Unit 4 Study guide (Chapter 6) Flashcards
What are the basic and types of malnutrition discussed in class and in this chapter by Seear causes, prevalence? Also note in particular Table 6.1 re major factors that promote the development of malnutrition in a child.
Macro and micro malnutrition
Basic Nutrition:
• The adverse effects of malnutrition are important during rapid growth periods such as childhood and pregnancy.
• Early Malnutrition during the period of major organ development can have lifelong adverse results
• Protein, carbohydrates, and fat = macronutrients
• A diet deficient in all 3 macronutrients protein-energy malnutrition
• Some types of fats and amino acids cannot be produced by our bodies so they can only be obtained by our food (essential fats and amino acids)
• Micronutrients= essential vitamins (thiamin, vitamin c and folic acid), minerals (iron, calcium, iodine) A deficiency in any of these can result in serious diseases ex. Vit c=Scurvy, Iron=Anemia Iodine=hypothyroidism
• Malnutrition = BAD nutrition not starving…
• Children suffering from significant micronutrient diseases are not necessary hungry and may appear relatively well fed from a macronutrient perspective
• Obesity is the fastest-growing nutritional problem in the world
Cause of malnutrition
- Not having enough food (just part of the problem not full story)
- Although there is a broad average relationship, levels of nutrition still differ widely between countries of similar incomes. Explanations include variations in agricultural performances, pro-poor government policies, civil unrest, and attitudes toward women. EXAMPLE: Ghana has only a quarter the income of Angola buy less than half the malnutrition.
• 3 broad groups of requirements that must be met before a population’s children can have reliable nutrition (UNICEF)
1st: Adequate access to a reliable source of nutritious food (commonly referred to as household food security) 2nd: must be adequate care provided for children and women 3rd: Must be a safe and healthy society with adequate access to preventive care advice and basic health services
Variables that can ultimately affect the child’s nutrition:
The Child:
• Recurrent illness (measles, gastroenteritis, whooping cough, TB, HIV: becoming secondary factors) increase susceptibility to further infections
• Chronic intestinal parasites and infections
The mother:
• Combination of maternal poverty and lack of education leads to inadequate child-rearing practices
• Poor child care (lack of stimulation, baby left in care of children
• Inadequate support for mother (Overwork, poor access to medical care, education, family planning, and child care advice)
Mother/Family/Household:
• Poverty
• Lack of hygiene (food and water handling and storage )
• Poor child care
• Inadequate support for mother (Overwork, poor access to medical care, education, family planning, and child care advice)
• Family Disruption
• Inadequate housing (access to clean water, sanitation, waste disposal)
• Inadequate food (lack of breastfeeding, poorly prepared infant formula feeds, poor-quality and irregular supply of food)
The family:
• Family disruption (migrant labour, war, HIV, both parents working)
The Society:
• Discrimination against women and girls (maldistribution of food within a household, unequal access to education and employment)
• Lack of social support for the poor
• Violence, social chaos, war
o Even the type of food in a child’s diet may be factor: The use of high-volume, low caloric-density starch porridge can mean that the child may feel full even though they still have not obtained sufficient nutrition
Prevalence of Malnutrition:
- During the last 3 decades famines and deaths due solely to starvation has become increasingly rare
- Clinical presentation of malnutrition has changed greatly
- Nowadays, acute severe starvation has largely been replaced by the more insidious effects of chronic malnutrition
- While deaths due to absolute starvation is now less common, affected children suffer from life-long physical and developmental impairments that trap them within the cycle of poverty, ill health, and poor expectations.
- Malnutrition greatly increases the morality of common diseases by reducing the child’s immune response.
- Whether malnutrition acts as a chronic disease with a high morbidity and lower mortality or, more rarely nowadays, it kills rapidly with a high mortality due to starvation doesn’t change its importance.
- B/W 1990 and 2005the number of malnourished people in the world rose slightly from 840 million to 850 million
- When expressed as a percentage of the developing world’s growing population , malnutrition fell from 20% to 16%
- Childhood stunting and childhood underweight were improving!
- Unfortunately after 2005 nutritional standards worsened rapidly b/c of a combination of rising world food prices and the global financial recession.
- While there have been improvements in child stunting and underweight in most areas of the world huge numbers of children still have their ultimate potential limited by recurring cycles of illness and poor growth
The greatest numbers of people affected by malnutrition in the world can be found in
i) Asia
ii) Africa
Asia
pg.119)- b/c the population effects of India, China, and Bangladesh
What is the difference between macronutrient nutrition and micronutrient nutrition? How is each defined in the Seear text and in your class lecture notes?
Macronutrients:
• AKA - Protein-Energy Malnutrition
• Nutrients needed in large quantities
• Major Nutrients (fat, carbohydrates, and protein)
• When the intake of macronutrients persistently falls 10-20% below minimal requirements increasingly obvious changes occur
Effects:
Growth- Without fuel the body simply stops growing, the most obvious and easiest measurable result of malnutrition is poor growth
-Most extreme form of wasting and stunting in two definable clinical conditions
Marasmus-Typically a very wasted, but symmetrically small child without edema
Kwashiorkor- Typically a child with less growth failure, but obvious poor skin and edema
Development- Profound effects on neurological development, malnutrition in early school years cause apathy, reduced activity, lack of curiosity, which will inevitably reduce the child’s ability to learn
Immune Response –Severe malnutrition has profound adverse effects upon a child’s immune system, major killers- respiratory infections, diarrhea, malaria, and measles
Micronutrients:
• Nutrients needed in small quantities
• Minerals and vitamins (iodine, Vitamin A, Iron, Zinc, folate)
Iodine deficiency
- Roughly a third of the world’s population lives in areas where there is little to no iodine in the soil and consequently very little in the diet.
- Deficiency’s in large parts of China
- Iodine: is an essential factor in thyroid hormone, essential factor needed for early brain development
- Some children suffer severe developmental delay the problem is usually more subtle and manifest as poor school performance and lack of energy
- Iodine deficiency is the single most common cause of preventable mental retardation and brain damage.
- For decades many countries have legislated the addition of iodine rather to table salt or cooking oil. Food fortification is effective and very cheap
Vitamin A deficiency
- Vitamin A is part of a Chemicals called Carotenoids which contribute to the colour of some foods such as carrots and mangos.
- Widely distributed in a normal diet
- But large part of developing world are at high risk of deficiency, particularly their pediatric population
- A co factor in many important chemical reactions
- Deficiencies cause: severe eye disease (xerophthalmia) which can lead to blindness and increased susceptibility to infections (measles, and diarrheal diseases)
- Many countries now fortify foods such as wheat, maize, and sugar with vitamin A Fortification is effective and also cheap
Iron deficiency
- Most common micronutrient deficiency in the world
- Children born to iron-deficient mothers, whose breast milk is low in iron, only have marginal stores at birth to deal with a period of rapid physical and neurological growth
- It is estimated that at least half of the developing world’s children between six months and two years of age are iron deficient during this critical development period.
- The worse affected are often found in countries where children are weaned onto a rice porridge low in iron.
- Severe iron-deficiency anemia reduces the ability of adults to work greatly increases the risk of childbirth for women.
- Fortifying infant foods with iron is practised widely in developing countries, but these foods are expensive and may not reach the worst-affected populations
- Supplementations with iron-containing tablets and syrups is another approach But delivering the supplements to the huge number pf at-risk families is a problem (as is compliance with treatment)
- Recent research has developed the concept of fortification using vitamins and mineral preparation that can be easily added to the child’s food THO problem of compliance and distribution still remain
Zinc deficiency
- Zinc is analogous to Vitamin A’s action
- Has special effects against gastroenteritis
- Reduces all-cause mortality by significant amounts prob due to its effects on the immune system
- As many as a third of the world’s population are at risk of marginal intake because they live in regions with low soil levels of zinc
- Early studies in low zinc areas in Turkey showed that zin-supplemented fertilizers increased crop yields and also improves child health
- Necessary for brain development and for normal labour
- Zinc-deficient women have a higher rate of obstructive labour
- Acute use- shortens the duration of the illness
- Longer term use- reduces the risk of recurrent gastroenteritis and also reduces the risk of pneumonia and malaria
Folate deficiency
- Folate- water soluble vitamin in the B group (vitB9)
- Essential factor in fetal growth and development and also in the production of red blood cells
- Commonly in leafy vegetables
- Deficiency less common in areas where cereals and breads are fortified
- Folate deficiency during pregnancy is associated with severe anemia in the mother and fetal defects (forms of spina bifida)
- Studies showed clear reductions in neural defects in babies of supplemented mothers and folate giving during pregnancy also seems to reduce other developmental abnormalities, Congenital heart defects
- Combined folate/iron supplementation is essential part of prenatal care for women in all part of the globe.
- Ideally, folate should be starred before the women gets pregnant
Feeding Infants (p.129-135)
• Babies have been successfully raised using formula feeds for many decades
• In the 18th century, parents who could afford it would often choose a wet nurse , some cases the baby was lodged with the nurse and taken back only when the child is weaned
• In the 19th century, the practice of using animal milk grew popular (AKA- “dry nursing”) Milks from cows, goats, mares, and donkeys. Donkey milk was considered to be the best option… children who were not breastfed suffered a much higher mortality.
• Johann Simon published the first chemical analysis and comparison between cow and human milk in 1838 but it wasn’t used to develop formula until 1860
• By 1900 there was 3 available forms of infant feeding 1.breast milk 2.commercial breast-milk substitutes 3. Formula
• By World War 2 evaporated milk recipes had grown to become the most common form of infant nutrition.
• Move toward scientific motherhood
• For developing countries were populations must raise small children without easy access to education, sanitation, or clean water infant formula may do more harm than good
• Breast milk- is sterile and nutritionally tailored for the baby, its delivery is not complicated by malnutrition and infection resulting from incorrect mixing of the powder with dirty water by a mother who has not had any access to education.
• By 1960s it was clear there is an increased mortality amongst bottle-fed children living in poverty
Breastfeeding and the Impact of HIV/AIDS
• Breastfeeding has benefits for the baby and mother but for those who cannot breastfeed their kids a child can develop normally with infant formula
• Breastfeeding is the recommended form of infant feeding but in developed country, it is not a matter of life and death
• Exclusive BF in the first 6 months of life protects the child from a wide range of diseases, particularly malnutrition and gastroenteritis
• Infant of an overworked mother who has to leave the baby with older children each day cannot be nourished adequately
• Poverty forces the family to dilute the expensive feed to make it last longer
• HIV infected mothers showed a significant cumulative risk of transmission of the virus in breast milk
• The risk of early mortality associated with formula feeding has to be weighed against the risk of contracting HIV from breast milk
• Current Recommendations from WHO – infected mothers should remain on antiretroviral therapy for her lifetime and exclusively breastfeed her child for at least 6 months but preferably 12 months… a course of Nevirapine for the child is also effective
• Limitations in heat treating expressed breast milk-not a practical option in social circumstances that surround affected families
• Studies have clearly shown that whether a new mother is HIV-positive or not if she lives in poor socio-economic conditions, the risk of disease and death is higher for her child if she chooses to bottle-feeds
• The international code of marketing of breast milk substitutes, plus the baby-friendly hospital initiative, have helped control the unregulated spread of formula foods and slow establishing breast feeding as the nutrition of choice for young children
Food Security (p.132)
• It was generally believed that famines (extreme scarcity of food) were simply caused by intermittent crop failures in developing countries and were the inevitable consequence of too many people and not enough food
• Some blamed the victims (having too many kids, not working hard enough)
• Had to be other factors involved – principally hoarding and redistribution to troops fighting WW11 … There was plenty of food; just not giving to the local poor
• Food Security: to describe the degree to which a population has access to food… it is said to exist when all people at all times have access to sufficient, safe, and nutritious food to meet their dietary needs, plus an assured ability to acquire that food in an acceptable way
• Causes of poor food security:
o Poor food production: Poverty; crop failure, drought; lack of property rights, agricultural land, and pasture; lack of credit for seeds, fertilizers, or tools; lack of crop failure insurance
o Poor food distribution: Poverty; Corruption, hoarding, black market; Lack of storage for surpluses; poor distribution infrastructure; absence of social safety net; religious or tribal discrimination; powerlessness of the poor; War
Food Aid (pg.134)
• First provided to developing countries in 1950s as a way for the US and a few other countries to dispose of gain surpluses… Aid money was used to buy grain and transport it to developing countries suffering production shortfall
