CLINICAL NUTRITION- DCN 2203
Clinical nutrition centers on the prevention, diagnosis, and
management of nutritional changes in patients linked to chronic
diseases and conditions primarily in health care. Clinical in this
sense refers to the management of patients, including not only
outpatients at clinics and in private practice, but also inpatients in
hospitals. It incorporates primarily the scientific fields of nutrition
and dietetics. Furthermore, clinical nutrition aims to maintain a
healthy energy balance, while also providing sufficient amounts of
nutrients such as protein, vitamins, and minerals to patients.
This course describes the mechanisms involved in the inter-
relationships between diseases and nutrition. It evaluates the
relationships existing between nutrient requirements and the
path-physiology of diseases. Emphasis will be put on major
communicable and non-communicable diseases. The major
communicable diseases like diarrheal diseases, malaria, measles,
tuberculosis and HIV/AIDS etc will be covered. Major non
communicable diseases like diabetes, hypertension, obesity,
cardiovascular disease and cancer.
Also nutrition in surgical and traumatic conditions like burns and
scalds, fractures and wounds, pre & postoperative will be covered
Course objective:
To explain the relationships between nutrition and disease, be
able to plan diets of the sick
Learning objectives:
At the end of the course, students should be able to;
1. Describe the physiological and metabolic abnormalities
occurring in acute and chronic infections
2. Assess the nutrient needs/requirements during acute and
chronic infections
3. Explain the relationship between nutrition and infection
4. Describe the nutrition interventions required in acute and
chronic infections
5. Explain the nutritional needs and consequences of chronic
non-communicable diseases
6. Discuss the influences of lifestyles on the development of
nutrition-related chronic non-communicable diseases.
COMMUNICABLE Vs NON COMMUNICABLE DISEASES
Communicable diseases are the diseases which passes from one
individual to another individual. They are generally caused by
some bacteria, viruses or any other pathogens. For example,
malaria, AIDS etc. Non-communicable diseases are the diseases
which does not spread from one person to another person. They
are generally caused by some nutrient deficiency, allergy etc.
Communicable diseases are inheritable compared to non-
communicable diseases which can be heritable also.
Communicable diseases can be treated by some conventional
methods whereas non-communicable diseases need special
treatments.
NON COMMUNICABLE DISEASES
No communicable diseases (NCDs), also known as chronic
diseases, tend to be of long duration and are the result of a
combination of genetic, physiological, environmental and
behavioral factors.
Key facts
Non communicable diseases (NCDs) kill 41 million people
each year, equivalent to 71% of all deaths globally.
Each year, more than 15 million people die from a NCD
between the ages of 30 and 69 years; 85% of these
"premature" deaths occur in low- and middle-income
countries.
77% of all NCD deaths are in low- and middle-income
countries.
Cardiovascular diseases account for most NCD deaths, or
17.9 million people annually, followed by cancers (9.3
million), respiratory diseases (4.1 million), and diabetes (1.5
million).
These four groups of diseases account for over 80% of all
premature NCD deaths.
Tobacco use, physical inactivity, the harmful use of alcohol
and unhealthy diets all increase the risk of dying from a
NCD.
Detection, screening and treatment of NCDs, as well as
palliative care, are key components of the response to NCDs.
The main types of NCD are cardiovascular diseases (such as heart
attacks and stroke), cancers, chronic respiratory diseases (such
as chronic obstructive pulmonary disease and asthma) and
diabetes.
NCDs disproportionately affect people in low- and middle-income
countries where more than three quarters of global NCD deaths –
31.4 million – occur.
People at risk of NCDs
People of all age groups, regions and countries are affected by
NCDs. These conditions are often associated with older age
groups, but evidence shows that more than 15 million of all
deaths attributed to NCDs occur between the ages of 30 and 69
years. Of these "premature" deaths, 85% are estimated to occur
in low- and middle-income countries. Children, adults and the
elderly are all vulnerable to the risk factors contributing to NCDs,
whether from unhealthy diets, physical inactivity, exposure to
tobacco smoke or the harmful use of alcohol.
These diseases are driven by forces that include rapid unplanned
urbanization, globalization of unhealthy lifestyles and population
ageing. Unhealthy diets and a lack of physical activity may show
up in people as raised blood pressure, increased blood glucose,
elevated blood lipids and obesity. These are called metabolic risk
factors that can lead to cardiovascular disease, the leading NCD
in terms of premature deaths.
Risk factors
Modifiable behavioral risk factors
Modifiable behaviors, such as tobacco use, physical inactivity,
unhealthy diet and the harmful use of alcohol, all increase the risk
of NCDs.
Tobacco accounts for over 7.2 million deaths every year
(including from the effects of exposure to second-hand
smoke), and is projected to increase markedly over the
coming years.
4.1 million annual deaths have been attributed to excess
salt/sodium intake
More than half of the 3.3 million annual deaths attributable
to alcohol use are from NCDs, including cancer.
1.6 million deaths annually can be attributed to insufficient
physical activity
Metabolic risk factors
Metabolic risk factors contribute to four key metabolic changes
that increase the risk of NCDs:
raised blood pressure;
overweight/obesity;
hyperglycemia (high blood glucose levels); and
hyperlipidemia (high levels of fat in the blood).
In terms of attributable deaths, the leading metabolic risk factor
globally is elevated blood pressure (to which 19% of global deaths
are attributed), followed by overweight and obesity and raised
blood glucose.
The socioeconomic impact of NCDs
NCDs threaten progress towards the 2030 Agenda for Sustainable
Development, which includes a target of reducing premature
deaths from NCDs by one-third by 2030.
Poverty is closely linked with NCDs. The rapid rise in NCDs is
predicted to impede poverty reduction initiatives in low-income
countries, particularly by increasing household costs associated
with health care. Vulnerable and socially disadvantaged people
get sicker and die sooner than people of higher social positions,
especially because they are at greater risk of being exposed to
harmful products, such as tobacco, or unhealthy dietary practices,
and have limited access to health services.
In low-resource settings, health-care costs for NCDs quickly drain
household resources. The exorbitant costs of NCDs, including
treatment which is often lengthy and expensive, combined with
loss of income, force millions of people into poverty annually and
stifle development.
