1. HSERV 544 - Nutrition in Children
Jonathan Gorstein
Clinical Associate Professor
Department of Global Health
HSERV Nutrition in Children

2. HSERV 544 - Nutrition in Children
Terminology
Hunger – physiological state when food not able to meet energy needs
Malnutrition – impaired development linked to both deficient and excessive nutrient intake
Undernutrition – most common form of malnutrition in developing countries; energy, protein and micronutrients
HSERV Nutrition in Children

3. Major Nutritional Problems in the World
Protein-energy malnutrition
Obesity
Micronutrient deficiency problems
Iron deficiency anemia
Vitamin A deficiency
Iodine deficiency disorders
Zinc deficiency
Folate deficiency
Nutrition-related chronic diseases
HSERV Nutrition in Children

4. Causes of Undernutrition
Undernutrition is a complex condition that involves multiple, overlapping deficiencies of protein, energy and micronutrients – rarely do these occur in isolation
The primary cause of undernutrition is an inadequate food intake, but is compounded by illness and malabsorption
Insufficient access to food, poor health services, the lack of safe water and sanitation, inadequate child and maternal care and poverty are underlying causes
HSERV Nutrition in Children

5. Classification of Malnutrition
WHO recommends three anthropometric indicators for assessment of nutritional status
Wasting (Low weight-for-height)
Stunting (Low height-for-age)
Underweight (Low weight-for-age)
Classification based on International Growth Reference
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6. Prevention and Management of Undernutrition
Heightened visibility over past 2-3 years due to successful and innovative programs
Gates ….
Public-private partnerships
GAIN: Ten Year Strategy for Micronutrients
World Bank: Repositioning Nutrition
Lancet: Special Series on Undernutrition
Opportunities
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7. Intergenerational Cycle of Undernutrition
The cycle of poor nutrition perpetuates itself across generations - supported by scientific evidence
Childhood: Child growth failure, impaired mental development
Fetal and Infant stages: Low birthweight baby
Pregnancy
Compromised nutritional status
Adolescents: Low weight and height
Adult: Small adult woman, lowered productivity
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8. Consequences of Undernutrition: Economic costs
Undernutrition leads to reduced productivity, hampering economic growth and effectiveness of investments in health and education
Vitamin and mineral deficiencies are estimated to cost some countries the equivalent of more than 5 per cent of their GNP in lost lives, disability and productivity
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9. Infection-Malnutrition Synergism
Weight loss
Growth faltering
Immunity lowered
Inadequate dietary intake
Disease Incidence
Severity
Duration
Appetite loss
Nutrient loss
Malabsorption
Altered Metabolism
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10. Causes of Mortality among Preschool Children, 2005
Other
Perinatal
Deaths associated with undernutrition
55%
HIV/AIDS
Acute Respiratory Infection
Measles
Malaria
Diarrhea
Source: WHO (2003)
HSERV Nutrition in Children

11. HSERV 544 - Nutrition in Children
Interventions to improve nutrition and reduce HIV/AIDS progression – from Individual to Community
Therapeutic
Direct food assistance
Food aid provided in conjunction with ARVs
Social protection
Cash transfers
Sustainable Livelihoods
Income generating opportunities
Small-scale fortification
Agriculture, e. small-farmer initiatives
HSERV Nutrition in Children

12. Consequences of Malnutrition: Economic costs
Malnutrition leads to reduced productivity, hampering economic growth and effectiveness of investments in health and education
Vitamin and mineral deficiencies are estimated to cost some countries the equivalent of more than 5 per cent of their GNP in lost lives, disability and productivity
HSERV Nutrition in Children

13. HSERV 544 - Nutrition in Children
Micronutrients
Micronutrients are needed by the body only in minute amounts, are critical for:
Regulation of growth, activity, development
Immune and reproductive function
Three primary micronutrient deficiencies include:
Iodine
Vitamin A
Iron
HSERV Nutrition in Children

14. Population at Risk of Deficiency - Global
2.0
1.6
0.8
Source: UNICEF (2002)
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15. Iodine Deficiency Disorders (IDD)
Single most important cause of preventable brain damage and mental retardation
Significantly raises the risk of stillbirth and miscarriage in pregnant women
About 50 million people worldwide suffer from varying degrees of brain damage and physical impairment due to iodine deficiency – Concept of IDD (Spectrum of disability)
The primary intervention for the control of IDD is through salt iodization
HSERV Nutrition in Children

16. Iodine Deficiency Disorders (IDD)
Today
Some 70 per cent of households in the developing world are using iodized salt, compared to less than 20 per cent at the beginning of the decade.
As a result, 91 million newborns are protected yearly from significant loss in learning ability
Unfinished Business
There are still 35 countries where less than half the households consume iodized salt
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17. Coverage of Iodized Salt – by Region
Source: UNICEF (2002)
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18. Levels of Iodized Salt Coverage
90% or more
50% to 89%
Less than 50%
No recent data
Source: UNICEF (2002)
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19. Major Increases in Iodized Salt Coverage
Source: UNICEF (2004)
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20. 41 Million Newborns Still Unprotected from Learning Disabilities
Source: UNICEF (2002)
HSERV Nutrition in Children

21. HSERV 544 - Nutrition in Children
Vitamin A Deficiency
Contributing factor in 2.2 million deaths each year from diarrhea and 1 million deaths from measles among preschool children under five
Severe deficiency can also cause irreversible corneal damage, leading to partial or total blindness
Results of field trials indicate that VA supplementation of children with can reduce deaths from diarrhea. Four studies showed deaths were reduced by per cent.
VA can reduce by half the number of deaths due to measles
HSERV Nutrition in Children

22. Magnitude of Vitamin A Deficiency
Pre-school children
Clinically deficient: 3 million (Asia and Africa)
Subclinically deficient (low serum retinol): million
250, ,000 become blind each year
90 % case fatality among those who become blind
Pregnant women
25%-30% cases of night blindness reported in some Asian countries
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23. Interventions to Control VAD
In 1999, only 10 countries provided two rounds of VA supplementation with high coverage, this has increased to over 50 countries by 2004.
Between 1998 and 2004, UNICEF estimates that about two million child deaths may have been prevented from vitamin A supplementation
Food Fortification - A number of countries are successfully fortifying staple foods with vitamin A (e.g. sugar, maize flour, wheat) reaching large populations.
HSERV Nutrition in Children

24. Vitamin A Supplementation Coverage1: Developing world
1 Percent of children aged 6-59 months who received at least one vitamin A supplement within the last six months
HSERV Nutrition in Children
Source: UNICEF (2000)

25. VA Supplementation Coverage
Where VAD is a public health problem (U5MR>70)
70% or more
30 to 69%
Less than 30%
No data available
1 Percent of children aged 6-59 months who received at least one vitamin A supplement within the last six months
HSERV Nutrition in Children
Source: UNICEF (2000)

26. Iron Deficiency and Anaemia
Most common nutritional disorder in the world
Lowers resistance to disease and weakens a child's learning ability and physical stamina
Significant cause of maternal mortality, increasing the risk of hemorrhage and infection during childbirth.
Nearly 2 billion people estimated to be anemic and millions more are iron deficient, the vast majority are women.
Supplementation and fortification are primary interventions to improve iron intake
HSERV Nutrition in Children

27. Global Prevalence of Anaemia: Pregnant Women
Source: WHO (1999)
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28. Main Factors Contributing to Anaemia
Iron deficiency
Poor bioavailability of consumed iron
Insufficient dietary iron intake
Chronic and recurrent infections that interfere with food intake and absorption/utilization of iron
Helminth infections, primarily Hookworm
Chronic diarrheal disease
HIV
Malaria
HSERV Nutrition in Children

29. Interventions to Control Anaemia
Depends on etiology
For iron deficiency: supplementation and fortification
For parasitic disease control: appropriate measures for prevention and presumptive treatment
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30. HSERV 544 - Nutrition in Children
Thank you
HSERV Nutrition in Children