1.

Write in brief about Zero Hunger

SDG 2, "Zero Hunger," is a Sustainable Development Goal that seeks to end hunger, achieve food
security, improve nutrition, and promote sustainable agriculture by 2030. It recognizes that
access to sufficient, safe, and nutritious food is a fundamental human right and a prerequisite for
achieving sustainable development. The goal includes targets to end all forms of malnutrition,
double agricultural productivity, ensure sustainable food production systems, and maintain the
genetic diversity of seeds. "Zero Hunger" reflects a commitment to eradicating hunger and
addressing the complex challenges associated with food security, malnutrition, and sustainable
agriculture on a global scale. The goal acknowledges the interconnectedness of poverty,
inequality, and access to food, emphasizing the need for collaborative efforts to create a world
where no one goes hungry.
2. Briefly describe ‘Windows of Opportunity. Briefly describe the importance of ‘Windows of
Opportunity. 6. Why the first 1000 days of life are important- explain.
"Windows of Opportunity" refer to critical periods in an individual's life when interventions or
nutritional interventions can have a significant and lasting impact on health and well-being. The
first 1,000 days of a child's life, from conception to the second birthday, are considered a
particularly important window of opportunity. Proper nutrition during this time is critical for
physical and cognitive development, with potential long-term effects on health and productivity.
These first 1000 days of life set us up for good health across our lives. Ensuring babies have
the right mix of nutrients in their first 1000 days helps them to better resist infections and allows
their growing brains and bodies to realize their full developmental potential. This is because the
first 1,000 days are when a child's brain begins to grow and develop and when the foundations
for their lifelong health are built. ... It can also set the stage for later obesity, diabetes, and other
chronic diseases which can lead to a lifetime of health problems.
3. Describe the seven Essential Nutrition Action (ENA) approaches. 8. Explain the 7 Proven
Nutrition Actions.
1. (9) Promotion of Breast feeding

✓ Timely Initiation of breastfeeding (1 hour of birth)

✓ Exclusive breastfeeding until 6 months

✓ Breastfeed day and night at least 10 times

✓ Correct positioning & attachment

✓ Empty one breast before switching to the other

2 (16). Complementary Feeding to BF

✓ Introduce appropriate CF at 6 months

✓ Continue breastfeeding until 24 months & more

✓ Increase the number of feedings with age

✓ Increase density, quantity, quality, and variety with age

✓ Responsive feeding

✓ Ensure good hygiene (use clean water, food & utensils)

3. Nutritional Care of the Sick Child

✓ 0 to 6 months:
▪ increase breastfeeding during and after illness

✓ (Completion of) 6 months & older:

▪ increase breastfeeding during and after illness
▪ Increase complementary feeding during and after illness
▪ feed 1 extra meal each day for two weeks after illness

✓ Zinc and vitamin A, following national protocols

✓ Oral Rehydration Solution, as needed

✓ Appropriate therapeutic feeding for severely malnourished

4 (15). Women’s Nutrition

✓During pregnancy and lactation:

▪ Increase food intake for PLW (1 extra meal/day when
pregnant; 2 extra meals/day when lactating)
▪ Iron /folic acid supplementation
▪ Control and treatment of malaria

✓ De-worming during pregnancy

✓ Post-partum vitamin A capsule immediately or within 6 weeks of delivery.

5. Control of vitamin A deficiency

✓Promote breastfeeding: Best source of vitamin A

✓ Promote consumption of vitamin A-rich foods

✓ Maternal supplementation (post-partum)

✓ Child supplementation (NIDS, Child Health Days)

✓ Food fortification
6 (11). Control of Anemia

✓ Supplementation for women and children

✓ De-worming for pregnant women and children (twice/year)

✓ Malaria prevention and control

✓ Consumption of iron-rich foods

✓ Food fortification
7. Control of Iodine Deficiency Disorders (IDDs)
Promote consumption of iodized salt by all families
4. Describe Interventions targeted at young infants (0–5 months).
a. Early initiation of breastfeeding- actions- counselling and support at facility and
community level.
b. Exclusive breastfeeding- actions- implementation of the baby-friendly hospital
initiative., implementation of international code of marketing of breast milk
substitutes, maternity protection.
c. Feeding of low-birth-weight infants – actions- counselling and support.
d. Infant feeding in the context of HIV- counselling and support to HIV positive mothers.
5. Briefly describe the SDGs.
The Sustainable Development Goals (SDGs) are a set of 17 global goals adopted by all United
Nations member states in 2015 as part of the 2030 Agenda for Sustainable Development. The
SDGs are designed to address a wide range of global challenges and promote sustainable
development across economic, social, and environmental dimensions. They provide a universal
framework to guide collective efforts toward a more equitable, just, and environmentally
sustainable world by the year 2030.
The goals cover diverse issues, including poverty, hunger, health, education, gender equality,
clean water, sanitation, affordable and clean energy, economic growth, industry innovation,
reduced inequalities, sustainable cities, responsible consumption, climate action, life below
water, life on land, peace, justice, and partnerships for the goals.
6. What is SUN? Describe the vision and principles of SUN.
The Scaling Up Nutrition (SUN) movement is a global advocacy effort to mobilize governments,
institutions, communities and families to priorities nutrition as central to national development
and vital for achieving the MDGs.
Vision and mission- Since 2010, the SUN Movement has inspired a new way of working
collaboratively to end malnutrition, in all its forms. With the governments of SUN Countries in
the lead, it unites people—from civil society, the United Nations, donors, businesses and
researchers—in The SUN Movement Strategy and Roadmap (2016-2020) has helped illuminate
the importance of nutrition as a universal agenda. It is integral to achieving the promise of the
Sustainable Development Goals (SDGs). To realize the vision of a world without hunger and
malnutrition, the SUN Movement Principles of Engagement guide actors as they work in a multi-
sectoral and multi-stakeholder space to effectively working together to end malnutrition, in all its
forms.
10. What do you understand by “Three cornerstones of ENA programs”?
a. Health facility level: integrate ENA actions into existing health contacts at all health services;
b. Community-level: work with community-based organizations & networks from all sector; and
c. Behavior change: reinforce ENA actions through BCC at all levels, including: inter-personal
communication, mass media and community mobilization.
12. What Are the Scaling Up Nutrition (SUN) Framework and Roadmap?
The SUN Framework guides the international community in efforts to combat undernutrition and
builds on the Paris-Accra principle of supporting country-led strategies. The Framework is
endorsed by more than 100 partners, including international organizations, national
governments, civil society, and the private sector The SUN Framework and Roadmap are
grounded in the at scale implementation of the Lancet-endorsed nutrition actions that are
evidence-based, cost-effective interventions that could have enormous impact on reducing
undernutrition.
13. “The 1,000 Days Effort to Reduce Child Undernutrition” Why 1,000 Days? How to Support
the 1,000 Days?
1,000 Days refers to the time from the start of a mother’s pregnancy until a child is two years old.
Children suffering from undernutrition face physical stunting, mental impairment, higher
susceptibility to disease, increased risk of mortality, poorer performance in school, and lower
future incomes. 1,000 Days also refers to a window of opportunity for the international
community to take action to combat undernutrition.
How to Support- To jump-start the 1,000 Days in countries, the Core Group highly encourages its
members to adopt such ‘tested and proven’ field tools as the Essential Nutrition Actions (ENA)
Framework Trilogy training and communication materials. Not only does the ENA Framework
focus on the first 1,000 days of life, but it emphasizes targeting “action oriented” nutrition
messages and support -though multiple communication channels- to reach under-twos and their
mothers when they need it the most. The Core Group believes that having many different field
groups using these same ENA tools will lead to harmonized field approaches that result in greater
progress, synergies and nutritional impact. Such harmonization is extremely critical as resources
are scarce and the task ahead is enormous.
14. “Iron supplementation is necessary during pregnancy” – explain.
Prevention of Iron Deficiency Anemia: Iron is a crucial component of hemoglobin, the protein in
red blood cells that carries oxygen to tissues and organs. During pregnancy, a woman's blood
volume increases to support the growing fetus. Iron deficiency anemia can occur if the mother's
iron stores are insufficient to meet this increased demand, leading to fatigue, weakness, and an
increased risk of complications.
Fetal Development: Iron is essential for the development of the fetal brain and other organs.
Adequate iron levels in the mother contribute to the formation of the placenta and support the
baby's overall growth and development.
Prevention of Low Birth Weight and Preterm Birth: Iron deficiency during pregnancy has been
associated with an increased risk of low birth weight and preterm birth. Ensuring sufficient iron
levels can help reduce these risks and promote a healthier pregnancy.
Maternal Health: Iron is important for the mother's health as well. Iron deficiency anemia during
pregnancy can lead to fatigue, increased susceptibility to infections, and difficulties in coping with
the physical demands of pregnancy and childbirth.
Reduced Risk of Complications: Adequate iron supplementation can contribute to reducing the
risk of complications during pregnancy and delivery. This includes a lower risk of postpartum
hemorrhage, a leading cause of maternal mortality.
17. Briefly describe the policy brief on “Global Nutrition Target”.
a. 40% reduction in the number of children under 5 who are stunted.
b. 50% reduction on anemia in women of reproductive age.
c. 30% reduction in LBW.
d. no increase in childhood overweight.
e. increases the rate of exclusive breastfeeding in the first 6 months up to at least 50%.
f. reduces and maintain childhood wasting to less than 5%.
18. “Rome Declaration on Nutrition” ICN2, 2014– Why it matters and what can be done?
it matters because malnutrition has many forms like stunting, wasting, micronutrient deficiencies,
overweight and obesity. What needs to be done are- eradicate hunger and prevent all forms of
malnutrition, increase investments in effective interventions and actions to improve people’s
diets and nutrition at all stages of life. Implement coherent public policies across relevant sectors
from production to consumption, make food systems more sustainable, provide consumers with
clear nutrition information so they can make informed food choices, protect, promote and
support breastfeeding, protect consumers, especially children from inappropriate marketing and
publicity of food.
19. What are the Risk factors of NCDs? Write down the prevention of coronary heart disease
(CHD).
Risk factors of NCDs - Cigarette and other forms of smoking, Alcohol abuse, Failure or inability to
obtain preventive health services, Control hypertension, Detection of cancer, Management of
DM, Life-style changes, Dietary pattern, Physical activity, Environmental risk factors, Occupational
hazards, Air and water pollution. Stress factors.
prevention of coronary heart disease (CHD)- Primary prevention refers to avoid the onset of the
disease. Primary prevention can be achieved through two basic approaches: a) Population
approach: This approach is based on mass focusing prevention in whole population
i. Prevention in whole population
a. Dietary changes: According to WHO
- ↓of fat intake 30-35 % of total energy
- SF limited <10% of total energy
- Dietary cholesterol <200mg/ day
-↑complex CHO (i.e. vegetables,
fruits, whole grain, legumes)
- Avoid alcohol consumption
- ↓of salt intake to 5g/ day
b. Cessation of smoking
c. To reduce BP level
d. ↑ physical activity
ii. Ancient prevention in whole population: This approach involves preventing the emergence and
spread of CHD risk factors and life style that have not yet appeared endemic.
b) High-risk group approach
a. Identifying risk by simple test such as BP test, serum cholesterol measurement
b. Specific advice to the recognized cases, e.g. treatment of hypertension, helping
patient to break the smoking habit.
2) Secondary prevention means early detection of disease and prompt initiation of treatment to
prevent/delay the complications.
Principles of the secondary prevention are:
o Cessation of smoking
o Control of BP and DM
o Healthy life style & nutrition
• Drug abuse
• Sedentary life style
o Promotion of exercise
20. Write down the “Dietary management in reduction Obesity”.
Guideline principle of all weight reduction diet is to provide few calories. Not the quantity of food
but the low-calorie equivalent that produces weight loss
Recommended energy intake
For Sedentary worker- 20 kcal/kg of ideal body wt
For moderately active worker- 25 kcal/kg of ideal body wt
Recommended protein intake
Need for tissue repair
Have a specific dynamic action
1 g/kg body wt
Recommended fat intake- Concentrated source of energy, should be restricted, To supply
vegetables oil (except coconut and palm), so that EFA are supplied for proper nutrition.
Recommended Carbohydrate intake- like green vegetables and fruits are liberally prescribed.
Starches with a high CHO content like potatoes and rice are restricted.
With prolonged restriction of fats there is likely to be deficiency of the fat –soluble vitamin A and
D which may need to be supplemented. Restriction of sodium as common salt is helpful in a
weight – reducing diet. Fluids can be taken liberally if salt is restricted.
21. Write down the “Dietary management in Diabetes Mellitus”.
Total intake of calorie is more important for a diabetic than the exact proportion of proteins, fats
and CHOs. To maintain ideal body –Wt should be kept on a well-balanced diet. According to ADA
Recommended CHO intake- 45-65% of calories. After a meal the rise of BS does not depend on
the amount of CHO ingested, but also on the rapidity of absorption. The ability of a food item to
raise the BS is measured in terms of GI. Recommended protein intake- 10-35% of calories, need
for tissue repair, does not raise BS during absorption as much as CHO, does not supply as many
calories as fats. Recommended Fats intake- 20-35% of calories, Intake of saturated fat should be
<7% of total energy. Dietary cholesterol intake should be <200 mg/day. Dietary fiber. High fiber
intake reduced cholesterol synthesis in body. Vitamins and anti-oxidants, Minerals and trace
elements, Salt, Fluid.
22. Write down the “Population approach” to prevent NCDs.
Government Advocacy- supporting national associations and non-government organizations,
promoting the economic case for prevention
Engagement of private sector- Promoting health in the workplace, Ensuring healthy food policies
in food industry
Community support- Providing education in schools like nutrition and physical activity, promoting
opportunities for physical activity through urban design (e.g. to encourage cycling and walking),
Supporting sports facilities for the general population
Media communication- Improving level of knowledge and motivation of the population (press,
TV and radio), Fiscal and legislative (Economic & lawmaking)- Examining food pricing, labeling and
advertising, implementing environmental and infrastructure regulation, e.g. urban planning and
transportation policy to enhance physical activity.
The population approach centers the following key areas- Dietary changes, Increased physical
activity, Behavioral changes, Health & nutrition education, Self-care
23. Write down the “Dietary management in cardiovascular disease (CVD)”.
Recommended dietary guidelines- Calorie intake to maintain normal body weight, Fat intake 30-
35% of total calorie, Intake of unsaturated fat, Dietary cholesterol intake should be <200 mg/day,
Up to 10% of calories should be derived from PUFA, Protein intake 20% of total calorie, CHO intake
40-45% of total calorie
Nuts contain large amount of USFA (e.g linolenic acid). Consumption nut in 3 main meals improves
serum lipid profile and lowers cholesterol.
BP, S. Cholesterol increases by eating beef fat. But lean fat can be included in cholesterol lowering
diet.
Soybean, garlic, onions and fiber have good effect to reduce cholesterol, LDL-cholesterol and TG.
24. Write down the “Benefits of Physical Activity in NCDs”
• Decreases the risk of obesity and chronic diseases, including osteoporosis
• Better control of body weight, blood pressure, blood glucose, and cholesterol
• Improved mood and feelings ofwell-being
• Enhances independent living among older adults
• Improves quality of life for people of all ages
• Reduces Obesity
• PA is crucial for obtaining and maintaining an ideal weight
• Increasing PA helps in reducing sedentary behaviors
• Reducing inactivity is a critical factor in reducing obesity
• Helps in controlling blood sugars in diabetes
• Lowers Blood Pressure- PA can significantly lower both systolic and diastolic blood
pressure.
• Improve Blood Lipids- Regular PA in adults improves blood lipid levels, particularly by
increasing HDL-C.. Which are associated with a reduction in arteriosclerosis
• Reduces anxiety and stress
• Regular PA has the potential to promote psychological well being
• Improve self-esteem
• Reduce level of anxiety
 • Reduce symptoms of depression
25. Why NCDs need to be considered when addressing major nutritional challenges?
• Foods, diets and nutritional status are important determinants of non-communicable
diseases (NCDs)
• NCDs affect people in every corner of the world
• Populations around the world are increasingly exposed to foods and diets that influence
the risk of developing NCDs
• Undernutrition places people at risk of developing NCDs
• Food systems present challenges to the prevention and control of NCDs as well as
undernutrition
• A more concerted response is needed for policy actions, governance and monitoring and
evaluation