Nutrition

and
Global Health
Micheline Beaudry,
Ph.D.
Université Laval
 Learning Objectives
At 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
60
children by region, 1985-1995
50

40 South Asia

SubSaharan Africa
30
Sout-East Asia
20
N.Africa&M.East
10 Lat.Amer.&Caribb
.
0
1985 1990 1995
 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 malnutrition
Manifestations Growth, survival and
development
Immediate Diet intake Disease
Causes
Underlying Access to CARE practices HEALTH
Causes FOOD for mothers&ch serv & environ.
EDUCATION
Ressources & Control
Human, Economic &
Basic Organizational
Causes
Political, Ideological
&Economic structure
 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