Alimentary deficiency diseases

I. NUTRITION AND HEALTH

(General Information, Common Problems)

NUTRITION, MALNUTRITION AND IMPROPER DIET

Nutrition is one of the most important factors affecting people’s health and working capacity. Normal development of a child very largely depends on proper nutrition. Nutrition is one of the most therapeutic agents in medical practice. Nutrients coming from food are essential to us. With these, we can move about, see, hear, taste, speak, smell, feel, think, learn and remember, sing, walk, run, play and enjoy life. Without all the 40 to 45 nutrients none of these things so characteristic of human life is possible.

 

The quantity and composition of food required by a person depends on his or her age, stature, character of work etc. In making up a diet it is necessary to consider the need of the organism not omly in proteins, carbohydrates and fats, but also in vitamins and mineral salts. According to the contemporary classical medical notion, the diet must contain the different nutrients in different proportions. It must contain proteins and fats of animal origin, but vegetable fats and proteins must not be excluded either. One should keep it in mind that different foodstuffs are differently assimilated. A combination of various food best satisfies all the requirements of rational nutrition, or well-balanced diet.

Assimilation of food depends on how it is cooked, and under what conditions and how many times

a day it is ingested. Palatable delicious food taken at definite time is digested better and more rapidly. A lot of various diets have been invented to solve health problemsAs medical knowledge increases and the range of diseases changes with time, new ones keep appearing, each of them excluding certain kinds of food as harmful.

Millions of people, most of them children, suffer from diseases associated with malnutrition in Africa and other poor countries. In children poor food supply retards both mental and physical growth and development. In addition, malnutrition severely impairs the body’s resistance to infections or toxins coming not only from food, but also from the environment. The poor nutrition of the majority of developing countries population results in higher mortality and more severe disease cases than in the industrialized countries.

However, even in countries with a good food supply improper, poorly balanced, diet has been shown to be associated with quite a few conditions causing either deficiencies or overnutrition affecting a child’s health. In case of surplus food obesity and both physical and mental problems may result from it. Moreover, certain diet defects during pregnancy or childhood proved to harm health severely in the later life.

 

 

Diet, nutrition and the prevention of chronic diseases
Report of the joint WHO/FAO expert consultation

Executive summary

The WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases met in Geneva to examine the science base of the relationship between diet and physical activity patterns, and the major nutrition-related chronic diseases.

Recommendations were made to help prevent death and disability from major nutrition-related chronic diseases. These population nutrient intake and physical activity goals should contribute in the development of regional strategies and national guidelines to reduce the burden of disease related to obesity, diabetes, cardiovascular disease, several forms of cancer, osteoporosis and dental disease. They are based on the examination and analysis of the best available evidence and the collective judgement of a group of experts representing the global scope of WHO’s and FAO’s mandate.

Key findings include:

Obesity: the imbalance between declining energy expenditure due to physical inactivity and high energy in the diet (excess calories whether from sugar, starches or fat) is the main determinant of the obesity epidemic. Increasing physical activity, plus reducing intakes of foods high in fat and foods and drinks high in sugars, can prevent unhealthy weight gain. Taking these simple goals to concrete action requires major social and environmental changes in order to effectively promote and support healthier choices at the individual level.

Diabetes: excess weight gain, overweight and obesity and physical inactivity account for the escalating rates of type 2 diabetes, worldwide. Diabetes leads to increased risk of heart disease, kidney disease, stroke and infections. Increased physical activity and maintaining a healthy weight play critical roles in the prevention and treatment of diabetes.

Cardiovascular diseases: cardiovascular diseases, the major killers worldwide, are to a great extent due to unbalanced diets and physical inactivity. Risk of their main forms, heart disease and stroke, is reduced by eating less saturated and trans fats, and sufficient amounts of (n-3 and n-6) polyunsaturated fats, fruits and vegetables and less salt, as well as by physical activity and controlling weight. Reduction of salt intake helps reduce blood pressure, a major cause of cardiovascular diseases.

Cancer: tobacco is the number one cause of cancer, but dietary factors contribute significantly to some types of cancer. Maintaining a healthy weight will reduce the risk for cancers of the oesophagus, colorectum, breast, endometrium and kidney. Limiting alcohol intake will reduce risk for cancers of the mouth, throat, oesophagus, liver and breast. Ensuring an adequate intake of fruit and vegetables should further reduce risk for oral cavity, oesophagus, stomach and colorectal cancer.

Osteoporosis and bone fractures: fragility fractures are a problem of older people. Adequate intakes of calcium (500 mg per day or more) and of vitamin D in populations with high osteoporosis rates helps to reduce fracture risk, so does sun exposure and physical activity to strengthen bones and muscles.

Dental disease: caries is preventable by limiting the frequency and amount of consumption of sugars and by appropriate exposure to fluoride. Erosion of teeth by dietary acids in beverages or other acidic foods may contribute to tooth destruction.

The crucial role of physical activity as part of nutrition and health was acknowledged. Physical activity is a key determinant of energy expenditure, and thus fundamental to energy balance and weight control. The beneficial effects of physical activity on the metabolic syndrome are mediated by mechanisms beyond controlling excess body weight.

Physical inactivity is already a major global health risk and is prevalent in both industrialized and developing countries, particularly among the urban poor in crowded mega cities. Measures and policies required to promote healthier food consumption patterns and facilitate a physically active life share common grounds and are mutually interactive in determining healthier behaviours.

Healthy diets and physical activity are key to good nutrition and necessary for a long and healthy life. Eating nutrient dense foods and balancing energy intake with the necessary physical activity to maintain a healthy weight is essential at all stages of life. Unbalanced consumption of foods high in energy (sugar, starch and/or fat) and low in essential nutrients contributes to energy excess, overweight and obesity. The amount of the energy consumed in relation to physical activity and the quality of food are key determinants of nutrition related chronic disease.

Not all fats are the same, it pays to know the difference. The scientific complexities of these issues should not obscure the simple messages required to orient and guide consumers. People should eat less high-calorie foods, especially foods high in saturated or trans fats and sugar, be physically active, prefer unsaturated fat and use less salt; enjoy fruits, vegetables and legumes; and select foods of plant and marine origin. This consumption pattern is not only healthier but more favourable to the environment and sustainable development.

To achieve best results in preventing nutrition-related chronic diseases, strategies and policies should fully recognize the essential role of both diet and physical activity in determining good nutrition and optimal health. Policies and programmes must address the need for change at the individual level as well as the modifications in society and the environment to make healthier choices accessible and preferable.

In communities, districts and nations in which widespread, integrated interventions have taken place, dramatic decreases in NCD-related death and disability have occurred. Successes have come about where people have acknowledged that the unnecessary premature deaths that occur in their community are largely preventable and have empowered themselves and their civic representatives to create health-supporting environments.

This has been achieved most successfully by establishing a working relationship between communities and governments; through enabling legislation and local initiatives affecting schools and the workplace; involving food producers and processing industry. Beyond the rhetoric, this epidemic can be halted – the demand for action must come from those affected. The solution is in our hands.

This report is only the first step in a process that includes consultations with governments, as well as other public and private sector stakeholders in all geographic regions, to culminate in the formulation of a Global Strategy on Diet, Physical Activity and Health, to be considered by the World Health Assembly.

LACK OF APPETITE

 

 

One of the most frequent complaints mothers make to doctors is that their child has lost his appetite. The mother’s anxiety over her child‘s poor appetite is well-founded, as every mother knows that a healthy appetite is a sign of the child’s health. Lack of appetite is associated with many illnesses of childhood, but then there are also other signs which mother usually notices. If the cause is some illness the doctor will diagnose it and prescribe treatment, and the child’s appetite will improve as his health improves. However, feeding problems mostly arise in perfectly healthy children as the result of mismanagement of nutrition, feeding and care.

To understand the causes leading to loss of appetite one must understand the nature of appetite itself. To-day it has been proved by the experiments of Ivan Pavlov and his followers that digestion is regulated by the nervous system. There is in the child’s brain, as in the adult’s brain, a food centre the condition of which determines whether the individual feels hungry or full. If the food centre is in an excited state the person feels hungry. If the food centre is in a state of repression, or inhibition, the desire for food – the appetite - will deteriorate or disappear. Both excitation and inhibition of the food centre are associated with changes in the constituents of the blood flowing in this area of the brain. Depletion of the blood of nutritive substances stimulates the digestive centres; this stimulation or excitation is transmitted to the salivary glands and the glands secreting gastric juices, and also to the corresponding muscles.

 It is important to feed children at definite times over strictly definite intervals differing in children of different ages. If a definite feeding schedule is not observed and the baby has his food irregularly, he will not be hungry and refuse his food at the feeding hours. A particularly harmful effect on appetite is produced by sugar and various sweets when given to children before or between meals. An important point in serving the meals of older children is setting the table. If mothers set the table attractively and make preparations for the meal, the activity of the digestive glands will be stimulated, and the child’s appetite will improve. Normal appetite depends to a great extent on a properly managed schedule. Children must play outdoors, sleep and eat at fixed hours. If children do not spend much time in the fresh air, they are commonly poor eaters.

 Children must not be overfed, neither must they be given too much high-calorie food or fats in excess. Fat, if there is too much of it, will inhibit gastric juice secretion, disturb protein digestion, and thus finally will impair the appetite. Poor appetite may be connected with a decreased function of the salivary glands. In such cases children keep their food in the mouth for a long time, not being able to swallow it. These children should be taught to take their food in very small amounts at a time; they should also be given a little water to drink during the meal; the moistened food will be easier to swallow. As the child becomes older his appetite usually becomes normal; however all measures should be taken to ensure a healthy appetite at all meals.

Active Words to remember:

Lack; to lose appetite; to associate; to notice; nutrition; loss; to prove; to be excited; desire; inhibition; juice; harmful; to improve; to a great extent; impair; properly; 

to manage; to feed (overfeed); to disturb; to decrease; to moisten; to ensure; meals; to flow.                            

 

 EXERCISES

1. Answer the following questions:

 

1.Why are mothers anxious over the poor appetite of their children? 2. What may lack of appetite be connected with? 3. What is the nature of appetite? 4. When do we feel hungry or full? 5. What are excitation and inhibition of the food center associated with? 6. What stimulates the digestive center? 7. What factors does normal appetite depend on? 8. What may poor appetite be connected with? 9. Why is it not good to give children fats in excess?

 

 

II. Put all possible questions to the following sentences:

 

1. Mothers often complain to doctors that their children have lost their appetite. 2. To understand the cause leading to loss of appetite one must understand the nature of appetite itself. 3. If the food center of the brain is in a state of inhibition the child does not feel hungry. 4. Children must play outdoors, sleep and eat at fixed hours. 5. It is most harmful to give children various sweets between or before meals. 6. The sight of the attractively set table stimulates the activity of the digestive glands and improves the child’s appetite. 7. Normal appetite depends on a properly managed daily feeding schedule.

 

 

III. Group the following words into pairs with opposite meanings:

 

1. decrease                                          a. useful

2. improve                                          b. full

3. healthy                                                c. irregular

4. harmful    d. disappear

5. inhibition                     e. impair

6. hungry                     f. increase

7. regular                                                 g. rarely

8. stimulate

appear                    i. impair

10. frequently                                           j. sick       

 

OBESITY

 

 

Obesity in children is actually more frequent than those cases when  overweight children come for treatment. Parents are inclined to overlook obesity in a young child and to resent having attention to it.

Pathogenesis. Children grow fat when they persistently eat more than they need. At the same time there is usually marked physical inactivity. Obesity is only the symptomatic expression of some underlying disturbance in the weight-regulatory mechanism. In most children the reflex tends to persist into adult life.

Symptoms. Physical complaints due directly to the burden of weight are relatively rare in otherwise normal obese children. However, we know obesity to be a troublesome complication in children with cardiac conditions, diabetes and orthopedic disorders. Increase in blood pressure is frequently associated with severe degrees of obesity. Fatigue, perspiration, poor coordination and shortness of breath may be due to overweight, but these symptoms may also be related to emotional factors. Their real suffering is experienced in the field of social relations. They often become objects of ridicule and are excluded from the activities of their age group. The social and psychological problems which obesity creates for a child become more serious with increasing age. Obesity in an adolescent may lead to his or her complete withdrawal.

 

Treatment. As a physiological problem the treatment of an obese child is simple. Doctors suppose diet restriction alone or combined with increased physical activity to invariably result in a predictable loss of weight. In a rapidly growing child who is only moderately overweight, it may not be necessary or desirable to plan for weight reduction. It may be preferable merely to retard or arrest the rate of gain until the child grows up to his weight. Caution should be exercised in employing complete starvation as a therapy for obesity. It may be done only under a strict doctor’s supervision.

 

Metabolic Syndrome, an Epidemic of the 21^st Century

Obesity is closely associated with a so-called metabolic syndrome which has been recognized to be an epidemic of the 21^st century. The metabolic syndrome is a condition combining a group of risk factors leading to heart diseases, stroke, diabetes. The syndrome presents as a complex metabolic, hormone and clinical disorders. The metabolic syndrome depends on the tissue resistance to insulin. One of the basic signs of the metabolic syndrome is considered the presence of extra fatty layer in the waist area (visceral obesity). The adipose (fatty) tissue is a large endocrine organ. It is a source of diabetogenic, atherogenic and pro-inflammatory biologically active substances. The therapy of the metabolic syndrome focuses on the efforts to lose weight, especially in case it is accompanied by high blood pressure.

 

Active words to remember:

 

Obesity, to be inclined, avoidance, to persist, to respond, to achieve, to justify, to predispose, perspiration, to experience, adjustment, restriction, to retard, to arrest, caution, starvation, withdrawal.

 

EXERCISES

 

I.. Fill in the gaps with suitable words from the list in brackets.

 

(in spite of; either … or; not only … but also; both … and; that; after; and; before; if; for;)

 

1.Eating … … serves to appease bodily hunger … … is charged with emotional significance. 2. … the mother’s diet is insufficient, the milk will be poor in quality. 3. Parents should know … obesity may develop at any age. 4. The typical obese patient tends to be … broader … taller than his age peers. 5. This child is … in a state of blooming health with excellent nutrition … suffers from obesity.6. The child’s health was poor … … … the fact that he was carefully nursed. 7. Avoidance of fats is not necessary … in most individuals they inhibit gastric emptying and delay the onset of hunger. 8. In some instances there is colic … some food is ingested to which the patient is allergic. 9. Parents’ questions concerning hygienic … general care of infants engage an increasing proportion of the time of the pediatrician. 10. A baby must learn to creep … he begins to walk.

 

 

II. Translate sentences into Russian.

 

1.Excessive eating and avoidance of activity influence the child’s personality development and life experiences. 2. An evaluation of the emotional problems of an obese child and an appraisal of the difficulties inherent in his family interrelationships constitute a necessary part of the diagnostic study. 3. Mere weight reduction without attention to underlying problems will almost invariably be followed by another increase in weight. 4. Vitamin deficiency is to be prevented. 5. Although opinion as to how often to feed the baby varies, most doctors seem to favour a three or four hour schedule. 6. Obesity is the result of positive energy balance. 7. Caloric intake is regulated in accordance with energy expenditure. 8. Food requirements of individuals are affected by several factors: muscular activity, age, weight, pathologic conditions, climate etc. 9. The most rapid growth period in a child’s life is the first months.

 

II. VITAMINS