Micronutrient deficiencies and gender: social and economic costs
01 May 2005-The American Journal of Clinical Nutrition (American Society for Nutrition)-Vol. 81, Iss: 5
TL;DR: In examining the effect of sex on the economic and social costs of micronutrient deficiencies, the paper found that there is also an urgent need for increased effort to demonstrate the cost of these deficiencies, as well as the benefits of addressing them, especially compared with other health and nutrition interventions.
Abstract: Vitamin and mineral deficiencies adversely affect a third of the world's people. Consequently, a series of global goals and a serious amount of donor and national resources have been directed at such micronutrient deficiencies. Drawing on the extensive experience of the authors in a variety of institutional settings, the article used a computer search of the published scientific literature of the topic, supplemented by reports and published and unpublished work from the various agencies. In examining the effect of sex on the economic and social costs of micronutrient deficiencies, the paper found that: (1) micronutrient deficiencies affect global health outcomes; (2) micronutrient deficiencies incur substantial economic costs; (3) health and nutrition outcomes are affected by sex; (4) micronutrient deficiencies are affected by sex, but this is often culturally specific; and finally, (5) the social and economic costs of micronutrient deficiencies, with particular reference to women and female adolescents and children, are likely to be considerable but are not well quantified. Given the potential impact on reducing infant and child mortality, reducing maternal mortality, and enhancing neuro-intellectual development and growth, the right of women and children to adequate food and nutrition should more explicitly reflect their special requirements in terms of micronutrients. The positive impact of alleviating micronutrient malnutrition on physical activity, education and productivity, and hence on national economies suggests that there is also an urgent need for increased effort to demonstrate the cost of these deficiencies, as well as the benefits of addressing them, especially compared with other health and nutrition interventions.
Citations
More filters
TL;DR: This work states that estimated prevalence rates and patterns remain tenuous because measuring food security, an elusive concept, remains difficult.
Abstract: Food security is a growing concern worldwide. More than 1 billion people are estimated to lack sufficient dietary energy availability, and at least twice that number suffer micronutrient deficiencies. Because indicators inform action, much current research focuses on improving food insecurity measurement. Yet estimated prevalence rates and patterns remain tenuous because measuring food security, an elusive concept, remains difficult.
1,011 citations
TL;DR: It is widely accepted that intervention in the first 1,000 days is critical to break the cycle of malnutrition; however, a coordinated, sustainable commitment to scaling up nutrition at the global level is still needed.
Abstract: Micronutrients are essential to sustain life and for optimal physiological function. Widespread global micronutrient deficiencies (MNDs) exist, with pregnant women and their children under 5 years at the highest risk. Iron, iodine, folate, vitamin A, and zinc deficiencies are the most widespread MNDs, and all these MNDs are common contributors to poor growth, intellectual impairments, perinatal complications, and increased risk of morbidity and mortality. Iron deficiency is the most common MND worldwide and leads to microcytic anemia, decreased capacity for work, as well as impaired immune and endocrine function. Iodine deficiency disorder is also widespread and results in goiter, mental retardation, or reduced cognitive function. Adequate zinc is necessary for optimal immune function, and deficiency is associated with an increased incidence of diarrhea and acute respiratory infections, major causes of death in those <5 years of age. Folic acid taken in early pregnancy can prevent neural tube defects. Folate is essential for DNA synthesis and repair, and deficiency results in macrocytic anemia. Vitamin A deficiency is the leading cause of blindness worldwide and also impairs immune function and cell differentiation. Single MNDs rarely occur alone; often, multiple MNDs coexist. The long-term consequences of MNDs are not only seen at the individual level but also have deleterious impacts on the economic development and human capital at the country level. Perhaps of greatest concern is the cycle of MNDs that persists over generations and the intergenerational consequences of MNDs that we are only beginning to understand. Prevention of MNDs is critical and traditionally has been accomplished through supplementation, fortification, and food-based approaches including diversification. It is widely accepted that intervention in the first 1,000 days is critical to break the cycle of malnutrition; however, a coordinated, sustainable commitment to scaling up nutrition at the global level is still needed. Understanding the epidemiology of MNDs is critical to understand what intervention strategies will work best under different conditions.
870 citations
TL;DR: Physicians seeking systematic treatments for their patients might consider testing urinary organic acids to determine how best to treat mitochondrial diseases and dysfunction, and antioxidant therapies hold promise for improving mitochondrial performance.
Abstract: Since the first mitochondrial dysfunction was described in the 1960s, the medicine has advanced in its understanding the role mitochondria play in health, disease, and aging. A wide range of seemingly unrelated disorders, such as schizophrenia, bipolar disease, dementia, Alzheimer's disease, epilepsy, migraine headaches, strokes, neuropathic pain, Parkinson's disease, ataxia, transient ischemic attack, cardiomyopathy, coronary artery disease, chronic fatigue syndrome, fibromyalgia, retinitis pigmentosa, diabetes, hepatitis C, and primary biliary cirrhosis, have underlying pathophysiological mechanisms in common, namely reactive oxygen species (ROS) production, the accumulation of mitochondrial DNA (mtDNA) damage, resulting in mitochondrial dysfunction. Antioxidant therapies hold promise for improving mitochondrial performance. Physicians seeking systematic treatments for their patients might consider testing urinary organic acids to determine how best to treat them. If in the next 50 years advances in mitochondrial treatments match the immense increase in knowledge about mitochondrial function that has occurred in the last 50 years, mitochondrial diseases and dysfunction will largely be a medical triumph.
564 citations
TL;DR: This review focuses on agronomic biofortification with Zn, which has proved to be very effective for wheat and also other cereal crops including rice, and provides a practical and cost-effective option to tackle the global Zn malnutrition problem.
Abstract: Zinc (Zn) still represents an important health problem in developing countries, caused mainly by inadequate dietary intake. A large consumption of cereal-based foods with small concentrations and low bioavailability of Zn is the major reason behind this problem. Modern cultivars of cereals have inherently very small concentrations of Zn and cannot meet the human need for Zn. Today, up to 50% of wheat-cultivated soil globally is considered poor in bioavailable Zn. Agricultural strategies that are used to improve the nutritional value of crop plants are known as biofortification strategies. They include genetic biofortification, which is based on classical plant breeding and genetic engineering for larger nutrient concentrations, and greater agronomic biofortification, which is based on optimized fertilizer applications. This review focuses on agronomic biofortification with Zn, which has proved to be very effective for wheat and also other cereal crops including rice. Molecular and genetic research into Zn uptake, transport and grain deposition in cereals are critically important for identifying ‘bottlenecks’ in the biofortification of food crops with Zn. Transgenic plants with large Zn concentrations in seeds are often tested under controlled laboratory or glasshouse conditions with sufficient available Zn in the growth medium for the entire growth period. However, they might not always show the same performance under ‘real-world’ conditions with limited chemical availability of Zn and various stress factors such as drought. What purpose can an upgraded transport and storage system serve if the amount of goods to be transported and stored is limited anyway? Given the fact that the Zn concentrations required to achieve a measurable impact on human health are well above those required to avoid any loss of yield from Zn deficiency, providing crop plants with sufficient Zn through the soil and foliar fertilizer strategy under field conditions is critically important for biofortification efforts.
491 citations
Cites background from "Micronutrient deficiencies and gend..."
...Deficiencies of Zn and other micronutrients in developing countries are also reported to cause great economic losses and have a considerable effect on the gross national product by decreasing productivity and increasing the health care costs (Darton-Hill et al., 2005; Stein, 2014)....
[...]
TL;DR: Research and breeding programs are underway to enrich the major food staples in developing countries with the most important micronutrients: iron, provitamin A, zinc and folate, and biofortification offers a cost-effective and sustainable approach.
Abstract: Micronutrient malnutrition affects more than half of the world population, particularly in developing countries. Concerted international and national fortification and supplementation efforts to curb the scourge of micronutrient malnutrition are showing a positive impact, alas without reaching the goals set by international organizations. Biofortification, the delivery of micronutrients via micronutrient-dense crops, offers a cost-effective and sustainable approach, complementing these efforts by reaching rural populations. Bioavailable micronutrients in the edible parts of staple crops at concentrations high enough to impact on human health can be obtained through breeding, provided that sufficient genetic variation for a given trait exists, or through transgenic approaches. Research and breeding programs are underway to enrich the major food staples in developing countries with the most important micronutrients: iron, provitamin A, zinc and folate.
458 citations
Cites background from "Micronutrient deficiencies and gend..."
...enormous negative socio-economic impact at the individual, community, and national levels [7]....
[...]
...Conclusions Despite major concerted international efforts, eradication of MNM has remained a widespread and persistent global health problem in developing countries, where it continues to exact an enormous toll on individuals, populations, and society [7]....
[...]
References
More filters
9,849 citations
3,701 citations
TL;DR: Substantial proportions of global disease burden are attributable to these major risks, to an extent greater than previously estimated.
Abstract: Summary Background Reliable and comparable analysis of risks to health is key for preventing disease and injury. Causal attribution of morbidity and mortality to risk factors has traditionally been in the context of individual risk factors, Often in a limited number of settings, restricting comparability. Our aim was to estimate the contributions of selected major risk factors to global and regional burden of disease in a unified framework. Methods For 26 selected risk factors, expert working groups undertook a comprehensive review of published work and other sources-eg, government reports and international databases-to obtain data on the prevalence of risk factor exposure and hazard size for 14 epidemiological regions of the world. Population attributable fractions were estimated by applying the potential impact fraction relation, and applied to the mortality and burden of disease estimates from the global burden of disease (GBD) database. Findings Childhood and maternal underweight (138 million disability adjusted life years [DALY], 9·5%), unsafe sex (92 million DALY, 6·3%), high blood pressure (64 million DALY, 4·4%), tobacco (59 million DALY, 4·1%), and alcohol (58 million DALY, 4·0%) were the leading causes of global burden of disease. In the poorest regions of the world, childhood and maternal underweight, unsafe sex, unsafe water, sanitation, and hygiene, indoor smoke from solid fuels, and various micronutrient deficiencies were major contributors to loss of healthy life. In both developing and developed regions, alcohol, tobacco, high blood pressure, and high cholesterol were major causes of disease burden. Interpretation Substantial proportions of global disease burden are attributable to these major risks, to an extent greater than previously estimated. Developing countries suffer most or all of the burden due to many of the leading risks. Strategies that target these known risks can provide substantial and underestimated public-health gains. Published online Oct 30, 2002 http://image.thelancet.com/extras/02art9066web.pdf
3,654 citations
"Micronutrient deficiencies and gend..." refers background in this paper
...The Global Burden of Disease estimates showed that among the 26 major risk factors of the global burden of disease (8), iron deficiency ranks ninth overall,...
[...]
TL;DR: Prevention will be the most cost-effective and feasible approach for many countries and should involve three mutually reinforcing strategies throughout life, starting in the antenatal period.
Abstract: Objective: To briefly review the current understanding of the aetiology and prevention of chronic diseases using a life course approach, demonstrating the lifelong influences on the development of disease. Design: A computer search of the relevant literature was done using Medline-‘life cycle’ and ‘nutrition’ and reviewing the articles for relevance in addressing the above objective. Articles from references dated before 1990 were followed up separately. A subsequent search using Clio updated the search and extended it by using ‘life cycle’, ‘nutrition’ and ‘noncommunicable disease’ (NCD), and ‘life course’. Several published and unpublished WHO reports were key in developing the background and arguments. Setting: International and national public health and nutrition policy development in light of the global epidemic in chronic diseases, and the continuing nutrition, demographic and epidemiological transitions happening in an increasingly globalized world. Results of review: There is a global epidemic of increasing obesity, diabetes and other chronic NCDs, especially in developing and transitional economies, and in the less affluent within these, and in the developed countries. At the same time, there has been an increase in communities and households that have coincident under- and over-nutrition. Conclusions: The epidemic will continue to increase and is due to a lifetime of exposures and influences. Genetic predisposition plays an unspecified role, and with programming during fetal life for adult disease contributing to an unknown degree. A global rise in obesity levels is contributing to a particular epidemic of type 2 diabetes as well as other NCDs. Prevention will be the most cost-effective and feasible approach for many countries and should involve three mutually reinforcing strategies throughout life, starting in the antenatal period.
2,984 citations
"Micronutrient deficiencies and gend..." refers background in this paper
...Low birth weight may also lead to increased obesity and noncommunicable disease morbidity and mortality later in life (37)....
[...]
Book•
01 Sep 1993
TL;DR: The fourth edition of Modern Nutrition in Health and Disease follows the organization established in previous volumes, i.e., "Normal Nutrition," "Nutrition in Disease," and "Nut Nutrition in Periods of Physiologic Stress" Each of the 43 chapters is, in essence, a review of a given topic, with primary emphasis on nutritional principles rather than dietetics as mentioned in this paper.
Abstract: The fourth edition of Modern Nutrition in Health and Disease follows the organization established in previous volumes, ie, "Normal Nutrition," "Nutrition in Disease," and "Nutrition in Periods of Physiologic Stress" Each of the 43 chapters is, in essence, a review of a given topic, with primary emphasis on nutritional principles rather than dietetics Three new chapters have been added, two under "Normal Nutrition" and one under "Nutrition in Disease" These are (1) "Naturally Occurring Toxic Foods" by Mickelsen and Yang; (2) "Evaluation of Nutrition in Population Groups" by Pearson; and (3) "Nutrition in Brain Function" by Coursin All are timely, well-written additions to the book The rest of the volume has been revised extensively, and 12 new authors are listed In spite of the expansion in content, the fourth edition contains 20 fewer pages than the previous one, but this was accomplished by increasing the size of the page by
2,968 citations