Introduction to Global Nutrition and Health (HNH26806)
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Samenvatting - Introduction to Global Nutrition and Health (HNH26806)
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Course
Introduction to Global Nutrition and Health (HNH26806)
Institution
Wageningen University (WUR)
This document contains all courses for the Global Nutrition and Health course. The notes have been supplemented with relevant literature per lecture. Using this summary, I got a 9 for the exam.
Introduction to Global Nutrition and Health (HNH26806)
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Lecture 1.1: Maternal and child undernutrition: the
UNICEF framework model
05/09/2022
Hunters-gatherers: plants, low fat wild animals, varied diet, few nutritional deficiencies, infectious
diseases.
Agriculture: cereals predominant, low fat intake, nutritional deficiencies emerge
Technological revolution: increase in fat intake, sugar etc. physical labor declines, obesity, chronic
diseases
Today’s modern society: varied diets, less fat, increased carbohydrates.
Facts:
Countries with the highest burden of malnutrition: Southeast Asia, Africa.
Global Hunger Index: Africa, South America, South Asia
Since Corona (2018-2019) , undernourishment is increasing again. But worldwide, it is becoming
better.
Number of undernourishment is higher in Southeast Asia, due to the higher number of people that
are living there.
1945: founding of United Nations
- UN Standing Committee on Nutrition created in 1977, working in consultation with other UN
agencies.
- Global Nutrition Targets for 2025 (WHA):
o Stunting, anaemia, low birth weight …..
- Sustainable development goals: almost every goal has something to do with nutrition…
Course activities
- Lectures (not mandatory)
o Discussion board per group
- Tutorials (mandatory)
- Group assignments (mandatory group work)
o Meeting your supervisor & presentations
- Excursion (mandatory)
- Exam (knowing, not applying)
Lecture 1.1 UNICEF framework (part of theme 1)
Stunting = too short for your age
Example: Aïsha (7) had a low birth weight. Her mother gave birth early to her, and didn’t feel well at
the time. From 3 months onward she did not receive any breastfeeding and she got solid food. She
grew up, and by the year of 2 she didn’t receive all the nutrients and she was stunting.
Now, she is working and looking after her siblings.
Malnutrition:
- Stunting
- Wasting: not enough … for your height
, - Underweight
- Protein-energy malnutrition
- Low birth-weight
- Vitamin A deficiency, iron, iodine, zinc, folic acid, calcium
- Overweight and obesity! (you can have overweight and a vitamin A deficiency)
Consequences
- Over 159 million children under 5 are stunted as a result of malnutrition
- 50 million children are too thin and require special treatment
- At the same time, 41 million children are overweight, some as a result of poverty, when
families are unable to afford a balanced, nutritious diet.
- 2 billion people are deficient in key vitamins & minerals.
- 2-3 billion people experience consequences: health, education, economic development (not
sure about this slide, 12)
Categories of causes of malnutrition
- Household food insecurity
- Disease
- Inadequate access to resources (land, education, employment, income, technology)
- Inadequate maternal & child care
- Inadequate capital (financial, human (not enough doctors), physical, social (social network
that can take care of your child))
- Inadequate health services and unhealthy environment (water and sanitation)
- Inadequate formal and non-formal education (anything outside of school: vocational
training)
- Inadequate food intake
- Political, economic and socio-cultural context
Giving not the right food to the child is an immediate cause, a government which didn’t import food
is a further cause, but still a cause.
,UNICEF framework
Immediate causes:
1. direct dietary intake
2. diseases
Could be the mother who wasn’t properly nourished when giving birth.
Underlying causes:
1. Household food insecurity
2. Inadequate care and feeding practices
3. Unhealthy household environment and inadequate health services
Basic causes:
1. Quantity and quality of resources
2. Inadequate financial, human, physical and social capital
3. Social cultural, economic and political context
a. For example, in some Asian countries the girl/mother always eats last. Then all the
meat is already gone.
Programs & paradigms
A good program always touches upon different targets, different causes
When are actions taken? Prerequisites for inclusion of nutrition in policy and planning
- Consensus on the problem
- Formulation of objectives which are consistent, realistic and acceptable
- The political will to achieve these objectives
- Means and capacity to influence the causes
- Understanding of the causes of the problem to be addressed
Paradigms in Applied Nutrition (don’t study these by hard)
- Ideas can be contradictive. Over the past 50 years, several paradigms were dominant.
- You have the theory and the practice.
, 1. Paradigms before 1950
- Hunger as inevitable part of daily life, in some cultures even glorified
- Discovery of vitamins let to the Vitamin Deficiency Paradigm: malnutrition is caused by lack
of certain vitamins in the diet
- In 1932 new disease in Ghana discovered: Kwashiorkor, caused by protein deficiency
2. New paradigm in 1974 (1950-1974) The Protein Deficiency Paradigm
- Scientific evidence
o Need for a regular intake of proteins (essential amino acids)
o Caused by low consumption of protein-rich foods
o Protein requirements were much higher than expected
- 1967: UN report: international action to avert the Impending Protein crises
- Criticism (the Great Protein Fiasco)
o In most countries where this happens, most diets are low in protein AND energy
protein is used as energy source
o Protein quality more important: consuming normal diet protein content and
quality often adequate
o Increased estimates for daily protein requirements too high
o Most malnourished children have infections, contributing to malnutrition
3. Multisectoral nutrition planning paradigm (1974-1980)
- From practice: delivery of protein-rich foods did not solve malnutrition asked for broader
multi-causal approach
- Isolated technical fixed should be avoided
- Use of systems theory of modelling: resulted in unbelievable complicated maps of the
nutritional problem (everything depended on everything else)
- Criticism
o Much more data required than could be provided
o Systems analyses far too complicated
o Nutrition no political priority (not interesting)
4. The national nutrition policy paradigm (1980-1990)
- Some fundamental principles stayed:
o Malnutrition is result of social, economic, political and cultural processes
o Efforts should address all levels of society
- No longer protein problem but food supply and access problem only solution is to reduce
poverty
- Interventions should be coordinated (not integrated)
- National nutrition strategies or policies (expatriates) and national nutrition surveillance
- Criticism:
o Government is not committed and dependant on donors. It should come from
countries themselves, because external people made policies, but then there was no
commitment to do something about it.
o Food-biased: HFS only one of requirement
o Surveillance data not used for action
o There should be more coördination
5. The community-based nutrition paradigm (1985-1995)
- From macro to micro level (community), from curative to prevention
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