Nutrition and Global Health

1. Nutrition andGlobal Health Micheline Beaudry, Ph.D. Université Laval

2. 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

3. 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

4. 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

5. 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

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

7. 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

8. Other consequences of PEM • Impaired cognitive & behavioral development • Low educability • Reduced productivity & income • Poor reproductive health

9. Causes of malnutrition Manifestations Growth, survival and development Immediate Causes Diet intake Disease CARE practices for mothers&ch Underlying Causes Access to FOOD HEALTH serv & environ. EDUCATION Ressources & Control Human, Economic & Organizational Basic Causes Political, Ideological &Economic structure

10. 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)

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. Improving nutrition can lead future progress in health and development around the world