2.2: Nutrition

Question 1

Describe the Yalcoba, Cancun, Yucutan Mexico case study

Answer 1

Unusually stunted children and obese adults due to an influx of tourists and a tourists-tailored food market

Question 2

At a global scale, how much of the human population is obese?

Answer 2

1/4

Question 3

What do humans need for energy?

Answer 3

Fats
Carbs
Protein

Question 4

What do humans need for growth and repair?

Answer 4

Protein
Minerals
Water
Vitamins

Question 5

What do humans need for control of body processes?

Answer 5

Minerals
Water
Vitamins

Question 6

What constitutes a ‘well-balanced’ diet?

Answer 6

10-25% protein
20-35% fats
45-65% carbohydrates

Question 7

What is the most abundant nutrient in the human body and what is it used for?

Answer 7

Protein is most abundant in body
Cells are partially composed of protein
Protein is used for repair and growth (small intestine mucosa, red blood cells, collagen - bones)
Essential and non-essential amino acids
Protein is used for energy when carbs and fats are low

Question 8

How much protein do adults need?

Answer 8

Around 50g per day

11kg in their body

Question 9

How much protein do newborn children need?

Answer 9

5x the amount an adult needs (for growth)

Around 250g per day

Question 10

Give 4 examples of different nutritional environmental stresses and their different dietary adaptations

Answer 10

1. Inuit high fat diet in cold barren land of Greenland
2. Kung san in the Kalahari desert have rich diet of nuts, tubers, berries
3. Mbuti Pygmies in the Democratic Republic of Congo reside in rainforests with a lot of vegetative growth that isn’t that nutritious, therefore they find fruit and nuts and trade with local agriculturalists from around the forests
4. Pastoralists concentrate on milk and cattle milk; they have lactase persistence

Question 11

State 3 types of agriculture

Answer 11

1. Slash and burn
2. Floodplain rice subsistence strategy
3. Industrial agriculture

Question 12

Demographic transitions

Answer 12

Shifts in population size and age composition

Question 13

Epidemiological transitions

Answer 13

Shifts in disease patterns

Question 14

What is the nutrition transition?

Answer 14

Shifts in dietary and physical activity patterns due to shifts in the composition/behaviour of society, which are expressed in changes in nutritional outcomes (average stature and body composition)
Made up of 5 nutrition periods/patterns/historical developments in the history of humans
Each pattern was dominant to its period, but can still exist in other periods

Question 15

What are the 5 stages of the nutrition transition?

Answer 15

1. Collecting food (hunter-gatherers)
2. Famine (settlements begin)
3. Receding famine (industrialisation)
4. Nutrition-related non-communicable disease (NR-NCD)
5. Behavioural change

Question 16

How can the first stage of the nutrition transition be characterised?

Answer 16

Collecting food (hunter-gatherers): 
High prevalence undernutrition
Consumption of starchy staples
Labour intensive
Lean & robust
High disease rate
Low fertility
Low life expectancy

Question 17

How can the second stage of the nutrition transition be characterised?

Answer 17

Famine (settlements begin): 
High prevalence undernutrition
Consumption of starchy staples
Labour intensive
Nutritional deficiencies emerge
Stature declines
High fertility
Low life expectancy

Question 18

How can the third stage of the nutrition transition be characterised?

Answer 18

Receding famine (industrialisation):
Consumption of starchy staples becomes less important
Low-fat intake 
High-fibre intake
Limited fruits and vegetables
Increased animal protein intake
Labour intensive
Weaning disease
Stunting
Slow mortality decline

Question 19

How can the fourth stage of the nutrition transition be characterised?

Answer 19

Nutrition-related non-communicable disease (NR-NCD)
High-fat diet
High-cholesterol diet
High-sugar diet
Refined carbohydrates 
Low polyunsaturated fatty acids
Low fibre
Increasingly sedentary life
Increased prevalence of obesity
Contributes to degenerative diseases
Accelerated life expectancy

Question 20

How can the fifth stage of the nutrition transition be characterised?

Answer 20

Behavioural change
Reduced fat
Increased fruit and vegetables
Increased CHO
Increased Fibre
Increased water
Reduce caloric beverage intake
Purposefully replace sedentarianism with active recreation
Reduced body fatness
Improved bone health
Reduced NR-NCD
Extended health aging

Question 21

Which particular transition does the term ‘nutrition transition’ often reference, and why?

Answer 21

Transition from pattern 3 to 4
Because the concern about this period is very high; it affects lower and middle-income transitional countries; the diet shift is more dramatic in urban areas compared with rural areas, and happens more rapidly in the poor areas of the world

Question 22

Explain 4 criticisms of nutrition transition model

Answer 22

1. Nutrition transition model is accurate but does not capture all complexities of the effect of globalisation on diet; for example, depending on economic status, globalisation may create homogenization towards unhealthy diets or healthy diets – therefore homogenization and differentiation of dietary patterns occur simultaneously
2. This scale doesn’t describe the environmental stresses, which are varied across the planet, therefore humans are at different stages across the planet
3. Stages overlap periods, some early stages still dominate less developed geographic and socio-economic populations
4. Its just a broad understanding, cannot be used to develop hypotheses because it is not nuanced enough to describe human dietary shift overall

Question 23

How is undernutrition measured?

Answer 23

Measuring food intake using food diaries and recall
BMI
This is difficult to measure in a short time, so measurements are small scale rather than a broad overview

Question 24

What are the 3 indicators of undernutrition?

Answer 24

1. Underweight (for your age)
2. Stunted (height for age) – sign of malnutrition in early years of life
3. Wasted (weight for height and MUAC) – sign of acute short term malnutrition

Question 25

What are the 2 conflicting views on where average nutrition measurement should lie?

Answer 25

1. Fixed genetic potential view – average is worldwide | 2. Individual adaptability view – average is environmentally/socially/individually determined

Question 26

Why do nutrition studies focus on children?

Answer 26

Children require more protein for maintenance and growth, and there is a higher incidence of infection if a child is malnourished

Question 27

What is the name of the scale used to determine mild/moderate to severe undernurtrition?

Answer 27

Protein energy malnutrition (PEM)/Gross Food Deficiency spectrum

Question 28

What are the 3 short term consequences and 3 long term consequences of mild/moderate protein energy malnutrition (PEM)?

Answer 28

Short term: Slower growth Smaller body size Late menarche Long term: Higher mortality risk Higher morbidity Cost to educational attainment and economic status

Question 29

What are the consequences of severe protein energy malnutrition (PEM) in Kwashiokor?

Answer 29

Sudden weaning of children due to infectious disease | No easily treatable

Question 30

What are the consequences of severe protein energy malnutrition (PEM) in Marasmus?

Answer 30

Children born prematurely due to maternal malnutrition Children not breastfed Treatable if caught in time

Question 31

What are the four main symptoms that can arise from child malnutrition?

Answer 31

1. Stunting 2. Wasting 3. Underweight 4. Overweight

Question 32

What are the consequences of 5 specific nutrient deficiencies?

Answer 32

``` Vitamin A → night blindness Vitamin C → scurvy Vitamin D → rickets Iron → anaemia Iodine → goitre ```

Question 33

Overnutrition

Answer 33

Oversupply of nutrients, exceeding amount required for growth, development and metabolism, resulting in obesity and overweight

Question 34

How many deaths did overnutrition cause in 2010?

Answer 34

3.4 million deaths

Question 35

State the 3 methods of measuring overnutrition

Answer 35

1. BMI 2. Waist circumference 3. Skinfold thickness

Question 36

Between 1980 and 2013, how much did overweight and obesity rise?

Answer 36

Adults 27.5% | Children 47.1%

Question 37

Since 2006, has increase in adult obesity in developed countries slowed down or sped up?

Answer 37

Slowed down

Question 38

Where is overnutrition prevalent?

Answer 38

Under 5’s in Eastern Europe and Central Asia, Middle East and North Africa have high overnutrition rates USA are world leaders in obesity, Mexico is close behind UK among worst in Western Europe for overweight and obese people; obesity has more than doubled in the last few years; people with lower socio-economic status have higher levels of overnutrition (this is the opposition in other more underdeveloped countries)

Question 39

What are the consequences of overnutrition in childhood? (6)

Answer 39

1. Obesity 2. Premature death in adulthood 3. Insulin resistance 4. Breathing difficulties 5. Hypertension 6. Psychological effects

Question 40

Key trends in obesity: social class

Answer 40

``` Industrialised countries – obesity is inversely related to social class Developing countries – the converse ```

Question 41

Key trends in obesity: minority groups/ethnicity

Answer 41

Higher obesity in some minority groups

Question 42

Key trends in obesity: gender

Answer 42

Men plateau earlier Presence of high risk periods for women (pregnancy, menopause) For gender, it varies by country/region

Question 43

Key trends in obesity: children

Answer 43

Higher prevalence of obesity in children | Major risk factor for being overweight in adulthood

Question 44

What are the 5 main consequences of obesity?

Answer 44

1. Ineffective circulatory system – strain on heart, CVD 2. Ineffective metabolism – type 2 diabetes, gout/gallstones 3. Increased risk of cancers 4. Mechanical consequences – obstructive sleep apnea 5. Emotional disturbance – low self esteem, depression

Question 45

In which 2 ways has globalisation affected our nutrition?

Answer 45

1. Food and energy intake | 2. Physical inactivity

Question 46

How had globalisation affected food and energy intake?

Answer 46

Changes in global food system driven by market economies & consumption-based growth Nutrition transition – move from complex carbs to sugars and fats, diet decreased in diversity Food is more processed, energy-dense, affordable, effectively marketed Local food is more expensive and therefore a choice for the affluent

Question 47

How has globalisation created physical inactivity?

Answer 47

Urbanisation Mechanised transport Labour saving technology Adults are less active in the workplace due to information & service based economies Children receive less physical education at school, walk less, have more screen time

Question 48

What do acculturation/migrant studies show about how migrant nutrition is affected by globalisation? (4)

Answer 48

1. Generational differences in food preferences 2. Increase in wage employment for women, but low income with demanding work schedule – lack of time to prepare food and lack of money for good, diverse food 3. Re-invention of local ‘traditional’ foods in new country 4. Food as ‘instant gratification’

Question 49

Obsogenic environments

Answer 49

An environment that promotes gaining weight (diet and lifestyle) and is not conductive to weight loss within the home or workplace

Question 50

Describe how genetic factors at an individual level could incur obesity. Give examples.

Answer 50

Single gene disorders incur obesity E.g. Prader-Willi Syndrome arises when the paternal segment of chromosome 15 is deleted; it causes upper boy obesity, short stature, and intellectual disability Susceptibility genes increase an individuals susceptibility to becoming obese E.g. the FTO gene is involved in appetite regulation (leptin is a hormone that regulates energy balance by inhibiting/causing hunger) and thermodynamic regulation

Question 51

What is the thrifty genotype hypothesis and how is it linked to obesity?

Answer 51

Obesity was adaptive and enabled survival through periods of famine; in the modern world these genes make individuals more susceptible to obesity

Question 52

Critique the thrifty genotype theory

Answer 52

No one has found the gene that suggests obesity was adaptive | The theory suggests there were periods of feast and famine, but there is no evidence of this

Question 53

Suggest 2 ways in which obesity could have genetically evolved (aside from the thrifty genotype and thrifty phenotype hypotheses)

Answer 53

1. Obesity is a maladaptive by-product of positive selection on another traits, such as brown adipose tissue thermogenesis 2. Drifty gene hypothesis – obesity genes are neutral and drift over evolutionary time

Question 54

What is the thrifty phenotype hypothesis and how is it linked to obesity?

Answer 54

Mismatch between environment in early life (when developmental plasticity is higher) and environment during development in later life can cause obesity if the environment transitions from more stressful to more affluent

Question 55

Explain how health and disease could have origins in early development

Answer 55

Nutritional disturbance and environmental chemicals could effect development due to the plasticity of the epigenome, causing long term effects on gene expression and increased risk of disease

Question 56

What should the policy responses to obesity be? Describe 3 responses.

Answer 56

1. Policy interventions in economic systems, food supply an marketing, and recreational behaviour 2. Health promotion programmes and social marketing to change health behaviour (food consumption and activity levels) 3. Drugs, surgery to lower energy intake

Question 57

Environment of evolutionary adaptedness (EAA)

Answer 57

An environment you are adapted to, for example, it is argued that humans are adapted to the hunter-gatherer lifestyle and palaeolithic diet

Question 58

Evo-deviatonary

Answer 58

Development to the environment of evolutionary adaptedness (EAA), which can result in non-communicable disease

Question 59

What is the problem with BMI as a measurement?

Answer 59

Doesn’t actually measure the amount of fat in the body, so someone with high BMI could just have high muscle mass

Question 60

Obese

Answer 60

When body weight is 20% above average weight

Question 61

Underweight

Answer 61

When body weight is 15-20% under average weight