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B Abstention from alcohol should be advised for people with a history of alcohol abuse or dependence, women during pregnancy, and people with medical problems such as liver disease, pancreatitis, advanced neuropathy, or severe hypertriglyceridemia. For unplanned exercise, extra carbohydrate may be needed. Palmer talked about primary subluxation by injury or accident, and secondary subluxation caused by toxicity, nutritional deficiency and stress. J Clin Endocrinol Metab New marketing channels, ever-evolving techniques, and [ Although such diets may produce short-term weight loss and improved glycemia, it has not been established that these benefits are maintained long term, and long-term effects on kidney function for persons with diabetes are unknown.

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Once translocated to lakes, the extraction of phosphate into water is slow, hence the difficulty of reversing the effects of eutrophication. Cultural eutrophication is the process that speeds up natural eutrophication because of human activity. Extra nutrients are also supplied by treatment plants, golf courses, fertilizers, farms including fish farms , as well as untreated sewage in many countries.

When algae die, they decompose and the nutrients contained in that organic matter are converted into inorganic form by microorganisms. This decomposition process consumes oxygen, which reduces the concentration of dissolved oxygen. The depleted oxygen levels in turn may lead to fish kills and a range of other effects reducing biodiversity.

Nutrients may become concentrated in an anoxic zone and may only be made available again during autumn turn-over or in conditions of turbulent flow. Enhanced growth of aquatic vegetation or phytoplankton and algal blooms disrupts normal functioning of the ecosystem, causing a variety of problems such as a lack of oxygen needed for fish and shellfish to survive.

The water becomes cloudy, typically coloured a shade of green, yellow, brown, or red. Eutrophication also decreases the value of rivers, lakes and aesthetic enjoyment. Health problems can occur where eutrophic conditions interfere with drinking water treatment. Human activities can accelerate the rate at which nutrients enter ecosystems.

Runoff from agriculture and development, pollution from septic systems and sewers , sewage sludge spreading, and other human-related activities increase the flow of both inorganic nutrients and organic substances into ecosystems.

Elevated levels of atmospheric compounds of nitrogen can increase nitrogen availability. Phosphorus is often regarded as the main culprit in cases of eutrophication in lakes subjected to "point source" pollution from sewage pipes.

The concentration of algae and the trophic state of lakes correspond well to phosphorus levels in water. Studies conducted in the Experimental Lakes Area in Ontario have shown a relationship between the addition of phosphorus and the rate of eutrophication.

Humankind has increased the rate of phosphorus cycling on Earth by four times, mainly due to agricultural fertilizer production and application. Between and , an estimated ,, tonnes of phosphorus was applied to Earth's surface, primarily on croplands. Although eutrophication is commonly caused by human activities, it can also be a natural process, particularly in lakes. Eutrophy occurs in many lakes in temperate grasslands, for instance. Paleolimnologists now recognise that climate change, geology, and other external influences are critical in regulating the natural productivity of lakes.

Some lakes also demonstrate the reverse process meiotrophication , becoming less nutrient rich with time. Eutrophication is a common phenomenon in coastal waters. In contrast to freshwater systems, nitrogen is more commonly the key limiting nutrient of marine waters; thus, nitrogen levels have greater importance to understanding eutrophication problems in salt water. Estuaries tend to be naturally eutrophic because land-derived nutrients are concentrated where run-off enters a confined channel.

Upwelling in coastal systems also promotes increased productivity by conveying deep, nutrient-rich waters to the surface, where the nutrients can be assimilated by algae. Examples of anthropogenic sources of nitrogen-rich pollution include seacage fish farming and discharges of ammonia from the production of coke from coal.

In addition to runoff from land, fish farming wastes and industrial ammonia discharges, atmospheric fixed nitrogen can enter the open ocean. Terrestrial ecosystems are subject to similarly adverse impacts from eutrophication. Many terrestrial plant species are endangered as a result of soil eutrophication, such as the majority of orchid species in Europe. In meadows, tall grasses that can take advantage of higher nitrogen levels may change the area so that natural species may be lost.

Species-rich fens can be overtaken by reed or reedgrass species. Forest undergrowth affected by run-off from a nearby fertilized field can be turned into a nettle and bramble thicket. Chemical forms of nitrogen are most often of concern with regard to eutrophication, because plants have high nitrogen requirements so that additions of nitrogen compounds will stimulate plant growth.

Nitrogen is not readily available in soil because N 2 , a gaseous form of nitrogen, is very stable and unavailable directly to higher plants. Terrestrial ecosystems rely on microbial nitrogen fixation to convert N 2 into other forms such as nitrates.

However, there is a limit to how much nitrogen can be utilized. Ecosystems receiving more nitrogen than the plants require are called nitrogen-saturated. Saturated terrestrial ecosystems then can contribute both inorganic and organic nitrogen to freshwater, coastal, and marine eutrophication, where nitrogen is also typically a limiting nutrient.

However, because phosphorus is generally much less soluble than nitrogen, it is leached from the soil at a much slower rate than nitrogen. Consequently, phosphorus is much more important as a limiting nutrient in aquatic systems. Eutrophication was recognized as a water pollution problem in European and North American lakes and reservoirs in the midth century.

Many ecological effects can arise from stimulating primary production , but there are three particularly troubling ecological impacts: When an ecosystem experiences an increase in nutrients, primary producers reap the benefits first. In aquatic ecosystems, species such as algae experience a population increase called an algal bloom.

Algal blooms limit the sunlight available to bottom-dwelling organisms and cause wide swings in the amount of dissolved oxygen in the water. Oxygen is required by all aerobically respiring plants and animals and it is replenished in daylight by photosynthesizing plants and algae. Under eutrophic conditions, dissolved oxygen greatly increases during the day, but is greatly reduced after dark by the respiring algae and by microorganisms that feed on the increasing mass of dead algae.

When dissolved oxygen levels decline to hypoxic levels, fish and other marine animals suffocate. As a result, creatures such as fish, shrimp, and especially immobile bottom dwellers die off. Zones where this occurs are known as dead zones.

Eutrophication may cause competitive release by making abundant a normally limiting nutrient. This process causes shifts in the species composition of ecosystems. For instance, an increase in nitrogen might allow new, competitive species to invade and out-compete original inhabitant species. This has been shown to occur [27] in New England salt marshes. In Europe and Asia, the common carp frequently lives in naturally Eutrophic or Hypereutrophic areas, and is adapted to living in such conditions.

The eutrophication of areas outside its natural range partially explain the fish's success in colonising these areas after being introduced. Some algal blooms , otherwise called "nuisance algae" or "harmful algal blooms", are toxic to plants and animals.

Toxic compounds they produce can make their way up the food chain , resulting in animal mortality. When the algae die or are eaten, neuro - and hepatotoxins are released which can kill animals and may pose a threat to humans. Examples include paralytic , neurotoxic, and diarrhoetic shellfish poisoning. Other marine animals can be vectors for such toxins, as in the case of ciguatera , where it is typically a predator fish that accumulates the toxin and then poisons humans.

The indicator is a measure of the percentage of households consuming iodized salt, defined as salt containing parts per million of iodine. Iodine deficiency is most commonly and visibly associated with thyroid problems e. Consumption of iodized salt increased in the developing world during the past decade: This means that about 84 million newborns are now being protected from learning disabilities due to iodine-deficiency disorders.

Monitoring the situation of women and children. Sustainable elimination of iodine deficiency disorders by Micronutrient deficiencies, iodine deficiency disorders. Population with less than the minimum dietary energy consumption. This indicator is the percentage of the population whose food intake falls below the minimum level of dietary energy requirements, and who therefore are undernourished or food-deprived. The estimates of the Food and Agriculture Organization of the United Nations FAO of the prevalence of undernourishment are essentially measures of food deprivation based on calculations of three parameters for each country: The average amount of food available for human consumption is derived from national 'food balance sheets' compiled by FAO each year, which show how much of each food commodity a country produces, imports and withdraws from stocks for other, non-food purposes.

FAO then divides the energy equivalent of all the food available for human consumption by the total population, to derive average daily energy consumption. Data from household surveys are used to derive a coefficient of variation to account for the degree of inequality in access to food. Similarly, because a large adult needs almost twice as much dietary energy as a 3-year-old child, the minimum energy requirement per person in each country is based on age, gender and body sizes in that country.

The average energy requirement is the amount of food energy needed to balance energy expenditure in order to maintain body weight, body composition and levels of necessary and desirable physical activity consistent with long-term good health. It includes the energy needed for the optimal growth and development of children, for the deposition of tissues during pregnancy and for the secretion of milk during lactation consistent with the good health of the mother and child.

The recommended level of dietary energy intake for a population group is the mean energy requirement of the healthy, well-nourished individuals who constitute that group. FAO reports the proportion of the population whose daily food intake falls below that minimum energy requirement as 'undernourished'. Trends in undernourishment are due mainly to: The indicator is a measure of an important aspect of food insecurity in a population. Sustainable development requires a concerted effort to reduce poverty, including solutions to hunger and malnutrition.

Alleviating hunger is a prerequisite for sustainable poverty reduction, as undernourishment seriously affects labour productivity and earning capacity. Malnutrition can be the outcome of a range of circumstances. In order for poverty reduction strategies to be effective, they must address food access, availability and safety. Rome, October The State of Food Insecurity in the World Economic growth is necessary but not sufficient to accelerate reduction of hunger and malnutrition.

FAO methodology to estimate the prevalence of undernourishment. FAO, Rome, 9 October Infant and young child feeding. The recommendations for feeding infants and young children 6—23 months include: The caring practice indicators for infant and young child feeding available on the NLIS country profiles include: Early initiation of breastfeeding.

This indicator is the percentage of infants who are put to the breast within 1 hour of birth. Breastfeeding contributes to saving children's lives, and there is evidence that delayed initiation of breastfeeding increases their risk for mortality.

Infants under 6 months who are exclusively breastfed. This indicator is the percentage of infants aged 0—5 months who are exclusively breastfed. It is the proportion of infants aged 0—5 months who are fed exclusively on breast milk and no other food or drink, including water. The infant is however, allowed to receive ORS and drops and syrups containing vitamins, minerals and medicine.

Exclusive breastfeeding is an unequalled way of providing the ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process, with important implications for the health of mothers. An expert review of evidence showed that, on a population basis, exclusive breastfeeding for 6 months is the optimal way of feeding infants.

Breast milk is the natural first food for infants. It provides all the energy and nutrients that the infant needs for the first months of life. Breast milk promotes sensory and cognitive development and protects the infant against infectious and chronic diseases.

Exclusive breastfeeding reduces infant mortality due to common childhood illnesses, such as diarrhoea and pneumonia, and leads to quicker recovery from illness. Breastfeeding contributes to the health and well-being of mothers, by helping to space children, reducing their risks for ovarian and breast cancers and saving family and national resources. It is a secure way of feeding and is safe for the environment. Infants aged 6—8 months who receive solid, semisolid or soft foods.

WHO recommends starting complementary feeding at 6 months of age. It is defined as the proportion of infants aged 6—8 months who receive solid, semisolid or soft foods.

When breast milk alone no longer meets the nutritional needs of the infant, complementary foods should be added. This is a very vulnerable period, and it is the time when malnutrition often starts, contributing significantly to the high prevalence of malnutrition among children under 5 worldwide. Children aged 6—23 months who receive a minimum dietary diversity. This indicator is the percentage of children aged 6—23 months who receive a minimum dietary diversity. As per revised recommendation by TEAM in June , dietary diversity is present when the diet contained five or more of the following food groups: Children aged 6—23 months who receive a minimum acceptable diet.

This indicator is the percentage of children aged 6—23 months who receive a minimum acceptable diet. Proportion of children aged months who receive a minimum acceptable diet is included as a process indicator in the core set of indicators for the Global Nutrition Monitoring Framework. The composite indicator of a minimum acceptable diet is calculated from: Dietary diversity is present when the diet contained four or more of the following food groups: The minimum daily meal frequency is defined as: A minimum acceptable diet is essential to ensure appropriate growth and development for feeding infants and children aged 6—23 months.

Without adequate diversity and meal frequency, infants and young children are vulnerable to malnutrition, especially stunting and micronutrient deficiencies, and to increased morbidity and mortality. Source of all infant and young child feeding indicators. Infant and Young Child Feeding database. Infant and young child feeding list of publications.

Global Nutrition Monitoring Framework. Children with diarrhoea receiving oral rehydration therapy and continued feeding. This indicator is the prevalence of children with diarrhoea who received oral rehydration therapy and continued feeding. It is the proportion of children aged months who had diarrhoea and were treated with oral rehydration salts or an appropriate household solution and continued feeding.

As oral rehydration therapy is a critical component of effective management of diarrhoea, monitoring coverage with this highly cost-effective intervention indicates progress towards the child survival-related Millennium Development Goals. Health expenditure includes that for the provision of health services, family planning activities, nutrition activities and emergency aid designated for health, but excludes the provision of water and sanitation. Health financing is a critical component of health systems.

National health accounts provide a large set of indicators based on information on expenditure collected within an internationally recognized framework. National health accounts consist of a synthesis of the financing and spending flows recorded in the operation of a health system, from funding sources and agents to the distribution of funds between providers and functions of health systems and benefits geographically, demographically, socioeconomically and epidemiologically.

General government expenditure on health as a percentage of total government expenditure is the proportion of total government expenditure on health. General government expenditure includes consolidated direct and indirect outlays, such as subsidies and transfers, including capital, of all levels of government social security institutions, autonomous bodies and other extrabudgetary funds.

It consists of recurrent and capital spending from government central and local budgets, external borrowings and grants including donations from international agencies and nongovernmental organizations and social or compulsory health insurance funds. GDP is the value of all final goods and services produced within a nation in a given year.

Public health expenditure consists of recurrent and capital spending from government central and local budgets, external borrowings and grants including donations from international agencies and nongovernmental organizations and social or compulsory health insurance funds. Private health expenditure is the sum of outlays for health by private entities, such as commercial or mutual health insurance providers, non-profit institutions serving households, resident corporations and quasi-corporations not controlled by government involved in health services delivery or financing, and direct household out-of-pocket payments.

These indicators reflect total and public expenditure on health resources, access and services, including nutrition. Although increasing health expenditures are associated with better health outcomes, especially in low-income countries, there is no 'recommended' level of spending on health. The larger the per capita income, the greater the expenditure on health. Some countries, however, spend appreciably more than would be expected from their income levels, and some appreciably less.

When a government spends little of its GDP or attributes less of its total expenditure on health, this may indicate that health, including nutrition , are not regarded as priorities. National health accounts - World Health Statistics, http: Human development report http: Core health indicators http: Human development report indicator glossary for indicator 3.

Wealth, health and health expenditure. General government expenditure on health as a percentage of total government expenditure is defined as the level of general government expenditure on health GGHE expressed as a percentage of total government expenditure.

The indicator contributes to understanding the weight of public spending on health within the total value of public sector operations. It includes not just the resources channelled through government budgets but also the expenditure on health by parastatals, extrabudgetary entities and notably the compulsory health insurance. The indicator refers to resources collected and pooled by public agencies including all the revenue modalities.

The indicator provides information on the level of resources channelled to health relative to a country's wealth. These indicators reflect government and total expenditure on health resources, access and services, including nutrition, in relation to government expenditure, the wealth of the country, and per capita. When a government attributes less of its total expenditure on health, this may indicate that health, including nutrition , are not regarded as priorities.

UNDAFs usually focus on three to five areas in which the country team can make the greatest difference, in addition to activities supported by other agencies in response to national demands but which fall outside the common UNDAF results matrix. For each national priority selected for United Nations country team support, the UNDAF results matrix gives the outcome s , the outcomes and outputs of other agencies working alone or together, the role of partners, resource mobilization targets for each agency outcome and coordination mechanisms and programme modalities.

The nutrition component of the UNDAF reflects the priority attributed to nutrition by the United Nations agencies in a country and is an indication of how much the United Nations system is committed to helping governments improve their food and nutrition situation. The indicator is "strong", "medium" or "weak", depending on the degree to which nutrition is being addressed in the expected outcomes and outputs in the UNDAF. UNDAF documents follow a predefined format, with a core narrative and a results matrix.

The matrix lists the high-level expected results 'the UNDAF outcomes' , the outcomes to be reached by agencies working alone or together and agency outputs. The results matrix the UNDAF document was used to assess commitment to nutrition , because it represents a synthesis of the strategy proposed in the document and is available in the same format in most country documents. The outcomes and outputs specifically related to nutrition were identified and counted.

The outputs were compared with the evidence-based interventions to reduce maternal and child under nutrition recommended in the Lancet Nutrition Series Bhutta et al. The method and scoring are described in detail by Engesveen et al. What are the implications? A weak nutrition component in the UNDAF document does not necessarily imply that no United Nations agency in the country is working to improve nutrition ; however, unless such efforts are mentioned in strategy documents like the UNDAF, they may receive inadequate attention from development partners to ensure the necessary sustainability or scale-up to adequately address nutrition problems in the country.

The multisectoral nature of nutrition means that it must be addressed by a wide range of actors. Basing such action in frameworks for overall development contributes to ensuring the accountability of United Nations partners. Interventions for maternal and child under nutrition and survival. The Lancet Engesveen K et al. SCN News , Nutrition component of poverty reduction strategy papers.

The poverty reduction strategy approach was introduced in to empower governments to set their own priorities and to encourage donors to provide predictable, harmonized assistance aligned with country priorities. The PRSP should state the development priorities and specify the policies, programmes and resources needed to meet the goals.

It is prepared by governments in a participatory process involving civil society and development partners, including the World Bank and the International Monetary Fund, and should result in a comprehensive, country-based strategy for poverty reduction.

The indicator is "strong", "medium" or "weak", depending on the degree to which nutrition is addressed in the PRSP, in terms of recognition of under nutrition as a development problem, use of information on nutrition to analyse poverty and support for appropriate nutrition policies, strategies and programmes. The papers were systematically searched for key words to identify the parts that concerned nutrition , food security , health outcomes and interventions that would be relevant for the World Bank method.

In order to classify the commitments to nutrition in the PRSPs, a scoring system was developed, which is described in more detail by Engesveen et al. The emphasis given to nutrition in PRSPs reflects the extent to which the government considers it essential to improve nutrition for poverty reduction and national development. In other words, it can be an indication of the government's priority for improving nutrition.

A strong nutrition component in a PRSP means that the government considers nutrition a priority for poverty reduction and national development. A weak nutrition component in the document does not necessarily imply that no government department is working to improve nutrition ; however, unless such efforts are mentioned in strategy documents like PRSPs, they may not be sufficiently sustainable or be scaled-up to adequately address nutrition problems in the country.

Basing such action in frameworks for overall development contributes to ensuring the accountability of relevant government departments.

Sources and further reading. Poverty reduction strategy papers. Assessing countries' commitment to accelerate nutrition action demonstrated in poverty reduction strategy paper, UNDAF and through nutrition governance. SCN News , , Shekar M, Lee Y-K.

Mainstreaming nutrition in poverty reduction strategy papers: What does it take? A review of the early experience. Health, Nutrition and Population Discussion Paper, Landscape analysis on countries' readiness to accelerate action in nutrition , This indicator is a description of the strengths and weaknesses of various aspects of nutrition governance in countries.

The following 10 elements or characteristics are used to assess and describe the strength of nutrition governance: These elements were identified by countries as key elements for successful development and implementation of national nutrition policies and strategies during a review of the progress of countries in implementing the World Declaration and Plan of Action for Nutrition adopted by the International Conference on Nutrition, the first intergovernmental conference on nutrition Nishida et al.

The components of the composite indicator have been identified by countries as important for determining the completeness of national nutrition plans and policies Nishida, Mutru, Imperial Laue , For instance, a national nutrition plan and policy was considered to provide the political basis for initiating action. In many countries, official government endorsement or adoption of a national nutrition plan or policy facilitated its implementation.

The role of an intersectoral coordinating committee in implementing national nutrition plans and policies was also considered crucial, although the nature i. Another important element was considered to be regular surveys and other means of collecting data on nutrition.

A periodically updated national nutrition information system and routinely collected data on food and nutrition were considered important for evaluating the effectiveness of national nutrition plans and policies and identifying subsequent actions. Strategies for effective and sustainable national nutrition plans and policies. Modern aspects of nutrition , present knowledge and future perspective. Basel , Karger Forum for Nutrition 56 , This indicates whether a government has adopted legislation to monitor and enforce the International Code of Marketing of Breast-milk Substitutes, which helps create an environment that enables mothers to make the best possible feeding choice, based on impartial information and free of commercial influences, and to be fully supported in doing so.

This indicator is defined on the basis of whether a government has adopted legislation for effective national implementation and monitoring of the International Code of Marketing of Breast-milk Substitutes. The Code is a set of recommendations to regulate the marketing of breast-milk substitutes, feeding bottles and teats.

The Code aims to contribute "to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution" Article 1. Improper marketing and promotion of food products that compete with breastfeeding often negatively affect the choice and ability of a mother to breastfeed her infant optimally.

The Code was formulated in response to the realization that such marketing resulted in poor infant feeding practices, which negatively affect the growth, health and development of children and are a major cause of mortality in infants and young children.

Breastfeeding practices worldwide are not yet optimal, in both developing and developed countries, especially for exclusive breastfeeding under 6 months of age. In addition to the risks posed by the lack of the protective qualities of breast milk, breast-milk substitutes and feeding bottles are associated with a high risk for contamination that can lead to life-threatening infections in young infants.

Infant formula is not a sterile product, and it may carry germs that can cause fatal illnesses. Artificial feeding is expensive, requires clean water, the ability of the mother or caregiver to read and comply with mixing instructions and a minimum standard of overall household hygiene. These factors are not present in many households in the world. Frequently asked questions , These indicators provide information on national policies for legal entitlement to maternity protection, including leave from work during pregnancy and after birth, as well breastfeeding entitlements after return to work.

Since the International Labour Organization ILO was founded in , international labour standards have been established to provide maternity protection for women workers. Key elements of maternity protection include: The right to cash benefits during absence for maternity leave is intended to ensure that the woman can maintain herself and her child in proper conditions of health and with a suitable standard of living. The source of benefits is important due to potential discrimination in the labour market if employers have to bear the full costs.

The right to continue breastfeeding a child after returning to work is important since duration of leave entitlements generally is shorter than the WHO recommended duration of exclusive and continued breastfeeding. A composite indicator on maternity protection is included as a policy environment and capacity indicator in the core set of indicators for the Global Nutrition Monitoring Framework.

It currently uses the ILO classification of compliance with Convention on three key provisions leave duration, remuneration and source of cash benefits , but an alternative method taking into account higher standards as stated in Recommendation as well as breastfeeding entitlements is under development.

The ILO periodically publishes information on the above key indicators, including the assessment of compliance with Convention No. However, an alternative method is under development which may use a scale to indicate the degree of compliance is under development.

This method will also take into account higher standards for leave duration and remuneration in Recommendation , as well as breastfeeding entitlements within both the Convention and Recommendation. Pregnancy and maternity are potentially vulnerable time for working women and their families. Expectant and nursing mothers require special protection to prevent any potential adverse effects for them and their infants.

They need adequate time to give birth, to recover from delivery process, and to nurse their children. At the same time, they also require income security and protection to ensure that they will not suffer from income loss or lose their job because of pregnancy or maternity leave.

Such protection not only ensures a woman's equal access and right to employment, it also ensures economic sustainability for the well-being of the family. Returning to work after maternity leave has been identified as a significant cause for never starting breastfeeding, early cessation of breastfeeding and lack of exclusive breastfeeding. In most low- and middle-income countries, paid maternity leave is limited to formal sector employment or is not always provided in practice.

The ILO estimates that more than million women lack economic security around childbirth with adverse effects on the health, nutrition and well-being of mothers and their children. Maternity cash benefits for workers in the informal economy. Rollins et al Why invest, and what it will take to improve breastfeeding practices? Database of national labour, social security and related human rights legislation. The legislative data are collected by ILO through periodical reviews of national labour and social security legislation and secondary sources, such as the International Social Security Association and International Network on Leave Policies and Research; as well as consultations with ILO experts in regional and national ILO offices around the world.

The composite indicator on maternity protection included in the Global Nutrition Monitoring Framework is currently defined as whether the country has maternity protection laws or regulations in place compliant with the provisions for leave duration, remuneration and source of cash benefits in Convention Documentation for the maternity protection database http: Degree training in nutrition exists.

What does the indicator tell us? This indicator reflects the capacity of a country to train professionals in nutrition in terms of having national higher education institutions offering training in nutrition. This indicator is defined as the existence of higher education institutions offering training in nutrition in the country.

Higher education training institutions include universities and other schools offering graduate and post-graduate degrees in nutrition or dietetics, including public health nutrition, community nutrition, food and nutrition policy, clinical nutrition, nutrition science and epidemiology.

Trained nutrition professionals work at facilities including health facilities as well as at population and community levels and may influence nutrition policies, and designing and implementation of nutrition intervention programmes at various levels. They also play an important role in training of other health and non-health cadres to plan and deliver nutrition interventions in various settings. It is recognized that availability, within a country, of sufficient workforce with appropriate training in nutrition will lead to better outcomes for country-specific nutrition and health concerns.

A competency framework for global public health nutrition workforce development: World Public Health Nutrition Association. Registering as Registered Nutritionist. Antimicrobial peptides called defensins are an evolutionarily conserved component of the innate immune response found in all animals and plants, and represent the main form of invertebrate systemic immunity.

Ribonucleases and the RNA interference pathway are conserved across all eukaryotes , and are thought to play a role in the immune response to viruses.

Unlike animals, plants lack phagocytic cells, but many plant immune responses involve systemic chemical signals that are sent through a plant. Systemic acquired resistance SAR is a type of defensive response used by plants that renders the entire plant resistant to a particular infectious agent. Another important role of the immune system is to identify and eliminate tumors. This is called immune surveillance. The transformed cells of tumors express antigens that are not found on normal cells.

To the immune system, these antigens appear foreign, and their presence causes immune cells to attack the transformed tumor cells. The antigens expressed by tumors have several sources; [90] some are derived from oncogenic viruses like human papillomavirus , which causes cervical cancer , [91] while others are the organism's own proteins that occur at low levels in normal cells but reach high levels in tumor cells.

One example is an enzyme called tyrosinase that, when expressed at high levels, transforms certain skin cells e. The main response of the immune system to tumors is to destroy the abnormal cells using killer T cells, sometimes with the assistance of helper T cells. This allows killer T cells to recognize the tumor cell as abnormal. Clearly, some tumors evade the immune system and go on to become cancers.

Paradoxically, macrophages can promote tumor growth [] when tumor cells send out cytokines that attract macrophages, which then generate cytokines and growth factors such as tumor-necrosis factor alpha that nurture tumor development or promote stem-cell-like plasticity.

The immune system is involved in many aspects of physiological regulation in the body. The immune system interacts intimately with other systems, such as the endocrine [] [] and the nervous [] [] [] systems. The immune system also plays a crucial role in embryogenesis development of the embryo , as well as in tissue repair and regeneration. Hormones can act as immunomodulators , altering the sensitivity of the immune system. For example, female sex hormones are known immunostimulators of both adaptive [] and innate immune responses.

By contrast, male sex hormones such as testosterone seem to be immunosuppressive. When a T-cell encounters a foreign pathogen , it extends a vitamin D receptor.

This is essentially a signaling device that allows the T-cell to bind to the active form of vitamin D , the steroid hormone calcitriol. T-cells have a symbiotic relationship with vitamin D. Not only does the T-cell extend a vitamin D receptor, in essence asking to bind to the steroid hormone version of vitamin D, calcitriol, but the T-cell expresses the gene CYP27B1 , which is the gene responsible for converting the pre-hormone version of vitamin D, calcidiol into the steroid hormone version, calcitriol.

Only after binding to calcitriol can T-cells perform their intended function. Other immune system cells that are known to express CYP27B1 and thus activate vitamin D calcidiol, are dendritic cells , keratinocytes and macrophages. It is conjectured that a progressive decline in hormone levels with age is partially responsible for weakened immune responses in aging individuals. As people age, two things happen that negatively affect their vitamin D levels. First, they stay indoors more due to decreased activity levels.

This means that they get less sun and therefore produce less cholecalciferol via UVB radiation. Second, as a person ages the skin becomes less adept at producing vitamin D. The immune system is affected by sleep and rest, [] and sleep deprivation is detrimental to immune function.

When suffering from sleep deprivation, active immunizations may have a diminished effect and may result in lower antibody production, and a lower immune response, than would be noted in a well-rested individual. Additionally, proteins such as NFIL3 , which have been shown to be closely intertwined with both T-cell differentiation and our circadian rhythms, can be affected through the disturbance of natural light and dark cycles through instances of sleep deprivation, shift work, etc.

As a result, these disruptions can lead to an increase in chronic conditions such as heart disease, chronic pain, and asthma. In addition to the negative consequences of sleep deprivation, sleep and the intertwined circadian system have been shown to have strong regulatory effects on immunological functions affecting both the innate and the adaptive immunity.

First, during the early slow-wave-sleep stage, a sudden drop in blood levels of cortisol , epinephrine , and norepinephrine induce increased blood levels of the hormones leptin, pituitary growth hormone, and prolactin. These signals induce a pro-inflammatory state through the production of the pro-inflammatory cytokines interleukin-1, interleukin , TNF-alpha and IFN-gamma. These cytokines then stimulate immune functions such as immune cells activation, proliferation, and differentiation.

It is during this time that undifferentiated, or less differentiated, like naïve and central memory T cells, peak i. This milieu is also thought to support the formation of long-lasting immune memory through the initiation of Th1 immune responses. In contrast, during wake periods differentiated effector cells, such as cytotoxic natural killer cells and CTLs cytotoxic T lymphocytes , peak in order to elicit an effective response against any intruding pathogens.

As well during awake active times, anti-inflammatory molecules, such as cortisol and catecholamines , peak. There are two theories as to why the pro-inflammatory state is reserved for sleep time. First, inflammation would cause serious cognitive and physical impairments if it were to occur during wake times. Second, inflammation may occur during sleep times due to the presence of melatonin.

Inflammation causes a great deal of oxidative stress and the presence of melatonin during sleep times could actively counteract free radical production during this time.

Overnutrition is associated with diseases such as diabetes and obesity , which are known to affect immune function. More moderate malnutrition, as well as certain specific trace mineral and nutrient deficiencies, can also compromise the immune response. Foods rich in certain fatty acids may foster a healthy immune system. The immune system, particularly the innate component, plays a decisive role in tissue repair after an insult.

The plasticity of immune cells and the balance between pro-inflammatory and anti-inflammatory signals are crucial aspects of efficient tissue repair. According to one hypothesis, organisms that can regenerate could be less immunocompetent than organisms that cannot regenerate. The immune response can be manipulated to suppress unwanted responses resulting from autoimmunity, allergy, and transplant rejection , and to stimulate protective responses against pathogens that largely elude the immune system see immunization or cancer.

Immunosuppressive drugs are used to control autoimmune disorders or inflammation when excessive tissue damage occurs, and to prevent transplant rejection after an organ transplant. Anti-inflammatory drugs are often used to control the effects of inflammation. Glucocorticoids are the most powerful of these drugs; however, these drugs can have many undesirable side effects , such as central obesity , hyperglycemia , osteoporosis , and their use must be tightly controlled.

Cytotoxic drugs inhibit the immune response by killing dividing cells such as activated T cells. However, the killing is indiscriminate and other constantly dividing cells and their organs are affected, which causes toxic side effects.

Cancer immunotherapy covers the medical ways to stimulate the immune system to attack cancer tumours. Immunology is strongly experimental in everyday practice but is also characterized by an ongoing theoretical attitude.

Many theories have been suggested in immunology from the end of the nineteenth century up to the present time.

The end of the 19th century and the beginning of the 20th century saw a battle between "cellular" and "humoral" theories of immunity. In the mids, Frank Burnet , inspired by a suggestion made by Niels Jerne , [] formulated the clonal selection theory CST of immunity.

More recently, several theoretical frameworks have been suggested in immunology, including " autopoietic " views, [] "cognitive immune" views, [] the " danger model " or "danger theory" , [] and the "discontinuity" theory. This limits the effectiveness of drugs based on larger peptides and proteins which are typically larger than Da.

In some cases, the drug itself is not immunogenic, but may be co-administered with an immunogenic compound, as is sometimes the case for Taxol. Computational methods have been developed to predict the immunogenicity of peptides and proteins, which are particularly useful in designing therapeutic antibodies, assessing likely virulence of mutations in viral coat particles, and validation of proposed peptide-based drug treatments.

Early techniques relied mainly on the observation that hydrophilic amino acids are overrepresented in epitope regions than hydrophobic amino acids; [] however, more recent developments rely on machine learning techniques using databases of existing known epitopes, usually on well-studied virus proteins, as a training set.

The success of any pathogen depends on its ability to elude host immune responses. Therefore, pathogens evolved several methods that allow them to successfully infect a host, while evading detection or destruction by the immune system. These proteins are often used to shut down host defenses. An evasion strategy used by several pathogens to avoid the innate immune system is to hide within the cells of their host also called intracellular pathogenesis. Here, a pathogen spends most of its life-cycle inside host cells, where it is shielded from direct contact with immune cells, antibodies and complement.

Some examples of intracellular pathogens include viruses, the food poisoning bacterium Salmonella and the eukaryotic parasites that cause malaria Plasmodium falciparum and leishmaniasis Leishmania spp.

Other bacteria, such as Mycobacterium tuberculosis , live inside a protective capsule that prevents lysis by complement. Such biofilms are present in many successful infections, e. The mechanisms used to evade the adaptive immune system are more complicated. This is called antigenic variation. An example is HIV, which mutates rapidly, so the proteins on its viral envelope that are essential for entry into its host target cell are constantly changing.

These frequent changes in antigens may explain the failures of vaccines directed at this virus. In HIV, the envelope that covers the virion is formed from the outermost membrane of the host cell; such "self-cloaked" viruses make it difficult for the immune system to identify them as "non-self" structures.

From Wikipedia, the free encyclopedia. This is the latest accepted revision , reviewed on 13 August A biological system that protects an organism against disease. Cataphylaxis Clonal selection Hapten Human physiology Immune network theory Immune system receptors ImmunoGrid , a project to model the mammalian, and specifically human, immune system using Grid technologies Immunoproteomics Immunostimulator Original antigenic sin Plant disease resistance Polyclonal response Tumor antigens Vaccine-naive Mucosal immunology.

Retrieved 1 January British Journal of Cancer. Revue d'histoire des sciences et de leurs applications. Accessed 8 January Current Opinion in Immunology. Ed Oxford dictionary of biochemistry and molecular biology.

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