Emerging problems of Food

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Emerging problems of Food Nutrition
Malnutrition Double burden

• Farzana Ishrat
• March 22 2007

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What are the changes?

• less physical activities (elevators escalators,
  automatic doors, cars, disappearing playgrounds
  RAJUK EXPERIENCE
• sedentary work
• items of leisure -- TV and videos, computers,
  computer games, cellular phones etc
• Salty, sugary, fatty processed food wrapped in
  attractive packages wekx cY wKb nB aY
• smoking, though not food item is very important
  aggravating factor

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Malnutrition Double burden
defn. disease conditions that were hardly seen
till the early 20th century

due to changes in food dietary pattern and
lifestyle
Genetic factor central obesity (pot belly)
Poorest countries are the worst hit (WHO)
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Definitions

• Malnutrition various forms of poor nutrition
  caused by a complex array of factors including
  improper diet, infections, and socio-cultural
  factors.
• Under weight or undernutrition
• Overweight
• Micronutrient deficiency ( the hidden hunger)

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Definitions

• Overweight excess weight relative height
  measured by BMI
• BMI 25-29.99 is grade I overweight
• BMI 30-39.99 is grade II obese
• BMI gt40 grade III (frank or morbid obesity)
• overweight in children measured as weight
  -for-height two z scores above the international
  reference

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Definitions

• Obesity abnormal or excessive fat accumulation
  in adipose tissue, that health may be impaired
  (WHO).
• - result of chronic positive energy balance
  The excessive body fat content measured by BMI.
  BMI gt 30 is obese

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Definitions

• Diet related NCDs chronic illnesses that
  result from altered dietary pattern and changed
  lifestyle.
• Dietary modification can successfully arrest the
  development of NCDs and halt the global epidemic

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Definitions

• BMI
• bodyweight in kg. divided by height in meters
  squared. (kg/m²).
• BMI gt 25 kg/m²(overweight)
• BMI lt18.5 kg/m² (underweight) --- poor health and
  nutrition status
• Double burden of malnutrition
• the nutritional status of a population
  characterized by both Under-nutrition and
  over-nutrition, (in the same community/family)
  the population/region is said to be attacked by
  the double-burden of malnutrition

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Emerging problems and their causes

• Obesity
• calorie dense food including free sugar
• less physical activities,
• stunting in childhood
• not breastfeeding
• ignorance
• urbanisation

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Emerging problems and their causes

• Diabetes mellitus
• calorie dense food
• less physical activities
• LBW
• Not breastfeeding
• Obesity
• ignorance
• Urbanization

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Emerging problems and their causes

• Cardio-Vascular Diseases
• calorie dense food
• less physical activities
• tobacco smoking / chewing
• LBW
• Obesity
• ignorance

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Emerging problems and their causes

• Hypertension stroke
• high salt containing diet
• calorie dense food
• less physical activities,
• LBW
• Obesity
• ignorance
• urbanization

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Emerging problems and their causes

• Osteoporosis
• Less physical activities
• Less vegetable containing diet -- vegetarians
  suffer less
• Dental diseases
• bottle feeding
• high sugar containing food chocolates,
  ice-cream, free-sugar rich dessert
• ignorance
• urbanisation

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Emerging problems and their causes

• Some types of cancer
• high fat containing diet etc
• less fibre in the diet
• NOTE
• Undernutrition is a terrible TIME-BOMB that paves
  the way for overnutrition NCDs later (Barker
  theory)
• Genetic predisposition

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Myths

• NCDs mainly affect high income countries even
  today many doctors have this impression because
  textbooks have pretty old information. In spite
  of receiving high numbers of stroke, IHD and DM
  patients from among the rural and urban poor
• Low and middle income countries should first
  control infectious diseases before chronic
  diseases --- they are in the middle of both the
  old and emerging dietary challenges

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Myths

• NCDs affect mainly the rich people -- poor are
  not only more affected but die more leading to
  further poverty of the survivors
• NCDs mainly affect the old -- premature deaths
  occur in people less than 65-70yrs

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Myths

• NCDs affect primarily affect the male --- almost
  equal in fact cancer breast and uterus is
  exclusively in women
• NCDs are result of unhealthy lifestyles
  --LBW, passive smoking are not the lifestyle of
  the affected
• electronic media promote unhealthy lifestyle

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Myths

• NCDs cannot be prevented -- prevention is the
  mainstay of intervention against NCDs
• NCD prevention and control is too expensive not
  money wise but effort wise yes. People must
  learn to regulate their lifestyle and restrain
  themselves from the luxuries of modern
  technological development

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Myths

• My grandfather smoked and was overweight and
  lived till 96.
• Yes, but he grew up in environment where there
  was no TV making leisure time sedentary no
  adulterated food no energy-dense, sugary or
  salty fast food probably walked to school
  plenty physical activities, and had traditional
  diet including plenty fruits vegetables and
  MOST IMPORTANLY HE WAS BREASTFED!

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Myths

• Everyone has to die of something ---
• true but why suffer the prolonged pain and
  anxiety of NCDs? Mostly they dont cause sudden
  death
• Why spend fortunes on treatment?

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• Situation in Asian countries and Bangladesh

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Asia

• NCDs have now become a global epidemic and Asia
  is leading.
• The industrialised countries have controlled and
  reversed the epidemic
• NCDs have become the major killer in the
  Asia-pacific region
• Obesity is termed Globesity - global prevalence

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Asia

• 60 of total deaths in the region due to NCDs in
  2002 (WHO) ( IDs including HIV/AIDs caused 30
  deaths)
• 50 of the disease burden in DALY due to NCDs in
  2002(WHO)
• Obesity has doubled in China since 1991

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Prevalence of Diabetes in some Asian countries

• Year
• China 1997 2.7
• India 1998 5.8
• Indonesia 1998 4.6
• Sri Lanka 1994 2.9
• Source International Diabetes Foundation

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Bangladesh

• 40 of total deaths were due to NCDs in 2000
• 60 total deaths will be due to NCDs by 2010
• 9.1 urban poor and 4.1 rural women were
  overweight (HKI surveillance 2007)

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Bangladesh

• increasing trend of obesity in both rural and
  urban population
• every second household in the Dhaka city now has
  one or more diabetes patient.

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Greatest challenge

• co-existence of undernutrition, hidden hunger
  (micronutrient deficiency), obesity and other
  NCDs in the same country, in the same community
  and even in the same family pose the Greatest
  challenge to development, to poverty reduction,
  to reaching the MDGs.

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Prevention main intervention

• Prevention should be the mainstay of the
  intervention against the emerging NCDS as well as
  the earlier problem of undernutrition ie double
  burden of malnutrition in resource-constrained
  Bangladesh.
• 3Ms
• man
• Material
• money

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Prevention main intervention

• a concerted effort between all the players that
  have a role in the food chain from farm to the
  dining table.
• farmers,
• transporters traders,
• food processors
• food industries,
• food sellers food buyers,
• the cook AND
• the consumer him/herself).

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Prevention main intervention

• Also important
• ad firms,
• the electronic media,
• school teachers etc
• to promote
• healthy feeding and
• health eating behaviour
• healthy lifestyles.
• Prevent over-consumption and unbalanced diets
  through information and education

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need of the hour

• an integrated intersectoral food and nutrition
  action.
• The common policy options and intersectoral
  strategic framework should include at least
• Exclusive breastfeeding for first 6 months (180
  days)
• Appropriate and adequate complementary feeding
  practices from the 7th month with continued BF up
  to 2 yrs or beyond

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need of the hour

• Promotion of agriculture policies that support
  healthy dietary patterns
• Promotion of trade policies thee improve food
  and nutrition security
• Development of infrastructure
• Promotion of transportation policies
• Development of school policies that promote
  schools to be nutrition-friendly
• Promote physical activities at all level of life

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WHO/FAO recommendation for prevention

• Avoid excess weight gain --- max 5kg
• Increased physical activity --- sedentary
  occupations (not only office workers but also
  cooks! tailors)
• Limit energy intake reduce high energy, fat or
  free sugar content
• saturated fat should not be gt 10 of toal calorie
• Consume more low energy food fruits,
  vegetables, cereals high in fibre sprouted
  beans

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WHO/FAO recommendation for prevention

• Fresh fruit intake 200gm/d
• vegetable intake 400g/day
• Limit salt or sodium intake
• Increase fish consumption, preferably sea fish
  BUT free from formalin
• Median BMI of adult population ---- 21-23

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Immediate actions

• Raising public awareness
• schools,
• electronic media,
• billboards etc.
• ( media has very important role _ eg TV drama
  serials show serving and drinking of green
  coconut water or lassi or fresh fruit juice.
• instead of the so called trendy sugary
  softdrinks

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Immediate actions

• Encouraging periurban horticulture production
  development there are at least 30 different
  types of locally produced seasonal fruits in the
  country. Unfortunately the apples and grapes
  have displaced them even in the remotest
  villages. This must be reversed before the
  species become extinct.

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Immediate actions

• Regulations in the food industry
• Not just formulating regulations but their strict
  implementation against
• Food adultery
• Limiting salt content of packaged food
• Limiting fat content
• Limiting ads eg. Malaysia is currently
  considering banning of fast food ads

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Immediate actions

• Save the future generation
• Increasing physical activities
• Moving out from the City
• Schools with large playgrounds
• Stop the culture of keeping children farmed in
  apartments
• Building regulations to ensure playgrounds in
  every locality
• Reduce TV/ Video/ computer viewing

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Our commitment

• Before we close today, lets all commit ourselves
  to save ourselves and our future generation from
  the curse of the double-burden of malnutrition.
• Lets each of us take at least one step from
  TODAY to prevent the NCDs in our family and
  community.

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• THANK
• YOU