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Public Health Nutrition (Community Nutrition)

Public Health Nutrition (Community Nutrition). Instructor: MC Huang. Nutrition and Diseases. 不均衡 的飲食. 營 養 不均衡. Biochemical Damage. Clinical Symptons. Chronic Diseases Cancer CVD DM. Overnutrition undernutrition. Overnutrition. Public Health (Community) Nutrition.

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Public Health Nutrition (Community Nutrition)

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  1. Public Health Nutrition (Community Nutrition) Instructor: MC Huang

  2. Nutrition and Diseases 不均衡 的飲食 營 養 不均衡 Biochemical Damage Clinical Symptons • Chronic Diseases • Cancer • CVD • DM Overnutrition undernutrition Overnutrition

  3. Public Health (Community) Nutrition • Past problems:undernutrition - goiter - beriberi, pellegra, scurvy • Present problems: overnutrition - malignant tumor - cardiovascular diseases - diabetes mellitus

  4. 國民營養調查Nutrition & Health Survey in Taiwan

  5. 國民營養調查 行政院衛生署食品衛生處為有效掌握國人營養以及健康狀況,1980從年起進行全國性營養調查

  6. 國民營養調查 • 第一次國民營養調查 (1980-81) • 第二次國民營養調查 (1986-88) • 1993-1996 第一次國民營養健康 狀況變遷調查調查 • 1997-2002 第二次國民營養健康 狀況變遷調查調查

  7. 台灣地區十大死亡原因 • 惡性腫瘤 • 事故傷害 • 腦血管疾病 • 心臟疾病 • 糖尿病 • 慢性肝病及肝硬化 • 肺炎 • 腎炎及腎症候群 • 自殺 • 支氣管炎,肺氣腫,氣喘

  8. 第一次國民營養調查 (1980-81) • 調查方法：實際秤量食物盤存法(台灣常用食品營養成分表） • 目的：調查家戶飲食狀況 • 抽樣：分層隨機抽樣 • 對象：12鄉鎮 539戶 3163人

  9. 第二次國民營養調查 (1986-88) • 調查方法：實際秤量食物盤存法(台灣常用食品營養成分表） • 目的： 調查家戶飲食狀況 • 抽樣： 分層隨機抽樣 • 對象： 12鄉鎮 552戶 20176人

  10. 第三次國民營養調查 (1993-96)第一次國民營養健康狀況變遷調查 • 調查方法：體位測量 生化檢驗24小時飲食回憶法 食物頻率問卷 營養/健康/行為問卷 • 目的： 飲食以及健康狀況變遷調查 • 抽樣： 分層隨機抽樣/集體抽樣 • 對象： 21鄉鎮 63村里 10080人（四歲以上）

  11. 取樣方式第一次國民營養健康狀況變遷調查 將台灣地區365鄉鎮市區分成七層 客家 澎湖 山地 院轄市 省轄市 都市化一級以及二級地區 以分層隨機抽樣的方式每層抽出 三個鄉鎮市區 從鄉鎮市區 再抽出三個村里 以集體抽樣的方式再抽出兩個首戶 一個首戶對應兩個集區 再以年齡層或性別層各抽出8-16個個案 共10080 抽樣人數 （取樣：9962）

  12. 體位測量第一次國民營養健康狀況變遷調查 • 身高 • 體重 • 三頭肌以及肩胛後肌皮層厚度 • 腰臀圍 • 血壓,心電圖 • 生物抗阻

  13. 肥胖指標第一次國民營養健康狀況變遷調查 • 理想體重 ≧120% • BMI ≧ 26.4 • 三頭肌皮層厚度 男≧20mm 女≧28mm • 體脂肪 男≧25% 女≧30% • 腰臀圍比 男≧0.9 女≧0.85

  14. 飲食攝取狀況調查第一次國民營養健康狀況變遷調查飲食攝取狀況調查第一次國民營養健康狀況變遷調查 • 24小時飲食回憶- 每人每日營養素平均攝取量- 和 RDNA相較 • 飲食頻率問卷- 食物長期攝取情形 • 飲食營養及健康知識之行為問卷- 對營養飲食健康的認知以及行為表現

  15. 飲食問卷-量化分析 • 台灣地區食物營養成分資料庫 • SAS 統計軟體

  16. 健康狀況調查第一次國民營養健康狀況變遷調查健康狀況調查第一次國民營養健康狀況變遷調查 • 目的- 瞭解台灣地區營養相關疾病盛行率- 高血壓,糖尿病,高血脂,高尿酸 • 檢查項目- 血中膽固醇,三酸甘油酯,高低密度 脂蛋白,尿酸,血糖- 疾病問卷

  17. 第三次國民營養調查的意義 • 建立一個適合國人飲食型態 以及長期營養健康偵測之方法 • 逐步將此一調查方法以及技術 教導基層衛生單位, 以落實 基層保健工作

  18. 第四次國民營養調查 (1997-2002)第二次國民營養健康狀況變遷調查 • 調查方法：基本資料 • 健康狀況 飲食狀況 身體檢查 • 目的： 老人（兒童）飲食以及健康狀況變遷 • 抽樣： 分層隨機抽樣/集體抽樣 • 對象： 39鄉鎮 78村里 2028個老人

  19. 第四次國民營養調查 (1997-2002)第二次國民營養健康狀況變遷調查 • 主負責單位- 中央研究院生醫所 • 調查人員：- 衛生行政體系為架構- 縣市衛生營養員負責 • 調查方式- 家戶調查- 巡迴體檢

  20. 取樣方式第二次國民營養健康狀況變遷調查 將台灣地區以特殊族群或地理位置分層 客家 澎湖 山地 東部 北中南各三層 以分層隨機抽樣 的方式每層抽出三個鄉鎮市區 從鄉鎮市區 再抽出二個村里 每一村里調查26位老人 共 2028人

  21. Community Nutrition in Actions • Nutrition assessment in community - ABCD • Nutritional program planning • Nutrition education • Marketing nutrition for health promotion and disease prevention • Nutritional program management

  22. Epidemiological Findings Nutritional Assessment Nutritional Plan- define the problems- define goals & objective- develop a program plan- evaluate the program Nutritional education

  23. What knowledge doesa community nutritionist need ??

  24. Nutritional Assessment Definition: The interpretation of information obtained from Anthropometric, BiochemicalClinical and Dietary studies. The information used to determine - health status of individuals or population - influenced by their intake and utilization of nutrients.

  25. Anthropometric Measurement Definition: Measurements of the variations of the physical dimensions and gross composition of the human body at different age levels and degree of nutrition

  26. Anthropometric Measurement Growth measurement • Head Circumference • Weight - adult & children • Height - adult & children

  27. Ideal Body WeightAdult • M: 62 + [Ht (cm)-170) X 0.6 F: 58 + [Ht (cm)-158) X 0.5 • M: [Ht (cm)-80] X 0.7 F: [Ht (cm)-70] X 0.6 • 22 X Ht (m2)

  28. Indices for % of wt change (adult): • Usual Body Weight – Ideal Body Weight X 100% • Ideal Body Weight • Obese: + 20% • Overweight: + 10-15% • Normal: + 10% , normal • Underweight: - 10-15% • Marasmus: - 20 %

  29. Indices for BMI - adult • Normal: 20-24.9 • Obesity I: 25-29.9 • Obesity II: 30-40 • Obesity III: > 40

  30. Indices for BMI – 6-18 歲 • Usual BMI – 22 X 100% • 22 • 身體質量指數百分位表- 正常: 25-75 percentile - 過重: 75-95 percentile - 肥胖: > 95% - 過輕: 5-25 percentile - 消瘦: < 5%

  31. Indices of growth for children0-6歲身體發展曲線圖 • Normal: 25-75 percentile • Normal ?: 10-25/75-90 percentile • Medical evaluation: <10 or >90 percentile • Priority for medical evaluation/follow up- <5 or > 95 percentile Use of Growth Charts • Public health office • Community Health • Nutrition surveys • Physician’s office

  32. Body Height - Direct Measurement • 站立- > 3 yr old • 平躺(recumbent Length) - 0-6 yr old • 評估依據: 0-6, 6-15, 8-19 yr身體發展曲線圖

  33. Body Height - Indirect Measurement • Arm Span • Knee Height Male: 85.10 + 1.73X knee height – 0.11 X age Female: 91.45 + 1.53X knee height – 0.16 X age

  34. Body Composition Assessment • Body fat: content dependent on sex, height, weight • Fat free mass: mixture of water, protein, minerals

  35. Body Fat : kg fat or % body wt • Triceps skinfold (TSF): mid point of the back of the upper left arm • Biceps skinfold (BSF): thickness of a vertical fold on the front of the upper left arm • Subscapular skinfold (SSF): below and laterally to the angle of the left shoulder blade • Waist/Hip ratio (W/H) – M > 0.9; F>0.8 -> increased CVD risk -> 中間形肥胖

  36. Skinfold Meaurement • Measurement tool: capiler • suitable for all ages’ measurement • Indices: body fat or energy storage status • assessment reference (評估依據): Assessment reference • Normal: 25-75 percentile • Normal?: 10-25 percentile, 75-90 percentile • Excessive body fat: > 90 percentile • Body fat/protein exhaustion : <10 percentile

  37. Fat free mass……… • Mid-upper-arm Circumference (MAC) • Mid-upper-arm Muscle Circumference (MAMC): “derived from MAC & TSF”MAMC = MAC-3.14X TSF

  38. Arm Circumferance fat free mass assessment • Indices: body energy/protein storage status • MAC, MAMC: usual indicator • muscle area: preferable indicator than MAC/MAMC • assessment reference (評估依據): Assessment reference (MAC/MAMC) • Normal: 60-90 percentile • mild nutrition depletion: 25-60 percentile • moderate nutrition depletion:5-25 percentile • severe nutrition depletion: <5 percentile

  39. Fat mass: fat area measurement • Arm area (mm2): A = (3.14/4) X (MAC/3.14)2 • Fat area (mm2): F = A – MAMA (mid-arm muscle area)

  40. Skinfold Meaurement • Measurement tool: capiler • suitable for all ages’ measurement • Indices: body fat or energy storage status • assessment reference (評估依據): Assessment reference • Normal: 25-75 percentile • Normal?: 10-25 percentile, 75-90 percentile • Excessive body fat: > 90 percentile • Body fat/protein exhaustion : <10 percentile

  41. Correlations between Anthropometric variables & Body fat Am J Clin Nutr, Roche et al, 1981

  42. Conclude anthropometric measurement…… • Body fat content: combination of skinfold measurement • distribution of subcutaneous fat: Skinfold + W/H ratio • Fat free mass: “ MAC + TSF ” provide good indication for muscle area • No anthropometric indices are good indicators for short term nutritional support or deprivation

  43. Biochemical Measurement Laboratory assessment is used to detect subclinical deficiency state. It provides objective means of assessing nutritional status, independent of emotional and other subjective factors.

  44. Biochemical Measurement measurement of a nutrient in biological fluid or tissues -> Blood: plasma/serum erythrocyte leukocyte/lymphocyte -> tissues: bone marrow, adipose tissues, bone hair, fingernails, toenails Urinary excretion rate of a nutrient Functional Tests: measuring abnormal metabolite or enzyme activities dependent upon a nutrient

  45. Distribution of Protein

  46. Somatic Protein Status Urinary creatinine excretion/24 hr M: 20-26mg /kg/24hr F: 14-22 mg/kg/24hr Creatinine Height Index (CHI)CHI%=24hr urinary creatinine X 100%Ideal 24hr urinary creatinine for Ht Normal condition: 90-100% moderate depletion: 60-90% severe depletion: >60%

  47. Visceral protein status • Albumin: 3.5~5.0 g/dl • Prealbumin: 15.7-29.6 mg/dl • Globulin: serum globulin 2.3~3.5 gm/dl A/G ratio- 1.2~1.9 mg/dl • Transferrin: 200~400 mg/dl • RBP: 2.6~7.6 mg/dl • Total serum pro: 6-8.4

  48. Overall Protein Status Short Method nitrogen balance= (protein intake/6.25)-(urinary urea nitrogen+4) Long Methodnitrogen balance= I- (U-Ue)+(F-Fe)+S I: nitrogen intake in gram U: total urinary nitrogen Ue: endogenous urinary nitrogen F: Nitrogen excreted in feces Fe: endogenous fecal nitrogen loss S: dermal nitrogen loss

  49. CVD Risk based on Lipoprotein Levels in DM Adults Risk LDL Chol HDL Chol TG High > 130 <35 > 400 Borderline 100-129 35-45 200-399 Low < 100 >45 <200 * Data is expressed as mg/dl

  50. Vitamin Assessment

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