midterm Flashcards

Question

# NUTRITION ASSESSMENT signs of protein deficiency + how to test for edema

Answer 1

depigmentation of hair, traverse ridging on nails, edema (swelling due to excess fluid accumulation) **bilateral pitting edema:** sign of SAM; press feet gently with thumbs for 3 seconds → if there’s a dent on both feet, then pitting edema

Answer 2

**Dietary:** measurements of foods and beverages consumed by a person in 1 day, several days, or a longer time period **24-hour recall:** participant asked for quick list of foods/beverages consumed in the past 24 hours; quick/cheap/easy/doesn't alter diet, but relies on memory accuracy + labour intensive data entry + not representative

Answer 3

**food records:** records type and amount of food/beverage consumed for a period of time; more detailed + representative but requires literacy + might alter diet/not represent usual intake **FFQ:** can determine how often person consumes a limited number of foods; can be self-administered + machine readable, but might not include usually consumed foods/portion size info, requires literacy

Answer 4

**malnutrition** = hunger, micronutrient deficiencies, overweight/obesity **undernutrition** = nutritional deficiency, maternal underweight. child stuntint + wasting, micronutrient deficiencies **maternal underweight:** BMI < 18.5 among women of reproductive age; prevalence > 20% = serious health problems **overweight and obesity:** BMI >= 25 = overweight, BMI >= 30 = obesity

Answer 5

**hunger:** individual sensations, behavioural responses, food scarcity (actual or feared), national food balance sheets based on kcal * dietary risk factors + physical inactivity accounts for 10% of global burden of disease * 6/11 of global disease risk factors related to diet: incl undernutrition, high BMI, high cholesterol

Answer 6

undernutrition decreasing in china, brazil, ethiopia, bangladesh * brazil: maternal and child health services in underserved regions, social reform and safety net programs, equitable poverty reduction, food supplementation * ethiopia: increased enrolment and retention of girls in school, agricultural productivity, employment based safety net; treating nutrition as a multisector challenge, improved sanitation * bangladesh: economic growth policies, girls’ education, improved sanitation, agricultural investment

Answer 7

africa and asia have highest extreme poverty; greatest risk of famine * famine mostly due to human induced crises, like political mismanagement, armed conflict, discrimination of marginalized political/ethnic groups → compounded the effects of environmental shocks like droughts, locust invasions * cause of mortality in famines: wasting in children

Answer 8

* eradicate hunger * resolve all forms of undernutrition * tackle obesity * need triple duty investments bc wealth and food sufficiency won’t resolve low quality diets

Answer 9

* equitable growth policies → reduce poverty overall * targeted safety nets for the poor, invest in accessible services (education, clean water, healthcare) * govs should assume responsibility for responding to shocks (economic, environmental, conflict) * nutrition-specific programming → preventing, resolving defined nutrition problems (price support interventions, support for women farmers) * healthcare investment esp in maternity care

Answer 10

**nutrition transition:** notable changes in dietary intake and physical activity that, together, increase the prevalence of overweight and obesity in a society **double burden of malnutrition:** over- and undernutrition coexisting within the same country, family, or person

Answer 11

causes * mother was malnourished during pregnancy * rationed food during hunger season * drought of 2003 → mother left vulnerable consequences * physically stunted * possibly cognitively stunted * economic cost of stunting: $3.5 tril in diminished education, lost * productivity, higher healthcare costs * stunted ambitions

Answer 12

**basic causes:** act upon society, * sociocultural, economic, political context * inadequate financial/human/physical/social capital * lack of access to resources (land, education, employment, income, tech) **underlying causes:** act upon communities * household food insecurity * inadequate care and feeding practices * unhealthy household environment + inadequate health services **immediate causes:** act upon the individual * inadequate dietary intake * disease > impairs absorption of nutrients, reduces appetite

Answer 13

**short-term consequences:** mortality, morbidity, disability **long-term consequences:** adult height, cognitive ability, economic productivity, reproductive performance, metabolic and cardiovascular disease

Answer 14

1. positive narrative, focuses on positive outcomes 2. more about determinants and outcomes, not causes and consequences | ask WHY 5 times

Answer 15

**biochemical markers:** hemoglobin (less oxygen carried to tissues), serum ferritin (storage form of iron) **clinical markers:** pale conjunctiva (less blood), anemia

Answer 16

causes of iron deficiency: * low dietary intake → plus underlying and basic causes * poor absorption → phys reasons, ex. diarrhea, or dietary reasons, ex. low bioavailability in plant foods, ex. black tea limits absorption * increased need → growth, pregnancy, lactation * infections → malaria, hookworms, tuberculosis consequences * children born from iron-deficient mother: premature birth, low birthweight, incr risk of infections, death, impaired physical growth * impaired cognitive development, negative impact on learning * reduced productivity, incr likelihood of death during childbirth → blood loss can be fatal * accounts for 20% of all maternal deaths | 8 mg/day vs 18 mg > 1000 kcal of a mixed diet provides 6 mg of iron

Answer 17

change diet to increase iron intake * dietary diversification * increase enhancers, and reduce inhibitors of iron fortification * industrial: ex. wheat flour; ROI is $15000 per person per lifetime, only costs $2 to fortify wheat flour * household: micronutrient powder (sprinkles); easy, highly acceptable, can be added to any soft cooked food, encapsulated in lipid to prevent transfer of taste to other food control hookworm and other infections that cause anemia * lives in the small intestine of host * wear shoes

Answer 18

**heme:** part of hemoglobin and myoglobin, only in blood and muscle * more absorbable; 25% of iron absorbed, but only 10% of iron present in mixed diet **non-heme:** found in both animal and plant foods, not in hemoglobin and myoglobin * animal tissue is 40% heme, 60% non-home * eggs and dairy only have non-heme

Answer 19

* contributes to growth failure, weakened immunity * 800K child deaths per year → from diarrhea, pneumonia, malaria * negative health consequences: central nervous system , skeleton, digestive system, immune system * found in whole grains, beans fortified cereals, meat, fish, poultry, and seafood | oral rehydration salts (ORS), zinc supplements ## Footnote zinc supplements can help reduce diarrheal mortality by 50%

Answer 20

* major preventable cause of intellectual disability * iodine deficiency in pregnancy leads to ~20 mil infants born with cognitive and growth impairments * **cretinism:** severely stunted physical and mental growth due to maternal hypothyroidism * goiter: swelling in thyroid gland

Answer 21

seafood cereals grown in iodine-rich soils milk → if soil is iodine-rich fortified foods > salt

Answer 22

**marasmus:** wasting, severe weight loss; results in losing >30% of protein → less strength for breathing, susceptibility to infections, abnormal organ function, death * body becoming more efficient w energy usage; can be easier to recover from **kwashiorkor:** nutritional edema, bilateral pitting edema, bloated/water retention * can obscure wasting occurring concurrently → prevents early diagnosis of growth failure **marasmic-kwashiorkor:** combination of wasting (low MUAC) and bilateral edema; form of SAM

Answer 23

**anemia:** iron or vitamin B12 deficiency * individual’s blood lacks enough red blood cells to carry oxygen efficiently around the body * anemia in women/children: ⅓ are anemic * highest in south asia, sub-saharan africa | pregnant women and young children

Answer 24

* leading cause of preventable blindness in children → starts as night blindness and progresses to permanent blindness * exacerbates serious disease and illness → leads to incr rates of maternal and childhood mortality * children under the age of 5 are most vulnerable * highest across Africa and Asia incl east Asia, North Africa; night blindness has the same pattern | leafy veg, yellow veg, dairy, fish, eggs, palm oil; BREAST MILK

Answer 25

* metric used to indicate the severity of micro-malnutrition * used commonly for preschool children * average of prevalence of stunting, anemia, and vitamin A deficiency * alarmingly high in sub-saharan Africa and South Asia

Answer 26

**supplementation:** use of concentrated micronutrients in pill, powder, or liquid form * vitamin A supplementation: countries provide at least 2 high-dose capsules over a year → relatively common in Africa and South Asia * oral rehydration salts to treat diarrhea **food fortification:** small amounts of micronutrients added to common food products used by the general population, such as cereals, wheat flour, and rice * ex. iodized salt supply **biofortification:** agronomic and plant-breeding approaches in agriculture are used to increase the concentration of particular micronutrients in staple food crops * ex golden rice → high concentration of vitamin A | poor dietary diversity (higher share of cereals/roots/tubers), income

Answer 27

1. infant girls: low birth weight, growth restriction in womb, risk diarrhea, learning difficulties 2. girls are breastfed 6-8 weeks less, in the hope that the mother will become pregnant sooner with a boy 2. young girls have stunted growth, wasting, rickets, learning difficulties 3. teen: delayed menarche, narrow pelvis 4. women begin having babies as soon as puberty is reached; high risk of micronutrient deficiencies esp anemia; goiter, infection 5. pregnancy: more birth complications, risk anemia → goes back to infant girls | only 42% are exclusively breastfed for the first 6 months

Answer 28

1. colostrum → thick honey-like, secreted for first 2-3 days; nutritious, concentrated, mild laxative, contains growth factors and antibodies; only consumes ~1 tsp of colostrum in a feeding 2. transitional milk → until infant ~2 weeks old 3. mature milk → 2 wks - 6 months 4. extended lactation → beyond 6 months | high bioavail of iron, immunoglobulins, WBC, lysozymes, lactoferrin

Answer 29

foremilk → watery hindmilk → high fat; more energy and vitamin A dense | drain one breast before offering the other one

Answer 30

exclusive breastfeeding from 1 hour - 6 months, introduce complementary foods at 6 months but continue breastfeeding until 24+ months * timing of introduction: too early/lae * may not be nutritionally adequate * may be unsafe | iron-rich, fatty (energy-dense)

Answer 31

reduced risk of infant mortality * following WHO recommendations would save 800,000 child lives + 300 bil USD every year * better breastfeeding practices reduces all-cause mortality among infants reduced risk of postpartum hemorrhage * if mother can breastfeed shortly after delivery increased birth spacing → interval of at least 24 months between birth and next conception → better health outcomes * lactational amenorrhea → 98% protection against pregnancy for 6 months, if the baby feeds frequently day and night, and not given any other food, drinks, or a pacifier * also reduces ovarian cancer

Answer 32

if a safe alternative to breastmilk is available, use that safe alternative * formula w safe water, or safe donor breast milk if not available: breastfeed + ARV, follow WHO guidelines * but breastfeeding should stop once nutritionally adequate and safe diet without breast milk can be provided * much higher risks if not breastfeeding esp if diarrhea, pneumonia etc is common | antiretroviral medications

Answer 33

1. hunter-gatherer 2. modern agriculture and famine 3. receding famine (as incomes grow) 4. changes in activity levels and diet lead to increased levels of noncommunicable diseases 5. behavioural change in which populations reduce their fat, increase fiber intake, and do meaningful physical activity that extends mortality and reduces NCDs * fiber bc it increases satiety

Answer 34

children under 5, people in poverty, rice-dominant countries, pregnant and lactating women (higher vitamin A req)

Answer 35

canada: * very private * weaning is the goal * associated with dependency mongolia: * very public, encouraged, celebrated, normalized * weaning is not the goal * not associated with dependency; associated with strength and good wrestling * only stop when the child wants to stop * even adults drink breast milk; used medicinally * used to pacify children