PUBLIC HEALTH NUTRITION HEI-ICI COURSE Arja Erkkilä Assistant professor (public health nutrition) UEF
INTRODUCTION TO THE COURSE In this first part you will learn, 1. What is public health nutrition? 2. Characteristics of a healthy diet
WHAT IS PUBLIC HEALTH/ COMMUNITY MEDICINE? A branch of medicine which deals with populations or groups rather than individual patients. Public health focuses on protecting and improving the health of the people through organized efforts and actions to the society.
Population Health Improving Everyone s Quality of Life: Group Health Foundation, 2001
PUBLIC HEALTH NUTRITION PHN focuses on the promotion of good health through nutrition and primary prevention of diet-related illness in the population. The emphasis is on the maintenance of wellness in the whole population. (Nutrition Society,UK 1998) The promotion and maintenance of nutrition-related health and well-being of populations through the organised efforts and informed choices of society. (World Public Health Nutrition Association 2007) Related fields: public health context skills and knowledge of epidemiology and health promotion
MODES OF NUTRITION PRACTICE Clinical dietetics Community dietetics Community nutrition Public health nutrition Setting Hospitals Community Community Community Reach Individuals Individuals and small groups Population subgroups Prevention Secondary, tertiary, quaternary Primary Paradigm Illness Wellness Determinant of activity Outcome timeframe Health worker referral Short to medium Populations Community development, needs and policy directives Medium to long Hughes R, Margetts BM. Practical Public Health Nutrition. West Sussex: Wiley-Blackwell 2011
What factors have influence on what people eat?
COMMUNITY NUTRITION PRACTICE Community nutrition includes any nutrition program whose target is the community. Community nutrition includes people, policy, and programs.
Community Nutrition People Policy Program
COMMUNITY NUTRITION.. People in the community who benefit from community nutrition programs A policy is a course of action chosen by public authorities to address a given problem and they are accomplished through laws, regulations. Programs are instruments used by community nutritionists to seek behavior changes that improve nutritional status and health.
CORE PUBLIC HEALTH NUTRITION FUNCTIONS Research & Analysis Monitor, assess and communicate population nutritional health needs and issues Develop and communicate intelligence about determinants of nutrition problems, policy impacts, intervention effectiveness and priorisation through research and evaluation. Building capacity Develop the various tiers of the PHN workforce and its collaborators through education, dissemination intelligence and ensuring organizational support Build community capacity and social capital to engage in, identify and build solutions to nutrition problems and issues Build organizational capacity and systems to facilitate and coordinate effective public health nutrition action.
CORE PUBLIC HEALTH NUTRITION FUNCTIONS Intervention management Plan, develope, implement and evaluate interventions that address the determinants of priority PHN issues and problems and promote equity. Enhance and sustain population knowldege and awereness of healthful eating so that dietary choices are informed choices. Advocate for food and nutrition-related policy and government support to protect and promote health. Promote, develop and support healthy growth and developent throughout all life-stages. Promote equitable access to safe and healthy food that healthy choices are easy choices.
The picture is from the Finnish nutrition recommendations 2014 and guides to healthy eating using the food items that belong to Finnish food culture.
CHARACTERISTICS OF HEALTHY DIET Study the WHO fact sheet on healthy diet (Sep 2014) at: http://www.who.int/mediacentre/factsheets/fs394/en/ Focus on food level instructions.
ENERGY NEEDED FOR Basal metabolic rate, BMR or resting energy expenditure Basic processes: breathing, circulation, tissue repair and renewal, ionic pumping Appr. 70-75% of the total energy expenditure Affected by fat free mass, age, sex, obesity, temperature, sleeping/awake, nutritional status, genetic factors, hormones and drugs. Diet-induced (or postprandial) thermogenesis (specific dynamic action) Energy required to absorb, digest, transport, interconvert and store nutrients. 10% of total energy expenditure Physical activity Appr. 15 % of total energy expenditure. Tissue growth (children, pregnancy)
ENERGY REQUIREMENT Can be estimated by estimating the basal metabolic rate and multiplying that with physical activity level. You will practice this in the assignment. Nutrients that provide energy include Carbohydrate Protein Fat Alcohol
RECOMMENDATIONS FOR MACRONUTRIENT INTAKE (WHO) Macronutrients provide energy and include carbohydrates, protein, fat. Carbohydrates 55-75% of energy Sugar less than 10% of energy Fat: total fat 20-35% of energy Saturated fat less than 10% of energy Polyunsaturated fat 6-11% of energy Protein Safe limit of protein intake 0.83 g/body weight kg in healthy adults Joint FAO/WHO Scientific update on carbohydrates in human nutrition. European Journal of Clinical Nutrition, Volume 61(Supplement 1), December 2007FAO. Fats and fatty acids in human nutrition. Report of an expert consultation 2010. Protein and amino acid requirements in human nutrition. Report of a joint FAO/WHO/UNU expert consultation (WHO Technical Report Series 935, 2007
MICRONUTRIENTS Vitamins and minerals are micronutrients that are essential nutrients needed in small amounts. Needed to maintain and regulate body s functions, minerals (calcium) also needed for structural role. Do not yeild energy. Most important micronutrient deficiencies for global public health include: Vitamin A Iron Iodine
VITAMINS Synthetized by plants, microbes, animals Biologically active organic compounds Humans need small amounts from food (micro-milligrams) vitamins work in metabolic regulation (coenzymes) usually individually (some in cooperation) some are stored excessive amounts can be harmful Chemically heterogenic group: fat soluble vitamins: vitamin A (retinol), vitamin D (cholecalciferol), vitamin E (tocoferol), vitamin K (phyllokinone) water soluble vitamins: B 1 (thiamine), B 2 (riboflavine), B 3 (niacin), B 6 (pyridoxine), folate, B 12 (cyanocobalamine), pantothenic acid, biotine, vitamin C (ascorbic acid)
AMOUNT OF MINERALS IN ADULT BODIES (G) MINERALS CONSTITUTE ~4% OF THE WEIGHT OF A HUMAN BODY Iodine Copper Manganese Iron Magnesium Cloride Sodium Sulphur Potassium Phosphorus Calcium 0 200 400 600 800 1000 1200
MINERALS Classification macro/major minerals calsium (Ca), phosphorus (P), magnesium (Mg), sulphur (S) appr. 75-80 % of the minerals requirement 100 mg -1 g/d electrolytes: sodium (Na), potassium (K), chloride (Cl) essential trace elements iron (Fe), copper (Cu), zinc (Zn), cobalt (Co), molybdene (Mo), manganese (Mn), iodine (I), selenium (Se), fluoride (F) are essential to humans requirement in micro to milligrams non-essential trace elements mercury (Hg), lead (Pb), cadmium (Cd) are toxic heavy metals
MINERALS specific functions in the body eg. Ca, P in bone metabolims Na, K, Cl in regulation of osmotic pressure, nerve impulse Fe in oxygen transport I in regulation of metabolism homeostasis (concentrations in tissues/blood regulated, absorption and/or excretion regulated, transport proteins) Nutritional role of minerals is dependent on the intake (content in food, amount of food, food choice) and bioavailability (absorption, distribution in the body, excretion, interactions)
USEFUL SOURCES ON HEALTHY NUTRITION British Nutrition Foundation http://www.nutrition.org.uk/healthyliving/healthyeating.html USDA nutrition information http://www.nutrition.gov/ WHO nutrition http://www.who.int/topics/nutrition/en/ European Food Information Council http://www.eufic.org/