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  1. 1. Understanding Nutrition and the Consequences of Undernutrition Brian R. Barthel, Ph.D.
  2. 2. Components of Nutrition <ul><li>We need to eat and drink to obtain: </li></ul><ul><ul><li>Nutrients: chemical compounds in foods to provide fuel for energy (measured in kilocalories), growth, maintenance and to regulate body processes </li></ul></ul><ul><ul><ul><li>Six classes: carbohydrates, fats, protein, vitamins, minerals, water </li></ul></ul></ul><ul><ul><li>Phytochemicals: nonnutrient compounds that contribute to health and may play a role in fighting chronic diseases </li></ul></ul>
  3. 3. What Is Nutrition and Why Is Good Nutrition So Important? <ul><li>Nutrition: a science that studies how nutrients and compounds in foods nourish and affect body functions and health </li></ul><ul><ul><li>Chronic deficiencies, excesses, and imbalances of nutrients can affect health, both short-term and long-term. </li></ul></ul><ul><ul><li>Good nutrition plays a role in reducing the risk of many chronic diseases and conditions, including heart disease, cancer, stroke, diabetes, osteoporosis, high blood pressure, and obesity. </li></ul></ul>
  4. 4. What Are the Essential Nutrients and Why Do You Need Them? <ul><li>The six classes of nutrients are all essential in the diet. </li></ul><ul><ul><li>Alcohol provides calories but is not an essential nutrient. </li></ul></ul><ul><li>Macronutrients: energy-yielding nutrients needed in higher amounts </li></ul><ul><ul><li>Carbohydrates, lipids (fats) and proteins </li></ul></ul><ul><li>Micronutrients: needed in smaller amounts </li></ul><ul><ul><li>Vitamins and minerals </li></ul></ul><ul><li>Water: Large amounts of water needed daily </li></ul>
  5. 5. What Are the Essential Nutrients and Why Do You Need Them? <ul><li>Carbohydrates: supply glucose , a major energy source. </li></ul><ul><li>Fats: are another major fuel source and also: </li></ul><ul><ul><li>Cushion organs </li></ul></ul><ul><ul><li>Insulate body to maintain body temperature </li></ul></ul><ul><li>Proteins: can provide energy but better suited for: </li></ul><ul><ul><li>Composed of Amino Acids </li></ul></ul><ul><ul><li>Growth and maintenance of muscle, tissues, organs </li></ul></ul><ul><ul><li>Making hormones, enzymes, healthy immune system </li></ul></ul><ul><ul><li>Transporting other nutrients </li></ul></ul>
  6. 6. What Are the Essential Nutrients and Why Do You Need Them? <ul><li>Vitamins and Minerals are essential for metabolism . </li></ul><ul><ul><li>Many assist enzymes in facilitating chemical reactions in the body </li></ul></ul><ul><ul><ul><li>Example : B vitamins are coenzymes in carbohydrate and fat metabolism. </li></ul></ul></ul><ul><ul><li>Minerals: Key role in body processes and structures </li></ul></ul>
  7. 7. What Are the Essential Nutrients and Why Do You Need Them…Cont.? <ul><li>Water: is vital for many processes in your body. </li></ul><ul><ul><li>Part of fluid medium inside and outside of cells </li></ul></ul><ul><ul><li>Helps chemical reactions, such as those involved in energy production </li></ul></ul><ul><ul><li>Key role in transporting nutrients and oxygen to cells and removing waste products </li></ul></ul><ul><ul><li>Lubricant for joints, eyes, mouth, intestinal tract </li></ul></ul><ul><ul><li>Protective cushion for organs </li></ul></ul>
  8. 8. How Should You Get These Important Nutrients? <ul><li>The best way to meet your daily nutrient needs is with a well-balanced diet. </li></ul><ul><ul><li>Composed of a variety of foods, providing: </li></ul></ul><ul><ul><ul><li>Essential nutrients from all six classes </li></ul></ul></ul><ul><ul><ul><li>Fiber and phytochemicals </li></ul></ul></ul><ul><ul><ul><ul><li>Whole grains, fruits and vegetables are rich sources. </li></ul></ul></ul></ul>
  9. 9. Nutrients and Their Functions
  10. 10. What Is Healthy Eating and What Tools Can Help? <ul><li>Key principles of healthy eating: </li></ul><ul><ul><li>Balance </li></ul></ul><ul><ul><li>Variety </li></ul></ul><ul><ul><li>Moderation </li></ul></ul><ul><li>Undernutrition: state of inadequate nutrition </li></ul><ul><li>Overnutrition: excess nutrients and/or calories in diet </li></ul><ul><li>Malnourished: long-term outcome of consuming diet that doesn’t meet nutrient needs </li></ul><ul><ul><li>Can result from both under- and overnutrition </li></ul></ul>
  11. 11. How Does the Average American Diet Stack Up? <ul><li>Obesity Trends Among U.S. Adults </li></ul>
  12. 12. Obesity in America
  13. 13. Leading Causes of Death in the United States
  14. 14. Leading Causes of Death - Peru TABLE 1. Leading causes of mortality, Peru, 2004. Causes of mortality (PAHO List 6/67) per 100,000 population 1 Acute respiratory infections 68.0 2 Ischemic heart diseases 25.7 3 Cerebrovascular diseases 24.3 4 Septicemia, except for neonatal 21.5 5 Cirrhosis and certain other chronic liver diseases 21.4 6 Hypertensive diseases 16.9 7 Malignant stomach tumors 15.6 8 Respiratory disorders originating in the perinatal period 14.7 9 Tuberculosis 13.2 10 Diabetes mellitus 12.3 Source: Adapted from Peru, Ministerio de Salud, mortality database .
  15. 15. Causes of Death Southern Highlands, Peru Leading causes of death, Southern Highlands, Peru, 2000. Causes of mortality (List 6/67 PAHO) per 100,000 population 1 Acute respiratory infections 147.9 2 Cirrhosis and certain other chronic liver diseases 51.0 3 Cardiac insufficiency 46.5 4 Nutritional deficiencies and anemia 44.8 5 Appendicitis, hernia of the abdominal cavity, and intestinal obstruction 44.2 6 Cerebrovascular diseases 41.3 7 Respiratory disorders originating during the perinatal period 31.3 8 Septicemia, except for neonatal 26.2 9 Land transportation accidents 25.9 10 Malignant stomach tumors 25.0 Source: Adapted from Peru, Ministerio de Salud, mortality database.
  16. 16. Nutritional Profile of Peru Nationwide, 24 percent of children under five are chronically undernourished, and the prevalence has not changed over the last decade. In remote rural areas, rates can reach up to 70 percent (ENDES 2004). Almost 50 percent of children less than five suffer from anaemia, and the figures are much higher in the highlands (60-70 percent).
  17. 17. Issues Contributing to Undernutrition in Peru <ul><li>Approximately 53 percent of the Peruvian population lives below the national poverty line, and 25 percent lives in extreme poverty. Peru ranks 82nd out of 177 countries (2006 HDI). </li></ul><ul><li>Insufficient allocation of public resources in the areas of health, education and infrastructure, as well as limited availability of farming land and very low yields of agricultural production in areas higher than 3,000 meters above sea level make the Southern Andean population extremely vulnerable to food insecurity. Forty two percent of the population cannot cover the minimum required caloric intake (2,100 Kcal). </li></ul>World Food Program
  18. 18. Climate and Natural Disaster Issues A lack of access to food commodities, poor consumption patterns, inadequate child care and nutrition practices and poor educational levels among mothers, are the main causes of chronic undernutrition in Peru. Food insecurity in Peru tends to be periodically aggravated by recurrent emergencies which mainly affect the southern highland area. 2007 was a particularly difficult year in terms of natural disasters: floods, frost, hail storms and heavy snowfalls affected approximately 700.000 people in 13 Peru regions. And along with all the other disasters a 7.9 earthquake!
  19. 19. The Malnutrition Downward Spiral
  20. 20. Essential and Nonessential Amino Acids <ul><li>Nine essential amino acids </li></ul><ul><ul><li>Cannot be made by the body </li></ul></ul><ul><ul><li>It is “essential” to obtain them from the diet. </li></ul></ul><ul><li>Eleven nonessential amino acids </li></ul><ul><ul><li>Can be synthesized in the body from other amino acids or by adding nitrogen to carbon-containing structures </li></ul></ul><ul><li>Conditionally essential amino acids </li></ul><ul><ul><li>Under certain conditions, some nonessential amino acids cannot be made in body. </li></ul></ul>
  21. 21. How Much Protein Do You Need and What Are Protein-Rich Food Sources? <ul><li>Protein quality varies among food sources . </li></ul><ul><ul><li>Depends on digestibility and amino acid profile </li></ul></ul><ul><li>Complete proteins contain all of the essential amino acids along with the nonessential ones. </li></ul><ul><ul><ul><li>Examples: animal proteins, soy protein </li></ul></ul></ul><ul><li>Incomplete proteins are low in one or more essential amino acids (the limiting amino acid). </li></ul><ul><ul><ul><li>Example: plant proteins </li></ul></ul></ul>
  22. 22. What Happens if You Eat Too Little Protein? <ul><li>Eating too little protein: </li></ul><ul><ul><li>Low-protein diets associated with loss of bone mass </li></ul></ul><ul><li>Protein Energy Malnutrition (PEM) </li></ul><ul><ul><li>Inadequate calories and/or protein </li></ul></ul><ul><ul><li>More common in children, because they are growing </li></ul></ul><ul><ul><li>Factors: poverty, poor food quality, insufficient food, unsanitary living conditions, lack of knowledge, stopping lactation (nursing) too early </li></ul></ul>
  23. 23. Protein Energy Malnutrition <ul><li>Kwashiorkor: severe deficiency of dietary protein </li></ul><ul><ul><li>Signs: edema, muscle loss, skin rashes, hair changes, water and electrolyte imbalances </li></ul></ul><ul><ul><li>Seen in children weaned to low-protein cereals </li></ul></ul><ul><li>Marasmus: severe deficiency of calories </li></ul><ul><ul><li>Signs: emaciation, lack of growth, loss of fat stores </li></ul></ul><ul><li>Marasmic Kwashiorkor: worst of both conditions </li></ul><ul><li>Medical treatment and food: Two-step approach </li></ul>
  24. 24. Comparison of Kwashiorkor and Marasmus A classic sign of Kwashiorkor is edema. Marasmus results in an emaciated appearance.
  25. 25. Signs of Protein Energy Malnutrition in Peruvian Children
  26. 26. Treatment of Protein Energy Malnutrition <ul><li>Step One In both children and adults, the treatment of protein-energy malnutrition (PEM) is to correct fluid and electrolyte abnormalities and to treat any infections. The most common electrolyte abnormalities are hypokalemia, hypocalcemia, hypophosphatemia, and hypomagnesemia. Macronutrient repletion should be commenced within 48 hours under the supervision of nutrition specialists. </li></ul><ul><li>Step two: The second step in the treatment of protein-energy malnutrition (which may be delayed 24-48 h in children) is to supply macronutrients by dietary therapy. Milk-based formulas are often the treatment of choice for young children. </li></ul><ul><li>Correct contributors to the PEM condition in the first place </li></ul>
  27. 27. Vitamin A <ul><li>Vitamin A: retinoids (retinol, retinal, retinoic acid) </li></ul><ul><ul><li>Preformed vitamin A only found in animal foods: liver, eggs, fortified milk, cheese </li></ul></ul><ul><ul><li>Some plants contain P rovitamin A carotenoids, which are converted to retinol in your body. </li></ul></ul><ul><ul><ul><li>Carotenoids, including beta-carotene, are pigments which give color to carrots, cantaloupe, sweet potatoes, spinach, broccoli. </li></ul></ul></ul><ul><ul><ul><ul><li>Like fat-soluble vitamins, absorbed more efficiently if fat present in intestinal tract </li></ul></ul></ul></ul>
  28. 28. Vitamin A <ul><li>Functions: </li></ul><ul><ul><li>Essential for healthy eyes </li></ul></ul><ul><ul><ul><li>Component of rhodopsin and iodopsin, light-sensitive proteins needed for vision </li></ul></ul></ul><ul><ul><li>Involved in cell differentiation, reproduction and immunity by promoting gene expression for: </li></ul></ul><ul><ul><ul><ul><li>Healthy skin, mucus membranes </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Bone growth </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Fetal development </li></ul></ul></ul></ul><ul><ul><ul><ul><li>White blood cells to fight deadly infections </li></ul></ul></ul></ul>
  29. 29. Animation: Vitamin A and Epithelial Tissue | Vitamin A and Epithelial Tissue
  30. 30. Vitamin A <ul><li>Too little: </li></ul><ul><li>Prolonged vitamin A deficiency leads to xerophthalmia . </li></ul><ul><ul><li>Abnormal dryness of the conjunctiva and cornea of the eyes due to a systemic deficiency of vitamin A </li></ul></ul><ul><ul><ul><li>#1 cause of preventable blindness in children, mostly in developing countries </li></ul></ul></ul><ul><ul><ul><ul><li>As many as 500,000 children go blind each year due to vitamin A deficiency. </li></ul></ul></ul></ul><ul><li>Chronic vitamin A deficiency causes night blindness. </li></ul><ul><ul><li>Vitamin A deficiency also associated with stunting of bones </li></ul></ul>
  31. 31. Vitamin D <ul><li>Called “Sunshine Vitamin” because vitamin D is made in the body with help of sunlight (UV) </li></ul><ul><ul><li>Cholesterol-containing compound in skin is converted to inactive form of vitamin D </li></ul></ul><ul><ul><li>People with insufficient sunlight exposure must meet needs through diet; vitamin D in foods is also an inactive form. </li></ul></ul><ul><ul><li>Inactive form converted to circulating form in liver, to active form in kidneys </li></ul></ul>
  32. 32. Vitamin D <ul><li>Functions: active form acts as a hormone </li></ul><ul><ul><li>Regulates two important bone minerals: calcium (Ca) and phosphorus (P) </li></ul></ul><ul><ul><ul><li>Stimulates intestinal absorption of Ca and P to maintain healthy blood levels and build and maintain bones </li></ul></ul></ul><ul><ul><ul><li>When dietary calcium is inadequate, Vitamin D and parathyroid hormone cause calcium to leave bones to maintain necessary blood levels. </li></ul></ul></ul><ul><ul><li>May prevent type 2 diabetes and some cancers </li></ul></ul>
  33. 33. Vitamin D <ul><li>Too much or too little: </li></ul><ul><ul><li>Overuse of supplements may lead to hypervitaminosis D, which causes hypercalcemia. </li></ul></ul><ul><ul><ul><li>Damaging calcium deposited in kidneys, lungs, blood vessels, heart </li></ul></ul></ul><ul><ul><ul><li>UL: 2,000 IU (50 µ g) </li></ul></ul></ul><ul><ul><li>Rickets: vitamin D deficiency disease in children </li></ul></ul><ul><ul><ul><li>On the rise in U.S. due to decreased milk consumption, other factors </li></ul></ul></ul><ul><ul><ul><li>The bones of children with rickets aren’t adequately mineralized with calcium and phosphorus, causing them to weaken and leading to bowed legs. </li></ul></ul></ul><ul><ul><li>Osteomalacia: adult equivalent of rickets </li></ul></ul>
  34. 34. Rickets Before Treatment After Treatment Wind Swept Rickets
  35. 35. Rickets Before and After Treatment
  36. 36. Childhood Rickets – Vitamin D Deficiency
  37. 37. Calcium <ul><li>Most abundant mineral in body </li></ul><ul><ul><li>>99% located in bones and teeth </li></ul></ul><ul><li>Functions: </li></ul><ul><ul><li>Helps build strong bones and teeth </li></ul></ul><ul><ul><li>Plays a role in muscles, nerves and blood </li></ul></ul><ul><ul><li>May help lower high blood pressure </li></ul></ul><ul><ul><li>May fight colon cancer </li></ul></ul><ul><ul><li>May reduce risk of kidney stone </li></ul></ul><ul><ul><li>May reduce risk of obesity </li></ul></ul>
  38. 38. Calcium <ul><li>Daily needs: </li></ul><ul><ul><li>1,000-1,200 µg/day , depending on age </li></ul></ul><ul><li>Food sources: </li></ul><ul><ul><li>Milk, yogurt, cheese, dark green vegetables, kale, fish (with bones), calcium-fortified foods like juices and cereals </li></ul></ul>
  39. 39. Calcium <ul><li>Too much or too little: </li></ul><ul><ul><li>UL: 2,500 µg/day </li></ul></ul><ul><ul><li>Too much calcium leads to hypercalcemia: impaired kidneys, calcium deposits in body </li></ul></ul><ul><ul><li>Too little can lead to less dense, weakened, brittle bones and increased risk for osteoporosis </li></ul></ul>
  40. 40. Iron <ul><li>Functions: </li></ul><ul><ul><li>Hemoglobin in red blood cells transports oxygen from lungs to tissues and picks up carbon dioxide waste from cells. </li></ul></ul><ul><ul><li>Myoglobin transports and stores oxygen in muscle cells. </li></ul></ul><ul><ul><li>Helps enzymes that make neurotransmitters </li></ul></ul><ul><li>Daily needs: </li></ul><ul><li> varies depending on gender and age </li></ul><ul><ul><li>Women 19-50: 18 m g/day : higher due to iron lost during menstruation </li></ul></ul><ul><ul><li>Males 11mg/day until age 18 then 8 mg/day after </li></ul></ul><ul><li>Food sources: </li></ul><ul><ul><li>Dark green vegetables, beans; heme-iron in meats, liver, fish and poultry </li></ul></ul>
  41. 41. Iron <ul><li>Too much or too little: </li></ul><ul><ul><li>Deficiency is most common nutritional disorder in world </li></ul></ul><ul><ul><li>Iron-deficiency anemia occurs when iron stores depleted and hemoglobin levels decrease </li></ul></ul>
  42. 42. Iodine <ul><li>Functions: needed by thyroid to make essential hormones </li></ul><ul><ul><li>Thyroid hormones regulate metabolic rate; help heart, nerves, muscle and intestines function properly </li></ul></ul><ul><li>Daily needs: adults: 150 µg/day </li></ul><ul><li>Food sources: iodized salt (400 µg/tsp) </li></ul><ul><ul><li>Amount in foods is low, depends on iodine content of soil, water, fertilizer </li></ul></ul><ul><ul><li>Salt-water fish have higher amounts. </li></ul></ul>
  43. 43. Iodine <ul><ul><li>Early sign of deficiency = goiter (enlarged thyroid gland) </li></ul></ul><ul><ul><li>Not nearly as much a problem in Peru as it once was </li></ul></ul><ul><ul><ul><li>Mandatory iodization of salt has decreased iodine deficiency in U.S. but not in other parts of world </li></ul></ul></ul><ul><ul><ul><li>Iodine deficiency during early stages of fetal development can cause cretinism (congenital hypothyroidism). </li></ul></ul></ul>
  44. 44. Iodine Deficiency Goiter is an early sign of iodine deficiency Cretinism can result from an iodine deficiency during the early stages of fetal development
  45. 45. Confronting Undernutrtion <ul><li>Prevent it in the first place through the consumption of a variety of foods </li></ul><ul><li>Early identification of, and interaction with, those among us who may not be receiving adequate nutrition </li></ul><ul><li>Begin and maintain treatment for PEM, and establishing an adequate food source for populations suffering from undernutrition </li></ul>
  46. 46. Peruvian Native Foods Eat a Variety of These <ul><li>Camote – high in carotene </li></ul><ul><li>hoja de olluco </li></ul><ul><li>Zanahoria (carrot) </li></ul><ul><li>Cochayuao (alga) </li></ul><ul><li>cebada (barley) </li></ul><ul><li>trigo (wheat) </li></ul><ul><li>Maize (corn) </li></ul><ul><li>Quinoa </li></ul><ul><li>Arvela seca (dried peas) -Protien </li></ul><ul><li>Huevo (egg) –Protein </li></ul><ul><li>Pescado salado (dried fish, caballa) </li></ul><ul><li>Carne de gallina (hen) </li></ul><ul><li>Aceite, seb de carnero, Linasa – Fats </li></ul><ul><li>naranja (oranges) </li></ul><ul><li>Mangos </li></ul><ul><li>Banana – not a source of Vit. A </li></ul><ul><li>Chiclayo (like a squash) </li></ul><ul><li>aji seco (like chili) & aderezos (sauce) </li></ul><ul><li>caldo verde </li></ul>
  47. 47. Thank You! Eat Healthy!