Nutrition for Developing Countries Flashcards
Chronic Hunger
- Inability to acquire sufficient food (to meet dietary energy requirements) over a period of at least 1y
- May kill more people globally than the acute crisis of a famine does.
- It results from the continuous failure to generate sufficient livelihoods to sustain the population.
Poverty
- Central to chronic hunger
- Is considered to be an integral part of chronic hunger.
- Even in famine, the richer households within a population rarely go hungry.
Understanding poverty
Con Pov Fail
- The consumption approach: income or production is insufficient to provide basic nutrition or necessities - the cost of life in society.
- The poverty Line: income below a global minimal standard - usually useless when comparing across-cultures.
- The failure of capabilities: Failure to achieve basic human capabilities - accessing healthcare, achieving an adequate standard of living.
Tackling hunger
Public action such as providing jobs, healthcare, education and social security (to an extent) - in general - development.
Millennium Development Goals
FAO 2005 & UN, 2015
linked to reducing hunger
1)Eradicate extreme poverty and hunger
2)Achieve universal primary education
3)Promote gender equality and empower women
4)Reduce child mortality
5)Improve maternal health
6)Combat HIV/AIDS, malaria and other diseases
7)Ensure environmental sustainability
8)Develop a global partnership for development
Barriers to education
1) Expense = food acquisition prioritised over school fees
2)Productivity = children, esp. girls, required to help run the household (collect firewood, carry water…)
3)Health = stunting/illness can prevent/delay enrolment
4)Malnutrition = cognitive ability is impaired by e.g. IDA, IDDs, SAM, MAM & LBW
“…a farmer with 4y of primary education is, on average, almost 9% more productive than a farmer with no education” (FAO 2005)
Barriers to gender equality
1)Cultural tradition/law =
e.g. ♀ can be barred from owning land (thus no collateral for credit to irrigate, install drainage etc.)
2)Education gender gap =
widest where hunger is most prevalent
3)Vicious cycle of maternal malnutrition
-> low weight baby
->stunting
-> lower education
-> low work capacity
->poverty
“A recent study of 63 countries concluded that gains in women’s education made the single largest contribution to declines in malnutrition during 1970-95, accounting for 43% of the total progress” (FAO 2005)
proportion of undernourished people in dev. countries
1990/92 ->23.3
2014-16 ->12.9
Sociological determinants of physical growth
(Adapted from Crow 1992)
1) Land
2)Income
3)Infant feeding practise
4)Health Practises
5)Environmental sanitation
6) Food resources
7) Nutrient intake
8) infection
9)Nutrient availability at a cellular level
-> Growth
Proxy measures of undernourishment
include measuring nutrient intake (diet histories, weighed intake, questionairres),
nutritional status (including wasting and stunting, MUAC, BMI and so on).
Vulnerable to undernourishment
the poor,
the young,
the sick,
the infirm,
the disabled,
women (status),
pregnant of lactating women (energy sharing)
migrants,
refugees,
broken families,
female-headed households, the elderly
(Filteau & Akik 2017)
Undernutrition
Filteau &Akik 2017
Malnutrition due to nutritional deficiency
Current terminology for childhood acute malnutrition make no reference to mechanism
SAM (severe)
MAM (moderate)
Child indicator = Weight-for-length/height
Anthropometric deficit = <-2.0Z = wasting
MAM = -2.0 to -3.0Z
SAM = <-3.0 Z
Child indicator = Height-for-age
Anthropometric deficit =
<-2.0Z = stunting
MAM = -2.0 to -3.0Z
SAM = <-3.0Z
Adult undernutrition
BMI (kg/m2)
Normal = 18.50-24.90
Mild malnutrition = 17.00-18.49
Moderate malnutrition = 16.00-16.99
Severe malnutrition = <16.00
Consequences of undernutrition
- no energy….
Limited/no fuel affects;
BMR
PAL
Energy storage
Repair
Growth
Structural support
Enzymatic process
The Cycle of Malnutrition & Infection
-> INFECTION
->Slow recovery time
->Fewer antioxidants
-> Immune system less effective
->decreased tissue resistance
-> MALNUTRITION
-> Increased need for energy and nutrients
-> decreased absorption of nutrients
-> decreased appeitite
-> INFECTION
Payne & Cutler – 1984:
“…from the [related] ‘cost of production’ perspective, it is [also] vital to improve the growth potential and work capacity of adults and children through supplementary feeding so that they can be made fully productive and disease resistant, thus breaking out of the supposed trap of the vicious cycle of undernutrition-diseae-suboptimal production-further poverty-more undernutrition.”
Uncomplicated underweight
(Filteau & Akik 2017)
cause
what is used for energy instead
treatment
Weight loss and wasting due to negative energy balance
- Low intake of low energy-dense foods
- Malabsorption
- Increased energy loss via urine
- Increase energy expenditure (infection, malignancy, fever etc.)
- Infection-related anorexia
Compensated by use of stored energy
- Adipose
- Lean tissue (muscle mass)
Treatment
- Incr. intake of energy and EAAs
- Treatment of infections to restore appetite, improve gut function & reduce energy costs (e.g. fighting infection)
Barriers to Accessing Sufficient Energy in Childhood
(Duggan 2011)
Maternally Mediated
- Poor maternal diet (esp. 3rd trimester)
- Lactation failure (poss. due to HIV or multiple births)
- Maternal death
- High maternal fertility rates
OTHER
- Low energy-dense weaning diets (porridge)
-> low BV (protein), virtually no vitamin A, iron/zinc poorly available
- Infection
- Poverty
- Land-hunger
- Insufficient/contaminated water
- Gender inequality
- War
- Drought
Stunting definition
What
Who
Consequence
height-for-age <-2.0Z
An adaptation to longstanding underfeeding and/or repeated infection (Filteau & Akik 2017)
Affects ~40% of children <5y in DCs (esp. S.Asia & Sub-Saharan Africa) compared to ~7% in Europe
incr. morbidity & mortality, poorer cognitive development, obstruction in labour, maternal mortality, low birthweight
Nutritional Factors in Stunting
(Filteau & Akik 2017)
Action at growth pates of long bones alongside growth hormone & IGF-1, also influenced by:
- AAs (esp. leucine)
- Calcium
- Zinc
- Copper
- Vitamin D
- Vitamin A (?)
- More so than anything else, dietary ‘quality’ (variation, dairy, fruit, green vegetables)
Catch-up growth may occur immediately, may be delayed or may never occur
Hidden Hunger
Industrial countries fortify so many products that micronutrient deficiency is barely thought of as a public health problem in most instances. However, in Developing countries, the scale of hidden hunger is huge and the implications wide ranging. The cost of such deficiencies in terms of lives lost, forgone economic growth and poor quality of life are difficult to quantify.
Hidden Hunger: Causes
(von Grebmer et al. 2014)
TIMES OF INCREASED REQ
Times of increased requirement
- Infancy (‘first 1,000 days’ - from birth to age 2)
- Childhood
- Adolescence
- Pregnancy
- Lactation
Other
- Dietary inadequacy
- Infection/ disease
- Impaired intestinal absorption
- Double or even triple burden
- Coexistence of undernutrition, micronutrient deficiency and obesity
Vitamin A deficiency
(Filteau & Akik 2017)
- scale
- risk factor
- consequences
~250,000-500,000 vitamin A-deficient children become blind/y, half die within 12mo of losing their sight
(WHO, 2016)
“…repetitive periodic distribution of high-dose vitamin A supplements has contributed to a reduction in impaired ocular health and blinding malnutrition…” (Underwood, 2002).
SCALE
- Mainly Preschool children
~250mill., esp. in Asia & Africa
- Pregnant women
…in tropical LIDCs
RISK FACTOR
- Low intakes +
- Metabolic disruption (disease)
- Concomitant deficiencies
- Enhanced requirements (infection)
- Dietary over-reliance on β-carotene Vs retinol
- Seasonality of dietary β-carotene avail.
CONSEQUENCES
- Eye-related: night blindness, xerophthalmia, blindness
0.5mill. incident cases preventable blindness/y
- Reduced immunity: exacerbation of infection (particularly measles, diarrhoea, respiratory infection)
- Overall child: ↑ childhood morbidity & mortality due to ↑ likelihood & severity of various diseases (Ferraz et al., 2005)
- Overall adult: mental slowness, fatigue
Water sol. vits
BC
fat sol vits.
ADEK
Iodine deficiency
- scale
- risk factor
- consequences
SCALE
- Infants, children & adolescents
Nepal: 27.4% school-aged children have IDD
(Siva, 2010)
- Pregnancy & lactation
~18mill. babies with brain damage born to iodine deficient mothers/y
(von Grebner et al. 2014)
RISK FACTORS
- Low intake +/-
landlocked countries & mountainous areas (e.g. Nepal, Himalayas)
- Iodine deficient soil
- Goitrogens in the diet (inhibit absorb)
CONSEQUENCES
- Thyroid-specific: enlargement incl. goitre; hypothyroidism (sleepiness, lethargy, problems during pregnancy)
- Development: mental problems, deafness, possible mortality in infancy
