All decks combined

Question 1

Broadly describe what is meant by ‘malnutrition’.

Answer 1

An all inclusive term that represents all manifestations of poor nutrition. It can mean any or all forms of undernutrition, overweight, and obesity (Webb et al., 2018)

Question 2

Discuss factors that contribute to over- and under-nutrition.

Answer 2

Economic inequality is a primary cause of both over- and under-nutrition.

Undernutrition → food insecurity

Overnutrition → obesogenic culture

Question 3

Clearly define food security and give specific examples of what can cause food insecurity.

Answer 3

Food security means that all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their food preferences and dietary needs for an active and healthy life.

Examples of causes of insecurity:

• Poverty, unemployment, or low income
• Lack of affordable housing
• Chronic health conditions or lack of access to healthcare
• Poor sanitation and high prevalence of infectious disease → disease can impair absorption of nutrients and reduce appetite
• Systemic racism
• Lack of access to arable land
• Conflict, violence, and wars
• Unfair trade
• Biofuels → decrease available crops for food as they are diverted to biofuel production
• Natural disasters
• Climate change
• Food waste

Question 4

Identify examples of consequences of undernutrition at individual and population levels and justify why issues associated with malnutrition need to be addressed.

Answer 4

• Maternal underweight → BMI <18.5; represents chronic energy deficiency; associated with LBW children which can lead to stunting; loss in linear growth during the first 1000 days of life is not recovered
  
  • Low birthweight → associated with increased morbidity and mortality; in South Asia, ~28% of infants are born with LBW.
• Child stunting → height for age < -2 SD of median; sign of chronic distress; captures early chronic exposure to undernutrition; 4x higher risk of death
• Child wasting → weight for height < -2 SD of median; major cause of child mortality in famine; sign of acute hunger; 9x higher risk of death
• Underweight → inadequate weight for age; a composite indicator that includes elements of stunting and wasting.
• Undernutrition can also cause various diseases such as blindness due to vitamin A deficiency and neural tube defects due to maternal folic acid deficiency.
• At the population level, undernutrition negatively impacts social and economic development as well as human capital formation. For instance,
  
  • Iron deficiency reduces school performance in children and physical capacity for work in adults.
  • Stunting is associated with poor school achievement/performance.
  • Reduced school attendance and educational outcomes leads to diminished income capacity in adulthood
  • Improvements in nutrition after the age of 2 do not lead to recovery of lost potential; undernourishment in this critical period causes irreversible intellectual impairment.
  • Impact of stunting on rapid and disproportionate weight gain later in life increases risk of: CVD, stroke, hypertension, and T2D.
  • Undernourished children are at a higher risk of death to common infections.

Question 5

Differentiate between hunger and malnutrition; clearly indicate what the terms refer to and the ways in which they are similar and/or different.

Answer 5

• Hunger—is characterised in many ways. It encompasses individual sensations and household behavioural responses, food scarcity (actual or feared) and national food balance sheets that focus on supply of energy (kilocalories) in any country in relation to a minimum threshold of need. The food balance sheet approach is the only standard of measurement used globally. It is based on data collated by the Food and Agriculture Organization of the United Nations. This organisation has replaced its previous use of the word “hunger” in describing this metric with the phrase “chronic undernourishment”.
  
  • This today is defined as “a person’s inability to acquire enough food to meet daily minimum dietary energy requirements during 1 year”
• Malnutrition—An all inclusive term that represents all manifestations of poor nutrition. It can mean any or all forms of undernutrition, overweight, and obesity.

> Thus; we can see that chronic hunger is associated with malnourishment, but it is possible to be malnourished and not hungry.

Question 6

Describe patterns of hunger and undernutrition throughout the world (e.g., regions most affected, trends over time) and provide examples of how particular regions have achieved nutrition-related improvements.

Answer 6

• Of 800 million undernourished, 780 million are in low income countries, especially in sub-Saharan Africa and South Asia
• Somalia, Yemen, South Sudan, and Nigeria → struggling to cope with famine as of 2017, due to instability induced by conflict, terrorism, drought, and decades of failed governance
• China, Brazil, Ethiopia, and Bangladesh have been successful at reducing hunger.
• South America was particularly successful, reducing undernourishment by over 50% in 25 years.
• Made possible by various strategies, including (Webb et al., 2018):
  
  • (1) Rapid reduction of poverty
  • (2) Rising levels of literacy
  • (3) Health improvements that reduced preventable child mortality
  • (4) Education for women
  • (5) Declining fertility
  • (6) Improved stability of governance
  • (7) Large scale investments in social reform and safety net programmes (supported narrowing of income gap through equitable poverty reduction)
  • (8) Improved sanitation
  • (9) Food supplementation targeted at mothers and children
  • (10) Cash transfers targeted at the poorest groups
  • (11) Expanded access to maternal and child health services

> Firstly, they tend to be politically stable countries that have pursued relatively equitable growth policies (not only increasing wealth for some but reducing poverty overall). Secondly, they employ targeted safety nets for the poor and invest in accessible services (education, clean water, healthcare). Thirdly, they assume responsibility for responding to shocks (economic, environmental, or due to conflict) in timely ways that mitigate human suffering. (Webb et al., 2018)

Question 7

Explain why it is important to promote sustainable food systems and enable all people to access nutritionally adequate diets.

Answer 7

We need food systems that are economically viable and that enhance food security, prevent all forms of malnutrition and minimize further environmental degradation. Achieving healthy diets from sustainable food systems is a global public health goal.

Question 8

Describe ‘energy’ within a nutritional context and be able to identify and describe 3 energy-requiring processes of the human body.

Answer 8

Energy → ability to do work

Forms → heat, kinetic, mechanical, light, electrical, chemical etc.

1. Basal metabolism → Energy required to maintain normal body functions at rest; largest need (60-75% of total kcal needs)
2. Physical activity → Energy needed for muscular work; most variable component between people
3. Dietary thermogenesis → Energy used to ingest and digest food (e.g., peristalsis: wavelike muscular contractions/relaxation of the intestine that propels contents forward)

Question 9

Explain the difference between ‘digestion’ and ‘absorption’ of nutrients.

Answer 9

Digestion → The (1) chemical (e.g., enzymes; HCl) and (2) mechanical (e.g., chewing; stomach churning) processes that breakdown food into (3) absorbable units.

Absorption → The uptake of nutrients into the body; the process by which nutrients and other substances are transferred from the digestive system into body fluids for transport throughout the body; most CHO, PRO, & FAT is absorbed within 30 minutes of the chyme reaching the small intestine

Question 10

Define and describe carbohydrates and the nutritional significance of their consumption.

Answer 10

• CHO (CH₂O)_n family includes three types of chemical substances:
  
  • (1) Simple sugars → require little or no digestion
    
    • E.g., glucose, fructose, galactose
    • Monosaccharides: can be absorbed ‘as is’; do not need to be broken down by digestive enzymes
    • Disaccharides: must be digested into monosaccharides prior to absorption by the GI tract
  • (2) Complex CHO (e.g., starch)
    
    • Starches → glucose molecules linked together
    • Glycogen → storage form of glucose in liver and muscle (i.e., ‘animal starch’)
  • (3) Fibre → does not provide energy
    
    • Dietary fibre → polysaccharides that can’t be digested: humans lack the digestive enzymes that could break them down → helps with gastric motility, reduces risk of cardiovascular disease
• Significance → ENERGY!
  
  • 40-80% of total food intake, depending on locale, economic status, cultural considerations
  • The body can only use one simple sugar for energy → glucose
  • Adequate intake prevents protein breakdown for energy → protein sparing effect
  • Provides taste, sweetness

Question 11

Define ‘famine foods’ and their strengths and limitations.

Answer 11

• Famine foods → foods that would otherwise be considered inedible but are eaten during times of extreme food scarcity
• Why → helpful to still have mealtimes; helps to ease hunger pangs
• However → they can make people feel unwell; do not provide notable nutrition-related benefits
• Examples:
  
  • Corn husks
  • Leaves
  • Moss
  • Dirt
  • In the Dutch famine → paper from books, tulip bulbs

Question 12

Define and describe protein.

Answer 12

• Protein is an essential structural component of all living matter → a sequence of a chain of amino acids
• It is involved in almost every biological process in the body
• 20 different amino acids used to make proteins → 9 of which are ‘essential’ (i.e., must consume in diet)

Question 13

Identify four functions of protein.

Answer 13

• Brain, liver, kidneys, muscle → more metabolically active than adipose (accounts for ~80% of BMR)

1. Structural material in muscles, connective tissue, organs, hemoglobin (e.g., RBCs and fibrin (a type of protein) in clotting blood)
2. Basic component of enzymes, hormones, transporters, immune system (e.g., lactase: an enzyme that breaks down lactose into glucose and galactose)
3. Maintains and repairs protein-containing tissues (e.g., muscle)
4. Energy source → least important role of protein

Question 14

Summarize protein requirements and comment on the likelihood of a plant-based diet providing sufficient protein (quality and quantity).

Answer 14

• It is possible to provide sufficient protein via a plant-based diet via complimentary proteins (e.g., legumes and cereals) or by consuming complete plant proteins (e.g., soybeans and quinoa)

Question 15

Identify some consequences of inadequate (or excessive) protein intake.

Answer 15

Inadequate → nutrient deficiencies are usually multiple (e.g., vitamin B12, zinc, niacin, iron)

Excessive → adults can consume up to 35% of kcal from protein without ill effects; higher intake can lead to nausea, weakness, diarrhea, and eventually death

Question 16

Define fat.

Answer 16

• Body fat → less metabolically active than other tissues (accounts for <20% of BMR)
• Lipids → fats, oils, cholesterol, triglycerides
• Common property → not water soluble (i.e., will not dissolve in water)
• 1 gram of fat provides 9 kcal of energy

Question 17

What is the kcal/g content of FAT, CHO, and PRO?

Answer 17

FAT → 9 kcal/g

CHO → 4 kcal/g

PRO → 4 kcal/g

Question 18

What provides ~60% of the world’s food energy?

Answer 18

Carbohydrates, specifically:

(1) Maize, (2) Rice, (3) Wheat

• These are examples of ‘staple foods’:
  
  • Staple foods are eaten regularly, in relatively large amounts - as a result, they supply a large amount of dietary energy and nutrients
  • They cannot supply all the nutrients needed → dietary diversity is needed

Question 19

Where do Canadians get ~21% of the kcal from?

Answer 19

Sugar!

Question 20

In contexts of food scarcity, why might mothers be advised to add sweeteners to a young child’s food?

Answer 20

“Sugar and honey are ways to increase the energy content, and they can be added to porridge and other foods. This will help your children grow!”

• Sugars provide energy → 4kcal/g
• Sugars provide taste & sweetness → boost the palatability and consumption of an otherwise bland (albeit more nutritious) food

Question 21

Where can protein be found in the body?

Answer 21

• A lean man weighing 154lbs contains ~24lbs of protein (~16%)
  
  • ~half in muscle
  • Remainder in skin, collagen, blood, enzymes, immunoproteins, organs, etc.
  • All protein is continually being turned over (i.e., broken down and re-built)

Question 22

Describe protein quantity.

Answer 22

• How much protein do people need?
• Protein requirements are increased in certain circumstances.
  
  • (1) Infections, burns, fever, surgery (i.e., clinical conditions)
  • (2) Pregnancy (second half only)
  • (3) Breastfeeding
  • (4) Infants and young children

Question 23

Describe protein quality. [4]

Answer 23

• Complete protein → contain all of the essential amino acids in amounts needed to support the body’s protein requirements; derived from meat, dairy, eggs, soybean, quinoa
• Incomplete protein → are ‘deficient’ in one or more essential amino acids; derived from grains, legumes, nuts, seeds, vegetables
• Limiting amino acid → the amino acid in an incomplete protein that is present in the least amount relative to the requirement for that amino acid (e.g., lysine is the limiting amino acid in cereal grains)
• Complimentary proteins → a protein that is ‘incomplete’ on its own, but becomes ‘complete’ when combined with another protein source with a complimentary amino acid content
  
  • E.g., legumes and cereals

Question 24

Answer 24

Answer → 5-month-old infant (protein is required for healthy growth and development; insufficient quality of protein will adversely affect this in a permanent fashion since this is still within the critical first 1000 days of life)

Question 25

Give examples of complete plant proteins.

Answer 25

Soybean; quinoa → contains all the essential amino acids in sufficient quantity to support human needs

Question 26

Identify the functions of fat. [5]

Answer 26

1. Concentrated energy source → 9kcal/g 2. Carrier for essential fatty acids and fat soluble vitamins (A, D, E, K) 3. Adds flavour and palatability to food 4. Contributes to feeling of **satiety** 5. Components of cell membranes, vitamins, sex hormones, cholesterol

Question 27

Differentiate between triglycerides, saturated, unsaturated fat, and cholesterol.

Answer 27

1. **Triglycerides** → 98% of dietary fat and most of body's fat stores; used by cells for energy and tissue maintenance; glycerol backbone + 3 fatty acids (which may be saturated or unsaturated) 2. **Saturated fat** (contains saturated fatty acids); carbon atoms are attached to as many hydrogen atoms as possible; no ‘kinks’; no double bonds; solid at room temperature; mostly found in animal products (e.g., lard, palm oil, coconut oil) 3. **Unsaturated fat** (contains unsaturated fatty acids); contain fewer than the maximum hydrogens; at least one double bond; ‘kinks’ present; liquid at room temperature; best sources are plant foods (e.g., avocado, flaxseeds, sunflower seeds, canola oil) 1. Monounsaturated → one double bond 2. **Polyunsaturated →** more than one double bond; **includes omega-3 and omega-6 FA → ESSENTIAL** 1. EPA 2. DHA 3. Trans 4. **Cholesterol**

Question 28

What is the AMDR for fat?

Answer 28

Know the AMDR for adults and children age 1-3.

Question 29

What is the AMDR for protein?

Answer 29

Know the AMDR for adults and children age 1-3.

Question 30

What is the AMDR for CHO?

Answer 30

Know the AMDR for adults and children age 1-3.

Question 31

What is the risk for mortality associated with higher fat vs higher carbohydrate intakes?

Answer 31

Higher fat intakes associated with **lower** risk of overall mortality Higher carbohydrate intakes associated with **higher** risk of overall mortality

Question 32

Describe the intergenerational undernourishment cycle.

Answer 32

Undernourished girls have a greater likelihood of becoming undernourished mothers who in turn have a greater chance of giving birth to low birthweight babies, perpetuating an intergenerational cycle. This may be compounded further by adolescent girls who become pregnant before attaining adequate growth and development. Short intervals between pregnancies and having several children may accumulate or exacerbate nutrition deficits, passing these deficiencies on to the children.

Question 33

Describe the outcomes of good nutrition for women and children.

Answer 33

Improved survival, health, physical growth, cognitive development, school readiness and school performance in children and adolescents; improved survival, health, productivity and wages in women and adults; and improved prosperity and cohesion in societies.

Question 34

Describe the three categories of **enabling determinants** used in the UNICEF Conceptual Framework on the Determinants of Maternal and Child Nutrition.

Answer 34

* **Governance** → Good governance refers to the political, financial, social and public and private sector actions needed to enable children’s and women’s right to nutrition * **Resources** → Sufficient resources refer to the environmental, financial, social and human resources needed to enable children’s and women’s right to nutrition. * **Norms** → Positive norms refer to the gender, cultural and social actions to enable children’s and women’s right to nutrition.

Question 35

Describe the three categories of **underlying determinants** used in the UNICEF Conceptual Framework on the Determinants of Maternal and Child Nutrition.

Answer 35

* **Food** → comprises age-appropriate, nutrient-rich foods – including breastmilk and complementary foods for children in the first two years of life – with safe drinking water and household food security for all children and women. * **Feeding** → comprises age-appropriate dietary practices – including breastfeeding, responsive feeding and stimulation in early childhood – with adequate food preparation, food consumption and hygiene practices for all children and women. * **Environments** → comprise healthy food environments, adequate nutrition, health and sanitation services, and healthy living environments that prevent disease and promote good diets and physical activity for all children and women.

Question 36

Describe the two categories of **immediate determinants** used in the UNICEF Conceptual Framework on the Determinants of Maternal and Child Nutrition.

Answer 36

* **Diets** → Good diets are driven by adequate food and feeding to support good nutrition for children and women. * **Care** → Good care is driven by adequate services and practices to support good nutrition for children and women. > The co-occurrence of good diets and good care leads to adequate nutrition for children and women across the life course.

Question 37

Describe the situation in Venezuela.

Answer 37

* Since ~2013 has seen economic, political, and social collapse. * ~94% life in poverty (lack economic access to sufficient food) * Government initiated food distribution program was meant to be delivered twice a month but people only received them once every ~3 months. * Hyperinflation has led to soaring food prices - third highest in the world * Involuntary weightless is common * Food production and imports have fallen (lack physical access to sufficient food) * Dietary quality has shifted from meat & dairy to cheap vegetables (e.g., cassava) * ~20% of the population fled the country * Now they live as refugees in neighbouring countries in slums * Inadequate access to food, water, and sanitation; rely on one meal a day (flour, rice) * Experience xenophobia and discrimination

Question 38

Define and describe vitamins.

Answer 38

* Vitamins are chemical substances that perform specific functions in the body * Organic compounds (i.e., contain carbon) * They are **essential** nutrients in the diet (must be consumed in small amounts. * Body cannot produce them, or produce them in sufficient amounts * 13 vitamins → 4 fat-soluble; 9 water-soluble * Inadequate intakes of vitamins leads to **deficiency diseases**

Question 39

Define minerals and describe their functional properties.

Answer 39

* Minerals are **elements** - specific single atoms that perform particular functions int he body * Human body contains 40 or more minerals, but only 15 are essential in the diet (obtain others through air we breathe, etc.) * Single atom of a mineral typically carries a charge, so minerals are quite **reactive**.

Question 40

Define bioavailability and give an example of how bioavailability of a nutrient has implications for nutritional status.

Answer 40

* Proportion of intake that is capable of being absorbed through/by small intestine and made available for metabolic use or storage. * e.g., tannic acid in tea that can bind elemental iron and prevent its absorption * e.g., zinc bound to phytate in grain is unavailable for absorption but zinc found in meat is easily accessed since the body easily digests protein to release the zinc

Question 41

Of all the kcal consumed throughout the world, ~60% are from maize, rice, and wheat. Does this raise any concerns? What might be some potential issues?

Answer 41

* Micronutrient deficiencies → poor dietary diversity * If something goes wrong with those crops → corn is not very resilient for example → people suffer * Agricultural implications

Question 42

What are two issues to consider when assessing the adequacy of protein intake?

Answer 42

Quality & quantity of protein in diet

Question 43

Describe water-soluble vitamins.

Answer 43

* Vitamin C & the B vitamins (thiamin, riboflavin, niacin, folate, etc.) * Only small amounts stored in the body * Intake beyond body's needs excreted in urine * Deficiencies can develop rather quickly if intake is insufficient (within a few weeks or months) * Exception → **Vitamin B₁₂** (recirculation of a small amount that can be effective for years; thus, signs of deficiency take a long time to develop)

Question 44

Describe fat-soluble vitamins.

Answer 44

* Vitamins A, D, E, K * Stored in body, primarily in adipose and the liver * Because extra is stored in the body, symptoms of deficiency take a long time to develop if dietary intake is poor * If dietary intake was too high for a period of time → toxicity may develop

Question 45

Describe the consequences of the fact that minerals are charged.

Answer 45

* (1) They can **combine** with minerals with the opposite charge, and form stable compounds that become parts of tissue (e.g., bone) * (2) Their **electric charge** can stimulate muscles to contract and nerves to fire. * (3) They may combine with other substances in food to form stable compounds that are not easily **absorbed**. Examples: * **Zinc** → bound to ‘phytate’ in whole grains and so it is very poorly absorbed - but zinc in meat is bound to **protein**, so it is easily absorbed * **Iron** → If tea/coffee is consumed with an iron-rich meal, the tannic acid in tea will **bind** to iron in the small intestine → decreases iron absorption by up to 50%

Question 46

Define and describe nutrition assessment.

Answer 46

* **Nutrition assessment** → how we measure nutritional status; the science of determining nutritional status by analyzing individual's: * **A** → Anthropometric measurements * **B** → Biochemical tests * **C** → Clinical signs * **D** → Dietary assessment * Both in terms of history and current data * **Why conduct them?** * To determine who is malnourished (baseline) and to evaluate the impact of any program or other change (follow-up) → need to measure nutritional status * Optimal nutritional status is a balance

Question 47

Describe specific examples of anthropometric measurements and their strengths and limitations.

Answer 47

* **Anthropometry** → measurement of (1) physical dimensions and (2) gross composition of the body * **Key measurements** → height; weight; mid upper arm circumference (MUAC) * Results compared to **standard values** in order to interpret them

Question 48

Clearly define, describe, and evaluate: Wasting.

Answer 48

* **Wasting** → reflects **acute** malnutrition; generally result of weight loss due to recent period of starvation or severe disease * Severe Acute Malnutrition → weight-for-height is -3 SD or more below WHO standard * Moderate Acute Malnutrition → between -2 and -3 SD below WHO standard

Question 49

Briefly describe how biochemical measurements can be used in nutrition assessments.

Answer 49

* Measure a nutrient or its metabolite in blood, urine, faces… or measure other components related to nutritional status.

Question 50

Differentiate between clinical signs and symptoms.

Answer 50

* **Clinical methods** → use medical history and physical examination to detect and interpret the **signs** (can be observed by a trained examiner; affected person usually unaware of them) and **symptoms** (subjective; reported by affected person → e.g., feeling tired, dizzy, nauseous) of malnutrition

Question 51

Identify and explain some useful clinical signs of malnutrition. [5]

Answer 51

* **Hair** → depigmentation of hair suggests protein deficiency; ‘**flag sign**’ = transfer depigmentation of hair (reflects period of undernutrition and then improvement); dull, discolouration * **Eyes** → xerophthalmia = night blindness, photophobia, Bitot's spots (distinct white-grey foamy plaques lateral to cornea), corneal ulceration or scarring → suggests deficiency in vitamin A * **Skin** → pallor (paleness) of skin and conjunctiva → consider iron deficiency anemia * **Nails** → transverse ridging (consider protein deficiency); Koilonychia (spoon-shaped nails) → consider iron deficiency anemia * **Bilateral pitting oedema** (= swelling due to excess fluid accumulation) → sign of severe acute malnutrition → how to test (see photo)

Question 52

Summarize the limitations of a physical examination in the assessment of nutritional status.

Answer 52

* Signs and symptoms can be **hard to interpret** * (1) Physical signs are often **not specific** (especially if deficiency is mild or moderate) * Same sign could be caused by different deficiencies; signs may be caused by non-nutrition factors * (2) Examiner inconsistencies * (3) Inter-individual **variability**

Question 53

Identify and describe various types of dietary assessment.

Answer 53

* **Dietary assessment** → measurements of foods and beverages consumed by a person in one day, several days, or longer time period (months - years) → difficult to accurately assess! * **24 hour recalls** * **(1)** Participant asked for a quick list of foods/beverages consumed in the past 24 hours * **(2)** Starting with the first item on the list, the interviewer probes for details (type, amounts, additions or condiments, preparation method) * **(3)** Review details and amounts and correct any inaccuracies. * **Food records → ‘multiple-pass’ method** * Person records type and amount of food/beverage consumed for a period of time * Typically lasts 1 - 7 days * Foods/beverages are written down right after they are eaten * **Food frequency questionnaires** * Can determine how often person consumes a limited number of foods * Usually 150 or fewer items.

Question 54

Determine which method of dietary assessment would be most appropriate in various settings.

Answer 54

* Goal? Resources? Respondents? Setting? * Depends on goal of assessment (e.g., assess vitamin A status; optimize athletic performance) * Depends on resources available (remote location? funding? people power?) * Depends on the individual/population of interest (are they literate? is memory potentially a problem? can they access an online tool?)

Question 55

Describe MUAC.

Answer 55

* Measures muscle content; correlates with total muscle mass → a way to detect wasting and acute malnutrition * Reflects protein status * Common for field assessment (measurement is **quick, easy, and informative**) * MAM = \<12.5 cm * SAM = \<11.5 cm * Major determinants → arm muscle; subcutaneous fat * More sensitive measure of malnutrition than low body weight * Strong predictor of risk for death * Easy measurement to perform * Primarily used for children aged **6-59** months of age * Some studies have shown low MUAC is correlated with poor outcomes among adults and adolescents. * No international cut-offs exist * Additional research is needed * Example → MUAC \< 23.5cm in pregnant women associated with higher risk of having baby born with LBW in Guatemala

Question 56

Clearly define, describe, and evaluate: Stunting

Answer 56

* Low height-for-age → shows a physiological restriction of growth (brain growth & cognition as well) * Failure to reach linear growth potential * Reflects **chronic** malnutrition (sustained and cumulative episodes of undernutrition) * Child considered ‘stunted’ if height-for-age is -2 SD below WHO standard * **Recumbent length** → measured if child cannot stand erect without assistance

Question 57

Describe two benefits and two limitations of MUAC.

Answer 57

Strengths: (1) Cheap: Cost of a MUAC arm band is not prohibitively expensive, so even the most vulnerable/impoverished people can gain access to this important anthropometric monitoring tool. (2) Simple & effective: Anyone (service providers; community members) can easily learn how to use a MUAC arm band and simply understand and interpret the results. Limitations: (1) Excludes older children, adolescents & adults: In children over 3 years old there are no standards cut-offs correlating with risk for mortality. This means that MUAC cannot currently be used to monitor the nutritional status of older children. (2) Not always informative: Only very low MUAC scores provide information on nutritional status; however, normal or high MUAC scores may result in overlooked nutritional concerns. Furthermore, MUAC only confers information about wasting, but does not correlate with stunting.

Question 58

Stunting and wasting can occur together or independently. True or False?

Answer 58

True.

Question 59

Stunting and wasting cannot occur together or independently. True or False?

Answer 59

False.

Question 60

What is the difference between ‘failing to grow’ and ‘having failed to grow’?

Answer 60

Question 61

Clearly define, describe, and evaluate: underweight and BMI.

Answer 61

* Low weight for age in children * Influenced by both height-for-age and weight-for-height, so interpretation can be difficult * Indicator of poor nutritional status * Reflects chronic and/or acute malnutrition

Question 62

What are the strengths [5] and limitations [4] of 24 hour diet recalls?

Answer 62

**_Strengths_** 1. Quick 2. Inexpensive 3. Easy for person to complete 4. Can be used in a variety of settings 5. Does not alter diet **_Limitations_** 1. Under/over-reporting of certain foods 2. Relies on memory 3. Labour-intensive data entry 4. One recall does not represent individual's typical intake

Question 63

What are the strengths [4] and limitations [5] of food records?

Answer 63

**_Strengths_** 1. Does not rely on memory 2. Can provide great detail 3. Can give insight into eating habits/patterns 4. Multiple days more representative of individual's usual intake **_Limitations_** 1. Takes time and effort to complete accurate record 2. Requires literacy 3. Recording diet alters diet 4. Labour-intensive data entry and analysis 5. May not represent usual intake

Question 64

What are the strengths [4] and limitations [4] of food frequency questionnaires?

Answer 64

**_Strengths_** 1. Can be self-administered 2. Machine-readable 3. Inexpensive 4. May be more representative of usual intake **_Limitations_** 1. May not include foods usually consumed by participants 2. May not include information on portion size 3. Typically requires literacy 4. If self-administered, cannot ask clarifying questions

Question 65

Critically evaluate the causes of high prevalence undernutrition in Nepal.

Answer 65

* Early marriage * Low eduation * poverty * Natural disasters * Climate change * Lack of health care * No clean water * Poor sanitation * Son preference/daughter aversion

Question 66

Comment on whether it is appropriate to use international standards (e.g., cut-offs for wasting and stunting) to evaluate a child's growth.

Answer 66

* Race/ethnicity has a **small** impact on preschool growth, compared to **environmental** effects

Question 67

Describe the UNICEF conceptual framework of the determinants of child undernutrition and use it to analyze the causes of malnutrition in complex situations. Demonstrate the correct use of the terms contained in the framework (e.g., basic, underlying, immediate; household food insecurity; inadequate care; etc.)

Answer 67

* Immediate causes: acts on the individual * Underlying causes: acts on the household/community * Basic causes: acts on the whole society (affect some groups more than others)

Question 68

Describe how son preference/daughter aversion may contribute to malnourishment.

Answer 68

* Common in many regions of the world * Can affect family size and treatment of girls (who eats what and when; who is in charge of household tasks; who gets an education; etc.), for example: * Photo: woman in India pictured with her 5 children; after first giving birth to two girls, family now satisfied that number of sons \> number of daughters * Study in India → girls in families with stronger son preference do more hours of household labour each week * Study in Bangladesh → Children's nutritional status adversely affected by family size, but girls more negatively affected than boys

Question 69

Answer 69

Answer → B

Question 70

What factors put children at risk for malnourishment? [4]

Answer 70

* **Low weight (BMI)** of mother * Child's age → younger children are more at risk * **Higher** birth order (1st child in a family is 1st birth order; 5th or 6th child may have less resources) * Lower standard of living

Question 71

What factors are protective of malnourishment for children? [2]

Answer 71

* Mother's education (minimum of 5 years of education) * Participation in vitamin A or nutrition program

Question 72

For many years, the proportion of people experiencing hunger and food insecurity was declining throughout the world. However, in recent years it has stayed the same. True or False?

Answer 72

False. For many years, the proportion of people experiencing hunger and food insecurity was declining throughout the world. However, in recent years it has started to increase.

Question 73

For many years, the proportion of people experiencing hunger and food insecurity was declining throughout the world. However, in recent years it has started to increase. True or False?

Answer 73

True.

Question 74

For many years, the proportion of people experiencing hunger and food insecurity was declining throughout the world. However, in recent years it has decreased even more dramatically. True or False?

Answer 74

False. For many years, the proportion of people experiencing hunger and food insecurity was declining throughout the world. However, in recent years it has started to increase.

Question 75

To eliminate hunger in the world, we need to focus on increasing global food production -- especially production of staple foods such as rice, wheat, maize, and cassava. True or False?

Answer 75

False.

Question 76

More than half of the risk factors that contribute to the global burden of disease are related to poor quality dietary intake. True or False?

Answer 76

True.

Question 77

Less than half of the risk factors that contribute to the global burden of disease are related to poor quality dietary intake. True or False?

Answer 77

False. More than half of the risk factors that contribute to the global burden of disease are related to poor quality dietary intake.

Question 78

Hunger and undernutrition are not evenly spread throughout the world; some regions are affected more severely than others. In which regions are hunger and undernutrition more common?

Answer 78

* Low income countries (e.g., Haiti, Malawi, Mozambique, Syria, Yemen) * Africa, especially sub-Saharan Africa * Asia, especially South Asia

Question 79

Famine and its associated deaths are primarily due to natural causes unaffected by human behaviour (e.g., natural recurring cycles of drought). True or False?

Answer 79

False. ## Footnote > "Famine is the most acute face of hunger. Over 70 million people died in famines during the 20th century. Most deaths occurred in human induced crises, in which political mismanagement, armed conflict, and discrimination of marginalised political or ethnic groups compounded the effects of environmental shocks, such as droughts or locust invasions."

Question 80

Define ‘overweight’ in adults.

Answer 80

A body mass index (BMI; weight in kg/height in m²) of 25 - 29.9 kg/m²

Question 81

Briefly describe ‘stunting’.

Answer 81

Low height for age (dramatically shorter than expected for age)

Question 82

Define ‘obesity’ in adults.

Answer 82

Correct match:A body mass index (BMI; weight in kg/height in m²) of 30 kg/m² or more

Question 83

Define ‘underweight’ in adults.

Answer 83

A body mass index (BMI; weight in kg/height in m²) of less than 18.5 kg/m²

Question 84

Briefly define wasting.

Answer 84

Low weight for height (dramatically thinner/lighter than expected for height)

Question 85

Micronutrient deficiencies (such as iron deficiency) are common in high-income countries (such as Australia, Canada, the United Kingdom) True or False?

Answer 85

True.

Question 86

It is not common for a malnourished person to have multiple forms of malnutrition (e.g., it would be unusual for for a child to be both stunted and wasted, or for an adult to be both overweight and have micronutrient deficiencies) True or False?

Answer 86

False.

Question 87

Overnutrition and its associated health risks are increasingly common throughout the world. For example, in sub-Saharan Africa in recent decades, the prevalence of overweight/obesity has tripled and hypertension (i.e., high blood pressure) has also increased notably. True or False?

Answer 87

True.

Question 88

A woman's health and nutrition status during pregnancy has a big impact on her child's health status at birth, and beyond True or False?

Answer 88

True.

Question 89

Explain, with specific examples, what is meant by: **nutrition transition**

Answer 89

* Nutrition transition is the shift in dietary consumption and energy expenditure that coincides with economic, demographic, and epidemiological changes. * The “nutrition transition” is a model used to describe the shifts in diets, physical activity and causes of disease that accompany changes in economic development, lifestyle, urbanisation, and demography. It most commonly is used to refer to the change from traditional diets towards “Western” diets rich in fats, sugars, meat and highly processed foods and low in fibre, and accompanied by a rise in sedentary lifestyles.

Question 90

Explain, with specific examples, what is meant by: **double burden of malnutrition**

Answer 90

* The double burden of malnutrition is the coexistence of overnutrition (overweight and obesity) alongside undernutrition (stunting and wasting), at all levels of the population—country, city, community, household, and individual. * E.g., → Kibera, a large urban slum in Nairobi, the capital of Kenya. People here are undernourished, and there is also a high prevalence of overweight and obesity due to the availability of cheap, low quality food (e.g., fast food). Both quantity and quality of food are compromised. Food is often rich in calories, but lacking in nutrition. * It is important to note that, as countries throughout the world experience the nutrition transition, both *over*nutrition (overweight/obesity) and *under*nutrition (such as wasting, stunting, and micronutrient deficiencies) actually *_co-exist_* -- definitely within the country as a whole, but sometimes within the same family or even within the same person. This is what is referred to as the **"double burden of malnutrition."** The World Health Organization (WHO) defines the double burden of malnutrition as [_"the coexistence of undernutrition along with overweight and obesity, or diet-related noncommunicable diseases, within individuals, households and populations, and across the life course."_](https://apps.who.int/nutrition/double-burden-malnutrition/en/index.html)

Question 91

Explain, with specific examples, what is meant by: **hidden hunger**

Answer 91

* This form of hunger – known as hidden hunger or ***micronutrient deficiency*** – is often ignored or overshadowed by hunger related to energy deficits.

Question 92

Where in the world is undernutrition and over nutrition most common?

Answer 92

* Undernutrition is most common in sub-Saharan Africa (e.g., Somalia), parts of South America (e.g., Venezuela), and Southeast Asia. * Overnutrition is most common in richer countries (e.g., Canada, the US, the UK) From 2001 -2019, undernourishment in the world decreased in certain areas (e.g., China, Brazil); however, in other areas a decrease in undernourishment was not permanent (e.g., Venezuela). Moreover, in certain countries, undernourishment has been a permanent fixture across the years (e.g., Somalia, North Korea), and in many Sub-Saharan African countries undernourishment has worsened. From 1975 - 2016, overweight and obesity has increased in most countries in the world, except for certain countries in sub-saharan Africa, and south East Asia where undernourishment is severe. However, undernourished countries are not immune to obesity. For instance, Venezuelan’s share of adults that are overweight or obese had increased to 80-90% by 2016, while at the same time, their share of the population that is undernourished has increased to 30%. Even in Somalia, where the proportion of undernourished is 50%, the share of adults that are overweight or obese has increased to 30%, indicating the double burden of malnourishment is a serious problem for many countries in the world today. Wealtheir countries (e.g., Canada, the US, the UK) have seen a much more drastic increase in overweight and obesity. While few individuals are undernourished, by 2016, 2/3rds of the population were overweight or obese.

Question 93

Answer 93

Answer: C A: Immediate cause B: Underlying cause C: Basic cause

Question 94

Briefly define malnutrition.

Answer 94

Poor nutritional status due to dietary intake either above or below optimal level.

Question 95

What are the 3 clinical forms of acute malnutrition?

Answer 95

1. **Marasmus** (wasting): severe weight loss, wasting 2. **Kwashiorkor** (nutritional edema): bloated, water retention, bilateral pitting 3. **Marasmic-kwashiorkor**: combination of wasting and bilateral edema

Question 96

Describe marasmus.

Answer 96

* = wasting * Body tries to conserve energy (reduced activity of liver, kidneys, heart, etc.) * Mainly due to energy deficiency; but some diversity present, just not enough! * Use proteins from muscle and other tissues to help meet body's protein requirements. * Note: loss of \>30% of body protein results in: * Less strength for breathing * Susceptibility to infections * Abnormal organ function * Death

Question 97

What does loss of \>30% of body protein result in? [4]

Answer 97

* Less strength for breathing * Susceptibility to infections * Abnormal organ function * Death

Question 98

Describe Kwashiorkor.

Answer 98

* Bilateral pitting edema starts in feet, progresses to legs, arms, hands, face. * More serious! * Associated with metabolic abnormalities. * Kwashiorkor is more difficult to treat and has lower survival rates than marasmus

Question 99

Kwashiorkor is more difficult to treat and has lower survival rates than marasmus. True or False?

Answer 99

True.

Question 100

Marasmus is more difficult to treat and has lower survival rates than kwashiorkor. True or False?

Answer 100

False. Kwashiorkor is more difficult to treat and has lower survival rates than marasmus.

Question 101

Describe marasmic-kwashiorkor.

Answer 101

* Both wasting and bilateral pitting edema * A form of **severe** acute malnutrition * Features of both are present simultaneously. * Edema can hide growth failure

Question 102

What are the immediate, underlying, and basic causes of Alemitu's malnutrition?

Answer 102

* Immediate: inadequate dietary intake * Underlying: inadequate feeding care/practices (e.g., lack of exclusive breastfeeding) * Basic: inadequate access to land; inadequate employment & income

Question 103

How many people living with type 2 diabetes live in low and middle-income countries?

Answer 103

* Type 2 diabetes is a growing worldwide concern * 79% of people living with T2D live in low and middle-income countries

Question 104

Describe how dietary intake changes in the nutrition transition paradigm.

Answer 104

Diets rich in complex carbs and lean protein are traded for diets rich in simple carbs, added sugars, saturated fats, and processed food.

Question 105

Describe how physical activity changes in the nutrition transition paradigm.

Answer 105

‘ Active transportation’, physical occupations and physical labour during daily tasks are traded for cars, buses, trains, etc, sedentary occupations, and automation.

Question 106

What are the 5 stages of the nutrition transition?

Answer 106

1. Hunter-gatherer or Palaeolithic 2. Modern agriculture and famine 3. Receding famine (as incomes grow) 4. Changes in activity levels and diet lead to increased levels of non-communicable diseases (NCDs) 5. Behavioural change in which populations reduce their fat, increase fibre intake, and do meaningful physical activity that extends mortality and reduces NCDs.

Question 107

What are the 10 social determinants of health?

Answer 107

1. Income and social status 2. Employment and working conditions 3. Education and literacy 4. Childhood experiences 5. Physical environments 6. Social supports and coping skills 7. Healthy behaviours 8. Access to health services 9. Biology and genetic endowment 10. Gender - culture - race

Question 108

How much iron do we need?

Answer 108

* Vegetarian recommendation = **1.8x higher** = males 14mg and females 32 mg

Question 109

What are dietary sources of iron?

Answer 109

* Liver, beef, pork, blood * Dried beans * Iron-fortified foods * Dried fruits * Spinach * Cooking tools (e.g., cast iron pot; lucky iron fish ‘ingot’)

Question 110

Who is at risk or affected by iron deficiency?

Answer 110

* Iron-deficiency affects more than 2 billion people worldwide * Severe iron deficiency results in death of 50,000 women per year in pregnancy and childbirth * Iron deficiency lowers productivity of workforces: estimated losses of 2% or more of GDP in worst-affected countries

Question 111

What are the consequences of iron deficiency in children?

Answer 111

* Premature birth, low birthweight, increased infections, death, impaired physical growth * Impaired cognitive development, negative impact on learning * Lasting life-long impact

Question 112

How can nutritional assessment detect iron deficiency?

Answer 112

* Two components of nutrition assessment are important * **Biochemical** → blood test measuring **hemoglobin** (indicates anemia is present) and **serum ferritin** (indicates anemia is iron-deficiency related) * **Clinical** → pale conjunctiva indicates low circulating levels of RBCs

Question 113

Identify, describe, and evaluate strategies that could reduce iron deficiency and improve iron status.

Answer 113

1. Change diet to increase iron intake and absorption → dietary diversity; increase enhancers, and reduce inhibitors 2. Fortification → industrial (iron fortification of flour) or household (lucky iron fish) 3. Control hookworm (and other infections that can cause anemia) → wear shoes!

Question 114

Identify and justify WHO recommendations for zinc supplementation during acute diarrheal episodes in children. Evaluate one approach to increase adherence to this recommendation in rural Zambia.

Answer 114

* Deficiency contributes to growth failure and weakened immunity in children * Contributes to 800k child deaths per year (resulting from diarrhea, pneumonia, malaria) * ColaLife operational trial of ‘Kit Yamoyo’; 10 packages fit in a crate of Coke * Proportion of children with diarrhea treated with oral rehydration salts and zinc at baseline \<1%; after 1 year of trial: 45% * Other findings: * 93% mixed salts correctly * only 4% of kits were actually transported in Coke crates * Success resulted from creating effective value chain → every step adds value and generates profit for organization or individual * Design * Manufacture * Assembly * Storage * Distribution * Purchase by mother

Question 115

Describe the causes and consequences of iodine deficiency at different stages of life.

Answer 115

* Major preventable cause of intellectual disability worldwide * Cretinism → severely stunted physical and mental growth usually due to maternal hypothyroidism (resulting from iodine deficiency) * Goiter → swelling of thyroid gland 90% caused by iodine deficiency * Iodine deficiency in pregnancy leads to approximately 20 million infants per year born with cognitive and growth impairments * Public health response → iodine has been added to household table salt

Question 116

Describe and evaluate the impact of fortification as a strategy to reduce the global prevalence of iodine deficiency.

Answer 116

* 75% of the world population has access to iodized salt * However, fortification programs are not always mandatory; levels of fortification vary

Question 117

What are the consequences of iron deficiency in adults?

Answer 117

* Reduced productivity / work capacity owing to less physical and mental energy * Increased likelihood of death during childbirth * With good iron status, may lose up to a litre of blood during childbirth, but for a woman with iron-deficiency anemia, the loss of 1 cup of blood can be fatal * IDA contributes to ~20% of all maternal deaths

Question 118

What causes iron deficiency?

Answer 118

* **Low dietary intake** (this is an immediate cause; consider the underlying and basic causes of low dietary intake) * **Poor absorption** → physiological reasons like diarrhea, or dietary reasons like low bioavailability in plant forms * **Increased need** (growth, pregnancy, lactation) * **Infections** (e.g., malaria, HIV/AIDS, hookworms, schistosomiasis, tuberculosis)

Question 119

Could a ‘lucky iron fish’ help reduce iron deficiency in Cambodia? Name some of the consequences of iron deficiency in Cambodia.

Answer 119

* Dizziness; complacency; lethargy; inability to concentrate; premature births; complications for birth for women * Cooking with a cast iron pot can release iron into the food which can then be absorbed in the diet → most Cambodian women use aluminum pots because they are cheaper and lighter * Lucky Iron Fish is cheap and accessible; the shape of the fish increases compliance because the fish is a symbol of good luck in Cambodia

Question 120

What is a key factor affecting iron absorption?

Answer 120

* The type of iron consumed * 2 types of iron in foods: heme and non-heme * **Heme** → part of hemoglobin and myoglobin → more absorbable * **Non-heme** → not part of hemoglobin and myoglobin; found in BOTH animal and plant foods

Question 121

What factors increase iron absorption? [2]

Answer 121

* Vitamin **C** * **MFP** factor (meat, fish, poultry factor or ‘meat factor’)

Question 122

What factors decrease iron absorption? [8]

Answer 122

* Phytates * Oxalates * Polyphenols * Fibre * Calcium * Zinc * Antacids * EDTA (a preservative)

Question 123

What are ‘sprinkles’?

Answer 123

An example of home fortification → Micronutrient powder 1. Easy to use 2. Highly acceptable 3. Can be added to any cooked food 4. Sprinkles are encapsulated in lipid: prevents transfer of taste to other food

Question 124

Dietary iodine likely to be sufficient if consuming: [4]

Answer 124

* Seafood * Cereals grown in iodine-rich soils * Milk * Fortified foods

Question 125

Describe vitamin A deficiency.

Answer 125

* VAD is one of the most widespread and serious nutritional issues for young children (affects ~⅓ of children aged 6-59 months) * Leading cause of preventable blindness * Deficiency compromises immune system activity: increases risk for infections, disease, and death (150 million children at increased risk of dying from infectious disease due to VAD * A public health problem in \>50% of countries

Question 126

Who is at risk of vitamin A deficiency? [4]

Answer 126

1. People who live in poverty 2. Populations in which rice provides bulk of daily diet 3. Can occur at any age, but at greatest risk = children \< 5 years old 4. Pregnant and lactating women: have higher requirements (in South Asia, night blindness occurs in 15-20% of pregnancies)

Question 127

What are sources of vitamin A?

Answer 127

* Variety of plant and animal foods * Industrialized countries: ~⅔ of dietary vitamin A from animal sources as preformed vitamin A (e.g., liver, milk, eggs, fish; in animal-source foods: ~70-90% bioavailable) * Developing world: mostly provitamin A from carotenoids in plant foods (e.g., yellow and orange fruit and vegetables, dark leafy greens, red palm oil; carotenoids: ~5-65% bioavailable)

Question 128

What is xerophthalmia? What are the signs and symptoms?

Answer 128

* A consequence of vitamin A deficiency; progresses as follows: * Night blindness = earliest sign; specific; sensitive; responds very rapidly to vitamin A therapy (within 1-2 days can be reversed) * Conjunctival xerosis * Bitot's spots; potentially still reversible * Corneal xerosis; irreversible * Ulceration; irreversible * Necrosis/keratomalacia = permanent damage; irreversible

Question 129

Why has vitamin A deficiency been described as ‘nutritionally acquired immunodeficiency disorder’?

Answer 129

* Compromised immunity with VAD * Mucous barriers that line gastrointestinal, respiratory, and genitourinary tracts are not as effective * Immune system response impaired * VAD predisposes individuals to severe infection, including: * Respiratory infection (coughing) * Infectious diarrhea * Dysentery * Measles (if a child with VAD gets measles they have a 50% chance of dying) * HIV, malaria * VAD responsible for 35% of child deaths in Mozambique! * Community based improvement in vitamin A status of deficiency children reduces their overall risk of dying by 20-30%.

Question 130

What can be done to solve vitamin A deficiency?

Answer 130

1. Education and awareness (target women) 2. Increase dietary sources of vitamin A 1. Promote breastfeeding; breast milk contains vitamin A 2. Dietary diversification 3. Promote consumption of available vitamin A-rich foods (palm oil; greens; varieties (e.g., of maize) high in vitamin A) 3. Fortification 1. Sugar; oil; margarine (should provide 15% of daily kcal intake for target group to be effective) 2. Biofortification (e.g., breeding maize or cassava varieties with high beta-carotene content) 3. Typically needs to be combined with other strategies (e.g., supplementation) 4. Needs to be monitored (i.e., evaluated)

Question 131

What can be done to solve vitamin A deficiency?

Answer 131

1. **Education and awareness** (target women) 2. **Increase dietary sources** 1. Promote breastfeeding; breast milk contains vitamin A 2. Dietary diversification 3. Promote consumption of available vitamin A-rich foods (palm oil; greens; varieties (e.g., of maize) high in vitamin A) 3. **Fortification** 1. Sugar; oil; margarine (should provide 15% of daily kcal intake for target group to be effective) 2. Biofortification (e.g., breeding maize or cassava varieties with high beta-carotene content) 3. Typically needs to be combined with other strategies (e.g., supplementation) 4. Needs to be monitored (i.e., evaluated) 4. **Local (household; community) food production** (night blindness was more common if family did _not_ have home garden)

Question 132

Answer 132

Answer: A (immediate)

Answer 133

Question 134

Describe the cycle of malnutrition in women, and list some socio-economic factors.

Answer 134

Question 135

What are the WHO breastfeeding recommendations?

Answer 135

* Exclusive (= no other liquids/solids) breastfeeding is recommended **up to 6 months of age**, with continued breastfeeding along with appropriate complementary foods up to **2 years** of age of beyond. * Breastfeeding should begin within an hour of birth * Should be ‘on demand’ * Bottles and pacifiers should be avoided

Question 136

What is the 1-6-24 model?

Answer 136

* Breastfeeding should be initiated within **1 hour** of birth * Exclusive breastfeeding for the first **6 months** * Continue breastfeeding (with complementary foods) for **24+ months**

Question 137

What percent of infants worldwide are exclusively breastfed for the first 6 months?

Answer 137

42%

Question 138

When is the complementary feeding period, and what are complementary foods?

Answer 138

* 6-24 months of age * Foods and beverages introduced at ~6 months age (to ‘complement’ breast milk) → **priority = iron-rich foods** * At ~6 months: infant needs more energy and nutrients than can be provided by breast milk alone - but they definitely still need the nutrient and other contributions of breast milk! * Challenges: * Timing of introduction: too early/late * May not be nutritionally adequate * May be unsafe

Question 139

Why is ‘breast best’?

Answer 139

1. **Reduced infant mortality** * Non-breastfed infants in developing countries 6-10x more likely to die in first months of life * Diarrhea and pneumonia are more severe in non-breastfed infants **2. Reduced risk of postpartum hemorrhage if mother can breastfeed shortly after delivery** **3. Increased birth spacing** * An interval of at least 24 months between a live birth and the next conception reduces risk of negative outcomes for mother and infant

Question 140

How can breastfeeding increase the interval between births?

Answer 140

* Breastfeeding can increase birth spacing by causing “lactational amenorrhea” * Exclusive breastfeeding can give a woman 98% protection against pregnancy for 6 months, *if her baby feeds frequently day and night, and is not given any other food, drinks, or a pacifier.* * Breastfeeding at night is an important part of this.

Question 141

What are breast-feeding benefits for the child? [7]

Answer 141

1. Lowers neonatal and infant mortality 2. Protects against diarrhea and respiratory infections 3. Protects against middle-ear infection 4. Reduces incidence of leukaemia 5. Reduces sudden infant deaths and life-threatening necrotizing enterocolitis (intestinal disease) 6. Lowers likelihood of overweight and obesity 7. Improves school performance and intelligence test scores

Question 142

What are the economic benefits of breastfeeding? [3]

Answer 142

1. Higher adult earnings 2. Lower healthcare costs 3. Gains due to increased productivity

Question 143

What are the breast-feeding benefits for the mother? [3]

Answer 143

1. Helps prevent postpartum hemorrhage 2. Improves birth spacing 3. Decreases risk of breast and ovarian cancer

Question 144

Describe the composition of breastmilk.

Answer 144

* **Vitamins** → sufficient amounts, except vitamin D (and vitamin K) * **Minerals** → low in iron (but bioavailability high, and infant stores will last ~6 months) * **Anti-infective factors** → Immunoglobulins, white blood cells, lysozyme, lactoferrin, etc. * **Other bioactive factors** → Lipase, growth factors (e.g., promote growth and development of intestinal tract), laxative factors

Question 145

Describe how breast milk composition changes over time.

Answer 145

1. **Colostrum** → secreted for first 2-3 days after delivery 2. **Transitional milk** → until infant ~2 weeks old 3. **Mature milk** → from 2 weeks to ~6 months 4. **Extended lactation** → beyond 6 months *Composition matches needs of infant!*

Question 146

What is colostrum?

Answer 146

* Concentrated, very nutritious, mild laxative, contains growth factors and antibodies * Infant will consume only ~1 tsp of colostrum in a feeding!

Question 147

What affects whether a woman breastfeeds or not? [3]

Answer 147

1. Opportunity to feed right away 2. Supportive sociocultural context 3. Direct information and support

Question 148

Which of the statements is TRUE?

Answer 148

D → all of the above are true

Question 149

Describe how breast milk composition changes _within_ each feed.

Answer 149

* Foremilk → watery * Hindmilk → high fat; fat soluble vitamins (e.g., vitamin A); more energy dense

Question 150

What myths exist regarding breastfeeding in emergencies? How have breastfeeding rates changed in countries that have experienced large-scale humanitarian emergencies (e.g., drought, refugee crisis)?

Answer 150

* Myth → A mother under stress cannot nurse * Breastfeeding rates have increased (e.g., drought in Madagascar)

Question 151

Should HIV+ women breastfeed their infants? Children of HIV-Infected mothers are more likely to be stunted, wasted, or underweight.

Answer 151

* If a safe alternative is available → use that safe alternative (e.g., commercial infant formula (if safe water, sanitation, reliable preparation, sufficient supply); safe donor breast milk) * If no safe alternative is available → breastfeed and antiretroviral therapy (exclusive for 6 months; continue for at least 12 months with addition of complementary foods)

Question 152

Define: maternal mortality.

Answer 152

Death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration of the pregnancy, from any cause related to or aggravated by the pregnancy.

Question 153

What are the causes of maternal mortality? Who is at greatest risk?

Answer 153

Approximately 20% due to iron deficiency Other causes: high blood pressure during pregnancy (eclampsia); complications during delivery; severe bleeding after birth; infections; unsafe abortion At greatest risk: people living in poverty; young women

Question 154

How many pregnant women in low-and middle-income countries have anemia?

Answer 154

Up to 50%!

Question 155

Describe malnutrition and obstructed labour.

Answer 155

* Passage of fetus through pelvis is mechanically blocked * Pelvis may be too small due to inadequate development e.g.,: * Growth was stunted due to malnutrition * Vitamin D deficiency during early years can lead to a malformed pelvis * Young age at first pregnancy

Question 156

What is ‘Lip Yaleh’?

Answer 156

* Ethiopia's National Health Care Quality Strategy 2016-2020 aims to reduce maternal mortality to 199 per 100,000 live births * In October 2019, a song ‘Lib Yaleh’ was released emphasizing ‘care at the clinic saves lives’ as part of efforts to reduce maternal mortality.

Question 157

How can maternal mortality be reduced? [4]

Answer 157

1. Promote access to necessary health care: reproductive, sexual, maternal, and newborn 2. Universal health coverage (address inequities in access) 3. Strengthen health care systems to respond to needs of women and girls 4. Ensure accountability to improve quality of care and equity

Question 158

Describe the global gender gap.

Answer 158

* Iceland has the smallest gender gap in the world, scoring 0.908 (1.0 = complete equality); Afghanistan has the greatest (0.435) * At the current rate of progress, it would take 132 years to reach full parity (i.e., equality)

Question 159

Evaluate the role of women’s education in reducing poverty and undernutrition

Answer 159

* Educating women reduces proportion of population in poverty. * Example: If mothers complete primary school, proportion of population living in poverty decreases by ~34% in Egypt and ~23% in Mozambique. * Women's education and status contribute more than 50% to reductions in child malnutrition * Example: Child malnutrition in developing world decreased by ~15% from 1970 to 1995. Why? Increased education for women (43%), improved food availability (26%), improved status of women (12%)

Question 160

Poor nutritional status compromises growth and development and makes infection and disease more likely. The impact of poor nutritional status is more severe during certain periods of life than in others. During which period of life is good nutritional status considered to be the very most important (because of the negative consequences of undernutrition during that time)?

Answer 160

**The start of pregnancy to when the child turns 2 years old.** ## Footnote The first 1,000 days (which is from the very beginning of pregnancy to the child's second birthday) is the time of life when good nutritional status is the most important, in terms of the notable negative consequences of poor nutritional status during that time. "From a life-cycle perspective, the most crucial time to meet a child’s nutritional requirements is in the 1,000 days including the period of pregnancy and ending with the child’s second birthday. During this time, the child has increased nutritional needs to support rapid growth and development, is more susceptible to infections, has heightened sensitivity to biological programming and is totally dependent on others for nutrition, care and social interactions."

Question 161

What is stunting and why is it problematic?

Answer 161

Stunting refers to a child having an inadequate height for age, meaning the child is too short for its age compared to international standards, due to chronic undernutrition. Stunting is problematic because it has short-term effects and long-term effects. In the short-term, a child is at risk of dying, disease and disability. In the long-term, because being stunted means that a child will have minimal catch-up growth after the age of 24 months, a person will have reduced physical capacity (short adult height) and reduced cognitive capacities leading to reduced educational outcomes and economic productivity.

Question 162

Imran is a 4-year-old boy in Bangladesh. He is underweight and malnourished, in part due to repeated respiratory infections such as pneumonia. According to the UNICEF framework, respiratory infections would be an example of a(n) […] cause of undernutrition for Imran.

Answer 162

Immediate

Question 163

An infant born with low birth weight indicates that there were insufficient resources (i.e., energy and nutrients) available during fetal development to support appropriate growth. True or False?

Answer 163

True.

Question 164

It is very rare to be born with LBW. True or False?

Answer 164

False. "In South Asia, an estimated 28 per cent of infants are born with low birthweight."

Question 165

A child born with low birth weight may be part of an intergenerational cycle of undernutrition. True or False?

Answer 165

True.

Question 166

A child born with low birth weight is more likely to die in the first year of life than infants born with a normal birth weight. True or False?

Answer 166

True.

Question 167

Infants born with low birth weight are more likely to experience illness in the first year of life than infants born with a normal birth weight. True or false?

Answer 167

True.

Question 168

Samira is a 2-year-old girl in Niger. She is the fourth of five children. She usually eats once per day, but it is not enough to meet her nutrient needs. She is becoming increasingly undernourished. Her mother and father try to provide for their family through subsistence farming (70% of the population of Niger is reliant on subsistence farming), but have struggled in recent years because of bad weather conditions (drought and flooding) and locusts. There is often political instability in Niger and according to the World Bank, it is among the world's poorest countries, with an economy particularly vulnerable to challenges associated with the climate crisis. According to the UNICEF Framework, what is a "basic" cause of undernutrition in Samira's case?

Answer 168

Niger experiences political instability and does not have a strong economy

Question 169

Which could be considered "the real reasons" or "the root causes" for malnutrition, according to the UNICEF Framework?

Answer 169

Basic causes

Question 170

Micronutrient deficiency is referred to as "hidden hunger." True or False?

Answer 170

True. "Unlike energy-protein undernourishment, the health impacts of micronutrient deficiency are not always acutely visible; it is therefore sometimes termed ‘hidden hunger’ (the two terms can be used interchangeably)."

Question 171

Who is **_most_** likely to experience micronutrient deficiency? [2]

Answer 171

Pregnant women Children 5 years of age or younger "Although any individual can experience micronutrient deficiency, pregnant women and children are at greatest risk of developing deficiencies. This is not only as a result of low dietary intake, but also from higher physiological requirements; pregnancy and childhood development often increases demand for specific vitamins and minerals."

Question 172

Give examples of the serious effects on human health from micronutrient deficiencies. [4]

Answer 172

* Blindness * Death * Impaired cognitive development * Susceptibility to infection and disease

Question 173

Only people who do not consume enough energy (kcal) experience micronutrient malnutrition. In other words, if people consume enough energy (kcal), they will get enough micronutrients. True or False?

Answer 173

False.

Question 174

What are the two main consequences of vitamin A deficiency?

Answer 174

Susceptibility to infection and blindness

Question 175

Which micronutrient deficiency will cause susceptibility to infection and blindness?

Answer 175

Vitamin A deficiency

Question 176

What is the main consequence of iodine deficiency?

Answer 176

Leading cause of preventable brain damage in children

Question 177

Which micronutrient deficiency is the leading cause of preventable brain damage in children?

Answer 177

Iodine deficiency

Question 178

What is a consequence of iron deficiency in adults?

Answer 178

Reduced work capacity

Question 179

Which micronutrient deficiency is responsible for reduced work capacity?

Answer 179

Iron deficiency

Question 180

Which micronutrient deficiency causes increased susceptibility to infection and stunted growth?

Answer 180

Zinc deficiency

Question 181

What are the two main consequences of zinc deficiency?

Answer 181

Increased susceptibility to infection Stunted growth

Question 182

Most cases of vitamin A deficiency in children and pregnant women result in *night blindness*. True or False?

Answer 182

False.

Question 183

In the body, iron is used to make hemoglobin, a component of red blood cells which is needed to carry […] to the body's tissues. […] (i.e., inadequate hemoglobin levels in the blood), usually results from […] deficiency, but can also be the result of […] deficiency, and it negatively impacts children's ability to learn and adults' ability to work. In severe cases, it can even result in […] for pregnant women.

Answer 183

In the body, iron is used to make hemoglobin, a component of red blood cells which is needed to carry **oxygen** to the body's tissues. **Anemia** (i.e., inadequate hemoglobin levels in the blood), usually results from **iron** deficiency, but can also be the result of **vitamin B12** deficiency, and it negatively impacts children's ability to learn and adults' ability to work. In severe cases, it can even result in **death** for pregnant women.

Question 184

One metric that has been developed to indicate the severity of micronutrient malnutrition is the Global Hidden Hunger Index (GHHI). The GHHI is calculated as the average of three important nutritional indicators:

Answer 184

Prevalence of stunting Anemia Vitamin A deficiency

Question 185

Why is food often the first thing Canadians reduce or forgo when they do not have enough money to pay for everything they need?

Answer 185

Food is often the only flexible item among people's expenses (e.g., how much you spend on food each month is up to you, but how much you spend on rent each month is not)

Question 186

Statistics Canada has measured food insecurity among Canadians periodically since 2007. However, there are some notable limitations to the data collected, including: [2]

Answer 186

* Some Canadians who may actually be more likely to be food insecure are not included in the surveys intended to measure the prevalence of food insecurity in Canada (including homeless people and indigenous people living on-reserve) * Provinces can often opt out of measuring food insecurity, making it difficult to measure national prevalence of food insecurity and/or changes over time

Question 187

Which subsets of the Canadian population have a greater likelihood of being food insecure than others? [5]

Answer 187

* Children * University students * Single mothers * Recent immigrants * People of colour

Question 188

Food insecurity is common among university students: approximately half of university students in a 2016 study on several Canadian campuses had to sacrifice buying healthy food in order to pay for their university-related expenses, like tuition, books, and rent. True or False?

Answer 188

True.

Question 189

Which Canadian city has the highest rate of food insecurity?

Answer 189

Halifax

Question 190

What contributes to food insecurity in Canada? How does this differ from food insecurity in Yemen, Nepal, or Venezuela?

Answer 190

Food insecurity in Canada is an issue of inadequate income from all sources. Many financial restrictions prevent people from being able to afford sufficient healthy food. Housing costs are prohibitive, social assistance is lacking, and many employers only offer restrictive, low-wage, part-time, or contract positions, so even employed individuals can struggle with food insecurity. This differs from many of the places we have discussed in class because food insecurity in Canada is not a question of lack of access to sufficient, nutritious food, but rather, inability to purchase the food due to financial constraints. There is plenty of healthy food available in Canada, but people cannot afford to buy it. This is in contrast with the situation in Yemen, Nepal, or Venezuela for instance, where there is lack of access to sufficient food completely.

Question 191

What do you think needs to be done to reduce the prevalence of food insecurity in Canada? Include the following phrases in your response: priority, limitation, individuals, government

Answer 191

In order to address food insecurity in Canada, the **limitations** of charity-based solutions (e.g., food banks; soup kitchens) need to be acknowledged before real progress can be made. Then, **governments** needs to focus on policy reform that benefit the most vulnerable **individuals**, such as people of colour, immigrants, students, single mothers and children. For example, **priority** should be to increase access to affordable housing and full-time jobs that pay a living wage, as well as to revise tax allocations to bolster social assistance programs.

Question 192

List the four main groups of factors affecting food choice.

Answer 192

Culture Nutrition Knowledge & beliefs Food Practical considerations

Question 193

Describe the cultural factors affecting food choice. [4]

Answer 193

* Acceptable foods * Customs * Food symbolism * Religious beliefs

Question 194

Describe the nutrition knowledge and beliefs influence on food selection. [3]

Answer 194

* Health concerns * Attitudes and values * Education

Question 195

Describe practical considerations affecting food choice. [4]

Answer 195

* Food availability and cost * Hunger * Convenience * Health status

Question 196

Describe how food preferences influence food choice. [3]

Answer 196

* Taste, smell, colour, texture, temperature * Hereditary * Familiarity ## Footnote Primarily learned; change over time; informed by culture

Question 197

What is culture? [3]

Answer 197

* The system of shared beliefs, values, customs, behaviours, and artifacts that the members of society use to cope with their world and with one another, and that are transmitted from generation to generation through learning * All cultures are equally developed – none is better, more advanced, or more primitive than any other * Food is a major part of culture (it both informs and demonstrates culture) * Something we learn throughout life * Culture is dynamic, it's always changing. ## Footnote "Customary ways of thinking and acting"

Question 198

Answer 198

Answer: C At the end of the day, what foods you're able to eat depends on convenience, availability and cost, as well as health status (i.e., ability to acquire and prepare food). Your preferences, beliefs knowledge, and culture all come secondary to practical considerations.

Question 199

Describe the importance of cultural factors in dietary habits. [5]

Answer 199

1. How food is acquired and stored 2. Which foods are selected for consumption (food availability) 3. How foods are prepared 4. Meal patterns 5. Attitudes towards food

Question 200

What is acculturation? [2]

Answer 200

* The adoption of the behavior patterns of the surrounding culture * Results in changes in culture and customs, food, clothing, language

Question 201

What is ethnocentrism? [3]

Answer 201

* The belief that one’s own value system and lifestyle is most appropriate * Judging another culture by the values and standards of one’s own culture * How ethnocentrism can be expressed: When we encounter lifestyle/values that are different from ours and respond with: dissaproval, anger, disgust, disbelief, pity, or amusement.

Question 202

What is cultural relativism? [3]

Answer 202

* Beliefs, values, customs, behaviours, ethics (i.e., culture) is relative to social context * Belief that there are no right or wrong cultures, cultures are just different * We should not judge another society's culture

Question 203

Describe the influence of religion on food for Jewish people.

Answer 203

* Jewish dietary rules based on scholarly interpretations of the Torah * Kosher: what acceptable is to eat * “The pig ….. he is unclean to you. Of their flesh you shall not eat, and their carcasses you shall not touch; they are unclean to you.” (Leviticus 11:8)

Question 204

Describe the influence of religion on food for Islamic people.

Answer 204

* Halal: that which is permitted * Examples of non-halal (i.e., ‘haram’ = prohibited) foods: pork (pig); animals not slaughtered in accordance with halal practices; alcohol

Question 205

The body functions best with what kind of diet?

Answer 205

A diet emphasizing lean protein, high fibre, complex carbohydrates, vegetables & fruits, and minimizing sugar and sodium.

Question 206

What is the basis for modern dietary habits? [2]

Answer 206

*** Agricultural revolution:** human culture moved away from hunter-gatherer to agriculture and settlement approximately 12,000 years ago. *** Industrial revolution:** consolidation and intensification in agriculture and industry; began in the UK ~1750-1850

Question 207

Describe some processes in the food industry that were introduced during the Industrial Revolution. [6]

Answer 207

* Refining whole grains: removal of most of the fibre and vitamins * Refining sugar: processed sugar cane or sugar beets * Pasteurization * Refrigeration * Canned food * Hydrogenation ## Footnote Industrialization increases food processing and consumption of processed foods.

Question 208

What are some of the social determinants of health? [10]

Answer 208

* Income & social status * Physical environments * Employment & working conditions * Education & literacy * Childhood experiences * Gender * Culture * Social support * Race * Indigeneity

Question 209

Define urban ‘slums’ and provide examples of nutrition-related challenges associated with living in an urban slum.

Answer 209

A “slum” is defined by the following 5 characteristics: 1. Overcrowding 2. Inadequate access to safe water 3. Inadequate access to sanitation and infrastructure 4. Housing is of poor structural quality 5. Insecure residential status ## Footnote Globally, it is estimated that approximately 1/3 of people living in an urban setting are living in an urban slum and lack access to improved water, improved sanitation, sufficient housing area, and/or housing of adequate quality.

Question 210

Describe production via sack gardens and how they improve food security in the context of urban slums. Also list: Benefits [4]. Challenges [3]. ## Footnote Sack gardens: urban farming initiative, can contribute to food security in urban slums

Answer 210

****Empty sugar sack filled with soil, manure, stones * In holes, plant kale, spinach, Swiss chard, etc. * Applies agricultural knowledge of many urban poor who have migrated from rural villages **Benefits?** * Improved food security * Average harvest: vegetables for 4 meals/wk * Dietary diversification * May be able to sell some of harvest **Challenges?** * Limited availability of clean soil, water, manure, seedlings, space * Damage from pests and animals * Goats and “midnight harvesters”

Question 211

Wash interventions reduce [3].

Answer 211

WASH interventions reduce: * diarrhea: kills 1,370 children per **day**; 60% of these deaths due to inadequate WASH * intestinal parasites * environmental enteropathy

Question 212

Comment on the extent to which diarrhea is responsible for children’s deaths throughout the world

Answer 212

**Diarrhea burden from birth–24 months predicts stunting** Example: In a pooled analysis of 9 studies, 28% of stunting at 24 months attributed to having 5+ episodes of diarrhea from birth–24 months ## Footnote Diarrhea kills 1370 children per day. This is more than malaria, aids and measles combined. 60% due to inadequate WASH.

Question 213

Who pays via lost opportunities when water is not available on premises?

Answer 213

“When water is not on premises and needs to be collected, it’s our women and girls who are mostly paying with their time and lost opportunities” -Sanjay Wijesekera, UNICEF Water, Sanitation, and Hygiene Division Worldwide, women and girls spend an estimated 200 million hours—every day—collecting water. -UNICEF, 2016 = 8.3 million (24-hour) days ## Footnote More than 2 billion people do not have access to safe drinking water.

Question 214

Consider the role of social norms and personal beliefs in strategies to reduce open defecation and give examples of initiatives that have aimed to change social norms

Answer 214

* **Social pressure** used to help end open defecation and increase sanitation facilities via large media campaign (key message: women should be able to use a latrine in privacy and security) * Encouraged girls’ families to demand a latrine of boys’ families before marriage * Appears to have increased latrine ownership among families with boys of marriage age by ~20% in 2004 * Resulted in ~700,000 more toilets in the state in 2008 versus 2004 | “No toilet, no bride” – “No loo, no I do”

Question 215

Answer 215

Answer: C Vitamin A is integral to a strong immune response.

Question 216

Answer 216

Answer: Zinc 10-14 days of supplementation in addition to oral rehydration.

Question 217

List some improved water sources. [7] ## Footnote Even improved sources can be contaminated.

Answer 217

Improved sources of drinking water include: * Piped water into dwelling * Piped water to yard/plot * Public tap * Tubewell or borehole * Protected dug well * Protected spring * Rainwater collected and stored until used

Question 218

List some improved sanitation.

Answer 218

* Flush toilet * Piped sewer system * Septic tank * Flush/pour flush to pit latrine * Pit latrine with slab * Composting toilet ## Footnote ~2.4 billion people worldwide do not have access to an “improved” sanitation facility. 13% of global population engages in “open defecation”

Question 219

How many people wash their hands after potential contact with waste?

Answer 219

Though hard to measure, it is estimated that **only 19% of people** throughout the world wash hands after potential contact with excreta.

Question 220

What is 'pourism'?

Answer 220

“Poorism” (i.e., taking tourists into slums to observe people living in significant economic poverty) is a growing niche in the tourism industry throughout Africa and elsewhere (e.g., Brazil, India).

Question 221

What is 'voluntourism'?

Answer 221

Doing volunteer work on another country with an aim to make a positive contribution Pros: learn about others; deepen empathy; tourism provides economic opportunities; if volunteer is trained to do the work they are doing - may be helpful Cons: drains local resources; disrupts local economy; volunteers inexperienced; inadequate supervision; short involvement; may have (very) negative impacts on people

Question 222

From a public health perspective, why would we want to reduce the number of people who engage in open defecation?

Answer 222

* Reduce chance of excreta entering water crops and food crops * Infection can spread through feces * Limit risk of transmission of transmission * Vectors (i.e., pests like flies) can spread disease * Support mental health

Question 223

Most of the people worldwide who defecate in the open live in India (most in rural areas). True or False?

Answer 223

True.

Question 224

Open defecation is associated with increased infant mortality, stunting, and reduced cognitive development. True or false?

Answer 224

True

Question 225

Most people without a latrine do without because they cannot afford to build one; if they could build one, they would use it True or False?

Answer 225

False. ## Footnote Millions of people choose to defecate in the open even if they have access to improved sanitation.

Question 226

If governments built latrines for everyone who did not have one (and nothing else changed), most people who currently defecate in the open would continue to do so True or False?

Answer 226

True

Question 227

What are the consequences of open defecation in India?

Answer 227

* High rate of stunting (~40%) among children * Diarrhea is cause of death for ~10% of the children <5 years of age who die each year.

Question 228

How did these children contribute to changing sanitation practices in their community? ## Footnote Children in Rajnandgaon, Chhattisgarh, India, promote toilet use

Answer 228

* Associated shame with open defecation. * Connected open defecation to health implications. * Social pressure on those resisting * Expressed distaste in the filth of their environment (i.e., surrounding mountains, roads) * Actually going out and preventing people from accessing areas they use to defecate * Demonstrates the importance of youth empowerment and community engagement

Question 229

Describe the current use of toilet facilities in India.

Answer 229

* In 2015/16, 39% of households in India practiced open defecation * In 2019/21, the proportion was 19% * Open defecation continues to be much more common in rural vs. urban areas.

Question 230

Describe how food is central to climate change. [2]

Answer 230

* Food and agriculture are a key contributor of the greenhouse has emissions that drive climate change * Food and agriculture are very sensitive to the impacts of a changing climate (higher temperatures, reduced precipitation, more extreme weather events)

Question 231

Describe how global temperature increases are not consistent worldwide. [3]

Answer 231

Increases in temperature are greater in regions at (1) higher latitudes (compared to those located closer to the equator), (2) over land (compared to over oceans), (3) in continental interiors (compared to coastal regions).

Question 232

Livestock production accounts for [...] of agricultural land, and [...] of land surface of the planet

Answer 232

Livestock production accounts for **77%** of agricultural land, and **~30%** of land surface of the planet

Question 233

Livestock production accounts for [...] of current greenhouse gas (GHG) emissions – roughly equal to emissions from all forms of transportation combined)

Answer 233

Livestock production accounts for **14.5%** of current greenhouse gas (GHG) emissions – roughly equal to emissions from all forms of transportation combined)

Question 234

How do high temperatures reduce yields of crops? [3]

Answer 234

1. Impacts plant biology 2. Higher temperatures cause glaciers to melt 3. Higher temperatures change weather patterns

Question 235

How do high temperatures reduce yields of crops? [3]

Answer 235

1. Impacts plant biology 2. Higher temperatures cause glaciers to melt 3. Higher temperatures change weather patterns

Question 236

Describe how 'small' changes in temperature have BIG impacts.

Answer 236

1°C rise in temperature during growing season leads to **10%** reduction in wheat, rice, maize yields ## Footnote Wheat, rice, maize provide 60% of world's dietary energy intake (kcal)

Question 237

Why do melting glaciers reduce crop yields?

Answer 237

* Mountain glaciers melt; rivers that rely on them disappear; irrigation systems that rely on rivers will be challenged * Mountain glaciers in the Himalayas feed major rivers in India and China; these rivers provide water for 1.4 billion people! * Melting glaciers (non-mountainous) in Greenland and Antarctic ice sheets raise sea level; poses particular risk for river deltas of Asia where rice is produced; threatens agricultural viability in these regions

Question 238

How do changing weather patterns reduce crop yields?

Answer 238

* More drought * More heat waves

Question 239

How does climate change impacts on plant biology reduce crop yield? [3]

Answer 239

* Reductions in pollination * Reductions in photosynthesis * Increases in dehydration

Question 240

What is the difference between mitigation strategies and adaptation strategies?

Answer 240

Question 241

Describe sustainable diets as a strategy to mitigate climate change.

Answer 241

* Low environmental impacts * Nutritionally adequate * Safe and healthy * Culturally acceptable * Accessible * Affordable * Consuming a 'sustainble diet' reduces GHG emissions and can result in substantial personal health benefits

Question 242

Give 3 reasons we should reduce meat consumption.

Answer 242

1. Meat production is an inefficient use of land and water and drives deforestation 2. Livestock production is responsible for a significant proportion of greenhouse gas emissions 3. Overconsumption of meat has negative health consequences (e.g., diet high in red and processed meats is associated with higher rates of cancer, obesity, diabetes…) | BUT, meat is a good source of heme iron, zinc, B12, and protein. ## Footnote Also, livestock provide livelihood and food security for almost 1 billion people worldwide

Question 243

Describe how malnutrition can confer greater risk of disease. (e.g., from COVID-19).

Answer 243

* **Undernutrition**: weakened immune system may increase risk and severity of infection * **Overnutrition**: poor metabolic health (e.g., obesity, type 2 diabetes) associated with worse health outcomes (e.g., hospitliziation and death)

Question 244

Aside from malnutrition, what other factors affect how COVID-19 does not treat people equally?

Answer 244

* People who already experience inequality are more affected by both the virus and the strategies implemented to contain its spread. * Factors: * Poverty * Conflict (displacement) * Fragile states (not as resilient) * Minorities * Marginalization * Women and children

Question 245

Describe how COVID-19 exposes the vulnerability and weaknesses of our already fragile food system.

Answer 245

* Our food system is already challenged by climate change * In some areas, strategies to contain the virus has caused food shortages and lack of of access to nutrition support services that many marginalized groups rely upon

Question 246

Describe how COVID-19 exposes disparities in healthcare.

Answer 246

* Healthcare capacity varies dramatically throughout the world * Preventive services (including nutrition) should be better integrated into healthcare * Healthcare services should address challenges faced by sub-groups at particular risk

Question 247

Describe the way forward in regards to global nutrition in the context of COVID-19.

Answer 247

* Strengthened coordination, alignment, financing, and accountability * Requires coordination of efforts from national governments and civil society organizations * Requires political commitment and investment

Question 248

Discuss food waste. [3]

Answer 248

* Approximately 1/3 of all food produced for human consumption is wasted. * Approximately 30% of the world's agricultural land is used to produce food that is never eaten * Amount of GHG emissions resulting from food that is produced but not consumed is significant: if food waste was a country, it would be the 3rd highest emitter of GHGs

Question 249

Describe food waste in Canada.

Answer 249

* Canadians waste almost $50 billion of food every year (3% of Canada's 2016 GDP; more than the combined BDP of the world's 32 poorest countries; would feed everyone in Canada for 5 months) * 21-47% of food waste in Canada occurs in the household

Question 250

What are some strategies to reduce food waste? [6]

Answer 250

* Source reduction * Feed Hungry People * Feed Animals * Industrial Uses * Composting * Incineration or Landfill

Question 251

What is the green revolution?

Answer 251

* Increase agricultural production (primarily in the 1960s) via: * (1) High-yield varieties of cereals (e.g., wheat, rice) * (2) Irrigation * (3) Fertilizers (synthetic nitrogen sources) * (4) Pesticides, Herbicides

Question 252

How has food production changed since the 1950s?

Answer 252

* 1950: world produced 700 million tons of grain from 600 million hectares * Forty years later: 1.9 billion tons from roughly the same amount of land * ... an increase of 170%

Question 253

Name 3 benefits of the Green Revolution.

Answer 253

1. Dramatic increases in yields of staple cereal grains 2. Reduced/eliminated need for food imports in some countries 3. Reduction in poverty/hunger in countries affected by Green Revolution - but effects are uneven

Question 254

Describe 6 disadvantages of the Green Revolution.

Answer 254

1. Dependent on fertilizers, irrigation, chemical pesticides, mechanical plowing 2. Environmental effects (e.g., eutrophication) 3. Expensive: poor farmers cannot afford fertilizers, pesticides, machines, and equipment (*e.g., in Bangladesh, necessary nputs cost 60% more than traditional varieties and methods and there is high rates of interest on loans*) 4. Loss of crop diversity; depletion of soil fertility 5. Increasing disparity between rich landowners and tenant farmers 6. Increased yields are not experienced everywhere

Question 255

What is sustainable intensification?

Answer 255

* Sustainable agriculture intensification = more output from same land area while reducing environmental impacts (and considering social, political, and economic factors) * Produce more, in environmentally sustainable way * Use resources at a rate that does not exceed Earth's capacity to replace them.

Question 256

What is sustainable production characterized by? [6]

Answer 256

1. Using crop varieties or livestock breeds that produce a lot relative to inputs 2. Avoiding unnecessary external inputs (e.g., human labour, machinery, diesel, gasoline, nitrogen, seeds, irrigation, herbicides, electricity) 3. Using agroecology: nutrient cycling, nitrogen fixation, predation and parasitism 4. Minimizing strategies with negative effects on the environment and/or human health 5. Using human and social capital 6. Minimizing greenhouse gas emissions, water pollution, negative impacts on biodiversity, etc.

Question 257

What are the three views of aid's role and timeline?

Answer 257

1. Aid as **temporary** : 'Big push' out of poverty traps, cope with short-term crisis and disasters (e.g., humanitarian responses/relief) 2. Aid as **permanent**: Global social safety net, redistribution of some wealth and resources 3. Aid as **distortion**: Distorts markets and causes dependency

Question 258

Compare the timeliness of local/regional procurement (LRP) with transoceanic delivery of food.

Answer 258

LRP: Quicker delivery Transoceanic: Longer delivery

Question 259

Compare the cost of local/regional procurement (LRP) with transoceanic delivery of food.

Answer 259

LRP: Often cheaper; especially grains and pulses Transoceanic: Particular items may be cheaper (e.g., fortified oil, corn soy blend)

Question 260

Compare the recipient satisfaction of local/regional procurement (LRP) with transoceanic delivery of food.

Answer 260

LRP: Generally preferred overall (re: quality, storability, texture) Transoceanic: Preferred on some criteria (re: cleanliness, perceived nutritional quality); measured quality ~same or better

Question 261

Compare the price impacts on local markets of local/regional procurement (LRP) with transoceanic delivery of food.

Answer 261

LRP: Does not appear to have significant impact Transoceanic: May have negative impacts on local markets

Question 262

Does food aid promote 'dependency' (at household, community, or national level)?

Answer 262

* Dependency occurs if an intervention intended to meet a recipient's current need results in reduced capacity for recipient to meet needs in the future * Does providing aid discourage self-reliance?

Question 263

Is aid effective? (Yes, no, maybe)

Answer 263

* Yes: Humanitarian aid saves lives; aid is needed to make progress towards development goals * Maybe: benefits of aid may be exaggerated; aid may not reach those who need it most * No: aid increases risk of conflict/war, it promotes corruption, it weakens dependency, it may promote dependence, it undermines social capital

Question 264

Describe why the dependency narrative is not true.

Answer 264

* In one scenario in Karnali * Farmers grow diverse local crops (diversity has increased in recent years) * Local grains = 65% of dietary consumption * Food aid covers: ~20% of total need (an important resource for households with high levels of food insecurity

Question 265

Why is it hard to evaluate the effects of food aid?

Answer 265

* Significant methodological issues exist with most data collected * Often report on (which may not be generalizable) * Many confounding variables (unlikely all measured and considered in analysis) * There is a lag between the intervention (aid) and the outcome to be evaluated (and disagreement on what potential outcomes should be assessed)

Question 266

What are the 5 key principles of the Paris Declaration (2005)?

Answer 266

1. **Ownership**: Developing countries set their own strategies for poverty reduction, improve their institutions and tackle corruption 2. **Alignment**: Donor countries align behind these objectives and use local systems 3. **Harmonization**: Donor countries coordinate, simplify procedures and share information to avoid duplication 4. **Results**: Developing countries and donors shift focus to development results and results get measured 5. **Mutual accountability**: Donors and partners are accountable for development results

Question 267

What is Golden Rice?

Answer 267

* A variety of rice produced through **genetic engineering** * Added pathway to produce **beta-carotene** (provitamin A) * Research report first published in Science in 2000 * 2005: Golden Rice 2 variety announced (produces 23 times more beta-carotene than original Golden Rice) * Not currently available due to 'extreme interpretation of the precautionary principle'.

Question 268

What is the precautionary principle?

Answer 268

"Take no action unless you are certain it will do no harm".

Question 269

Golden Rice could be one way to reduce vitamin A deficiency. Why would we want to reduce vitamin A deficiency?

Answer 269

* Vitamin A deficiency is a pervasive killer of malnourished children and pregnant mothers. * Each year, at least a half million children and a hundred thousand women go blind or die from VAD because resistance to infection is reduced.

Question 270

Why do some people (and organizations such as Greenpeace) oppose genetically modified organisms (GMOs)?

Answer 270

* Primarily fear of contamination of other crops. * Once this spread occurs, there's no way to reverse the change. * Concerned of the long-term impacts on the environment and long-term health of humans because there's no proof they are safe.

Question 271

How much Golden Rice would a person need to eat to reduce the risk for vitamin A deficiency?

Answer 271

A cup of rice a day.

Question 272

If Golden Rice were to be available, what factors would be most important to farmers deciding whether or not to grow it?

Answer 272

* Amount of yield * Profitability ## Footnote Golden rice does not measure up; consumer demand may not be there.

Question 273

What are the pros of Golden rice? [4]

Answer 273

* Humanitarian intention * Would be distributed free * Easy substitution for regular white rice * Increases beta-carotene in a **staple food**

Question 274

What are the cons of Golden rice?

Answer 274

* Concerns re: GMO * Emphasizes reliance on cereal grains; **dietary diversification** would be better * Yellow colour may not be acceptable

Question 275

What are ethical concerns with the use of GMO crops? [5]

Answer 275

1. Potential harm to human health 2. Potential negative impact on the environment 3. Negative impact on traditional farming 4. Corporate dominance 5. They are 'unnatural'

Question 276

What is a crime against humanity?

Answer 276

* Any of the following acts committed as a part of a widespread of systematic attack directed against any civilian population, with knowledge of the attack: * Murder * Extermination * Enslavement * Torture * Other inhuman acts of a similar character intentionally causing great suffering or serious bodily or mental injury

Question 277

What is period poverty?

Answer 277

Refers to lack of access to menstrual products and/or safe hygiene facilities It is estimated to affect ~500 million women and girls worldwide.

Question 278

Describe the Ethiopian Famine of 1983-85.

Answer 278

* A defining event in celebrity engagements with humanitarian causes; "Tonight thank God it's them intsead of you" * "Band Aid representation of famin [contributed to] a view of humanitarianism in which moral responsibility towards impoverished parts of imagined 'Africa' is based on **pity rather than demand for justice.**

Question 279

Describe the International Declaration of Human Rights (1948).

Answer 279

Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing, and medical care and necessary social services.

Question 280

Describe how children with severe acute malnutrition were treated before RUTFs.

Answer 280

* Hospitalized and fed milk-based diet * Challenges: * Required a lot of resources (e.g., in 2002, MSF needed 2000 staff to treat 10,000 children in Angola) * In-patient treatment difficult for family (hard to leave home for weeks at a time) * Severely malnourished children prone to infections; spread among children in close quarters.

Question 281

Describe the development of RUTF.

Answer 281

* 1996: Andre Briend (a French pediatric nutritionist working in Malawi) had the idea * The product that spurred the idea: Nutella * Developed as a home-based alternative * Used on a large scale in 2005 to respond to famine in Niger

Question 282

Describe Plumpy'nut.

Answer 282

* 500 kcal * 25% * 25% oil * 25% sugar * 25% milk powder * Micronutrients | Dose: 200kcal/kg/day for 6-8 weeks (~2-3 sachets daily)

Question 283

What are advantages of RUTF?

Answer 283

* Does not require water, cooking, or refrigeration (lasts 2 years without refrigeration) * Low water content (<2%; discourages microbial growth) * Can be administered by anyone, anywhere * Children can be treated at home * Easy to eat * Highly palatable * Very effective

Question 284

Is the formulation of RUTF optimal?

Answer 284

* Successful in promoting weight gain but: * Effects on mortality and relapse unknown * We need greater measurement of functional outcomes

Question 285

What is microcredit? What is the underlying assumption?

Answer 285

* Small loans given to people (or groups for social collateral) living in **poverty** (often remote areas) * Underlying assumption: poor lack capital to invest in their small businesses; being able to do so would improve success of business and thus their family living standards.

Question 286

How do microloans lead to poverty reduction?

Answer 286

* Access to microfinance * Invest in future * Increase income * Increase education, health, etc. * Get out of poverty

Question 287

What are 4 impacts of microfinance that have been on food security and nutrition?

Answer 287

* Does not appear to impact meal quantity but does improve meal quality * Increase in meat consumption in Tanzania, Zimbabwe and Rwanda, increase fish consumption in Zanzibar * Generally, improvements in diet quality of household observed if microcredit client was female but not if client was male * Farms receiving microcredit loans have average income 9.5% higher and are 1% more efficient

Question 288

Describe why microcredit loans are not always a good thing.

Answer 288

* Mixed impacts on income * Some people are made poorer * Appears to negatively impact clients' children's education (does not seem to increase child labour) * Loans should target entrepreneurs rather than the 'poorest of the poor' ## Footnote Impacts are context-specific. Do not assume benefits.

Question 289

Low weight for height is called […], while low height for weight is called [...].

Answer 289

Low weight for height is called **wasting**, while low height for weight is called **stunting**.

Question 290

What anthropometric measurement can be used to detect wasting in children who are between the ages of 6 months and 5 years?

Answer 290

Mid-upper arm circumference (MUAC)

Question 291

Marasmus is mainly due to [...] deficiency and kwashiorkor is mainly due to [...] deficiency.

Answer 291

Marasmus is mainly due to **energy** deficiency and kwashiorkor is mainly due to **protein** deficiency.

Question 292

Moon face, “flaky paint” dermatosis, and/or loss of appetite may be present in which condition(s)?

Answer 292

Kwashiorkor

Question 293

[...] is an indicator of chronic malnutrition, while [...] is an indicator of acute malnutrition.

Answer 293

**Stunting** is an indicator of chronic malnutrition, while **wasting** is an indicator of acute malnutrition.

Question 294

Cases of kwashiorkor can be classified as moderate or severe. True or False?

Answer 294

False. All cases are severe.

Question 295

Children 2 years old or younger who have growth failure are referred to as “stunting” while children over the age of 2 with growth failure are referred to as having “stunted” growth. True or False?

Answer 295

True.

Question 296

List two factors that are protective and lower children’s risk for malnutrition.

Answer 296

1. Mother was educated for at least 5 years 2. Participation in nutrition supplementation programs

Question 297

Bilateral pitting edema is an indicator of kwashiorkor. This is a less serious condition than marasmus/wasting. True or False?

Answer 297

False. Bilateral pitting edema is an indicator of kwashiorkor. This is a **more** serious condition than marasmus/wasting.

Question 298

What explains a relatively SMALL amount of the differences in children's growth?

Answer 298

Race/ethnicity

Question 299

For each of A and B, indicate: 1) What test is being demonstrated? (1 point) 2) How would you advise a mother to do this test? (3 points; your answer should be in the words you would use to train a mother to do the test)

Answer 299

A: 1) testing for **bilateral pitting edema** 2) Use your thumbs to press down on the tops of both of your child's feet. Press gently with a little bit of pressure and count out 3 seconds. Then, remove your fingers and look to see if there is a little dent (or "pit") where your fingers were. If you can still see a dent in both feet after you have removed your fingers, that is a sign of malnutrition and your child should be brought to the clinic for treatment. B: 1) **Mid-upper arm circumference**(MUAC) 2) Remove any clothing from your child's arm, and have their arm by their side (not up in the air). Put the band halfway between your child's shoulder and elbow, and insert the tip of the long end into the little slit so that it forms a loop around your child's arm. Gently tighten the band so that it lies flat on your child's skin (not too tight, not too loose). Look at where the arrow is pointing - if it points to a number in the yellow or red areas of the band, that is a sign of malnutrition and your child should be brought to the clinic for treatment.

Question 300

Dietary iron requirements are [...] times higher in people who are consuming primarily plant-based diets.

Answer 300

Dietary iron requirements are **1.8** times higher in people who are consuming primarily plant-based diets. ## Footnote This higher target is to account for the reduced bioavailability of iron in plant-based diets. A person consuming a plant-based diet will absorb a sufficient quantity or iron if they consume 1.8 X the target daily intake for a person who consumes meat. (For example, a woman of child-bearing age is advised to consume 18 mg of iron daily; for women consuming a plant-based diet, the target would be 32 mg per day).

Question 301

Vitamin A is a fat-soluble vitamin, so we must consume it as often as possible to prevent deficiencies. True or False?

Answer 301

False. Fat-soluble vitamins have toxicity risk.

Question 302

[...] can occur in children due to maternal hypothyroidism. This is caused by lack of [...] in the mother during pregnancy.

Answer 302

**Cretinism** can occur in children due to maternal hypothyroidism. This is caused by lack of **iodine** in the mother during pregnancy.

Question 303

Zinc deficiency can cause weakened immunity. True or False?

Answer 303

True.

Question 304

Zinc deficiency can cause pallor. True or False?

Answer 304

False.

Question 305

Zinc deficiency can cause brittle nails. True or False?

Answer 305

False.

Question 306

Which of the following micronutrient deficiencies will show clinical symptoms first? * Protein * Vitamin B12 * Vitamin A * Vitamin C

Answer 306

Vitamin C

Question 307

100g of bread contains 2.0g of iron and 100g of beef rump contains 2.4g of iron. Therefore, we can consider bread and beef as equivalent sources of iron. True or False?

Answer 307

False.

Question 308

Zinc supplements, along with oral rehydration solutions, can reduce [...] and [...] of diarrheal infections in children and can reduce diarrheal mortality by 50%.

Answer 308

Zinc supplements, along with oral rehydration solutions, can reduce **duration** and **severity** of diarrheal infections in children and can reduce diarrheal mortality by 50%.

Question 309

Which symptoms of vitamin A deficiency can be reversed if detected early on? [2]

Answer 309

1. Bitot's spots 2. Night blindness

Question 310

Identify and briefly explain 2 potential solutions to improve dietary intake of Vitamin A in young children in areas such as India or Sub-Saharan Africa. (2 marks) Which of these two options do you think would be most effective? Why? (1 mark)

Answer 310

Potential answers for the first portion of the question include 2 of the following (identifying each of the two strategies would be 0.5 mark, an appropriate brief explanation of the strategy would be 0.5 mark): **1.** Increase dietary sources through dietary diversification (palm oil, greens, varieties of maize, golden rice, etc.) Improving dietary diversity will not only help improve vitamin A status, but contribute to better overall health. **2.** Education and awareness for women of childbearing age. Educate women on the importance of vitamin A in preventing infection and promote breastfeeding as it contains vitamin A. **3.** Distribute vitamin A supplements since the effects can last 4-6 months and 2 doses per year costs only ~$1 per child per year. This is a cost effective solution and has lasting impact. **4.** Local food production like home gardens can increase dietary diversity and bring a lot of co-benefits. Studies done in Bangladesh show that night blindness was more common in families that did not have home gardens. **5.** Fortification of staple foods such as sugar, oil, and margarine, keeping in mind that fortified foods should provide a minimum of 15% of daily calorie intake. This an easy way to incorporate vitamin A into food that are already being consumed by the masses. For the second portion of the question, 0.5 mark would be for clearly identifying which of the strategies you identified would be most effective, and 0.5 mark would be for giving a very brief explanation as to why. (For example: "I think that vitamin A supplements would be most effective because they are cost-effective, you can reach a lot of people, and they have been shown to work.")

Question 311

Optimal infant feeding can play a key role in breaking the cycle of malnutrition in women because it can prevent stunting, wasting, and micronutrient deficiencies in the infant. True or False?

Answer 311

True.

Question 312

Breastfeeding should be "on demand" (i.e., the mother should breastfeed the infant whenever the infant shows signs of being hungry). True or False?

Answer 312

True.

Question 313

Breastfeeding should occur alongside bottle and pacifier use. True or False?

Answer 313

False.

Question 314

Breastfeeding should begin within an hour of birth. True or False?

Answer 314

True.

Question 315

Breastfeeding should only occur in developing countries where there is no alternative. True or False?

Answer 315

False.

Question 316

Complementary foods should be rich in both energy (kcal) and nutrients. With respect to the micronutrient content of foods, the highest priority is that complementary foods include foods that are very good sources of [...].

Answer 316

Iron ## Footnote It is very important to include iron-rich foods among the complementary foods offered to an infant (from the age of 6 months onwards) because an exclusively-breasted infant's iron stores will no longer provide enough iron to meet the infant's needs at that point. Breast milk is low in iron; if additional sources of iron are not introduced through complementary foods, the infant may become iron deficient.

Question 317

[...] is the phase of breast milk that is consumed by the infant during the first 2-3 days of lactation and helps the infant expel the meconium (i.e., the first bowel movement).

Answer 317

**Colostrum** is the phase of breast milk that is consumed by the infant during the first 2-3 days of lactation and helps the infant expel the meconium (i.e., the first bowel movement).

Question 318

According to the WHO guidelines : "Exclusive breastfeeding is recommended up to [...] of age, with continued breastfeeding along with appropriate complementary foods up to [...] of age or beyond".

Answer 318

According to the WHO guidelines : "Exclusive breastfeeding is recommended up to **6 months** of age, with continued breastfeeding along with appropriate complementary foods up to **2 years** of age or beyond".

Question 319

Breast milk composition changes throughout various stages of lactation as the infant gets older (e.g., first colostrum is produced, then transitional milk, then mature breast milk). However, there is no difference in breast milk composition during a single breastfeeding session. True or False?

Answer 319

False. Foremilk is less energy dense and contains less fat-soluble vitamins than hind milk.

Question 320

List 3 benefits of breastfeeding for mother and child.

Answer 320

1. Reduced infant mortality 2. Reduced risk of postpartum bleeding 3. Increased lactational amenorrhea (i.e., birth spacing)

Question 321

The prevalence of HIV has increased because many more people are becoming newly infected with the disease every year. True or False?

Answer 321

False.

Question 322

Give four factors that decrease the number of children born per woman.

Answer 322

1. Higher level of education 2. Women are able to join the workforce 3. Family planning (i.e., contraception) is accessible 4. Children are not needed for work

Question 323

List 3 reasons why breastfeeding rates may be low in a population.

Answer 323

1. Effective marketing from formula companies 2. Lack of education among healthcare providers 3. Lack of social support for breastfeeding

Question 324

Should HIV+ women breastfeed their infants if there are no safe alternatives to breast milk available? Answer yes or no and provide a justification for your response. (3marks)

Answer 324

Each of the following points could count for 0.5 marks, to a maximum of 3 marks. * Yes, HIV+ women should breastfeed their infants if no safe alternative available * Breastfeeding is particularly important in areas where diarrhea and pneumonia are common among children * Mother should also receive ARV treatment * Risk of transmitting HIV is lowered to ~1% when the mother is on ARV therapy * Should breastfeed exclusively for 6 months * Should continue breastfeeding along with providing complimentary foods for at least 12 months, or up to 24 months or more * Breastfeeding should stop when a safe, nutritionally-adequate diet can be provided without breast milk * Breastfeeding has many benefits for infant that outweigh the relatively small risk of HIV infection via breast milk * If a mother passes HIV to her child, this is called "Mother-to-Child transmission" or "vertical transmission" * Risk of death from other causes if infant is not breastfed is greater than risk of HIV infection if infant is breastfed * Benefits of breastfeeding include increased birth spacing, reduced infant mortality, reduced risk of postpartum hemorrhage -- mentioning any one of the benefits of breastfeeding could count for 0.5 mark * If safe alternative (safe donor milk or infant formula prepared with safe water) became available and there was confidence that the safe alternative would continue to be available throughout the months the infant would require it, it would be appropriate to switch to the safe alternative

Question 325

People with less iron stored in their body absorb less iron from their diet. True or False?

Answer 325

False. People with less iron stored in their body absorb **more** iron from their diet.

Question 326

Non-heme iron is present only in plant-based foods. True or False?

Answer 326

False. Non-heme iron is present in both plant- and animal-based foods.

Question 327

[...] iron is only found in hemoglobin and myoglobin in animal-based foods.

Answer 327

**Heme** iron is only found in hemoglobin and myoglobin in animal-based foods.

Question 328

Tannic acid binds to iron, thereby increasing the bioavailability of the iron. True or False?

Answer 328

False. Tannic acid binds to iron, thereby **decreasing** the bioavailability of the iron.

Question 329

List 4 things that inhibit iron absorption.

Answer 329

1. Phytates and oxalates 2. Zinc 3. Calcium 4. Tannic acid

Question 330

List 2 things that boosts iron absorption.

Answer 330

1. Vitamin C 2. MFP (found in meat)

Question 331

Non-heme iron accounts for 60% of the iron found in animal tissues (i.e., muscle). The absorption of this iron is increased by the presence of MFP factor. True or False?

Answer 331

True.

Question 332

How could you increase the absorption of dietary iron?

Answer 332

Have a glass of orange juice with your meal

Question 333

List 4 factors that affect iron absorption.

Answer 333

1. An individual's iron status 2. The amount of iron in the diet 3. The type of iron present in the foods consumed 4. The amount of acid present in the stomach

Question 334

[...] is an example of a staple food that is commonly fortified with iron.

Answer 334

**Flour** is an example of a staple food that is commonly fortified with iron.

Question 335

If the same meal was given to a person with iron deficiency anemia (IDA) and a person without IDA, the person with IDA would absorb [...] iron than the person without IDA, because iron absorption [...] if iron status is low.

Answer 335

If the same meal was given to a person with iron deficiency anemia (IDA) and a person without IDA, the person with IDA would absorb **more** iron than the person without IDA, because iron absorption **increases** if iron status is low.

Question 336

Iron deficiency is the leading cause of preventable blindness in the world. True or False?

Answer 336

False. Vitamin A deficiency is the leading cause of preventable blindness in the world.

Question 337

Heme iron is only found in [...]

Answer 337

Hemoglobin Myoglobin

Question 338

Eggs and dairy products contain heme iron. True or False?

Answer 338

False. Heme iron is found only in animal tissues (i.e., meat) and blood. Eggs and dairy products contain only non-heme iron.

Question 339

What are the advantages of using "Sprinkles" (micronutient powder packets) in preventing iron deficiency? [4]

Answer 339

1. Easy to use 2. Highly acceptable 3. Can be added to any cooked food 4. Imparts no discernable taste to food

Question 340

Why does the daily iron requirement vary between adult males and adult females? What is the requirement for each? Why would a vegetarian's requirement be different?

Answer 340

* Women lose iron every month in their period. * Males = 8.7 mg/day * Females = 14.8 mg/day * Plant-based iron (i.e. non-heme iron) is less bioavailable

Question 341

What is/are probably true for this child? * He has marasmus * He has kwashiorkor * He will probably be stunted

Answer 341

He has marasmus and he will probably be stunted.

Question 342

This photo shows a UNICEF doctor measuring the mid upper arm circumference (MUAC) of a young boy in an internally displaced persons (IDP) camp in north-west Yemen in 2009. Identify and briefly describe 2 signs of severe malnutrition can you observe in this boy.

Answer 342

* His MUAC measurement is in the red zone, signalling severe acute malnutrition * His hair is an orange colour, reflecting depigmentation, which is due to severe protein undernutrition * He is very thin. The loss of muscle mass and adipose (or fat) tissue is clearly visible and reflects severe kcal (or energy) restriction and wasting.

Question 343

Very few of the people with Type 2 Diabetes in the world live in low- or middle-income countries. True or False?

Answer 343

False. **The majority** of the people with Type 2 Diabetes in the world live in low- or middle-income countries.

Question 344

Basal metabolism typically accounts for 30% of a person's total energy (kcal) needs. True or False?

Answer 344

False. Basal metabolism typically accounts for 60-75% of a person's total energy (kcal) needs.

Question 345

A deficiency in which of the following micronutrients may lead to blindness?

Answer 345

Vitamin A

Question 346

Digestion is the process by which nutrients and other substances are transferred from the digestive system into body fluids for transport throughout the body. True or False?

Answer 346

False. **Absorption** is the process by which nutrients and other substances are transferred from the digestive system into body fluids for transport throughout the body.

Question 347

Bilateral pitting edema is a clinical sign of kwashiorkor. True or False?

Answer 347

True.

Question 348

Famine foods are eaten during extreme food scarcity because they are a good source of energy. True or False?

Answer 348

False. * Famine foods may not actually provide much energy (kcal), but they do provide satiety (a feeling of fullness). * Famine foods tend to be high in fibre, which humans cannot break down for energy, so they are not a good source of energy. * Famine foods are not typically a good source of energy, but they are eaten as a "last resort" when nothing else is available.

Question 349

Identify and briefly describe one factor that puts children at risk for malnutrition and one factor that can be protective. (2 points)

Answer 349

Factors that would put children at risk (as mentioned in class) include: * Low weight (BMI) of mother * Child’s age * Higher birth order * Lower standard of living Factors that would be protective include: * Mother’s education ≥ 5 years * Participation in vitamin A or nutrition program ## Footnote For full marks, also have to briefly explain/describe the factor (or how it would increase or decrease a child's risk for malnutrition).

Question 350

The presence of bilateral pitting edema may indicate a child has either "moderate" or "severe" acute malnutrition. True or False?

Answer 350

False. All cases of bilateral pitting edema (kwashiorkor) are considered "severe" acute malnutrition

Question 351

The red zone on a mid upper arm circumference (MUAC) band indicates moderate acute malnutrition. True or False?

Answer 351

False. The **yellow** zone on a mid upper arm circumference (MUAC) band indicates moderate acute malnutrition.

Question 352

Healthy adults can regularly consume up to [...]% of their total energy (kcal) intake from protein without adverse effects.

Answer 352

Healthy adults can regularly consume up to **35%** of their total energy (kcal) intake from protein without adverse effects.

Question 353

Which simple sugar can the body use for energy?

Answer 353

Glucose

Question 354

What is the AMDR for CHO?

Answer 354

45-65% of total energy (kcal)

Question 355

All protein from plant souces is "incomplete" True or False?

Answer 355

False. Soy for example is a complete protein.

Question 356

A 24-hour recall may not be an appropriate method for assessing dietary intake in particular circumstances. What is a limitation of its use?

Answer 356

It relies on memory

Question 357

When the Pima Indians of Arizona shifted from a traditional diet (largely based on wild foods) to a modern diet (based on foods made from ingredients such as wheat flour, lard, and sugar) the prevalence of obesity and type 2 diabetes increased substantially. True or False?

Answer 357

True.

Question 358

Wasting (i.e., marasmus) is more easily treated than nutritional edema (i.e., kwashiorkor). True or False?

Answer 358

True.

Question 359

Based on the information provided, identify one macronutrient you think might be lacking in the diet of these children and clearly justify your response.

Answer 359

It is highly likely that the dietary intake of these children would be lacking in protein, because the majority (59%) of their kcal are coming from cassava, which is very rich in carbohydrate but has hardly any protein (or fat).

Question 360

Are you surprised that children under the age of 5 years are most at risk for malnutrition in the context of drought? Explain your response.

Answer 360

No, not surprised. Children are usually at greater risk for malnutrition (compared to adults) because they have higher needs relative to their body size because of the increased requirements associated with growth and development.

Question 361

Identify and briefly describe two (2) clinical signs of malnutrition that might be observed among children under 5 years of age experiencing malnutrition. In your description, clearly indicate how one would interpret each sign (e.g., what type of malnutrition does it suggest?).

Answer 361

* Depigmentation of hair: indicates protein deficiency * Dull, discoloured hair: protein deficiency * Swollen, bleeding, red gums: vitamin C deficiency * Bitot's spots: white foamy plaque: vitamin A deficiency * Pallor in conjunctiva/skin: iron deficiency * Transverse ridging of nails: protein deficiency * Koilonychias: spoon-shaped nails: iron deficiency * Bilateral pitting edema: severe acute malnutrition

Question 362

What are famine foods? Define the term and include at least two examples of foods that would be considered famine foods.

Answer 362

Famine foods are foods that would otherwise be considered inedible, but they are eaten during times of extreme scarcity (they tend to be high in fibre and low in kcal). Examples include: corn husks; banana leaves; moss; weeds; leaves; paper; tulip bulbs

Question 363

Given what you have learned so far in the course, what do you think needs to be done in this situation? Integrate the following words into your response: immediate, underlying, basic, priority, limitation, Canada.

Answer 363

Question 364

Considering what you have learned in FNH 355, what do you think needs to be done in this situation, to improve the nutritional status (and overall health and wellbeing) of people living in Yemen? Integrate the following terms into your response: UNICEF conceptual framework, micronutrient malnutrition, education, priority, limitation, Canada. (6 marks; underline each of those 6 terms where they appear in your response)

Answer 364

Question 365

Where do temperature increases tend to be greatest? [2]

Answer 365

* Higher latitudes (i.e., closer to the poles) * In continental interiors

Question 366

When it comes to dealing with climate change, *adaptation* responses act on the root cause of the issue, by reducing such as greenhouse has (GHG) emissions, whereas *mitigation* responses take place at a local level to deal with the impacts of climate change in that particular context. True or False?

Answer 366

False. The opposite is true.

Question 367

When it comes to dealing with climate change, *mitigation* responses act on the root cause of the issue, by reducing such as greenhouse has (GHG) emissions, whereas *adaptation* responses take place at a local level to deal with the impacts of climate change in that particular context. True or False?

Answer 367

True.

Question 368

Higher temperatures during the growing season are reducing crop yields of staple grains like wheat, rice, and maize. This is happening because higher temperatures have detrimental impacts on biological processes important for plant growth and development. For example, at higher temperatures, [...] and [...] of plants decrease, and [...] of plants increases.

Answer 368

At higher temperatures, **pollination** and **photosynthesis** of plants decrease, and **dehydration** of plants increases.

Question 369

Farmers in Mozambique have started to bake and sell bread as an alternative source of income when crop yields are reduced due to changing climate conditions. What is this an example of? [2]

Answer 369

1. Adaptation due to climate change 2. Diversification of income sources

Question 370

Food waste in Canada occurs primarily at the [...] level.

Answer 370

Food waste in Canada occurs primarily at the **household** level.

Question 371

What is meant by a sustainable diet?

Answer 371

* Lower environmental impact than typical Western diet * Contains more plant-based foods and fewer animal-based foods * Nutritionally adequate * Safe and healthy * Culturally acceptable * Accessible/Affordable

Question 372

Do you think dietary guidelines should advise people to consume sustainable diets? Explain.

Answer 372

* Yes, in richer nations like Canada. * Sustainable diets are associated with fewer GHG emissions, and this will help reduce the extent of future climate change * A vegan diet is associated with 45% fewer GHG emissions than a typical Western diet * A UK study showed that sustainable diets cost ~the same as a typical UK diet * Consuming a sustainable diet is a "no-regret option" (there is no downside) * There are "co-benefits" to consuming a sustainable diet (i.e., they benefit personal health as well as planetary health) * Personal health benefits of consuming a sustainable diet include reductions in risk for chronic disease (e.g., cardiovascular disease, type 2 diabetes, some forms of cancer, obesity, etc.)

Question 373

Golden rice could be a good way to introduce a vitamin A-rich food into the diets of many populations who rely on rice as a staple grain without altering their regular pattern of eating. People unanimously agree that using Golden Rice would be an effective way to prevent vitamin A deficiency. True or False?

Answer 373

False.

Question 374

Strategies to produce more agricultural output from the same land area while reducing environmental impacts (and considering social, political, economic factors) are called ____________. These strategies allow us to use resources at a rate that does not exceed the Earth’s capacity to replace them.

Answer 374

Strategies to produce more agricultural output from the same land area while reducing environmental impacts (and considering social, political, economic factors) are called **sustainable intensification**. These strategies allow us to use resources at a rate that does not exceed the Earth’s capacity to replace them.

Question 375

Using a flush toilet or latrine is an example of improved WASH. True or False?

Answer 375

True.

Question 376

Drinking water from a nearby river is an example of improved WASH. True or False?

Answer 376

False.

Question 377

Storing food in a refrigerator is an example of improved WASH. True or False?

Answer 377

False.

Question 378

Plumpy'nut is an example of [...]. These foods are often administered at home to treat malnutrition in children because they are easy to use, highly effective, and do not require refrigeration or cooking.

Answer 378

Plumpy'nut is an example of **RUTF**. These foods are often administered at home to treat malnutrition in children because they are easy to use, highly effective, and do not require refrigeration or cooking.

Question 379

Name 3 benefits of the Green Revolution.

Answer 379

* Yields of staple grains increased * The need for imported food aid was reduced or eliminated * Poverty and hunger were reduced in countries most affected

Question 380

Transoceanic delivery of food aid typically takes longer to deliver than food aid that is obtained locally, but the nutritional quality of food transported by transoceanic delivery is much higher than locally procured food. True or False?

Answer 380

False.

Question 381

Briefly summarize the view of aid as temporary.

Answer 381

“Big push” out of poverty traps, cope with short-term crisis and disasters. A humanitarian response.

Question 382

Briefly summarize the view of aid as permanent.

Answer 382

Global social safety net, redistribution of some wealth and resources.

Question 383

Briefly summarize the view of aid as distortion.

Answer 383

Distorts markets and causes dependency

Question 384

What is the leading cause of preventable blindness in the world?

Answer 384

Vitamin A deficiency

Question 385

Pallor (unexpectedly pale skin) could be a sign of which micronutrient deficiency?

Answer 385

Iron deficiency

Question 386

Name 3 functions of fat.

Answer 386

* It contributes to a sense of satiety (fullness) * It is a carrier of vitamins A, D, E, and K * It is a concentrated source of energy, supplying 9 kcal/g

Question 387

How would you increase absorption of dietary iron?

Answer 387

Have a glass of orange juice with your meal

Question 388

Basal metabolism typically accounts for approximately 20% of a person's total energy (kcal) needs. True or False?

Answer 388

False. Basal metabolism typically accounts for approximately 60-75% of a person's total energy (kcal) needs.

Question 389

Basal metabolism typically accounts for approximately 60-75% of a person's total energy (kcal) needs. True or False?

Answer 389

True.

Question 390

Digestion is the process by which nutrients and other substances are transferred from the digestive system into body fluids for transport throughout the body. True or False?

Answer 390

False. Absorption is the process by which nutrients and other substances are transferred from the digestive system into body fluids for transport throughout the body.

Question 391

Absorption is the process by which nutrients and other substances are transferred from the digestive system into body fluids for transport throughout the body. True or False?

Answer 391

True.

Question 392

Describe the top 6 strategies for reducing food waste from most preferable to least preferable.

Answer 392

1. Reduce the amount of waste generated at the source 2. Feed hungry people (e.g., donate surplus to food banks) 3. Feed animals (e.g., divert leftover food to livestock) 4. Industrial uses (e.g., use oil as biofuel) 5. Compost to create a nutrient-rich soil amendment 6. Dispose of waste in landfill or incinerate (burn) it

Question 393

What is a limitation of the 24-hour recall method of assessing dietary intake?

Answer 393

It relies on memory

Question 394

Maternal mortality may result from complications during pregnancy or delivery, high blood pressure, and a variety of other factors. For example, deficiency in the micronutrient [...] is estimated to cause approximately 20% of maternal mortality (because women with this deficiency cannot sustain as much blood loss as women with good nutritional status can).

Answer 394

Maternal mortality may result from complications during pregnancy or delivery, high blood pressure, and a variety of other factors. For example, deficiency in the micronutrient **iron** is estimated to cause approximately 20% of maternal mortality (because women with this deficiency cannot sustain as much blood loss as women with good nutritional status can).

Question 395

Due to the effects of climate change on the environment Oueme Valley, Benin, people there are using agro-fingerponds to increase the amount of food they can reliably grow. This is an example of what type of response to climate change?

Answer 395

Adaptation

Question 396

Grace is a 22-year-old woman who just gave birth to her second child. If she feeds her infant exclusively with her breastmilk for the first 6 months of the infant's like, Grace is less likely to get pregnant during that time than she would be if she fed the infant her breastmilk and rice porridge. True or False?

Answer 396

True. Exclusive breastfeeding (i.e., feeding an infant breastmilk only, no other fluids or foods) reduces the likelihood a woman will ovulate and thus possibly get pregnant again during that time.

Question 397

[...] reflects acute malnutrition and is defined as low weight for height.

Answer 397

**Wasting** reflects acute malnutrition and is defined as low weight for height.

Question 398

Bilateral pitting edema is a clinical sign of kwashiorkor. True or False?

Answer 398

True.

Question 399

Healthy adults can regularly consume up to [...]% of their total energy (kcal) intake from protein

Answer 399

Healthy adults can regularly consume up to **35%** of their total energy (kcal) intake from protein

Question 400

MFP factor decreases iron absorption. True or False?

Answer 400

False. MFP factor enhances iron absorption.

Question 401

Phytate decreases iron absorption. True or False?

Answer 401

True.

Question 402

Where is heme iron found?

Answer 402

Hemoglobin Myoglobin

Question 403

Famine foods are eaten during extreme food scarcity because they are a good source of energy. True or False?

Answer 403

False. Famine foods may not actually provide much energy (kcal), but they do provide satiety (a feeling of fullness).

Question 404

Why are nutrition interventions aiming to reduce undernutrition during the "first 1,000 days" are important? [3]

Answer 404

* Consequences of undernutrition during this time of development are significant and long-lasting. * Intervening during this time is cost-effective (i.e., a large benefit can be derived from a relatively smaller investment). * Deaths that result from undernutrition during this time are largely preventable

Question 405

Iron deficiency makes death during childbirth more likely because loss of blood during childbirth can be fatal to a woman with iron deficiency anemia. True or False?

Answer 405

True.

Question 406

The proportion (%) of iron absorbed is higher when the iron content of the diet is low True or False?

Answer 406

True.

Question 407

The World Health Organization (WHO) recommends that zinc supplements be given to children experiencing acute diarrhea True or False?

Answer 407

True.

Question 408

Although food waste is an issue worldwide, fortunately Canadians do not waste very much food. True or False?

Answer 408

False. Canadians waste a lot of food; it is estimated that Canadians waste more than $31 Billion dollars of food per year; Canadians waste food valued at more than the GDP of 29 of the world's poorest countries -- or most of the food wasted in Canada is at the household level

Question 409

Colostrum is the first phase of breast milk produced. It is discoloured and of lesser volume than mature breast milk and is thus considered rancid and should be discarded. True or False?

Answer 409

False. It is true that colostrum is the first phase of breast milk produced and that it is a different colour from mature breast milk (though that does not mean it is 'discoloured' -- but it is NOT considered rancid and it should NOT be discarded. Colostrum is very nutritious (and contains growth factors and antibodies) and infants should consume it.

Question 410

Wasting (i.e., marasmus) is more easily treated than nutritional edema (i.e., kwashiorkor). True or False?

Answer 410

True.

Question 411

Plumpy'nut (a ready-to-use therapeutic food; RUTF) can be administered at home. True or False?

Answer 411

True.

Question 412

Approximately what proportion of land used for agriculture is used to support livestock production?

Answer 412

70%

Question 413

Evaluate this recipe in terms of the nutrition it would provide and answer the following questions: Which ingredients would provide macronutrients? (Specify which macronutrients would be provided by specific ingredients) (2 marks) Which ingredients would provide energy (kcal)? (1 mark) Do you think this recipe is appropriate for a child between 6 and 24 months of age? Why or why not? Clearly justify your response, considering both the nutrients provided by this recipe and the nutritional needs of children aged 6 to 24 months. (2 marks)

Answer 413

* Cassava (CHO); fish (protein and fat): oil (fat); sugar (CHO) * The same ingredients also provide energy. * Yes, this would be good for children * Cassava provides energy * Fish provides complete protein, essential fatty acids, and is nutrient-dense * Palm oil could provide vitamin A (if red palm oil) * If salt is iodized, it could provide iodine * Little bit of sugar will add sweetness and encourage consumption

Question 414

Briefly describe three views of foreign aid. Which view do you think is most appropriate? Why?

Answer 414

i) **Aid as "temporary"** - i.e., it would be provided for a short time period only (e.g., short-term humanitarian food aid, a large investment in programs or infrastructure that is expected to help groups get out of poverty) ii) **Aid as "permanent"**- i.e., wealthier nations should provide aid to less economically developed nations on an ongoing (indefinite) basis, as part of an overall global safety net iii) **Aid as "distortion"** - i.e., aid is not beneficial, it distorts markets and causes dependency and so should not be used

Question 415

Tiru is a 25-year-old widowed mother of five, in Miyo, Oromia Region (a drought-affected area in southern Ethiopia). Tiru is pictured with her two six-month-old twins, Gorore and Tadhala and her 9 year old daughter. Tiru says: “I lost my husband when I was pregnant with my twins, due to sickness. We used to work together, we had cattle then. We lost our 2 cattle because of the drought. We also watered crops for the rich farmers. I now do this alone. It is very difficult with two babies to work. My income is much less. I can no longer support my children. My father is old. He was able to support me at the start but now cannot.” Identify and briefly describe one immediate, one underlying, and one basic cause of undernutrition for Tiru's children. Your description of each cause should indicate how that cause could result in undernutrition for Tiru's children.

Answer 415

**Immediate:** inadequate dietary intake (e.g., low energy or insufficient micronutrient intkae); children become malnourished because their energy needs are not being met. **Underlying:** relatively large family means many mouths to feed, each child is not able to get enough food; mother is likely not educated and this is associated with poorer nutritional status in her children; the father/husband died which reduces household income, causes household food insecurity, and reduces her capacity to care for her children which ledas to inadequate care; likely inadequate care for 6-month-old twins in particular -- unlikely that undernourished/underweight mother could produce enough breast milk to adequately feed both, this would result in inadequate dietary intake for them **Basic causes:** drought (poor climate conditions) makes it hard to grow/obtain sufficient food (their 2 cattle died because of the drought) to feed children; social/political/economic context of Ethiopia (e.g., disparity, poverty, lack of infrastructure, landlocked country, fewer opportunities for women) and its impact

Question 416

Northern Cameroon has a harsh climate (with temperatures often above 45 degrees Celsius) and often experiences water scarcity. Food insecurity is increasing in the Far North region of Cameroon and it is estimated that ~180,000 people in the area may experience severe food shortage this year. The “lean season” (the time before the next harvest) is underway, and insecurity caused by Boko Haram (a militant terrorist group) has severely disrupted farming and cross-border trade. Insecurity and attacks by Boko Haram have caused more than 70% of farmers (and their families) in the region to desert their farms, and refugees from neighbouring Nigeria are currently occupying 200 hectares of land that was previously used for farming. These factors have combined to drastically reduce harvests of key crops such as sorghum, millet, cowpea, and rice (e.g., 132,000 tonnes of cereal grains were produced and it is estimated that the region needs 770,000 tonnes per year). Reduced food production has caused the cost of food to increase to the point that it is very difficult for many people to afford. Malnutrition among children under 5 years of age (especially those who have been displaced from their homes) is at emergency levels. Women are also experiencing malnutrition, many of whom are giving their portions of food to their children in the hope that their children will get enough to eat. Are you surprised that women and children are experiencing malnutrition in this context? Explain your response.

Answer 416

No, not surprised. * Women and children are typically the most vulnerable to malnutrition * Children have relatively high needs relative to their body size because it is a time of rapid growth, and women would have higher nutrition-related needs if pregnant or breastfeeding * Women often consume less food because other members of the family eat first when food is scarce, so they would be more likely to have inadequate intake and experience malnutrition

Question 417

Northern Cameroon has a harsh climate (with temperatures often above 45 degrees Celsius) and often experiences water scarcity. Food insecurity is increasing in the Far North region of Cameroon and it is estimated that ~180,000 people in the area may experience severe food shortage this year. The “lean season” (the time before the next harvest) is underway, and insecurity caused by Boko Haram (a militant terrorist group) has severely disrupted farming and cross-border trade. Insecurity and attacks by Boko Haram have caused more than 70% of farmers (and their families) in the region to desert their farms, and refugees from neighbouring Nigeria are currently occupying 200 hectares of land that was previously used for farming. These factors have combined to drastically reduce harvests of key crops such as sorghum, millet, cowpea, and rice (e.g., 132,000 tonnes of cereal grains were produced and it is estimated that the region needs 770,000 tonnes per year). Reduced food production has caused the cost of food to increase to the point that it is very difficult for many people to afford. Malnutrition among children under 5 years of age (especially those who have been displaced from their homes) is at emergency levels. Women are also experiencing malnutrition, many of whom are giving their portions of food to their children in the hope that their children will get enough to eat. Identify and briefly describe two (2) clinical signs of malnutrition that might be observed among children under 5 years of age experiencing malnutrition in this context. In your description, clearly indicate how one would interpret each sign (e.g., what type of malnutrition does it suggest?)

Answer 417

* Depigmentation of hair (reflects protein deficiency) * Bitot's spots, foamy plaque on white part of eye (reflects vitamin A deficiency) * Night blindness (reflects vitamin A deficiency) * Swollen, bleeding, red gums (reflects vitamin C deficiency) * Bilateral pitting edema (indicates kwashiorkor) * Palor/pale conjunctiva (reflects possible iron deficiency)

Question 418

Northern Cameroon has a harsh climate (with temperatures often above 45 degrees Celsius) and often experiences water scarcity. Food insecurity is increasing in the Far North region of Cameroon and it is estimated that ~180,000 people in the area may experience severe food shortage this year. The “lean season” (the time before the next harvest) is underway, and insecurity caused by Boko Haram (a militant terrorist group) has severely disrupted farming and cross-border trade. Insecurity and attacks by Boko Haram have caused more than 70% of farmers (and their families) in the region to desert their farms, and refugees from neighbouring Nigeria are currently occupying 200 hectares of land that was previously used for farming. These factors have combined to drastically reduce harvests of key crops such as sorghum, millet, cowpea, and rice (e.g., 132,000 tonnes of cereal grains were produced and it is estimated that the region needs 770,000 tonnes per year). Reduced food production has caused the cost of food to increase to the point that it is very difficult for many people to afford. Malnutrition among children under 5 years of age (especially those who have been displaced from their homes) is at emergency levels. Women are also experiencing malnutrition, many of whom are giving their portions of food to their children in the hope that their children will get enough to eat. Myriam is a 2-year-old girl in the Far North region of Cameroon. Two months ago, she and her family (mother, father, and five older brothers and sisters) were forced to leave their small homestead farm due to nearby attacks by Boko Haram. Myriam has lost weight during this time and now suffers from moderate acute malnutrition. Based on the information you have, do you think Myriam is experiencing wasting (marasmus) or nutritional edema (kwashiorkor)? Justify your response.

Answer 418

* Marasmus * Kwashiorkor is always severe acute malnutrition, but marasmus may be moderate or severe - since she has moderate malnutrition, it must be marasmus/wastinig

Question 419

South Sudan is the world’s newest country. After decades of conflict with the north, it became an independent country in July 2011 (following a referendum in which people overwhelmingly voted to separate from Sudan). Since December 2013, what started as a power struggle between political leaders has expanded to become a widespread violent and deadly conflict, affecting millions. An estimated 6 million people in South Sudan are currently experiencing extreme food insecurity and more than one million children have been forced to flee the country as refugees, many of whom are separated from their families. Thousands of people have fled their homes in Eastern Bieh State in South Sudan in recent months, due to violent clashes between government and opposition military forces. “I left running – there was no time to take anything,” said William, a 41-year-old father of 5 children. William and his family, like many others, are taking shelter in the bush. They are currently living under a tree, surviving on leaves and small amounts of food from aid organizations. “When there is no food, we eat the leaves on the trees.” William’s 5-year-old son died recently, most likely from cholera. (Cholera is a disease characterized by severe watery diarrhea, caused by consuming food or water contaminated with the bacterium V. cholerae; the risk of cholera transmission increases when access to clean water and sanitation facilities is lacking). The international humanitarian organization Doctors Without Borders (MSF) is currently operating three health clinics in the region. They have reported an increase in malnutrition among children under the age of 5 years, with approximately 1 in 10 children having severe acute malnutrition. **Considering what you have learned so far in FNH 355, what do you think needs to be done in this situation, to improve the nutritional status (and overall health and wellbeing) of people living in South Sudan?** Integrate the following terms into your response: UNICEF framework, nutrition assessment, famine foods, priority, limitation, Canada. (6 marks; underline each of those 6 terms where they appear in your response)

Answer 419

Example 1: Using the **UNICEF conceptual framework** we can determine the immediate, underlying, and basic causes of malnutrition in South Sudan. Immediate causes are inadequate food intake and disease. Underlying are poor living environments, limited access to health care services, inadequate care and food insecurity. The basic causes are the political struggle and deadly conflict. The basic causes are at the root of the malnutrition problem and the **priority** needs to be addressing these issues. **Canada** can assist in addressing the malnutrition in South Sudan by providing food aid so that the people there have more access to nutritious foods, rather than being so dependent on **famine foods**, such as leaves which provide them with little in the way of nutrients and energy because they are so high in fibre. A **limitation** of sending food aid during a time of political conflict is that so many people are displaced and infrastructure is destroyed, making it difficult to distribute food to all those who need it. Therefore, Canada could instead work toward meeting the UN recommendation of contributing 0.7% of the country's GNI to international aid. This may provide the UN with sufficient support so they can go in to South Sudan and conduct various **nutrition assessments** (e.g., anthropometric, dietary, clinical) to determine who needs the most help and in what form. Example 2: In order to improve nutritional status, the basic or "real" causes according to the **UNICEF Conceptual Framework** need to be addressed, which in South Sudan is the war and conflict. This is the **priority** for domestic and international agencies to help decrease the number of people suffering from malnutrition. Specifically, **Canada** can aid by sending peacekeepers (once situational assessments are made) or increase their spending on foreign aid to 0.7% of gross national income, as recommended by the UN. In addition to addressing the basic causes of undernutrition, the immediate and underlying causes need to be addressed. After conducting **nutrition assessments** using anthropometric, clinical, and dietary measures, we can start to address the cholera by sending zinc supplements to communities. Furthermore, with more international food aid, we can reduce the number of people eating the **famine foods** (leaves in South Sudan which are normally not edible). However, until the basic causes (war) are resolved, the giving of food aid and micronutrient supplementation has **limited** impact on improving the overall nutritional status.

Question 420

Muhammad Yunus was born into a privileged family in Bangladesh. True or False?

Answer 420

False. Muhammad Yunus was born into a low-income family in Bangladesh. Both his parents had low levels of education.

Question 421

A region's fertility rate (i.e., the average number of children born to a woman over her lifetime in that region) tends to be [...] if many people in that region live in poverty, and [...] if many people in that region are economically wealthy.

Answer 421

A region's fertility rate (i.e., the average number of children born to a woman over her lifetime in that region) tends to be **higher** if many people in that region live in poverty, and **lower** if many people in that region are economically wealthy.

Question 422

Regions with high [...] also tend to have high [...] and/or high [...].

Answer 422

Regions with **high fertility rates **(i.e., a relatively large average number of children born to a woman over her lifetime) also tend to have **high infant mortality rates** (i.e., a relatively large number of deaths in children aged 1 year or less, per 1000 live births) and/or **high child mortality rates** (i.e., a relatively large number of deaths in children aged 5 years or less, per 1000 live births)

Question 423

In many developing countries, girls have less access to education than boys. True or False?

Answer 423

True.

Question 424

Conflict and political instability can lead to disruptions in food systems, resulting in hunger and even famine. True or False?

Answer 424

True.

Question 425

Identify and briefly describe three (3) ways that the Grameen Bank differs from a traditional bank.

Answer 425

1) Unlike traditional banks which require a single, complete repayment, Grameen Bank allows borrowers to repay their loans through several weekly repayments. This novel financial approach largely ameliorates stress associated with loan repayment, prevents borrowers from defaulting, and facilitates financial freedom. 2) Traditional banks do not lend money to women, as women are not supposed to be involved in business or finances according to the primary religion in Bangladesh, Islam. Yunus recognized that lending to women elicits the most rapid change for society, since women use money to benefit children and the household, whereas men mostly prioritized their own needs. As such, 97% of Grameen Bank's clients are women, because women not only lift themselves, but also others, out of poverty. 3) Where traditional banks fixate on a person's past and require collateral before agreeing to finance a loan, Grameen bank is not interested in the past, and instead looks to the future. Traditional banks consider the poor untrustworthy and not worthy of credit, whereas Yunus understands that the poor are neither lazy nor stupid, they simply lack the support to flourish. Thus, Grameen Bank lends to destitute individuals, because Yunus believes that people will build a better life for themselves and their loved ones, given the opportunity.

Question 426

When people living in poverty were offered the opportunity to borrow money from the Grameen Bank, they were immediately enthusiastic, recognizing that the opportunity to borrow small amounts of money with relatively small interest represented an important opportunity to break free from poverty. True or False?

Answer 426

False. People were initially skeptical and thought it might be "un-Islamic" because it charged interest on loans and lent money to women, thought they might be communists or missionaries. Not only did men try to frighten women from taking loans, but also women did not have confidence they would be able to manage the loans.

Question 427

In countries such as South Sudan, how many girls currently finish primary school?

Answer 427

<20%

Question 428

People are prone to binary thinking (i.e., thinking in terms of two mutually exclusive categories, like "good" and "bad"), so it is very hard to replace people's perceptions of a world divided into "rich" and "poor" regions with an understanding of the world in which they recognize that most people live in between those two categories True or False?

Answer 428

True.

Question 429

Roughly similar numbers of people live at Income Level 1 and Income Level 4, with the majority of people living in between, at Levels 2 and 3 True or False?

Answer 429

True.

Question 430

For people living with Income Level 4, $3 per day more or less would not make a substantial difference to their quality of their life — so they find it hard to understand how big an impact an additional $3 per day could have for someone living with Income Level 1 True or False?

Answer 430

True.

Question 431

With hard work and perseverance, it would be quite common for a person to move up through several levels of income within their lifetime True or False?

Answer 431

False.

Question 432

Where does the majority of the global population live? (income-wise)

Answer 432

Middle-income countries

Question 433

People living with an income at Level 2 have more resources than those living with extreme poverty at Level 1, but they are still very vulnerable economic shocks. For example, if a family member becomes ill and needs medicine, the cost of medicine alone could result in the family experiencing much worse poverty. True or False?

Answer 433

True.

Question 434

How is a statement like "On average, men score higher than women on the SAT math test (527 versus 496)" an over-simplification of information that might actually mislead people?

Answer 434

The statement is an oversimplification even while technically true. By ignoring the distribution of the data and only focusing on averages, the implication is that men are always better at math than women (i.e., that there is a 'gap' in math ability between males and females). However, by looking at the number of individuals with different math scores and examining the spread of the data, the overlap in math ability becomes very clear. We can see that a slightly higher number of women than men scored 500, and a slightly higher number of men than women scored 800. Nonetheless, some men and some women achieved every single score, from 200 to 800. By analyzing the distribution of the math scores, we can see that women have nearly the same capacity for math as men, or put another way, men have nearly the same potential for not understanding math as women. There is no gap, there is significant overlap in ability - men are not inherently better at math.

Question 435

Moving forward, what can you do when you are presented with information that gives you a comparison of averages, in order to make it less likely that you will be misled into believing an over-simplified view of what those averages are describing? Identify two specific strategies you can use in the future, to critically evaluate and better understand the simplification of information that is presented in averages. Be specific!

Answer 435

* Always consider the distribution of the data. * Always consider the scale that the data is presented on

Question 436

The news report, Global hunger toll soars by 150 million as Covid and Ukraine war make their mark, states: "About 149 million children under five had stunted growth and development due to a chronic lack of essential nutrients." Is chronic lack of essential nutrients the only immediate cause of stunting?

Answer 436

No. * Stunting is also caused by chronic low energy intake in early childhood, repeated bouts of illness and/or diarrhea, and inadequate access to safe water and sanitation facilities.

Question 437

In 2015, the United Nations established the Sustainable Development Goals, which include the goal of eradicating hunger by 2030. We are currently on track to meet this goal of eradicating hunger by 2030. True or False?

Answer 437

False. David Beasley, the director of the UN's World Food Programme, warned that the Ukraine war may push some vulnerable regions into famine. Moreover, since the start of the Covid-19 pandemic, the number of people living with hunger, or chronic undernourishment, increased by 150 million. These crises mean that we are currently not on track to meet the goal of eradicating hunger by 2030. "Although current forecasts suggest that staple crop production will remain relatively unaffected by the pandemic (rice, wheat, maize, lentils and soybeans), the same cannot be said for high-value, labour-intensive and perishable crops such as fresh fruits and vegetables, and animal-sourced foods."

Question 438

The current crisis (sparked by the global impacts of the Covid pandemic and the invasion of Ukraine) highlights the need to redesign global food systems to increase resilience in the face of such shocks True or False?

Answer 438

True.

Question 439

Food aid (in which food is provided to countries experiencing extreme food crisis by other donor countries) is the best way to avoid famine True or False?

Answer 439

False.

Question 440

Farmers in regions affected by extreme food crisis cannot play a role in avoiding famine; no food can be produced in countries experiencing extreme food crisis True or False?

Answer 440

False.

Question 441

Do you think identifying when and where famine occurs is a relatively straightforward and accurate process?

Answer 441

No, I do not believe that identifying when and where famine occurs is a straightforward process because many disparate groups must concur, and this is never simple. Even when extreme suffering is already evident, governments often disagree with international famine committees and humanitarian organizations, which delays the famine declaration process and reduces the potential for international aid to reach starving people in time. For example, in Ethiopia, the government was accused in 2020 by the emergency relief coordinator of the UN of delaying famine declaration for their own political means. In another case, the government of South Sudan denied the famine review committee's declaration that famine was underway in Pibor county even during conditions severe flooding and conflict.

Question 442

What is the staple crop in South Sudan?

Answer 442

Sorghum

Question 443

When the rain eventually started to come, it was too late for it to help with agriculture for this season. In fact, it could make the crisis even worse by causing flooding and making the transportion of food and other emergency supplies more difficult. True or False?

Answer 443

True.

Question 444

This reading conveys some of the challenges associated with providing food aid during a humanitarian crisis, such as that in South Sudan. Identify and briefly describe three (3) specific and different difficulties associated with providing food aid in crisis situations that were illustrated in this reading.

Answer 444

**1. Dangerous political unrest/ fighting/ war:** Not only are militia a threat to people who live in South Sudan (they will kill people and steal their money, food, and animals), but they're also a threat to international aid workers (e.g., WFP workers) who must pass through war zones and disputed regions to provide food aid. Furthermore, this has resulted in raids of food warehouses. For example, in July 2016 in Juba, food that was meant to support 200,000 people was destroyed or stolen in a warehouse raid. Since WFP maintains neutrality, there is no 'fighting back', yet this kind of disruption to aid work will directly result in more deaths due to starvation. **2. Flooding:** Heavy rain can cause flooding that easily destroy dirt roads and reduce access to rural regions. This makes it very difficult to deliver food aid via ground-based convoys. When roads are completely destroyed or closed, this means food aid must be delivered via airdrop, which is significantly more expensive and logistcally complicated. **3. Timing:** South Sudan was already in a state of L-3 humanitarian crisis before food aid was deployed. When Leila arrived for vulnerability assessment and mapping, the situation was already urgent, complex, widespread, and the local community was already unable to respond to the crisis in any meaningful way. Still, Leila had to complete her assessment and prepare thorough data and reports to advocate for funding and food aid for the region. This work takes time, (weeks to months), and in that time, malnutrition severity worsens, and more and more people die to starvation or migrate out of the region. Unfortunately, even after WFP was notified of the situation, many weeks of assessment work had to be conducted before food aid could be administered. This meant there is a significant lag between when the crisis was identified, and when food aid was delivered to the people in need.

Question 445

We are already experiencing some of the consequences of climate change and if actions are not taken to both reduce climate change (by reducing greenhouse gas emissions) and adapt to climate change (by changing how we do things, to deal with our changing climate context), the consequences of climate change will become increasingly intense. True or False?

Answer 445

True.

Question 446

According to the UNICEF conceptual framework, climate change would be considered:

Answer 446

Climate change is a basic cause of malnutrition. It affects household-level underlying factors such as household income and food security, parental care, and access to basic services such as water and sanitation. These, in turn, affect individual-level immediate factors such as dietary intake and disease.

Question 447

The consequences of climate change on food production and food supply are uniformly negative. True or False?

Answer 447

False. Climate change affects each step of the food supply chain. While these effects are often negative, they can also be positive and may lead to better growing conditions and increased yields at some mid to high latitudes (Parry et al., 1999). However, these positive effects are ex- pected to be overshadowed by negative ones.

Question 448

Climate change can increase undernutrition through several different pathways. Use i) the UNICEF Framework and ii) what you learned by creating your concept map to explain two different ways in which climate change can result in undernutrition.

Answer 448

Climate change is a basic cause of malnutrition, therefore it affects underlying factors like food security, income, care practices and access to basic services like health care and sanitation, which in turn affect immediate factors of malnutrition, namely dietary intake and disease. Two examples of these interconnected pathways follow: 1) Climate change can cause significant challenges associated with food production due to both acute and chronic weather events, for example drought and flooding. Heat and water stress can destroy crops and kill livestock and is a basic cause of malnutrition which influences the underlying causes, food insecurity within households and exacerbated poverty. Food shortages and loss of income present challenges, so women are often required to work long hours to provide for their families, for instance to fetch water, to work for money, or to grow food and tend to livestock. This in turn means women are less available to provide the recommended best care and feeding practices for their children. In this case, that often means young children are not being exclusively breastfed for the first six months of life, nor up to 2+ years, which can lead to inadequate dietary intake, micronutrient deficiencies, weakened immunity, and increased risk for disease. Disease in young children can have life-long impact or even be fatal, especially when there is lack of access to affordable health care. Incidence of diarrheal disease for example can lead to increased risk of stunting and death, so it is paramount to provide sufficient nutrition within the first 2 years of life. However, since the basic cause of climate change causes the underlying food insecurity and poverty that forces women to allocate their hours to work, they are not able to provide the care and feeding that is recommended by the WHO. This ultimately affects the basic causes of malnutrition in their children through inadequate dietary intake and increased prevalence of disease. Basic (climate change) > Underlying (poverty, food insecurity & inadequate care in combination with lack of access to affordable health care) > Immediate (inadequate intake and disease) 2) As prior mentioned, climate change as a basic cause can lead to heat stress which damages crops and livestock, but it can also reduce access to clean water. Both drought and flooding may have this effect. Where drought leads to decreased water availability which forces people to rely on sources that are not sanitary, flooding can lead to contamination of previously safe water sources. In each case, this can lead to increased transmission of water-borne diseases. As previously described, diarrheal disease is especially dangerous for children in their first 1000 days of life. Disease can worsen nutritional deficiencies, so preventing disease is paramount. Basic (climate change) > Underlying (inadequate access to clean water and health care services) > Immediate (disease) 3) Since I'm not sure my first two examples are different enough that you'll award me full marks, here's a third example. Climate change can cause severe weather events like violent hurricanes and devastating wildfires. These cause acute damage that destroys transportation infrastructure and public services. Lack of health care services and transportation due to the acute damage means that if people get sick, there is nowhere to turn for help. Further, disruption to the supply chain will result in reduced available food for in the region, meaning there will be worsened household food insecurity. These underlying causes lead to the immediate stress of inadequate intake and disease. Basic (climate change & lack of economic and social capital) > Underlying (inadequate access to health care services; disrupted supply chain leading to household food insecurity) > Immediate (inadequate intake & disease)

Question 449

Safe water, sanitation and hygiene (WASH) practices are associated with better nutritional status among children. For example, stunting is less common among children in areas with access to improved sanitation than it is in areas where open defecation is common. True or False?

Answer 449

True.

Question 450

With regard to WASH, define water quantity.

Answer 450

Efforts to increase the amount of water available (e.g., for drinking, cooking, handwashing, sanitation)

Question 451

With regard to WASH, define water quality.

Answer 451

Efforts to improve and protect the microbiological or chemical quality of drinking water

Question 452

With regard to WASH, define sanitation.

Answer 452

Efforts to enable safe disposal of urine and feces (i.e., strategies to separate urine, and feces from human contact)

Question 453

With regard to WASH, define hygiene.

Answer 453

Efforts to promote handwashing (with soap) when needed (e.g., after defecation or contact with others' feces)

Question 454

A significant proportion of the world's population (approximately 1 in 3 of the global population) does not have access to improved sanitation facilities (such as toilets) and approximately 13% (more than 1 in 10 of the global population) practices open defecation. True or False?

Answer 454

True.

Question 455

Give 3 examples when water may be contaminated.

Answer 455

* Water may become contaminated with microbes at water treatment plants, if equipment is not properly used or maintained. * Water may become contaminated with microbes during transport of water (e.g., containers being used for transport are not clean) * Water may become contaminated with microbes during the storage of water in the household

Question 456

According to the UNICEF framework, lack of access to improved sanitation facilities would be?

Answer 456

An underlying cause of undernutrition

Question 457

According to the most recent estimates of the global burden of disease, access to improved water, sanitation, and hygiene (WASH) could prevent what proportion of deaths from diarrhea among children under the age of 5 years?

Answer 457

58%

Question 458

How might you explain the benefits of improved water, sanitation, and hygiene (WASH) to a 4-year-old child?

Answer 458

“Poop” contains germs and bacteria that could make you sick. There are three important things we can do to keep those germs away from you and make it less likely that they could make you sick. The first thing we can do is make sure that you use the toilet (or latrine) when you have to pee or poop. Using a toilet is better than peeing or pooping in the field or somewhere else. The toilet helps collect the poop and keeps it away from where you or other people might walk on it and pick up those germs (or that it prevents your poop from getting into streams we use for drinking etc.). The second thing you can do is to drink only safe, clean drinking water. The water that comes from the tap is clean and will prevent you from getting sick. The third thing you can do is to wash your hands with soap and water – especially after you poop and before you eat your food. This will help wash away the germs and prevent them from getting into your mouth and making you sick.