Community Nutrition Exam ch 10-14

USDHHS 2015 Poverty-level income

$24,250 annually for a family of four

People-Centered Development

-Development enables people to meet their essential needs - cannot be measured by gross national product or quantity of the community harvest -Development should serve the people -Requires ongoing community involvement and participation in project development and implementation

Healthy Eating Index (HEI) findings

-Dietary quality of most children aged 2-17 is less than optimal -Consumption of dairy products and protein foods were closest to standards -Consumption of dark green vegetables and beans were farthest from recommendations

Improving Nutrition in the Childcare setting: Child and Adult Care Food Program (CACFP)

-Ensures nutritious meals and snacks are served to low-income children in qualifying daycare facilities -provides reimbursement -federally funded through the U.S. department of agriculture

Impact of Child Nutrition Programs on Children's Diets: School Meal Programs

-Participation resulted in a positive effect on consumption of milk, fruits, vegetables, and some vitamins and minerals -some evidence that schools meals contributed too much fat in menu items -in 1995, a final rule directed schools to upgrade nutritional value of their meals

Breastfeeding Recommendations: Benefits

-Promotes emotional bonding -Helps protect against infection- antibodies and white cells; bifidus factor; lactoferrin -protects against allergy development -favors normal tooth and jaw alignment-suckling -decreases obesity risk-infants less likely to be overfed -provides convenience and lower cost

Nutrition and Development

-The United Nations views a healthful, nutritious diet as a basic human right. -Nutrition and health are now seen as tools of economic development as well as goals.

Building Healthful School Environments

-actions for creating healthful school environments -provide age-appropriate nutrition and health education -adopt policies that require Dietary Guidelines for Americans compliance -Provide food options that are low in solid fat, calories, and added sugars -ensure healthy snacks and foods are provided -prohibit or restrict access to vending machines that compete with healthy school meals -provide adequate time for students to eat school meals

Childhood Obesity and early development of chronic diseases

-associated with hyperinsulinemia, hypertriglyceridemia, and reduced HDL-cholesterol -Increased risk of cardiovascular disease, type two diabetes, sleep apnea, gallbladder disease, psychosocial dysfunction, and orthopedic problems

Americans are living linger than ever before... -average age at death -life expectancy -max life span

-average age of death has changed dramtically (78.8 years) (changed about 30 year difference) life expectancy White women = 81.4 yrs. Black women = 78.4 yrs. White men = 76.7 yrs. Black men = 72.3 yrs. mac life span had changed very little (max age where people die)

more HEI findings

-children of all ages, races, and ethnic groups were sown to be at risk of inadequate intakes of folate, calcium, magnesium, and vitamin A, C, D and E -Iron is under-consumed by adolscent females -Beverage choices for all ages changed from whole milk to lower-fat milk, soft drinks, and fruits and fruit-flavored drinks -portion sizes have increased (soft drinks and hamburgers)

cost effective interventions to reduce malnutrition examples:

-improved maternal nutriton -improved breastfeeding -micronutrient and deworming interventions -complementary and therapeutic feeding interventions

Some WIC foods

-iron-fortified infant formula -infant cereal -iron-fortified breakfast cereal -Vitamin C risk fruit or vegetable juice -Eggs -Milk -Cheese -Peanut butter -Dried beans and peas -Canned fish -Fruits and Vegetables

Breastfeeding Barriers

-lack of knowledge or experience of how best to support mothers and babies -not enough opportunities to communicate with other breastfeeding mothers -lack of up-to-date instruction and information from health care professionals -non-supportive hospital practices -lack of work place accommodation

Nutrition security requires access to

-nutritious foods and potable drinking water -knowledge, resources, and skills for healthy living -prevention, treatment, and care for diseases affecting nutrition status -safety-net systems during crisis situations

Commodity Distribution Program -purposes

-program purchases US produced food with funds from congress and price supports -coordinated their distribution to public and nonprofit private schools that provide meals to students -includes fruits, vegetables, meats, dairy, grains, and cereals

Specific nutrition-related problem among children and adolescents

-undernutrition -iron-deficiency and iron-deficiencyanemia -blood lead level -dental caries -high blood cholesterol -eating disorders

Nutrition Assessment in Pregnancy 3 categories of nutrition assessment and monitoring during pregnancy

1. Preconception care 2. The initial prenatal visit 3. subsequent prenatal visits

Evaluation of Nutritional Status... -who in hospitals may be suffering from malnutrtion -who have difficulty performing one of more actives of daily living (ADLs)

1/4 older adults and 1/2 all patients 45% -reliance on others places a person at nutritional risk

U.S. Poverty Rates

14.5% of people live in poverty 20% of children under the age of 18 live in poverty

Anthropometric Measures in Infancy

Assessment of physical size and growth length, weight, and head circumference are typical measurements Head circumference measures can help detect protein-energy malnutrition (PEM) Growth charts are used to analyze measures of growth status in infants Can assess obesity or failure to thrive

Obesity and Overweight percentile

BMI of the 95th percentile on CDC growth chart is Obese BMI at or above the 85th percentile but below 95th percentile on CDC growth chart

Healthy Babies: Adequate nutrition is critical to support rapid growth and development

Birthweight doubles first four to six months and triples by the end of the first year

The initial prenatal visit

Dietary Measures Clinical Measures Anthropometric Measures Laboratory Values

Each person ages at a different rate sometimes ____ age is different for _____

Each person ages at a different rate Sometimes making chronological age different from biological age

Sustainable Development

Environmental concerns include: -Accelerated soil erosion -The need for crop rotation -Management of agricultural resources Development that meets present needs without compromising ability of future generations to meet needs

Early Head Start Program

Expands benefits to low-income families with children under age three and to pregnant women

GOBI-UNICEF

GOBI - UNICEF's Child Survival campaign G-Growth monitoring O-Oral rehydration therapy B-Breastfeeding promotion -Breastfeeding versus formula feeding -Baby-friendly initiatives -Timely and appropriate complementary feeding I-Immunizations

Agricultural Technology

Governments can learn from recent history the importance of developing local agricultural technology -The Green Revolution -Labor-intensive, rather than energy intensive, agricultural methods -Biotechnology and genetically modified food may help mitigate problems of malnutrition

Poverty

Having too little money to meet minimum needs for food, clothing, and shelter

U.S department of health and human services' nutrition programs

Head Start and Early Head Start program

Healthy Mothers National Academy of Sciences Recommendations for Maternal Weight Gain

Healthy (18.5-24.9) pre-pergancy weight 25-35 pounds Underweight (BMI less than 18.5) prior to pregnancy 28-40 pounds Overweight (BMI 25-29.9) prior to pregnancy 15-25 pounds Obese (BMI over 30) prior to pregnancy 11-20 pounds Twins 35-45 pounds Triplets 45-55 pounds

Weighing In on the Problem of Childhood Obesity: lack of good nutrition..... in the past two decades...

Lack of good nutrition habits and physical inactivity led to an epidemic of overweight children and adolescents in the past two decades... -percentage of overweight children has nearly doubled -percentage of overweight adolescents has nearly tripled

Feeding America food banks, food pantries, and soup kitchens prepared and perishable food programs (PPFP)

Largest supplier of surplus food

Scaling Up Nutrition (SUN)

Main elements of the SUN framework for action -Develop individual country nutrition strategies and programs -Scale up evidence-based interventions -Use a multisectoral approach -Provide substantially scaled-up domestic and external aid

Overpopulation

Major factors affecting population growth Birth rates, death rates and standards of living World's population continues to grow Threatens capacity to produce adequate food

Healthy People 2010 Progress for Maternal and Infant Health Still Needs Improvement

No progress or reverse direction Maternal death for African-American women Iron deficiency in women aged 12-49 years Low birth weight

Infant Mortality Rate (IMR)

Number of US infant deaths under one year of age per 1000 births=6

Mini Nutrition Assessment (MNA)

Nutrition screening -developed by the Academy of Nutrition and Dietetics, American Academy of Family Physicians, and National Council on Aging -developed simplified assessment tools such as the mini nutritional assessment (MNA)

Preconception care

Nutritional assessment Nutritional Counseling Appropriate Supplementation Referral to correct any existing nutritional problems

Subsequent prenatal visits

Ongoing monitoring, screening, assessment and referral

Other Recommendations on Feeding Infants

Plain milk not recommended during first year of life -breast milk or iron-fortified formula during first six month -begin adding solid foods at six months Special formulas are available for infants with special problems -soy-based-formulas-allergies to milk protein -formulas with lactose removed-lactose intolerance

The Millennium Development Goals set targets for progress in eight areas:

Poverty and hunger Primary education Women's equality Child mortality Maternal health Disease Environment A global partnership for development

Adolescent Pregnancy

Pregnant adolescents are nutritionally at risk and require intervention early and throughout pregnancy Risks include hypertension, iron-defeinceint anemia, premature birth, still birth, LBW infants, and prolonged labor Mothers under 15 bear more babies who die within the first year than do any other age group

HealthyPeople 2020 National Nutrition Objectives

Priority health-related areas for children and adolescents: -Physical activity and fitness -Nutrition -Dental health Health People 2020 includes separate targets for fruits, vegetables, whole grains consumption

Keeping Children and Adolescents Healthy

Programs and services designed to keep children and adolescents healthy -lasting effect on the nations public health -lead to healthy communities Successful, effective programs -recognize early twenty-first century stresses and mixed media messages -work when they are fun and informative

School Breakfast Program -Purposes -Eligibility

Purposes-assists states in providing a nutritious breakfast for students high school grades and under Eligibility-same as for national school lunch program

Summer Food Service Program -purposes -eligibility

Purposes-provide food for free for low-income children during summers and other designated times when schools are closed eligibility-homeless children -children attending public or private nonprofit schools -youth participating in the national youth sports program

Nutrient Needs and Growth Status in Infancy

Rapid growth and metabolism require adequate supply of all essential nutrients Relative to body weight, infants need more than twice as much of many nutrients as adults Growth rate begins to slow down after six months However some energy saved by slower growth is spent on increased activity

Healthy Babies: Growth of infants

Reflects nutritional well-being A major indicator of nutritional status

Resource Distribution

Resources are distributed unequally between rich and poor within nations and between nations -Developing nations must be allowed to increase their agricultural productivity by gaining access to five resources simultaneously: land capital water technology knowledge

SNAP (Supplemental Nutrition Assistance program)

SNAP improves the diet of low-income households by increasing their food purchasing ability Entitlement program: anyone who meets eligibility standards is entitled to receive benefits Problems: insufficient allotments to last the entire month and meet the nutritional needs of the family; and may not purchase the most nutritious foods

Break down the resolution of global food security into small, local problems where success can be achieved -The World Health Assembly -The World Health Organization

The World Health Assembly -Endorsed a comprehensive plan for improving maternal, infant, and young child health -Global nutrition targets to meet by 2025 The World Health Organization -Has produced a series of policy briefs, linked to each of the global nutrition targets -Guide policymakers regarding strategies necessary to achieve the nutrition targets

Making the World Fit for Children UNICEF

UNICEF World Summit for Children -Overall goal of ending child deaths and malnutrition broken down into specific targets including: -A 50% reduction in the levels of moderate to severe malnutrition among children under five years old -A 50% reduction in the levels of low-birthweight infants -The virtual elimination of blindness and other consequences of vitamin A deficiency

Micronutrient deficiencies of worldwide concern

Vitamin A Iron Iodine Zinc

Focus on Women

Women with their children represent the majority of those living in poverty -Development projects frequently overlook women's needs -Women play a vital role in the well-being of their nation's people

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

addressing special nutritional needs of women and their young children

Eligibility

all students attending schools where lunch program is operating free lunch to students with household incomes below 130% of the federal poverty line reduced price lunch to students with household incomes between 103% and 185% of poverty line

U.S. Department of Agriculture Food Assistance Programs

array of programs targeted at different populations with different nutrition needs provides needy individuals access to a more nutritious diet improve eating habits of children provide an outlet and distribution for farmers food products

Food insecurity:problem of poverty

available but not accessible decline in living standards poverty leads to unsafe drinking water poverty is much more than economic condition

Polypharmacy use of multiple drugs is problematic for many older adults because

average older person often takes three or more drugs at a time

Leading causes of death among US infants

birth defects preterm delivery low birth weights SIDS maternal complications of pregnancy

Lifestyle

convenience and peer pressure

Older adults face the choose of choosing a nutrient dense diet because..

dec caloric needs inc certain nutrients

aging involves...

decline in functional capacity for almost every organ system after age 35 changes in absorption of nutrietns increase risks and conditions impact of genetic and environmental factors

Economic burden of malnutrition and hunger -direct costs -indirect costs

direct costs-health related expenses indirect costs- lost productivity and income, stunted physical and mental development, reduced lifetime earnings, etc.

Media and Advertising

directed toward children

Global food insecurity is more extreme than hunger is a product of....

domestic food insecirty most people find it hard to imagine the severity of poverty in the developing world Hunger is a product of poverty resulting from the ways in which governments and businesses manage national and international economics.

The WIC program

federally funded by administered by the states the program plays both a remedial and preventative role -provides monthly checks or vouchers for foods -offers nutrition education and counseling -gives screening and referrals to health care services WIC works -one of the most efficient programs undertaken by the federal government

Individual influences

food choices not made based on health impact

Successful nutrition education projects

fresh fruit and vegetable program expanded food and nutrition education program (EFNEP) Team Nutrition Coordinated School Health Program (CHSP)

Food allergies causes

genetics is the most significant factor in susceptibility -food allergies less prevalent in breastfed infants introduce foods singly to facilitate prompt detection

Social Influences

growing independence from parents with more eating out

what can retard the aging process?

healthy diet exercise work and recreational environments

International Trade and Debt

high import costs and low export profits push a developing country into accelerating international debt that sometimes leads to bankruptcy debt and trade are closely related to the progress a country can make toward achieving adequate diets for its people

Effects of malnutrition on those most valuable:

inadequate weight gain during pregnancy low birthweight; stunted children higher infant and under fire mortality rate (U5MR)

some two billion people are deficient in one of more of threee major micronutrients

iron iodine vitamin A (4th zinc)

food insecurity

limited or uncertain ability to acquire or consume an adequate quality or sufficient quantity of food in socially acceptable ways (e.g., not knowing where one's next meal if coming from)

Physical Environment Influences

low-cost, quick-serve restaurants, snacks from convenience stores

most important goal of health promotion and disease prevention is

maintaining health and functional independence

Purposes

makes lunch available to students of high school grade and under encourages the consumption of nutritious agricultural commodities

Low birthweight (LBW)

more likely to experience complications during delivery increased risk for physical and mental birth defects increased risk of contracting diseases more likely to die during the first year of life

Protein energy malnutrition (PEM)

most widespread form of malnutrition

Multinational Corporations

multinational corporations hire indigenous people for low-wages to grow crops to be exported for profit -leaves little farm land for local farmers -Some multinational corporations also contribute to hunger through marketing unhealthy/unnecessary products Nutritional status suffers when tight budgets are pinched by the purchase of goods associated with prosperity

worldwide malnutrition and health:

nearly 23% of the worlds population experiences some form of malnutrition more than 146 million children (1/4) in developing countries suffer from malnutrition

optimal nutrition can _______ up to ____ but cannot _____

optimal nutrition can help to prolong life up to the maximum lifespan - but cannot extend it further.

Who are the food-insecure in the U.S

poor working poor young ethnic minorities older adults inner-city and rural dwellers certain states many farmers homeless

National School Lunch Program

programs addressing special nutritional needs of children National School Lunch Program (NSLP) School Breakfast Program (SBP) After school snack program special milk program (SMP) Summer Food Service Program (SFSP) for Children Child and Adult Care Food Program (CACFP)

Head Start Project

provide meals and snacks as well as nutrition assessment and education for children and their parents

Nutrition Education in Schools

purpose is to provide improved eating patterns among children schools are an ideal setting for nutrition education for the following reasons: -more than 95% of all children and adolescents are enrolled in school -more than 50% eat at least one of three meals at school -professionally prepared teachers and staff can provide nutrition education that teaches students to resist social pressure for unhealthful eating

After school snack program -purposes -eligibility

purposes-provides healthful snacks to children in school-based after-school programs eligibility-sites qualify to serve all children free based on the percentage of children receiving free and reduced-brie meals at school

Colonialism

removal of raw materials for industrial use fertile farmland was taken over for cash crops; used to grow cotton, sesame, sugar, cocoa, coffee, tea, tobacco, and livestock for export

Marasmus

severe emaciation from energy deficiency with chronic wasting of fat, muscle, and other tissues:starvation

Kwashiorkor

severe malnutrition caused by inadequate protein and alcoves leading to apathy. anemia, loss of body proteins, and poor growth

Healthy People 2010 Progress for Maternal and Infant Health Improvement has occurred in several areas:

small decline infant mortality rates for Hispanics, Whites, and Blacks Incidence of spinal bifida and other neutral tube defects has decreased increase in breastfeeding by women in all racial and ethnic groups continued decline in smoking during pregnancy

Poverty guidelines

sometimes called poverty lines or federal poverty level used for administrative purposes such as determining eligibility for federal assistance programs such as SNAP government programs are not required to use the official poverty line revised each year by the USDHHS

Key programs

together accounted for 96% of all 2014 federal expenditures for food assistance

Causes of hunger and Food Insecurity are many and interrelated

unemployment (most frequently mentioned) poverty (most compelling single reason) low wages high housing and health care costs

Iron deficiency causes

use of cow's milk earlier than recommended breast feeding after six months without iron supplementation

Older adults (65+)

will nearly double by 2040 to more than 82.3 million tend to consume large amount of total health care and long term care resources