University of Toronto Department of Nutritional Sciences NFS 490H1S INTERNATIONAL AND COMMUNITY NUTRITION Winter 2013

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NFS 490 International and Community Nutrition

1

University of Toronto

Department of Nutritional Sciences

NFS 490H1S INTERNATIONAL AND COMMUNITY NUTRITION

Winter

201
3


Course Description



This course focuses on current issues in international and community nutrition and will
consider relevant environmental, political, cultural and social
determinants of health.

A
selection of topics including obesity and chronic disease prevention, micronut
rient
deficiencies, maternal and infant nutrition,
aboriginal nutrition issues
, and food security
will be addressed. Examples of both global and local approaches will highlight the
complex considerations involved in addressing these issues.


Location


SS
2110


Lectures


Tuesday 9:
10

a.m.
-
noon
.



Course
Instructors


Ann Fox
,
MHSc,
PhD
, RD

Department of Nutritional Sciences

Room
141

FitzGerald B
uilding


Christine Hotz, PhD

Consultant, Nutridemics

Room
140

Fitzgerald Building


Office hours:

Christine Hotz:
Tuesday, 1:
30
p.m.


3:
30
p.m.

Ann Fox: Thursday 1
-
4pm or by appointment

E
-
mail:
ann.fox@utoronto.ca
,
christine.hotz@utoronto.ca



Teaching Assistants

Rachel
Loopstra

Ellen Bolden






NFS 490 International and Community Nutrition

2


Course Objectives


This course is intended to promote a better understanding and appreciation of the
complexity, the relative significance and interaction of factors affecting food availability,
dietary quality,
acceptability
,

an
d
consumption

in the global and local community along
with
the

potential health
, nutritional

and environmental consequences
.

Students
will be
exposed to a selection of local and international programs and will begin to consider the
ethical and efficacy i
ssues associated with planning, implementing and evaluating such
approaches.

Specifically, students will
demonstrate knowledge of
:




The social determinants of health



Difference between individual and population nutritional status



The current state of
local

and global f
ood security



Dietary quality and the g
lobal

burden of malnutrition



Current strategies to manage and
prevent

micronutrient deficiencies



O
ptimal infant feeding practices and barriers to their successful implementation



The role of food policy in health and nutrition



Contributing factors and consequences of household food insecurity in Canada



Strategies for promoting community food security



The epidemiological and nutrition transition in the developing world



Obesity and
chronic disease prevention st
r
ategies



Course Schedule


Week

Date

Topic

Speaker/facilitator

1

Jan 8

1)
Course Overview & Introduction

2) Population vs. Individual

Approaches

3) Using
epidemiological
tools and
monitoring



A.
Fox &
C.
Hotz

2

Jan

15

1)

Determinants of Health


A. Fox

3

Jan 22

1)

Approaches and strategies for
enhancing nutritional health of
populations

2)

How to write briefing notes


A. Fox

4

Jan 29

1)

Maternal and Infant Nutrition:
overview and international
perspectives


2)

Promoting breastfeeding

C. Hotz




E
lizabeth

Sterken


NFS 490 International and Community Nutrition

3


3)

Healthiest Babies Possible Program



(InFACT)

Diane Birch

(Toronto Public
Health)
,
RD

5

Feb 5


Diet Quality


part one


1) Food/agricultural based strategies



Agriculture
-
Nutrition strategies



Biofortification



Dietary Diversification


2) Food fortification


C. Hotz

6

Feb 12

Diet
Quality



part two


3) Supplementation


Case 1
-

Micronutrient sprinkles in Africa


Case
2
-

Preventing spinal cord defects in
Canada

through flour fortification with
folic acid

C. Hotz




A
shley

Aimone



D
ebbie

O’Connor



Feb 19

Reading week



7

Feb 26

1)

Population food security (World
Vision perspective)


2)

Household and c
ommunity food
security

David Mbugua



Rachel Loopstra

Valerie Tarasuk

8

March 5

Obesity and Chronic Disease Prevention


1)

The under/over nutrition paradox

Case: Mexico as an example


2)

School nutrition policy


3)

Social marketing and policy
approaches
-

sodium reduction in
Canada





C. Hotz



Sielen Raoufi,

RD


Joanne Arcand

9

March 12

Aboriginal Health

Kue Yung

Jessica Dutton


10

March 19

Group Debates

Students

11

March 26

Group Debates

Students

12

April 2

Group Debates

Students



NFS 490 International and Community Nutrition

4

R
eference Materials


There is no assigned textbook for this course. Links to
readings found in e
-
journals are
posted on the course website

(see “
Course
Readings” on
the
Blackboard
course
menu).

Any reading
not available on
-
line
will be
available in Short
-
Term Loan at the Gerstein
Science and Information Library.

Additional readings may be assigned from time to
time during the course.
An additional list of relevant reference documents will also be
made available, to be consulted as needed for assignments.
Students are responsible for
all
readings
, audiovisuals
and other
material covered in class

unless otherwise instructed
.





E
valuation



1.

Briefing Notes

(40%)
:



At the end of classes 4
-
9, the instructor(s) will provide the class with a question related to
the topics covered in that class. Each student is expected to use the format described at
the beginning of the course, to compile a 2 page briefing note that add
resses the question
posed. Students are expected to engage with the assigned readings,
class presentations,
and student input during class to compile their notes. Additional research may be
necessary to complete the note. Each note is due at the beginning
of the following class.
Students must submit f
our

out of the six notes assigned.


2.

Group Debate Presentation

and Summary
(40%):


In groups of 4, students will
prepare and
present a
n oral

debate for the
class on a topic
chosen from a

list
.

Topics will be chosen by signing up on Blackboard on a first
-
come
first
-
served basis. Each
group will form two
team
s

of
four

students
, with each team
presenting opposing viewpoints on the chosen topic
.
Viewpoints must be justified based
on existing evide
nce in the literature and refer to any relevant program policies.
The
debate format provided must be followed. Time limits will be strictly adhered to.
Prior to
the debate
, e
ach team will provide the instructors and the class with a one page written
summa
ry of their position
including

3
-
5 key references that support
t
heir position
and

provide substantive background/context to

the

issue being debated.

Students are expected
to work together in their teams to prepare the debate material
s
.


3.

Debate Responses

(20%)
:



At the end of each debate, each
non
-
debating
student will
complete a summary
evaluation on the form provided

that explains which
team

s/he

feel
s

won the debate and
why.

Each summary will be submitted during the class in which the debate is held
.

These
summaries

will be evaluated collectively based on the overall quality of submissions. A
quality submission is one
which

is well written,
clearly presented,
reflects sound
reasoning,
demonstrates
critical thought, incorporates other course material, and
shows

engagement with the debate topic. Marks will be deducted for each response that is not
submitted.



NFS 490 International and Community Nutrition

5


L
ate Penalties and Extensions




A lateness penalty will apply to overdue
course work inclu
ding individual papers and
group

project
s

(
5
% reduction in the final mark for each day of lateness including
weekend days).
As
signments
submitted on the due date, but after class, wil
l receive a
one
-
day late penalty
.

Late assignments should be dropped of
f in 316 FG. Make sure to
have

one of the office staff stamp
late assignments with the date received.
Extensions on
due dates will be granted
only
on the basis of appropriate documentation such as a
medical certificate
.

Late presentations of the debate wi
ll not be permitted without prior
consent of the instructor(s).


A
cademic Honesty




Academic honesty is a serious offense and will be dealt with accordingly.
Most cases of
plagiarism are unintentional. That is, they occur because students

1)
do not

use correct
citation methods
;

2) “cut and paste” material from sources then either neglect to use
quotation marks or do not paraphrase
and cite
properly
;

3) leave assignments to the last
minute and do not check material for possible plagiarism. Whether i
ntentional or
unintentional, the penalties for plagiarism remain the same. S
tudents are expected to
adhere to university regulations regarding academic honesty. For details

regarding
academic offenses
, students should refer to the


Code of Behaviour on A
cademic
Matters”

at:
www.governingcouncil.utoronto.ca/policies

Students should also refer to the handout “How Not to Plagiarize” by Margaret Proctor,
Ph.D., Coordinator of Writing Support, Un
iversity of Toronto

available at
:

www.wrditing.utoronto.ca/advice/using
-
sources/how
-
not
-
to
-
plagiarize





U
niversity of Toronto Accessibility Policies


All s
tudents
with the stated pre
-
requisites
are welcome in this course

on a first
-

come,
first
-

serve basis, space permitting
. I
f

you
require accommodation for a
disability or
health need
,
please
contact the instructor or
Accessibility Services as soon as possible.
Sta
ff at Accessibility Services

are available by appointment to assess specific needs,
provide referrals and arrange for appropriate accommodations. The sooner you let them
and
/or
the instructor know your needs, the
sooner you will be assisted.


www.accessibilitgy.utoronto.ca


P
rint Double
-
Sided Initiative



In support of the Print Doublesided Initiative launched at the University of Toronto in
June 2009, you are asked to please conserve paper by printing a
ll assignments double
-
sided. For instructions, go to
http://printdoublesided.sa.utoronto.ca/





NFS 490 International and Community Nutrition

6


A
ssigned Course Readings


January 8:

Population vs. Individual Health, Epidemiological Tools and
Monitoring



Etches V, Frank J, DiRuggiero E and Manuel D. Measuring Population Health: A Review
of Indicators. Ann Rev Public Health, 2006; 27
-
29
-
55.

http://simplelink.library.utoronto.c
a/url.cfm/331608


MacDougall H. Reinventing Public Health: A New Perspective on the Health of
Canadians and its International Impact. J Epidemiol Community Health 2007; 61:955
-
959.


http
://simplelink.library.utoronto.ca/url.cfm/331609


Black RE, Allen LH, Bhutta ZA, et al. Maternal and child undernutrition: global and
regional exposures and health consequences. Lancet 371: 243
-
260; 2008.

http://simplelink.library.utoronto.ca/url.cfm/331611


January 15:

Determinants of Health


The Social Determ
ina
n
ts of Health

-

25 resources to support your work. November 2012.

http://healthnexus.ca/index_eng.php


Raphael D (Ed). Introduction to the social determinants of health
.

I
n
:

Soci
al Determinants
of Health, 2004;

pp.
1
-
8.

Link to ebook record in catalogue:
http://go.utlib.ca/c
at/8066243


Raine KD. Determinants of healthy eating in Canada. Canadian Journal of Public Health
2005;96(supplement 3):S8
-
S14.

http://simplelink.library.utoronto.ca/url.cfm/331612


Pow
er E. Determinants of h
ealthy eat
ing among low i
ncome Canadians. Canadian
J
ournal of Public Health
: Understanding the Forces that Influence
our Eating Habits
.
96:
S37
-
42, S42
-
8
; 2005
.

http
://simplelink.library.utoronto.ca/url.cfm/331614


Rozin P. The meaning of food in our lives: a cross
-
cultural perspective on eating and
well
-
being. Journal of Nutrit
ion Education and Behavior
37:S107
-
S112
; 2005
.

http://www.sciencedirect.com.myaccess.library.utoronto.ca/science/article/pii/S1499404606602091#




NFS 490 International and Community Nutrition

7

January 22:

Strategies and Approaches, Briefing
Notes


Saksvig B, Gittelsohn J, Harris S, Hanley A, Valente

T
, Zinman B.

A pilot school
-
based
healthy eating and physical activity intervention improves diet, food knowledge, and
self
-
efficacy for native Canadian children.
Journal of

Nutr
ition

135:
2392
-
239
8
; 2005
.

http://simplelink.library.utoronto.ca/url.cfm/163193


Lask
a

M,
Hearst M, Forsyth A, Pasch K, Lytle L.

Neighbourhood food environments: are
they associated with adolescent dietary

intake, food purchases and weight status?
Public Health Nutrition

13
:
1757
-
1763
;
2010
.

http://simplelink.library.utoronto.ca/url.cfm/163195


Tester J, Yen I, Pallis L, Laraia B.

Healthy food availability and participation in WIC
(Special Supplemental Nutrition Program for Women, Infants and Children) in food
stores around lower
-

and higher
-
income elementary schools.
Public Health Nutrition

14:

960
-
964
;
2010
.

http://simplelink.library.utoronto.ca/url.cfm/163227


Glanz

K, Lankenau B, Foerster S
, Temple

S, Mullis R, Schmid

T. Environmental and
policy approaches to cardiovascular disease prevention

through nutrition: Opportunities
for state and local action.

Health Education Quarterly
,
22
:

512
-
527
;
1995
.

http://simplelink.library.utoronto.ca/url.cfm/163229


Carlisle S. Health promotion, advocacy and health inequalities: A conceptual framework.
Health Promotion International

15
:

369
-
376
;
2000
.

http://simplelink.library.utoronto.ca/url.cfm/16
3232




January 29
:

Maternal and Infant Nutrition


Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera
J
. Maternal and child undernutrition: global and regional exposures and health
consequences.
The Lancet 371:
243
-
260
; 2008
.

http://simplelink.library.utoronto.ca/url.cfm/331869


ADA Reports. Position of the American Dietetic Association: Promoting and supporting
breastfeeding. Journal of the Ame
rican
Dietetic Association

109
:
1926
-
1942
; 2009
.

http://simplelink.library.utoronto.ca/url.cfm/331870


Kramer MS. “Breast is best”:The evidence. Early

Human Development
86:729
-
732
;
2010
.

http://simplelink.library.utoronto.ca/url.cfm/331871



NFS 490 International and Community Nutrition

8


Bhutta ZA, A
hmed T, Black RE,

Cousens S, Dewey K, Giugliani E, Haider BA,
Kirkwood B, Morris SS, Sachdev HPS, Shekar M
. What works? Interven
tions for
maternal and child undernutrition and survival.
The Lancet 371:
417
-
440; 2008.

http://simplelink.library.utoronto.ca/url.cfm/331873


Lutter C
K, Daelmans BM, de Onis

M, Kothari MT, Ruel MT, Arimond M, Deitchler M,
Dewey KG, Blossner M, Borghi E
. Undernutrition, poor feeding practices, and low
coverage of key nutrition interventions. Pediatrics 128:1418
-
1427; 2011.

http://pediatrics.aappublications.org.myaccess.library.utoronto.ca/content/128/6/e1418


Desjardins E, Hardwick D. How many visits by health professionals are needed to make a
difference in low birthweight? A

dose
-
response study of the Toronto Healthiest Babies
Possible Program. Canadia
n Journal of Public Health 90:
224
-
228; 1999.

http://search.proquest.com.myaccess.librar
y.utoronto.ca/docview/232012156




February 5
:

Diet Quality Part 1


Masset E, Haddad L, Cornelius A, Isaza
-
Castro J. Effectiveness of agricultural
interventions that aim to improve nutritional status of children: systematic review.
British Medical
Journal 344:d8222; January 17, 2012.

http://www.bmj.com.myaccess.library.utoronto.ca/content/344/bmj.d8222


Bouis HE, Hotz C, McClafferty B, Meenakshi JV, Pfeiffer W. Bio
fortification: A new
tool to reduce micronutrient malnutrition. F
ood and Nutrition Bulletin 32
:
S31
-
S40;

2011.

http://nsinf.publisher.ingentaconnect.
com/content/nsinf/fnb/2011/00000032/A00101s1/art00005


Arimond M, Ruel MT. Dietary diversity is associated with child nutritional status:
evidence from 11 Demographic and Health Surveys. Journal of Nutrition 134:2579
-
2585;

2004.

http://simplelink.library.utoronto.ca/url.cfm/331880


Nathoo T, Holmes CP, Ostry

A. An analysis of the development of Canadian food
fortification policies: the case of vitamin B. Health Promotion International 20:375
-
382;

2005.

http://simplelink.library.utoronto.ca/u
rl.cfm/331882


Lynch SR. Why nutritional iron deficiency persists as a worldwide problem. J
ournal of

Nutrition 141: 763S
-
768S; 2011.

http://simplelink.library.utoronto.ca/url.cfm/331883





NFS 490 International and Community Nutrition

9

February 12:

Diet Quality

Part 2


Stoltzfus RJ. Iron interventions for women and children in low
-
income countries. J
ournal
of

Nutrition 141: 756S
-
762S; 2011.

http://simplelink.library.utoronto.ca/url.cfm/331895


Zlotkin et al. Micronutrient sprinkles to control childhood anaemia. PloS Medicine
January 25, 2:24
-
28; 2005.

ht
tp://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020001


Nordin S. Sustainable super
-
sprinkle: Powdered local foods. PLoS Med
icine

2(7): e188;
2005.

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0020188


Zlotkin SH, Schauer C, Christofi des A, Sharieff W, Tondeur MC, et al. Authors’ reply:
Sprinkles as a home fortifi cation strategy to improve the quality of complementary

foods. PLoS Med
icine

2(7): e202; 2005.

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0020202


Crider KS, Bailey LB, Berry RJ. Folic a
cid food fortification


its history, effect,
concerns, and future directions. Nutrients 3:380
-
384; 2011.

http://www.mdpi.com/2072
-
6643/3/3/370



February 19
:

Reading Week



February 26
:

Food Security


Godfray
HCJ, Beddington JR, Crute IR, Haddad L, Lawrence D, Muir JF, Pretty J,
Robinson S, Thomas SM, Toulmin C
. Food security: the challenge of feeding

9 billion
people. Science
327:812
-
818
; 2010
.

http://www.sciencemag.org.myaccess.library.utoronto.ca/content/327/5967/812


Rosegrant MW, Cline SA. Global food security: challenges and policies. Science
302:1917
-
1919; 2003.

http://www.sciencemag.org.myaccess.library.utoronto.ca/content/302/5652/1917


Power E. Individual and household food insecurity in Canada. Position of Dietitians of
Canada.
Can
adian
J
ournal of

Diet
etic

Prac
ti
ce

and
Res
earch 66
:43
-
46
; 2005
.

http://www.sciencemag.org.myaccess.library.utoronto.ca/content/302/5652/1917




NFS 490 International and Community Nutrition

10

Kirkpatrick SI, Tarasuk V. Food insecurity and partic
ipation in community programs
among low
-
income Toronto families. Canadian Journ
al of Public Health 100
:
135
-
139
;
2009
.

http://search.proquest.com.myaccess.library.utoronto.ca/docview/232010070/13B7B8393F22990
E0EC/1?accountid=14771


Tarasuk V. Policy directions to promote health dietary patterns in Canada. Applied
Physio
logy Nutrition
and
Metabolism

35:229
-
233
; 2010
.

http://www.nrcresearchpress.com.myaccess.library.utoronto.ca/doi/abs/10.1139/H10
-
009#.UOswHll
-
FdY




March 5
:

Obesity and Chronic Disease Preve
ntion


Rivera JA, Barquera S, Gonzal
ez
-
Cossio T,
Olaiz G, Sepulveda J
. Nutrition transition in
Mexico and other Latin American cou
ntries. Nutrition Reviews 62
:
s1
-
s9; 2004.

http://onlinelibrary.wiley.com.myaccess.library.utoronto.ca/doi/10.1111/j.1753
-
4887.2004.tb00086.x/abstract


Popkin

BM. Contemporary nutritional transition: determinants of diet and its impact on
body composition. Proc
eedings of the

Nutr
ition

Soc
iety

70:82
-
91; 2011.

http://resolver.scholarsportal.info.myaccess.library.utoronto.ca/resolve/00296651/v70i0001/82_c
ntdodaiiobc


Lobstein T. Child obesity: what can be done and who will do it? Proceeding
s of the
Nutrition Society
67:301
-
306
; 2008
.

http://resolver.scholarsportal.info.myaccess.library.utoronto.ca/resolve/00296651/v67i0003/301_
cowcbdawwdi


Friel S, Chopra M, Satcher D. Unequ
al weight: equity
-
oriented policy responses to the
global obesity epidemic. British Medical Jou
rnal
335:1241
-
1243
; 2007
.

http://www.jstor.org.myaccess.library.utoronto.ca/stable/20508511


Ludwig DS, Nestle M. Can the food industry play a constructive role in the obesity
epidemic? Journal of the American
Medical Association 300
:1808
-
1811
; 2008
.

http://jama.jamanetwork.com.myaccess.library.utoronto.ca/article.aspx?articleid=182715


Dietitians of Canada. Current Issues: The Inside Story. An overview of school nutrition
policie
s in Canada. 2008

http://www.livinghealthyschools.com/pdf/2008/Current_Issues2.pdf


McKenna ML. Policy options to support healthy eating in schools. Canadia
n Journal of
Public

Health
Supplement 2:S13
-
S17
; 2010
.

http://search.proquest.com.myaccess.library.utoronto.ca/docview/763187190



NFS 490 International and Community Nutrition

11

March 12
:

Aboriginal Health


Kuhnlein H, Erasmus B, Cree
d
-
Kanashiro H, Englberger L, Okeke C, Turner N, Allen L,
Bhattacharjee L
. Indigenous peoples’food systems for health: finding interventions that
work. P
ublic Health Nutrition 9
:1013
-
1019
; 2006
.

http://resolver.scholarsportal.info.myaccess.library.utoronto.ca/resolve/13689800/v09i0008/1013
_ipfsfhfitw


Willows ND. Determinants of

healthy eating in Aboriginal Peoples in Canada. Canadia
n
Journal of Public Health
96(supp 3):S32
-
S36
; 2005
.

http://search.proquest.com.myaccess.library.utoronto.ca/d
ocview/232000077


Waldram JB, Herring DA, Young TK. Chapter 4. Aboriginal pe
oples and the health
transition
.
In
: Aboriginal Health in Canada. Historical, Cultural and Epidemiological
Perspectives, 2
nd

edition. Toronto: University of Toronto

Press;

2006
,

pp. 73
-
125
.
(
Supplementa
ry Reading)
, available in Short
-
Term Loan, Gerstein Library, RA
449W352006