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The U.S. government isincreasingly asking de-velopment practitioners

to integrate nutritional consid-erations into core value chain

development and to measurenutritional impact. This primerwas developed to acilitate theseeorts. It provides an overviewo the major nutrients essen-tial to good health, lists oodsources o these nutrients anddescribes the health implicationso nutritional deciencies.

Eating a wide variety o oodsneeded or growth and mainte-

nanceincluding protein, carbo-hydrates, ats, vitamins, nutrientsand antioxidantskeeps thehuman body strong and helpsprevent disease. Both micronu-trients (e.g., vitamins, minerals)and macronutrients (e.g., ats,carbohydrates, protein) areessential. Macronutrients areneeded in large amounts ornormal growth and develop-

ment. Micronutrients are neededin very small quantities or nor-mal growth and development.

Macronutrients

CarbohydratesSource o En-ergy: Carbohydrates contributemost o the energy (i.e., calories)in human diets. Carbohydrates

should comprise 4565 percento the daily calories or maxi-mum nutrition. The body turnscarbohydrates into sugars, whichare used as uel or energy. In

addition, some carbohydrates,known as complex carbohy-drates, are high in dietary ber,which plays an important role incholesterol control, blood sugarstabilization and bowel unctionimprovement. Complex carbo-hydrates include whole grains,brown rice, and ruits and veg-etables.

Carbohydrates are ound in the

ollowing oods:

Fruits and vegetables Breads, cereals and other

grains (e.g., rice, maize,wheat, sorghum)

Breastmilk, animal milk andmilk products (e.g., butter,cheese)

Foods containing addedsugars (e.g., cakes, cookies

and sugar-sweetened bever-ages)1

ProteinsSource o AminoAcids: Protein is an essentialcomponent o muscle tissue,organs, enzymes, blood, anti-bodies and neurotransmittersin the brain. Proteins are maderom amino acids, which are thebuilding blocks o lie, and regu-late every biochemical reaction

in the body, such as metabolism.Protein intake should be 1035percent o total daily calories.

There are two types o protein:

complete and incomplete. Ani-mal protein sources are consid-ered complete (i.e., they containall essential amino acids); plant-based proteins are incomplete(i.e., they do not have all essen-tial amino acids by themselves).For populations ollowing aplant-based diet, it is necessaryto combine at least two plantprotein sources to obtain acomplete protein prole, or ex-

ample, rice and beans or peanutbutter and bread. A nondiversediet, such as one consisting onlyo rice, may ulll caloric needsbut leave out protein or otheressential micronutrients romother ood sources, leading tomalnutrition. Protein is ound inthe ollowing oods:

Eggs, meats, poultry and sh

Legumes (e.g., dry beans,peas, nuts, seeds) Milk and milk products Grains, some vegetables and

some ruits (provide smallamounts)

Fats: Fats are also an essentialpart o the diet and should com-prise 2035 percent o the dailycalories or maximum nutrition.Fats play a vital role in maintaining

A Nutrition

Nutrition Integration Fact Sheet

PRIMER

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healthy skin and hair, insulat-ing body organs against shock,maintaining body temperature,

delivering at-soluble vitaminsand promoting healthy cell unc-tion. Fat is ound in the ollowingoods:

Cooking oil, coconut oil, redpalm oil

Nuts (cashews, almonds) andsome legumes (soybeans,groundnuts)

Butter or margarine Meats, sh and dairy products

Micronutrients

Micronutrients include vitaminsand minerals. They do not pro-vide energy but are vital to manybody unctions, including growthand brain development. De-ciencies in the three micronutri-ents discussed below cause themost signicant public health

concerns and are priorities orthe majority o ood security pro-grams. The dietary requirementso each nutrient vary by ageand lie stage (e.g., pregnancy,inancy, prepuberty).

Vitamin A and Vitamin A Def-ciency:Vitamin A plays a role invision, immune unction, promo-tion o growth and skin health,

among other things. Night blind-ness is the best-known symptomo vitamin A deciency. Otherhealth consequences includepoor growth, higher morbidityand increased vulnerability to in-ections. Vitamin A supplemen-tation is widely promoted orwomen and or children under 5years o age. Vitamin A is oundin the ollowing oods:

Livers o bee, pork, chicken,turkey, sh

Orange vegetables, ruits

(e.g., orange fesh sweetpotatoes, pumpkin, carrots,papaya)

Dark green leay vegetables(e.g., kale, spinach, collardgreens, broccoli)

Zinc and Zinc Defciency: Zincis an essential mineral. It is in-volved in the metabolism o car-bohydrates, synthesis o energyprotein and transport o carbon

dioxide. It is also important inwound healing, brain unctionand bone growth. Zinc is oundin the ollowing oods:

Oysters Red meats and poultry Whole grains Dairy products

Zinc deciency causes diarrhea,growth retardation, loss o ap-

petite and impaired immuneunctions. Zinc status is verydicult to measure and thus zincdeciency prevalence is rarelyreported, though it is generallythought to be high. Zinc supple-mentation, with or without othermicronutrients, has been widelyused in public health interven-tion to control diarrhea andprevent malnutrition.

Iron and Anemia: Iron is criticalor brain development and unc-tion, regulation o body temper-ature, muscle activity and me-tabolism. Iron deciency resultsin nutritional anemia, which is asyndrome caused by malnutri-tion. In addition to anemia, otherunctional impairments includedecreased immunity, reducedresistance to inection, increased

morbidity and mortality, and de-creased work perormance. Ironis ound in the ollowing oods:

Eggs and meats Dark green leay vegetables

(e.g., kale, spinach, collardgreens, broccoli)

Legumes (e.g., beans, lentils) Whole grains Enriched ood products (e.g.,

ortied fours)

Malnutrition

Malnutrition covers a broadrange o clinical conditionscaused by an insucient orpoorly balanced diet, disease,aulty digestion and poor utiliza-tion o oods by the body. Bothobesity and undernutrition aretypes o malnutrition. The inci-dence o obesity is rising andnow aects both urban popula-tions and the rural poor in many

developing countries. Poorhousehold diet and adult inac-tivity has led to situations withundernourished children andobese adults in the same house-hold, with both suering romthe same underlying vitamin andmineral deciencies. With in-creased obesity rates, diabetes,heart disease and cancers arealso on the rise.

Malnutrition that results romundernutrition is a leading causeo death in young children in de-veloping countries. Underlyingcauses o undernutrition include:

Insucient access to ood Poor maternal and child car-

ing practices Inability, typically as a result

o disease, o the body to

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utilize ood properly Poor water quality and sani-

tation Inadequate access to health

services

Stunting: Stunting is refected inthe linear growth (or lack there-o) o a child under the age o 5and measures long-term growthaltering, reerred to as chronicmalnutrition. Stunted childrenare too short or their age. Stunt-ing develops over a long period

o time as a result o inadequatedietary intake (e.g., insucientprotein, calories or micronutri-ents, particularly vitamin A andzinc) and/or repeated inections.It is irreversible; a stunted childwill become a stunted adult.Worldwide, stunting preva-lence increases as children age,reaching a plateau around 24months.2 The 1,000-day period

rom pregnancy through age 2is the critical window o oppor-tunity to shape a childs lielonghealth and development. Aterthis, the damage is irreversible.The irreversible physical andcognitive damage rom stuntingleads to lower adult productivityand enormous long-term eco-nomic loss to societies.3

Interventions include increasingdietary diversity and improvingeeding practices, such as Exclu-sive Breast Feeding (EBF) rom

immediately ater birth until 6months o age.

Greater access to and utilizationo nutritious oods or pregnantwomen and children duringthe rst 5 years o lie and pro-motion o EBF and continuedbreast eeding until 2 years oage are key to sustainably re-ducing stunting in a population.In addition to increased health

care access, improved water andsanitation, and improved childcaring practices, stunting canalso be alleviated by improvingdiet diversity through agricul-tural interventions.

Wasting: Wasting refects cur-rent nutritional status and ismeasured us-ing the ratio oa childs cur-rent weight tocurrent height.It is the mostlie threaten-ing o thethree typeso malnutri-tion. Wastedchildren aretoo light ortheir height or

length. The condition is causedby inadequate intake o totalcalories (carbohydrates, proteinand micronutrients), resultingin rapid weight loss or ailure togain weight.

Wasting and acute malnutritionare oten used interchangeably.Wasting can be reversed withimproved diet and the treatmento underlying illnesses. Bothchildren and adults can becomeseverely wasted.

Underweight: An underweightchild is too light or his/her age.Children may become under-weight because o wasting orstunting or both. An under-weight child may suer romacute or chronic malnutrition orboth.

Underweight is measured inchildren using weight or age.Underweight is used less oten

than stunting and wasting inmeasuring child malnutritionin developing countries. BodyMass Index (BMI) is oten usedto measure underweight duringpregnancy. Global Acute Mal-nutrition (GAM) is a population-level indicator dened by wast-ing or the presence o bilateral

You cannot identiy stunting simplyby looking at a child. The girl on the

let is 2 years, 2 months old; the girlon the right is 5 years old.

Edema starts rom eet and extends upward to otherparts o the body. I a shallow print or pit persists ater thethumbs press and lit, the child has oedema. It cannot betold by just looking.

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pitting edema.4 GAM rates areused by health and nutritionpractitioners to gauge the se-riousness o a nutritional emer-gency and educate program-matic responses required.

While prevention o stunting andunderweight through diet diver-sity may be the main contribu-tion o agricultural developmentprograms in addressing chronic

malnutrition, children who areacutely malnourished need to bereerred or treatment. Monitor-ing GAM rates along with oodsecurity indicators can be usedto orecast and possibly preventa major nutrition emergency.The GAM rate classication is as

ollows:

>10% = Serious Emergency >15% = Critical Emergency

>30% = Famine

GAM is a combination o mod-erate acute malnutrition (MAM)and severe acute malnutrition(SAM). MAM + SAM = GAM.MAM = Weight For Height(WFH) -3 z-score and < -2 z-score. SAM=WFH