Nutrition/Session 1

A child who is moderately or severely wasted has an increased risk of: death, but treatment is possible.

death, but treatment is possible.

Poor maternal iron and folate status has been associated with:

preterm births and intrauterine growth retardation (IUGR), which are associated with greater risk of neonatal death.

What ages equal the first 1000 days in terms of nutrition?

Conception to 2 years

Acute malnutrition is more common than chronic malnutrition. True or False

False. It is less common

childhood stunting may be irreversible after two years of age. T or F

False. Stunting appears to be irreversible after 2 years of age.

What is the definition of wasting?

(low weight for height)

Bilateral pitting edema is clinically classified by grade scores + ++ or +++. What does each represent?

+ is Mild: edema in both feet and ankles ++ is Moderate: both feet, plus lower legs, hands and lower arms. +++ is Severe: Generalized edema in feet, legs, hands, arms, and face

Acute malnutrition differs from chronic malnutrition in three important ways which explain why it is traditionally prioritized in emergencies. What are they?

1)First, it progresses and becomes visible over a much shorter time period. 2)the mortality risk associated with acute malnutrition is roughly double that for chronic malnutrition (although chronic malnutrition is more prevalent). 3) wasting and nutritional oedema have a much greater potential to be reversed within a few months of treatment if detected early enough.

What is MUAC?

1. A third way to measure acute malnutrition 2. It measures the circumference of the upper third of the arm. 3. It is an indicator or wasting and in particular lean body mass. 4. It is a proxy measure of nutrient reserves in muscle and fat. 5. an effective predictor of risk of death in children aged 6 to 59 months 6. endorsed as an independent admission criterion for nutrition programmes

What is global acute malnutrition?

1.) is a measurement of the nutritional status of a population that is often used in protracted refugee situations. 2) Along with the Crude Mortality Rate, it is one of the basic indicators for assessing the severity of a humanitarian crisis.[ 3) The weight to height index is compared to the same index for a reference population that has no shortage of nutrition. 4)All children with weight less than 80% of the median weight of children with the same height in the reference population, and/or suffering from Oedema, are classified as GAM 5) The World Health Organization describes Moderate Acute Malnutrition (MAM) as GAM in the 79% - 70% range, and Severe Acute Malnutrition (SAM) as GAM below 70%. Practice slide, session 1, slide 43

The in utero period accounts for what % of stunting?

20%

Iron deficiency leads to:

Anemia and low immune function (30% of the world).

Why is the treatment of SAM prioritized in emergency settings?

Because acute malnutrition presents a more immediate and potentially reversible public health problem, its management or treatment is generally prioritised in emergencies when case loads are often high.

Kwashiorkor classification

Bilateral pitting edema and WFH (wasting score) of = or > -2 Z-scores. Marasmic Kwashiorkor Bilateral pitting edema and WFH Score of < - 2 Z scores.

How is stunting assessed anthropometrically?

For stunting, we assess height for age. This compares the height of our child with the height of a normal child at the same age. I can then calculate a z-score and determine how far away they are from the average normal child's height for this age group.

Why did 2 scientists refer to stunting as an inflammatory disease?

Frequent diarrhea in first 2 years increases risk of stunting. Can then impair cognitive development and that as children have weaker immune systems it means they are more susceptible to enteric infections, leading to more severe and prolonged episodes of diarrhea. Given its chronic nature, Prendergast and Humphrey (2014) argue that stunting should be viewed as an inflammatory disease partly arising from primary gut pathology

What is the most micronutrient deficiency globally?

Iron deficiency anemia

MUAC is important in emergency settings in directing important resources because:

It is important to target resources to those who are most at risk of dying, particularly when resources are limited.

Classification of Bilateral Edema

MAM ...no SAM ...Yes

Classification of MUAC in children 6 to 60 months

MAM equal = or > than 115 mm or 11.5 cm & < 125 mm SAM <115 mm or 11.5 cm

Classification of Wasting in children 6 to 60 months

MAM equal to or greater than SD -3 or less than - SD2. SAM SD of < -3.

What is MAM characterized by?

MAM is characterized by moderate wasting.

MUAC for height/age in kids 6 go 60 months

SAM only .... < -3 SD

Know how to calculate global acute malnutrition:

Session 1, slide 43

What is SAM characterized by?

Severe wasting and/or nutritional oedema.

What is anthropometry?

The measurement of the size and proportions of the human body.

Wasted and stunted represents:

Thinner and shorter than normal or low weight and height for their age.

MUAC is associated with mortality where weight for height is not. True or False?

True

In contrast to SAM, chronic malnutrition is difficult to reverse, particularly in children older than two years. True or false

True, because chronic malnutrition reflects past growth failure (i.e. failure to add height) due to the cumulative effects of poor diet and care that may have even begun in the womb (see chronic malnutrition and intrauterine growth restriction).

What are 2 other risk factors for stunting?

Unimproved sanitation and diarrhea

What is a second way to classify wasting other than anthropomorphic measures?

Whether the child has pitting edema or Kwashiorkor

There are three ways to measure acute malnutrition. What are they?

Z-scores, MUAC, presence of edema

What is the strong link between SAM and chronic malnutrition?

single or repeated bouts of acute malnutrition will contribute to growth failure during the first five years of life.

What is a Z Score?

the number of standard deviations from the mean a data point is. But more technically it's a measure of how many standard deviations below or above the population mean a raw score is.

How is malnutrition assessed anthropometrically?

weight for height z score (wasting), MUAC (left upper arm circumference), height for age (stunting);

What constitutes food access?

- Income or other resources are adequate to obtain sufficient and appropriate food through home production, buying, bartering, gathering etc. Food may be available but not accessible to people who do not have adequate land to cultivate or enough money to buy it.

How much would it cost to scale up 10 nutrition interventions to the people in these countries?

1 billion dollars

Benefits to children who receive good nutrition in the first 1000 days:

1) Are 10x more likely to: 1) over-come the most life-threatening childhood diseases, 2) Complete 4.6 more grades of school 3) Go on to earn 21% more wages as adults. 4)Are more likely as adults to have healthy families.

What is the impact on the fetus of being undernourished in the womb?

1) Being undernourished in the womb increases the risk of death in the early months and years of a child's life. 2) Those who survive tend to have a) impaired immune function and increased risk of disease, are b) likely to remain undernourished, with reduced muscle strength, and c) reduced cognitive abilities and IQ throughout their lives. 3)As adults, they suffer a higher incidence of diabetes and heart disease.

Best breastfeeding practices recommended?

1) Initiate breastfeeding within the first hour after birth 2) Maintain skin to skin contact, especially for special needs infants 3) Exclusively breastfeeding infant up to 6 months

Malnutrition increases an individual's risk of dying because:

1) It compromises immunity and impairs a whole range of bodily functions. a)When food intake or utilisation (e.g. due to illness) is reduced, the body adapts by breaking down fat and muscle reserves to maintain essential functions, leading to wasting. b. The body also adapts by decreasing the activity of organs, cells and tissues, which increases vulnerability to disease and mortality. c. For reasons not completely understood, in some cases, these changes manifest as nutritional oedema. d. A vicious cycle of disease and malnutrition is often observed once these adaptations commence. e. SAM can be a direct cause of death due to related organ failure. f. More often, however, acute malnutrition works as a driver of vulnerability, while the actual, final cause of death may be a common illness, such as diarrhoea, respiratory infection or malaria. g. Despite operating as a less visible 'underlying cause', acute malnutrition is responsible for a shocking 14.6% of

What is the global burden of malnutrition?

1) Malnutrition contributes to nearly half of all deaths in children under 5 and is widespread in Asia and Africa and affects over 200 million children worldwide. 151 million are stunted, 51 million wasted. 2) Of the 51 million wasted children, more than half live (35.9 million) in Southern Asia and a third are severely wasted. Aggregates can hide problems within countries however. In the Sahel and Eastern Africa, you have countries that experience very high levels of malnutrition, particularly worse in drought years where 25-35% of children under five are wasted. 3)Of 151 million stunted children globally, two out of five live in Southern Asia. 4) Africa is the only continent where stunting is increasing by 17%. It has fallen in S Asia by 35%.

What is optimal maternal nutrition during pregnancy?

1) Maternal micronutrient supplements to all 2) Calcium supplemental to moms at risk of low-intake 3) Maternal balanced energy protein supplements as needed. (Plumpy mum) 4) Universal salt iodization

Optimal infant and young child feeding consists of:

1) Promotion of exclusive breastfeeding for 6 months; continued breastfeeding until 24 mo 2)Appropriate commplementary feeding educadtion in food secure populations and additional complementary food supplementation in food insecure populations. (Plumpy doz)

Management of acute malnutrition consists of:

1) Supplementary feeding for moderate acute malnutrition. (Plumpy nut RUTF) 2) Management of severe acute malnutrition

Babies who survived poor pre-natal nutrition tend to have:

1) Those who survive tend to have impaired immune function and increased risk of disease; 2) they are likely to remain undernourished, with reduced muscle strength, cognitive abilities and IQ throughout their lives. 3) As adults, they suffer a higher incidence of diabetes and heart disease.

Micronutrient supplementation in children at risk consists of:

1) Vitamin A supplementation for children 6 to 59 months 2)Preventative zinc supplements between 12 and 59 months of age. (Sprinkles)

What are the benefits of good nutrition?

1). Health, 2) well-being, 3)normal development and 4) high quality of life 5) Increased physical and mental development including cognitive development 6) less risk of illness and improved immune function

What constitutes food Access?

1). Income or other resources are adequate to obtain sufficient and 2) appropriate food through home production, buying, bartering, gathering etc. Food may be available but not accessible to people who do not have adequate land to cultivate or enough money to buy it.

The three main components of food security are:

1)Availability - 2)Access - 3)Utilisation - (AAU)

How big is the problem of malnutrition?

1)Child hunger and undernutrition are persistent problems worldwide: one child in three in developing countries is stunted. 2) Children who survive are more vulnerable to infection, don't reach their full height potential and experience impaired cognitive development. This means they do less well in school, earn less as adults and contribute less to the economy. Without intervention undernutrition can continue throughout the life cycle. 3)While less than half of all children live in lower middle income countries, two thirds of all stunted children and three quarters of all wasted children live there

Among the key causes of malnutrition are:

1)Insufficient access to food, 2) poor dietary diversity, 3)poor quality healthcare services, 4) poor environmental sanitation, 5) inadequate care of children, 6)gender inequalities, 7) and low educational levels of caregivers.

Intakes lacking dietary diversity are strong predictors of:

1)Micronutrient deficiency disease (MDD).

What works during first 1000 days to support good nutrition? Be able to give a written answer.

1)Starting in pregnancy: access to multiple micronutrients, especially iron and folic acid and if underweight have access to multiple micronutrients and food supplements. 2) balanced energy protein supplement such as plumpy mum .These products are essential in emergencies when markets are interrupted, resources are low and people are displaced. 3) To promote breastfeeding, it's important that women have skilled support starting right after delivery and monthly until at least 6 months. 4) Non-breastfed infants must also be supported 5)To ensure good nutrition through complementary feeding, families must have resources to access a rich and diverse diet for children. 6)In food insecure contexts and where malnutrition levels are already high, we consider supplements that can be used as a home fortification to add both energy and micronutrients to family foods to improve the nutrient profile. 7) prevent micronutrient deficiencies and include supplementation of micronutrients relevant for the context, such as Vitamin A or consider multiple micronutrient sprinkles in food insecure contexts that can raise the profile of locally available foods. 8) provide management of acute malnutrition,

What consistutes stunting?

1)Stunting refers to a child who is too short for his or her age. 2) Stunting is the failure to grow both physically and cognitively and is the result of chronic or recurrent malnutrition. 3) Devastating effects of stunting can last a lifetime

How are proxy indicators used to detect micronutrient deficiencies and give examples:

1)Vitamin A deficiency initially presents as night blindness, which if untreated may progress to bitots spots and gradually progress to xerophthalmia. 2) Night blindness can be roughly assessed through interviews and the progressive symptoms through the clinical signs. When such micronutrient-related deficiencies become widespread they can present themselves as epidemics within the population group.

What has made the problem worse world wide in the past century?

1. Climate change. 2. Failed states 3. Corruption 4. Conflict

How many children world wide are thought to be affected by stunting?

155 million children

How many countries account for 90% of the global burden of malnutrition?

34 countries

# children worldwide with malnutrition

50 million

Toddlerhood age #

6 mo to 2 years

Acute malnutrition or wasting (and/or oedema) occurs when:

An individual suffers from 1)current, severe nutritional restrictions, 2)a recent bout of illness, 3)inappropriate childcare practices 4)or, more often, a combination of these factors.

25% of low birth weight is due to :

Anemia in pregnancy

What is the critical window of opportunity to prevent undernutrition in children which can reduce under 5 mortality by 6%?

At 6 months, foods should be introduced in addition to breastfeeding. Breastfeeding continues to provide a significant source of nutrition until 2 years,

Importance of Pre-pregnancy to birth

Babies developing in the womb draw all of their nutrients from their mother. If mom lacks nutrients, so will her baby putting baby's future health and safety at risk.

What are the WHO recommendations for undernourished pregnant women to reduce the risk of stillbirths and small for gestational age neonates?

Balanced energy and protein dietary supplementation.

Most growth faltering in developing countries occurs between which ages and why?

Between 6 and 24 months when infants and young children should receive foods to complement the nutrients in breastmilk, which are inferior in quality

Kwashiorkor is characterized by:

Bilateral pitting edema and is indicative severe acute malnutrition (SAM).

What is the definition of low birth weight?

Birth weight assessed as per health care facility'Newborn infant weighed within 24 h of birth AND Weight recorded as <2500 g OR

Vit A deficiency leads to:

Blindness and mortality (250 million people world wide).

Importance of optimal nutrition (breastfeeding) birth to 6 months (infancy) because:

Breastmilk is superfood for babies because 1) not only the best nutrition for babies but 2) serves as the first immunization against illness and disease

Levels of acute malnutrition tend to be highest in:

Children from 12 to 36 months of age when changes occur in the child's life such as 1) rapid weaning due to the expected birth of a younger sibling or 2) a shift from active breastfeeding to eating from a family plate, which may increase vulnerability.

Why is stunting sometimes referred to as "the silent malnutrition?

Chronic malnutrition is often referred to as 'silent malnutrition' or 'invisible malnutrition' largely because stunted children are short but proportional and because it is so prevalent in some regions it is accepted as 'normal'.

Stunting is associated with what type of malnutrition? Why?

Chronic malnutrition. Stunting results from the same underlying causes as acute malnutrition but occurs more gradually over a longer-term. Chronic malnutrition is most critical during childhood when it inhibits growth and essential cognitive development. The result is childhood stunting, where the child is too short for his/her age. Unfortunately, childhood stunting may be irreversible after two years of age, and stunted children grow up to be stunted adults with reduced physical and cognitive capacity. As a result, stunting is associated with poverty, poor health, impaired educational attainment, reduced work productivity and lower wage earning potential throughout one's life. Chronic malnutrition is often referred to as 'silent malnutrition' or 'invisible malnutrition' largely because stunted children are short but proportional and because it is so prevalent in some regions it is accepted as 'normal'.

What is one of the most impactful public health interventions on both neonatal and under five mortality ?

Early and exclusive breastfeeding

Ensuring that micronutrient deficiency diseases are monitored as part of the health information system is an important part of:

Effective surveillance

What are the elements of food utilization?

Food is properly used through: 1) Appropriate food processing and storage practices, 2) Adequate knowledge and application of nutrition and child care principles, and 3)adequate health and sanitation services. 4) How food is shared within the household compared with each person's nutrient requirements. 5) Utilisation also includes biological use, which is linked to a person's health.

What resources must all be available for survival, optimal growth and development?

Food, health and care

Why is nutrition important?

Good nutrition is an important part of leading a healthy lifestyle. Combined with physical activity, your diet can help you to reach and maintain a healthy weight, reduce your risk of chronic diseases (like heart disease and cancer), and promote your overall health.

Utilisation includes: how food is

How food is 1)shared within the household compared with each person's nutrient requirements. 2)Utilisation also includes biological use, which is linked to a person's health.

maternal undernutrition is highly prevalent and is recognized as a key determinant of poor perinatal outcomes in which areas of the world?

In re sourcepoor countries in sub-Saharan Africa, south-central and south-east Asia,

Which endemic micronutrient deficiencies often affect people in emergency settings?

Iron deficient anemia, iodine and Vit A deficiencies

Two clinical forms of acute malnutrition are:

Marasmus (wasting) or Kwashiorkor (or nutritional edema).

High rates of acute malnutrition often indicate the presence of:

Micronutrient deficiencies within the under-5 child population

What are the three types of malnutrition addressed in emergencies?

Micronutrient deficiencies, wasting (low weight for height), stunting (low height for age).

When are micronutrient powders necessary and what has been the benefit?

Multiple micronutrient powders are necessary when there are multiple deficiencies and have been shown to improve anemia.

Good breastfeeding practices can reduce neonatal and under 5 mortality by:

Neonatal by 6% and under five mortality by 13%

What is the importance of nutrition in Toddlerhood?

Nutrients from a variety of healthy foods are an essential complement to breast milk.

Women need skilled support to help them achieve their infant feeding goals. What types of support can help them overcome challenges and misconceptions of breastfeeding?

Offering of support immediately after delivery, support from grandmothers, individual counselling to help address difficulties and peer (mother to mother, father to father) support groups to address common misconceptions and challenges. The more contact visits women have with skilled support, the more likely they are to succeed

Epidemics of MDD which occur in populations affected by severe poverty or experiencing crisis tend to include:

Pellagra, scurvy, beriberi, ariboflavinosis and rickets

Zinc deficiency leads to:

Poor neural development (20 % of the world)

Acute malnutrition is divided into 2 main categories:

Severe acute malnutrition (SAM) and moderate acute malnutrition (MAM)

What helps to reduce iron-deficient anemia in infants and young children?

Single dose packets of micronutrient powder (MNP) distributed by NGO's like UNICEF, Sprinkles by Sick KIDS org.

Is Stunting reversible?

Stunting is a process of the slowing of linear growth that is generally considered to reflect long-term exposure to nutritional stresses, which takes time to develop and is completely reversed only by a change in the conditions in which the child is living." (But not after 2)

What constitutes food Availability -

Sufficient quantity of appropriate food is physically available. The food may come from household production, commercial imports or food assistance.

There is a crucial window of time during which undernutrition can be prevented :

The first 1000 days....the period from pregnancy to a child's second birthday. If action is not taken during this period the effects of undernutrition can be permanent'. The lifetime adverse effects on physical growth and brain development during this period are extensive and largely irreversible without intervention .

What plays a key role in fetal growth and development?

The nutritional status of women prior to and during pregnancy

Current evidence indicates that balanced energy and protein supplementation improves fetal growth, and may reduce:

The risk of stillbirth, low-birth-weight infants and infants born small-for-gestational age, especially among undernourished pregnant women.

What would be the benefit of this?

This could reduce 15% of under five mortality, 1 million lives saved and avert one fifth of stunting

Acute malnutrition reduces resistance to disease. True or False?

True

Marasmus is may be moderate or severe wasting. T or F.

True

Poor nutrition leads to poor pregnancy outcomes. True or False?

True

Stunted children grow up to be stunted adults with reduced physical and cognitive capacity.

True

Food aid rations have often failed to meet Sphere standards for micronutrient adequacy. True or False

True. Food aid rations have often failed to meet Sphere standards for micronutrient adequacy

Acute malnutrition may affect infants, children and adults. True or False

True. It is more commonly a problem in children under-five and pregnant women, but nonetheless this varies and must be properly assessed in each context

2 Types of malnutrition

Undernutrition, overnutrition

The main cause of micronutrient malnutrition ?

Usually an inadequate dietary intake of vitamins and/or minerals.

What is the 4 typologies of malnutrition?

Wasting, stunting, low birthweight, micronutrient deficiencies

What is the estimated percent of babies globally who are breastfed?

about 30%

Pregnancy requires a healthy diet that includes an adequate intake of:

energy, protein, vitamins and minerals to meet maternal and fetal needs.

Undernourished pregnant women may be at increased risk for adverse pregnancy outcomes, including:

giving birth to low-birth-weight infants.

What is the definition of stunting?

low height for age

Another name for wasting is (other than acute malnutrition):

marasmus

A baby's weight at birth is a strong indicator of:

maternal and newborn health and nutrition

What is the relationship between pregnancy and women who live Particularly in lowand middle-income countries (LMICs) :

multiple nutritional deficiencies often co-exist, for many pregnant women, dietary intake of vegetables, meat, dairy products and fruit is often insufficient to meet these needs

In 2013, what was the estimate of number and per cent of newborns born globally who had a low birthweight?

nearly 22 million newborns—an estimated 16 per cent of all babies born globally that year—had low birthweight.

Wasting, or acute malnutrition, is the result of: recent rapid weight loss or the failure to gain weight.

recent rapid weight loss or the failure to gain weight

SAM can be a direct cause of death due to:

related organ failure.

What is the impact of stunting over a person's lifetime?

stunting is associated with poverty, poor health, impaired educational attainment, reduced work productivity and lower wage earning potential throughout one's life

If we could scale these packages of intervention up, what would the impact be (numbers impacted)?

the impact on lives saved, in total, we could save 800,000 lives under 5 each year.

We could save even more $ if we devise strategies that reach:

the most vulnerable, the displaced, those affected by conflict, drought, natural disasters, etc and are the hardest to reach. And most are affected by conflict making it even harder to reach them.

Wasting refers to a child who is:

too thin for his or her height