|
||||||||||
|
||||||||||
CUBAN PROFESSIONAL LITERATURE - REVIEW ARTICLE The Need for Teaching
the Molecular Fundamentals ABSTRACT: Throughout the world, and especially in Latin America, nutritional disorders are among the primary causes of morbidity and mortality. The sociopolitical systems and serious economic crises that exist in underdeveloped countries foster malnutrition and poor eating habits, while lack of knowledge often exacerbates the situation. Medical professionals, whose primary duty it is to provide basic medical attention, must have solid nutritional knowledge to provide preventative and curative care. There is an intrinsic link between one’s health and one’s eating habits. Throughout history there have been numerous sayings that show that people understood this relationship, at least empirically. Such sayings include:
Nutrition is the science that deals with the composition and chemical properties of food and how the body uses the nutrients in one’s diet. It’s about the changes in dietary requirements under different physiological and pathological situations, such as illnesses caused by nutritional deficiencies or excesses.[4,5] Malnutrition continues to be one of the primary causes of death and morbidity in underdeveloped countries around the world. It has been calculated that 450 million people suffer from malnutrition, and it is expected that this figure will rise with population growth.[6] A balanced diet prevents multiple illnesses, and one of the primary pillars of treatment in many illnesses is diet-based. Along with other information taught to medical students, nutrition should be included because once these students graduate, it will assist them in their preventative medicine work, as well as contributing to the dietary education of their community. Although it will not solve the nutritional problems of humanity, an adequate knowledge of dietary needs will lead to better use of available food, and be another tool in their therapeutic medicine chest. With the implementation of the new Biochemistry curriculum, the subject matter previously dealing with the molecular basis of human nutrition was eliminated; the current curriculum includes some elementary aspects of proteins, lipids and sugars under the course on Metabolism, while omitting relevant aspects such as requirements for energy, vitamins, minerals and other nutrients. Objectives This article has two objectives:
Program Development Malnutrition: A Worldwide Health Issue - Particularly in Latin America According to the Pan American Health Organization, death from malnutrition in absolute figures on the American continent numbered 32,156 during the 1980s, 40% of whom were over the age of 65. Figures for Latin America are much better than those from Asia and above all, Africa.[7] According to the nutritional balance for children worldwide from 1990-2000, South America has achieved a 60% reduction in the prevalence of low-weight births, although only about half of nursing infants relied exclusively on their mothers’ milk in the first four months of life.[8] Countries like Ecuador, El Salvador, Guatemala, Peru and the Dominican Republic have not been able to attain the goal of lowering the rate of low-weight births to under 10%. The link between malnutrition and infection remain the most serious problem among children throughout Latin America.[9] Chronic malnutrition is the most serious nutritional problem facing Latin America because it is primarily the result of heretofore irreversible conditions; If we do not work to improve conditions for the current generation, there is dim hope for the future. Populations suffering from chronic malnutrition don’t have much hope for improvement during this generation: ‘We will have to start from square one,’ according to Dr. José María Bengoa. ‘We have to begin with the moment of conception to ensure adequate fetal development. The strategy should include breast-feeding, control of the possibility of infection, and adopting better eating habits. Nutritional Education during Medical Training, particularly in the Basic Sciences At present, there is no course dedicated to nutrition, although certain aspects of this discipline are scattered throughout other subjects such as Intermediate Metabolism and its Regulation (Biochemistry), Physiology, Pediatrics, Epidemiology and Public Health.[10,11] As for postgraduate studies, the Nutrition specialty was eliminated in 1989, although in 1992, an MS in Nutrition and Public Health was launched at the Institute of Nutrition and Food Hygiene (INHA).[12] Nutritional training is prioritized by the FAO and WHO, both of which lead community teaching programs, teachers’ training, etc., in many countries throughout the Third World. In UNESCO’s Studies Abroad, published annually, there are several postgraduate, Master’s and academic degree programs in this discipline. When will a medical student in Cuba learn the basics of human nutritional needs before their postgraduate studies? As the current curriculum is structured, it is not adequately included. Within the study of Biochemistry, begun in 1985, students get basic nutritional training in Biochemistry III. Biochemistry and its Ability to Introduce the Molecular Fundamentals of Human Nutritional Needs Knowledge of biochemistry is essential to understanding nutrition. Many examples of nutrition courses including the intrinsic link between the two can be cited. This year, a new university-level career has begun at the INHA called Nutrition and Diet; one of the subjects included in this plan is Biochemistry.[13] In the curriculum for a Master’s in Nutrition at the Pontifical Catholic University of Chile, Biochemistry is taught,[14] just as it is for a Master’s in Nutrition at the Central American Institute of Nutrition in Guatemala.[15] At ELAM, courses in Nutrition are given to the North American students to prepare them for their first level exam (Board I) in Basic Sciences. It is impossible to understand the complexity of the metabolism of different nutrients if one lacks the basic knowledge of their functions. Because of the breadth of information it covers, the course in Biochemistry is needed to introduce the basic elements of nutrition during initial training in the Medical Sciences, supplemented with other subjects, especially in the areas that focus on Clinical Nutrition. Understanding the importance of the molecular basics of human nutrition, our Biochemistry Department has utilized various intra- and extracurricular activities with this goal in mind, such as:
for second-year students - The course consisted of the theory and practice of nutrients in which their values were measured under various physiological conditions. It was inspiring to see the quality of the work presented by each student as his/her final evaluation for the course.[17] In a survey conducted among second-year ELAM students on different electives they were offered by the school, a large number indicated their preference for this course, an indicator of our students’ interest in Nutrition. The ELAM can contribute to helping the Latin American [medical] professional to ‘return to square one,’ quoting José María Bengoa, in tackling the problem of malnutrition among their people. Upon graduation, the future [medical] professionals whose fundamental function will be carrying out primary medical attention, will be able to use their knowledge of Basic and Clinical Nutrition to practice preventative medicine. This is not only true for those pathologies caused by malnutrition, but it is also for use in Modern and Traditional Medicine, diet therapy, and to contribute to raising the awareness among their community as to what constitutes a safe and complete dietary regime, leading to healthy new generations. Conclusions It is necessary to analyze the medical degree curriculum and evaluate the inclusion of this subject into the Biochemistry course “Intermediate Metabolism and its Regulation.” This would necessitate a time frame adjustment. Another option is to evaluate inclusion of another subject – within the Biochemistry course – perhaps giving it in the second year to guarantee preparation of the students in the Molecular Bases of Human Nutrition, adequately preparing them for later training in Clinical Nutrition. REFERENCES
|
||||||||||
|
||||||||||
