National Food Policy Capacity Strengthening Programme NFPCSP

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National Food Policy Capacity Strengthening
Programme (NFPCSP)   TRAINING COURSE ON  FOOD AND
NUTRITION BACKGROUND FOR POLICY
ANALYSIS Module 4 Nutritional Indicators,
Deficiency Diseases and Current Nutrition
Situation in Bangladesh Lecture Protein Energy
and Malnutrition (PEM) in Childhood and Chronic
Energy Deficiency (CED) in Women      by Harun
K.M. Yusuf and Lalita Bhattacharjee Nutrition
Advisors, GoB/FAO NFPCSP Biplab K. Nandi Senior
Food Nutrition Officer, FAO RAP
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Changing food intake pattern in Bangladesh
(g/capita/day)
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Prevalence of goitre in Bangladesh (a) Children
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Prevalence of iodine deficiency (UIElt100 ?g/L) in
school-aged children and women in 1993, 1996 and
2004-5
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What is adolescence?   Adolescence is the period
when a growing child experiences a linear growth
spurt to attain his or her fullest potential of
adult height, shape, body composition, physical
and sexual function.   Adolescence includes
puberty, which consists of the beginning of the
characteristic physical developments that differ
in boys and girls, due to differences in hormonal
functions in male and female body.
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Secondary sexual characteristics emerge, with the
onset of menarche (periods) in girls and
semenarche (production of semen) in boys.   These
physical developments are accompanied by marked
changes in psychological and emotional make-up,
characteristic of teenage behaviour.   Adolescen
ce begins approx. 2 years earlier in girls than
in boys, with acceleration of growth of muscle in
boys and deposition of adipose tissue in
girls. According to WHO, the age of 10 to 18
years is the period of adolescence.
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The adolescents need more nutrition to support
their growth spurt. They also need energy for
school, work and play. These needs remain often
unmet as older children and adolescents tend to
eat less food than what they need, or they may
not get enough food inside or outside the home.
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Adolescent boys experience rapid muscular growth
and engage in more physical activities than girls
so they need more energy foods.   Adolescent
girls, because of menstruation, need more iron
than boys. Iron is essential for building and
maintaining blood supplies and giving the blood
it red color. Girls should eat more foods high in
iron such as liver, egg yolk, lean meat, green
leafy and yellow vegetables, dried beans, dried
fruits and vegetables and unpolished rice.
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Older children and adolescents usually prefer
sugary, fatty or salty foods for snacks. These
foods often have low nutritional value and may
take the place of suitable snacks that will
provide the needed nutrients. These foods may
also encourage obesity and tooth decay.
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While nutrition for adolescent boys is important,
the adolescent girls deserve special attention to
prepare them to take the physiological load of
motherhood that they are destined to take in
course of time. This is important in countries
and societies where girls get married during
adolescence period. In Bangladesh, 80 of
adolescent girls get married between the age of
14 and 18, i.e. at a time when their own growth
is yet to be complete. Malnutrition in adolescent
girls is therefore a matter of great importance
as far as the health and nutrition status of the
future generation is concerned.
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Not much study has been done on the nutritional
status of adolescent girls in Bangladesh. In one
small study on 909 children, malnutrition was
found high among both adolescent girls and boys
in a rural area (see Table).
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Table Prevalence of PEM among adolescent
children in a rural area of Bangladesh
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Women of reproductive age The reproductive age in
Bangladeshi mothers is considered as 15 to 44
years. CED in women of reproductive age is
measured by height and by Body Mass Index (BMI).
  Height lt145cm and BMI lt18.5 kg/m2 is
indicative of chronic CED.
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According to studies of different organizations,
nearly half (45) of women in rural Bangladesh
suffer from CED, although there has been a
decreasing trend since 1992 when the prevalence
was 76. The prevalence decreased from 62 to 35
in urban areas over the same period of time.
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CED is found higher in women aged below 20 years
and above 34 years. CED is much more prevalent
among women of rural (48.7) than urban (29.9)
areas (see Figure).
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Reports from NIPORT and HKI show highest
prevalence of CED in Sylhet division and lowest
prevalence in the divisions of Khulna and
Chittagong.
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• Weight gain during pregnancy
• Weight gain during pregnancy is an indicator of
  nutrition of pregnant women.
• A weight gain of 11-13 kg is ideal.
• According to various studies, weight gain during
  pregnancy in Bangladeshi mothers is only 7-9 kg,
  indicative of poor nutritional status of the
  mother and poor growth of the foetus.
• The foetus is born with low birth weight (lt2.5
  kg).
• Over one-third (36) of Bangladeshi babies are
  born with LBW.

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Lactating mothers   Lactation is the period when
the mother feeds her baby through the breast. On
an average, some 600 to 800 ml of milk are
produced by a mother every day.   Approx. 1 Kcal
of energy is needed to produced 1 ml of
milk. Malnutrition during pregnancy is likely to
continue after the birth of the baby. A
malnourished mother cannot breastfeed her baby
adequately.   Malnutrition affects the volume of
milk produced, if not its quality.
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Intergenerational transfer of malnutrition   Low-b
irth weight, followed by improper breastfeeding
and faulty weaning, leads to children becoming
stunted or underweight during childhood.   A
stunted or underweight child grows into a stunted
or underweight adolescent.   A stunted or
underweight adolescent girl gets married and
becomes pregnant before she attains her full
physical growth.
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She is likely to suffer from malnutrition during
pregnancy. Her gain in weight during pregnancy is
far less (around 7-9 kg) than desired (11-13 kg).
  She gives birth to a low-birth weight baby.
  The cycle goes on for generations in poor
communities. This is how malnutrition is
transmitted from one generation to the next (see
Figure).
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LBW baby
Pregnancy
Stunted/underweight child
Stunted/underweight woman
Stunted/underweight adolescent
Stunted/underweight man
Figure Intergenerational transmission of
malnutrition