Professional Documents
Culture Documents
CN Cluster 3
CN Cluster 3
Vision : The people of Bangladesh will attain healthy and productive lives through gaining
expected nutrition .
Goal
Objectives
1. Improve the nutritional status of all citizens, including children, adolescent girls,
pregnant women and lactating mothers
2. Ensure availability of adequate, diversified and quality safe food and promote healthy
feeding practices
2, Discuss nutrition specific intervention for children, adolescent girls and women.
Ans. Nutrition-specific or direct interventions for children :
Increase the rate of exclusive breastfeeding in infants younger than age 6 months
Supplementary feeding
Supplementary feeding
good nutrition
11. Reduction of severe protein -energy malnutrition (PEM) in under 2
children by 50 percent.
12. Reduction of moderate Protein Energy Malnutrition among Under
2 children by one-third
13. Reduction of low birth weight (LBW) incidence by 50 percent
pregnant women
15. To lay the foundation for proper psychological, physical and social
13. 'To enhance the capacity of mother to look after the normal health and
nutritional needs of the child through proper nutrition and health education
When to start:
1. When an emergency first arises, before the food pipeline and general food ration are
improved and sustained.
2. Scurvy, beriberi, or pellagra outbreaks among the target group.
When to close:
When to start : When there is a need for large-scale therapeutic feeding and to
prevent a decline in the nutritional health of the population’s most vulnerable
groups (children under five, pregnant women, nursing women, families affected by
HIV/AIDS, and the elderly).
When to stop : When the rate of acute malnutrition around the world is steady or
decreasing.
Food fortification
• When the vitamins and minerals are not added to the foods during the processing but
just before consumption at home or at schools or child‐care facilities, it is called point-
of-use fortification
Fortifying Commercial food
Biofortification
• Breeding of crops with higher levels of vitamins and minerals or higher proteins and
healthier fats
• seen as an upcoming strategy for dealing with micronutrient deficiencies in low and
middle income countries
• In the case of iron, the WHO estimated that biofortification could help curing the 2
billion people suffering from iron deficiency induced anemia .
- to address malnutrition
The final decision as to what type of transfer to apply (cash, food or a combination of the
two) should necessarily be taken in relation to program objectives (effectiveness) .
The predictability, stability, timing and amount of cash transfers matter importantly to
household preferences for or against cash (over food)
Distance from markets and seasonal and gender factors also seem to be important
determinants of beneficiary preferences.
1. Location :
In relief situations, cash is said to be more appropriate right after the harvest,
Food security is broadly defined as physical and economic access by all people at all times
to sufficient food to meet their dietary needs for a healthy and productive life.
All individuals :
Population-based strategies
Provide iron-folate (IFA) or multiple micronutrient (MMN) supplements to low birth weight infants
aged 2-5 months and all children aged 6-23 months, pregnant women, and breastfeeding women for
the first three months after delivery, adolescent girls and newly wed women in the recommended
dose and frequency.
If resources are available, provide IFA or MMN supplements to other vulnerable groups, such as
children aged 24-59 months, school-aged children and non-pregnant women of reproductive age in
the recommended dose and frequency.
Counsel women and caregivers on how to take the IFA/MMN supplements, the importance of taking
the full dose, and help them solve any problems they have in complying, such as managing side
effects.
Screen all children, adolescent girls and women for severe anaemia at every contact with a health
service provider using the most appropriate and feasible screening method at the health care level.
Provide appropriate treatment for anaemia or refer children and women for treatment.
In emergencies, provide MMN supplements or therapeutic spreads to children aged less than 5 years,
pregnant women, and breastfeeding women.
Provide presumptive anthelmintic treatment to children aged 24-59 months2 and adolescent girls
once every six months.
Provide a single dose of presumptive anthelmintic treatment to pregnant women at the
earliest opportunity in the second trimester. If the local prevalence of hookworm
infections is >50%, provide a second dose of anthelmintic treatment at the earliest
opportunity after delivery.
If resources allow, provide anthelmintic treatment to children aged 5-11 years every six
months.
Provide information to women and caregivers on the danger signs of malaria, and when and how to
seek treatment.
Provide rapid malaria treatment to young children and pregnant women with symptoms of fever or
malaria in line with national malaria management protocol
Promote protection measures against malaria (use of insecticide-treated bed-nets, particularly by
pregnant women and children aged less than 5 years, and environmental control of mosquitoes)
Set legislation and regulations for fortification with iron and other micronutrients.
Develop, produce and market foods fortified with iron and/or other micronutrients
(including folic acid, vitamin B-12 and vitamin A) for the general population.
Develop, produce, and market low cost foods fortified with iron and/or other
micronutrients for specific vulnerable groups, particularly infants and young children.
Fortify food aid products for development and emergency response programmes with
iron and other micronutrients, including school-feeding programmes.
Promote (through social marketing) foods fortified with iron and other micronutrients.
Non nutritive sweeteners are no-calorie or low-calorie artificial and natural sweeteners that
have been developed as an alternative to sugars .
Saccharin
Aspartame
Acesulfame-K
Sucralose
Stevia
Characteristics of Non-nutritive sweeteners
Weight control
Diabetes control
Prevent tooth decay
Pleasant taste without increasing energy intake.
Can be used to replace sugar in cooking or baking.
Decrease calorie content of food.
Only require small amount to sweeten foods and beverages.
It is widely understood that high sugar/high fat diet partly blamed for increasing obesity and
related health issue such as type 2 DM, CVD, hypertension and certain cancers.
Analysis of national health and nutrition examination survey data that NNs are high
intensity, low calorie, high potency, and non nutritive.
This intense sweetness allow for smaller portion yield sugar like sweetness in food
products.
Food manufacturer label them as virtually sugar free or non-calorie.
Use of NNs is that individuals struggling with obesity can enjoy the food and
beverages without the risk of consuming additional calories.
Growing concern about NNs about health and quality of life encouraged people to
avoid consumption of food rich in sugar, salt and fat.
Obesity
Causes of Obesity :
High energy diet and over eating: daily excess of 100 kcal(equivalent to a small
chocolate bar) leads to increased body weight by 5kg over 1 year and 50 kg over
10 years.
Lack of physical activity: Sedentary life style, More involvement with media
time.
Diagnosis of obesity
(CAT SCAN)
Surgical treatment
Prevention
Eat healthy diet-low fat die high fiber(fruit and vegetables) whole grain, nut
Limit intake of CHO, sugar free diet(now NNs show healthy and beneficial effect.)
The latest WHO projections indicate that at least one in three of the world's adult
population is overweight and almost one in 10 is obese. Additionally, there are over
40 million children under age five who are overweight.
Being overweight or obese can have a serious impact on health. Carrying extra fat
leads to serious health consequences such as :
16. Cardiovascular disease (mainly heart disease and stroke)
17. Type 2 diabetes
18. Musculoskeletal disorders like osteoarthritis
19. some cancers (endometrial, breast and colon).
The risk of health problems starts when someone is only very slightly overweight,
and that the likelihood of problems increases as someone becomes more and more
overweight. Many of these conditions cause long-term suffering for individuals and
families. In addition, the costs for the health care system can be extremely high.
Dietary Fiber
Examples include
The Geo Nutrition Project has demonstrated results that micronutrient deficiencies of
selenium can be alleviated through adding selenium fertilizers to staple cereal crops in
Malawi (Joy et al., 2019) .
Write down the impact of nutritional anemia. Mention the strategies for prevention of
nutritional anemia in Bangladesh.
Distinguish between bulimia nervosa and binge eating disorder.
2. Bulimia nervosa :
Like anorexia, bulimia tends to develop during adolescence and early adulthood and
appears to be less common among men than women .People with bulimia frequently
eat unusually large amounts of food in a specific period of time.
Common symptoms:
Recurrent episodes of binge eating with a feeling of lack of control
Recurrent episodes of inappropriate purging behaviors to prevent weight gain
Self-esteem overly influenced by body shape and weight
A fear of gaining weight, despite having a typical weight
In severe cases, bulimia can also create an imbalance in levels of electrolytes,
such as sodium, potassium, and calcium. This can cause a stroke or heart
attack.
Binge eating disorder is the most prevalent form of eating disorder and one of
the most common chronic illnesses among adolescents.
Individuals with this disorder have symptoms similar to those of bulimia or the
binge eating subtype of anorexia.
Common symptoms :
Eating large amounts of food rapidly, in secret, and until uncomfortably full,
despite not feeling hungry
Feeling a lack of control during episodes of binge eating
Feelings of distress, such as shame, disgust, or guilt, when thinking about the
binge eating behavior
No use of purging behaviors, such as calorie restriction, vomiting, excessive
exercise, or laxative or diuretic use, to compensate for the binge eating .
4. Pica
Pica is an eating disorder that involves eating things that are not considered food and
that do not provide nutritional value .
Individuals with pica crave non-food substances such as ice, dirt, soil, chalk, soap,
paper, hair, cloth, wool, pebbles, laundry detergent, or cornstarch.
It is most frequently seen in individuals with conditions that affect daily functioning,
including intellectual disabilities, developmental conditions such as autism spectrum
disorder, and mental health conditions such as schizophrenia .
Individuals with pica may be at an increased risk of poisoning, infections, gut injuries,
and nutritional deficiencies. Depending on the substances ingested, pica may be fatal.
5. Rumination disorder
This rumination typically occurs within the first 30 minutes after a meal .
This disorder can develop during infancy, childhood, or adulthood. In infants, it tends
to develop between 3 and 12 months of age and often disappears on its own. Children
and adults with the condition usually require therapy to resolve it.
If not resolved in infants, rumination disorder can result in weight loss and severe
malnutrition that can be fatal.
Adults with this disorder may restrict the amount of food they eat, especially in
public. This may lead them to lose weight and become underweight (16).
6. Avoidant/restrictive food intake disorder :
Avoidant/restrictive food intake disorder (ARFID) is a new name for an old disorder.
The term has replaced the term “feeding disorder of infancy and early childhood,” a
diagnosis previously reserved for children under age 7 .
Individuals with this disorder experience disturbed eating due to either a lack of
interest in eating or a distaste for certain smells, tastes, colors, textures, or
temperatures.
avoidance or restriction of food intake that prevents the person from eating
enough calories or nutrients
eating habits that interfere with typical social functions, such as eating with
others
weight loss or poor development for age and height
nutrient deficiencies or dependence on supplements or tube feeding
In addition to the six eating disorders above, other less known or less common eating
disorders also exist.
Eating disorder treatment plans are specifically tailored to each person and may
include a combination of multiple therapies.
Treatment will usually involve talk therapy, as well as regular health checks with a
physician
It’s important to seek treatment early for eating disorders, as the risk of medical
complications and suicide is high ,
Listening to them. Taking time to listen to their thoughts can help them feel heard,
respected, and supported. Even if you don’t agree with what they say, it’s important
that they know you’re there for them and that they have someone to confide in.
Including them in activities. You can reach out and invite them to activities and
social events or ask if they want to hang out one-on-one. Even if they do not want to
be social, it’s important to check in and invite them to help them feel valued and less
alone.
Trying to build their self-esteem. Make sure they know that they are valued and
appreciated, especially for nonphysical reasons. Remind them why you are their
friend and why they are valued.
Lactose intolerance
Lactose intolerance means the body cannot digest lactose. This is
not food allergy to milk.
• When lactose moves through the large intestine without being properly
digested, it can cause uncomfortable symptom such as gas, belly pain,
bloating .
Types of Lactose intolerance
Autosomal recessive genetic disorder that prevent lactose tolerance from 1st
feed
Infant fail to thrive unless given lactose free formula feed.
Symptoms
• Can be mild to moderate, depending how much lactase body can make. Symptom
usually begin 30 minutes to 2 hours after drinking milk or milk product.If have, LI
may include
• Bloating
• Pain
• Crump
• Gurgling or rumbling sound in belly
• Diarrhea
Diagnosis
• Dietary history
• Family History
• Patient has underwent partial gastrectomy and other related procedure
• Test
• Stool acidity test, Hydrogen breath test
Treatment :
There is no cure for Lactose intolerance but treatment is by limiting or avoiding milk
& milk products. Some people use milk with reduce milk or substitute soy milk, soy
cheese for milk or milk product.
Disease Treatment
There is no cure for Lactose
intolerance but treatment is by
limiting or avoiding milk & milk
Lactose intolerance
products.
Some people use milk with reduce
milk or substitute soy milk, soy
cheese for milk or milk product.
Control by nutritional therapy,
mainly both galactose and lactose
free diet.
Galactosemia and galactosuria
Infant should fed soya formula.
Continued dietary restriction of
dairy products in older child
Vit C and low protein diet.
Alkaptonuria Newborn screening
Oral nitisinone therapy may helpful.