International nutrition

Question 1

1. Name three nutrition related 2015 Sustainable Development goals (SDG).

Answer 1

1. good health and well being
2. clean water and sanitation
3. zero hunger

Question 2

2. Describe the framework for the contextual factors that contribute to malnutrition.

Answer 2

social economic and political context
-ineffective infrastructure from government and programs
Income poverty
-dwellings w/o electricity or running water, food insecurity, -indoor air pollution
Inadequate healthcare
Lack of clean water and sanitation

Disease

Short term consequences- morbidity, mortality, disability

Long term consequences- adult size, intellect, economic productivity, reproductive performance, metabolic and CV disease

Question 3

3. State and describe three major nutrition problems in developing countries, including growth, dietary, and reproductive outcomes.

Answer 3

PEM (stunting&raquo_space; wasting)
MN deficiencies (hidden hunger)
Role of environment and enteropathy

1. Maternal undernutrition (BMI 500,000/yr women die in childbirth
   Undernutrition↑↑ risk of death (~20% of maternal mortality)
2. Growth faultering
   - Environmental Enteropathy, stunting, chronic disease

Question 4

4. Describe the role of the impoverished gut ; the triple burden of poverty: diarrhea, stunting and chronic diseaese

Answer 4

Diarrhea/EE–>intestinal damage and inflammation–>nutrient malabsorption or loss–> malnutrition–> impaired innate or acquired gut defenses, worsened infection intensity and damage—> cognitive impairment, Obesity or other comorbidities–> Poverty

• Stunting
• Chronic disease

Question 5

5. Describe four approaches to improving nutritional status in vulnerable populations.

Answer 5

Supplements, fortification, technology, education

Daily micronutrient supplements
-Doses – interactions, safety
-Which ones
-Distribution and; sustainability/compliance
Home fortification w/ micronutrients
-Micronutrient powders (MNP):(+) efficacy for anemia, -bioavailability (add to what foods?), dose, sustainability
Staple food fortification
-Levels of micronutrients – target group…if safe for all, may -not be high enough for target
-Vehicle: salt (I), sugar (Vit A), grains
-Requires centralized production

Plant breeding (not-GMO)-> ↑ micronutrients and/or ↑ bioavailability (↓ phytate)
Taste and characteristics of final product
(e.g. color-maize; taste-high Fe; cultural acceptability)
Issues related to production (scale, local production, cost of seeds, sustainability
Golden rice (high Vit A), high Zn & Fe maize, millet, wheat

Dietary diversification
-Small animal husbandry
-Foraging animals(Food vs cash?)-
-Home gardening
-Agriculture
-Efficacy
Evidence 
Cost, resources, political will

Education strategies
“Behavior change communication” – joint agenda setting; negotiate priorities
Delivery through health centers or directly w/ families
Positive deviance (Who in community is successful & why?)

Question 6

interventions that work

Answer 6

maternal- Peri-conceptional folate supplementation, Iodine fortification
Balanced energy-protein supplement
Calcium supplement
Multiple micronutrient supplementation in PG

infants- Promotion of breastfeeding 
Appropriate complementary feeding
Vitamin A supplementation
Preventive Zn supplementation
Management severe and moderate acute malnutrition (SAM and MAM)