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The challenge of assessing malnutrition and its health implications – the added
value of nuclear technology
Anura Kurpad
St John’s Medical College,India
ADULT
ADOLESCENT GROWTH
COMPLEMENTARY FEEDINGEARLY GROWTH
LACTATIONEARLY GROWTH
PREGNANCY
CHRONIC DISEASE
Addressing malnutrition through:
• Feeding and supplementation Programs• Addressing Sanitation and Parasites• Infectious Disease Programs
What to do?
How much to do?
What was the impact?
Increases in life expectancy are associated with a double burden of disease
A double burden
87%
7%6%
Life Expectancy (years)
40
50
60
70
80
90
1962 1967 1972 1977 1982 1987 1992 1997 2002
36%
10%
54%
non-communicable diseasescommunicable diseasesinjuries
LMIC
DC
High-income countries
Middle-income countries
Low-income countries
BMI frequencies with migration of populationsRural to Urban migration• BMI distributions shift to the right over 10 years
Varadharajan et al; Asia Pac J Clin Nutr; 2014
Nuclear techniques are critical to all these problems
4
Water
Mineral
Protein
Fat
Fat Free Mass:• Organs• Muscles• Bone• Fluids
Measuring Fat and Fat free mass
BMI = fatness!
• Big and muscular• Thin and fat
Why is measuring fat and (fat free mass) important?Insulin resistance; diabetes
Overnutrition‐High Fat
Capacity(Liver and muscle) – help dispose
glucoseLoad (Store)(Fat)
– increases insulin resistance
Load increases‐beyond capacity
Overnutrition‐Sarcopenia with fat
Poor Capacity
+Load
Poor Capacity
Undernutrition‐sarcopenia
All these constitute forms of malnutrition
Health =• Appropriate stores +• Appropriate capacity
What are the challenges in measuring fat stores?How do nuclear technologies help?
Impute the FFM
No water in fat
Deuterium dilution to
measure water (TBW)
Body Fat = Body weight ‐ FFM
Sum of Fat and FFM = Body weight
Water is only present in the fat
free mass
Translates into a very simple field method, which can be deployed with minimal capacity building
Water
Shadow Shield‐Whole body potassium counterCounting natural 40K in the body as an index of body cell mass
It is a challenge to measure body tissue or fat in pregnancy or in babiesVariable amounts of water in the body, which confounds usual measurementsPicture Courtesy: Dr Rebecca Raj
Nutrition in pregnancy and foetal growthFat stores and FFM (capacity)
Measuring body fat of infants in field situations by the use of deuterium dilution
Infant receiving an oral dose of deuterium oxide using a syringe (courtesy: Photo; M. Thame, Jamaica)
IAEA Human Health Series #7
• Early undernutrition and later NCD are linked
• Starting with pregnancy ‐ what food does a pregnant woman need for the best outcome and healthy babies?– Some concern that undernourished babies are born already ‘fat’
Nuclear techniques are also critical at other stagesBreast feeding is difficult to measure, invasive…
8
DeuteriumDose to mother
Saliva samples for 2H enrichment
Breast feeding
Measuring lactation
Translates into a very simple non‐invasive, field method, which can be deployed with minimal capacity building
0
200
400
0 5 10 15 20
Mother water enrichment
Baby
Photo courtesy: Dr S Sreeman, India
Measuring protein quality for infant feeding through stable isotopes (2H and 13C)
Photo courtesy: Dr N Shivakumar, India
Collecting breath sample
Understanding how much protein should be fed –protein digestibility
Impact evaluations
• Exclusive Breast Feeding• Complementary Feeding
Programs• Promoting Diversified
Diet • Promoting Physical
Activity
Added value of nuclear technology in the nutrition value chain…
What is the state of nutrition?
Pregnant women, children, adolescents
Requirements for mother and babyBody comp at birthlactation measures
Best Practices Complementary
feedingWASH ‐Unsanitary environments
http://www.thebetterindia.com/8580/