Low Birthweight and Intrauterine Growth Restriction

One in 13 children, or 50 million children under five, is estimated to be wasted. South-Central Asia has the highest prevalence of wasting (14.2 percent) and also the highest numbers of children affected (34.3 million).

This regional pattern is the same for severe wasting, which is often the criterion for admission to therapeutic feeding interventions. The prevalence of severe wasting in developing countries is 2.4 percent, or 16 million children.

Children who are wasted need immediate attention. Prevalence of wasting may be high in specific seasons (e.g., the diarrhea season) or in periods of food insecurity. Where there is a strong correlation between child wasting and maternal nutritional status, wasting is likely related to food insecurity rather than disease.

(Children who are severely wasted suffer from severe acute malnutrition, or SAM, which is discussed under Identifying Acute Malnutrition.)

(Sources: Black et al. 2013; EC-FAO Programme on Linking Information and Decision Making to Improve Food Security 2007; UNICEF/WHO/World Bank Group 2015)

In 2015, 159 million children were stunted, indicating chronic deficiencies occuring over time – caused by recurrent infections and poor diet. Forty countries have a stunting prevalence of 40 percent or more.

The prevalence of stunting is highest in Africa, but the largest number of stunted children is in south-Central Asia (69 million).

Countries in Asia have made greater progress in reducing stunting over the last 2 decades than those in Africa, however.

The second target of the Sustainable Development Goal for Hugner (SDG-2) includes ending “all forms of malnutrition”, including acheiving, by 2025, “the internationally agreed targets on stunting and wasting in children under 5 years of age.”

Stunting refers to low height-for-age. Stunting results from a failure to grow over time and reflects chronic deficiency.

Wasting refers to low weight-for-height. A wasted child appears very thin. Wasting can take place rapidly and reflects current (or recent) deprivation.

Underweight can be a result of either stunting or wasting (or both), so these two indicators are considered more precise. Although the conditions can overlap, they have different determinants (and respond to different interventions). In children, underweight refers to low weight-for-age. 

(Source: Black et al. 2013, 2008; UN Sustainable Development 2015)

Malnutrition is a general term meaning literally “bad” nutrition. It encompasses both undernutrition and overnutrition.

Undernutrition refers to a lack of one or more nutrients – reflected in anthropometric measurements (such as height and weight), in clinical signs, or through biochemical tests. (These are discussed further in the session “Nutrition Assessment and Indicators.”)

Overnutrition, which includes both overweight and obesity, is increasingly common in the developing world. Over-consumption (of calories and/or specific nutrients) can lead to high blood pressure and stroke, diabetes, heart disease, and certain kinds of cancer.  

Countries with large prevalences of both undernutrition and overnutrition are said to experience a double burden of malnutrition. Some families even experience this seeming contradiction within their households, with some members suffering from undernutrition while others are overweight or obese.

Nutrition indicators of primary interest in the developing world still focus overwhelmingly on those related to undernutrition, particularly for young children and women in their childbearing years.

(Sources: Black et al. 2013, EC-FAO Programme on Linking Information and Decision Making to Improve Food Security 2007, Shrimpton 2013, WHO 2012)

Nutrition and Food Quality (Dietary Diversity)

Good nutrition requires not only appropriate quantity of food (or energy) but adequate quality. A quality diet is defined by its diversity, or the number of different types of foods eaten.

A diverse diet includes foods that provide protein. The best sources of protein are animal-source foods (including meat, fish, eggs, and dairy products), and these are generally the most expensive. Plant-source foods include beans, legumes, nuts, and grains. A variety of plant-source food must be eaten over the course of a day to benefit from complete protein.

A diverse diet also includes foods that provide essential vitamins and minerals (called micronutrients because only small amounts are needed). The importance of vitamin A, iron, iodine, and zinc are particularly well established.

“Hidden hunger” is a term used to refer to poor micronutrient status because it is not linked to calories or quantity of food per se.

A diverse diet is important not only because it contains nutrients we know are important, but also many whose role we might not yet understand.

Poor families tend to have monotonous diets consisting mainly of whatever starchy foods are easily available and cheap. When measured at the household level, dietary diversity reflects a family’s access to food. Household dietary diversity is therefore a key indicator of food security. It affects the nutritional status of individual family members.

(Sources: USAID/CSHGP 2007; Swindale and Bilinsky 2006)

Good nutrition is fundamental to growth and cognitive development; to produce energy for the body to stay warm, move, and work; to resist and fight infections; and to support reproduction and nourish new life.

The immune system relies on proteins, carbohydrates and fats, and micro-nutrients: vitamins and minerals. By improving individual cell function as well as interactions between cells, adequate nutrition strengthens resilience to fight infection.

An adequate supply of micro-nutrients such as iron, vitamin A and iodine is necessary for ideal learning, attention and memory, proper development of motor skills, appropriate emotional expression and resilience to stress.

The science of nutrition is complex. Our understanding of the range and importance of nutrients and the chemical processes involved in their utilization is always advancing, leading to revised policies and new interventions.

Good nutrition requires:

• Access to food on a regular basis
• Consumption of adequate quantity and quality of nutrients each day
• Prevention or treatment of the many nutrition-related threats caused by unhealthy environments and infectious disease

Eating is a social activity and often a care-giving activity, especially for children and those who are sick or have special needs (such as pregnant women). Time, knowledge, and skills are important factors in nutrition.

Food is steeped in social and cultural tradition, influencing how ingredients are acquired and prepared, as well as who consumes what and when. Food and status are closely connected. Gender issues permeate almost every aspect of nutrition.

Efforts to improve the nutritional status of a population inevitably confront questions of resources and equity. Poor nutrition is both a consequence and a cause of poverty. For this reason, program efforts often distinguish between short- and long-route strategies for change, according to how deep the targeted determinants lie within the structure of a given society.

(Sources: Bhutta el al. 2008; Black et al. 2008; The World Bank 2006)

Improving people’s nutritional status will contribute to achieving the Sustainable Development Goals in the areas of poverty, hunger, education, gender, economic growth, and inequality. Nutrition is an economic issue. It is also a health issue, a social issue, and an issue of basic human rights.

In 2015 approximately 793 million people globally were estimated to be hungry by the Food and Agriculture Organization (unable to meet their minimum daily calorie requirements).

Those most vulnerable are children under 2 years of age and pregnant women. Inadequate maternal and child nutrition is the underlying cause of 3.5 million child deaths every year and approximately 45 percent of under-five; mortality.

The rates of malnutrition of children under 5 years are high – particularly in developing countries: 159 milion children under age 5 are stunted (too short for their age – an indicator of chronic malnutrition), 50 million are wasted (low weight for their height – an indicator of acute malnutrition) and 41 million are overweight.

Nutritional damage in early life can lead to permanent impairment, including lower IQ and school performance, lower economic status in adulthood, and lower birth weight in the next generation.

Stunting (height for age) at 2 years is the single best predictor of human capital in a population.

Investments in nutrition have a high benefit-cost ratio of 16 to 1.

Poor nutrition undermines achievement of all other development goals. Yet it remains a low development priority in many countries with the highest burdens.

(Sources: Black et al. 2013, 2008; Bhutta 2013; Bryce et al. 2008; FAO 2015; Horton et al. 2014; Hoddinott et al. 2013; Victora et al. 2008; WHO 2015)