3 community nutrition exam
Problem:
"substantial discrepancy between what is and what should be"
What are the Dietary Guidelines for Americans (Briefly describe)
*Were developed to promote health and reduce chronic disease risks *Includes basic guidelines for healthy eating *Must be revised every 5 years; newest revision 2010
Briefly describe the Process of Policy Making (Figure 6-1) Which phase starts at a grassroots level and what is interesting about this part? How can you build interest in policy agenda as a nutritionist?
1. problem definition and agenda setting 2. formulation of alternatives 3. policy adoption 4. policy implementation 5. policy evaluation 6. policy termination or redefinition of the public policy The phase that starts at the grassroots level is the policy formulation of alternatives, the interesting part about this phase is that A nutritionist can build interest in policy agenda by making your opinion known, writing a letter to the editor of a newspaper, become directly involved in the political process, join an interest group, lobbing to influence the political process, and to join a coalition or network.
definition of LBW
A birth weight of 5 pounds (2500 grams) or less, used as a predictor of poor health in the newborn and as a probable indicator of poor nutritional status of the mother during and or before pregnancy. Very low birth weight is defined as less than 1500 grams, or 3 pounds 4 ounces.
What are the Demographic Trends and Aging. What is a major concern of the Policy makers ?
4% in 1900, 12.4% in 2000 were over 65 ; by 2030 20% will have reached age 65. Policy makers' concern: meeting the health needs of older adults, challenging political, retirement, and social service system.
National Nutrition Policy:
A set of nation wide guidelines that specify how the nutritional needs of the population will be met. Nationwide guidelines which specify meeting nutritional needs of people Address issues of: hunger malnutrition food safety food labeling and menu labeling food fortification sustainable agricultural practices nutrition research
HEI: Healthy Eating Index
A summary measure of the quality of ones diet. The HEI provides an overall picture of how well one's diet conforms to the Dietary Guidelines for Americans. The index factors in such dietary practices as consumption of whole fruits, dark green and orange vegetables, whole grains, milk, meat and beans, oils, saturated fat, sodium, and the calories from solid fats and added sugars in the diet.
Metabolic Syndrome:
A syndrome associated with development of type 2 diabetes and cardiovascular disease and is defined by abnormal values of three or more of the following indicators; waist circumference- Men: > 40 inches Women: >35 inches serum triglycerides- fasting blood triglycerides greater than or equal to 150 mg/dL HDL - cholesterol- Blood HDL cholesterol: Men < 40 mg/dL Women < 50 mg/dL blood glucose- fasting blood glucose greater than or equal to 110 mg/dL blood pressure- greater than or equal to 130/85 mm Hg
Breastfeeding Recommendations
Benefits • Helps protect against infection • Protects against allergy development • Favors normal tooth and jaw alignment • Breastfed babies are less likely to be obese • Convenience and lower cost Breastfeeding Recommendations Healthy People 2020 goals: • Incidence of breastfeeding at 82% early postpartum • 60% at 6 months • 34% at one year
BMI for Under-weight/Healthy-weight/Over-weight: BMI = weight in kg / height in m2
Body Mass Index - An index of a persons weight in relation to height that correlates with total body fat content. Underweight - < 18.5 Healthy weight - 18.5 - 24.9 Overweight - 25 - 29.9 Obese 1 - 30 - 34.9 Obese 2 - 35 - 39.9 Obese 3 - equal to or greater than 40
List some of the diseases or conditions with aging and their effects on nutritional status (Table 13-4)
Cancer- weight loss, loss of appetite, Dental and oral disease- may alter the ability to chew or swallow, Diabetes- increased risk of other diet related diseases.
Central Adiposity: Central obesity:
Characterized by an "apple-shaped" body with large fat stores around the abdomen; a strong risk factor for type 2 diabetes, heart disease, and other problems. Central fat is also known as android fat to distinguish it from fat deposition on thighs and hips.
Problems with obesity for children and adults (Table 8-3)
Children - accidents, complication with surgical procedures, decreased quality of life, depression, difficulties with pubertal development, gallbladder and liver diseases, high blood cholesterol levels, hormonal imbalances, hypertension, injury to weight bearing joints, kidney abnormalities, metabolic syndrome, poor self esteem, respiratory problems, sleep disturbances, type 2 diabetes. Adults - abdominal hernias, accidents, certain cancers; colon, rectum, prostate, breast, uterus, cervical, ovarian, complication during pregnancy, complication with surgical procedures, decreased longevity, decreased quality of life, depression, fertility problems, gallbladder and liver diseases, gout, heart disease, high blood cholesterol levels, hormonal imbalance, hypertension, injury to weight to weight bearing joints, kidney abnormalities, metabolic syndrome, osteoarthritis, poor self esteem, respiratory problem, sleep disturbances, type 2 diabetes, varicose veins.
Briefly describe the following and state who sets the standards for each: DRI's Dietary Recommendations of other countries and Groups (FAO/WHO) BRFSS (provide the actual name) & YRBS and describe the focus areas of each
DRIs - Dietary Reference Intakes - *Developed to be used in planning and assessing the diets of individuals and groups *Are major shift from prevention of nutrient deficiencies to prevention of chronic disease *Include change in role of dietary supplements in achieving good health *Include three values in addition to the RDAs: Estimated Average Requirement, Adequate intake, and Tolerable Upper Intake Level --------- set the standards for the DRI levels
Review Table 7-10 The Connection between Policy tools and Policy decisions. Be Familiar with the DRIs and the Dietary Guidelines for Americans (decision, tool, and source)
DRIs - source of policy tool -Food and Nutrition Board of the National Academy of Sciences - decision - Program segment on osteoporosis should include recommendation for obtaining calcium from food, including fortified foods and dietary supplements. -decision - Program segment on dietary fats should include information about omega-3 fatty acids and alpha-linolenic acid. Dietary Guidelines for Americans - source of policy tool - U.S. Department of Agriculture: U.S. Department of Health and Human Services - decision- Program should include discussion of healthful eating patterns.
At a federal level, which two departments are important to public Health in the U.S.? Briefly describe these two Organizations (Hint: Figures 6-2, 6-3)
Department of Health and Human Services and the U.S. Department of Agriculture are important to public health. Department of Health and Human Services - the mission of the DHHS is to protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves. U.S. Department of Agriculture -the mission of the USDA's food nutrition and consumer services is to ensure access to nutritious, wholesome foods, and healthful diets for all Americans.
What are Children and Adolescents eating according to the HEI?
Dietary quality decreases from childhood to adolescence-decreased consumption of fruits and increased intake of sodium and extra calories (solid fats, added sugars). All children were shown to be at risk of inadequate intakes of magnesium, zinc, vitamins A and E. A majority of children consume soda, and other sugar-sweetened beverages. Primary energy source for children and youth come from high consumption of grain products-high in calories, saturated fat and sodium, low in fiber.
Be familiar with the Older American's Nutrition Program and what it provides.
Administration on Aging (AoA) administers - Older Americans Nutrition Program (OANP) 1972 includes:S 1) Congregate Nutrition Services Program, 2) Home Delivered Nutrition Service Program, 3) Nutrition Service Incentive Program (NSIP)
What are some of the Primary Nutrition Related Problems of the Aging (Table 13-3)?
After age 35 functional capacity declines in almost every organ system. Oral problems interfere with nutrient intake, gi tract problems- problems with digestion, cardiovascular functions and changes in the renal and musculoskeletal systems.
Describe the Healthy Hungry Kids Act 2010
Authorizes funding and sets new policy for the USDA child nutrition programs. Allows USDA to reform nutrition standards of school lunch and breakfast programs. Based on recommendations from 2009 IOM report school meals: Building Blocks for Healthy Children to enhance diet and health of school children and decrease childhood obesity. New 2012 NTR standards: NSLP and SBP with 2010 Dietary Guidelines for Americans. Requires increase availability of fruits, veg, whole grains, low-fat milk, decrease na, and saturated fat, help meet NTR needs with calorie requirements. Proper portion sizes.
Maternal Weight Gain Table 11-4 Know These & Review Points to consider for optimal weight gain (Table 11-4)
BMI < 18.5, underweight, Recommended Gain(lb) 28-40 BMI 18.5-24.9, Normal weight Recommended Gain(lb) 25-35 BMI 25.0-29.9, overweight Recommended Gain(lb) 15-25 BMI ≥ 30.0, obesity Recommended Gain(lb) 11-20 Points to consider: If weight gain is slow or if weight loss occurs; -measurement or recording error? -overall pattern acceptable? -evidence of edema? resolved? -nausea, vomiting, or diarrhea? -problem with access to food? -psychosocial problems led to poor appetite? -resist weight gain? understand the relationship between her weight gain and her infant's growth and health? -smoking? how much? -using alcohol or drugs? -energy expenditure exceed her energy intake? -have infection or illness that require treatment? if weight gain is very rapid; -measurement or recording error? -overall pattern acceptable? -evidence of edema? -stopped smoking recently? -twin possibility? -signs of gestational diabetes? -dramatic decrease in physical activity? -if serious overeating is occurring, explore why.
List and Briefly Explain the determinants of Obesity
Genetic Risk Factors Predisposition to obesity caused by interaction of at least 250 genes Genes related to lipid and lipoprotein metabolism Expression of genes influenced by behavioral risk factors psychosocial risk factors - stress, depression Psychosocial Risk Factors Childhood depression associated with increased BMI in adulthood Adults may eat high-fat, high-carbohydrate comfort foods to counter body's response to stress People are more likely to be obese if family and friends are behavioral/lifestyle risk factors -dietary intake, physical activity. Behavioral/Lifestyle Risk Factors Dietary intake - increased consumption of refined grains, added fats, sugars, energy density Physical activity - neither children or adults meet recommended physical activity levels Other lifestyle behaviors - sedentary activities, meal frequency, inadequate sleep
Nutrition Education in the Public Sector: What can the nutritionist use to combat obesity? Why are/are not schools an ideal setting for nutrition education?
Goal is to improve eating patterns among children. Govt and commercial sites on Internet provide databases of Ed materials and resources. Ex: interactive games and puzzles for children. Nutritionist: build on understanding of problem, put policies and practices into effect that target individual behavior and environment, bring interested stakeholders together to increase funding for research, create solutions for prevention of overwt, obesity. -More than 95% children and adolescents enrolled in school, more than 50% eat at least 1 of 3 meals at school, professionally prepared teachers and staff can provide NTR edu that teaches students to resist social pressures for unhealthy eating.
What influences child and adolescent eating patterns and behaviors?
Growing independence from parents, eating away from home, concern with physical appearance and body weight, the need for peer acceptance, advertising, television viewing, and busy schedules.
Compare and Contrast Life Expectancy in the U.S.
In 1900 a person was expected to live to 47 as oppose in 2008 one is expected to live 77.8 years. Women expect to live from 76.8-80.6 as oppose to men which are expected to live 70.2-75.7.
Baby Boomers—Define the age by calendar years & list three characteristics of this target market
In 2010 40 million people were 65 and older which accounted for 14 percent of the population. It is projected to rise to 20 percent by 2030. Minority groups are projected to increase in percent and non Hispanic white only groups will be decreasing in percent in relation to the 65 years of age and older.
Feeding recommendations for infants (Table 11-7)
Infant Feeding • Whole cow's milk not recommended during first year of life • Breast milk or iron-fortified formula during first six months • Begin adding solid foods at six months. First foods for the infants- 4-6 months : iron-fortified rice cereal followed by other cereals; pureed fruits and vegetables. 6-8 months : mashed vegetables and fruits, infant breads and crackers, unsweetened fruit juices. 8-10 months : protein foods, toast, teething crackers, soft-cooked vegetables, fruit. 10-12 months : whole egg, whole milk (at 1 year)
IMR:
Infant Mortality Rate (IMR) -Number of liveborn infants who die within first year of life per 1000 births -Used as indicator of health status and quality of life of populations
Infant mortality rate is one of the best indicators of ________
Infant mortality rate is one of the best indicators of__ a nations health.
Common nutritional problems in infancy
Iron deficiency and food allergies are two of the most significant nutrition related problems of infants.
What is one of the best indicators of a Nation's Health?
IMR - infant mortality rate
LBW:
Low birthweight (LBW) -A birthweight of 5 lb (2,500g) or less, used as a predictor of poor health in the newborn and as a probable indicator of poor nutritional status of the mother during and/or before pregnancy.
Healthy People 2020 Progress Review Define the following objectives: MICH-1.3 MICH-8 MICH 11 NWS-21
MICH-1.3: Reduce the rate of all infant deaths within first year of life. MICH-8: Reduce LBW and VLBW. MICH 11: Increase abstinence from alcohol, cigarettes, and illicit drugs among pregnant women. NWS-21: Reduce iron deficiency among young children and females of childbearing age.
Toxic Environment:
Modern eating and exercise environment that contributes to obesity; includes the wide availability of food and technological innovations that contribute to increases in sedentary activity and decreases in physical activity.
Chapter 11
Mothers and Infants
Describe Continuous NHANES (and provide the actual name): What are some of the health and laboratory measurements they use?
National Health and Nutrition Examination Survey (NHANES) *Representative sample of civilian non-institutionalized *population ages 2 months and older *Dietary intake (one 24-hour recall) *Body composition *Biochemical analyses of blood and urine *Bone density *Dietary and health behaviors *Collects data at household, family, and individual level
NNMRRP (Provide the actual name and tell which government departments implement and coordinate their activities):
National Nutrition Monitoring and Related Research Program (NNMRRP) USDA and the DHHS would jointly implement and coordinate the activities of the NNMRRP.
Describe the current diet of children and adolescents in 1 word; or in 4 words. Use data trends in your textbook:
Needs improvement. Convenience. Poor diet consisting of grain products, foods high in fat, sodium, and added sugars.
what does the NSI do for seniors -
Nutrition Services Incentive Program (NSIP, OAA Section 311) The Nutrition Services Incentive Program (NSIP) provides grants to states, territories and eligible tribal organizations to support the Congregate and Home-Delivered Nutrition Programs by providing an incentive to serve more meals. States, territories and eligible tribal organizations can choose to receive their grant as cash, commodities (food) or a combination of cash and commodities. For more information on the Nutrition Services Incentive Program, see Older Americans Act Section 311.
Weight Classifications in Children:
Obesity - BMI for age, equal to or greater than 95th percentile Over-weight - BMI for age, equal to or greater than 85th to 95th percentile.
What are some obesity and treatment options for adults and children What is the policy statement updated in 2007 of recommendations by the IOM and the AAP state? Healthy People 2020 - objectives addressing overweight and obesity American Academy of Pediatrics and Institute of Medicine - recommend BMI tracking of children and adolescents Surveillance and monitoring - data obtained from NHANES, NYPANS, YBRFSS
Obesity prevention program - goal is to maintain stable weight and not increase body size over time Obesity treatment program - goal is to lose weight over time Lifestyle changes- Behavioral therapy- Clinical therapy Most public health interventions have been conducted through schools Increasing physical activity, reducing carbonated drinks Interventions involving family and other environmental components may be important Parents are "gatekeepers" for diet and physical activity Parents serve as role models For pre-school - need to include day care Health care providers need to consistently screen Public health interventions - focus on lifestyle approaches Most effective interventions include dietary alterations and increased physical activity Most community-based studies in adults have not been effective One success - faith-based intervention (The WORD) Worksite-based programs have shown some success
Table 13-7 Review and Describe -
Older americans nutrition prog.- congregate and home delivered meals- meals, transportation, shopping assistance, limited nutrition ed., SNAP- Income subsidy- USDA funded- electrnic benefits for food purchases. SNAP ED- Nutrition ed.- USDA- provide info in eating healthy Adult DAY care food prog.- meal prog. supervised daycare-usda- meals and snack to participating day care programs. Senior Farmers market nutrition prog.-Income subsidy- usda- provide low income seniors with coupons that can be exchanged for eligible foods at farmer's markets, roadside stands, and community supported agriculture programs. Medicare/Medicaid- third party payment system-DHHS CMS SSA- Covers medical and related services provided by participating hospitals, HMOs, private medical practices, ambulatory centers, rehabilitation and skilled nursing facilities, home health agencies, and hospice programs.
Special Milk Program for Children
Provides subsidies to schools & institutions to encouraging consumption of milk by children. Any public or private nonprofit school or child care institution of high school grade or under may participate on request if it does not participate in a meal service program authorized under the National School Lunch Act or Child Nutrition Act of 1966. All students attending schools & institutions in which the program is operating may participate.
What is the impact of child nutrition programs on kids' diets?
Researchers from USDA's Continuing Survey of Food Intakes by Individuals reported that children who ate both breakfast and lunch at school on any given day received over 50% of their daily food energy from these meals. Also came much closer to meeting RDA for fruits and vegetables, consume more grains, drank more milk, while eating less sweet and salty snacks and drinking less sweetened drinks compared to those not participating. School breakfast participants had higher intakes of many vitamins and minerals and had no increase in saturated fat and sugars compared to those who skipped breakfast. Participants in only NSLP was linked to higher intake of nutrients, such as B vitamins, calcium, magnesium, and zinc than those who did not eat school lunch. USDA launched a reform of NSLP to improve nutritional value of meals called School Meals Initiative for Healthy Children. States are required to review school programs to determine whether meals meet Dietary Guidelines for Americans and meet specified energy and nutrient standards for calories, total fat, saturated fat, pro, CHO, calcium, iron, and vitamins A and C. Menus now include more fruits, veg, whole grains, low/reduced fat foods, and vegetarian/vegan options.
SNAP WIC EFNEP Title V Maternal & Child Health Program
SNAP- major means for many economically disadvantaged women by which they are able to purchase adequate diets for their families. WIC -It provides supplemental foods to infants; children up age 5; and pregnant, breastfeeding, and nonbreastfeeding postpartum women who qualify financially and are considered by competent professionals to be at nutritional risk because of inadequate nutrition and inadequate income. Services include checks or vouchers to purchase specific supplemental foods each month; nutritional education; referral to health care services. EFNEP (Expanded Food and Nutrition Education Program) - It assists limited-resource audiences in acquiring the knowledge, skills, attitudes, and changed behavior necessary for nutritionally sound diets, and to contribute to their personal development and the improvement of total family diet. Title V Maternal and Child Health Program- Only federal program concerned exclusively with the health of mothers, infants, and children. It provides for nutrition assessment, dietary counseling, nutrition education, and referral to food assistance programs for infants, preschool and school-aged children, children with special health care needs, adolescents, and women of childbearing age.
What does a low HEI score indicate? Healthy Eating Index The Healthy Eating Index (HEI) is a measure of diet quality that assesses conformance to federal dietary guidance. USDA calculated Healthy Eating Index component and overall scores from dietary recall interviews collected during the National Health and Nutrition Examination Survey (NHANES).
The overall HEI score is the sum of 10 dietary components, weighted equally. Each component of the index has a maximum score of 10 and a minimum score of zero. The maximum overall HEI score is 100. High component scores indicate intakes close to the recommended ranges or amounts; low component scores indicate less compliance with the recommended ranges or amounts.
what does the OAA provide to seniors -
The purpose of the OAA Nutrition Program is to: •Reduce hunger and food insecurity among older individuals, •Promote socialization of older individuals, •Promote the health and well-being of older individuals, and •Delay adverse health conditions for older individuals. The Nutrition Programs are authorized under Title IIIC of the Older Americans Act. They fulfill their purpose by providing access to healthy meals, nutrition education and nutrition counseling. The Nutrition Programs are targeted to adults age 60 and older who are in greatest social and economic need with particular attention to: •low income older individuals, •minority older individuals, •older individuals in rural communities, •older individuals with limited English proficiency, and •older individuals at risk of institutional care.
BMR: Basal Metabolic Rate
The rate at which the body expends energy to support the basal metabolism. Basal metabolism - is influenced by fat free body mass (muscle and skeletal tissue), age, genetics, temperature, hormones growth, and other factors. BMR is the largest influence on energy expenditures (60-65%), followed by volitional physical activity (25-35%), and the energy needed for digestion of food (the thermic effect of food, 5-10%).
Health Care Cost of Obesity Annually
The total economic cost of overweight and obesity in the United States is $270 billion a year. when researchers separated out the economic cost of overweight and obesity to the United States in 2009, they found it was $72 billion for overweight and $198 billion for obesity. Annual U.S. medical expenditures attributable to obesity have been estimated to be $75 billion in 2003,with approximately half of these expenditures being financed by government and, ultimately, the taxpayer through Medicare and Medicaid.
Describe the eating pattern of Okinawa Elders
They have a low calorie diet and only eat until they are 80% full. 80% plant based diet and high in unrefined grains, soy, vegetables, and fruits. High intakes of omega 3s low saturated and trans fat.
Describe the gap between current nutrition recommendations and consumer practices
Trends such as eating away from home and increased portion sizes in grocery and restaurant items negatively affect Americans eating habits. Americans are eating to much fat, sugars, refined grains and sodium. American consume to little fruits, vegetables, whole grains, and fat free or low fat milk products. By eating to little of these nutrient dense foods Americans are at risk for lower than recommended levels of specific nutrients, such as vitamin D, calcium, potassium, and dietary fiber.
Using Table 6-3 Briefly Describe the Food Safety Responsibilities of the following: USDA FSIS) FDA CDC FTC National Marine Fisheries Service EPA Bureau of Alcohol, Tobacco, and Firearms
USDA (FSIS) - United States Department of Agriculture's Food Safety and Inspection Service. Ensures that meat, poultry, and some eggs and egg products are safe, wholesome, and correctly marked, labeled, and packaged. FDA - Food and Drug Administration for Food Safety and Applied Nutrition - Ensures safety of domestic and imported food products (except meat, poultry, and processed egg products) animal drugs, and animal feed. CDC - Center for Disease Control - Conducts surveillance for foodborne diseases; develops new methods to enhance surveillance and detection outbreaks; assists local, state, and national efforts to identify, characterize, and control foodborne hazards. FTC - Federal Trade Commission - prevents representations about food that are meant to deceive consumers. National marine Fisheries Service - conduct voluntary safety and inspection programs for seafood products meant for human consumption. EPA - Environmental Protection Agency - regulates all pesticide products and sets maximum allowed residue levels for pesticides on food and animal feed. Bureau of Alcohol, Tobacco, and Firearms - administers and enforces laws covering the production, use, and distribution of alcoholic beverages.
Describe how the following federal programs/supports assist mothers and their children:
USDA Programs - WIC, SNAP, WIC Farmers' Market Nutrition Program, EFNEP DHHS program - Title V Maternal and Child Health Program Medicaid and EPSDT, Health Center Program, Healthy Start Program
What are some of the health problems associated with central adiposity?
strong risk factor for type 2 diabetes, heart disease, and other problems.
Nutrition Monitoring:
the assessment of dietary or nutritional status at intermittent times with the aim of detecting changes in the dietary or nutritional status of a population.
Nutrition Surveillance:
the continuous assessment of nutritional status for the purpose of detecting changes in trends or distributions so that corrective measures can be taken.
Nutrition Assessment:
the measurement of indicators of dietary status and nutrition related health status to identify the possible occurrence, nature, and extent of impaired nutritional status. Ranging from deficiency to toxicity.
What are the two stages of the budget process, in its simplest form?
the president proposes a budge, and then congress reacts to the presidents proposal.
Policy agenda:
the set of problems to which policy makers give their attention
Response Rate:
the value obtained by multiplying the participation rates for each survey component.
know the problems with waist circumference, which waist circumferences are a problem for each gender, and what the term "Central adiposity" means -
waist circumference - a measure used to assess abdominal (visceral) fat. substantially increased risk of obesity-related health problems is associated with waist circumference measures as follows: Men: > 40 inches (greater than) Women: > 35 inches (greater than) central adiposity - Characterized by an "apple-shaped" body with large fat stores around the abdomen; a strong risk factor for type 2 diabetes, heart disease, and other problems. Central fat is also known as android fat to distinguish it from fat deposition on thighs and hips.
distinguish BMI (body mass index) in children: overweight vs. obesity (%)
weight classification in children: Obesity - BMI for age - greater than or equal to 95th% Overweight -BMI for age - greater than or equal to 85th% to < 95th%
What does an initial prenatal visit include?
• Dietary measures-diet history • Clinical measures-obstetric history • Anthropometric measures-measurement BMI • Laboratory values-screening
What anthropometric measurements are collected in infancy? Why?
•Length, weight, and head circumference assess physical size and growth • Head circumference measures can help detect protein-energy malnutrition (PEM) • NCHS growth charts can assess overweight or failure-to-thrive infants
WIC Foods:
WIC foods not only address specific nutritional deficiencies but also focus on "food that promote the health of the population served, as indicated by relevant nutrition sciences, public health concerns, and cultural eating patterns".
Markup Session:
a congressional committee session during which a bill is put into its final form before being reported out of committee.
Genetic Disorder:
a disease caused in whole or in part by a variation or mutation of a gene.
Coalition (alliance):
a group of individuals or organizations working together in a common effort toward a common goal to make more effective and efficient use of resources.
Waist Circumference:
a measure used to assess abdominal (visceral) fat. Substantially increased risk of obesity-related health problems is associated with waist circumference measures as follows: Men: > 40 inches Women: >35 inches
Nutrition Screening:
a system that identifies specific individuals for nutrition or public health intervention, often at the community level.
Genome:
a word that combines the word gene and chromosome; the genetic material in the chromosomes of the cell that contains the complete set of instructions (DNA) for making and organism.
Which of the child nutrition programs was initiated before all others?
an amendment of the Agricultural Act of 1933 gave surplus agricultural commodities to the 1946 pres Truman signed the National School Lunch Act 1966 Child Nutrition Act
Healthy People 2000 - summarize and name the diseases they aimed to reduce.
arthritis, osteoporosis, cancer, heart disease, diabetes, and kidney disease.
Childhood obesity is associated with which health problems?
associated with hyperinsulinemia, hypertriglyceridemia, reduced HDL cholesterol increased risk of cardiovascular disease, type 2 diabetes, sleep apnea, gallbladder disease, psychosocial dysfunction, orthopedic problems
What are the primary indicators of the infant's future health status?
birthweight and length of gestation
Briefly describe the Legislative Body Who Sets the Policy/Laws that govern our lives?
congress and senate are the legislative bodies that set laws that govern our lives.
another term for "subjective data" -
data not based on fact but opinion; biased data, ex: patient says weight rather than recorded through a physical exam
what the school lunch program provides (nutrients) and what it has decreased since USDA guidelines have changed?
decreased fat in the meal increased nutrient per calories school lunches must provide no more than 30% of an individuals calories form fat, and 10% or less from saturated fat. lunches must provide 1/3 of the DRI for calories, protein, calcium, iron, vitamin A, and vitamin C for the applicable age or grade groups.
VLBW:
defined as less than 1,500 g, or 3 lb 4 oz.
two nutrient groups often targeted in nutrition programs
elderly - healthy amount of energy or carbs low in fat, trans fats, sugar, sodium, cholesterol, alcohol, good in whole grain fiber.
Fiscal year begins and ends in which months of the year?
fiscal year begins October 1 and runs through to September 30 the following year.
List and be familiar with Environmental Risk Factors Environmental Risk Factors Food production and transportation - mass production, ready-to-eat meals Other technological changes - expanding food supply, energy-dense foods Portion sizes - increase in sizes Foods available in restaurants - meals are larger and have more calories than at home Social environment - breastfeeding, stress Urban sprawl and built environment - walkability Poverty - lower availability of healthful foods
food production and transportation technological changes portion sizes foods available at restaurants social environment urban sprawl and the built environment poverty
What are the most commonly prescribed drugs for the elderly?
hypertension related rx's high blood pressure
risk factors for LBW
if the pregnant woman does not receive adequate nourishment and does not gain the recommended amount of during her pregnancy, smoking also
Describe the various levels of living for seniors (independent, semi-independent, and Institutional care) including the community based services they may require
independent- self care support in own home. semidependent- maintain ability to live at home with help or at relative's home. Institutional care- food service and nutritional care in apartments in congregate housing, continuing care retirement community, assisted living housing, nursing homes.
prevalent nutrition problems in infant nutrition
iron deficiency and food allergies
Maternal risk factors associated with LBW
poverty, minority status, lack of access to healthcare, inability to pay for health car, poor nutrition, low level of educational achievement, and unhealthful habits such as smoking, drinking, and drug use.
Policy Making -
process by which authorities decide what actions to take to address a problem or set of problems
Entitlements:
programs that require the payment of benefits to all eligible people as established by law.
List and briefly Explain the Behavioral/Lifestyle Risk Factors Likely due to societal and environmental factors: Increased calorie intake due to food technology and transportation Increased portion sizes Increased meals away from home Sedentary lifestyles Media influences Social inequities and poverty Urban sprawl and built environment changes
psychosocial risk factors - stress, depression behavioral/lifestyle risk factors -dietary intake, physical activity.
Describe the trends of Dietary Adequacy and Moderation in the U.S.
-Less than 15% of girls aged 12-17 met RDA for calcium and magnesium, 50% met standard for iron intake. -As children get older consume more fast food and salty snacks. Dietary Adequacy Components: -All ages groups had adequate intake of total grains (100%) and above 50% for total and whole fruit, milk, meat and beans and oils. Children ages 2-3 met intake for total fruit and milk. All age groups low intake (at or below 50%) of total vegetables, dark green and orange vegetables, and whole grains. Dietary Moderation Components: -Ages 12-17 highest intake of sodium (score below 40%). -Ages 2-5 lowest intake of extra calories (score above 50%). -All age groups did not meet moderation recommendations (score of 100%) for dietary intake of saturated fat, sodium, and extra calories.
Describe the early development of chronic diseases with obesity in children
-Overweight children are at risk for CVD, insulin resistance and type 2 diabetes, sleep apnea, gallbladder disease, psychosocial dysfunction, and a variety of orthopedic complications. -Nearly 60% of overweight children have shown to have at least one cardiovascular risk and 25% of overweight children had 2 or more risk factors. -HTN occurs with low frequency but in study elevated blood pressure occurred 9X more frequently in those overweight. -The risk of developing type 1 diabetes is higher than risk of all other severe chronic diseases of childhood. Peak incidence usually occurs in girls 10-12 and boys 12-14. -Complications of type 2 diabetes include: heart disease, stroke, vision loss/blindness, amputation, and kidney disease. -Factors to childhood overweight/obesity: genetics. lifestyle, family eating patterns, lack of positive role models, and inactivity. Also, prior obesity and TV watching contribute to future overweight/obesity.
List Nutritional Risk Factors in Pregnancy
-age 15 or under -unwanted pregnancy -Many pregnancies close together (depletes nutrient stores) -history of poor pregnancy outcome -poverty -lack of access to health care low education level -inadequate diet (food faddism or dieting) -iron-deficiency anemia early in pregnancy -cigarette smoking -alcohol or drug abuse -chronic disease requiring special diet (ex. diabetes) -underweight or overweight -insufficient or excessive weight gain in pregnancy -carrying twins or triplets
What are the risk factors of Type 2 Diabetes in children?
-overweight -strong family history -older than 10 yrs -tend to be from certain race/ethnic groups: African American, Hispanic, and Native American.
What are the five service areas that the NNMRRP get involved with (& Refer to Figure 7-2): The data obtained by the NNMRRP serves which two government departments (hint: related to public health)
1. Nutritional status and nutrition-related health measurements 2. Food and nutrient consumption 3. Knowledge, attitudes, and behavior assessments 4. Food composition and nutrient databases 5. Food supply determinations Implementation and coordination of activities by USDA and DHHS
List three health claims authorized by the U.S. Food & Drug Administration (Table 6-1)
1. While many factors affect heart disease, diets low in saturated fats and cholesterol may reduce the risk of heart disease. 2. Low fat diets rich in fruits and vegetables may reduce the risk of some types of cancer, a disease associated with many factors. 3. Healthful diets with adequate folate may reduce a woman's risk of having a child with a brain or spinal cord birth defect.
National School Lunch and Breakfast Program
Assist states in providing nutritious free or reduced-price breakfasts and lunches to eligible children. Schools receive cash subsidies and USDA commodities for each meal served (meals must meet federal requirements). Public or nonprofit private schools of high school grade or under, public or nonprofit private residential child care institutions. All students may participate. Free meals: children less than or equal to 130% poverty guidelines. Reduced-price: 130%-185%. Full price: above 185% over poverty guidelines.
Afterschool Snack Program
Assists school-based after-school programs in providing healthful snacks to children. Sites can qualify to serve all children free of charge based on the % of children receiving free and reduced-price meals at the school.
Summer Food Service Program for Children
Assists states in conducting nonprofit food service programs for low-income children during the summer months and at other approved times, when area schools are closed for vacation. Homeless children & children attending public or private nonprofit schools & residential camps or participating in the National Youth Sports Program can receive free meals.
Describe Problems with Adolescent Pregnancy
Pregnant adolescents are nutritionally at risk and require intervention. Risks include hypertension, iron deficiency anemia, premature birth, stillbirth, LBW infants, prolonged labor.
List the risk factors, major indicators and minor indicators of poor nutritional status. (Table 13-5)
Risk factors- inappropriate food intake, poverty, social isolation, dependence/disability,acute/chronic diseases or conditions, chronic medication use, advanced age(80+). Major indicators- weight loss of 10lbs or more, under/overweight, serum albumin level 3.5 g/dl, change in functional statues, inappropriate food intake, mid arm circumference < 10 th percentile, obesity, nutrition related disorders. Minor indicators- alcoholism, cognitive impairment, chronic renal insufficiency, multiple concurrent medications, malabsorption syndromes, anorexia, nausea, dysphagia, change in bowel habits, fatigue, apathy, memory loss, dehydration, poor oral/dental status, poor healing wounds
National Goals for Health Promotion. Healthy People 2010 -what were the objectives and what was the outcome of the four objectives? (Figure 13-4)
The 4 objectives for fruit, vegetables, grain, and sodium consumption showed little or no progress.
Which two departments of the USDA target obesity related programs and policies?
The Federal Trade Commission Department of Transportation
Built Environment:
The built environment encompasses a variety of community design elements such as street layouts, zoning, transportation option stairs, public and green spaces, and business areas.
Maternal Mortality Rate:
Women's deaths assigned to causes related to pregnancy, expressed as the number of such deaths per 100,000 live births.
Appropriation:
a budget appropriation is the authority to spend money.
complication of LBW
low birth weight babies are more likely to experience complications during delivery than a normal weight baby and has a statistically greater chance of having physical and mental birth defects, of contracting diseases, and of dying during the first year of life.
National School Lunch Program must provide a balanced lunch. What are the components of this lunch? *(hint DRI)
must provide no more than 30 % of an individual's calories from fat, and 10 % or less from saturated fat. Regulations also require that lunches provide one third of the DRI for calories, protein, calcium,iron, vitamin A, and vitamin C, for the applicable age or grade group.
What type of diet should seniors follow to best meet their needs?
need to emphasize variety, nutrient density, and fiber-rich foods from all food groups. To meet nutritional needs, older adults should use www.ChooseMyPlate.gov site to find their recommended amounts from each food group.
risk factors for LBW in babies (think maternal health)
not adequate nourishment and odes not gain the recommended amount of weight, drugs, smoking. poverty, minority status, lack of access to health care, inability to pay for health care, poor nutrition, low levels of educational achievements, unhealthful habits such as smoking, drinking, and drug use.
single most prevalent contributer to health car costs in U.S. -
obesity
Obesogenic:
obesity promoting, as in "obesogenic environment."
