COMMUNITY NUTRITION
Suryani Tawali
Department of Public Health and
Community Medicine
Faculty of Medicine UNHAS
OBJECTIVES
• To identify the major nutrition problems
in the community;
• To understand and be able to do
nutritional measurements in the
community
Clinical Nutrition & Public
Health/community Nutrition
1. Clinical Nutrition: related to nutritional
problems in individuals and focus on
curative care
2. PH/Community Nutrition : related to
nutritional problems in a group of people
(community or population) and focus on
promotion of nutritional status and
prevention of nutritional problems.
NUTRITION (DEFINITION)
• A science about food in relation with
human health
• Therefore, nutrition as a science has 2
components: food and health
NUTRIENTS
• Macronutrients:
Carbohydrates, lipids, proteins
• Micronutrients:
Vitamins and minerals
Nutritional Problems
• Imbalance of nutrients including
overnutrition & undernutrition
• Malnutri tion : - starvation
- undernutrition
- specific deficiency
- overnutrition
• Nutritional process is an interaction of
1. agent (nutrients)
2. host (human)
3. environment (geography,
microorganism , etc)
Nutritional Problems in
community
• Protein Energy Malnutrition
• Anemia
• Zerophthalmia(Vit A deficiency)
• Goitre
• Obesity
• Explanation.1 PEM
An inadequate intake of carbohydrate and
protein
National prevalence :
- severe malnutrition 3 %
- moderate malnutrition 30%
South Sulawesi :
- severe malnutrition 6,3 %
- moderate malnutrition 35 %
Classified into :
Mild PEM 84% - 95 %
of Harvard Standard weight
Moderate 44% - 60 %
Severe < 44%
• Implications of PEM :
1. Increase frequency and severity of
disease
2. Increase mortality
3. Hinder physical growth
4. Reduce productivity
• Ad.2 Anemia
Iron deficiency anemia
National prevalence
- Preschool children 40%
- 6-14 years 13%
- Pregnant women 70%
- Adult (men) 40%
Implications:
- Increase mortality (mother & child)
- Increase infection frequency
- Reduce productivity
• Ad.3 Zeropthalmia (def.Vit A)
dryness in corneum epithels , reduce
eye’s function
Mainly affects children under five
National statistic 13.4 per 1000 children
under five
• Ad.4 Endemic Goitre
Endemic if prevalence > 10% in population
Kriteria :
OA : no goitre
OB : enlargement of thyroid gland 2-4 times of
normal size. (diagnosed through palpation)
I : through palpation, only be seen if head tilted
up )
II : be seen in normal head position
III: very large, can be seen from a distance
Effects of endemic goitre :
Hypothyroidisme
Thyroid gland enlargement (hypertrophy)
Cretinisme
Dumb (afasia), deafness, speaking
disorder, neurologic disorders
Cosmetic problem
Respiratory obstruction
• Ad.5 Obesitas
weight > 15% from ideal body weight
(men) and > 20 % (women)
Vulnerable groups
• Children
1. Infants
2. Children under five
3. Schoolchildren (6-12 years)
4. Adolescents (13-18 years)
• Pregnant/ lactating mothers
• Elderly people
Assessing Nutritional status in
Community
• Direct
1. Anthropometry (body measurement)
2. Clinical signs
3. Biochemical measurements
• Indirect: vital statistic
Anthropometry
• Weight
• Height
• MUAC (middle upper arm circumference)
• Skinfold thicknesses
Anthropometry
Essentials data to assess nutritional status through
anthropometry :
1. Age
2. Gender
3. Weight
4. Height
5. MUAC (For quick survey)
5. Additional : Measles immunisation (for
children)
Anthropometry : Indicators
1. Weight for Age (W/A)
Easy
Difficult to differrentiate acute and chronic
malnutrition
normal > 80% of Harvard standard
moderate malnutrition 60,1 % - 80 %
Severe malnutrition < 60 %
2. Height for Age (H/A)
identify “stunting” chronic malnutrition
Height is linear,
less sensitive than weight in the change
of nutritional status
Normal > 80 % Harvard standard
Moderate malnutrition 70,1% - 80%
Severe malnutrition < 70%
3. Weight for Height (W/H)
- identify “wasting” acute malnutrition
- Weight is sensitive of lack of food
- Also good for assessing overweight
Normal > 90 % standar harvard
Moderate malnutriton 70,1% - 90% of
Harvard standard
Severe malnutrition < 70%
4. MUAC for Age
- For quick survey
- Less sensitive (easily
overestimate/underestimate)
Normal infant/child MUAC > 85% of
Wolanski standard
Moderate malnutrition 70,1%-85%
Severe <70%
5. Skin fold
- Not recommended for practical nutritional
status assessment
• Measuring tools :
Weight
- Salter scale, Platform Balance Scale, spring loaded
scale,
Height
- microtoise/meteran, infantometric
MUAC
- Insertion tape
Skinfold thickness
- Skinfold Calipers Harpenden or Lange
