Nutrition

and

Global Health
Micheline Beaudry,
Ph.D.
Universit 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 peoples 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

60

Proportion (%) of underweight

children by region, 1985-1995

50
South Asia

40

SubSaharan Africa

30

Sout-East Asia
20

N.Africa&M.East

10
0
1985

Lat.Amer.&Caribb
.
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
Immediate
Causes
Underlying
Causes

Growth, survival and

development
Diet intake
Access to
FOOD

Disease

CARE practices
HEALTH
for mothers&ch serv & environ.
EDUCATION

Basic
Causes

Ressources & Control

Human, Economic &
Organizational
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. breastfeeding, 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 worlds
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 2030%
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 mothers diets. By 1997 is closer to
28 million

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