September 27, 2001 1

UNIVERSITY OF AGRICULTURE MAKURDI

255TH SENATE

Nutrition, your family & youFrank Onyezili

Presentation Outline

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

UNICEF

Malnutrition

Insufficient Health Services

& Healthy Environment

Inadequate Maternal and

ChildCare

Insufficient Household

Food security

Resources and Control(Human, Economic, and

Organizational)

Potential resources

Inadequate dietary intake

Disease

Inadequate Education

Political and Ideological superstructure

Economic StructureBasic Causes

Underlying Causes

Immediate Causes

Manifestation

Conceptual Framework (simplified)

of the causes of

malnutrition

A commo

n Thread

!!

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 problemsTension/anxietyWork mistakesPoor concentrationApathyMany 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 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

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).

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

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)

UNICEF

The RDA (1)*Food type

Recommended Dietary Allowance of nutritional

elements

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

RDA for people 4 years or older, eating 2000 Calories per day

UNICEF

The RDAs (2)Requirement - mg. per kg. of body weight

Infant Child Adults

Amino acid 3 - 6 mo. 10 - 12 yr. Histidine 33 not known not known

Isoleucine 80 28 12 Leucine 128 42 16 Lysine 97 44 12

S-containing amino acids

45 22 10

Aromatic amino acids

132 22 16

Threonine 63 28 8 Tryptophan 19 4 3

Valine 89 25 14

RDI listings (1)*

Energy Protein Vitamin A Vitamin D

Vitamin E

Vitamin K Age

k. cal g IU *ug RE IU *ug IU *mg

TE *ug

Children 4-6 1,800 30/24 2,500 500 400 5 9 7 -/ 20

7-10 2,400/

2,000 36/28 3,300 500 400 5 10 7 -/ 30

Males 15-18 3,000 54/59 5,000 1,000 400 5 15 10 -/ 65

19-24

3,000/

2,900 54/58 5,000 1,000 400 5 15 10 -/ 70

25-50 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

Females 15-18 2,100 48/44 4,000 800 400 5 12 8 -/ 55

19-24 2,100 46/46 4,000 800 400 5 12 8 -/ 60

25-50 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

Fat-soluble vitamins

The RDI listings (2)

Ascorbic Acid

Folacin/ Folate Niacin Riboflavin Thiamine Vitamin

B6 Vitamin B12 Age

mg mcg mg mg mg mg mcg

Children 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

Males 15-18

45/60 400/200 20 1.8 1.5 2.0 3.0/2.0

19-24

45/60 400/200 20/19 1.8/1.7 1.5 2.0 3.0/2.0

25-50

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

Females 15-18

45/60 400/180 14/15 1.4/1.3 1.1 2.0/1.5 3.0/2.0

19-24

45/60 400/180 14/15 1.4/1.3 1.1 2.0/1.6 3.0/2.0

25-50

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

Water soluble vitamins

* first figure refers to the old RDA listing while the second figure refers to the newer DRI listing

The RDI listings (3)

Calcium Phosphorous Iodine Iron Magnesium Zinc Selenium Fluoride Age mg mg ug mg mg mg *ug *mg

Children 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

Males 15-18

1200/1300 1200/1250 150 18/12 400/410 15 -/50 -/3.8

19-24

800/1000 800/700 140/150 10 350/400 15 -/70 -/3.8

25-50

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

Females 15-18

1200/1300 1200/1250 115/150 18/15 300/360 15/12 -/50 -/3.1

19-24

800/1000 800/700 100/150 18/15 300/310 15/12 -/55 -/3.1

25-50

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

Minerals, others

* 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

Sahel. Major causes of child mortality

Pneumonia20%

Neonatal26%

Measles6%

Others1%

Diarrhea16%

Malaria24%

Malnutrition53%

A Key Question: Why do we lose our U5s?

Most U5 diarrhea deaths result from dehydration, replaceable (with SSS, ORS, ORT)

Nutrition and Growth (1)Key messages for caregivers:

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: 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

First two years are critical, including for early stimulation and learning

Next three (i.e. 3-5 years) are important too, including for pre-school 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

3% cretinism 10%

moderate/severe

mental

retardation 87% mild

intellectual

impairment

Consume adequately iodized salt

17%

Not enough Exclusive Breastfeeding!!!

500,000 infant deaths annually

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

UN

ICE

F/P

irozz

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Protein Energy Malnutrition: May be not child of UAM staff, but…

0.25 million U5 deaths annuallyProtein-rich,

Energy- rich diets, but watch out

for phytate-rich

grains/tubers

Vitamin A Deficiency, again may be not child of UAM staff, but…

3030,000 U5 ,000 U5 deaths deaths

annuallyannually Vitamin A supplements, plus vitamin A-fortified foods, vitamin A-rich dark green vegetables, carrots, mangoes etc

ADEQUATE NUTRITION

ADEQUATE SLEEP

REGULAR EXERCISE

The Health Triangle

What is sleep hygiene?Different practices that promote normal, quality night-

time 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?

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

Last, not leastPlease Pray!