International NutritionCurrent & Emerging Issuesin Nutrition, Health & SurvivalInternational Nutrition: Major Nutritional ProblemsInternational Nutrition:Responses to Nutritional StressInternational Nutrition:Other Issues CoveredBurden of UndernutritionWorld Declaration on the Survival, Protection and Development of Children Plan of Action for Implementing the World DeclaratWorld Summit for Children 1990: Nutrition GoalsWorld Food Summit of 1996 FAOMillennium Development Goals (MDGs)(based on Goals at UN Millennium Summit, Sept 8, 2000)Goal 1: Eradicate Extreme Poverty and HungerUndernutritionUnderweight in Under FivesMicronutrient Malnutrition:Hidden HungerVitamin A DeficiencyIron Deficiency/Anemia:A Major Global ProblemAnemia: Many CausesAnemia: Many SolutionsIodine Deficiency DisordersWHO 2004Effects of Iodine Deficiency on Neural FunctionZinc DeficiencyZinc in the National Food Supply (% mean per capita requirement)Effects of Daily Zinc Supplement Use on Diarrhea and Pneumonia in PreschoolersHousehold Food SecurityNational & International Responses“Classic” Chain of CausationThe Nutrition Transition- An Emerging Global Epidemic of Obesity-Trends in Prevalence of Underweight and Obesityin the Poorest and Richest 25% of Brazilian WomenMonteiro C, Conde W, PopkinPrevalence Ratios for Underweightand Obesity Among Brazilian Women, 1975-97This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this site.Copyright 2006, The Johns Hopkins University and Keith P. West, Jr. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided “AS IS”; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed.International NutritionCurrent & Emerging Issuesin Nutrition, Health & SurvivalKeith P. West, Jr. DrPH, MPHInternational Nutrition: Major Nutritional Problems• General food insecurity• Protein-energy malnutrition (PEM)• Micronutrient deficiencies• Vitamin A deficiency & disorders• Iron deficiency anemia• Zinc deficiency• Iodine deficiency & disorders• Other micronutrient deficits• Infection and infectious morbidity• Overweight & obesity• Chronic diseases of imbalance and overabundanceInternational Nutrition:Responses to Nutritional Stress• Household Responses: • Breast feeding/Complementary feeding• Home-based fortification• Improving household food security (quantity, quality distribution)• Improving household hygiene• Food and non-food budgeting• Community Responses:• Growth monitoring & promotion• Supplementary feeding• Cooperatives • Nutrition education activities• National and International Responses: • Nutritional surveillance and program monitoring• Food aid• National food & nutrition policies• Multilateral and bilateral assistance programsInternational Nutrition:Other Issues Covered • Obesity and the Nutrition Transition• Nutrition and Reproductive Health• HIV and Micronutrient Nutrition • Epidemiology of Famine• Nutritional Problems Emerging from Student Papers (aka consultant reports!)Population Distributions of Nutritional StatusOvernourishedOverweight/ObeseToxicUndernourishedDeficientPopulation DistributionNormally NourishedFor more information see: West et al. Nutrition. Intl Public Health. Aspen:Gaithersberg, 2001Population Distributions of Nutritional StatusMostly Undernourished (PEM, Micronutrient Deficiencies)OvernourishedOverweightToxicUndernourishedDeficientFamishedPopulation DistributionNormally NourishedFor more information see: West et al. Nutrition. Intl Public Health. Aspen:Gaithersberg, 2001Population Distributions of Nutritional StatusMostly Undernourished (PEM, Micronutrient Deficiencies)OvernourishedOverweightToxicUndernourishedDeficientFamishedPopulation DistributionNormally NourishedTPFPFNTNLow weight for height..…Normal weight for height Low circulating retinol….Normal circulating retinol levelsLow hemoglobin…………Normal hemoglobin Low urinary iodine………Normal iodine statusFor more information see: West et al. Nutrition. Intl Public Health. Aspen:Gaithersberg, 2001Burden of Undernutrition• ~20% of world popn → inadequate food• Growth failure → ~1/3 of children• ~40% of women → under weight and/or anemic• >1 billion suffer nutritional deficienciesACC/SCN of the UN 2000Household Food Security Decisions Food & Nutrition Policies Growth Monitoring Screening Treatment Supplementary Feeding Food Aid Disaster Relief Overnutrition Normal Undernutrition FamineSpectrum of Nutritional ConditionsTypes of ResponsesSpectrum of nutritional well-being and examples of types of responses in developing countries.World Declaration on the Survival, Protection and Development of ChildrenPlan of Action for Implementing the World Declaration on the Survival, Protection and Development of Children in the 1990sUNICEF 1990World Summit for Children 1990: Nutrition Goals• Reduce severe & moderate malnutrition < 5 yrs by half of 1990 levels; • Reduce rate of low birth weight (<2.5 kg) to < 10 %; • Reduce iron deficiency anemia in women by 1/3 of 1990 levels; • Virtually eliminate iodine deficiency disorders; • Virtually eliminate vitamin A deficiency and consequences, including blindness; • Empower women to exclusively breast-feed for four to six months (now 6 months) and to continue breastfeeding, with complementary food, well into the second year; • Institutionalize growth promotion and monitoring in all countries by the end of the 1990s; • Disseminate knowledge and support services to increase food production to ensure household food security.December 1992FAO & WHOBy the year 2000 . . . eliminate:• famine and related deaths• starvation• man-made disaster-induced deficiencies• iodine deficiency• vitamin A deficiencyICN, Rome 1992World Food Summit of 1996 FAO•Monitoring adequacy of food supplies •Gender equality for education, training in food industry•Increased expert guidance to countries on human nutrition•Improved opportunities for nutrition education•Attention to food quality