nutrition exam 1

What are the Sustainable Development Goals? How do they relate to nutrition?

17 goals that were set by the UN in 2017 for peace and prosperity while tackling climate change

• They want to protect the health of the planet while also protecting the health of the people

Aim to end all forms of poverty

• Recognize that ending poverty goes hand in hand with economic growth and social needs (ex: education, job opportunities, etc.)

The germ

The embryo that has the potential to become a new plant

Contains many vitamin Bs, some protein minerals, and healthy fats

The bran

Outer shell

Multi-layered outer skin

Contains antioxidants, B vitamins, and fiber

The endosperm

The germ’s food supply

Has lots of sugar for the future plant that will grow

The largest portion of the kernel

Contains starchy carbs, proteins, and small amounts of vitamins and minerals

Refined grains

Will have removed at least one of the three original plants

Typically, it will keep the endosperm, although this causes the grains to be nutrient-deficient

Kwshiokor

Usually, an indication of protein-energy malnutrition

The biggest indicator is edema in the ankles, feet, and abdomen

Hidden hunger

Impaired health outcomes that aren’t so visible

o   They don’t show normal symptoms associated with hunger and malnutrition, but they have impaired health and development

How do we classify micronutrients?

o   First into vitamins (organic) and minerals (inorganic)

o   If vitamin:

• Into fat-soluble and water-soluble

What are the causes and consequences of anemia?

It can be caused by a deficiency in:

o   Iron, B12, Vit C, non-nutritional causes

Consequences

o   Fatigue, weakness, dizziness, and drowsiness

o   Complications during pregnancy

o   Impaired cognitive development

Potential interventions

o   Iron and folate acid supplements

o   Dietary diversification

o   Non-nutrient interventions

Iron - what are some dietary sources? Are there important differences between animal vs plant-source foods for that micronutrient? What are the functions of that nutrient? consequences

Sources

§  Heme iron (meat, poultry, and fish) or non-heme iron (plants and dairy)

§  Absorption is dependent on dose and other nutrients

Animal sources (heme iron) have higher bioavailability and absorb iron at a faster rate, while plant sources (non-heme iron) are less likely to be absorbed

Functions

·       Oxygen transport

·       Also important in enzyme systems, like the regulation of cell growth and differentiation, and immune function

consequences

• anemia

Iodine - what are some dietary sources? Are there important differences between animal vs plant-source foods for that micronutrient? What are the functions of that nutrient? consequences

Sources

§  Seaweed and seafood, iodized salt, yogurts, fruits, and veggies (will depend on the soil

Functions

§  Essential component of thyroid hormones

·       Thyroid hormones are essential for the development and differentiation of cells

·       Involved in metabolic rate, macronutrient metabolism, heat regulation, growth, and sensitivity to catecholamines

No difference between animal vs plant sources?

consequences

• hyperthyroidism

• goiter

• mental retardation

• impaired growth and development

zinc - what are some dietary sources? Are there important differences between animal vs plant-source foods for that micronutrient? What are the functions of that nutrient? consequences

Sources

§  Animal sources (beef, poultry, oysters, crab meat)

§  Plant sources (bean nuts, dairy, etc.)

·       Phytates found in whole grain breads, cereals, and legumes inhibit bioavailability (how well they are absorbed)

Animal sources will have better bioavailability than plant sources

§  The plant sources will have the phytates

§  Since zinc and iron are found in the same foods, the phytates will also inhibit the bioavailability of the iron

Functions

§  Component of >100 enzymes

§  Essential for cell growth and differentiation

§  Essential for the immune system and the GI tract

§  Good for diarrhea treatment because it reduces the duration and severity

consequences

• dwarfism

vitamin a - what are some dietary sources? Are there important differences between animal vs plant-source foods for that micronutrient? What are the functions of that nutrient? consequences

Sources

§  Animal products (beef, eggs, and mostly liver and fatty fish) - retinol

§  Orange and yellow fruits – beta carotene

§  Green leafy veggies

Functions

§  Essential for vision, cell function for growth, epithelial cellular integrity, immune function, and reproduction

§  Vit A deficiency → night blindness

§  Can reduce all-cause mortality

Animal sources have more bioavailability than plant sources

§  Plant sources need to be converted into vitamin A

consequences

• night blindness → blindness

• Increases susceptibility to infection and mortality in pregnant women and young children

folate - what are some dietary sources? Are there important differences between animal vs plant-source foods for that micronutrient? What are the functions of that nutrient? consequences

Most B vitamins work together

Don’t give you energy, but you need them to produce energy

Folate is a B vitamin naturally found in food

We make the synthetic form of folic acid, and it’s also found in supplements/fortified foods

Sources

§  Green leafy veggies, liver, lima beans, etc.

§  Folic acid is used to fortify things like flour, cereal, etc., and it’s also found in supplements

Function

§  RBC formation

·       That is why it is usually given with iron

§  Essential for making new cells, protein synthesis, and metabolism

consequences

• Megaloblastic anemia

• neural tube defects

Why is it important to be able to measure nutritional status in global health? When might researchers and/or practitioners measure nutritional status?

Why it’s important

o   To assess changes over time or to compare across regions

o   To identify vulnerable individuals/communities for an intervention

o   To evaluate an intervention

They might want to do it whenever they want one of the above

What are the ABCDs of nutritional assessment?

Anthropometric data

o   Growth/anthropometry

o   Body composition analysis

Biochemical

o   Nutrients or their metabolites

Clinical/physical examination

Dietary assessment

What is the difference between a “population-level” and “individual-level” food indicator? What is an example of each?

Population-level

o   Won’t really tell you about nutritional intake

o   Collect data on a population level

o   Ex: national food balance sheets

§  They track production, import, export, etc., of a product

§  It can be used to estimate the calories available for consumption for the population on average

o   Ex: household consumption and expenditure surveys

Individual-level

o   Provide a snapshot of one or more domains of dietary quality of an individual

o   They don’t measure intake of calories or nutrients

o   Ex: DDS, food variety scores, etc.

What are the global trends in overweight, obesity, and thinness in women between the ages of 18-45? Is it the same and/or different across different regions?

Overweight and obesity

o   The trend is that they are increasing globally

o   They are most prevalent in the Americas, the Caribbean, and Oceania

Thinness

o   Somewhat decreasing but overall persistent

o   Most prevalent in Africa and Asia

stunting, wasting, and underweight

Wasting

o   Weight for height

o   Can be thought of as thinness

o   Indicates acute/recent malnutrition

§  Can be reversed

o   Severely wasted (<-3 SD) have 11x the risk of dying

Stunting

o   Height for age

o   Can be thought of as shortness

o   Indicates chronic malnutrition

§  Most strongly associated with long-term health outcomes, such as cognitive and motor development, and GDP

§  Not reversible

o   Severe stunting (<-3 SD) has 5x the risk mortality

Underweight

o   Weight for age

o   Could be chronic or acute/recent malnutrition or both

§  It’s a less informative indicator

o   Used in some programmatic settings because it doesn’t require height measurement

§  This can be difficult to attain

§  It’s for this same reason that this indicator is less informative

Review the Victora article - main objective, take-home message, interpret figures, and low birth weight

What was the main objective of the study?

o   Wanted to describe the growth patterns in low and middle-income countries and compare them with the WHO curves

§  This is because the WHO curves were tested in healthy, high-income participants

o   Wanted to identify the critical window for intervention

What was the take-home message?

o   The first two years of life (1,000 days) are when there is a critical window during which we can intervene at

§  This reality is much lower than the healthy people that the WHO tested

o   This is when the worst and irreversible problems happen

Be able to interpret the figures we discussed in class. How do these figures elucidate the main messages of the article?

o   Large decline in stunting z-scores (more stunting is happening) during the critical window

o   Not as big a decline for underweight, but notice SEARO already starts low

§  Emphasizes that maternal nutrition is also super important

What is low birth weight? Why is it relevant to the Victora article?

o   When a child is born weighing under 2500g

§  Either because of prematurity or fetal growth restriction

o   Early vulnerability is later linked to growth faltering  again highlights how important maternal nutrition is