News from Caribbean Association of Nutritionists and Dietitians (CANDi)
  • Nutrition for Infection in Adults and Children – Past Lessons

    With the shift in focus to obesity and chronic diseases, it is a re-awakening when infectious diseases again rear their heads. Although vector (mosquito) transmitted infections have always been with us, the epidemic of chikungunya (chikv) in 2016 made the medical profession review their treatment protocols. The scare of Zikv in 2018 again challenged us, indicating that our vigilance cannot be relaxed. This occurred simultaneously with the upsurge of infectious diarrhoea in babies causing deaths in hospital from protein energy malnutrition (PEM). This new influenza pandemic of covid-19 has never been experienced in this generation and our health sector personnel are stretched beyond local resources, despite the many WHO praises of their efficient handling of the systems in place. There is no known medical cure for these new viral diseases and nutrition is often overlooked.
    Viral transmitted infections and nutrition
    The role of nutrition in treating infections, was especially evident for the elderly, those with metabolic conditions and babies. It reminded us that it was the intensification of the nutrition programme in the 1970s and control of infections that eventually led to the reduction to negligible levels of PEM in children under 5 years of age. During the Chikv crisis, many elderly persons were hospitalized and died, and yet there is a case to be made for proper nutrition to contribute to the survival rate.
    On a personal level, my own 86 year old father was able to overcome the attack of chickv even while travelling from Kingston to Montego Bay (4½ hours) and back while ill, as he insisted on attending his grand-daughter’s wedding. This meant consistent nourishment by feeding and drinking of high calorie meals/feeds adjusted in consistency for the reduced appetite, and this led to his full recovery.
    Many persons recognized that hydration was important but selected to use the high potassium coconut water.  Perusal of the blood profile however, informed me that the sodium levels were exceptionally low relative to the potassium levels so that the reverse formula was warranted.  We knew that the chikv tended to aggravate already existing symptoms such as arthritic pain, and being hypertensive and on medication, the result was to intensify the effect of the medication in ridding the body of sodium.  The remedy was to reduce visible potassium intake from fruits, vegetables and fresh foods while adding salt source to the diet.  Another observation was the need for more vitamins such as A and B12 to supplement declining dietary sources. These lessons in treatment were repeated with subsequent cases referred to me, leading to positive results even for the elderly who were already hospitalized.
    Diarrhoea and other infections
    The temptation is to generalize nutrition treatment and information as if we are all the same. The above treatment is contrary to the high potassium feeds that would be more appropriate for children suffering with diarrhoea. It should be noted that individualization of nutrition assessment and treatment is just as important as individualization of medical assessment and treatment. In the community, babies and children at risk of malnutrition are subject to nutrition assessment and monitoring from birth.  The metabolic nutritionist or clinical dietitian in hospital should also be an integral part of the medical team and be included in all case consultations from the start.  Too often, medics ignore the need for nutrition intervention until it is too late. Data from the USA show that patients deprived of appropriate food in hospital, especially when kept too long on the drip, promotes or aggravates malnutrition and patients may die.

    The Future

    It is noteworthy, that many of our government hospitals have only general dietitians and the private hospitals are not even required to have dietitians. The feeding of patients in hospital is the purview of the nurses and is often erroneous and inappropriate, while the true dietetic specialists are not consulted.  Their expertise includes calculating individualized diets and especially high calorie, metabolic feeds for babies suffering with protein energy malnutrition. This condition should not have to lead to death.  Government hospitals should employ clinical dietitians separate from those involved as general dietitians or administrative dietitians and all private hospitals should be required to have consultant nutritionists.  The nutrition and dietetics profession is woefully understaffed in hospital and community practice and this must be remedied to achieve high quality medical care.
    RNutr. Patricia Thompson
     Caribbean – Jamaica

    Caribbean Nutrition Day 2020
    Caribbean Nutrition Day is orgnized on every 1st of June. The theme remains the same each year (Healthy Eating Active Living – HEAL); however, the tag line is changed. The Caribbean Association of Nutritionists and Dietitians (CANDi) is the organization responsible for spearheading the focus of Caribbean Nutrition Day. The topic of Caribbean Creativity became an important point for consideration to educate and promote the use of local foods and natural resources, especially during the COVID-19 crises.  The benefits of using locally available foods and resources are important to increase nutritional intake, boost immunity and overall wellness.
    The theme for 2020 is, therefore:
    "Healthy Eating, Active Living: Be Creative Caribbean Style!"
    The rationale behind the selected tagline this year were as follows:
    While CANDi is a professional association, its role in the Region involves community outreach. Therefore, as part of its health promotion and education efforts, information is shared, and activities are encouraged among the general public across the Caribbean.
    Numerous health practices in the Caribbean can be maximized to promote optimal nutrition, adequate exercise, and overall wellbeing. Thousands of visitors travel to the Caribbean to enjoy the natural health resources often taken for granted by citizens. So, each person is reassured that it is okay to embrace the nutritional and wellness benefits of locally grown as opposed to imported foods.     
    Individuals are encouraged to be adventurous and to try nutritious cuisines from across the Caribbean while enjoying national dishes by incorporating heart-healthy fats and oils. Persons are also encouraged to use the multi mix principle to obtain a good nutrient supply from combining different food groups.
    In addition, there are wonderful natural available resources such as the beach, cold river water, hot water springs, mineral baths and rich bentonite soil. Children in the Caribbean still sing, dance, and play games like hopscotch, skip rope, and "Chinese" skip (a game made from ropes of rubber-band where they jump in skilful array of movements). The Caribbean is also blessed with valuable heritage, music, and ways that evoke laughter and dance, thereby helping to improve overall mental health. 
    Some key messages are highlighted on the colourful flyer, and dietitians around the globe are invited to participate in available nutrition and wellness practices wherever they are. Planning to visit a Caribbean island of choice? Come and experience distinct Caribbean flavours!

    Dorothy M. Graham-Charles, PhD Candidate
    Board of Directors 2019 - 2021
    Caribbean Association of Nutritionists and Dietitians [CANDi]