6. Dr Batte NUTRITION AND HEALTH ppt.pptx

nutrition and health

1. Dr Batte Anthony Paediatric Nephrologist / Lecturer CHDC With contribution from Dr Arthur Mpimbaza Child Health and Development Centre, Makerere University NUTRITION AND HEALTH

2. Introduction The function of nutrients in our bodies include:- Provide energy Build and repair tissue Regulate body processes The Six Classes of Food include; Carbohydrates Fats (lipids) Proteins Vitamins Minerals Water Roughages

3. What is Malnutrition Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. The term malnutrition covers 2 broad groups of conditions. ‘ Undernutrition ’—which includes stunting (low height for age), wasting (low weight for height), underweigh t (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals). The other is overweight , obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and cancer).

4. Who is most at risk of malnutrition Women Infants Children Adolescents The elderly All persons in emergency situations

5. FACTS ABOUT NUTRITION For Children, WHO and UNICEF recommend: Early initiation of breastfeeding within 1 hour of birth; Exclusive breastfeeding for the first 6 months of life; and Introduction of nutritionally-adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years of age or beyond.

6. Minimum acceptable diet for children 6-24 months 1. Breastfeeding, or not breastfeeding & receiving ≥2 feedings of commercial infant formula; fresh, tinned, or powdered animal milk; or yoghurt 2. Children to feed with foods from ≥4 of the following groups: a) Infant formula, milk other than breast milk, and cheese or yoghurt or other milk products; b) Foods made from grains, roots, and tubers, including porridge and fortified baby food from grains; c) Vitamin A-rich fruits and vegetables; d) Other fruits and vegetables; (e) eggs; (f) meat, poultry, fish, and shellfish (and organ meats); and g) Legumes and nuts

7. Minimum acceptable diet at 6-24months 3. Children fed the minimum recommended number of times per day according to their age and breastfeeding status: a) For breastfed children, minimum meal frequency is; receiving solid or semisolid food at least 2X a day for infants age 6-8 months and at least 3X a day for children age 9-23 months b) For children age 6-23 months who are not breast fed, minimum meal frequency is receiving solid or semisolid food or milk feeds at least 4X a day.

8. Uganda DHS 2016 findings on Nutrition

9. How do we assess malnutrition Before After WHO 2018

10. Nutritional assessment can be done by Anthropometry (length, height, weight, mid upper arm circumference and head circumference) Biochemical/biophysical methods Clinical methods Dietary methods.

11. Measuring Height Measuring Length

12. Measuring Weight

13. Mid upper arm circumference (MUAC)

14. What we use Anthropometry measures for Weight-for-age for assessing children who may be underweight . Height-for age is an index used for assessing stunting (chronic malnutrition in children) Weight-for-height is an index used for assessing wasting (acute malnutrition) Mid upper arm circumference for assessing severity of acute malnutrition BMI can also be used in assessing malnutrition

15. Anthropometry also used in Growth monitoring

16. Other methods of assessing nutrition Clinical methods e.g Body swelling ( oedema ) Visible wasting Bitot’s spots Etc Dietary methods of assessment include Looking at past or current intakes of nutrients from food by individuals or a group You can ask what the family or the mother and the child have eaten over the past 24 hours

17. Malnutrition in women/adults How are they defined? Body mass index (BMI) is the index of weight-to-height commonly used to classify underweight, overweight and obesity in adults It is defined as the weight in kilograms divided by the square of the height in metres (kg/m2). • BMI < 17.0 indicates moderate and severe thinness • BMI < 18.5 indicates underweight • BMI 18.5–24.9 indicates normal weight • BMI ≥ 25.0 indicates overweight • BMI ≥ 30.0 indicates obesity

18. Malnutrition in women/adults Women in the reproductive age, pregnant women and mothers especially during breastfeeding period are high risk for malnutrition Women need to receive iron and folate supplements during pregnancy

19. MICRONUTRITIENTS Micronutrients  are essential elements needed by life in small quantities. They include microminerals and Vitamins. Microminerals or trace elements include at least iron, cobalt, chromium, copper, iodine, manganese, selenium, zinc, and molybdenum.

20. Vitamin and mineral deficiencies Anemia WHO defines anaemia in children under 5 years of age and pregnant women as a haemoglobin concentration < 11.0 g/dl at sea level. Anaemia is associated with increased risks for maternal and child mortality. Iron-deficiency anaemia affects cognitive and physical development of children and on physical performance Risk factors for iron-deficiency anaemia include a low dietary intake of iron or poor absorption of iron from diets rich in phytate or phenolic compounds Infectious diseases. Malaria, HIV/AIDS, hookworm infestation, schistosomiasis and other infections such as tuberculosis

21. Question for SDL; What are the sources of iron which you will tell caretakers to feed their children on?

22. Vitamin A deficiency The stages of xerophthalmia Clinical spectrum of ocular manifestations of vitamin A deficiency, from the milder stages of night blindness and Bitot spots to the potentially blinding stages of corneal xerosis , ulceration and necrosis ( keratomalacia ) Night blindness is one of the clinical signs of vitamin A deficiency and is common during pregnancy Vitamin A deficiency also contributes to maternal mortality and other poor outcomes of pregnancy and lactation. It diminishes the ability to fight infections. It may increase children's risk for respiratory and diarrhoeal infections, decrease growth rates, slow bone development and decrease the likelihood of survival from serious illness.

23. QUESTIONS FOR SDL What are the other common vitamin deficiencies? What are the sources of the vitamins? What are the challenges of the vegetarians vs those who eat all foods in relation to vitamins and mineral deficiencies?

24. Iodine deficiency Goitre assessment by palpation or ultrasound may be useful for assessing thyroid function Currently prevented by iodisation of salt Iodine-deficiency disorders, which can start before birth, jeopardize children’s mental health and often their very survival. Iodine deficiency disorders can lead to hypo- and hyperthyroidism. Serious iodine deficiency during pregnancy can result in stillbirth, spontaneous abortion and congenital abnormalities such as cretinism, a grave, irreversible form of mental retardation Of even greater significance is mental impairment that reduces intellectual capacity at home, in school and at work.

25. ZINC IN DIARRHEA All children under 5 years with acute diarrhoea who are given supplements of 20 mg zinc daily for 10–14 days 10 mg/day for infants under 6 months. The greater the prevalence of zinc supplementation during diarrhoea treatment, the better the outcome of treatment for diarrhoea. Zinc supplements reduces duration and severity of diarrhea episode, and lowers the incidence of diarrhoea in the following 2–3 months. Don’t forget ways to prevent diarrhea Exclusive breastfeeding, vitamin A supplementation, improved hygiene, better access to cleaner sources of drinking water and sanitation facilities and vaccination against rotavirus

26. CONCEPTS YOU FOR SDL Food security Growth monitoring Health promotion Community programs and national wide programs aimed at promoting growth and nutrition in children and adults

27. THANK YOU