Nutrition transition

Question 1

Undernutrition Overview

Answer 1

» Wasting (acute malnutrition)
» Stunting (chronic malnutrition)
» Micronutrient defciencies

Question 2

Types of malnutrition

Answer 2

» Undernutrition
- Wasting (acute malnutrition)
- Stunting (chronic malnutrition)
- Micronutrient defciencies
» Overnutrition
- Obesity / overweight

Question 2

Child malnutrition

Answer 2

“Good nutrition sets children on the path to survive and
thrive. Well-nourished children grow, develop, learn, play,
participate and contribute – while malnutrition robs children
of their full potential, with consequences for children, nations
and the world.”

Question 2

Wasting and stunting

Answer 2

Question 2

Child malnutrition

Answer 2

» Undernutrition is most commonly associated with children
» All forms of undernutrition can afect a child’s health in adulthood and later life
» Stunting afects a child’s growth trajectory and cognitive development
» Severe wasting can be life-threatening

Question 3

Wasting (acute malnutrition)

Answer 3

» Wasting is the most immediate, visible and life-threatening form of malnutrition
» It often indicates recent and severe weight loss, although it can also persist for a long time
» Children with wasting are too thin and their immune systems are weak, leaving them
vulnerable to developmental delays, disease and death

Question 3

Wasting (acute malnutrition)

Answer 3

Question 4

Wasting (acute malnutrition)

Answer 4

Question 5

Consequences of wasting

Answer 5

“Wasting impairs the functioning of the immune system and can lead to increased severity and
duration of, and susceptibility to, infectious diseases, and an increased risk of death.”
~ World Health Organisation
» Wasting in children is associated with a higher risk of death due to:
- Pneumonia
- Diarrhea
- Measles
- Meningitis

Question 6

Treatment for wasting

Answer 6

» Ready-to-Use Therapeutic Food (RUTF)
- e.g. “Plumpy’Nut”
» Made from powdered milk, peanuts,
butter, vegetable oil, sugar, and a mix of
vitamins and minerals
» High nutritional value, allowing wasted
children to gain weight quickly

Question 6

Stunting (chronic malnutrition)

Answer 6

“Stunting is the impaired growth and
development that children experience
from poor nutrition, repeated
infection, and inadequate
psychosocial stimulation.”
~ World Health Organisation

Question 6

Stunting (chronic malnutrition)

Answer 6

» Stunting is caused by factors throughout childhood, but primarily during the “frst 1,000
days”—the period just before conception (when the mother’s nutritional status is of
paramount importance) to a child’s second birthday.
» The impact of the poor diet, health, and care that lead to stunting, however, lasts far beyond
childhood.
» The physical and cognitive consequences are largely irreversible, despite parents’ best
eforts later in the child’s life.
» For the most part, stunting itself cannot be treated, only prevented.

Question 6

Consequences of stunting

Answer 6

» Closely linked with child development in several domains including cognitive, language, and
sensory-motor capacities
» Poor cognition and educational performance
» Lost productivity, low adult wages
» When accompanied by excessive weight gain later in childhood, an increased risk of
nutrition-related chronic diseases in adult life

Question 7

Micronutrient defciencies

Answer 7

» Micronutrient defciencies compromise
immune systems, hinder child growth and
development, and afect human potential
worldwide
» Defciencies in iron, vitamin A, iodine, zinc
are the most common around the world,
particularly in children and pregnant
women

Question 8

Consequences of MN defciencies

Answer 8

» Iodine defciency may cause mental impairment that reduces intellectual capacity.
» Vitamin A defciency is the leading cause of preventable blindness in children and increases
the risk of disease and death from severe infections such as diarrhoeal disease and measles.
» Zinc defciency can contribute to increased severity of diarrhea and pneumonia.
» Defciencies in iron, folate and vitamins B12 and A can lead to anaemia.

Question 8

Overweight and obesity

Answer 8

“Abnormal or excessive fat
accumulation that presents a risk to
health.”
~ World Health Organisation

Question 9

Key points

Answer 9

» Malnutrition can take various forms, including undernutrition (wasting, stunting,
micronutrient defciencies) and overnutrition (obesity).
» Undernutrition is a particular concern for children, as it afects a child’s growth trajectory
and cognitive development.
» Wasting involves the rapid loss of weight, brought on by sudden food insecurity or infection
(i.e. acute malnutrition).
» Stunting concerns poor dietary intake over the frst few years of a child’s life (i.e. chronic
malnutrition).
» Defciencies in iron, vitamin A, iodine, and zinc are the most common micronutrient
defciences in children around the world.

Question 10

Body mass index (BMI)

Answer 10

» There are no perfect measures of overweight and obesity.
» Body mass index (BMI) provides the most useful population-level measure of overweight
and obesity as it is the same for both sexes and for all ages of adults.
» BMI has pit falls, but it is the most widely used tool and is useful for comparing global
obesity rates.
» For adults, the World Health Organisation defnes overweight and obesity as follows:
- overweight is a BMI greater than or equal to 25;
- obesity is a BMI greater than or equal to 30.

Question 11

Consequences of obesity

Answer 11

» Obesity is a major risk factor for many non-communicable
(chronic) diseases, including:
- cardiovascular diseases, such as heart disease and stroke,
which are the leading causes of death worldwide;
- diabetes and its associated conditions;
- musculoskeletal disorders, including osteoarthritis;
- some cancers, including endometrial, breast, ovarian,
prostate, liver, gallbladder, kidney and colon cancers.
» Obesity does not directly cause of any of these conditions,
but it increases their likelihood of occurring.

Question 12

Medical complications of obesity

Answer 12

Question 13

The global obesity crisis

Answer 13

“Worldwide, obesity has nearly tripled since
1975.”
~ World Health Organisation
» In 2016, more than 1.9 billion adults, 18
years and older, were overweight. Of these
over 650 million were obese.
» 39% of adults aged 18 years and over were
overweight in 2016, and 13% were obese.

Question 14

Burden of disease

Answer 14

“According to the Global Burden of Disease
study, 4.7 million people died prematurely in
2017 as a result of obesity. To put this into
conbullet: this was close to four times the
number that died in road accidents, and close
to fve times the number that died from HIV/
AIDS in 2017.”
~ Our World in Data

Question 15

What causes obesity?

Answer 15

“The fundamental cause of
obesity and overweight is an
energy imbalance between
calories consumed and
calories expended.”
~ World Health Organisation

Question 16

Why the global obesity epidemic?

Answer 16

» Globally, there has been:
- an increase in the intake
of energy-dense foods
that are high in fat and
sugars; and
- a decrease in physical
activity due to the
increasingly sedentary
nature of many forms of
work, changing modes
of transportation, and
increasing urbanisation.

Question 17

The complex determinants of obesity

Answer 17

“Changes in dietary and physical activity
patterns are often the result of environmental
and societal changes associated with
development and lack of supportive policies in
sectors such as health, agriculture, transport,
urban planning, environment, food
processing, distribution, marketing, and
education.”
~ World Health Organisation

Question 18

Key points

Answer 18

» “Overweight and obesity are defned as abnormal or excessive fat accumulation that
presents a risk to health.” (World Health Organisation)
» Body mass index (BMI) is an imperfect metric that we use to measure and compare global
rates of obesity.
» Obesity is a major risk factor for many non-communicable diseases, including
cardiovascular disease, diabetes, musculoskeletal disorders, and some cancers.
» The prevalence of obesity is increasing around the world, due to:
- an increase in the intake of energy-dense foods, and
- a decrease in physical activity due to increasingly sedentary lifestyles

Question 19

Overview

Answer 19

» Nutrition transition
» Double burden of malnutrition
» Nutrition and climate change

Question 20

Nutrition and globalisation

Answer 20

» The nutrition transition is rooted in the processes of globalisation.
» Dietary trends are shaped by the same policies and processes designed to advance
globalisation of the world economy; for example, in agriculture, trade, investment, and
marketing.
» Globalisation has afected food supply chains (altering quantity, nutrition quality, cost and
desirability of foods).
» The global market place afects food consumption trends, through:
- Production and trade of agricultural goods
- Foreign investment in food processing and retailing
- Global food advertising and promotion

Question 20

Nutrition transition

Answer 20

» In recent decades, large shifts have occurred in dietary patterns.
» Modern societies have converged on a diet high in saturated fat, sugar, and refned foods
and low in fbre – often referred to as a “Western diet”.
» This type of diet is associated with higher rates of obesity and non-communicable disease.
» Across the globe we have seen:
- increased intake of processed foods and refned carbohydrates,
- increased consumption of high-calorie beverages,
- reduced intake of fruits, vegetables, and legumes,
- reduced preparation time, increased use of pre-cooked foods,
- increased snacking

Question 20

Obesity and the nutrition transition

Answer 20

» The trend toward higher rates of obesity in highincome countries reaches back a century, but there
has been a major increases since the 1980s.
» By contrast, there was minimal obesity in lowincome countries until the late 1980s, but this has
changed over the past 30 years.
» We are now at a point where, in most countries,
obesity far exceeds undernutrition.

Question 21

Nutrition transition

Answer 21

“A shift from scarce, plant-based diets with fresh and unprocessed foods towards afuent diets
high in sugar, fat, and animal-source foods, featuring highly-processed food products.”
“A shift in public health challenges from undernutrition-related infectious diseases and
neonatal disorders towards overconsumption-related chronic diseases such as diabetes and
cardiovascular diseases.”

Question 22

Double burden of malnutrition

Answer 22

Question 23

Stages of the nutrition transition

Answer 23

Question 24

Double burden of malnutrition

Answer 24

“The double burden of malnutrition is… the
coexistence of undernutrition along with overweight
and obesity, or diet-related noncommunicable
diseases, within individuals, households and
populations, and across the lifecourse.”
~ World Health Organisation

Question 25

Food production and climate stability

Answer 25

“Global food production threatens climate stability and
ecosystem resilience. It constitutes the single largest driver of
environmental degradation and transgression of planetary
boundaries.”
“A radical transformation of the global food system is urgently
needed.”

Question 26

Double burden of malnutrition

Answer 26

Question 27

EAT-Lancet Commission

Answer 27

“Food is the single strongest lever to optimize human health
and environmental sustainability on Earth.”

Question 28

Food production and climate stability

Answer 28

» Food production depends on land, water, and energy to produce
food.
» Fertile lands for food production are diminishing.
» Soils are eroding, which threatens sustainable food production.
» Clean, fresh water is decreasing.
» Agriculture currently accounts for 70% of freshwater use.
» Food and livestock are a major source of greenhouse gases.
» Agriculture also contributes to greenhouse gas emissions through
land clearing and methane releases.

Question 29

Parallel challenges

Answer 29

» A report from the UK on “Tackling Obesities”
identifed a number of parallels between the
obesity crisis and climate change:
- Failure to act early is already having signifcant and
undesirable consequences
- Policy discussions are vibrant but not yet matched by
positive change
- Determinants remain misunderstood, underresearched, and policy drifts towards individual
responsibility
- A danger that the time to act has passed and unable to
reverse population-wide obesity
- Being normalised even as trends accelerate and grow

Question 30

Key points

Answer 30

» The “nutrition transition” refers to a global shift from scarce, plant-based diets with fresh
and unprocessed foods, towards afuent diets high in sugar, fat, and animal-source foods,
featuring highly-processed food products.
» This transition includes changes in how foods are grown, processed, marketed, prepared,
and consumed, and is linked to broader changes arsing from globalisation.
» The nutrition transition has brought with it a rapid rise in obesity, in both high-income and
low-income countries, and related increases in non-communicable disease.
» The “double burden of malnutrition” refers to the coexistence of undernutrition and
overnutrition (obesity) within individuals, households and populations, and across the
lifecourse.
» The way in which we currently produce and consume food is exacerbating climate change.