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what are characteristics of communicable disease
Infectious
Caused by pathogenic or virulent microorganisms
Transmitted from host to host
Usually acute
May be cured with antimicrobial medications
what is an example of a food and water borne disease
E.Coli
Cholera
Rotavirus
what is an example of a sexually transmitted or blood borne disease
HIV
Hepatitis B
what is an examples of inhalation / respiratory tract disease
Tuberculosis
what is an example of a vector borne disease
malaria
what does a Geni score show
inequality in a country, 1 is perfectly equal, 100 Is completely inequal
why do communicable disease have a higher burden in developing countries
Communicable disease has a higher burden in developing countries
Poverty increases vulnerability to disease
Basic causes of malnutrition
Social political ideological superstructure
Underlying causes of malnutrition
Inadequate food security, inadequate woman and child care, insufficient access to health services and an unhealthy environment
Immediate causes of malnutrition
Inadequate dietary intake and disease
what is a nutrition specific intervention
looking at immediate causes
what are characteristics of nutrition specific interventions
look at the immediate causes
Look at adequate food and nutrient intake
Feeding, caregiving and parenting practices
Lowering burden of infectious diseases
what are examples of nutrition specific interventions
Adolescent, preconception, maternal health and nutrition
Maternal micronutrient supplementation
Promotion of optimum breastfeeding
Dietary supplementation
Disease prevention and management
Treatment of acute malnutrition
what does a nutrition sensitive intervention do
look at the underlying causes
what are characteristics of nutrition sensitive interventions
Food security
Caregiving resources
Access to health services
Safe and hygienic environment
what are examples of nutrition sensitive interventions
Agriculture and food security
Women’s empowerment
Water sanitation and hygiene
Health and family planning services
Schooling
what is diarrhoea a carrier of of
pathogens, especially in developing countries
what does diarrhoea lead to in infants
villous atrophy
what does villous atrophy lead to
decreased absorptive capacity
what happens to ingested lactose for pt with diarrhoea disease
meets damaged villi, lactase enzymes not present here, lactase not fully hydrolysed.
lactose enters bloodstream, removed by kidneys leading to lactosuria
what can diarrhoea in infants lead to
Stunted growth
Associated developmental delay
Disruption of immune function
Higher risk of illness and death
what are characteristics of HIV
weakened and depleted immune system
how does HIV survive
targets CD4 T-Cells (immune cells) and replicates there
HIV strains 1 and 2
how is HIV transmitted
Via mucous membranes
Sexual intercourse
Contact with infected secretions
Vertical transmission
Mother to child transmission
In utero
During labour
Breastfeeding
Contact with injected bodily fluids
Needle stick injuries
Sharing needles
what is the 7 step life cycle of HIV
binding
fusion
reverse transcription
integration
replication
assembly
budding
what are symptoms of HIV
Lymphoma
Herpes simplex
Oesophageal thrush
Oral thrush
what are the reasons for the improved prevalence, cases and survival rates of HIV
Improved access to treatment
Improvement in life expectancy
Societal impact
People live longer but require care
HIV is now like a chronic condition, and so dietetic advice is general healthy eating
what is the treatment for HIV
Antiretroviral therapy medication
how has ART medication moved forward HIV
Changed HIV/AIDS from progressive, terminal illness to chronic manageable disease
how does ART work
Six classes of drugs, working at different stages of the HIV life cycle
To interrupt life cycle of HIV
what is important in ART
adherence to treatment
what are the 6 types of ART drug
entry inhibitors
fusion inhibitors
nucleoside reverse transcriptase inhibitors
non-nucleoside reverse transcriptase inhibitora
protease inhibitors
how do entry inhibitors work
binds to CCR5 receptors on immune cells, blocking use as a co-receptor for cell entry by HIV
how do fusion inhibitors work
block gp41, a viral surface protein, preventing conformational surface change necessary to allow viral fusion to cell membranes
how do nucleoside reverse transcriptase inhibitors work
work on viral reverse transcriptase enzyme which converts viral RNA into DNA copies
NRTIs are nucleus acid analogues, and terminate DNA chain as reverse transcriptase copies viral RNA into DNA
effect human DNA processing enzymes, affecting mitochondrial DNA
how do non-nucleoside reverse transcriptase inhibitors work
similar action to NRTIs, blocking
how to integrate inhibitors work
block the integrate enzyme which incorporates viral copy DNA into cellular DNA
how do protease inhibitors work
bing to viral protease
what is the recommendation for a pt starting ART
start ART containing 2 NRTIs plus one of PI/r, NNRTI or INI
what are the dietary considerations with ART
Side effects frequently observed
Some ARVs better absorbed with or without food
Side effects may be improved with or without food
Interactions with other meds and or food
Generally far less complicated due to modern medications
Timely adherence to prevent resistance which may link into meal patterns
what are the dietary recommendations for pt starting ART
eat well guide
what is the nutritional management of anorexia as an ARV side effect
eat small and frequent meals
eat favourite foods
select foods that are energy dense
avoid strong smelling foods
what is the nutritional management of change or loss of appetite as an ARV side effect
use flavour enhancers
chew food well and move around mouth to stimulate receptors
what is the nutritional management of constipation as an ARV side effect
eat foods high in fibre
drink plenty of fluids
avoid processed or refined foods
exercise regularly
what is the nutritional management of diarrhoea as an ARV side effect
drink plenty of fluids
eat energy and nutrient dense foods
what is the nutritional management of flatulence as an ARV side effect
avoid gas forming foods like beans, cabbage, broccoli, cauliflower
what is the nutritional management of high blood cholesterol as an ARV side effect
eat a low fat diet and limit intake of foods rich in cholesterol and saturated fat.
eat fruit and vegetables and whole grains daily.
exercise regularly
what is the nutritional management of high triglycerides as an ARV side effect
limit sweets and excessive carbohydrate and saturated fat intake
eat fruit and vegetables and whole grains daily.
avoid alcohol and smoking
exercise regularly
what is the nutritional management of nausea and vomitting as an ARV side effect
small quantities of food at frequent intervals
drink after meals
limit intake of fluid with meals
avoid having an empty stomach
avoid lying down after eating
eat lightly salty and dry foods to calm the stomach
rest between meals
what are the 5 steps to support pt on ART
identify specific food and nutrition interactions with drugs
identity available accessible foods
plan diet and drug timetable
follow up
adjust
why does malnutrition and wasting occur
Due to
reduced oral intake
Malabsorption
Hyper metabolism
what is poor nutritional status associated with
disease progression, morbidity and mortality
what are examples of Targeted food supplementation programmes
Supplementary feeding
Therapeutic feeding
Food as an incentive
Improving adherence to ART/TB treatment
School feeding schemes
what is the current advice on HIV mother breastfeeding
If viral load suppressed, no reason not to breastfeed
what is the pathogenesis of tuberculosis
entry into host
bacilli inhaled as droplets into alveoli
primary infection
infected macrophages
clearance of infection
latent infection
reactivation
granuloma formation
active infection granuloma maturation
adaptive immune response
containment of infection
caveating granuloma
dissemination and transmission
what is the treatment of tuberculosis
Isoniazid
what are the nutrition related side effects of Isoniazid
Constipation
Dry mouth
GI disorders
Hypoglycaemia
Nausea
Nicotinic acid deficiency
Vomitting
what should you check for with pt on isoniazid
vitamin B3 deficiency
what is the nutrition related advice for pt on isoniazid
Adequate diet meeting all macro and micro nutrient needs
Nutritional screening needed
Look for food insecurity and poverty
Consider low cost so that compliance with drugs is increases
Antibiotic needs to be taken with food
what are the comorbidities for tuberculosis
HIV, diabetes mellitus, smoking and alcohol or substance misuse, which have their own nutritional implications, and these should be fully considered during nutritional screening assessment and counselling
what are symptoms of tuberculosis
productive cough
structural abnormalities
chest pain
cough with increasing mucus/ blood
fever
weight loss
night sweats
weakness
