Chapter 6: Malnutrition Flashcards
Malnutrition is a result of numerous interlocking ___ and ____ factors
social and economic factors
Malnutrition is not simply due to the lack of food.
Just like poverty isn’t bc of lack of money
What could malnutrition be an end result of? 4 things
Poverty
Lack of education
Social inequity
And chronic recurrent infections
What are one of the main consequences of malnutrition? (Increased…)
Increased mortality from common childhood illnesses
Case mortality in what 5 diseases are higher among malnourished children?
Measles
Bronchiolitis
Whooping cough
Pneumonia
Gastroenteritis
Widespread starvation is ultimately a failure of what?
Failure of Food distribution from the rest of the country
What was Malthus’s early 19th century theory?
That malnutrition was an unavoidable feature of life in developing countries
Because there would always be far more ppl than food available
Sick children survived better if they were not, what?
Not separated from their mothers
What did Cicely Williams’s studies in west Africa led her to identify?
When in Malaysia, she was the first to criticize what?
Kwashiorkor
Criticize infant food companies for advertising practices
Cicely Williams was influential in what, and she is also considered the founder of what ?
Influential in reestablishing breastfeeding
Founder of the study of maternal and child health
What is Amartya Sen study, and what did his research show?
Studied famine,
Research showed that malnutrition is complex,
A result of numerous interrelated contributory factors
Micronutrient deficiencies have clinical effects even in children who might appear ….
Well nourished, ex survey
What 3 things have combined to halt/reverse the gains in MalNu improvements before 2005
Recession
Rising food costs
Wars
What 4 interventions are available that have nutritional benefits?
Feeding programs
Micronutrient fortification
Maternal education
Agricultural extension projects
Adverse effects of malnutrition are particularly important during what periods ?
Rapid growth periods such as childhood and pregnancy
Early malnutrition during what can have Lifelong adverse effects?
the period of major organ development
A diet deficient in macronutrients is called what?
Protein-energy malnutrition
Some types of what cannot be produced by the body ?
So they can only be obtained from what?
Fats and amino acids
Obtained from our food
Can most micronutrients be made in the body
No
What are micronutrients?
Vitamins: thiamin, vitamin C, folic acid
Minerals: iron, calcium, iodine
What are the diseases that arise as a result of; vitamin C, iron, and iodine?
Survey
Anemia
Hypothyroidism
Malnutrition means what?
What does the term refer to?
Means “bad” nutrition
Refers to wife range of diseases resulting from abnormalities in dietary intake
What is the fastest growing nutritional problem in the world
Obesity
Levels of nutrition still differ widely between what?
Countries of similar income
Why do countries with similar income differ widely in levels of malnutrition?
Agricultural performance
Pro-poor government policies
Civil unrest
Attitudes towards women
What are the 3 broad groups of requirements that must be met before a pops children can have reliable nutrition?
1) access to reliable source of nutritious food (household food security)
2) adequate care for women and children
3) safe and healthy society w access to preventive care & basic health services
Common infections/ factors of malnutrition in children?
Gastroenteritis
HIV infection
TB
Combo of what 2 things lead to inadequate child-rearing practices ?
Maternal poverty
Lack of education
Lack of knowledge about what 3 things contribute to maternal impact on malnutrition?
Breastfeeding
Contraception
Nutritional requirements of children
High phytate levels in vegetarian ___ diets inhibits absorption of what which leads to development of what disease?
Cereal diets inhibits absorption of calcium
Leads to rickets
Apart from long term adverse effects on growth, malnutrition greatly increases ___ by reducing ___.
Increases mortality of common disease
By reducing the child’s immune response
How many kids under 5 are undernourished and underweight?
90 million +
What is the monitoring agency for the nutrition goal
Food and Agriculture Organization
FAO tracks malnutrition by measuring ____ through ____.
Daily caloric intake
Through household income/expenditure survey
What are the bad sides of the FAO surveys
Don’t measure food eaten outside of the house
Measure money spent on food vs type of food
How many ppl are undernourished globally?
795 million (1 in 9)
What is the MDG target for malnutrition?
11.6%
Which two regions account for the larger share of global undernourishment? How much has it increased since 1990?
South Asia
Sub Saharan Africa
Increases by 44 million
Most underweight children live where?
South Asia
Setbacks in a small area can go unnoticed if there are what?
Large improvements in another region
Countries with highest percentage of undernutrition are where ?
In Africa
(Especially Sun Saharan Africa)
What are the 4 most affected African counties in undernutrition?
Burundi
Chad
DRC
Eritrea
What are the 4 most affected counties by undernutrition in Asia ?
Bangladesh
Nepal
North Korea
Cambodia
What are 3 of the principal contributory factors of malnutrition in Asia ?
Poor education
Gender inequality
Poverty
What are 3 of the principal contributory factors of malnutrition in Africa ?
Conflict
Government ineffectiveness
High rates of HIV/AIDS
Countries with the highest level of malnutrition is prolonged what 2 things? What are examples of 4 counties?
Humanitarian or natural disasters
North Korea
Afghanistan
Sudan
Haiti
On what two people does the burden fall most heavily on?
Women and small children
First two targets of SDG on hunger is by 2030 end what?
End Hunger and Malnutrition
How many ppl suffer from malnutrition globally and what percentage are preschool kids
795 million, 20-25% preschool
What is the case mortality of severe malnutrition
1 in 4 die
What is the most obvious and easily measurable result of malnutrition
Poor growth
Why is BMI not used
Harder to calculate
Marasmus vs Kwashiorkor
Marasmus: very wasted, symmetrically small, no edema
Kwashiorkor: less growth failure, poor skin, edema
Why does one get kwashiorkor or marasmus ?
Abnormal hormone/immune response to starvation
Alfatoxins in grain
Micronutrient deficiencies
When does the child’s brain grow most rapidly?
Conception to the 2nd or 3rd bday
Malnutrition in early school years causes what 3 things that will reduce the child’s ability to learn
Apathy
Reduced activity
Lack of curiosity
Severe malnutrition has profound adverse effects on what?
A child’s immune system
Of the 10 mill kids that die a year from major killers (respiratory infections, diarrhea etc), what % of deaths were from malnutrition
25-50%
It is possible to have micronutrient deficiencies despite what?
A normal diet
What is micronutrient deficiency often referred to as
Hidden hunger
Regular Provision of micronutrient ROI = what 3 things
improved growth, development, and survival
How much of the worlds population live in areas where there’s little iodine in soil
1/3
Iodine is an essential factor in what hormone, which is an essential factor needed for early what?
Thyroid hormone, early brain development
How does the subtle problem of iodine deficiencies manifest itself?
As poor school performance and lack of energy
Iodine deficiencies is the single most common cause of preventable what?
Mental retardation and brain damage
The average IQ is how many points higher in an iodine supplemented pop?
13 points
Before vitamin A supplementation and measles vaccine how many kids were blinded per year
250k
What happened to the Morality rate from measles with the addition of vitamin A?
Rate was halved
What are examples of Food fortification with iodine and vitamin A
Iodine: salts and cooking oil
Vit A: maize, wheat, sugar
What is the most common micronutrient deficiency in the world?
Iron
What happens to children who are born to iron deficient mothers
Breast milk is low in iron
Baby has Marginal storage of iron at north to deal with a period of rapid physical and neurological growth
How many children in the developing world between 6mo-2yr are iron deficient
At least half
Worst affected children in iron deficiency are found in countries where children are weaned onto what?
A rice porridge low in iron
What are the effects of iron deficiency in adults?
Reduced ability to work
Increases risks during childbirth
Zinc is necessary for what 2 things?
Zinc deficient women have a higher rate of what?
Brain development
Normal labour
Higher rate of obstructed labour
Acute and longer term use of zinc does what with gastroenteritis?
Acute use shortens duration of illness
Long term use reduces risk of pneumonia, malaria, and recurrent gastroenteritis
Folate is essential for what 2 things?
Fetal growth & development
Production of red blood cells
Folate deficiency during pregnancy is associate with what for the mother, and what for the baby?
Anemia for mom
Fetal defects for baby esp Spina Bifida
Folate during pregnancies reduces what?
Developmental abnormalities particularly congenital heart defects
Combined what supplementation is essential for prenatal care
Folate - iron supplements
What is the longest lasting uncontrolled experiment lacking informed consent
Formula feeding
In 19th century dry nursing with other animal milk, what milk was the best option?
Donkey milk
Children in 19th century who weren’t breastfed suffered what?
Much higher mortality
Nestle and Von Leibig breast milk substitutes were based on what 4 ingredients?
Cows milk
Wheat
Malt
Sugar
Baby formulas started during American Civil war by adding ___ to ___ which extended its storage life
Sugar to evaporated cows milk
Cookbooks included recipes for milk formula which additives included what
Cows milk
Cod liver oil
Orange juice
Sugar
By WWII ____ recipes became the most common form of infant nutrition
Evaporated milk recipes
By the 1970s what % of 2-3 month old babies in the US were breastfed
25%
What was a major factor behind the popularity of commercial formulas
Aggressive marketing by baby food industries
Breastfeeding delivery isn’t complicated by malnutrition and infection resulting from incorrect ____ by a mother who has not had any access to ___
Incorrect mixing of powder with dirty water by a mom who hasn’t had access to education
Commerciogenic malnutrition pamphlet “Child nutrition in developing countries” and “The Baby Killer” campaign led to what?
International boycott of Nestle products in 1977
Code of conduct by WHO in 1981 and Innocenti Declaration in 1990 places restrictions on what?
Advertising of baby formulas
and requires sales ppl to not provide milk or promotional gifts in hospitals
Exclusive breastfeeding in the first 6 months of life protects the child from what?
Wide range of diseases
Particularly gastroenteritis and malnutrition
How many deaths of children / year can be prevented from exclusive breast feeding
Over a million
First large attempt to repopularize breast feeding was in 1989 by WHO and UNICEF creating a pamphlet called
Protecting, promoting, and supporting breastfeeding: the special role of maternity service
The baby friendly hospital initiative in 1991 includes what strategies?
Extra training for health care staff
Promotion of breastfeeding before and after pregnancy
Support for breastfeeding by trained lactation consultants
Food security exists when all people at all times have ___ access to what?
Physical, social, and economic access to sufficient, safe, and nutritious food to meet their dietary needs and food preferences for an active and healthy life
What are the 4 pillars of food security
Availability
Access
utilization
stability
1974 world food conference declared “every man woman and child has the inalienable right to be ….”
Free from hunger and malnutrition
Food aid was first provided to developing countries in 1950s was a way for developed countries to do what?
Dispose of grain surpluses
What are some of the controversies/criticism food aid has attracted?
Creating disincentives
Depressing food prices
Distorting markets
Delaying need for policy reform
