International Nutrition

Question 1

3 Nutrition-related MDGs

Answer 1

• Eradicate extreme poverty and hunger (“Halve between 1990 & 2015 the proportion of people who suffer from hunger”)
• reduce child mortality
• Improve maternal health

Question 2

Current prognosis for acheiving MDGs

Answer 2

• “Though progress has been made, it is uneven…without a major push forward, many of the MDG targets are likely to be missed in most regions.”
• Reaching goals has become more challenging:
  
  • Global economic slowdown ==> ↓ income of poor
  • Food security crisis ==> ↑ hunger
  • Climate change disproportionately impacts the poor

Question 3

Groups at risk for malnutrition

Answer 3

• Women of childbearing age
• Infants
• Children (esp “under 5’s”)

Question 4

Contextual factors that ==> malnutrition

Answer 4

• social, economic, politcal context
  
  • poor infrastructure, isolation
  • lack of access to resources
  • lack of clean water
• income poverty
  
  • lack of capital
  • dwellings w/out electricity
• lack of access/availability to health care

Question 5

Immediate causes of malnurition

Answer 5

• Inadequate intake
• Monotonous diet
• Food insecurity
• Disease/illness

Question 6

3 major nutrition problems in developing countries

Answer 6

• maternal undernutrition
• stunting
• wasting

Question 7

Consequences of maternal undernutrition

Answer 7

• Underweight & short stature = independent risk factors for poor reproductive outcomes
• > 500,000/yr women die in childbirth
• Undernutrition ==> ↑↑ risk of death (~20% of maternal mortality)
• ==> growth problems/faltering in children

Question 8

Malnutrition in children

Answer 8

• wasting = acute energy deficit
• stunting = chronic malnutrition
  
  • micronutrient deficiencies
  • inflammation, recurrent infection
  • intergeneration effects
  • often have no outward signs of illness of vulnerability

Question 9

Consequences of malnutrition in children

Answer 9

• Malnutrition = largest percentage of any risk factor for mortality
  
  • Stunting: 26%
  • Wasting: 8%
  • Severe wasting: 3%
• Undernourished children…
  
  • ↓ resistance to infection
  • ↑ mortality from common ailments
  • For survivors, each illness saps nutritional status ® vicious cycle

Question 10

Critical periods of growth

Answer 10

• most critical: first 1000 after conception (conception ==> 2 yrs)
• other critical periods:
  
  • pre-conception
  • 2 yrs ==> school age
  • puberty

Question 11

Myths about malnurtion

Answer 11

“Malnutrition is primarily a matter of inadequate food intake”

“Improved nutrition can only come as by-product of poverty reduction”

“Broad based action to improve nutrition not feasible”

Question 12

Implications of “inadequate food intake” myth

Answer 12

• Actually, under-nutrition is not simply result of food insecurity
• Inappropriate feeding & care practices
  
  • Exclusive breastfeeding = single most important factor in prevention of deaths in < 5 yo
• Poor sanitation & disease

Question 13

Implications/challenges to “poverty reduction” myth

Answer 13

• Education and focused action by parents & communities
• Use resources available
• Positive deviance
• Water/sanitation

Question 14

Implications/challenges to “not feasible” myth

Answer 14

• Fortification programs (selected) cheap
  
  • E.g. Iodized salt
• Promotion/support of breastfeeding & Comp Fdg
• Vitamin A supplements: large dose q 6 mo
• Zn supplements – for mgt of diarrhea
• Good management of common illness (ORS, “feed through” diarrhea, etc)

Question 15

Approaches to improving nutritional status

Answer 15

• Supplements
• fortification
• technology
• education

Question 16

Pros and cons of supplementation programs