The global challenge to address malnutrition
In developed countries these are mainly childhood and adult obesity and the NCDs related to a combination of overnutrition, lack of activity, smoking, alcohol abuse, and stressful lifestyles. In developing countries the magnitude of undernutrition is staggering. Moreover, obesity and NCDs have emerged in these countries and are increasingly becoming major causes of mortality. This double burden is further exacer-bated by the HIV/AIDS pandemic.
The dietary patterns and nutrient intakes responsible and contributing to these problems have been inten-sively researched in epidemiological, clinical, and basic molecular studies. There is a huge body of sci-entific evidence available to identify the immediate deficiencies and excesses in intakes, as well as all the environmental factors associated with suboptimal dietary patterns that lead to the nutrition-related diseases. Broadly, these dietary problems can be summarized as:
● hunger and food insecurity in developing coun-tries, with infants, pregnant women, and older people being the most vulnerable
● “hidden hunger” or micronutrient deficiencies in both developed and developing countries, espe-cially of iron, vitamin A, zinc, iodine, and all dietary antioxidants
● overconsumption of unfortified and refined staple foods in “low-quality diets”
● availability and intake of too many high-fat, sugary, and refined convenience and fast foods, increasing total fat, saturated fat, trans fat, omega-6 fatty acid, sugars, and salt intake
● not enough fish and other sources of omega-3 fatty acids in the diet
● not enough vegetables and fruit and their products in the diet
● not enough dietary fiber-rich foods in the diet;
● too little dietary variety
● over-reliance on dietary supplements in the devel-oped world.
In an ideal world, every human being would be able to exercise their right (often constitutionally defined) to regularly access, at affordable prices, adequate (enough, sufficient), safe (uncontaminated), and nutritious food to prevent undernutrition and to ensure optimal nutritional status for health, well-being, a quality life, ability to actively and produc-tively work and play, and moreover to reach their mental and physical development potential. This is often defined as being food and nutrient “secure.”
The above situation would be possible if all stake-holders in the global community (UN agencies, gov-ernments, NGOs, food industries, academics, civil society, and others) worked together in partnerships to create a food and nutrition environment in which healthy food choices were available, acceptable, and affordable and where consumers were educated, informed, and motivated to make the right choices.
But we do not live in an ideal world, as the high prevalences of nutrition problems indicate. So the questions that need to be answered are what should be done and by whom to rectify the situation?
Clearly, the time for individual, separate programs to address undernutrition in one way and overnutri-tion and NCDs in another is past. What is needed is a holistic, integrated approach that will promote and make optimum nutrition possible. Several UN agen-cies, separately or in combination have developed “strategic directions” and described policy principles, strategies to introduce this on different levels in dif-ferent settings, as well as actions to promote healthy diets. The challenge is huge, for there are many bar-riers to overcome: from war, to uncommitted political agendas, to “unhealthy” food preferences of individu-als. The lessons learned from the failure of many developing countries to be on-track in reaching the Millennium Development Goals by 2015 plead for a new approach and global leadership. This could be possible in partnerships in which there is recognition and respect for different agendas, but where partners are willing to develop a common nutrition agenda and agree on steps to reach common goals. But there are also many success stories. For example great strides have been made in the past few decades to reduce child undernutrition in some developing regions. A global database on child growth and mal-nutrition covers 95% of the world’s under-5 popula-tion (http://www.who.int/nutgrowthdb). Much is being done by several UN agencies and international donors and NGOs to improve the global nutrition situation, assisting countries in nutrition surveillance and implementation of targeted programs.
There is agreement that policies and programs should be implemented at all “levels” – from global macrolevels to individual microlevels. These pro-grams will include a variety of actions – from food assistance of displaced people to educating consum-ers how to choose healthy diets. The development of food-based dietary guidelines in both the developed and developing world to assist people to choose an adequate but prudent diet for optimal nutrition is an example of the latter. There is total agreement in the body of literature on the nutrition challenges of the twenty-first century that the focus should be on pre-vention of nutrition-related diseases to minimize their serious economic and social consequences.
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