NAME NIM PUSKESMAS

: Benita Putri Permata : 030.05.050 : Kelurahan Bangka, jakarta selatan

Sh rt !uesti ns " r #e$ture in % mmunit& Nutriti n Please ans'er Brie"l& the " ll 'ing (uesti ns. Su)mit the ans'ers )& *+st ,e$em)er *0+3 " r the latest. 1. Nutrition is important for all stages of life cycle. Please explain how you would manage to break the cycle of malnutrition problem from generation to generation. 2. Iron requirement is increased during pregnancy. Please explain how would you advise a married woman to prepare for the pregnancy !. "hat is the best time to introduce the complementary feeding to the infant #riefly mention about the energy and nutrient gap. $. "hy is nutrition important for healthy aging %. "hich biomarkers will you measure for vitamin & survey in a community where malaria infection is common

ANS-E.

+. 'ptimal feeding of children during the first two years is critical to break the cycle of malnutrition from generation to generation. (he first 2$ months is recognised as being the most important window of opportunity for establishing healthy growth. Infant and child feeding practices are ma)or determinants of the risk of malnutrition. & very large proportion of women do not practice optimal breastfeeding and complementary feeding behaviour for their children. *ually important are the serious problems related to when complementary food is introduced+ because a large ma)ority of infants are given such foods too early or too late. &t six to eight months of age+ only one in two children is consuming solid or semisolid food. ,uch of the inappropriate breastfeeding and complementary feeding behaviour is actually due to lack of knowledge+ rather than practical or financial constraints+ and you will have plenty of opportunities in your work to give mothers the best information possible. ,y strategies during the first two years .xclusive breastfeeding during the first six months /exclusive breastfeeding is defined as giving only breastmilk and no other food or fluid including water except medication0 1tart optimal complementary feeding at six months with continuation of breastfeeding for the first two years or beyond /complementary feeding means giving solid or semisolid food to a child in addition to breastmilk0.

&n important part of my )ob is connected to helping mothers and caregivers to feed their children in the most effective way possible. It is therefore very important that we have to help them to understand the importance of optimal breastfeeding. (he following are key messages that need to be explained to the mother. i should make sure that she understands why these behaviours are important and that i have given her the underlying reasons for each of the key messages. I will be using these messages when you are educating or counselling mothers. (he mother initiates breastfeeding within one hour of birth Initiating breastfeeding within one hour protects the infant from disease by providing the thick+ yellowish first milk /colostrum0 which is the equivalent to the infant2s first vaccine. It also helps to expel the placenta more rapidly and reduces blood loss by the mother. It also helps expel meconium /the infant2s first stool0+ stimulates further breastmilk production and keeps the newborn warm through skin3to3skin contact. (he mother breastfeeds frequently+ day and night (he mother should allow the infant to breastfeed on demand /as often as the infant wants0 .(his means feeding every two to three hours /4512 times per 2$ hours0 or more frequently if needed+ especially in the early months. (he mother needs to breastfeed frequently to stimulate milk production. #reastmilk is perfectly adapted to the infant2s small stomach si6e because it is quickly and easily digested. (he mother gives infant only breastmilk for the first six months. (he mother needs to breastfeed frequently to stimulate milk production. #reastmilk contains all the water and nutrients that an infant needs to satisfy its hunger and thirst. .xclusive breastfeeding helps to space births by delaying the return of fertility. .xclusively breasted infants are likely to have fewer diarrhoea+ respiratory+ and ear infections. 7ou should encourage and support the mother to exclusively breastfeed her baby+ explaining how it will help both her and her infant #y the age of six months the mother or caregiver must add complementary food (he complementary food given to the child should be varied as much as possible+ increasing the quantity+ frequency and density of the food as the child gets older. (his is in addition to the need for the mother to continue breastfeeding until the child is two years of age or older. It is important because the fore milk has a high water content to quench the infant2s thirst and the baby also needs to get the hind milk which is rich in fat and nutrients.

2. "omen with low iron levels prior to and during pregnancy are at increased risk of iron

deficiency anaemia 5 the most common type of anaemia in pregnancy affecting about one in five women. I will tell a patient that a complications arising as a result of iron deficiency anemia include increase risk of premature births+ low birth weight+ and reduced fetal organ growth.8ommon signs and symptoms /whether pregnant or not0 include excessive tiredness+ shortness of breath+ lack of motivation and feeling irritable or weak. If iron deficiency continues+ women may experience headaches or have a lowered immune resistance. 9or breastfeeding woman+ iron deficiency anemia presents itself as a contributing factor for low milk supply+ plugged ducts+ mastitis+ and delayed healing of sore nipples. (he best source of iron comes from haem3iron found in animal foods+ such as lean red meat+ chicken and fish: as well as non3haem iron found in plant foods+ including dark green leafy vegetables+ wholemeal bread+ iron3fortified cereals+ beans and lentils. 8ertain foods and drinks can help the body to absorb greater amounts of iron including vitamin 83rich foods.(ry drinking a glass of orange )uice or eating fruit or vegetables when you have an iron3rich meal. 'n the contrary+ caffeine+ calcium and 6inc supplements can interfere with iron absorption. It;s therefore wise to avoid drinking tea or coffee and taking these supplements with meals. 'r taking an addition to food+ iron supplements can be used to meet dietary iron requirements. ,ost supplements provide !<3=<mg iron>day. 1o its really important to prepare it before Pregnancy. 3. 9ull term+ healthy infants reach developmental readliness to begin a complimentary food between $ and = months old. ?uring the period of complementary feeding+ children are at high risk of undernutrition. 8omplementary foods are often of inadequate nutritional quality+ or they are given too early or too late+ in too small amounts+ or not frequently enough. Premature cessation or low frequency of breastfeeding also contributes to insufficient nutrient and energy intake in infants beyond = months of age. #reastfeeding should continue with complementary feeding up to 2 years of age or beyond+ and it should be on demand+ as often as the child wants. #reast milk can provide one half or more of a child;s energy needs between = and 12 months of age+ and one third of energy needs and other high quality nutrients between 12 and 2$ months. #reast milk continues to provide higher quality nutrients than complementary foods+ and also protective factors. #reast milk is a critical source of energy and nutrients during illness+ and reduces mortality among children who are malnourished. In addition+ breastfeeding reduces the risk of a number of acute and chronic diseases. 8hildren tend to breastfeed less often when complementary foods are introduced+ so breastfeeding needs to be actively encouraged to sustain breast3milk intake. (he overall quantity of food is usually measured for convenience according to the amount of energy 5 that is+ the number of kilocalories /kcal0 5 that a child needs. 'ther nutrients are equally important+ and are either part of+ or must be added to+ the staple food.the energy needs of infants and young children up to 2 years of age+ and how much can be provided by breast milk. It shows that breast milk covers all needs up to = months+ but after = months there is an energy gap that needs to be covered by complementary foods. (he energy needed in addition to breast milk is about 2<< kcal per day in infants

=54 months+ !<< kcal per day in infants @511 months+ and %%< kcal per day in children 1252! months of age. (he amount of food required to cover the gap increases as the child gets older+ and as the intake of breast milk decreases. summari6es the amount of food required at different ages+ the average number of kilocalories that a breastfed infant or young child needs from complementary foods at different ages+ and the approximate quantity of food that will provide this amount of energy per day. (he quantity increases gradually month by month+ as the child grows and develops+ and the table shows the average for each age range. &s a child gets older and needs a larger total quantity of food each day+ the food needs to be divided into a larger number of meals.(he number of meals that an infant or young child needs in a day depends on how much energy the child needs to cover the energy gap. (he more food a child needs each day+ the more meals are needed to ensure that he or she gets enough. the amount that a child can eat at one meal . (his depends on the capacity or si6e of the child;s stomach+ which is usually !< ml per kg of the child;s body weight. & child who weighs 4 kg will have a stomach capacity of 2$< ml+ about one large cupful+ and cannot be expected to eat more than that at one meal. the energy density of the food offered . (he energy density of complementary foods should be more than breast milk+ that is+ at least <.4 kcal per gram. If the energy density of food is lower+ a larger volume of food is needed to fill the gap+ which may need to be divided into more meals.

/. Aealthy eating is important for healthy aging for adults over age %<. 8hoosing healthy foods for meals and snacks can help you feel your best every day. Aealthy eating also helps prevent some chronic and other illnesses. 7ou need fewer calories and more nutrients as you get older. (o maintain a healthy weight+ eat foods with more nutrients and not too many foods with high calories. .at foods that contain fibre such as whole grain products+ legumes+ vegetables and fruit+ and plenty of fluids to keep your bowels healthy. Aealthy eating means choosing foods that meet your daily nutritional needs. Aere are some tips Bet enough calories to have a healthy weight and to be physically active .at a variety of foods from Eating -ell 'ith %ana0a1s 2 0 3ui0e ?rink plenty of fluids+ including water .n)oy eating by sharing meals with family and friends

%ar) h&0rates are a main source of the body;s energy+ despite the myth that carbohydrate3rich foods are fattening. .xamples of nutritious carbohydrate foods include whole grains+ cooked dried beans+ fruits+ vegetables+ milk and yogurt. 8arbohydrate3rich foods are often good sources of fibre+ vitamins+ and other nutrients. (hese are important for staying healthy and preventing cardiovascular and other diseases.

Pr tein is found in meat+ fish+ poultry+ milk products+ legumes+ tofu+ soy beverage+ and peanut butter. 9oods from animal sources are high in protein+ as well as 6inc+ iron and vitamin #12. 7ou need protein for building or repairing muscles+ and for maintaining healthy hair+ nails and skin. 2at is a concentrated source of energy or calories. Ceducing the amount of fat in your diet lowers the number of calories. Aowever+ it is important to eat enough ;healthy fats;+ such as fats from fish+ nuts+ seeds and vegetable oils. .ating "ell with 8anada;s 9ood Buide recommends adding a small amount /!< to $% mD or 2 to ! tablespoons0 of unsaturated fat every day+ such as cooking oil+ salad dressings+ mayonnaise and margarine. #y eating less trans and saturated fat+ you make the most important dietary change for improving your heart health. 1aturated fats are found in cheese+ ice cream+ high fat dairy products+ high fat meats+ chicken skin+ lard+ shortening+ and coconut and palm kernel oils. (rans fats are found mainly in baked goods+ including those made with shortening+ partially hydrogenated vegetable oils+ and hard margarines. %al$ium needs increase for people over %< years of age. 8alcium is one of the vital nutrients for having healthy bones and preventing osteoporosis. 8alcium may also help you keep a healthy blood pressure. .xamples of foods with high calcium are lower fat milk and alternatives+ including calcium fortified soy beverages+ canned fish with bones+ and calcium3enriched fruit )uices. 4itamin , is needed to help you balance calcium levels in your body for healthy bones. 7ou need more vitamin ? as you get older. Eitamin ? is found in milk+ fortified soy beverages+ egg yolk+ and fish. &dults over %< years of age should take a daily vitamin ? supplement containing $<< IF of vitamin ?+ and follow .ating "ell with 8anada;s 9ood Buide. 4itamin B5 needs also increase as people age. 7ou need vitamin #= for protein metabolism and brain function. 9ood sources of vitamin #= include fish+ beef liver+ meat+ poultry+ whole grains+ nuts+ peas+ dried beans and lentils. 4itamin B+* is found naturally in foods such as milk and alternatives+ meat+ fish+ poultry and eggs. &s you get older+ it is harder for your body to absorb vitamin #12 from these foods. 7our body can absorb vitamin #12 from fortified foods and supplements more easily+ so if you are over age %<+ it is recommended that you get vitamin #12 from fortified foods or a supplement every day. Not absorbing vitamin #12 over a long time can cause a type of anemia. 9oods that are fortified with vitamin #12 include vegetarian food sources such as vitamin #12 fortified meatless deli slices+ soy burgers and soy beverages. 2 late is one of the # vitamins important for a healthy heart and blood cells. & lack of folate may cause anemia. 9oods with folate are dried peas+ beans+ lentils+ orange )uice+ dark green leafy vegetables and other vegetables+ fruits+ nuts and seeds. 2i)re is important for your bowels and for heart health. 7our bowels may become less active as you age+ causing constipation. 8ertain types of fibre can help to lower cholesterol and to keep blood sugar levels normal. 9ibre may also help you achieve or keep a healthy weight. 9oods with fibre include whole grains+ legumes+ vegetables and fruit. 2lui0s are important for good hydration+ oral health+ and regular bowel function. 1eniors may not drink enough or notice thirst. "ater+ milk+ and )uice are your best sources of

fluids. ,oderate amounts of tea and coffee can also be counted as fluids. S 0ium or salt use may increase as you get older+ possibly due to less sense of taste. (oo much sodium in your diet can increase your blood pressure+ leading to heart disease or stroke. (ry using unsalted herbs+ spices and seasonings in cooking instead of adding salt to foods. Dimit the use of salty foods+ including instant soup+ sauce and gravy mixes+ soy sauce+ salad dressings+ and salted meats such as ham+ bacon and sausages.

5. (he plasma concentrations of several important nutritional biomarkers are influenced by inflammation + including retinol+ 2%3hydroxy cholecalciferol /vitamin ?0+ iron + ferritin + transferrin receptors + 6inc + carotenoids + selenium + pyridoxal phosphate + G3tocopherol and total lipids + and vitamin 8 . In addition+ concentrations of the transport proteins albumin+ retinol3binding protein /C#P0 and transferrin are often low in children frequently exposed to infections or trauma . In the above reports the abnormal nutrient biomarker concentration was associated with a raised concentration of the acute phase protein /&PP0 83reactive protein /8CP0 or other evidence of inflammation. Aemoglobin+ .P and serum ferritin concentrations were significantly worse and the prevalence of anemia+ elevated .P and low serum ferritin was increased with increasing intensity of hookworm infection. Aookworm infection intensity was the strongest predictor of iron status+ especially of depleted iron stores. Dow serum retinol was most strongly associated with mild anemia+ whereas P. vivax malaria and hookworm infection intensity were stronger predictors of moderate to severe anemia. (hese findings reinforce the need for programs to consider reducing the prevalence of hookworm+ malaria infection and vitamin & deficiency where indicated+ in addition to providing iron supplements to effectively control anemia. (he mechanism of this interaction is unclear. Eitamin & deficiency may inhibit erythropoiesis directly or through inhibition of iron mobili6ation or transport. ,alaria attacks hemoly6e both infected and uninfected red cells+ and the immune response of the body to infection results in further red cell destruction and progressive anemia due to phagocytosis.

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