CPH Lesson 6 Part 1

• Public Health Nutrition

  • Is about applying knowledge to the solution of nutrition related problems.
  • Prevention of nutrition-related illness in the population
  • Depends on epidemiological evidence and involves the development.
• Health (WHO)

  • A state of complete mental, physical and social well-being and not merely the absence of disease.
• Public Health

  • A collective action taken by society to protect and promote the health of entire populations.
• Epidemiology

  • Provides a rigorous set of methods to study disease occurrence in human populations
• Public Health Approaches

  Narrow Approach

  • Focuses on disease prevention and cost containment
  • Links an individual’s own behavior to the risk of disease
  • The approach is aimed at identifying immediate and obvious problems now and addressing them now
• Public Health Approaches

  Broad Approach

  • As more than the absence of disease
  • links public health science with policy:
  • The underlying theoretical model is sociocultural
  • about addressing the underlying sociostructural factor such as poverty, global issues and structure at a local, regional, national and international level that affect health
• Nutrition Assessment

  • Estimating the number of calories (kcal) needed per day is not easy

  Female: 1,600 - 2,400 kcal

  Male: 2,200 - 3,000 kcal

  • Both overfeeding and underfeeding are to be avoided

  An “ABCD” approach includes four key areas of data

  
  

  A. Anthropometrics assessment

  B. Biochemical assessment

  C. Clinical assessment

  D. Dietary evaluation/assessment

  E . Ecological assessment
• Anthropometric Assessment

  • Noninvasive techniques that measure height and weight, head circumference, and skinfold thickness (Subcutaneous fat).
  • Useful to assess body composition changes or growth over time.
  • Involves a comparison of data collected with predetermined reference limits or cutoff points that allow classification into one or more risk categories
• Height

  • Stature (height/length) is important in evaluating growth and nutrition status in children. In adults, height is needed for assessment of weight and body size
  • As people age, their height tends to decline may be related to osteoporotic changes
  • Men overstate height more often than women.
• Weight

  • When accurately measured, body weight is a simple, gross estimate of body composition.
  • Beam scales with movable but nondetachable weights or accurate electronic scales are recommended to obtain accurate results. - Spring scales are not recommended.
  • A nutrition screening tool, weights can be used to detect changes that may represent or suggest serious health problems.
  • Magnitude and direction of weight change are more meaningful when dealing with sick or debilitated patients
• Percent weight change is a useful nutrition index and may be computed as follows

  % Weight change = (Usual weight – Actual weight) ÷ Usual weight x 100
• Body Mass Index (BMI)

  • Ratio of weight to height has been associated with overall mortality and nutrition risk
  • BMI does not determine the body composition (lean body mass and adipose tissue) but it is a gauge of total body fat
• Limitations of Body Mass Index

  • BMI has not been validated in acutely ill patients
  • BMI may underestimate body fat in the elderly and others who have lost muscle mass.
  • BMI may overestimate body fat in individuals who have a muscular build
  • Cardiorespiratory Fitness (CRF) is a potential modifier because the risk of all cause mortality is lowest in the overweight category.
• Waist Measurement (WC)

  • Is an economical and straight forwarded measure that can be used to assess abdominal (visceral) fat content
  • A circumference greater than 40 inches in men and 35 inches in women indicates a risk for disease.
  • Note that visceral adiposity may vary among racial and ethnic groups
• Waist to Hip Ratio (WHR)

  • used for the patients with Human-immunodeficiency virus acquired immunodeficiency syndrome (HIV-AIDS)
  • Measure waist circumference divided by hip circumference
• Waist to Height Ration (WHtR)

  • Has higher predicative capacity than either BMI or WC for diabetes, hypertension, and cardiovascular risks and outcomes in both men and women
  • Measure waist circumference and divide by height
  • simple goal is to keep WC to less than half of height (<0.5)
• Biochemical Assessment

  1.    No single test is available for evaluating short- term response to nutrition therapy

  2.    Some tests may be inappropriate for certain patients

  Ex. Serum albumin

  3. Laboratory tests conducted serially will give more accurate information than a single test.
• Visceral Proteins

  Proteins found in internal organs and blood rather than in muscle. it is estimated through tests of serum albumin and prealbumin.

  Albumin: most abundant protein in the body (Liver)
• Dietary Intake Assessment

  
  

  24–Hour Diet Recall

  
  

  • Trained interviewer to report all foods and beverages consumed during the past 24 hours
  • Detailed description of all foods, beverages, cooking methods , brand names , condiments, and supplements, along with portion sizes in common household measures are included.
  • This method is useful in screening or during a follow-up to evaluate adaptation and compliance with dietary recommendations
• Ecological Assessment

  • Ecological Assessment sometimes called “Environmental Assessment” or “Ecological Diagnosis”

  • An indirect method of nutritional assessment that involves obtaining information from ecological factors that influences the nutritional status of an individual or community.

  • An ecological assessment is a comprehensive process in which data is collected about how a child functions in different environments or settings
• Ecological Factors Affecting Nutrition

  1. Socio-economic factors

  • Refers to society-related economic factors that relate to and influence one another.

  • A composite measure of an individual’s economic and sociological standing.

  • Accounts for a person's work experience and economic and social position in relation to others, based on income, education, and occupation
• Ecological Factors Affecting Nutrition

  1. Socio-economic factors

  Employment – Has a large impact on one’s food intake and Nutrition
• Ecological Factors Affecting Nutrition

  1. Socio-economic factors

  a. Employment – Has a large impact on one’s food intake and Nutrition

  
  

  • Manual labor – Uses more energy

  
  

  • Busy or demanding jobs – frequency of meals and quality of food compromised

  
  

  • Nature of work (shifting schedule, exposure to hazards, etc) – at risk for micronutrient deficiencies
• Ecological Factors Affecting Nutrition

  1. Socio-economic factors

  b. Education

  • Education influences the choice of employment.
  • Affects the knowledge and level of understanding of nutrition and health in general.
• Ecological Factors Affecting Nutrition

  1. Socio-economic factors

  c. Income

  • Dramatically influence the food choices. Suggest purchasing power of a family.
• Ecological Factors Affecting Nutrition

  1. Socio-economic factors

  d. Housing condition

  • A medium through which socio-economic status is expressed and health determinants operate.
  • It provides physical security and protection from the elements and plays a central role in determining an individual’s physical and social risk environment
• Ecological Factors Affecting Nutrition

  
  

  2. Demography

  • Aspects of human population include size and density, composition, and distribution
  • Size – the actual number of individuals in a population
  • Density – Measurement of population size per unit area
  • Composition – Population described in terms of age and sex.

  • Population distribution – Pattern of where people live (urban/rural)
• Ecological Factors Affecting Nutrition

  
  

  3. Geography and Climate

  
  

  • Environmental factors affect opportunities and potential for food production

  • Location (Coastal/Mountainous)

  • Altitude (Low/High)

  • Climate (Cold/Hot)
• Ecological Factors Affecting Nutrition

  
  

  4. Agricultural factors

  
  

  • Food is a key outcome of agricultural activities, and, in turn, is a key input into good nutrition.

  -The agricultural sector can impact nutrition through the production, purchase and consumption of more, better and cheaper food.
• Ecological Factors Affecting Nutrition

  
  

  5. Health System and Service Delivery

  
  

  • The management and delivery of quality and safe health services.

  
  

  • Help achieve high coverage of a broad range of health and nutrition services, especially for low-resource settings.