Nutrition Exam 3

· Describe some of the sources of disruptions in fertility

- Adverse nutritional exposures - Severe stress - Infection - Tubal damage and other structural problems possibly from scarring from STI's and endometriosis - Chromosomal abnormalities - Unknown causes (about 10% of cases)

· Explain why antioxidants are an important aspect of preconception nutrition

- Antioxidant nutrients are needed to protect cells of the reproductive system from damage due to oxidative stress - Free radicals can damage fatty acids in sperm membranes, reducing motility and ability of sperm to fuse with egg - Can leave sperm DNA susceptible to damage - Antioxidants from whole foods reduce oxidative stress

· Residential criteria

- Applicants must live in the state or Indian Tribal Organization where they apply - Applicants may be required to live in a local service area and apply at a WIC clinic that serves that area - Applicants are not required to live in the state or local service area for a certain amount of time to meet the WIC residency requirement

o How did the researchers measure success? (GREEN)

- Baseline and follow up measurements: photos of food from home and surveys of parent and child - Process data: dose of campaign, teacher feedback, classroom observations - Key informant interviews with principals

· Explain why we use BMI percentiles to assess child weight status rather than BMI

- Because children are growing we expect BMI to increase with age so instead we measure weight status using BMI percentiles which shows how children compare to others of the same age and sex.

· Describe the role of early child nutrition on brain development and cognitive performance

- Brain development depends on proper nutrition during a 1000 day window. - Undernutrition is linked to cognitive impairment. - Stunting is linked to poor school achievement and behavioral problems - Deficiencies of iron, iodine, protein cause impaired cognitive and motor development.

· Describe the benefits of the mobile app to support WIC purchasing over printed educational supports.

- Cant lose them - Can see how many benefits are remaining - Can tell what foods you are allowed to buy

· Explain why the periconceptional period is a critical period for nutrition

- Critical because pregnancy may not be recognized and prenatal care likely hasn't begun - Gene function in embryo and fetus can be modified in early pregnancy by DNA methylation - Modifications can affect growth, development, and disease risk later in life - Low energy intakes during periconceptional period due to food restriction, weight loss, eating disorders, or excess exposure to vitamin A in the form of retinol/retinoic acid from supplements or drugs can cause metabolic changes that affect the future health of the offspring

What is the periconceptional period?

- Critical period when nutritional and other exposures can impact conception, pregnancy maintenance, and growth, development and future health of offspring - Peri-conceptional period defined by about 3 months before and after conception

· Describe WIC's public health impact

- Decreased premature birth - Decreased low and very low birthweights among babies - Decreased fetal and infant death - Decreased incidence of iron-deficiency anemia - Increased access to prenatal care early in pregnancy - Increased pregnant women's consumption of iron, protein, calcium and vitamins A and C - Increased immunization rates - Increased access to regular healthcare - Increased diet quality

· Income criteria

- Income thresholds are set by the state agency - Must be between 100% and 185% of the federal poverty level - Applicants can be deemed automatically income-eligible if they are eligible for SNAP Medicaid, Temporary assistance for needy families or if certain families are eligible for these programs

· Identify the Healthy People 2020 Goals relevant to preconception

- Increase the proportion of women at a healthy weight prior to pregnancy by 10% - Reduce the proportion of women aged 18-44 who have impaired fecundity by 10% - Reduce the proportion of men aged 18-44 who have impaired fecundity by 10% - Increase the proportion of women who did not drink alcohol prior to pregnancy by 10% - Reduce iron deficiency among females of childbearing age by 10% - Increase the proportion of women of childbearing potential with intake of at least 400 mcg of folic acid from fortified foods or dietary supplements by 10% - Reduce the proportion of women of childbearing potential who have low red cell folate concentrations by 10% - Increase the proportion of women delivering a live birth who received preconception care services and practiced key recommended preconception health behaviors by 10%

· Discuss factors that influence diet and physical activity behaviors at each level of the social-ecological model.

- Individual factors: such as age sex, economic status, race, knowledge, etc. - Settings: such as homes, schools, worksites, food service establishments, community settings, early care and education, etc. - Sectors: Systems such as government, education, healthcare, transportation, organizations such as public health, community, advocacy, and business such as planning and development, agriculture, retail, media, marketing, etc. - Social and Cultural Norms and Values: Belief systems, heritage, religion, tradition, lifestyle, priorities, body image, etc.

o Why is knowledge often not enough to change dietary behavior? (GREEN)

- Knowledge transfer alone does not equate to a behavior change, multi-channel, theory based campaigns that target a well-defined audience can have an impact on behavior.

· Identify at least three barriers to breastfeeding

- Lack of knowledge - Social norms - Poor family and social support - Embarrassment - Lactation problems

· Share examples of how the Shape Up Somerville campaign worked to prevent child obesity among children in the community

- Large multi-component community based participatory intervention - Introduced safe routes to school maps - Healthier school lunches - Healthy home snacks - Healthy school breakfast - PA 5days/week - Nutrition and PA education 1 day/week - Restaurant participation - Parent newsletter with coupons - Community Events

· Describe the evidence-based recommendations for physical activity.

- Preschool aged children (3-5) should be physically active throughout the day to enhance growth and development - Adult caregivers of preschool aged children should encourage active play that includes a variety of activity types - Children between 6-17 should complete 60 minutes or more of moderate to vigorous physical activity each day. Such as aerobic (at least 3 days/week), muscle-strengthening (3 days/week), and bone strengthening. (at least 3 days/week)

· Explain the role of ready-to-use therapeutic foods in addressing undernutrition.

- Provide all the nutrients a child needs during development, helps reverse deficiencies and promote weight gain, allows most patients to be treated at home, doesn't require water (prevent contamination) and is shelf-stable - Criticized for being expensive and detracting from more sustainable solutions

· Describe the benefits provided in WIC

- Supplemental nutritious foods - Nutrition education and counseling - Screening and referrals

o Fertility

- The actual production of children

o Fecundity

- The biological capacity to bear children

· Describe the features and consequences of kwashiorkor

- The disease that the first child gets when the new child comes - Energy needs barely met, but protein needs not met - Often results from abrupt transition from breastfeeding to starchy roots and gruels (low protein, high fiber) - Typically children also have infections and parasites which raise energy and protein needs - Marked by edema in stomach and legs, changes to hair color, flaky skin, fatty liver, reduced muscle mass, apathy, diarrhea, listlessness, failure to grow - May be reversed but may have long term effects on growth and cognition

o Subfertility

- Women who experience multiple miscarriages (2-3) and who ovulate infrequently and men who have sperm abnormalities (low count, density, motility, or malformalities) are considered subfertile

· Describe how zinc and iron are linked to fertility

- Zinc acts as an antioxidant and plays an important role in sperm maturation and testosterone synthesis. Deficiency in men associated with poor sperm quality and concentrations along with abnormal shapes. Zinc supplements are not shown to improve fertility in the absence of a deficiency - Iron deficiency has been linked to reduced fertility in women and affects 9-16% if women of childbearing age in the US

Zinc deficiency

- Zinc deficiency impairs growth and immune function and is associated with increased risk of GI infections, it is a contributing factor in child diarrheal deaths - Zinc deficiency is common in developing countries due to low intake of zinc rich foods (meat, seafood, poultry, whole grains, fortified cereals, and dairy products) as well as poor absorption - Both Zinc and Folate deficiencies can be addressed with supplementation or improvements to dietary diversity

the WIC eligibility criteria

Categorical, residential, income, nutrition risk

Malnutrtion

Malnutrition is poor nutritional status due to dietary intake either above or below the optimal level

· Define body mass index (BMI)

- BMI is a measure of weight adjusted for height - BMI= (weight in kg)/(height in m)^2

Major micronutrient deficiencies across the globe

- Common micronutrtient deficiencies in developing nations are iron, vitamin A, iodine, zinc, and folate

How WIC is administered

- Federal level by the USDA Food and Nutrition Service (FNS) - State level by WIC state agencies - Local level operates through 1900 local agencies and 10,000 clinical sites

o What was the role of formative research in developing the campaign?(GREEN)

- It is important to find out what the kids parents teachers and administrators would want in a campaign

WIC PHN goals

- To promote healthy habits and healthy families - To encourage participants to breastfeed, eat more fiber, eat more FVs, eat more whole grains, drink less SSBs and eat family meals

Vitamin A deficiency

- Vitamin A deficiency is the leading cause of preventable blindness in children - Vitamin A deficiency occurs in more than half of all countries, especially in Africa and Southeast Asia and especially among young children and pregnant women - Vitamin A requires fat for absorption - Vitamin A can cause Xerophthalmia: night blindness, dry eyes, ulceration, keratomalacia, blindness - Vitamin A can also cause compromised immunity, increased risk of disease and death from severe infections, and increased risk of maternal mortality

· Describe the racial/ethnic disparity in child obesity rates

- 14.7% of non-hispanic whites between 2-19 are obese - 19.5% of non-hispanic blacks between 2-19 are obese - 21.9% of Hispanics between 2-19 are obese

o key historical milestones WIC

- 1972: program piloted in response to concern over malnutrition among poverty stricken mothers and young children - 1974 WIC operating in 45 states - 1975: WIC established as permanent program, eligibility extended to non-breastfeeding women and children up to age 5 - 1978: Legislation required nutrition education, regulated nutrition profile of supplemental foods and integrated referrals to other social services (immunization, alcohol/drug abuse prevention, child abuse counseling, family planning) - 1992: offered an enhanced food package for mothers exclusively breastfeeding - 1997: launched a breastfeeding promotion campaign - 2004: launched breastfeeding peer counselor initiative - 2009: introduced a new food package to align with dietary guidelines for Americans incorporating FV's, culturally sensitive substitutes and increased package for mothers who exclusively breastfeed

· Describe rates of conception for healthy couples having regular, unprotected intercourse

- 20-25% chance of a diagnosed pregnancy within one menstrual cycle - 30-35% of conceptions are lost by resorption into the uterine wall in the first 6 weeks after conception - Another 9% lost by miscarriage in the first 20 weeks of pregnancy

· Describe the current state of undernutrition across the globe.

- 815 million people undernourished in 2016 (up from 777 in 2015) - Mostly confined to developing countries - Many economic, social and political factors contribute to food insecurity, hunger, and undernutrition - Conflict and climate events further exacerbate food and health crises

Describe the WIC program

- A short term intervention program designed to safeguard the health of low-income women, infants and children up to age 5 who are at nutritional risk

Explain the nutrition transition and its effects on global nutrition

- Adverse changing is populations eating habits with globalization - Changing from traditional diets (often plant-based, with high nutrient dense foods) to modern "westernized" diets - Dietary changes are accompanied by dramatic reductions in physical activity levels and increased sedentary behavior

· Nutritional risk criteria

- Applicants must be seen by a health professional who determines whether the individual is at nutritional risk (typically done at a WIC clinic but can be obtained by another healthcare provider) - Defined as medical or dietary-based conditions including anemia, underweight, poor pregnancy outcome, poor diet

· List the determinants of nutrition and food security in a global context.

- Availability of locally-produced healthy food - Availability of healthy food at local markets - Adequate education level of the population - Access and utilization of health services - Access to job opportunities - Exposure to a healthy environment - Availability of adequate living conditions, including proper sanitation - Access to communication and information technology - Adequate social support and social interactions - Opportunities for participation in community organization and development - In a nutshell: Location, Healthcare, Education, Agriculture, Housing, Environment/Infrastructure, Livelihoods, Political Climate, Social/Cultural norms, Conflict, Climate Events

o Why are elementary school children a good target population for this type of intervention?

- Captive audience - In the process of integrating social norms - Strongly influenced by advertising - Able to comprehend the impact of human activities on the environment and take action to protect it - Able to successfully transmit environmental knowledge to their parents

o Undernutrition and fertility

- Causes a dramatic decline in fertility that recovers when food intake does - Ex famine in Holland and Bangladesh caused decline in fertility and birthrate, fertility staturs improved in about 4 moths but it took many more months for menstrual cycles to return

· List contributors to child obesity at each level of the social-ecological model (2,4,5,3,1)

- Cell: Food allergies, genes predisposing one to obesity, propensity to develop white fat cells - Child: Sufficient sleep, media use, gender, diet, spending money - Clan: parent fitness knowledge, work schedule, race, traditions, nutrition knowledge - Community: transportation practices, local employment, community BMI, peer food choices, Accessibility to food outlets - Country: government funding of exercise campaigns, media fitness portrayals, media body portrayals, media eating portrayals, health care system structure - Culture: Gender role expectations concerning activity, norms for exercise in public, cultural beauty standards, norms for oversized portions, gender-role expectations for eating.

· Explain how physical activity benefits health throughout the life course.

- Children and adolescents: - Improved bone health and weight status(3-17) - Improved cardiorespiratory and muscular fitness as well as improved cardiometabolic health (6-17) - Improved cognition and reduced risk of depression (6-13) - Adults and older adults: - Lower risk of all-cause mortality - Lower risk of CVD, and CVD related death - Lower risk of hypertension - Lower risk of type 2 diabetes - Reduced risk of dementia - Reduced anxiety - Increased cognition - Reduced anxiety and depression - Improved sleep - Reduced weight gain, and increased weight loss - Prevention of weight regain - Improved bone health and physical function - Lower risk of falls

· Describe the composition of human milk and how it aligns with child nutritional needs

- Colostrum (early human milk): higher in immune factors - Fats: 3.5g/100ml provide half of energy (higher concentrations in hind milk than foremilk and includes long chain polyunsaturated fatty acids) - Carobhydrates: 7g/100ml mainly lactose - Protein: 0.9g/100ml lower than other milks but higher quality, greater bioavailability and more digestible - Vitmains and minerals: Mostly sufficient for infant if mother is sufficient, vitamin D recommended for mother and infant, iron and zinc have low concentrations, but high bioavailability and absorption - Bioactive factors: Anti-infective factors and factors to enhance digestion

· Suggest risk reduction strategies for the preconception period

- Counsel women of reproductive age to consume 400 mcg of folic acid/day from fortified foods and/or supplements and to consume a balanced healthy diet of folate-rich foods - Achieve or maintain healthiest BMI possible - Achieve adequate intake of other key nutrients including: - Vitamin D: 600 IU/day - Calcium: 1000 mg/day - Iron: 15-18 mg/day - Iodine: 150 mg/day

Where are WIC services provided?

- County health departments - Hospitals - Mobile clinics - Community centers - Schools - Public housing sites - Migrant health centers and camps - Indian health service facilities

· Compare and contrast developed and developing countries.

- Developed countries are more industrialized, have higher per capita income rates, higher life expectancies, higher education level and literacy rates, and the population has enough money to pay for schools, hospitals, etc. Has an average daily food supply of 3400 calories per person - Developing countries are less industrialized, have lower per capita income rates, lower life expectancy, lower education and literacy rates, and the population does not have enough money to pay for schools, hospitals and other services. Have an average daily food supply of less than 1800 calories per person.

· Describe the desirable characteristics of complementary foods

- Energy - Protein - Fat: should provide 35% of total energy, contains essential fatty acids for immune system and brain - Vitamins and minerals: vitamin A, iron, and iodine are commonly deficient

· Define child overweight and obesity, as well as the cutoffs for each weight status category

- Excess accumulation of body fat with the potential to impair health - Overweight: 85th-95th percentile for weight - Obese: 95th percentile or higher for weight

o Body fat and fertility

- Excessive levels of fat are linked to declines in fertility for women and men - Fat cells produce estrogen, testosterone, and leptin and their availability changes with fat content - These changes can interfere with reproductive processes such as follicular development, ovulation, and sperm maturation and production - Women with obesity tend to have higher levels of estrogen, androgens and leptin which leads to menstrual cycle irregularities, disruptions to ovulation and amenorrhea - Men with obesity tend to have lower levels of testosterone and higher levels of estrogen and leptin which can lead to reduced sperm production and erectile disfunction

· Summarize the WHO and UNICEF recommendations for infant and young child feeding

- Exclusive breastfeeding for 6 months - Nutritionally adequate and safe complementary feeding starting from age of 6 months with continued breastfeeding for 2 years of age or beyond

· Distinguish between exclusive breastfeeding and complementary feeding

- Exclusive: An infant receives only human milk from his or her mother or a wet nurse or expressed breast milk and no other liquids or solids, not even water. The only exceptions being oral rehydration solution, drops or syrups consisting of vitamins minerals supplements or medicines. - Complementary: The process starting when human milk is no longer sufficient to meet the nutritional requirements of infants. Other foods and liquids are needed, along with human milk. Breastfeeding may continue beyond two years.

Folate Deficiency

- Folate deficiency is a particular concern during pregnancy because it can cause neural tube defects such as spina bifida - Folate is in leafy green vegetables, fruits, nuts, beans, dairy, animal products, grains, and it plays a key role in the formation of red blood cells and production of genetic material - Both Zinc and Folate deficiencies can be addressed with supplementation or improvements to dietary diversity

· Persuade someone of the benefits of breastfeeding for two years or beyond

- For the child not breastfeeding is associated with increased risk of diarrhea, pneumonia, ear infections, meningitis, UTI's, asthma, type 1 diabetes, celiac disease, ulcerative colitis, leukemia, obesity, heart disease, lower IQ scores - For the mother not breastfeeding is associated with increased risk of postpartum hemorrhage, breast and ovarian cancer - In developing countries infants not breastfed are 6-10 times more likely to die in the first months of life

o What were the campaign components? (GREEN)

- Healthy eating curriculum including food demonstrations and tastings, monthly newsletters, welcome kits, school wide poster contest, FV tastings, family based homework activities, food shopping and packing guide.

· Describe intervention and policy strategies for improving IYCF

- Implementation of the International code of marketing of breastmilk substitutes - Baby friendly hospital initiative: ten steps for hospitals to take to support mothers in breast feeding. Need additional programs such as prenatal counseling where home delivery is common - Advocacy and policy changes for prioritizing nutrition in medical, nursing, and health professional education and training - Community based promotion and support - Maternity legislation and workplace support: maternity leave, workplace policies to allow breastfeeding, pumping, and storage - Mass media campaigns to raise awareness

· Discuss how child obesity rates in the United States have changed over the past 50 years

- In the past 50 years obesity rates between the ages of 2-5 nearly tripled and they quadrupled for those between 6 and 11 and for those between 12 and 19

o Folate/folic acid (periconceptional period)

- Inadequate folate early in pregnancy is related to the development of about 50% of cases of neural tube defects such as spina bifida - Required for DNA replication, amino acid synthesis, and vitamin metabolism - Highly absorbable form of folate is vitamin B - FDA mandated fortification of refined grains in 1998 and rates of NTDs have decreased significantly - 400 mcg recommended per day

Discuss the major nutrition issues in developing countries:

- Inadequate sanitation is the largest nutrition problem in the world, affecting over 30% of the population - Infant mortality increases with malnutrition and could be reduced with more breastfeeding - Childhood undernutrtion is related to poverty, hunger and infectious diseases - Hidden hunger is micronutrient deficiencies such as vitamin A, iron, iodine, and folate

· List benefits of breastfeeding for infants and children, for mothers, and for society

- Infants and children: Optimal nutrition, strong bonding, safe, fresh milk, enhanced immune system, protection against allergies and intolerances, correct development of teeth and jaw, higher IQ and school performance - Mothers: Strong bonding with infant, increased energy expenditure, faster shrinkage of the uterus, reduced postpartum bleeding, improved bone density and decreased risk for hip fracture, increased self-esteem

· Explain the cycle of infection and malnutrition.

- Infection increases metabolic rate causing anorexia and acute-phase response. This causes a negative energy balance and protein catabolism which leads to wasting/malnutrition. - Malnutrition causes compromised barrier defenses and impaired cellular immunity, causing impaired humoral immunity which leads to increased risk and severity of infection.

Iodine Deficiency

- Iodine deficiency is the most common cause of brain damage, but it is easily preventable, and the prevalency has significantly decreased in the past 20 years (still affects about 30% of the population, parts of Africa and Asia) - Iodine deficiency can cause loss of pregnancy, stillbirth, congenital abnormalities, mental impairments, goiter

o Iron (periconceptional period)

- Iron deficiency prior to pregnancy increases risk that iron-deficiency anemia will occur during pregnancy and ingants will be born with low iron stores - Linked to pre-term delivery - Easier to build up iron stores before pregnancy than during pregnancy - Regular consumption of vitamin C rich foods alongside plant sources of iron, iron-fortified cereals, and lean meat is recommended

Iron Deficiency

- Iron is the most common nutrition deficiency in the world, with over 30% of the worlds population having anemia - Iron deficiency is caused by poor dietary diversity and limited consumption of animal proteins - Iron deficiency is exacerbated by infectious diseases such as malaria, HIV/AIDS, hookworms and tuberculosis - Iron deficiencies can cause poor pregnancy outcomes, maternal mortality, impaired physical and cognitive development, increases risk of morbidity in children and reduced work productivity in adults (economic impact)

· Describe how child diet and physical activity patterns in the US compare to federal recommendations, and suggest targets for intervention

- Low on whole grains, legumes, FV's, etc. but high in saturated fat, added sugar and sodium - D- for overall physical activity and sedentary behaviors, F for Active transportation, C- for organized sport participation, D for health related fitness, D+ for school, and B- for Community and built environment

List contributors to child obesity on both sides of the energy balance equation

- Low-cost energy dense foods, over consumption of SSB's, food advertising, media saturation, less sleep, large portions, FAFH, increase energy in. - Declines in PA, PE and recess cuts, changing the built environment, media saturation, and less sleep, decrease energy out.

o Why is food brought from home to school an important target for intervention? (GREEN)

- Meals from home tend to have poorer nutrition profiles than school meals. They are less likely to contain milk, FV's and more likely to contain SSB's, deserts, snacks, etc.

· Describe the guidelines for complementary feeding

- Meets nutritional needs and prevents deficiencies - Appropriate for developmental level - Consider appetite, taste, density, and nutrient absorption - Caregiver behaviors and childs interest - Priority to optimize breastfeeding - Addresses common gaps, hazards or pitfalls - Cultural adaptation for locally available foods and diets in each community or country

o Alcohol and fertility

- More than 1 drink/day may modestly decrease fecundability - Recommended that individuals not drink or limit it to 1 drink/day for women and 2 for men if conception is possible - No alcohol once conception occurs

· Discuss the characteristics of the WIC program in North Carolina

- More than 270,000 women, infants and children served each month - Family income must be less than 185% the US poverty line - Children must be recertified every year - Applications completed in person at local WIC agency - North Carolina has recently adopted the EBT system to replace paper vouchers

· Explain breastfeeding behavior in the context of the socio-ecological model (i.e. describe the many factors at each level that influence breastfeeding behaviors and suggest strategies to address these factors to promote breastfeeding)

- Mothers and their Families: educate fathers and grandmothers about breastfeeding. Encourage women to attend prenatal classes, etc. - Communities: Support groups, create campaigns, reinforce breastfeeding recommendations - Healthcare: Improve maternity care systems and eliminate gaps in continuity of care. Improve knowledge, develop lactation team and provide safe banked donor milk for fragile infants - Employment: Maternity leave, establish lactation support for employees, allow working mothers direct access to their babies, ensure child care providers support breastfeeding - Research and Surveillance: Increase funding of high quality research, monitor and track breastfeeding rates, policies, and environmental factors. - Public helath infrastructure: Approve national leadership on the promotion andsupport factors that affect breastfeeding (USBC, State Coalitions). The USBC= United States Breastfeeding Committee, nongovernmental organizations and liaisons from the federal government collaborate on joint initiatives in support of breastfeeding

How is WIC funded?

- Not an entitlement program (not guaranteed to everyone who is eligible) - Domestic discretionary program - Congress authorizes a specific amount of funds each year for the program and grants are provided to each state - Program authorized in the Child Nutrition and WIC Reauthorization Act

Overnutrition

- Overnutrtion is a form of malnutrition characterized by dietary intake above optimal levels

Explain the phenomenon of protein-energy malnutrition and describe the features and consequences of marasmus and kwashiorkor

- PEM results from insufficient food intake - When energy deficiency is quite severe, marasmus can result - When protein deficiency is quite severe and is combined with an existing infection, kwashiorkor can result - Primarily seen in children

· Explain the human and economic consequences of obesity throughout the life course

- Physical health: CVD, cancer, type 2 diabetes, hypertension, sleep apnea, gallbladder disease, etc. - Psychosocial: Stigma, negative stereotyping, discrimination, low self-esteem, negative body image, depression, etc. - Functional: Unemployment, disability, absenteeism from school/work, reduced productivity, reduced academic performance, etc.

· List the requirements for successful breastfeeding

- Physiological considerations: oxytocin and prolactin regulate supply, ecen malnourished mothers can breastfeed - Baby's mouth must be well attached - Production increases with demand - Demand breastfeeding: unrestricted or baby-led breastfeeding. On demand for as long as desired

Who WIC is for

- Pregnant women - Breastfeeding women who have had a baby in the last 12 months - Non-Breastfeeding postpartum women who have had a baby in the last 6 months - Infants up to first birthday - Children up to 5th birthday

· Categorical criteria

- Pregnant women through pregnancy and up to 6 weeks after birth or end of pregnancy - Breastfeeding women up to infants 1st birthday - Non-breastfeeding postpartum women up to 6 months after birth or end of pregnancy - Infants up to first birthday - Children up to 5th birthday

· Describe strategies and interventions to prevent childhood obesity in different settings

- School based efforts: increase PA during school day, improve school food and beverages, promote food literacy and nutrtition education and engage and support parents and educators - Home-based efforts: Improve quality of food in the home, reduce screen time, increase out of school PA, reduce FAFH - Community/policy efforts: Change the built environment, incorporate health/prevention into healthcare, and organizations, increase affordability of food and limit marketing to children, design and implement media campaigns

· Describe some of the reasons for pregnancy loss in the first 20 weeks of gestation

- Severe fetal defect - Maternal infection - Abnormality of the uterus - Endocrine or immunological disturbance - Unknown random events

Describe short- and long-term strategies to address undernutrition.

- Short term: Emergency food aid and supplementation - Long term: Increasing dietary diversity, fortification programs, behavioral approaches, addressing poverty, access to education, gender inequalities, livelihoods, and food systems

Stunting

- Stunting is low height for age - Stunting is failure to reach linear growth potential due to chronic undernutrition - For children under the age of 2 or three, low height for age reflects failing to grow or stunting - For older children low height for age reflects having failed to grow or being stunted as they tend to gain height in parallel to reference values - Stunting can lead to impaired brain development, lower IQ, weakened immune systems and a greater risk for chronic disease later in life.

· Identify organizations working to address global undernutrition.

- The SDG's have helped align global public health efforts to focus on the many factors that contribute to hunger and undernutrtion and address vulnerable populations

Describe the double burden of malnutrition

- The nutrition transition has led to a worldwide increase in overweight and obesity while undernutrition persists - In 2016 41 million children under 5 were overweight or obese and 155 million were chronically undernourished - In many developing nations childhood undernutrtion and adult overweight/obesity coexist in the same household - Undernutrtion early in life can predispose individuals to overweight/obesity and chronic diseases

o How did the project find a fresh way of communicating to children about nutrition? (GREEN)

- The success of the recycling movement hinted that kids care about protecting the environment so they came up with the idea to show kids that food that is good for the body tends to be good for the environment

· Explain how the WIC program encourages mothers to breastfeed

- Through nutrition education and counseling at WIC clinics that promote and support breastfeeding. Trained personal provide education and peer counselors provide mother-to-mother counseling. Breastfeeding aids such as breast pumps are given to participants and there are enhanced food packages for women who exclusively breastfeed

· Describe the features and consequences of marasmus

- To waste away - Severe energy deficiency - Typically occurs as an infant gradually starves to death - Marked by skin and bones appearance with little or no subcutaneous fat - Typically develops in infants who are not breastfed or stop early - Unsafe water can exacerbate the problem - Can affect brain development - Full recovery may never occur

· Explain how the Sustainable Development Goals aim to address global undernutrition.

- Top three goals are no poverty, zero hunger, and good health and well-being

· Explain the public health importance of infant and young child feeding

- USDA estimates that more than 3.6 billion could be saved if rates of breastfeeding were increased to recommended levels and this only represents savings from only ear infections, gastroenteritis, and NEC. If all women participating in WIC breastfed for one month 30 million dollars would be saved and an additional 48 million if 75% of WIC mothers breastfed for 3 months

Undernutrition

- Undernutrtion is a form of malnutrition characterized by dietary intake below optimal levels

· Share examples of referrals that might be provided through WIC

- WIC may refer to other health, welfare, and social services. - Immunizations - Substance abuse counseling/treatment - Childcare - Food assistance - Health care (Medicaid, etc.) - Financial assistance (TANF)

· Explain how WIC addresses a public health nutrition need in the United States

- WIC provides individuals with a specific package of healthy options to support certain foods such as FV's, whole grains etc.

Wasting

- Wasting is low weight for height (may be assessed with mid-upper arm circumference) - Wasting reflects a recent and severe process of weight loss, aka acute starvation - Wasting may be moderate or severe - Wasting is usually below 5% even in poor countries - A prevalence of wasting from 10-14% is serious and at or above 15% is critical - Wasting often peaks in the second year of life (post weaning) - Wasting leads to child mortality, increased susceptibility to infection, and poor growth and development

· Explain the value of using people-first language when discussing child obesity

- We are talking about people with a condition. By putting a disease first you are defining a person based off of that condition which can stigmatize them.

· Describe the evidence-based recommendations for child nutrition.

- Whole FV's: 2.5-5 cups per day, young children (1-6) should consume no more than 4-6 fluid ounces of 100% fruit juice per day - Grains: At least half should be whole - Protein 3-6.5 ounces per day - Dairy: 2.5-3 cups per day of fat-free, low fat milk and milk products or fortified soy beverages - Calories: ages 4-8 between 1200 and 2000 per day and between 9-13, 1400-2600 per day - Total fat: 25-35% of total calories - Saturated fat: less than 10% of total calories - Sugar: Less than 10% calories per day from added sugar - Sodium: 4-8 less than 1900mg/day, 9-13 less than 2200 mg/day

o Physical activity/exercise and fertility

- Young females that competitively compete athletically may experience delayed age of puberty or amenorrhea (average menarche delayed 2-4 years in some sports, especially those that require thinness) - Very high levels of exercise can interrupt menstruation (abnormal cycles in 23% if runners and 86% of bodybuilders) - Disruption to menstruation more commonly related to caloric deficits rather than intensity of exercise - Metabolic and hormonal status generally reverts to normal after high levels of training end

o What were the study outcomes? (GREEN)

Principals and teachers gave it an A, parents were engaged, students enjoyed the project, but out of 582 children there were no significant differences in the food from home that the children brought