nutrition and global health micheline beaudry, ph.d. université laval
TRANSCRIPT
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Nutrition and
Global HealthMicheline Beaudry,
Ph.D.
Université Laval
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Learning ObjectivesAt the end of this lecture you will
• Be aware of the key role played by undernutrition in the lives of people & societies around the world
• Realize that food, though essential, is not equivalent to nutrition
• Know that there are affordable solutions & wish to find out more about them
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At the end of this lecture you will be able to (performance objectives)
• List the 4 major nutrition problems in the world, their major manifestations, consequences & global distribution
• List the major causes of these problems and solutions proposed
• Convince a friend of the opportunities provided to improve people’s lives
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The major nutrition problems in the world are:
• Protein-energy malnutrition (PEM)
• Iron deficiency
• Vitamin A deficiency or hypovitaminosis A (VAD)
• Iodine deficiency disorders (IDD)• Nutrition-related chronic diseases
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Protein-energy malnutrition (PEM)
• Stunting – insufficient height gain relative to age; – implies long-term malnutrition and poor health
• Wasting
– insufficient weight gain relative to height/losing weight – implies recent/acute malnutrition
• Underweight – insufficient weight gain relative to age or losing weight – implies various combinations of stunting and wasting
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Proportion (%) of underweight children by region, 1985-1995
0
10
20
30
40
50
60
1985 1990 1995
South Asia
SubSaharan Africa
Sout-East Asia
N.Africa&M.East
Lat.Amer.&Caribb.
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PEM and young child mortality
• Malnutrition potentiates the effect of disease on child mortality
• The effect is for both mild-to-moderate as well as severe malnutrition; it is not only due to confounding by socioeconomic factors or intercurrent illness
• The effect of malnutrition and infection on child mortality is multiplicative rather than additive as was implicitly assumed
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Other consequences of PEM
• Impaired cognitive & behavioral development
• Low educability
• Reduced productivity & income
• Poor reproductive health
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Causes of malnutritionManifestations Growth, survival and
development
Immediate Causes
Diet intake Disease
Underlying Causes
Basic Causes
Political, Ideological &Economic structure
Access to FOOD
Ressources & ControlHuman, Economic &
Organizational
CARE practicesfor mothers&ch
HEALTHserv & environ.
EDUCATION
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To ensure adequate growth & nutrition, it is necessary to facilitate
• The ability of households to provide CARE for mothers & young children (e.g. breast-feeding, complementary feeding, love...)
• Access by households to sufficient FOOD to lead an active & healthy life
• Access to adequate HEALTH services (e.g. immunization) & a healthy environment (e.g. clean water)
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Iron deficiency • Over 2 billion people suffer from some
form of iron deficiency
• Not all causes of anaemia are nutritional in origin; yet anaemia linked to iron and/or folic acid deficiency is among the world’s major nutritional disorders
• Africa & South Asia have the highest overall incidence of anaemia, followed by Latin America & East Asia
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Consequences of iron deficiency
• Reduces work capacity, thus productivity, earnings & ability to care for children
• Associated with 50% of maternal deaths & wholly blamed for up to 20%
• Retards fetal growth, causes low birth weight (LBW) & increases infant mortality
• Impairs ability to resist disease; in childhood, reduces learning
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Improving Iron status
• Iron tablets (daily vs. weekly)
• Iron fortification of basic foods
• Increased consumption of iron rich foods & factors which enhance absorption
• Control of parasitic infections
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Vitamin A deficiency (VAD)
• Subclinical, severe & moderate– 251 million children 0-4 years old
• Clinical (xerophtalmia) – 2.8 million children 0-4 years old
• Blindness, total or partial – at least half a million children a year
– about half die within a few months
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Consequences of VAD
• Onset of childhood diseases increases
• Partial or total childhood blindness
• Child mortality increases at least 20-30%
• May increase maternal mortality • May increase HIV transmission
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Improving vitamin A status
• Increased intake of vitamin A rich foods e.g. eggs, butter, whole milk, liver, red palm oil, dark green, yellow & red fruits & vegetables
• Fortification of basic foods with vit. A
• Supplements e.g. 2 capsules per year to young children
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Iodine deficiency disorders (IDD)
• In 1990: 1.6 billion people worldwide at risk of IDD
• At least 655 million with goitre
• 43 million with some degree of mental impairment
• 11 million with cretinism
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Other consequences of IDD• Moderate Iodine deficiency: associated with
average reduction of over 13 IQ points
• Adequate intake of Iodine: can prevent all IDD, make milder forms of goiter disappear & improve development of older children mildly affected
• Severe forms of IDD such as cretinism, cannot be reversed; can only be prevented by adequate intake of I during pregnancy
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Progress in iodizing salt
• 60% of all edible salt in the world is now iodized in 1997
• Before 1990, some 40 million children were born each year at some risk of mental impairment due to I deficiency in their mother’s diets. By 1997 is closer to 28 million
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Improving nutrition can lead future
progress in health and development around the world