Nutrition and Global Health

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Nutrition and Global Health

• Micheline Beaudry, Ph.D.
• Université Laval

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Learning ObjectivesAt the end of this lecture
you will

• Be aware of the key role played by undernutrition
  in the lives of people societies around the
  world
• Realize that food, though essential, is not
  equivalent to nutrition
• Know that there are affordable solutions wish
  to find out more about them

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At the end of this lecture you will be able to
(performance objectives)

• List the 4 major nutrition problems in the world,
  their major manifestations, consequences global
  distribution
• List the major causes of these problems and
  solutions proposed
• Convince a friend of the opportunities provided
  to improve peoples lives

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The major nutrition problems in the world are

• Protein-energy malnutrition (PEM)
• Iron deficiency
• Vitamin A deficiency or hypovitaminosis A (VAD)
• Iodine deficiency disorders (IDD)
• Nutrition-related chronic diseases

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Protein-energy malnutrition (PEM)

• Stunting
• insufficient height gain relative to age
• implies long-term malnutrition and poor health
• Wasting
• insufficient weight gain relative to
  height/losing weight
• implies recent/acute malnutrition
• Underweight
• insufficient weight gain relative to age or
  losing weight
• implies various combinations of stunting and
  wasting

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Proportion () of underweight children by region,
1985-1995
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PEM and young child mortality

• Malnutrition potentiates the effect of disease on
  child mortality
• The effect is for both mild-to-moderate as well
  as severe malnutrition it is not only due to
  confounding by socioeconomic factors or
  intercurrent illness
• The effect of malnutrition and infection on child
  mortality is multiplicative rather than additive
  as was implicitly assumed

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Other consequences of PEM

• Impaired cognitive behavioral development
• Low educability
• Reduced productivity income
• Poor reproductive health

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Causes of malnutrition

Manifestations
Growth, survival and development
Immediate Causes
Diet intake
Disease
CARE practices for mothersch
Underlying Causes
Access to FOOD
HEALTH serv environ.
EDUCATION
Ressources Control Human, Economic
Organizational
Basic Causes
Political, Ideological Economic structure
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To ensure adequate growth nutrition, it is
necessary to facilitate

• The ability of households to provide CARE for
  mothers young children (e.g. breast-feeding,
  complementary feeding, love...)
• Access by households to sufficient FOOD to lead
  an active healthy life
• Access to adequate HEALTH services (e.g.
  immunization) a healthy environment (e.g.
  clean water)

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Iron deficiency

• Over 2 billion people suffer from some form of
  iron deficiency
• Not all causes of anaemia are nutritional in
  origin yet anaemia linked to iron and/or folic
  acid deficiency is among the worlds major
  nutritional disorders
• Africa South Asia have the highest overall
  incidence of anaemia, followed by Latin America
  East Asia

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Consequences of iron deficiency

• Reduces work capacity, thus productivity,
  earnings ability to care for children
• Associated with 50 of maternal deaths wholly
  blamed for up to 20
• Retards fetal growth, causes low birth weight
  (LBW) increases infant mortality
• Impairs ability to resist disease in childhood,
  reduces learning

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Improving Iron status

• Iron tablets (daily vs. weekly)
• Iron fortification of basic foods
• Increased consumption of iron rich foods
  factors which enhance absorption
• Control of parasitic infections

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Vitamin A deficiency (VAD)

• Subclinical, severe moderate
• 251 million children 0-4 years old
• Clinical (xerophtalmia)
• 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

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Consequences of VAD

• Onset of childhood diseases increases
• Partial or total childhood blindness
• Child mortality increases at least 20-30
• May increase maternal mortality
• May increase HIV transmission

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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 basic foods with vit. A
• Supplements e.g. 2 capsules per year to young
  children

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Iodine deficiency disorders (IDD)

• In 1990 1.6 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

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Other consequences of IDD

• Moderate Iodine deficiency associated with
  average reduction of over 13 IQ points
• Adequate intake of Iodine can prevent all IDD,
  make milder forms of goiter disappear improve
  development of older children mildly affected
• Severe forms of IDD such as cretinism, cannot be
  reversed can only be prevented by adequate
  intake of I during pregnancy

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Progress in iodizing salt

• 60 of all edible salt in the world is now
  iodized in 1997
• Before 1990, some 40 million children were born
  each year at some risk of mental impairment due
  to I deficiency in their mothers diets. By 1997
  is closer to 28 million

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Improving nutrition can lead future progress in
health and development around the world