Nutrition and food security

some principles (cont)

DRAFT

Nutrient Size (req/day) Role, reason Deficiencies

1. CHOs, Fats, N(protein: AAs)

Up to 500 g Energy, buildingblocks – structure,metabolism

Diverse clin signs. Not clearly linked torole.

2. Na, K, Ca. Up to 5 g Solute (seawater),homeostasis

Not really seen

3. Phosphate, Cl Up to 5 g As 2 Not really seen

4. Vit C Up to 0.1 g, 100mg

Antioxidant in mostcells; enzyme lostin evolution

Scurvy. Not clearlyrelated to function.

5. B-vits Up to 50 mg Co-factors inmetabolism(opportunisticevolution)

Specific signs, notclearly related tofunction

6. Essential Aasand FAs

... g Structure,metabolism; like B-vits

Some specificsigns, but not wellknown nor clearlyrelated to function

7. Metals: Fe, Zn,Cu, Mg, Mn, ...

1 – 10 mg(available)

a) Fe: carry O2

b) active sites ofenzymes (incl. Fe)c) other (e.g.cognitive)

a) anemia andcorrelatesb) non-specific orno signs (e.g. Zn)c) research area

8. I, vit D mcg Hormones, controlof homeostasis,growth, etc.

Specific signs(IDDs, rickets)when severe.

9. Vit A mcg a) visual cycleb) membranes

Specific signswhen severe; mild,mortality effect

plus almost all affect immune system

Energy needs of population depend on:

• Resting metabolic needs (BMR)

• Activity: > 1.5 BMR

• Demographic composition – ( includes pregnancy and lactation)

• Temperature

• E.g. emergencies 2100 kcals; usually around 2200 kcals; see RDAs

• Energy needs: about 2200 kcals/hd/day, averaged over popn

• Protein: about 10% of energy should be from protein.

• CHO: 3.5-4.0 kcals/g

• Protein: 4.0 kcals/g

• Fat: 9.0 kcals/g

Nutrient types and deficiencies

Type I - reduced tissue concentration and specific clinical signs

Type II - reduced growth rate and non-specific signs

TYPE I

growth continues in early stages specific clinical signs develop tissue concentration drops with deficiency body stores exist concentrated in particular tissues specific enzymes affected not usuallv anorexic tissue concentration independent of the other type I nutrients tissue concentration maintained in different metabolic states food sources very variable diagnosed by biochemical tests anthropometric abnormality only appears late in the deficiency .

TYPE I nutrients Iron copper manganese iodine selenium calcium fluorine thiamine riboflavine pyridoxine nicotinic acid cobalamin folate ascorbic acid vitamin A (retinol) vitamin E (tocopherol) vitamin D vitamin K

Nutrient types and deficiencies

Source: M Golden

TYPE II nutrients potassium sodium magnesium zinc phosphorus protein

nitrogen carbon skeletons of essential amino acids threonine lysine sulphur [oxygen] [water]

[energy]

TYPE II

growth failure first response no specific clinical signs tissue concentration maintained with deficiency no body store of these nutrients not in any particular tissue general effect on metabolism anorexia common response tissue concentration dependent upon all the other type II nutrients tissue concentration may change (drop) with metabolic state ratio in foods not very variable do not give biochemical abnormalities diagnosed by anthropometric abnormality

Nutrient types and deficiencies

Source: M Golden

TABLE 1 PERCEPTIONS AND RELATIVE PRIORITIES OF INTERVENTIONS Problem Presentation Intervention Vitamin A deficiency Striking: blindness,

increased child and maternal mortality risk

Easy in children: infrequent high dose capsules

Iodine deficiency Striking: cretinism, dwarfs, goitre

Easy: iodized salt

Iron deficiency Subtle: anemia, reduced cognitive development

Difficult: e.g. frequent supplementation

General malnutrition -- growth failure

Subtle: smaller children Difficult: community-based programs

General malnutrition -- starvation in emergencies

Striking: emaciated and dying children and adults

Easy (in principle): emergency food aid and other assistance

What would it take to eliminate malnutrition?

Economic growth, jobs, improved income distribution

Education, especially for women Reduced fertility, family planning Nutrition in health services,

schools Community-based programs

including nutrition

Nutrition influence

Low Higher

Household food security.• Except in emergencies (and even then) interventions to improve food security

are pretty much the same as those to reduce poverty.

• Relevant actions:– Macroeconomic adjustment

– Employment policies

– Employment provision

– Agricultural policies

– Food prices and subsidies, public distribution• General subsidies

• Targeted

• Rations and quotas

• Food stamps and coupons

See: ‘nutrition-relevant actions’ www.unsystem.org/scn

Measure food security and hunger:

• FPI/CPI

• Income/exp surveys

• Food cons surveys (incl 24 hr recall)

• Food perception q’aires

• Anthropometry ?See FIVIMS meeting: http://www.fivims.net/documents/ISS/ISS_e/ISS_exesum.pdf

ISSUES IN COMPLEMENTARY FEEDING

Weanling’s dilemma

Time for caring – feeding frequency

Quality

Timing

Bulk

Cleanliness

... and continue breastfeeding

Complementary foods

Ideal pattern of infant feeding

6 mo

12 mo

24 mo

100%

50%

0%

Breast fed only

Breast fed and complementary foods

Interventions in relation to the life cycle.

Antenatal care Birth attendance

Breastfeeding – initiation, exclusive to 4-6 months,

continue into second year

Child feeding practices (weaning)

Immunization

Water/sanitation/food security

Household food security.• Except in emergencies (and even then) interventions to improve food security

are pretty much the same as those to reduce poverty.

• Relevant actions:– Macroeconomic adjustment

– Employment policies

– Employment provision

– Agricultural policies

– Food prices and subsidies, public distribution• General subsidies

• Targeted

• Rations and quotas

• Food stamps and coupons

See: ‘nutrition-relevant actions’ www.unsystem.org/scn

• Community-based and service delivery (facility-based) programs

• Vertical micronutrient programs

• Nutrition in health services and schools

• Contextual and supporting policies.

PROGRAM DESIGN FACTORS

Coverage — % of population participating

Examples: % children immunized (of appropriate age) % pregnant women with ANC

Targetting — preferentially including a target group

by vulnerable group (often biological, e.g. by age, pregnancy),usually involving selection of individuals

by administrative or geographic area by s-e status (uncommon in practice — e.g. food stamps by

means testing)

Assess by estimating prevalence in participants: prev in overall population(should be > 1).Note: principle should be to only target those who can respond ...

Intensity — resources applied per participating population

Examples: $/head/year personnel/population/year — e.g. mobilizers/family supervision ratios — facilitators/mobilizer; nurses/doctor other resources: hospital beds/head; nurses/head;

supplies/head; etc.

Program content

depends on causes of the problem open to intervention depends on interaction with contextual factors — e.g. literacy/

behaviour change adequate intensity needed before impact for many actions;

probably non-linear.

PREQUISITES

Decide on: objectives (incl for whom) program activities that could reach objectives indicators of outcome (i.e. of objectives) and process (i.e.

of activities) coverage, intensity and targetting required to actually

meet objectives (see next) organization, institutions, finance ... iterate and negotiate until it makes sense (or doesn’t —

that must be decided too).

It’s not in principle more complicated than that; the most difficult partis deciding the content. Most planning protocols come down to this. Some try to impose a cookbook approach (like the ‘log frame’) —they don’t usually work. Better by far is to build the local capacity tofigure these things out ... help to get started ... fund crucial elements.

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