GLOBAL FOCUS ON NUTRITION

 

Global nutrition report 2016

“Few challenges facing the global nutrition community today match the scale of malnutrition, a condition that directly affects one in three people. Investing in preventing malnutrition delivers a 16% return on investment. Malnutrition drives the global burden of disease.”

 

Sustainable development goals

The Sustainable Development Goals (SDGs) is a set of 17 Global Goals with 169 targets between them. Spearheaded by the United Nations, and supported by 193 member states and global civil society, the SDGs build on a resolution known as ‘The future we want’.

The SDGs were informed by UN secretary general Ban Ki-moon’s statement “We do not have a plan B because there is no planet B”.

Malnutrition includes several forms of undernutrition and overweight and obesity. It impairs people’s productivity which, in turn, hinders the growth of people and nations. Malnutrition presents a barrier, that is often invisible, to the successful achievement of the SDGs. Good nutrition is both an outcome of development and the seed that will grow future development.

Although SDG 2 focuses specifically on the goal to ‘End hunger, achieve food security and improved nutrition and promote sustainable agriculture’, a total 12 of the 17 SDGs include indicators that are relevant to nutrition. Without adequate and sustained investments in good nutrition, the SDGs will not be achieved.

 

NUTRITIONAL CHALLENGES IN SUB-SAHARAN AFRICA

Many countries in Africa face a double burden of nutrition-related diseases, with both under- and over-nutrition seen in the same household, community or population.

Hunger and under-nutrition, of especially energy and several micronutrient deficiencies, have not been successfully addressed in Africa.

At the same time there has been an increase in the prevalence of obesity and other non-communicable diseases (NCDs) in many African countries. The nutrition transition is defined as “the changes in dietary patterns and nutrient intakes when populations adopt modern lifestyles during economic and social development, urbanization and acculturation”. The process is associated with proven increases in NCDs.

Throughout man’s history, there have been changes in dietary patterns. These changes are now happening at a much quicker rate in developing countries. They are also happening at earlier stages of countries’ economic and social development. This causes the global burden of obesity and other NCDs to shift towards the poor. There are other factors that work alongside the nutrition transition to increase people’s risk of illness and disease. These include sedentary and stressful lifestyles, a lack of physical activity, consuming too much alcohol and smoking cigarettes. These behaviours are common in urbanizing populations.

 

Stunting

Stunted growth is a slow growth rate in human development. It is caused by long term undernutrition and recurrent infections, such as diarrhoea, in early childhood. It may even start before birth, if the mother is undernourished.

Stunted growth in children has the following public health impacts:

• A greater risk of illness and of premature death
• It may result in delayed and / or reduced mental development which can cause poor school performance and later in life, reduced productivity in the work force
• Women who are short tend to have small pelvises. They are more likely to have problems when giving birth and the chance of delivering small, underweight babies is greater
• Stunting can even be passed on from a mother to her baby, this is called the “intergenerational cycle of malnutrition”

 

Micronutrient deficiencies

Micronutrient deficiencies are seen in people who don’t have enough of one or more micronutrients (vitamins and minerals) that are necessary for good health. This may be caused by long-term shortages of nutritious foods, or by repeated infections. These deficiencies may also occur when illnesses such as diarrhoea or malaria cause rapid losses of nutrients.

Micronutrient deficiencies cause some diseases, while they make others worse and prolong recovery from illness.

Micronutrient deficiencies may be difficult to identify, hence the condition is often called ‘hidden hunger’.

A lack of one micronutrient is typically associated with shortages of other micronutrients.

The highest risk groups for micronutrient malnutrition are young children, adolescent girls, pregnant women and breastfeeding women.

 

Overweight and obesity

Overweight and obesity occur when a person consumes more food (energy) than the body needs. Being obese puts a person at risk for developing specific non-communicable diseases (NCDs). These include cardiovascular diseases, diabetes and some cancers. Such diseases develop over a long period of time. Other factors can increase the risk of developing NCDs, such as a diet too high in salt, in saturated fats and / or in free sugars.

Undernutrition during the foetal period and during infancy may make a child more likely to develop NCDs during adulthood.

People who are overweight or obese may have a shortage of micronutrients because, although they eat a lot, the foods they eat may not be nutritious.

 

ADDRESSING MICRONUTRIENT MALNUTRITION

There are three main types of interventions used to prevent and combat micronutrient deficiencies. These can be used individually or in combination, which is often the most effective. These interventions should be delivered by several sectors of government and other stakeholders; including health, agriculture, education and trade and industry.

 

Food fortification

Fortification (also called enrichment) means adding nutrients, often micronutrients, to a food during processing. This can be to replace nutrients lost in processing, or to add extra nutrients. Large scale commercial food fortification has many benefits, it:

• Improves nutritional status if people who lack the nutrients buy and eat the food
• Greatly lowers the incidence of iodine deficiency, neural tube defects, beriberi and pellagra
• Is sustainable and cost effective, and requires no change in food habits.
• Examples of fortified foods are:
  • Salt with iodine
  • Sugar with vitamin A
  • Vegetable oil with vitamins A and E
  • Wheat flour and maize meal with iron, zinc, folic acid, vitamin B12 and other B group vitamins
  • Milk with vitamins A and D
  • Margarine with vitamins A and D

 

Supplementation

Nutrient supplements are concentrated sources of vitamins and minerals produced by pharmaceutical manufacturers in the form of capsules, powders, tablets or injections. They may be advised as part of routine individual health care, or during specific nutrition campaigns.

• Vitamin A supplementation is given to children under the age of five years in countries where vitamin A deficiency is widespread.  A single vitamin A dose provides a 4 – 6 month supply of the nutrient, as it is easily absorbed and is stored in the liver.
• Iron and folic acid supplements are given to pregnant women as part of routine antenatal care to help meet their increased needs for these nutrients.

 

Dietary Diversification

Ultimately the goal of nutrition interventions is to achieve the best possible nutritional status by eating a variety of nutritious foods. This includes making sure a person gets enough, but not too much, of all macro and micronutrients.

This is a long-term process and may require what is known as ‘diversification of food cultivation’, so as to make a wider variety of nutrient dense foods available. This also requires nutrition education, to create demand for a variety of crops, and to resist the marketing of ultra-processed, nutrient-poor foods.

Diversification can also include the introduction of crops that have been bio-fortified, as they will contain more micronutrients than other crops.