COMMUNICABLE DISEASES EPIDEMIOLOGY, CONTROL & PREVENTION CHP300.
CHP300 :Community Health Program-l
description
Transcript of CHP300 :Community Health Program-l
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CHP300:Community Health Program-lMohamed M. B. Alnoor
NUTRITION AND HEALTH
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Objectives: To define nutrition and related words. To identify nutritional requirements. To understand Food pyramid. To list types of nutrients and their relation
to health. To define malnutrition and its classification. To list main malnutrition problems. To understand Obesity.
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Nutrition
Definitions
NUTRITION AND HEALTH
Nutrients Macronutrients Micronutrients
Community Nutrition:
Dietetics: Nutritional
Epidemiology:
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- Foods of animal origin
- Foods of vegetable origin
CLASSIFICATION OF FOODS by origin
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Carbo-hydratesProtein Fat
Water
Vitamins
Minerals
-Proteins-Fats
-Carbohydrates
-Minerals-Water
-Vitamins
CLASSIFICATION OF FOODS by chemical composition
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Body building foods:
CLASSIFICATION OF FOODS by predominant function
Energy giving foods:
Protective foods:
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The adequate diet & Food Pyramids
Food Group System: Classifies foods according to similarity in nutrient content.
Nutritional Requirements
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2- Eat good fats (avoid bad fats):Oils found in nuts, seeds, grains and fish. Rich in unsaturated fats necessary for good health.Should constitute > 30 to 45% of the total fat.
1- Maintain a healthy weight. BMI: 18.5 to 24.9
Food PyramidsLessons from Food Pyramid
Nutritional Requirements
19 to 25
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More nutritious than refined carbohydrates More slowly digested Less stress on pancreas.
Food Pyramids Lessons from Food Pyramid
Nutritional Requirements
3 .Eat whole-grain carbohydrates . (whole meal bread, whole wheat, brown
rice) Why?
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4-Avoid red meat as a protein source and emphasize plant proteins.
5- Take a multivitamin daily. Insurance against any deficiency.
Food PyramidsLessons from Food Pyramid
Nutritional Requirements
6- Eat plenty of dark green leafy vegetables and fruits.
Lowers blood pressure and cholesterol and reduces the risk of cancer.
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Carbohydrates Lipids Protein
Vitamins Minerals Water
Energy Supplying Nutrients:
Main types of Nutrients
Non-Energy Supplying Nutrients:
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PROTEINS
Complex organic nitrogenous compounds.
Contain sulfur, phosphorous and iron. About 20 different amino acids(aa) in
human body. 8-9“essential” aa Why are they called “essential” ?Essential for what ?
Main types of NutrientsEnergy Supplying
Nutrients
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Protein Needs:
Adults: 0.8 gm/kg body weight per day
Excess protein is not used to build more muscle
- extra aa are used for energy - or converted to fat and stored.
PROTEINS
Main types of NutrientsEnergy Supplying
Nutrients
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Animal sources : Complete proteins; have all essential aa.
Plant sources : Incomplete proteins; lack one or more essential aa.
Sources of Proteins :
PROTEINS
Main types of NutrientsEnergy Supplying
Nutrients
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Body building Repair and maintenance of body
tissues Maintenance of osmotic pressure Synthesis of bioactive substances
and vital molecules e.g. immunoglobulins
Functions of Proteins:
PROTEINS
Main types of NutrientsEnergy Supplying
Nutrients
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Lipids include cholesterol and triglycerides
Fats are necessary for healthFunctions 1 – Highest source of energy (9Kcal/g). 2 - Spare protein. 3 - Adipose tissue holds the body organs
and nerves in place. 4 - Maintain body temperature. 5 - Transportation of fat soluble vitamins.
LIPIDS
Main types of NutrientsEnergy Supplying
Nutrients
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Classification of Fats
Saturated fat: Animal
foods Palm oil
coconut oil
LIPIDS
Main types of NutrientsEnergy Supplying
Nutrients
(Richest source)
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Monounsaturated fat:
Classification of Fats
Olives oil Peanuts
oil
canola oil
LIPIDS
Main types of NutrientsEnergy Supplying
Nutrients
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Polyunsaturated fat:
Classification of Fats
Corn oil
Sunflower oil
cotton seed oil
nut
oil
LIPIDS
Main types of NutrientsEnergy Supplying
Nutrients
Richest source
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Trans Fatty AcidsHydrogenated &Partially hydrogenated fats
Classification of Fats
LIPIDS
Main types of NutrientsEnergy Supplying
Nutrients
liquid oils more solid margarinehydrogenation
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Saturated fat and trans fatty acids could be harmful to health
Baked products and fried foods are often made with hydrogenated fats
Classification of Fats
Hydrogenated fat:
LIPIDS
Main types of NutrientsEnergy Supplying
Nutrients
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Necessary for:
Classification of Fats
Cholesterol:
LIPIDS
Main types of NutrientsEnergy Supplying
Nutrients
cell membranes production of: vitamin D
Bile some hormones
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Only in animal foods
Classification of Fats
Cholesterol:
LIPIDS
Main types of NutrientsEnergy Supplying
Nutrients
blood levels risk of heart
disease
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The WHO Expert committee on Prevention of Coronary Heart Disease has recommended that only 20 to 30% of total dietary energy is to be provided by fats. (<30%)
At least 50 % of fat intake should consist of vegetable oils rich in essential fatty acids.
Fat requirements
LIPIDS
Main types of NutrientsEnergy Supplying
Nutrients
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1 - Main source of energy: 4 Kcals/gram. 2 - Essential for the synthesis of certain
non-essential aa. 3 - Necessary for normal fat metabolism. 4 - Necessary for integrity of nerve cells.
CARBOHYDRATES
Main types of NutrientsEnergy Supplying
Nutrients
Functions:
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5 - Lactose allows growth of beneficial bacteria in the intestine. 6 - Important for normal elimination (excretion); fibers
Recommended intake is 55% to 65% of calories, primarily from
starchy foods.
CARBOHYDRATES
Main types of NutrientsEnergy Supplying
Nutrients
Functions:
The inability of the body to metabolize carbohydrates properly = DM
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1- Monosaccharides: glucose or fructose 2- Disaccharides: Sucrose (G + F) 3- Oligosaccharides (3-10). 4- Polysaccharides (11-1000) a-Digestible e.g. starch b-partially digestible e.g. dextrin c-Indigestible e.g. cellulose
Classification of CHOS
CARBOHYDRATES
Main types of NutrientsEnergy Supplying
Nutrients
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Fiber Indigestible plant material e.g. cellulose Dietary fiber is mainly non-starch
polysaccharide It is found in vegetables, fruits and grains. Soluble fiber swells or dissolves in water. Rich sources include apples, bananas,
citrus fruits, carrots
CARBOHYDRATES
Main types of NutrientsEnergy Supplying
Nutrients
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Importance:Reduces cholesterol absorption Slows absorption of glucose
Soluble fiber
Fiber
CARBOHYDRATES
Main types of NutrientsEnergy Supplying
Nutrients
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Insoluble fiber remains unchanged in water.
Fiber
CARBOHYDRATES
Main types of NutrientsEnergy Supplying
Nutrients
Insoluble fiber
Rich food sources include brown rice, wheat bran, and whole grain products.
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Reduces the risk of:
Fiber
CARBOHYDRATES
Main types of NutrientsEnergy Supplying
Nutrients
Insoluble fiber Importance:
Heart disease Diabetes type II Diverticulosis Hemorrhoids Constipation Colorectal cancer
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Refined CHOS Versus Whole Grains Whole grains are higher than refined
carbohydrates in fiber, vitamins, minerals, and other beneficial compounds
Whole grains:• Take longer to digest• Make people feel full sooner• Cause a slower rise in glucose
levels
CARBOHYDRATES
Main types of NutrientsEnergy Supplying
Nutrients
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Choose foods that have a whole grain as the first item on the ingredient list on the food label
• Whole wheat, whole rye, whole oats, oatmeal, whole-grain corn, brown rice, popcorn, barley, etc.
ADVICE
CARBOHYDRATES
Main types of NutrientsEnergy Supplying
Nutrients
Refined CHOS Versus Whole Grains
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Vitamins
Minerals
Water
Main types of NutrientsNon-Energy Supplying
Nutrients
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Regulate growth. Maintain tissues. Help carbohydrates, proteins, and
fats release energy.
Main types of NutrientsNon-Energy Supplying
NutrientsVITAMINS
Functions:
• Provide no calories (no energy)
• Needed in very small amounts
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Water Soluble:
Fat Soluble:
Main types of NutrientsNon-Energy Supplying
NutrientsVITAMINS Classification of
Vitamins
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Water Soluble: 8 different B Vits and vitamin C
Fat Soluble: Vits A, D, E, and K - Healthy people do not need supplements;
Main types of NutrientsNon-Energy Supplying
NutrientsVITAMINS Classification of
Vitamins
-Supplementation toxic high levels
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«Vitamin A» covers both: a pre-formed vitamin: retinol(animal sources) a pro-vitamin: beta carotene(plant
sources) which is converted to retinol in the intestinal mucosa.
Main types of NutrientsNon-Energy Supplying
NutrientsFat Soluble VitaminsVitamin A
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Essential for normal vision. Necessary for maintaining the integrity
and the functioning of glandular and epithelial tissue which lines intestinal, respiratory and urinary tracts as well as the skin and eyes.
Functions of Vitamin A:
Main types of NutrientsNon-Energy Supplying
NutrientsFat Soluble VitaminsVitamin A
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It supports growth, especially skeletal growth
It may protect against some epithelial cancers such as bronchial cancers.
Main types of NutrientsNon-Energy Supplying
NutrientsFat Soluble Vitamins
Functions of Vitamin A:
Vitamin A
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The nutritionally important forms of Vitamin D in man are: -Calciferol (Vitamin D2) and -Cholecalciferol (Vitamin D3)
Main types of NutrientsNon-Energy Supplying
NutrientsFat Soluble VitaminsVitamin D
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Main types of NutrientsNon-Energy Supplying
NutrientsFat Soluble Vitamins
Functions of Vitamin D: Intestine: Promotes intestinal
absorption of calcium and phosphorus
Bone: Stimulates normal mineralization, enhances bone reabsorption( resorption), affects collagen maturation
Kidney: Increases tubular reabsorption of phosphate
Vitamin D
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Leads to:
Main types of NutrientsNon-Energy Supplying
NutrientsFat Soluble Vitamins
Deficiency of Vitamin D:
Vitamin D
-Rickets in children
-Osteomalacia in adults
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Antioxidant, Protects RBCs from haemolysis.
Vitamin E deficiency :
Neurological problems:• spinocerebellar ataxia• myopathies
Aaemia
Main types of NutrientsNon-Energy Supplying
NutrientsFat Soluble VitaminsVitamin E
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Important for blood coagulation
Deficiency causes hemorrhagic manifestations.
Main types of NutrientsNon-Energy Supplying
NutrientsFat Soluble VitaminsVitamin K
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Function: essential for the utilization of carbohydrates, (found on the membranes of neurons).
Main types of NutrientsNon-Energy Supplying
NutrientsWater Soluble VitaminsVitamin B1 (Thiamine)
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Deficiency of (Thiamine) Beriberi may occur in three main forms:
Main types of NutrientsNon-Energy Supplying
Nutrients
Vitamin B1 (Thiamine)
Infantile beriberi
Wet beriberi Dry beriberi
Water Soluble Vitamins
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Important for cellular metabolism, oxidation and reduction.
Deficiency: angular stomatitis & glossitis (magenta tongue).
Main types of NutrientsNon-Energy Supplying
Nutrients
Vitamin B2 (Riboflavin)
Water Soluble Vitamins
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Pyridoxine (vitamin B6) plays an important role in the metabolism of amino acids, fats and carbohydrate.
The requirement of adults vary directly with protein intake.
Main types of NutrientsNon-Energy Supplying
Nutrients
Vitamin B6 (Pyridoxine)
Water Soluble Vitamins
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The primary role of vitamin B6 is to act as a coenzyme to many enzymes in the body that are involved predominantly in metabolism.
Toxicity: Can occur with supplementation with high doses for long periods of time.
Main types of NutrientsNon-Energy Supplying
Nutrients
Vitamin B6 (Pyridoxine)
Water Soluble Vitamins
Destruction of dorsal root ganglia
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Vitamin B12 is a complex organo-metallic compound with a cobalt atom (Cyanocobalamine)
Main types of NutrientsNon-Energy Supplying
Nutrients
Vitamin B12 (Cyanocobalamine)
Water Soluble Vitamins
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Cooperates with folate in the synthesis of DNA.
Separate biochemical role, unrelated to folate, in synthesis of fatty acids in myelin.
Main types of NutrientsNon-Energy Supplying
Nutrients
Vitamin B12 (Cyanocobalamine)
Water Soluble Vitamins
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Associated with megaloblastic anaemia (pernicious anaemia), demyelinating neurological lesions in the spinal cord.
Dietary deficiency of B12 may affect subjects who are strict vegetarians and eat no animal product.
Vitamin B12 deficiency
Main types of NutrientsNon-Energy Supplying
Nutrients
Vitamin B12 (Cyanocobalamine)
Water Soluble Vitamins
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Important for maintenance of the nervous system and healthy epithelium
Deficiency: Pellagra, dermatitis, dementia
and diarrhoea
Main types of NutrientsNon-Energy Supplying
NutrientsVitamin B3 (Niacin, Nicotinic acid)
Water Soluble Vitamins
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Vitamin C (ascorbic acid) is a water-soluble vitamin.
It is the most sensitive of all vitamins to heat.
Vitamin C has an important role to play in tissue oxidation
Main types of NutrientsNon-Energy Supplying
NutrientsVitamin C (Ascorbic acid)
Water Soluble Vitamins
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It is needed for the formation of collagen in connective tissue, which constitutes 25% per cent of total body protein.
Present in vegetables and fruits.
Main types of NutrientsNon-Energy Supplying
NutrientsVitamin C (Ascorbic acid)
Water Soluble Vitamins
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Deficiency of vitamin C Results in scurvy. Signs of scurvy are:
Swollen and bleeding gums, Subcutaneous bruising, Bleeding into the skin or joints, Delayed wound healing, Anaemia and weakness.
Main types of NutrientsNon-Energy Supplying
NutrientsVitamin C (Ascorbic acid)
Water Soluble Vitamins
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Minerals are certain elements that may: regulate chemical reactions in the body be part of organic molecules:
Iron in hemoglobin Calcium in bone and teeth
Small amounts are needed for health
Main types of NutrientsNon-Energy Supplying
NutrientsMinerals
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Most plentiful mineral in the body
regulating blood pressure, blood clotting, and muscular movements
Calcium
Main types of NutrientsNon-Energy Supplying
NutrientsMinerals
Involved in Needed for strong bones and
teeth
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Bones store calcium Osteoporosis
Bones lose mineral density and strength
Aging people, especially menopausal women, are at risk
Calcium
Main types of NutrientsNon-Energy Supplying
NutrientsMinerals
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Most of the body’s iron is in hemoglobin, which is in red blood cells
The iron in hemoglobin picks up oxygen from the lungs and transports it to the cells.
Iron
Main types of NutrientsNon-Energy Supplying
NutrientsMinerals
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Sources of vitamins & trace elements
Vit. AVit. E
Vit. DVit. KVit. B1 Vit. B2Vit. B3Vit. B12
Vit. B6Vit. CIro
nCalciumBody
buildingEnergy FoodsProtectiv
efoods
liver m
eat m
ilk berries
Required homework.
Included in the EXAM
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Variety of functions: Helps transport of materials in the body, Involved in many chemical reactions.Beverages and most foods, especially fruits and vegetables, supply waterDiuretics such as alcohol and caffeine increase losses of water from the body
Main types of NutrientsNon-Energy Supplying
NutrientsWater
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To be properly hydrated, a person needs at least 8 cups of water daily
Dehydration can be deadly Sports, drinks replenish minerals and
water that are lost during heavy exercise
Main types of NutrientsNon-Energy Supplying
NutrientsWater
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Thirst sensation is not sensitive enough Continue drinking after you are no longer
thirsty Clear or near clear urine indicates
hydration
Main types of NutrientsNon-Energy Supplying
NutrientsWater
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Signs of Dehydration Headache Fatigue Needlessly lifeless Dark, concentrated urine
Main types of NutrientsNon-Energy Supplying
NutrientsWater
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Malnutrition is a pathological state resulting from a relative or absolute
deficiency or excess
of one or more of the essential nutrients.
Definition:
MALNUTRITION
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Under-nutrition:
MALNUTRITION
Over-nutrition:
The major forms of malnutrition :
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It is a pathological state resulting when nutrient intake does not meet the nutrient needs for cell activities and body maintenance.
Under-nutrition:
MALNUTRITIONThe major forms of
malnutrition :
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It includes: Macronutrient deficiency e.g., protein-
energy malnutrition (marasmus &kwashiorkor).
Micronutrient deficiency e.g. iron deficiency anaemia, vitamin A deficiency, Iodine deficiency….etc.
Under-nutrition:
MALNUTRITIONThe major forms of
malnutrition :
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The major malnutrition problems in the world are:
1 .Protein–energy malnutrition (PEM)2. Iron deficiency anaemia3. Iodine deficiency disorders (IDD)4. Vitamin A deficiency (VAD)
Under-nutrition:
MALNUTRITION
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Over 2 billion people suffer from some form of iron deficiency
One of the most common nutritional disorders worldwide.
Iron deficiency anemia Under-nutrition:
MALNUTRITIONThe major forms of
malnutrition :
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incidence Africa & South Asia.
Under-nutrition:
MALNUTRITIONThe major forms of
malnutrition :
Parasitic infestation contributes to high percent of cases in developing countries.
Common causes are dietary deficiency and chronic blood loss
Iron deficiency anemia
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Reduces work capacity, thus reduces productivity & earnings
Associated with 50% of maternal deaths Retards fetal growth, causes low birth
weight (LBW) & increases infant mortality Impairs ability to resist disease; in
childhood it reduces learning ability
Consequences
Under-nutrition:
MALNUTRITIONThe major forms of
malnutrition :
Iron deficiency anemia
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Improving Iron status Iron tablets Iron fortification of basic foods (bread) Increased consumption of iron rich
foods & factors which enhance absorption(e.g. vit. C)
Control of parasitic infections
Under-nutrition:
MALNUTRITIONThe major forms of
malnutrition :
Iron deficiency anemia
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2 billion people worldwide at risk of IDD At least 655 million with goitre 43 million with some degree of mental
impairment 11 million with cretinism Moderate Iodine deficiency is associated
with average reduction of over 13 IQ points
Iodine deficiency disorders(IDD)
Under-nutrition:
MALNUTRITIONThe major forms of
malnutrition :
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Adequate intake of Iodine can: prevent all IDD make milder forms of goiter disappear improve development of older
children mildly affected
Prevention of(IDD)
Under-nutrition:
MALNUTRITIONThe major forms of
malnutrition : Iodine deficiency disorders(IDD)
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Severe forms of IDD such as cretinism, cannot be reversed; but, can be prevented by:
Prevention of(IDD)
Under-nutrition:
MALNUTRITIONThe major forms of
malnutrition :
Adequate intake of Iodine during pregnancyNow, iodized salt is all over the world
Iodine deficiency disorders(IDD)
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Vitamin A deficiency (VAD)
May be subclinical, severe or moderate Clinical (xerophthalmia)
2.8 million children 0-4 years old Blindness, total or partial
at least half a million children a year about half die within a few months
Under-nutrition:
MALNUTRITIONThe major forms of
malnutrition :
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Conjunctival xerosis
The signs of Vitamin A deficiency (VAD)
Under-nutrition:
MALNUTRITIONThe major forms of
malnutrition :
Follicular hyperkeratosis
Night blindness
Vitamin A deficiency (VAD)
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The signs of Vitamin A deficiency (VAD)
Under-nutrition:
MALNUTRITIONThe major forms of
malnutrition :
Keratomalacia
Corneal xerosis
Bitot's spots
Vitamin A deficiency (VAD)
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Improving vitamin A status Increased intake of vitamin A rich
foods e.g. eggs; butter, whole milk; liver; red palm oil; dark green, yellow & red fruits
& vegetables Fortification of food (oils &
margarine) Supplements e.g. capsules of
Vitamin A 2-3 times per year to young children
Under-nutrition:
MALNUTRITIONThe major forms of
malnutrition :
Vitamin A deficiency (VAD)
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It is a pathologic state resulting when nutritional intake exceeds
the body needs. This leads to caloric excess, usually over an extended period of time.
Over-nutrition:
MALNUTRITION The major forms of
malnutrition :
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It is a disorder of Body Regulatory System leading to Excess Body Fat
Assessment: Body Mass Index (BMI) Waist Circumference (WC) Waist to Hip ratio (WHR)
Fat
Over-nutrition:
MALNUTRITION The major forms of
malnutrition :
OBESITY
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Causes & Associated Factors
Over-nutrition:
MALNUTRITION The major forms of
malnutrition :
OBESITY
Genes Metabolism Behavior Environment Culture SES
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Assessment of ObesityOver-nutrition:
MALNUTRITION The major forms of
malnutrition :
Body Mass Index (BMI)
Waist circumference
Waist Hip Ratio (WHR)
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Assessment of Obesity
The international standard for assessing body size in adults .
BMI is computed using the following formula: BMI = Weight (kg)/ Height (m²)
Evidence shows that high BMI (obesity level) is associated with:
• type 2 diabetes & • cardiovascular morbidity & mortality
Over-nutrition:
MALNUTRITION The major forms of
malnutrition :
Body Mass Index (BMI)
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BMI (WHO - Classification)Underweight…………………………………….……………….<18.50Normal range…………………………………..……….….18.50 - 24.99 Overweight …................................................….25.00 - 29.99(Pre-obese) Obese class I…………………………………………....30.00 - 34.99 Obese class II………………………..……………...35.00 - 39.99 Obese class III……………….................…..≥40.00
Source: Adapted from WHO, 1995, WHO, 2000 and WHO 2004.
Over-nutrition:
MALNUTRITION The major forms of
malnutrition :
Assessment of ObesityBody Mass Index (BMI)
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Waist circumferenceWaist circumference predicts mortality better than any other anthropometric measurement.Waist measurement alone can be used to assess obesity.Two levels of risk have been identified:
Over-nutrition:
MALNUTRITION The major forms of
malnutrition :
Assessment of Obesity
MALES FEMALELEVEL 1 > 94cm > 80cmLEVEL2 > 102cm > 88cm
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Level 1 is the maximum acceptable waist circumference irrespective of the adults and there should be no further weight gain.Level 2 denotes obesity and requires weight management to reduce the risk of type 2 diabetes & CVS complications.
Over-nutrition:
MALNUTRITION The major forms of
malnutrition :
Assessment of Obesity
MALES FEMALELEVEL 1 > 94cm > 80cmLEVEL 2 > 102cm > 88cm
Waist circumference
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Waist Hip Ratio (WHR)
Visceral obesity (apple shaped)
Peripheral obesity (Pear shaped)
WHR > 0.8 F > 1.0 M
WHR< 0.8 F< 1.0 M
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Interpretation of WHR Females: WHR= >0.80 or >80% Males: WHR= >0.95 or >95% It indicates central (upper body) or
visceral obesity and is considered high risk for diabetes & CVS disorders.
A WHR below these cut-off levels is considered low risk (peripheral obesity).
Waist Hip Ratio (WHR)
High risk :
Over-nutrition:
MALNUTRITION The major forms of
malnutrition :
Assessment of Obesity