Iron deficiency is the most widespread dietary deficiency in the world affecting close to two billion people or one-third of the world's population. Its most visible impact is iron-deficiency anaemia (IDA) which contributes significantly to high levels of maternal and neonatal deaths in poor, vulnerable populations, while the 'hidden' impact of iron deficiency extends to all areas of individual growth and development. Anaemia is most prevalent in pregnant women and pre-school children. The insidious nature of IDA has made it a difficult challenge for the international community to address effectively as its scale and impact are often overlooked. This chapter presents the requirements for iron and related micronutrients and describes the prevalence and geographic and socio-economic distribution of anaemia. The public health consequences of anaemia on both the individual and on society are outlined and the determining or contributing factors that can lead to or hinder their alleviation are discussed. The chapter concludes that increasing the availability and consumption of a nutritionally adequate diet is the only sustainable and long-term solution, not just for overcoming IDA, but for overcoming other micronutrient deficiencies as well. Policies and intervention programmes that effectively alleviate micronutrient deficiencies are described, including increasing overall food intake, increasing consumption of micronutrient-rich foods, modifying intake of dietary inhibitors and enhancers, using improved processing, preservation and preparation techniques, consumer education for behaviour change, improving food quality and safety and public health, and food fortification and supplementation. The Food and Agriculture Organization of the United Nations is committed to placing food-based strategies for preventing micronutrient deficiencies high on the development policy agenda and urges all parties to speed up their wider implementation if the Millennium Development Goals are to be achieved on time.
The importance of coexisting micronutrient defi ciencies in developing countries is gaining recognition, prompted by the disappointing responses often observed with single micronutrient supplements. Further, of concern is the feasibility and sustainability of supplementation as a mode of delivery in poor resource settings. Consequently, there is increasing emphasis on food-based approaches: fortifi cation, dietary diversifi cation and modifi cation, and biofortifi cation. Novel delivery approaches exist for fortifying complementary foods in the household using tablets, sprinkles and fat-based spreads. These are all designed to supply micronutrients without any changes in feeding practices, and irrespective of the amount of food consumed. A version of the fortifi ed spread is also used as a ready-to-use therapeutic food for treating malnourished children. Dietary diversifi cation and modifi cation, in conjunction with nutrition education, focuses on improving the availability, access to and utilization of foods with a high content and bioavailability of micronutrients throughout the year. The strategies are designed to enhance the energy and nutrient density of cereal-based porridges; increase the production and consumption of micronutrient-dense foods (especially animal-source foods); incorporate enhancers of micronutrient absorption; and reduce the phytate content of cereals and legumes through germination, fermentation and soaking. In the future, biofortifi cation via processes such as agronomic practices, conventional plant breeding or genetic modifi cation holds promise as a sustainable approach to improve micronutrient adequacy in the diets of entire households and across generations in developing countries. This review summarizes new developments in food-based approaches, their advantages and limitations, and examines some of the effi cacy studies and programmes utilizing food-based strategies to alleviate micronutrient defi ciencies.
The Second International Conference on Nutrition (ICN2) was jointly organized by the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) and was held at the FAO Headquarters in Rome, Italy, from 19 to 21 November 2014. The ICN2 was a high-level intergovernmental meeting that focused global attention on addressing malnutrition in all its forms: undernutrition, including micronutrient deficiencies, overweight, and obesity. The ICN2 was held to specifically address the persistent and unacceptably high levels of malnutrition. Despite much progress in reducing hunger globally, 795 million people remain undernourished, over 2 billion people suffer from various micronutrient deficiencies, and an estimated 161 million children under 5 years of age are stunted, 99 million underweight, and 51 million wasted. Meanwhile, more than 600 million adults are obese. Global problems require global solutions. The ICN2 brought together national policy-makers from food, agriculture, health, education, social protection and other relevant sectors to address the complex problem of malnutrition through a multi-sectoral approach. Two outcome documents - the Rome Declaration on Nutrition and the Framework for Action - were endorsed by participating governments at the Conference, committing world leaders to establishing national policies aimed at eradicating malnutrition in all its forms and transforming food systems to make nutritious diets available to all. The Rome Declaration on Nutrition is a political statement of 10 commitments for more effective and coordinated action to improve nutrition, while the Framework for Action is a voluntary technical guide of 60 recommendations for the implementation of the political commitments. This chapter provides information on the ICN2 and its outcomes as well as follow-up activities. Emphasis is placed on the Rome Declaration on Nutrition and the Framework for Action, with special focus on hidden hunger problems that have to be addressed through different interventions and a multi-sectoral approach.
Home gardening, focusing on provitamin A-rich vegetables, is a long-term strategy that can contribute to combating vitamin A and other nutritional deficiencies which are of public health significance in developing countries. The provitamin A carotenoid content of foods and their potential contribution towards meeting the vitamin A requirements of the target population are predominant considerations in the selection of crops to be planted. This chapter describes a home garden approach that integrates gardening activities with nutrition education, using community-based growth monitoring as entry point. Studies using this approach in South Africa showed a favourable effect on maternal knowledge of vitamin A nutrition, dietary intake of provitamin A-rich vegetables, caregiver-reported child morbidity and children's vitamin A status. Provitamin A-rich vegetables and fruits contributed significantly towards achieving the recommended dietary intake of vitamin A and various other micronutrients. Seasonal availability of provitamin A-rich vegetables and fruits needs to be taken into consideration to ensure year-round availability of provitamin A-rich foods. The approach is flexible and entry points other than community-based growth monitoring can be used to promote production and consumption of provitamin A-rich vegetables and fruits. Demonstration gardens to serve as training centres, community-based nurseries for orange-fleshed sweet potato cuttings and a seed distribution system are important components of the home garden projects. Various constraints experienced with vegetable gardens and possible solutions are highlighted. Participation in gardening projects is self-selective. Non-participating households within the project areas are, however, exposed to the promotion activities, resulting in a spill-over effect to non-participating households.
The poor quality of the habitual diet and the lack of dietary diversity in much of the developing world contribute to deficiencies of micronutrients. Micronutrient malnutrition is a global problem much bigger than hunger and imposes enormous costs on societies in terms of ill health, lives lost, reduced economic productivity and poor quality of life. Addressing the global challenge of micronutrient malnutrition requires the need for many strategies - both short- and intermediate-term and long-term sustainable approaches. In addition to the conventional approaches of micronutrient supplementation and fortification, promoting sustainable food-based approaches to enable adequate intakes of micronutrients by much of the population includes dietary diversification strategies and agriculture-based approaches. Dietary diversification is possible by the promotion of homestead food production, which includes home gardening, small livestock rearing and fishing as well as the processing and preservation of food. Agriculture and agricultural biotechnology offer the opportunity of increasing crop yields and have the potential to improve the micronutrient content of staple foods and cereal crops, thus contributing to better nutrition of populations and thereby helping to achieve nutrition security. By ensuring food and nutrition security and by reducing the widespread problem of micronutrient malnutrition we may hope to achieve the targets set for the Millennium Development Goals.
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