status.

II. LEARNING ACTIVITY

TOPIC 1: Factors affecting food choices

Your food choices and diet have direct impact in your nutritional status. Each day
food choices may not create an obvious effect in your health, but when these choices are
repeated over a long period of time, the consequences become very evident. Shils et. al
(2005) noted that poor diet can have an injurious impact on health, causing deficiency
diseases such as scurvy, beriberi, and kwashiorkor; health-threatening conditions like
obesity and metabolic syndrome, and such common chronic systemic diseases as
cardiovascular disease, diabetes, and osteoporosis. In general, chronic disease progresses
slowly or with less obvious change until it becomes acute, leaving one no options but to
avoid or limit foods that he or she indulged or enjoyed much before, along with
medications. This occurs because our body has a definite nutritional requirement.
Excessive nutrient intake from the food will result to over nutrition, while deficiency will
result to under nutrition.

Factors affecting food choices or eating habits (Whitney and Rolfes, 2005; Revilla
et. Al, 2018)

1. Personal preference. There is universal preference for sweetness of sugar,

savoriness of salt and richness or creaminess of fatty rich foods. But individual
choice varies in terms of flavor combination, extent or strength of taste or flavor,
 and addition of spices and herbs to create a peculiar flavor such as curry, hot
pepper, cinnamon, basil and others.
2. Habit. People sometimes select food out of habit like eating bread and coffee in the
morning which in the long run becomes a routine.

3. Economics. Equal access to food is influenced by income. Oftentimes, affluent

families can eat whatever they wish while poor can only have what their income
can buy.
4. Ethnic, heritage and tradition. Play significant influence on food choices. People
who grew up eating rice like Filipinos, would always look for rice even when they
migrate to Western countries. Indians would prefer food with curry, Mexican loves
spicy. Filipino traditions during Fiestas and Christmas depict bounty and festive
dishes.
5. Early food experiences. Toddler who was forced to swallow mushy vegetables or
finish eating a certain food up to the last bite is likely to dislike the same food when
they grow up. Hence, it is important to introduce food at the early age with
pleasant experience.
6. Geographical location. Expectedly, those who live at the seaside are likely to eat
more of seafoods and those from Pangasinan tend to use a lot of fermented fish or
“bagoong” in the dishes.
7. Social factor. Peers and colleagues admittedly have influence on food choices like
students with peers who always eat at the fast-food are likely to prefer fast foods
than home cooked foods.
8. Health concerns. There are some people who have allergies with some food like
shrimps, peanut, etc. or have lactose intolerant. Others need to be on special diet
due to health issues like low-salt diet, low fat diet, etc.
9. Emotions. There is a wide range of issues that emotion can affect food choice and
eating habit like individuals facing stressful situation tend to over eat or the other
way around; others resort to what they call comfort foods.
10. Religion. Different religions impose food restrictions such as Seventh day
Adventists forbid eating hooved-footed animals, shrimps, fish without scales;
 Muslims considered Haram or unlawful to eat pork and blood of animals. Catholics
refrain from eating pork on Friday during Lenten season.
11. Body weight and image. Some people select certain foods that they believe will
improve their physical appearance and avoid those that are detrimental.
12. Nutrition and health benefits. This is the most ideal basis of food choices. Selecting
health promoting foods and beverage like functional foods (this will be expounded
separately in other module) such as bright colored fruits and vegetables like
strawberries, carrots, canistel; and quality foods.

Achieving a Healthy Diet

In order to achieve a healthy diet, it is of paramount importance to balance the

quality and quantity of the food that you eat. There are five key factors to observe of what
makes up a healthful diet:

1. A diet must be adequate, by providing sufficient amounts of each essential

nutrient, as well as fiber and adequate calories.
2. A balanced diet results when you do not consume one nutrient at the expense of
another, but rather get appropriate amounts of all nutrients.
3. Calorie control is necessary so that the amount of energy you get from the
nutrients you consume equals the amount of energy you expend during your day’s
activities
4. Moderation means not eating to the extremes, neither too much nor too little.
5. Variety refers to consuming different foods from within each of the food groups on
a regular basis.

A healthy diet is one that favors whole foods. As an alternative to modern

processed foods, a healthy diet focuses on “real” fresh whole foods that have been
sustaining people for generations. Whole foods supply the needed vitamins, minerals,
protein, carbohydrates, fats, and fiber that are essential to good health. Commercially
prepared and fast foods are often lacking in nutrients and often contain inordinate
amounts of sugar, salt, saturated and trans fats, all of which are associated with the
development of diseases such as atherosclerosis, heart disease, stroke, cancer, obesity,
diabetes, and other illnesses. A balanced diet is a mix of food from the different food
groups (vegetables, legumes, fruits, grains, protein foods, and dairy). This poses a
challenge to food technologist: producing shelf-stable food that preserves nutritional
components of foods.

Achieving a Healthy Diet by University of Hawai‘i at Mānoa Food Science and Human Nutrition Program is licensed under a Creative Commons
Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted
http://www.ars.usda.gov/Services/docs.htm?docid=17032
(adopted with modifications)

Topic 2: Consequences of Malnutrition

Malnutrition is the condition of the body resulting from either prolonged

nutritional deficiency or lack of needed nutrient for the body function normally
(undernutrition) or excessive supply of nutrients from over eating more of the same
classes of foods for a long period of time (overnutrition).

A. Undernutrition

Malnutrition in developed countries is unfortunately still more common in situations

of poverty, social isolation and substance misuse. However, most adult malnutrition is
associated with disease and may arise due to the following culprits (Saunders and Smith
(2010):

Reduced Dietary intake

Probably the single most important etiological factor in disease-related

malnutrition is reduced dietary intake. This is thought to occur due to reductions in
appetite sensation as a result of changes in cytokines, glucocorticoids, insulin and insulin-
like growth factors.6 The problem may be compounded in hospital patients by failure to
provide regular nutritious meals in an environment where they are protected from
routine clinical activities, and where they are offered help and support with feeding when
required.

Malabsorption of micro and macronutrients

For patients with intestinal failure and those undergoing abdominal surgical
procedures, malabsorption represents an independent risk factor for weight loss and
malnutrition.

Increased losses or altered requirements

In some circumstances, such as enterocutaneous fistulae or burns, patients may

have excessive and/or specific nutrient losses; their nutritional requirements are usually
very different from normal metabolism.

Energy expenditure

It was thought for many years that increased energy expenditure was
predominantly responsible for disease-related malnutrition. There is now clear evidence
that in many disease states total energy expenditure is actually less than in normal health.
The basal hypermetabolism of disease is offset by a reduction in physical activity, with
studies in intensive care patients demonstrating that energy expenditure is usually below
2,000 kcal/day. The exception is patients with major trauma, head injury or burns where
energy expenditure may be considerably higher, although only for a short period of
time.8,9

Muscle function

Weight loss due to depletion of fat and muscle mass, including organ mass, is often
the most obvious sign of malnutrition. Muscle function declines before changes in muscle
mass occur, suggesting that altered nutrient intake has an important impact independent
of the effects on muscle mass. Similarly, improvements in muscle function with nutrition
support occur more rapidly than can be accounted for by replacement of muscle mass
alone.

Downregulation of energy dependent cellular membrane pumping, or reductive

adaptation, is one explanation for these findings. This may occur following only a short
period of starvation. If, however, dietary intake is insufficient to meet requirements over a
more prolonged period of time the body draws on functional reserves in tissues such as
muscle, adipose tissue and bone leading to changes in body composition. With time, there
are direct consequences for tissue function, leading to loss of functional capacity and a
brittle, but stable, metabolic state. Rapid decompensation occurs with insults such as
infection and trauma. Importantly, unbalanced or sudden excessive increases in energy
intake also put malnourished patients at risk of decompensation and refeeding syndrome.

Cardio-respiratory function

Reduction in cardiac muscle mass is recognized in malnourished individuals. The

resulting decrease in cardiac output has a corresponding impact on renal function by
reducing renal perfusion and glomerular filtration rate. Micronutrient and electrolyte
deficiencies (e.g. thiamine) may also affect cardiac function, particularly during refeeding.
Poor diaphragmatic and respiratory muscle function reduces cough pressure and
expectoration of secretions, delaying recovery from respiratory tract infections.

Gastrointestinal function

Adequate nutrition is important for preserving GI function: chronic malnutrition

results in changes in pancreatic exocrine function, intestinal blood flow, villous
architecture and intestinal permeability. The colon loses its ability to reabsorb water and
electrolytes, and secretion of ions and fluid occurs in the small and large bowel. This may
result in diarrhea, which is associated with a high mortality rate in severely malnourished
patients.
Immunity and wound healing

Immune function is also affected, increasing the risk of infection due to impaired
cell-mediated immunity and cytokine, complement and phagocyte function. Delayed
wound healing is also well described in malnourished surgical patients.

Psychosocial effects

In addition to these physical consequences, malnutrition also results in

psychosocial effects such as apathy, depression, anxiety and self-neglect.

Clinical outcome

The consequences of malnutrition on physiological function have an important

impact on clinical outcome. In the 1930s surgeons observed that patients who were
starved or underweight had a higher incidence of postoperative complications and
mortality. A large number of studies have subsequently supported this original
observation. Malnourished surgical patients have complication and mortality rates three
to four times higher than normally nourished patients, with longer hospital admissions,
incurring up to 50% greater costs. Similar findings have also been described in medical
patients, particularly the elderly. It is often difficult to separate the deleterious effects of
malnutrition from the underlying disease process itself, especially because each can be a
cause and/or consequence of the other. However, there is clear evidence that nutrition
support significantly improves outcomes in these patients; it is therefore vital that
malnutrition is identified through screening.

The cost

Malnutrition is also a major resource issue for public expenditure. BAPEN has recently
calculated that the costs associated with disease-related malnutrition in the UK in 2007
were over £13 billion (greater than that for obesity). This calculation involved the
summing of treatment costs for both the underlying disease process and malnutrition.
The potential cost savings associated with prevention and treatment of malnutrition are
considerable: a saving as small as 1% represents £130 million per year. There is evidence
that for specific situations treating malnutrition produces cost savings of 10–20% or
more.

B. Overnutrition

Chronic overfeeding

According to Svacina (2008) Chronic overnutrition is the most important

cause of obesity. There are, however, other causal factors, notably genetic
disposition, sedentary lifestyle and impaired mechanisms that protect an
individual against excessive storage of fat. These mechanisms include
postprandial thermogenesis, non-exercise activity thermogenesis, physical
activity, the composition of muscle fibers, the inherent activity of thyroid
hormones and uncoupling proteins and so-called futile cycles.
Studies on animals and volunteers have shown, that, after the period of
overfeeding is finished, the body weight usually returns to its original value.
There were some interesting revelations in studies on sumo wrestlers, who
chronically overfeed themselves but are highly active. However, when they stop
exercising the muscle mass is quickly replaced by fatty tissue. This is in accord
with recent prospective studies, which show that quite obese patients with
sufficient levels of physical activity do not have an increased mortality. It is
actually better to be obese but physically fit (fit–fat) rather than slim but unfit
(unfit–unfat).
 She further noted that in the developed world, more than 40% of the
population are overweight and over 20% are obese. In some countries as much
as ¾ of the adult population are overweight. The steep rise in the incidence of
obesity in the developed world, when the genetic background has not changed,
is due to the excess intake of energy and diminishing levels of activity. It is also
probable that the thrifty gene hypothesis plays a part. It has been postulated
that the individuals who survived as far as the 20th century are the descendants
of those who could cope with shortage of food, wars and famine with highly
efficient storage and energy conserving mechanisms. Those from the Indian
subcontinent, for example, who migrate from subsistence farming communities
to more affluent urban societies, suffer particularly from obesity and its
consequences. Mammals have many ways of adapting to low intake of food,
including reduced energy expenditure. On the other hand, mechanisms, other
than by physical activity, for dealing with excess energy intake are limited.
Nowadays obesity is classified according to the BMI although obesity is defined
as a BMI>30, the health risks of increased body weight rise progressively when
BMI exceeds 25. Morbid obesity (BMI>40) is a serious disease and patients
rarely live longer than 60 years. The optimum BMI in terms of life expectancy
seems to be between 20 and 22. Using BMI as a measure of obesity is accepted
worldwide; it can be used as an indicator of life expectancy and the risk of the
majority of obesity complications.
Of importance also is the qualitative distinction between android (abdominal)
and gynoid (buttock and thigh) obesity, because it is the android type that is
accompanied by metabolic complications including the development of diabetes
and atherosclerosis. A ratio between waist and hip circumferences (WHR) of >1
was used as an index of android obesity, although waist circumference alone
correlates better with the amount of visceral fat. The risk of metabolic
complications, i.e. the predisposition to develop android type of obesity, is
related to the waist circumference and is usually classified as mild or severe.

Table 1. Clinical identification of metabolic syndrome (Adult Treatment Panel

Guidelines III, 2001 in Svacina, 2008)

Mild (cm) Severe (cm)

Women >80 >88
Men >94 >102

HDL cholesterol

Men <40 mg/dl (1.04 mmol/l)

Women <50 mg/dl (1.3 mmol/l)

Blood pressure >130/85 mmHg

Fasting glucose >110 mg/dl (6.2 mmol/l)

Functional changes and risk factors connected with chronic overnutrition:

 Production of fat, steatosis of liver, muscles and pancreas.

  Excessive secretion of fat cell hormones fatty acids and cytokines.
 Insulin resistance.
 Obesity.
 Metabolic syndrome, including type 2 diabetes, hypertension,
hyperlipidemia, etc.
 Impaired coagulation and fibrinolysis.
 Sterility and hormonal disorders.
 Sleep apnea syndrome.
 Respiratory failure.
 Impaired regeneration and wound heeling.
 Infections.
 Atherosclerosis, endothelial dysfunction.
 Oxidative stress.
 Obesity related tumors.

Risks of obesity

These include threats to health and to socio-economic well being.

 Health:

o Increased risk of metabolic syndrome

o Diabetes.

o Cardiovascular disease.

o Accidents.

o Depression.

o Thromboembolic diseases.
  Socio-economic:

o Low educational attainment.

o Lower income.

o Lower social status.

o More insurance claims.

o Earlier retirement.

Effects of Overnutrition (Ivyrose Hollistic (2020)

III. ASSESSMENT

 Perform Activity 1

 Take Online quiz

References:

Titchenal, Alan, A. Calabrese, C. Gibby, M.K. Fialkowski Revilla and W. Meinke. 2018.
Human Nutriion. University Of Hawai‘I At M Noa Food Science And Human
Nutrition Program

John Saunders and Trevor Smith. 2010. Malnutrition: causes and consequences. Clinical
Medicine. 2010 Dec; 10(6): 624–627. Royal College of Physicians
Svacina, Stephan. 2008. Basic concepts in nutrition: Functional and clinical consequences. Educational
Paper. Vol.3, Issue 4.

Whitney Ellie and Sharon Raldy Rolfes. 2005. Understanding Nutrition. 10th edition.
Thompson Wadsworth, Australia

https://www.ncoa.org/healthy-aging/chronic-disease/nutrition-chronic-conditions/why-
malnutrition-matters/10-ways-malnutrition-impact-your-health-6-steps-prevention/. Date
accessed September 25, 2020
https://www.ivyroses.com/HumanBiology/Nutrition/Overnutrition-Effects.php Date
accessed September 26, 2020

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4892290/