Wednesday, 25 February 2015

Health Effects of Dyspepsia and Curative Measures


Dyspepsia, also known as indigestion, is a condition of impaired digestion. It is a medical condition characterized by chronic or recurrent pain in the upper abdomen, upper abdominal fullness and feeling full earlier than expected when eating. It can be accompanied by bloating, belching, nausea, or heartburn. Dyspepsia is a common problem and is frequently caused by gastroesophageal reflux disease (GERD) or gastric. In a small minority it may be the first symptom of peptic ulcer disease (an ulcer of the stomach or duodenum) and occasionally cancer. Hence, unexplained newly onset dyspepsia in people over 55 or the presence of other alarming symptoms may require further investigations.
 
Causes
Non-ulcer dyspepsia
In about 50-70% of patients with dyspepsia, no definite organic cause can be determined. In this case, dyspepsia is referred to as non-ulcer dyspepsia and its diagnosis is established by the presence of epigastralgia for at least 6 months, in the absence of any other cause explaining the symptoms.

Diseases of the gastrointestinal tract

When dyspepsia can be attributed to a specific cause, the majority of cases concern gastroesophageal reflux diseases (GERD) and peptic ulcer disease. Less common causes include gastritis, gastric cancer, esophageal cancer, coeliac disease, food allergy, inflammatory bowel disease, chronic intestinal ischemia and gastroparesis.
 
Liver and pancreas diseases
These include cholelithiasis, chronic pancreatitis and pancreatic cancer.
Drugs:  The list of drugs causing dyspepsia is long and includes non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics (mostly macrolides and metronidazole), oral ferrous sulfate, corticosteroids, cardiac medications (such as digoxin, calcium channel blockers and nitrates), theophylline, colchicine, bisphosphonates, oral contraceptives and L-DOPA.

Signs and symptoms
The characteristic symptoms of dyspepsia are upper abdominal pain, bloating, fullness and tenderness on palpation. Pain worsened by exertion and associated with nausea and perspiration may also indicate angina. The presence of gastrointestinal bleeding (vomit containing blood), difficulty swallowing, and loss of appetite, unintentional weight loss, abdominal swelling and persistent vomiting are suggestive of peptic ulcer disease or malignancy, and would necessitate urgent investigations. In some cases, the clinical manifestations include symptoms indicative of more severe disease like cancer.
 
Treatment
-A systemic review of herbal products found that several herbs, including peppermint and caraway, have anti-dyspeptic effects for non-ulcer dyspepsia with "encouraging safety profiles.
- Red pepper powder has also found to be promising.
- Ginger and related products made there from have been shown to have some positive alleviation of symptoms, in particular for motion sickness and pregnancy-related nausea.
- Acotiamide is a new drug approved in Japan in March 2013 for the treatment of meal related symptoms of functional dyspepsia. It is an acetylcholinesterase inhibitor.
REMEMBER: ADEQUATE NUTRITION, HEALTHIER SOCIETY.
 

FOR MORE INFO. CONTACT

Kenneth Mercy (B.sc Human Nutrition & Dietetics)
Consultant Nutritionist
http://mercynutritioncorner.blogspot.com
kennethmercy@yahoo.com
+234 806 134 4343

Treatment for Constipation

                            
Constipation (also known as costiveness or dyschezia), refers to bowel movements that are infrequent or hard to pass. ( Typically  three  times or  fewer  per  week). This is a difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools), or the sensation of incomplete bowel evacuation.


 Constipation is a common cause of painful defecation. Severe constipation includes obstipation (failure to pass stools or gas) and fecal impaction, which can progress to bowel obstruction and become life-threatening. Constipation is a symptom with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypomobility). About 50% of patients evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet, hormonal disorders such as hypothyroidism (low thyroidism), side effects of medications, and rarely heavy metal toxicity. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and in particular situations surgery may be required.
                 
 CAUSES OF CONSTIPATION
The causes of constipation can be divided into congenital, primary, and secondary. The most common cause is primary and not life-threatening .Constipation can be caused or exacerbated by a low fiber diet, low liquid intake, or dieting.. In the elderly, causes include: insufficient dietary fiber intake, inadequate fluid intake, decreased physical activity, side effects of medications. In children, constipation usually occurs at three distinct points in time: after starting formula or processed foods (while an infant), during toilet training in toddlerhood, and soon after starting school (as in a kindergarten)
After birth, most infants pass 4-5 soft liquid bowel movements (BM) a day. Breast-fed infants usually tend to have more BM compared to formula-fed infants. Some breast-fed infants have a BM after each feed, whereas others have only one BM every 2–3 days. Infants who are breast-fed rarely develop constipation. By the age of two years, a child will usually have 1–2 bowel movements per day and by four years of age; a child will have one bowel movement per day

Image showing Faeces of individual with constipation

             
 TREATMENT : The main treatment of constipation involves the increased intake of water and fiber (either dietary or as supplements). The routine use of laxatives is discouraged, as having bowel movements may come to be dependent upon their use. Enemas can be used to provide a form of mechanical stimulation. However, enemas are generally useful only for stool in the rectum, not in the intestinal tract.  
 1)   Laxatives :If laxatives are used, milk of magnesia is recommended as a first-line agent      due to its low cost and safety. Stimulants should only be used if this is not effective. In cases of chronic constipation, polyethylene glycol appears superior to lactulose. 
 
2)  Frequent physical exercise is recommended to improve bowel movement.
 
ADEQUATE NUTRITION, HEALTHIER SOCIETY.
 
FOR MORE INFO. 

Kenneth Mercy (B.sc Human Nutrition & Dietetics)
Consultant Nutritionist
http://mercynutritioncorner.blogspot.com
kennethmercy@yahoo.com
+234 806 134 4343

Tuesday, 3 February 2015

FOOD AND NUTRITION SECURITY IN NIGERIA



Food, one of the basic necessities of life is needed for the sustenance of life. Thus, the goal of a good government especially on agricultural transformation is the attainment of food sufficiency through the promotion and implementation of good agricultural programmes. Nigeria, like every other developing country since independence struggles to provide sufficient food for her citizen. Nigeria with about 140 million people (2006, Population Census) is facing a deepening food crisis.

Food Security and its manifestations in Nigeria: In the Agricultural Trade Development
Assistance Act of 1990, it is seen as “access by all people at all times to sufficient food and nutrition for healthy and productive life”. USAID Bureau for Africa sees food security as a situation “when all people at all times have access to sufficient food security to meet their dietary needs for a productive and healthy life.
Food security was defined in the 1974 by World Food Summit as “availability at all times of adequate world food supplies of basic foodstuffs to sustain a steady of expansion of food consumption and to offset fluctuations in production and prices”.
In 1983, FAO expanded its concept to include security access by vulnerable people to available supplies, implying that attention should be balanced between the demand and supply side of food security equation. This definition was again refined in the Food Security 2000 as “ a situation that exists when all people at all times have physical, social and economic access to sufficient, safe and nutrition food that meet their dietary needs and food preferences for an active and healthy life.
 There are four dimensions to this: (i) availability of sufficient amount of food which is a function of food production (ii) stability of supply over time which depends on the ability to preserve/store produced food and supplement available food through imports if necessary (iii) access to the available food which depends on income levels and its distribution and (iv) food utilization which encompasses procurement, ingestion and digestion all of which are dependent on nutritional quality, education and health.
  The Understanding of any concept/topic starts with definition of terms.
Food: This is any substance, solid or liquid which when ingested and absorbed gives nutrient to the body
 Nutrition: This is the science of food and its constituents, as to how it is being ingested, digested, absorbed and utilized in the body to promote optimum growth and development.
Concept: this can be said to be an idea, strategy or plan to achieve a desired goal.      
 ISSUES FACING FOOD AND NUTRITION IN NIGERIA
Since the beginning of colonial rule, shortage of food in Nigeria has become more recurrent to the extent that at present, it has reached a stage of crisis. This has manifested in various forms such as stagnation in agricultural production, the growing dependence on food importation, increasing and prohibitive food prices, low nutritional standards and so on. Agriculture which was the backbone of Nigerian economy at independence began to decline owing to the increased importance of oil in the economy in the 1970s and 1980s even up till today. It is very pathetic that Nigeria which was an exporter of food in the 1960s became a net importer of food in the 1970s.
This was due largely to the neglect of the agricultural sector. The contribution of agricultural sector to the country’s GDP has continued to drop.  For example, the GDP dropped from 63% in 1960 to 12.6% in 1982. In the area of food production, the story has been one of stagnation and decline. For instance, in 1960, food production grew at almost 4% per annum compared with an annual population growth of about 3% between 1960 and 1967
From that time up till 1970, food situation in the country has worsened to the extent that it dropped to a net -15% between 1970 and 1977. The implication of the high food import bill was that substantial portion of the much needed foreign exchange meant for importing capital goods for developmental purposes were spent on food importation. Despite the two major agricultural policies of Operation Feed the Nation and Green Revolution Programme launched in 1976 and 1980 by Gen. Olusegun Obasanjo and Alhaji Sheu Shagari respectively to increase food production, attainment of self-sufficiency in food supply and self-reliance in food production, the situation was far from being abated.   
Even as at today, the situation has not changed. This is observed from the statement of the CBN Governor, Mr. Lamido Sanusi when he spoke at the Northern Nigeria Economic Summit organized by the Northern Political Summit Group otherwise known as “G20” at Kaduna that Nigeria spent ₦155 billion on rice importation in 2010. While presenting the Lead paper titled “Mobilizing Capital for Transformation of Northern Nigeria”, he wondered why Nigeria should be a major importer of rice when it had good climate and resources to produce staple food locally.
The escalation of food prices, severe food scarcity and poor harvest losses are another major aspects of the manifestation of food insecurity in Nigeria is food insecure because domestic aggregate production of food grows at slower rate than the population. He therefore opined that Nigeria’s food production was not balance since demand side was greater than the supply side. The Nigerian Minister of Agriculture and Rural Development, Prof. Sheikh Abdullah disclosed in an interview with the New Agency of Nigeria in Abuja on Thursday 5th May, 2011 on the global food price increases which he hinged on some factors among which were, high population growth, low income, land constraints and under investment in rural infrastructure, poor agricultural mechanization and limited farmer’s access to agricultural inputs. He also said that due to this development, some states in the country recorded poor harvest occasioned by natural disasters such as flooding, inadequate farm input and declining interest in agriculture, particularly among youths. He submitted that the high cost of food constitutes an “inherent” danger to nation security and thus the need to address the threat was urgent because of its contribution to the GDP and employment opportunities.
Food nutrition is another aspect of the manifestation of food insecurity in Nigeria. This can be measured through the use of calorie, protein and vitamins intake per day per person. In 1997, the UNDP reported that the average daily calorie intake in Nigeria was 2125kcal which was less than the daily recommended average of 2550kcal minimum standard. Egbuna, 2001 also emphasized that other food values such as protein, vitamin and minerals also fall below the component dietary requirement in Nigeria. Food security situation has not improved in Nigeria despite previous government efforts because of some factors among which is the ineffective and inconsistency in agricultural food policy.


     SOME FOOD AND NUTRITION POLICIES AND PROGRAMMES IN NIGERIA    
The River Basin Development Authority (RBDA): was first conceived in 1963 with the involvement of the Lake Chad Basin and River Niger Commissions for countries bordering on Lake and the Niger River. The concept was first tried in 1973 with the establishment of the Sokoto-Rima and the Chad Basin Development Authorities. Eleven others were set up under Degree Nos 25 and 31 of 1976 and 1977 respectively all over the country. These were Sokoto-Rima (for Sokoto), Hadjia-Jamare (for Kano), the Chad (for  Borno), the Upper Benue (for Gongola), the Lower Belt (for Benue and Plateau), the Cross River (for Cross River), the Ogun-Osun (for Oyo, Ogun and Lagos), the Benin-Owena (for Bendel and Ondo) and the Niger Delta (for Rivers).  The RBDA was expected to cater for the development of land and water resources potentials of Nigeria for agricultural purposes and general rural development. The RBDA did not yield much result. If they did, the federal military government that came on board would not have ordered their fold-up. The activities of RBDA were hindered as a result of inadequate planning data, shortage of funds, difficulties in securing land for development especially in the South, shortage of qualified and experienced technical and professionals.
 Operation Feed the Nation (OFN)
In 1976, Operation Feed the Nation (OFN) was launched by Obasanjo regime for the purpose of increasing food production and attaining self-sufficient in food supply. People were encouraged to grow their own food irrespective of their occupation. Government made effort to subsidized essential farm inputs like fertilizer, livestock feed, pesticide, farm implements among others. The effect of OFN as a development strategy was not as profound as it initiators may want people to believe. The programme, although succeeded in creating awareness to the citizenry about food shortage and how to fight against the problem, the programme did not actually achieved its set goals due to poor implementation and funding. Besides, the subsidized fertilizers meant for farmers got into wrong hands. 
Green Revolution Programme
The Green Revolution Programme was launched in 1980 following the return to civil rule after thirteen years of military interregnum under the leadership of President Alhaji Shehu Shagari. The objective of the programme was centred on self-reliance in food production and the diversification of Nigeria’s sources of exchange. The programme covered all areas of agricultural production, food and export crops, livestock, fisheries and forestry.
The programme provides generous supply of fertilizers, which the construction of rural physical infrastructures were embarked upon through massive federal funds allocation. The programme recorded some positive results as there was increase in cultivated land hectares, livestock, forestry and fishery production. The effect of the achievements of the programme was short-lived due to shortage of funds, mismanagement and fraud, poor and lack of thorough research and extension services, problem of land acquisition, inadequate data, and lack of infrastructural facilities.    Structural Adjustment Programme (SAP)
Between 1986 and 1993, a number of programmes were introduced by General Babangida regime to support agricultural development. They were, first, the Structural Adjustment Programme (SAP), which was meant to deregulate and stimulate local production. Though SAP in principle was a good programme, the then government was not committed to its faithful implementation, and second, the Directorate of Foods, Roads and Rural Infrastructure (DIFRRI). DIFRRI was a laudable programme which was aimed at alleviating poverty and hunger. The purpose of DIFRRI was to open-up rural areas, construct feeder roads and bridges, water supply among others which in turn would help to promote agricultural development. The programme eventually failed because the officials in charge of it became corrupt and thus the programme lost its focus.
Government budget for agriculture over the years by successive governments is an indication that frantic effort has not been made to tackle the problem of food security in the country. Poor funding is said to be one of the major problems which hindered the successful implementation of various agricultural policies and programmes that have been formulated in the country.
Another major reason for lack of successful implementation of some agricultural policies geared towards food sufficiency in the country is mismanagement. Nigeria is blessed and endowed with fertile land for agricultural development.
Various regimes in the country over the years were guilty of awarding contracts and making payment while concrete efforts were not made to adequately supervise and monitor such projects. Sincerely, majority of the projects are either abandoned or uncompleted
It is abundantly clear from the above discourse that over the years, Nigeria has been battling with problem of food sufficiency. Despite various policies and programmes being formulated to tackle the perennial food crisis, the situation is far from being abated. The ugly situation is hinged on the absence of good governance which manifests itself in various forms such as corruption, mismanagement, lack of political leadership, maladministration, and so on. Good governance considering its characteristics and principles is critical to the attainment of food sufficiency in Nigeria. The absence of good governance over the years has been the bane of food security in the country.

ENERGY EXPENDITURE DURING RE-FEEDING AND ENERGY IMBALANCE



ENERGY EXPENDITURE DURING RE-FEEDING AND ENERGY IMBALANCE
 Perturbations in energy balance underlie the most common public health nutrition problems today. In the United States, 68% of adults and 35% of children are now overweight or obese. The prevalence of obesity is also increasing in developing countries, where under nutrition has traditionally been the primary nutrition challenge and remains prevalent. For example, the prevalence of obesity has increased recently in both Brazil and China, especially in urban areas but also in very low - income families such as those living in shanty towns. In addition to being associated with increased risks of type 2 diabetes, osteoarthritis, angina, and hypertension, obesity is also associated with premature death and increased health care costs. The estimated number of deaths attributable to obesity in the United States alone is 300,000 per year.  The excess weight gain that accumulates in obesity results from energy intake exceeding energy expenditure over a considerable period of time and has both genetic and environmental origins. This positive energy balance can occur because energy expenditure is low or energy intake is high, or a combination of these two factors. The importance of energy expenditure is suggested by several prospective studies showing that low energy expenditure is a risk factor for excess weight gain, and mechanistically may result from the effects of energy expenditure on both energy requirements and insulin sensitivity. In addition, the fact that excess energy intake is important, at least in the United States, is suggested by national survey statistics showing that per capital energy availability (adjusted for spoilage and waste) has increased over the past 20 years.