lec 4

• Global syndemic


  Obesity, Undernutrition and Climate Change (syndemic = combined as single super problem)
• The Lancet Commission Report on the Global Syndemic was published in January 2019
• Rethink of business models, food systems, civil society involvement, national and international governance needed to address the Global Syndemic
• The Global Syndemic involves both Human Health and Planetary Health
• Undernutrition


  Inadequate intake of dietary energy, regardless of whether any specific nutrient is a limiting factor [not enough calories]
• Malnutrition


  Deviation from adequate and optimal nutritional status; arises from deficiencies of specific nutrients or from diets based on inappropriate combinations or proportions of food

  
• Childhood malnutrition


  • Commonly involves the inadequate intake of protein and calories, with superimposed micronutrient deficiencies
  • Leads to growth faltering and dysregulated inflammation/immune function
  • Increases risk and severity of infections by many pathogens, including viruses, bacteria, protozoa, and helminths
  • Causes morbidity and mortality
• Stunting


  Low height-for-age - outcome of chronic/recurrent undernutrition and persistent infection in the first 1000 days of a child's life

  
• Wasting


  Low weight-for-height - often indicates recent and severe weight loss although can persist for a long time - typically from non enough food/recent infectious disease
• Underweight


  Low weight-for age - may be stunted or wasted or both
• Overweight/obesity


  Abnormal or excessive fat accumulation that may impair health - excessive weight for height in children under 5 years of age, raised BMI in anyone over 5 years of age

  
• Comprehensive National Nutritional Survey, India 2016 - 2018

  • Stunting: 34.7%
  • Wasting: 17%
  • Underweight: 33.4%

  
• Stunting, wasting and underweight are more prevalent in rural versus urban areas; and in the poorest wealth quintile versus the richest wealth quintile
• Types of malnutrition


  • Undernutrition (wasting, stunting, underweight)
  • Micronutrient-related malnutrition (micronutrient deficiencies or excess)
  • Overweight, obesity and diet-related non-communicable diseases
• Malnourished children can mount an acute phase response to infections, with elevated CRP and low negative acute phase reactants, even in the absence of clinical infection
• Around 45% of deaths in children under 5 are linked to undernutrition, mostly in low- and middle-income countries

  
• Rates of overweight/obesity are increasing in low- and middle-income countries
• Malnutrition has enormous developmental, economic, social and medical impacts
• Macronutrients


  The three main types of macronutrients are carbohydrates, proteins, and fats
• Micronutrients


  Essential vitamins and minerals required in small amounts for proper growth and development
• Metabolism


  The chemical processes that occur within a living organism to maintain life
• Vitamin A


  An essential nutrient that plays a crucial role in immune function, vision, and skin health
• Vitamin A deficiency can lead to increased susceptibility to infections