Ch 9: Nutrition and Global Health

Nutritional Needs Throughout the Life Cycle​: Infancy and Young Childhood​

"Window of opportunity" is conception to 2 years of age​ Nutritional gaps during this time can cause problems with stature, mental development, and frequent infection​ Children need sufficient protein, energy, and fats as well as iodine, iron, vitamin A, and zinc​ Children grow best and stay healthiest if exclusively breastfed for first 6 months​ ​

Key Nutritional Needs​: Overweight and Obesity​

A balanced, healthy diet is crucial for the prevention of obesity and noncommunicable diseases​ Basic components to a healthy diet: vegetables, fruits, whole grains, legumes, and nuts, with limited amounts of red and processed meat​ Various dietary components are playing a large role in the growth of global obesity and overweight​

Nutritional Needs Throughout the Life Cycle​: Adolescence​

Adolescents need protein and energy to grow, as well as iron, iodine, folic acid, and calcium​ Adolescent girls who are poorly nourished are much more likely to give birth to an underweight child and experience complications during pregnancy than well-nourished girls​ Children who are stunted are generally unable to make up later for their hindered growth​

Nutritional Needs Throughout the Life Cycle : Adulthood and Old Age​

Adults need a well-balanced diet with protein, energy, and iron in order to stay productive​ Foods that contain too much fat, cholesterol, sugar, or salt can be harmful​ The ability of older people to live on their own can depend on their nutritional status​ Older adults need calcium to reduce risk of osteoporosis ​ ​

Nutritional State of the World: Deaths Associated with Undernutrition

An important risk factor for death from other causes including diarrhea, pneumonia, measles, and other communicable diseases​ About 45% of all deaths in children under 5 years worldwide are associated with nutritional deficits

Nutrition, Health, and Economic Development​: Overweight and Obesity​

Associated comorbidities have high medical costs that can trap poor households in cycles of debt and illness​ Affect worker productivity​ Affect mental health, especially harmful to the academic achievement of children and adolescents

Nutrition-specific interventions—those interventions that can have a direct impact on nutrition

Examples: promotion of exclusive breastfeeding, micronutrient supplementation, and food fortification

The enabling environment for nutrition—this concerns laws, policies, resources, and institutional issues that relate to the approach countries take to nutrition and how effective they are at formulating, implementing, and monitoring nutrition interventions​

Examples: taxing sweetened beverages or foods high in fat

Nutrition-sensitive interventions—those interventions that address the underlying determinants of malnutrition​

Examples: vaccination program or nutrition programs to enable farmers to increase the yield of crops that they consume

Addressing Future Nutrition Challenges: Undernutrition Young child deaths could be reduced by about 15% with a package of nutritional interventions for pregnant women that includes:

Folic acid supplementation or fortification ​ Balanced energy protein supplementation ​ Calcium supplementation

Nutrition, Health, and Economic Development: Poor nutrition

Impacts maternal health, which affects household income and health status and survival of children​ Affects children's ability to grow or achieve full intellectual capacity, impacting future prospects ​ Leads to lower productivity in adult workers​ Impacts life expectancy ​

The Determinants of Nutritional Status: Undernutrition: Immediate causes:

Inadequate dietary intake: weakens the body and opens it up to infection​ Illness: makes it harder for people to eat, absorb the nutrients they take in, and raises the need for some nutrients ​ This relationship creates a cycle of illness and infection​

Addressing Future Nutrition Challenges​: Overweight and Obesity​

International organizations can set global nutrition and physical activity standards​ Governments can promote campaigns and align national dietary goals with nutritional and agricultural policies​ Tax unhealthy foods​ Subsidize agricultural production of healthy foods Legislation can be used to restrict unhealthy food marketing aimed at children​ Schools can encourage healthy eating​ Adopt national physical activity guidelines and education campaigns​ Reduce television viewing and internet usage​ Improve safety of recreational spaces

Nutritional State of the World​

Low Birthweight​ Low birthweight: babies born under 2,500 grams

The Determinants of Nutritional Status​: Overweight and Obesity​

Most immediate cause is an increase in total energy intake coupled with a decrease in energy expenditure​ Genetic and cultural factors are important​ Rising global rate of obesity is being driven by global financial and trade liberalization, increased income and socioeconomic status, and urbanization

Addressing Future Nutrition Challenges: Undernutrition Package of interventions for pregnant women continued:

Multiple micronutrient fortification ​ Balanced energy protein supplementation​ Promotion of appropriate breastfeeding practices

Nutritional State of the World​: Overweight and Obesity​

Nearly 31% of the world's population, 2.3 billion people, are obese or overweight​ Obesity has nearly doubled worldwide since 1980​ Childhood obesity has emerged as one of the most serious public health challenges of the 21st century​ The U.S. has the highest proportion of the world's obese people (13%)​

The importance of nutrition

Nutritional status has a profound relationship with health status ​ Childhood underweight is the leading risk factor for death of under-5 children globally​ Forty-five percent of all deaths in children under 5 are attributable to nutrition-related causes​ Low-cost, highly effective interventions are available to improve nutrition status ​ The nutritional picture of the world has changed dramatically in the last few decades​ Nearly 31% of the world's population is overweight or obese; most of these people are in low- and middle-income countries​ Overweight and obesity are closely linked with many noncommunicable diseases, and prevention is complex​ Nutrition is central to achievement of the SDGs​

Addressing Future Nutrition Challenges​

Policy makers need to understand the exceptional importance of nutrition to good health and human productivity and act accordingly​ Governments need to work with the food industry to improve the way in which foods are fortified and to be sure that processed foods are healthy​ Further research on what works​ Create partnerships of civil society, government, and the private sector

Root Causes of Hunger and Undernutrition​

Poverty​ Deprivation​ Social inequality​ Lack of education​ Population growth​ Government ​failures/disinterest​ - one in five people in developing world are chronically hungry

Nutritional Needs Throughout the Life Cycle​: Pregnancy and Birthweight ​

Pregnant women need a sufficient amount of protein and energy and should consume 300 more calories a day​ Iron, iodine, folate, zinc, and calcium are also important to the health of the woman and child​ The birthweight of a baby is an extremely important determinant of the extent to which a child will thrive and become a healthy adult

Addressing Future Nutrition Challenges: Undernutrition Introduce packaged nutritional interventions, including:

Supplementation with vitamin A and zinc for children aged 6 to 59 months​ Appropriate management of moderate acute malnutrition ​ Appropriate management of severe acute malnutrition ​ Exclusive breastfeeding​ Hygienic introduction of complementary foods​ --Highly cost-effective: cost per DALY averted of about $179​ ​

Nutritional State of the World: Undernutrition

The rate of underweight in children younger than 5 years of age in low- and middle-income countries fell from about 28% in 1990 to about 14% in 2016​ Still - about 155 million are stunted, and more than 50 million are wasted​

Key Nutritional Needs​: The Needs of Young Children and Pregnant Women

Undernourishment raises the risk of illness, associated with decreased linear growth and decreased intellectual capacity​ Malnourished children who rapidly gain weight are at high risk of nutrition-related chronic diseases as adults ​ Undernourished women have greatly increased risks of dying of pregnancy-related causes​

Key nutritional needs

Vitamin A​ Iodine​ Iron​ Zinc​ Folic Acid and Calcium​ Avoid excess Fat, Sodium, and Sugar​ Get more Dietary Fiber and Refined Carbohydrates

Key Points

Why is nutrition important undernutrition overweight/obesity solutions

SSB Taxes​

https://www.youtube.com/watch?v=DQQXtqQfMf8​ Recommended by the WHO

Why Important

https://www.youtube.com/watch?v=T0-B9HfaZW8

Why Breastfeeding is Important?​

https://www.youtube.com/watch?v=Wd-mtl3F0p4

The Vicious Cycle of Undernutrition

illness -> severe undernutrition -> lack of food -> infection: malaria, rotavirus, ARI, Measles, Diarrhea in the middle of the cycle: poverty

wasted stunted and wasted impact

wasted: thinner than a boy of the same age stunted and wasted: sometime later, the same child is now shorter as well as thinner. Inadequate height for a particular age is described as stunting Impact: excess infection, excess mortality, decreased activity, delayed development, poor school performance