Micronutrient deficiencies in developing countries -
Women and girls are at heightened risk of malnutrition due to systematic discrimination; women and girls typically eat the least and eat last. Nearly half of the children who die before they reach the age of five suffer from undernutrition.
They do not have enough nutritious food and essential vitamins and minerals to grow, develop and fight off disease.
Millions of kids become permanently mentally and physically disabled because of inadequate nutrition. Undernourished children show stunted growth patterns by the age of three and have poorer cognitive skills than their well-fed peers.
Beyond these human tragedies, there are also economic implications. At the root of all forms of malnutrition are many common causes, notably poor diet quality.
Contemporary food systems are unable to deliver nutritious, safe, affordable, inclusive and sustainable diets, which became starkly apparent during the COVID pandemic.
Malnutrition is caused not just by the lack of adequate, nutritious food, but also by frequent illness, poor care practices, and lack of access to health and other social services.
The changing nutrition landscape, the COVID pandemic, contemporary agricultural production, demographic changes, and climate change have all highlighted the need to take a broader, "multi-sectoral food systems approach" to ending malnutrition, in order to build strong food systems that have positive nutrition and health outcomes.
Double duty interventions — or actions, which simultaneously prevent or reduce the risk of undernutrition and obesity or non-communicable diseases, with the same intervention, program, or policy — are critical to tackling malnutrition.
Micronutrients such as vitamin A, iron, folic acid, zinc and iodine offer one, high-impact and cost effective way to improve birth outcomes for mother and child. Babies born to women with inadequate nutrition may have many complications including birth defects, premature birth, and death.
Vitamin A is a critical micronutrient for children under 5 years to ensure sustained growth and development, including vision and immune system strengthening. Children who receive adequate nutrition are not as likely to die from diseases like diarrhea, malaria, pneumonia, measles and HIV.
Children who receive adequate nutrition in the first 1, days are more likely to stay in school, contribute to the needs of their family and reach their full potential. Vitamin A is a fat-soluble vitamin that has multiple roles in the body including vision, cell differentiation, immune function, reproduction, and organ and bone formation and growth.
Vitamin A comes from animal sources in the diet preformed as retinol or retinyl esters, or from provitamin A carotenoids found in plant sources. Provitamin A carotenoids, which exhibit differential vitamin A activity, are converted to the active forms of the vitamin retinal and retinoic acid for use by the body.
Vitamin A deficiency VAD has been associated with increased rates and severity of infections and is a primary cause of childhood morbidity and mortality in the developing world, particularly in Africa and Southeast Asia [ 22 ].
VAD is the leading cause of preventable blindness in children. VAD causes xerophthalmia, a series of ocular manifestations like night blindness, Bitot's spots, and corneal ulcerations and lesions [ 1 ].
The WHO estimates that million children are blind because of VAD, and half of these children will die within a year of vision loss. Very little is known about older children and adults with regard to vitamin A status; however, because VAD tends to cluster in families, communities, and regions, we can assume that vitamin A status is low in areas with child and pregnancy burden.
Subclinical VAD affects far greater numbers of individuals, particularly in Africa and Asia [ 23 ]. Often, VAD occurs in clusters, so prevention and treatment schedules are in place to provide high-dose oral supplementation intermittently i.
semi-annually, every months, etc. based on age beginning at birth , life stage, and severity of deficiency. Vitamin A can also be added as a fortificant to the food supply.
For example, in Guatemala, vitamin A is added to sugar [ 24 ] in addition to intermittent supplementation programs, together yielding a low rate of VAD determined by serum retinol [ 25 ].
Despite the Cochrane reviews limiting maternal, neonatal, and infant vitamin A supplementation in developing countries [ 26, 27 ], continued emphasis should be placed on vitamin A supplementation programs in Southeast Asia given the clearly documented effects on ocular health and mortality [ 22, 28, 29 ].
Iodine is a trace mineral, and its primary function is in the synthesis of thyroid hormone. Thyroid hormone is necessary for regulation of human growth and development.
Iodine in foods and dietary supplements is generally either in a salt or organic form [ 31 ]. The iodine content of many foods is dependent upon soil concentration of the element and fertilization and irrigation practices [ 15 ]. The iodine content of fish and seaweed is also highly variable [ 32 ].
Iodine stores in vivo during a sufficient state are estimated at 60 µg, and during deficiency, stores are much lower in the to µg range [ 30 ]. Iodine absorption and utilization can be impaired by the presence of goitrogens [ 33 ] or exposure to percolate, disulfides, and thiocyanates from tobacco exposure [ 34 ].
Hypothyroidism can occur in individuals when dietary intakes are lower than µg daily, and it is frequently accompanied by goiter [ 15 ]. Thyroid hormones are essential for optimal fetal and postnatal central nervous system growth and development [ 35, 36 ]. Maternal iodine deficiency, particularly when it occurs during early pregnancy, can lead to irreversible neurological complications and mental retardation in the offspring referred to as iodine deficiency disorder IDD [ 35 ].
IDD represents a spectrum of diseases affecting the entire life course. From infancy to adulthood, IDD includes goiters, impaired mental function, and hypo- or hyperthyroidism.
At the most severe form, in utero iodine deficiency can result in cretinism [ 38 ]. It is intuitive to think that thyroid hormones may serve as a biomarker of iodine status; however, thyroid hormones, with the exception of thyroglobulin [ 43 ], do not appear to be adequately sensitive to change in iodine status [ 44, 45 ].
As previously stated, in pregnancy, requirements are greatly increased, and infants have the highest requirements per kg of body weight of any age group [ 30 ]. Exclusively breastfed infants may also be at risk if not provided iodine in complementary foods [ 46 ].
While iodine is found in breast milk [ 15 ], its concentration is dependent on maternal intake and status [ 47, 48 ]. While the group of highest concern is pregnant females, we have no global estimation of the burden of iodine deficiency in this group [ 51 ].
Salt is traditionally the food vehicle chosen for iodization because it is universally consumed at a relatively consistent intake level; the process of adding iodine to salt is very cheap at less than 5 cents per person per year. Universal salt iodization refers to all salts used within a country, regardless if iodine is in table salt or in salt used by the food industry.
Very few countries in the world have achieved universal salt iodization, and often, the food industry does not use iodized salt in food production [ 30 ]. Iodine can also be found in dietary supplements. Universal salt iodization is the most practical strategy to reduce iodine deficiency globally.
Correcting iodine deficiency does have some health risks for certain populations in terms of thyroid function and should be considered within the context of each country separately [ 38 ]. Folate is a generic term for multiple forms of the essential B vitamin.
Folate naturally occurs in foods, whereas folic acid is a synthetic form of the vitamin that is used in fortified foods and in dietary supplements. Folic acid is much more bioavailable than folate naturally occurring in foods and when ingested is converted by dihydrofolate reductase to the dihydrofolate and then the tetrahydrofolate form of folate; these reduced compounds are identical to those that would arise from ingestion of natural folate.
Folate is essential for synthesis of purines and thymidylate and, therefore, is involved in DNA synthesis, stability, and repair.
Folate is also involved in one carbon metabolism and, as such, can alter DNA methylation, which is an important epigenetic determinant in gene expression, in the maintenance of DNA integrity, and in the development of mutations.
Folate deficiency can be determined by serum, plasma, or erythrocyte folate concentrations. Folate deficiency is very low in countries with mandatory or voluntary folic acid fortification programs [ 52 ]. Folate deficiency causes megaloblastic or macrocytic anemia and increases the likelihood for pregnancies affected by neural tube defects.
The global prevalence of anemia secondary to folate deficiency is very low. Folate deficiency in pregnancy has also been associated with low birth weight, preterm delivery, and fetal growth retardation [ 53, 54 ].
No good estimates of global folate deficiency exist for those considered to be of highest risk: women of reproductive age, pregnant females, and young children [ 56 ]. Folic acid supplementation in the periconceptional period unequivocally reduces the occurrence of neural tube defects [ 57, 58 ].
For this reason, the governments of both the United States and Canada instituted national fortification programs with folic acid to enhance the diets of reproductive-aged females [ 59, 60, 61 ], and neural tube defect rates decreased in both the United States [ 62 ] and Canada [ 63, 64, 65 ].
Since this time, more than 75 countries have instituted folic acid fortification programs, and the amount of folic acid added varies by country [ 66 ]. Several more countries allow folic acid to be added to flour on a voluntary basis, while other countries fortify with iron and other B vitamins, but not with folic acid [ 67, 68 ].
Concerns exist about high exposure to folic acid through fortification practices and supplements among nontarget groups i. females not in the reproductive age like children, males, and the elderly. Zinc is an essential mineral that is involved in multiple aspects of cellular metabolism [ 69 ].
Zinc is required for the activity of more than enzymes, and it is critical for immune system function, cell division, and protein and DNA synthesis [ 15 ].
Zinc is also required for normal growth and development from in utero until puberty. The human body has no long-term storage system for zinc, so consistent dietary intake is needed to sustain all of these functions and maintain the relatively small exchangeable zinc pool.
Because of its diverse functions in vivo, it has been difficult to develop a single biomarker of zinc status; plasma zinc concentrations have been used, but this biomarker is nonspecific [ 69 ]. Zinc is primarily found in animal products and seafood. Similar to iron, zinc absorption is impaired by phytates, fiber, and lignins, all of which impair the bioavailability from nonanimal sources of zinc.
Calcium and casein may reduce the bioavailability of zinc from cow's milk. Zinc is present in human breast milk. Zinc status has been associated with reduced incidence, severity, and mortality due to diarrhea and respiratory and malarial infection as summarized by Patel et al.
Infection is known to compromise dietary intake and micronutrient absorption, and diarrhea can contribute to losses in key micronutrients.
A recent Cochrane review of randomized clinical trials 80 trials with , participants in children 6 months to 12 years of age indicates a positive effect for zinc supplementation in reducing all-cause and infectious disease mortality and a small positive impact on linear growth [ 72 ].
A recent clinical trial in full-term infants in India receiving placebo or 5 mg zinc daily indicated a significantly higher skinfold thickness for infants in the treatment group when compared to the placebo group, without a difference observed in linear growth [ 73 ].
The effect of zinc on anthropometry, but not linear growth, was also seen in a Peruvian clinical trial in which mothers were supplemented prenatally with zinc; infants born to zinc-supplemented mothers had greater weight gain, higher calf and chest circumference, and more calf muscle area than children born to mothers without zinc supplementation [ 74 ].
Zinc supplementation during pregnancy is associated with a significant reduction in preterm births without an effect on infant birth weight [ 75 ]. Deficiency in zinc is thought to be one of the primary causes of morbidity in developing countries and, yet, surprisingly little is known about the status of the world [ 76 ].
Given the issues concerning the assessment of zinc status by biomarkers, estimates of inadequacy are largely based on the prevalence of child stunting, estimates of dietary intakes, and the availability of zinc from the food supply [ 76 ].
Globally, it is estimated that Pregnant females and their young children are the highest-risk groups for zinc deficiency. Currently, the WHO and UNICEF recommend provision of zinc supplements for days along with oral rehydration therapy for acute diarrhea; however, no routine supplementation recommendations currently exist for the prevention of zinc deficiency.
Single MNDs rarely happen in isolation; more often, multiple MNDs are occurring simultaneously [ 1, 5 ]. Many factors contribute to food security and MNDs, including lack of available quality and diversity of foods, poverty in certain population groups, lack of access to health care and nutrition education, subsistence farming practices, volatile food prices, urbanization, high rates of infection both acute and chronic , and issues with sanitation, climate change, and access to potable water [ 5, 78, 79, 80 ].
Estimates of multiple MNDs have been difficult to ascertain due to limitations in the available data. Muthayya et al. Iodine may be the exception to the clustering of MNDs, and iodine deficiency is region specific and does not necessarily track with countries with a high hidden hunger [ 5 ].
However, deficiency in other micronutrients, like selenium, iron, and vitamin A, can exacerbate iodine deficiency by altering thyroid function [ 81, 82, 83 ]. Several options exist to combat MNDs, including supplementation, fortification, and food-based approaches like dietary diversification.
The choice of intervention strategy or strategies should depend on the cause, severity, and scope of the MND. The intervention strategy should always try to eliminate the root cause and must be considered within the cultural preferences [ 2 ].
Understanding the sustainability and feasibility of interventions is critical a priori. Ensuring continued access to the intervention or strategy is of upmost importance depending on the intervention. In general, supplementation is the approach to utilize when an MND is severe and requires a therapeutic approach to treatment, or for the purpose of prevention [ 2 ].
Supplementation can be daily or intermittently i. Widespread success has been achieved with vitamin A supplementation for the prevention of night blindness and infant mortality; the success is in part due to the intermittent requirements for supplementation i.
Supplementation as a strategy requires that provision of supplements is feasible and that adequate educational programs are in place to garner compliance.
Ideally, supplementation is limited to these purposes because supplementation does not address the root cause of the deficiency. However, supplementation offers a relatively cost-effective short-term solution to MNDs. There are growing concerns that supplemental nutrients may exhibit different physiological responses and absorption than nutrients found in food; this has been noted for folic acid, zinc, and iron.
Food fortification is a more long-term strategy to combat MNDs than supplementation. Fortification differs from supplementation in that most of the population is exposed to fortification, whereas supplementation is targeted toward certain individuals or groups.
Fortification generally requires policy and procedural changes and engagement of the food industry and, thus, requires substantially more time to implement than supplementation. However, if an MND is widespread, fortification is the tool with the greatest capacity to reach the most within a country.
The choice of the food vehicle is equally critical as the amount of fortificant to add; ideally, fortification will enhance the intakes at the lowest tail of the intake distribution without causing excessive intakes among those with already high intakes.
Using more than one food vehicle and understanding the current intake patterns have been recommended to avoid excessive intakes of nutrients caused by fortification [ 84 ]. An emerging option for enhancing micronutrient intakes is by biofortification. Biofortification utilizes recombinant DNA technology or fermentation procedures to alter the micronutrient content, but not the appearance, taste, or smell, of an existing food or crop [ 85 ].
The use of nanotechnology to create new delivery systems and storage forms of micronutrients is also a rapidly evolving field [ 86, 87 ]. Continued monitoring of any widespread food fortification program is necessary. An alternative to fortification of the food supply are home-based fortification systems in which micronutrients are added to foods that are already consumed within the home.
Most often, home fortification involves adding multiple micronutrients to a semi-solid food prepared in the home. The micronutrients generally come in packets or sachets. Home-based fortification programs were ongoing in 22 countries as of In one trial in Pakistan, the use of home fortification with multiple micronutrients in children aged months was associated with a significant decline in iron deficiency anemia but was also associated with increased rates of diarrhea [ 88 ].
A Cochrane review of home fortification suggests that home fortification with multiple micronutrients is effective for reducing anemia and iron deficiency but cautions that such products be used judiciously in areas with malaria as limited data exist at present.
Issues have been raised concerning the compliance to home fortification systems and also concerning an increase in pollution due to the foil-lined packaging needed to preserve the micronutrients [ 89 ]. While optimal in terms of sustainability, changing the dietary patterns of individuals and communities may be difficult to achieve.
Dietary diversification may not be possible due to limited food availability within certain regions. However, resources could be directed towards agricultural practices to change food availability; this is a sustainable mechanism to ensure access to a particular food or foods.
However, a change in dietary patterns usually is not enough to ameliorate certain deficiencies such as iodine deficiency given that the root cause is the geographic location in which foods, animals, and seafood are produced. Food-based approaches can include additions or changes to complementary feeding practices when infants start to consume foods other than breast milk or infant formula.
This transition period between liquid and solid nourishment is often accompanied by MND in developing countries. Provision of meals served outside the home, like school lunches, provides one opportunity to enhance micronutrient intakes of school-aged children.
Several fortified food products exist to add micronutrients to the diet without changing dietary patterns, such as biscuits or noodles which have been delivered by aid programs either intermittently or consistently depending on the scope of the problem.
Finally, if infection is the root cause of an MND, none of these intervention strategies alone would combat the problem of MNDs. In such instances, deworming or other public health control measures are needed [ 2 ].
Thus, those instituting interventions must adequately address all root causes of the MND in determining which strategy or combination of strategies to employ. Given the widespread impacts that MNDs have across the life span, it is not surprising that they cause tremendous financial burdens to societies [ 71 ].
Adequate nutritional status is a primary building block of human capital [ 90, 91 ]. Early-life nutrition has long-lasting impacts on the individual and society, including poorer adult health, less educational attainment, diminished work capacity, and lower lifetime earning potential [ 71, 92 ].
boys in Guatemala. For this reason, the Expert Panel for the Copenhagen Consensus Center determined nutrition through bundled micronutrient interventions as the top recommended global health issue to target resources toward in Bailey and Keith P.
have no conflicts of interest to disclose. Robert E. Black presides on the governing boards of the Micronutrient Initiative and Vitamin Angels; he is also a member of the Creating Shared Value Advisory Council of Nestlé.
Sign In or Create an Account. Search Dropdown Menu. header search search input Search input auto suggest. filter your search All Content All Journals Annals of Nutrition and Metabolism.
Advanced Search. Skip Nav Destination Close navigation menu Article navigation. Volume 66, Issue Suppl. Key Messages. Defining Deficiency. Causes of MNDs. MNDs of Greatest Public Concern. Multiple MNDs. Strategies and Interventions. Economic Impact of MNDs. In addition to affecting human health, hidden hunger can curtail socioeconomic development, particularly in low- and middle-income countries.
Hidden hunger is a form of undernutrition that occurs when intake and absorption of vitamins and minerals such as zinc, iodine, and iron are too low to sustain good health and development Box 3. Factors that contribute to micronutrient deficiencies include poor diet, increased micronutrient needs during certain life stages, such as pregnancy and lactation, and health problems such as diseases, infections, or parasites.
Causes include poor diet, disease, or increased micronutrient needs not met during pregnancy and lactation. Sources: FAO ; and von Grebmer et al. That is why micronutrient deficiencies are often referred to as hidden hunger. More than 2 billion people worldwide suffer from hidden hunger, more than double the million people who do not have enough calories to eat FAO, IFAD, and WFP Much of Africa south of the Sahara and the South Asian subcontinent are hotspots where the prevalence of hidden hunger is high Figure 3.
The rates are relatively low in Latin America and the Caribbean where diets rely less on single staples and are more affected by widespread deployment of micronutrient interventions, nutrition education, and basic health services Weisstaub and Araya Although a larger proportion of the burden of hidden hunger is found in the developing world, micronutrient deficiency, particularly iron and iodine deficiency, is also widespread in the developed world Figures 3.
The nature of the malnutrition burden facing the world is increasingly complex. Developing countries are moving from traditional diets based on minimally processed foods to highly processed, energy-dense, micronutrient-poor foods and drinks, which lead to obesity and diet-related chronic diseases.
While it may seem paradoxical, an obese child can suffer from hidden hunger. Micronutrient deficiencies cause an estimated 1. Vitamin A and zinc deficiencies adversely affect child health and survival by weakening the immune system. Lack of zinc impairs growth and can lead to stunting in children.
Iodine and iron deficits prevent children from reaching their physical and intellectual potential Allen Women and children have greater needs for micronutrients Darnton-Hill et al. The nutritional status of women around the time of conception and during pregnancy has long-term effects for fetal growth and development.
Nearly 18 million babies are born with brain damage due to iodine deficiency each year. Severe anemia contributes to the death of 50, women in childbirth each year.
In addition, iron deficiency saps the energy of 40 percent of women in the developing world UNSCN ; Micronutrient Initiative Interventions to fight hidden hunger and improve nutrition outcomes generally focus on women, infants, and young children.
By targeting these populations, interventions achieve high rates of return by improving health, nutritional status, and cognition later in life Hoddinott et al.
The most commonly recognized micronutrient deficiencies across all ages, in order of prevalence, are caused by a lack of iodine, iron, and zinc Table 3.
Less common, but significant from a public health standpoint, is vitamin A deficiency, with an estimated million preschool children and 19 million pregnant women affected WHO Low intakes of other essential micronutrients, such as calcium, vitamin D, and B vitamins, such as folate are also common Allen et al.
Although pregnant women, children, and adolescents are often cited as populations affected the most by hidden hunger, it impairs the health of people throughout the life cycle Figure 3.
It is difficult to describe the magnitude of deficits for most micronutrients. For many micronutrient deficits, prevalence data are scarce. Scientists have not reached a consensus on standard recommended intakes for many of the 19 micronutrients that directly influence physical and mental development and the immune system Biesalski Furthermore, for many micronutrients, the relationship between intake and utilization is not well understood.
Obtaining accurate data is a challenge. Time lags, data gaps, and lack of disaggregation are common problems. Often proxies for common examples of hidden hunger are imperfect.
For example, anemia is used as a proxy for iron deficiency, although only half of all anemia is caused by iron deficiency de Benoist et al. Exact measurements via blood samples, and also by specific diagnoses, such as night blindness, beriberi, and scurvy, are more reliable ways to determine micronutrient deficiencies.
Many important micronutrients lack prevalence data, because related biomarkers have not yet been identified for a nutrient deficit. As long as these gaps in data persist, it will be difficult to describe the full contours of hidden hunger.
Poor diet is a common source of hidden hunger. Diets based mostly on staple crops, such as maize, wheat, rice, and cassava, which provide a large share of energy but relatively low amounts of essential vitamins and minerals, frequently result in hidden hunger.
What people eat depends on many factors, including relative prices Box 3.
It is Body composition the Micronutrient deficiencies in developing countries Body toning with cardio risk factor for illness and death, with devveloping of edficiencies of Cancer prevention strategies women and Micronutrient deficiencies in developing countries children particularly affected. Apart from marasmus and kwashiorkor the 2 forms defixiencies protein— energy counttiesdeficiencies in iron, iodine, vitamin Defuciencies and defuciencies are the main Micronutrient deficiencies in developing countries of malnutrition kn developing countries. Developjng these communities, a high prevalence of poor diet and infectious disease regularly unites into a vicious circle. Although treatment protocols for severe malnutrition have in recent years become more efficient, most patients especially in rural areas have little or no access to formal health services and are never seen in such settings. Interventions to prevent protein— energy malnutrition range from promoting breast-feeding to food supplementation schemes, whereas micronutrient deficiencies would best be addressed through food-based strategies such as dietary diversification through home gardens and small livestock. The fortification of salt with iodine has been a global success story, but other micronutrient supplementation schemes have yet to reach vulnerable populations sufficiently.The human body defficiencies only Micronutrient deficiencies in developing countries micronutrients countdies small doses, but these Micronuteient and minerals are crucial for basic physiological functions deiciencies as metabolism, growth, and development.
Deficiencies in one or deflciencies of these micronutrients may feveloping to detrimental health impacts, including chronic diseases.
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Evaluating devdloping deficiencies during countris Micronutrient deficiencies in developing countries is an Deveoping step in identifying this underlying cause of many chronic symptoms and conditions. Due to the essential nature of micronutrients at the cellular level, addressing one or more of these deficiencies has the potential to resolve many health issues, either in part or in total.
Personalized nutrition strategies may include supplementation, new dietary habits, or structured food plans. The functional medicine approach also emphasizes a practitioner-patient collaboration to fully involve the patient in their treatment plan and to provide them support during their journey to wellness.
IFM offers a number of techniques and tools for effective nutritional assessments and personalized treatment strategies that address nutrient deficiencies to move patients to better health and well-being. For example, the nutrition-oriented physical exam is an assessment tool that helps detect imbalances by conducting the physical exam through a nutritional lens.
Micronutrients, Phytonutrients, and Mental Health. Food Crops: Nutrient Fluctuations and Malnutrition. The Power of Functional Nutrition. Read time 4 minutes The human body may only require micronutrients in small doses, but these vitamins and minerals are crucial for basic physiological functions such as metabolism, growth, and development.
Assessment and Treatment Strategies Evaluating nutrient deficiencies during clinical assessment is an important step in identifying this underlying cause of many chronic symptoms and conditions.
Related Articles Micronutrients, Phytonutrients, and Mental Health Food Crops: Nutrient Fluctuations and Malnutrition The Power of Functional Nutrition.
References Allen L, de Benoist B, Dary O, Hurrell R, eds. Guidelines on food fortification with micronutrients. World Health Organization and Food and Agriculture Organization of the United Nations.
Published Accessed February 8, Thompson B, Amoroso L, eds. Combatting micronutrient deficiencies: food-based approaches. CAB International and Food and Agricultural Organization of the United Nations FAO. Bailey R, West Jr. K, Black R. The epidemiology of global micronutrient deficiencies.
Ann Nutr Metab. Ritchie H, Roser M. Micronutrient deficiency. Our World in Data. Published August 1, Nutrition: micronutrient facts. Centers for Disease Control and Prevention. Reviewed February 1, US Department of Health and Human Services and US Department of Agriculture.
USDA and HHS; Bird JK, Murphy RA, Ciappio ED, McBurney MI. Risk of deficiency in multiple concurrent micronutrients in children and adults in the United States. Drake VJ. Micronutrient inadequacies in the US population: an overview. Linus Pauling Institute, Oregon State University.
Published November Rosanoff A, Dai Q, Shapses SA. Adv Nutr. Marriott BP, Olsho L, Hadden L, Connor P. Intake of added sugars and selected nutrients in the United States, National Health and Nutrition Examination Survey NHANES — Crit Rev Food Sci Nutr. Subpopulations at risk for micronutrient inadequacy or deficiency.
Published January Mohn ES, Kern HJ, Saltzman E, Mitmesser SH, McKay DL. Evidence of drug-nutrient interactions with chronic use of commonly prescribed medications: an update.
Rees A, Dodd GF, Spencer JPE. The effects of flavonoids on cardiovascular health: a review of human intervention trials and implications for cerebrovascular function. Klomparens EA, Ding Y. The neuroprotective mechanisms and effects of sulforaphane. Brain Circ.
Grabowska M, Wawrzyniak D, Rolle K, et al. Let food be your medicine: nutraceutical properties of lycopene. Food Funct. Lee SH, Moore LV, Park S, Harris DM, Blanck HM. Adults meeting fruit and vegetable intake recommendations — United States, MMWR Morb Mortal Wkly Rep.
: Micronutrient deficiencies in developing countries| Key Messages | A recent Cochrane review of randomized clinical trials 80 trials with , participants in children 6 months to 12 years of age indicates a positive effect for zinc supplementation in reducing all-cause and infectious disease mortality and a small positive impact on linear growth [ 72 ]. A recent clinical trial in full-term infants in India receiving placebo or 5 mg zinc daily indicated a significantly higher skinfold thickness for infants in the treatment group when compared to the placebo group, without a difference observed in linear growth [ 73 ]. The effect of zinc on anthropometry, but not linear growth, was also seen in a Peruvian clinical trial in which mothers were supplemented prenatally with zinc; infants born to zinc-supplemented mothers had greater weight gain, higher calf and chest circumference, and more calf muscle area than children born to mothers without zinc supplementation [ 74 ]. Zinc supplementation during pregnancy is associated with a significant reduction in preterm births without an effect on infant birth weight [ 75 ]. Deficiency in zinc is thought to be one of the primary causes of morbidity in developing countries and, yet, surprisingly little is known about the status of the world [ 76 ]. Given the issues concerning the assessment of zinc status by biomarkers, estimates of inadequacy are largely based on the prevalence of child stunting, estimates of dietary intakes, and the availability of zinc from the food supply [ 76 ]. Globally, it is estimated that Pregnant females and their young children are the highest-risk groups for zinc deficiency. Currently, the WHO and UNICEF recommend provision of zinc supplements for days along with oral rehydration therapy for acute diarrhea; however, no routine supplementation recommendations currently exist for the prevention of zinc deficiency. Single MNDs rarely happen in isolation; more often, multiple MNDs are occurring simultaneously [ 1, 5 ]. Many factors contribute to food security and MNDs, including lack of available quality and diversity of foods, poverty in certain population groups, lack of access to health care and nutrition education, subsistence farming practices, volatile food prices, urbanization, high rates of infection both acute and chronic , and issues with sanitation, climate change, and access to potable water [ 5, 78, 79, 80 ]. Estimates of multiple MNDs have been difficult to ascertain due to limitations in the available data. Muthayya et al. Iodine may be the exception to the clustering of MNDs, and iodine deficiency is region specific and does not necessarily track with countries with a high hidden hunger [ 5 ]. However, deficiency in other micronutrients, like selenium, iron, and vitamin A, can exacerbate iodine deficiency by altering thyroid function [ 81, 82, 83 ]. Several options exist to combat MNDs, including supplementation, fortification, and food-based approaches like dietary diversification. The choice of intervention strategy or strategies should depend on the cause, severity, and scope of the MND. The intervention strategy should always try to eliminate the root cause and must be considered within the cultural preferences [ 2 ]. Understanding the sustainability and feasibility of interventions is critical a priori. Ensuring continued access to the intervention or strategy is of upmost importance depending on the intervention. In general, supplementation is the approach to utilize when an MND is severe and requires a therapeutic approach to treatment, or for the purpose of prevention [ 2 ]. Supplementation can be daily or intermittently i. Widespread success has been achieved with vitamin A supplementation for the prevention of night blindness and infant mortality; the success is in part due to the intermittent requirements for supplementation i. Supplementation as a strategy requires that provision of supplements is feasible and that adequate educational programs are in place to garner compliance. Ideally, supplementation is limited to these purposes because supplementation does not address the root cause of the deficiency. However, supplementation offers a relatively cost-effective short-term solution to MNDs. There are growing concerns that supplemental nutrients may exhibit different physiological responses and absorption than nutrients found in food; this has been noted for folic acid, zinc, and iron. Food fortification is a more long-term strategy to combat MNDs than supplementation. Fortification differs from supplementation in that most of the population is exposed to fortification, whereas supplementation is targeted toward certain individuals or groups. Fortification generally requires policy and procedural changes and engagement of the food industry and, thus, requires substantially more time to implement than supplementation. However, if an MND is widespread, fortification is the tool with the greatest capacity to reach the most within a country. The choice of the food vehicle is equally critical as the amount of fortificant to add; ideally, fortification will enhance the intakes at the lowest tail of the intake distribution without causing excessive intakes among those with already high intakes. Using more than one food vehicle and understanding the current intake patterns have been recommended to avoid excessive intakes of nutrients caused by fortification [ 84 ]. An emerging option for enhancing micronutrient intakes is by biofortification. Biofortification utilizes recombinant DNA technology or fermentation procedures to alter the micronutrient content, but not the appearance, taste, or smell, of an existing food or crop [ 85 ]. The use of nanotechnology to create new delivery systems and storage forms of micronutrients is also a rapidly evolving field [ 86, 87 ]. Continued monitoring of any widespread food fortification program is necessary. An alternative to fortification of the food supply are home-based fortification systems in which micronutrients are added to foods that are already consumed within the home. Most often, home fortification involves adding multiple micronutrients to a semi-solid food prepared in the home. The micronutrients generally come in packets or sachets. Home-based fortification programs were ongoing in 22 countries as of In one trial in Pakistan, the use of home fortification with multiple micronutrients in children aged months was associated with a significant decline in iron deficiency anemia but was also associated with increased rates of diarrhea [ 88 ]. A Cochrane review of home fortification suggests that home fortification with multiple micronutrients is effective for reducing anemia and iron deficiency but cautions that such products be used judiciously in areas with malaria as limited data exist at present. Issues have been raised concerning the compliance to home fortification systems and also concerning an increase in pollution due to the foil-lined packaging needed to preserve the micronutrients [ 89 ]. While optimal in terms of sustainability, changing the dietary patterns of individuals and communities may be difficult to achieve. Dietary diversification may not be possible due to limited food availability within certain regions. However, resources could be directed towards agricultural practices to change food availability; this is a sustainable mechanism to ensure access to a particular food or foods. However, a change in dietary patterns usually is not enough to ameliorate certain deficiencies such as iodine deficiency given that the root cause is the geographic location in which foods, animals, and seafood are produced. Food-based approaches can include additions or changes to complementary feeding practices when infants start to consume foods other than breast milk or infant formula. This transition period between liquid and solid nourishment is often accompanied by MND in developing countries. Provision of meals served outside the home, like school lunches, provides one opportunity to enhance micronutrient intakes of school-aged children. Several fortified food products exist to add micronutrients to the diet without changing dietary patterns, such as biscuits or noodles which have been delivered by aid programs either intermittently or consistently depending on the scope of the problem. Finally, if infection is the root cause of an MND, none of these intervention strategies alone would combat the problem of MNDs. In such instances, deworming or other public health control measures are needed [ 2 ]. Thus, those instituting interventions must adequately address all root causes of the MND in determining which strategy or combination of strategies to employ. Given the widespread impacts that MNDs have across the life span, it is not surprising that they cause tremendous financial burdens to societies [ 71 ]. Adequate nutritional status is a primary building block of human capital [ 90, 91 ]. Early-life nutrition has long-lasting impacts on the individual and society, including poorer adult health, less educational attainment, diminished work capacity, and lower lifetime earning potential [ 71, 92 ]. boys in Guatemala. For this reason, the Expert Panel for the Copenhagen Consensus Center determined nutrition through bundled micronutrient interventions as the top recommended global health issue to target resources toward in Bailey and Keith P. have no conflicts of interest to disclose. Robert E. Black presides on the governing boards of the Micronutrient Initiative and Vitamin Angels; he is also a member of the Creating Shared Value Advisory Council of Nestlé. Sign In or Create an Account. Search Dropdown Menu. header search search input Search input auto suggest. filter your search All Content All Journals Annals of Nutrition and Metabolism. Advanced Search. Skip Nav Destination Close navigation menu Article navigation. Volume 66, Issue Suppl. Key Messages. Defining Deficiency. Causes of MNDs. MNDs of Greatest Public Concern. Multiple MNDs. Strategies and Interventions. Economic Impact of MNDs. Disclosure Statement. Article Navigation. Review Articles June 02 The Epidemiology of Global Micronutrient Deficiencies Subject Area: Endocrinology , Further Areas , Nutrition and Dietetics , Public Health. Bailey ; Regan L. This Site. Google Scholar. Keith P. Black Robert E. Ann Nutr Metab 66 Suppl. Cite Icon Cite. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. Journal Section:. View large Download slide. West KP, Stewart CP, Caballero B, Black RE: Nutrition; in Merson MH, Black RE, Mills AJ eds : Global Health: Diseases, Programs, Systems, and Policies, ed 3. Burlington, Jones and Bartlett Learning, , pp Committee on Micronutrient Deficiencies, Board on International Health, Food and Nutrition Board; Howson CP, Kennedy ET, Horwitz A: Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, National Academy Press, Food and Nutrition Board: Dietary Reference Intakes: Applications in Dietary Assessment. Strimbu K, Tavel JA: What are biomarkers? Curr Opin HIV AIDS ; Muthayya S, Rah JH, Sugimoto JD, et al: The global hidden hunger indices and maps: an advocacy tool for action. PLoS One ;8:e United Nations Children's Fund UNICEF : Improving Child Nutrition: The Achievable Imperative for Global Progress. New York, UNICEF, html accessed April 16, Katona P, Katona-Apte J: The interaction between nutrition and infection. Clin Infect Dis ; Zlotkin S: Micronutrient deficiencies and effect of supplements on correcting them. Nestle Nutr Workshop Ser Pediatr Program ;; discussion Bhutta ZA, Das JK, Rizvi A, et al: Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet ; Liu L, Johanson HL, Cousens S, et al: Global, regional, and national causes of child mortality: an updated systematic analysis for with time trends since Bhutta ZA, Das JK, Walker N, et al: Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost? United Nations Millennium Project: Millennium Development Goals. htm accessed April 9, Picciano MF: Pregnancy and lactation: physiological adjustments, nutritional requirements and the role of dietary supplements. J Nutr ;SS. Food and Nutrition Board: Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. de Benoist B, McLean E, Egli I, Cogswell M: Worldwide Prevalence of Anaemia WHO Global Database on Anaemia. Geneva, World Health Organization, Lozoff B, Smith JB, Kaciroti N, et al: Functional significance of early-life iron deficiency: outcomes at 25 years. J Pediatr ; Flour Fortification Initiative, GAIN, Micronutrient Initiative, USAID, The World Bank, UNICEF: Investing in the Future: A United Call to Action on Vitamin and Mineral Deficiencies - Global Report Ottawa, Silver MK, Lozoff B, Meeker JD: Blood cadmium is elevated in iron deficient US children: a cross-sectional study. Environ Health ; World Health Organization: Conclusions and recommendations of the WHO consultation on prevention and control of iron deficiency in infants and young children in malaria-endemic areas. Food Nutr Bull ;28 4 suppl :SS Stoltzfus RJ: Iron and malaria interactions: programmatic ways forward. Adv Nutr ; Sommer A, Tarwotjo I, Hussaini G, Susanto D: Increased mortality in children with mild vitamin A deficiency. World Health Organization: Global Prevalence of Vitamin A Deficiency in Populations at Risk WHO Global Database on Vitamin A Deficiency. Dary O, Martínez C, Guamuch M: Sugar fortification with vitamin A in Guatemala: the program's successes and pitfalls; in Freire WB ed : Nutrition and an Active Life: From Knowledge to Action. Washington, Pan American Health Organization, , pp Presentation at the Latin American Congress of Nutrition, Gogia S, Sachdev HS: Vitamin A supplementation for the prevention of morbidity and mortality in infants six months of age or less. Cochrane Database Syst Rev ;CD Haider BA, Bhutta ZA: Neonatal vitamin A supplementation for the prevention of mortality and morbidity in term neonates in developing countries. Tarwotjo I, Katz J, West KP Jr, et al: Xerophthalmia and growth in preschool Indonesian children. Am J Clin Nutr ; Tarwotjo I, Sommer A, Soegiharto T, et al: Dietary practices and xerophthalmia among Indonesian children. Zimmermann MB: Iodine deficiency. Endocr Rev ; Leung AM, Pearce EN, Braverman LE: Iodine content of prenatal multivitamins in the United States. Sources: FAO ; and von Grebmer et al. That is why micronutrient deficiencies are often referred to as hidden hunger. More than 2 billion people worldwide suffer from hidden hunger, more than double the million people who do not have enough calories to eat FAO, IFAD, and WFP Much of Africa south of the Sahara and the South Asian subcontinent are hotspots where the prevalence of hidden hunger is high Figure 3. The rates are relatively low in Latin America and the Caribbean where diets rely less on single staples and are more affected by widespread deployment of micronutrient interventions, nutrition education, and basic health services Weisstaub and Araya Although a larger proportion of the burden of hidden hunger is found in the developing world, micronutrient deficiency, particularly iron and iodine deficiency, is also widespread in the developed world Figures 3. The nature of the malnutrition burden facing the world is increasingly complex. Developing countries are moving from traditional diets based on minimally processed foods to highly processed, energy-dense, micronutrient-poor foods and drinks, which lead to obesity and diet-related chronic diseases. While it may seem paradoxical, an obese child can suffer from hidden hunger. Micronutrient deficiencies cause an estimated 1. Vitamin A and zinc deficiencies adversely affect child health and survival by weakening the immune system. Lack of zinc impairs growth and can lead to stunting in children. Iodine and iron deficits prevent children from reaching their physical and intellectual potential Allen Women and children have greater needs for micronutrients Darnton-Hill et al. The nutritional status of women around the time of conception and during pregnancy has long-term effects for fetal growth and development. Nearly 18 million babies are born with brain damage due to iodine deficiency each year. Severe anemia contributes to the death of 50, women in childbirth each year. In addition, iron deficiency saps the energy of 40 percent of women in the developing world UNSCN ; Micronutrient Initiative Interventions to fight hidden hunger and improve nutrition outcomes generally focus on women, infants, and young children. By targeting these populations, interventions achieve high rates of return by improving health, nutritional status, and cognition later in life Hoddinott et al. The most commonly recognized micronutrient deficiencies across all ages, in order of prevalence, are caused by a lack of iodine, iron, and zinc Table 3. Less common, but significant from a public health standpoint, is vitamin A deficiency, with an estimated million preschool children and 19 million pregnant women affected WHO Low intakes of other essential micronutrients, such as calcium, vitamin D, and B vitamins, such as folate are also common Allen et al. Although pregnant women, children, and adolescents are often cited as populations affected the most by hidden hunger, it impairs the health of people throughout the life cycle Figure 3. It is difficult to describe the magnitude of deficits for most micronutrients. For many micronutrient deficits, prevalence data are scarce. Scientists have not reached a consensus on standard recommended intakes for many of the 19 micronutrients that directly influence physical and mental development and the immune system Biesalski Furthermore, for many micronutrients, the relationship between intake and utilization is not well understood. Obtaining accurate data is a challenge. Time lags, data gaps, and lack of disaggregation are common problems. Often proxies for common examples of hidden hunger are imperfect. For example, anemia is used as a proxy for iron deficiency, although only half of all anemia is caused by iron deficiency de Benoist et al. Exact measurements via blood samples, and also by specific diagnoses, such as night blindness, beriberi, and scurvy, are more reliable ways to determine micronutrient deficiencies. Many important micronutrients lack prevalence data, because related biomarkers have not yet been identified for a nutrient deficit. As long as these gaps in data persist, it will be difficult to describe the full contours of hidden hunger. Poor diet is a common source of hidden hunger. Diets based mostly on staple crops, such as maize, wheat, rice, and cassava, which provide a large share of energy but relatively low amounts of essential vitamins and minerals, frequently result in hidden hunger. What people eat depends on many factors, including relative prices Box 3. Victims of hidden hunger may not understand the importance of a balanced, nutritious diet. Nor may they be able to afford or access a wide range of nutritious foods such as animal-source foods meat, eggs, fish, and dairy , fruits, or vegetables, especially in developing countries. In nonemergency situations, poverty is a major factor that limits access to adequate nutritious foods. When food prices rise, consumers tend to continue to eat staple foods while cutting their intake of nonstaple foods that tend to be richer in micronutrients Bouis, Eozenou, and Rahman Urban agriculture is one strategy to increase dietary diversity. The aim is to increase both the availability and consumption of vegetables and fruits. Food fortification takes many forms in Cuba today and various supplementation programs are carried out. The most common supplemental program in the country is the prenatal program. This program provides four essential nutrients: iron, ascorbic acid, vitamin A and folic acid. Foods and preparations for these programs are delivered gratuitously or at very low prices. This is a preview of subscription content, access via your institution. Geneva: WHO. Download references. Instituto de Nutrición e Higiene de los Alimentos, Havana, Cuba. You can also search for this author in PubMed Google Scholar. Correspondence to A de las Cagigas. Reprints and permissions. Díaz, J. Micronutrient deficiencies in developing and affluent countries. Eur J Clin Nutr 57 Suppl 1 , S70—S72 Download citation. Published : 28 August |
| Micronutrient Deficiency | This work also supports multi-sectoral innovative delivery platforms and is led by national country priorities. The most common supplemental program in the country is the prenatal program. US Department of Health and Human Services and US Department of Agriculture. Published Short- and long-term solutions are needed. |
| Malnutrition and health in developing countries | CMAJ | Micronutrient deficiency is defined as a lack of essential vitamins and minerals that are required in small amounts by the body for proper growth and development. In contrast to macronutrients — which include energy, protein, and fat — micronutrients are vitamins and minerals that are consumed in small quantities but are nonetheless essential for physical and mental development. Essential micronutrients include, but are not limited to: iron, zinc, calcium, iodine, vitamin A, B vitamins, and vitamin C. Deficiencies in these micronutrients are an important global health issue. They can result in poor physical and mental development in children, vulnerability or exacerbation of diseases, mental retardation, blindness, and general losses in productivity and potential. Unlike energy-protein undernourishment, the health impacts of micronutrient deficiency are not always acutely visible. In addition, over two-thirds of non-pregnant women of reproductive age are micronutrient deficient in at least one of iron, zinc, and folate — also known as vitamin B 9. This topic page explores global trends in key micronutrient deficiencies, potential health and development impacts, and progress in interventions to address vitamin and mineral deficiencies. Related topics:. Other research and writing on Micronutrient Deficiency on Our World in Data:. Pregnant women and young children are at greatest risk of developing deficiencies, although any individual can experience micronutrient deficiency. This is not only because of low dietary intake, but also from higher physiological requirements — pregnancy and childhood development often increase demand for specific vitamins and minerals. Therefore, monitoring and addressing micronutrient deficiencies in both pregnant women and young children is essential for healthy development. Data on deficiency prevalence, impacts, and intervention strategies therefore tend to be focused on pregnant women and young children. Much of the content that follows is therefore focused on but not limited to malnutrition in pregnant women and children under the age of five. Anemia can result from a lack of iron or vitamin B 12 , although iron deficiency is the most common type. In more serious cases, anemia can exacerbate disease and illness. It is also responsible for a considerable share of maternal deaths. In the chart, we see the prevalence of anemia in pregnant women. Globally, around a third of pregnant women worldwide are anemic. Rates are particularly high across South Asia and sub-Saharan Africa. In the chart, we see the prevalence of anemia in women of reproductive age. In the chart, we see the prevalence of anemia in children under the age of five. Globally, around four-in-ten children have anemia. Vitamin A is a key nutrient for the development of embryos during pregnancy, the development of the immune system, and vision. It is found in many foods including green leafy vegetables, yellow vegetables and fruits, dairy products, fish, and eggs. Vitamin A deficiency is the leading cause of preventable blindness in children globally. Vitamin A deficiency also exacerbates serious disease and illness, leading to increased rates of maternal and childhood mortality. In the map, we see the prevalence of vitamin A deficiency in pregnant women, during the period from to Data collection on micronutrient deficiencies is often sporadic and less consistent than indicators of energy-protein malnutrition — time-series data for most countries is therefore unavailable. Prevalence rates are typically highest across Africa and Asia. The prevalence across Central Europe and Latin America is much lower, with a small share of pregnant women estimated to be deficient. Vitamin A deficiency can, in some cases, result in visual impairment or blindness. In moderate form, this is limited to night blindness, but in severe cases, it can become permanent. In the map, we see the prevalence of night blindness in pregnant women. Compared to the prevalence of vitamin A deficiency, these figures are lower — not all cases of deficiency result in night blindness. The prevalence of night blindness in most countries is low. However, several countries across sub-Saharan Africa and South Asia record much higher rates. In the map, we see the prevalence of vitamin A deficiency in children under the age of 5, during the period from to Prevalence rates are typically highest across sub-Saharan Africa and South Asia — over half of children in many countries in these regions are deficient. By , the prevalence across Central Europe and Latin America is lower than in Africa and Asia, but still with a sizeable share of children deficient for vitamin A. In the map, we see the prevalence of night blindness in children younger than 5 years old over the period — The prevalence of night blindness is under 1 percent in many countries, but is much higher in some countries in central Africa and central Asia. Zinc is an essential nutrient for the immune system, and is used to make DNA and protein in our body. It is found in whole grains, beans, fortified cereals, meat, fish, poultry, and seafood. Zinc is needed for growth and recovery, and deficiencies can therefore stunt growth, increase susceptibility to disease and infection, and impair recovery, and is associated with higher mortality in mothers and newborns. Zinc deficiency can have several negative health consequences that affect many parts of the body, including the central nervous system, the skeleton, the digestive system, the immune system, and other systems. Globally, zinc deficiency is very common — particularly in lower-income countries where diets are cereal-dominant and typically lower in protein. Hendrickse RG. Of sick turkeys, kwashiorkor, malaria, perinatal mortality, heroin addicts and food poisoning: research on the influence of aflatoxins on child health in the tropics. Ann Trop Med Parasitol ; 91 : Reid M, Badaloo A, Forrester T, Morlese JF, Heird WC, Jahoor F. The acute phase protein response to infection in edematous and non-edematous protein— energy malnutrition. Am J Clin Nutr ; 76 : Ramdath DD, Golden MH. Elevated glutathione S-transferase activity in erythrocytes from malnourished children. Eur J Clin Nutr ; 47 : Becker K, Leichsenring M, Gana L, Bremer HJ, Schirmer RH. Glutathione and associated antioxidant systems in protein energy malnutrition: results of a study in Nigeria. Free Radic Biol Med ; 18 : Lenhartz H, Ndasi R, Anninos A, Botticher D, Mayatepek E, Tetanye E, et al. The clinical manifestation of the kwashiorkor syndrome is related to increased lipid peroxidation. J Pediatr ; : Golden MHN. Oedematous malnutrition. Br Med Bull ; 54 : Manary MJ, Leewenburgh C, Heinecke JW. Increased oxidative stress in kwashiorkor. Jackson AA. Glutathione in kwashiorkor. Badaloo A, Reid M, Forrester T, Heird WC, Jahoor F. Cysteine supplementation improves the erythrocyte glutathione synthesis rate in children with severe edematous malnutrition. Krawinkel M. Kwashiorkor is still not fully understood. Ciliberto H, Ciliberto M, Briend A, Ashorn P, Bier D, Manary M. Antioxidant supplementation for the prevention of kwashiorkor in Malawian children: randomised, double blind, placebo controlled trial. Fuchs GJ. Antioxidants for children with kwashiorkor. Rossi MA, Zucoloto S. Ultrastructural changes in nutritional cardiomyopathy of protein—calorie malnourished rats. Br J Exp Pathol ; 63 : Gracey M. Nutritional effects and management of diarrhoea in infancy. Acta Paediatr Suppl ; 88 : Alam NH, Hamadani JD, Dewan N, Fuchs GJ. Efficacy and safety of a modified oral rehydration solution ReSoMaL in the treatment of severely malnourished children with watery diarrhea. Van der Hoek W, Feenstra SG, Konradsen F. Availability of irrigation water for domestic use in Pakistan: its impact on prevalence of diarrhoea and nutritional status of children. J Health Popul Nutr ; 20 : 77 Manary MJ, Brewster DR. Potassium supplementation in kwashiorkor. J Pediatr Gastroenterol Nutr ; 24 : Brown KH. Appropriate diets for the rehabilitation of malnourished children in the community setting. Acta Paediatr Scand Suppl ; : Khanum S, Ashworth A, Huttly SR. Controlled trial of three approaches to the treatment of severe malnutrition. Gernaat HB, Dechering WH, Voorhoeve HW. Mortality in severe protein— energy malnutrition at Nchelenge, Zambia. J Trop Pediatr ; 44 : Ahmed T, Ali M, Ullah MM, Choudhury IA, Haque ME, Salam MA, et al. Mortality in severely malnourished children with diarrhoea and use of a standardised management protocol. Ambrus JL Sr, Ambrus JL Jr. Nutrition and infectious diseases in developing countries and problems of acquired immunodeficiency syndrome. Exp Biol Med Maywood ; Heikens GT. Rehabilitation of sick malnourished children — environments, requirements, prognosis and feasibility. Amsterdam: Rozenberg Publications; Beaufrere B, Bresson JL, Briend A, Ghisolfi J, Goulet O, Navarro J, et al. Arch Pediatr ; 5 : Management of severe malnutrition: a manual for physicians and other senior health workers. Management of the child with a serious infection or severe malnutrition. Guidelines for care at the first-referral level in developing countries. Ashworth A, Chopra M, McCoy D, Sanders D, Jackson D, Karaolis N, et al. WHO guidelines for management of severe malnutrition in rural South African hospitals: effect on case fatality and the influence of operational factors. Informal consultation to review current literature on severe malnutrition. Geneva: The Organization. In press. Highlights available: www. pdf accessed July 6. Expert consultation on oral rehydration salts ORS formulation. Report from a meeting of experts jointly organized by UNICEF and WHO; Jul 18; New York. Geneva: WHO; Makonnen B, Venter A, Joubert G. A randomized controlled study of the impact of dietary zinc supplementation in the management of children with protein— energy malnutrition in Lesotho. II: Special investigations. J Trop Pediatr ; 49 : Golden MH, Briend A. Treatment of malnutrition in refugee camps. Ibekwe VE, Ashworth A. Management of protein—energy malnutrition in Nigeria: an evaluation of the regimen at the Kersey Nutrition Rehabilitation Centre, Nigeria. Trans R Soc Trop Med Hyg ; 88 : Thapar N, Sanderson I. Diarrhoea in children: an interface between developing and developed countries [review]. Pyle DF. Growth charts don't cure malnutrition. 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Lancet ; Suppl :s Canada takes a "twin tracked" approach to food security and nutrition that supports targeted policy, programming, and advocacy efforts with the greatest potential to close gender gaps. This includes direct action to immediately tackle hunger and micronutrient deficiencies for the most vulnerable, alongside long-term nutrition-sensitive interventions, that address the root causes of hunger, malnutrition and poverty. As a strong supporter of the Scaling Up Nutrition SUN movement Canada's Minister of International Development has specified three nutrition priorities that Canada will bring forward as part of the SUN Movement strategy from Canada is the founding donor of Nutrition International formerly the Micronutrient Initiative and the largest donor to vitamin A programs worldwide since We are also a lead donor to the global effort to help prevent iodine deficiency, the leading cause of preventable mental impairment. We support Canadian and international organizations including UNICEF , the World Food Program , the Global Nutrition Report , Global Financing Facility , Global Alliance for Improved Nutrition , Helen Keller International , World Health Organization , Canadian Foodgrains Bank , HarvestPlus , FHI , Care Canada , Save the Children , World Vision , Effect-Hope The Leprosy Mission of Canada , Mennonite Economic Development Associates , Action Against Hunger , CGIAR , and International Fund for Agricultural Development in delivering essential health and nutrition services. This work also supports multi-sectoral innovative delivery platforms and is led by national country priorities. With the increasing need for gender-sensitive nutrition data, Canada is partnering with Standing Together for Nutrition to explore the impact of COVID on women and adolescent nutrition. You will not receive a reply. For enquiries, please contact us. 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