Nutrition throughout

the Life-cycle
Public Health Nutrition
Module III

Aim of the Module

Describe importance of proper nutrition

throughout the lifecycle,

Learning Objectives
By the end of the module, the student should
be able to;

Discuss nutrition issues at different life

stages,

Understand intergenerational link of

malnutrition,

Introduction

Nutrition challenges continue throughout the

life cycle,
Poor nutrition often starts in utero

extends into adolescent and adult life, (girls and

women)
Spans generations

Undernutrition during childhood,

adolescence, and pregnancy,

additive negative impact on birth weight of infants

Intrauterine (foetal) Life

Low birth weight infants,

Intrauterine growth retardation (IUGR),

High risk of neonatal or infant mortality,
Less likely to catch-up significantly,
High risk of developmental deficits,
More likely to be underweight or stunted,
Consequences extend into adulthood,

foetal origins of disease hypothesis

Figure 1. Nutrition throughout the Lifecycle

Infancy and Childhood

Frequent, prolonged infections,

Inadequate intake of nutrients

Energy, protein, vitamin A, zinc, iron

Exacerbate effect of fetal growth retardation

Most growth faltering, resulting in stunting

and underweight, occurs during first two
years of age

Undernutrition in early childhood has serious

consequences;

More severe illness (diarrhea, pneumonia, etc.)

Strong exponential association between severity
of underweight and mortality
54% of 11.6million child deaths in 1995 in
developing countries associated with underweight,

Most deaths attributable to mild-moderate undernutrition

School-age Children

Health-nutrition received attention recently,

Assumed to have passed critical stage, and
no longer vulnerable ?
Little data on health-nutrition (school children)
Many infections affecting preschool children
persist into the school years,
Malnutrition widespread in school children,

Adversely affect

school attendance,
performance, learning

Determinants of physical growth

Environmental + genetic factors

Potential for catch-up growth among stunted

children is limited after age two,

Poor food consumption pattern,

Illness,
Lack of sanitation,
Poor health and hygienic practices

Particularly when children remain in poor environment

Stunting at age two years associated with later

deficits in cognitive ability, regardless of catch-up

School feeding (breakfast, lunch)

Cost-effective interventions

Improves school performance (hunger alleviation),

Malnourished children benefited most,

Mass application of antihelminthics,

Micronutrient supplementation (iron, iodine)
Treatment of injuries and routine health problems

Enormous educational and economic gains

Achieved from improving health and nutrition of children

Figure 1. Nutrition throughout the Lifecycle

Adolescent Nutrition

Transition between childhood-adulthood,

Accelerated growth in height (hormonal changes)
Second period of rapid growth

Window of opportunity for compensating for early childhood

growth failure,
Limited potential for significant catch up,
Effects of early childhood undernutrition on cognitive
development and behavior may not be fully redressed,
Stunted girl most likely to become a stunted adolescent
and later a stunted woman => LBW

Better nourished girls have higher premenstrual

growth velocities and reach menarche earlier,

Malnourished girls grow slowly but for longer,

menarche is delayed,

May not finish growing before their first pregnancy,

Growing adolescents give birth to smaller baby,

Poor placental function,

Competition for nutrients

Adolescent pregnancies;

High risk of maternal and infant mortality,

Preterm delivery
Less likely to use antenatal and obstetric services

Maternal mortality ratios for 15-19 year olds

twice as high as those 20-24 year olds
(Bangladesh)

Adult undernutrition

Economic livelihood of populations depends on

health and nutrition of adults,
Continuous gradient in working capacity and
productivity, linked to body weight,
Progressive increase in mortality and morbidity

individuals with a BMI<18.5 (devg countries)

Higher mortality rates among Nigerian adults with

CED;

Mild 40%, moderate 140%, severe 150% greater

Womens health and nutrition

Productivity and quality of womens life,

Survival and development of children

Nutrition policy and interventions

Aimed at reducing young child malnutrition

Pregnant or lactating women

Target but not intended beneficiary

Nutrition interventions in pregnancy and early

childhood

improvements in body size and composition in adolescents

and young adults,
Improvements in physical and intellectual performance

Investing in maternal and childhood nutrition

Short- and long-term benefits (economic, social)

Reduced health care costs through the lifecycle
Increased educability and intellectual capacity,
Increased adult productivity

Figure 1. Nutrition throughout the Lifecycle

Intrauterine Growth
Retardation

Foetal growth constrained by inadequate

nutritional environment in utero,
Newborn that has not attained its growth
potential,
Difficult to determine gestational age in
developing countries,
Low birth weight (<2500) often used as a
proxy for intrauterine growth retardation
(IUGR)

Three types of IUGR

Group 1:

Group 2:

Born after 37 weeks of gestation and weight less

than 2,500 g at birth,
Newborns are preterm and weigh less than the
10th percentile at birth,

Group 3:

Weigh less than the 10th percentile, but have a

birth weight greater than 2,500 g.

Figure 2. Different types of IUGR

Epidemiology of IUGR

In 2000, an estimated 11.0% f newborns in

developing countries, or 11.7 million infants,
have low birth weight at term,

In Asia, 20.9% of newborns are affected, and

sub-region accounts for 80% of all affected
newborns worldwide,

IUGR affects more newborns than who have

low birth weight; about 24% or 30 million
newborns per year in developing countries,

Major global human development problem

with profound short- and long-term
consequences for individuals, communities,
and whole populations,

Causes of IUGR

Developing countries, mainly nutritional;

Inadequate maternal nutritional status before

conception,
Short maternal stature,

Poor maternal nutrition during pregnancy,

undernutrition and infection in childhood,

low gestational weight gain (inadequate dietary intake)

Infections, diarrheal diseases, intestinal

parasitosis, respiratory infections, malaria, etc.
Cigarette smoking

Underlying and basic causes

Care of women,
Access to and quality of health services,
Environmental hygiene and sanitation,
Household food security,
Educational status,
Poverty,

Industrialized countries,

Cigarette smoking is the most important

determinant of IUGR,
Low gestational weight gain,
Low pre-pregnancy body mass index
Pre-eclampsia, short stature, genetic factors,
alcohol and drug use during pregnancy,

Established etiological roles, but quantitatively less

important

Etiologic role of micronutrieints

Remain to be clarified;
RCT required to define possible effects of folate,
iron, calcium, vitamins D and A, magnesium, and
zinc, especially in developing countries,
Use of multiple vitamin and mineral supplements
by women in developing countries is an important
strategy to improve micronutrient status and
benefit womens health, pregnancy outcome, and
child health

Consequences of IUGR

Risk of neonatal death for term infants weighing

2,000-2,500 g at birth is four times higher than for
infants weighting 2,500-3,000 g, and ten times
higher than for infants weighting 3,000-3,500 g,
In developing countries with a high prevalence of
low weight at birth, IUGR infants account for the
majority of neonatal deaths,
Risk of mortality due to IUGR extends beyond
neonatal period,
Increased risk of morbidity due to diarrhea, ARI,

Long term consequences of

IUGR

Less likely to catch-up during first two years

of life,
Neurodevelopmental outcomes;

Neurological dysfunction associated with

Cognitive development and behavior,

Attention deficit, hyperactivity, clumsiness, poor school

performance,
Deficit in cognition

Impaired immune function

Related to extent of foetal growth retardation

Barkers foetal origins of

disease hypethesis

Evidence of association between retarded

foetal growth & chronic diseases in adult life;

Blood pressure,
Noninsulindependent diabetes,
Coronary heart disease,
Cancer

Barkers foetal origins of

disease hypethesis, . Contd

Adult consequences of early undernutrition

may be accelerated by the nutrition transition;

Shifts in dietary patterns and lifestyle related to

urbanization and rapid economic development,

Life-cycle approach

Analysis of nutrition problems,

Choice of interventions
Emphasis on

nutritional status, unlike disease, as cumulative over

time and not an isolated incident,
Centrality of nutrition in maintaining womens health

Birth weight is a critical indicator of lifecycle

of malnutrition (maternal-child-adult),

The life cycle provides a strong framework for

discussing the challenges facing human
nutrition

Nutrition of Older People

World population is aging;

1950: 200 million people over 60 years,

2025: 1.2 billion, 70% live in devng countries,
Demographic transition in 20th century

High birth and death rates to low fertility and mortality

Majority of poor older people in developing

countries enter old age after a lifetime of poverty
and deprivation, poor access to health care, a diet
usually inadequate in quality and quantity

Poverty, lack of pension, death of younger

adults from AIDS, and rural to urban
migration of younger people compel older
people to continue working,

Adequate nutrition, healthy ageing, and ability

to function independently are essential
components of a good quality of life,

Conventional BMI cut-offs for defining CED

may not be appropriate for older people
above 70 years,

Age related changes in body composition,

Practical problems in obtaining accurate height
measurements, (curvature of spine)

Nutritional status in elderly related to;

functional ability,
Psychomotor speed and coordination,
Mobility,
Ability to carry out activities of daily living

Research needed on elderly;

Magnitude of malnutrition (+ micronutrient status),

Refine techniques of anthropometric methods,
Nutrient requirements,

Age related changes leading to reduced/altered intake,

Physiological changes in sense of taste,
Poor appetite associated with loneliness, social
isolation, depression, medications,
Physical factors such as absent or ill-fitting dentures,
limited ability to procure or prepare food,
chronic diseases,