Transcript BILAN COMMUN DE PAYS – REPUBLIQUE DE GUINEE GROUPE

UNIVERSITY OF
AGRICULTURE MAKURDI
255TH SENATE
September 27, 2001
1
Nutrition, your family & you
Frank Onyezili
Presentation Outline
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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
What is Malnutrition?
There’s a Conceptual
Framework (from Unicef),
with a common thread
Manifestation
Immediate
Causes
Underlying
Causes
A
common
Thread !!
Malnutrition
Inadequate
dietary intake
Insufficient
Household
Food security
Disease
Inadequate
Maternal and
ChildCare
Insufficient
Health Services
& Healthy
Environment
Inadequate Education
Resources and Control
(Human, Economic, and
Organizational)
Political and Ideological superstructure
Basic Causes
UNICEF
Economic Structure
Potential resources
Conceptual
Framework
(simplified)
of the
causes of
malnutrition
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
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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
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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).
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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
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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
Recommended Dietary
Food type
Allowance of nutritional
elements
The RDA (1)*
UNICEF
Total Fat
65 g
Saturated fatty acids
20 g
Cholesterol
300 mg
Sodium
2400 mg
Potassium
4700 mg
Total carbohydrate
300 g
Fiber
25 g
Protein
50 g
The RDAs (2)
Requirement - mg. per kg. of body weight
Infant
Amino acid
Histidine
Isoleucine
Leucine
Lysine
S-containing amino
acids
Aromatic amino
acids
Threonine
Tryptophan
UNICEF
Valine
Child
Adults
3 - 6 mo.
33
80
128
97
10 - 12 yr.
not known
28
42
44
not known
12
16
12
45
22
10
132
22
16
63
19
89
28
4
25
8
3
14
RDI listings (1)*
Fat-soluble vitamins
Age
Children
4-6
Vitamin A
Vitamin
D
Vitamin
E
Vitamin
K
Energy
Protein
k. cal
g
IU
*ug
RE
IU
*ug
IU
*mg
TE
*ug
1,800
30/24
2,500
500
400
5
9
7
-/20
36/28
3,300
500
400
5
10
7
-/30
54/59
5,000
1,000
400
5
15
10
-/65
54/58
5,000
1,000
400
5
15
10
-/70
2,400/
7-10
2,000
Males
1518
1924
Females
3,000
3,000/
2,900
2550
2,700
56/63
5,000
1,000
-
5
15
10
-/80
50+
2,400
56/63
5,000
1,000
-
10
15
10
-/80
1518
2,100
48/44
4,000
800
400
5
12
8
-/55
1924
2,100
46/46
4,000
800
400
5
12
8
-/60
2550
2,000
46/50
4,000
800
-
5
12
8
-/65
50+
1,800
46/50
4,000
800
-
10
12
8
-/65
* 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
Ascorbic
Acid
Folacin/
Folate
Niacin
Riboflavin
Thiamine
Vitamin
B6
Vitamin
B12
mg
mcg
mg
mg
mg
mg
mcg
4-6
40/45
200/75
12
1.1
0.9
0.9/1.1
1.5/1.0
7-10
40/45
300/100
16/13
1.2
1.2/1.0
1.2
2.0/1.4
1518
45/60
400/200
20
1.8
1.5
2.0
3.0/2.0
1924
45/60
400/200
20/19
1.8/1.7
1.5
2.0
3.0/2.0
2550
45/60
400/200
18/19
1.6/1.7
1.4/1.5
2.0
3.0/2.0
50+
45/60
400/200
16/15
1.5/1.4
1.2
2.0
3.0/2.0
1518
45/60
400/180
14/15
1.4/1.3
1.1
2.0/1.5
3.0/2.0
1924
45/60
400/180
14/15
1.4/1.3
1.1
2.0/1.6
3.0/2.0
2550
45/60
400/180
13/15
1.2/1.3
1.0/1.1
2.0/1.6
3.0/2.0
50+
45/60
400/180
12/13
1.1/1.2
1.0
2.0/1.6
3.0/2.0
Age
Children
Males
Females
* first figure refers to the old RDA listing while the second figure refers to the newer DRI listing
The RDI listings (3)
Minerals, others
Calcium
Phosphorous
Iodine
Iron
Magnesium
Zinc
Selenium
Fluoride
mg
mg
ug
mg
mg
mg
*ug
*mg
4-6
800
800/500
80/90
10
200/130
10
-/20
-/1.1
7-10
800
800
110/120
10
250
10
-/30
-/3.2
1518
1200/1300
1200/1250
150
18/12
400/410
15
-/50
-/3.8
1924
800/1000
800/700
140/150
10
350/400
15
-/70
-/3.8
2550
800/1000
800/700
130/150
10
350/420
15
-/70
-/3.8
50+
800/1200
800/700
110/150
10
350/420
15
-/70
-/2.9
1518
1200/1300
1200/1250
115/150
18/15
300/360
15/12
-/50
-/3.1
1924
800/1000
800/700
100/150
18/15
300/310
15/12
-/55
-/3.1
2550
800/1000
800/700
100/150
18/15
300/320
15/12
-/55
-/3.1
50+
800/1200
800/700
80/150
10
300/320
15/12
-/55
-/3.1
Age
Children
Males
Females
* 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
BMI
Weight Status
Below 18.5
Underweight
18.5 - 24.9
Normal
25.0 - 29.9
Overweight
30.0 and
Above
Obese
Calculating your BMI*
SI units
US units
UK mixed units
*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
Sahel. Major causes of child mortality
U5s?
Neonatal
26%
Measles
6%
Malaria
24%
Malnutrition
53%
Others
1%
Pneumonia
20%
Diarrhea
16%
Most U5 diarrhea deaths result from dehydration,
replaceable (with SSS, ORS, ORT)
Nutrition and Growth (1)
Key messages for caregivers:
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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:
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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
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First two years are critical, including
for early stimulation and learning
Next three (i.e. 3-5 years) are
important too, including for preschool 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
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…
Protein-rich,
Energy- rich
diets, but watch
out for phytaterich
grains/tubers
UNICEF/Pirozzi
0.25 million
U5 deaths
annually
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 nighttime 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?
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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