1. Chapter Eight Nutrition and Global Health

2. The Importance of Nutrition • Nutritional status is intimately linked with health status • Nutrition is the leading risk factor for loss of health in low- and middle-income countries • Low-cost, highly effective interventions are available to improve nutrition status

3. Definitions and Key Terms • Malnutrition - refers to those who do not get proper nutrition, whether too little, too much, or the wrong kind • Undernourished - refers to those who lack sufficient energy or nutrients • Underweight - refers to those who have low weight for their height or age • Overweight or obese - refers to those who are nourished to the point of being too heavy for their height or age

4. Table 8.3: Key Terms and Definitions Source: Adapted with permission from The World Bank. Repositioning Nutrition as Central to Development. Washington, DC: The World Bank; 2006:xvii.

5. Table 8.3: Key Terms and Definitions (cont.) Source: Adapted with permission from The World Bank. Repositioning Nutrition as Central to Development. Washington, DC: The World Bank; 2006:xvii.

6. The Determinants of Nutritional Status Immediate causes of malnutrition: • Inadequate dietary intake- weakens the body and opens it up to infection • Illness- makes it harder for people to eat, absorb the nutrients they take in, and raises the need for some nutrients Relationship creates a cycle of illness and infection

7. Figure 8.1: The Determinants of Nutritional Status: The UNICEF Framework

8. Gauging Nutritional Status • Nutritional status of infants and children is gauged by measuring and weighing them, then plotting weight and height on a growth chart • Child’s position on growth curve indicates if they are developing normally • Large share of nutritional deficits are mild, but still have negative consequences on development

9. Key Nutritional Needs Undernutrition • Outcome of insufficient food intake and repeated infectious disease • Includes underweight, stunted, wasted, and micronutrient malnutrition • Raises risk of illness and decreased intellectual capacity in children • Raises risk of pregnancy-related death and delivering prematurely in women

10. Key Nutritional Needs Vitamin A • Deficiency associated with night blindness and eventually, permanent blindness • Important to growth and the proper functioning of the immune system • Impact on severity of illness and chance of survival from several causes, including diarrhea, malaria, and pneumonia

11. Key Nutritional Needs Iodine • Deficiency associated with a growth on the thyroid called a goiter and the failure to develop full intellectual potential • Occurs in people who live in mountainous regions where less seafood is consumed and the soil is deficient in iodine

12. Key Nutritional Needs Iron • Deficiency causes iron deficiency anemia which is associated with fatigue and weakness • Iron-deficient pregnant women have an increased risk of giving birth to a premature or low birthweight baby or hemorrhaging and dying in child birth

13. Key Nutritional Needs Zinc • Deficiency is associated with growth retardation, impaired immune function, skin disorders, hypogonadism, and cognitive dysfunction • Deficiency is a major risk factor for morbidity and mortality from diarrhea, pneumonia, and malaria

14. Nutritional Needs Throughout the Life Cycle Pregnancy and Birthweight • Pregnant women need a sufficient amount of protein and energy as well as iron, iodine, folate, zinc, and calcium • Fetuses that do not get sufficient nutrition from the mother may suffer from stillbirth, mental impairment or birth defects

15. Nutritional Needs Throughout the Life Cycle Infancy and Young Childhood • Children need sufficient protein and energy as well as iodine, iron, vitamin A, and zinc • Nutritional gaps during this time can cause problems with stature and mental development, and frequent infection • Grow best and stay healthiest if exclusively breastfed for first 6 months • “Window of opportunity” is in utero to two years of age

16. Nutritional Needs Throughout the Life Cycle • Adolescents need protein and energy to grow as well as iron, iodine, folic acid, and calcium • Adolescent girls who are poorly nourished are much more likely to give birth to an underweight child and experience complications during pregnancy than well-nourished girls

17. Nutritional Needs Throughout the Life Cycle Adulthood and Old Age • Adults need a well-balanced diet with protein, energy, and iron • Foods that contain too much fat, cholesterol, sugar, or salt can be harmful • Older adults need calcium to reduce risk of osteoporosis

18. Nutritional State of the World Undernutrition • 26% of under-5 children are underweight according to most recent estimates • Rates of underweight vary considerably by region • Only about 0.5% of total deaths in low- and middle-income countries are directly due to undernutrition • Deaths are usually “nutrition related”

19. Nutritional State of the World Low Birthweight • 11% of babies in low- and middle-income countries are born low birthweight according to recent estimates • About 3% of DALYs lost in low- and middle-income countries are attributable to low birthweight

20. Nutritional State of the World Vitamin A • About 250 million children suffer from vitamin A deficiency worldwide • 6.5% of all deaths of children under-5 in low- and middle-income countries are due to vitamin A deficiency

21. Nutritional State of the World Iodine • About 70 million people worldwide are affected by iodine deficiency • Associated with substantial DALYs lost in low- and middle-income countries

22. Nutritional State of the World Iron • About 1.6 billion people were affected by anemia between 1993 and 2005 • Substantial public health problem for children under 5 and pregnant women, especially in low- and middle-income countries • 0.7% of DALYs lost in low- and middle-income countries is related to iron deficiency anemia

23. Nutritional State of the World Zinc • Second most important micronutrient responsible for death and DALYs in children under 5 • About 4% of DALYs lost in children under 5 years of age are due to zinc deficiency

24. Nutrition, Health, and Economic Development • Nutrition impacts health and human development • Link to what people learn and their productivity Poor nutrition: • Impacts maternal health, which affects household income and health of children • Affects children’s ability to learn in school, which impacts their future prospects • Leads to lower productivity in adult workers