Introduction to Human

Nutrition
for MPH students
Professor Tefera Belachew (MD, MSc, DLSHTM, PhD)
Jimma University
ABH Campus
August, 2016

Learning objectives
By the end of this session the learners will be
able to :
Define key terms in Nutrition study.
Understand the consequences of malnutrition
of on socioeconomic development, educability
and survival.
Explain the key interventions that prevent
theses consequences.
Be a champion of nutrition as a public health
cadre.

Definition of Terms
Nutrition: is the science that interprets the interaction of
nutrients and other substances in food (e.g.
Phytonutrients, anthocyanins, tanins etc..) in relation to
health and maintenance, growth, reproduction, disease of an
organism. It also includes the process by which the organism
ingests, digests, absorbs, transports, utilizes and excretes food
substances ===> natural science origin
In addition, nutrition must be concerned with social,
economic, cultural and physiological implications of food and
eating =====> social science origin

Cont
Food - Is defined as anything edible as defined
based on specific culture, religion, etc. It includes
all foods and drinks acceptable to be ingested by
certain society.
Edibility: What is edible? How is it defined?
Nutrient: - Is an active chemical component in
the food that play specific structural or functional
role in the bodys lively activity.

 Nourishment: the status/situation

of being nourished.

 Malnourishment or Malnutrition or is a condition

that results from eating a diet in which nutrients are
not enough or are too much such that it causes
health problems
It is often used specifically to refer to
undernutrition where there are no enough calory,
protein or micronutrients; however, it also includes
overnutrition

Cont
Diet: - Is the sequence and balance of meals in a
day.
It is concerned about the eating patterns of
individuals or a group
For instance:

some people may eat twice in a day (breakfast

and dinner),
others may eat four times in a day (breakfast,
lunch, snack and Dinner)
still others may remain munching all the day
round, etc.

 Balanced diet/Healthy diet: is a diversified diet

that contains all the essential nutrients in the
proportion that is required for optimal health and
long-term survival.

Your Menu Should be colourful

!
Nourishment

Diet as an agent determining health

Important Aphorisms
Whatsoever was the
father of a disease, an ill
diet was the mother

You are what you eat

Nutrition and
Development
Why invest on nutrition?

UNICEF/C-55-38/Watson

Ethiopia is committed to Millennium Development

Goals(PASDEP)

Nutrition in the MDGs

MDGs

Relevance of nutrition

1. Eradicate extreme poverty

and hunger

Contributes to human capacity and productivity

throughout life cycle and across generations

2. Achieve universal primary

education

Improves readiness to learn and school

achievement

3. Promote gender equity and

empower women

Empowers women more than men

4. Reduce child mortality

Reduces child mortality (over half attributable to

malnutrition)

5. Improve maternal health

Contributes to maternal health thru many

pathways
Addresses gender inequalities in food, care and
health

6. Combat HIV/AIDS, malaria

and other diseases

Slows onset and progression of AIDS

Important component of treatment and care

7. Ensure environmental
sustainability

Highlights importance of local crops for diet

diversity and quality

8. Develop a global
partnership for development

Brings together many sectors around a common

problem

But, What is the nutrition situation of

children in developing countries?

Malnutrition is high in underdeveloped countries

Eg. Trends in stunting (low height for age) in children < 5 yrs, by region and year

4th Report on World Nutrition Situation, ACC/SCN

Rates of stunting in children < 5 years have

increased or remained high in Africa

De Onis et al, 2000 - WHO Global Databank

The number of stunted children is rising

dramatically in Africa
Number of children in
millions

De Onis et al, 2000 - WHO Global Databank

Prevalence of stunting in children under five

years, in selected east African countries
40

Prevalence of stunting in children

in Ethiopia (EDHs 2011)

What are the causes of malnutrition ?

The Global conceptual framework for the causes of

malnutritionReduced educability, lost

Functional
consequence
s

productivity, mortality,
morbidity

Manifestation

Nutritional Status

Diet

Household
Food Security

Health

Care of Mother
and Child

Environ. Health,
Hygiene & Sanitation

Immediate
Causes

Underlying
Causes

Human, Economic, and Institutional

Resources, manmade & natural calamities

Political and Ideological Structure

Ecological Conditions

Adapted

Potential Resources

Basic
Causes

Majority (80%)
mild & moderate

Victims not aware

UNICEF/94-1173 Pirozzi

Malnutrition: Is A Hidden Problem

Child Malnutrition by Age Group

(The first 24 months are critical)
Percentage

Source:: EDHS 2005

Trends over years

Nutritional problems of public Health

Importance in Ethiopia

Protein-energy malnutrition

Vitamin A deficiency

Iodine deficiency

Iron deficiency anemia

Vtamin D deficiency
*Folate deficiency
*Zinc deficiency

What are the consequences of

malnutrition in quantitative terms?

The profiles model

Current scientific data
Profiles Model

Functional Consequences

Assumptions & Data Sources

Period: 2006-2015

UN Medium Population Projection

EDHS 2005, National Surveys & MOH Reports

Targets: National Micronutrient Guidelines and

National Nutrition Strategy

Four Functional Consequences

Mortality

Illness

Intelligence loss

Reduced productivity

Malnutrition
and

Child Survival

Child mortality trends in Ethiopia

Causes of Death among Ethiopian

Children 0-5 Years Old
Other 2%
Measles 4%
AIDS 1%

Neonatal 25%

Diarrhea 20%
Malnutrition
53%

Pneumonia
28%

Malaria 20%

Causes of Child Mortality in Ethiopia

Malnutrition

53%

Other

47%

Greatest single cause of child

mortality

Causes of Child Mortality in Ethiopia

Mild &
moderate
severe

Only 1 in 5 malnutrition-related deaths is due to severe

malnutrition

UNICEF/C-56-19/Murray-Lee

Child Mortality (2006-2015)

1.3 million child deaths

Breastfeeding Practices

Complementary
Feeding
UNICEF/93-COU-0173/Lemoyne

Exclusive
Breastfeeding

Poor Breastfeeding Practices

infant deaths
every year

UNICEF/93-COU-0173/Lemoyne

50,000

Breastfeeding and Birth Spacing

Delay in fertility due to

breastfeeding = 14 months
Value of birth spacing effect of
breastfeeding = 167 million
Birr/year

UNICEF/D0192-0060/Johnson

Total Fertility Rate = 5-6 births

per woman

Vitamin A Deficiency

Night blindness

Ulceration of the cornea

Permanent blindness

Children with Vitamin A Deficiency

(VAD)
Permanent blindness
Xerophthalmia
Night blindness
Sub-clinical
Vitamin A deficiency

VAD: Prevalence

UNICEF/ Pirozzi

61%

VAD: Associated Mortality

800,000 child lives lost

UNICEF/ Pirozzi

32%

13.5%

2006-2015: 0ver 600,000 infant deaths

UNICEF/C-56-19/Murray-Lee

Low Birth Weight

MALNUTRITION
AND

EDUCATION

Malnutrition and Intellectual

Development

Learning ability

School performance

Retention rates

UNICEF/C-56-19/Murray-Lee

Reduced:

severe mental and physical damage

moderate mental retardation

mild intellectual disability

UNICEF/HQ93-2200/Pirozzi

Iodine Deficiency
during Pregnancy

Iodine Deficiency
and Intellectual Development

UNICEF/C-56-19/Murray-Lee

Intelligence Quotient

87

Total Goiter Rate = 38% amog <5

years old children in Ethiopia
If this is not corrected
4.5 million babies
nwill be born
intellectually impaired

UNICEF/Ethiopia

from 2006-2015:

Nutritional Problems Associated with Brain

Development

Summary of intellectual consequences

Iron deficiency anemia lowers IQ by about 9 points

Mild iodine deficiencies lowers IQ by about 10 points

Severe stunting associated with IQ loss of 5-10 points

Low birth weight babies have IQs 5 points lower

MALNUTRITION
&
ECONOMIC DEVELOPMENT

Economic Consequences of
Malnutrition

Malnutrition results in:

Mental Impairment

Physical Stunting

Iodine Deficiency and Productivity

Mental retardation(Cretinism) in fetuses and children

Physical shortness(Iodine dewarfism) in children

Weakness and morbidity in adults

Weakness, poor reproduction in the beasts of burdon

Mortality

Unemployement and discounting future earnings

Productivity Losses
due to Iodine Deficiency (2006-2015)

Present Value = 64 billion Birr

UNICEF/93-COU-0931/Ethiopia/Thomas

Anemia
Iron deficiency anaemia leads to:
Decreased physical growth in children and
results in short stature
Impaired learning (Decreased attention span) in
children
Poor metabolic efficiency and physical
productivity
Impaired Immunity

Productivity Losses due to Anemia (2006-2015)

Present Value = 36 billion Birr

UNICEF/93-COU-0931/Ethiopia/Thomas

Child Stunting

UNICEF/C-55-34/Watson

Inadequate nutrition in
early childhood 1st 24
months leads to reduction of
11 cm in height

Stunting at Age 2
(EDHS - 2005)

UNICEF/C-55-34/Watson

51%

Consequence of Stunting

Reduced
productivity

1.4% decrease in productivity

for every
1% decrease in height
(Haddad & Bouis, 1990)

Productivity Losses due to Stunting (20062015)

Present Value = 44 billion Birr
UNICEF/93-COU-0931/Ethiopia/Thomas

Total Economic Losses with and without

Nutrition Improvement (2005-2015)

Total Economic Losses with and without

Nutrition Improvement (2005-2015)
144 billion

Total Economic Losses with and without

Nutrition Improvement (2005-2015)
144 billion
98 billion

Gain = 46

billion

In summary, the functional consequences

of malnutrition are immense:
Deficiency

Vitamin A
PEM
Iron
IODIN
E

Reduces

survival
Physical
productivity

intelligence

Invest in Nutrition!