2. CHAPTER OBJECTIVES
Upon completion of this chapter, the student will be able to:
• Develop an eating plan based on the concepts of variety,
balance, moderation, nutrient density, and energy
density.
• Use the caloric values of energy-yielding nutrients to
determine the total calories (kcal) in a food or diet.
• Describe how various factors affect our food habits: body
physiological processes, meal size and composition, early
experiences, ethnic customs, health concerns,
advertising, social class, and economics.
• Define the terms nutrition, Malnutrition etc and
correlate with different types of disease .
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3. Cont …
• Define and use correctly all of the key words about
manutrition .
• Summarise the magnitude and types of nutritional
problems in Ethiopia.
• List the common causes of malnutrition in children using
a conceptual framework.
• Describe the consequences of malnutrition to the
community.
• List the strategies to promote proper nutrition in the
community.
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4. Introduction to Nutrition
• What is nutrition?
• Why is nutrition important?
• Do people can survive up to 40 days without eating food?
• What is Nutrition Transition
• What are the factors affecting nutrition?
• Why invest on nutrition?
• What is the nutrition situation of children in developing
countries?
• What are the causes of malnutrition ?
• What are the conséquences of malnutrition in quantitative
terms?
• Malnutrition and éducations ?
• Malnutrition & economic development?
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6. • Quality intake that allows you to function at
your best and promotes health.
– Intake that provides adequate levels of each nutrient
• Quantity of intake that promotes a healthy body
weight.
Nutritional Goals
“The doctor of the future will no longer treat the human frame with drugs, but rather
will cure and prevent disease with nutrition.” ~Thomas Edison
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7. Scope and Categories of Nutrition
Problems
• Sufficient quantity
of
• Macronutrients
• Micronutrients
• Excessive or
Insufficient quantity
of
• Macronutrients
• Micronutrients
• Insufficient
quantity of
• Macronutrients
• Micronutrients
Health status and nutrition are integral to one another—that is, poor
nutritional status negatively impacts health, and poor health status can
negatively impact nutritional status.
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7
8. CONCEPT ----------
NUTRITION
Nutrition
The process by which
the body ingests,
absorbs, transports
uses and eliminates
nutrients and foods
(NC)
Nursing Care
Antecedents
Normal Alimentary Tract
and Associated Organs
Adequate Ingestion of
Nutrients and Water
Normal Temperature
Normal ph
Attributes
Adequate Intake for:
Development-Energy- Growth-
Tissue Repair
Ideal Ht-Wt-BMI—(MAC) (MAMM)
Muscle Tone-Strength-Agility-Reflex
Response
Cognitive & Mood Response.
Albumin WNL
Hemoglobin & Hematocrit WNL
Electrolytes WNL
Interrelated
Concepts
Human Development
Thermoregulation
Sub -
Concepts
Lifestyle Behaviors
Age-Gender-Genetics
Ethnicity
Socioeconomics
Knowledge
Consequences
(Outcomes)
Malnutrition
Insufficient/Excess Intake
Failure to thrive--Obesity
Growth/ Developmental Delay
Decreased Bone Density
Delayed-Inadequate Healing
Illness-Muscle wasting-Death
Low energy-Fatigue
Depression-Isolation
Positive
Negative
Engage in Physical Activity
Homeostasis/Adequate
Nutrition Hydration
Physiological and
Psychological
Wellness
Clotting
Malnutrition
Physiological-Psychological- Dysfunction
Ingestion- Digestion-Absorption-Metabolism
Diversity-(Lifestyle-Culture)
Medical
Conditions
Medications
Physiological &
Psychological
Development
Risk factors
Growth &
Tissue
Repair
Cognition
Fluid and Electrolytes
Food Allergies
Altered Hydration Status
Metabolis
m
Diets
Nutrients
Patient Education
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8
9. Definition of Terms
• Nutrition: is the science that interprets the interaction of
nutrients and other substances in food (e.g.
Phytonutrients, anthocyanins, tanins etc..) in relation to
health and maintenance, growth, reproduction, disease of
an organism.
• It also includes the process by which the organism ingests,
digests, absorbs, transports, utilizes and excretes food
substances ===> natural science origin
• In addition, nutrition must be concerned with social,
economic, cultural and physiological implications of food and
eating =====> social science origin
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From Latin: “nutrire” = “nourishing”
11. Cont…
• Nutrition (also called nutrition science) studies the
relationship between diet and states of health and disease.
• The scope of nutrition science ranges from malnutrition to
optimal health. Many common symptoms and diseases can
often be prevented or alleviated with better nutrition.
• Food - Is defined as anything edible as defined based on
specific culture, religion, etc. It includes all foods and drinks
acceptable to be ingested by certain society.
• Edibility: What is edible? How is it defined?:safe to eat, fit to eat, fit to be
eaten, fit for human consumption, wholesome, good to eat, consumable, digestible, palatable, comestible
• Nutrient: - Is an active chemical component in the food that
play specific structural or functional role in the body’s lively
activity.
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15. WHY IS NUTRITION IMPORTANT-
CONT’D
Nutrition can prevent disease
•Nutrient-deficiency diseases: scurvy,
goiter, rickets
•Diseases influenced by nutrition:
chronic diseases such as heart
disease
•Diseases in which nutrition plays a
role: osteoarthritis, osteoporosis
Melese.S
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15
38. Cont…
• Diet: - Is the sequence and balance of meals in a day.
• Diet -the foods one consumes
• The quality of which affects health and the risk of
chronic diseases
• The word “diet” is derived from the Greek word
“diatia” which means “manner of living”
• It is concerned about the eating patterns of individuals
or a group
For instance:
– some people may eat twice in a day (breakfast and dinner),
– others may eat four times in a day (breakfast, lunch, snack and
Dinner)
– still others may remain munching all the day round, etc.
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41. Nutrients divided into two categories:
Macronutrients
• Are the nutrients which the body needed in large
amount such as carbohydrate, protein and fats.
• Carbohydrates, protein and fats are the main source of
energy for human body.
• Are the energy yielding nutrients.
Micronutrients
Are nutrients needed in lesser amounts such as: Vitamins &
minerals.
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46. Why Do Humans Need Nutrients?
• To give us ENERGY!
– We need energy for heat, movement, and
chemical reactions in our bodies.
– Carbs + Fats.
• To give us Building Materials:
– We need to build the cells in our bodies.
– Proteins.
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49. Diet Health
Linked to each other
If we want to fulfill the dream our country, we will have to educate our people
regarding what to eat to build a nation of strong and healthy citizens.
Good Diet Good Health
Bad Diet Bad Health
Bad Health Weak Nation
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51. Good Food v.s. Bad Food?
A food that is beneficial to
the body is regarded as a
Functional Food, in that, it is
one claiming to have
additional benefits other
than nutritional value.
• Foods may also contain
substances that are harmful
to health, these are
regarded as Naturally
Occurring Toxicants.
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52. Functional foods
• There are two different types of claim that are
specific for functional foods:
• Type A – relates to a positive contribution to health
or to a condition linked to health, to the
improvement of a function or to modifying or
preserving health.
• Type B – relates to the consumption of a food that
might help reduce the risk of a specific disease or
condition.
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53. Two types of health claims relevant to functional foods,
must always be valid in the context of the whole diet and must relate to the amounts
of foods normally consumed.
These are:
1. TYPE A: "Enhanced function"claims that refer to specific physiological,
psychological functions and biological activities beyond their established role in
growth, development and other normal functions of the body.
This type of claim makes no reference to a disease or a pathological state,
e.g. certain non-digestible oligosaccharides improve the growth of a specific
bacterial flora in the gut; caffeine can improve cognitive performance.
2. TYPE B "Reduction of disease-risk "claims that relate to the consumption of a
food or food component that might help reduce the risk of a specific disease or
condition because of specific nutrients or non-nutrients contained within it
(e.g. folate can reduce a woman's risk of having a child with neural tube defects,
and sufficient calcium intake may help to reduce the risk of osteoporosis in later
life).
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54. FUNCTIONAL FOOD ACTIVE FOOD COMPONENT TARGET FUNCTION
Yogurts, sugar Probiotics: Foods with beneficial
live cultures as a result of
fermentation or that have been
added to improve intestinal
microbial balance, such as
Lactobacillus sp. Bifidobacteria sp
Prebiotics: A non-digestible
component that has beneficial
affects by stimulating the growth of
bacteria in the colon. Examples
include inulin and oligofructose.
Optimal intestinal function and
intestinal microbial balance
Margarines ???? Added plant sterols and stanols
esters
Decreased LDL-cholesterol (bad
cholesterol)
Decreased risk of coronary heart
disease (CHD)
Omega-3 fatty acids enriched
eggs
Omega-3 fatty acids Control of hypertension, lipids
metabolism
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Examples of functional foods
Melese.S
55. • Balanced diet/Healthy diet: is a diversified diet
that contains all the essential nutrients in the
proportion that is required for optimal health and
long-term survival.
• Nourishment
Your Menu Should be colourful !
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58. Benefits of a
healthy diet
• Protection against chronic diseases
• Preservation of immune function, digestive health, functional
ability, bone health, oral health, vision (for example)
• Benefits for cognitive function, mental health, wellbeing
• Minimises risk of weight loss, under-nutrition, low nutrient status,
deficiency diseases (e.g. anaemia)
• Aids recovery from illness.
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59. Diet & physical activity -synergistic
effects
• For overweight/ obese individuals a low fat diet PLUS
physical activity reduces risk of type 2 diabetes by
50%
• Benefit continues after intervention ends
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60. Q)Do people can survive up to 40 days without
eating food?
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61. Cont …
• Generally, people can survive up to 40 days without food, a
period largely depending on the amount of water consumed,
stored body fat, muscle mass and genetic factors (Lieberson AD ,8
November 2004, December 2014 and Janiszewski S ,13 May
2011,December 2014).
Ref
1. Lieberson AD (8 November 2004). "How long can a person survive without food?". Scientific
American. Retrieved 17 December 2014.
2. Janiszewski S (13 May 2011). "The Science of Starvation: How long can humans survive without food
or water?". The Public Library of Science, Science Blog Network. Retrieved 17 December 2014.
3. Progress for Children: A Report Card on Nutrition (No. 4), UNICEF, May 2006, ISBN 978-92-806-3988-
9. http://www.unicef.org/nutrition/index_33685.html
4. World Health Organization. (2013). Essential Nutrition Actions: improving maternal, newborn, infant
and young child health and nutrition. Washington,DC:WHO.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/index.html
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62. Diet as an Environment determining health
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63. Important Aphorisms
• “ Whatsoever was the
father of a disease, an ill
diet was the mother”
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64. 1/28/2024 64
“ You are what you eat”
“ Whatsoever
was the father
of a disease, an
ill diet was the
mother”
Melese.S
66. Why is nutrition important?
• Maintains health
• Prevents disease
• Can help with disease regression (cure?)
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67. Group I includes communicable, maternal, and
perinatal causes and nutritional deficiencies.
Group II includes the non-communicable causes
including cancers, diabetes, cardiovascular
disorders and chronic respiratory diseases.
Group III includes unintentional and intentional
injuries.
Causes of Deaths: Groups I, II and III
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68. New Dynamics
• Global Dynamics: The US is no longer be the
nation with the highest BMI and overweight levels
• Total Caloric Change: Eating Frequency(snacking),
Caloric Beverages and Portion Sizing
• The World is Flat and Fat: globalization has occurred
for centuries
• How do we proceed
• The World Is Fat: New Dynamics Shifts in Patterns of
the Nutrition Transition
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69. 3 kinds of transitions determine
global health
Health transition: the shifts that have taken place in the
patterns and causes of death in many countries
The health transition has been covered by three
separate terms:
• Epidemiological transition
– Omran’s stages: epidemics, receding pandemics, NCD
• Demographic transition
– From high birth and death rates to low birth rates and death
rates
• Nutritional transition
– Processed foods with added sugar, saturated fats and sodium
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70. Nutrition Transition
Definition
Is the shift in dietary consumption and energy expenditure that
coincides with economic, demographic, and epidemiological
changes
Used for the recent transition of developing countries from
traditional diets high in cereal and fiber to more Western pattern
diets high in sugars, fat, and animal-source food.
Modern societies seem to be converging on a diet high in saturated fat,
sugar, and refined foods and low in fiber, "Western diet."
Many see this dietary pattern to be associated with high levels of chronic
and degenerative diseases and reduced disability-free time
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71. Cont …
Nutrition Transition,
It is increased consumption of unhealthy foods compounded
with increased prevalence of overweight in middle-to-low-
income countries.
• Increased caloric consumption in a milieu of
reduced energy expenditure
– Sedentary lifestyle
– Motorized transport
– Labor-saving devices
– Reduced leisure time physical activity
It occurs in conjunction to the Epidemiological transition and
has serious implications in terms of public health outcomes,
risk factors, economic growth and international nutrition
policy.
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72. Cont …
The nutrition transition model was first proposed in 1993 by Barry
Popkin
He posits that two other historic transitions affect and are affected by
nutritional transition
1. Demographic transition :-a pattern of high fertility and high
mortality transforms to one of low fertility and low mortality
2. Epidemiological transition:-shift from a pattern of high
prevalence of infectious diseases associated with malnutrition,
and with periodic famine and poor environmental sanitation, to a
pattern of high prevalence of chronic and degenerative diseases
associated with urban-industrial lifestyles
3. Nutrition Transition:- is the shift in dietary consumption and energy
expenditure that coincides with economic, demographic, and epidemiological
changes. Specifically the term is used for the transition of developing countries
from traditional diets high in cereal and fiber to more Western pattern diets
high in sugars, fat, and animal-source food.
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73. World Health in Transition
Epidemiological
Chronic disease replacing infectious disease;
dual burden in developing countries
Demographic Aging of the population
Nutritional
- Shifting dietary pattern
-high fiber low fat replaced by energy-
dense high sat fat
-complex CHO replaced by refined
CHO
- Sedentary life style
- decreasing leisure-time activity
Economic & Social - Globalization of time, trade & travel
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74. Stages of the Nutrition Transition
Urbanization, economic growth, technological changes for work, leisure,
& food processing, mass media growth
Source: Popkin 2002 revised 2006.
Pattern 1
Paleolithic man/
Hunter-gathers
• Wild plants &
animals
• water
• Labor intensive
Pattern 3
Industrialization/
Receding Famine
• Starchy, low variety,
low fat, high fiber
• water
• Labor-intensive
work job/home
• Increased fat, sugar,
processed foods
• caloric beverages
• Shift in technology
of work and leisure
Pattern 4
Noncommunicable
Disease
• Reduced fat, increased
fruit, veg, CHO, fiber
• Increase water, Reduce
caloric beverage intake
• Replace sedentarianism
w/ purposeful activity
Pattern 5
Behavioral Change
• Cereals
dominate
• water
• Labor-intensive
Pattern 2
Settlements begin/
Monoculture period/
Famine emerges
Low fertility,
Low life expectancy
Lean & robust,
high disease
rate
Slow mortality decline
MCH deficiencies,
weaning disease,
stunting
Accelerated life
expectancy, shift to
increased DR-NCD,
increased disability
period
Obesity emerges,
bone density problems
Extended health aging,
reduced DR-NCD
Reduced body fatness,
improved bone health
High fertility,
high MCH mortality,
low life expectancy
Nutritional
deficiencies
emerge, stature
declines
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Source: Popkin 2002 revised 2006.
Melese.S
75. Globalization Diet and Lifestyle
Global markets Global trading system
Cultural globalization
Migration
Cross-cultural interaction Increasing world trade
Increasing array of
manufactured goods
Widespread flow of
information, ideas, lifestyles Product marketing
Advertising
Changing dietary and life style patterns
Nutrition Transition
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76. Global Trends in Nutrition
• Reduced intake of
fruit and vegetables
• Increase intake of fats
and sugars
• Decrease intake of
fiber
www.csrees.usda.gov/ree/Presentations/The%20Obesity%20Pandemic%20Aug%2022.ppt
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86. From Ancient to Modern .....
Transport
The Nutrition Transition Program,
The University of North Carolina at Chapel Hill
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87. Sweetness Preference was Essential to
Survive: Huge Shift in Amounts, Energy
Density
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88. Biology vs Technology: Shift from Water
to Caloric Beverages with No Food
Calorie Compensation
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89. Remarkably Short History for Caloric Beverages:
Might the Absence of Compensation Relate to This Historical Evolution?
AD
BCE
10000
BCE
200000
BCE
Beginning
of
Time
100000 BCE
200000 BCE
Homo Sapiens
Pre-Homo
Sapiens
200,000BCE
-
10,000
BCE
Origin
of
Humans
Modern
Beverage
Era
10,000
BCE
-
present
0
Earliest possible date
Definite date
Water, Breast Milk
2000 BCE
Milk (9000 BCE)
Beer (4000 BCE)
Wine (5400 BCE)
Wine, Beer, Juice
(8000 BCE)
(206 AD)
Tea (500 BCE)
Brandy Distilled (1000-1500)
Coffee (1300-1500)
Lemonade (1500-1600)
Liquor (1700-1800)
Carbonation (1760-70)
Pasteurization (1860-64)
Coca Cola (1886)
US Milk Intake 45 gal/capita
(1945)
Juice Concentrates (1945)
US Coffee Intake 46 gal/capita
(1946)
US Soda Intake 52/gal/capita
(2004)
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90. Fat Preference Key for Survival:
Technology, Marketing have Utilized this
Preference for Fatty Food
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91. Major Global Dietary Shifts
• Increased animal source foods
Over 1.6 billion people in the world are overweight
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92. The Struggle Over the Millenia to
Eliminate Arduous Effort Could Not
Foresee Modern Technology
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93. Transition paradox
• Developmental transition: better food and nutritional status; urbanisation
and globalisation as countries become more developed. Urbanisation and
meat consumption rising hand in hand
• Nutrition transition: shift to food with high energy density especially fat
“stone age appetites meeting capitalist abundance”
• Life style changes especially less physical activity
• Social disparities in obesity are unabated. Obesity shifting
disproportionately to poor.
• Paradox: persisting underweight along with rising obesity within the same
country, sometimes household.
Source: http://www.nottingham.ac.uk/globalfoodsecurity/documents/prahash-shetty-presentation.pdf;
images: http://www.cpc.unc.edu/projects/nutrans/presentations/worldisfat.ppt/view; The Economist September 1st 2012 “More or less”
http://epianalysis.files.wordpress.com/2012/09/obesity.jpg;
That’s a
cupcake!
That’s a
cupcake!
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94. Nutrition transition
Convergence of diets and lifestyles globally:
• More globalised food tastes such as westernised habits of meat eating, more dairy which takes
more energy to produce and drives future grain consumption.
– Media encourages the food transition from traditional diets of grains and vegetables to
often high protein and fats and sugars, westernised dietary habits and lower physical activity
levels. Globalisation can mean that there is a switch from associating being obese with being
rich to with being poor.
– With rising income rising middle classes in transition economies such as China are changing
their food habits (China more quickly than India for various reasons)
• More choices and less active life style in urban areas
• Mechanisation of farm activity, switch from subsistence farming to high yielding cash crop also
imports bad eating habits to rural areas. Food transition drives obesity and heart disease health
risks and changes in the social and physical environment of production areas.
• The shift to foods that are far more resource-intensive to produce such as meat puts pressure on
scarce resources.
.
Source: http://www.fao.org/FOCUS/E/obesity/obes2.htm; Edexcel Student Guide Unit 4, Option 3;
http://www.edexcel.com/migrationdocuments/GCE%20New%20GCE/Unit-4-Option-3-Life-on-the-margins-Food-supply-problem-final.ppt.
Image: http://transitionbuxton.co.uk/node/431
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95. Obesity
• Health Risks of Obesity
– Primary risk factor for
coronary heart disease.
– Associated with HTN,
DM, dyslipidemia, &
cerebrovascular disease.
– Obesity-related medical
complications account
for 10% of national
health care.
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96. Overweight and Obesity
• Overweight: body weight
that exceeds some average
for stature, perhaps age.
• Overfat: body fat that
exceeds an age- and/or
gender appropriate
average by some amt.
• Obesity: overfat condition
that accompanies
components of obese
syndrome.
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98. Causes of Obesity
• Physical Inactivity: an
important component
• Each hour increase in TV
by adolescents 2%
increase obesity.
• Adults 15 & over spent
average 2.73 hr/day
watching TV in 2010.
• Each hour increase in TV
by adults increase risk of
death 11%.
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99. Causes of Obesity
• Obesity is a long term
process.
• Obesity frequently begins
in childhood. Obese
parents likely have
overweight children.
• Regardless of final body
weight as adults,
overweight children exhibit
more illnesses as adults
than normal kids.
You gonna
finish that?
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100. Causes of Obesity
• Characteristics of fast food
linked to increased
adiposity:
– Higher energy density
– Greater saturated fat
– Reduced complex
carbohydrates & fiber
– Reduced fruits and vegetables.
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101. Causes of Obesity
• Overeating and Other Factors
• Factors that cause human obesity:
genetics, environmental, metabolic, behavioral, social
• Factors that predispose a person to gain
excessive weight gain.
– Eating patterns Eating environment
– Food packaging Food availability
– Body image Physical inactivity
– Basal body temp Dietary thermogenesis
– Fidgeting Biochemical differences
– Quantity & sensitivity to satiety hormones
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102. Most important
risk factor !
61% of new
cases DM result
of overweight
87 % new cases
preventable ????
NEJM 2001, 345:790-797
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106. Obesity in Developing Countries
• Urbanization
• Lifestyle changes
– Diet
– Physical activity
– Genetics
– Early life
www.csrees.usda.gov/ree/Presentations/The%20Obesity%20Pandemic%20Aug%2022.ppt
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107. Obesity: Physical factors
Apart from social disparities and being at the bottom of the
income distribution, physical factors cause obesity. These are
influenced by the food and physical activity environment in
which people live.
Further info on obesity causes and source: http://www.hsph.harvard.edu/obesity-prevention-
source/obesity-causes/
Shifting
consumption
Too little sleep,
too little exercise
Poor diet
Genes (a
little)
Prenatal and
early life
development
Too much
TV
Image: http://factfile.org/wp-
content/uploads/2012/02/Obesity-Facts-
obesity-epidemic-requires.jpg
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112. Child and teen obesity spreading across the globe
• Child and teenage obesity levels have risen ten-fold in the last four decades,
meaning 124m boys and girls around the globe are too fat, according to new
research.
• The analysis in the Lancet is the largest of its kind and looks at obesity trends in
over 200 countries.
• In the UK, one in every 10 young people aged five to 19, is obese.
• Obese children are likely to become obese adults, putting them at risk of
serious health problems, say experts.
• These include type 2 diabetes, heart disease, stroke and certain types of cancer,
such as breast and colon.
• The Lancet analysis, released on World Obesity Day, comes as researchers from
the World Obesity Federation warn that the global cost of treating ill health
caused by obesity will exceed £920bn every year from 2025.
• Source lancet , Published: 10 October 2017,
DOI: http://dx.doi.org/10.1016/S0140-6736(17)32129-3
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115. Obesity
Not just an adult concern anymore…
Conditions Seen in Children
• High Cholesterol
• Type 2 Diabetes/
Impaired Glucose Tolerance
• High Blood Pressure
• Social Problems and
Poor Self-Esteem
• Sleep Disturbances
• Orthopedic Problems
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116. Obese children and adolescents are
more likely to become overweight or
obese adults
• Heart Disease
• Cancer
• Stroke
• Type 2 Diabetes
• Osteoarthritis
• Physical Disability
• High Blood Pressure
• Sleep Apnea
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121. Target* Notes
Fruits 3 servings per
day
Whole fruits (fresh, frozen, canned) are preferable to
100% juice; limit the latter to about 1 glass per day.
Nuts, seeds 4 servings per
week
Choose from a variety of different nuts and seeds.
Vegetables, including
legumes (excluding
white potatoes)
3 servings per
day
Minimize starchy vegetables, especially white potatoes.
Minimally processed
whole grains
3 servings per
day, in place of
refined grains
As a practical rule of thumb, choose grain products with
at least 1 g of fiber for every 10 g of total carbohydrate
(i.e., a carb:fiber ratio of <10:1).
Fish, shellfish 2 or more
servings per
week
Aim for oily fish, e.g. salmon, tuna, mackerel, trout,
herring, sardines.
Dairy products,
especially yogurt and
cheese
2-3 servings per
day
The choice of whole-fat vs. low-fat can be based on
personal preference, as current evidence is insufficient
to confirm which is superior.
Vegetable oils 2 to 6 servings
per day
Aim for polyunsaturated and/or phenolic-rich oils and
soft spreads, such as from soybean oil, canola oil, and
extra-virgin olive oil.
Table 1: Evidence-Based Dietary Priorities for Cardiovascular and Metabolic Health
*Based on a 2,000 kcal/day diet. Servings should be adjusted accordingly for higher or lower energy consumption.
Modified from Mozaffarian D. Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review. Circulation 2016 Jan 8.
[Epub ahead of print]
http://www.acc.org/latest-in-cardiology/articles/2016/05/05/07/45/diet-and-heart-disease-what-every-cardiologist-should-know
CONSUME MORE
122. Target* Notes
Refined grains,
starches, sugars
No more than 1-2
servings per day
Do not focus on total or added sugars alone, as
low-fiber, high glycemic complex carbs (refined
grains, starches) appear similarly harmful.
Processed meats Don't eat Avoid meats preserved with sodium or nitrates,
e.g. hot dogs, bacon, sausage, pepperoni, salami,
and chicken, turkey, ham, or beef deli meats.
Red meats No more than 2-3
servings per week
Fresh or frozen beef, pork, lamb.
Industrial trans fat Don't eat Avoid foods made with partially hydrogenated
vegetable oils.
Sugar-sweetened
beverages
Don't drink Avoid sugar-sweetened soda, sports drinks,
energy drinks, iced teas, and fruit drinks.
Alcohol Up to 1 drink per day
for women, 2 drinks
per day for men
For those who drink alcohol, moderate daily use
appears optimal, without clear differences in
health effects between wine, beer, or spirits.
Sodium No more than 2,000
mg/d
Avoid packaged, restaurant, or deli foods high in
sodium. Major sources include bread, chicken,
cheese, processed meats, soups, and canned
foods.
CONSUME LESS
125. “The most serious epidemic ever is
insidiously engulfing the world. Barry
Popkin draws upon his decades of
research and experience to describe its
origins–and a set of potential
solutions. Those interested in the
future of mankind should read this
book.”
Walter Willett, author of Eat, Drink,
and Be Healthy, and chair,
Department of Nutrition, Harvard
University
THE BOOK
1/28/2024 125
Melese.S
126. New Health Guidelines for Your Heart
• The nation's top group of heart doctors is offering new guidance on
when and how frequently Americans should eat meals and snacks in
order to control their weight and preserve or improve their heart
health.
• Based on a review of dozens of studies, the team of American Heart
Association doctors behind the report was able to make a number
of suggestions and observations, including:
1) Don't skip breakfast: Daily breakfast consumption has been linked
to better glucose metabolism and insulin levels.
2) Alternate-day fasting and periodic fasting may be effective for
weight loss: More evidence is needed to determine whether this
weight stays off in the long term.
1/28/2024 Melese.S 126
127. Cont…
3) Size of meals doesn't seem to matter: It doesn't seem to matter
for weight loss or heart health whether you eat a few large meals
or several smaller meals throughout the day, as long as the amount
of calories remains the same.
• The researchers also looked at the impact of meal timing (in other
words, what time of the day people ate their meals), but said that
this area needs further study.
• Overall, the researchers stressed that Americans should adopt a
"more intentional" approach to eating that focuses on the timing
and frequency of meals and snacks.
• Reviewed by Dan Childs, managing editor of the ABC News Medical
Unit.
Source : copyright American Heart Association, February ,02,2017
1/28/2024 127
Melese.S
129. 10 Objectives to prevent Chronic Diseases
1. Promote physical activity (in school, work community, leisure environments)
2. Increase availability, access and consumption of water
3. Reduce consumption of sugar and fat in beverages*
4. Increase consumption of vegetables and fruits, legumes, whole grains and fiber
in the diet
5. Improve the capacity for decision making for a healthy diet (nutrition literacy) *
6. Promote and protect exclusive breast-feeding until 6 months of age and
adequate complementary feeding starting at 6 months of age
7. Reduce the quantity of added sugar in industrialized foods*
8. Reduce consumption of saturated fats and eliminate consumption and
production of trans fats of industrial origin*
9. Reduce portion sizes of dishes, snacks and industrialized foods in restaurants and
sale points*
10.Limit the quantity of added sodium in foods and reduce its consumption*
* Actions in which industry cooperation and participation and social responsibility are needed
1/28/2024 129
Melese.S
130. Multiple Factors Interact to Influence Health & Disease
built
environment
disease stress
energy
chemicals
nutrients
1/28/2024 130
Melese.S
133. Ethiopia is committed to Millennium Development
Goals(PASDEP)
Plan for Accelerated and Sustained Development to
End Poverty
UNICEF/C-55-38/Watson
1/28/2024 133
Melese.S
134. Nutrition in the MDGs
MDGs Relevance of nutrition
1. Eradicate extreme poverty
and hunger
Contributes to human capacity and productivity
throughout life cycle and across generations
2. Achieve universal primary
education
Improves readiness to learn and school achievement
3. Promote gender equity and
empower women
Empowers women more than men
4. Reduce child mortality Reduces child mortality (over half attributable to
malnutrition)
5. Improve maternal health Contributes to maternal health thru many pathways
Addresses gender inequalities in food, care and health
6. Combat HIV/AIDS, malaria
and other diseases
Slows onset and progression of AIDS
Important component of treatment and care
7. Ensure environmental
sustainability
Highlights importance of local crops for diet diversity and
quality
8. Develop a global
partnership for development
Brings together many sectors around a common problem
1/28/2024 134
Melese.S
135. The Millennium Development Goals
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Build a global partnership for development
1/28/2024 135
Melese.S
141. WHAT ARE THE ELEMENTS UNDERPINING THE SUSTAINABLE
DEVELOPMENT GOALS (SDGs)?
The Goals will stimulate action over the next 15 years in 5 areas of critical importance:
People, Planet, Prosperity, Peace & Partnership.
1/28/2024 141
Melese.S
143. But, What is the nutrition situation of children
in developing countries?
1/28/2024 143
Melese.S
144. 49%
36%
15%
22%
57%
21%
Communicable diseases,
maternal and perinatal
conditions and
nutritional deficiencies
Noncommunicable Conditions
Injuries
1990 2020 (baseline scenario)
Source: WHO, Evidence, Information and Policy, 2000
Global Burden of Disease in Developing Countries
(DALYs) 1990-2020
1/28/2024 144
Melese.S
145. Malnutrition = “undernutrition”
• Inadequate intake of energy, protein and other nutrients
• Obese malnourished: excess fat stores but micronutrient or
macronutrient (typically protein) malnourished
• Sustained inadequate intake leads to functional change in
tissues of the body e.g. muscle loss, weakness, immune
function, capacity for recovery, cognition
• Responds to re-feeding
• Inflammation (disease) can influence response to re-feeding
1/28/2024 145
What is Malnutrition?
CMTF website adapted from: AW McKinlay:
Malnutrition: the spectre at the feast. J R
Coll Physicians Edinb 2008:38317–21.
Melese.S
146. Malnutrition:
Malnutrition has two types:
Undernutrition: deficient energy or nutrients.
•Symptoms of under nutrition (extremely thin, losing
muscle tissues, prone to infection and disease, skin
rashes, hair loss, bleeding gum and night blindness).
Overnutrition: excess energy or nutrient.
•Symptoms of overnutrition (heart disease, diabetes,
yellow skin, rapid heart rate and low blood pressure).
1/28/2024 146
Melese.S
148. The UNICEF/WHO/WB Joint Child Malnutrition
Estimates (JME) group released new data for
2021
1/28/2024 Melese.S 148
149. 1/28/2024 149
Over nutrition: too
fat for height and
age
Wasting:
too thin for
height
Stunting: too
short for age
Good nutrition status,
or may suffer
micronutrient
deficiencies
Types of malnutrition
Melese.S
150. Status of Malnutrition in Ethiopia Compared with
Neighboring Countries
150
1/28/2024 Melese.S
151. Trends in nutritional status of children
under 5 years of age, in the last 4 DHSs
Oromia
47.2
42.4
41
34.4
41.4
26
37
22
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
45.00
50.00
Children Stunted Children UW
DHS 2000 EDHS 2005 EDHS 2011 MEDHS 2014
PERCENTAGE
Melese.S 151
1/28/2024
158. Melese.S
… stunting
Off course
Target: 40% reduction in the number of children under
5 who are stunted
Baseline (2012)
2017 data
Target (2025)
There will be
about 130
million
stunted
children in
2025 if
current
trends
continue.
165.2m
150.8m
Around 100m
Childhood stunting
160. What are the causes of malnutrition ?
• Malnutrition affects every system in the body and always
results in increased vulnerability to illness, increased
complications and in very extreme cases even death.
1/28/2024 160
Melese.S
161. Causes of undernutrition
• We can divide the causes of undernutrition into immediate, underlying and
basic.
Immediate causes are:
• Poor diets. Meals may be low in quantity, nutrient density or variety, or eaten
infrequently. Infants may get insufficient breastmilk.
• Disease, particularly HIV/AIDS, diarrhoea, respiratory tract or ear infections,
measles, hookworms and other gut parasites.
Underlying causes are:
• Family food insecurity
• Inadequate care of vulnerable household members (e.g. ‘unfair’ sharing of food
within families)
• Unhygienic living conditions (e.g. poor water supplies and poor sanitation)
• Inadequate health services
Basic causes are:
• Poverty ,Lack of information, political and economic insecurity
• War , Lack of resources at all levels, unequal status of women, and/or natural
disasters
1/28/2024 161
Melese.S
164. A VICIOUS CYCLE: MALNUTRITION AND INFECTION
1/28/2024 Melese.S 164
165. The vicious cycle of poverty and malnutrition
Indirect loss in
productivity from poor
cognitive development
and schooling
Direct loss in
productivity from
poor physical
status
Loss in resources
from increased
health care costs
of ill health
Income poverty
Low food intake Frequent
infections
Hard physical labor Large
families
Frequent
pregnancies
Malnutrition
Source: Modified from World Bank (2002a); Bhagwati et al. (2004).
1/28/2024 165
Melese.S
166. Who is at risk of malnutrition?
• Older people over the age of 65, particularly if
they are living in a care home or nursing home or
have been admitted to hospital
• People with long-term conditions, such as
diabetes, kidney disease, chronic lung disease
• People with chronic progressive conditions – for
example, dementia or cancer
• People who abuse drugs or alcohol
1/28/2024 166
Melese.S
167.
168. Malnutrition: Is A Hidden Problem
UNICEF/94-1173
Pirozzi
Majority (80%)
mild & moderate
Victims not aware
1/28/2024 168
Melese.S
169. Stunting is preventable : BUT
Need to act before the child is 2 years
Source: Victora et al 2010
The Critical “Window of Opportunity”:
1000 DAYS
Pregnancy: 9*30= 270 days
2 years: 365*2=730 days
Melese.S 169
1/28/2024
171. IRON & FOLIC ACID
USE IODIZED SALT
CORRECT FEEDING OF A SICK CHILD
SLEEP UNDER TREATED BED NETS
SAFE BIRTH &
NORMAL BIRTH
WEIGHT BABY
DEWORMING
VACCINATIONS
EXTRA MEAL/ DIVERSE DIET
CORRECT COMPLEMENTARY FEEDING & FOODS
VITAMIN A
ANTENATAL CARE
SAFE WATER & CAREFUL HYGIENE
GROWTH MONITORING & PROMOTION
EXCLUSIVE BREASTFEEDING CONTINUED BREASTFEEDING
FORTIFIED STAPLES
1 , 0 0 0 C R I T I C A L DAY S
PMTCT (NUTRITION AND BREASTFEEDING OPTIONS)
Melese.S 171
1/28/2024
177. Nutritional problems of public Health Importance
in Ethiopia
Protein-energy malnutrition
Vitamin A deficiency
Iodine deficiency
Iron deficiency anemia
Vtamin D deficiency
*Folate deficiency
*Zinc deficiency
1/28/2024 177
Melese.S
178. What are the conséquences of
malnutrition in quantitative terms?
1/28/2024 178
Melese.S
179. CONSEQUENCES OF MALNUTRITION
Increased risk of infections
Poor physical growth and brain development
Weakened immunity, increased morbidity and mortality
Faster disease progression in people with HIV and TB
Increased risk of mother-to-child transmission of HIV
Reduced medication effectiveness and adherence
Increased poverty and disease
Lower educational and economic prospects
Increased health and education costs
Increased risk of chronic diseases (e.g., diabetes from
overnutrition)
1/28/2024 Melese.S 179
180. Four Functional Consequences
Mortality
Illness
Intelligence loss
Reduced productivity
1/28/2024 180
Short-term adverse effects include recurring illness, weakness,
delayed physical and mental development, irritability, poor appetite, low weight for
age, etc.
Long-term adverse effects are stunting or short height for age, poor
learning ability, poor performance at school and poor general health. All of which reflect
in poor working capacity, resulting in low income. Stunting in girls can have effects
on child bearing, resulting in low birth weight babies.
Melese.S
181. Consequences of Maternal Undernutrition
Maternal consequences Child consequences
Increased risk of maternal
death
Increased infections
Anaemia
Compromised immune
functions
Lethargy and weakness
Lower productivity
Lactational failure
Increased risk of foetal and
neonatal deaths
Intrauterine growth retardation
Low birth weight
Pre-term birth
Compromised immune functions
Birth defects
Cretinism and reduced IQ
Source: UNICEF, 2006
181
1/28/2024 Melese.S
190. Breastfeeding and Birth Spacing
UNICEF/D0192-0060/Johnson
• Total Fertility Rate = 5-6 births per
woman
• Delay in fertility due to
breastfeeding = 14 months
• Value of birth spacing effect of
breastfeeding = 167 million
Birr/year
1/28/2024 190
Melese.S
191. Vitamin A Deficiency
Night blindness
Ulceration of the cornea
Permanent blindness
1/28/2024 191
Melese.S
202. B. Estimation of Public and Private Education
Costs
Primary Total
Number of repetitions 152,488 ------
Public Costs per student
(ETB)
223 ------
Total Public Costs
(millions of ETB)
34 34 million
Private Costs per student
(ETB)
390 ------
Total Private Costs
(millions of ETB
59 59 Million
Total (millions of ETB) 93 Million ETB
Source: Estimations based on official education statistics of Ministry of Education (2009).
COSTS OF GRADE REPETITION ASSOCIATED TO STUNTED CHILDREN,
2009
Equival
ent to
0.03%
of GDP
1/28/2024 202
Melese.S
203. C. Effects on Retention/dropout
19% of non stunted
population completed
primary school compared
to only 8% of stunted
children
12% of non-
stunted
completed
secondary school,
while 4% of the
stunted
population
completed
secondary
school
Impact on
non manual
labor
1/28/2024 203
Melese.S
204. Iodine Deficiency during Pregnancy
UNICEF/HQ93-2200/Pirozzi
severe mental and physical damage
moderate mental retardation
mild intellectual disability
1/28/2024 204
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206. Total Goiter Rate = 38%
If this is not corrected
from 2006-2015:
4.5 million babies will
be born intellectually
impaired
UNICEF/Ethiopia
1/28/2024 206
Melese.S
207. Summary of intellectual consequences
Iron deficiency anemia lowers IQ by about 9 points
Mild iodine deficiencies lowers IQ by about 10 points
Severe stunting associated with IQ loss of 5-10 points
Low birth weight babies have IQs 5 points lower
1/28/2024 207
Melese.S
209. Birth
Pregnancy Infancy Childhood Adolescence Adulthood
Nutrition Throughout the Life Cycle
High Impact
Pregnancy until 2 years old
Micronutrient Supplements
• Vitamin A
• Iron-Folate
• Zinc
Malaria Prevention
using Insecticide
Treated Nets
Breastfeeding Promotion & Infant
and Young Child Feeding
(including complementary feeding)
Improve Hygiene and Sanitation
Universal Salt
Iodization
Zinc Mgmt of Diarrhea
Deworming
Treatment of severe
undernutrition with RUTF
Community Management of
Acute Malnutrition (CMAM)
Improved Nutritional
Value of Food
• Better quality crops
• Household Dietary
Diversity
• Fortification
1/28/2024 Melese.S 209
211. Human Costs of Malnutrition
Negative outcomes associated
with malnutrition
Delayed wound healing
Impaired immunity
Lower quality of life
Impaired function
Increased length of stay,
readmission, mortality and/or
morbidity rates
Correia M.I. Et al: Clin Nutr. 2003; 22:235-9.; Covinsky K.E. et al: J Am Geriatr Soc. 2002; 50:631-7.;
Middleton M.H. et al:. Intern Med J 2001;31:455-61.; Ferguson M. et al. J Am Diet Assoc 1998;98
(suppl.): A22. Suominen M et al. Eur J Clin Nutr 2005; 59: 578-583.; Neumann SA et al. J Hum Nutr
Dietet 2005; 18: 129-136.; Norman K et al. World J Gastroenterol 2006; 12: 3380-3385.; Pauly L et al. Z
Gerontol Geriatr 2007; 40: 3-12.; Keller H, Can J Rehab 1997; 10(3): 193-204; Keller H, J Nutr Elder
1997;17(2):1-13.
1/28/2024 211
Melese.S
212. Economic Impact of Child Undernutrition
The aggregate cost estimation for Health, Education and
Productivity are equivalent to between 1.9% to 16.5% of GDP
.
BURKINA
FASO
7.6% of GDP
$ 802
million
MALAWI
10.3%
GDP
$ 597
million
Rwanda
11.5_% of
GDP
$ 820
million
Country
Losses in
Currency
Annual
in USD
Egypt
EGP 20.3
billion
$3.7 billion
Ethiopia
ETB 55.5
billion
$4.5 billion
Swaziland
SZL 783
million
$76 million
Uganda
UGX 1.8
trillion
$899 million
Burkina Faso
FCFA 409
billion
$ 802
Ghana
GHC 4.6
trillion
$2.6 billion
Rwanda
RWF 503
billion
$ 820
Malawi
MWK 147
billion
$597 million
1/28/2024 212
Melese.S
214. In primary care, disease related malnutrition results in
• Increased dependency
• Increased GP visits
• Increased prescription costs
• Increased referrals to hospital
• Increased admissions to care homes
In secondary care, disease related malnutrition results in
• Increased complications such as wound infections, chest
infections, pressure ulcers
• Increased length of hospital stay
• Increased numbers of patients who are readmitted to hospital
• Increased numbers of deaths
1/28/2024 214
Melese.S
216. Iodine Deficiency and Productivity
Mental retardation(Cretinism) in fetuses and children
Physical shortness(Iodine dewarfism) in children
Weakness and morbidity in adults
Weakness, poor reproduction in the beasts of burdon
Mortality
Unemployement and discounting future earnings
1/28/2024 216
Melese.S
217. Productivity Losses
due to Iodine Deficiency (2006-2015)
• Present Value = 64 billion Birr
UNICEF/93-COU-0931/Ethiopia/Thomas
1/28/2024 217
Melese.S
218. Productivity Losses due to Anemia (2006-2015)
• Present Value = 36 billion Birr
UNICEF/93-COU-0931/Ethiopia/Thomas
1/28/2024 218
Melese.S
219. Anemia
Iron deficiency anaemia leads to:
• Decreased physical growth in children and
results in short stature
• Impaired learning (Decreased attention span) in
children
• Poor metabolic efficiency and physical
productivity
• Impaired Immunity
1/28/2024 219
Melese.S
220. Productivity Losses due to Anemia (2006-2015)
• Present Value = 36 billion Birr
UNICEF/93-COU-0931/Ethiopia/Thomas
1/28/2024 220
Melese.S
222. Stunting at Age 2
UNICEF/C-55-34/Watson
51%
(EDHS - 2005)
1/28/2024 222
Melese.S
223. Productivity Losses due to Stunting (2006-
2015)
• Present Value = 44 billion Birr
UNICEF/93-COU-0931/Ethiopia/Thomas
1/28/2024 223
Melese.S
224. What is food security ?
• Food security exists when all people, at all times, have physical,
social and economic access to sufficient, safe and nutritious
food that meets their dietary needs and food preferences
for an active and healthy life (World Food Summit Declaration,
1996).
• This definition is based on three core concepts of food
security:
– availability (physical supply),
– access (the ability to acquire food) and
– utilization (the capacity to transform food into the desired
nutritional outcome).
– Stability/Sustainability
• If these conditions are not fulfilled a person is said to be in
the state of food insecurity
1/28/2024 224
Melese.S
225. 225
Three pillars of food security
• Availability of food
food production, food imports, etc
• Access to food
household food production and reserves,
family income, solidarity mechanisms,
Barter/exchange, etc
• Utilization of food
health situation (diarrhoea, malaria,
AIDS), food storage and cooking
practices, fuel, age related needs, etc
1/28/2024 Melese.S
226. 1/28/2024 226
Categories Examples of indicators
Food
availability /
general context
Rainfall and expected effects on harvest
Crop production (types of crops, yields, methods of
production)
Livestock holdings and status
Land area cultivated and systems of land access
Food access
Livelihood strategies
Income and food sources
Essential expenditures
Household food consumption patterns
Household food stocks
Productive household assets
Market prices of key staples and productive assets (e.g.
livestock) – Terms of trade
Coping strategies
Food utilisation
Nutritional status
Health status
Water sources and sanitation facilities
Feeding and caring practices
Food consumption patterns
Melese.S
227. Cont …
Food sovereignty :
– Food Sovereignty is a political term defined as:
“…the right of people to healthy and culturally
appropriate food produced through
ecologically sound and sustainable methods,
and their right to define their own food and
agriculture systems”
–Food sovereignty is a prerequisite for food
security . How?
1/28/2024 227
Melese.S
228. Components of the Food Security Definition
Key Question Indicator
Who should get the
food?
Everyone/ all people (Universality)
When?
At all times/ sustained access (Stability)
How?
Through normal food channels/ not from emergency
assistance program (Dignity)
How much food?
Enough/ enough for a healthy active life (Quantity)
What kind of food?
Safe and nutritious (Safety)
Culturally appropriate (Quality)
Produced in environmentally sustainable ways that
promote communities(Quality)
Source: adapted from.: http://www.toronto.ca/health/children/pdf/fsbp_ch_1.pdf.
1/28/2024 228
Melese.S
230. Nutrition insecurity
• The current approach focuses on 3-pronged factors
food, care and health.
• Nutrition security, comprising a framework called the
“food-care–health framework”.
• Household food security, care of the vulnerable
segments of the population and
• Adequate health services and environmental hygiene
are the underlying determinants of Nutrition security
that have a very close interrelationship.
230
1/28/2024 Melese.S
231. Major Causes of food insecurity
• Global water crisis
• Land degradation
• Land deals and grabbing
• Climate change
• Agricultural diseases
• Dictatorship and kleptocracy
• Population growth
• Fossil fuel dependence
• Hybridization, genetic engineering and loss of
biodiversity
• Intellectual property rights
• Price setting
1/28/2024 231
Melese.S
234. Energy Sources
• Carbohydrates
– Limited storage capacity, needed for CNS function
– Yields 4 kcal/gram
– Pitfall: too much=lipogenesis and increased CO2 production
• Fats
– Major endogenous fuel source in healthy adults
– Yields 9 kcal/gm
– Pitfall: too little=essential fatty acid (linoleic acid deficiency-
dermatitis and increased risk of infections
• Protein
– Needed to maintain anabolic state (match catabolism)
– Yields: 4 kcal/gm
– Pitfall: must adjust in patient with renal and hepatic failure
• Elevated creatinine, BUN, and/or ammonia
1/28/2024 234
Melese.S
235. Lower energy density
This 450-gram breakfast delivers
500 kcal, for an energy density
of 1.1
(500 kcal/450 g = 1.1
kcal/g)
Higher energy density
This 144-gram breakfast
delivers 500 kcal, for an energy
density of 3.5
(500 kcal/144 g = 3.5
kcal/g)
1/28/2024 235
Melese.S
236. • Good nutrition enhances your quality of life and
helps you prevent disease.
• It provides you with the calories and nutrients
your body needs for maximum energy and
wellness.
• NUTRITION: The process by which the body takes in and
uses food.
• NUTRIENTS: Substances in foods that your body needs to
grow, to repair, and to provide energy.
• CALORIES: Units of heat that measure the energy used by
the body and energy supplied to the body by foods.
1/28/2024 236
Melese.S
237. Principles of Good Nutrition
• Adequacy
• Balance
• Energy Control
• Nutrient Density
• Moderation
• Variety
1/28/2024 237
Melese.S
238. Elements of a Healthy Diet - ABCMV
Adequacy - get enough of essential nutrients.
Balance - contains a good proportion of nutrients. No
overemphasis of a food group.
Calorie control - choose foods to maintain ideal body
weight.
Moderation - eat any food in reasonable-size portions.
Variety - eat different types of food to prevent
boredom.
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Melese.S
239. What are the factors affecting nutrition ?
• History- e.g. historical factors including war, food
availability
• Psychology- e.g.eating disorders
• Economics-e.g. poverty
• Politics-e.g. ethnic cleansing
• Anthropology-cultural (e.g. religious) influences
• Sociology-e.g. eating in groups
• Health-e.g desire for health
• Combination of all the above-i.e. all related
1/28/2024 239
Melese.S
240. Determinants of Food Choice and
Eating Patterns throughout Life
1/28/2024 240
Melese.S
255. Time of Day and Eating: Does It Impact Your
Health?
• Eat breakfast may decreases the total number of
kilocalories you eat in a day
– Increased satiety with breakfast foods
– May be a good strategy for weight control
• Eating later in the day may increase kilocalorie
intake
• Eating more fat and consuming more alcohol on
the weekends can result in weight gain
1/28/2024 255
Melese.S
256. Time of Day and Eating: Does It Impact Your
Health?
• Start your day with a nutrient-dense breakfast
• Choose breakfast foods that are more satisfying
• Control kilocalorie intake on nights and weekends
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257. Healthy Eating Pyramid
Carbohydrates: take most food
from this group (rice, pasta, bread,
potatoes)
Fruit and vegetables: take 5
portions a day from this group
Meat, fish and dairy: take
something from this group
Foods high in fats and sugars: take
only small amounts from this
group
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258. Figure 18-7
Page 641
Food Guide Pyramid for Disease Prevention
Maintain a healthy
weight. be physically
active. Don’t smoke.
Fats, Oils
& Sweets
• Limit salt to < 6 grams.
• Reduce energy-rich foods high in sat. fat & sugar.
• Use unsaturated fats instead of sat. or trans fats.
• Drink alcohol in moderation, if at all.
• Eat < 4 eggs per week.
• Eat red meat sparingly.
• Eat fish frequently.
• Eat nuts and legumes often.
• Eat fruit in abundance.
• Eat whole-grain breads,
cereals, rice, and pastas
instead of refined products.
• Eat low-fat or fat-
free milk products.
• Eat vegetables
in abundance.
Milk, Yogurt &
Cheese Group
Vegetable Group
Meat, Poultry,
Fish, Dry Beans,
Eggs & Nuts Group
Fruit Group
Bread, Cereal, Rice & Pasta Group
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259. Many“Top 10”/“Power Food” Lists
(cancer, CHD, disease prevention)
…eat often but don’t overdo it! These are not magic foods!
• Red/blue berries (grapes,
blueberries, strawberries,
cranberries, blackberries, etc)
• Soy foods
• Beans (pinto, garbanzo, lentils,
kidney)
• Oats and grains (oatmeal, whole
grain breads & cereals)
• Stanols/sterols (Take Control,
Benecol)
• Nuts (almonds, cashews, pecans,
walnuts, peanuts, hazelnuts)
• Garlic, onions
• Red wine (2 glasses/d max)
• Green and black teas
• Tomatoes, oranges
• Salmon and fish in general
• Spinach, green leafy veggies in
general
• Olives, olive oil
• Sweet potatoes
• Lowfat milk
• Apples
• Fruits and veggies in general
• Flaxseed
• Hot chocolate/chocolate/cocoa
• Cruciferous veggies: broccoli,
Brussels sprouts, cauliflower,
cabbage, kale, kohlrabi
• Total calcium intake
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260. Anatomy of MyPyramid
GRAINS VEGETABLES FRUITS MILK
MEAT &
BEANS
O
I
L
S
PROPORTIONALITY
Different food
group bands
shown by
different widths
Widths are a
general guide
to proportions
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263. 263
It’s a healthy way to
eat and live for the rest
of your life.
Not at all like
those fad diets
you’ve tried.
The Mediterranean Lifestyle
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264. 264
The Mediterranean Diet...
... is based on traditional
foods from countries
that surround the
Mediterranean Sea.
But you can enjoy it with
delicious, fresh, affordable
foods from your local
supermarket.
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265. 265
Eat lots of
vegetables.
1
Can you fill half your plate with
them at lunch and dinner?
8 Simple Steps for Good Health
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266. 266
Change the way
you think about
meat.
2
Enjoy small amounts
as a garnish for flavor.
8 Simple Steps for Good Health
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267. 267
Enjoy some dairy
products.
Greek or regular yogurt and a variety
of traditional cheeses are great.
8 Simple Steps for Good Health
3
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268. 268
Eat seafood
twice a week.
4
For brain and heart health, enjoy
tuna, herring, salmon, shellfish and
other fish.
8 Simple Steps for Good Health
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269. 269
Cook a vegetarian
meal once a week.
5
When one night feels comfortable,
try two.
8 Simple Steps for Good Health
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270. 270
Use good fats.
6
Think extra-virgin olive oil, nuts,
seeds, peanuts, avocados and
more.
8 Simple Steps for Good Health
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271. 7
271
Switch to
whole grains.
The fuller, nuttier taste of whole
grains and their extra fiber can
help keep you full for hours.
8 Simple Steps for Good Health
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272. 272
For dessert,
eat fresh fruit.
8
Save sweets for a rare treat or
special occasion.
8 Simple Steps for Good Health
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286. 286
Many Health Benefits
Scientific evidence shows the Med Diet helps:
• Reach weight loss or management goals
• Lower your risk of heart disease and
high blood pressure
• Fight certain cancers and chronic diseases
• Reduce asthma
• Avoid diabetes; manage blood sugar
• Resist depression
• Nurture healthier babies
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287. Healthy Fats in Foods
http://www.hsph.harvard.edu/nutritionsource/questions/omega-3/index.html
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290. This can be translated simply into these 4 Messages of the
Modified DASH DIET:(dietary approaches to stop hypertension)
1. Consume a combination of vegetables and fruit that add up to 5-6
cups a day.
2. Choose only lean meat, chicken and fish and limit daily intake to
2 servings of 3 ounces each (3 oz. = size of a deck of
cards).Choose only low fat dairy products and consume 2-3
servings a day.(1 kilogram is equal to 35.2739619496 oz, or 1000
grams).
3. Consume a serving of beans (1/2 cup) or nuts (1/4 cup) every day.
4. Choose carbohydrate foods that are unprocessed and high in
fiber (>3 g/serving).
• These are low in glycemic index.
For more reference: Website on the standard DASH Diet, with Guidelines and 7-Day
Menu: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/
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292. The Dietary Guidelines
1. Eat Nutrient Dense Foods
Caloric Breakdown
Carbohydrates: 55-60%
Fat: No more than 30%
Protein: 10-15 %
Average American eats too much fat,
sugar, calories & sodium
Average American doesn’t eat enough
fiber.
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293. 2. Balance calories to manage
weight
Monitor food and beverage intake, physical
activity and body weight.
Reduce portion sizes
When eating out, make better choices
Limit screen time (increase your activity)
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294. 3. Reduce sodium, fats, added
sugars, refined grains & alcohol
What can too much salt/sodium
do to your body?
Can cause high blood
pressure and heart disease.
Where does it hide?
In prepared foods (frozen,
canned, etc.)
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295. 4. Increase vegetables, fruits, whole grains, milk,
seafood and use oil instead of fat
It’s recommended that we eat 8 oz of
seafood per week
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296. 5. Build healthy eating patterns that meet nutritional needs
over time at an appropriate calorie level.
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297. 6. Include physical exercise as
part of healthy eating patterns
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298. “The doctor of the future will no longer treat the human frame with
drugs, but rather will cure and prevent disease with nutrition.”
- Thomas Edison (1847 – 1931), American Inventor, Scientist & Businessman
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299. “However much a mother may love her children, but impossible for her
to provide quality child care if she herself is poor, illiterate, anemic
and unhealthy”.
-Dr. V. Ramalingaswami (1921 - 2001), Director (AIIMS) & Director General (ICMR)
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