1. The Physical Side of Hunger Concepts & Measurements

2. First Steps: Define Interrelationships Food Insecurity Hunger Under-nutrition

3. Three Nested Concepts Food Insecurity HungerUnder-nutrition

5. Food Security vs. Food INsecurity Food security: A condition that exists when all people at all times are free from hunger. It has four elements : - Availability - Access - Utilization - Vulnerability Food insecurity = absence of food security

6. Food Security Framework Hunger status Inadequate food Availability Elements of vulnerability Physical and environmental risks Physical and environmental risks Economic and market risks Economic and market risks Social and health risks Social and health risks Inappropriate food utilization Inadequate food access

7. Hunger

8. A condition in which people lack the required nutrients, both: Macronutrients (protein, carbohydrates, & fats) AND Micronutrients (vitamins & minerals), for fully productive, active, & healthy lives

9. Hunger Short term Chronic, Acute, or Hidden Physical & Mental Hunger Sensation

10. Short-term Hunger A transitory, mild form of hunger that temporarily affects mental and physical capacity (i.e. school children)

11. Chronic, Acute, & Hidden Hunger Chronic Hunger Occurs when people suffer from hunger for long periods. Hunger becomes their normal condition.

12. Chronic, Acute, & Hidden Hunger Acute Hunger Occurs when people suffer from hunger for short periods, usually due to shocks such as drought or conflict

13. Chronic, Acute, & Hidden Hunger Hidden Hunger Occurs when people lack essential micronutrients, even if the consume adequate amounts of calories and protein

14. Physical Side of the Hunger Sensation 2. Hypothalamus creates hunger sensation 1. Gherlin released in stomach and/or glycogen levels in blood go down 4. Leptin and other hormones released in stomach 5. Hypothalamus creates satiation sensation 3. You eat food

15. Gherlin Helps Trigger Hunger Sensation Gherlin levels rise before meals, but fall after them Gherlin has been called the ‘hunger hormone,’ but in fact, a number of hormones are involved

16. Mental Side of the Hunger Sensation Cultural/Societal Factors – Meal times – Preferred foods – Appropriate color of food Emotional Factors – Stress – Repulsion – Anger

17. Under-Nutrition

18. Malnutrition vs. Under-Nutrition Often used loosely & Interchangeably Malnutrition refers to all deviations from adequate and optimal nutritional status, including energy under-nutrition and over- nutrition (obesity is a form of malnutrition)

19. Malnutrition vs. Under-Nutrition Under-nutrition is used to refer to generally poor nutritional status, but also implies underfeeding

20. Malnutrition Nutritional deficiencies (under- nutrition) OR An excess of certain nutrients (over- nutrition)

21. Under-Nutrition A form of hunger that results from serious deficiencies in one or more essential nutrients and that can have lasting mental and physical impacts Mild Moderate Severe

22. Under-Nutrition Two Principal Types Protein Energy Malnutrition (PEM) – A result of deficiencies in any or all nutrients (in particular macronutrients) Micronutrient Deficiency Diseases (MDD’s) – A result of deficiencies in specific micronutrients (such as vitamins or minerals)

23. Measurements of Under-Nutrition STUNTING (shortness – height for age) CHRONIC UNDER-NUTRITION WASTING (thinness – weight for height) ACUTE UNDER-NUTRITION Occurs as a result of recent rapid weight loss or a failure to gain weight Occurs as a result of inadequate nutrition over a long period of time UNDER-WEIGHT (thinness/shortness – weight for age) Occurs as a result of weight loss or inadequate nutrition over a long period of time

24. Who is stunted & who is wasted? A: Healthy B: Stunted C: Wasted D: Stunted & Wasted A B C D

25. Malnutrition

26. Forms of Protein Energy Malnutrition (PEM) Marasmus – Severe loss of body weight Kwashiorkor – Swelling (oedema) Marasmic Kwashiorkor – Combines symptoms of Marasmus & Kwashiorkor

27. Marasmus

28. Marasmic child Same child after refeeding Marasmus

29. Kwashiorkor Note the peeling of the skin around The stomach area

30. KwashiorkorSame child after refeeding Kwashiorkor

32. Three Most Common Micronutrient Deficiency Diseases Iron Deficiency – Anemia Vitamin A Deficiency – VAD Iodine Deficiency – Goitre

33. Iron Deficiency Iron is essential for transport of oxygen in blood Iron deficiency leads to poor cognitive development of children, contributes to maternal death, & causes fatigue

34. Iron Deficiency 3 to 5 billion people are affected by this disease in the world, particularly: – Pregnant women – Children 5-14 years and pre-school age – Older adults

35. Symptoms of Iron Deficiency

36. Approaches to Anemia Access to fortified foods (e.g. cereal- legume blends, wheat, maize flour, etc.) Access to dietary sources of iron & Vitamin C

37. Approaches to Anemia Iron/folate supplements for pregnant & lactating women, infants (especially with low birth weight), and young children Control of infections (such as malaria, worms, etc.)

38. Vitamin A Deficiency (VAD) VAD is the leading cause of preventable blindness among pre- school children VAD weakens the immune system and increases clinical severity and mortality risk from measles and diarrhea

39. Vitamin A Deficiency (VAD) WHO estimates that 21% of all children suffer from VAD, mostly in Africa & Asia

40. Symptoms of Vitamin A Deficiency

41. Approaches to Address Vitamin A Deficiency Vitamin A supplements for children 6 months to 5 years and women after delivery Access to dietary sources of Vitamin A (orange and red fruits & vegetables)

42. Approaches to Address Vitamin A Deficiency Promotion and support of breastfeeding Access to fortified commodities: oil, cereal- legume blends

43. Iodine Deficiency Single most common preventable cause of mental retardation and brain damage

44. Iodine Deficiency 1 billion people are estimated to have some degree of goitre (mostly in Africa, Middle-East and Asia, but also in Europe)

45. Symptoms of Iodine Deficiency

46. Approaches to Address Iodine Deficiency Fortification (iodization of salt) Access to iodine rich foods (seafish, seaweed, etc.)

47. Conclusion: Three Nested Concepts No current hunger, but vulnerability to it It can take many forms, including Protein Energy Malnutrition and micronutrient deficiencies Food Insecurity HungerUnder-nutrition