Exam 4- Community Nutrition

Question 1

Complementary Medicine

Answer 1

medical interventions used along with standard interventions

Question 2

Alternative Medicine

Answer 2

Medical interventions that are neither commonly taught in US medical schools nor readily available in US hospitals. Eisenberg 1993

Question 3

Integrative Medicine

Answer 3

◦Complementary, alternative, or adjunctive health care practices are not an integral or customary part of conventional medicine
◦Includes acupuncture, meditation, naturopathy, and chiropractic care
◦Integrative medicine is focused on combined use of conventional and complementary and alternative approaches
-Integrative medicine= healing-oriented medicine that considers the whole person (body, mind and spirit)

Question 4

CAM Therapies

Answer 4

• considered holistic
• Alternative medical systems: naturopathy, traditional Chinese Medicine, ayurveda, homeopathy
• Mind-body therapies: meditation, prayer, art or music therapy, cognitive behavior therapy
• Biologically based therapies: herbs, whole foods, dietary supplements
• Manipulative therapies: massage, chiropractic medicine, osteopathy, yoga
• Whole medical systems based on energy therapies: qi gong, magnetic therapy, reiki

Question 5

Use of CAM Therapies

Answer 5

• enhance conventional medical practices
• increasing use
• provided in more conventional medical settings
• National Center for Complementary and Alternative Medicine, National Institutes of Health
• 49.6 bil spent on conventional vs 14.7 on complementary

Question 6

2012 NHIS Highlights

Answer 6

• 33.2% of U.S. adults used complementary health approaches. This is similar to the percentages in 2007 (35.5%) and 2002 (32.3%).
• 11.6% of U.S. children age 4 to 17 used complementary health approaches in 2012. There was no meaningful change from 2007, when 12.0% used them.
• The most commonly used complementary approach was natural products (dietary supplements other than vitamins and minerals). 17.7% of adults and 4.9% of children age 4 to 17 used natural products.
• Pain—a condition for which people often use complementary health approaches—is common in U.S. adults. More than half had some pain during the 3 months before the survey.
• U.S. adults who take natural products or who practice yoga were more likely to do so for wellness reasons than for treating a specific health condition. In contrast, people who use spinal manipulation more often do so for treatment reasons rather than wellness.
• About 59 million Americans spend money out-of-pocket on complementary health approaches, and their total spending adds up to $30.2 billion a year.
• 60% of NHIS respondents who used chiropractic care had at least some insurance coverage for it, but rates were much lower for acupuncture (25%) and massage (15%).

Question 7

Most commonly used natural products

Answer 7

fish oil/omega 3, glucosamine, echinacea, flaxseed, and ginseng

Question 8

Why RDNs Should Know About These Things: Assessment

Answer 8

-over 60% of people use these therapies and are asking questions about them
◦Many use when traditional medicine fails – last hope
◦Approximately 18.4% of all prescription users use herbal therapies but only 38.5% told their doctors
An essential part of the assessment to get information from the patient – may be drug/dietary supplement interactions
◦St. John’s wort with Digoxin and Idinavir
◦Gingko with aspirin
◦Kava with levodopa and alprazolam
-can alert patients to warnings and safety info
-need to stop taking a lot of them before surgery

Question 9

Why RDNs Should Know About These Things: Regulation

Answer 9

-most herbs and phytomedicines are regulated as dietary supplements
◦Dietary Supplement Health and Education Act (DSHEA) places dietary supplements under general umbrella of “foods,” not drugs, and requires that every supplement be labeled as a dietary supplement
◦Claims about the structure and function of the components are legal while claims about prevention or cure of specific diseases are not
◦Further testing for safety and efficacy and manufacturing standardization are not required
◦Currently- no quality standard for herbal medicine
◦In the US, lack of regulations to assure quality, safety and active ingredients make these products difficult to use
◦This also makes PRCCT with these products impossible – and most studies cited have no control groups, either
◦German standards and E monographs frequently cited

Question 10

Why RDNs Should Know About These Things: Evidence assessment

Answer 10

◦NCCAM at NIH manages the research collection for these therapies
-must look at how studies are done:
frequently no control group, different parts of plants or extracts used, dosages, etc.
◦Use scientific process to evaluate

Question 11

Advice on CAM products

Answer 11

Consumer Advice: “The use of phyto-medicines is best limited to preventative measures or minor problems.” Krause’s
Lecturer: Buyer Beware

Question 12

Food insecurity

Answer 12

exists whenever the available of nutritionally adequate and safe food and the ability to acquire acceptable food in socially acceptable way is limited or uncertain

Question 13

Hunger

Answer 13

uneasy/painful sensation caused by lack of food

Question 14

food secure

Answer 14

access to enough food for a healthy active lifestyle

Question 15

undernutrition

Answer 15

inadequate intake, absorption, or utilization of nutrients

Question 16

Malnutrition

Answer 16

Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. Impaired development of function

Question 17

Protein-energy Malnutrition:

Answer 17

extremely deficiency intake of protein and calories; exacerbated by accompanying illness

Question 18

Famine

Answer 18

extreme shortage of food with underlying crop failure due to bad weather, war and civil strife or both

Question 19

Types of Malnutrition

Answer 19

Overnutrition
Secondary Malnutrition
Micronutrient malnutrition
Protein-energy Malnutrition

Question 20

Critical life stages

Answer 20

Pregnancy
Infancy/fetal
Childhood
Later years/elderly

Question 21

Pregnancy and Undernutrition

Answer 21

=increased maternal death rate

Depleted maternal stores

Question 22

Fetal and Infancy Undernutrition

Answer 22

-increase in preterm birth and LBW
-Infant mortality rate used as the marker of undernutrition
◦US ranks 26th amongst industrialized countries
◦6.14 deaths per 1,000 live births

Question 23

Childhood Undernutrition

Answer 23

Brain impairment from decreased growth
Iron deficiency anemia
◦Decreased stamina, stunted growth, impaired motor development, learning problems
Immune function decreases resulting in increased infection

Question 24

Later Years Undernutrition

Answer 24

Need for nutrient dense food because of health and activity level
Fixed incomes and medical costs make food low priority
Isolation and depression can affect intake
Malnutrition leads to decreased functional capacity and need for more help

Question 25

General Effects of Semistarvation

Answer 25

• Reproductive capacity affected
• disease resistance and illness recovery decrease
• Physical activity and work output decreases
• attitude and behaviors change

Question 26

Keyes Study

Answer 26

32 men on 1600 kcal for 6 months
Lost 24% of bodyweight
After 3 months, complained of fatigue, muscle soreness, irritability and hunger pains
Lack of ambition, self discipline, poor concentration, moody, depressed
Became less able to laugh heartily, sneeze and tolerate heat
Heart rate and muscle tone decreased
After being allowed to eat normally at 12 weeks, still had desire for more food and a feeling of fatigue
◦Full recovery took 33 weeks

Question 27

Socioeconomic Factors Related to Undernutrition

Answer 27

Poverty
◦Federal poverty line is $24, 250 for a family of four in 2015
Homelessness/housing
◦61% of low income families (100-199% poverty) and 81% of those below poverty spent >33% of income on housing
-likely to experience undernutrition w/o direct food assistance
◦2.5 million children are homeless

Question 28

How do we monitor hunger in the US?

Answer 28

-USDA Economic research service
-Based on direct survey measure developed by the US Food Security Measurement Project
-A food security survey questionnaire was used in the field as a supplement to the Current Population Survey on the US Census Bureau
◦Tested for validity, reliability and applicability

Question 29

Food Insecurity Scale Questions

Answer 29

• anxiety or worry about food budget
• Perceptions by the respondent that the food eaten by the household members is inadequate in quality or quantity
• Instances of reduced food intake by adults in the household or consequences of reduced intake such as the physical sensation of hunger or weight loss
• reduced food intake by children in the household

Question 30

Food Security Status Categories: low food security

Answer 30

Anxiety and concerns about food and money available, and in adjustments to food management including reducing quality of diets.

Question 31

Food Security Status Categories: very low food security

Answer 31

◦Multiple indications of reduced food intake
◦Disrupted eating patterns due to inadequate resources for food
◦Most households reported hunger without eating because of lack of money for food at some time during the year

Question 32

Prevalence of food insecurity

Answer 32

10-15%, with 3-6% of that being very low

Question 33

National Findings- 2016

Answer 33

12.3 % of US household were food insecure (having experienced the condition at any time during the previous 12 months
◦4.9% of US households experienced very low food insecurity
Children were food insecure at times in 8% of US households with children (3.1 million households)
◦Children experienced very low food insecurity in 298,000 households with children (0.8%)

Question 34

Frequency of food insecurity- 2016

Answer 34

◦On a given day, the number of households with very low food security was a small fraction of the number “at some time during the year”
◦Typically households classified as having very low food security experienced the condition in 7 months of the year, for a few days in each of these months
Rates of food insecurity were higher than average among
◦households with incomes near or below the Federal Poverty Line
-higher for female head than male headed

Question 35

Wisconsin Statistics- food insecurity

Answer 35

10.7 % of WI households were food insecure (2014-2016 yearly average)
◦4.2% of WI households were very low food secure

Question 36

US Policy/Programs

Answer 36

Federal Food Assistance Programs are an outgrowth of the farm support laws enacted during the Great Depression of the 1930s
Goal: to improve nutrition of low income while providing outlet for surplus agriculture commodities from the farm program

Question 37

Timeline for Food Programs: 1930s to 1968

Answer 37

1930s: soup kitchens and food distribution due to the Great Depression
1946: School lunch program
◦Draft physicals showed importance of childhood nutrition (effects of malnutrition during the depression)
1960s: JFK observed extensive hunger and poverty- revitalized the Food Stamp Program
1965: Breakfast program and senior congregate meals
1968: Hunger in America (documentary) documented hunger existing in all areas and ethnic groups in the US
◦Response was to expand Food Stamp Program and School Breakfast
1968: Senate Select Committee on Nutrition and Human Needs was formed
◦Nixon vowed to “put an end to hunger in the America itself for all time”

Question 38

Timeline for Food Programs: 1969 to 1982

Answer 38

December 1969: White House Conference on Food, Nutrition, and Health
◦Recommendations from this conference have helped shape nutrition policy for the next 25 years
1972: WIC, Nutrition program for older adults
1977: survey showed poverty worse than in 1967, but undernutrition had disappeared
◦1970s: cash subsidies and vouchers increasingly replaced commodities to improve purchasing power of the poor
◦1969-> 1977: annual federal expenditures for food assistance increased about 6 times, and donated farm products were less than 10%
1980-1982: congress decreased food assistance by 1/3
1982: reappearance of hunger- soup kitchens and breadlines◦Increased unemployment
◦Eligibility and funding for federal programs tightened and reduced
◦Only for “truly needy”
◦Decrease in AFDC benefits

Question 39

Timeline of Food Programs: 1985-1990

Answer 39

1985: Food Security Act of 1985
◦Reinstated lost nutritional benefits for low income households through changes in the Food Stamp Act and TEFAP (temporary emergency food assistance program)
1986: School lunch and Nutrition program amendments
◦Included increased funds for WIC and School Breakfast Programs
◦Reauthorized Child Nutrition Program benefits extended to homeless
1988: Hunger Prevention Act in 1988
◦Provided federal matching funds to states for outreach for Food Stamp Program
1990s: challenges to the food programs◦“block grant” proposals in 1995
◦Welfare reform◦“W-2” in WI

Question 40

Timeline of Food Programs:

Answer 40

1996: World Food Summit response◦Increased health care coverage for uninsured children, increased funding for Head Start, inclusion of Healthy People 2010 objective to cut food insecurity in half by 2010
◦Privately funded programs augment state and federal programs◦Second Harvest estimated more than 1 in 8 Americans rely on food repositories and soup kitchens to feed themselves and their families
◦50 food pantries in Dane County alone2011: proposed cuts to many programs
2012: 2012 Farm Bill- cuts to nutrition assistance programs (passed in Senate/stalled in House)
2013: sequestration- “extended without reauthorization” 28% cut in SNAP-ED
2014:
◦$8.6 billion in cuts to SNAP in 10 years
◦Removes “Heat and Eat Provision”
◦Affects 850,000 households (4% of SNAP population) nationwide
◦Average $90 per household per month

Question 41

Public Policy

Answer 41

“public policy can be generally defined as a system of laws, regulatory measures, courses of action, and funding priorities concerning a given topic promulgated by a governmental entity or its representatives.

Question 42

Steps in Policy Development

Answer 42

Problem recognition
Agenda setting
Policy formation
Policy implementation
Policy evaluation

Question 43

Program Planning

Answer 43

Assessment
Development of strategies/interventions
Implementation
Monitoring
Evaluation

Question 44

Shaping Public Policy

Answer 44

Done through education, advocacy or mobilization of interest groups
Process “involves efforts by competing interest groups to influence policy makers in their favor”
Major aspect of public policy is law
◦Includes specific legislation and more broadly defined provisions of law
◦Public policy debates occur over proposed legislation and funding

Question 45

Public Policy Advocacy

Answer 45

“Defined as attempting to influence public policy through education, lobbying, or political pressure.”
◦Education of general public as well as policy makers about
◦Nature of the problems
◦What legislation is needed to address problems
◦Funding required to provide services or conduct research
◦“Although advocacy is viewed as unseemingly by some in the professional and research community, it is clear that public policy priorities are influenced by advocacy.”