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                                                               Introduction

About Miss Noreen Aslam

" It is the right of every individual resident/patient to receive the benefits of the presence of the Professional Nutritionist as a member of the health care team ".
Awareness of health and nutrition remains in its infancy in Pakistan. The role of clinical nutritionist in the care of patients in healthcare institutions is unique. Many nutritionists, realizing how important their special skills are to patient care, are successfully establishing their position as member of the healthcare team. Being a clinical nutritionist, I am facing this challenge in my institute because I know the importance of nutritional care process, and now responsible to provide the planning and implementation of a professional nutritional care program.

The meaning of food, Nutrition, and Nutritional Care

Nutrition
Nutrition is " the science of foods, the nutrients and other substances therein; their action, interaction, and balance in relationship to health and disease; the process by which the organism ingests, digests, absorbs, transports and utilizes nutrients and disposes of their end products. In addition, nutrition must be concerned with social, economic, cultural, and psychological implications of food and eating ".

What does food mean to you?
Food-menu-diet-hunger-nutrition-malnutrition. What images do these words bring to your mind? Are they oriented to your physical senses? To your social enjoyment? To your concerns about your own well being? To your emotions? Do they raise questions about the quality of life for your fellow human beings?

Food is anything either solid or liquid possessing a chemical composition which enable it when swallowed to do it 2 or 3 functions.
            * to provide the body with material from which it can provide heat and other forms                  of energy.
            * to provide material for growth, maintenance, repair & reproduction.
            * supply substances which normally regulate the production of energy or the process                  of growth, repair and reproduction.

Health is defined as the " state of complete physical, mental and social well being and not merely the absence of disease or infirmity ".

Nutrients are the constituents in food that must be supplied to the body in suitable amounts. These include water, proteins and the amino acids of which they are composed, fats and fatty acids, carbohydrates, minerals and vitamins.

Nutritional Status is the condition of health of the individual as influenced by the utilization of the nutrients. It can be determined only by the correlation of information obtained through a careful medical and dietary history, a thorough physical examination, and appropriate laboratory investigations.

Nutritional Care is " the application of the science and art of human nutrition in helping people select and obtain food for the primary purpose of nourishing their bodies in health or in disease throughout the life cycle. This participation maybe in single or combined functions: in feeding groups involving food selection and management; in extending knowledge of food and nutrition principles; in teaching these principles for application according to particular situations; and in dietary counseling ".

Malnutrition is an impairment of health resulting from a deficiency, excess, or imbalance of nutrients. It includes Undernutrition, which refers to a deficiency of calories and/or one or more essential nutrients, and Overnutrition, which is an excess of one or more nutrients and usually of calories.

Nutrition and Disease Prevention
Traditionally, health care has been concerned primarily with healing the sick and helping them maintain health. Today prevention is described as a " unifying theme " among Public health professionals, consumers, employers, workers, physicians, nutritionists, nurses, legislators, and policy makers.

The preventive measures described in this section are related to nutrition. However, its clear that the etiology of chronic disease is complex and that there are many other risk factors such as cigarette smoking, alcohol and drug abuse, stress, lack of exercise, heredity, poverty, age, sex and occupation. One can't change one's heredity, age, or sex, but one can control most of the environmental factors.

In assessing the value of preventive measures one must differentiate between that which has been proven and that for which final proof is not yet available. The following measures are of proven value:
            * The adequate intake of specific vitamins to prevent scurvy, pellagra, beriberi,                  rickets, and other deficiency diseases; adequate prenatal diets to reduce infant                  mortality; iodinization of salt to prevent endemic goiter; fluoridation of water                  supplies to reduce dental decay; and many others.
            * There is much evidence to support some widely recommended measures, but final                 proof is not yet forthcoming. since moderation of fats, cholesterol, and salt intake                 carries no health risks and since a reduced intake of fats and sugars is likely to                 improve the nutrient of the diet, it seems prudent to adopt such measures even                  though final proof is not yet available.

Indeed it seems irresponsible to wait for final proofs or to wait for disease signs to appear before making any modifications in diet.

The hard realities of Pakistan's health care system
The hard realities of pakistan's health care system are as follows

            * The nutritional status of the population is the same as it was 20 years ago.
            * 35% of pregnant women and 41% of lactating women take less than 80% of the                  recommended daily allowance for various nutrients.
            * Among women aged 15-44 years, 43%-47% of rural women and 33%-39% of                  urban women are anaemic.
            * Half of the children aged 5 years are under weight.
            * 70% of people from the Northern areas are iodine deficient and the deficiency in                  the country as a whole may be affecting approximately 40 million people.
            * 1 out of 7 adults are overweight or obese.
            * Pakistan has the world's 8th largest diabetic population
            * 69% of children between 7-9 months old receive no solid foods and even at                  12-17 months upto 15% receive only liquids.
            * 50% of meat, milk, milk products and vegetables are contaminated with variety of                  harmful micro organisms.
            * Government expenditure on the health sector for general population has been                  0.7-0.8% of the GDP, one of the lowest in the world.