Nutrition Issues Case Study Paper

Nutrition Issues Case Study Paper

The risks of poor nutrition

Good nutrition, based on healthy eating is one essential factor that helps us to stay healthy and be active.Nutrition Issues Case Study Paper

What causes poor nutrition?

Poor eating habits include under- or over-eating, not having enough of the healthy foods we need each day, or consuming too many types of food and drink, which are low in fibre or high in fat, salt and/or sugar.

These unhealthy eating habits can affect our nutrient intake, including energy (or kilo joules) protein, carbohydrates, essential fatty acids, vitamins and minerals as well as fibre and fluid.

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How does poor nutrition affect us?

Poor nutrition can impair our daily health and well being and reduce our ability to lead an enjoyable and active life.

In the short term, poor nutrition can contribute to stress, tiredness and our capacity to work, and over time, it can contribute to the risk of developing some illnesses and other health problems such as:

  • being overweight or obese
  • tooth decay
  • high blood pressure
  • high cholesterol
  • heart disease and stroke
  • type-2 diabetes
  • osteoporosis
  • some cancers
  • depression
  • eating disorders.Nutrition Issues Case Study Paper

Steps to good nutrition - it’s easier than you think

A good place to start is to:

  • have a good variety of healthy foods from the five food groups each day. For more information see the Healthy eating for different ages and stages and Healthy Eating tips sections
  • aim for two serves of fruit and five serves of vegetables each day
  • only occasionally eat sugary, fatty or salty food, and then only in small amounts
  • drink fresh, clean tap water instead of sugary drinks
  • switch over to healthy recipes that look and taste good
  • plan your meals ahead and shop for healthy ingredients
  • enjoy cooking and eating healthy food with family or friends and without distractions such as the television.

The nutritional problems of developing countries are conditioned by poverty, near exclusive reliance on plant sources of nutrients, and high rates of infections. Common deficiency diseases include protein-energy malnutrition, nutritional anemia's, vitamin A deficiency, iodine deficiency, and possibly others. Population subgroups at particularly high risk are the children and women of poor families. Control of these nutritional diseases requires systematic diagnosis of the existing situation and appropriate intervention strategies such as targeted food and specific micro nutrient supplementation, food fortification, nutrition education, and reductions in infections as well as general improvements in economic conditions and social equity.

The body requires many different vitamins and minerals that are crucial for both body development and preventing disease. These vitamins and minerals are often referred to as micro nutrients. They aren’t produced naturally in the body, so you have to get them from your diet.

A nutritional deficiency occurs when the body doesn’t absorb or get from food the necessary amount of a nutrient. Deficiencies can lead to a variety of health problems. These can include digestion problems, skin disorders, stunted or defective bone growth, and even dementia.

The amount of each nutrient you should consume depends on your age. In the United States, many foods that you buy in the grocery store — such as cereals, bread, and milk — are fortified with nutrients that are needed to prevent nutritional deficiency.Nutrition Issues Case Study Paper

But sometimes your body is unable to absorb certain nutrients even if you’re consuming them. It’s possible to be deficient in any of the nutrients your body needs.

Keep reading to learn about some common nutritional deficiencies and how to avoid them.

Iron deficiency

The most widespread nutritional deficiency worldwide is iron deficiency. Iron deficiency can lead to anemia. This is a blood disorder that causes fatigue, weakness, and a variety of other symptoms.

Iron is found in foods such as dark leafy greens, red meat, and egg yolks. It helps your body make red blood cells. When you’re iron-deficient, your body produces fewer red blood cells. The red blood cells it produces are smaller and paler than healthy blood cells. They’re also less efficient at delivering oxygen to your tissues and organs.

According to the World Health Organization (WHO)Trusted Source, over 30 percent of the world’s population is anemic. Many of these people are anemic due to iron deficiency.

In fact, it’s the only nutritional deficiency that’s prevalent in both developing and industrialized countries. Iron deficiency anemia affects so many people that it’s now widely recognized as a public health epidemic.

Vitamin A deficiency

Vitamin A is a group of nutrients crucial for eye health and functioning and reproductive health in men and women. It also plays a part in strengthening the immune system against infections.

According to WHO Trusted Source, a lack of vitamin A is the leading cause of preventable blindness in children. Pregnant women deficient in vitamin A have higher maternal mortality rates as well.Nutrition Issues Case Study Paper

Beta carotene is a nutrient that functions as an antioxidant. It’s found in red, orange, yellow, and dark green produce. Beta carotene can be converted to vitamin A in the body when needed.

For newborn babies, the best source of vitamin A is breast milk. For everyone else, it’s important to eat plenty of foods high in vitamin A. These include:

  • milk
  • eggs
  • green vegetables, such as kale, broccoli, and spinach
  • orange vegetables, such as carrots, sweet potatoes, and pumpkin
  • reddish-yellow fruits, such as apricots, papaya, peaches, and tomatoes
Thiamine (vitamin B-1) deficiency

Another common nutritional deficiency occurs with thiamine, also known as vitamin B-1. Thiamine is an important part of your nervous system. It also helps your body turn carbohydrates into energy as part of your metabolism.

A lack of thiamine can result in:

  • weight loss
  • fatigue
  • confusion
  • short-term memory loss

Thiamine deficiency can also lead to nerve and muscle damage and can affect the heart.

In the United States, thiamine deficiency is most often seen in people with excessive alcohol use. Alcohol reduces the body’s ability to absorb thiamine, store thiamine in the liver, and convert thiamine to a usable form. Thiamine deficiency is a common cause of Wernicke-Korsakoff syndrome. This is a form of dementia.

Many breakfast cereals and grain products in the United States are fortified with thiamine. Other good sources of thiamine include:Nutrition Issues Case Study Paper

  • eggs
  • legumes
  • nuts
  • seeds
  • wheat germ
  • pork
Niacin (vitamin B-3) deficiency

Niacin is another mineral that helps the body convert food into energy. It’s also known as vitamin B-3.

A severe deficiency in niacin is often referred to as pellagra. Niacin is found in most animal proteins but also in peanuts. As a result, this condition is rare in industrialized countries or in meat-eating communities.

Symptoms of pellagra include diarrhea, dementia, and skin disorders. You can usually treat it with a balanced diet and vitamin B-3 supplements.

Shop for vitamin B-3 supplements.

Folate (vitamin B-9) deficiency

Vitamin B-9 helps the body create red blood cells and produce DNA. It’s often referred to as folate. Folate also helps brain development and nervous system functioning. Folic acid is the synthetic form found in supplements or fortified foods.Nutrition Issues Case Study Paper

Folate is especially important for fetal development. It plays a crucial role in the formation of a developing child’s brain and spinal cord. Folate deficiency can lead to severe birth defects, growth problems, or anemia.

You can find folate in the following foods:

  • beans and lentils
  • citrus fruits
  • leafy green vegetables
  • asparagus
  • meats, such as poultry and pork
  • shellfish
  • fortified grain products
  • whole grains

While beans can provide a great amount of folate, the folate content in canned beans is about half of what cooked, dried beans offer.

Most people in the United States get enough folate. But pregnant women and women of childbearing age sometimes don’t consume enough folate for a healthy pregnancy.Nutrition Issues Case Study Paper

The National Institutes of Health (NIH) recommends that women who are pregnant or who may become pregnant consume up to 400 micro grams of folic acid each day — over and above the folate they’re getting from food naturally — to help prevent birth defects.

There’s also research showing that some people have genetic mutations that prevent their body from methylating folate, or converting it to a form the body can use. In these cases, while folate intake might be adequate, a supplement of methylated folate may be necessary to prevent deficiency.

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Cobalamin (vitamin B-12) deficiency

Vitamin B-12 is a B vitamin that’s responsible for assisting the body in making enough healthy red blood cells. Deficiency in this vitamin is common among people who:

  • are vegans
  • have had gastric surgery
  • are over 60 years old
  • have diabetes and take metformin (Glucophage)
  • have a long history of antacid use
  • lack intrinsic factor

Intrinsic factor is a transport protein secreted by the stomach cells. It binds to B-12 and takes it to the small intestine for absorption. This is the way the body is able to absorb and utilize B-12.

Adequate calcium intake at meals is required for intrinsic factor to assist in B-12 absorption in the small intestine.Nutrition Issues Case Study Paper

A deficiency in this vitamin may cause pernicious anemia. This is a type of anemia caused by a decreased ability to absorb B-12 efficiently. Pernicious anemia is more common in people with autoimmune disorders and inflammatory or digestive diseases.

Symptoms of vitamin B-12 deficiency include:

  • fatigue and weakness in extremities
  • dizziness
  • shortness of breath
  • weight loss
  • nausea or poor appetite
  • sore, red, or swollen tongue
  • pale or yellowish skin

Left untreated for too long, vitamin B-12 deficiency may cause irreversible damage to the nervous system. More severe symptoms include:

  • difficulty walking
  • muscle weakness
  • irritability
  • dementia
  • depression
  • memory loss

Your doctor can order a variety of blood tests to check for vitamin B-12 deficiency. Blood tests can check for:

  • levels of vitamin B-12
  • methylmalonic acid
  • intrinsic factor antibodies

Treatment may be provided in a variety of ways, including:

  • increasing vitamin B-12 sources in the diet
  • taking vitamin B-12 supplements
  • receiving vitamin B-12 injections
  • blood transfusions

Vitamin B-12 is commonly found in red meat and animal products. Vegetarian sources include fortified plant-based milks and nutritional yeast.Nutrition Issues Case Study Paper

Vitamin D deficiency

According to Harvard’s School of Public Health, about 1 billion people worldwide don’t get enough vitamin D. People with darker skin tones are at a higher risk of vitamin D deficiency.

Vitamin D is essential for healthy bones. It helps the body maintain the right levels of calcium in order to regulate the development of teeth and bones. A lack of this nutrient can lead to stunted or poor bone growth. Osteoporosis, caused by a lack of calcium and vitamin D, can lead to porous and fragile bones that break very easily.

Vitamin D is only found naturally in a few foods. Foods with vitamin D include:

  • fish liver oils
  • fatty fish
  • mushrooms
  • egg yolks
  • liver

Many dairy products and plant milks in the United States are fortified with vitamin D.

The best source of vitamin D is sunlight. According to the NIH, some research suggests that 5 to 30 minutes of midday sun exposure twice a week on the face, arms, neck, or back can provide you with enough vitamin D.

Although recommended, sunscreen does hinder vitamin D absorption from sunlight through the skin. Spend a few minutes in the sun prior to sunscreen for optimal vitamin D absorption.Nutrition Issues Case Study Paper

Calcium deficiency

Calcium helps your body develop strong bones and teeth. It also helps your heart, nerves, and muscles work the way they should.

A calcium deficiency often doesn’t show symptoms right away, but it can lead to serious health problems over time. If you aren’t consuming enough calcium, your body may use the calcium from your bones instead. This leads to bone loss.

The primary goal of this review is to examine the timing and nature of dietary inadequacy during the first 5 years of life. An important issue is that many children in developing countries are already nutritionally depleted by the end of the first year of life, because maternal under nutrition can cause low fetal accumulation of nutrient stores and secretion of inadequate amounts of some micro nutrients in breast milk. Improvement of maternal diet and micro nutrient status is required to remedy this situation. During the period of complementary feeding, most households may be able to provide their young children with sufficient energy and protein from home-produced complementary foods, but many do not feed foods with an adequate energy density or a sufficient number of meals per day. Inadequate micro nutrient intakes and resulting deficiencies are common in preschoolers because of a lack of sufficient animal source foods, and have been associated with delayed child development. Dietary diversity is an especially important determinant of micro nutrient intakes when animal source food intake is low. Interventions with animal source foods have produced improvements in growth, micro nutrient status, cognitive performance and activity of children. Although much is now known about the role of inadequate diets in preschooler malnutrition, on a global scale the ability of households to apply this knowledge to improve the diets of their children is still limited.Nutrition Issues Case Study Paper

Nutritional problems in children constitute the major health problem in developing countries. Impact of a factors leading to different kinds of nutritional problems in developing countries are reviewed. Prevention and treatment of some special disease states are discussed. Outlines for some solutions to the greatest nutritional problems are presented.Poor nutrition among children is the primary health problem plaguing developing countries. The problem stems primarily from the social and economic inequalities extant in the world today and could be ameliorated by reducing unemployment and urban migration through rural and village level development keyed to the needs and desires of the community. The major nutritional problems facing the developing countries are described and suggestions for preventing the problems and for treating specific nutritional diseases are made. Major nutritional problems include: 1) Maternal nutritional anemia; 2) protein energy malnutrition; 3) vitamin A deficiency; 4) lactation failure; 5) addiction to milk feeding; and 6) inadequate preparation and use of artificial milk products. Maternal nutritional anemia increases the frequency of low weight births in developing countries. Protein energy malnutrition afflicts approximately 100 million children under the age of 5 and can permanently affect the physical and mental development of these children. Vitamin A deficiency is one of the major causes of preventable blindness. The economic loss resulting from preventable blindness is tremendous; this loss could be prevented by spending only 10 cents a day to supplement the diet of each malnourished child. Lactation failure is especially devastating for babies born to poor women and all practices, such as temporary bottle feeding, which contribute toward lactation failure should be halted. Inappropriate use of artificial milk products increases nutritional deficiency and gastrointestinal problems among babies in the developing countries.Nutrition Issues Case Study Paper

Malnutrition results from a poor diet or a lack of food. It happens when the intake of nutrients or energy is too high, too low, or poorly balanced.

Under-nutrition can lead to delayed growth or wasting, while a diet that provides too much food, but not necessarily balanced, leads to obesity.

In many parts of the world, under nutrition results from a lack of food. In some cases, however, undernourishment may stem from a health condition, such as an eating disorder or a chronic illness that prevents the person from absorbing nutrients.

According to the World Health Organization (WHO), malnutrition is the gravest single threat to global public health. Globally, it contributes to 45 percent of deaths of children aged under 5 years.

This article will focus mainly on under nutrition.

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What is malnutrition?
Malnutrition involves a dietary deficiency. People may eat too much of the wrong type of food and have malnutrition, but this article will focus on under nutrition, when a person lacks nutrients because they do not consume enough food.

Poor diet may lead to a lack of vitamins, minerals, and other essential substances. Too little protein can lead to kwashiorkor, symptoms of which include a distended abdomen. A lack of vitamin C can result in scurvy.

Scurvy is rare in industrialized nations, but it can affect older people, those who consume excessive quantities of alcohol, and people who do not eat fresh fruits and vegetables. Some infants and children who follow a limited diet for any reason may be prone to scurvy.

According to the World Health Organization (WHO), 462 million people worldwide are malnourished, and stunted development due to poor diet affects 159 million children globally.

Malnutrition during childhood can lead not only to long-term health problems but also to educational challenges and limited work opportunities in the future. Malnourished children often have smaller babies when they grow up.

It can also slow recovery from wounds and illnesses, and it can complicate diseases such as measles, pneumonia, malaria, and diarrhea. It can leave the body more susceptible to disease.Nutrition Issues Case Study Paper

Symptoms

Signs and symptoms of under nutrition include:

  • lack of appetite or interest in food or drink
  • tiredness and irritability
  • inability to concentrate
  • always feeling cold
  • loss of fat, muscle mass, and body tissue
  • higher risk of getting sick and taking longer to heal
  • longer healing time for wounds
  • higher risk of complications after surgery
  • depression
  • reduced sex drive and problems with fertility

In more severe cases:

  • breathing becomes difficult
  • skin may become thin, dry, inelastic, pale, and cold
  • the cheeks appear hollow and the eyes sunken, as fat disappears from the face
  • hair becomes dry and sparse, falling out easily

Eventually, there may be respiratory failure and heart failure, and the person may become unresponsive. Total starvation can be fatal within 8 to 12 weeks

Children may show a lack of growth, and they may be tired and irritable. Behavioral and intellectual development may be slow, possibly resulting in learning difficulties.

Even with treatment, there can be long-term effects on mental function, and digestive problems may persist. In some cases, these may be lifelong.Nutrition Issues Case Study Paper

Adults with severe undernourishment that started during adulthood usually make a full recovery with treatment.

Causes

Malnutrition can result from various environmental and medical conditions.

1) Low intake of food

This may be caused by symptoms of an illness, for example, dysphagia, when it is difficult to swallow. Badly fitting dentures may contribute.

2) Mental health problems

Conditions such as depression, dementia, schizophrenia, anorexia nervosa, and bulimia can lead to malnutrition.

3) Social and mobility problems

Some people cannot leave the house to buy food or find it physically difficult to prepare meals. Those who live alone and are isolated are more at risk. Some people do not have enough money to spend on food, and others have limited cooking skills.

4) Digestive disorders and stomach conditions

If the body does not absorb nutrients efficiently, even a healthful diet may not prevent malnutrition. People with Crohn's disease or ulcerative colitis may need to have part of the small intestine removed to enable them to absorb nutrients.

Celiac disease is a genetic disorder that involves a gluten intolerance. It may result in damage to the lining of the intestines and poor food absorption.

Persistent diarrhea, vomiting, or both can lead to a loss of vital nutrients.

5) Alcoholism

Addiction to alcohol can lead to gastritis or damage to the pancreas. These can make it hard to digest food, absorb certain vitamins, and produce hormones that regulate metabolism.

Alcohol contains calories, so the person may not feel hungry. They may not eat enough proper food to supply the body with essential nutrients.Nutrition Issues Case Study Paper

6) Lack of breastfeeding

Not breastfeeding, especially in the developing world, can lead to malnutrition in infants and children.

Risk factors

In some parts of the world, widespread and long-term malnutrition can result from a lack of food.

In the wealthier nations, those most at risk of malnutrition are:

  • older people, especially those who are hospitalized or in long-term institutional care
  • individuals who are socially isolated
  • people on low incomes
  • those who have difficulty absorbing nutrients
  • people with chronic eating disorders, such as bulimia or anorexia nervosa
  • people who are recovering from a serious illness or condition
Diagnosis

Prompt diagnosis and treatment can prevent the development and complications of malnutrition.

There are several ways to identify adults who are malnourished or at risk of malnutrition, for example, the Malnutrition Universal Screening Tool (MUST) tool.

MUST has been designed to identify adults, and especially older people, with malnourished or a high risk of malnutrition.

It is a 5-step plan that can help health care providers diagnose and treat these conditions.

Here are the steps:

  • Step 1: Measure height and weight, calculate body mass index (BMI), and provide a score.
  • Step 2: Note the percentage of unplanned weight loss and provide a score. For example, an unplanned loss of 5 to 10 percent of weight would give a score of 1, but a 10-percent loss would score 2.
  • Step 3: Identify any mental or physical health condition and score. For example, if a person has been acutely ill and taken no food for over 5 days, the score will be 3.
  • Step 4: Add scores from steps 1, 2 and 3 to obtain an overall risk score.Nutrition Issues Case Study Paper
  • Step 5: Use local guidelines to develop a care plan.

If the person is at low risk of malnutrition, their overall score will be 0. A score of 1 denotes a medium risk and 2 or more indicates a high risk.

MUST is only used to identify malnutrition or the risk of malnutrition in adults. It will not identify specific nutritional imbalances or deficiencies.

Treatment

Following the MUST screening, the following may happen:

Low risk: Recommendations include ongoing screening at the hospital and at home.

Medium risk: The person may undergo observation, their dietary intake will be documented for 3 days, and they will receive ongoing screening.

High risk: The person will need treatment from a nutritionist and possibly other specialists, and they will undergo ongoing care.

For all risk categories, help and advice on food choices and dietary habits should be offered.

Treatment types

The type of treatment will depend on the severity of the malnutrition, and the presence of any underlying conditions or complications.

The healthcare provider will prepare a targeted care plan, with specific aims for treatment. There will normally be a feeding program with a specially planned diet, and possibly some additional nutritional supplements.

People with severe malnourished or absorption problems may need artificial nutritional support, either through a tube or intravenously.

The patient will be closely monitored for progress, and their treatment will be regularly reviewed to ensure their nutritional needs are being met.Nutrition Issues Case Study Paper

Diet

A dietitian will discuss healthful food choices and dietary patterns with the patient, to encourage them to consume a healthy, nutritious diet with the right number of calories. Those who are undernourished may need additional calories to start with.

Monitoring progress

Regular monitoring can help ensure an appropriate intake of calories and nutrients. This may be adjusted as the patient's requirements change. Patients receiving artificial nutritional support will start eating normally as soon as they can.

Prevention

To prevent malnutrition, people need to consume a range of nutrients from a variety of food types. There should be a balanced intake of carbohydrates, fats, protein, vitamins, and minerals, as well as plenty of fluids, and especially water.

People with ulcerative colitis, Crohn's disease, celiac disease, alcoholism, and other health issues will receive appropriate treatment for their condition.

Nutritional disease, any of the nutrient-related diseases and conditions that cause illness in humans. They may include deficiencies or excesses in the diet, obesity and eating disorders, and chronic diseases such as cardiovascular disease, hypertension, cancer, and diabetes mellitus. Nutritional diseases also include developmental abnormalities that can be prevented by diet, hereditary metabolic disorders that respond to dietary treatment, the interaction of foods and nutrients with drugs, food allergies and intolerance's, and potential hazards in the food supply. All of these categories are described in this article. For a discussion of essential nutrients, dietary recommendations, and human nutritional needs and concerns throughout the life cycle, see nutrition, human.Nutrition Issues Case Study Paper

Nutrient deficiencies

Although the so-called diseases of civilization—for example, heart disease, stroke, cancer, and diabetes—will be the focus of this article, the most significant nutrition-related disease is chronic under nutrition, which plagues more than 925 million people worldwide. Under nutrition is a condition in which there is insufficient food to meet energy needs; its main characteristics include weight loss, failure to thrive, and wasting of body fat and muscle. Low birth weight in infants, inadequate growth and development in children, diminished mental function, and increased susceptibility to disease are among the many consequences of chronic persistent hunger, which affects those living in poverty in both industrialized and developing countries. The largest number of chronically hungry people live in Asia, but the severity of hunger is greatest in sub-Saharan Africa. At the start of the 21st century, approximately 20,000 people, the majority of them children, died each day from under nutrition and related diseases that could have been prevented. The deaths of many of these children stem from the poor nutritional status of their mothers, as well as the lack of opportunity imposed by poverty.

Only a small percentage of hunger deaths is caused by starvation due to catastrophic food shortages. During the 1990s, for example, worldwide famine (epidemic failure of the food supply) more often resulted from complex social and political issues and the ravages of war than from natural disasters such as droughts and floods.

Malnutrition is the impaired function that results from a prolonged deficiency—or excess—of total energy or specific nutrients such as protein, essential fatty acids, vitamins, or minerals. This condition can result from fasting and anorexia nervosa; persistent vomiting (as in bulimia nervosa) or inability to swallow; impaired digestion and intestinal malabsorption; or chronic illnesses that result in loss of appetite (e.g., cancer, AIDS). Malnutrition can also result from limited food availability, unwise food choices, or overzealous use of dietary supplements.

Consuming too few calories or too many nutritionally empty calories is among the most important public health problems, according to Marion Nestle, a New York University professor and coauthor of the book "Why Calories Count: From Science to Politics." Nestle says that the health consequences of overeating -- obesity or diabetes -- and under eating -- depression, irritability or organ failure -- affect billions of people globally.Nutrition Issues Case Study Paper

Obesity

The Centers for Disease Control and Prevention states a dramatic increase in obesity has occurred in the United States during the past 20 years. Approximately one in three adults -- or 34 percent -- and one in six children and adolescents -- or 16.2 percent -- are obese, according to Healthy People.gov. Obesity, an energy imbalance caused by consuming too many calories and not getting enough exercise, is an accumulation of excess body fat. People are considered obese if they have a body mass index, which is calculated from your height and weight, equal to or greater than 30. Obesity increases the risks of other health conditions including diabetes, sleep apnea, osteoarthritis and liver disease.

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Over consumption

Over-consumption of foods and beverages that are high in fat, sugar and salt is a significant health problem, according to Mayo Clinic.com. Eating food prepared and purchased outside of the home may be a factor influencing over consumption, according to the CDC. Portion sizes at restaurants have become larger, which can tempt you to eat more high-calorie fatty foods. To avoid overeating when dining out, split your dish with a friend or request that half of your meal be wrapped up before it is brought to the table. Scan the menu for healthier food choices, including steamed, broiled or baked items, instead of fried fare and choose low-calorie condiments such as vinaigrette or mustard sauce instead of a cream sauce.

Malnutrition

Malnutrition, also referred to as under nutrition, occurs when your diet does not provide adequate nutrient-rich calories required for good health, reports Medical News Today. Unhealthy food choices void of essential vitamins, such as A and C, and minerals including calcium and iron may lead to fatigue, irritability and lengthier healing times for injuries. People experiencing a caloric deficit for an extended period of time may suffer heart, liver or respiratory failure. Preventing malnutrition means consuming the correct balance of food from the five major food groups: protein, dairy, whole grains, fruits and vegetables.

Poor Dietary Choices

The United States Department of Agriculture reports that most Americans are not eating enough fresh produce and whole grains while consuming too much saturated fat and sodium. Poor dietary choices are linked to obesity, high LDL cholesterol levels, high blood pressure, heart disease, stroke and cancer, according to the USDA. Developing a healthy eating plan and making consistent nutritious food choices may lead to better health. According to the Dietary Guidelines for Americans 2010, a healthy eating plan limits the intake of salt, fats, added sugars and processed grains and focuses on nutrient-dense foods such as fresh fruits and vegetables, especially dark-green, red and orange, fiber-rich whole grains, lean meats and fat-free or low-fat milk products, while staying within your daily caloric needs.Nutrition Issues Case Study Paper

There is no agreed definition of adolescence; the WHO defines it as ages 10-18 while the American Academy of Pediatrics defines it as 13-18 years. The overriding fact is that this period is characterized by rapid, physical, emotional, social, sexual, psychological, development and maturation. Along with social factors, these characteristics make adolescents vulnerable to a range of nutritional issues.

There are arguably two key reasons for interest in nutrition issues among adolescents. Numbering over one billion, they constitute roughly 20%, of the world population; and in many developing countries their demographic slice is much larger. This large number makes them important as a group as the future economic prospects of any country will depend on the health and education of adolescents today. Secondly, adolescence provides an opportunity to nurture the life-style habits necessary for a healthy productive life which avoids or reverses the current trend towards obesity and premature cardiovascular disease. This review outlines the most common nutrition issues of adolescence.

Unhealthy eating habits

The bulk of data on the eating habits among adolescents comes from the west and particularly the USA. The data indicate that some dietary patterns are consistently observed among adolescents which put them at risk of unhealthy eating. These include snacking (on energy-dense but nutrient-poor items); meal skipping; irregular eating patterns; and a wide use of fast food for meals and snacks. More than 50% of respondents in the National Adolescent School Health Survey (US Dept Health and Human Services, 1989) reported missing breakfast while snacking was reported by 90% in the same survey. Only 39% reported eating nutritious snacks, the majority reported snacks of “junk” food - chips, soda, sweets and cake. Healthy snacks can be important for adolescents owing to their high energy requirements but fast foods - a popular choice – can contribute to high intakes of saturated fat. Other common habits include eating away from home, low intake of fruits, vegetables and dairy products. Self-image and body weight concerns particularly in girls may lead to faulty dieting practices. Tooth decay and periodontal disease may result from a combination of poor oral hygiene and poor eating habits.Nutrition Issues Case Study Paper

Because adolescence is characterized by increasing maturity and a trend towards autonomy and independence, adolescents are generally curious, adaptive and open to new ideas. They may explore unconventional dietary practices (e.g. vegetarian diets). As they mature, their own choices and preferences gain priority over eating habits acquired in the family and they have more control over what they eat, when and where. This is an important window for nutritional education interventions with potential to impact lifetime eating habits and health.

Under nutrition and pregnancy

Under nutrition - manifesting as stunting or underweight - is associated with deficiencies in earlier childhood. Other causes include unhealthy eating habits and poor access to food may be an issue in developing countries. The increased metabolic requirements of pregnancy in affected adolescents increase their risk of nutritional deficiencies, maternal morbidity and mortality, low birth weight. Low birth weight babies are at increased risk of stunted growth and all the known co-morbidity of later life.

Obesity

Obesity among both adolescents and adults is increasing worldwide in both poor and rich economies. While genetic factors have a role, environmental factors (a sedentary life style and high fat diets) play the dominant role. The major long term consequence of adolescent obesity is persistence into adulthood and association with an increased risk of cardiovascular and metabolic disease in later life. It is estimated that at least one half of cardiovascular mortality is nutrition-related and up to half of type-2 diabetes cases are nutrition-related.  In addition obesity in adolescent has other undesirable health consequences. According to a review by the WHO (1990) obesity-related issues include sleep disturbances; psychological and social problems; poor self-esteem and body image. In women obesity during adolescence may affect future marital and social economic status.Nutrition Issues Case Study Paper

Micro nutrient deficiency

Iron is the most widespread micro nutrient deficiency. Deficiency is most prevalent among pregnant women, followed by per-school children and adolescents – particularly girls. Key causes include poor dietary intake, reduced bio availability and increased losses due to intestinal worms. Efforts to mitigate iron deficiency should include diets rich in Vitamin C (to increase bio availability of iron) and Vitamin A (to increases the effectiveness of iron).

As maximum bone growth occurs during this period adolescents are prone to calcium deficiency and increased tendency to bone fracture. Later on in life calcium deficiency in adolescence is associated with high post-menopausal bone loss. These deficiencies and effects can be reversed by adequate intake of calcium. Studies have also reported a positive impact of zinc on linear growth among adolescents with zinc deficiency – particularly boys.

Iodine deficiency is still an issue in parts of the world without access to iodized salt. To prevent the deleterious mental effects of iodine deficiency on the fetus, normal iodine status must be achieved prior to pregnancy; and for this to happen adolescents, particularly girls, should be targeted in places where iodine deficiency is endemic.

Although Vitamin A deficiency has in the past been seen as primarily a problem of children under the age of five years, it is now recognized from the impact of supplementation studies that it may be widespread among women, and an important contributor to maternal mortality. It may also be common among adolescent girls; and as indicated above, it is entangled with iron deficiency. Therefore adolescence is a good time to prevent vitamin A deficiency. This can be achieved primarily through education and food.

Eating disorders

Unnecessary dieting is highly prevalent in western societies especially among adolescent girls. There is a broad spectrum of eating disturbances with bulimia nervosa (excessive eating followed by self-induced vomiting or periods of fasting) and anorexia nervosa (aversion  to food) representing the extreme.  Risks associated with eating disorders include stunted growth, delayed puberty and progression to overt eating disorders. Self-esteem seems to play a major role. School-based primary prevention program mes targeting girls may be the best way to tackle eating disorders.Nutrition Issues Case Study Paper

Conclusion

Adolescence is associated with a number of important nutritional issues. At the same time this period provides an important window of opportunity for interventions that promote the principles of a healthy eating life style - with potential to radically change the chronic disease landscape among adults across the world.

Rapid urbanization and dramatic sociology-economic advances in Malaysia since Independence has brought about marked changes to the lifestyle of the population.

This has resulted in significant changes in the nutrition scene, with the existence of the paradoxical double burden of malnutrition.

Various strategies and action plans have been put in place to promote healthy nutrition and active lifestyles for the prevention of these diet-related nutrition problems.

Dr Tee E Siong, president of the Nutrition Society of Malaysia (NSM), shares his views on effective and practical ways of curbing these nutritional problems in the country and how the community itself can play a role in preventing these diseases.NSM was officially registered in 1985. It is a not-for-profit professional nutrition organization in the country, with its vision guided by a simple belief: the more people understand food and nutrition, the better they can care for their health and well-being.

Could you elaborate on the double burden of malnutrition situation in our country?

The double burden of malnutrition alludes to the simultaneous existence of over-nutrition among some segments of the population and under-nutrition problems among others.Nutrition Issues Case Study Paper

Over-nutrition has become more significant in Malaysia, as evidenced from the high prevalence of overweight and obesity combined, affecting almost 50% of adults and 30% of school-going children.

As overweight or obesity is a major risk factor for non-communicable diseases (NCDs), this has contributed to the high prevalence of these diseases, especially heart disease, cancer and diabetes in Malaysia.

On the other hand, under-nutrition problems have declined markedly over the last 30 years.

Nevertheless, there still exist pockets of mild-to-moderate under-nutrition among st underprivileged groups, as manifested by underweight and stunting (especially among children), and micro nutrient deficiencies.

What are the current strategies or plans in place by the Government to address these malnutrition problems?

Various Government strategies and action plans have been formulated and implemented, especially to combat the rising statistics of NCDs and its risk factors.

The 11th Malaysia Plan 2016-2020 and National Strategic Plan for Non-Communicable Disease 2016-2025 are key Government strategies that have been drawn up.

The third National Plan of Action for Nutrition Malaysia (NPANM III, 2016-2025) has identified various programmes and activities to tackle the existing double burden of malnutrition.

The Health Ministry’s (MOH) Anti-Obesity Taskforce has also proposed several policy options to be implemented.

NSM wholeheartedly supports these identified strategies and action plans.

It is imperative that adequate resources are provided for these identified program mes to be systematically implemented.

Who are the stakeholders that have been identified for the implementation of the proposed program mes and activities?

All the Government strategies and national action plans have called for a strategic, multi–stakeholder, multi-pectoral collaboration and cooperation approach to effectively tackle the double burden of malnutrition.Nutrition Issues Case Study Paper

This would entail a whole-government approach, involving several key ministries, as well as engaging other key stakeholders, including civil society and private sector entities.

NSM fully supports MOH’s Nutrition Division, along with the Food Safety & Quality Division, NCD Division and the Health Education Division, in playing a lead role to implement the NPANM III activities.

All efforts must be made to have the support of other ministries and agencies, including, but not limited to, agriculture, education, and housing and local government, all of which should also develop their own nutrition and lifestyle-related activities.

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Relevant professional bodies, as well as corporate companies, must also be invited to participate in well-coordinated collaborative program mes.

How does NSM contribute to the data required for the development and implementation of the strategies and plans mentioned above?

NSM contributes to the development and implementation of these strategies and plans through conducting various scientific activities.

We conduct research studies to provide evidence-based data to support the formulation of sound public health policies.

For example, a large nationwide My Breakfast Study of primary and secondary school children provided useful data such as body mass index (BMI), physical activity and food consumption pattern.

In the Healthy Kids Program-me, we developed and evaluated a nutrition education module for promoting healthy eating among primary school children.

In MyNutriStudy, we studied the nutritional status, food habits and cognitive performance of preschool children.

NSM has been organising national and international scientific conferences and seminars for the last three decades, thereby contributing to the professional development of nutrition scientists.Nutrition Issues Case Study Paper

As a further scientific contribution, NSM has been publishing an official peer-reviewed scientific journal called Malaysian Journal of Nutrition since 1985.

How does NSM contribute to the strategies identified in NPANM III aimed at preventing NCDs in the country?

In supporting government efforts to prevent NCDs in the country, NSM has relentlessly conducted various nutrition promotion activities for the past three decades.

To promote nutrition to the community at large, NSM contributes to an annual Nutrition Month Malaysia, which began in 2002 and continues to this day.

To promote nutrition to the community at large, NSM contributes to an annual Nutrition Month Malaysia, which began in 2002 and continues to this day.

It is a strategic partnership of three professional founding bodies (NSM, the Malaysian Dietitians’ Association and the Malaysian Association for the Study of Obesity) and supported by MOH.

NSM also conducts nutrition promotion programmes for specific target groups, especially infants, children and pregnant and lactating women.

In addition, NSM has published a variety of educational materials for the public, for example, recipe books, leaflets and booklets.

NSM also initiated the Malaysia Nutrition Leadership Programme last year to enhance leadership competency, thus contributing towards establishing a critical mass of able leaders in nutrition in the country.

How does NSM implement these programmes you summarised? Where does NSM obtain its resources?

In the implementation of the various activities mentioned above, NSM adopts a multi-stakeholder approach, including working with government agencies, relevant professional organisations, as well as corporate companies.Nutrition Issues Case Study Paper

One good example is the Nutrition Month Malaysia mentioned above, which has enabled a variety of activities and educational materials to be made available to the public.

It is a successful collaboration lasting more than 10 years among three professional organisations, sponsorship by several corporate companies and supported by MOH.

Why does NSM work with private/corporate companies?

Public-private partnerships with corporate companies have provided opportunities to enable NSM to embark on projects and activities that eventually benefit the scientific community and the public at large.

We are able to utilise the resources and expertise available in the private sector.

I must emphasise such collaboration is not merely for securing funding.

It enables us to have access to technical expertise in research and communications, which are also available in the private sector.

Such collaborations have enabled our activities and educational messages to be disseminated to a much wider segment of the population.

By working with corporate companies to publish educational materials, NSM can ensure that the information is unbiased and based primarily on the Malaysian Dietary Guidelines.

How does NSM manage this partnership with the private sectors, as some groups may see this as a potential conflict of interest, especially in research projects?

We are always mindful that the professional standards of the society must be maintained at all times.Nutrition Issues Case Study Paper

Thus, NSM applies strict ethical standards and has in place necessary checks and balances to remain independent and to ensure that the research is not being manipulated by the corporate partners.

Each research project is carefully scrutinised and monitored by the nine NSM council members who are professors or senior lecturers in the major universities in the country.

Any funding received for research projects are received on an “unconditional” basis, which means that the collaborating corporate companies cannot influence the findings or publications.

The NSM Council establishes a research committee with members from appropriate backgrounds to ensure proper conduct of data collection, analysis and publication in a transparent manner, in line with established international practice.

With regard to the community projects, how does NSM manage to maintain its professionalism and not be seen as promoting the company’s products?

For community nutrition promotion projects, the NSM Council establishes an expert committee to oversee the implementation of the project activities and the publication of all the educational materials in a professional manner.

The corporate partner does not participate in the development of the materials and there is no mention of specific brands.

To give due acknowledgement and in order to be transparent, the respective corporation is allocated an advertisement/advertorial page.Nutrition Issues Case Study Paper

All funds received are for the sole purpose of implementing the planned activities.

Financial statements are properly documented and available for scrutiny.

Besides promoting healthy nutrition locally, what are NSM’s activities in the regional or international arena?

NSM mooted the formation of the Southeast Asia Public Health Nutrition (SEA-PHN) Network in 2014, aimed at bringing together five professional nutrition organisations from Indonesia, Malaysia, Vietnam, the Philippines and Thailand.

It represents a regional multi-stakeholder partnership of nutrition societies and corporate companies to promote public health nutrition in South-East Asia.

NSM also conducts joint seminars with the International Life Sciences Institute, and participates in international meetings with the International Union of Nutritional Sciences and the Federation of Asian Nutrition Societies.

As the president of NSM who has led the society for two decades, how do you envision it’s direction in moving forward with the challenges of tackling nutrition problems in the country?

First of all, the NSM Council reaffirms that the society will continue to champion nutrition in the country.

We will continue to remain resilient and visionary, as well as a key partner to the Government in promoting the nutritional wellbeing of the population.

As NCDs are multi-factorial, we do not believe that tackling any single factor or food item will bring about meaningful impact.

NSM calls for urgent, systematic and holistic measures to be taken.

Educating and empowering the people is the long-term solution to preventing nutritional disorders.Nutrition Issues Case Study Paper

To ensure a healthier generation of Malaysians, preventive measures among children must be taken now.

In closing, what advice would you give to the public to prevent NCDs?

I urge all readers to take your health seriously!

Remember that the only way to enjoy good health for many years to come is to practise healthy eating and living an active life now.

You do not need to buy expensive foods or adopt special dietary programmes, only willpower and discipline.

Start your children off on the right foot by teaching them to eat right and stay active from young.

These are the keys to maintain healthy weight, reduce risk of diseases and promote overall health.Nutrition Issues Case Study Paper