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Combating hidden hunger: the role of international agencies.

The importance of micronutrient deficiencies or "hidden hunger" was clearly emphasized by the inclusion of specific goals on iron, vitamin A, and iodine deficiency at the 1990 World Summit for Children and other major international nutrition conferences. Significant progress has since been made toward eliminating vitamin A and iodine deficiencies, with less progress made toward reducing the burden of iron-deficiency anemia. The role of international agencies, such as the World Health Organization, United Nations Children's Fund, Food and Agricultural Organization, and World Bank in assisting countries to make progress toward the World Summit for Children goals has been very important. International agencies have played a critical role in advocating for and raising awareness of these issues at the international, regional, and national levels among policymakers and the general population. Using a rights-based approach, UNICEF and other agencies have been instrumental in elevating to the highest political level the discussion of every child's right to adequate nutrition. International agencies have also been very supportive at the national level in providing technical guidance for programs, including monitoring and evaluation. These agencies have played a critical role in engaging the cooperation of other partners, including bilateral donors, non-governmental organizations, and the private sector for micronutrient programs. Furthermore, international agencies provide financial and material support for micronutrient programs. In the future, such agencies must continue to be heavily involved in programs to achieve the newly confirmed goals for 2010. The present paper focuses on the role of international agencies in combating micronutrient deficiencies, drawing on the lessons learned over the last decade. The first section of the paper summarizes the progress achieved since 1990, and the second section describes the specific role of international agencies in contributing to that progress.

Anemia, Iron-Deficiency↗

Using the school feeding system as a vehicle for micronutrient fortification: experience from South Africa.

School-age children are often a neglected group in terms of micronutrient interventions because they are not reached by the intervention strategies aimed at preschool children or pregnant women. School feeding, however, offers an excellent opportunity for targeted intervention in this age group, especially with regard to fortification. This paper first gives a brief overview of the school-feeding program in South Africa, and second reports on a number of trials conducted in South African schools by the South Africa Medical Research Council that examined the feasibility of using school feeding as a vehicle for micronutrient fortification. Various food items, such as biscuits, bread spread, and soup, are evaluated as potential carriers for micronutrients with positive effects on outcomes such as micronutrient status, growth, morbidity and cognitive function. For schoolchildren to realize their full mental and physical potential and to perform optimally at school, both short-term hunger and hidden hunger (micronutrient deficiencies) need to be addressed. School feeding has the potential to contribute toward alleviating both of these conditions and should therefore be fully utilized.

Child↗

Consequences of hunger for individuals and societies.

Famine and the manifestations of acute hunger that result are an unnecessary disgrace to our global society and serious in their political, economic, and social consequences. Probably more damaging is the chronic undernutrition that afflicts such a large proportion of the populations of developing countries and the hidden hungers of iron deficiency, avitaminosis A, and iodine deficiency disorders that are enormously widespread. Famine in the modern world is almost invariably superimposed on chronic undernutrition that is not solved with emergency relief. Adaptation to this undernutrition requires a reduction in physical activity needed for household and community improvement as well as work output. Iron deficiency interferes with cognitive performance, resistance to infection, and capacity for work. Other nutrient deficiencies add to the damage to the individual and society. Prevention of famine and hunger is not primarily a technological issue, but a moral, political, and social one.

Adaptation, Physiological↗

Nutrition education of the cancer patient and family. Myths and realities.

Common myths about nutrition education and care of cancer patients are debunked and realities are discussed. First, frequently held misconceptions of nonspecialized health professionals are considered. These include the myths that diet change in the population will be rapid now that dietary guidelines to prevent cancer have been issued; nutrition education is best relegated to the dietitian for cancer patients; patients do not need nutritional advice until treatment is actually in progress, and then only rarely while they are hospitalized; nutrition education needs taper off once consolidation or intermittent therapy begins and cease entirely with survival of 5 or more years; and nutrition education of the family usually can be ignored. Next, common myths which many patients and their families subscribe to are discussed. These myths include the following: by following the cancer prevention dietary guidelines, protection against cancer is guaranteed; if only the victim had eaten differently, the cancer never would have developed; cancer prevention dietary guidelines also should be followed in the nutritional support of cancer patients; cancer patients can rely on their appetites and hidden hungers to stay in good nutritional balance; special diets can cure cancer; all cancer anorexia can now be reversed by following proper diet; children who have cancer should neither be fed nor can they eat diets similar to those fed to other children at that age; special nutritional support measures such as tube feeding and total parenteral nutrition are only useful for those younger than 65 years; and there is no sense in paying attention to the nutrition of cancer patients in hospices because they are going to die anyway. It is concluded that nutrition education can enhance quality of life, for the patient and his family, throughout his illness and after his recovery.

Adult↗

Role of micronutrients for physical growth and mental development.

Due to control of florid and severe cases of protein-energy malnutrition, deficiencies of micronutrients in children have assumed public health importance. According to National Nutrition Monitoring Bureau of India, over 50% of apparently healthy looking children have subclinical or biochemical deficiencies of vitamin A, vitamins B2, B6, folate and vitamin C. Over two-third of children have clinical evidences of iron deficiency while deficiency of trace minerals like iodine and zinc is quite common in certain populations. Children have food preferences and they are quite fussy to take green leafy vegetables and fruits thus compromising their intake of micronutrients from dietary sources. The full genetic potential of the child for physical growth and mental development may be compromised due to subclinical deficiencies of micronutrients which are commonly referred to as "hidden hunger". Micronutrients are required for the integrity and optimal functioning of immune system. Children with subclinical deficiency of micronutrients are more vulnerable to develop frequent and more severe common day-to-day infections thus triggering a vicious cycle of undernutrition and recurrent infections. A number of micronutrients are required for optimal physical growth and neuromotor development. Isolated deficiencies of micronutrients are rare in clinical practice and usually deficiencies of multiple micronutrients co-exist. The first 3 years of life are most crucial and vulnerable to the hazards of undernutrition. All efforts should be made so that preschool children are given a balanced and nutritious home-based diet. However, it has been shown that it is not possible to meet 100% requirements of recommended dietary allowances (RDA's) of micronutrients from dietary sources alone and most preschool children need administration of nutritional supplements to optimize their genetic potential for physical growth and mental development.

Adolescent↗

Emerging prospects of Bacillus species in attaining the sustainable development goals.

The world is witnessing a serious challenge of poverty which is reflected as hidden hunger and simultaneously overpopulation puts a grave burden on our ecosystem. In order to overcome these serious issues, the sustainable development goals (SDGs) serve a very significant role. Concurrently, the contribution of microorganisms in achieving the SDGs cannot be overlooked. Bacillus species as a probiotic has led to the development of various commercial fermented products that are available in the market. Additionally, the formulated products have been clinically validated for their health benefits. Bacillus species have also been reported to serve as bio-preservatives and biocontrol agents because they aid in preserving and maintaining the final food product as well as post-harvest goods. The utilization of Bacillus spp. as probiotics has significantly contributed to the overall well-being of animals. Moreover, many different species of Bacillus have been reported to be utilized as bio-cementing agents. All the aforementioned roles of Bacillus species contribute to addressing zero hunger (SDG 2), good health and well-being (SDG 3), and industry, infrastructure, and innovation (SDG 9). KEY POINTS: • Role of Bacillus spp. as probiotic have been successfully proven by clinical studies. • Prescence of antimicrobial genes in the Bacillus spp. genome play important role in bio-preservation and biocontrol. • In animal feeds Bacillus spp. are a good alternate of antibiotics and use of Bacillus spp. in cement industry is innovative approach.

Bacillus↗

Micronutrient deficiencies in developing and affluent countries.

Micronutrient deficiencies, also known as 'hidden hunger', are determining and aggravating factors for health status and quality of life. Three nutritional problems that have serious consequences are deficiencies of iron, vitamin A and iodine. It is estimated that in today's world, iron deficiency anemia affects two billion people, mostly women and children. Blindness due to vitamin A deficiency affects 2.8 million children under 5 years of age. Iodine deficiency disorders affect 740 million people. Cuba is employing various programs to deal with these micronutrient deficiencies. Dietary diversification, fortification of foods and supplementation with pharmaceutical preparations are included in Cuba's response to these deficiencies. 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. At present, iodination covers more than 90% of the total amount of salt used for human consumption. Results of research carried out in Cuba have shown that vitamin A deficiency is nonexistent in children up to 7 y of age. Foods and preparations for these programs are delivered gratuitously or at very low prices.

Developed Countries↗

Challenges for meeting the global food and nutrient needs in the new millennium.

Major advances have occurred in food production during the last 30 years as a result of the adoption of green revolution technology. The price of rice and wheat is 40 % lower than it was in the 1950s. This lower price has helped the poorer sections of society, who spend 50-60% of their income on food. The proportion of the population in the developing world that is malnourished fell from 46.5% in the early 1960s to 31% in 1995. However, there are still 1.3 billion of the population who go to bed hungry every day. Deficiencies of micronutrients such as Fe, Zn and vitamin A affect millions of the population in the developing world. The world population is increasing at the rate of 1.4%, or an increase of eighty million per year. It is estimated that we will have to produce 50% more food grains by 2025. Various strategies for meeting this challenge exist, including the development of cereal varieties with a higher yield potential and yield stability, and farmer-friendly public policies. In order to tackle hidden hunger, efforts are underway to develop crop varieties with higher concentrations of Fe and Zn. Recently, a breakthrough has occurred in the introduction of the genes for the pathway leading to the biosynthesis of beta-carotene, a precursor of vitamin A, in rice. Various conventional approaches and modem tools of biotechnology are being employed in the development of crop varieties with higher yields and higher levels of micronutrients.

Biotechnology↗

Breeding for micronutrients in staple food crops from a human nutrition perspective.

Over three billion people are currently micronutrient (i.e. micronutrient elements and vitamins) malnourished, resulting in egregious societal costs including learning disabilities among children, increased morbidity and mortality rates, lower worker productivity, and high healthcare costs, all factors diminishing human potential, felicity, and national economic development. Nutritional deficiencies (e.g. iron, zinc, vitamin A) account for almost two-thirds of the childhood death worldwide. Most of those afflicted are dependent on staple crops for their sustenance. Importantly, these crops can be enriched (i.e. 'biofortified') with micronutrients using plant breeding and/or transgenic strategies, because micronutrient enrichment traits exist within their genomes that can to used for substantially increasing micronutrient levels in these foods without negatively impacting crop productivity. Furthermore, 'proof of concept' studies have been published using transgenic approaches to biofortify staple crops (e.g. high beta-carotene 'golden rice' grain, high ferritin-Fe rice grain, etc). In addition, micronutrient element enrichment of seeds can increase crop yields when sowed to micronutrient-poor soils, assuring their adoption by farmers. Bioavailability issues must be addressed when employing plant breeding and/or transgenic approaches to reduce micronutrient malnutrition. Enhancing substances (e.g. ascorbic acid, S-containing amino acids, etc) that promote micronutrient bioavailability or decreasing antinutrient substances (e.g. phytate, polyphenolics, etc) that inhibit micronutrient bioavailability, are both options that could be pursued, but the latter approach should be used with caution. The world's agricultural community should adopt plant breeding and other genetic technologies to improve human health, and the world's nutrition and health communities should support these efforts. Sustainable solutions to this enormous global problem of 'hidden hunger' will not come without employing agricultural approaches.

Biological Availability↗

Perspectives from micronutrient malnutrition elimination/eradication programmes.

Micronutrient malnutrition cannot be eradicated, but the elimination and control of iron, vitamin A and iodine deficiencies and their health-related consequences as public health problems are currently the targets of global programmes. Remarkable progress is occurring in the control of goitre and xerophthalmia, but iron-deficiency anaemia (IDA) has been less responsive to prevention and control efforts. Subclinical consequences of micronutrient deficiencies, i.e. "hidden hunger", include compromised immune functions that increase the risk of morbidity and mortality, impaired cognitive development and growth, and reduced reproductive and work capacity and performance. The implications are obvious for human health and national and global economic and social development. Mixes of affordable interventions are available which, when appropriately adapted to resource availability and context, are proven to be effective. These include both food-based interventions, particularly fortification programmes, such as salt iodization, and use of concentrated micronutrient supplements. A mix of accompanying programmes for infection control, community participation, including education, communication and information exchange, and private sector involvement are lessons learned for overcoming deterrents and sustaining progress towards elimination.

Anemia, Iron-Deficiency↗

[Risk of macro and micronutrients deficiency in low income preschool children. Valencia, Venezuela].

The dietary pattern and energy and nutrient intake as basic indicators of nutritional deficiencies were assessed in 408 preschoolers by three 24-hour recalls and food frequency questionnaire. Socioeconomic status (Graffar/Méndez-Castellano) and nutritional status by corporal dimensions were assessed. Student t test, ANOVA and Chi2 were applied. 95% of the children were living in poverty (62% relative and 32% critical). Nutritional deficit was present in 14% of children, being more prevalent in the group from 4 to 6.99 years of age (p < 0.01). Protein adequacy was significantly higher and iron adequacy was significantly lower in children aged 1 to 3.99 years (p < 0.005), probably related to a higher milk intake, while children aged 4 to 6.99 consumed a larger variety of foods, including corn flour fortified with iron and Vit. A. There was a deficient intake of energy and iron in 52.5%, of Vit. A in 31% and zinc in 88.6% of the children. 90% of the studied population consumed an excessive amount of proteins. The risk of deficiency was low for protein intake in all social classes and high for Vit. A, iron and zinc intake, with a higher risk for children of low socioeconomic level. The food pattern intake was based on 10 food items, suggesting a monotonous alimentation. Cereals and legumes were the main source of proteins, vit A, iron and zinc. Due to a deficient intake of calories and micronutrients, a situation of "hidden hunger" must be considered.

Child↗

[Prevalence of iron deficiency and its association with vitamin A deficiency in preschool children].

OBJECTIVES: To identify the prevalence of iron deficiency in the population studied, as well as verifying if such deprivation is associated with vitamin A deficiency. METHODS: One hundred seventy-nine children, > or = 24 months and < 72 months of age, with no diarrhea and/or fever at collection were studied. Vitamin A deficiency identification was carried out through serum 30-day dose-response test. Samples of peripheral blood from fasting children was obtained for hemoglobin counts, serum iron, and unsaturated iron binding capacity assays. Information about the presence of diarrhea and/or fever during the 15 days preceding the study was also obtained. RESULTS: 35.8% (64/179) of the children presented iron deficiency and 75.4% (135/179), vitamin A deficiency. 29.1% (52/179) of the children presented both iron and vitamin A deficiencies. Iron deficiency was not associated with vitamin A deficiency. A separate analysis for each hematimetric index also demonstrated no significant difference between children with or without vitamin A deficiency. Children aged 24 to 36 months presented significantly higher prevalence rates of iron deficiency (p = 0.0005) as did children with diarrhea and/or fever during the 15 days preceding the study (p = 0.003). CONCLUSIONS: Although iron deficiency was not associated with vitamin A deficiency, high rates of both deficiencies were exhibited in a "healthy" population with low malnutrition indices. Such situations are known as "hidden hunger". Younger children presented a higher risk of iron deficiency as did children with diarrhea and/or fever during the 15 days preceding the study.

Anemia, Iron-Deficiency↗