Comm Med - Public Health Nutrition

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What is food

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Food: Any substance which when ingested provides necessary raw materials for the structure and functions of life.(to enable the body to carry out its functions).

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What is nutrition

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Nutrition: Science of food, their actions, interactions and balance in relation to health and disease. Nutrition also deals with the social, economic and cultural issues related to making the right food choices and to purchasing and eating the ‘correct’ type of food in appropriate quantities as well as factors that determine this aspect of essential daily human activity and behaviour. Nutrition is influenced by food intake quantity, quality & physical health.

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What is public health nutrition

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Public Health Nutrition is the branch of Human Nutrition concerned with nutritional problems that affect large numbers of people and which can be solved most effectively through group action.

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What is Dietetics

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Dietetics is the practical application of the principles of nutrition; it includes the planning of meals for the well and the sick.

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What is a balanced diet

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Balanced diet: A meal that contains all the nutrients in adequate quantity and proportion to maintain health and provides a reserve for short period of leanness.

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What are the 5 greatest nutritional deficiencies

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•energy

•protein

•iron

•vitamin A

•iodine

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Effects of infection on nutrition

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Reduced food intake as a result of a central anoxia and general loss of appetite or as a result of local causes e.g. oral thrush, sore tongues and mouth ulcers. Malabsorption resulting from damage to gut epithelium e.g. in measles. Increased catabolism may occur in severe infections e.g. tuberculosis. Loss of weight is observed. Loss of nutrients through loss of epithelial cells containing protein, iron and vitamin A. Loss of nutrients e.g. Iron may also be from intestinal parasites.

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Effects of nutrition on infection

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The capacity to exhibit delayed hypersensitivity response is significantly reduced in malnutrition. There is also a decrease in lymphocytic count and an impairment of humoral immunity in malnourished people. Amino acids from proteins are required for the multiplication of lymphocytes and the production of immunoglobulins by plasma cells. Impairment of these defense mechanisms may explain why the malnourished child is a likely candidate for infection.

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Food contents

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•Nutrients

•Anti-nutrients

•Dietary fibers/non-starch polysaccharides

•Naturally occurring toxic substances e.g cyanide

•Contaminants, residue of agricultural chemicals

•Food additives

•Antioxidants

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What is hazard analysis critical control point

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It is a process by which the most critical point in the elimination of hazard in a food chain is identified

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Recommended daily allowance, Recommended daily intake/Recommended nutritional intake

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These are dietary guidelines and nutritional recommendations which are being used by policy makers and health professionals for the general populace. RDA is defined as the amounts of nutrient sufficient for the maintenance of health in nearly all people. They are reference standards of nutritional intakes. RDI does not apply to sick people but rather is estimated to meet the requirements of practically all healthy people. It represents value judgments based on the existing knowledge of nutritional sciences. RDA is term commonly used on USA while RNI is commonly used in UK.

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Nutritional requirements in pregnancy

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Key nutrients: Energy requirement : 325 to 425kcal/day above pre-pregnant values; Weight gain: from 7kg to 18kg; Protein: Extra 14g/day (Normal 0.8g/kg/day) RDA of protein in pregnancy is 60g/day; Folic acid and other vitamins as supplements; Calcium supplementation of 12g/day needed.; Iron:15-30 mg/day.

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Effects of malnutrition on pregnant woman

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•Low immunity->infections •Goitre from iodine deficiency •Anaemia in pregnancy •Obstructed labour •Postpartum haemorrhage. •Mortality at labour: Severe anaemia during pregnancy is linked to increase mortality

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Effects of nutritional problems on fetus

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•Foetal growth retardation. •Intrauterine death •Increase in still birth •Increase in premature babies •Poorer cognitive and neurological development •Deformity in different areas of the body •High morbidity and mortality •Increased risk of diabetes, cardiovascular and other degenerative diseases in adult life

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Benefits of breastfeeding

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•Lowers risk of PPH, prevents pregnancy

•Convenient , readily available and economical

•The casein-lactalbumin ratio in human milk is lower than in cow’s milk

•Balanced diet; prevents anaemia

•Lowers the incidence of diarrhoea,

•Anti-infective constituents that limit infection

•Pro-biotic found in breast milk helps alleviate symptoms of digestive disorders

•Contains some hormones and growth factors

•Decrease in risk of infant & mortality

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Effect of malnutrition on children

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•Lowers immunity-- infection •Multi-nutrient malnutrition •Poor cognition •Disturbs growth •Weight for height and age is < 2 sd compared with reference values •Influence adult susceptibility to diet-related chronic diseases.

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Main nutritional problems of adolescents

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Main problems – Iron deficiency anaemia, subclinical calcium deficiency, stunting, obesity, anorexia nervosa

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Nutritional assessment

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•Identify individuals and population groups at risk of becoming malnourished or who are malnourished. •Develop health care programs that meet the community needs. •Measure the effectiveness of the nutritional programs and interventions once initiated.

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Methods of nutritional assessment

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Direct and indirect methods. Direct methods deal with the individual and measure objective criteria. Indirect methods use community health indices that reflects nutritional influences. Examples : IMR, Child death rate, age at menarche.

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Direct methods of nutritional assessment

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Summarized as ABCD: Anthropometric methods; Biochemical, laboratory methods; Clinical methods; Dietary evaluation methods

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Clinical assessment

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•Good nutritional history. •General clinical examination, with special attention to organs like hair, angles of the mouth, gums, nails, skin, eyes, tongue, muscles, bones, & thyroid gland. •Utilizes a number of physical signs that are known to be associated with malnutrition and deficiency of vitamins & micronutrients to establish diagnosis. •Vit D: rickets, vit c:scurvy

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Anthropometric methods

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Essential component of clinical exam of infants, children & pregnant women. Used to evaluate both under & over nutrition.Accurate measurement of height and weight is essential (height for age ; weight for age).Results can then be used to evaluate the physical growth of the child. For growth monitoring: growth velocity is compared with international standards. Other anthropometric measurements:•Mid- upper arm circumference: should be above 13.5cm •Skin fold thickness •Head circumference •Head/chest ratio •Waist/Hip ratio •Waist circumference

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Nutritional indices in adults

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The international standard for assessing body size in adults is the body mass index (BMI). BMI is computed using : Weight (kg)/Height (m2).High BMI (obesity level) is associated with type 2 diabetes & high risk of cardiovascular morbidity & mortality. ~BMI < 18.5 = Underweight ~BMI 18.5-24.9 = Healthy weight range ~BMI 25-30 = Overweight (grade 1 obesity) ~BMI >30-40 = Obese (grade 2 obesity) ~BMI >40 = Very obese (morbid or grade 3 obesity) Can also measure WC or WHR or % body Fat WHR has been found to be a more efficient predictor of mortality in older people than WC or BMI. Some other studies have found WC, not WHR, to be a good indicator of cardiovascular risk factors & diabetes

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Dietary assessment

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Nutritional intake of humans is assessed by five different methods. These are: •24 hours dietary recall •Food dairy technique •Food frequency questionnaire •Dietary history since early life •Observed food consumption

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Laboratory assessment

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Initial : •Hemoglobin estimation, Stool examination, and •Urine dipstick & microscopy for albumin, sugar and blood. Specific: •Measurement of individual nutrient in body fluids •Detection of abnormal amount of metabolites in the urine•Measurement of enzymes •Analysis of hair, nails & skin for micro-nutrients.

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Indirect methods of nutritional assessment

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These include three categories: •Ecological variables including crop production •Economic factors e.g. per capita income, population density & social habits •Vital health statistics particularly infant & under 5 mortality & fertility index.

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Malnutrition

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It is defined as an impairment of health due to deficiency or excess of micro and/or macro nutrients and other nutrients. It may also be described as a pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients. It comprises of 4 forms: ~Under nutrition ~Over nutrition ~Imbalance ~Specific deficiency. The World Health Organization cites malnutrition as the gravest single threat to the world's public health.

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Vulnerable groups for malnutrition

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•Pregnant and lactating mothers •Children: They require proportionately more energy for each kg of body weight than adults. • Adolescents: as much energy as adults ~Puberty sets in ~Spurt in growth and an increase in metabolic rate. ~Greater deal of physical activity

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Nutritional problems in children

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1. Multi-nutrient malnutrition (PEU) Major health and nutrition problem in Nigeria Occurs in children especially within the first year of life Its severe (clinical forms) are Kwashiorkor and Marasmus. 2. Micronutrients deficiencies: e.g Vitamin D-rickets,

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Causes of Malnutrition

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•Poor maternal health •Failure of lactation •Premature termination of breastfeeding •Poverty •Illiteracy and lack of nutrition information •Large family size •Poor environmental conditions •Adverse cultural practices

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Nutritional problems in adolescents

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•Anaemia is one of the key nutritional problems in adolescent girls. •Folate deficiency •Other micronutrient deficiencies: Vit A, Zinc & Ca •Stunting •Overweight/Obesity

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Prevention of malnutrition

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1. Health Promotion: •Promotion of breastfeeding •Development of low cost complementary foods. •Nutrition education: Promotion of correct feeding practices•Measures to improve family diet & access to nutritious food•Home economics •Family planning and spacing of births •Family environment: Prevent infections 2. Specific Protection: •Protein and micronutrient rich foods: milk, eggs, fresh fruits etc •Immunization •Food fortification: e.g iodine, Animal and plant protein, Adapt to each tribe and situation •Supplements: iron with folic acids, zinc etc 3. Early diagnosis and treatment: •Early diagnosis of any lag in growth •Early diagnosis and treatment of infection and diarrhoea•Programme for early rehydration of children with diarrhoea•Supplementary feeding programmes during epidemics•Deworming of heavily infested children 4. Rehabilitation of malnourished children: •Nutritional rehabilitation services •Hospital treatment •Follow-up care

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Community nutrition

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A branch of human nutrition that tends to bring about a change in the eating habits of people with a view to bringing about prevention and cure of nutritional disease. • Identifying their nutritional problems• Documentation of the problems• Collation of Baseline statistics.• Clearly stating programme goals and objectives.

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Methods of community nutrition programme

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1. Nutrition and Health Education (a)For health and nutrition staff (b)For the community 2. Food diversification 3. Food supplementation: target groups(school children, pregnant women) 4. Food fortification 5. Encouraging agricultural production 6. Treatment of cases 7. Periodic assessment

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Evaluating nutrition intervention programmes

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•To assess the extent to which the objectives have been achieved. •To know the levels of improvement in knowledge, attitude and nutritional practices of individuals and communities after an intervention. •To determine the proportion of those eligible who are actually receiving services. E.g anaemia receiving Rx •Efficiency

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Addressing malnutrition in the Nation

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1. Production: Malnutrition increases during rainy (planting season) but drops during harvest. 2. Preservation: Inadequate preservation techniques, Linked with power supply 3. Poverty: purchasing power is reduced. 4. Population: Large family size affects the food available to each person. 5. Politics: Policies and political decisions. Grants are available for cash crops rather than food crops. 6. Pathology: Better health system (increased need, yet lower intake and absorption)

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Food security

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Food security exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food which meets their dietary needs and food preferences for an active and healthy life. Food insecurity exists when this access is jeopardized.

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Household food security

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Access by all members at all times to enough food for an active, healthy life. Food security includes at a minimum the ready availability of nutritionally adequate and safe foods, and an assured ability to acquire acceptable foods in socially acceptable ways (that is, without resorting to emergency food supplies, scavenging, stealing, or other coping strategies). A household is considered food secure when it has enough food to cover the nutrient needs of each member throughout the year. Stunting indicates chronic household food insecurity Underweight indicates transitory food insecurity

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Dimensions of food security

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•Availability: Increased Production •Accessibility: ~Equality of Access between the rich and the poor within and between societies. ~Economic ability to purchase sufficient foods •Adequacy: ~Sustainability of production, distribution, consumption and waste management ~Sustainable food system: satisfy those who are alive now without jeopardising the future . •Acceptability: food options determined by culture. E.g Pork is unacceptable in the North.

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Pillars of food security

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•Food availability: sufficient quantities of food available on a consistent basis. •Food access: having sufficient resources to obtain appropriate foods for a nutritious diet. •Food use: appropriate use based on knowledge of basic nutrition and care, as well as adequate water and sanitation.

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Major forms of malnutrition and nutrition-related diseases

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•Protein-energy malnutrition (PEM) (26.7% of the world’s under 5years). •Vitamin A deficiency (VAD) •Iodine deficiency disorders (IDD) •Iron deficiency anaemia •Obesity •Diet-related cancers •CVD •Osteoporosis

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Benefits of prevention of malnutrition in women and children

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Prevention of malnutrition in women and children will reduce foetal malformations, IUGR, IUD, Poor cognition, MMR, NMR, IMR, Under–five mortality , and improve the economy.