PUBLIC HEALTH NUTRITIONHEI-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 NutritionAssociation 2007)

Related fields:

public health context

skills and knowledge of epidemiology and health promotion

MODES OF NUTRITION PRACTICEClinical

dietetics

Community

dietetics

Community

nutrition

Public health

nutrition

Setting Hospitals Community Community Community

Reach Individuals Individuals and

small groups

Population

subgroups

Populations

Prevention Secondary, tertiary, quaternary Primary

Paradigm Illness Wellness

Determinant of

activity

Health worker referral Community development, needs

and policy directives

Outcome

timeframe

Short to medium 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.

Policy

Program

People

Community Nutrition

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 NUTRITIONFUNCTIONS

Research & Analysis Monitor, assess and communicate population nutritional health needs

and issues

Develop and communicate intelligence about determinants of nutritionproblems, policy impacts, intervention effectiveness and priorisationthrough research and evaluation.

Building capacity Develop the various tiers of the PHN workforce and its collaborators

through education, dissemination intelligence and ensuringorganizational 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 coordinateeffective public health nutrition action.

CORE PUBLIC HEALTH NUTRITIONFUNCTIONS

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 healthfuleating 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 throughoutall life-stages.

Promote equitable access to safe and healthy food that healthy choices areeasy choices.

The picture is from the Finnish nutrition recommendations 2014 and guidesto 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 MACRONUTRIENTINTAKE (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 essentialnutrients 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 publichealth 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: B1 (thiamine), B2 (riboflavine), B3 (niacin), B6 (pyridoxine), folate, B12 (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

0 200 400 600 800 1000 1200

Calcium

Phosphorus

Potassium

Sulphur

Sodium

Cloride

Magnesium

Iron

Manganese

Copper

Iodine

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/orexcretion 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 HEALTHYNUTRITION

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/