Rao 2c mannan lalita analytics 3 nutrition


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  • Distinguished participants, good afternoon,I shall present my topic on food utilization or nutrition today.
  • All the acceptable definitions of food security in use imply nutrition but only in the sense thatHousehold FS means that if the household’s food are consumed according to the dietaryrequirements of all household members their dietary/nutritional needs will be met; Nutrition security requires simultaneously ‘food’, ‘health’ and ‘care’. So, there is no way toachieve nutrition security without FS at household level. FS must include ‘food safety; FS and NS are closely interrelated and may appear in a vicious cycle, but at a differentmagnitude, according to the context. For instance, where infectious diseases are theprevailing cause of malnutrition, the addition of more food is not effective, or, vice versa, afurther investment in the health sector does not help, if food insecure was the fundamentalproblem
  • The WFS goal of halving the number of undernourished people in the world by 2015 threatens to be out of reach. FAO’s most recent estimates put the number of hungry people at 925 million in 2008 versus 842 million in 1990-92, the baseline period for the World Food Summit (WFS) and Millennium Development Goals (MDGs). The majority of the world’s undernourished live in developing countries; 2/3 live in just 7 countries (BGD, Democratic Republic of Congo, Ethiopia, India, Indonesia and Pakistan) and over 40% live in China and India alone. Projections for 2010 indicate that the number of undernourished people will decline in the developing regions although with a different pace; the region with most undernourished continues to be Asia and the Pacific, but with a decline of 12% from 658 M in 2009 to 578 M in 2010.
  • The situation in selected S Asia countries shows that the % decline of undernourishment in the last 15 years has been satisfactory in Bangladesh, Nepal and better in Sri Lanka but this is not the situation in India and Pakistan.
  • FAO recommends maximum contribution of DES from cereals (DES Cer % ) as 60% for good health and nutrition; higher than 60% DES Cer makes the diet imbalanced; population habitually consuming relatively high amounts of cereals are likely to suffer from MN; regression analysis on data from 29 countries between dietary indicators and prevalence of stunting, wasting and UW was done; significant correlations were seen between DES Cer % and child MN rates in the region
  • The definition of FS emphasizes availability, accessibility and utilization of food; the inclusion of utilization underlines that nutrition security is more than food security; This figure illustrates the relationship among the categorical elements within the conceptual framework of FS; 2 determinants influence the framework. Physical determinants influence the food flow :availability, accessibility and utilization; availability is achieved if adequate and safe food is ready to have at people’s disposal; access is ensured when all HHs have sufficient resources to obtain appropriate foods (through production, purchase or donation) for a nutritious diet. Adequate utilization refers to the ability of the human body to ingest and metabolize food; nutritious and safe diets, an adequate biological and social environment, proper health care to avoid disease ensure utilization of food. In most cases utilization is discussed only from the biological perspective, however, food has also an imp social role keeping flys and communities together; in times of fis, this role fns can be achieved only when sufficient culturally adapted food is available within the hh and communities to meet their biological and social needs; Stability is a temporal determinant of FS and affects all 3 physical determinants; includes factors of seasonality and disaster situations
  • In Bangladesh, the contribution of cereals (mainly rice) to total dietary energy consumption is unacceptably high, especially in rural areas. This is a result of various factors, including high availability, cheaper prices, but also old-age dietary habits and cultural practices. DES from cereals in Bangladeshi diet was as high as 79.6 in the early nineties, decreasing only marginally to 72.9 in 2005. The dietary imbalance is much more pronounced in rural areas, with the DES from cereals reaching 75.2%, against 66.7% in urban areas. One will note, however, that the decrease in the ratio has been slower in urban compared to rural areas.  Inadequate but also highly imbalanced energy supply is one of the important factors leading underweight and stunting in young children and CED in adults. In particular, the dietary supply of micronutrients - rich foods like fruits and vegetables is far from adequate, making the population, particularly children and women, highly vulnerable to micronutrient deficiencies, particularly vitamin A deficiency night blindness and iron deficiency anemia.The current daily per capita total energy intake is derived from a consumption of a total food amount of 947.7 g/d of which cereals contribute to 469.2 g (16.55 oz). Taking an average energy content of 3.48 kcal/g cereal, the total energy supply from cereals in the Bangladesh diet is 1633 kcal/d which is 73% of the total dietary energy consumed.
  • Some hygiene and sanitation indicators for selected countries in SE Asia show a mixed picture; on the whole the population with access to improved (adequate) sanitation is much lower than the population having access to improved (safe) water; Bangladesh appears to be better in comparison to even Thailand; however, the situation in Thailand, Bhutan, Sri Lanka comparatively better than the other countries; Nepal and India need to make progress
  • The source of drinking water is important for good health. About 97% households get drinking water from improved source. The urban HHs have the better opportunity of drinking water from improved sources than the rural HHs. Besides, the higher % of urban HHs are habituated in appropriate water treatment (boiling, etc) prior to drinking than the rural HHs.
  • UW rate had quite steadily decreased from 64 % in 1999 to 42% in 2007; this was followed by a slight increase in 2007 (for UW) and in 2008 and 2009 for stunting. This is attributed to the impacts of the price hike notably as chronic undernutrition and the reversal of the gains made over the past decade.
  • BGD has achieved commendable success in bringing down some of the common problems of MNM namely VAD and IDD; XN which was prevalent to the extent of 4.1 % in the 1960s is now non existent. The main actions behind this success have been two pronged :blend of VAC , EPI and national scale home gardening programmes.
  • Diabetes is becoming a serious health concern in BGD; Between 2004 to 2008, the proportion of people suffering from diabetes increased from 4% to 7%; considering the country’s average population growth of around 1.6% the increase is even more marked in absolute terms: from 5.3 to 10.2 M people.
  • Comparing 10 varieties, analysis at DU, BRRI and BIRDEM showed that effect of rice on BSL differs widely between varieties. Following the introduction and promotion of HYV, BGD has seen a remarkable increase in production of rice; howeevr in 2007 -2008, 66% of the total boro rice cropped area; 29 % of total rice cropped area for 2007-2008 was dedicated to the production of 2 rice varieties; varieties that do not lead to high bsl rises were limited to only 4% of the total rice cropped area
  • Bangladesh is seen to be facing typical problems of using synthetic chemicals in accelerating ripening of climacteric fruits such as mango, banana, papaya, tomato and jackfruit; in the case of jackfruit chemical ripening is used (Ripen -15) is sprayed over the fruit by the bepari and wholesalers; the chemical spray is then followed by fruit piercing; as a result the chemicals directly penetrate the fruit which causes quick rpiening but poses danger of leaving chemical residues higher than MRLs that are to the detriment of consumer health ; the shelf life of chemically ripenied fruits is also very short due to faster rot as compared to those ripened by conventional methods, the post harvest loss of JF in the marketing channel is also v high; jackfruit piercer gets 25 paisa per fruit pierced; everyday around 200 JF are pierced by each piercer (Baluka, Mymensingh)
  • Consumer’s willingness to pay more for purchasing safe fruits and vegetables: while it was noted that consumers were aware of the harmful effects they were willing to pay up to 20% more as compared to the usual payment for safe fruits and vegetables; they were however reluctant to pay more than 20%; a little more than a third were willing to pay 10 % more ; this would have implications with regard to marketing of quality and safe produce; only 20% more money could be spent for marekting as compared to the usual price for a particular commodity for the entire supply chain
  • Rao 2c mannan lalita analytics 3 nutrition

    1. 1. Project GCP/BGD/037/MUL National Food Policy Capacity Strengthening Programme (NFPCSP) Training Workshop onFOOD SECURITY CONCEPTS, BASIC FACTS & MEASUREMENT ISSUES 25 June – 07 July, 2011 Topic: Analytical Approaches for Food security Sub-topic 2c : Analytics 3: Food Utilization Lecture : Food Utilization/Nutrition By Mohammad Abdul Mannan, PhD Nutrition Advisor, NFPCSP-FAO
    2. 2. OUTLINE OF THE PRESENTATIONBackgroundConceptual frameworkNutrition and health statusFood consumption and nutrition situationSeasonality and disasterLinkage with different sectorsConcludingWay forward
    3. 3. Food security – An evolving concept In the 50s and 60s: Food security = self sufficiency in major staples After World Food Conference of 1974:Food Security = Access to sufficient food World Food Summit of 1996:“Food security exists when all people, at all times, have physical and economic access tosufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life”. Food Security is part of Nutrition Security  The concept of Nutrition security — ensuring access to food that is nutritious as well as sufficient — is increasingly being used to stress the importance of the quality of food for people of all ages
    4. 4. What is Nutrition?Nutrition is the scienceand practice ofconsuming and utilizingfoods. It is the study ofnutrients in food, howthe body usesnutrients, and therelationship betweendiet, health and disease.
    5. 5. Why nutrition is important? Foundation to development contributing to MDG’s Economic benefit LBW perpetuates the intergenerational cycle of undernutrition and disease Economic growth alone unlikely to yield Nutrition results
    6. 6. Conceptual framework for analyzing the causes of malnutrition Outcomes Malnutrition, death & disability Immediate Inadequate causes Disease dietary intake Underlying causes at Inadequate maternal Poor water, Insufficient access to sanitation & household / & child CARE FOOD inadequate HEALTH family level practices services Quantity and quality of actual resources – human, economic & organisational - and the way they are controlledBasic causes at societal level Potential resources: environment, technology, people UNICEF
    7. 7. The food and agriculture sector and nutrition Narrowing the “nutrition gap”the gap between what foods are available and what foods are needed for a healthy diet  Diets are often low in quantity, quality and variety (hunger and micro-nutrient deficiencies)  Increased production of staple foods is not sufficient  Need to ensure local availability and access of the right mix of foods in all seasons  Consumers must be informed  Collaboration must be established with : (a) social protection programmes to support the poorest and (b) with health & multi sectors/programmes
    8. 8. Undernourishment in 2010, by Region (millions) Total: 925 million 19 37 Developed Countries 53 Near East and North Africa Latina America and the 578 Caribbean 239 Sub-Saharan Africa Asia and the PacificSource: FAO, 2010
    9. 9. Undernourishment: FAO estimates• Proportion of undernourished population remains the largest in South Asia• Between 1990-92 and 2005-07,prevalence of undernourished decreased in Bangladeshby 11%, the largest decline in South Asia Country Undernourished Undernourished Proportion (%) Proportion (%) (millions) (millions) of population of population in 1991-93 in 2005-07 undernourished undernourished in 1991-93 in 2005-07 Bangladesh 44.4 41.7 38 27 India 172.4 237.7 20 21 Nepal 4.2 4.5 21 16 Pakistan 29.6 43.4 25 26 Sri Lanka 4.8 3.8 28 19 Total South Asia 255.4 331.1 22 22 Source: SOFI ,2010
    10. 10. CONTEXT : Bangladesh continues to have the highest Cer DES - 80%
    11. 11. Undernourishment trends Undernutrition trends among <5 children in Bangladesh 80 65.8 68.3 70 60 64.6 57.4 64.2 51 50 51.4 47.8Percent 43 44.6 48.3 40 43.1 42.4 41 30 20 16.7 16.6 14.4 12 12.7 17 13 10 1989/90 1992 1995 2000 2005 2007 2009 Underweight <5 Stunting <5 Wasting <5 MDG target for underweight Source: 1990-2005 CMNS; 2007 BDHS; 2009 HFSNA
    12. 12. FOOD CONSUMPTION SITUATION•Significant + correlations between DES Cer% and child MN rates Association between DES Cereal% and % stunting in U-5 children (n = 20, p = 0.000) 55 50 45% Stunting 40 35 30 25 y = 0.7634x - 17.671 20 15 R2 = 0.5154 10 5 0 35 40 45 50 55 60 65 70 75 80 85 DES Cereal% Source: Authors own calculation from FAO RAP 2007
    14. 14. Nutritional and health statusThis „vicious cycle‟ is known as the “malnutrition-infection cycle”: Weight loss, growth faltering and reduced INADEQUATE leads to immunity, which lower the body’s ability to DIETARY INTAKE resist infection. this causes this results inLoss of appetite, malabsorption of Longer, more severe andnutrients, altered metabolism and leads to more frequent diseaseincreased nutrient needs. episodes.
    15. 15. Nutritional and health status Nutrition and health are closely linked:NUTRITIONAL STATUS disease contributes to malnutritionHEALTH STATUS while malnutrition makes an individual more susceptible to disease. This can eventually lead to severe malnutrition and death.
    16. 16. FOOD CONSUMPTION SITUATION •Increase in consumption of vegetables by 20% (157g); potato by 50% (63g) Consumption trend of non-rice foods in Bangladesh180160140120100 80 60 40 20 0 1991-92 1995-96 2000 2005 Meat and Egg Milk Fish Potato Fruits Vegetables Source: Adapted from BBS-HES/HIES, 1991-2005
    17. 17. FOOD CONSUMPTION SITUATION•DEI Cer % decreased from 80 % to 73 % in the last 10 years•FAO recommendation contribution of cereals to DEI optimally 60%•Prospects by 2020 Decline in percent dietary energy intake (DEI) from cereals in Bangladesh (1991-2005)(BBS HIES) and projection up to 2020 National Rural Urban 85 80.3 79.7 80 77.1 79.6 75.2 78.5DEI cereal (%) 75 72.2 75.6 69 70 72.9 69.2 68.5 65 65 66.7 60 60 55 1991-92 1995-96 2000 2005 2010 2015 2020 Source: Authors’ own calculations
    18. 18. Population with access to improved water source and sanitation water Sanitation 97100 92 87 90 85 84 83 81 82 80 77 80 73 70 59 60 52 50% 39 40 30 20 10 0 Bangladesh Nepal Maldives India Sri Lanka Bhutan Thailand Source: WHO SEARO, 2007 Selected Asian Countries
    19. 19. Source of hazards in the food chain Vehicle emission Crops Processing Agricultural practices Livestock Cooking Retail Landfills Storage SeafoodIndustrial emissions and effluents Distribution
    20. 20. Household drinking water source and treatment prior to drinking 99.4 96.5 97.1 100 90 80 70% of households 60 Improved source 50 Non-improved source 40 % of appropriate water treatment 30 prior to drinking 20.3 20 6.7 10 3.5 2.9 2.8 0.5 0 Urban Rural Total Source: BDHS, 2007
    21. 21. Population Pyramid - Bangladesh
    22. 22. Health servicesHealth services delivery includes- Maternal, Neonatal and Child Health Communicable disease control TB and Leprosy control HIV/AIDS prevention and controlNon communicable disease control including Emergency preparedness programme and climate change, Hospital based emergency obstretic care,Health education and promotion, Hospital services at upazila, district, and tertiary level, andAlternative medical care.
    23. 23. NUTRITION SITUATION•% Decline in BMI (< 18.5) in women over the last decade 53 % to 26%•Emerging concern of double burden- prevalence of overweight (BMI > 23) Maternal Nutrition Status 60% 52% 50% 45% 38% 40% 32% 33% 30% 26% 20% 25% 17% 16% 10% 12% 9% 6% 0% BDHS BDHS BDHS CMNS BDHS FSNSP 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 CED (BMI<18.5) Overweight (BMI>23.0)
    24. 24. Stunting and Underweight• Indicators for under five children remain alarming despite improvements• Nutrition outcomes highly susceptible to variability of food prices70% Trends in stunting and underweight (<-2 sd, children 6 to 59 months)60% 64% 60% Stunting Underweight 58% 54% 55%50% 50% 51% 50% 47% 49% 48% 45% 49% 49% 47% • Slight increment in 200740% 45% 43% 41% 41% 42% (underweight) and 2008 39% and 2009 (stunting). 37% 37%30% 32% • Evidences of impact of the20% food crisis of 2007 and 2008 in reverting the10% positive trend0% NSP NSP NSP NSP NSP NSP CMNS NSP* BDHS* HFSNA*HFSNA* FSNSP* 1-3, 8, 9 3-8 11-12 1 1-4 Months of the survey 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
    25. 25. NUTRITION SITUATION •3 fold increase in % of UW among 6-12 month infants •Faulty weaning and feeding behaviour along with infectious disease are critical factors Child Malnutrition by age in months - 5 month moving average70%60%50%40%30%20%10%0% 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 Stunting Wasting Underweight
    26. 26. % children 6-59 months receiving Vitamin A supplementation 94 97 two doses of vitamin A during 100 90 85 82 80 calander year 70 60 50 50 40 30 20 10 0 1995 2000 2005 2007 2008 Year
    27. 27. NUTRITION SITUATION •Night blindness almost non existent, prevalence below 0.1% in 2006; •Attributed to blend of actions VAC distribution with EPI and food based strategies •VAD is still high, 30% among women and children Decline in nightblindness among under-5 children in Bangladesh, 1962-2005 4.5 4.1 4 3.6 3.5 3Percent 2.5 2 1.78 1.5 1 1 0.6 0.3 0.2 0.2 0.5 0 1962-64 1982 1989 1995 1997 1999 2002 2005 Source: HKI, 2006
    28. 28. NUTRITION SITUATION •Success due to USI initiated in 1994-95; marked annual decline of 3.48%; •Physiological iodine deficiency still exists around 36% Change in goitre prevalence among women and children in Bangladesh, 1962-2005 Children WomenTotal goitre rate (%) 60 55.6 50 40 49.9 32.7 30 24.2 20 26 11.7 10 17.2 6.2 0 1962-64 1993 1999 2004-5 Source :Yusuf et al, 2008
    29. 29. Food safety in horticulture : Bangladesh Results- Survey (fruit ripening) JACKFRUIT RIPENING, BHALUKA, MYMENSINGHSource: Hassan et al,2010, BAU
    30. 30. Consumers’ perception on quality and safety 40 37 35 34 Dhaka (N=500) 30 Mymensingh (N=500) 26 25% of consumers Consumers’ willingness to pay more for purchasing safe fruits 20 and vegetables 15 15 12 10 6 6 5 2 0 0 0 Up to 2% Up to 5% Up to 10% Up to 20% Up to 50%
    31. 31. Framework on access toeducation, credit, and health care
    32. 32. From farm to table, table to farm: a newagricultural paradigm (Rouse and Davis, 2004)
    33. 33. AGRICULTURE-NUTRITION LINKAGES •Horticulture technology models from DAE show a wide range and quantity of fruits •Can be produced over a 10 year period at HH level •Fruits rich in vitamins and minerals; contribute to food security and dietary diversity An example of a small mixed orchard intercropped with vegetablesSource: DAE, MoA: GoB/FAO/UNDP Integrated Horticulture and Nutrition Development (BGD/97/041) 2000 -2006
    34. 34. AGRICULTURE-NUTRITION LINKAGES •Vitamin A supply from fruits/HH/d and per capita noted to be adequate •Provides substantial part of the RDA for micronutrients at HH and individual levels •Papaya and drumstick leaves : furnish 97% of the RDA for Vitamin A Vitamin A supply /person/d (mcg) 10000 8000 Mango 6000 Papaya 4000 2000 Drumstick leaves 0 Ye 1 Ye 2 Ye 3 Ye 4 Ye 5 Ye 6 Ye 7 Ye 8 Ye 9 10 ar ar ar ar ar ar ar ar ar ar YeSource: Report on Food based Nutrition Strategies for Bangladesh, Integrated Horticulture and Nutrition Development Project, FAO/GoB/UNDP, 2000 -2006
    35. 35. DESIRABLE DIETARY PATTERN •Current national average cereal intake 469 g/person/d (rice 449g) contributing to 70% DEI as against the optimal FAO/WHO norm of 55% -60% •Need to reduce cereal intake and increase non-cereal foods •Need to increase calorie intake Current intake of rice (g) and total energy kcal (HIES 2005) as against desired intake in Bangladesh Current intake Desired intake 2500 2238 2350 2000 1500 930 1050 1000 469 448 375 350 500 0 Cereal, g Rice, g Total, g KcalSource: FPMU, MoFDM, MoA, MoH&FW, NFPCSP Expert Consultation, August 2007
    36. 36. DESIRABLE DIETARY PATTERN Desirable food basket total energy intake set at 2350 kcal and % energy from cereals proposed at 55%; absolute terms 375 g(350 g rice + 25g wheat & other cereals) some 77 g less than present intake (rice low by 90g and wheat up by 13g) Desirable intake of non-rice foods vs current intake in Bangladesh Current intake Desired intake 250 200 200 180g/capita/day 157 150 96 100 100 60 75 63 60 55 44 40 35 32 33 50 2125 14 15 15 16 8 18 18 20 5 0 g to t sh l at ilk ur es es t s ui oi es ea Eg od ta he Fi Fr r/g M ls ic bl ng M Po fo Pu Sp W ta ga ki al ge oo Su m Ve C ni A Source: FPMU, MoFDM, MoA, MoH&FW, NFPCSP Expert Consultation, August 2007
    37. 37. Thresholds for assessing nutritional status in emergency situationSeverity of Prevalence of Mean weight malnutrition wasting for height • Starting point (% below Z-score for median – interpretation, 2SD) rather than the sole basis…Acceptable < 5% > -0.40 • Thresholds varyPoor 5–9% -0.40 to -0.69Serious 10–14% -0.70 to -0.99Critical > 15% < -1.00
    38. 38. Adaptation of Health sector: Community action for malnutrition amidst climate changeClimate change through nutrition intervention Actions needed and mainstreaming nutrition • Review evidence of relationship consideration in food, agriculture and health sectors: among nutrition, health and climate change• Increase vector borne diseases like malaria and dengue fever due to global • Establish community based warming and climate change nutrition program• Increase depletion of nutrients, minerals • Deliver integrated package of and reserves due to diarrhoea – because health and nutrition of increased flooding and drainage • Home gardening, poultry congestion rearing, fisheries development• Increase heat strokes –further aggravated by shortages of drinking water • Food storage and processing• Increase malnutrition, morbidity, mortality technologies suffering and loss of productivity • Population planning at community• Reduce the capacity of individuals to level adapt to climate change
    39. 39. Feeding programmes: decision making frameworksFood availability at household level Unsatisfactory situation: improve general<2100 kcal/day rationsMalnutrition rate 15% or more or 10- Serious situation:14% with aggravating factors General rations, supplementary feeding for all members of vulnerable groups, therapeutic feedingMalnutrition rate 10-14% or Risky situation:5-9% with aggravating factors No general rations, but supplementary feeding targeted to malnourished individuals, therapeutic feeding for severely malnourishedMalnutrition rate under 10% with no Acceptable situation:aggravating factors No need for population interventions Attention to malnourished individuals through regular community services
    40. 40. Malnutrition and Mortality – can we review rates in order to diagnose food crises, health crises and famines that kill? 1.8 1.6 1.4Crude Mortality Rate 1.2 1 0.8 0.6 0.4 0.2 0 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% Prevalence of Acute Malnutrition
    41. 41. The Country Investment Plan  Responding to L’Aquila Initiative and in line with the 5 Rome Principles, the CIP was Approved on 14 June 2010 following the Bangladesh Food Security Forum.  Translates the policy frameworks in a comprehensive set of 12 priority investment programmes and aims at • convergence and alignment of domestic and external funding • mobilizing additional resources: Bangladesh qualified as first Asian country receiving a grant under the Global for US $ 52.5 million The revised CIP, based on extensive consultation, incorporates over 400projects of which 146 ongoing (for US$ 3.036 billion) and 262 in pipeline(for US$ 4.945 billion of which US$ 3.299 billion are priority).
    42. 42. Concluding Remarks Bangladesh is an exemplary case of a consistent long term effort to put in place a comprehensive policy framework for food security and nutrition HPNSDP is ready for implementation This framework provides a platform for  Dialogue among government, civil society and development partners  Alignment, coordination and harmonization of interventions Within the FS framework, CIP is the tool for prioritizing, enhancing effectiveness and scaling up food security investments Food security is critical to nutrition security – ensuring access to safe and nutritious food – emphasis on quality of food A conducive institutional setting and continued commitment of all partners are needed to sustain the implementation and monitoring process in the medium/long term
    43. 43. Way Forward Global/regional/national commitment to mobilize the necessary resources to address the problem decisively. Improve capacity building and awareness raising on food and nutrition security at household level Integrate /strengthen nutritional considerations into agriculture, food and health policies and interventions to improve food security and nutrition Establishing information and surveillance systems that are critical for developing evidence-based food security and nutrition policies. Sustain involvement of multiple actors – strengthen/establish community based and national mechanisms for nutrition