© T. M. Whitmore

Today• Vitamins, minerals, & deficiency diseases

• Synergies between nutrition & disease

• Especially vulnerable populations

• 4 faces of hunger

© T. M. Whitmore

Contemporary acute deficiency diseases: Iron

• Iron deficiency: Most common single nutrient deficiency

in the world > 1/3 of pop in many developing

countriesReduces cognitive performance, energy

and work ability, and resistance to infection (especially to diarrheal and respiratory diseases) even in mild cases

Severe forms = anemia

© T. M. Whitmore

Contemporary acute deficiency diseases: Iodine

• Iodine deficiency:Iodine is lacking in soils from some

mountain areas and in domr highly leached soils e,.g., Andes, Himalayas, C Africa, SE

Asia...Major consequences:

Swelling of thyroid (goiter) Important mental deficiencies

(cretinism) in kids if deficient in pregnant women

© T. M. Whitmore

Contemporary acute deficiency diseases: Vitamin A

• Vitamin A deficiency:Major consequences

To vision can lead to blindness Also decreased immune function Kids with severe protein-calorie

malnutrition often have impaired sight as a result of this

© T. M. Whitmore

Synergy: nutrition and disease• Poor nutrition (protein-calorie or other

nutrient shortages) => reduced ability to fend off new infections or makes existing ones more severe

• Diseases interfere with nutrient absorption and/or actively deplete nutrients from our bodies

© T. M. Whitmore

How poor nutrition => disease• Reduction in the body's innate immunities

(that react to general patterns of proteins in pathogens) Less effective phagocytosis (process by

which microorganisms are engulfed and encapsulated)

Weakened epithelial barriers (protective coverings on body surfaces inside and out)

Lowered lysozyme production (a bodily protein that functions as an antibacterial)

© T. M. Whitmore

How poor nutrition => disease II

• Reduction in ability to generate acquired immunities - the specific immunities one acquires to a particular disease pathogenReduced production of humoral

antibodiesImpaired cell-mediated immunity

© T. M. Whitmore

How disease => poor nutrition• Most infections interfere with the body's

ability to absorb nutrition and/or actively deplete nutrientsReduced appetitePoorer quality of diet ingestedDiseases deplete bodily tissueFevers => increased metabolic rate

thus, the body needs more kcal but they may not be there

© T. M. Whitmore

Special case of GI tract diseases

• 1.8 billion cases/yr of infant/weanling GI diseases

• Predominantly diarrheas, but also intestinal parasites, cholera, & various types of dysentery Impede absorption of nutrients

(diarrheas just don't let food sit in gut long enough)

© T. M. Whitmore

Special case of GI tract diseases II

• Many if not most deaths (perhaps 1 million/ yr in the world) can be averted with adequate treatment (called Oral Rehydration Therapy) According to The Lancet (1978), ORT is

"potentially the most important medical discovery of the 20th century"

Clean water with 60 cent packets of salts/sugars to recover health

Full recovery => increased nutrition above basic levels – often hard to get

Oral Rehydration Therapy(packet for addition to water)

Oral Rehydration Therapy(home made)

© T. M. Whitmore

Especially vulnerable populations I

• Increased likelihood of malnutrition and more serious consequences

• Women in general due to cultural traditions that privilege food to males

• Pregnant womenPoor nutrition => low birth weight

babiesDevelopmental problems for baby

physically and mentallyReduced resistance to diseasesLess able to breast feed (=> less

resistance for the baby as well)

© T. M. Whitmore

Especially vulnerable populations II

• Lactating womenPoor nutrition seldom greatly interferes

with ability to produce milkBut, poor nutrition does deplete the

mother's body of necessary nutrientsIf nutrition is not better between end of

lactation and next pregnancy => spiral down to chronic anemia etc.

• ElderlyAbility to fend off infections is reduced

with great age and malnutrition hurts that as well

© T. M. Whitmore

Especially vulnerable populations III

• ChildrenMalnutrition in infants and children very

problematic if timing coincides with critical growth processes Up to age 5 risk is greatest

Especially at weaning age (approx 2 yrs)Due to impure water used to make

weaning foods (not sufficiently boiled due to lack of fuel) and general low hygiene => Kids die from diarrheal diseases and

dehydration and malnutritionWeaning foods are typically not nutrient-

rich enough (e.g., maize gruels)

© T. M. Whitmore

Four Faces of Hunger I• I. Starvation/Famine

Widespread to complete lack of protein/calorie nutrition

A small percentage of global hunger – perhaps 1% at risk annually

Leads to increased mortality (usually to infectious diseases not starvation per se)

Great social disruption => increased problems with diseases and access to food

In any famine not all starve – the well off can buy food -- thus NOT usually only a simple shortage

© T. M. Whitmore

Four Faces of Hunger II• II. Malnutrition/Undernutrition

Seasonal or periodic P/C under-nutritionMost serious effects on kids and special

needs adults (pregnant and lactating women, the elderly)

measures of malnutrition in children Stunting - stature too short for age/sex

(adjusted for local norms) => chronic Wasting – weight too light for age/sex

(adjusted for local norms) => acute

© T. M. Whitmore

Four Faces of Hunger III• III. Micro-nutrient deficiencies

Vitamin and mineral shortagesSometimes called “hidden hunger”

• IV. Nutrition-depleting illnesses Secondary malnutritionMost common nutrient depleting

diseases are infant/weanling diarrheas – 5 million deaths annually world wide

© T. M. Whitmore

Global Hunger• Global situation late 1990s

• Data drawn from FAO’s SOFA report 2007

• http://www.fao.org/docrep/010/a1200e/a1200e00.htm

• The International Food Policy Research Institute:

• http://www.ifpri.org/media/20071012GHI.asp

• The concept of “food security”

© T. M. Whitmore

Global Trajectories of Hunger I• Proportions undernourished (or food

insecure)Late 1970s ~ 28%Late 1990s ~17%Thus, some real progressLess progress in absolute numbers

• Micro-nutrient deficienciesIron: 40% of global southIodine: 12% of global southVitamin A: 14% of kids in global south

© T. M. Whitmore

Global Trajectories of Hunger II• Absolute numbers undernourished (or food

insecure)1970s ~ 900m; 2000 ~ > 800 m => decrease of ~ 100m in absolute

numbers (but smaller %)

• Children 1993 ~ 200 m; now ~ 175 m

• World food summit target (MDG) in 2015 => 400mCurrent trajectory => 475-500m by 2015Progress in some places, regression in

others

© T. M. Whitmore

Regional differences malnourished or food insecure

• Global SouthSub-Saharan AfricaE. Asia, SE Asia, & PacificSouth AsiaLatin America & CaribbeanNear East & N. Africa

• Developed Economies (mostly N America)

Source: FAO

Source: FAO

Source: FAO SOFA 2007

Number of malnourished children, 1993, 2010, and 2020Source: IFPRI IMPACT simulations.

Source: IFPRI Global Hunger Index 2007

Source: FAO SOFA 2007

Countries with food shortfalls – requiring assistance