Lecture 1- nutration Introduction (1).pdf

nutritional disease, any of the nutrient-related diseases and conditions that cause illness in humans. They may include deficiencies or excesses in the diet, obesity and eating disorders, and chronic diseases such as cardiovascular disease, hypertension, cancer, and diabetes mellitus.

1. Introduction to Human Nutrition
Abel Gebre (MPH-Nutrition)
Department of Public Health
College of Health Sciences
Samara University

2. Definition of terms
Food:
•Scientifically, food is defined as any solid or liquid
substance which when ingested will enable the body
to carry out any of its life function.
•Food is also defined as anything edible as defined
based on specific culture, religion, etc.
•“What we eat and how we eat makes up our food habit.”

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3. The food pattern of people is influenced by many factors
including:
Availability of food
Economic & cultural condition
Knowledge & attitude towards food
Advertising
Social pressure
Physical ability
Geographical location
Religious & ethnic believes
living habits.


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4. Diet:
•is the sequence of meals in a day.
• It is concerned about the eating styles of individuals or
groups.
•e.g.:
Twice in a day (breakfast and dinner)
Three times in a day
Some may munching all the day


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5. Nutrition:
•It is the science of food, nutrients and the substances therein, their
action, interaction, and balance in relation to health and disease.
It is the process by which the organism ingests, digests, absorbs,
transports, utilizes, and excretes food substances
It is the sum total of the process by which living things receive and
utilize the necessary foods for survival, growth and maintenance of
worn out tissues.
•In general, the science of nutrition is the science of showing how food nourishes
the body.



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6. Human Nutrition
Is a scientific discipline, concerned with the access and
utilization of food and nutrients for human life, health,
growth, development and well-being.
Is a fundamental pillar of human life, health and
development across the life-span.




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7. Principles of Human Nutrition

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8. Nutrient:
•Is an active ingredient of the food that play specific
structural or functional role in the body‟s lively activity.
•Are chemical substances present in the food.
•Six categories
–Carbohydrates
–Proteins
–Fat(lipids)
–Vitamins
–Minerals and
–Water

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9. Classification of nutrients
Based on body requirement
–Macronutrients
oRequired in large quantities on a daily basis
oNeed to be transformed to smaller units by the body in order
to provide essential functions (Includes: Carbohydrates, lipids
and proteins)
–Micronutrients
oAre required in smaller quantities on a daily basis
oPerform essential physiological and structural functions
(Includes: Vitamins and minerals)
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10. Proper food and good nutrition is essential for:
Survival
Physical growth
Mental development
Performance and productivity
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11. Malnutrition:
•Is the condition caused by an improper balance between what an
individual eats (dietary intake) & what he required (dietary
requirements) to maintain health.
– It occurs due to excessive intake of nutrients or under nutrition.
– It is the most pressing health problem that appears on the
morbidity and mortality reports of the health institutions in
Ethiopia.
– Even though the problem is serious, limited attention has been
given to alleviate the problem by the concerned sectors.

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12. Forms of Malnutrition
1. Under nutrition
•Pathological state resulting from the consumption of an inadequate
quality/ quantity over an extended period of time.
E.g PEM:- Kwashiorkor, Marasmus, Marasmic-Kwash
Vit & Minerals -IDD, VAD etc
2. Over-nutrition
•Pathological state resulting from the consumption of an excess
quantity of food, and hence an energy excess, over an extended period
of time.
E.g Obesity, Cancer, etc


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13. 13

14. Nutrition origin & development
• The idea of nutrition existed during the ancient times
Hippocrates (460-359 B.C): “Persons who are naturally
very fat are to die earlier than those who are
slender.”
Leonardo davinci (1452-1519): “--- If you do not
supply nourishment equal to the nourishment
departed, life will fail in vigor ---”


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15. 19
th
century-notable discoveries in nutrition:
 Isolation of glycogen & different amino acids
 Chemical methods for analysis of foodstuffs
developed
 Studies on protein composition & energy
studies in animals…

15

16. 20
th
century-great advancements
- Researches:
- vitamins discovered; essential amino acids & certain minerals
found to be essential; nutrition studies at cellular level…
- Gained emphasis in the international agenda:
World food & Nutrition Summits, UN Declarations &
Commitments
International agencies working on food & nutrition


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17. Nations with food & nutrition policies
The end of the 20
th
century gave priority for the role of nutrition
through the MDG.
•The one - world concept emerged in the 20
th
century; Hunger
anywhere in the world is of concern to us.
•The importance of nutrition education was recognized in this era
with the founding of the ‘Nutrition Education’ Society in 1971.

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18. Significance of nutrition
•Nutrition for quality of life- growth, development, health,
productivity
•Malnutrition- negative consequences in health, education, productivity
& economic development
Malnutrition & Infection
 Malnutrition & chronic diseases
Malnutrition & education-psychomotor & cognitive development
Malnutrition & economic development-nutrition as an input

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19. •“In developing countries, effective nutrition
interventions are likely to have MORE of an
effect on human health than comparable
investments in medical care”

National Research Council, 1977


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20. Why nutrition
matters?



20

21. 21

22. LIFECYCLE: THE CAUSAL LINKS
22

23. State of malnutrition in developing
countries …

23

24. Status and trend of child mortality
•Numbers of under-five deaths have
declined from 12.0 million in 1990 to 7.6
million in 2010; nearly 21 000 children
every day; about 12 000 fewer children
died every day in 2010 than in 1990.
•Globally, under-five mortality has
decreased by 35%, from an estimated
rate of 88 deaths per 1000 live births in
1990 to 57 deaths per 1000 live births in
2010.
•This decline translates into an average
annual decrease in child mortality of
2.2%, which remains insufficient to
achieve the MDG4 target of reducing
under-five mortality rates by two-thirds
between 1990 and 2015.

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25. •Three-quarters of these deaths
were concentrated in just two
regions of the world: 46% in
the African Region and 28% in
South-East Asia.
•More than half of all child
deaths were clustered in only
six countries: India, Nigeria,
Democratic Republic of the
Congo, Pakistan, China, and
Ethiopia.
•Regionally, the highest child
mortality rates were in Africa
(119 deaths per 1000 live
births) and in the Eastern
Mediterranean Region (68
deaths per 1000 live births).


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26. 26

27. 27
18 countries with the highest prevalence of stunting (UNICEF 2009)

28. State of malnutrition in
Sub-Sahara Africa…
…the problem is getting
worse

29. The number of stunted children is rising dramatically in Africa 0
20
40
60
1980 1990 2000
East and Southern West North
De Onis et al, 2000 - WHO Global Databank
Number of children in millions

30. Prevalence of stunting in children under five, in selected African countries.
(Source: AED/Linkages)

31. Some problems in dealing with malnutrition:
•In the past there was a lack of consensus on the:
• Nature of malnutrition problem
• Causes of the problem…
• What actions to take…

31

32. Two extreme schools of thought
32
Technologists:
• Technological interventions
(eg. magic bullets) can solve the
problem
Structuralists:
• Eradicating poverty will solve
the problem

33. Some myth-information on nutrition
• Increasing food production will reduce malnutrition
• Protein deficiency is the cause of malnutrition
• Children in developing countries are genetically short
• Malnutrition should be left in the hands of
nutritionists
33

34. What is the double burden of malnutrition?
•Malnutrition refers to deficiencies, excesses or
imbalances in intake of energy, protein and/or other
nutrients.
–Under-nutrition is the result of food intake that is continuously
insufficient to meet dietary energy requirements, poor absorption
and/or poor biological use of nutrients consumed.
•This usually results in loss of body weight.
–Over-nutrition refers to a chronic condition where intake of food is
in excess of dietary energy requirements, resulting in overweight
and/or obesity
34

35. What is the double burden…
•These problems are often thought of as separate
issues of rich and poor, but in reality both are
increasingly rooted in poverty.
•This is the double burden of malnutrition

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36. Why investing on nutrition ?

36
Human & Economic
Costs

37. Ethical Imperative
37
Nutrition is a human
right…

38. Ethical…
“every man, woman & child has the inalienable
right to be free from hunger & malnutrition in
order to develop their physical & mental
faculties”
WFS 1974


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39. Malnutrition: Hidden Problem
39
•
UNICEF/94
-
1173 Pirozzi

• No obvious signs

•Victims not aware

40. Conceptual framework of malnutrition
40

41. Determinants of malnutrition
A.Immediate causes; such as food intake (micronutrient
status and supplementation) and infectious diseases
(diarrhea and respiratory infections)
B.Underlying causes of malnutrition include inadequate
levels of household food security, inadequate care of
children and women, low education levels and information,
insufficient health services and an unhealthy environment
(availability of sanitation and safe water)


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42. •Food security concentrates on four aspects:
a.Availability of food,
b.Stability of food supply,
c.Access to food, and
d.Utilization of food.
•The food must be safe and of high quality and the
environment should be hygienic enough to use the
food so that all members can lead healthy and
productive lives.
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43. •Food insecurity can occur due to poor agriculture
production, destruction of infrastructure and markets
and therefore loss of income, loss of livestock and
insufficient land for food production.
•These factors influence the quantity and quality of food
available

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44. C. Basic causes, also called national or root causes, of malnutrition
–include poor availability and control of resources
(political, social, ideological and economic),
environmental degradation, poor agriculture, war,
political instability, urbanization, population growth
and size, distribution, conflicts, trade agreements and
natural disasters, religious and cultural factors
–landlessness and migrant labour are also considered to
be basic causes of malnutrition
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45. Malnutrition and child survival
•Child malnutrition is viewed as one important
manifestation of a larger development problem
that reaches across multiple sectors and social,
political, economic, and cultural institution.

45

46. Why nutrition
matters in
Ethiopia?



46

47. Malnutrition and infection
•Increased risk of
–Illness and
–Death

47

48. Nutritional Problems of PHI in Ethiopia
48
1.Protein-energy malnutrition
(Marasmus, Kwashiorkor, Mixed type)
2.Vitamin A deficiency
3.Iodine deficiency
4.Iron deficiency anemia
5.Zinc deficiency

49. Four Functional Consequences of malnutrition
 Mortality
 Illness
 Intelligence loss and
 Reduced productivity
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50. Causes of Child Mortality in Ethiopia
• Greatest single cause of
child mortality
50
Malnutrition
Other
51%
49%

51. Child Mortality (2006-2015)
51
UNICEF/C
-
56
-
19
/Murray
-
Lee

1.3 million child deaths

52. Underweight & Mortality
•… the majority of these deaths, as much as
80%, are associated with mild & moderate
malnutrition
•… invisible to „see‟ as nearly all Ethiopian
children are malnourished

53. Malnutrition

&

Education
53

54. Malnutrition & Intellectual Development
UNICEF/C
-
56
-
19
/Murray
-
Lee

Reduced:
• Learning ability
• School performance
• Retention rates

55. Intellectual Consequences
•Iron deficiency anemia lowers IQ by about 9 points
•Mild iodine deficiencies lowers IQ by about 10 points
•Severe stunting associated with IQ loss of 5-10 points
•Low birth weight associated with IQ loss of 5 points
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56. Iodine Deficiency during Pregnancy
•severe mental & physical damage
•moderate mental retardation
•mild intellectual disability
56
UNICEF/HQ
93
-
2200
/Pirozzi

57. Iodine Deficiency in Ethiopia
57
Of babies born from IDD mothers:
• 3% cretins
• 10% moderate mental retardation
• 87% mild intellectual deficit

58. Total Goiter Rate = 38%
58
2006-2015:
15 million babies born
intellectually impaired


2000-2005:
4.5 million babies already born
intellectually impaired
UNICEF/Ethiopia

59. Malnutrition

&

Economic Development


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60. Economic Consequences of Malnutrition
Malnutrition results in:
Mental Impairment
Physical Stunting

61. Iodine Deficiency & Productivity
61
Mental retardation(Cretinism) in fetuses & children
Physical shortness (Iodine dewarfism) in children
Weakness, poor reproduction & morbidity in adults
Mortality decreases human power
Unemployement & discounting future earnings

62. Productivity Losses due to Iodine Deficiency (2006-2015)
• Present Value = 64 billion Birr
62
UNICEF/93
-
COU
-
0931/Ethiopia/Thomas

• Past value = 11.3 billion Birr (2000-2005)

63. Anemia
•Iron deficiency anaemia leads to:

–Decreased physical growth in children & results in
short stature

–Impaired learning (decreased attention span) in
children


–Poor metabolic efficiency & physical productivity

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64. Productivity Losses due to Anemia (2006-2015)
• Present Value = 36 billion Birr
64
UNICEF/93
-
COU
-
0931/Ethiopia/Thomas

65. 65

66. Slide 66

67. Regional trends of Child Nutrition
67

68. Consequence of Stunting
•Stunted children become stunted adults
•Reduced productivity :1.4% decrease in productivity
for every 1% decrease in height


68

69. Productivity Losses due to Stunting (2006-2015)
• Present Value = 44 billion Birr
69
UNICEF/93
-
COU
-
0931/Ethiopia/Thomas

• Past value = 18 billion Birr (2000-2005)

70. 64
31
36
30
44
37
0
50
100
150
No Change Improved
Birr (billions)
Stunting
Anemia
Iodine Deficiency 70
144 billion
98 billion
Gain = 46 billion
Total Economic Losses with & without
Nutrition Improvement (2005-2015)

71. The Intergenerational Cycle of Malnutrition
71
Child growth
failure
Early
pregnancy
Small adult
women
Low birth
weight babies
Low weight &
height in
teens

72. In Ethiopia what is the way forward?
Planners from each sector need to address:
impact of nutrition on their sector
impact of their sector on nutrition

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73. 73

The Millenium Development Goals
& Relevance of Nutrition…

…nutrition is central to MDGs

74. Nutrition in the MDGs
sno MDG Relevance of nutrition
1 Eradicate extreme poverty & hunger Contributes to human capacity & productivity
throughout life cycle & across generations
2 Achieve universal primary education Improves readiness to learn & school achievement
3 Promote gender equity & empower women Empowers women more than men
4 Reduce child mortality Reduces child mortality (>50% attributable to
malnutrition)
5 Improve maternal health Contributes to maternal health thru many pathways
Addresses gender inequalities in food, care & health
6 Combat HIV/AIDS, malaria & other diseases Slows onset & progression of AIDS
Important component of treatment & care
7 Ensure environmental sustainability Highlights importance of local crops for diet diversity
& quality
8 Develop a global partnership for development Brings together many sectors around a common
problem

76. Findings from the Lancet…
“…a group of effective nutrition interventions,
including breastfeeding, complementary
feeding, vitamin A & zinc supplementation
could save about 2.4 million children each
year (25% of child deaths)”

Jones et. al., The Lancet, Vol. 362, 2003

77. 1. Macroeconomic Policies
2. Sectoral Policies
3. Direct Nutrition Interventions
Where can we focus our efforts?

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78. 1.Macroeconomic Policies
•Trade & exchange rate policies
•Price policy
•Social safety nets (subsidies, public works &,
feeding programs, targeting…) etc


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79. 2. Sectoral Policies
•Agriculture: availability, access, stability, utilization
•Health (especially primary)
•Education (especially primary)
•Environment
•Commerce etc…


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80. 3. Direct Nutrition Interventions
•Maternal & child health programs
•Supplementary feeding programs
•Fortification etc…

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81. 81 81