Nutritional status is a measure of the health condition of an individual as affected primarily by the intake of food and utilization of nutrients. According to the World Health Organization (WHO), health is not only the absence of disease but a state of complete mental and physical wellbeing in relation to the productivity and performance of an individual. Good nutritional status can only be realized and sustained when individuals within families and communities are food-secure. Food security has been defined as access by all people at all times to the food needed for a healthy life (FAO/WHO, 1992a). Food security has three important dimensions: adequate availability of food supplies; assured access to sufficient food for all individuals; and its proper utilization to provide a proper and balanced diet. The state of hunger and malnutrition within a country is related to its level of development (OMNI, 1998). The relationship between nutrition and human resource development was best described by the 1992 International Conference on Nutrition (ICN) held in Rome, which, in its World Declaration and Plan of Action for Nutrition, stated that nutritional well-being of all people is a pre-condition for the development of societies and is a key objective of progress in human development.
A
well-nourished, healthy workforce is a pre-condition for sustainable
development. At the same time, the nutritional well-being of a population is a
reflection of the performance of its social and economic sectors; and to a
large extent, an indicator of the efficiency of national resource allocation. In
order for a national social and economic development programme to be successful
and sustainable, the majority of the population should be able to participate
in the process. Therefore, the majority of the population should be in good
health and have good nutritional status.
Nutrition
plays a critical role in human resource development since deficiencies in
essential nutrients lead to malnutrition, which affects an individual's mental
and physical state, resulting in poor health and poor work performance. In
addition, a hungry, malnourished child may have mild to serious learning
disabilities, resulting in poor school performance; a sick, poorly nourished
individual will not respond well to treatment, could lose many working hours
and may continue to drain family and national resources. Thus, malnutrition may
undermine investments in education, health and other development sectors.
The importance of food and nutrition in human development is
widely recognized in both high income and middle to
low income countries. Malnutrition in all its forms amounts to an intolerable
burden not only on national health systems but the entire cultural, social and
economic fabric of nations, and is the greatest
impediment to the fulfilment of human potential. Investing in nutrition
therefore makes economic sense because it reduces health care costs, improves
productivity and economic growth and promotes education, intellectual capacity
and social development for present and future generations.
Malnutrition
has been defined as a pathological condition, brought about by inadequacy of
one or more of the nutrients essential for survival, growth, reproduction and
capacity to learn and function in society (Latham, 1997). People whose diets
fall short of standard levels of intake for essential nutrients suffer from
malnutrition that can be mild, moderate or severe, depending on the level of
deficiency. Current trends in malnutrition (Gillespie Mason and Martorell,
1996) show that although nutritional status is improving for many people in the
world, for some the rate is not fast enough. At the World Food Summit (WFS) in
1996, it was stated that more than 800 million people do not have sufficient
food to meet their nutritional needs. This situation results from many inter-related
factors, including social, economic, environmental and political ones.
The nutrition situation reports of
the United Nations Administrative Committee on Co-ordination/Sub-Committee on
Nutrition (ACC/SCN) stated that protein-energy malnutrition (PEM), measured by
the proportion of children falling below the accepted weight standards, affects
26.7 percent of all pre-school children in the developing world. In 2000, the
problem affected some 150 million children, based on national anthropometric
measurements (ACC/SCN, 2000). WHO reports that in developing countries, 10.7
million children die each year, and of these deaths, 49 percent are associated
with malnutrition (WHO, 2000). Data from Table 4 confirm that malnutrition has
a far more powerful impact on child mortality than is generally believed (WHO,
1995).
Table 1: Average per caput dietary energy supply (DES)
COUNTRIES
|
1990-92
(CALORIES/CAPUT/DAY) |
1997-99
|
Developing
World
|
2 540
|
2 530
|
Asia and the
Pacific
|
2 710
|
3 010
|
Latin America
and Caribbean
|
2 120
|
n/a
|
Near East and
North Africa
|
2 680
|
2 710
|
Sub-Saharan
Africa
|
2 830
|
3 010
|
Countries in
Transition
|
2 190
|
2 910
|
Adapted from
FAO, 2001. The State of Food Insecurity in the World
|
||
Nutrition is a foundation for development, as is elaborated in the UNSCN brief compilation from 2002, designed to facilitate dialogue between nutrition and other development professionals and to make the case for integrating nutrition into the work of the development community. Income poverty reduction and increased food production alone will not solve the nutrition problems of the poor in low income countries. Tackling global nutrition problems is essential for achieving the Millennium Development Goals (MDGs). The critical role of nutrition for reaching the MDGs was the topic an UNSCN Special Information Meeting held with ECOSOC at the UN in June 2005, and of UNSCN News 28 and the 31st UNSCN Session.
Moreover,
good nutrition is a human right. Nutrition security encompasses
many rights, especially the right to adequate food and to the highest
attainable standard of health. It includes children's
rights to food, health and care as well as survival and development. Besides
that, it comprises women’s right to appropriate services in connection with
pregnancy, confinement and the post-natal period
along with adequate nutrition during pregnancy and lactation. This is the focus
area of the UNSCN Working Group on Nutrition, Ethics and Human Rights and the topic of UNSCN News No 18
and No 30.
Table 2: Percentage of all deaths of children under five years of age associated with malnutrition for selected countries in Africa
COUNTRIES
|
%
|
%
|
|
Tanzania
|
53
|
Sierra Leone
|
42
|
Burundi
|
52
|
Togo
|
41
|
Nigeria
|
52
|
Senegal
|
39
|
Mali
|
48
|
Lesotho
|
29
|
Namibia
|
44
|
Cote d'Ivoire
|
26
|
Rwanda
|
44
|
Zimbabwe
|
24
|
Ghana
|
42
|
||
David L.
Pelletier and others. The effects of malnutrition on child mortality in developing
countries,
Bulletin of the World Health Organization, vol. 73 No. 4, 1995 |
|||
Nutrition is ever more important in the light of the recent financial and food price crises. These crises increase malnutrition among the most vulnerable people in developing countries, with pregnant women and children being the hardest hit. The UNSCN has developed a technical briefing note as well as an advocacy note on the nutrition impacts of the global financial and food crises. On 14 October 2008, the UNSCN held a Side Event focusing on the Impact of High Food Prices on Nutrition at the 34th Session of the Committee on World Food Security (CFS), 14-17 October 2008,FAO, Rome.
These
recent crises overlap with and deepen the effects other crises. Nutrition remains a concern in emergencies
like conflict or natural disaster. The UNSCN Working Group on Nutrition in Emergencies is a very active one and has pioneered
cooperation and thinking in the field. One recent achievement was the community-based treatment of severe malnutrition, such as
in UNSCN Nutrition Policy Paper 21. The UNSCN Secretariat has through its Nutrition
Information in Crisis Situations (NICS)
reported on the nutrition situation of refugees, displaced and resident
populations affected by a crisis since 1993.
Moreover,
undernutrition has adverse
intergenerational effects that significantly
increase its economic and other social costs. This is elaborated in the fourth
of the UNSCN Reports on the World Nutrition Situation as well as in the report of the Commission on the Nutrition Challenges of the 21st Century. The UNSCN News No 11
on Maternal and Child Nutrition in 1995 first presented the life-cycle
approach. The first ever meeting to discuss low birth weight and how to prevent
it, led to the development of a Nutrition Policy Paper No 18. Several UNSCN
Working Groups also focus on nutrition across the lifecourse, such as the one
on Nutrition Throughout the Lifecycle, or on specific stages of the lifecycle, such
as the Working Groups on Breastfeeding and
Complementary Feeding
and on Nutrition of School Age Children.
At
the same time the world is also increasingly affected by another sort of
malnutrition, namely overweight and obesity which as proposed in UNSCN News No 29
may constitute a new nutritional emergency. The emerging global epidemic of
non-communicable or chronic diseases is no longer a problem restricted to
affluent, industrialized countries. It is increasingly affecting low income
countries and contributing to their existing burden of undernutrition. Thus in
low income societies, diseases caused by caloric inadequacy and deficiency
continue to persist, but now co-exist with the growing presence of nutrition
related chronic diseases; this is the double burden of
malnutrition. UNSCN News No 32
and No 33
look at the double burden of malnutrition at the global level and in West
Africa, respectively.
Micronutrient deficiencies
being the risk factor for many diseases, can contribute to high rates of
morbidity and mortality and even moderate levels of deficiency can have
detrimental effects on human health. They are widespread in industrialized
nations, but even more so in the developing regions of the world. Young
children and women of reproductive age are among those most at risk of
developing micronutrient deficiencies. The forthcoming Nutrition Policy
Paper 22 will present a
systematic review of multi-micronutrient supplementation during pregnancy in
developing countries, looking at how these could improve iron status as well as
have an effect on critical outcomes like birth weight. The three most common
forms of micronutrient malnutrition are iron, vitamin A and iodine deficiency.
Measures to correct these major micronutrient deficiencies are well-known. The
recent UNSCN News 35
describes how the control of iodine deficiency disorders through salt
iodization has been a major accomplishment over the last decades. Measures to
control Vitamin A deficiencies were addressed in Nutrition Policy Papers 13 and 14,
whereas Nutrition Policy Paper 9
described measures to control iron deficiencies. Since the inception of the SCN
a series of different Working Groups have focused on specific micronutrients,
today the Working Group on Micronutrients cover all aspects of vitamin and mineral
nutrition.
Nutritional status is an outcome
of a series of determinants clustered into food, health and care. Each of
these clusters is essential but alone insufficient for achieving nutrition
security. The UNSCN network address the causes of malnutrition at the
immediate, underlying and basic level. For example, the Working Group on
Household Food Security
is concerned with food security of vulnerable households. Others are focusing
on interactions between nutrition and health, such as the Working Group on
Nutrition and HIV/AIDS.
Reducing malnutrition requires attention to the three areas of food, health and
care. However, in order to achieve sustainable improvements, capacity
development is essential. The aim of the Working Group on Capacity
Development in Food and Nutrition
is therefore to assist developing regions enhance individual, organizational
and institutional capacity in the area of food and nutrition.
Micronutrient
malnutrition is a term commonly used to refer to vitamin and mineral deficiency
disorders. Vitamins and minerals are referred to as micronutrients because the
body needs them in only small amounts to maintain normal health and
functioning. However, lack of these micronutrients results in serious health
repercussions. Vitamin A deficiency (VAD), iron deficiency anaemia (IDA) and
iodine deficiency disorders (IDD) are among the most common forms of
micronutrient malnutrition. Vitamin A is found only in animal products such as
eggs, liver and milk. Many fruits and vegetables, such mangoes, papaya, pumpkin
and carrots, contain chemicals called carotenes which the body can convert into
vitamin A. Good sources of iron are foods such as meat, beans and dark green
leafy vegetables. Iodine is normally found in foods that are grown in soils
that are rich in iodine, as well as food from the sea. Because it is not
normally easy to know if the food we eat contains enough iodine, the use of
iodized salt for normal seasoning of food is highly recommended. A large
proportion of people, particularly children under five years of age, school-age
children, and pregnant and lactating women, suffer from problems of PEM and
micronutrient malnutrition disorders. Usually, people do not suffer from single
nutrient deficiencies, as micronutrient deficiencies often occur in conjunction
with other nutritional deficiencies. The concurrent prevalence of chronic
malnutrition, IDD and IDA can reduce the gross domestic product (GDP) by 2-4
percent. According to FAO, over 2 billion people in the world suffer from
micronutrient malnutrition (FAO 2002). VAD principally affects pre-school age
children. The March of Dimes estimates that worldwide, about 251 million
children from 0-5 years of age are either at risk of or affected VAD because of
inadequate diets; and 2.8 million are afflicted with xerophthalmia (see Table
7). VAD can lead to xerophthalmia, night blindness and, eventually, total
blindness. Every year, 250,000 to 500,000 children lose their sight as a result
of VAD: two-thirds of these children are likely to die. An estimated one
million additional children die each year of infectious diseases because VA D
impairs their resistance to infection (FAO, 2002).
IDA is caused by
insufficient intake and/or inadequate biological utilization of dietary iron.
It is considered the most frequently occurring nutritional disorder in the
world, and affects mainly young children, pregnant women, lactating women and
women in the reproductive age range. It is estimated that in developing
countries, the prevalence of anaemia is three to four times that of
industrialized countries. In developing countries, the most affected group are
pregnant women (57%), compared to 43 percent in women in the 15- to 59-year age
range, and 42.2 percent in children 0-4 years of age. The prevalence in
developed countries is almost reversed, with the highest figure being that of
the 0- to 4-year age group at 16.7 percent, followed by 14 percent for pregnant
women and 10.3 percent for women in the 15- to 59-year age range (March of
Dimes, 2002).
For women, poor
nutritional status is associated with an increased prevalence of anaemia,
pregnancy and delivery problems, increased rates of intra-uterine growth
retardation, low birth-weight and perinatal mortality. According to FAO, where
iron deficiency is prevalent, the risk of women dying at childbirth can be
increased by as much as 20 percent. Anaemia in infants and children is
associated with retardation of physical, intellectual and psychomotor
development, as well as reduced resistance to infection. In adults,
undernourishment and anaemia can lead to poor health and productivity,
resulting in impaired physical and intellectual performance, and subsequently
constrained community and national development. Studies show that IDA can
reduce work capacity and productivity by 10-15 percent, and GDP by 0.5-1.8
percent (FAO, 2002a).
IDD occur in
populations living in areas where iodine in the soil has been washed away by
glaciers and rain, and in areas of frequent flooding. Over 2 billion people in
the world are at risk of IDD, although this is undoubtedly the easiest of the
micronutrient deficiencies to reduce (March of Dimes, 2002). IDD can lead to
visible goitre and impaired physical and mental development. Worldwide, about
20 million people are mentally retarded due to iodine deficiency. Severe or
moderate iodine deficiency during pregnancy can lead to foetal neurological or
hypothyroid cretinism, resulting in impaired hearing, mutism, impaired motor
co-ordination, severe mental defects and increased rates of abortion and/or
still births. It is the most common cause of preventable mental retardation.
The March of Dimes reports that about 741 million people worldwide are affected
by goitre (see Table 7). South East Asia has the highest number of people at
risk (599 million), followed by West Pacific (513 million) and East
Mediterranean (348 million). East Mediterranean has the highest number of
people affected by goitre (152 million), followed by Africa and West Pacific,
with 124 million people affected in each of the two regions.
Fortifying salt
with iodine is one of the most effective ways of eliminating IDD. Increasingly,
countries with IDD problems are now using iodized salt.
Although some
countries continue to have significant iodine deficiency, availability and
consumption of iodized salt has increased significantly to about 90 percent in
the Americas, 70 percent in Southeast Asia and 63 percent in Africa (see Table
8). This has had a significant effect on the goitre rate in those regions, and
millions of children each year are being protected from mental retardation and
loss of intellectual potential.
Table 3: Global prevalence estimates of deficiencies of iodine, vitamin A, and iron
REGION
|
IODINE DEFICIENCY
DISORDERS |
VITAMIN A DEFICIENCY
(0-5 YEARS) |
IRON DEFICIENCY ANAEMIA
|
||||
At Risk
|
Affected
(Goiter) |
At Risk
and Affected |
Affected
(xerophthalmia) |
Children
|
Women
|
||
Preg
|
All
|
||||||
(million)
|
(million)
|
(million)
|
(million)
|
0-4 yr
(%) |
15-59 yr
(%) |
||
Africa
|
295
|
124
|
52
|
1.0
|
42.1
|
50.0
|
38.3
|
The Americasa
|
196
|
39
|
16
|
0.1
|
23.3a
|
39.0
|
30.6
|
Southeast Asia
|
599
|
72
|
125
|
1.5
|
62.6
|
76.0
|
58.5
|
Europe
|
2751
|
30
|
-
|
-
|
21.7
|
24.0
|
10.3
|
Eastern
Mediterranean |
348
|
152
|
16
|
0.1
|
45.4
|
55.0
|
49.8
|
West Pacific
|
513
|
124
|
42
|
0.1
|
21.4b
|
40.0
|
31.9
|
Total
|
2 226
|
741
|
251
|
2.8
|
42.2
|
57.1
|
43.0
|
It is often assumed that access to a stable
and varied food supply and good health are the only pre-conditions for good
nutritional status. Yet, achieving nutritional well-being can be a complex
issue because of the intersectoral factors involved in the process.
Table 4: Current status of household consumption of iodized salt, 1999
REGION
|
NUMBER
OF COUNTRIES WITH IDD |
NUMBER OF COUNTRIES WITH A GIVEN %
OF HOUSEHOLDS CONSUMING IODIZED SALT |
OVERALL % OF
HOUSEHOLDS CONSUMING IODIZED SALT |
||||
NO DATA
|
<10%
|
10-50%
|
51-90%
|
>90%
|
|||
Africa
|
4
|
8
|
6
|
8
|
19
|
3
|
63
|
The Americas
|
19
|
0
|
0
|
3
|
6
|
10
|
90
|
Southeast Asia
|
9
|
0
|
1
|
2
|
5
|
1
|
70
|
Eastern
Mediterranean |
17
|
5
|
1
|
2
|
6
|
3
|
66
|
Europe
|
32
|
10
|
4
|
12
|
4
|
2
|
27
|
Western Pacific
|
9
|
0
|
1
|
4
|
3
|
1
|
76
|
Total
|
130
|
23
|
13
|
31
|
43
|
20
|
68
|
Source:
ACC/SCN, 2000 4th Report on the World Nutrition Situation
|
|||||||
In order for
people to enjoy active, productive lives, it is mandatory that their basic
needs a stable and varied food supply all year-round, for all family members;
good health services; safe water supply and good sanitation; education; and
adequate family care are met. Where these basic needs cannot be met by the
majority, good health and nutritional well-being will remain elusive.
References
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978-92-806-3988-9. http://www.unicef.org/nutrition/index_33685.html
World Health Organization.
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young child health and nutrition. Washington,DC:WHO. http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/index.html.
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Sylvia Escott-Stump (2012). Krausw's Food and the Nutrition Care Process
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