1. UNIVERSITY OF AGRICULTURE MAKURDI
255TH SENATE
September 27, 2001

2. Nutrition, your family & you
Frank Onyezili

3. Presentation Outline Nutrition’s Conceptual Framework
Nutrition/Stress and handling stress
Nutrition Package, RDA, RDI, RDV and BMI
Under 5 nutrition, and what can go wrong
The health triangle, sleep and exercise
Last word

4. What is Adequate Nutrition?
Nutritionally-adequate dietary intake (addressing, in particular, the four most important forms of malnutrition (i.e. protein energy malnutrition (PEM), vitamin A deficiency, iron deficiency anaemia, and iodine deficiency)
In this context:
inclusive of the economic, social, political, and cultural causes of malnutrition
not directly related to disease factors affecting the processes of digestion, absorption, transport, and utilization of the nutrients

5. There’s a Conceptual Framework (from Unicef), with a common thread
What is Malnutrition?
There’s a Conceptual Framework (from Unicef), with a common thread

6. A common Thread !!
Malnutrition
Manifestation
Immediate Causes
Inadequate dietary intake
Disease
Insufficient Health Services & Healthy Environment
Insufficient Household Food security
Inadequate Maternal and ChildCare
Underlying Causes
Inadequate Education
Conceptual Framework (simplified) of the causes of malnutrition
Resources and Control
(Human, Economic, and Organizational)
Political and Ideological superstructure
Basic Causes
Economic Structure
Potential resources
UNICEF

7. Nutrition and stress have always been linked
Foods with high vitamin and mineral levels actively help to reduces stress levels
(Water, Fresh vegetables, Fresh fruits, Fish, Soups, Yoghurts
Herbal products)
Certain foods and drinks can aggravate stress (i.e. consume them in moderation), e.g. Tea, coffee, cocoa, energy drinks, fast foods and takeaways, Butter, cheese, Meat and shellfish, Sugar, Alcohol, Soda, soft drinks and chocolate drink, Coconut oil

8. What is stress?
Pressure that triggers physiological responses (the fight or flight responses that increase heart rate/blood pressure)
Down to what we feel/think about a situation and happens when we feel we can’t cope with situation
Focuses our attention on the threat; we sense hostility
Many day-to-day situations can set it off - a change of home, a difficult boss, divorce, separation, demanding children, traffic jams, the fear of Boko Haram and so on
We soon begin to operate at fever pitch level; we’re left with stress build up ,

9. Signs of stress Depression, Sleep problems Tension/anxiety
Work mistakes
Poor concentration
Apathy
Many others

10. What do we do to control Stress?
We learn to control our reactions (this does not counteract the stress response, though)
Control our :
excitability
anxiety, jumpiness and irritability
So that we can
work more effectively
execute precise, controlled skills
be open to information from other sources
make more balanced and rational decisions

11. Handling stress Assess what is stressful/the causative factor/s
Prioritize tasks/limit distractions
Seek social support (family/friends)
Practice thought management (there may be some professional books on this)
Exercise & Quiet time
Eat a healthy, adequate diet
Get adequate sleep (practice ‘sleep hygiene’)
Take your earned leave!

12. Adequate Nutrition is a basic Nutrition package
Adequate maternal (paternal too?) Nutrition
Optimal infant and Young child feeding
Micronutrient supplementation
De-worming (albendazole, periodicity & infestation)
Growth monitoring
Good Childcare Practices

13. Defining some terms (1) The Recommended Dietary Allowance (RDA)
developed during world war II by America’s National Research Council
states the amount of a nutrient that is needed for most people to stay healthy. They are different for children, adults, males, and females
includes a "margin of safety”

14. Defining some terms (2)
Reference Daily Intake (RDI), formerly called Recommended Dietary Allowance (RDA).
daily dietary intake level of a nutrient considered sufficient to meet the requirements of nearly all (97–98%) healthy individuals in each life-stage and gender group
a collaborative effort between the USA and Canada
RDI is used to determine the Recommended Daily Value (RDV)
Uses of RDV include
food labels
composition of diets for schools, prisons, hospitals or nursing homes
industry developing new foodstuffs
healthcare policy makers and public health officials

15. Defining some terms (3) Body mass index (BMI) or Quetelet Index
a statistical measure of the weight of a person scaled according to height
invented between 1830 and 1850 by the Belgian polymath Adolphe Quetelet
Measures body fat based on height and weight
applies to both men and women between the ages of 18 and 65 years
can be used to indicate if you are overweight, obese, underweight or normal. (healthy BMI score is between 20 and 25; below 20 indicates underweight; above 25 indicates that you may be overweight)

16. RDA for people 4 years or older, eating 2000 Calories per day
The RDA (1)*
UNICEF

17. The RDAs (2)
UNICEF

18. RDI listings (1)* Fat-soluble vitamins
* first figure refers to the old RDA listing while the second figure refers to the newer DRI listing

19. The RDI listings (2) Water soluble vitamins
* first figure refers to the old RDA listing while the second figure refers to the newer DRI listing

20. The RDI listings (3) Minerals, others
* first figure refers to the old RDA listing while the second figure refers to the newer DRI listing

21. The Body Mass Index (BMI)*
*A graph of body mass index. The dashed lines represent subdivisions within a major class. For instance the “Underweight” classification is further divided into “severe,” “moderate,” and “mild” subclasses

22. The BMI

23. Calculating your BMI*
*A simple numeric measure of a person's "fatness" or "thinness", allowing health professionals to discuss the problems of over- and under-weight more objectively with their patients. But somewhat controversial now, esp. as a medical diagnostic tool

24. A Key Question: Why do we lose our U5s?
Sahel. Major causes of child mortality
Pneumonia
20%
Neonatal
26%
Measles 6%
Others 1%
Diarrhea
16%
Malaria
24%
Malnutrition
53%
Most U5 diarrhea deaths result from dehydration, replaceable (with SSS, ORS, ORT)

25. Nutrition and Growth (1)
Key messages for caregivers:
From birth to age two, children should be weighed every month. (if a child has not gained weight for about two months, something is wrong)
Breastmilk alone is the only food and drink an infant needs until the age of six months
From the age of six months to two years, children need to be fed five times a day, in addition to sustained breastfeeding
Children need vitamin A* to resist illness and prevent visual impairments
* apart from vitamin A capsules, vitamin A can be found in many fruits and vegetables, oils, eggs, dairy products, fortified foods, breastmilk.

26. Nutrition and Growth (2)
More key messages for caregivers:
Children need iron-rich foods** to protect their physical and mental abilities
Iodized salt is essential to prevent learning disabilities and delayed development in children
During illness, children need to continue to eat regularly. After an illness, children need at least one extra meal every day for at least a week.
** the best sources of iron are liver, lean meats, fish, eggs and iron-fortified foods or iron supplements

27. Adequate U5 Nutrition
First two years are critical, including for early stimulation and learning
Next three (i.e. 3-5 years) are important too, including for pre-school learning

28. But what can go wrong?

29. May be not UAM staff, but…
Prevalence of Anemia in Women of Reproductive Age: 25%
ANC, Iron folate, iron-rich diet

30. Iodine deficiency in Pregnant women
3% cretinism
10% moderate/severe mental retardation
87% mild intellectual impairment
Consume adequately iodized salt

31. 500,000 infant deaths annually
Not enough Exclusive Breastfeeding!!!
500,000 infant deaths annually
17%

32. Exclusive breastfeeding (EBF) and HIV
EBF recommended by UNICEF and WHO for where formula feeding is not Available, Feasible, Affordable, Safe and Sustainable (AFASS)
New Findings (Lancet Mar 31, 2007) in KwaZulu-Natal
infants who were exclusively breastfed were significantly less likely to die by month 6 than those that received replacement feeding (6.1% vs 15.1%, hazard rartio 2.06, CI 1.00 * 4.27, p=0.051)
risk of HIV transmission to infants initially breastfed but subsequently fed solids alongside breast milk (n=203) was nearly eleven times higher than among infants who were exclusively breastfed (hazard ratio 10.87, CI 1.51 * 78.0, p=0.018)
Women with low* CD4 counts should receive immediate antiretroviral treatment for their own health and that of their child.
*WHO recommends provision of HAART to pregnant women with CD4 counts lower than 200 cells/mm3

33. Protein Energy Malnutrition: May be not child of UAM staff, but…
0.25 million U5 deaths annually
Protein-rich, Energy- rich diets, but watch out for phytate-rich grains/tubers
UNICEF/Pirozzi

34. Vitamin A Deficiency, again may be not child of UAM staff, but…
30,000 U5 deaths annually
Vitamin A supplements, plus vitamin A-fortified foods, vitamin A-rich dark green vegetables, carrots, mangoes etc

35. The Health Triangle
ADEQUATE NUTRITION
REGULAR EXERCISE
ADEQUATE SLEEP

36. What is sleep hygiene?
Different practices that promote normal, quality night-time sleep and full daytime alertness
Avoid napping during the day
Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime
Exercise {morning or late afternoon, relaxing (yoga?) exercise b/4 bed}
No large meals right b/4 sleep
Adequate exposure to natural light
Regular relaxing bedtime routine (i.e.no emotionally upsetting conversations or activities b/4 trying to sleep)
Don’t dwell on, or bring your problems to bed.
Associate bed with sleep (no TV/radio/novel)

37. Do you need sleep? all mammals need it regulates mood
is related to learning/memory functions
Is critical for health, weight and energy level
No sleep, no commitment to exercise and/or diet
No sleep, bigger appetite, as leptin levels fall

38. Exercise: What Benefit?
gets oxygen into the system
releases mood-enhancing chemicals (endorphins, neurotransmitters)/depletes stress hormones
modulates appetite,
releases different sex hormones
enhances immune response

39. Please Pray!
Last, not least