1. Food Security, Health and Sustainable Development: Are the current production, distribution and use of food healthy, safe, secure and sustainable in the Americas? Reflections towards Rio+20 XV Seminar: 16 May 2012 Food security and nutrition: trends in the American Region Dr. Chessa Lutter Family and Community Health Pan American Health Organization

2. Outline Nutrition situation and trends Nutrition and food production and processing Policy environment

3. 0.0 10.0 20.0 30.0 40.0 50.0 60.0 Argentina, 2006 Dominican Republic, 2002 Brazil, 1996 México, 2006 Colombia, 2005 El Salvador, 2003 Nicaragua, 2001 Ecuador, 2004 Haiti, 2005 Honduras, 2005 Bolivia, 2003 Peru, 2004-2008 Guatemala, 2002 % Low weight (<-2 SD) Stunting (<-2 SD) Low prevalence of underweight compared to stunting (children < 5 years) Sources: PAHO. Undernutrition in Latin America and the Caribbean: Achieving the Millennium Development Goals. PAHO, 2008; Lutter et al., Undernutrition, poor feeding practices, and low coverage of key nutrition interventions. Pediatrics 2011 13.5% or 7 million stunted in LAC

4. Overweight/obesity among women of reproductive age in 4 Latin American countries % Source: Nationally representative surveys % Source: Nationally representative data

5. High prevalence of anemia in young children and pregnant women Source: PAHO. Anemia in Latin America and the Caribbean, 2009. Situation analysis, trends, and implications for public health programming. Washington DC, PAHO. 2012.

6. Overlapping Risk Factors Child stunting and anemia –Non optimal breastfeeding –Poor quality of complementary feeding diet –High burden of clinical and subclinical infections, particularly gastrointestinal Maternal overweight and anemia –Diet rich in energy, fat and salt and poor in fruits, vegetables, whole grains –Lack of physical activity

7. Overlapping Results Photo credit: UNICEF, Peru

8. Overlap of undernutrition and overweight/obesity –Anemia and overweight/obesity among women coexist in some low- and middle-income countries –In 36 low- and middle-income countries, on average 10% of households had both stunted children and overweight mothers (more in Latin America) Sources: Garret and Ruel. The coexistence of child undernutrition and maternal overweight: prevalence, hypotheses, and programme and policy implications. Matern Child Nutr 2005; Eckhardt et al.,The overlap of overweight and anemia among women in three countries undergoing the nutrition transition. Eur J Clin Nutr 2008.

9. Availability Access Intake (quantity and quality) Utilization Factors influencing food and nutrition security Source: CEPAL. MDG Report. 2010. Chile. Prevalence of poverty in LAC 72 million 180 million

10. Increased production of fruits and vegetables Micronutrient fortification of staple foods (iron, iodine, folic acid, B-complex, vitamin A, zinc) Reduction of salt, sugar and fats of poor nutrition quality Elimination of trans fatty acids Nutrition and food production

11. Nutritional characteristics – low nutrient density, little dietary fiber – excess simple carbohydrates, saturated fats, sodium, trans fats – energy-dense Eating patterns – not consumed with or as part of minimally processed foods, dishes and meals. – ready-to-eat – consumed alone or in combination - savory snacks with soft drinks, bread with burgers Nutrition and food processing (ultra processed foods)

12. Policy environment National policies on prevention of undernutrition Conditional cash transfers Multi-sectoral policies to improve income, education, water and sanitation, access to health services Health sector interventions National policies on prevention of overweight/obesity Food import and trade policies Legislation on marketing food and beverages to children Nutritional labeling Taxation and price policies

13. Thank you! Photo credits: Chessa Lutter, Linda Arturo, Jan Pappalardo