Nutrition and

Global HealthMicheline Beaudry,

Ph.D.

Université Laval

Learning ObjectivesAt the end of this lecture you will

• Be aware of the key role played by undernutrition in the lives of people & societies around the world

• Realize that food, though essential, is not equivalent to nutrition

• Know that there are affordable solutions & wish to find out more about them

At the end of this lecture you will be able to (performance objectives)

• List the 4 major nutrition problems in the world, their major manifestations, consequences & global distribution

• List the major causes of these problems and solutions proposed

• Convince a friend of the opportunities provided to improve people’s lives

The major nutrition problems in the world are:

• Protein-energy malnutrition (PEM)

• Iron deficiency

• Vitamin A deficiency or hypovitaminosis A (VAD)

• Iodine deficiency disorders (IDD)• Nutrition-related chronic diseases

Protein-energy malnutrition (PEM)

• Stunting – insufficient height gain relative to age; – implies long-term malnutrition and poor health

• Wasting

– insufficient weight gain relative to height/losing weight – implies recent/acute malnutrition

• Underweight – insufficient weight gain relative to age or losing weight – implies various combinations of stunting and wasting

Proportion (%) of underweight children by region, 1985-1995

0

10

20

30

40

50

60

1985 1990 1995

South Asia

SubSaharan Africa

Sout-East Asia

N.Africa&M.East

Lat.Amer.&Caribb.

PEM and young child mortality

• Malnutrition potentiates the effect of disease on child mortality

• The effect is for both mild-to-moderate as well as severe malnutrition; it is not only due to confounding by socioeconomic factors or intercurrent illness

• The effect of malnutrition and infection on child mortality is multiplicative rather than additive as was implicitly assumed

Other consequences of PEM

• Impaired cognitive & behavioral development

• Low educability

• Reduced productivity & income

• Poor reproductive health

Causes of malnutritionManifestations Growth, survival and

development

Immediate Causes

Diet intake Disease

Underlying Causes

Basic Causes

Political, Ideological &Economic structure

Access to FOOD

Ressources & ControlHuman, Economic &

Organizational

CARE practicesfor mothers&ch

HEALTHserv & environ.

EDUCATION

To ensure adequate growth & nutrition, it is necessary to facilitate

• The ability of households to provide CARE for mothers & young children (e.g. breast-feeding, complementary feeding, love...)

• Access by households to sufficient FOOD to lead an active & healthy life

• Access to adequate HEALTH services (e.g. immunization) & a healthy environment (e.g. clean water)

Iron deficiency • Over 2 billion people suffer from some

form of iron deficiency

• Not all causes of anaemia are nutritional in origin; yet anaemia linked to iron and/or folic acid deficiency is among the world’s major nutritional disorders

• Africa & South Asia have the highest overall incidence of anaemia, followed by Latin America & East Asia

Consequences of iron deficiency

• Reduces work capacity, thus productivity, earnings & ability to care for children

• Associated with 50% of maternal deaths & wholly blamed for up to 20%

• Retards fetal growth, causes low birth weight (LBW) & increases infant mortality

• Impairs ability to resist disease; in childhood, reduces learning

Improving Iron status

• Iron tablets (daily vs. weekly)

• Iron fortification of basic foods

• Increased consumption of iron rich foods & factors which enhance absorption

• Control of parasitic infections

Vitamin A deficiency (VAD)

• Subclinical, severe & moderate– 251 million children 0-4 years old

• Clinical (xerophtalmia) – 2.8 million children 0-4 years old

• Blindness, total or partial – at least half a million children a year

– about half die within a few months

Consequences of VAD

• Onset of childhood diseases increases

• Partial or total childhood blindness

• Child mortality increases at least 20-30%

• May increase maternal mortality • May increase HIV transmission

Improving vitamin A status

• Increased intake of vitamin A rich foods e.g. eggs, butter, whole milk, liver, red palm oil, dark green, yellow & red fruits & vegetables

• Fortification of basic foods with vit. A

• Supplements e.g. 2 capsules per year to young children

Iodine deficiency disorders (IDD)

• In 1990: 1.6 billion people worldwide at risk of IDD

• At least 655 million with goitre

• 43 million with some degree of mental impairment

• 11 million with cretinism

Other consequences of IDD• Moderate Iodine deficiency: associated with

average reduction of over 13 IQ points

• Adequate intake of Iodine: can prevent all IDD, make milder forms of goiter disappear & improve development of older children mildly affected

• Severe forms of IDD such as cretinism, cannot be reversed; can only be prevented by adequate intake of I during pregnancy

Progress in iodizing salt

• 60% of all edible salt in the world is now iodized in 1997

• Before 1990, some 40 million children were born each year at some risk of mental impairment due to I deficiency in their mother’s diets. By 1997 is closer to 28 million

Improving nutrition can lead future

progress in health and development around the world