Test 8 Flashcards
1
Q
factors affecting nutritional status of an individual
A
- quality
- quantity
- health of individual
2
Q
nutritional status of the community
A
sum of nutritional status of individuals who form that community
3
Q
objective of COMPREHENSIBLE nutritional surveys
A
- information about given community
- PREVALENCE of nutritional problems (how many people have it)
- geographical DISTRIBUTION of disease (where do people have it) - information leads to identification:
- at risk population (age group, sex group etc) who are at greatest need of assist
4
Q
nutritional surveys - role
A
- collect information about nutritional disorders
- identify people who are at risk
- define the disorders and
- form the policies
5
Q
purpose of nutritional assessment
A
- define needs of people
- develop a health care programme that meet those needs
- evaluate the progress
6
Q
Nutritional surveys - SAMPLE that gives valid conclusions
A
- random
- representative
- cover all ages
- cover both sexes
- cover all socioeconomic classes
7
Q
survey planning with aid of expert statistical advice
A
decisions are to be made (don’t just wing it man)
- duration
- type
- measurement techniques (standardized)
- instruments
finally -do extensive investigation on a sub sample about the nutritional status - if possible
8
Q
nutritional survey
A
- role/ objectives - info (prevalence, distribution) - > disorders and risk groups = status assessment (define needs) -> policies formation (form programme that meet the needs and keep evaluating them)
- survey planning (duration, type, instruments, measurement kind, investigation)
- sample
9
Q
types of surveys
A
- cross sectional
2. longitudinal
10
Q
methods of nutritional assessment
A
evaluate - all disease stages (i.e. prepatho, patho, postpathogenesis) by under given COMPLEMENTARY methods:
- clinical examination (GPE)
- anthropometry (childhood data)
- biochemical evaluation (serum levels)
- functional assessment (bodily responses)
- assessment of dietary intake (food)
- vital and health statistics (rates, death births, marriages, divorces etc)
- ecological studies (environmental)
11
Q
clinical examination
A
simplest
practical
look for physical signs (specific signs, non specific signs):
1. assess status of nutrition (of individual/ population)
i.e. if the person is nourished or has malnutrition:
12
Q
nutritional surveys goals
A
- health vs food consumed
13
Q
diagnosis of deficiency diseases
A
when two or more signs characteristic for a particular diseases are present simultaneously
14
Q
classification of signs used in nutritional surveys (WHO expert committee)
A
- not related to nutrition
- need further investigation
- known of value
15
Q
WHO classification of signs: not related to nutrition
A
- alopecia
- pyorrhea
3 pterygium
16
Q
WHO classification of signs:: that needs further investigation
A
- malar pigmentation
- corneal vascularisation
- geographical tongue
17
Q
WHO classification of signs: known to be of value
A
- angular stomatitis (deficiency of riboflavin, iron
- bitot’s spots (vitamin A deficiency)
- calf tenderness
- absence of knee or ankle jerks (beri beri)
- enlargement of thyroid gland (endemic goitre)
18
Q
drawbacks of clinical signs/ examination
A
- malnutrition cannot be quantified
- subjectivity or lack of specificity
- some diseases aren’t associated with signs
19
Q
how to overcome subjective and objective errors
A
- cover all parts of body in the survey (standard survey forms)
20
Q
anthropometric measurements in young children
A
- height
- weight
- chest circumference
- arm circumference
- head circumference
- skin fold thickness
21
Q
anthropometric measurements
A
- height
- weight
- skin fold thickness
- arm circumference
22
Q
anthropometric measurements
A
- can be done non medical - given enough training
- record over a period of time:
- reflect pattern of growth
- reflect pattern of development
- reflects deviation from average values (of size, built and status) at various ages
23
Q
natural history of disease
A
- prepathogenesis period
2. pathogenesis period
24
Q
prepathogenesis period course
A
- diminishing reserves
2. reserves exhausted + physiological alteration
25
prepathogensis assessment methods
1. food balance sheets
| 2. dietary surveys
26
pathogenesis course (+ assessment methods)
1. non specific signs and symptoms (anthropometric measurements, clinical examination)
2. illness (lab investigations etc)
3. permanent damage (morbidity data)
4. death (mortality data)
27
lab assessment
1. blood (hemoglobin, rbc, hematocrit values)
2. urine
3. stool
28
hemoglobin assessment is the index of
1. anemia
| 2. over all state of nutrition
29
stool testing is done for
intestinal parasites
| Hx of infestation, diarrhea, dysentery = signify the nutritional status
30
urine examination is done for
1. albumin
| 2. serum
31
biochemical examination - role
1. precise
2. detection of malnutrition in pre clinical stage by checking levels of individual nutrients or body molecules they affect
32
biochemical examination is done for
1. vitamins in serum (retinol)
2. minerals in serum (iron levels)
3. enzymes for which vitamins are co factors (riboflavin is co enzyme of number of enzymes that are involved in energy metabolism eg. glutathione reductase)
4. metabolites in urine (iodine)
33
normal iron levels of blood
0.8-1.8 mg/L
34
disadvantage of biochemical tests
1. time consuming
2. expensive
3. cannot be applied on large scale (sub sample only)
4. cross sectional findings
5. only mild deficiencies detected
6. confirmatory test for clinical assessment
35
currently advocated tests in nutritional surveys
1. serum retinol
2. TPP stimulation of RBC transketolase activity
3. RBC glutathione reducatase activity stimulation by flavine adenine dinucleotide
4. urine N-methyl nicotinamide
5. serum folate, RBC folate
6. serum B12 concentration
7. leucocyte ascorbic acid
8. prothrombin time
9. serum albumin, serum transferrin, thyroid binding pre-albumin
36
biochemical tests - vitamin A
serum retinol - 20 mcg/dl
37
biochemical tests - thiamine
TPP stimulation of RBC transketolase activity - 1-1.23 ratio
38
biochemical tests - riboflavin
RBC glutathione reductase stimulation by flavine adenine dinucleotide - 1- 1.2 ratio
39
biochemical tests - niacin
urine N-methyl niicotinamide
40
biochemical tests - folate
```
serum folate (6 mcg/ml)
rbc folate (160 mcg/ml)
```
41
biochemical tests - vitamin B12
serum B12 concentration (160 mg/ L)
42
biochemical tests - ascorbic acid
leucocyte ascorbic acid - 15 mcg/ 10^8 cells
43
biochemical tests - vitamin K
prothrombin time - 11-16 seconds
44
biochemical tests - protein
serum albumin - 35 g/L
serum transferrin - 20 g/L
thyroid binding pre albumin - 250 mg/L
45
functional indices of nutritional status / deficiencies
1. structural integrity
2. host defenses (P/E, Zn, Fe, Se)
3. hemostasis
4. reproduction
5. nerve function
6. work capacity
46
erythrocyte fragility indicates
vitamin E, selenium deficiencies
47
[functional indicator] state
indicates amt of deficiency
like, lesser the level of nutrient (say Se) associated with the said indicator (i.e erythrocyte fragility) is, worse is the state of that indicator (i.e. worse is the fragility)
48
capillary fragility indicates
vitamin C deficiency
49
amt of tensile strength indicates
copper levels (i.e less strength= less copper levels)
50
normal leucocyte chemotaxis indicates
normal P/E and Zinc levels
51
normal leucocyte phagocytosis indicates
normal P/E and Fe levels
52
normal leucocyte bacteriocidal capacity indicates
normal P/E and Fe, Se levels
53
normal T cell blastogenesis indicates
normal P/E and Zn levels
54
delayed cutaneous hypersensitivit indicates
low P/E and Zn levels
55
increased prothrombin time indicates
vitamin K deficiency
56
sperm count levels indicates
energy and Zn levels
57
nerve conduction capacity indicates
P/E, B1, B12 levels
58
dark adaptation capacity indicates
vitamin A, Zn levels
59
EEG indicates
P/E levels
60
heart rate indicates
P/E, Fe levels
61
vasopressor response indicates
vitamin C levels
62
what are the indices of nutritional status
things that are influenced by the nutritional status
63
direct assessment of food consumption is done by
food surveys
1. household
2. individual
64
dietary survey methods
1. weightment of raw food
2. weightment of cooked food
3. oral questionnaire
65
dietary survey methods - weightment of raw food
1. widely employed
2. weigh all foood items
- cooked and eaten
- wasted, discarded
3. ideal 7 days (one dietary cycle) recall (vary 1-21 days)
66
dietary survey methods - weightment of cooked food
1. not usually accepted
67
dietary survey methods - oral questionnaire
1. short time
2. large number of people
3. inquiries about
- nature of food
- quantity of food
- dietary habits and practices
4. duration 24- 48 hours
68
dietary survey data is translated into
1. mean food intake (gms) in terms of particular foods
| 2. mean nutrient intake per adult man (per consumption unit) by seeing the table of nutritive value of indian foods
69
dietary survey provides information
1. dietary patterns (quantity, variety, combination of foods)
2. specific food consumed
3. estimated nutrient intake
4. estimated nutrient inadequacies (present standards)
70
dietary survey - benefits
1. help plan health education activities
| 2. assess the NEED of CHANGE in nature and extent of agricultural and food practices
71
vital statistics - identify
1. groups at high risk
| 2. extent of that risk in the community
72
malnutrition (assessing risk by seeing the number of deaths in the given group and country)
1. 1-4 years age - at risk group for mortality
| 2. more in developing countries (communities)
73
vital statistics include
1. mortality
2. morbidity
3. infant mortality rate
4. second year mortality rate
5. low birth weight
6. life expectancy
(everything other than mortality rate provides good picture of the nutritional status of the community )
74
data on morbidity is collected via
hospitals
| community health centers and morbidity surveys
75
morbidity data in relation to - (i.e data of the kinds and severities of the morbidity seen in following diseases)
1. PEM
2. anemia
3. xerophthalmia
4. vitamin deficiencies
5. endemic goitre
6. diarrhea
7. measles
8. parasitic infestation
76
complete nutritional survey must include
1. ecological survey
77
study of ecological factors comprises of
1. food balance sheet
2. socio economic factors
3. health and educational services
4. conditioning influences
78
conditioning influences
1. precipitate malnutrition
| 2. eg. infections, infestations
79
before putting effect measures for the prevention and control malnutrition
make ecological diagnosis of various factors influencing nutrition
80
health and educational services
1. health centers
2. feeding
3. immuniZation
81
socioeconomic factors
food consumption factors varies with
1. occupation
2. family size
3. income
4. education
5. customs
6. cultural practices of feeding, mother and child
82
food balance sheet
1. indirect
2. assess food consumption
3. supplies are related to census and then per capita supply availability is used to count the approx. food consumption
83
advantages of balance sheet
1. cheaper
2. simpler
3. gives general pattern for food consumption
84
disadvantages of balance sheet
1. conceals differences between regions, age, sex, economic groups
85
nutritional surveillance
keeping watch
over nutrition
in order to improve nutrition
in a population
86
objectives of nutritional surveillance
1. aid in LONG TERM PLANNING in health and development
2. to provide input for programme MANAGEMENT AND EVALUATION
3. give timely WARNING and INTERVENTION to prevent short term food crisis
87
growth monitoring - prepatho measure
1. goal is to preserve normal growth
2. approach is educational and motivational
3. all infants are monitored
4. starts before 6 months
5. done monthly
6. 10-20 people groups
7. mothers weigh or record
8. weight card is simple and its emphasis is on the growth
9. emphasis is on maintaining nutrition rather than treating undernutrition
10. in case of lacking growth, a child is given early home based interventions
11. the early home based interventions are given for brief period, until normal growth is resumed
12. interventions include primary health care, ORS, vaccines, vitamin A, deworming, contraceptives, chloroquine, other treatments
13. in case of severe lack in growth - referral is to health system for check up and food supplements
88
nutritional surveillance - patho measures
1. strategy/ goal is to detect of undernutrition
2. approach is diagnosis and inteventions
3. representative samples are monitored
4. representative ages are monitored 5. for long periods of time
6. any size - mostly 50-100
7. recording is done by trained workers
8. weight card is very precise, include nutritional status
9. emphasis is on treating undernutrition
10. response include rehabilitation with supplements
11. supplements are given for long periods, until there is good nutrition in community
12. interventions include - food supplements to community, subsidy etc.
89
growth monitoring
1. individual child
2. individual dynamic health
3. normal nutrition
4. promote growth and health
5. enrollment by 6 months
6. regular monthly participation
90
nutritional surveillance
1. representative sample
2. over all health of community
- bad or good
- relative to other communities
- improving or deteriorating
3. help diagnose malnutrition
4. impact of negative factors (drought)/ positive factors (interventions)
91
nutritional status indicators - maternal
1. birth weight
92
overall nutritional status of infant/ preschool children
1. proportion being breast fed
2. proportion on weaning food (by age in months)
3. mortality rates in children aged 1-4
4. mortality rates of 2 year olds specially
5. if age is known - height for age, weight for age
6. if age is unknown - weight for height, arm circumference, clinical signs and symptoms
93
school children nutritional status
1. height for age (during admission, at 7 years)
2. weight for age (during admission, at 7 years)
3. clinical signs and symptoms
94
nutritional status indicators - role
1. measure quality of life
| 2. evaluate health and development programmes
95
malnutrition
1. pathological state
2. resulting from relative or absolute
- deficiency
- excess
3. of essential nutrient
96
malnutrition - PATHOLOGICAL FORMS
1. undernutrition
2. overnutrition
3. imbalance
4. specific deficiency
97
undernutrition (or in extreme cases - starvation) - pathological forms
1. due to insufficient food intake over extended period of time
98
overnutrition - pathological forms
1. due to excessive food intake over extended period of time
2. can cause, obesity, diabetes,
99
imbalance of nutrients - pathological forms
1. relative deficiency of any nutrient
with or without absolute deficiency
2. disproportion among different nutrients
100
specific deficiency - pathological forms
1. relative or absolute deficiency
| 2. of specific nutrient
101
five principle nutritional deficiency diseases
1. stunting
2. wasting
3. xerophthalmia
4. nutritional anemia
5. endemic goitre
102
effects of malnutrition in a community
1. direct
| 2. indirect
103
direct effects of malnutrition
1. frank nutritional deficiencies
| 2. subclinical nutritional deficiencies
104
nutritional deficiencies include
1. kwashiorkor
2. marasmus
3. vitamin and mineral deficiencies
105
indirect effects of malnutrition
1. high mortality and morbidity in young children
- predisposal to infections (tb, gastro disorders)
- developing country 50% deaths are that of preschool children (in developed countries that % is 5)
2. retarded physical and mental growth
3. lower vitality
4. lower productivity
5. lower life expectancy
6. maternal mortality
7. stillbirth
8. low birth weight
106
hazards of over nutrition
1. obesity
2. cardiovascular diseases
3. diabetes
4. hypertension
5. liver and gall bladder disorders
107
ecology of malnutrition
1. man made disease
2. begins in womb
3. ends in grave
108
ecological factors related to malnutrition as listed by jeliffee
1. conditioning factors
2. cultural influences
3. socioeconomic factors
4. food production
5. health and other services
109
conditioning factors associated with malnutrition
1. infectious diseases (esp in smol children) causes malnutrition and malnutrition predisposes children to infections
- example measles, whooping cough, parasites (intestinal), malaria, tb
2. in poor environmental conditions half the first 3 years of one's life could be spent sick
110
cultural influences
1. food habits
2. customs
3. beliefs
4. attitudes
5. religion
6. food fads
7. cooking practices
8. child rearing
9. men eating first, alcoholism
111
cultural influences - food habits
1. psychological roots
2. entrenched deeply
3. associated with love, affection, warmth, self image, prestige
4. shaped by family - passed to generations
112
cultural influences - customs and beliefs
1. apply to vulnerable groups
113
cultural influences
- people may refuse to eat food that is against their culture even if it is present in plenty . eg. wheat during ww in south india, anti beri beri food by that one dumbass (respek) phillipine student who knew to prevent it but didn't because of the stupid culture fuck u look what u caused, papaya by pregnant woman, dals, leaf greens, rice and fruits by lactating gujrati woman
- belief = if woman eat more- baby big, will rip vag apart apparently
- harmful food for children
- hot cold, light heavy foods
114
cultural influences - religion
1. influence food habits (food taboos)
- hindus don't eat beef, fish eggs, onions
- muslims don't eat pork
115
cultural influences - food fads
1. personal dislikes and likes
| 2. can pose a nutritional problem when we are trying to correct deficiencies
116
cultural influences - cooking practices
1. cooking influence nutritive values of food
- peeling vegetables
- throwing rice water
- prolonged boiling in open pans
117
cultural influences - child rearing practices
1 . influence nutritional status of infants and children
2. practices include
- premature weaning
- bottle feeding - commercially refined food
118
socioeconomic factors / political structures (national, international)
1. population growth
2. poverty
3. ignorance
4. education lack
5. lack of knowledge about nutrition
119
food production
1. increased food production = increased food consumption
2. indian average per capita land 0.6 hectare (5.8 in developed countries)
3. average per capita arable land 0.3 hectares
4. indian average yield per hectare 1/4th of devolped countries
120
problems associated with food production
1. even though food production can be increased several folds, the main problem in uneven distribution of foods between countries and within countries
121
health and other services needs
it needs to be
1. properly organised
2. given resources
to combat malnutrition
122
malnutrition remedial actions that should be taken by health sectors
1. nutritional surveillance
2. nutritional rehabilitation
3. nutritional supplementation (mothers and children - stop gap measure)
4. health education - programmes
123
nutritional surveillance
```
continuous monitoring
in a community or an area
of factors or conditions
which indicate, relate to or impinge
nutritional status of
individuals or groups
```
124
nutritional rehablitation
1. malnoruished subject detected
2. immediate measures put into action
eg PEM child - hospitalisation, domiciliary or rehab centers depending on the degree of malnourishment
3. supplementation can be given as a stop gap measure
125
levels of preventing malnutrition
1. family (principle target)
2. community
3. national
4. international
126
coordinated approach for malnutrition treatment by which disciplines
1. nutrition
2. food technology
3. health administration
4. health education
5. marketing
127
action at the family level to prevent malnutrition
key position for imparting education - community health workers, multipurpose workers
1. nutritional education (programmes) of especially husband and wife
- right kind of local food
- nutritionally adequate
- promote breast feeding
- improve infant and child feeding practices
- counter misleading commercials about baby foods
- food taboos and dietary prejudices can be identified and corrected
- focus on expecting, lactating mothers
- kitchen garden, poultry keeping
2. mother child health
3. family planning
4. immunisation
128
action at community level to prevent malnutrition
1. analysis of nutritional problem /deficiency
- extent
- distribution
- type
2. at risk population identification
3. dietary/ non dietary factors contributing to malnutrition
4. surveys - samples - methods - compare
5. feasible approach to combat malnutrition with local available resources
129
action at national level to prevent malnutrition
1. rural development (raise living standard, purchasing power - by broad based rural development programme)
2. increasing agricultural production
3. stabilisation of population ( spacing, small fam norm)
4. nutritional intervention programmes (NIDDCP, control of anemia, blindness control, supplementary feeding programme)
5. nutrition related health activities (malaria eradication, , immunisation , sanitisation, family planning, food and nutrtional planning)
130
action at international level to prevent malnutrition
1. international cooperation during floods, drought
2. multilateral world food programme 1963 - stimulate social and economic growth
- enough safe food for those who need
- aid to victims of emergency
131
international agencies helping national government to combat malnutrition
FAO, UNICEF, WORLD BANK, WHO, CARE
132
approaches to combat malnutrition at community level - temporary
palliative, partial , temporary solution
1. mid day meal programme
2. supplementary feeding
3. vitamin A prophylaxis
133
approaches to combat malnutrition at community level - - permanent
1. increasing food quality
2. increasing food quantity
3. making sure at risk people obtain it
4. programme like applied nutrition programmes, ICDS
5. improving overall living conditions like water supply, education health, controlling infectious disease, socioeconomic development
134
ICDS - acitvity
1. provide nutritional education to mother
2. informal education to pre school children
3. supplements
4. immunisation
5. health check up
beneficiaries - children upto 6 years, preganant, lactating women, 15-44 years old women
135
indian population living in rural areas
72%
136
how to increase food production (programmes should include)
1. better farming practices
2. expansion of cultivation area
3. fertilisers
4. better seeds
5. effective distribution
6. irrigation +pest control
137
anemia prevention
1. ifa ot pregnant and lactating females
| 2. fortification with iron in common foods
138
NIDDCP
iodised salt
139
nutritional blindless control
large doses of vitamin A
2 lac retinol palmitate 12 months to 6 years - 6 monthly
1 lac - 6 months to 1 year
