Nutrition in Developing Countries

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Nutrition in Developing Countries
NUTR 555/HSERV 555
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Instructor Jonathan Gorstein gorstein_at_u.washin
gton.edu
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Learning Objectives

• Analyze the relationship between the main
  determinants of malnutrition, and describe the
  direct effects of food insecurity and infectious
  disease, as well as underlying factors related to
  poverty
• Distinguish between the main vitamin and mineral
  deficiencies that affect populations in
  developing countries
• Describe the magnitude of micronutrient
  deficiencies and their consequences on morbidity,
  physical growth and cognitive development.

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Learning Objectives

• Identify the main intervention strategies
  employed for the control of micronutrient
  malnutrition and analyze the cost-effectiveness
  of alternative approaches
• Outline the relationship between food subsidies
  in industrialized countries, surplus production
  of cereal grains, local agriculture in developing
  countries and food security
• Compare different approaches to improve the
  nutritional status and food intake of patients
  receiving ARV for the treatment of HIV/AIDS and
  consider their sustainability

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Course topics

• Overview of Nutrition/ Global Nutrition
  Transition
• Vitamin A Deficiency
• Stunting and Wasting
• Nutrition and Infection - HIV/AIDS
• Iodine Deficiency
• Assessment of Micronutrient Deficiencies
• Maternal Nutrition and Breastfeeding
• Public-Private Partnerships Innovations in
  Global Nutrition Programs
• World Hunger and Global Food Supply

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Project Presentation

• Team project to develop a proposal to
• address a specific nutrition problem in the
  developing world, and
• establish the basis and justification for a
  project.
• This will be presented to the rest of the class
  and evaluated according to the rubric in the
  syllabus.

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Web Page

• Syllabus
• Schedule of topics and speakers
• Required readings
• http//hserv.washington.edu/courses/course/view.ph
  p?id243

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Importance of Nutrition

• Malnutrition is the single most important risk
  factor for disease
• When poverty is added to the picture, it produces
  a downward spiral that may end in death
• Malnutrition has important consequences for
  cognitive and behavioral development

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Importance of Nutrition

• Because small children become small adults, their
  work capacity is also reduced physically
• Small women have more complications from
  pregnancy they also give birth to smaller
  babies, perpetuating the cycle of poor growth and
  development

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Class Objective

• Review international dietary guidelines
• Define transition diets
• Identify trends in body weight
• Discuss the paradox of under and over nutrition
  in developing countries
• Consider global consequences of chronic disease

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Malnutrition

• Discuss your definition of malnutrition

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The Two Faces of Malnutrition

• Overnutrition
• A diet high in energy, saturated fat,
  cholesterol, and sodium, but low in fiber
• cardiovascular disease
• Obesity
• Cancer
• Diabetes
• osteoporosis
• Undernutrition
• A diet low in either energy or various specific
  nutrients
• Low birth weight
• Higher infant mortality rate
• Stunting
• Infectious disease

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FAO The nutrition transition and obesity

• The underweight and overweight share
• high levels of sickness and disability,
• shortened life spans and
• reduced productivity.
• Obesity increases the risk of chronic diseases
  such as diabetes, hypertension, heart disease,
  stroke, gall bladder disease and a number of
  cancers.

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Class Objective

• Review international dietary guidelines
• Define transition diets
• Identify trends in body weight
• Discuss the paradox of under and over nutrition
  in developing countries
• Consider global consequences of chronic disease

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Food Based Dietary Guidelines
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Guías alimentarias para la población colombiana
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Class Objective

• Review international dietary guidelines
• Define transition diets
• Identify trends in body weight
• Discuss the paradox of under and over nutrition
  in developing countries
• Consider global consequences of chronic disease

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What is nutrition transition?

• The shift in dietary pattern that occurs as
  incomes increase
• Diet shifts from one high in complex
  carbohydrates and fiber to a more varied diet
  higher in fats, saturated fat, and sugar

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Nutrition Transition
..
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Pingali P Westernization of Asian diets and the
transformation of food systems

• What
• What are the driving forces of dietary change in
  Asia?
• Are there other factors you would add to this
  list?
• Analysis
• Compare these factors to dietary changes in
  developed countries.
• Synthesis
• If there are parallels between the dynamics of
  the changes in developed and developing
  countries, what health consequences do you
  predict for developing countries in the next five
  years? Twenty years?

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Obesity and income

• In China, when per capita income grew fourfold
  after the economic reforms of the late 1970s, the
  consumption of high-fat foods soared. And while
  incomes grew, the income needed to purchase a
  fatty diet decreased. In 1962, a diet containing
  20 percent of total energy from fat correlated
  with a per capita GNP of US1 475. By 1990, a GNP
  of just 750 correlated with the same diet.

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..
http//www.fao.org/focus/e/obesity/obes1.htm
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Pingali P Westernization of Asian diets and the
transformation of food systems

• What
• Describe the situation with rice consumption.
• Analysis
• How may the displacement of rice in the Asian
  diet impact nutritional status?

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The five elements of our diets
Chemicals
Nutrients
Foods
Food Groups
Food Patterns
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Class Objective

• Review international dietary guidelines
• Define transition diets
• Identify trends in body weight
• Discuss the paradox of under and over nutrition
  in developing countries
• Consider global consequences of chronic disease

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..
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..
http//www.fao.org/focus/e/obesity/obes1.htm
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Prevalence of Obesity in some Countries
FIGURE 1 Prevalence of obesity in some countries
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..
http//www.fao.org/focus/e/obesity/obes1.htm
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Popkin BM, Gordon-Larson P The nutrition
transition worldwide obesity dynamics and their
determinants

• Dr. Popkin describes the heterogeneity of
  patterns in obesity in developing coutries.
  Describe some of these patterns. (P. 56)

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Class Objective

• Review international dietary guidelines
• Define transition diets
• Identify trends in body weight
• Discuss the paradox of under and over nutrition
  in developing countries
• Consider global consequences of chronic disease

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..
http//www.fao.org/focus/e/obesity/obes1.htm
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(No Transcript)
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Class Objective

• Review international dietary guidelines
• Define transition diets
• Identify trends in body weight
• Discuss the paradox of under and over nutrition
  in developing countries
• Consider global consequences of chronic disease

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Obesity related Diabetes

• The developing world risks suffering the lion's
  share of the growing disease burden.
• The number of people is expected to double to
• 300 million between 1998 and 2025
• 75 (225 million)- projected in the developing
  world.
• For nations whose economic and social resources
  are already stretched to the limit, the result
  could be disastrous.

FAO The nutrition transition and obesity
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..
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Future Directions

• What will health planners need to address the
  threat of obesity?

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Future Directions

• Unfortunately, data from developing countries are
  limited. As a result, policy makers don't have
  what they need to evaluate the threat of
  increasing obesity and the rise of related
  chronic diseases. And the misconception that
  obesity is a problem afflicting only affluent
  countries may be holding back further research

FAO The nutrition transition and obesity
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Make food more nutritious

• "We have to look beyond growing a single crop
  because it's disease resistant and produces a
  high yield and start choosing crops because they
  offer better nutrition," says Barbara Burlingame,
  Senior Officer in FAO's Nutrition Impact
  Assessment and Evaluation Group.

FAO The nutrition transition and obesity
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Common Themes

• Fetal origins of disease
• Early intrauterine or early postnatal,
  undernutrition causes an irreversible
  differentiation of metabolic systems which has
  been associated with chronic disease.
  (epigenetics) Caballero B NEJM 200635215
• Exposure to sweet diets early in childhood may
  alter food reward systems and increase the risk
  of obesity

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Metabolic Imprinting Effects of the Maternal
Environment on Subsequent "Diabesity" Risk

• Overfeeding babies may condemn them to obesity
  and diabetes later in life. Since the current
  practice is to over-feed babies that are born
  pre-maturely in an effort to help them "catch up"
  to a normal weight more quickly, these findings
  are particularly relevant. More research should
  be directed to evaluate how this practice may
  influence subsequent risk of "diabesity."
• Maxine Hayes, State Health Officer for the
  Washington State Department of Health.
• Nov. 17, 2005

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Metabolic Imprinting Effects of the Maternal
Environment on Subsequent "Diabesity" Risk

• A mother's health during pregnancy has
  significant implications for the developing
  fetus. A poor diet during pregnancy may cause
  changes in the fetus that serve to increase the
  risk later in life for obesity and other health
  problems. Policy and programs that support
  education and access to healthy foods for
  pregnant women are essential to help prevent
  obesity.
• Maxine Hayes, State Health Officer for the
  Washington State Department of Health.
• Nov. 17, 2005

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Metabolic Imprinting Effects of the Maternal
Environment on Subsequent "Diabesity" Risk

• Breast-feeding is protective for obesity later in
  life. In addition, the mother's obesity and the
  quality of the maternal diet are directly
  associated with the quality of milk that is
  produced. Mothers who consume a high-fat diet
  produce milk that is high in fat. Policy and
  programs that promote breast-feeding and health
  eating for nursing mothers are important
  preventive public health measures. In addition,
  preventive measures need to address obesity risk
  in women before they may become pregnant.
• Maxine Hayes, State Health Officer for the
  Washington State Department of Health.
• Nov. 17, 2005

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Metabolic Imprinting Effects of the Maternal
Environment on Subsequent "Diabesity" Risk

• It generally takes 17 years to translate research
  into practice, highlighting the need for
  increased attention to translational research. A
  diverse array of public health professionals,
  clinicians, and public health, behavioral, basic,
  and clinical researchers attended the symposium
• Maxine Hayes, State Health Officer for the
  Washington State Department of Health.
• Nov. 17, 2005

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