NS 3060 Prelim 1

Consequences of stunting

-Instrumental value: physical manifestation of undernutrition -Intrinsic value: being short has an impact on some people -Cognitive development -School attainment -Hypertension in children -Future risk of obesity -Future risk of chronic diseases -Poverty in adulthood

Consequences of adult underweight?

-J-shaped relationship between BMI and mortality -At low BMI and high ranges, hazard ratio of all-cancer mortality and odds ratio of being a high medical expender are higher than healthy/middle BMI ranges -Malnutrition and functional ability was associated with poorer survival rate -Low maternal BMI is associated with: *Maternal death and illness *Fetal growth restriction which contributes to 12% of child deaths worldwide *Stunting (obesity, non-communicable diseases, developmental deficits) -Low BMI associated with: *all-cause mortality *impaired immune responses *disruption to endocrine system

What is a bitot spot?

-Keratin build up on the outside of the eye -Indicative of vitamin A deficiency -Reversable w/ vitamin A supplementation -Can progress to blindness

How does development relate to nutrition?

-Nutrition relates to health and wellbeing, and a long and healthy life is one of the dimensions of the HDI. Also, income and poverty are strongly linked to nutrition, & GNI per capita is another dimension.

Difference between nutrition specific and nutrition sensitive programs

-Nutrition-specific interventions address the immediate determinants of nutrition (maternal and child dietary supplementation, treating severe acute malnutrition) -Nutrition-sensitive programs address underlying causes of undernutrition (agriculture and food security, social safety nets)

What are the consequences of vitamin D deficiency?

-Osteoarthritis, osteoporosis, osteomalacia, bone pain -Cancer: breast, colon, prostate, pancreas, etc -Schizophrenia, depression -Infections (URI, TB) -Asthma & wheezing diseases -HBP, CHD -Autoimmune diseases (T1D, MS, Crohn Disease) -Muscle weakness, muscle aches

What is POU? How is it used by the WFP?

-Prevalence of Undernourishment -It's used by the WFP to map hunger and predict how many will be hungry in the future based on current trends

Consequences of childhood obesity

-Pulmonary: asthma, exercise intolerance -Cardiovascular: abnormal blood lipid levels, high BP, blood clotting impairment, long-term inflammation -Endocrine: T2D, early onset puberty -Psychosocial: depression, low self esteem

Dietary records

-Respondent records detail lists of all foods and beverages consumed over period of time -Used in clinical practice (weight management) -Validation of other dietary assessment methods ("Gold Standard")

Dietary diversity score

-Respondents report whether they ate an item from various food groups over a specific recall period -Score based on number of food groups consumed -Info on quantity of foods not gathered -Can be measured at household or indiv. level -Rough proxy for diet quality and nutrient adequacy -Useful among populations where micronutrient deficiency is more likely

Know child malnutrition and the SDGs

-SDG targets are most on target in terms of wasting -Stunting majority off track with some progress -Overweight mostly off track with no progress or off track and worsening

What are the different sources of bias?

-Selection bias: occurs when there are problems w/ the procedures used to select subjects and from factors that influence study participation -Information bias: occurs when information that is collected about or from the study subjects is erroneous

What is stunting, how is it measured, why is it important/health consequences/long-term consequences?

-Stunting is a height-for-age z-score <-2 (severe is <-3) (low height for age; shortness) -It reflects skeletal growth and long-term nutritional inadequacies

What are nutritional interventions to address anemia?

-Supplementation -Fortification, biofortification -Home fortification (MNP) -Dietary diversification (balance of enhancers and inhibitors, community gardens, animal production)

What are the different sources of error? How do you define them?

-Systemic errors ("biases") result from problems in study design (don't change with study size) -Random errors are variability in data that cannot be readily explained -As a study increases in size, the impact of random errors on findings decreases

What is the Copenhagen Consensus? What were the conclusions regarding the SDGs?

-The Copenhagen Consensus Center provided information on which targets will do the most social good relative to their costs in 2015 -They concluded that 19 of the 169 sustainable development targets are so effective that focusing on them first would effectively quadruple the aid budget without any extra spending, providing phenomenal social, environmental and economic benefits at a cost of $140bn+ per year

What are the objectives of nutritional assessments?

-To identify individuals or populations at risk -To map the magnitude and geographic distribution of a nutritional problem -To assess changes in nutritional status over time -To assess the efficacy of a nutritional intervention

What is the purpose of clinical assessments?

-Uses medical history and physical exam to evaluate signs and symptoms of malnutrition

What are the WHO growth standards and how are they used?

-WHO growth standards were developed using data from the multicenter growth reference study (MGRS) -Data (from children following MGRS feeding recommendations) included: *Longitudinal follow-up from birth to 24 months *Cross-sectional survey of children aged 18 to 71 months *8440 healthy breastfed infants and young children -Used as a norm for growth (z-scores are based on data from the WHO growth standards)

What is wasting, how is it measured, why is it important/health consequences?

-Wasting is a weight-for-height z-score < -2 (severe <-3) (low weight for height; thinness) -Reflects recent rapid weight loss or failure to gain weight; ACUTE MALNUTRITION -Preferable for use during nutritional emergencies

Describe a normal curve, SD, and z-scores

-A normal curve is symmetrical about the mean; the area under the normal distribution curve represents probability -95% of the population falls within 2 standard deviations from the mean -99.7% of the population falls within 3 SD of the mean -Standard deviation is a measure of dispersed data is relative to the mean -Z-score is the measure of number of standard deviations from the mean

What is goiter?

-Enlarged thyroid -Manifestation of iodine deficiency -Reversed w/ iodine supplementation

24 hour recall

-Interview that asks to recall in detail everything eaten over 24-hour period (ingredients, portion sizes, brand names, food prep methods)

Different classifications of BMI and cutoffs?

-Underweight <18.5 -Healthy weight 18.5 - 24.9 -Overweight 25.0-29.9 -Obesity >= 30

What are the millennium development goals? What was their time span? Why are they important to nutrition and global health?

1) Eradicate extreme poverty and hunger 2) Achieve universal primary education 3) Promote gender equality and empower women 4) Reduce child mortality 5) Improve maternal health 6) Combat HIV/AIDS, malaria, and other diseases 7) Ensure Environmental Sustainability 8) Develop a global partnership for development 2000-2015

Trends of the Millennium Development Goals: 1) POU in developing regions 2) Proportion of children under 5 who are moderately or severely underweight in the world, SSA, and Southern Asia 3) U5 mortality rate in the developing world

1) POU in developing regions -Decreased in almost all regions, except increased in Western Asia -Decreased in developing regions overall; just barely did not meet 2015 goal 2) U5 moderately/severely underweight in world, SSA, and S Asia -Decreased in the world ~10%, 2015 not projected to be met (barely) -Decreased in Southern Asia and Sub-Saharan Africa, however neither met 2015 goal 3) U5 mortality rate in developing world -Decreased overall in developing world by 53%; did not meet 2015 goal

What are the six different dietary assessments?

1. 24-hour recall 2. Food frequency questionnaires 3. Diet record 4. Dietary diversity scores 5. Food consumption score 6. Food insecurity experiential score

What are three components of energy expenditure? Which one is modifiable?

1. Thermal effect of food 2. Thermal effect of exercise (MODIFIABLE) 3. Resting energy expenditure

3 Forms of Malnutrition

1. Undernutrition (insufficient energy intake) 2. Micronutrition deficiencies 3. Overnutrition (excessive energy intake)

EAT-Lancet: Know the key messages (page 448) and the feasibility of implementing the diet including the findings from the affordability study

1. Unhealthy and unsustainably produced food poses a global risk to people and the planet. More than 820 million people have insufficient food and many more consume an unhealthy diet that contributes to premature death and morbidity. Moreover, global food production is the largest pressure caused by humans on Earth, threatening local ecosystems and the stability of the Earth system. 2 Current dietary trends, combined with projected population growth to about 10 billion by 2050, will exacerbate risks to people and planet. The global burden of non-communicable diseases is predicted to worsen and the effects of food production on greenhouse-gas emissions, nitrogen and phosphorus pollution, biodiversity loss, and water and land use will reduce the stability of the Earth system. 3. Transformation to healthy diets from sustainable food systems is necessary to achieve the UN Sustainable Development Goals and the Paris Agreement, and scientific targets for healthy diets and sustainable food production are needed to guide a Great Food Transformation. 4. Healthy diets have an appropriate caloric intake and consist of a diversity of plant-based foods, low amounts of animal source foods, unsaturated rather than saturated fats, and small amounts of refined grains, highly processed foods, and added sugars. 5. Transformation to healthy diets by 2050 will require substantial dietary shifts, including a greater than 50% reduction in global consumption of unhealthy foods, such as red meat and sugar, and a greater than 100% increase in consumption of healthy foods, such as nuts, fruits, vegetables, and legumes. However, the changes needed differ greatly by region. 6. Dietary changes from current diets to healthy diets are likely to substantially benefit human health, averting about 10·8-11·6 million deaths per year, a reduction of 19·0-23·6%. 7. With food production causing major global environmental risks, sustainable food production needs to operate within the safe operating space for food systems at all scales on Earth. Therefore, sustainable food production for about 10 billion people should use no additional land, safeguard existing biodiversity, reduce consumptive water use and manage water responsibly, substantially reduce nitrogen and phosphorus pollution, produce zero carbon dioxide emissions, and cause no further increase in methane and nitrous oxide emissions. 8. Transformation to sustainable food production by 2050 will require at least a 75% reduction of yield gaps, global redistribution of nitrogen and phosphorus fertilizer use, recycling of phosphorus, radical improvements in efficiency of fertilizer and water use, rapid implementation of agricultural mitigation options to reduce greenhouse-gas emissions, adoption of land management practices that shift agriculture from a carbon source to sink, and a fundamental shift in production priorities. 9. The scientific targets for healthy diets from sustainable food systems are intertwined with all UN Sustainable Development Goals. For example, achieving these targets will depend on providing high-quality primary health care that integrates family planning and education on healthy diets. 10 Achieving healthy diets from sustainable food systems for everyone will require substantial shifts towards healthy dietary patterns, large reductions in food losses and waste, and major improvements in food production practices. This universal goal for all humans is within reach but will require adoption of scientific targets by all sectors to stimulate a range of actions from individuals and organizations working in all sectors and at all scales.

What regions of the world have highest prevalence of obesity?

Africa, South Asia, SE Asia, South America, Oceania

What are the dietary sources of iron?

Ferritin (beans, lentils, etc) Heme (red meat) Iron supplements (ferrous sulfate, fumarate, ferric-EDTA, etc)

What regions have the highest prevalence of stunting?

Southern Asian, SE Asia, N/E/W/Middle Africa

What are ULs and how are they used?

The tolerable upper intake level is the highest level of daily nutrient intake that is likely to pose no risk of adverse health effects in almost all individuals.

Heme vs. non-heme iron

The two forms of dietary iron are heme iron and non-heme iron: Heme iron is found only in meat, poultry, seafood, and fish, so heme iron is the type of iron that comes from animal proteins in our diet. Non-heme iron, by contrast, is found in plant-based foods like grains, beans, vegetables, fruits, nuts, and seeds.

What are the sustainable development goals? What was their time span? Why are they important in nutrition and global health?

-17 global goals designed to be a "blueprint to achieve a better and more sustainable future for all" -Time Span: 2015-2030 -Goal 1 is "no poverty" (poverty limits access to adequate food intake and makes it difficult to reach nutritional recommendations) -Goal 2 is "end hunger, achieve food security and improved nutrition and promote sustainable agriculture" which directly relate to nutrition and global health (unsustainable food production => undernourishment) -Goal 3 is "good health and wellbeing" (healthy and sustainable nutrition may reduce premature death including from non-communicable diseases) -Goal 4 is "quality education" (malnutrition affects learning abilities, while higher awareness may affect healthy and sustainable food choices) -Goal 5 is "gender equality" (empowering women to claim their rights => improved quality of life and nutrition; proper nutrition improves learning performance which can lead to better job opportunities) -Goal 6 is "clean water and sanitation"

Food consumption score

-Aggregates household-level data on diversity and frequency of food groups consumed over past week. -Food groups assigned a weight according to its relative nutritional value (ex meat and fish have weight of 4; sugars, oils and fats have score of 0.5) -Households are classified as poor, borderline, or acceptable -FCS proxy for caloric and nutrient availability

Experienced-based food insecurity scale

-Aimed at understanding "the lived experience of hunger"; revealed it to be a process characterized first by uncertainty about having enough food, then by dietary changes to make limited food resources last, and lastly a decreased consumption of food in household -Consists of yes / no questions capturing a range of food insecurity experiences

Food frequency questionnaires

-Assess frequency of food consumption -Large epidemiological studies -Comprehensive for overall diet

Consequences of anemia?

-Central: fatigue, dizziness, memory problem -Muscular: weakness -Respiratory: shortness of breath -Intestinal: changes stool color -Hair loss -Eye yellowing -Heart: chest pain, irregular heartbeats -Pale skin -Enlargement of spleen

Who is most vulnerable to anemia?

-Children U5 -Infant and young children under 2 years of age -Adolescents and women of reproductive age

What is confounding?

-Confounding: occurs when the effect of the exposure is mixed with the effect of another variable (ex: Birth Order -> Down's syndrome vs. Maternal Age -> Down's Syndrome; link between birth order and down's syndrome is confounding)

Interconnected common determinants between underweight and obesity?

-Early life nutrition -Diet quality -Food environments -Socioeconomic factors

What are the consequences of zinc deficiency?

-Growth stunting -Supplementation in infants born small for gestational age reduces mortality

Non-nutritional interventions to address anemia?

-Hookworm, parasite treatment -Malaria treatment -Increasing birth interval; increasing age at first pregnancy -Income-generating activities; delayed cord clamping

What is the HDI? How does the PHDI differ?

-Human Development Index - used to measure development -Dimensions (and indicators) for HDI: 1) Long and healthy life (life expectancy at birth) 2) Knowledge (expected years of schooling; mean years of schooling) 3) A decent standard of living (GNI per capita) -The Planetary pressures-adjusted HDI (PHDI) is created by multiplying the HDI by an adjustment factor -The adjustment factor is the mean of: CO2 emissions per capita index and the material footprint per capita index -Approaching PHDI = HDI => lower planetary pressures -Approaching PHDI = 0 => higher planetary pressures

What are the two areas where IDA is lower than expected?

-In countries where anemia prevalence was >40%, especially in rural areas -In countries with very high inflammation

Consequences of wasting/acute malnutrition

-Increased risk of mortality due to infectious diseases -Acute malnutrition can lead to chronic malnutrition -Impaired macronutrient absorption -Altered immune function -Lethargy and irritability, decreased appetite

How does infection impact anemia?

-Infection can impair nutrient absorption or nutrient losses (such as with intestinal parasites) -Inflammatory cytokines alter iron metabolism, iron is sequestered in stores as ferritin and the production and lifespan of red blood cells is reduced

Trends in sustainable development goals: 1) Proportion of children U5 who are affected by stunting in the world, SSA, and Central and Southern Asia in 2020 2) Prevalence of overweight and wasting among children U5 world, Central and Southern Asia, SSA, Europe and Northern America 3) Prevalence of anemia in women 15-49 world, Central and Southern Asia, SSA 4) Maternal mortality in the world 5) U5 and neonatal mortality rates in the world

1) Children U5 affected by stunting in world, SSA, and Central & Southern Asia in 2020 -Decreased between 2000 and 2020 in world, SSA, and Central & Southern Asia 2) Prevalence of overweight & wasting among children U5 world, SSA, Central & Southern Asia, Europe & NA -Wasting is more prevalent than overweight in C. & S. Asia, SSA, and the world -Overweight is FAR more common than wasting in Europe & NA 3) Prevalence of anemia in women 15-49 world, C. & S. Asia and SSA -Decreased barely in C. & S. Asia between 2000 and 2019 and decreased slightly more in SSA 4) Maternal mortality world -Decreased 342 deaths per 100,000 live births to 211 per 100,000 live births 5) U5 and neonatal mortality rates in world -U5 decreased 76.4 deaths per 1,000 live births to 38.6 deaths per 1,000 live births -Neonatal decreased 30.6 to 17.7 deaths per 1,000 live births

What is an observational study? What are the 3 types of observational studies?

A study where investigators observe w/o intervention other than to record, classify, count, and statically analyze 1. Cross sectional 2. Cohort 3. Case-control

What is an experimental study?

A study where the investigators intentionally alter one or more factors and controls the other study conditions to isolate effects of the intervention or exposure on an outcome Randomized control trial = experimental

Where is anemia highest?

Africa, South and Eastern Asia, Eastern Europe, South America

Understand the different conceptual frameworks for malnutrition. What are some basic/distal causes, what are some basic causes/intermediate I, underlying/intermediate ii, immediate/proximal?

Basic Causes (Distal): Socioeconomic factors Basic Causes (Intermediate I): nutrition sensitive and specific programs Underlying Causes (Intermediate II): inadequate feeding practices and food insecurity, inadequate care and health services, unhealthy household environment Immediate causes (Proximal): Disease, inadequate dietary intake, child characteristics (low birthweight, preterm birth, etc.), maternal characteristics (maternal age, maternal malaria/anemia, etc.)

Bioavailability, inhibitors and enhancers of iron

Bioavailability = term that denotes degree to which a nutrient can be absorbed and utilized by tissues that need this nutrient from a given dietary source Enhancers -Ascorbic acid -Meat -Dietary protein / amino acids -Alcohol Inhibitors -Tannins -Phytates -Polyphenols -Calcium -Zinc

What is anemia?

Common medical condition in which the red blood cell count or the hemoglobin in the blood is less than normal Global health-wise, focus on: iron-deficiency anemia and vitamin-deficiency anemia

Define and calculate incidence

Cumulative Incidence: measure of number of new cases of characteristics that develop in a population during a specific time period, different from incidence rate Incidence = # of new cases occuring/# of people at risk ---(during a time period)

What are DRIs and how are they used?

DRIs: Dietary Reference Intakes; set of reference values used to assess nutritional intakes (EAR, RDA, AI, and UL)

When would it be appropriate to use each different type of study?

Observational: -Epidemiologic questions: *Disease frequency *Determine risk factors/predictors *Generate hypothesis about treatments Experimental: -Epidemiologic questions: *NOT disease frequency *Ethical constraints for determining risk factors/predictors *Evaluate treatments

What are the strengths and limitations of food consumption score?

Strengths -Captures usual household diet -Designed to capture both quantity (energy) and quality (micronutrients0 -Easy to administer Limitations -Not validated against gold standard of micronutrient adequacy -Disagreement over the weighting of food groups -Does not capture household allocation of food

What are the strengths and limitations of experienced-based food insecurity scale?

Strengths -Fast and less expensive -Gives info on how households adapt to inadequate food access -Can be collected for households or for individuals, providing insight into who within the household is altering their food consumption Limitations -No quantities -No info on diet quality -Experiential nature making it difficult to make interpersonal comparisons -Some suggestion that respondent's mood or recent experiences influences responses asymmetrically w/ a negative affect having a larger influence than a positive affect

Strengths and limitations of biochemical assessments?

Strengths -Objective -Used across different populations Limitations -Expensive -Laboratory equipment, infrastructure -Invasive -Non-dietary factors may affect levels -Some nutrients do not have an appropriate biomarker -Homeostatic control

Findings from the affordability study on EAT-Lancet

Findings The most affordable EAT-Lancet diets cost a global median of US$2.84 per day (IQR 2 41-3 16) in 2011, of which the largest share was the cost of fruits and vegetables (31 2%), followed by legumes and nuts (18 7%), meat, eggs, and fish (15 2%), and dairy (13 2%). This diet costs a small fraction of average incomes in high-income countries but is not affordable for the world's poor. We estimated that the cost of an EAT-Lancet diet exceeded household per capita income for at least 1.58 billion people. The EAT-Lancet diet is also more expensive than the minimum cost of nutrient adequacy, on average, by a mean factor of 1.60 (IQR 1 41-1 78). Interpretation Current diets differ greatly from EAT-Lancet targets. Improving diets is affordable in many countries but for many people would require some combination of higher income, nutritional assistance, and lower prices. Data and analysis for the cost of healthier foods are needed to inform both local interventions and systemic changes."

Urban/rural trends in adult nutritional status across LMIC?

Generally, as GDP increases (more developed), BMI tends to be increase in rural areas whereas BMI tends to be higher in urban areas in countries with lower GDP

DBM paper 1 (Ten Priority Candidates and their strength and weaknesses)

HEALTH SERVICES 1. Scale up new WHO antenatal care recommendations 2. Scale up programs to protect, promote, and support breastfeeding 3. Redesign guidance for complementary feeding practices and related indicators 4. Redesign existing growth monitoring (GMP) programs 5.Prevent undue harm from energy-dense and micronutrient-fortified foods and ready to use supplements SOCIAL SAFETY NETS 6. Redesign cash and food transfers, subsidies, and vouchers EDUCATIONAL SETTINGS 7. Redesign school feeding programs and devise new nutritional guidelines for food in and around educational institutions AGRICULTURE, FOOD SYSTEMS, and FOOD ENVIRONMENTS 8. Scale up nutrition-sensitive agriculture programs 9. Design new agricultural and food system policies to support healthy diets 10. Implement policies to improve food environments from the perspective of malnutrition in all its forms

Main themes from EAT-Lancet discussion

How culturally appropriate the diet was How to get the main stakeholders to cooperate in following the diet (govt, food producers, and consumers)

How does the Global Hunger Index measure hunger?

It is a score based on insufficient caloric intake, child undernutrition (wasting and stunting), and child mortality. The three dimensions are given equal weight in the final standardized scores for each country.

What are the strengths and limitations of dietary diversity score?

Strengths -Easy to use and integrate as a short module into surveys -Fast to administer in a survey -Requires fewer resources than dietary recall -Requires little training of research staff to collect data and calculate scores -Provides insight into types of foods that are consumed Limitations -Survey require tailoring to specific contexts -No detailed info on quantity of dietary intakes and are not a direct measure of nutrient adequacy -Cut-offs do not predict nutrient adequacy in all contexts for all population groups -Household-level dietary diversity scores do not provide info on individual household members

What are determinants and associations of anemia?

Most distal: political economy, climate, geography 2nd: education, wealth, norms and behavior 3rd: physiological vulnerability of women and children 4th: access to: diverse (and fortified) food sources, knowledge about anemia, health services 5th: inadequate nutrient intake and absorption, infectious diseases, genetic hemoglobin disorders Most direct: decreased erythrocyte production, increased erythrocyte loss => anemia

What are the different components of the PICO framework?

P: patient, problem, or population I: intervention, exposure C: comparison, control, or comparator O: outcome

Define and calculate prevalence. What causes prevalence to change?

Prevalence: number or proportion of cases or events or conditions in a given population Prevalence = # of people in a population with given condition/total # of people in population Changes over time, depending upon: -incidence -number of people cured (decreases) -number of people that die (decreases)

RR/OR how do you interpret them? When are they meaningful?

RR = risk ratio OR = odds ratio -RR/OR = 1 => no difference in risk/odds between groups -RR/OR > 1 => INCREASE in risk among exposed compared to unexposed -RR/OR <1 => DECREASE in risk among exposed group compared to unexposed -Statistically Significant (/= clinically significant necessarily): *p-value <0.05 *CI that DOES NOT include 1 -Clinical significance refers to practical importance of a treatment effect (what's meaningful to a population may not be meaningful to an individual and vice versa)

What are RDAs and how are they used?

Recommended dietary allowance: average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%-98%) healthy people.

What regions have the highest prevalence of wasting?

Southern Asian, SE Asia, N/E/W/Middle Africa

What are the strengths and limitations of dietary records?

Strengths -"Gold standard" -Does not require recall -Details on portions -Info on eating habits -More representative of overall diet -Open-ended = can record culture-specific foods -Seasonal changes Limitations -High participant burden -Intensive training -Literacy -Expensive -Difficult to code -Errors/omissions if not recorded immediately -Expensive

What are strengths and limitations of anthropometry?

Strengths -Objective w/ high specificity and sensitivity -Measures many variables of nutritional significance (height, weight, MUAC, HC, skin fold thickness, waist and hip ratio, BMI) -Readings are numerical and gradable on standard growth charts -Readings are reproducible -Non-expensive and need minimal training Limitations -Inter-observers errors in measurements -Limited nutritional diagnosis -Problems w/ reference standards (i.e. local versus international standards) -Arbitrary statistical cut-off levels for what considered as abnormal values

What are the strengths and limitations of food frequency questionnaires?

Strengths -Set food list, food database -Can be self-administered -Inexpensive -Assess usual diet, long-term intake -Low participant burden Limitations -Population-specific -Length of FFQ -Requires literacy -Culture-specific foods -Time demanding

What are the strengths and limitations of 24-hour recall?

Strengths -Short-term intake -Inexpensiveterm-24 -Minimal burden/effort -Not time-intensive -Short term memory -Recall - not alter diet -Literacy not needed -Open-ended Limitations -Difficult to calculate nutrient intake w/ many food items -Memory: foods, portion sizes -Food omission -Interviewer training -Over/under reporting -Not representative of usual intake

What are EARs and how are they used?

The estimated average requirement (EAR) is the amount of a nutrient that is estimated to meet the requirement for a specific criterion of adequacy of half of the healthy individuals of a specific age, sex, and life-stage.

Difference between correlation and causation. What are criteria for causality?

There are more murders when it is hot; there is also more ice cream sold when its hot. They are correlated, but ice cream does not CAUSE more murder. Criteria: 1. Strength: larger association between exposure & disease => more likely to be causal 2. Consistency: association present in multiple studies in various settings 3. Specificity: association specific to one exposure and one outcome 4. Temporality: exposure must precede outcome 5. Biological gradient: dose-response relationship exists. More exposure, more certain outcome 6. Plausibility: association can be explained by biological mechanism

Trends in overweight/obesity, underweight, and anemia from GNR 2018

Undernutrition: -POU has been decreasing but is expected to increase again -Prevalence of underweight among women 20-49 has slowly decreased