Lecture 9

Public Health Nutrition

Nutrition – the science of how the body uses the food. It’s the food we eat, the air we breathe,
the water we drink, the supplements we ingest, and all that we do that literally “feeds” or
nourishes the body.

Nutrients - comprise various chemical substances in the food that make up each person’s diet.
Many nutrients are essential for life, and an adequate amount of nutrients in the diet is necessary
for providing energy, building and maintaining body organs, and for various metabolic processes.

Macronutrients are energy-producing. They are required in large quantities as our body
needs them more.
1. Fat
2. Protein
3. Carbohydrates
Carbohydrates Protein Fats
• Main source of fuel • Essential for • Essential in cell, nerve
and energy. growth, tissue tissue, and hormone
repair, immune production.
Why we need them? • 50-75% of daily function, and
energy should be producing essential • Also essential for absorbing
from carbs hormones and fat-soluble vitamins like A,
enzymes. D, E, and K.

• Break down into • Body protein for • Most concentrated source

glucose which is energy when carbs of energy.
used for energy. are not available.
• If consumed fats aren’t
• Also stored in burned as energy or used to
muscles and the build body tissues, they are
How are they used? liver for later use. stored in the body fat’s cells
for later use.

• Important for CNS,

kidneys, brain,
muscles, and
intestinal health.
 Grains, fruit, mill, and Meat, fish, poultry, • Unsaturated fat such as
yoghurt cheese, milk, and nuts. olive oil, avocado, nuts,
Where to find them?
fatty fish (like salmon), and
canola oil

Balanced Diet
• On average a male should consume 2,500 kcal/day and a woman should consume
2,000kcal/day
Bad (Mal-) Nutrition

• Acute – wasting – low weight for height.

• Chronic - Stunting – low height for age
• Acute and chronic – underweight – low weight for age

Kwashiorkor – A portion of acute protein-energy malnutrition develops edema. Edema is an

accumulation of fluid in the tissue, especially in the feet, and legs. These children may look fat or
swollen. But they suffer from malnutrition.
Marasmus – Other children develop thinness without edema.

Body Mass Index (BMI)

𝑤𝑒𝑖𝑔ℎ𝑡 (𝑘𝑔𝑠)
𝐵𝑀𝐼 = 𝑘𝑔/𝑚2
ℎ𝑒𝑖𝑔ℎ𝑡 2 (𝑚2 )
1 𝑓𝑡 = 12 𝑖𝑛𝑐ℎ𝑒𝑠
1 𝑖𝑛𝑐ℎ = 2.54 𝑐𝑚
• High BMI indicates a higher risk of heart disease, high blood pressure, type 2 diabetes,
gallstones, breathing problems, and certain cancers
• Limitations: might overestimate (in athletes) or underestimate (in older people) body fat.
 Lecture 10
Introduction to NCD and Obesity
Non-communicable diseases:
1. Cardiovascular disease
2. Chronic respiratory disease
3. Diabetes
4. Cancer

Criteria Non-communicable Communicable

Onset Gradual onset Sudden onset

Number of causes Most commonly multiple Most commonly single agent

Natural history Long Short

Treatment duration Long or lifetime Short

Possibility of cure Very much improbable Possible and easily obtained

Not required or if required,

Follow up duration Required for life
usually short

Back to normal Unlikely Possible

Risk factors
• Generally multiple risk factors.
• 2 categories: modifiable and non-modifiable
• Modifiable risk factors CAN BE changed and examples are unhealthy diet, tobacco use,
physical inactivity, and harmful use of alcohol.
• Non-modifiable risk factors are factors that CANNOT BE changed or controlled, i.e., Age,
Sex, Family history, and Race.
Obesity
• Obesity is a condition where a person has accumulated so much body fat that it might harm
their health.
• It is not about more weight, it's about more fat.

Risk factors
Modifiable Non-modifiable
Inactivity Genetics
Diet Medical conditions
Lack of sleep Pregnancy
Drugs Family lifestyle
Age

Health Risks
1. Type 2 diabetes
2. High blood pressure
3. Stroke
4. Heart disease
5. Poor wound healing
6. Sleep apnea ( dangerous sleep disorder in which breathing repeatedly stops and starts)
7. High cholesterol and triglycerides
8. Metabolic syndrome
9. Cancer

Complication
1. Depression
2. Sexual problems
3. Social isolation
4. Physical disability
5. Discomfort.
 Lecture 11
Cardiovascular Disease
• Cardiovascular diseases are a group of diseases of the heart (cardio) and blood vessels
(vascular) in our body.
• Two markers:
o Atherosclerosis (fat depositing in blood vessels)
▪ A disease where plaque forms inside blood vessels and reduces the supply of
blood, thereby the supply of nutrients and oxygen. Plaques are made of fat,
calcium, and other substances found in blood.
o Hypertension (high blood pressure)

Common types of CVD

1. Cerebrovascular disease – Stroke
2. Peripheral arterial diseases – Reynaud’s Disease
3. Rheumatic Heart diseases - Rheumatic fever
4. Coronary artery disease - Heart Attack
5. Congenital heart disease

Risk Factors
Modifiable Non-modifiable
Inactivity Age (Men ≥ 45, Women ≥ 55) [elasticity of
blood vessels decreases as we age]

High cholesterol Sex

High blood pressure Race
Diabetes Family history
Obesity
Alcohol
Blood pressure
• Movement of blood flowing through a blood vessel. The pressure comes from the pumping
of blood from the heart.
• Cystolic pressure – max value – when the heart is pumping.
• Diastolic pressure - min value – when the heart is resting.

Symptoms
1. Angina (chest pain due to cardiac pain)
• Always starts from the left side of the chest and then spreads to the left side of the body.
• Angina can persist for 2 months or 6 months. But the day the patient will have a heart attack
is when they can’t talk or have difficulty talking due to the pain.
• Check BP three times – left, right, left – abnormal readings mean they will for sure have a
heart attack.
2. Spreading of the pain
• Chest → arm and shoulder → neck → jaw
• Characteristic of pain is usually tightness and pressure on the chest,
3. Cold body temp / profuse sweating (shoulder, neck, and forehead)
4. Face drooping
• Look at their face and see if the jaw is deviated. The side that is deviated, that side’s hand
cannot be lifted past the heart length. The opposite side can easily be lifted.
• Also, there will be slurryness in speech.
5. Vomiting
• If the patient vomits, you have a maximum of 40 mins before they have a heart attack.
• If the patient doesn’t vomit, you have about 2-3 hrs before they have a heart attack.

Prevention approaches
No drug approach
• Stop smoking
• Change diet: Reduce fat to <30% and saturated fat to <10%, reduce salt intake
• Weight control through dietary change and increased physical activities
• Moderate physical activities for at least 30 mins
• Reduce alcohol intake

Good Cholesterol VS. Bad Cholesterol

→ LDL
o LDL cholesterol is known as bad cholesterol. It tends to increase the risk of heart
disease.
o LDL cholesterol is a major component of the plaque that clogs arteries.
→ HDL
o HDL cholesterol is known as the good cholesterol.
o Higher in women, increases with exercise.
o HDL cholesterol helps carry some of the bad cholesterol out of arteries.
→ Desirable numbers
o Total cholesterol < 200
o LDL < 100
o HDL > 40
o triglycerides < 200

Regular physical exercise is the key to preventing CV. Justify it.

The heart needs exercise just like any other muscle. Muscles that are utilized regularly become
stronger and healthier, whereas muscles that aren’t used weaken and atrophy. When it’s
exercised, the heart can pump more blood through the body and continue working at optimal
efficiency with little strain. This will likely help it to stay healthy longer. Regular exercise also
helps to keep arteries and other blood vessels flexible, ensuring good blood flow and normal
blood pressure.
 Lecture 12
Diabetes

• Healthy sugar level = 3.5 to 11.1 mmol/L

• When sugar level increases, >11.1

• When sugar level decreases, <3.5

• When insulin isn’t produced by the body, the sugar level will be high and persistently high.
When it’s persistently high, it’s called diabetes.

Type 1 VS. Type 2

Type 1 Type 2

Mainly adults (after >40, sugar level is persistently

Mainly children (born with diabetes from day 1)
high)

Zero insulin production Loss in the efficiency of the insulin

Developmental anomalies Lifestyle choices

Try to correct the lifestyle then give insulin then give

Must give insulin from the start
insulin
Gestational diabetes:
• In mothers, due to their heavy consumption of carbs at the beginning of the pregnancy.
• No need for treatment
• In 90% of cases, it corrects itself.
• 10% of cases, it turns to type 2 diabetes when they are 45 to 50.

Risk Factors
Modifiable Non-modifiable
Overweight or obese Age (45 or older)
Good vs bad cholesterol Family history
High blood pressure PCOS
Physical inactivity Have history of heart disease or stroke
Depression

Symptoms
• Primary/ classical symptoms that every diabetic patient has them
1. Frequent thirst
2. Frequent hunger
3. Frequent urination
• Associative symptoms
1. Weight loss
2. Fatigue/tiredness
3. Headaches

Complications
1. Retinopathy/ disease of eyeball
2. Nephropathy/ disease of kidney
3. Neuropathy/ disease of nerve
 Lecture 13
Cancer
What is cancer?
→ Cancer is a fatal disease characterized by abnormal cell growth & multiplication which
invade, erode & destroy normal cells.

At the very onset of cancer:

1. Hyperplasia (excessive number of cell in a tissue)
2. Dysplasia (disorientation of cell – the structure of cell changes.)

Stages of cancer

Normal → Hyperplasia – the number of cells increases in a tissue but does not change the cell
structure. It's called a tumor.
Hyperplasia → Mild dysplasia – the cell structure slowly changes.
Mild dysplasia → Severe dysplasia – carcinoma has taken hold. The cell has turned cancerous.
Severe dysplasia → invasive – when it leaves the tissue and affects other places. That’s when we
call it the last stage of cancer.
 Difference between normal and cancerous cell

Normal cell Cancerous cell

They produce their own ‘go’ chemical messages and

Wait for the ‘go’ signal before dividing
continue dividing

Stops dividing when there is a ‘stop’ signal from Even if the neighboring cells produce a ‘Stop’
neighboring sites signal, cancer cells continue dividing

Normal cells can kill itself by triggering a ‘Self Sneaks past these self-destruct signals and continue
Destruct’ button to divide

It takes nutrients from other cells and can survive

It cannot take nutrients from other cells
longer

Have a finite life span Manipulate their own DNA to keep dividing

Cannot spread to other locations Spreads to other locations which is called metastatis

What is metastasis and how it occurs?

→ Metastasis is the ability of cancerous cells to spread to other locations.
→ This contributes to the lethal nature of cancer.
→ 90% of cancer deaths are due to metastasis.
→ Routes of metastasis:
1. Lymphatic
2. Blood vessels
3. Coeliac spaces

How does Cancer spread?

→ All cancers start because of uncontrolled growth and the spread of abnormal cells.
→ There are over 100 different forms of cancer.
→ Cancer is caused by both external and internal factors
o External factors: chemicals, radiation, viruses, and lifestyle.
 o Internal factors: hormones, immune condition, inherited mutations.
→ Cancer is one of the most common diseases in the developed world
→ 1 in 4 deaths are due to cancer.

Types of cancer

Male Female

Lung Endocrine

Prostate Breast

Colon Blood

Sarcoma Gynecologic

Risk Factors
Modifiable Non-modifiable
Obesity Family trait
Lifestyle Exposure to sun
Cooking style Medical technicians
Alcohol consumption and smoking Coal miners or working with anelin dye

Signs and Symptoms

1. Unusual bleeding
2. Change in bowel habits
3. A sore that doesn’t heal
4. Nagging cough
5. Decrease in weight
6. Change in mole/wart
7. Indigestion
8. Thickening or lump

Treatment
→ Surgery
→ Immunotherapy
→ Chemotherapy (treatment with drugs)
→ Radiotherapy (treatment with radiation)
→ Hormone therapy
→ Bone marrow transplant

** 50% of most common cancers can be prevented by changing lifestyle.

 Lecture 15
Tobacco and Substance Abuse

Smoke Tobacco Smokeless Tobacco

Cigarette Zarda

Cigar Gul

Hookah Sadaa paata

→ 28 chemicals found in tobacco that can potentially cause cancer.

→ With 1 cigarette smoke, 70- carcinogens go into our body.

Why do we smoke?
→ Family exposure
→ Peer pressure
→ Curiosity

Why do people continue to smoke?

→ Nicotine activates receptors in the midbrain, inducing the release of DOPAMINE.
→ Exerting dependence producing effects, in a similar way to amphetamines and cocaine
→ Tolerance soon develops and these effects are not seen in chronic users.

Problems of tobacco use

1. Cancers
2. Blindness
3. Gum infection
4. Reproduction and fertility issues
5. Erectile dysfunction
6. Ear problems

Benefits of quitting
Hours
8 hours - Nicotine and carbon monoxide levels halved, and Blood oxygen levels return to
normal.
24 hours - Carbon monoxide is eliminated from the body.
48 hours - Nicotine is eliminated from the body, and Taste buds start to recover.

Months
1 month – Appearance improves – skin loses greyish pallor; less wrinkled; Withdrawal
symptoms have stopped.
3-9 months – coughing and wheezing decline

Years
5 years – excess risk of a heart attack reduces by half
10 years – risk of lung cancer halved

Dopamine
→ Most drugs affect the brain's "reward circuit," causing euphoria as well as flooding it with
dopamine.
→ A properly functioning reward system motivates a person to repeat behaviors needed to
thrive, such as eating and spending time with loved ones.
→ Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but
unhealthy behaviors like taking drugs, leading people to repeat the behavior again and again.

Types of drugs
1. Stimulants – alcohol, caffeine, tobacco, cocaine.
2. Depressants – alcohol, magic mushrooms, LSD, PCP.
3. Hallucinogens – alcohol, caffeine, cannabis, morphine, opium.
What they do - Stimulants

Short-term Long-term

Euphoria Anorexia

Increased alertness and attention Aggression

Increased energy Impulsivity

What they do - Depressants

Short-term Long-term

Relaxation Depression

Slow brain function Sexual function

Fatigue and dizziness Respiratory depression and arrest

Stages of addiction
Stage 1 – experimentation
Stage 2 – regular use
Stage 3 – risky use/ abuse
Stage 4 – dependency

Difference between dependence, addiction, and tolerance

Dependence – initial stage, feels happy and wants to continue to feel that.

Addiction – out-of-control urge, need to take it, you have to get it even if it's unavailable to you.
 Tolerance – reduced reaction, the drug doesn’t give that euphoric feeling. So, you take more,
depositing in your body rather than getting flushed out.

Dependence Addiction Tolerance

Reduced reaction, the drug

Initial stage feels happy and
Out-of-control urge doesn’t give that euphoric
wants to continue to feel that.
feeling.

So, you take more, depositing

Experiences withdrawal if
Need to take it in your body rather than
they stop taking that drug
getting flushed out.

Increasing the dose may give

Body functions normally if You must get it even if it's
that euphoric feeling but it
the drug is consumed unavailable to you.
also increases tolerance.

Can be rewarding or
Symptoms maybe physical or
reinforcing even if the It’s a step closer to addiction
psychological
consequences are negative.

Consequences
Individual Friends & family Society
Physical Psychological
Marital/ relationship
Weakens immune system Wild mood swings Increased crime
problems
Anxiety, panic, and Economic burden from
Respiratory problems Poor work performance
paranoia cost of drugs

Pregnant mothers using

drugs have higher risk of
Kidney and liver damage Hallucinations giving birth to low-weight Healthcare expenses
babies and babies with
birth defects

Desire to engage in risky

Stroke, brain damage Loss of productivity
behavior
 Lecture 16
Mental Health Disorders

Common mental health disorders

→ Depression
→ Bipolar Affective Disorder
→ Obsessive Compulsive Disorders (OCD)
→ Schizophrenia and other psychoses
→ Cognitive disorders, e.g., Dementia
→ Developmental Disorders, including Autism
→ Anxiety disorders

Bipolar Disorder
→ Two types: manic and depressive
→ Manic episodes involve elevated or irritable mood, overactivity, pressure of speech, inflated
self-esteem, and a decreased need for sleep.
→ Depressive episodes are characterized by sad feelings, no energy, fatigue, suicidal thoughts,
etc.
Risk factors
→ Having a first-degree relative, such as a parent or sibling, with bipolar disorder
→ Periods of high stress, such as the death of a loved one or other traumatic event
→ Drug or alcohol abuse

Symptoms

Manic Depressive
Mood: elevated and irritable Mood: anxious and depressed
Speech: loud, rapid, and vulgar Negative views and fatigue
Delusions Loss of appetite and libido
Hyperactive Suicidal thoughts
OCD
Risk factors
→ Working conditions
→ Nutrition
→ Environmental hazards
→ Stress
→ Substance abuse
→ Genetics

Symptoms
Obsession:
• Obsession of contamination
• Obsession of harm
• Obsession of religiousness
• Obsession of symmetry

Compulsion:
• Washing and cleaning
• Repeated body movements
• Checking
• Ordering and rearranging

Chronic Depression
Risk factors
→ Genetics
→ Life events
→ Sudden death or loss
→ Conflict
→ Abuse
Symptoms
→ Sadness
→ Loss of interest or pleasure
→ Feelings of guilt or low self-worth
→ Disturbed sleep or appetite, tiredness, and poor concentration

Indicators of a healthy sound mind

→ Not at war with himself
→ Get well with others
→ Strong self-esteem ü Knows thyself
→ The balance between rationality and emotionality
→ Problem-solving/coping ability
→ Lead a productive life
→ Realizes own potential
→ Able to make a contribution to the society or community

Preventive approaches for mental health disorders

→ Talk about your feelings
→ Eat well
→ Sleep well
→ Stay active
→ Take a break
→ Accept who you are
→ Ask for help
→ Do things you are good at
→ Care for others
 Lecture 17
SDGS
→ The Sustainable Development Goals (SDGs) were adopted on September 25 th, 2015.
Countries adopted a set of goals to stimulate action for people, planet, prosperity, peace and
partnership as part of a new sustainable development plan. There are 17 SDGs and 169
Associated targets.
→ They are the blueprint to achieve a better and more sustainable future for all. They address
the global challenges we face, including those related to poverty, inequality, climate change,
environmental degradation, peace, and justice.

5 goals in order:
1. No Poverty
2. Zero hunger
3. Good health and well-being
4. Quality education
5. Gender equality