The multiple burden of malnutrition and healthy diets

Transcription

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 1

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

3 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

4 Central sub-saharan Africa, DALY 2010

5 Southern sub-saharan Africa, DALY 2010

6 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

7 165 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).

8 Africa Current trends in stunting Asia Latin America & Caribbean Global Source: UNICEF, WHO, The World Bank. Joint Child Malnutrition Estimates. (UNICEF, New York; WHO, Geneva; The World Bank, Washington, DC; 2012).

9 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).

10 Wasting (%) Wasting (%) Number of wasted (millions) Number of wasted (millions) Current trends in wasting 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).

11 Over 500 million women of reproductive age affected by anemia 468 M non pregnant + 56 M pregnant Source : WHO, 2008

12 Prevalence % Current trends in anemia rates - Africa 50 Anemia in non-pregnant women Africa E Afr M Afr N Afr Srn Afr W Afr

13 Current trends in Low Birth Weight % s 1990s 2000s Years World Africa East Asia South Asia South East Asia latin America & Caribbean West Asia Source : UNSCN, 2010

14 The double burden of malnutrition Source: WHO Global Database on Child Growth and Malnutrition WHO Lausanne University Seminar on NCD Geneva,

15 % of population 500 million obese individuals aged 20+ years (2008) AFR AMR EMR EUR SEAR WPR Low income Low er middle income Upper middle income High income Men Women Both Sexes Source: Global status report on noncommunicable diseases World Health Organization 2011

16 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).

17 Overweight (%) Number of overweight (millions) Current trends in childhood overweight 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).

18 % population ages 0-4 Children's overweight growing in Low Income Countries 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).

19 Global nutrition targets endorsed by the WHA in May 2012

20 National systems response Risk factors Mortality and morbidity Set of 9 voluntary global targets Premature mortality from NCDs 25% reduction Harmful use of alcohol 10% Physical inactivity 10% Salt/ sodium intake 30% Tobacco 30% Raised blood pressure 25% Diabetes/obesity 0% Drug therapy and counseling 50%

21 Ranges of population nutrient intake goals Source :WHO/FAO, 2003

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

23 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

24 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 cisunsaturated, zero TFA replacement fats and oils Approaches to removing trans fatty acids from the food supply

25 Fats and fatty acid intake - adults

26 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%

27 Sugars and body weight in adults Source : Te Morenga et al., BMJ 2013

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

29 What goals for a healthier food supply? Saturated fat Unsaturated fat Trans fat Sugars Animal source foods Fruit and vegetables Ultraprocessed foods. Fortified food Salt/ sodium intake 30% Raised blood pressure 25% Diabetes/obesity 0%