- Currently, there are more overweight people in the world than people who go hungry.
- This is, however, not as good as it sounds as many overweight people suffer from micronutrient deficiencies.
- This can result in poor growth, sub-optimal brain development, and increased risk for infectious diseases during early childhood.
According to the 2020 Global Nutrition Report, one in every nine people in the world goes hungry, and one in every three is overweight or obese.
These statistics, however, do not necessarily account for a third type of malnutrition, i.e. micronutrient deficiency, also referred to as hidden hunger. In fact, more than two billion people worldwide are estimated to be deficient in key micronutrients such as iron, folate, vitamin A, iodine and zinc.
Infants and young children, especially in low- and middle-income countries, are among those who have the greatest risk of developing hidden hunger.
SA statistics don’t look good
Micronutrients are essential for growth and development especially during the first 1 000 days of life (i.e. from conception until a child’s second birthday), a period characterised by rapid physical growth and brain development. As such, the requirements for most micronutrients are higher during the first 1 000 days compared to any other stage of life.
Micronutrient deficiencies during this important stage can result in poor growth, sub-optimal brain development, and increased risk for infectious diseases, such as diarrhoea and respiratory diseases. Long-term consequences include a higher risk of developing non-communicable diseases later in life, poor cognitive function and behavioural disorders that affect school achievement and future work capacity, which ultimately decreases the economic and developmental potential of a country.
The nutrition indicators for children under five years in South Africa don’t look good. More than one-quarter (27%) are stunted (low height-for-age), while 13% are classified as overweight (SADHS, 2016). Approximately one-third (35%) are vitamin A deficient. (vitamin A is important for the development of many organs, including the eye and brain, as well as for the development of the immune system.)
Forty percent of children under five are zinc deficient. (Zinc is also important for the development of the brain, the immune system and for growth.) One-third (32%) are anaemic (Harika et al., 2017). Iron is needed for the production of red blood cells and is also very important for the development of the brain, the immune system and growth.
Low nutrient density
Poor infant and young child feeding practices are a big culprit contributing to the high percentage of micronutrient deficiencies in children under five. The exclusive breastfeeding rate in South Africa is low (32%) and complementary foods are often introduced too early (under four to six months of age). Early introduction of complementary foods may not only replace breast milk, these foods may also have a low micronutrient density and contain phytates (maize) and tannins (tea) that can inhibit the body’s uptake of iron and zinc.
Foods commonly introduced before four to six months are indeed tea and soft, diluted maize porridge – a bulky food with a low nutrient density – that easily fill up an infant’s limited tummy space. The diets of many infants and young children aged six to 23 months in South Africa are also low in animal-source foods (source of iron and zinc) and dairy (source of calcium), as well as vitamin A-rich foods, such as yellow vegetables.
In addition, sugar-sweetened beverages, fruit juice, sweets and salty crisps are often given to infants between six months and one year (Sayed and Schönfeldt, 2018). These high-energy, low-nutrient-dense foods and beverages not only contribute to excess energy intake but displace micronutrient-dense foods and can cause dental caries (sugar) during the complementary feeding period.
Optimal infant and young child feeding practices to prevent micronutrient deficiencies include exclusive breastfeeding until six months, followed by the introduction of adequate and safe complementary foods while maintaining breastfeeding. Breastfed infants aged six to eight months should receive at least two complementary meals per day, and breastfed infants aged nine months and older should receive three.
A broader systems approach
They should receive micronutrient-dense meals because of their limited stomach capacity, without excess energy, saturated and trans fats, and with no added sugar or salt. Infants and young children should also receive a diverse diet with a variety of foods from different food groups, including grains, fruits and vegetables – especially vitamin A-rich fruits and vegetables, dairy, eggs, and animal source foods (UNICEF, 2020).
Optimising the status of the key micronutrients during the complementary feeding period can further be achieved by including fortified foods in the diet, routine supplementation (e.g. vitamin A), and the maintenance of good health and prevention of disease (good hygienic practices and consumption of safe, clean water, as well as immunisation). However, to successfully address micronutrient malnutrition requires a broader systems approach – including strengthening the health system.
One example of this is to improve the counselling and support provided by healthcare professionals. Since optimal nutrition during the first 1 000 days is a critical window of opportunity for growth and development, the establishment of an effective, evidence-based training programme to better equip health care professionals with knowledge and skills to support mothers, families and caregivers during the first 1 000 days, will add value.
After all, children have the right to the best healthcare possible, clean water to drink, healthy food to eat, and a clean and safe environment to live in.
*Prof Lize Havemann-Nel is appointed to the Centre of Excellence for Nutrition at North-West University
References
National Department of Health and South African Medical Research Council (2019). South African Demographic and Health Survey 2016. Pretoria, South Africa.
Harika et al. (2017). Are low intakes and deficiencies in Iron, Vitamin A, Zinc, and Iodine of Public Health Concern in Ethiopian, Kenyan, Nigerian, and South African Children and Adolescents? Food and Nutrition Bulletin, Vol. 38(3) 405-427.
Sayed, N., & Schönfeldt, H. C. (2018). A review of complementary feeding practices in South Africa. South African Journal of Clinical Nutrition, 33(2), 36-43.
United Nations Children’s Fund (UNICEF) (2020). Improving Young Children’s Diets During the Complementary Feeding Period. UNICEF Programming Guidance. New York.
