Paper No. :  16 Applied Anthropology 
                         Module     : 03 Nutrition  epidemiology 
                                                                                                                                                                                                                                             
                          
                                                                           Development Team 
                                                                                                                                                           
                             Principal Investigator               Prof. Anup Kumar Kapoor                                         
                                                                                                       
                                                                               Department of Anthropology, University of Delhi 
                                                                                                        
                                                                                                       
                             Paper Coordinator                                 Dr. Rashmi Sinha                                                             
                                                                                                        
                                                                               Faculty of Anthropology, School of Social Sciences, 
                                                                               IGNOU, Delhi   
                                                                                                      
                             Content Writer                                    Ms. Kshetrimayum Surmala Devi & Dr. Meenal Dhall                                                                                            
                                                                                                       
                                                                               Department of Anthropology, University of Delhi 
                                                                                                       
                                                                                                       
                                                                               Dr. Satwanti Kapoor (Retd Professor)                                        
                              Content Reviewer                                   
                                                                               Department of Anthropology, University of Delhi 
                                                                                                       
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                                                       Nutrition  epidemiology 
                 Anthropology                           
                        
                        
                                                                  
                                                                                                              
                                                    Description of Module 
             Subject Name         Anthropology 
             Paper Name           Applied Anthropology 
             Module Name/Title    Nutrition  epidemiology 
             Module Id            03 
               
              Contents: 
              1. Introduction 
              2. History of nutritional epidemiology 
              3. Nutritional deficiency diseases 
              3.1. Malnutrition  
                  3.1.1. Protein energy malnutrition (PEM) 
                  3.1.2. Kwashiorkor 
                  3.1.3. Marasmus   
              3.2  Micro-nutrient malnutrition  
                  3.2.1. Iron Deficiency Anaemia (IDA) 
                  3.2.2. Vitamin A Deficiency (VAD) 
                          3.2.2.1. Night Blindness (XN) 
                          3.2.2.2. Conjunctival Xerosis (X1A) 
                          3.3.2.3. Bitot’ Spot (X1B) 
                          3.3.2.4. Corneal Xerosis (X2) 
                          3.3.2.5. Cornea Ulceration (X3A) 
                          3.3.2.6. Keratomalacia (X3B) 
                   3.2.3. Iodine Deficiency Disorders (IDD) 
                   3.2.4. Water soluble vitamin deficiency disorders 
                        3.2.4.1. Thiamine (Vitamin B1) Deficiency Diseases  
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                                 Nutrition  epidemiology 
          Anthropology            
               
               
                                                                                                            
                                                                                                                                                                                     
                                            3.2.4.2. Riboflavin (vitamin B12) Deficiency Diseases 
                       3.3. Nutrition and Non Communicable Diseases (NCDs) 
                               3.3.1. Obesity  
                               3.3.2. Type 2 diabetes 
                               3.3.3. Coronary heart disease (CHD) 
                        
                       Learning Objectives: 
                       To understand: 
                             1.  Definitions and concepts of nutritional epidemiology. 
                             2.  Deficiency diseases due to suboptimal intakes of micronutrients and its dietary management. 
                             3.  Non  Communicable  Diseases  (NCDs)  due  to  excessive  intakes  of  macronutrients  (over 
                                   nutrition) and its dietary management. 
                        
                       Introduction  
                       The word epidemiology comes from two Greek words epi, meaning on or upon, demos, meaning 
                       people, and logos, meaning the study of. Several definitions have been proposed, but the underlying 
                       principles  and  public  health  spirit  of  epidemiology  following  is  define  by  the  following. 
                       “Epidemiology is the study of the distribution and determinants of health-related states or events in 
                       specified populations, and the application of this study to the control of health problems”.  
                       Nutritional epidemiology studies the role of food and nutrition and in relation to disease in human 
                       populations. Nutritional epidemiological research involves the role of food and nutrition in etiology of 
                       diseases, assess and monitor the food consumption and nutritional status of populations, measures to 
                       prevent, control and improvement of health, develop interventions in order to maintain healthy eating 
                       lifestyle and also to analyze the association of nutrition and physical activity in relation to diseases. 
                        
                       History of nutritional epidemiology 
                       Epidemiology  is  the  study  of  the  distribution  and  frequency  of  diseases  in  human  populations.  
                       Nutritional epidemiology examines the association of diet and our health.  Earliest epidemiological 
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                                                       Nutrition  epidemiology 
                 Anthropology                           
                        
                        
                                                                                                            
                                                                                                                                                                                     
                       investigation  dates  back  to  more  2000  years  ago,  when  Hippocrates  conducted  a  clinical  trial  to 
                       observe the cause of a disease and belief in notion that health depends on magical influence. Lind in 
                       1753 observed that scurvy was caused by deficiency of vitamin C when he conducted one of the 
                       earliest  clinical  trials  with  lemons  and  oranges.  Milestones  in  classic  epidemiology  include  John 
                       Snow’s (1813-1858) who studied the spread of cholera due to of polluted water, and suppresses the  
                       outbreaks of the disease 44 years even  before the discovery of , the causal agent Vibrio cholera. 
                       Casimir Funk in 1912 investigated that deficiency of substances which he called “vitamins” may cause 
                       diseases such as sprue, beriberi, rickets, pellagra etc. 
                       Another  epidemiological  investigation  of  19th  and  20th  century  include  Joseph  Goldberger  who 
                       observed the occurrence of pellagra among poor relying on as staple diet. He suspected the disease 
                       could be due to nutritional deficiency. It was later identified as deficiency of niacin, a B-complex 
                                                                                                                                           th
                       vitamin (B3). With the discovery of microorganisms, at the end of the 19  century mark the era of 
                       infectious disease epidemiology. Robert Edward Koch work on the etiology of tubercle bacillus in 
                       1882 resulted in improved environmental conditions and interventions for preventing transmission of 
                       certain  microorganisms.    Epidemiological  observation  thus  has  provided  the  insight  into  the  diet-
                       disease relationship and the cause and prevention of diseases. Earlier epidemiologist focused on the 
                       etiology of infectious diseases but since early decades of 20th century, they shifted to chronic disease 
                       and remarkable contribution have made to the understanding of nutrition-related diseases as well. Band 
                       and Dyerberg studied coronary disease in Eskimos and observed that it was uncommon despite their 
                       high fat diet and later found that omega -3 fatty acid from fish oil is responsible for low plasma lipid 
                       level in their diet. Hospital based case control study in 1950 showed that smoking was associated with 
                       lung cancer. So, epidemiology play an increasingly important  role and its evolution has led to the 
                       development of specialized areas like environmental, clinical, psychiatric, genetic, occupational within  
                       the epidemiology. 
                        
                       Nutrition and health related diseases 
                       In developed countries excessive intakes of macronutrients (over nutrition) and suboptimal intakes of 
                       micronutrients (hidden hunger), lead to obesity and related non-communicable diseases (NCDs). There 
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                                                       Nutrition  epidemiology 
                 Anthropology