Medicine

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Public Health Nutrition (COM 405)
Dr. MUSA Zakka (MBBS, MScPH, FWACP)
Department of Community Medicine
Federal University of Health
Sciences, Azare

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Outline
• Definitions
• Terms
• Concepts

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Terminologies
• Nutrition
• Dietetics
• Nutrients
• Recommended daily allowance
• Malnutrition
• Food supplementation, fortification &diversification

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Public Health Nutrition
• The promotion and maintenance of nutrition-
related health and wellbeing of populations
through the organised efforts and informed
choices of society

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Nutrition (1)
• The study of food systems, foods and drinks and
their nutrient and other constituents; and their
interaction within and between all relevant
biological, social and environmental systems with
the purpose to contribute to a world in which
present and future generations fulfil their human
potential, live in the best of health, and develop,
sustain and enjoy an increasingly diverse human,
living and physical environment( The Giessen
Declaration 2005)

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Nutrition (2)
• The science of food and its relationship to health
• Concerned primarily with part played by nutrients
in body growth, development and maintenance
• “Nutrients” or “food factor” used for specific
dietary constituent such as proteins, vitamins and
minerals

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Nutrients
• Organic and inorganic complexes contained in food
are called nutrients. They are broadly divided in to:
• Macronutrients:
-proteins
-fats
-carbohydrates
• Micronutrients:
-vitamins
-minerals

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Dietetics
• The practical application of the principles of
nutrition
• It includes the planning of meals for the well
and the sick
• Good nutrition means “maintaining a
nutritional status that enables us to grow well
and enjoy good health.”

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Why study nutrition? (1)
• Links the reduction of poverty and hunger
• Nutrition is an economic issue, health issue, social
issue, and an issue of basic human rights
• Nearly 1 billion people in the world are hungry
(unable to meet their minimum daily calorie
requirements).
• Good nutrition enable us grow well and enjoy good
health
• Poor diet and sedentary lifestyle are risk factors for
life-threatening chronic diseases (Cvs dx, stroke,
HTN, DM , cancer) and death.

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Why study nutrition? (2)
• In 22 countries, 40 percent of the population are hungry.
• Those most vulnerable are children under 2 years of age and
pregnant women
• Inadequate maternal and child nutrition is the underlying
cause of 3.5 million deaths every year and 35 percent of the
disease burden for children under 5
• Failure to meet the nutrient needs in younger years
predisposes to suffering health consequences of poor nutrition
in later years e.g bone fractures, iron deficiency anaemia
• Too much intake of supplements e.g Vit A, Vit D, calcium or
copper can be harmful

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Why study nutrition? (3)
• Nutritional damage in early life can lead
to permanent impairment,
• including lower IQ and school performance,
lower economic status in adulthood, and
lower birth weight in the next generation.
• Height-for-age at 2 years is the single best
predictor of human capital in a population.
• Universal coverage of proven nutrition-
related interventions could reduce overall
mortality of children under 3 by 25 percent

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Why study nutrition? (4)
• Poor nutrition undermines achievement of all
other development goals.
• Yet it remains one of the lowest health
priorities, even in many countries with the
highest burdens.

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Sources of food/classification (1)
1. By origin
– Animal
– Plants /Vegetable
2. Predominant function
– Body building (meat, milk, poultry, fish, eggs, pulses etc)
– Energy giving foods (cereals, sugars, fats, oils etc.)
– Protective foods (vegetables, fruits, milk, etc)

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Sources of food/classification (2)
3. Chemical composition
– Macro-nutrients e.g. proteins, carbohydrates, fats
– Micro-nutrients e.g. vitamins and minerals

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Recommended Daily Allowance (1)
• Recommended Daily Intake refers to the amount of
nutrients sufficient for the maintenance of health
in nearly all individuals (97.5%)
• They are reference standards of nutritional intake
• Minimum requirements plus a generous extra
(safety margin) due to individual variations and
stresses of everyday life

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Recommended Daily Allowance (2)
• If minimum food requirement is not met,
there is reduced ability to work, function and
inability to resist infection/diseases

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What is Malnutrition?

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Malnutrition
• Malnutrition is a spectrum of conditions that results from
relative or absolute deficiency or excess intake of
nutrients in relation to requirement
– Under-nutrition
– Over-nutrition
– Imbalance
– Specific deficiency

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Classification (1)
• WHO recommends three anthropometric indicators for
assessment of nutritional status
– Wasting (Low weight-for-height)
Reflects acute and recent malnutrition
– Stunting (Low height-for-age)
Reflect chronic (prolonged, cumulative) malnutrition
– Underweight (Low weight-for-age)
Reflects chronic or acute malnutrition or both
• Classification based on International Growth Reference

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Classification (2)
–A. CLINICAL ( WELLCOME )
–Parameter: weight for age + oedema
–Reference standard (50th percentile)
–Grades:
• 80-60 % without oedema is under weight
• 80-60% with oedema is Kwashiorkor
• <60 % with oedema is Marasmic-Kwashiorkor
• < 60 % without oedema is Marasmus

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Prevalence of Malnutrition in Nigeria

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Conceptual Framework- Causes of
Malnutrition
Adapted from UNICEF
Human, Economic, and
Institutional Resources
Nutritional Status
Health
Feeding practices
Household
Food Security
Potential Resources
Ecological Conditions
Care of mother
and child…
gender
Health
Services, Hygiene,
Sanitation
Political and Ideological Structure Basic
Causes
Immediate
Causes
Underlying
Causes
Short-term
consequences:
Mortality, morbidity
Long term consequences:
adult size, intellectual ability, economic
productivity, reproductive performance,
metabolic, cardiovascular disease

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Micronutrients
• Micronutrients are needed by the body only in minute
amounts, required for:
– Regulation of growth, activity, development
– Immune and reproductive function
• Primary micronutrient deficiencies include:
– Iodine
– Vitamin A
– Iron
– Zinc

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Concepts
• Food supplementation
• Food fortification
• Food diversification
• Food additives

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Supplementation
• Vitamins and minerals are supplied in the form of
tablets, capsules and syrups to the vulnerable
groups eg vitamin A supplements, Zinc tablets

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Food Fortification
• Vitamins and minerals are added to foods or
condiments that are commonly used by a
significant proportion of the target population
– flour, salt , sugar, cooking oil, margarine,

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Food diversification(1)
• This involves encouraging people to produce
more foods that are rich in all the essential
micronutrients
• Available in sufficient quantities and accessible
to people all year-round
• Encourage them to eat micronutrient-rich
foods
• Key to the long-term prevention and control of
micronutrient malnutrition

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Food diversification (2)
• Usually requires the collaboration of people
working in agriculture, fishery, forestry, small
animal husbandry, industry, marketing,
communication, women’s participation, home
economics and nutrition.

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Additives
• Non-foods substances or chemicals added to
food to increase the shelf-life, improve taste
or change its colour
• Food additives are of no nutritive value

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Nutrition Assessment
• Anthropometry
• Biochemical evaluation
• Clinical examination
• Dietary intake
• Ecological studies

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Nutrition and Developmental Goals
• Nutrition and PHC
– Development of effective food supply and proper nutrition
• Nutrition and MDGs
– GOAL 1: Eradicate extreme poverty and hunger
• TARGET 2: Halve, between 1990 and 2015, the proportion of people
who suffer from hunger
– Indicator 4: Prevalence of underweight children under 5 years of age
– Indicator 5: Proportion of population below minimum level of dietary energy
consumption
• Nutrition and SDGs

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