1

The multiple burden of malnutrition and healthy diets

F.Branca

Director Department of Nutrition for Health and development

WHO/HQ Acting Executive Secretary SCN

Leading risk factors for global burden of disease in 1990 and 2010

Burden of disease attributable to 20 leading risk factors in 2010, as a % of global DALYs

High BMI accounted for 3.4 M deaths and 3·8% of global DALYs in 2010 Poor diet and physical inactivity 10% of global DALYs

Central sub-saharan Africa, DALY 2010

Southern sub-saharan Africa, DALY 2010

Maternal and child undernutrition

accounted for 1,400,000 deaths or 6.7% of the

global burden of disease in 2010

• childhood underweight : 860,000 deaths, 3·1% DALYs

• iron deficiency anaemia : 120,000 deaths, 1·9% DALYs

• sub-optimal breastfeeding : 544,000 deaths, 1·9% DALYs

• Vitamin A : 120,000 deaths, < 0·8% DALYs

• zinc deficiency : 97,000 deaths, < 0·8% DALYs

165 million children under 5 stunted growth (2011)

Source: UNICEF, WHO, The World Bank. Joint Child Malnutrition Estimates. (UNICEF, New York; WHO, Geneva; The World Bank, Washington, DC; 2012).

Current trends in stunting Africa Asia

Global Latin America & Caribbean

Source: UNICEF, WHO, The World Bank. Joint Child Malnutrition Estimates. (UNICEF, New York; WHO, Geneva; The World Bank, Washington, DC; 2012).

52 million wasted children (2011)

Source: UNICEF, WHO, The World Bank. Joint Child Malnutrition Estimates. (UNICEF, New York; WHO, Geneva; The World Bank, Washington, DC; 2012).

Current trends in wasting 0

24

68

10

1990 2000 2010

Wasting (

%)

8.7

11.4

2.6

8.6

10.9

1.9

8.5

10.2

1.4

010

20

30

40

50

1990 2000 2010N

um

ber

of w

aste

d (

mill

ions)

10

45

2

11

40

1

13

36

1

AFRICA ASIA LATIN AMERICA

Source: United Nations Children’s Fund, World Health Organization, The World Bank. UNICEF-WHO-World Bank Joint Child Malnutrition Estimates. (UNICEF, New York; WHO, Geneva; The World Bank, Washington, DC; 2012). http://www.who.int/nutgrowthdb/estimates/en/index.html

Was

tin

g (%

)

Nu

mb

er o

f w

aste

d (

mill

ion

s)

Over 500 million women of reproductive age affected by anemia

Source : WHO, 2008 468 M non pregnant + 56 M pregnant

Current trends in anemia rates - Africa

0

10

20

30

40

50

1990 1995 2000 2005 2010

Pre

vale

nce

%

Anemia in non-pregnant womenAfrica

E Afr

M Afr

N Afr

Srn Afr

W Afr

Current trends in Low Birth Weight

0

5

10

15

20

25

30

35

40

1980s 1990s 2000s

%

Years World Africa East Asia

South Asia South East Asia latin America & Caribbean

West AsiaSource : UNSCN, 2010

WHO – Lausanne University

Seminar on NCD Geneva,

9.5.2012

The double burden of malnutrition

Source: WHO Global Database on Child Growth and Malnutrition

0

10

20

30

40

50

60

70

AFR AMR EMR EUR SEAR WPR Low

income

Low er

middle

income

Upper

middle

income

High

income

% o

f p

op

ula

tio

n

Men Women Both Sexes

500 million obese individuals aged 20+ years (2008)

Source: Global status report on noncommunicable diseases 2010. World Health Organization 2011

43 million children under 5 are overweight (2011)

Source: UNICEF, WHO, The World Bank. Joint Child Malnutrition Estimates. (UNICEF, New York; WHO, Geneva; The World Bank, Washington, DC; 2012).

Current trends in childhood overweight 0

24

68

10

1990 2000 2010

Overw

eig

ht (%

)

4.2

3.7

6.5

5.3

3.9

6.87.1

4.6

7.1

05

10

15

20

1990 2000 2010N

um

ber

of

overw

eig

ht (m

illio

ns)

5

14

4

7

14

4

11

17

4

AFRICA ASIA LATIN AMERICA

Source: United Nations Children’s Fund, World Health Organization, The World Bank. UNICEF-WHO-World Bank Joint Child Malnutrition Estimates. (UNICEF, New York; WHO, Geneva; The World Bank, Washington, DC; 2012). http://www.who.int/nutgrowthdb/estimates/en/index.html

Children's overweight growing in Low Income Countries

0

2

4

6

8

1990 1995 2000 2005 2010

% p

op

ula

tio

n a

ges

0-4

Overweight Prevalence

Low income Lower middle income Upper middle income Low & middle income

Source: United Nations Children’s Fund, World Health Organization, The World Bank. UNICEF-WHO-World Bank Joint Child Malnutrition Estimates. (UNICEF, New York; WHO, Geneva; The World Bank, Washington, DC; 2012). http://www.who.int/nutgrowthdb/estimates/en/index.html

Global nutrition targets endorsed by the WHA in May 2012

Set of 9 voluntary global targets

Raised blood pressure

25%

Salt/ sodium intake

30%

Tobacco 30%

Physical inactivity

10%

Harmful use of alcohol

10%

Drug therapy and counseling

50%

Premature mortality from

NCDs 25% reduction M

ort

alit

y

and

m

orb

idit

y R

isk

fa

cto

rs

Nat

ion

al

syst

ems

resp

on

se

Diabetes/obesity 0%

Ranges of population nutrient intake goals

Source :WHO/FAO, 2003

1. Reducing trans fatty acids and salt

2. Restricting availability of energy dense

foods and high calorie non-alcoholic

beverages

3. Increasing availability of healthier foods

including fruits and vegetables

4. Practice of responsible marketing to reduce

impact of unhealthy foods to children

5. Making healthy options available and

affordable

6. Providing simple, clear and consistent food

labels that are consumer friendly

7. Reshaping industry to introduce new

products with better nutritional value

8. Making physical activity accessible in all

settings

Global Strategy on Diet, Physical Activity and Health (2004)

Scientific update on carbohydrates (2007)

• Terminology and classification, characterization and measurement, physiology

• Overweight and obesity : – support the population nutrient intake goals on free sugars (<10% of

total energy) – Evidence insufficient for the use of glycaemic index (GI) of

carbohydrate-containing foods to predict the likelihood of their ability to reduce the risk of obesity

• Carbohydrates in the aetiology of diabetes and cardiovascular disease : – Whole-grains, legumes, vegetables and intact fruits are the most

appropriate sources of carbohydrate – no good evidence of protection against cardiovascular disease and

diabetes when various oligosaccharides or polysaccharides or other isolated components of whole-grains, fruits, vegetables and legumes are added to functional and manufactured foods

• Carbohydrates in the treatment of diabetes and cardiovascular risk factors : – Low-GI foods may confer benefits in terms of improving glycaemic

control in people with diabetes

• Cancer

Scientific update on Trans Fatty Acids (2009) • Health effects of trans fatty acids

– TFA consumption induces characteristic cardiovascular and metabolic effects linked to the insulin resistance syndrome

– trans-18:2 isomers may be more strongly associated with CHD risk than trans-18:1 isomers

– limited evidence indicates that industrial and ruminant TFAs may have similar effects on serum lipoproteins when ruminant TFA are consumed in sufficient quantities (much higher than seen with usual dietary intakes)

• CHD effects of replacing PHVO with other fats/oils – clear effects of TFA, in comparison with SFA, MUFA or

PUFA, on blood lipid concentrations, ApoB, ApoA-I and Lp(a)

• Feasibility of recommending replacement fats – there is an insufficient world supply of high cis-

unsaturated, zero TFA replacement fats and oils

• Approaches to removing trans fatty acids from the food supply

Fats and fatty acid intake - adults

Fats and fatty acid intake recommendations

Adults Children 2-18

Total fat 20-35%

SFA 10% 8%

PUFA 6-11% 11%

N-6 PUFA 2.5-9%

N-3 PUFA 0.5-2%

TFA <1%

Sugars and body weight in adults

Source : Te Morenga et al., BMJ 2013

Fat and body weight

Reducing fat in the diet leads to reductions in body weight in adults, with supportive evidence in children

What goals for a healthier food supply ?

Raised blood pressure

25%

Salt/ sodium intake

30%

Diabetes/obesity 0%

Saturated fat Unsaturated fat Trans fat Sugars Animal source foods Fruit and vegetables Ultraprocessed foods …. Fortified food …