The document discusses opportunities and challenges for achieving nutrition security in low and middle income countries. It finds that while stunting in children under 5 has decreased from 44% to 29% between 1990 and 2010, 171 million children are still stunted. Overweight in children is also increasing steadily. There has been slow progress in reducing micronutrient deficiencies and low birth weight. Undernutrition and overnutrition can coexist in the same country, individual, and even household. Improving nutrition is important as malnutrition impacts cognitive development, economic productivity, and overall societal and economic costs. To accelerate progress in nutrition, countries need to focus on prevention during the first 1000 days of life from conception to 24 months, invest in nutrition-specific and nutrition

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Opportunities and Challenges for
Achieving Nutrition Security in Low
and Middle Income Countries
Marie Ruel ︳ Food Secure Arab World ︳ Beirut, Feb 6-7, 2012

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GLOBAL TRENDS IN NUTRITION
INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE

3. Click to edit Master title 5 are stunted
171 million children under style
Source: WHO Global Database on Child Growth and Malnutrition, May 2009 - Mercedes de Onis, BMGF meeting 2010

4. Stunting ↓ from 44-29% style
Click to edit Master title(1990-2010)
50
% 4 8 .6
200
190
4 0 .3
40
3 9 .3
3 7 .7 3 8 .2
150
138
Number of stunted (millions)
30
2 7 .6
Stunting (%)
100
2 3 .7 100
20
1 8 .1
60
1 3 .5
51
50
45
10
13
10
7
0
0
1990 2000 2010 1990 2000 2010
Mercedes de Onis, BMGF meeting 2010
Source: Department of Nutrition, World Health Organization AFRICA ASIA LATIN AMERICA

5. Overweight children ↑ steadily (1990-2010)
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10
20
18
8 .5
8
15
6 .8 6 .8 6 .9 14
Number of overweight (millions)
13
13
6
Overweight (% )
5 .7
10
4 .9
4
4
3 .7 7
3 .2
5
4
4 4 4
2
0
0
1990 2000 2010 1990 2000 2010
Source: Department of Nutrition, World Health Organization AFRICA ASIA LATIN AMERICA
Mercedes de Onis, BMGF meeting 2010

6. Slow progress on ↓ micronutrient deficiencies
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and low birth weight
 Vitamin A: 160 million children affected; ~30%
children (40% in Africa and South Asia); also
prevalent in women
 Anemia: (half of which is due to iron deficiency):
Static at ~45% in children (Africa and Asia); 500
million women anemic (highest burden in Asia)
 Iodine: widespread deficiency
 Low birth weight: 25-33% in Africa and Asia
Marie Ruel ︳ Food Secure Arab World ︳ Beirut, Feb 6-7, 2012

7. Coexistence of under andtitle style
Click to edit Master over nutrition
Egypt
35
30
In same country 25
20 Stunting
15 Wasting
10 Overweight
In same individual 5
100
90
0
80 2003 2005 2008
Anemia in women
70
60
Other
Overweight
In same household
% 50 Obese
*, † †
40
30
20
10
0
Egypt Peru Mexico
Marie Ruel ︳ Food Secure Arab World ︳ Beirut, Feb 6-7, 2012

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WHY DOES NUTRITION MATTER?
INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE

9. Stunted child – Stunted style
Click to edit Master title adult
 Damage is irreversible
Height
81.2
at 18 y
Height
at 3 y
Severe Moderate Mild Well-nourished
Source: Paul Melgar, INCAP

10. Being undernourished in early childhood
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= Being handicapped for life
 High risk of illness and mortality (associated with
35% of child deaths)
 Poor cognitive development, delays in starting
school, poor school performance
 Reduced economic productivity – wages, income,
skilled jobs
 Increased risk of obesity and NCD at adulthood
(and premature death)
 Small mothers, small babies
Marie Ruel ︳ Food Secure Arab World ︳ Beirut, Feb 6-7, 2012

11. Click cost to society & title style
Huge to edit Master global economy
Malnutrition Poverty
 GPD losses > 2-3 %
 US $80 billion/y (Sridhar 2007)
Marie Ruel ︳ Food Secure Arab World ︳ Beirut, Feb 6-7, 2012

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WHAT NEEDS TO BE DONE TO
ACCELERATE PROGRESS IN
IMPROVING NUTRITION?
INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE

13. 1. PREVENT – Focus on 1st 1000 Days
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-9 to 24 mo
Europe &
Central Asia
LAC
North Africa &
Near East
SS Africa
South Asia

14. 2.Click to edit Master title style
Scale-up targeted nutrition Interventions
 Series of Nutrition Interventions of known
efficacy (Lancet 2008):
• Maternal health and nutrition during pregnancy
(and before)
• Appropriate child feeding practices
• Micronutrient supplementation (e.g. vitamin A,
zinc, iron)
• Immunization
• Hygiene
Marie Ruel ︳ Food Secure Arab World ︳ Beirut, Feb 6-7, 2012

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3. Integrate nutrition into other
relevant sectors
GOVERNANCE GENDER
Agriculture & Water &
Food Security Sanitation
Social Environment &
Protection Climate Change
Work
Multi-
Sectorally Private
Sector
Poverty
Reduction
Trade/Fiscal
Health Policies
15
Source: World Bank 2011

16. 4. Useto life cycle approach
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17. 5. Focus on poor, vulnerable, left
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behind, and on reducing inequities
6. Improve data, information,
measurement, documentation,
learning, evaluation
Marie Ruel ︳ Food Secure Arab World ︳ Beirut, Feb 6-7, 2012

18. Several to edit Master title style these
Click new initiatives are following
principles
How will these translate into actions on the
ground and Improvements in nutrition at scale?
UK DFID
Marie Ruel ︳ Food Secure Arab World ︳ Beirut, Feb 6-7, 2012