1

THE GLOBAL CHALLENGES IN

FOOD NUTRITION AND HEALTH

Emorn Wasantwisut,

Institute of Nutrition, Mahidol University, Thailand

Outline

* Global commitment in food and nutrition

* Global Situation

- Poverty

- Undernutrition

- Micronutrient Deficiencies

- Over-nutrition and Chronic Diseases

* Economic costs of malnutrition

* Food production and consumption trends

* Food-based strategies towards Nutrition & Health

• World Food Conference 1974

• World Summit for Children 1991

• International Conference on Nutrition 1992

• Millenium Development Goals 2000

Nutrition Commitment : Global Country

Millennium Development Goals

Eradicate extreme

poverty and hunger

Achieve universal

primary education

Promote gender equality

and empower women

Reduce child mortality

Improve maternal health

Combat HIV/AIDS,

malaria, other diseases

Ensure environmental

sustainability

Global partnership

for development

Millennium Summit, Sep.2000

1

2

3

4

5

6

7

8

0

2

4

6

8

10

1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050

Po

pu

lati

on

(b

illio

ns)

North America

Latin America and Caribbean

EuropeAsia and Oceania

Africa

Global population will continue to riseGlobal population will continue to rise

0

200

400

600

800

1,000

1,200

1,400

1,600

(mil

lio

ns

in

ab

so

lute

po

ve

rty

)

East Asia Latin

America

Middle

East

South

Asia

Sub-

Saharan

Africa

Total

1987 1990 1998

The number of poor continues to grow

2

0

5,000

10,000

15,000

20,000

25,000

1970 1975 1980 1985 1990

Africa Asia

Latin America W. Europe

N. America

Growing disparities in incomes among regions(per capita income in constant international dollars)

The rich get richer while the poor remain the same

0

25

50

75

100

20 40 60 80 100 120

Years of Life

1930

1965

2000

Nutrition: a Lifecourse approach

%

Prevent Child DeathsLBW / PEM / Stunting

Infection/diarrhea

Micronutrient deficiency

Prevent PrematureDeathDiet Related Chronic Disease Cardiovascular(CHD, Stroke)Obesity, Diabetes,

DyslipidemiaCancer, Osteoporosis, AgingPreventing

Disability

Physical/Mental

0

20

40

60

80

100

120

140

160

180

Africa Americas South-East Europe Eastern Western World

Asia Mediterranean Pacific

De

ath

s p

er

10

00 l

i ve b

irth

s

Source: World Health Report 2003

Child mortality by region Top five child killers Top five child killers

Causes of underCauses of under--5 mortality 5 mortality

Percentages 1998Percentages 1998

Other

23%

Malaria

7%

Vaccine-

preventable

diseases

15%

Diarrhoeal diseases

17%

Respiratory Infections

18%

Perinatal Conditions

20%

Selected major risks to health : Selected major risks to health :

Childhood and maternal Childhood and maternal undernutritionundernutrition

Risk factor Measured adverse outcomes (of exposure)

Underweight Mortality and acute morbidity from infectious

diarrhoea, malaria, measles, pneumonia and

other infectious diseases.

Perinatal conditions from maternal underweight

Iron deficiency Anaemia, maternal and perinatal causes of death

Vitamin A deficiency Diarrhoea, malaria, maternal mortality,

vitamin A deficiency disease

Zinc deficiency Diarrhoea, pneumonia, malaria

Source : World Health Report 2002

0

200

400

600

800

1,000

1969-71 1979-81 1990-92 2010mil

lio

n p

ers

on

s su

fferin

g

fro

m u

nd

ern

utr

itio

n

Sub-Saharan Africa Near East and North AfricaEast and Southeast Asia South AsiaLatin America and the Caribbean

Despite Gains, Millions Go Hungry

3

Irreversibility

-2

-1

0

0 6 12 18 24 30 36 42 48 54 60

Age (months)

Weig

ht

for

ag

e Z

-sco

re

Africa Latin America and Caribbean Asia

Shrimpton et. al. 2001สถาบันวิจัยโภชนาการ

IronIronIronIronIodineIodineIodineIodineVitamin Vitamin Vitamin Vitamin AAAAZincZincZincZinc • Growth and development Growth and development Growth and development Growth and development • Immune functionImmune functionImmune functionImmune function• CognitionCognitionCognitionCognitionMicronutrient Malnutrition

Pregnancy

outcome

HEALTH/FUNCTIONAL CONSEQUENCES

DeficienciesIodine Iron Vit. A Zinc

Growth

Cognition ?

Vision - -

Immunity ?

Work Capacity ? ? ?

Progress in combating

malnutrition has been slow

Malnutrition declines at a

rate of 4 million per year

1991- 99

If malnutrition

declines at rate

of 22 million per

year 2001-15

If malnutrition

declines at

present rate

สถาบันวิจัยโภชนาการ

http://www.who.int/chp/chronic_disease_report/contents/part1.pdf

4

สถาบันวิจัยโภชนาการ

http://www.who.int/chp/chronic_disease_report/contents/part1.pdf

Trends in overweight in children 1970- 2000

0

5

10

15

20

25

30

35

1970 1980 1990 2000

Pre

vale

nce

% Australia

Brazil

Canada

China

Spain

UK

USA

0.0

10.0

20.0

30.0

40.0

America

s

Near/

Middle E

ast Eu

rope

Asia

& Pa

cific

Sub-S

aharan

AfricaWor

ldwide

obese

overweight

•Increase in use of motorised transport, school

•Increase in hazards for walkers and cyclists

•Fall in opportunities for physical activity

•Increased sedentary recreation

•Multiple TV channels around the clock

•Quantities and variety of energy dense foods

Frequent and widespread food purchasing ties

•Larger portions of food at lower prices

•Processed snacks (sweet, salty and/or fatty)

increasingly replacing fruits and vegetables

•Use of sugary soft drinks to replace water

•More use of restaurants and fast food stores

Examples oftrends

% Prevalence ofOverweight and

Obesity in 5-17 yrs old

Diet and Physical Activity RelatedDeath (% preventable)

StrokeColon Cancer

Myo-cardial

Infarction

Type 2 Diabetes

Science 2002

23

Diabetes mellitus, regional estimates, 1995-2025

Africa Americas E. Mediterranean Europe S.E. Asia W. Pacific

Esti

ma

ted

pre

vale

nce (

mil

lio

ns

)

0

20

40

60

80

3.4

30.7

13.8

32.8

27.6 26.4

4

34.8

16.7

35.332.7

30.4

9.8

63.5

42.8

47.5

79.5

56

1995 2000 2025

The World Health Report, 1997 - WHO, Geneva.

NCD prevention : a Life Course Approach

Age

Devel opment of NCD

FetalLife

Adult Life

AdolescenceInfancy and

ChildhoodSESInfectionPEMMicronutrientsGrowth rateStaturePhysical ActivityFood behaviour

ObesitySendentarismInactivitySmoking

Established adult risky

behaviours Diet/Physical activity, Tobacco, Alcohol

Biological risksSocioeconomic statusEnvironmental conditions

SESMother’sNutritionGrowthbirth weight

Accumulated risk

Source: WHO/NMH/NPH/ALC, 2001

Genetic susceptibility to NCDs

Elderly

5

6

17

5

10 10

02468

1012141618

Protein-energymalnutrition(moderatestunting)

iron

deficiency

(heavy labor)

Iron

deficiency(blue-collar

labor)

iodine

deficiency

Current losses in productivity (manual labour)Losses based on childhood malnutrition (cognitive)

The economic costs of undernutritionare high: productivity losses

As are the economic costs of diet-

related chronic disease

2.4

0.3

0

0.5

1

1.5

2

2.5

3

% loss in GDP

China

Sri Lanka

China’s economic cost of diet-related chronic disease is 2.4 percent of GDP

Note: GDP loss likely to be much higher

when taking into account morbidity(Popkin, Horton and Kim 2000)

สถาบันวิจัยโภชนาการ

Dietary

Practice

Agriculture

Trade policy Education

Advertising Culture

Urbanization

Science & Technology

Household Food

Availability

Activity

Practice

Obesity and related NCD

Morbidity, Mortality, Lost Productivity

Intake Energy Expenditure

Basic Causes

Underlying

cause

Immediate

causes

Manifestations

Functional

Consequences

943243733809502333328387121323003Industrialized

671223529069412455339678025073287Transition

337234426812422248249016118982059Developing

AVTAVTAVT

1997-981987-891967-69

Kcal/capita/day (T=total, V=vegetable, A=animal)

Food production has increased but distribution is unequal

Available Energy (Kcal per person/day

R2 = 0.975

2000

2200

2400

2600

2800

1960 1970 1980 1990 2000

Available Protein (grams per person/day)

R2 = 0.9306

50

55

60

65

70

75

80

1960 1970 1980 1990 2000

The world has been able to increase per caput food availability for the last 4 decades

6

Hunger is not due to lack of food: The world produces enough calories & protein:

Those that need less get more than they need

The poor that have greater needs

get lesswhile

Trends in diet composition

26.8200.081.6Developed countries

8.836.617.1Developingcountries

9.420.715.1Latin America

4.460.719.6West Asia

8.693.941.1East and South Asia

8.027.511.4Africa

Fish kg /caput/day

Milk kg /caput/day

Meat kg /caput/day

Region

0

100

200

300

1950 1960 1970 1980 1990

No

nco

d C

atch

(000

met

ric

ton

s)

0

200400

600800

1000

12001400

16001800

2000

Co

d C

atc

h (000 m

etr

ic t

on

s)Flatfishes (flounders, halibuts, etc.)

Haddock

Red hake

Atlantic cod

Overfishing : Some Fish Stocks Have Collapsed

0

20

40

60

80

100

120

1984 1986 1988 1990 1995 2000

(mil

lio

n m

etr

ic t

on

s)

Total Capture Total Aquaculture

Farmed Fish Are a Growing Share of the Global Fish Harvest

Hunter-Gatherer

Agricultural Industrial

Time (years)

% energ

y

Changes in dietary fat sources during Evolution

7

12.47110.67112.83101.97101.57Oceania

33.10143.00138.30124.93116.90North America

30.9380.6373.4064.8754.0Latin Amer & Caribbean

41.13149.03142.8127.93117.2European Union

24.17104.67116.0110.5390.47Eastern Europe

26.2780.6373.5062.1051.20Near East

61.3078.5047.5327.1323.23China

15.3345.5338.8632.3729.07South Asia

26.0351.9343.932.2727.77East & South-east Asia

3.2744.4741.3343.0341.47Sub-Saharan Africa

25.8363.9365.2358.4343.97North Africa

24.7773.5766.657.1552.5World

change (g/cap/day) 1969-1999

1997-991987-891977-791967-69Region

Grams of fat /caput/dayQuality of Fats in Modern Nutrition

• Saturated fats (C12:0, C14:0, C16:0, C18:0)• Trans fatty acids (hydrogenated fats)• Monounsaturated fatty acids (18:1)• Sats / MUFA / PUFA • Cholesterol

• Essential fatty acids w -3 and w -6• Long Chain PUFAs (AA,EPA,DHA)

• Energy Density of diet (fats and carbohydrates)

Food-based approaches

• Food-based dietary

guidelines

• Food guides for general

populations, pregnant

women, infants and

young children (several

countries)

• Nutrition labeling

(where processed foods

are commonly

consumed)

� Total fat

� Saturated Fats (C14,C16)

� Trans fatty acids

� Free sugars

� Refined starches

� Sodium/salt

� Preserved meats

� Vegetables,

� Fruits, legumes

� Fibre/NSP

� ω ω ω ω - 3 fatty ac

(LNA,EPA,DHA)

� Iron/iodine

� Zinc/folate?

� PHYSICAL ACTIVITY

Principal nutrient/food changes

Principal nutrient/food Principal nutrient/food changeschanges

IncreaseIncreaseIncreaseReduceReduceReduce

Food based dietary guidelinesFood based dietary guidelines

Individual/FamilyIndividual/Family

andand

Community as CoreCommunity as Core

Nutrition labelingNutrition labeling

CONSUMERCONSUMER

PROTECTIONPROTECTION

CONSUMPTIONCONSUMPTION

UTILIZATIONUTILIZATION

FOOD PRODUCTIONFOOD PRODUCTIONDISTRIBUTIONDISTRIBUTION

FOOD PROCESSINGFOOD PROCESSING

hygienichygienic

food handlingfood handling-- Rice Rice -- FishFish

-- Legumes Legumes -- ChickenChicken

-- Vegetables Vegetables -- EggEgg

-- Fruits Fruits -- Milk & milk productsMilk & milk products

Food and Nutrition Food and Nutrition SecuritySecurity

Health services and Health services and

caring practicescaring practices

Specific Specific

Food&NutriFood&Nutri

programsprograms

Monitoring and Monitoring and

SurveillanceSurveillance

INMU 1998INMU 1998

8

• Home gardening (several countries)• Self-sufficient economy (Integrated food production for food security – Thailand)

WHO

International Diabetes

Federation

International

Paediatric

Association

IOTF

International Medical Federation International Medical Federation

interacting with WHO and ministersinteracting with WHO and ministers

สถาบันวิจัยโภชนาการ

2005 : Global Alliance for the prevention of 2005 : Global Alliance for the prevention of 2005 : Global Alliance for the prevention of 2005 : Global Alliance for the prevention of obesity and chronic diseaseobesity and chronic diseaseobesity and chronic diseaseobesity and chronic diseaseIPA

IOTF

IDF

WHF

Countries initiating action plans Countries initiating action plans ––2005/62005/6

Countries targeted initially by WHO:Countries targeted initially by WHO: now all visitednow all visited

•• WPRO: MalaysiaWPRO: Malaysia**,, Singapore Singapore **, ,

ChinaChina** (Hong Kong(Hong Kong**), Pacific Islands), Pacific Islands**

•• SEARO: IndiaSEARO: India **,, ThailandThailand**

•• EMRO: PakistanEMRO: Pakistan**

•• PAHO: BrazilPAHO: Brazil**, Canada , Canada (Quebec)(Quebec), US, Caribbean, US, Caribbean**

•• EURO: Major developments in association with EURO: Major developments in association with

WHO EuroWHO Euro**:: 52 Ministries' Conference in 52 Ministries' Conference in

Istanbul 15Istanbul 15--1717thth Nov 2006Nov 2006

*Councils or Task Forces supported by Global Prevention Alliance underway

*Support from Global Prevention Alliance requested

Governmental/community initiatives Governmental/community initiatives

are the most costare the most cost--effective effective

Schools

Federal / National Parliament

Regional

Local Council Local Council Local Council

Schools Schools SchoolsSchools

GENERAL POPULATION

IMPACT COSTS

Minimum

Maximum

Maximum

Minimum

Trade Liberalization: A Blunt Instrument

Trade

Liberalization

Distribution

channels

Government

Nutrition status of

individuals

Enterprise

Price Levels

and

variability

Services Employment

and wages

Adapted from

Winters 2000

9

Promising: quality foods

* Biodiversity

* Innovative techniques

- Plant breeding (GMO, conventional)

- Nutrient dense crops

- Animal husbandry

- Aquaculture

Environment

Nutrition Nutrition

& Health& Health

Agriculture

EducationScience and Technology

IndustryTrade

FOOD PRODUCTION, NUTRITION AND HEALTH

Emorn Wasantwisut,

Institute of Nutrition, Mahidol University, Thailand