Nutrition in Children

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Nutrition in Children
Jonathan Gorstein Clinical Associate
Professor Department of Global Health
http//www.who.int/nutrition/topics/elena_video/en
/index.html http//www.youtube.com/watch?vX-2KA5
Ht9YM
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Terminology

• Hunger physiological state when food not able
  to meet energy needs
• Malnutrition impaired development linked to
  both deficient and excessive nutrient intake
• Undernutrition most common form of malnutrition
  in developing countries energy, protein and
  micronutrients

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Major Nutritional Problems in the World

• Protein-energy malnutrition
• Obesity
• Micronutrient deficiency problems
• Iron deficiency anemia
• Vitamin A deficiency
• Iodine deficiency disorders
• Zinc deficiency
• Folate deficiency
• Nutrition-related chronic diseases

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Causes of Undernutrition

• Undernutrition is a complex condition that
  involves multiple, overlapping deficiencies of
  protein, energy and micronutrients rarely do
  these occur in isolation
• The primary cause of undernutrition is an
  inadequate food intake, but is compounded by
  illness and malabsorption
• Insufficient access to food, poor health
  services, the lack of safe water and sanitation,
  inadequate child and maternal care and poverty
  are underlying causes

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Classification of Malnutrition

• WHO recommends three anthropometric indicators
  for assessment of nutritional status
• Wasting (Low weight-for-height)
• Stunting (Low height-for-age)
• http//www.undispatch.com/stunting-the-least-under
  stood-most-under-appreciated-development-issue-in-
  the-world
• Underweight (Low weight-for-age)
• Classification based on International Growth
  Reference

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Prevention and Management of Undernutrition

• Heightened visibility over past 2-3 years due to
  successful and innovative programs
• Gates .
• Public-private partnerships
• GAIN Ten Year Strategy for Micronutrients
• http//www.gainhealth.org/
• World Bank Repositioning Nutrition
• Lancet Special Series on Undernutrition
• Opportunities

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Intergenerational Cycle of Undernutrition

• The cycle of poor nutrition perpetuates itself
  across generations - supported by scientific
  evidence

Childhood Child growth failure, impaired mental
development
Adolescents Low weight and height
Pregnancy Compromised nutritional status
Fetal and Infant stages Low birthweight baby
Adult Small adult woman, lowered productivity
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Consequences of UndernutritionEconomic costs

• Undernutrition leads to reduced productivity,
  hampering economic growth and effectiveness of
  investments in health and education
• Vitamin and mineral deficiencies are estimated to
  cost some countries the equivalent of more than 5
  per cent of their GNP in lost lives, disability
  and productivity

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Infection-Malnutrition Synergism
Weight loss Growth faltering Immunity lowered
Inadequate dietary intake
Disease Incidence Severity Duration
Appetite loss Nutrient loss Malabsorption Altered
Metabolism
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Causes of Mortality among Preschool Children, 2005
Other
Perinatal
Deaths associated with undernutrition
55
HIV/AIDS
Acute Respiratory Infection
Measles
Malaria
Diarrhea
Source WHO (2003)
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Interventions to improve nutrition and reduce
HIV/AIDS progression from Individual to
Community

• Therapeutic
• Direct food assistance
• Food aid provided in conjunction with ARVs
• Social protection
• Cash transfers
• Sustainable Livelihoods
• Income generating opportunities
• Small-scale fortification
• Agriculture, e. small-farmer initiatives

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Consequences of MalnutritionEconomic costs

• Malnutrition leads to reduced productivity,
  hampering economic growth and effectiveness of
  investments in health and education
• Vitamin and mineral deficiencies are estimated to
  cost some countries the equivalent of more than 5
  per cent of their GNP in lost lives, disability
  and productivity

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Micronutrients

• Micronutrients are needed by the body only in
  minute amounts, are critical for
• Regulation of growth, activity, development
• Immune and reproductive function
• Three primary micronutrient deficiencies include
• Iodine
• Vitamin A
• Iron

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Population at Risk of Deficiency - Global
2.0
1.6
0.8
Source UNICEF (2002)
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Iodine Deficiency Disorders (IDD)

• Single most important cause of preventable brain
  damage and mental retardation
• Significantly raises the risk of stillbirth and
  miscarriage in pregnant women
• About 50 million people worldwide suffer from
  varying degrees of brain damage and physical
  impairment due to iodine deficiency Concept of
  IDD (Spectrum of disability)
• The primary intervention for the control of IDD
  is through salt iodization

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Iodine Deficiency Disorders (IDD)

• Today
• Some 70 per cent of households in the developing
  world are using iodized salt, compared to less
  than 20 per cent at the beginning of the decade.
  
• As a result, 91 million newborns are protected
  yearly from significant loss in learning ability

• Unfinished Business
• There are still 35 countries where less than half
  the households consume iodized salt

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Coverage of Iodized Salt by Region
Source UNICEF (2002)
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Levels of Iodized Salt Coverage
90 or more
50 to 89

Less than 50
No recent data
Source UNICEF (2002)
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Major Increases in Iodized Salt Coverage
Source UNICEF (2004)
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41 Million Newborns Still Unprotected from
Learning Disabilities
Source UNICEF (2002)
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Vitamin A Deficiency

• Contributing factor in 2.2 million deaths each
  year from diarrhea and 1 million deaths from
  measles among preschool children under five
• Severe deficiency can also cause irreversible
  corneal damage, leading to partial or total
  blindness
• Results of field trials indicate that VA
  supplementation of children with can reduce
  deaths from diarrhea. Four studies showed deaths
  were reduced by 35-50 per cent.
• VA can reduce by half the number of deaths due to
  measles

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Magnitude of Vitamin A Deficiency

• Pre-school children
• Clinically deficient 3 million (Asia and
  Africa)
• Subclinically deficient (low serum retinol)
  100-140 million
• 250,000-500,000 become blind each year
• 90 case fatality among those who become blind
• Pregnant women
• 25-30 cases of night blindness reported in some
  Asian countries

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Interventions to Control VAD

• In 1999, only 10 countries provided two rounds of
  VA supplementation with high coverage, this has
  increased to over 50 countries by 2004.
• Between 1998 and 2004, UNICEF estimates that
  about two million child deaths may have been
  prevented from vitamin A supplementation

• Food Fortification - A number of countries are
  successfully fortifying staple foods with vitamin
  A (e.g. sugar, maize flour, wheat) reaching
  large populations.
• http//www.one.org/us/living-proof?vid9sOteg1xwls
  

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Vitamin A Supplementation Coverage1 Developing
world
1 Percent of children aged 6-59 months who
received at least one vitamin A supplement within
the last six months
Source UNICEF (2000)
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VA Supplementation Coverage Where VAD is a public
health problem (U5MRgt70)

70 or more
30 to 69
Less than 30
No data available
1 Percent of children aged 6-59 months who
received at least one vitamin A supplement within
the last six months
Source UNICEF (2000)
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Iron Deficiency and Anaemia

• Most common nutritional disorder in the world
• Lowers resistance to disease and weakens a
  child's learning ability and physical stamina
• Significant cause of maternal mortality,
  increasing the risk of hemorrhage and infection
  during childbirth.
• Nearly 2 billion people estimated to be anemic
  and millions more are iron deficient, the vast
  majority are women.
• Supplementation and fortification are primary
  interventions to improve iron intake

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Global Prevalence of AnaemiaPregnant Women
Source WHO (1999)
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Main Factors Contributing to Anaemia

• Iron deficiency
• Poor bioavailability of consumed iron
• Insufficient dietary iron intake
• Chronic and recurrent infections that interfere
  with food intake and absorption/utilization of
  iron
• Helminth infections, primarily Hookworm
• Chronic diarrheal disease
• HIV
• Malaria

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Interventions to Control Anaemia

• Depends on etiology
• For iron deficiency supplementation and
  fortification
• For parasitic disease control appropriate
  measures for prevention and presumptive treatment

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Thank you