Nutrition and activity performance

Prof Shashi Jain

Dept of Foods and Nutrition
College of Home Science, MPUAT, Udaipur
Interest in the influences of food on the capacity for physical activity is as old as mankind.
Individuals who seek to boost physical performance rely on proper diet and increased training. The
growing awareness of the synergy between diet and physical activity has fueled an expanding interest
in the valuable role that nutrition can play in achieving ones genetic potential in physical performance.
From earliest times, certain foods were regarded as essential preparation for strenuous physical activity.
In a recent consensus conference on food, nutrition and sports performance, carbohydrate containing
foods were identified as having the most significant impact on exercise performance. The nutritional
importance of protein, as a fuel for exercise and as a contributor to strength development, has been over
emphasized, whereas the fluid intake has been, by comparison, underplayed
Macro and micronutrients differ from in key characteristics. Water, proteins, carbohydrates, and
fat are consumed in large amounts (_100 g/d), whereas vitamins and minerals are ingested in much
smaller amounts (milligrams to micrograms per day). These differences in magnitude reflect turnover
rates in the body and specific functions. Macronutrients provide sources of energy needed to fuel the
body, maintain cellular hydration, and provide the body structure to perform work. Micronutrients
enable the use of macronutrients for all physiologic processes. Despite their relative paucity in the diet
and the body, vitamins and minerals are key regulators of health and function, including work
performance.
Energy Metabolism
Energy expenditure must equal energy intake to achieve energy balance. The energy systems
used during exercise for muscular work include the phosphagen and glycolytic (both anaerobic) and the
oxidative (aerobic) pathways. The phosphagen system is used for events lasting no longer than a few
seconds and of high intensity. Adenosine triphosphate (ATP) and creatine phosphate provide the readily
available energy present within the muscle. The amount of ATP present in the skeletal muscles (~5
mmolkg1 wet weight) is not sufficient to provide a continuous supply of energy, especially at high
exercise intensities. Creatine phosphate is an ATP reserve in muscle that can be readily converted to
sustain activity for ~3-5 min.[2] The amount of creatine phosphate available in skeletal muscle is
approximately four times greater than ATP and, therefore, is the primary fuel used for high-intensity,
short-duration activities such as the clean and jerk in weight lifting or the fast break in basketball.
The anaerobic glycolytic pathway uses muscle glycogen and glucose that are rapidly
metabolized anaerobically through the glycolytic cascade. This pathway supports events lasting 60-180
s. Approximately 25%-35% of total muscle glycogen stores are used during a single 30-s sprint or
resistance exercise bout. Neither the phosphagen nor the glycolytic pathway can sustain the rapid
provision of energy to allow muscles to contract at a very high rate for events lasting greater than ~2-3
min.
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The oxidative pathway fuels events lasting longer than 2-3 min. The major substrates include
muscle and liver glycogen, intramuscular, blood, and adipose tissue triglycerides and negligible
amounts of amino acids from muscle, blood, liver, and the gut. As oxygen becomes more available to
the working muscle, the body uses more of the aerobic (oxidative) pathways and less of the anaerobic
(phosphagen and glycolytic) pathways. Only the aerobic pathway can produce much ATP over time via
the Krebs cycle and the electron transport system. The greater dependence on aerobic pathways does
not occur abruptly, nor is one pathway ever relied on exclusively. The intensity, duration, frequency,
type of activity, sex, and fitness level of the individual, as well as prior nutrient intake and energy
stores, determine when the crossover from primarily aerobic to anaerobic pathways occurs.
Conversion of Energy Sources over Time
Approximately 50%-60% of energy during 1-4 h of continuous exercise at 70% of maximal
oxygen capacity is derived from carbohydrates and the rest from free fatty acid oxidation. [3] A greater
proportion of energy comes from oxidation of free fatty acids, primarily those from muscle
triglycerides as the intensity of the exercise decreases. Training does not alter the total amount of
energy expended but rather the proportion of energy derived from carbohydrates and fat. As a result of
aerobic training, the energy derived from fat increases and from carbohydrates decreases. A trained
individual uses a greater percentage of fat than an untrained person does at the same workload. Longchain fatty aids derived from stored muscle triglycerides are the preferred fuel for aerobic exercise for
individuals involved in mild- to moderate-intensity exercise.
Performance is usually assessed as either the time to exhaustion (endurance capacity) during
exercise of constant intensity, or the time to run a predetermined distance or complete a prescribed
workload (performance) in the shortest time possible. The division between endurance capacity and
endurance performance is artificial because in any real life endurance race or event, both endurance
capacity and pace are required in order to be successful. Nevertheless, by obtaining a better
understanding of simple endurance capacity, we can get a clearer picture of the essential determinants
of endurance performance.

Macronutrient
Carbohydrate, protein and fat are important nutrients for active individuals, but the amounts of
these macronutrients need will depend on an individuals exercise intensity, duration and frequency, the
type of exercise engaged in, and their health, body size, age and gender. Macronutrient
recommendations for those engaged in daily physical activity are given below and in Table 1.
Table 1. Dietary Reference Intakes (DRIs) for macronutrients and recommendations for active individuals
Nutrient
Ratio to energy
Carbohydrate 45-65% of
Total energy

Guidelines for Active Individuals

The amount of carbohydrate required for moderate intensity
exercise is 5-7 g/kg body weight; 7-12 g/kg body weight for high
intensity endurance activities.
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Nutrient
Protein
Fat

Ratio to energy
10-35% of total
energy; 0.8 g/kg of
body weight
20-35% of
Total energy

Guidelines for Active Individuals

Protein requirements are higher in active individuals.
Recommendations range from 1.2-1.7 g of protein/kg body
weight. This level of protein represents 15% of total energy.
Fat intakes between 20-35%.
Carbohydrate and protein needs should be met first.

Carbohydrate
The mix of fuel (protein, fat, carbohydrate) burned during exercise depends primarily on the
intensity and duration of the exercise performed, ones level of fitness, and prior nutritional status. All
other conditions being equal, as exercise intensity increases the use of carbohydrate for energy will also
increase. The duration of exercise also changes substrates use. As duration of exercise increases (e.g.,
from 60 to 120 min), muscle glycogen becomes depleted, causing the body to draw on circulating blood
glucose as a source of carbohydrate. If blood glucose cannot be maintained within physiological range
during exercise, the ability to perform intensity exercise will decrease . Fat can be used as a source of
energy over a wide range of exercise intensities; however, the proportion of energy contributed by fat
decreases as exercise intensity increases. In these circumstances, carbohydrate becomes the dominant
fuel source while the contribution from fat decreases . Protein can also be used for energy at rest and
during exercise; however, in well-fed individuals it probably provides <5% of the energy expended . As
the duration of exercise increases, the energy contribution of protein may increase to maintain blood
glucose.
Protein
Active individuals often think that they need to consume high protein diets to cover the building
and repair of their muscle tissue. Exercise increases the need for protein (g/kg body weight) in three
ways:
1) Increased need for protein to repair exercise-induced damage to muscle fibers;
2) Support gains in muscle mass that occur with exercise; and
3) Provide energy source during exercise
How much additional protein is needed may depend on the type of exercise performed
(endurance vs. resistance), the intensity and duration of the activity, body composition (e.g., kg of lean
tissue mass), and whether weight loss is being attempted.
In general individual consume closer to 15% of energy from protein. Thus, there is usually little
need to recommend that active individuals consume more protein. Increasing protein intakes beyond
the recommended level is unlikely to result in additional increases in lean tissue, since there is a limit to
the rate at which protein tissue can be accrued. Those individuals at greatest risk for low protein intakes
are active individuals who restrict energy intake for weight loss or follow vegetarian diets, especially
active women.
Fat
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Over the years the amounts and types of fat recommended for good health have changed, which
is frustrating and confusing for the consumer. Dietary recommendations for active individuals have
typically focused on getting adequate intakes of carbohydrate and protein, and keeping fat intake to 2530% of energy intake. Although fat is seen by many individuals as something to avoid, fat is a
necessary component of a normal diet. Fat provides energy and essential elements for cell membranes,
and is associated with the intakes of the fat-soluble vitamins E, A and D. However, the type of fat
consumed is important since the long-term negative effects of high saturated fat diets on health are well
known. In addition, low fat intakes (<15-17% of energy) are generally not recommended for active
individuals, since are reported to decrease energy and nutrient intakes and exercise performance. These
recommendations apply to all individuals, regardless of activity level.
Diets should be low in saturated and trans fats, while providing adequate amounts of essential
fatty acids (linoleic and linolenic acids). The essential fatty acids are required to make a number of
potent biological compounds within the body that help regulate blood clotting, blood pressure, heart
rate and the immune response. Linoleic acid is found in vegetable and nut oils (e.g., sunflower,
safflower, corn, soy, peanut oil) and it is recommended that adult men consume 14-17 g/day and adult
women consume 11- 12 g/day. The second essential fatty acid, -linolenic acid, is found primarily in
leafy green vegetables, walnuts, soy oil and foods, canola oil, and fish products and fish oils. The
recommended intakes for - linolenic is 1.6 g/day for adult men and 1.1 g/day for adult women. If
active individuals consume very low fat diets (<15% of energy), getting adequate amounts of the
essential fatty acids can be a problem. Research has also examined the impact of high fat diets (40-70%
of energy intake) on fat utilization during exercise and athletic performance. It was hypothesized that
consuming a high fat diet would enhance fat oxidation and utilization during exercise. Unfortunately,
most individuals cannot tolerate these high fat levels for long, nor can health professionals recommend
them for long-term health; thus, there is little support for recommending these diets to active
individuals.
Hydration
It is well-documented in the literature that exercise performance is optimal when athletes and
active individuals maintain fluid balance during exercise. Conversely, exercise performance is impaired
with progressive dehydration which can eventually lead to potentially life-threatening heat injury if
action is not taken. Thus, it is imperative that all active individuals attempt to remain well hydrated.
Active individuals exercising in special environmental conditions (heat, cold, altitude) need to take
extra precautions to remain hydrated.
Maintaining water and electrolyte balance
Maintaining fluid and electrolyte balance means that active individuals need to replace the water
and electrolytes lost in sweat. This requires that active individuals, regardless of age, strive to hydrate
well before exercise, drink fluids throughout exercise, and rehydrate once exercise is over. Generous
amounts of fluids should be consumed. If activity is of long duration (usually >1 h) or occurs in a hot
environment, sport drinks containing carbohydrate and sodium should be used. Sodium helps the
rehydration process by maintaining plasma osmolality and the desire to drink.

Micronutrients
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Micronutrients play an important role in energy production, hemoglobin synthesis, maintenance

of bone health, adequate immune function, and protection of body against oxidative damage. They
assist with synthesis and repair of muscle tissue during recovery from exercise and injury. Heavy
physical activities stress many of the metabolic pathways where micronutrients are required, and
exercise training may result in muscle biochemical adaptations that increase micronutrient needs.
Routine activity may also increase the turnover and loss of these micronutrients from the body. As a
result, greater intakes of micronutrients may be required to cover increased needs for building, repair,
and maintenance of lean body mass.
The most common vitamins and minerals found to be of concern in heavy workers diets are
calcium and vitamin D, the B vitamins, iron, zinc, magnesium, as well as some antioxidants such as
vitamins C and E, -carotene, and selenium. Individuals are at risk for poor micronutrient status who
restrict energy intake, eliminate one or more of the food groups from their diet, or who consume
unbalanced and low micronutrient-dense diets.

Vitamins
Organic compounds, found in small amounts in foods, are designated as nutrients because they
cannot be synthesized by the body and are required to support health and well being. Vitamins catalyze
numerous biochemical reactions. They are not direct sources of energy; vitamins facilitate energy
metabolism. Because the rates or activities of these metabolic processes increase during physical
activity, an adequate supply of vitamins is needed to promote optimal physical performance. Vitamins
are classified based on their solubility in water or fat.
Table 2 : Biological functions of some vitamins with reference to exercise
Nutrients
Thiamin (B1)
Riboflavin (B2)
Niacin
Pyridoxine (B6)
Cyanocobalamin (B12)
Folic acid
Ascorbic acid (vitaminC)
Retinol (vitamin A)
Tocopherol (vitamin E)

Function
Carbohydrate and amino acid
metabolism
Oxidative metabolism, electron
transport system
Oxidative metabolism, electron
transport system
Gluconeogenesis
Hemoglobin formation
Hemoglobin and nucleic acid
formation
Antioxidant
Antioxidant
Antioxidant

Deficiency sign or symptom

Weakness, decreased endurance,
muscle
Altered skin and mucous membrane
and nervous system function
Irritability, diarrhea
Dermatitis, convulsions
Anemia, neurologic symptoms
Anemia, fatigue
Fatigue, loss of appetite
Appetite loss, prone to infections
Nerve and muscle damage

WATER-SOLUBLE VITAMINS

Vitamin B1 (Thiamin)
Thiamin plays a key role in carbohydrate and protein metabolism. As the compound thiamin
pyrophosphate, it acts as a coenzyme in the conversion of pyruvate to acetyl coenzyme A and
ketoglutarate to succinyl coenzyme A and participates in the decarboxylation of branched-chain amino
acids. Thus, thiamin may be a potentially limiting nutrient in physical performance. The suggested
intakes for thiamin are 1.1 and 1.2 mg/d for women and men, respectively. Because the thiamin
requirement depends on energy intake, the suggested RDA is 0.5 mg/1000 kcal. Physically active
individuals who consume large energy intakes should increase thiamin intakes proportionally. Although
short-duration thiamin restriction does not adversely affect physical performance, brief thiamin
insufficiency can cause pyruvate accumulation and increase circulating lactate during work, which may
promote fatigue, impair training, and thus reduce performance.
Vitamin B2 (Riboflavin)
Riboflavin functions in the mitochondrial electron transport system as the coenzymes flavin
mononucleotide and flavin adenine dinucleotide. Thus, riboflavin is required for oxidative energy
production. Recommendations for riboflavin intake are based on energy intake. It is suggested that an
intake of 0.6 mg/1000 kcal will meet the needs of most healthy adults. Initiation of increased physical
activity has an adverse effect on riboflavin status. Sedentary young women consuming 2.15 mg/d of
riboflavin experienced a significant increase in the glutathione reductase receptor activity coefficient
(e.g., decreased riboflavin status) within 4 d of starting an endurance exercise program with a
concomitant increase in urinary riboflavin excretion. Thus, biochemical evidence of altered riboflavin
status reflects changes in riboflavin retention or use in response to exercise training without adverse
effects on physical performance. This suggests that functional consequences of decreased riboflavin
nutriture likely occur after decreases in biochemical indices of riboflavin status.
Niacin
Niacin refers to two compounds, nicotinic acid and nicotinamide. Nicotinamide is a precursor of
nicotinamide adenine nucleotide and nicotinamide adenine dinucleotide phosphate, which serve as
electron and proton acceptors, respectively. Nicotinamide adenine nucleotide is an electron carrier in
many oxidative reactions, and reduced nicotinamide adenine dinucleotide phosphate is a hydrogen
donor in the pentose phosphate shunt. The role of niacin on performance is based on the potentially
adverse effect of niacin on fatty acid use and its indirect effect on accelerating depletion of glycogen
stores and performance measures.
Vitamin B6
Vitamin B6 refers to all biologically active forms of vitamin B6. The forms include pyridoxine,
pyridoxal, pyridoxamine, pyridoxine phosphate, pyridoxal phosphate, and pyridoxamine phosphate. 25
Pyridoxine, pyridoxal and pyridoxamine. Vitamin B6 in the form of pyridoxal phosphate acts as a
cofactor for transferases, transaminases, decarboxylases, and cleavage enzymes used in transformations
of amino acids. During exercise, pyridoxal phosphate is needed for gluconeogenesis and for
glycogenolysis in which it serves as a cofactor for glycogen phosphorylase.
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Folate
Folate serves as a coenzyme in single-carbon transfers in the metabolism of nucleic and amino
acids. It is required for synthesis of purines and pyrimidines that are needed for DNA production
and erythropoiesis. A deficiency of folate causes abnormal cell replication, particularly in the
erythropoietic system, and results in megaloblastic anemia. This type of anemia also is caused by
vitamin B12 deficiency.
Vitamin B12 (Cobalamin)
Cobalamin is a general term that describes a group of cobalt containing compounds, the
corrinoids. This vitamin contains cobalamin with or without a cyanide group, both of which are
biologically active for humans. Vitamin B12 functions as a coenzyme for the methyl transfer reaction
that converts homocysteine to methionine and another reaction that converts L-methyl-malonyl
coenzyme A to succinyl coenzyme A. It also is required for normal erythrocyte production and
neurologic function.
Vitamin C (Ascorbic Acid)
Vitamin C has certain biological functions that can influence physical performance. It is needed
for synthesis of carnitine, which transports long-chain fatty acids into mitochondria, and the
catecholamines, epinephrine, and norepinephrine. Ascorbic acid facilitates the transport and uptake of
non-heme iron at the mucosa, the reduction of folic acid intermediates, and the synthesis of cortisol.
Vitamin C is a potent antioxidant that serves to regenerate vitamin E from its oxidized byproduct.
Vitamin C depletion may adversely affect various aspects of physical performance. These detrimental
effects range from nonspecific responses such as fatigue and muscle weakness to anemia. Vitamin C
depletion also decreases training because of recurrent injuries to connective tissues and causes
decrements in endurance performance as a result of anemia. Physiologic stressors, such as infection,
cigarette smoking, altitude, and extreme environmental temperatures, increase vitamin C requirements.
Exercise is another physiologic stressor that may increase vitamin C needs. Vitamin C may indirectly
benefit physical performance by enhancing physiologic functions.
FAT-SOLUBLE VITAMINS

Vitamin A
Vitamin A refers to a group of compounds including retinol, retinaldehyde, and retinoic acid.
Carotenoids, principally _-carotene, are precursors of vitamin A and another source of vitamin A.
Vitamin A is important for normal vision, gene expression, growth, and immune function by its
maintenance of epithelial cell functions. Very large intakes of vitamin A are toxic and can result in
significant metabolic perturbations including nausea, anorexia, hair loss, and kidney and liver damage.

Vitamin D
Vitamin D is required for adequate calcium absorption, regulation of serum calcium and
phosphorus levels, and promotion of bone health. Vitamin D also regulates the development and
homeostasis of the nervous system and skeletal muscle.

Vitamin E
Vitamin E is a generic term for eight naturally occurring compounds in two classes designated
as tocopherols and tocopherols. Vitamin E serves as an antioxidant of polyunsaturated fatty acid in
cell membranes and subcellular structures. It influences cellular response to oxidative stress through
signal transduction pathways. Vitamin E deficiency is associated with neurologic damage and
erythrocyte hemolysis. Vitamin E may play a differential role in oxidative metabolism of different
muscle fibers. Vitamin E is a key nutrient in supporting physical performance. Vitamin E deficiency
adversely affects skeletal muscle; it can lead to muscle degradation in humans. Severe vitamin E
deficiency increases oxidative stress in skeletal muscles, alters muscle fiber types, and causes
degradation and inflammatory processes that lead to dystrophic conditions.

Minerals
Iron
Iron is a key trace element that is required for the delivery of oxygen to tissues and the use of
oxygen at the cellular and subcellular levels. It serves as a functional component of iron containing
proteins including hemoglobin, myoglobin, cytochromes, and specific iron-containing enzymes. Iron
plays a critical role in energy use during work. Studies in humans verify the importance of iron to work
performance. Iron-deficient workers treated with iron supplements had decreased blood lactate
concentrations and increased oxygen uptake during standardized testing compared with pretreatment
values. Iron supplementation improves blood biochemical measures of iron status. Among irondeficient anemic women, iron supplementation not only improves iron status but also increases work
capacity and reduces exercise heart rate and lactate concentration. Investigators hypothesized that low
tissue iron, characterized by significantly decreased ferritin concentrations, may explain the beneficial
effects on exercise performance after concurrent iron supplementation and endurance exercise training.
Iron deficiency without anemia also impairs work performance by promoting skeletal muscle fatigue.
Magnesium
Magnesium is required in a wide variety of fundamental cellular activities that support diverse
physiologic systems. Magnesium is involved in more than 300 enzymatic reactions in which food is
metabolized and new products are formed. Some of these activities include glycolysis, fat and protein
metabolism, adenosine triphosphate hydrolysis, and the second-messenger system. Magnesium also
serves as a physiologic regulator of membrane stability and neuromuscular, cardiovascular, immune,
and hormonal functions. Thus, magnesium may be considered a potentially limiting element for human
performance. Magnesium deficiency impairs physical performance. Clear evidence was provided when
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muscle spasms in a tennis player were associated with decreased serum magnesium concentration
Treatment with 500 mg/d of magnesium gluconate relieved the muscle spasms within a few days.
Dietary restriction of magnesium results in reduced magnesium status, impaired physiologic function,
and performance in adults. Erythrocyte and skeletal muscle magnesium concentrations and magnesium
balance decreased significantly and heart rate and oxygen consumption increased significantly during
submaximal exercise in postmenopausal women. Thus depletes cellular magnesium stores, and
decreases muscular efficiency during submaximal work in women. Similarly, physically active
collegians experienced significant increases in endurance performance and decreased oxygen use
during submaximal exercise after magnesium supplementation
Zinc
Zinc is required for the structure and activity of more than 300 enzymes from many species.
Zinc is required for nucleic acid and protein synthesis, cellular differentiation and replication, and
glucose use and insulin secretion. Zinc exerts regulatory actions in various aspects of hormone
metabolism including the production, storage, and secretion of hormones and regulating interactions
between hormones and receptors and end-organ responsiveness. Adequate zinc is needed for the
integration of many physiologic systems such as immunity, reproduction, taste, wound healing, skeletal
development, behavior, and gastrointestinal function. This array of zinc dependent functions suggests
that zinc status should regulate work performance. Zinc enhances in vitro muscle contraction. Muscle
strength and endurance were improved in middle-age women supplemented with zinc Because these
muscle functions rely on recruitment of fast-twitch glycolytic muscle fibers, it may be hypothesized
that zinc supplementation enhanced the activity of lactate dehydrogenase, a zinc-dependent enzyme.
However, because respiratory quotient increased with zinc restriction, it may be speculated that lactate
dehydrogenase activity also was adversely affected. These findings provide the first evidence of
impaired metabolic response during work when dietary zinc is suboptimal.
Chromium
Chromium is an essential mineral that functions broadly in the regulation of glucose, lipid, and
protein metabolism by potentiating the action of insulin at the cellular level. The mechanism has been
proposed to involve several enzymatic changes including insulin binding to its membrane receptor,
resulting in an intermolecular phosphorylation cascade leading to increased insulin sensitivity. It was
observed that chromium supplementation promotes gains in lean body mass.
Calcium.
Calcium is especially important for growth, maintenance and repair of bone tissue, maintenance
of blood calcium levels, regulation of muscle contraction, nerve conduction, and normal blood clotting.
Inadequate dietary calcium and vitamin D increase the risk of low bone mineral density and stress
fractures.
Sodium, Chloride, and Potassium

Sodium is a critical electrolyte, particularly for athletes with high sweat losses. Potassium is
important for fluid and electrolyte balance, nerve transmission, and active transport mechanisms.
During intense exercise, plasma potassium concentrations tend to decline to a lesser degree than
sodium.

Factors Affecting Work performance

1. Ageing
About half of the physical decline associated with ageing may be due to problems including:

Reduced muscle mass, strength and physical endurance

Reduced coordination and balance
Reduced joint flexibility and mobility
Reduced cardiovascular and respiratory function
Reduced bone strength
Increased body fat levels
Increased blood pressure
Increased susceptibility to mood disorders, such as anxiety and depression
Increased risk of various diseases including cardiovascular disease and stroke.

2. Body composition
In physical fitness, body composition is used to describe the percentages of fat, bone, water
and muscle in human bodies. Because muscular tissue takes up less space in our body than fat tissue,
our body composition, as well as our weight, determines leanness. A statistically significant
relationship between percent of body fat and the time to perform the job tasks is observed in studies.. A
negative relationship was observed between lean body mass (muscle mass) and job-related
performance. As the amount of muscle mass increased, the time to perform the job tasks decreased. The
percent of body fat and lean body mass are important predictors of job performance.

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3. Diet, Nutrition and Life style

Unhealthy diets, smoking and a lack of exercise are cutting down on how much one can work.
Unhealthy individual lifestyle choices may result in substantially higher levels of lost productive work
time. Studies indicated that employees with an unhealthy diet were more likely to experience a loss in
productivity than those who regularly ate whole grains, fruits and vegetables. In addition, persons who
exercised only occasionally were 50 percent more likely to report having lower levels of productivity
than those who were regular exercisers, while smokers were 28 percent more likely to suffer from a
drop in productivity than nonsmokers.
A nutritious diet is considered to be one of many factors influencing an individuals mental and
physical health; regular exercise, adequate rest and sleep, good hygiene, protection from workplace
chemicals and noise, and a positive work climate in general are also important. However, many chronic
diseases develop as a direct consequence of poor eating habits, particularly where obesity is involved.
Although conditioned by background and geography, obesity is generally recognized as an increasing
problem affecting work efficiency

4. Environment
Temperature, humidity, altitude etc also affect the work performance.

5. Sicknes and stress

Reduces the work performance

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