Nutrition by yaofenjin


									Public Health
What Is Public Health Nutrition?
 Strives to improve or maintain optimum nutritional
    health of the whole population and high risk or
    vulnerable subgroups within the population.

    Emphasizes health promotion and disease prevention
    but may include therapeutic and rehabilitative
    services when these needs are not adequately
    addressed by other parts of the health care system.
 Uses multiple, coordinated strategies to reach and
    influence the community, and organizations and
    individuals that make up the community.

    Requires organized and integrated community
    nutrition efforts with leadership provided by the state
    and local health agency
   Community nutrition efforts involve a wide range of
    programs that provide increased access to food
    resources, nutrition information and education, and
    health-related care. They also include efforts to
    change behavior and environments and to initiate
What types of organizations do this kind
               of work?
   Many types of organizations are involved in public
    health/community nutrition work.

   Leadership of community nutrition efforts is usually
    provided by a public health nutritionist employed in
    an "official" public health agency–a state, city, or
    county health department.
 Public-private partnerships or coalitions are
    frequently formed to address priority nutrition
    problems in the community.

   Ideally, organizations providing nutrition-related
    programs communicate and coordinate to effectively
    address nutrition problems and avoid service gaps
Why is it important to know about public
health nutrition?

* Adequate nutrition for all is the goal

 Adequate food and balanced nutrient intake are basic
 necessities for life, health and well being. Adequate
 nutrition is especially important in periods of rapid
 growth and development. Poor nutrition during
 pregnancy, infancy, childhood and adolescence can
 mean stunted physical, mental and social
 development with lifelong consequences.
 * Dietary factors are associated with five of
  the ten leading causes of death
   Coronary heart disease
   some types of cancer (colon cancer)
   stroke
   non-insulin dependent diabetes (type 2 diabetes), and
    atherosclerosis.

Currently attention is focused on total caloric intake; amount and
  type of fat; vitamins such as folic acid and the antioxidants of
  vitamins A, C and E; minerals such as calcium;

Overweight and obesity an important contributing factor for disease
  and disability.
* Maternal and child nutrition sets the stage for life

   The health of mothers and infants has historically
    been a focus of public health and public health

    Now attention is also directed to preconception
    concerns such as folic acid intake and its association
    with neural tube defects
   Breastfeeding for the first year of life is
    recommended because of its many benefits to infants
    and their mothers

   Childhood is a time when food preferences and
    habits are shaped.

   Low calcium intake of girls and young women sets
    the stage for osteoporosis in later years
*Vulnerable subgroups are at high risk for
nutritional problems

   Low incomes,

   Some racial and ethnic minority groups,

   people with disabilities (defined as functional
    impairments) experience a disproportionate amount
    of preventable illness and premature death.
* Behavior change is challenging
Nutrition behavior (Food selection, preparation and consumption)
  is the product of:
 Culture,
 Education,
 Economics,
 Food availability
 Social strata
 Health status

Nutritional status depends on all those factors plus biological and
  genetic factors.
   Guiding all members of the population toward more
    healthful food choices and optimum nutritional health
    is a great challenge. And doing so early enough to
    prevent the development of disease is a goal of public
    health nutrition.

   Meeting this challenge requires the use of multiple,
    reinforcing behavior change strategies, including food
    and nutrition information and education.
Other strategies include:

   Structuring the environment to enable positive food
    choices (e.g., juice machines replace pop machines)
   Modifying food ingredients and preparation
    techniques to reduce fat content
   Improving the availability of foods such as fruits and
    vegetables, and
   Enacting legislation and regulation (such as required
    nutrition labels on food packages).

   is a multifactorial condition caused by inadequate
    intake or inadequate digestion of nutrients. It may
    result from eating an inadequate or unbalanced diet,
    digestive problems or other medical conditions.
   "A state of nutrition in which a deficiency, excess or
    imbalance of energy, protein, and other nutrients
    causes measurable adverse effects on tissue, function
    and clinical outcome." (BAPEN, British association of
    parenteral and enteral nutrition)
Causes of Malnutrition

   Famine (severe hunger).
   Poverty.
   Digestive disease.
   Mal-absorption.
   Depression.
   Anorexia nervosa.
   Bulimia nervosa.
   Untreated diabetes mellitus.
   Fasting.
   Coma
   Alcoholism and other certain drug addictions
   Over-consumption of fat and sugar
   Overpopulation
   Industrial food processing
Consequences of malnutrition:

 Impaired immune responses
 Reduced muscle strength and fatigue
 Increased difficulties in breathing
 Impaired thermoregulation
 Impaired wound healing
 Apathy, depression and self-neglect
 Poor libido
 Longer hospital stay
 Higher health costs
 Higher morbidity
 Higher mortality
Micronutrient deficiencies

   Iron deficiency

   Iodine deficiency

   Vitamin A deficiency

   Folic acid deficiency
Nutritional assessment

   Comprehensive process of identifying and evaluation
    nutritional problems (risk factors) and needs
    (nutrients, education, special diet) and determining
    nutritional status, uses appropriate, measurable
    methods to gather and evaluate data, by 4
   History / diet history

   Clinical /physical examination

   Anthropometrics (weight, height, mid arm
    circumference, BMI etc).

   Biochemical tests (CBC, vitamins level, TFTs)
   Height for age (stunting) reflects chronic
    malnutrition among children.

   Weight for height (wasting) reflects acute

   Weight for age (underweight) reflects both acute and
    chronic malnutrition.
Protein energy malnutrition

   Causes and consequences:
    Protein-energy malnutrition (PEM) is a problem in
    many developing countries, most commonly affecting
    children between the ages of 6 months and 5 years.
    The condition may result from lack of food or from
    infections that cause loss of appetite while increasing
    the body’s nutrient requirements and losses
  Children between 12 and 36 months old are
   especially at risk since they are the most vulnerable
   to infections such as gastroenteritis and measles.
  Chronic PEM has many short-term and long-term
   physical and mental effects including :
                       Growth retardation,
                Lowered resistance to infection,
             and increased mortality rates in young
Even after treatment begins it is not uncommon for
   deaths to result from electrolyte imbalance,
   hypothermia, or complicating infections.
Nutritional Marasmus

   It results from prolonged starvation. It may also result
    from chronic or recurring infections with marginal
    food intake. The main sign is a severe wasting and the
    child appears very thin and has no fat .

    The affected child (or adult) is very thin (“skin and
    bones”), most of the fat and muscle mass having been
    expended to provide energy. There is severe wasting
    of the shoulders, arms, buttocks and thighs, with no
    visible rib outlines.
Associated signs of the condition
   A thin “old man “face.

   “ Baggy pants “ (the loose skin of the buttocks
    hanging down).

   Affected children may appear to be alert in spite of
    their condition.

   There is no oedema (swelling that pits on pressure) of
    the lower extremities.

   Ribs are very prominent.

   It usually affects children aged 1–4 years, although it also
    occurs in order children and adults. The main sign is oedema,

    usually starting in the legs and feet and spreading, in more
    advanced cases, to the hands and face.

   Because of Oedema, children with kwashiorkor may look “fat”
    so that their parents regard them as well fed.
Associated signs

   Hair changes : loss of pigmentation; curly hair
    becomes straight easy pluck-able;

   Skin lesions and hypo-pigmentation, outer layers of
    skin may peel off and ulceration may occur; the
    lesions may reassemble burns.

   Children with Kwashiorkor are usually apathetic,
    miserable, and irritable. They show no signs of
    hunger, and it is difficult to persuade them to eat.
   The associated signs of Kwashiorkor do not always occur. In some
    cases, Oedema may be the only visible sign
Chronic malnutrition

 Children who suffer from chronic malnutrition fail to
 grow to their full genetic potential, both mentally and
 physically. The main symptom of this measured is
 stunting - shortness in height compared to others of
 the same age group - and takes a relatively long time
 to develop
   What causes chronic malnutrition?

   What happens to children who are stunted?

   How much mortality is caused by malnutrition?

   How many stunted children are there in the world and
    where is the problem the greatest?
   Every year, over 10 million children under the age of
    5 die globally; malnutrition is directly or indirectly
    associated with more than half of these deaths.

   According to UNICEF, there were an estimated 170
    million stunted children living in developing
    countries in 2005. South Asia is the region with the
    highest percentage of its under-5 population stunted.
    Burundi's population has the most severe level of
    chronic malnutrition, but India has the largest
    absolute number of stunted children.
Obesity can be defined as a condition of
abnormal or excessive fat accumulation
adipose tissue; to the extent that health may be
impaired (WHO 1998)
   Body mass index (BMI) is a simple index of
    weight-for-height that is commonly used in
    classifying overweight and obesity in adult
    populations and individuals. It is defined as the
    weight in kilograms divided by the square of the
    height in meters (kg/m2).

 The fundamental cause of obesity and overweight is
 an energy imbalance between calories consumed on
 one hand, and calories expended on the other hand.
 Global increases in overweight and obesity are
 attributable to a number of factors including:
   a global shift in diet towards increased intake of
    energy-dense foods that are high in fat and sugars but
    low in vitamins, minerals and other micronutrients;

   a trend towards decreased physical activity due to the
    increasingly sedentary nature of many forms of work,
    changing modes of transportation, and increasing
Obesity, an epidemic

   World Health Organization, Geneva 2000
    Obesity is a health problem in its own right and is
    considered a major risk factor in the development of
    diabetes and cardiovascular disease. There are around
    16 million diabetics in the Eastern Mediterranean
    Region. This figure was expected to rise almost 43
    million by 2025.
   Physical exercise had become a leisure activity;
    people had air-conditioned cars and bought their food
    from supermarkets. Along the same lines, dietary
    habits had undergone a major change as well. Fat
    consumption rose, fast food outlets were found every
    where and most inhabitants of the Gulf Cooperation
    Council countries reportedly had processed foods at
    every meal.
Salient features of the obesity epidemic are as
   Obesity is a complex, multifaceted disorder;

   Obesity is prevalent in both developing and
    industrialized countries
    In many countries, especially developing
    countries, obesity co-exists with under-nutrition;
   Obesity affects children and adolescents, as well as
    the adult population
   More women have become obese than men, while
    there is a higher proportion of overweight men than
    overweight women;

    Obesity is a major risk factor for serious non-
    communicable diseases, such as cardiovascular
    disease, hypertension, stroke, diabetes mellitus and
    various forms of cancer;

   It is projected that by 2025 approximately 60% of
    deaths worldwide will be caused by circulatory
    diseases and cancers. This evidence suggests that
    the prevention and control of the problem of
    obesity needs to be taken very seriously in both
    industrialized and developing countries.
The economic costs of overweight and

   Determining the economic cost of obesity is an
    important activity which can highlight the true impact
    of the obesity problem for policy-makers in a
    language they understand-money.

   The costs of obesity are usually divided into three
   Direct costs: health care resources for the
    management of obesity and related illness

   Indirect costs: loss of economic activity due to
    illness and premature death associated with obesity.

   Intangible costs: social and personal loss associated
    with obesity and its related illnesses.
MDG (millennium development goals)

   Eradicate extreme poverty and hunger

   Achieve universal primary education

   Promote gender equality and empower

   Reduce child mortality
   Improve maternal health

   Combat HIV/AIDS and other diseases

   Ensure environmental sustainability

   Develop a global partnership for development
Balanced nutrition contributes to:

   Child survival
   Better education
   Poverty alleviation
   Reproductive health
   Sustained economic growth
   Global equity, stability and prosperity
According to the Palestinian central bureau of
statistics (5/11/2005)

   3.5% of children aged 6-59 months in the Palestinian
    Territory are underweight or too thin for their age
    (4.0% in the West Bank and 2.6% in Gaza Strip).

   9.0% of children are stunted or too short for their age
    (8.0% in the West Bank and 10.5% in Gaza Strip),
    and 2.5% are wasted or too thin for their height (2.9%
    in the West Bank and 2.0% in Gaza Strip
   Birth weight: Approximately 9.6% of infants in the
    Palestinian Territory (10.3% in the West Bank and
    8.3% in Gaza Strip) are estimated to weigh less than
    2,500 grams at birth.

   Breast feeding: show that 95.8% of children aged 6-
    59 months were breast-fed, of them 96.0% in the West
    Bank and 95.7% in Gaza Strip
Thank you for your time.

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