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
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
* 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)
non-insulin dependent diabetes (type 2 diabetes), and
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
* 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
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:
Nutritional status depends on all those factors plus biological and
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
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
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).
Untreated diabetes mellitus.
Alcoholism and other certain drug addictions
Over-consumption of fat and sugar
Industrial food processing
Consequences of malnutrition:
Impaired immune responses
Reduced muscle strength and fatigue
Increased difficulties in breathing
Impaired wound healing
Apathy, depression and self-neglect
Longer hospital stay
Higher health costs
Vitamin A deficiency
Folic acid deficiency
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
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 :
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.
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
Affected children may appear to be alert in spite of
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.
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
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
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.
WE EAT TO LIVE
LIVE TO EAT
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).
WHAT CAUSES OBESITY AND
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
Salient features of the obesity epidemic are as
Obesity is a complex, multifaceted disorder;
Obesity is prevalent in both developing and
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
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:
Sustained economic growth
Global equity, stability and prosperity
According to the Palestinian central bureau of
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.