The challenge of assessing malnutrition and its health implications the added value of nuclear technology

Transcription

1 The challenge of assessing malnutrition and its health implications the added value of nuclear technology Anura Kurpad St John s Medical College, India

2 PREGNANCY LACTATION EARLY GROWTH COMPLEMENTARY FEEDING EARLY GROWTH ADOLESCENT GROWTH Addressing malnutrition through: Feeding and supplementation Programs Addressing Sanitation and Parasites Infectious Disease Programs What to do? How much to do? ADULT What was the impact? CHRONIC DISEASE

3 A double burden 10% LMIC Life Expectancy (years) Increases in life expectancy are associated with a double burden of disease High-income countries Middle-income countries Low-income countries 36% non-communicable diseases communicable diseases injuries 7% 6% 54% DC % BMI frequencies with migration of populations Rural to Urban migration BMI distributions shift to the right over 10 years Varadharajan et al; Asia Pac J Clin Nutr; 2014

4 Nuclear techniques are critical to all 4 these problems Measuring Fat and Fat free mass BMI = fatness! Big and muscular Thin and fat Fat Free Mass: Organs Muscles Bone Fluids Fat Mineral Protein Water

5 Why is measuring fat and (fat free mass) important? Insulin resistance; diabetes Load (Store) (Fat) increases insulin resistance Capacity (Liver and muscle) help dispose glucose Health = Appropriate stores + Appropriate capacity Poor Capacity Load increasesbeyond capacity Poor Capacity + Load Undernutritionsarcopenia All these constitute forms of malnutrition Overnutrition High Fat Overnutrition Sarcopenia with fat

6 What are the challenges in measuring fat stores? How do nuclear technologies help? No water in fat Water Water is only present in the fat free mass Sum of Fat and FFM = Body weight Deuterium dilution to measure water (TBW) Body Fat = Body weight FFM Impute the FFM Translates into a very simple field method, which can be deployed with minimal capacity building

7 Nutrition in pregnancy and foetal growth Fat stores and FFM (capacity) Shadow Shield Whole body potassium counter Counting natural 40 K in the body as an index of body cell mass Early undernutrition and later NCD are linked Starting with pregnancy what food does a pregnant woman need for the best outcome and healthy babies? Infant receiving an oral dose of deuterium oxide using a syringe (courtesy: Photo; M. Thame, Jamaica) Measuring body fat of infants in field situations by the use of deuterium dilution Some concern that undernourished babies are IAEA Human Health Series #7 born already fat It is a challenge to measure body tissue or fat in pregnancy or in babies Variable amounts of water in the body, which confounds usual measurements Picture Courtesy: Dr Rebecca Raj

8 Nuclear techniques are also critical at other stages Breast feeding is difficult to measure, invasive 8 Measuring lactation Breast feeding Deuterium Dose to mother 400 Mother water enrichment 200 Baby Saliva samples for 2 H enrichment Translates into a very simple non invasive, field method, which can be deployed with minimal capacity building

9 Measuring protein quality for infant feeding through stable isotopes ( 2 H and 13 C) Photo courtesy: Dr S Sreeman, India Understanding how much protein should be fed protein digestibility Collecting breath sample Photo courtesy: Dr N Shivakumar, India

10 Added value of nuclear technology in the nutrition value chain What is the state of nutrition? Pregnant women, children, adolescents Impact evaluations Exclusive Breast Feeding Requirements Complementary for Feeding mother Programs and baby Body comp Promoting at birth Diversified lactation Diet measures Promoting Physical Best Practices Activity Complementary feeding WASH Unsanitary environments

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