UNIVERSITY OF AGRICULTURE MAKURDI 255TH SENATE September 27, 2001

Nutrition, your family & you Frank Onyezili

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

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

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

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

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

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 ,

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

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

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!

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

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”

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

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)

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

The RDAs (2) UNICEF

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

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

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

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

The BMI

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

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)

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.

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

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

But what can go wrong?

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

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

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

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

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

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

The Health Triangle ADEQUATE NUTRITION REGULAR EXERCISE ADEQUATE SLEEP

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)

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

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

Please Pray! Last, not least