NUSC 3230 - Lecture notes 1-5 PDF

Preview

Summary

Lecture notes on powerponint slides from in class...

Description

Lecture 1- Jan. 22, 2018 

01/16/2018

The Concept of Community  Community o A grouping of people residing in a specific locality who interact and connect through a definite social structure to fulfill a wide range of daily needs  Four components: people, a location in space, social interaction, shared values



Community Nutrition Focuses on:  People: o Individuals who will benefit from community nutrition programs  Policy: o Course of action chosen by public authorities to address a given problem, 

accomplished through laws, regulations, and programs Programs: o Instruments used to seek behavior changes that improve nutritional status and health



What is Community Nutrition?  Strives to improve health, nutrition, and well-being of individuals and groups within 



communities Uses programs to seek behavior changes to improve nutritional status and health

Clinical vs. Community Nutrition  Clinical o Individual focus o Individual Problem 

Subjective and objective  Subjective- talking to patient and family



Objective- Health Data (health, weight, etc.)

o Assessment o Plan  Individually-focused  Family 

Community o Group focus o Group problem 

Subjective and objective  Subjective: interviews with key informants o Assessment o Plan  Intervention  Policy Change  Environmental Change 

Community vs. Public Health Nutrition  Community Nutrition o Any nutrition program whose target is the community, whether the program 



is funded by the federal government or sponsored by a private group Public Health Nutrition o Community-based programs conducted by a government agency whose

official mandate is the delivery of health service to individuals living in a particular area Core Functions and Essential Services of Public Health





1. Assessment o Demographics  Age  Diversity  Poverty o Health  To identify health Problems and priorities and evaluate health services Social and Economic Trends for Community Nutrition o Increasing ethnic/racial diversity o An aging population 

People are living to be older o Increasing rate of poverty o Need for community nutrition approaches  Cultural competence and diverse professionals  



Community nutrition to support health in again

Nutrition assistance to decrease food insecurity and hunger How is “good health” achieved? o Many determinants:  Biological, lifestyle, living/working/social conditions, community conditions, other conditions  Refer to table 1-2, page 10 o We know more about the cause of disease and injury than we do the determinants/causes of good health



2. Policy Development o Policy:  Course of action chosen by public authorities to address a given problem o To solve local and national health problems and priorities that have been







identified 3. Assurance o To assure that all populations have access to appropriate and cost effective

care (as well as food !), including health promotion and disease prevention services. “Health Promotion”  Focuses on lifestyle (behavior) change to work toward optimum health  A health promotion activity is called an intervention, which focuses on promoting 

health and preventing disease An important part of community nutrition is health promotion, much of what we do



focuses on motivation to influence people to change behaviors. Behavioral focus: eating well, exercising, strengthening social networks, sleeping

well. People often make decisions to do unhealthy things, smoking, eating poorly. Health promotion is a nudge or encouragement to adapt healthy habits. Three Main Levels of Disease Prevention  Primary Prevention o Preventing disease by controlling risk factors 



Ex: Going to a health fair and providing information



Secondary Prevention o Detecting disease early through screening and other forms of risk appraisal o Helps find out before it's too late(ex: CVD, hemoglobin A1C)



Tertiary Prevention o Treat and rehabilitate people with illness and injury

What is the United States doing to improve health?



Healthy People 2020 o A resource for promoting health and preventing disease throughout the nation o A national agenda that communicates a vision for improving health and achieving health equity o Set of specific, measurable objectives with targets to be achieved over the decade o These objectives are organized within distinct topic areas



Looking Ahead Healthy People 2020 o Healthy People 2020 builds on accomplishments and challenges of meeting Healthy People 2010 o Goals of Healthy People 2020 include:  –Attaining high-quality, longer lives free of preventable disease,





disability, injury, and premature death –Achieving health equity, eliminate disparities, and improve the



health of all groups –Creating social and physical environments that promote good health



for all –Promoting healthy development and healthy behaviors across every

stage of life Healthy People 2020 o Nutrition-Related Objectives  –Healthy weight     

–Intake of nutrients – reduce saturated fat, and added sugar intake –Intake of foods - fruits, vegetables, whole grains –Targets for prevalence of iron deficiency and anemia –Worksites offering nutrition or weight management counseling –Reducing food borne illnesses





Healthy People 2020: Tracking Progress  Weight status for children, adolescents, and adults: little or no change  Total Vegetable Consumption: Little or no change 

Added Sugars: Significant decrease o Still far above target of 10% of total calories or less



Disparities persist in: o Weight status by age, race, and income o Food and nutrient consumption by age, sex, race, and income

The Dietary Guidelines for Americans  Science-based advice for ages 2 years+ o Promote health, prevent chronic disease  Cornerstone for federal nutrition policy/program o Policy makers, nutrition educators and health professionals 

 

Joint effort of HHS/USDA every 5 years o 2015 (8th edition) just released

Vegetables  Choose a variety from all 5 subgroups o Dark green o Red and orange o Beans and peas (legumes)

o Starchy o Other 

Fruits  Choose fresh, frozen, canned, or dried  Juice: Choose 100%, and only have 1 serving (4-6 oz.)  Without or low added sugars



Grains  Choose grains that are not refined or processed (wheat bread, brown rice, oatmeal, cereals with bran)

Dairy  



Milk, yogurt, cheese Soymilk is included in this category o Fortified with calcium, vitamin A and vitamin D o Others lack nutrient content (almond, rice, etc.)

Protein  Choose lean meat: Chicken, turkey, fish, seafood  Choose non-meat sources: beans, nuts, legume, eggs, soy products

Limit Saturated Fat  Main sources of saturated fat: burgers and sandwiches, tacos; pizza; rice, pasta and 

grain dishes; and meat, poultry, and seafood dished Avoid Trans Fat  Hydrogenation- artificial processing  Mai sources: some desserts, microwave popcorn, frozen pizza, margarines and coffee creamers

 

Look at the label!

Limit Added Sugars  Sugars added to sweeten foods/beverages  NOT: naturally occurring sugar in fruit or milk  Main sources: sugar-sweetened beverages (sodas) and snacks/sweets  Look at the label: brown sugar, corn sweetener, corn syrup, dextrose, fructose, glucose, high-fructose corn syrup, honey, invert sugar, lactose, malt syrup, maltose,



molasses, raw sugar, sucrose, trehalose, and turbinado sugar, cane juice, evaporated cane juice Sodium and Dietary Cholesterol  Limit sodium to 2300 mg/day o Main sources: mixed dished like burgers, sandwiches; rice, meat, poultry, 

pasta and grain dishes No cholesterol recommendation in the 2015 Dietary Guidelines: not linked to blood cholesterol concentrations

Moderation: Alcohol & Caffeine  Alcohol: 1 drink for women, up to 2 drinks for men o –One drink equals …  12 fluid ounces of regular beer (5% alcohol),  5 fluid ounces of wine (12% alcohol)  



1.5 fluid ounces of 80 proof distilled spirits (40% alcohol)

Caffeine o –Moderate consumption of 3-5 cups of 8 oz coffee/day is OK for most adults o –Main sources: coffee, tea, soda and energy drinks

Physical Activity  Physical Activity Guidelines for Americans



Adults: 150 minutes of moderate intensity activity per week or 75 minutes of



vigorous intensity activity AND muscle strengthening at least 2 times per week Children: 60 minutes of activity per day



Making Changes  Small shifts in food choices  Add physical activity gradually  Everyone together can make a difference for healthy communities



Review  What is the main difference between a community nutritionist and a public health nutritionist? o Public Health is more government related 



What are the three core functions of public health? o Assessment Policy Development, Assurance

Community Needs and Nutrition Assessments

01/16/2018

Purpose of Community Needs Assessment  Determine nutritional problem (s) of the target population  Determine factors that contribute to the nutritional problem(s)  

Determine what can be done to improve problem(s) o Interventions/programs/policies, raise awareness, allocation of resources

Community Needs Assessment  Factors that may trigger a community needs assessment: o Need for data or updated data o Government Mandate o Research findings o Availability of funding





Step 1- Define the Nutritional Problem  What is the impact of the problem on general health or nutritional status?  Who is affected by the nutritional problem? Where are the gaps in the community’s knowledge of a nutritional problem? Step 2- Set the Parameters of the Assessment  Define “Community”  Determine the purpose of the needs assessment o Define the target population o Set goals and objectives 



Specify type of data needed Step 3- Collect Data



What would you want to collect? o Diet o Physical Activity o Risk Factors for disease o Living, working, social conditions- education, income, household



Types of Data to Collect about the Community  Background Conditions o Food systems and food availability o Geography and climate o Health Systems o Housing o Policies o Recreation o Social and cultural conditions o Transportation systems o Water supply



Obtaining Data about the Target Condition  Existing Data vs direct data collection o Pros vs. cons  Qualitative data include opinions and insights o Focus groups



Small subset (8-10 people) who are representative of larger group you

are focusing on o Interviews 

Quantitative data o Vital statistics (births, deaths, marriages) o Published research studies o Hospital records o Surveys, surveillance, assessments, screenings



Methods of Obtaining Data about the Target Population  Survey o A systematic study of a cross-section of individuals who represent the target population o Relatively inexpensive method of collecting information from a large group or 



people Surveillance o Continuous assessment (nutritional status) for the purpose of detecting

changes in trends or distributions Health Risk Appraisal (HRA)  The HRA consists of three parts: o A questionnaire o Certain calculations that predict risk of disease o An educational message or report to the participant 



Used to alert people about risky health behaviors and how behaviors might be

modified through a lifestyle modification program Screenings  Can be conducted in clinical and community settings and examples include:

o Blood Pressure Checks o Blood Cholesterol Checks o Height and Weight  

Screenings programs are not meant to substitute for a health care visit Review of Nutrition Assessment Methods- Direct Data Collection

 A= Anthropometry 

Measurement of body size, weight and proportions Anthropometry



Anthropometry o Uses  Indicators of health, development and growth  Evaluate nutritional status  Monitoring impact of nutrition interventions



Height o Recumbent length (infants, up to 24 month) o “recumbent board” o Stadiometer- Stand up one



Weight o Electronic scale o Ensure appropriate capacity for population o Pan-type scales are available for infants



Head Circumference

o Screen for abnormal head/brain growth o Charts for up to 36 months of age 

BMI o Body Mass Index o Describes relative weight for height o Significantly correlated with total body fat content o Used to assess overweight and obesity and monitor changes in body weight o Not appropriate for? 

Elderly population o Bod weight(kg)/height (m^2) 

Using BMI for age o BMI-for-Age needs to be plotted on an appropriate growth chart o Needs a series of BMI plots to determine the growth trend o If indices deviate from normal growth patterns, further assessment may be



needed BMI-for-Age interpretation o 95th percentile Overweight is obese o 85th to < 95th…. Risk of overweight ___ overweight o < 5th percent______ underweight o Hard to convey to parents that’s is average size not weight



Can you see risk? o Obese---- prove to show that sometimes kids are just big (BOY)

o Normal (GIRL) 

Waist Circumference o Independent Predictor of risk factors and morbidity o Positively correlated with abdominal fat content



“High Risk” Waist Circumference o Waist circumference:  



> 40 inches in men > 35 inches for women

Assessing Body Consumption o Skinfolds o Bioelectrical Impendence o Plethysmography (Bod Pod) o Underwater Weighing o Dual Energy X-Ray Absorptiometry (DEXA) o

 B= Biochemical 

Biochemical Assessment o Pros:  Most objective and quantitative method of assessment  

Earlier Detection Can validate dietary assessment



Drawback o Can be affected by on-nutritional factors (infection, disease); medications; collection and analysis methods o No single test is sufficient; must be used in conjunction with other tests o Can be expensive, time consuming



Examples o Blood  Vitamin D  Lipids, glucose  Hemoglobin, hematocrit o Stool:  Examination for the presence of the ova and/or intestinal parasites, blood o Urine: check for albumin, glucose, ketones and blood

 C= Clinical Assessment o Simplest method of ascertaining nutritional statue o Involved detailed history, physical exam, interpretation of signs and symptoms  Signs= observations by qualified examiner  Symptoms= reported by patient o Multiple indicators with special attention to hair, angles of the mouth, gums, nails, skin, eyes, tongue, gastrointestinal tract, muscles, bones, and thyroid gland o Advantages  Fast and Easy to perform  Inexpensive



Non-invasive o Limitations  Does not detect early cases

 D=Dietary Assessment o Different Methods Available:  24 hr dietary recall 

recall of all food and drink in the previous 24 hours  depends on short-term memory 

may not truly representative of the person’s usual



intake Food frequency questionnaire

 

Dietary history Food record/ food diary



Observed food consumption, weighed food records o Step 1: Quick List  Write a list of all the foods you have eaten in the past 24 hours  Choose a 24 hr period  Don’t focus on the details  

Can be in any order (not necessarily breakfast—lunch—dinner) One food item per line o Step 2: Forgotten Foods  Write down all of the foods you hear off the commonly forgotten foods list that you ate in the past 24 hours



Go slowly through list of common foods



Re-affirm that this is non-judgmental o Step 3: Time and Occasion  Remember all the activities you did during the past 24 hours. Try and connect those with foods you may have eaten  Prompt participants to think of before breakfast, between 

meals, and after dinner Suggest activities that may be related to foods such as sporting

events, going for a coffee or tea with a friend, driving in a car o Step 4: Food Details  What was the size/amount of food eaten?  How was it prepared?  Was it a brand name?  

Did you use any condiments? What was the specific type of bread, milk, meat?

 

Was the meat with the bone or without the bone? How was the skin? Think about potentially added foods: sugar to tea, butter to bread,

 

lettuce, mayo or mustard, gravy How much was actually consumed? Use visual aids to help estimate portion size:  Liquids: cans/glasses/Styrofoam cup  Bowls/mound able shapes   

Food models Known amounts (i.e. egg, banana) Palm = 3 oz., fist = 1 cup



Do not use leading questions – this can influence a participant’s answer  NO: Did you have about one cup of the yogurt?  YES: How full was your bowl of yogurt?

o Step 5: Final Probe  Read over your list one more time and write down any food you have 

forgotten This is an important step!

Food Frequency Questionnaire  Checklist of foods and beverages with a frequency of how often each item was consumed over a specified period of time o Pros: habitual intake; suitable for very large groups o Cons: relies upon memory; may not contain all foods consumed 

Diet History  Past diet o Collection of the detailed (preparation methods and foods eaten in combination) about meals o Intake of foods plus other risk factors such as the economic status of the





client Food Record/Food Diary  Provides detailed information about daily eating habits o The respondent s usually asked to record all foods and beverages consumed during a defined period, typically over 3-7 consecutive days Observed Food Consumption  Foods eaten by the individual is weighed and contents are analyzed or calculated 

“Duplicate Plate Methods” Most accurate Measurement compared to other Assessments o Least used method in practice

o Recommended for research purposes o High degree of accuracy o Expensive, time consuming 

Issues in Data Collection  Practical Issues o The number of staff available to collect and analyze the data o The cost of administering the test or buying equipment o The amount of time needed to collect the data o Need a method:  Simple to administer   



Inexpensive Safe

Methods Of Obtaining Data- Interviews  Key Informants may have worked with the target population in the community or 
<...