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• 1 FSHN 360

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• • Hospitals in Ghana (differences compared to traditional hospitals in the US)

  oNo pumps in hospitals (too expensive)
  oNutritional formulas are prepared in the Korle Bu diet therapy unit
  §Yam, fish powder, palm oil, sugar
  oAdministrated via NG tube as Bolus feedings
  oAsesewa is a district hospital in Ghana

• Nutrition Assessment in Ghana

  oFocus group discussion
  oAnthropometric measurements
  §Weight, height/length, mid upper arm circumference
  oSurveys regarding child feeding practices
  §24 hour recall
  §Introduction of complimentary foods
  §Breast feeding
  §Food taboos
  oLength for age is the best indicator of long-term nutritional status of children
  oStunting: prevent from growing properly, height is below the 5% for age

• Nutritional Assessment in Disease Prevention 

  oProminent role of diet/nutritional status in chronic disease
  oHeart disease, osteoporosis, DM
  §Major causes of death and disability
  oReduce individual and societal burden via prevention of premature onset
  §Modify risk factors
  §Early detection/diagnosis
  §Research

• Obesity ↑ risk of many health conditions including:

  oCHD, stroke, high BP
  oType 2 DM
  oCancers (endometrial, breast, colon)
  oHigh total cholesterol, high TGs
  oLiver and gallbladder disease
  oSleep apnea and respiratory problems
  oOsteoarthritis
  oReproductive Health
  oMental Health 

• Composition and diversity of microbial species in modulating health and disease

  oLower microbiota diversity:
  §Associated with overweight, obesity, type 2 DM
  §Low-grade and systemic inflammation
  §Cardiometabolic abnormalities
  §Increase intestinal gut permeability
  oMicrobiota composition & diversity increase by:
  §Increase physical activity
  
  §Increase consumption of diets rich in non-digestible CHOs (f & v, legumes, whole grains)

• Fructose and Added Free Sugar Overconsumption 

  oStimulant of de novo lipogenesis à leading to ectopic fat deposition and insulin resistance
  oDoes not stimulate insulin and subsequent leptin secretion (Fails to induce satiety signals)
  oAssociated with obesity, cardio metabolic risk, and CV diseases
  oGut flora:
  oPossible â diversity
  oAlterations favoring pro-inflammatory response 

• America's Heart Disease Burden

  oAbout 610,000 people die of heart disease in the United States every year
  oLeading cause of death for both men and women for most races and ethnicities
  oCoronary heart disease costs the US $108.9 billion each year (health care services, medications, lost productivity)

• Coronary Heart Disease: Begins in childhood with the formation of fatty streaks as lipids become deposited in macrophages and smooth muscle cells within the inner lining of large elastic and muscular arteries

  oMost common type of heart disease
  oCoronary arteries supplying the heart with oxygen and nutrients become narrowed and inelastic because of atherosclerosis

• CHD Risk Factors

  oSmoking, high LDL, low HDL, high BP, inactivity, obesity, overweight, type 2 DM, overconsumption of added sugars, family history, men > 45, women post-menopausal 

• Lipid Biomarkers Lipoproteins (LDL and HDL)

  oLDL
  §Cholesterol transport (70% of serum’s TC)
  §Most atherogenic
  oHDL
  §Reverse transport: thought to pick up cholesterol from bloodstream and cells → transported to liver and other lipoproteins → excreted in bile, converted to bile acids, or reprocessed into VLDL