Nutrition Publication

Health Economics and Nutrition: Over- and Under- nutrition

Editor(s): J. C. Seidell and J. Spieldenner. 73 / 1

In this issue, the proceedings of a meeting on globalnutritional problems are presented. They deal with severalproblems that long were thought to be mutually exclusive:under-nutrition and over-nutrition. The first wasconsidered to be a problem related to poverty which mayresult in inadequate intake of energy and/or micronutrientsand strenuous labor. Chronic noncommunicablediseases were associated with affluence and related over-consumptionof food and sedentary lifestyles. The papersin this issue show that this is no longer a useful distinction.In fact, in many circumstances, especially in low andmiddle-income countries, people have access to energy-dense but, at the same time, nutrient-poor foods.There is an increasing trend in developing countries,where the demographic and socioeconomic transitionimposes more constraints on dealing with the doubleburden of infectious and noninfectious diseases as well asmalnutrition in a poor environment, characterized by ill-healthsystems. It is predicted that, by 2020, noncommunicablediseases will cause seven out of every ten deathsin developing countries. Among noncommunicable diseases,special attention is devoted to cardiovascular disease,diabetes, cancer and chronic pulmonary disease.The burden of these conditions affects countries worldwidebut with a growing trend in developing countries.Preventative strategies must take into account the growingtrend of risk factors correlated to these diseases. Inparallel, despite the success of vaccination programs forpolio and some childhood diseases, other diseases likeAIDS, tuberculosis, malaria and dengue are still out ofcontrol in many regions of the world. In addition, preventingand combating micronutrient deficiencies is ofgreat importance.A life course approach to combating under- and over-nutritionis essential. This is illustrated by the paper byKC et al. that focuses on gestational diabetes and macrosomia.Many noncommunicable diseases have their originsin utero. Intrauterine growth retardation resulting inlow-birth-weight babies as well as macrosomia (highbirth weight) are associated with an increased risk of obesity,type 2 diabetes and cardiovascular disease in the offspring.The paper by Seidell and Halberstadt shows thatobesity is an increasing problem in children around theworld. Similarly, the paper by Bailey et al. shows that theglobal problem of micronutrient deficiencies starts earlyin life with lifelong consequences.Both under- and over-nutrition greatly contribute tothe global burden of disease with severe global economicconsequences. These do not only relate to the direct costsassociated with the medical consequences of malnutritionbut also to the indirect costs of reduced productivityof those affected. The paper by Detzel and Wieser in thisissue illustrates that combatting iron deficiency by foodfortification can be cost-effective.

Related Articles

Food Fortification for Addressing Iron Deficiency in Filipino Children Benefits and Cost-Effectiveness

Author(s): P Detzel & S Wieser

Iron deficiency is one of the most widespread nutritional disordersin both developing and industrialized countries, makingit a global public health concern. Anemia, mainly due toiron deficiency, affects one third of the world’s populationand is concentrated in women and children below 5 years ofage. Iron deficiency anemia has a profound impact on humanhealth and productivity, and the effects of iron deficiencyare especially pronounced in the first 1,000 days of life. This critical window of time sets the stage for an individual’sfuture physiological and cognitive health, underscoringthe importance of addressing iron deficiency in infantsand young children. This review focuses on the use offortified foods as a cost-effective tool for addressing iron deficiencyin infants and young children in the Philippines.

Gestational Diabetes Mellitus and Macrosomia A Literature Review

Author(s): Kamana KC, S Shakya, H Zhang

 Fetal macrosomia, defined as a birth weight≥ 4,000 g, may affect 12% of newborns of normal women and15–45% of newborns of women with gestational diabetesmellitus (GDM). The increased risk of macrosomia in GDM ismainly due to the increased insulin resistance of the mother.In GDM, a higher amount of blood glucose passes throughthe placenta into the fetal circulation. As a result, extra glucose in the fetus is stored as body fat causing macrosomia,which is also called ‘large for gestational age’. This paper reviewsstudies that explored the impact of GDM and fetalmacrosomia as well as macrosomia-related complicationson birth outcomes and offers an evaluation of maternal andfetal health. Summary: Fetal macrosomia is a common adverseinfant outcome of GDM if unrecognized and untreatedin time. For the infant, macrosomia increases the risk ofshoulder dystocia, clavicle fractures and brachial plexus injuryand increases the rate of admissions to the neonatal intensivecare unit. For the mother, the risks associated withmacrosomia are cesarean delivery, postpartum hemorrhageand vaginal lacerations. Infants of women with GDM are atan increased risk of becoming overweight or obese at ayoung age (during adolescence) and are more likely to developtype II diabetes later in life. Besides, the findings ofseveral studies that epigenetic alterations of different genesof the fetus of a GDM mother in utero could result in thetransgenerational transmission of GDM and type II diabetesare of concern.

The Epidemiology of Global Micronutrient Deficiencies

Author(s): R. L. Bailey

Micronutrients are essential to sustain life and for optimalphysiological function. Widespread global micronutrientdeficiencies (MNDs) exist, with pregnant women and theirchildren under 5 years at the highest risk. Iron, iodine, folate,vitamin A, and zinc deficiencies are the most widespreadMNDs, and all these MNDs are common contributors to poorgrowth, intellectual impairments, perinatal complications,and increased risk of morbidity and mortality. Iron deficiencyis the most common MND worldwide and leads to microcyticanemia, decreased capacity for work, as well as impairedimmune and endocrine function. Iodine deficiencydisorder is also widespread and results in goiter, mental retardation,or reduced cognitive function. Adequate zinc isnecessary for optimal immune function, and deficiency is associatedwith an increased incidence of diarrhea and acuterespiratory infections, major causes of death in those <5years of age. Folic acid taken in early pregnancy can preventneural tube defects. Folate is essential for DNA synthesis andrepair, and deficiency results in macrocytic anemia. VitaminA deficiency is the leading cause of blindness worldwide andalso impairs immune function and cell differentiation. Single MNDs rarely occur alone; often, multiple MNDs coexist. Thelong-term consequences of MNDs are not only seen at theindividual level but also have deleterious impacts on theeconomic development and human capital at the countrylevel. Perhaps of greatest concern is the cycle of MNDs thatpersists over generations and the intergenerational consequencesof MNDs that we are only beginning to understand.Prevention of MNDs is critical and traditionally has been accomplishedthrough supplementation, fortification, andfood-based approaches including diversification. It is widelyaccepted that intervention in the first 1,000 days is critical tobreak the cycle of malnutrition; however, a coordinated, sustainablecommitment to scaling up nutrition at the globallevel is still needed. Understanding the epidemiology ofMNDs is critical to understand what intervention strategieswill work best under different conditions.

The Global Burden of Obesity and the Challenges of Prevention

Author(s): J. C. Seidell, J Halberstadt

 The prevalence of obesity is increasing at an alarming rate inmany parts of the world. About 2 billion people are overweightand one third of them obese. The plight of the mostaffected populations, like those in high-income countries inNorth America, Australasia and Europe, has been well publicized.However, the more recent increases in populationobesity in low- and middle-income countries that are nowincreasingly being observed have been less recognized.Based on the existing prevalence and trend data and the epidemiologicalevidence linking obesity with a range of physicaland psychosocial health conditions, it is reasonable todescribe obesity as a public health crisis that severely impairs the health and quality of life of people and adds considerablyto national health-care budgets. Intersectoral action tomanage and prevent obesity is urgently required to reversecurrent trends.