Global malnutrition

The four most important forms of malnutrition worldwide (protein-energy mal nutrition, iron deficiency and anaemias (IDA), vitamin A deficiency (VAD), and iodine deficiency disorders (IDD)) are examined below in terms of their global and regional prevalences, the age and gender groups most affected, their clinical and public health consequences, and, especially, the recent progress in country and regional quantitation and control. Zinc deficiency, with its accompanying diminished host resistance and increased susceptibil ity to infections, is also reviewed. WHO estimates that malnutrition(underw eight) was associated with over half of all child deaths in developing coun tries in 1995. The prevalence of stunting in developing countries is expect ed to decline from 36% in 1995 to 32.5% in 2000; the numbers of children af fected(excluding China) are expected to decrease from 196.59 millions. Stun ting affects 48% of children in South Central Asia, 48% in Eastern Africa, 38% in South Eastern Asia, and 13-24% in Latin America. IDA affects about 4 3% of women and 34% of men in developing countries and usually is most seri ous in pregnant women and children, though non-pregnant women, the elderly, and men in hookworm-endemic areas also comprise groups at risk. Clinical V AD affects at least 2.80 million preschool children in over 60 countries, a nd subclinical VAD is considered a problem for at least 251 millions; schoo l-age children and pregnant women are also affected. Globally about 740 mil lion people are affected buy goitre, and over two billions are considered a t risk of IDD. However, mandatory salt iodisation in the last decade in man y regions has decreased dramatically the percentage of the population at ri sk. Two recent major advances in understanding the global importance of mal nutrition are (1) the data of 53 countries that links protein-energy malnut rition (assessed by underweight) directly to increased child mortality rate s, and (2) the outcome in 6 of 8 large vitamin A supplementation trials sho wing decreases of 20-50% in child mortality.