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Proteins Biochem > International Nutrition > Flashcards

International Nutrition Flashcards

1
Q

Millennium Development Goals were established in the year 2000 and included 8 anti-poverty targets to be accomplished by 2015.

A

Enormous progress was made towards achieving the MDGs:
•Global poverty continues to decline
•More children than ever are attending primary school
•Child deaths have dropped dramatically
•Access to safe drinking water has been greatly expanded
•Targeted investments in fighting malaria, AIDS and tuberculosis have saved millions

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2
Q

Sustainable Development Goals:

A

Sustainable Development Goals:
goals to be achieved by 2030 that respond to the world’s main development challenges; in Sept 2015, countries given opportunity to adopt global goals to end poverty, protect the planet, and ensure prosperity for all; engagement from governments, private sector, and civil society essential & sought.

Details at www.un.org/sustainabledevelopment/sustainable-development-goals/ (will present overview in class)

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3
Q

Millennium Development Goals (MDG): 2000-2015

A

a. Eradicate extreme poverty & hunger
i. Major declines achieved (~15% 2015)

b. Promote gender equality & empower women
i. Gender parity in primary school = 95% in 6/10 regions

c. Reduce child mortality by 2/3
i. Major declines: ↓ 28%: 12.5M → 8.8M death/yr

d. Improve maternal health
i. + achievements, slower on maternal mortality

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4
Q

Millennium Development Goals (MDG)

Less Progress

A

a. Hunger
b. Sanitation
c. Environmental sustainability
d. Nutritional indicators requiring social & behavior change
* These are four hard categories*

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5
Q

“Number of hungry people in 2010”

A

a. 925 M ≈ 13.1% of world population
b. ~ 1 in 7

c. Hunger:
Want/scarcity of food
Malnutrition–2 types
Hunger ~ PEM
Micronutrient def
(Obesity)
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6
Q

MDG: Why the success?

A

a. Repeated message: health essential for development – required attention of heads of state

b. MDG’s focused attention on short list of outcomes w/ broad appeal
i. keep a small list of goals for these countries, important goals

c. Annual measurement & reporting to media, civil society, governments
d. Donor organizations prioritized investments based on the MDG

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7
Q

MDG—>SDG

“Sustainable Development Goals”

A

a. Five P’s: people, planet, prosperity, peace, and partnership
i. 17 goals & 169 targets (= 8x the number of MDG targets)

b. Health – Goal #3: “Ensure healthy lives and promote well-being for all at all ages”
c. Water, sanitation, poverty, gender equality=targets in other goals—> total of 23 health-related targets

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8
Q

Not included explicitly in SDG…

Sustainable Development Goals

A
  1. Unhealthy diet
  2. Obesity
  3. Inadequate physical activity
  4. High fasting plasma glucose levels
  5. High systolic blood pressure

—->especially important for middle income countries in rapid economic transition

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9
Q

Who is at risk for malnutrition?

A
  1. Women of Reproductive Age (WRA)
  2. Infants
  3. Children (“under 5’s”)
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10
Q

The First 1,000 Days

A

“Good nutrition in the 1,000 days between a woman’s pregnancy and her child’s second birthday sets the foundation for all the days that follow”

1000 Days: Change a Life, Change the Future, HR Clinton, 2010

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11
Q

Conceptual Framework:

A

Relationships between:

a. Basic causes
i. Lack of capital
ii. Social, economic, political context

b. Underlying causes
i. poverty
ii. food insecurity
iii. unhealthy household
iv. environment
v. inadequate care

c. Immediate causes
i. Inadequate intake
ii. Disease
to…
d. Maternal and child undernutrition:
i. short-term consequences
ii. long-term consequences.

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12
Q

Maternal & child under-nutrition is the underlying cause of 3.1 million deaths, 45% of child deaths annually.

A

Number of global deaths < 5 yr attributed to stunting, severe wasting, & intrauterine growth restriction constitutes the largest percentage of any risk factor in this age group. Data (2011) by UN regions Africa, Asia, Latin America (only 1% of deaths in under 5’s occur outside these regions):

o Stunting (Z-score < -2 HAZ): overall: 26% (165 million children)

o Wasting (Z-score < -2 WHZ): overall: 8% (52 million children) (70% live in Asia)

o Severe wasting (< -3 Z WHZ): overall: 3% (19 million children)

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13
Q

Basic Causes

A

a. Poor roads, lack of electricity—> isolation
b. Limits markets, access to resources
c. Social, political, economic context

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14
Q

Underlying cause-Infrastructure

A

a. Income poverty: Dwellings w/o electricity, running water; + indoor air pollution (open fires); food insecurity

b. Health center: No electricity, limited staff, isolation by lack of roads; minimally “furnished”/stocked facility
i. Inadequate care
ii. Few trained professionals

c. Clinic pharmacy: few Rx, no micronutrient supp’s

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15
Q

Underlying Cause-Recoruses

A

a. Lack of clean, running water, soap, sanitation
b. Poverty
c. Food insecurity
d. Unhealthy household environment
e. Obtaining water often assigned to girls & women
f. Interference w/ school, time for feeding, physical stress

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16
Q

Immediate causes of undernutrition

A
  1. Inadequate intake
  2. Monotonous diet
  3. Food insecurity
  4. Disease/illness

Maternal & Child Undernutrition

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17
Q

Response:

“Scaling Up Nutrition: A Framework for Action”

A

Major elements of framework:

  1. What ultimately matters is what happens at the country level. Individual country nutrition strategies and programs, while drawing on international evidence of good practice, must be country-“owned” and built on the country’s specific needs and capacities.
  2. Sharply scale up evidence-based cost-effective interventions to prevent and treat undernutrition, with highest priority to the minus 9 to 24-month “window of opportunity” (aka the “1000 days”) where we get the highest returns from investments.
    i. A conservative global estimate of financing needs for these interventions is $10+ billion per year.
  3. Take a multi-sectoral approach that includes integrating nutrition in related sectors and using indicators of impact on undernutrition as one of the key measures of overall progress in these sectors.
    i. The closest actionable links are to food security (including agriculture), social protection (including emergency relief) and health (including maternal and child health care, immunization and family planning).
    ii. There are also important links to education, water supply and sanitation as well as to cross-cutting issues like gender equality, governance (including accountability and corruption), and state fragility.
  4. Provide substantially scaled up domestic and external assistance for country-owned nutrition programs and capacity.
    i. Ensure that nutrition is explicitly supported in global as well as national initiatives for food security, social protection and health, and that external assistance follows the agreed principles of aid effectiveness of the Paris Declaration and the Accra Agenda for Action. Support major efforts at the national and global levels for strengthening the evidence base—through better data, monitoring and evaluation, and research—and, importantly, for advocacy.
18
Q

Evidence-based interventions:

A

Scale up the following 10 interventions from present levels to 90% coverage—> 15% reduction in deaths in < 5 yr old children (Bhutta ZA, et al, Evidence-based interventions… Lancet, 2013)
a. Periconceptional folic acid supplementation/fortification

b. Maternal balanced energy protein supplementation
c. Maternal calcium supplementation
d. Multiple micronutrient supplementation in pregnancy
e. Promotion of breastfeeding
f. Appropriate complementary feeding
g. Vitamin A supplementation
h. Preventive Zn supplementation (6-59 mo of age)
i. Management of severe acute malnutrition (SAM)
j. Management of moderate acute malnutrition (MAM)

19
Q

Nutrition-sensitive interventions:

A

draw on complementary sectors such as agriculture, health, social protection, early child development, education, water & sanitation; address underlying determinants of nutrition.

20
Q

Broad categories of nutrition-related interventions:

A
  1. General Nutrition Interventions
  2. Micronutrient interventions
  3. Disease control interventions
21
Q

Interventions that affect maternal & child nutrition

A
  1. Maternal & birth outcomes:
    a. Iron & folate supplementation
    b. Maternal supplements of balanced energy & protein
    c. Maternal iodine supplementation through salt iodisation
    d. Maternal iodine supplements
    e. Maternal calcium supplementation
    f. Maternal deworming in pregnancy
    g. Interventions to reduce tobacco consumption &/or indoor air pollution Intermittent preventive treatment for malaria
  2. Newborn Baby intervention
    a. Promotion of breastfeeding (individual & group counseling)
    b. Neonatal Vitamin A supplementation
    c. Delayed cord clamping
  3. Infant and Children Intervention
    a. Promotion of breastfeeding
    b. Conditional cash transfer programs (w/ nutr educ)
    c. Behavior change communication for improved complementary feeding
    d. Iron fortification & supplementation programs (where malaria is not endemic)
    e. Zinc supplementation [or multiple micronutrients?]
    f. Insecticide treated bednets
    g. Zinc in management of diarrhea
    h. Deworming
    i. Vitamin A fortification or supplementation
    j. Universal salt iodisation
    k. Handwashing or hygiene interventions
    l. Treatment of severe acute malnutrition
22
Q

Maternal & birth outcomes:

Useful interventions

A

a. Iron & folate supplementation
b. Maternal supplements of balanced energy & protein
c. Maternal iodine supplementation through salt iodisation
d. Maternal iodine supplements
e. Maternal calcium supplementation
f. Maternal deworming in pregnancy
g. Interventions to reduce tobacco consumption &/or indoor air pollution Intermittent preventive treatment for malaria

23
Q

Newborn Baby

Useful intervention

A

a. Promotion of breastfeeding (individual & group counseling)
b. Neonatal Vitamin A supplementation
c. Delayed cord clamping

24
Q

Infant and Children

Useful Intervention

A

a. Promotion of breastfeeding
b. Conditional cash transfer programs (w/ nutr educ)
c. Behavior change communication for improved complementary feeding
d. Iron fortification & supplementation programs (where malaria is not endemic)
e. Zinc supplementation [or multiple micronutrients?]
f. Insecticide treated bednets
g. Zinc in management of diarrhea
h. Deworming
i. Vitamin A fortification or supplementation
j. Universal salt iodisation
k. Handwashing or hygiene interventions
l. Treatment of severe acute malnutrition

25
Q

Examples & issues of interventions

A
  1. Food aid – emergency/famine situations; supply, food choices, sustainability, economic impact
  2. Daily supplements (liquids or tablets): supply, compliance, dose/interactions, sustainability
  3. “Sprinkles” (dispersible micronutrient sachets; use in home food fortification) – bioavailability/nutrient interactions, supply, dose, sustainability
  4. Staple food fortification: levels of fortification (different requirements for different groups), vehicle (e.g. I in salt, Vitamin A in sugar); quality control, bioavailability
  5. Selective plant breeding/food modification to enhance bioavailability: e.g. phytate reduced maize
  6. Biofortification - enhanced micronutrient content of plants: nutrient levels required; production at scale; cost & sustainability of hybrids
  7. Dietary diversification, small animal husbandry, home gardening, agriculture – cost, resources, sustainability, political will
  8. Educational strategies, e.g. for complementary ± food supplements; positive deviance/Hearth model
26
Q

Under-nutrition…the silent killer

A

a. Short term consequences: morbidity, mortality, disability
i. 45% of the disease burden in children U5’s
ii. Underlying cause of 3.1M deaths/yr in U5’s

b. Long term consequences:
i. Limited adult size
ii. Limited intellectual capacity
iii. Economic productivity
iv. Reproductive performance
v. Chronic diseases (metabolic & cardiovascular)

27
Q

Scope of the problem: Mothers

A

a. Maternal undernutrition (BMI < 18.5)
i. 10-19% of women

b. Underweight & short stature = independent risk factors for poor reproductive outcomes

c. > 500,000/yr women die in childbirth
Undernutrition–>↑↑ risk of death (~20% of maternal mortality)

28
Q

Scope of the problem: Women & the Transmission of Stunting

A

South-central Asia:
10% women 15-49 yr, height < 145 cm (57”)

Guatemala:
Sample 400 women, mean ht= 144 cm (57”)
Mat. ht  infant length at 6 &amp; 12 mo;
Infant stunting rates-6 mo: 
	Shortest ♀:	52% 
	Tallest ♀:	29%
29
Q

Scope of Problem : Malnutrition

A

a. Malnutrition = largest percentage of any risk factor for mortality
Stunting: 26%
Wasting: 8%

b. Undernourished children…
↓ resistance to infection
↑ mortality from common ailments
For survivors, each illness saps nutritional status  vicious cycle

30
Q

The Invisibility of Malnutrition

A

¾ of children who die…

  1. Are mild-moderately undernourished
  2. Have no outward signs of illness or vulnerability“Hidden Hunger”
31
Q

What does poor growth reflect?

A

a. Wasting: ~ acute energy deficit

b. Stunting:
i. Chronic malnutrition,≠ energy deficit
ii. Micronutrient deficiencies
(Zn, I, Fe, et al)
iii. Inflammation, recurrent infection
iv. Intergenerational effects
v. Rural > urban; M>F

32
Q

The Impoverished Gut:

A Triple Burden:

A
  1. Diarrhea/EE
  2. Stunting
  3. Chronic disease
33
Q

Interventions

A

Evidence-based interventions, if scaled up from present levels to 90% coverage  15% —> in deaths < 5 yr olds

34
Q

Interventions that work: Maternal

A

a. Peri-conceptional folate supplementation, Iodine fortification
b. Balanced energy-protein supplement
c. Calcium supplement
d. Multiple micronutrient supplementation in PG

35
Q

Interventions that work: Infants

A

a. Promotion of breastfeeding
b. Appropriate complementary feeding
c. Vitamin A supplementation
d. Preventive Zn supplementation
e. Management severe & moderate acute malnutrition (SAM & MAM)

36
Q

Exclusive Breastfeeding (EBF)

A

a. Infant (0-2 mo) not Exclusive Breast Feeding is 23x more likely to die of diarrhea

b. Single most important factor in prevention of deaths in < 5 yr:
> 800,000 deaths/yr
i. Breast feeding is critical!!

37
Q

Exclusive Breastfeeding & Complementary Feeding (CF)

A

a. Improved CF 2nd most potent strategy to prevent child deaths
b. Traditional CF low in Zn, Vit A, Fe

c. Supplements, fortification, food?
(Increased requirements?)

38
Q

Interventions/Approaches

A
  1. Daily micronutrient supplements:
    i. Which ones & doses – interactions, safety
    ii. Distribution & sustainability/compliance
  2. Home fortification w/micronutrients
    i. Micronutrient powders (MNP):
    (+) efficacy for anemia, bioavailability (add to what foods?), dose, sustainability
  3. Lipid-based Nutrient Supplements
    i. Milk powder, peanut butter, micronutrients-sachet
  4. Staple food fortification
    i. Levels of MN – target group…if safe for all, may not be high enough for target
    ii. Vehicle: salt (I), sugar (Vit A), grains
    iii. Requires centralized production
39
Q

Interventions:Plant Breeding(+- GMO) & Biofortification

A

a. ↑ MN &/or ↑ bioavailability (e.g. ↓ phytate)

b. Taste & characteristics
(e. g. color-maize; taste-high Fe; cultural acceptability)

c.Production challenges(scale, local production, cost of seeds, sustainability

d. Examples:
i. Golden rice, orange swt potatoes(↑ Vit A)
ii. Zn & Fe maize, millet, wheat

40
Q

Interventions…

Dietary diversification

A

a. Dietary diversification
i. Small animal husbandry
ii. Foraging animals(Food vs cash?)
iii. Home gardening
iv. Agriculture
v. Efficacy

b. Evidence
c. Cost, resources, political will

41
Q

Intervention-Education Strategies

A

Education strategies

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

42
Q

Summary

A
  1. MDG: + progress; 925 M “hungry”
  2. Framework/context of malnutrition
  3. Review major nutrition issues
    i. PEM (stunting&raquo_space; wasting)
    ii. MN deficiencies (hidden hunger)
    iii. Role of environment & enteropathy
  4. Interventions:
    i. BF promotion, MN supplements & fortification, technology, education
  5. Must address the underlying causes

Proteins Biochem (20 decks)

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