Human nutrition in the developing world Food and Nutrition Series - No. 29 By Michael C. Latham Professor of International Nutrition Cornell University Ithaca, New York, USA FAO FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS ISSN 1014-3181 Rome, 1997 The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Food and Agriculture Organization of the United Nations concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. David Lubin Memorial Library Cataloguing in Publication Data Latham, M.C. Human nutrition in the developing world (FAO Food and Nutrition Series No. 29) ISBN 92-5-103818-X ISSN 1014-3181 1. Human nutrition I. Title II. Series III. FAO, Rome (Italy) FAO code: 80 AGRIS: S01 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying or otherwise, without the prior permission of the copyright owner. Applications for such permission, with a statement of the purpose and extent of the reproduction, should be addressed to the Director, Information Division, Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, 00100 Rome, Italy. © FAO 1997 Human nutrition in the developing world covers the most important nutritional problems of developing countries and suggests appropriate programmes and policies to address them. It provides sound science-based information on food, nutrients, the causes of malnutrition, nutritional disorders and their prevention. It emphasizes three prerequisites of good nutrition: food security, good health and adequate care. Special stress is given to applied and multidisciplinary approaches for the alleviation of malnutrition. Food-based approaches are emphasized as the only sustainable way to improve the nutritional status of all. In developing countries better development of agricultural resources can improve food supplies, employment and incomes and thus enable adequate diets. Human nutrition in the developing world will serve as a comprehensive introduction to nutritional problems in developing countries. It is also designed as a useful reference for workers in agriculture, health, education and other fields who are seeking to promote simple, practical and affordable actions to solve nutritional problems in developing countries. The publication will be especially useful for those working with rural populations. Contents Foreword Preface Acknowledgements Part I. Causes of malnutrition Chapter 1. International nutrition and world food problems in perspective The scale of the problem Nutrition improvement: Nature and evolution A framework for causes of malnutrition Promotion and protection of nutritional well-being: The ICN approach The six Ps Chapter 2. Food production and food security National food security Household food security Food policies in a development context Chapter 3. Nutrition and infection, health and disease Effects of malnutrition on infection Effects of infection on nutritional status Chronic diseases and old age Intervention studies Nutrition, infection and national development Chapter 4. Social and cultural factors in nutrition Food habits and their origins Nutritional advantages of traditional food habits Food taboos Changing food habits Harmful new habits Influencing change for the better Chapter 5. Population, food, nutrition and family planning Population growth Urbanization Technology Reproduction and nutritional status Chapter 6. Nutrition during particular times in the life cycle: Pregnancy, lactation, infancy, childhood and old age Women of reproductive age Pregnant women Lactating mothers Infants and preschool-age children School-age children Older persons Chapter 7. Breastfeeding Advantages of breastfeeding Problems with bottle-feeding or feeding breastmilk substitutes Properties and value of breastmilk Colostrum How breastmilk is made Infant feeding trends Management of breastfeeding Breastfeeding problems Breastfeeding, fertility and birth spacing Breastfeeding and AIDS Control of infant formula promotion Protection, support and promotion of breastfeeding Part I. Causes of malnutrition Chapter 1. International nutrition and world food problems in perspective We, the Ministers and Plenipotentiaries representing 159 nations... declare our determination to eliminate hunger and to reduce all forms of malnutrition. Hunger and malnutrition are unacceptable in a world that has both the knowledge and the resources to end this human catastrophe. These are the opening sentences of the World Declaration on Nutrition produced by the FAO and World Health Organization (WHO) International Conference on Nutrition (ICN) held in Rome in December 1992. That important conference reviewed the current nutrition situation in the world and set the stage for markedly reducing these unacceptable conditions of humankind. Reaching the ICN goal is possible. Most of the work will need to be done in the developing countries by their own people. However, cooperative work across nations and across disciplines is also essential. This book is aimed to help move forward the noble objectives elaborated by the ICN. It is hoped that a comprehensive text that describes the nature of the problems, their causes and ways to deal with them can be helpful. A brief review highlighting international food and nutrition issues can help to bring the most important issues into perspective. The ICN declaration goes on to state: 1. ... We recognize that globally there is enough food for all and that inequitable access is the main problem. Bearing in mind the right to an adequate standard of living, including food, contained in the Universal Declaration of Human Rights, we pledge to act in solidarity to ensure that freedom from hunger becomes a reality. We also declare our firm commitment to work together to ensure sustained nutritional well-being for al] people in a peaceful, just and environmentally safe world. 2. Despite appreciable worldwide improvements in life expectancy, adult literacy and nutritional status, we all view with the deepest concern the unacceptable fact that about 780 million people in developing countries - 20 percent of their combined population - still do not have access to enough food to meet their basic daily needs for nutritional well-being. 3. We are especially distressed by the high prevalence and increasing numbers of malnourished children under five years of age in parts of Africa, Asia and Latin America and the Caribbean. Moreover, more than 2 000 million people, mostly women and children, are deficient in one or more micronutrients; babies continue to be born mentally retarded as a result of iodine deficiency; children go blind and die of vitamin A deficiency; and enormous numbers of women and children are adversely affected by iron deficiency. Hundreds of millions of people also suffer from communicable and non- communicable diseases caused by contaminated food and water. At the same time, chronic non-communicable diseases related to excessive or unbalanced dietary intakes often lead to premature deaths in both developed and developing countries. The scale of the problem Protein-energy malnutrition (PEM), vitamin A deficiency, iodine deficiency disorders (IDD) and nutritional anaemias - mainly resulting from iron deficiency or iron losses - are the most common serious nutritional problems in almost all countries of Asia, Africa, Latin America and the Near East. Nutrition and development: a global assessment, prepared by FAO and WHO for the ICN, reviewed all available current information on the prevalence of hunger and malnutrition and provided a global estimate for the various regions of the world. FAO updated the estimates of the chronically undernourished population of the world for the Sixth World Food Survey and in preparation for the World Food Summit (Table 1), and WHO updated the estimates for iodine, vitamin A and iron deficiencies in 1995 (Table 2). The figures suggest that one of every five persons in the developing world is chronically undernourished, 192 million children suffer from PEM and over 2 000 million experience micronutrient deficiencies. In addition, diet-related non- communicable diseases such as obesity, cardiovascular disease, stroke, diabetes and some forms of cancer exist or are emerging as public health problems in many developing countries. While these numbers and trends are alarming, progress has been made in reducing the prevalence of nutritional problems, and many countries have been remarkably successful in addressing the issues of hunger and malnutrition. For the developing countries as a whole there has been a consistent decline since the early 1970s in the proportion and absolute number of chronically undernourished people. From 1969 to 1971 approximately 893 million people were chronically undernourished, compared with 809 million from 1990 to 1992; these figures represent a drop from 35 to 20 percent of the population of these countries. The current - and achievable - challenge is to build upon and accelerate the progress that has been made. FAO and WHO data indicate improvements of the nutritional situation in Asia and Latin America from 1980 to 1990 but a deterioration in sub-Saharan Africa. Although the prevalence of underweight children remained virtually unchanged in sub-Saharan Africa