Community Nutrition: Basics & Principles

Dr Nugroho AbikusnoMedical Nutrition Dept

Trisakti University

MDGs

1. Eradicate extreme poverty and hunger2. Achieve universal primary education3. Promote gender equality and empower women4. Reduce child mortality5. Improve maternal health6. Combat HIV/AIDS, malaria & other diseases7. Ensure environmental sustainability8. Develop global partnership for development

Public Health problems

• Malnutrition consisting of• Under nutrition• Nutritional anemia• Vitamin A Deficiency• Over nutrition - Obesity

Vulnerability in life course

• Fetal period• Infancy & Early Childhood• School age• Adolescence• Young Adulthood including pregnancy and

lactation• Middle age• Old age

Nutrition Assessment

• Clinical examination• Anthropometry• Dietary assessment• Biochemical examination• Functional examination

Clinical examination

• Anamnesis on general health condition whether any possible complaints related to malnutrition

• Clinical examination from head to toes. Focus on complaints that may be related to malnutrition

Physical signs of malnutrition

• Under nutrition• Macro-nutrient deficiency• Marasmus (energy deficiency)• Kwashiorkor (protein deficiency)• Mixed

Physical signs

Marasmus• Old man face• Apathy• Dry, thin skin• Frail & thin

Kwashiorkor• Corn-strand hair• Crying• Boils• Pot belly• Oedema

Malnutrition (2)

• Micro-nutrient deficiency• Nutritional anemia• Iron deficiency• Vitamin B12 deficiency• Zinc deficiency

Physical signs of malnutrition

• Over nutrition/ obesity

Anthropometry

• Measurements:• Body Weight• Body Height• Arm circumference• Skinfold thickness• Knee height (proxy Body Height)

Anthropometry (2)

• Each measurement or index are valid & reliable indicators to measure nutrition status in each nutritionally vulnerable period in an individual’s life course

Anthropometry (3)Life course AnthropometryFetal period Fundal height

Weight gainInfancy & Early Child W/A; AC/ASchool age H/A; W/HAdolescence BMI by Age; BDEarly Adult BMIMiddle age BMIOld age BMI by KH (proxy)

BMI

• Body Mass Index = BW in kg/BH in m2• Criteria:• < 18.5 : under nutrition/under nourished• 18.5-23.9: normal• 24-29.9: over nutrition/over nourished• 30 and above: obese/obesity• 35 and above: morbid obesity

Waist circumference

• As risk of cardio-vascular disease:• Women: 70 cm• Men: 80 cm

Dietary assessment

• Food diary• Food Frequency Questionnaire• Weighted FFQ• Dietary Recall• Food leftover

Biochemical examination

• Malnutrition:• Macro-nutrient• Micro-nutrient

Metabolic syndrome

• Obesity• Hypertension• Diabetes• Dyslipidemia• NAFLD

Biochemical (2)

Nutrition Disorder BiochemicalKwashiorkor UN AlbuminObesity BS; BLP, SGPTNutritional anemia Iron; Folic acid; B12Vitamin A Deficiency

Vitamin A

Immunity Zinc

Functional examination

Nutrition Disorder

Test

Under nutrition Grip testThorax photo

Obesity Waist circumferenceOsteoporosis Bone densityVitamin A deficiency Night blindness

Terima Kasih.