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Nutrition and food security

some more principles

Spring 2009

I 613-2-09

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•Energy requirements

•Nutrient types and deficiencies

•Household food security

•Care interventions, feeding practices

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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 requirements

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• 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

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Nutrient types and deficiencies

Type I - reduced tissue concentration and specific clinical signs

Type II - reduced growth rate and non-specific signs

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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

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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

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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

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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– Cash transfers (maybe conditional)– Food prices and subsidies, public distribution

• General subsidies• Targeted• Rations and quotas• Food stamps and coupons

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

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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

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Care Interventions

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ISSUES IN COMPLEMENTARY FEEDING

Weanling’s dilemma

Time for caring – feeding frequency

Quality

Timing

Bulk

Cleanliness

... and continue breastfeeding

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Complementary foods

Ideal pattern of infant feeding

6 mo

12 mo

24 mo

100%

50%

0%

Breast fed only

Breast fed and complementary foods

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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

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

• Vertical micronutrient programs

• Nutrition in health services and schools

• Contextual and supporting policies.