International Nutrition Midterm
Epidemiology definition
"The study of the distribution and determinants of health related states and events in populations and the application of this study to control health populations."
How to calculate Z Score
(child value - mean reference value)/ standard deviation of a reference population
"Children throughout the world can reach their growth potential if they are nurtured in healthy environments and their caregivers follow recommended health, nutrition, and care practices." - Dewey and Begum
-Global Prevalence of Malnutrition in Children in LMIC's: -Stunting: 20% -Wasting: 10% -Underweight: 32%
Lots of work done to examine and shape the underlying principles and value system around the new "Sustainable Development Goals".
-Goals: End hunger, achieve food security and improved nutrition, and promote sustainable agriculture.
Child mortality is disproportionately concentrated in a few world regions.
-Six countries account for 50% of all mortality. -42 account for 90%. -Despite substantial improvements in late 20th/early 21st, nearly 10 million children die annually.
How do we measure malnutrition in children?
-Stunting: low height for age -Wasting: low weight for height -Underweight: low weight for age -Assessed as a standard deviation from a reference population in Z-scores (Two Z-scores below median classifies child as stunted, wasted, or overweight)
When does child undernutrition occur?
-critical window: pre-pregnancy to 2 years (basically, the first 1000 days of life)
Body Mass Index (BMI)
-kg/m^2 -Underweight = <18.5 -Normal= >18.5 to <25 -Overweight= >25 -Obesity= >30
Women are so important in child/infant nutrition.
-need to be cared for: -Ex. Maternal Stunting & Low BMI --> leads to fetal growth restriction --> great risk of child death before age 5 -Ex. Maternal Obesity --> gestational diabetes, pre-eclampsia, etc.
178 Million Children Under 5 suffer from Stunting
...
SGA = Small Gestational Age
32.4 million babies were born SGA in 2011; 27% of all births in LMIC's.
Growth faltering can involve linear growth retardation and/or wasting is a short term adaptation to preserve vital functions.
A child's growth is used both clinically and in public health as a holistic measure of the child's well-being and nutritional status.
Risk Factors are not direct causes of death.
Childhood Underweight is the leading risk factor for percentage of DALYs.
In a healthy environment with proper standards, children should grow the same in the first few years of life.
From 2 years & up, you measure height - which is tricky. Less than 2 years, measure recumbent length lying down.
The main causes of stunting include intrauterine growth retardation, inadequate nutrition to support the rapid growth and development of infants and young children, and frequent infections during early life.
Most immediate causes of Undernutrition are Inadequate dietary intake and Disease.
Height for age (length for age) is the best for assessing populations.
Stunting; HAZ < -2
Carefully examine and understand the conceptual framework that describes how poverty and nutritional deficits lead to impaired cognitive development.
Topic Eight. Nutrition and Cognitive Development, Lipids.
Draw a conceptual framework to convey how poor nutrition can contribute to intergenerational transmission of poverty, using cognitive development outcomes as intermediary steps.
Topic Eight. Nutrition and Cognitive Development, Lipids.
Understand the impact that nutritional supplementation can have on cognitive development, including the intergenerational effects.
Topic Eight. Nutrition and Cognitive Development, Lipids.
What long-term cognitive development and economics consequences exist for poor nutrition in childhood?
Topic Eight. Nutrition and Cognitive Development, Lipids.
Describe the "U-shaped hypothesis" that explains how iron levels (either depletion or excess) relate to susceptibility of infection.
Topic Eleven. Key Micronutrient Deficiencies - Iron.
Describe the normal process for maintaining iron homeostasis and the uses of iron in the body.
Topic Eleven. Key Micronutrient Deficiencies - Iron.
Distinguish between iron deficiency and anemia.
Topic Eleven. Key Micronutrient Deficiencies - Iron.
How do the absolute and relative requirements for iron differ for men, women, and infants?
Topic Eleven. Key Micronutrient Deficiencies - Iron.
How does hepcidin influence the iron absorption rate, and thereby work to maintain iron homeostasis? Why is this a helpful homeostatic mechanism?
Topic Eleven. Key Micronutrient Deficiencies - Iron.
In the Stoltzfus reading about Iron Interventions in LMICs, she discusses four global health interventions that could incorporate iron. What are these, and why has there been such little progress towards this incorporation thus far in global health programs?
Topic Eleven. Key Micronutrient Deficiencies - Iron.
Why do women and children have an increased demand for iron (and therefore an increased likelihood of deficiency)?
Topic Eleven. Key Micronutrient Deficiencies - Iron.
Describe the social and biological threats to breastfeeding.
Topic Five. Breastfeeding in the Global Context.
Discuss why breastfeeding is the most optimal of nutritional sources, especially in developing countries.
Topic Five. Breastfeeding in the Global Context.
How does breastmilk contribute to the development of a child's immunity?
Topic Five. Breastfeeding in the Global Context.
How is the release of breastmilk controlled?
Topic Five. Breastfeeding in the Global Context.
Recognize breastfeeding as an underutilized global health intervention.
Topic Five. Breastfeeding in the Global Context.
Review/reconstruct an intervention strategy to promote exclusive breastfeeding in a low-income country. What behaviors need to be addressed? How would you address them? (not -t he ten steps to successful bf can be helpful in this activity.)
Topic Five. Breastfeeding in the Global Context.
Understand how breastfeeding can reduce death and disability among children.
Topic Five. Breastfeeding in the Global Context.
Understand how to read a survival curve, and what these curves tell us about breastfeeding and survival.
Topic Five. Breastfeeding in the Global Context.
What are the components of optimal breastfeeding?
Topic Five. Breastfeeding in the Global Context.
Describe how stunting can be viewed as a successful short-term adaptation in biologic/metabolic terms.
Topic Four. Growth, Growth Faltering and the Role of Morbidity.
How did our measurement of malnutrition change as a result of the shift in reference populations from the US formula fed population to the WHO multi-country population?
Topic Four. Growth, Growth Faltering and the Role of Morbidity.
How have these two illnesses been addressed until recently? What major programmatic flaw has there been in addressing these problems?
Topic Four. Growth, Growth Faltering and the Role of Morbidity.
Practice calculating Z scores to assess whether a child is malnourished according to the measures of wasting, stunting, and underweight.
Topic Four. Growth, Growth Faltering and the Role of Morbidity.
What are the consequences of stunting and wasting? When do these nutritional inadequacies occur?
Topic Four. Growth, Growth Faltering and the Role of Morbidity.
Describe vitamin A's critical role in promoting child survival. Conversely, how does vitamin A deficiency contribute to mortality?
Topic Nine. Key Micronutrient Deficiencies in the Global Context I - Zinc and Vitamin A
Explain how vitamin A and zinc function in the immune system.
Topic Nine. Key Micronutrient Deficiencies in the Global Context I - Zinc and Vitamin A
Given the information you've learned, how would you hypothesize interactions between zinc and vitamin A?
Topic Nine. Key Micronutrient Deficiencies in the Global Context I - Zinc and Vitamin A
Given the reasons for vitamin A deficiency, propose a supplementation program.
Topic Nine. Key Micronutrient Deficiencies in the Global Context I - Zinc and Vitamin A
List three functions of vitamin A and how these functions would be affected in vitamin A deficiency.
Topic Nine. Key Micronutrient Deficiencies in the Global Context I - Zinc and Vitamin A
What are some objections or risks associated with large scale vitamin A supplementation programs?
Topic Nine. Key Micronutrient Deficiencies in the Global Context I - Zinc and Vitamin A
What factors contribute to decreased absorption of zinc?
Topic Nine. Key Micronutrient Deficiencies in the Global Context I - Zinc and Vitamin A
Why is it important to ensure Vitamin A is not given in excess?
Topic Nine. Key Micronutrient Deficiencies in the Global Context I - Zinc and Vitamin A
How does nutrition fit within the Millennium Development Goals?
Topic One. Millennium Development Goals and Recent Events.
Recognize how the relative mortality risks from common childhood illness change with increasing malnutrition.
Topic One. Millennium Development Goals and Recent Events.
Recognize the dual burden of under and over nutrition in many developing countries.
Topic One. Millennium Development Goals and Recent Events.
What is food security and what are it's two dimensions?
Topic One. Millennium Development Goals and Recent Events.
What world regions are disproportionately affected by child malnutrition?
Topic One. Millennium Development Goals and Recent Events.
Describe the ethical and social challenges HIV+ mothers face in their infant feeding decisions.
Topic Seven. Nutrition and HIV.
Discuss the HIV breastfeeding controversy. What key tradeoffs do HIV+ women face with their infant feeding decisions?
Topic Seven. Nutrition and HIV.
How many of these occur as a result of breastfeeding?
Topic Seven. Nutrition and HIV.
Understand how the Infant Feeding Guidelines for children of HIV+ mothers have changes in the past 10 years.
Topic Seven. Nutrition and HIV.
What fractions of new HIV infections occur among children?
Topic Seven. Nutrition and HIV.
What is the WHO's position on whether a child of an HIV+ mother should be breastfed? How have things changed from their earlier position?
Topic Seven. Nutrition and HIV.
Appreciate the general magnitude of effect (in terms of WAZ and HAZ Z scores) for the various types of complementary feeding interventions.
Topic Six. Infant and Young Child Feeding.
Compare and contrast an infants absolute energy and energy density (kcal/kg of body weight) needs with those of an adult male.
Topic Six. Infant and Young Child Feeding.
Compare the effectiveness of education versus fortification for increasing micronutrient intakes.
Topic Six. Infant and Young Child Feeding.
Describe and interpret the 10 Guiding Principles for Complementary Feeding the breastfed child.
Topic Six. Infant and Young Child Feeding.
Describe several reasons why breastfeeding to 6 months is recommended.
Topic Six. Infant and Young Child Feeding.
Understand the role of breastfeeding on an infant's energy requirements from dietary fat? (i.e. how does this need change with High versus low breastfeeding)
Topic Six. Infant and Young Child Feeding.
What are essential nutrition actions, and what impact on child mortality are these expected to have if these interventions are delivered at maximum coverage?
Topic Six. Infant and Young Child Feeding.
What are the key problem micronutrients for infants in developing countries? Which of these can be met from plant foods and which cannot (in most cases)?
Topic Six. Infant and Young Child Feeding.
What are the recommendations for vitamin A supplement in vitamin A deficient areas for women and children?
Topic Six. Infant and Young Child Feeding.
What are ways to increase the nutrient quality of child diets?
Topic Six. Infant and Young Child Feeding.
What contextual factors must be understood to compose a "best package" for a complementary feeding intervention?
Topic Six. Infant and Young Child Feeding.
What is the general understanding of the sole provision of micronutrients on growth?
Topic Six. Infant and Young Child Feeding.
When in the life cycle are critical nutrition actions applied?
Topic Six. Infant and Young Child Feeding.
Which nutrients are not provided in sufficient amounts after 6 months, even in BF is continued?
Topic Six. Infant and Young Child Feeding.
Appreciate how folate is involved in one carbon metabolism.
Topic Ten. Key Micronutrient Deficiencies in the Global Context II - The B Vitamins - Folate and Vitamin B12
Describe the differences between fortification, enrichment, and supplementation and when each of these interventions may be more or less ideal.
Topic Ten. Key Micronutrient Deficiencies in the Global Context II - The B Vitamins - Folate and Vitamin B12
How does pregnancy and lactation change normal folate needs and what are the implications of these for public health programs?
Topic Ten. Key Micronutrient Deficiencies in the Global Context II - The B Vitamins - Folate and Vitamin B12
In general, what are the main effects of folate supplementation trials among pregnant women in reducing NTD's?
Topic Ten. Key Micronutrient Deficiencies in the Global Context II - The B Vitamins - Folate and Vitamin B12
Understand the folate, B12 pathway for regulating homocysteine and for producing DNA precursors.
Topic Ten. Key Micronutrient Deficiencies in the Global Context II - The B Vitamins - Folate and Vitamin B12
What benefits have been ache vied through folate fortification? Are these reasons why fortification should be cautiously applied, or applied to only some sub-populations?
Topic Ten. Key Micronutrient Deficiencies in the Global Context II - The B Vitamins - Folate and Vitamin B12
What factors affect the bioavailability of folate?
Topic Ten. Key Micronutrient Deficiencies in the Global Context II - The B Vitamins - Folate and Vitamin B12
Why can a mutation in methyltetrahydrofolate reductase (MTHFR) cause hyperhomocysteinemia and why this mutation is associated with many types of cancer?
Topic Ten. Key Micronutrient Deficiencies in the Global Context II - The B Vitamins - Folate and Vitamin B12
Distinguish the goals of causal, program planning/decision making, and accountability/measurement frameworks.
Topic Three. Key Frameworks for Understanding Nutrition Problems in Developing Countries.
Review the conceptual framework we constructed in class to understand the facts that influence low birth weight in Southeast Asia.
Topic Three. Key Frameworks for Understanding Nutrition Problems in Developing Countries.
Understand in detail how the UNICEF Framework (reproduced in the Black et al, 2003 version) conceptualizes maternal and child undernutrition.
Topic Three. Key Frameworks for Understanding Nutrition Problems in Developing Countries.
What are the major governmental and developmental sectors that need to be strengthened to promote nutrition at a national level?
Topic Three. Key Frameworks for Understanding Nutritional Problems in Developing Countries.
What is the Global Burden of Disease Project? What is a DALY and how are these generally constructed? Why are DALYs useful for understanding nutrition problems?
Topic Three. Key Frameworks for Understanding Nutritional Problems in Developing Countries.
How can healthier body weight among women postpartum link to better birth spacing?
Topic Twelve. Nutrition, Gender, and Pregnancy.
How does poor nutrition get passed along inter-generationally? Appreciate early pregnancy age as a key factor in this cycle.
Topic Twelve. Nutrition, Gender, and Pregnancy.
What are the increased nutritional costs for women during pregnancy?
Topic Twelve. Nutrition, Gender, and Pregnancy.
What do results of maternal supplementation studies generally conclude in terms of women's health and child growth, mortality outcomes?
Topic Twelve. Nutrition, Gender, and Pregnancy.
Describe the three key anthropometric measures of undernutrition. What different information does each give about child's growth and nutritional status? What is the general global prevalence of these conditions among children?
Topic Two. Epidemiology of Major Nutrition Problems Worldwide.
Discuss why undernutrition can be viewed as an indirect and direct cause of child mortality.
Topic Two. Epidemiology of Major Nutrition Problems Worldwide.
Recognize several key trends in the leading causes of mortality on from 1990 to 2001 in several world regions in children and adults. Which relate to nutrition?
Topic Two. Epidemiology of Major Nutrition Problems Worldwide.
What is the critical first 1000 days and why has this period been so heavily emphasized as the critical window for nutrition interventions?
Topic Two. Epidemiology of Major Nutrition Problems Worldwide.
40% of child deaths worldwide are caused by Neonatal problems.
Undernutrition, itself, is associated with 35% of child deaths.
Macronutrient
carbs, fats, proteins (needed in large quantities)
Micronutrient
iron, iodine, vitamin A, etc. (needed in smaller, trace quantities)
Low Birth Weight (LBW)
less than 5.5 pounds
Disability Adjusted Life Year (DALY)
measure of years of life lost and years of life lived with disease or disability