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Folic Acid in Prevention of Neural Tube Defects

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NUTRITION AND HEALTH CHP300:Community Health Program-l Mohamed M. B. Alnoor – PowerPoint PPT presentation

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Title: Folic Acid in Prevention of Neural Tube Defects


1
NUTRITION AND HEALTH
CHP300Community Health Program-l
Mohamed M. B. Alnoor
2
Objectives
  • To define nutrition and related words.
  • To identify nutritional requirements.
  • To understand Food pyramid.
  • To list types of nutrients and their relation to
    health.
  • To define malnutrition and its classification.
  • To list main malnutrition problems.
  • To understand Obesity.

3
Definitions
NUTRITION AND HEALTH
  • Nutrition
  • Nutrients
  • Macronutrients
  • Micronutrients
  • Dietetics
  • Community Nutrition
  • Nutritional Epidemiology

4
CLASSIFICATION OF FOODS
by origin
  • - Foods of animal origin
  • - Foods of vegetable origin

5
CLASSIFICATION OF FOODS
by chemical composition
-Proteins
-Fats
Vitamins
-Carbohydrates
-Vitamins
Water
Minerals
-Minerals
-Water
Carbo- hydrates
Fat
Protein
6
CLASSIFICATION OF FOODS
by predominant function
  • Body building foods
  • Energy giving foods
  • Protective foods

7
CLASSIFICATION OF FOODS
by predominant function
  • Body building foods

meat
poultry
fish
eggs
milk
pulses etc
8
CLASSIFICATION OF FOODS
by predominant function
  • Energy giving foods

cereals
fats
sugars
oils etc.
9
CLASSIFICATION OF FOODS
by predominant function
  • Protective foods

vegetables
fruits
cereals
milk
Legumes etc.
10
The adequate diet Food Pyramids
Nutritional Requirements
  • Food Group System
  • Classifies foods according to similarity in
    nutrient content.

11
(No Transcript)
12
Nutritional Requirements
Food Pyramids
Lessons from Food Pyramid
1- Maintain a healthy weight. BMI 18.5 to
24.9
19 to 25
  • 2- Eat good fats (avoid bad fats)
  • Oils found in nuts, seeds, grains and fish.
  • Rich in unsaturated fats necessary for good
    health.
  • Should constitute gt 30 to 45 of the total fat.

?
13
Nutritional Requirements
Food Pyramids
Lessons from Food Pyramid
3. Eat whole-grain carbohydrates.
(whole meal bread, whole wheat, brown rice)
Why?
  • More nutritious than refined carbohydrates
  • More slowly digested
  • Less stress on pancreas.

14
Nutritional Requirements
Food Pyramids
Lessons from Food Pyramid
  • 4-Avoid red meat as a protein source and
    emphasize plant proteins.
  • 5- Take a multivitamin daily.
  • Insurance against any deficiency.
  • 6- Eat plenty of dark green leafy vegetables
    and fruits.
  • Lowers blood pressure and cholesterol and
    reduces the risk of cancer.

15
Main types of Nutrients
Energy Supplying Nutrients
  • Carbohydrates
  • Lipids
  • Protein
  • Vitamins
  • Minerals
  • Water

Non-Energy Supplying Nutrients
16
PROTEINS
Main types of Nutrients
Energy Supplying Nutrients
  • Complex organic nitrogenous compounds.
  • Contain sulfur, phosphorous and iron.
  • About 20 different amino acids(aa) in human body.
  • 8-9essential aa
  • Why are they called essential ?
  • Essential for what ?

17
Protein Needs
Main types of Nutrients
Energy Supplying Nutrients
PROTEINS
  • Adults 0.8 gm/kg body weight per day
  • Excess protein is not used to build more muscle
  • - extra aa are used for energy
  • - or converted to fat and stored.

18
Sources of Proteins
Main types of Nutrients
Energy Supplying Nutrients
PROTEINS
  • Animal sources Complete proteins have all
    essential aa.
  • Plant sources Incomplete proteins lack one or
    more essential aa.

19
PROTEINS
Main types of Nutrients
Energy Supplying Nutrients
Functions of Proteins
  • Body building
  • Repair and maintenance of body tissues
  • Maintenance of osmotic pressure
  • Synthesis of bioactive substances and vital
    molecules e.g. immunoglobulins

20
Main types of Nutrients
Energy Supplying Nutrients
LIPIDS
  • Lipids include cholesterol and triglycerides
  • Fats are necessary for health
  • Functions
  • 1 Highest source of energy (9Kcal/g).
  • 2 - Spare protein.
  • 3 - Adipose tissue holds the body organs and
    nerves in place.
  • 4 - Maintain body temperature.
  • 5 - Transportation of fat soluble vitamins.

21
Classification of Fats
Main types of Nutrients
Energy Supplying Nutrients
LIPIDS
  • Saturated fat
  • Animal foods
  • Palm oil
  • coconut oil

(Richest source)
22
Classification of Fats
Main types of Nutrients
Energy Supplying Nutrients
LIPIDS
  • Monounsaturated fat
  • Olives oil
  • Peanuts oil
  • canola oil

23
Classification of Fats
Main types of Nutrients
Energy Supplying Nutrients
LIPIDS
  • Polyunsaturated fat

Richest source
  • Sunflower oil
  • Corn oil
  • cotton seed oil
  • nut oil

24
Classification of Fats
Main types of Nutrients
Energy Supplying Nutrients
LIPIDS
  • Trans Fatty Acids
  • Hydrogenated
  • Partially hydrogenated fats

more solid margarine
liquid oils
hydrogenation
25
Classification of Fats
Main types of Nutrients
Energy Supplying Nutrients
LIPIDS
Hydrogenated fat
  • Saturated fat and trans fatty acids could be
    harmful to health
  • Baked products and fried foods are often made
    with hydrogenated fats

26
Main types of Nutrients
Energy Supplying Nutrients
LIPIDS
Classification of Fats
Cholesterol
  • Necessary for
  • cell membranes
  • production of
  • vitamin D
  • Bile
  • some hormones

27
Main types of Nutrients
Energy Supplying Nutrients
LIPIDS
Classification of Fats
Cholesterol
  • Only in animal foods
  • blood levels

risk of heart disease
28
Main types of Nutrients
Energy Supplying Nutrients
LIPIDS
Fat requirements
  • The WHO Expert committee on Prevention of
    Coronary Heart Disease has recommended that only
    20 to 30 of total dietary energy is to be
    provided by fats. (lt30)
  • At least 50 of fat intake should consist of
    vegetable oils rich in essential fatty acids.

29
Main types of Nutrients
Energy Supplying Nutrients
CARBOHYDRATES
Functions
  • 1 - Main source of energy 4 Kcals/gram.
  • 2 - Essential for the synthesis of certain
    non-essential aa.
  • 3 - Necessary for normal fat metabolism.
  • 4 - Necessary for integrity of nerve cells.

30
Main types of Nutrients
Energy Supplying Nutrients
CARBOHYDRATES
Functions
  • 5 - Lactose allows growth of beneficial
    bacteria in the intestine.
  • 6 - Important for normal elimination
    (excretion) fibers

Recommended intake is 55 to 65 of calories,
primarily from starchy foods.
  • The inability of the body to metabolize
    carbohydrates properly DM

31
Main types of Nutrients
Energy Supplying Nutrients
CARBOHYDRATES
Classification of CHOS
  • 1- Monosaccharides glucose or fructose
  • 2- Disaccharides Sucrose (G F)
  • 3- Oligosaccharides (3-10).
  • 4- Polysaccharides (11-1000)
  • a-Digestible e.g. starch
  • b-partially digestible e.g. dextrin
  • c-Indigestible e.g. cellulose

32
Fiber
Main types of Nutrients
Energy Supplying Nutrients
CARBOHYDRATES
  • Indigestible plant material e.g. cellulose
  • Dietary fiber is mainly non-starch polysaccharide
  • It is found in vegetables, fruits and grains.
  • Soluble fiber swells or dissolves in water.
  • Rich sources include apples, bananas,
    citrus fruits, carrots

33
Fiber
Main types of Nutrients
Energy Supplying Nutrients
CARBOHYDRATES
Soluble fiber
  • Importance
  • Reduces cholesterol absorption
  • Slows absorption of glucose

34
Fiber
Main types of Nutrients
Energy Supplying Nutrients
CARBOHYDRATES
  • Insoluble fiber remains unchanged in water.

Insoluble fiber
Rich food sources include brown rice, wheat
bran, and whole grain products.
35
Fiber
Main types of Nutrients
Energy Supplying Nutrients
CARBOHYDRATES
Insoluble fiber
Importance
  • Reduces the risk of
  • Heart disease
  • Diabetes type II
  • Diverticulosis
  • Hemorrhoids
  • Constipation
  • Colorectal cancer

36
Refined CHOS Versus Whole Grains
Main types of Nutrients
Energy Supplying Nutrients
CARBOHYDRATES
  • Whole grains are higher than refined
    carbohydrates in fiber, vitamins, minerals, and
    other beneficial compounds
  • Whole grains
  • Take longer to digest
  • Make people feel full sooner
  • Cause a slower rise in glucose levels

37
Main types of Nutrients
Energy Supplying Nutrients
CARBOHYDRATES
Refined CHOS Versus Whole Grains
ADVICE
  • Choose foods that have a whole grain as the first
    item on the ingredient list on the food label
  • Whole wheat, whole rye, whole oats, oatmeal,
    whole-grain corn, brown rice, popcorn, barley,
    etc.

38
Main types of Nutrients
Non-Energy Supplying Nutrients
  • Vitamins
  • Minerals
  • Water

39
Main types of Nutrients
Non-Energy Supplying Nutrients
VITAMINS
  • Provide no calories (no energy)
  • Needed in very small amounts

Functions
  • Regulate growth.
  • Maintain tissues.
  • Help carbohydrates, proteins, and fats release
    energy.

40
Main types of Nutrients
Non-Energy Supplying Nutrients
VITAMINS
Classification of Vitamins
  • Water Soluble
  • Fat Soluble

41
Main types of Nutrients
Non-Energy Supplying Nutrients
VITAMINS
Classification of Vitamins
  • Water Soluble
  • 8 different B Vits and vitamin C
  • Fat Soluble
  • Vits A, D, E, and K
  • - Healthy people do not need supplements

- Supplementation toxic high levels
42
Main types of Nutrients
Non-Energy Supplying Nutrients
Fat Soluble Vitamins
Vitamin A
  • Vitamin A covers both
  • a pre-formed vitamin retinol
  • (animal sources)
  • a pro-vitamin beta carotene(plant sources)
    which is converted to retinol in the intestinal
    mucosa.

43
Sources of Vitamin A
Main types of Nutrients
Non-Energy Supplying Nutrients
Fat Soluble Vitamins
Vitamin A
  • Retinol (animal sources),

??? ??? ?????
liver
cod liver oil
butter
milk
eggs
44
Sources of Vitamin A
Main types of Nutrients
Non-Energy Supplying Nutrients
Fat Soluble Vitamins
Vitamin A
  • Beta carotene(plant sources)

coloured plants
????
apricot
carrots
pumpkin
tomatoes
spinach
mango
????????
45
Main types of Nutrients
Non-Energy Supplying Nutrients
Fat Soluble Vitamins
Vitamin A
Functions of Vitamin A
  • Essential for normal vision.
  • Necessary for maintaining the integrity and the
    functioning of glandular and epithelial tissue
    which lines intestinal, respiratory and urinary
    tracts as well as the skin and eyes.

46
Main types of Nutrients
Non-Energy Supplying Nutrients
Fat Soluble Vitamins
Vitamin A
Functions of Vitamin A
  • It supports growth, especially skeletal growth
  • It may protect against some epithelial cancers
    such as bronchial cancers.

47
Main types of Nutrients
Non-Energy Supplying Nutrients
Fat Soluble Vitamins
Vitamin D
  • The nutritionally important forms of Vitamin D in
    man are
  • -Calciferol (Vitamin D2) and
  • -Cholecalciferol (Vitamin D3)

48
Sources of Vitamin D
Main types of Nutrients
Non-Energy Supplying Nutrients
Fat Soluble Vitamins
Vitamin D
caviar
liver
Butter
Ultraviolet rays
Eggs
49
Main types of Nutrients
Non-Energy Supplying Nutrients
Fat Soluble Vitamins
Vitamin D
Functions of Vitamin D
  • Intestine Promotes intestinal absorption of
    calcium and phosphorus
  • Bone Stimulates normal mineralization, enhances
    bone reabsorption( resorption), affects collagen
    maturation
  • Kidney Increases tubular reabsorption of
    phosphate

50
Main types of Nutrients
Non-Energy Supplying Nutrients
Fat Soluble Vitamins
Vitamin D
Deficiency of Vitamin D
  • Leads to

- Rickets in children
- Osteomalacia in adults
51
Main types of Nutrients
Non-Energy Supplying Nutrients
Fat Soluble Vitamins
Vitamin E
  • Antioxidant, Protects RBCs from haemolysis.
  • Vitamin E deficiency
  • Neurological problems
  • spinocerebellar ataxia
  • myopathies
  • Aaemia

52
Sources of Vitamin E
Main types of Nutrients
Non-Energy Supplying Nutrients
Fat Soluble Vitamins
Vitamin E
wheat germ
green leafy vegetables
liver
corn
vegetable oils
eggs
53
Main types of Nutrients
Non-Energy Supplying Nutrients
Fat Soluble Vitamins
Vitamin K
  • Important for blood coagulation
  • Deficiency causes hemorrhagic manifestations.

54
Sources of Vitamin K
Main types of Nutrients
Non-Energy Supplying Nutrients
Fat Soluble Vitamins
Vitamin K
cauliflower
??????
broccoli
?????? (??? ?? ????????)
spinach
????????
??????????
avocado
kiwi
soybean oil
colonic bacteria
55
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin B1 (Thiamine)
  • Function essential for the utilization
  • of carbohydrates, (found on the
  • membranes of neurons).

56
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin B1 (Thiamine)
  • Sources

whole grain
?????????
Legumes
beans
???????
brewer yeast
???????
57
Deficiency of (Thiamine)
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin B1 (Thiamine)
  • Beriberi may occur in three main forms
  • Dry beriberi
  • Wet beriberi
  • Infantile beriberi

58
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin B2 (Riboflavin)
  • Important for cellular metabolism, oxidation and
    reduction.
  • Deficiency angular stomatitis glossitis
    (magenta tongue).

59
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin B2 (Riboflavin)
  • Sources

fish
vegetables
meat
eggs
liver
milk
60
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin B6 (Pyridoxine)
  • Pyridoxine (vitamin B6) plays an important role
    in the metabolism of amino acids, fats and
    carbohydrate.
  • The requirement of adults vary directly with
    protein intake.

61
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin B6 (Pyridoxine)
  • The primary role of vitamin B6 is to act as a
    coenzyme to many enzymes in the body that are
    involved predominantly in metabolism.
  • Toxicity Can occur with supplementation
  • with high doses for long periods of time.

?
Destruction of dorsal root ganglia
62
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin B6 (Pyridoxine)
  • Sources

vegetables
nuts
whole grain products
meat
bananas
63
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin B12 (Cyanocobalamine)
  • Vitamin B12 is a complex organo-
  • metallic compound with a cobalt atom
  • (Cyanocobalamine)

64
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin B12 (Cyanocobalamine)
  • Cooperates with folate in the synthesis of DNA.
  • Separate biochemical role, unrelated to folate,
    in synthesis of fatty acids in myelin.

65
Vitamin B12 deficiency
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin B12 (Cyanocobalamine)
  • Associated with megaloblastic anaemia
    (pernicious anaemia), demyelinating neurological
    lesions in the spinal cord.
  • Dietary deficiency of B12 may affect
  • subjects who are strict vegetarians and
  • eat no animal product.

66
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin B12 (Cyanocobalamine)
  • Sources

poultry
shellfish
liver
milk
eggs
67
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin B3 (Niacin, Nicotinic acid)
  • Important for maintenance of the nervous system
    and healthy epithelium
  • Deficiency Pellagra, dermatitis, dementia
  • and diarrhoea

68
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin B3 (Niacin, Nicotinic acid)
  • Sources
  • liver

brewer yeast
peanuts
???????
meat
colonic bacteria
69
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin C (Ascorbic acid)
  • Vitamin C (ascorbic acid) is a water-soluble
    vitamin.
  • It is the most sensitive of all vitamins to heat.
  • Vitamin C has an important role to play in tissue
    oxidation

70
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin C (Ascorbic acid)
  • It is needed for the formation of collagen in
    connective tissue, which constitutes 25 per
    cent of total body protein.
  • Present in vegetables and fruits.

71
Sources of Vitamin C
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin C (Ascorbic acid)
pepper
fresh cabbage
berries
green peas
strawberry
citrus fruits
green onions
72
Deficiency of vitamin C
Main types of Nutrients
Non-Energy Supplying Nutrients
Water Soluble Vitamins
Vitamin C (Ascorbic acid)
  • Results in scurvy.
  • Signs of scurvy are
  • Swollen and bleeding gums,
  • Subcutaneous bruising,
  • Bleeding into the skin or joints,
  • Delayed wound healing,
  • Anaemia and weakness.

73
Main types of Nutrients
Non-Energy Supplying Nutrients
Minerals
  • Minerals are certain elements that may
  • regulate chemical reactions in the body
  • be part of organic molecules
  • Iron in hemoglobin
  • Calcium in bone and teeth
  • Small amounts are needed for health

74
Calcium
Main types of Nutrients
Non-Energy Supplying Nutrients
Minerals
  • Most plentiful mineral in the body
  • regulating blood pressure,
  • blood clotting, and
  • muscular movements
  • Needed for strong bones and teeth
  • Involved in

75
Calcium
Main types of Nutrients
Non-Energy Supplying Nutrients
Minerals
  • Bones store calcium
  • Osteoporosis
  • Bones lose mineral density and strength
  • Aging people, especially menopausal women, are at
    risk

76
Sources of Calcium
Main types of Nutrients
Non-Energy Supplying Nutrients
Minerals
Calcium
milk,
????? ??????
cottage cheese
cheese
yoghurt
????????
parsley
77
Main types of Nutrients
Non-Energy Supplying Nutrients
Minerals
Iron
  • Most of the bodys iron is in hemoglobin, which
    is in red blood cells
  • The iron in hemoglobin picks up oxygen from the
    lungs and transports it to the cells.

78
Sources of Iron
Main types of Nutrients
Non-Energy Supplying Nutrients
Minerals
Iron
red meat
apples
liver
molasses
dried fruit
????? ??????
79
Sources of vitamins trace elements
berries
milk
meat
liver
Vit. A
Required homework.
Vit. D
Vit. E
Vit. K
Vit. B1
Vit. B2
Vit. B3
Vit. B6
Vit. B12
Included in the EXAM
Vit. C
Iron
Calcium
Body building
Energy Foods
Protective foods
80
Main types of Nutrients
Non-Energy Supplying Nutrients
Water
  • Variety of functions
  • Helps transport of materials in the body,
  • Involved in many chemical reactions.
  • Beverages and most foods, especially fruits and
    vegetables, supply water
  • Diuretics such as alcohol and caffeine increase
    losses of water from the body

81
Main types of Nutrients
Non-Energy Supplying Nutrients
Water
  • To be properly hydrated, a person needs at least
    8 cups of water daily
  • Dehydration can be deadly
  • Sports, drinks replenish minerals and water that
    are lost during heavy exercise

82
Main types of Nutrients
Non-Energy Supplying Nutrients
Water
  • Thirst sensation is not sensitive enough
  • Continue drinking after you are no longer thirsty
  • Clear or near clear urine indicates hydration

83
Signs of Dehydration
Main types of Nutrients
Non-Energy Supplying Nutrients
Water
  • Headache
  • Fatigue
  • Needlessly lifeless
  • Dark, concentrated urine

84
MALNUTRITION
Definition
  • Malnutrition is a pathological state resulting
    from a relative or absolute
  • deficiency or excess
  • of one or more of the essential nutrients.

85
The major forms of malnutrition
MALNUTRITION
  • Under-nutrition

Over-nutrition
86
The major forms of malnutrition
MALNUTRITION
Under-nutrition
  • It is a pathological state resulting when
    nutrient intake does not meet the nutrient
    needs for cell activities and body maintenance.

87
The major forms of malnutrition
MALNUTRITION
Under-nutrition
  • It includes
  • Macronutrient deficiency e.g., protein-energy
    malnutrition (marasmus kwashiorkor).
  • Micronutrient deficiency e.g. iron deficiency
    anaemia, vitamin A deficiency, Iodine
    deficiency.etc.

88
The major malnutrition problems in the world are
MALNUTRITION
Under-nutrition
1. Proteinenergy malnutrition (PEM) 2. Iron
deficiency anaemia 3. Iodine deficiency disorders
(IDD) 4. Vitamin A deficiency (VAD)
89
Iron deficiency anemia
MALNUTRITION
The major forms of malnutrition
Under-nutrition
  • Over 2 billion people suffer from some form of
    iron deficiency
  • One of the most common nutritional disorders
    worldwide.

90
Iron deficiency anemia
MALNUTRITION
The major forms of malnutrition
Under-nutrition
  • incidence Africa South Asia.
  • Parasitic infestation contributes to high percent
    of cases in developing countries.
  • Common causes are dietary deficiency and chronic
    blood loss

91
Iron deficiency anemia
MALNUTRITION
The major forms of malnutrition
Under-nutrition
Consequences
  • Reduces work capacity, thus reduces productivity
    earnings
  • Associated with 50 of maternal deaths
  • Retards fetal growth, causes low birth weight
    (LBW) increases infant mortality
  • Impairs ability to resist disease in childhood
    it reduces learning ability

92
Improving Iron status
MALNUTRITION
The major forms of malnutrition
Under-nutrition
Iron deficiency anemia
  • Iron tablets
  • Iron fortification of basic foods (bread)
  • Increased consumption of iron rich foods
    factors which enhance absorption(e.g. vit. C)
  • Control of parasitic infections

93
MALNUTRITION
The major forms of malnutrition
Under-nutrition
Iodine deficiency disorders(IDD)
  • 2 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
  • Moderate Iodine deficiency is associated with
    average reduction of over 13 IQ points

94
MALNUTRITION
The major forms of malnutrition
Under-nutrition
Iodine deficiency disorders(IDD)
Prevention of(IDD)
  • Adequate intake of Iodine can
  • prevent all IDD
  • make milder forms of goiter disappear
  • improve development of older children mildly
    affected

95
MALNUTRITION
The major forms of malnutrition
Under-nutrition
Iodine deficiency disorders(IDD)
Prevention of(IDD)
  • Severe forms of IDD such as cretinism, cannot
    be reversed but, can be prevented by
  • Adequate intake of Iodine during pregnancy
  • Now, iodized salt is all over the world

96
Vitamin A deficiency (VAD)
MALNUTRITION
The major forms of malnutrition
Under-nutrition
  • May be subclinical, severe or moderate
  • Clinical (xerophthalmia)
  • 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

97
The signs of Vitamin A deficiency (VAD)
MALNUTRITION
The major forms of malnutrition
Under-nutrition
Vitamin A deficiency (VAD)
Follicular hyperkeratosis
Night blindness
  • Conjunctival xerosis

98
The signs of Vitamin A deficiency (VAD)
MALNUTRITION
The major forms of malnutrition
Under-nutrition
Vitamin A deficiency (VAD)
  • Bitot's spots
  • Corneal xerosis
  • Keratomalacia

99
Improving vitamin A status
MALNUTRITION
The major forms of malnutrition
Under-nutrition
Vitamin A deficiency (VAD)
  • 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 food (oils margarine)
  • Supplements e.g. capsules of Vitamin A
  • 2-3 times per year to young children
  •  

100
MALNUTRITION
The major forms of malnutrition
Over-nutrition
  • It is a pathologic state resulting
  • when nutritional intake exceeds the body needs.
    This leads to caloric excess, usually over an
    extended period of time.

101
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102
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103
It is a disorder of Body Regulatory System
leading to Excess Body Fat
MALNUTRITION
The major forms of malnutrition
Over-nutrition
OBESITY
Fat
  • Assessment
  • Body Mass Index (BMI)
  • Waist Circumference (WC)
  • Waist to Hip ratio (WHR)

104
Causes Associated Factors
MALNUTRITION
The major forms of malnutrition
Over-nutrition
OBESITY
  • Genes
  • Metabolism
  • Behavior
  • Environment
  • Culture
  • SES

105
Assessment of Obesity
MALNUTRITION
The major forms of malnutrition
Over-nutrition
  • Body Mass Index (BMI)
  • Waist circumference
  • Waist Hip Ratio (WHR)

106
Assessment of Obesity
MALNUTRITION
The major forms of malnutrition
Over-nutrition
Body Mass Index (BMI)
  • The international standard for assessing body
    size in adults .
  • BMI is computed using the following formula BMI
    Weight (kg)/ Height (m²)
  • Evidence shows that high BMI (obesity level) is
    associated with
  • type 2 diabetes
  • cardiovascular morbidity mortality

107
BMI (WHO - Classification)
MALNUTRITION
The major forms of malnutrition
Over-nutrition
Assessment of Obesity
Body Mass Index (BMI)
Underweight..lt18.50
Normal range....18.50 - 24.99
Overweight ......................................
...........25.00 - 29.99 (Pre-obese)
Obese class I....30.00 - 34.99
Obese class II.....35.00 - 39.99
Obese class III...................40.00
Source Adapted from WHO, 1995, WHO, 2000 and WHO
2004.
108
Waist circumference
MALNUTRITION
The major forms of malnutrition
Over-nutrition
Assessment of Obesity
  • Waist circumference predicts mortality better
    than any other anthropometric measurement.
  • Waist measurement alone can be used to assess
    obesity.
  • Two levels of risk have been identified

MALES
FEMALE LEVEL 1 gt 94cm
gt 80cm LEVEL2 gt 102cm gt 88cm
109
Waist circumference
MALNUTRITION
The major forms of malnutrition
Over-nutrition
Assessment of Obesity
MALES
FEMALE LEVEL 1 gt 94cm
gt 80cm LEVEL 2 gt 102cm gt 88cm
  • Level 1 is the maximum acceptable waist
    circumference irrespective of the adults and
    there should be no further weight gain.
  • Level 2 denotes obesity and requires weight
    management to reduce the risk of type 2 diabetes
    CVS complications.

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Waist Hip Ratio (WHR)
Visceral obesity (apple shaped)
Peripheral obesity (Pear shaped)
  • WHR
  • gt 0.8 F
  • gt 1.0 M

WHR lt 0.8 F lt 1.0 M
111
Interpretation of WHR
MALNUTRITION
The major forms of malnutrition
Over-nutrition
Assessment of Obesity
Waist Hip Ratio (WHR)
High risk
  • Females WHR gt0.80 or gt80
  • Males WHR gt0.95 or gt95
  • It indicates central (upper body) or visceral
    obesity and is considered high risk for diabetes
    CVS disorders.
  • A WHR below these cut-off levels is considered
    low risk (peripheral obesity).
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