Download When breast milk is no longer sufficient

Reflections on the 2005 World Food
Prize Symposium:
Nevin S. Scrimshaw, PhD, MD, MPH
President, International Nutrition Foundation
THE LIFE CYCLE APPROACH TO
NUTRITION AND FOOD NEEDS
• At the moment of conception nearly
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everyone has the genotype for a long and
healthy life.
From the this time onward environmental
factors damage this potential to produce a far
different phenotype than at conception.
Malnutrition and overnutrition are the most
common and consistent factors responsible,
for this damage.
The Life Cycle Approach Involves
Nutrition at All Ages
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Pregnant & lactating women
Infant & toddler
School child & adolescents
Adults at all ages
Women of child bearing age
Pregnancy
• Folic acid deficiency in early pregnancy increases
neural tube defects.
• Iodine deficiency impairs fetal brain development
• Protein-energy deficiency lowers birthweight with
multiple consequences.
• Iron deficiency lowers infant iron stores at birth.
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Infancy
• When breast milk is no longer
sufficient, appropriate complementary
feeding is essential or physical and
mental stunting results.
• Iron deficiency and protein-calorie
malnutrition are the main risks.
Lactation/Infant Feeding
• Breast feeding provides only half the daily iron
required in infancy; the balance must come
from the stores at birth
• These are exhausted by about 6 months, by 4
months if mother is anemic, by 2 months for low
birth weight infants.
• Without supplementation or iron fortified food
permanent impairment of myelenation of cranial
nerves and dopamine neurons inevitable when
stores at birth are exhausted.
Toddler/Pre-school Child
• PEM can permanently reduce physical
and mental development.
• Vitamin D deficiency leads to rickets.
• Iron deficiency anemia causes reduced
cognitive and motor performance.
School child and adolescent
• PEM
affects physical growth and behavior.
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Iron deficiency impairs school performance.
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Vitamin D deficiency leads to rickets.
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Low calcium intakes predispose to adult
osteoporosis
Adult
• Poor diet and life style lead to the early
development of:
Diabetes type II
Hypertension
Heart disease
Increased susceptibility to cancer
Less resistance to infection
Elderly Adult
• Partially preventable declines in:
 Physical strength (sarcopenia)
 Cognitive function and dementia
 Mobility and independence
• Partially preventable increases in:
 Malignancies
 Infections
 Dependency
Still neglected:
Women of Child-bearing Age
• Women must enter pregnancy with
adequate folic acid status to avoid fetal
neural tube defects
• Iron supplementation during pregnancy
is too late!
• Good weight gain is essential to normal
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infant birth weight.
Examples of Destructive Non
Nutritional Factors :
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Use of Tobacco
Use of Narcotics
Alcohol Medication Abuse
Trauma
Heavy metal poisoning – lead, arsenic
fluoride
• Radiation
New insights into global hunger
• Agronomic Characteristics and
Nutritional Value
• Overt Hunger and Hidden Hunger
• Nutritional Deficiency and Nutritional
Excesses
• The triple burden of Nutritional Disease
(Due to Fetal Origins of Adult Disease)
Challenges to Agriculturists
• Plant breeding
 Improve protein quality
 Improve beta carotene content
 Improve availability of non-heme iron
• Animal husbandry
 Lower proportion of total fat
 More healthful fatty acid composition
Challenges to the Nutritionists
• By developing international consensus
priorities to avoid waste of financial and
human resources due to conflicting or
poor nutritional advice to agriculturists.
• Be advocates for maximizing the
qualitative as well as quantitative
contributions of agriculture to feeding the
human population.
Don’t depend on any one solution!
• Protein quality can be assured from genetically
improved cereals such as QPM or by legumes
or oil seed protein to complement a cereal
staple or by adding animal protein to the diet.
• Vitamin A activity can come from the beta
carotene of yellow vegetables and be enhanced
by genetic engineering as well as animals.
• B vitamins and minerals can be provided
cheaply and effectively by universal multiple
fortification of the cereal staple so that breeding
for them may not be worthwhile.
Conclusions
 Target the process, not just the problem:
Mainstreaming in development, PRSPs
 Challenge the ‘invisibility of malnutrition:
‘forgotten emergencies’, ‘hidden hunger’,
 Address all aspects (lifecycle) of malnutrition:
Wasting, stunting, micronutrients, obesity
 Protect investments against shocks:
Multiple inputs, links with all MDGs
Legislated empowerment (rights):
Meeting demand requires funds for nutrition
Thank you
Thank you