session 1 global nutrition needs: setting the scene chair: prof … · 2017-01-04 · global food...
TRANSCRIPT
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7 - 8 July, 2014Putrajaya Marriott Hotel, Malaysia
GLOBAL FOOD SECURITY FORUM‘Meeting Nutritional Needs’
Session 1
Global Nutrition Needs: Setting the Scene
Chair: Prof Jerry Roberts
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Global Food Security Forum 2014: Meeting Nutritional Needs – Prof. Jerry Roberts
Session 1 - Global Nutrition Needs: Setting the Scene
Global overview picture - Dr. Katrin Engelhardt
Case study: Asia - Prof. Khor Geok Lin
Case study: Europe - Prof. Ian Macdonald
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Overview of Food and Nutrition Security
Global Food Security Forum 2014Dr Katrin Engelhardt
Technical Lead, Nutrition (WHO/WPRO)
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• What do we need? What are we getting?
• Snapshot: malnutrition; the double burden
• Objective of the Forum (www):
– “Possible solutions to issues related to food and nutrition security threat in
the ASEAN region”:
• NCD Global and Regional Action Plans
• (Draft) Action Plan to Reduce the Double Burden of Malnutrition in the Western Pacific Region 2015-
2020
Presentation outline
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Nutrition need
And of course: Vitamins and MineralsA, B, D, C, E, K, etc.
Iodine, Iron, Folate, Selenium, etc.
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Global energy supply
FAO STATS – Food Balance Sheets
0
500
1000
1500
2000
2500
3000
1991 2001 2011
Global energy supply (Kcal per day per person)
Animal products Alcoholic beverages and stimulants
Oil crops and vegetable oils Fruits, vegetables, pulses and tree nuts
Sugar crops, sugar and sweetners Starchy Roots
Cereals - Excluding Beer
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0
500
1000
1500
2000
2500
3000
3500
4000
Australia Mainland China Burkina Faso
(Kcal per person per day; 2011)
Animal products Alcoholic beverages and stimulants
Oil crops and vegetable oils Fruits, vegetables, pulses and tree nuts
Sugar crops, sugar and sweetners Starchy Roots
Cereals - Excluding Beer
Energy supply Australia, Mainland China and Burkina Faso
FAO STATS – Food Balance Sheets
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Global stunting (children under five years)
Source: Levels & Trends in Child Malnutrition, UNICEF-WHO-The World Bank Joint Child Malnutrition Estimates
162 million children under 5
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Global wasting (children under five years)
Source: Levels & Trends in Child Malnutrition, UNICEF-WHO-The World Bank Joint Child Malnutrition Estimates
51 million children under 5
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Global anaemia (pre-school aged children)
Source: WHO VMNIS, http://www.who.int/vmnis/anaemia/prevalence/summary/Pre-SAC_anaemia.pdf?ua=1
47 million pre-school aged children
496 million WRA and 32 million pregnant
women
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Global overweight (children under 5 years)
Source: Levels & Trends in Child Malnutrition, UNICEF-WHO-The World Bank Joint Child Malnutrition Estimates
44 million children under 530 million LMIC and 6 million in LIC
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Low-income
Asian countries
Middle-income
Asian countries
High-income
countries
Pacific countries
Source: WHO Global NCD Status Report, 2010
Prevalence of overweight among adults
BMI >25, 25+ years
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Changes in the prevalence of malnutrition in women
15.7
30.228.6
25
37.1
41
26.1
6.6
17.6
0
5
10
15
20
25
30
35
40
45
1991 1995 1996 1996 2003
Overweight (BMI≥ 25) Underweight (BMI<18.5) Anaemia(Hb<120g/L)
1991 data: 19 – 59 years; 1995 data: 13-59 years; 1996 data: 20 – 100 years; 2003 data: 21-100 years Source: National Nutrition Surveys, 1991, 1995, 1996 and 2003
Thailand
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1.33
4.7
8
24.6
18.115.7
25.2
0
5
10
15
20
25
30
1987 1993 1995 2005-6
Overweight (WHZ>+2) Stunting (HAZ<-2) Anaemia (<110g/L)
Changes in the prevalence of malnutrition in children (<5 years)
Source: WHO Global Database on Child Growth and Malnutrition
Thailand
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The 1000 Days “ window of opportunity “ for good nutrition
Pre-pregnancy, including
adolescence
The 1000 Days
Conception to birth: 280 days Birth to 2 years: 720 days
Menzies School of Health Research
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Low-income
Asian countries
Middle-income
Asian countries
High-income
countries
0
5
10
15
20
25
30
35
40
45
50
55
60
65
Male
Female
Fasting glucose ≥ 7.00 mmol/L or on medication, 25+ years
Source: WHO Global NCD Status Report, 2010
Burden of NCDs Prevalence of Diabetes
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Low-income
Asian
countries
Middle-income
Asian countries
High-income
countries
0
5
10
15
20
25
30
35
40
45
50
55
60
65
Male
Female
Source: WHO Global NCD Status Report, 2010
Burden of NCDs Prevalence of Raised BP
SBP≥140 DBP≥90 mmHg or on medication, 25+ years
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Source: WHO Health Statistics 2011
Death by Broad Cause Group and WHO Region, 2011
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Leading risk factors for global burden of disease
1990 and 2010
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High BMI accounted for 3.4 M deaths and 3·8% of global DALYs in 2010Poor diet and physical inactivity 10% of global DALYs
Burden of disease attributable to 20 leading risk factors in
2010, as a % of global DALYs
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The double burden of malnutrition
Within individuals
Within families and households
Within communities Within countries
The Double Burden of Malnutrition can occur…
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Globalization, rapid urbanization and
transformation of food systems
Changing context
http://peacefulanarko.files.wordpress.com/2010/04/0522_mz_farming2.jpg
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New, unsustainable and distorted food and eating systems
Easy access to calorie-rich, nutrient-poor food
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Manufacturing an epidemic?
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Global monitoring framework (NCD Action Plan)
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• Protect, promote and support Breastfeeding
• Optimal complementary feeding (dietary diversity)
• Set of recommendations of marketing
• Healthy food options in schools
• Economic tools (e.g. taxes)
• Labeling (FOP)
• Engage food industry: food reformulation
Actions for healthy diets
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• Protect, promotion and support of BF
• Optimal complementary feeding (dietary diversity)
• Set of recommendations of marketing
• Healthy food options in schools
• Economic tools (e.g. taxes)
• Labeling (FOP)
• Engage food industry: food reformulation
Actions for healthy diets
Don’t engage food industry
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Global nutrition targetsendorsed by the WHA in May 2012
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Regional Action Plan to reduce the double burden
Five objectives
1. Elevate nutrition in the national
development agenda
2. Protect, promote and support optimal
breastfeeding and complementary
feeding practices
3. Strengthen and enforce legal
frameworks that protect, promote and
support healthier diets
4. Improve accessibility, quality and
implementation of nutrition services
across public health programmes and
settings
5. Use financing mechanisms to reinforce
healthier diets
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Enabling food environment to help people make healthy choices
• Food availability
• Food of appropriate quality
• Food accessibility for a nutritious diet
• Utilization of food through adequate diet, clean water, sanitation and health care
• Healthy food availability
• Food of appropriate quality
• Healthy food accessibility
• Food safety
• Utilization of food through adequate diet, clean water, sanitation and health care
Food and Nutrition Security
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• Global nutrition needs are not adequately being met
• Globally more overweight than undernourished
• Risk factors and disease patterns are changing
• Enabling food environment to help people make healthy choices
• Enhance nutrition through dietary diversity (food)
• Ensure policy making is free from conflict of interest
Key messages
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Thank you
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Case Study: Asia
Khor Geok Lin PhD, FASc
Professor of NutritionInternational Medical University, Malaysia
Emeritus ProfessorUniversiti Putra Malaysia
7-8 July 2014
Crops for the Future Research Center (CFFRC)The University of Nottingham Malaysia Campus
Global Food Security Forum 2014
KHOR GL 2014
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Concept and Dimensions of
Food Insecurity in Asia
Nutrition Transition from
Under-nutrition to NCDs
Concluding remarks
Outline of presentation
KHOR GL 2014
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Food security is defined as the existence of the
necessary conditions for human beings to have
physical and economic access, in socially
acceptable ways, to food that is safe, nutritious
and in keeping with their cultural preferences, so
as to meet their dietary needs and live productive
and healthy lives. (World Food Summit, FAO, 1996)
The term “socially acceptable ways” was added to the 1996definition in 2002.
KHOR GL 2014
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DIMENSIONS OF FOOD
SECURITY
Food availability
Food accessibility
Food utilisation
Having sufficient quantities
of food available on a
consistent basis
Having sufficient economic,
social and physical resources
to obtain appropriate
foods for a nutritious diet.
Having appropriate use based
on knowledge of basic nutrition
and care, as well as adequate
water and sanitation
KHOR GL 2014
Sta
bility
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Macro-factors that affect food security
Rapid population growth
Changing demographics
Escalating costs for food, housing, education, health care
Urbanisation
Changing food
production and
consumption
patterns
KHOR GL 2014
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In Asia, strong growth generally
has been key to the sharp
decline in poverty and
undernourishment
The economies of developing
Asia grew an average 7.6% a
year between 1990 and 2010,
far exceeding the 3.4% global
average.
But hunger remains stubbornly
high in many countries and
regions.
KHOR GL 2014
2013
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KHOR GL 2014
Asia
62.5%
Africa
34.3%
India 54.6%
China 21.2%
The World’s Poor, 2010 Estimates
Total: 1,173.2 million
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KHOR GL 2014
Asia & the
Pacific
63.4%Africa
28.0%
South Asia 55.7%
East Asia 31.1%
Southeast Asia 12.1%
The World’s Undernourished
Total: 847 million (2010-2012)
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KHOR GL 2014
World Food Prospects: Critical Issues for the Early 21st Century
(IFPRI)
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2008
Global context and recent trendsUnprecedented increase in agricultural productivity through R&D
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KHOR GL 2014
WORLD
Asia & the Pacific
North America
Latin America & the Caribbean
Europe
Production per capita by region 1999-2009(ton/capita)
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KHOR GL 2014
The trade maps show that supply
disruptions in these key countries can
trigger global food price hikes, and show
which importing countries are most likely
to be immediately affected.
Italy
Rice trade map
Thailand
USA
Vietnam
India
Pakistan
Egypt
China
People’s Republic of China (PRC), India, Pakistan, Thailand, and
Viet Nam are important hubs in Asia’s rice trade
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Asian countries generally are undergoing a
rapid nutritional transition
Characterized by a shift from
• a high proportion of locally grownstaple grains, legumes, low animalbased food
Toward more varied diets
• comprising more refined, energy-dense, animal based and processed foodgenerally high in sugar and fat, and lowin carbohydrate content.
which has a huge impact on
• the rising prevalence of chronic non-communicable diseases like diabetes,obesity and other associated diseases
KHOR GL 2014
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KHOR GL 2014
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KHOR GL 2014
Bishwajit et al., 2014
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KHOR GL 2014
Bishwajit et al., 2014
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KHOR GL 2014
Bishwajit et al., 2014
This shift in dietary habit, accompanied by reduced physical
activity and leisure period lead to increase in overweight and
obesity over time
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KHOR GL 2014
What this study adds
• Higher body mass index is a risk factor for mortality from overall
cardiovascular disease, coronary heart disease, ischaemic stroke, and
haemorrhagic stroke in east Asians, especially in middle aged men
and women
• Very low body mass index is also associated with an increased risk
of death from cardiovascular disease in east Asians
• Higher body mass index is a weak risk factor for death from
cardiovascular disease in south Asians
Association between body mass index and cardiovascular
disease mortality in east Asians and south Asians: pooled
analysis of prospective data from the Asia Cohort
Consortium. Chen et al., BMJ 2013;347:f5446
Total N=1,124,897; South Asians: 289, 815; East Asians: 835,082
East Asians: China, Taiwan, Singapore, Korea, and Japan
South Asians: Bangladesh and India
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KHOR GL 2014
Chen et al., 2013Total N=1,124,897; South Asians: 289, 815; East Asians: 835,082
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KHOR GL 2014
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KHOR GL 2014
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Concluding remarks
KHOR GL 2014
(Centre for International Security Studies,
University of Sydney, Australia, 2013)
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KHOR GL 2014
“Trends in population, economic growth,
industrialization, urbanization, and changing
dietary patterns have largely encumbered
already scarce natural resources.”
• Total arable land per person in East and South Asia
has been shrinking, falling from almost one-quarter
hectare per person 50 years ago to an estimated one-
tenth hectare by 2050.
• Water resources are also strained. Across Asia,
between 60% and 90% of water is used for
agriculture.
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KHOR GL 2014
Haddard et al 2002, IFPRI
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KHOR GL 2014
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KHOR GL 2014
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KHOR GL 2014
FOOD SECURITY IN
ASIA
A REPORT FOR
POLICYMAKERS
Centre for International
Security Studies
University of Sydney,
Australia
2013
“Across Asia, as in other parts of the world,
governments continue to interpret food
security in terms of food availability and self-
sufficiency in staples.
Current food security policies in Asia tend to
lack a holistic and comprehensive approach,
and invariably focus on the economics of
food supply and demand, and ‘the challenge
of procuring, and distributing, scarce
resources amongst the world’s population.
These interpretations of food security are
limited when compared with the definition
provided by the FAO (1996).”
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KHOR GL 2014
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KHOR GL 2014
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Global Nutrition NeedsCase study: Europe
I A Macdonald
School of Life Sciences
Faculty of Medicine & Health Sciences
Nottingham
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Nutritional challenges in Europe
• Obesity, Cardiovascular disease and Type 2DM
• Healthy ageing: maintain muscle and bone mass, reduce musculoskeletal disease, maintain cognitive capacity
• Economic development in Eastern European countries – consequences of previous poor nutrition (similar to Asean/Asian/Africa regions) and of reduction in manual jobs
• Evidence-based Health and Nutrition claims –European Food Safety Authority (EFSA)
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Prevalence of obesity
Increasing in:
N America, Western Europe, Eastern Europe, Australia, Japan,
Transition Economies (China / India),
Developing Countries.
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-80 -60 -40 -20 0 20 40 60 80
Norway
Italy **
Netherlands
Denmark
Switzerland *
Belgium
France **
Sweden
Turkey
Austria
Spain
Ireland
Russia
Hungary
Croatia
Latvia
Slovakia
Lithuania
Finland
Scotland
Wales, N. **
England
Czech Republic
Cyprus
Israel **
Germany
Greece
MenWomen
% obese % overweight % obese
020 20 40 60 80406080
* Urban ** Self-reported
European National Obesity Rates
IOTF, 2005.
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UK Prevalence of Obesity
• Now approx 25% adult men and women have BMI > 30
• 20 years ago, 6% men and 8% women were obese
• Increased prevalence in lower Socioeconomic groups, over 40’s and ethnic minorities (Abdominal obesity a particular problem)
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Prevalence of overweight and obesity among children aged 2-15 yearsHealth Survey for England 1995-2011
Child overweight including obese (excess weight): BMI ≥ 85th centile of the UK90 growth referenceChild obesity: BMI ≥ 95th centile of the UK90 growth reference
95% confidence intervals are displayed on the chart
0%
5%
10%
15%
20%
25%
30%
35%
40%
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Overweight (inc. obese)
Obese
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Prevalence of obesity by deprivation decile, Reception children (5yr olds)
National Child Measurement Programme 2006/07 to 2011/12
Child obesity: BMI ≥95th centile of the UK90 growth referenceDeprivation deciles assigned to the child area of residence using the Index of Multiple Deprivation 2010
95% confidence intervals are displayed on the chart
0%
2%
4%
6%
8%
10%
12%
14%
Least
deprived
Most
deprived
Ob
esit
y p
reva
len
ce
Index of Multiple Deprivation (IMD 2010) decile
2006/07 2007/08 2008/09 2009/10 2010/11 2011/12
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Prevalence of obesity by deprivation decile, 11 Yr old childrenNational Child Measurement Programme 2006/07 to 2011/12
Child obesity: BMI ≥95th centile of the UK90 growth referenceDeprivation deciles assigned to the child area of residence using the Index of Multiple Deprivation 2010
95% confidence intervals are displayed on the chart
0%
5%
10%
15%
20%
25%
30%
Least deprived
Most deprived
Ob
esit
y p
reva
len
ce
Index of Multiple Deprivation (IMD 2010) decile
2006/07 2007/08 2008/09 2009/10 2010/11 2011/12
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Prevalence of excess weight among adults aged 16+ yearsHealth Survey for England 1993-2011 (3-year average)
Adult (aged 16+) overweight including obese (excess weight): BMI ≥ 25kg/m2
30%
35%
40%
45%
50%
55%
60%
65%
70%
Pre
vale
nce
of e
xces
s w
eigh
t
Men
Women
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Prevalence of obesity among adults aged 16+ yearsHealth Survey for England 1993-2011 (3-year average)
Adult (aged 16+) obesity: BMI ≥ 30kg/m2
0%
5%
10%
15%
20%
25%
30%
Pre
vale
nce
of
ob
esi
ty
Women
Men
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Trend in raised waist circumference among adultsHealth Survey for England, 1993 - 2011
Adults aged 16+ yearsRaised waist circumference defined as >102cm for men and >88cm for women
0%
10%
20%
30%
40%
50%Women
Men
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Carbohydrates
• UK SACN Report on Carbohydrates and Health
Recommendations:
– Total CHO 50% energy
– Fibre: 30g/d (CV health, gut health)
– Free sugars 5% energy (teeth, obesity)
– Sugars sweetened beverages should be minimised (obesity, T2DM risk)
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Other nutritional issues
• Vitamin D: 25% of Adults in Northern Europe have sub-clinical D deficiency. Is supplementation/fortification justified?
• Folate: NTD prevention – needs fortification of flour/other foods. What about potential side effects?
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EFSA approved Health Claims(mainly for CV health)
• Olive oil
• Water soluble Tomato Concentrate
• Cocoa flavanols
US trial of cocoa flavanols on CV deaths will start 2015 – NIH, Harvard, Mars
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EUFP7 Preview project
Diabetes prevention in patients with IGT
Medium GI and medium proteinor
Low GI and higher proteinplus moderate or higher intensity
exercise
Duration 3 years – incidence of diabetes the primary outcome (2018)
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EUHorizon 2020 projects
• Obesity treatment – novel use of mobile technologies, developing novel food ingredients
• Nutrition in the Elderly
• Maintaining cognitive function