Free Template from www.brainybetty.com 1 Chapter 5 Impacts of Undernutrition Dr. WJ Mueller AG 201 Undernutrition is a physical condition Hunger is a subjective feeling that comes from not having enough food Previously we learned that under nutrition causes: Stunting Disease susceptibility Reduces capacity to do work Reduces intellectual development & ability 4 Height to Weight comparisons Many studies show that there is an ideal height to weight ratio People who are underweight or overweight have a higher risk of death than those in the normal range Part of a physical exam is to advise patients on their “healthy weight” See Figure 5.1 Waaler Surface (see Fig. 5.1) Waaler Surface (see Fig. 5.1) 5.1c Tall people - currently undernourished Short people, undernourished while growing up 7 Child Health Children underdeveloped immune system More susceptible to disease (they are already weakened) Undernourished & Pregnant Low birth-weight children Babies are 40X more likely to die 8 Child Health (cont.) Low birth-wt. children an indicator of: Mother malnourished during pregnancy, or Mother malnourished while growing up Remember: Low calories and protein &/or Micronutrient deficient 9 Child Health (cont.) Breast feeding results in healthier babies Provided with all the nutrients needed Immunities passed on to the child Clean food supply 10 Breast feeding (cont.) Infant does not have to compete with the rest of family for food Even women who are mild/moderately undernourished provide sufficient milk 11 Breast feeding (cont.) Problem AIDS can be passed to infant Vitamin A deficiency - increases chances of child getting AIDS 12 13 Menstruation & Breast-feeding Body makes estrogen from cholesterol (a type of fat) Low weight, less estrogen Delayed menarche (Age of first menstrual period) “Rises in intelligence in Western populations during the 20th century are due largely to improvements in nutrition.” 14 IV. Effects of undernutrition A. Mental development impaired B. Educational achievement lowered C. Smaller adults who do less physical work who earn less money IV. Effects of undernutrition (cont.) D. They are less productive when working and lose more work time to sickness so have less money to buy food Reduced Height-For-Age Reduced Educational Attainment Reduced Potential Work Experience All contribute to a 7 to 12% decrease in life-long earnings Studies show a relationship between nutrition and height-for-age. There is also a relationship between nutrition and educational attainment. So, is there a link between schooling completed and height-for-age? Yes! Perhaps this partially explains the “sex-appeal” of taller people?! 18 Is this an unfair “height” bias? World Bank Report: An increase in a person’s height by 1% is associated with an increase in that person’s wages by 1.38%. Even when only ‘uneducated’ were included in the analysis. Stunting causes an econom.

1. Free Template from www.brainybetty.com
1
Chapter 5
Impacts of Undernutrition
Dr. WJ Mueller
AG 201
Undernutrition is a physical condition
Hunger is a subjective feeling that comes from not having
enough food
Previously we learned that under nutrition causes:
Stunting
Disease susceptibility
Reduces capacity to do work
Reduces intellectual development & ability
4
Height to Weight comparisons
Many studies show that there is an ideal height to weight ratio
People who are underweight or overweight have a higher risk of
death than those in the normal range
Part of a physical exam is to advise patients on their “healthy
weight”

2. See Figure 5.1
Waaler Surface (see Fig. 5.1)
Waaler Surface (see Fig. 5.1)
5.1c Tall people - currently undernourished
Short people, undernourished while growing up
7
Child Health
Children underdeveloped immune system
More susceptible to disease (they are already weakened)
Undernourished & Pregnant
Low birth-weight children
Babies are 40X more likely to die
8
Child Health (cont.)
Low birth-wt. children an indicator of:
Mother malnourished during pregnancy, or
Mother malnourished while growing up

3. Remember:
Low calories and protein &/or
Micronutrient deficient
9
Child Health (cont.)
Breast feeding results in healthier babies
Provided with all the nutrients needed
Immunities passed on to the child
Clean food supply
10
Breast feeding (cont.)
Infant does not have to compete with the rest of family for food
Even women who are mild/moderately undernourished provide
sufficient milk
11
Breast feeding (cont.)
Problem
AIDS can be passed to infant
Vitamin A deficiency - increases chances of child getting AIDS
12

4. 13
Menstruation & Breast-feeding
Body makes estrogen from cholesterol (a type of fat)
Low weight, less estrogen
Delayed menarche (Age of first menstrual period)
“Rises in intelligence in Western populations during the 20th
century are due largely to improvements in nutrition.”
14
IV. Effects of undernutrition
A. Mental development impaired
B. Educational achievement lowered
C. Smaller adults
who do less physical work
who earn less money
IV. Effects of undernutrition (cont.)
D. They are less productive when working and lose more work
time to sickness
so have less money to buy food

5. Reduced Height-For-Age
Reduced Educational Attainment
Reduced Potential Work Experience
All contribute to a 7 to 12% decrease
in life-long earnings
Studies show a relationship between nutrition and height-for-
age.
There is also a relationship between nutrition and educational
attainment.
So, is there a link between schooling completed and height-for-
age?
Yes!
Perhaps this partially explains the “sex-appeal” of taller
people?!
18
Is this an unfair “height” bias?
World Bank Report:
An increase in a person’s height by 1% is associated with an
increase in that person’s wages by 1.38%.
Even when only ‘uneducated’ were
included in the analysis.
Stunting causes an economic loss of over $8.7 billion per year
worldwide.
Poorly nourished people are more likely to be unemployed.

6. So what is the size and scope of the problem?
http://www.youtube.com/watch?v=LPjzfGChGlE
Measuring Undernutrition
Chapter 4

7. From Chapter 3
What we Learned
Biggest problem, Over- & under-nutrition
Total Calories
Protein
Micronutrients
Common methods of assessing undernutrition

8. Clinical Assessment: Looking for physical signs of nutritional
disorders
Biochemical: Examine blood and urine looking for metabolic
changes that accompany nutritional disorders
Common methods of assessing undernutrition (cont.)
Dietary Assessment: Track what the person eats
Anthropometric Assessment: Measuring the human body and its
parts. It is the most common method of assessing nutritional
disorders

9. Clinical Assessment
Look at:
Hair color (lighter and thinner)
Ankle swelling
Enlarged necks
Poor eye sight

10. Clinical Assessment (cont.)
What is each an indicator of?
Hair color (Lighter and thinner)
Protein deficiency
Ankle swelling
Protein deficiency causing circulation problems
Enlarged necks
Goiter, iodine deficiency
Poor eye sight
Vitamin A deficiency

11. Clinical Assessment (cont.)
Be aware that other things can cause these symptoms
When these symptoms show to this extent then the problem is
advanced
Used to analyze:
most severe cases
Specific types of malnutrition

12. Biochemical Assessment
Blood and urine tests
Show micronutrient deficiencies
Accurate but relatively expensive

13. Dietary Assessment
2 Methods:
Survey – recall by the person, after-the-fact
Review dietary records

14. Dietary Assessment (cont.)
Problems with both methods
People can’t recall exactly
People lie
People adjust their eating habits when they are in a study
Breast feeding – difficult to determine how much the baby eats
Seasonal variations (price & availability)

15. Dietary Assessment
Useful in:
Doing comparisons of diet and income
Also useful to track food allocations within the family

16. Anthropometric Assessment
Most commonly-used method
Size – indicator of calories & protein intake

17. Anthropometric (cont.)
Acute undernutrition
Short-term inadequate food
Caused by famine or war
People can recover
Chronic undernutrition
Long-term inadequate food
Even moderate, effects are permanent

18. Stunting
Def.: low height-for-age
Shows that the person has experienced chronic undernutrition
during growth years
It is a symptom of past undernutrition
Stunting (cont.)
People born in 1910 were 4 cm (1.6 in) shorter than those born

19. in 1930
People born in 1950 1 cm (1/2 in) taller than those in 1930
What does that tell you?
Wasting
Def.: low weight for height
This is a symptom of current undernutrition

20. Under weight
Def.: low weight for age
A symptom of present undernutrition

21. What about Inheritance?
Part of people’s height is determined by their genes
Are there ethnic differences?
These factors are less important than other factors
Nature vs. nurture

22. Other Factors
Poverty
Poor food intake
Infectious & parasitic diseases
Other environmental factors

23. Use of Antropometry
Most useful in comparisons of infants
Older children, less so
In developed countries useful in measuring overnutrition of
adults

24. Antropometry (cont.)
What is measured?
Height
Weight
Arm circumference
One of the better measures of fat in the body
Skin-fold thickness

25. Antropometry (cont.)
Measurements are easy and cheap
Need:
Scale
Tape measure
Calipers (know what they are)

26. Antropometry (cont.)
Training someone to recognize undernutrition by clinical means
takes a lot more time
Comparisons to a Reference Group
“You are shorter than average”
“You weigh less than average”
What is the purpose of all this?
Identify those in need of help

27. Either those who are undernourished
Or Those who are overnourished
Method 1
Measuring Large Groups
(Note: Method 1 is not labeled, but is described in the
paragraph on p. 51 Drawing Inferences from a sample)
A continent?
A country?
A region?

28. Among demographic groups
Def: characteristics of a population or segment of the pop.
Among ethnic groups
Measuring (cont.)
Cannot measure everyone
Statistics – Sampling
If our sample is representative then inferences can be made of
the whole population

29. Method 2
Examine Aggregate Data
Look at data on:
Birth weight
Infant mortality
Morbidity
Def.: the rate of incidence of a disease
These are not direct measures of nutritional status

30. Method 3
Aggregate Nutrient Intake
Or: average nutrient intake
FAO keeps such data on each country
FAO Food and Agriculture Organization
Part of the UN
These food-balance sheets show sources and types of food –
over 100 different foods

31. Aggregate (cont.)
FAO keeps stats on sources of food:
Beginning stocks
Production
Imports

32. Aggregate (cont.)
FAO keeps stats on uses of food:
Ending stocks
Export
Animal feed
Consumption

33. Aggregate (cont.)
They use the word balance sheet because sources and use are in
balance

34. Aggregate data: These measures imply undernutrition in a
region
High IMR
Low birth-weights
High morbidity (illness) rates

35. Look at food availability to infer the existence of undernutrition
Food balance sheets estimate human consumption
1.Add up the supply of a specific food
beginning stocks + production + imports

36. 2. Subtract the amount used for:
exports + livestock feed + seed + ending stocks
What about food stocks used for fuel?
What is left can be assumed to go for human consumption

37. 3. Convert this to calories
do for all foods, to calculate available calories per capita per
day (a widely used measure of malnutrition)
Remember: Carbohydrate and protein has 4 calories/gram &
Fats and oils have 9 calories/gram
This is a mean, it could be that some people are consuming
above the average and some people are undernourished
a. Studies of individuals need to be done to infer the percentage
of the population that have inadequate food intake

38. IV. Undernutrition & child health
A. Undernourished mothers are likely to produce malnourished
babies
1. Low birth weight
2. 40 times more likely to die before their first year

39. B. Undernutrition leads to high under-five mortality rates
Worldwide average (1999) = 78 per 1,000 live births
Industrialized countries = 7
Developing countries = 85
Least developed countries = 161
(Sub-Saharan Africa)

40. C. Undernutrition results in a weakened immune system which
leads to death from childhood diseases
Infant mortality rate (IMR; children who die before their 1st
birthday per 1,000 live births) goes up as a child’s percent of
the median weight-for-age goes down

41. IMR in the U.S. is 2.1%
– before five = 2.5%
IMR in Guinea = 21.6%
– before five = 36.7%

42. V. Effects of undernutrition
A. Mental development impaired in undernourished children
B. Educational achievement lowered

43. C. Childhood undernutrition results in smaller adults who can
do less physical work & who earn less money
D. Undernourished adults are less productive when working and

44. lose more work time to sickness and so have less money to buy
food
(note the cycle)
Measuring nutritional status for large groups
A. Draw inferences from a sample using statistics
1. Use info from a subset of the population to infer
characteristics of the whole population
2. Sample must be representative

45. B. Use aggregate data on the effects of undernutrition to infer
how much undernutrition exists
Aggregate data: data compiled from several measurements

46. Malnutrition
Chapter 3
Dr. WJ Mueller
Malnutrition:
“Overconsumption or under-consumption of any essential
nutrient.”
Four Types of malnutrition
Over-nutrition
Secondary malnutrition

47. Dietary deficiency or micronutrient malnutrition
Protein-calorie malnutrition
Overnutrition
Over-nutrition
Consuming too many calories
The most common problem in high-income countries and high-
income people in low-income countries
Diet high in:
Calories
Saturated fat
Salt
Sugar
Over-nutrition (cont.)
Related illnesses include:
Obesity
Diabetes
Hypertension
Atherosclerosis
Secondary Malnutrition
Secondary Malnutrition
Person has a condition or illness that prevents proper digestion
or absorption of food
Causes include:

48. Diarrhea
Respiratory illnesses
Measles
Intestinal parasites
Secondary Malnutrition (cont.)
Mechanisms include:
Loss of appetite (anorexia)
Alternation of normal metabolism (illness)
Prevent nutrient absorption (diarrhea)
Parasites take nutrients
Solution
s
Sanitation (garbage disposal, human waste)
Clean water