Nutrition and Global Health Chapter Eight Nutrition and Global Health

The Importance of Nutrition Nutritional status is intimately linked with health status Nutrition is the leading risk factor for loss of health in low- and middle-income countries Low-cost, highly effective interventions are available to improve nutrition status

Definitions and Key Terms Malnutrition - refers to those who do not get proper nutrition, whether too little, too much, or the wrong kind Undernourished - refers to those who lack sufficient energy or nutrients Underweight - refers to those who have low weight for their height or age Overweight or obese - refers to those who are nourished to the point of being too heavy for their height or age

Table 8.3: Key Terms and Definitions Source: Adapted with permission from The World Bank. Repositioning Nutrition as Central to Development. Washington, DC: The World Bank; 2006:xvii.

Table 8.3: Key Terms and Definitions (cont.) Source: Adapted with permission from The World Bank. Repositioning Nutrition as Central to Development. Washington, DC: The World Bank; 2006:xvii.

The Determinants of Nutritional Status Immediate causes of malnutrition: Inadequate dietary intake- weakens the body and opens it up to infection Illness- makes it harder for people to eat, absorb the nutrients they take in, and raises the need for some nutrients Relationship creates a cycle of illness and infection

Figure 8.1: The Determinants of Nutritional Status: The UNICEF Framework

Gauging Nutritional Status Nutritional status of infants and children is gauged by measuring and weighing them, then plotting weight and height on a growth chart Child’s position on growth curve indicates if they are developing normally Large share of nutritional deficits are mild, but still have negative consequences on development

Key Nutritional Needs Undernutrition Outcome of insufficient food intake and repeated infectious disease Includes underweight, stunted, wasted, and micronutrient malnutrition Raises risk of illness and decreased intellectual capacity in children Raises risk of pregnancy-related death and delivering prematurely in women

Key Nutritional Needs Vitamin A Deficiency associated with night blindness and eventually, permanent blindness Important to growth and the proper functioning of the immune system Impact on severity of illness and chance of survival from several causes, including diarrhea, malaria, and pneumonia

Key Nutritional Needs Iodine Deficiency associated with a growth on the thyroid called a goiter and the failure to develop full intellectual potential Occurs in people who live in mountainous regions where less seafood is consumed and the soil is deficient in iodine

Key Nutritional Needs Iron Deficiency causes iron deficiency anemia which is associated with fatigue and weakness Iron-deficient pregnant women have an increased risk of giving birth to a premature or low birthweight baby or hemorrhaging and dying in child birth

Key Nutritional Needs Zinc Deficiency is associated with growth retardation, impaired immune function, skin disorders, hypogonadism, and cognitive dysfunction Deficiency is a major risk factor for morbidity and mortality from diarrhea, pneumonia, and malaria

Nutritional Needs Throughout the Life Cycle Pregnancy and Birthweight Pregnant women need a sufficient amount of protein and energy as well as iron, iodine, folate, zinc, and calcium Fetuses that do not get sufficient nutrition from the mother may suffer from stillbirth, mental impairment or birth defects

Nutritional Needs Throughout the Life Cycle Infancy and Young Childhood Children need sufficient protein and energy as well as iodine, iron, vitamin A, and zinc Nutritional gaps during this time can cause problems with stature and mental development, and frequent infection Grow best and stay healthiest if exclusively breastfed for first 6 months “Window of opportunity” is in utero to two years of age

Nutritional Needs Throughout the Life Cycle Adolescents need protein and energy to grow as well as iron, iodine, folic acid, and calcium Adolescent girls who are poorly nourished are much more likely to give birth to an underweight child and experience complications during pregnancy than well-nourished girls

Nutritional Needs Throughout the Life Cycle Adulthood and Old Age Adults need a well-balanced diet with protein, energy, and iron Foods that contain too much fat, cholesterol, sugar, or salt can be harmful Older adults need calcium to reduce risk of osteoporosis

Nutritional State of the World Undernutrition 26% of under-5 children are underweight according to most recent estimates Rates of underweight vary considerably by region Only about 0.5% of total deaths in low- and middle-income countries are directly due to undernutrition Deaths are usually “nutrition related”

Nutritional State of the World Low Birthweight 11% of babies in low- and middle-income countries are born low birthweight according to recent estimates About 3% of DALYs lost in low- and middle-income countries are attributable to low birthweight

Nutritional State of the World Vitamin A About 250 million children suffer from vitamin A deficiency worldwide 6.5% of all deaths of children under-5 in low- and middle-income countries are due to vitamin A deficiency

Nutritional State of the World Iodine About 70 million people worldwide are affected by iodine deficiency Associated with substantial DALYs lost in low- and middle-income countries

Nutritional State of the World Iron About 1.6 billion people were affected by anemia between 1993 and 2005 Substantial public health problem for children under 5 and pregnant women, especially in low- and middle-income countries 0.7% of DALYs lost in low- and middle-income countries is related to iron deficiency anemia

Nutritional State of the World Zinc Second most important micronutrient responsible for death and DALYs in children under 5 About 4% of DALYs lost in children under 5 years of age are due to zinc deficiency

Nutrition, Health, and Economic Development Nutrition impacts health and human development Link to what people learn and their productivity Poor nutrition: Impacts maternal health, which affects household income and health of children Affects children’s ability to learn in school, which impacts their future prospects Leads to lower productivity in adult workers