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Health and
nutrition of
women in
Afghanistan
AAEP WIA
Becky Ramsing, MPH, RD
University of Maryland
Outline
 Overview
– state of nutrition and women
 The link – nutrition and health


Immune system
Nutrients
 Diseases


Diarrhea, flu, etc.
Bone health, overweight
statistics
Countries with the greatest
number of rotavirus-related deaths
Cycle of poor intake and
malnutrition
disease
Worsened
disease
Weakened
immunity
Impaired
food
assimilation
& intake
Impaired
nutrition
status
The cycle of poor nutrition
 Impaired
disease resistance
 Immune tissue first impaired with nutrition
deficiency or toxicity

Not necessarily a severe deficiency (can be
subclinical)
 Severity
and speed of reaction vary
 Disease is more severe when immune
system is weakened
disease – nutrition cycle
Who is at risk?
 Children
 Those
with poor nutrition
 Elderly
Malnutrition – most common cause of
immunodeficiency in the world
Deaths in children under 5
Poor
nutrition
Low
disease
resistance
Impaired
host
defense
Susceptible
to illness
Access
to food
Access to
healthcare
poverty
Building blocks to health
The immune system
 The
immune system protects the body
against infection and disease. It is a complex
and integrated system of cells, tissues, and
organs that have specialized roles in
defending against foreign substances and
pathogenic microorganisms, including
bacteria, viruses, and fungi.
The immune system
 Cells
 Tissues
 organs
The Immune System
Bacteria
Parasite in red blood cell
SARS virus
Fungus
Mounting an Immune Response
Lymphokines
Complement
T cell
Antibodies
B cell
Macrophage
Killer cell
Virus
Effects of Protein-Energy Malnutrition on
the Body’s Defense System
System
Effects of PEM
Skin
Skin becomes thinner with less connective tissue to
serve as a barrier to protect underlying tissues
Digestive Tract
Antibody secretions and immune cell numbers are
reduced
Lymph tissues
Immune system organs are reduced in size; cells of
immune system are depleted
General
Invader kill time is prolonged; circulating immune
cells are reduced; antibody response is impaired
The Mucosal Immune System


The variety of human pathogens is very large
The vast majority of human pathogens enter the body at
mucosal surfaces
Nutrients and health
Does nutrition really matter?
o
Your body is continually
renewing its structure
o
o
o
Bone, skin, blood, tissue,
fat
Replacing old tissue with
new requires energy
and specific nutrients
Food supports growth &
maintenance by
providing
o
o
Energy (calories)
Nutrients
proteins
 Growth
and maintenance
 Enzymes, hormones, compounds =
reactions, messengers, responses,
regulation
 Immune system – antibodies
 Fluid balance
 Acid-base balance
 energy
Protein Quality
 Amino
acids
 digestibiliy
Protein deficiency
 Protein
only
Marasmus
 Young children
 Immunity decreased =>weakness/anemia
=> infections => diarrhea and illness

 Protein





energy
Kwashiorkor
Newly weaned children
Poor fluid balance
Fatty liver => toxins
Reddish hair
Protein energy - marasmus
Protein only - kwashiorkor
Adult malnutrition
carbohydrates
 Energy
– calories
 Brain and nervous system
 Provide vitamins, minerals, fiber
sources
 Grains
& breads
 Fruits
 Vegetables
 Plant
foods
Carbohydrates
deficiency
 Vitamin
and
mineral
deficiencies
 Wasting
Too much
 Overweight
 Diabetes
 Usually
deficient in
fat and protein
fats
 Energy

storage
 Essential


functions
Vision
immunity
 Absorption
of vitamins
 Insulation
 Cell
membranes
fat
Too much
 Obesity
 Heart
disease
Too little
Essential fatty acid
deficiency
 Wasting
 dry scaly rash,
 decreased growth in
infants and children,
 increased
susceptibility to
infection
 poor wound healing

Specific nutrients - lipids
 Omega-3
Eicosanoids
 Some Omega 6 as well
Vitamin A
 Normal
functioning of immune system
 Maintains integrity and function of skin and
mucosal cells
 Deficiency in children increases morbidity and
mortality related to measles, and diarrheal
infections
 may increase rates of certain infections
Zinc
 Growth
and immunity
 beans, nuts, certain
types of seafood, whole
grains, fortified
breakfast cereals, and
dairy products
Vitamin D
 Bone
turnover, immunity, muscle activity
 Sunlight
 Fortified foods


Milk, yogurt
Fish
 supplements
Vitamin C and E
 Antioxidants
– protect from cell
damage
 Vitamin C also regenerates
vitamin E
B-vitamins
 Helps
body use carbohydrates and protein to
make energy
 Also needed for healthy skin, hair, eyes, liver
 Help nervous system function
folate
Required to make new
cells
 Deficiencies affect
blood cells and
digestive tract first




Anemia
Abnormal digestive
function
Especially important in
growth of fetus
Nutrition and
disease
diarrhea
Diarrhea
 Frequent

passing of watery stools
3 or more times/day
 Causes
dehydration and loss of nutrients
 Can also be





vomiting
blood in stools
Fever
Mucus
Stomach pains
causes
 Infection
 Poor
sanitation
 Unclean Water
 Dirty hands – germs
 Dirty food
 Uncooked foods
 Contamination (meats)
dehydration
 Eyes
sunken
 Cheeks sunken
 Thirsty, dry mouth
 Skin pinch
rehydration
 Water,
tea, soup
 Small amounts every 5
minutes
 Oral rehydration solution –
salt, sugar
Treatment
 Rehydration
 Nutrition


Yogurt
nutrients
 Zinc
supplements
 Medical – antibiotics
Diarrhea and nutrition
 Worsened
with poor nutrition
 Loss of nutrients in stools
 Loss of intake
Acta Paediatr. 2003
May;92(5):531-6.
Role of Zinc in reducing diarrheal morbidity in children
35
incidence of diarrhoea (%)
30.5
30
25
20
16.5
15.8
15
2
10
5
0
Daily zinc
Weekly zinc
Placebo
Effect of zinc on time of recovery
7
6.2
6
Days
5
4.7
4
3
2
1
0
Zinc
Arch Dis Child. 1997 Sep;
77(3):196-200
Control
Zinc
Control
Lancet 2005; 366
(9490):999-1004
Iron
 Participates
in energy production
 Transports oxygen to cells
Low iron:
 Mental impairment
 Low performance in school
 Fatigue
 Poor development
Iron
deficiency
Anemia (IDA)
Iron
deficiency
Anemia
Causes of anemia
 Major
causes
Iron deficiency (1300-2200 m)
 Hookworm (876 m)
 Vitamin A deficiency (300 m)
 Malaria infection (300 m)

 Other



Important causes
Chronic infections: TB, HIV
Other vitamins
Genetic defects
Child Growth Defects
 Anemia
may result in growth
retardation which can be corrected
by giving them iron supplements.
 Due to its implications on
development, growth, health and
work output of an individual there is
an urgent need to control iron
deficiency anemia.
Treatment
A
good iron rich diet which should include
a dark green leafy vegetables, dry fruits,
enriched cereals, meats, beans and
Vitamin C food.
 Supplement of iron.
 Prophylaxis: Anemia is common is third
trimester of Pregnancy, iron and folate
needs to be prescribed.
Iron in food
 Two


types of iron
Heme iron (animal sources)
Non-heme iron (plant sources)
 Absorption
of heme iron is 20-
30%
 Absorption of non-heme iron
varies between 1-10% and is
much more affected by iron
status and intraluminal factors
Absorbing non-heme iron
 Enhancers
: ascorbic acid, meat
 Inhibitors : phytates, phosphates,tanins,
oxalates, soy protein
 Other nutrients: zinc, calcium
The role of nutrition in healing
 Involves
the activity of an intricate network of
blood cells, tissues, and growth factors.
 Adequate dietary protein is absolutely essential
for proper wound healing, and tissue levels of
the amino acids arginine and glutamine may
influence wound repair and immune function
Important nutrients

Greater demand for nutrients Glucose, fatty acids, proteins
 Vitamin A - collagen formation, proper immune
function, and as a tissue antioxidant
 Vitamin C
 Vit E - major lipid-soluble antioxidant in the skin
 Bromelain reduces edema, bruising, pain, and
healing time following trauma and surgical
procedures.
 Glucosamine -for hyaluronic acid production in
the wound
From: Eplasty. 2009; 9: e9 Published online 2009 February 3.
Skin health
 Nutritional
status plays an important role in
the maintenance of healthy skin.
 Macronutrients (carbohydrates, proteins,
and lipids) and micronutrients (vitamins
and nutritionally essential minerals) work
together to maintain the barrier functions
of skin.
 Changes in nutritional status that alter skin
structure and function can also directly
affect skin appearance
Nutrition in bone health
 Calcium
and vitamin D in
bone building and strength
 Osteoporosis – decreased
bone mass related to aging,
poor diet, and hormonal
changes
 Girls ages 12-14 building peak
bone mass
 Loss with aging
Food sources of calcium
 Milk,
yougurt
 Dark greens - spinach
Blood pressure and heart
disease
diabetes
What is diabetes?
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