Nutrition defines in great part how many survive infancy & how - PowerPoint PPT Presentation

Nutrition defines in great part how many survive infancy & how they will live and die Adults / Elderly 100 Ideal • Cardiovascular (CHD, Stroke ) • Obesity /Diabetes/ dyslipidemia • Cancer related to diet 2000 • Osteoporosis survival 75 • Aging 1930 Disability 50 Physical /Mental Note: for non- % commercial purposes Foetus / Infants / Children 25 only • LBW/IUGR • Stunting and wasting • Micronutrient deficiency ( Vit A,I,Fe,Zn ) • Infection (HIV/AIDS) 0 20 40 60 80 100 120 Years of age Nutrition-Infection interactions determine in great part, how we grow physically and develop mentally, Nutrition-Physical activity interactions define how we age and die.

We grow and develop according to age Determinants of loss

Deaths attributable to 16 leading risk factors: all countries Blood pressure Tobacco Use Cholesterol Underweight High mortality – Developing countries Low mortality – Developing countries Unsafe sex Fruit & vegetable Developed countries High body mass Index Physical inactivity Alcohol Unsafe water, hygiene Indoor smoke/fuels Iron deficiency Urban air pollution Zinc deficiency Vitamin A deficiency Unsafe health/injections 0 1000 2000 3000 4000 5000 6000 7000 8000 Deaths (000) Adapted from World Health Report 2008

Underweight for age < 5 yrs (WHO-UNICEF-BM 2012)

Stunting < 5 yrs Globally (WHO-UNICEF-BM 2012)

Wasting low weight for height in < 5 yrs in (WHO-UNICEF-BM 2012)

Prevalence of obesity < 5 yrs globally (WHO-UNICEF-WB 2012)

14 million premature deaths due to NCDs Source: WHO, 2008 http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index. html

Premature deaths due to NCDs in developing countries (men) Source: WHO, 2011 https://apps.who.int/infobase/CountryProfiles.aspx

Premature deaths due to NCDs in developing countries (women) Source: WHO, 2011 https://apps.who.int/infobase/CountryProfiles.aspx

Pre Pubertal Pregnancy Sexual BMI maturation Early Adiposity rebound Maternal Glucose feeding Insulin Central fast Obesity Weight Fetal gain Metabolic syn growth Placental restriction Hormonal Fetal blood Hormonal responses responses flow Fetal High BMI Macrosomia Obesity

Nutrition: Critical Timing Preconceptional Gestational Infant BMI  BMI  Micronutrients I, Vit A, Fe, EFA, Zn Diabetes Folic acid Malnutrition Overweight

Assessing Early Life I Interventions I • Early life interventions to prevent the consequences of malnutrition are now well established as a priority for global health and human development. • The prevention of early death is a key component of the millennium development goals to be met by 2015. • We now seek to promote optimal growth and mental development as key for human-social development; the early years lay the biological foundation for productive social and educational investments, building human capital with lifelong returns .

Malnutrition not only affects those who are malnourished but also affects the whole of society CONSEQUENCES OF UNDERNUTRITION Increase Costs Malnutrition is (private– públic) both an ethical & Productivity a socio-economic issue Unemployment Social Exclusion Morbidity Mental School Mortality Acute & Chronic Development performance UNDERNUTRITION Martínez R y Fernández A. Modelo de análisis del impacto social y económico de la desnutrición infantil en A.L. CEPAL 08

TWO APPROACHES IN EVALUATING COSTS OF HUNGER Retrospective Incidental Age at which loss occurss or identified Prospective 15 - 64 Productivity 6 - 18 Education Health 0 - 4 11 64 X 4 2 18 source: Economic Commission for Age at which effects are documented Latin America ECLA 2008

Incidental retrospective dimension (Estimate of the cost of undernutrition in a country’s population for a given year) It estimates the health costs of pre-school boys and girls who suffer from under nutrition during the year of analysis, It considers the educational costs stemming from the undernutrition children now in school suffered during the first five years of life Includes economic costs due to lost productivity by working-age individuals who were exposed to under- nutrition before the age of five. The cost of hunger: Social and economic impact of child undernutrition…

Prospective: potential savings approach Serves to project the present and future losses incurred as a result of medical treatment, repetition of grades in school, and lower productivity caused by under-nutrition among children under the age of five in each country, in a specific year. Based on that, potential savings derived from actions taken to achieve nutritional objectives can be estimated (for example, to attain MDG1, reducing undernutrition by half by 2015). The cost of hunger: Social and economic impact of child undernutrition…

Estimated Losses for 13 countries studied was US $ 17 billion or 3.4% of Aggregate GNP Estimated total cost of childhood malnutrition (US dollars and percent GNP 2004-2005) 4500 12% Total Cost Percent country GNP 4000 10% 3500 Millon US dollars 3000 8% 2500 6% 2000 1500 4% 1000 2% 500 Andean Central America & Countries & 0 0% Dominican Rep Paraguay VEN CRI PAR PAN PER COL ECU RDO NIC BOL ELS HON GUA (2004) (2005) Total US $ 6,659 10,552 ( Million) Fuente: CEPAL, sobre la base de información oficial y registro de costos de educación de cada país; 6.4 2.6 Percent GNP Ingresos y escolaridad, de encuestas de hogares de cada país

Higher mortality and lost opportunity for education determine 93% of the cost of hunger. Health is only 6.5% and school repetition less than 1%. Impact of malnutrition in Latin America (2004-05) Health Education (Morbidity) Productivity (Repetition) 7% (Education ) 1% 41% Productivity (Mortality) 52% lost productivity based on poor linear growth source: Economic Commission for Latin America ECLA 2008

Stunting: nting: the hidde den n impact act The normal al range e of childh dhood d growth th +2.0 S.D. Very High South th Ameri rica ca The missing +1.5 S.D. normal rapid Sub-Sa Sahar haran an Africa ca growers S. Asia Average Height ght Probable disrupted for r Age growth. Low Children -1.5 S.D. might have Normal or Above average growth. Very Low 14% at risk -2.0 S.D. 13% 13% 39% 39% 54% 54% Classi sified ed as Stunt nted ed the lowest limit (-2.0 S.D.) of normal linear growth. Those classified as Stunted fall below

DEATHS ATTRIBUTABLE TO 16 LEADING RISK FACTORS: Blood pressure Tobacco Use Cholesterol Underweight High mortality – Developing countries Low mortality – Developing countries Unsafe sex Fruit & vegetable Developed countries High body mass Index Physical inactivity Alcohol Unsafe water, hygiene Indoor smoke/fuels Iron deficiency Urban air pollution Zinc deficiency Vitamin A deficiency Unsafe health/injections 0 1000 2000 3000 4000 5000 6000 7000 8000 Deaths (000) Adapted from World Health Report 2008

WHO Chronic Disease report 2005

% of total DALYs lost OBESITY Under nutrition

Surface plots relating stature, weight, BMI and RISK of DEATH (Fogel 1997) Body size in the French population ------ 1705 -1975 BMI Stature m Ideal trends Secular trends in developing countries 1970-2000

Impact of Early Life Interventions II • We recognize that the interventions required to prevent stunting and improve brain development are complementary but differ from those needed to reduce underweight & wasting. • The issue is not about choosing between addressing under-nutrition in the poor versus treating obesity in the affluent; but how to maximize human development potential preventing death/disability in the early years with a life course perspective.

Assessing Impact of Early Life Interventions III •We need to assess the biological, social and economic impact of the various options beyond counting lives saved. •We must include the quality of life of those that survive and the resulting economic benefits to individuals and society. •The economic cost of preventable “adult non communicable chronic diseases” (NCDs) must be integrated in our impact analysis of early nutrition

Assessing Impact of Early Life Interventions IV • The largest fraction of these losses relate to poorer brain development and lower educational achievement followed by early death/disability of adults, all impact economic productivity and national development. • We should be talking to the Ministry of Finance and National Development and not only to the ministers of Health and Education

Health Policy. 2007 Mar 13; 83:295-303

Background In January 2000, the Chilean Ministry of Health mandated required fortification with folic acid (FA) at the level of 2.2 mg per kg of wheat flour to reduce the risk of neural tube defects (NTD) This policy would result in a mean additional intake of approximately 400 μg/d based on consumption of fortified bread. Program effectiveness was established documenting increased plasma and RBC folate content and lower incidence of NTD.