Lalita Bhattacharjee                          Nutritionist   National Food Policy Capacity Strengthening Programme   Food ...
 Introduction Nutrition through the life stages Dietary energy and nutritional requirements in: Infancy - birth to 1 y...
   Diets in all cultural variety define to a large    extent people‟s health, growth and    development   Advances in re...
   Nutritional status is internationally recognized as an indicator    of national development   Nutrition is both an in...
MATERNAL, CHILD AND HOUSEHOLD NUTRITION
   Intra uterine growth retardation (IUGR)   Premature delivery of a normal growth    for gestational age fetus   Overn...
   Dietary, energy and nutritional requirements   All neonates typically lose some weight after    birth   Pre term inf...
What defines Infancy?The first year of life.Why are the nutrientneeds of an infant sohigh?Infants grow ataccelerated rate:...
5.00%                                                                             4.37%                 4.50%             ...
New International Child Growth Standards for infants and young children released on 27 April 2006⇛ A community based study...
Monitoring infant growth:◦ Infants not receiving adequate nutrition may have  difficulty reaching milestones◦ Failure to t...
Infants have specific calorie, iron, and other  nutrient needs.   108 calories/kg of body weight for first 6 months   9....
   Complementary foods    ◦ Not recommended to give any solid foods before 6      months   When to begin    About 6 mon...
Solid foods should be introducedgradually to make sure child isn‟t allergic or   intolerant  ◦ One new food per week  ◦ Ri...
   Implementation of comprehensive policies by    the Government   Full support for two years of breastfeeding or    mor...
Prevalence of underweight                  (% of children under five)                   10                               2...
Country       H/A    H/A    W/H   W/H % <   W/A % <   W/A % < -and yr       %<-2   %<-3   %<-2    - 3 SD    - 2SD      3SD...
Region            Country                              Lowest            2nd                3rd               4th         ...
Quintile   H/A         H/A % < -   W/H % < -   W/H % < -   W/A % < -   W/A % < -           % < - 2SD   3 SD        2 SD   ...
Age group   Category   Body weight   Kcal/d   Kcal/kg/d                           kg Infants    0-6 mo         5.4        ...
   Association between low growth in childhood    and increased risk of CHD, irrespective of    size at birth   Postnata...
   LBW babies have characteristic poor muscle but    high fat preservation ( so called thin fat babies)   This phenotype...
   Secondary sexual characteristics emerge, with    onset of menarche (periods) in girls and    semenarche (production of...
   Adolescent boys experience rapid muscular growth    and engage in more physical activities than girls so    they need ...
Age       BW kg   Gain BW   Basal   Blood    Muscle   Store   Blood   Totalgroup             kg/y      loss    volume   ma...
   Development of risk factors   Tracking of risk factors (in terms of prevention)   Development of healthy/unhealthy h...
   Weight gain during pregnancy is an indicator of    nutritional status of pregnant women   A weight gain of 11 -13 kg ...
Rate of     1st trimester   2nd trimester        3rd trimester            Total   tissue          (g/d)          (g/d)    ...
   Lactation is the period when the mother feeds her    baby through the breast.   On an average 600-800 ml/d milk is pr...
Age group   Category     Body weight          Requirement                         (kg)          Kcal/d        kcal/kg/dMan...
Women of reproductive age:   The reproductive age in Bangladeshi mothers    is considered as 15 to 44 years   CED in wom...
0.50                                0.25                                                                                  ...
Mean height for age z-scores by age relative to the new WHO reference   By region (0-59 months)                           ...
Health                                     environm                       Womens             ent                      educ...
   To what extent risk factors continue to    influence development of CD   To what extent will modifying such risk    f...
   Most chronic diseases will be manifested in later stages of    life   Absolute benefits in changing risk factors and ...
   Disease   Eating poorly   Tooth loss/Mouth pain   Economic hardship   Reduced social contact   Multiple medicines...
   Reduced need for calories   More prone to disease due to lowered food    intake, physical activity and resistance to ...
• Confirms importance of first 2 years of life as a critical window within which childgrowth is most sensitive to environm...
PercentchildrenLBWSlide courtesy of John Newman, SAR (2010)Source: WB World Development Indicators, Latest available data ...
   GDP losses  2-3%   Leads to a >10% potential reduction in lifetime earnings for    each malnourished individual   M...
Dietary factor               Goal (% of total energy )            Total fat                         15-30%         Saturat...
Three child well being outcomes :   Mothers and children are well nourished    (measured by rates of stunting and anemia)...
Objective                           Baseline              Target 2016 ↓ in prevalence of LBW ( < 2.5           22% (SOWC, ...
Indicators           Unit measurements        Base line (with yr                    Projected target                      ...
   Unhealthy diets, physical inactivity and smoking are    confirmed risk behaviours for chronic diseases   Biological r...
   Globally, trends in the prevalence of many risk factors are    upwards especially for obesity, physical inactivity and...
Determinants of Child Nutrition and Interventions to Address them                                                         ...
Lalita 4c  nutrition in the life span
Lalita 4c  nutrition in the life span
Lalita 4c  nutrition in the life span
Lalita 4c  nutrition in the life span
Lalita 4c  nutrition in the life span
Lalita 4c  nutrition in the life span
Lalita 4c  nutrition in the life span
Lalita 4c  nutrition in the life span
Lalita 4c  nutrition in the life span
Lalita 4c  nutrition in the life span
Lalita 4c  nutrition in the life span
Lalita 4c  nutrition in the life span
Lalita 4c  nutrition in the life span
Lalita 4c  nutrition in the life span
Upcoming SlideShare
Loading in …5
×

Lalita 4c nutrition in the life span

960 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
960
On SlideShare
0
From Embeds
0
Number of Embeds
8
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Inter
  • In translating the nutrient intake goals into dietary guidelines due consideration should be given to setting up national dietary guidelines ( about 40 g fat/dA typical diet consists about 40 g fat of which 25 is invisible and 15 g is visible; in aflluent groups even 50 g of invisible fat per day and over 30 g visible ; such diets mayt have a fat intake that is over 30 % of the dietary energyIn BGD there has been an increasing trend in oil intake arising from 10.1 g/person/day in 1991/92 to 12.8 g in 2000 and 16.5 g in 2005 ; However, the present intake of oil is still quite low, which is one of the reasons for the diet being low in energy. Considering that the increasing trend in oil intake will sustain to desirable levels in future, the proposed intake is set at 40 g/person/day (15.3% of daily energy intake ) which is in conformity with a desirable dietary pattern. An optimum intake of oil is also essential to ensure better absorption of pro-vitamin A from vegetable and fruit sources. Total fat energy of at least 20% is consistent with good health
  • Lalita 4c nutrition in the life span

    1. 1. Lalita Bhattacharjee Nutritionist National Food Policy Capacity Strengthening Programme Food and Agriculture Organization of the United Nations Bangladesh Presented on 2 July 2011 at theTraining Workshop on “Food Security Concepts, Basic Facts and Measurement Issues” 25 June to 7 July 2011
    2. 2.  Introduction Nutrition through the life stages Dietary energy and nutritional requirements in: Infancy - birth to 1 year Childhood and adolescence Pregnancy and lactation Intergenerational effects Diet, energy and nutritional requirements in adulthood Nutrition during ageing and the elderly Operational Plan Indicators Life cycle approach Conclusion
    3. 3.  Diets in all cultural variety define to a large extent people‟s health, growth and development Advances in research, expansion of knowledge in prevention and control of chronic diseases Return to the concept of basic life course – continuity of human life from fetus to old age Need to address both undernutrition and overnutrition
    4. 4.  Nutritional status is internationally recognized as an indicator of national development Nutrition is both an input and an output/come of the development process A well-nourished population is essential for productive work force and development ◦ people need food, health and care to be well-nourished Two processes: ◦ on the one hand food security policies ◦ on the other sustainable livelihoods, right to food and nutrition policies …with different partners The food, agriculture and health sectors is responsible for food and nutrition security
    5. 5. MATERNAL, CHILD AND HOUSEHOLD NUTRITION
    6. 6.  Intra uterine growth retardation (IUGR) Premature delivery of a normal growth for gestational age fetus Overnutrition in utero Intergenerational factors
    7. 7.  Dietary, energy and nutritional requirements All neonates typically lose some weight after birth Pre term infants are born with more extra cellular water than term infants and thus lose more weight than term infants Post natal loss should not be excessive. Loss of 15-20% of birth weight can lead to dehydration – inadequate fluid intake or tissue wasting from poor energy intake
    8. 8. What defines Infancy?The first year of life.Why are the nutrientneeds of an infant sohigh?Infants grow ataccelerated rate:double birth weight by6 months; triples by 12months of age
    9. 9. 5.00% 4.37% 4.50% 4.00%Mortality Rate 3.50% 3.00% 2.34% 2.50% 1.90% 2.00% 1.50% 1.00% 0.50% 0.00% Exclusive breast fedding Predominant Feeding No breast feeding Source:Arifeen et al, 2001
    10. 10. New International Child Growth Standards for infants and young children released on 27 April 2006⇛ A community based study “The Multicentre Growth Reference Study (MGRS)’’ undertaken by WHO & United Nations University⇛ More than 8000 children followed after every 3 months from Brazil, Ghana, India, Norway, Oman and USA
    11. 11. Monitoring infant growth:◦ Infants not receiving adequate nutrition may have difficulty reaching milestones◦ Failure to thrive (FTT): delayed in physical growth or size or does not gain enough weight◦ Growth charts track physical development.  Head circumference, length, weight, and weight for length measures are used to assess growth
    12. 12. Infants have specific calorie, iron, and other nutrient needs.  108 calories/kg of body weight for first 6 months  9.1 g protein/day first 6 months, 11 g/day second 6 months  Fat should not be limited.  Vitamin K injection needed due to sterile gut  Iron-enriched cereals/home based foods should be introduced at 6 months.
    13. 13.  Complementary foods ◦ Not recommended to give any solid foods before 6 months When to begin About 6 months of age Iron and zinc stores depleted Look for physical signs Loss of extrusion reflex Nutrient-dense foods
    14. 14. Solid foods should be introducedgradually to make sure child isn‟t allergic or intolerant ◦ One new food per week ◦ Rice cereal is great first food: least allergy-causing ◦ Other grains, then vegetables, fruits over a period of monthsHomemade or store-bought baby food? ◦ Homemade is cheaper, but can also find high-quality store-bought foods without added sugar, salt, preservatives
    15. 15.  Implementation of comprehensive policies by the Government Full support for two years of breastfeeding or more Promotion of timely, adequate, safe and appropriate complementary feeding Guidance on IYCF in especially difficult circumstances, Legislation or suitable measures giving effect to the International Code
    16. 16. Prevalence of underweight (% of children under five) 10 20 30 40 50 60 70 0 80 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993Year 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Asia India Nepal Africa Pakistan Sri Lanka Bangladesh
    17. 17. Country H/A H/A W/H W/H % < W/A % < W/A % < -and yr %<-2 %<-3 %<-2 - 3 SD - 2SD 3SD SD SD SDBangladesh2007M 43.7 16.5 18.4 3.3 39.9 11.4F 42.7 15.8 16.5 2.5 42.1 12.1India2005 -06M 48.1 23.7 20.5 6.8 41.9 15.3F 40.0 23.4 19.1 6.1 43.1 16.4Nepal2006M 49.0 19.5 12.9 3.1 37.5 10.1F 49.6 20.8 12.3 2.2 39.7 11.2
    18. 18. Region Country Lowest 2nd 3rd 4th Highest South Asia Bangladesh 59 53 45 43 30 India 61 54 49 39 26 Pakistan 54 47 43 37 26 Africa Benin 29 30 23 20 10 Burkina Faso 42 40 41 39 22 Ethiopia 49 51 51 45 37 Mozambique 31 28 26 19 9 Rwanda 27 30 28 24 14 Tanzania 25 26 22 20 12 Uganda 27 26 25 19 12 Source: Gwatkin et al, Country Reports on HNP and Poverty: Socio-Economic Differences in Health, Nutrition, and Population, April 2007Is Malnutrition in South Asia Really Worse than in Africa?
    19. 19. Quintile H/A H/A % < - W/H % < - W/H % < - W/A % < - W/A % < - % < - 2SD 3 SD 2 SD 3 SD 2SD 3 SDLowest 54.0 23.2 20.8 3.8 50.5 15.1Second 50.7 20.4 17.8 2.8 45.9 15.8Middle 42.0 15.2 16.9 2.6 41.0 11.2Fourth 38.7 11.8 17.6 2.8 38.1 8.9Highest 26.3 13.2 13.2 2.0 26.0 6.5
    20. 20. Age group Category Body weight Kcal/d Kcal/kg/d kg Infants 0-6 mo 5.4 500 92 6-12 mo 8.4 670 80Children 1-3 y 12.9 1060 82 4-6 y 18.1 1350 75 7-9 y 25.1 1690 67 Boys 10-12 y 34.3 2190 64 Girls 10-12 y 35.0 2010 57 Boys 13-15 y 47.6 2750 58 Girls 13-15 y 46.6 2330 50 Boys 16-17 y 55.4 3020 55 Girls 16-17 y 52.1 2440 47
    21. 21.  Association between low growth in childhood and increased risk of CHD, irrespective of size at birth Postnatal factors shaping disease risk Growth rates of infants in Bangladesh (most of whom had chronic IUUN and were breast fed, were similar to growth rates of breast fed infants in industrialized countries Catch up growth was limited and weight at 1 yr was a function of birth weight
    22. 22.  LBW babies have characteristic poor muscle but high fat preservation ( so called thin fat babies) This phenotype persists throughout post natal life and is associated with increased central adiposity in childhood that is linked to ↑ risk of raised BP and disease Association between LBW and high BP and BMI – importance of weight gain after birth Relative weight in adulthood and weight gain associated with ↑ risk of cancers Height serves partly as an indicator of socio economic and nutritional status in childhood (energy and protein intake)
    23. 23.  Secondary sexual characteristics emerge, with onset of menarche (periods) in girls and semenarche (production of semen) in boys Physical developments are accompanied by marked changes in psychological and emotional make up, characteristic of „teenage‟ behaviour Adolescence begins approx 2 years earlier in girls than boys, with acceleration of growth of muscle in boys and deposition of adipose tissue in girls According to WHO, 10 to 18 y is the period of adolescence
    24. 24.  Adolescent boys experience rapid muscular growth and engage in more physical activities than girls so they need more energy foods Adolescent girls, because of menstruation, need more iron than boys Iron is essential for building and maintaining blood supplies ad giving the blood its red colour Girls should take more iron rich foods such as liver, egg yolk, lean meat, green leafy vegetables, dried beans, dried fruits and unpolished rice and whole wheat
    25. 25. Age BW kg Gain BW Basal Blood Muscle Store Blood Totalgroup kg/y loss volume mass Mg/d loss reqmt mg/d mg/d Mg/d Mg/d Mg/d10-12 yBoys 34.3 3.5 ----- 1.05 0.49 0.27 0.13 0.16Girls 35.0 3.7 0.28 1.3313-15 y 47.6 4.2 0.66 0.39 0.15 0.40 ---- 1.60Boys 46.6 1.7 0.65 0.13 0.06 0.15 0.37 1.36Girls16-17 y 55.4 1.5 0.78 0.14 0.05 0.40 ---- 1.37Boys 52.1 0.73 ---- ---- 0.15 0.42 1.30Girls
    26. 26.  Development of risk factors Tracking of risk factors (in terms of prevention) Development of healthy/unhealthy habits that tend to stay throughout life (physical inactivity) Older adolescents (habitual alcohol, tobacco use associated with risks of ↑ BP and related risks Syndrome X ( physiological disturbances, hyper insulinemia, impaired GT, HT, ↑ TG and ↓ HDL
    27. 27.  Weight gain during pregnancy is an indicator of nutritional status of pregnant women A weight gain of 11 -13 kg during the pregnancy term is ideal According to various studies, weight gain during pregnancy in Bangladeshi mothers is only 7-9 kg indicative of poor nutritional status of the mother and poor growth of the fetus The fetus is born with LBW ( < 2.5kg) Over a third (36%) of babies in Bangladesh are born with LBW
    28. 28. Rate of 1st trimester 2nd trimester 3rd trimester Total tissue (g/d) (g/d) (g/d) deposited deposition (g)Weight gain 17 60 54 12,000Protein 0 1.3 5.1 597depositedFat 5.2 18.9 16.9 3741depositedAverage of 12 kg increase2nd and 3rd 375 kcaltrimesters 10 kg increase 310 kcal NIN/ICMR (2010) Nutrient requirements and RDA for Indians
    29. 29.  Lactation is the period when the mother feeds her baby through the breast. On an average 600-800 ml/d milk is produced by a nursing mother Approximately 1kcal of energy is needed to produce 1 ml of milk Malnutrition during pregnancy is likely to continue after birth of the baby if the mother is poorly nourished; a malnourished mother cannot breast her baby adequately Malnutrition affects the volume of milk produced if not its quality
    30. 30. Age group Category Body weight Requirement (kg) Kcal/d kcal/kg/dMan Sedentary 60 2320 39 Moderate 60 2730 46 Heavy 60 3490 58Woman Sedentary 55 1900 35 Moderate 55 2230 41 Heavy 55 2850 52 Pregnant 55+ GWG + 350 Lactation 55 + WG + 600 + 520
    31. 31. Women of reproductive age: The reproductive age in Bangladeshi mothers is considered as 15 to 44 years CED in women of reproductive age is measured by height and BMI Height < 145 cm and BMI < 18.5 kg/m² is indicative of chronic CED
    32. 32. 0.50 0.25 Latin America and CaribbeanWeight for age Z-score (NCHS) 0.00 Africa -0.25 Asia -0.50 -0.75 -1.00 -1.25 -1.50 -1.75 -2.00 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 Age (months) Repositioning Nutrition, 2006
    33. 33. Mean height for age z-scores by age relative to the new WHO reference By region (0-59 months) 1.5 1.25 EURO PAHO 1 EMRO SEARO 0.75 AFRO 0.5 0.25 Z-scores (WHO) 0 -0.25 -0.5 -0.75 -1 -1.25 -1.5 -1.75 -2 -2.25 -2.5 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 Age (months)Source: Victora CG, et al. Worldwide timing of growth faltering: revisiting implications for interventions using the WorldHealth Organization growth standards. Pediatrics, 2010 (Feb 15 Epub ahead of print)
    34. 34. Health environm Womens ent education 19% National 43% food Womens availabilit status y 12% 26%Contributions to reductions inchild malnutrition, 1970-95 Source: Smith and Haddad 2000
    35. 35.  To what extent risk factors continue to influence development of CD To what extent will modifying such risk factors make a difference in the emergence of disease What is the role of risk factor reduction and modification in secondary prevention and the treatment of those with disease Adult phase of life –disease expressed, critical time for preventive reduction of risk factors and increasing effective treatment
    36. 36.  Most chronic diseases will be manifested in later stages of life Absolute benefits in changing risk factors and adopting health promoting behaviours (exercise and healthy diets) Maximize health by avoiding /delaying preventable disability Along with societal and disease transitions, major demographic shifts Older people defined above 60 y Average life expectancy increased from middle of last century Majority of elderly will be living in the developing world
    37. 37.  Disease Eating poorly Tooth loss/Mouth pain Economic hardship Reduced social contact Multiple medicines Involuntary weight loss/gain Needs assistance in self care Elder years above age 80
    38. 38.  Reduced need for calories More prone to disease due to lowered food intake, physical activity and resistance to infection Good food habits and regular exercise minimize the ill effects of ageing Need for more calcium, iron, zinc, VA and anti oxidants to prevent age related diseasesNote: Variety of nutrient rich foods, match food intake with physical activity, eat food in many divided portions/d, avoid fried, salty and spicy foods and exercise regularly
    39. 39. • Confirms importance of first 2 years of life as a critical window within which childgrowth is most sensitive to environmentally modifiable factors• Monitoring length/height (in addition to weight) seems essential because falteringpatterns are clearly different for HAZ and WAZ, and short stature is associated withdeleterious long-term outcomes• Reveal a much greater problem of undernutrition during the first 6 months of lifethan previously understood (shorter “window of opportunity”) with possibly evenhigher levels of intrauterine growth retardation emphasizing the need for even greaterneed for prenatal and early-life interventions, including preventing low birth weightand promoting appropriate infant feeding practices• Suggests that BMI gain after 6 months of age increases adiposity but not height at5years – hence potentially negative implications for NCDs in adulthood
    40. 40. PercentchildrenLBWSlide courtesy of John Newman, SAR (2010)Source: WB World Development Indicators, Latest available data for each country, GDP PC PPP, constant int’l 2005 $
    41. 41.  GDP losses  2-3% Leads to a >10% potential reduction in lifetime earnings for each malnourished individual Malnutrition (stunting) in early years linked to a  4.6 cm loss of height in adolescence  0.7 grades loss of schooling  7 month delay in starting school(Improved nutrition can be a driver of economic growth) Repositioning Nutrition, 2006
    42. 42. Dietary factor Goal (% of total energy ) Total fat 15-30% Saturated fat < 10% PUFA 6-10% Trans fatty acids < 1% Total CHO 55 -75% Free sugars 10% Protein 10-15% Cholesterol <300mg/d Na Cl <5g/d Fruits and vegetables at least 400 g/d Total dietary fibre From foods (40g/d)Non starch polysaccharides (NSP) From foods (whole grains, F&V) 20g/d
    43. 43. Three child well being outcomes : Mothers and children are well nourished (measured by rates of stunting and anemia) Mothers and children are protected from infection and disease (measured by rates of malaria/illness, care seeking for treatment of diarrhea and ARI and immunization rates) Mothers and children access essential health services (measured by rate of skilled attendance at birth and antenatal coverage)
    44. 44. Objective Baseline Target 2016 ↓ in prevalence of LBW ( < 2.5 22% (SOWC, 2009) 15% kg)↓ in the prevalence of UW (WAZ < 41% (BDHS, 2007) 34% -2 Z scores ) in children < 5 y↓ in prevalence of stunting (HAZ 43% ( BDHS, 2007) 38% < -2 Z scores↓ in prevalence of wasting (WHZ 17 % (BDHS, 2007) 10%< -2 Z scores ) in children < 5 y↓ in XN among pregnant women, 2.4 %; 2.7%, 0.04 % < 1% lactating women and children (IPHN/UNICEF/HKI, 2005) aged 12 -59 mo)↓ in the prevalence of anemia in Children < 5 -48% 23% < 5 y child, adolescents and in Adolescent girls 30% pregnant women Pregnant women 46% (National Anemia survey 2001 - 3) ↓ in prevalence of I deficiency 34.6% (IDD survey 2005) 23%(UIE < 100 mcg/L of school age 6-12 y children)↑ in rate of EBF in infants under 43% (BDHS, 2007) 50% < 6 mo↑ in the rate of 6-24 mo children 42% (BDHS, 2007) 52% fed minimum acceptable diet
    45. 45. Indicators Unit measurements Base line (with yr Projected target and data source) Mid 2014 Mid 2016 (1) (2) (3) (4) (5) Prevalence of XN % children 0.04% NSP 2006 <1% < 1% among < 5 y% of children 6-59 mo % children 88.3% BDHS 2007 90% > 90% receiving VA % of VA % PP women 19.5% BDHS 2007 50% > 90% supplementation in post partum women Rate of EBF in infants % children 43% BDHS 2007 47% 50% under < 6 mo% children 6-23 mo fed % children 41.5% BDHS 2007 48% 52% minimum acceptable diet Prevalence of anemia % pregnant women 46% National Survey 40% 35% among pregnant 2001 women Prevalence of anemia % of children 48% National Survey 40% 35% among children 6-59 2001 mo Prevalence of iodine % of school age 34.6% IDD survey 2005 30% 23% deficiency children # of MOs trained in No of MO in UHC 0 578 (60%) 964 (100%) nutrition services delivery# CC workers trained in No of HA, FWA and CHP 0 27,000 (60%) 40,500 (100%) nutrition services delivery % of UHCs having a # of Upazila Health 21 120 (60%) 200 (100 %) functional nutrition Complexes corner established
    46. 46.  Unhealthy diets, physical inactivity and smoking are confirmed risk behaviours for chronic diseases Biological risk factors of HT, obesity and lipidemia are firmly established as risk factors for CHD, stroke and diabetes Nutrients and physical activity influence gene expression and may define susceptibility Major biological and behavioral risk factors emerge and act in early life and continue to have a negative impact throughout the life course Major biological factors can continue to affect the health of the next generation
    47. 47.  Globally, trends in the prevalence of many risk factors are upwards especially for obesity, physical inactivity and in the developing world particularly, smoking Selected interventions are effective but must extend beyond individual risk factors and continue throughout the life course Some preventative interventions early in life offer life-long benefits Improving diets and increasing levels and increasing levels of physical activity and older people will reduce chronic disease risks for death and disability Secondary prevention through diet and physical activity is a complementary strategy in retarding the progression of existing chronic diseases and decreasing mortality and the disease burden from such diseases
    48. 48. Determinants of Child Nutrition and Interventions to Address them Nutrition S Interventions specific interventions H O R T - Infant and young child nutrition and treatment of Food/nutrient Health Immediate R severe undernutrition intake O causes - Micronutrient U supplementation & T fortification E - Hygiene practices S Water/- Agriculture & food security Access to Maternal Sanitation Underlying- Health Systems food and child- Health causes- Soc. Protection/safety nets care services L- Water & sanitation practices O- Gender & Development N- Girls’ Education G-Climate change INSTITUTIONS - Poverty reduction & R economic growth programs Basic causes O POLITICAL & IDEOLOGICAL FRAMEWORK -Governance, stewardship U capacities & management T -Trade & patents (&role of ECONOMIC STRUCTURE E private sector) Nutrition S - Conflict Resolution sensitive - Environmental Safeguards RESOURCES interventions ENVIRONMENT, TECHNOLOGY, PEOPLEAdapted from UNICEF 1990

    ×