Nutrition in Health and Illness

For Medicine students

Course Code:
Cried hour: 2

By:- Haji Aman (BSc, MPH & PhD fellow in Human

Nutrition)
AGHMC
Oct ,2019
 Course objectives:

At the end of the course the student will:

o Acquire knowledge of various nutrients and their importance in

maintenance of health

o List common foods rich in essential nutrients

o Calculate Claire need of an individual

o Develop food menu according to calories and nutrient need of an

individual

o Apply the knowledge in the promotion of health and in the care of sick

o Explain diets required to enhance recovery from illness

 Objectives….
o Discuses different nutrition assessment methods
o Describe hospital diets
o Explain food storage and preservation methods

o Conduct nutritional survey

o Describe factors that affect normal diets selection

• Discourses nutritional need of especial groups (infants,

pregnant women, lactating women, adolescents and
elderly people, PLWHA)
 Course contents

• Develop in early detection of nutritional deficiencies

• Prevent and mange common notional deficiencie
• Basic Nutrients (proteins, fats, carbohydrates,
vitamins minerals and water)
• Nutritional influence on growth and development

• Effects of deficiency and early detection

 Evaluation Methods

o Mid exam 40%

o Final exam 60%
 References

• Tefera Belachew: Human nutrition for health science students,

lecture note Jimmal University, and 2007
• Micygheel Rynbergen, abolition Dibble-nutrition in health and
disease 16th ed 1967
• Barker H.M Back’s. Nutrition and dietetics for nurses 8 th ed 1991
• Barker S.G nutritional Hand Book for nursing practices 1987
• Felicity savage king and Ann burgess-nutrition for developing
countries oxford medical pulsation 2nd edition 1995 Krause and
mahout, food nutrition and diet therapy 1996
INTRODUCTION TO HUMAN NUTRITION

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 Definitions of terms
o Food - Is defined as anything edible as defined
based on specific culture, religion, etc. It
includes all foods and drinks acceptable to be
ingested by certain society.
o Edibility: What is edible? How is it defined?
o Nutrient: - Is an active chemical component in
the food that play specific structural or
functional role in the body’s lively activity.

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 Definition Cont…
oNourishment: the status/situation of being
nourished.

oMalnourishment or Malnutrition? or is a condition

that results from eating a diet in which nutrients are
not enough or are too much such that it causes health
problems

oIt is often used specifically to refer to under nutrition

where there is not enough calories, protein or
micronutrients; however, it also includes over nutrition

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 Cont…
o Diet: - Is the sequence and balance of meals in a
day.
o It is concerned about the eating patterns of
individuals or a group, for instance:
some people may eat twice in a day (breakfast
and dinner),
others may eat four times in a day (breakfast,
lunch, snack and Dinner)
still others may remain munching all the day
round, etc.

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 Definition…..
o Dietetics:-Is the health profession with
primary responsibility for the practical
application of nutrition science to person
and groups in various conditions of health
and disease.

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o Balanced diet/Healthy diet: is a
diversified diet that contains all the
essential nutrients in the proportion that is
required for optimal health and long-term
survival.
Your Menu Should be
colourful !

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 Diet-Planning Principles

o Diet planners have developed several ways to

select foods.
o Whatever plan or combination of plans they use,
though, they keep in mind the six basic diet-
planning principles:
 Adequacy
 Balance
 kCalorie (energy) control
 Nutrient Density
 Moderation
 Variety

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 Dietary planning..
o Balancing:- Providing foods in proportion to each other
and in proportion to the body 's need s.
o kcalorie (energy) control: management of food energy
intake.
o Nutrient density: a measure of the nutrients a food
provide s relative to the energy i t provides.
o The more nutrients and the fewer kcalories, the higher
the nutrient density.
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 Nutrient Density
o To eat well without overeating, select foods that deliver the
most nutrients for the least food energy.
o One way to evaluate foods is simply to notice their nutrient
contribution preserving: 1 cup of milk provides about 300
milligrams of calcium, and ½ cup of fresh, cooked turnip
provides about 100 milligr ams.
o Thus a serving of milk offers three times as much calcium as
a serving of turnip greens.

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 Nutrition density
o Just like a person who has to pay for rent, food, clothes,
and tuition on a limited budget, we have to obtain iron,
calcium, and all the other essential nutrients on a limited
energy allowance.
o Success depends on getting many nutrients for each
kcalorie "dollar”.
o For example, a can of cola and a handful of grapes may
both provide about the same number of kcalories, but the
grapes deliver many more nutrients.
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 Nutrition density…..
o A person who makes nutrient-dense choices, such as fruit instead
of cola, can meet daily nutrient needs on a lower energy budget.
o Such choices support good health.

o Foods that are notably low in nutrient density-such as potato

chips, candy, and colas-are sometimes called empty-kcalorie
foods.
o The kcalories these foods provide are called "empty" because they
deliver energy (from sugar, fat, or both) with little, or no, protein,
vitamins, or minerals.

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 Moderation
o Foods rich in fat and sugar provide enjoyment
and energy but relatively few nutrients.
o In addition, they promote weight gain when
eaten in excess.
o A person practicing moderation, eats such
foods only on occasion and regularly selects
foods low in solid fats and added sugars, a
practice that automatically improves nutrient
density.

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 Variety
o A diet may have all of the virtues just described and still
lack variety, if a person eats the same foods day after day.
o People should select foods from each of the food groups
daily and vary their choices within each food group from
day to day for several reasons.
o First, different foods within the same group contain different arrays of
nutrients.
o Among the fruits, for example, strawberries are especially rich in
vitamin C while apricots are rich in vitamin A.
o Variety improves nutrient adequacy.

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 Variety…..
o Second, no food is guaranteed entirely free of substances
that, in excess, could be harmful.
o The strawberries might contain trace amounts of one
contaminant, the apricots another.
o By alternating fruit choices, a person will ingest very little
of either contaminant.

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 Variety…
o Third, as the age goes, variety is the spice of life.
o A person who eats beans frequently can enjoy pinto
beans in Mexican burritos today, garbanzo beans in Greek
salad tomorrow, and baked beans with barbecued chicken
on the weekend.
o Eating nutritious meals need never be boring.

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 Five food groups:

o Fruits
o Vegetables
o Grains
o Meat and legumes
o Milk

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 What is Nutrition?

o Definition from natural science origin

o Definition from social science origin

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 Nutrition contd…..
oNutrition: is the science that interprets the
interaction of nutrients and other substances in food
(e.g. Phytonutrients, anthocyanins, tanins etc..) in
relation to health and maintenance, growth,
reproduction, disease of an organism.
oIt also includes the process by which the organism
ingests, digests, absorbs, transports, utilizes and
excretes food substances ===> natural science
origin
oIn addition, nutrition must be concerned with social,
economic, cultural and physiological implications of food
and eating =====> social science origin
 NUTRITION……
o Nutrition is the provision of adequate
energy & nutrients (in terms of amount &
mix & timeliness) to the cells for them to
perform their physiological function (of
growth, reproduction, defense, repair,
etc).
o Science of food: deals w/the nutrients &
other substances in food

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Epidemiological applications in
Nutrition
(can we apply disease causation models?)

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 Diet as an agent determining health

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 Important Aphorisms

What so ever was the father of

a disease, an ill diet was the
mother”

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“You are what you eat”

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 Origin & Development
o The idea of nutrition existed during the ancient
times
 Hippocrates (460-359 B.C)
“Persons who are naturally very fat are to die
earlier than those who are slender.”
Leonardo davinci (1452-1519).
“--- If you do not supply nourishment equal to the
nourishment departed, life will fail in vigor --”
o Bankruptcy or money laundering?
 Origin & Development

o 19th century-notable discoveries in

nutrition:
o Isolation of glycogen & different amino
acids
o Chemical methods for analysis of
foodstuffs developed
o Studies on protein composition & energy
studies in animals…
 Origin & Development
o 20th century-great advancements
o Researches:
 vitamins discovered; essential amino acids & certain
minerals found to be essential; nutrition studies at
cellular level…
o Gained emphasis in the international agenda:
World food & Nutrition Summits, UN Declarations &
Commitments
International agencies working on food & nutrition
Nations with food & nutrition policies
The end of the 20th century gave priority for the role of
nutrition through the MDG.
 SO, why nutrition matters?

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Déclaration of the 1974 World Food Submit

‘… all governments & the international

community as a whole …. eliminate within
a decade hunger & malnutrition’
(Resolution V)

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 Malnutrition today – what progress
have we achieved today, after 4
decades?

Malnutrition rates remain

alarming: stunting is declining too
slowly while overweight continues
to rise
Some problems in dealing with
malnutrition:

o In the past there was a

lack of consensus on the:
 nature of the
malnutrition problem
 causes of the problem
 what actions to take
Two extreme schools of thoughts

o Technologists:
 Technological interventions (eg.
magic bullets) can solve the
problem
o Structuralists:
 Eradicating poverty will solve
the problem
 What happened?

 Too many viewpoints led to

CONFUSION &
 A lack of agreement on
How to tackle malnutrition
Some myth-information on nutrition

o Increasing food production will reduce

malnutrition
o Protein deficiency is the cause of
malnutrition(see protein fiasco)
o Children in developing countries are
genetically short
o Malnutrition should be left in the hands of
nutritionists
 Ethical Impérative

“every man, woman & child has the

inalienable right to be free from hunger
& malnutrition in order to develop their
physical & mental faculties”
WFS 1974

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 Ethiopia is implementing SDP )

UNICEF/C-55-38/Watson
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o How many MDG goals were related to
nutrition?
o What about SDP?

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 Nutrition in the MDGs
MDGs Relevance of nutrition

1. Eradicate extreme poverty Contributes to human capacity and productivity

and hunger throughout life cycle and across generations
2. Achieve universal primary Improves readiness to learn and school
education achievement
3. Promote gender equity and Empowers women more than men
empower women

4. Reduce child mortality Reduces child mortality (over half attributable to

malnutrition)
5. Improve maternal health Contributes to maternal health thru many
pathways
Addresses gender inequalities in food, care and
health
6. Combat HIV/AIDS, malaria Slows onset and progression of AIDS
and other diseases Important component of treatment and care
7. Ensure environmental Highlights importance of local crops for diet
sustainability diversity and quality
8. Develop a global Brings together many sectors around a common
partnership
09/02/2021 for development HAJIproblem
AMAN(PhD fellow in Human Nutrition) 45
What are the causes of malnutrition ?

09/02/2021 HAJI AMAN(PhD fellow in Human Nutrition) 46

o Dietary causes
o Free radical theories

o UNICEF conceptual frame work

o Adaptive theory

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 The Global conceptual framework for the causes of malnutrition
Reduced educability, lost Functional
productivity, mortality, morbidity consequences

Nutritional Status Manifestation

Immediate
Diet Health Causes

Household Environ. Health, Underlying

Care of Mother
Food Security Hygiene & Sanitation Causes
and Child

Human, Economic, and Institutional

Resources, manmade & natural calamities

Political and Ideological Structure Basic

Ecological Conditions Causes
Adapted from UNICEF
09/02/2021 Potential Resources
HAJI AMAN(PhD fellow in Human Nutrition) 48
 Malnutrition: Is A Hidden Problem

Majority (80%)
mild & moderate

UNICEF/94-1173 Pirozzi
 Victims not aware

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 Child Malnutrition by Age Group
(The first 24 months are critical)
Percentage
75

50

Stunting
Underweight
25

0
0 12 24 36 48 60

Age (months)
Source:: EDHS 2005
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 Trends over years

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What are Nutritional problems of public Health Importance in Ethiopia?

09/02/2021 HAJI AMAN(PhD fellow in Human Nutrition) 52

 Nutritional problems of public Health
Importance in Ethiopia
 Protein-energy malnutrition
o
Vitamin A deficiency
o
Iodine deficiency
o
Iron deficiency anemia
o
Vtamin D deficiency
o
*Folate deficiency
o
*Zinc deficiency
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Malnutrition in Ethiopia EDHS 2016
 Stunting
o 38 percent stunted
o 18 percent are severely stunted
o Rural areas 40%
o Urban areas 25% .
o 46 percent in the Amhara region
o To a low of 15 percent in Addis Ababa.

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 Weight-for-height

o Somali and Afar having the highest

percentages of children who are wasted,
23 percent and 18 percent, respectively.

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 Weight for Age

o In rural areas 25%

o Urban areas 13%.

o The highest percentages of underweight
children are observed in Afar (36 percent)
and Benishangul-Gumuz (34 percent).

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 Trends of malnutrition

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 Breast feeding in Ethiopia
o 58 percent of infants under 6 months are exclusively breastfed.

o 17 percent of infants 0-5 months consume plain water,

o 5 percent, each, consume nonmilk liquids or other milk,

o 11 percent consume complementary foods in addition to breast milk.

o Five percent of infants under age 6 months are not breastfed at all.

o The percentage exclusively breastfed decreases from 74 percent of infants

age 0-1 month to 64 under 6 months use a bottle with a nipple

o The percentage of children who are currently breastfeeding decreases from

91 percent among children age 12-17 months to 76 percent among

children age 18-23 months.

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 Anemia in children
o 56 % of children suffered from some degree of anaemia:

o 25 percent were mildly anaemic,

o 28 percent were moderately anaemic, and

o 3 percent were severely anaemic.

o The prevalence is highest ( 77 percent) among children age 6-11

o Low of 40 percent among children age 48-59 months.

o Rural children 57 percent anemic and

o Urban 47 percent.

o The lowest in Amhara (41 percent),

o Highest in in Somali (83 percent).

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 Anemia in Women
o About one-fourth of women age 15-49 (23 percent) are

anaemic.

o The proportion of women with any anaemia is notably

higher in rural than in urban areas (25 percent versus 16

percent).

o Anaemia prevalence among women ranges from 16

percent in Amhara and Addis Ababa to 59 percent in

Somali.
09/02/2021 HAJI AMAN(PhD fellow in Human Nutrition) 61
 EDHS 2016

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What are the causes of deaths in under five
children?

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Causes of Death among Ethiopian Children 0-5 Years
Old
Other 2%

Measles 4%
AIDS 1%
Neonatal 25%
Diarrhea 20%

Malnutrition
53%

Pneumonia
Malaria 20%
28%

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 Causes of Child Mortality in Ethiopia

Malnutrition
53%
Other
47%

• Greatest single cause of child

mortality

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Causes of Child Mortality in Ethiopia

Mild &
moderate
severe

Only 1 in 5 malnutrition-related deaths is due to severe

malnutrition

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 UNICEF/C-56-19/Murray-Lee
Child Mortality (2006-2015)
1.3 million child deaths
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 Breastfeeding Practices
100

75 Exclusive Complementary
Breastfeeding Feeding
49 50
% 50

UNICEF/93-COU-0173/Lemoyne
25

0
0-6 months 6-9 months

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 Poor Breastfeeding Practices

50,000

UNICEF/93-COU-0173/Lemoyne
infant deaths
every year
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 Breastfeeding and Birth Spacing

o Total Fertility Rate = 5-6 births

per woman

UNICEF/D0192-0060/Johnson
o Delay in fertility due to
breastfeeding = 14 months

o Value of birth spacing effect of

breastfeeding = 167 million
Birr/year

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 Vitamin A Deficiency

 Night blindness

 Ulceration of the cornea

 Permanent blindness

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Children with Vitamin A Deficiency (VAD)

Permanent blindness

Xerophthalmia

Night blindness

Sub-clinical
Vitamin A deficiency

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 VAD: Prevalence

61%

UNICEF/ Pirozzi
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 VAD: Associated Mortality

32%

UNICEF/ Pirozzi
800,000 child lives lost

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 Low Birth Weight

13.5%

UNICEF/C-56-19/Murray-Lee
• 2006-2015: 0ver 600,000 infant deaths

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 •
MALNUTRITION
AND
EDUCATION

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Malnutrition and Intellectual Development

Reduced:

 Learning ability

UNICEF/C-56-19/Murray-Lee
 School performance

 Retention rates
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 Iodine Deficiency during Pregnancy


severe mental and physical damage

moderate mental retardation

UNICEF/HQ93-2200/Pirozzi

mild intellectual disability

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Iodine Deficiency and Intellectual Development

100
87
Intelligence Quotient

UNICEF/C-56-19/Murray-Lee
0
Iodine suficient Iodine deficient
areas areas
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 Total Goiter Rate = 38%

If If this is not corrected from

2006-2015: 4.5 million
babies will be born

UNICEF/Ethiopia
intellectually impaired

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 Nutritional Problems Associated with Brain
Development
Prevalence (%)

100

75

50

25

0
Goitre Anemia Stunting LBW

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 Summary of intellectual consequences
 Iron deficiency anemia lowers IQ by about 9
points
 Mild iodine deficiencies lowers IQ by about 10
points
 Severe stunting associated with IQ loss of 5-10 points

 Low birth weight babies have IQs 5 points

lower
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 MALNUTRITION & ECONOMIC DEVELOPMENT

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Economic Consequences of Malnutrition

 Malnutrition results in:

 Mental Impairment

 Physical Stunting

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 Iodine Deficiency and Productivity
retardation(Cretinism) in fetuses and children

Physical shortness(Iodine dewarfism) in children

Weakness and morbidity in adults

Weakness, poor reproduction in the beasts of burdon

Mortality

Unemployement and discounting future earnings

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 Productivity Losses
due to Iodine Deficiency (2006-2015)
• Present Value = 64 billion Birr

UNICEF/93-COU-0931/Ethiopia/Thomas
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 Anemia
Iron deficiency anaemia leads to:

• Decreased physical growth in children and results in short

stature

• Impaired learning (Decreased attention span) in children

• Poor metabolic efficiency and physical productivity

• Impaired Immunity

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 Productivity Losses due to Anemia (2006-2015)

• Present Value = 36 billion Birr

UNICEF/93-COU-0931/Ethiopia/Thomas
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 Child Stunting

Inadequate nutrition
in early childhood 1st
24 months leads to
reduction of 11 cm in
UNICEF/C-55-34/Watson

height

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 Stunting at Age 2
(EDHS - 2005)

51%
UNICEF/C-55-34/Watson

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 Consequence of Stunting

• Reduced productivity

1.4% decrease in productivity for every

1% decrease in
height
(Haddad & Bouis, 1990)

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 Productivity Losses due to Stunting (2006-2015)

• Present Value = 44 billion Birr

UNICEF/93-COU-0931/Ethiopia/Thomas
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 Total Economic Losses with and without
Nutrition Improvement (2005-2015)
Birr (billions)

144 billion
150

44
100 Stunting
36 Anemia
Iodine Deficiency
50
64

0
No Change Improved

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Total Economic Losses with and without
Nutrition Improvement (2005-2015)

150
144 billion

44 Gain = 46 billion
98 billion
Birr (billions)

100
Stunting
36 37 Anemia
Iodine Deficiency
50 30
64
31
0
No Change Improved

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In summary, the functional consequences
of malnutrition are immense:

Deficiency Reduces

Vitamin A survival
PEM Physical
productivity
Iron
IODINE intelligence
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 ANY QUESTIONS?

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 Thank you!!

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