Hunger and malnutrition often result from a person not eating enough calories. But there are some children who may eat enough calories per day, yet not receive adequate nutrients and are still, therefore, malnourished. These are children who are micronutrient-hungry, or have “hidden hunger.” Their bodies are deteriorating, stunted and/or underperforming because their food in not nutritious enough.

Hidden hunger can affect anyone, but growing children and pregnant mothers are at the most risk since the developing children desperately need micronutrients to grow into healthy adults.

Micronutrients are vitamins and minerals that are present in a healthy diet. There are many micronutrients that are needed for optimal living, but UNICEF considers four to be the most vital: iron, Vitamin A, iodine and folate.

Vitamin A helps a person’s vision and keeps a body strong enough to combat diseases that can often take a child’s life such as measles, diarrhea, malaria and pneumonia.

Iodine helps the thyroid function properly. A healthy thyroid “regulates growth and metabolism.” Iodine deficiency is also a leading cause of preventable mental disabilities that often start in utero if the mother does not get enough iodine.

Iron and folate are both vital in the formation of red blood cells.

Often children are at risk to become malnourished after disasters or wars occur since access to food is one of the major issues for those in refugee camps.

But even in areas that are more stable, if poverty is rampant, then access to proper food is still compromised.

People who live in countries that are considered middle class have micronutrient-hungry children because the cheapest, most filling food is often processed or carbohydrate/energy dense food that have the least amount of the necessary micronutrients.

Much good is being done to ensure that the poverty cycle that is perpetuated by poor nutrition is stopped.

The World Health Organization (WHO) has a plan in place to help specifically with vitamin A deficiency. They are taking a multifaceted approach: “The arsenal of nutritional ‘well-being weapons’ includes a combination of breastfeeding and vitamin A supplementation, coupled with enduring solutions, such as promotion of vitamin A-rich diets and food fortification.”

Part of their plan includes helping those in poverty by “planting seeds,” both in the sense of promoting breastfeeding and of planting a physical garden. Helping rural families plant a garden with fruits and vegetables that are naturally micronutrient dense is a great way to help reduce vitamin A deficiency.

UNICEF is working on the problem of iodine deficiency in the Dominican Republic. Most Americans consume iodized salt on a regular basis, but that commodity is not a part of every culture. Since iodized salt is an easy solution to the devastating issue of iodine deficiency, UNICEF has created an educational initiative in the Dominican Republic to raise public awareness about iodized salt consumption.

The Micronutrient Initiative (MI) in a nonprofit organization based out of Ottawa, Canada and works with the Canadian government, private businesses, global partnerships and individuals to end micronutrient hunger. They are a large scale operation that has an impact around the globe providing education and direct resources to those who are suffering from hidden hunger.

Malnutrition is multifaceted. It cannot be solved through feeding hungry people cheap, calorie dense yet micronutrient-deficient food.  Thankfully, many great organizations also stand on this principle and the issue of micronutrient-hungry children is making great strides.

Megan Ivy

Sources: Micronutrient Initiative , UNICEF 1, UNICEF 2, World Health Organization 1, World Health Organization 2
Photo: Zomppa

Maldivian Children
The Maldives, with its sun kissed beaches, warm seas and clear blue waters, is a popular tourist destination and an oasis for honeymooners. In 2013, more than a billion tourists visited Maldives. It is no wonder that tourism is one of the major industries of these islands. The dark side of the sunny islands is the malnutrition in the Maldives that its children endure. 19 percent of children in Maldives suffer from stunting, or low height-to-age ratio. According to UNICEF, nearly 17 percent of children are underweight.

Infection, inadequate breast feeding, lack of access or awareness of nutritious foods all contribute to malnutrition. Although exclusive breast feeding is recommended for children up to six months of age, UNICEF reports that less than 50 percent of children are exclusively breast fed for the full 6 months. Maldives has met five of the Millennium Development Goals set forth by the UNDP and is on track to achieve the others, yet it has a long way to go to make its child population healthy. However, its progress relative to other south Asian countries is impressive and there is full hope that malnutrition can be curbed as well.

Maldives has recently achieved middle-income status yet 51 percent of its population live in poverty. A World Bank report states that although scaling up micronutrient interventions would cost 720,000 dollars a year, this should not be a roadblock for the Maldives as income alone is not an indicator of malnutrition. Development of public health systems and counseling for mothers could go far in bridging this gap.

Micronutrient fortification has had demonstrated success in helping children get to a healthy nourishment level. The Micronutrient Initiative has a special guide for the fortification of staple like wheat flour and maize meal. Flour fortification with folic acid and other B vitamins as well as iron and calcium among other minerals are well established procedures. Rice can also be fortified in a similar manner. The people of Maldives use both rice and wheat flour as staples in their diet, and can incorporate the food fortification initiative into their public health programs.

Twenty-one civil society organizations won grants from the World Bank in 2009 for innovative solutions to the malnutrition problems. The winning projects give an idea of the scope of creativity in finding solutions to these difficult situations. Many of the projects focus on improving maternal health during pregnancy and breast feeding practices through community programs and combining breast feeding awareness and behavioral change communication during routine or emergency health care visits for other health concerns. All are ideas that could create real impact in Maldives.

Maldives has come so far in their progress. Being a small island developing country, they have managed to reduce abject poverty, achieve gender equality and increase their per capita GDP faster than many of their South Asian counterparts. With an added push to ensure the health of their youth and maternal population, the Maldives could very well be an example for the South Asia region.

Mithila Rajagopal

Sources: Micronutrient Initiative, Ministry of Tourism, Maldives, UNDP, UNICEF, The World Bank
Photo: Rethink

Double Fortified Rice
Because salt is nearly universally used as a condiment, it represents an excellent avenue by which to affect the diet of almost any population. With this in mind, the addition of essential nutrients to salt is seen as an effective way to combat micronutrient deficiencies worldwide.

The concept of fortifying salt with both iodine and iron was first conceived in 1969, but it took years of research and technological advances to make the process possible. When both iron and iodine were first added to salt, multiple obstacles presented themselves. These included the instability of iodine compounds when combined with iron, the oxidation of iron, and the development of unappealing color in the salt. Decades later, after these issues had been carefully addressed, Double Fortified Salt was born.

The Micronutrient Initiative partnered with the University of Toronto to conduct groundbreaking research funded in part by the Canadian International Development Agency and the World Bank. This research produced a method by which salt can be effectively fortified with both iron and iodine without compromising the product. One of the most exciting details about this initiative is the price tag. At roughly 18 to 20 cents per person per year, double fortification of salt will inevitably save money by preventing many of the health complications that accompany iron and iodine deficiencies.

Of course, the final judge of the product is the consumer. If no one wants to use the amazing new salt, its effectiveness is irrelevant. Once tests had been done to ensure the stability and efficacy of double fortified salt, consumer surveys were conducted in Nigeria and Kenya. These tests confirmed that consumers found the product acceptable, giving the Micronutrient Initiative and its affiliates the green light to move forward with large-scale production. Commercial production in India was met with success, and other countries, such as Bangladesh, have since joined the initiative.

Salt is fortified with iodine fairly consistently, with roughly 70% of people worldwide consuming iodized salt. However, inadequate iodine consumption is still the leading preventable cause of brain damage in the world today, and universal salt iodization is the most effective way to ensure that those at risk are receiving enough of this essential nutrient.

Meanwhile, iron deficiency is the most common nutritional deficiency in the world today, and it has terrible consequences. Iron is instrumental in blood formation and a lack of it often causes blood hemoglobin levels to plummet, a condition known as anemia. An estimated 2 billion people worldwide suffer from anemia. Almost half of all women in developing nations experience iron deficiency that can cause complications in pregnancy, low birth weight, and infant and maternal deaths.

The capacity to fortify salt with both iron and iodine is an opportunity to fight poverty on many fronts. Decreased incidence of iodine deficiency will prevent 18 million children from being born mentally impaired each year and will improve the overall of health of many more. Iron supplementation will improve maternal and infant health, and protect multitudes of people from developing anemia. These enhancements in health will correspond with higher quality of life for billions of people around the world.

Katie Fullerton

Sources: Micronutrient Initiative DFS, Micronutrient Initiative Iodine