Malnutrition: From under-to-overnutrition
Poverty, discrimination and social exclusion are the main causes of malnutrition, which encompasses under-and-overnutrition. Undernutrition is characterized by imbalances and deficiencies of energy and/or nutrient intake and reveals itself in four main outcomes:
i) «stunting» (low-height-for-age), indicating a state of chronic undernutrition;
ii) «wasting» (low-weight-for-height), indicating a state of acute undernutrition;
iii) «underweight» (low-weight-for-age), which is a composite measure that reflects wasting, stunting or both and it is, therefore, difficult to interpret on its own; and
iv) «micronutrient deficiencies» (mostly of vitamin A, iron and iodine), which are a global threat, but affect with greater severity children and pregnant women in low-and-middle-income countries (LMICs).
Overnutrition is characterized by imbalances and excesses of energy and/or nutrient intake and includes overweight and obesity (defined by the WHO as an abnormal or excessive fat accumulation that may impair health), as well as diet-related noncommunicable diseases, such as cardiovascular disease, type-2 diabetes mellitus, some cancers, and metabolic syndrome.
Children living in poverty are more prone to undernutrition during their growing years and to overnutrition later in life. Sometimes, both forms coexist in the same individual, family or community. This is called the double burden of malnutrition. The exponential effects of these burdens linger for life, with marked differences between males and females, and with outcomes varying by country.
We have chosen to portray here two human groups who have, historically, lived We have chosen to portray here two human groups who have —historically— lived under poverty, discrimination and social exclusion: The Maya from Mexico and the «Cabo-Verdeano» migrants in the slums of Lisbon, Portugal. The Maya show high rates of stunting and overweight/obesity. The Cabo-Verdeano migrants have a low prevalence of stunting and their overweight/obesity rates are below the national average. Some lifestyle protectors are in place among the Cabo-Verdeanos that, even under duress, act against malnutrition. This is not to say that life in the slums is good and it cannot be used to justify political inaction. Neither can be used to reinforce pseudoscience-based, distorted ideas that try to justify these differences using outdated racist and discriminatory stereotypes.
No human group ‘adapts’ to poverty, discrimination and social exclusion. They all suffer, and many will die. The ones who survive to adulthood, do so at the expense of their health and productivity, in some way or other. These trade-offs may maximize survival but come at a cost that, sooner or later, will be painfully paid, with interest.
However, there has been evidence showing that, even in the most deprived environments, some behaviours, conditions and family strategies have a protective effect on children’s health and development. Increased maternal education and autonomy, breastfeeding, vaccinations, basic water and sanitation (WASH) practices, preservation of traditional foods intake with concurrent restraint of fast food consumption, adequate regular physical activity, and early childhood sensory stimulation are some of the many factors that can protect young children from malnutrition outcomes, even when the overall environment is adverse.
This Gallery illustrates the principles, commitments and call-for-action of three of the United Nations’ Sustainable Development Goals (SDGs):
i) SGD2, Zero hunger: End hunger, achieve food security and improved nutrition and promote sustainable agriculture;
ii) SDG3, Good health and wellbeing: Ensure healthy lives and promote well-being for all, at all ages and,
iii) SGD5, Gender equality: Achieve gender equality and empower all women and girls.
The reason for this choice is clearly summarised in the 2018 Global Nutrition Report, «[s]hining a light to spur action on nutrition» in which we see how the three SDGs intertwine:
«The burden of malnutrition across the world remains unacceptably high, and progress unacceptably slow. Malnutrition is responsible for more ill health than any other cause. Children under five years of age face multiple burdens: 150.8 million are stunted, 50.5 million are wasted and 38.3 million are overweight. Meanwhile 20 million babies are born of low birth weight each year. Overweight and obesity among adults are at record levels with 38.9% of adults overweight or obese, stretching from Africa to North America, and increasing among adolescents. Women have a higher burden than men when it comes to certain forms of malnutrition: one third of all women of reproductive age have anaemia and women have a higher prevalence of obesity than men. Millions of women are still underweight.» (p.11).
Including the principles behind the SDGs in maternal and child health research will have long-term benefits for current and future generations. Research developed this way will be more inclusive because it will bring to the table not only researchers, but also community members, health-care workers, students and local administration stakeholders. It involves a bottom-up approach from the project’s inception and throughout all its stages. Furthermore, it relies on everyone involved to disseminate results in formats suitable for academic and non-academic audiences providing, therefore, a wider spread of knowledge. [Inês Varela-Silva]
Inês Varela-Silva, Senior Lecturer in Human Biology at Loughborough University, School of Sport, Exercise and Health Sciences (Loughborough, UK), uses a biocultural approach to study health and nutritional outcomes among families in low- and middle-income countries (LMIC), mostly in Latin-America. The main purpose of her research is to further understand how intergenerational and early-life conditions, associated with poverty and discrimination, lead to child malnutrition in all its form; and how they potentiate health and disease outcomes throughout the lifecourse. Dr Varela-Silva is the director of The Maya Project, a Loughborough University social enterprise project that blends art and research outputs to portray the biosocial realities of the Maya in Mesoamerica.
Bibliography
Andre AL, Padez C, Rosado-Marques V, Griffiths PL, Varela-Silva MI (2017). Growing up in Portugal: Cape Verdean ancestry children exhibit low overweight and obesity compared with Portuguese in urban Lisbon. Journal of Biosocial Science, 49 (6), 842-857
Azcorra H, Dickinson, Eds (2020). Culture, Environment and Health in the Yucatan Peninsula: A Human Ecology Perspective. Springer International Publishing. ISBN: 978-3-030-27001-8
Sanchez-Escobedo S, Azcorra H, Bogin B, Hoogesteijn AL, Samano R, Varela-Silva MI, Dickinson F (2020). Birth weight, birth order, and age at first solid food introduction influence child growth and body composition in 6? to 8?year?old Maya children: The importance of the first 1000?days of life. American Journal of Human Biology. Early view
Varela-Silva MI, Azcorra H. Dickinson F, Bogin B, Frisancho AR (2009). Influence of maternal stature, pregnancy age, and infant birth weight on growth during childhood in Yucatan, Mexico: A test of the intergenerational effects hypothesis. American Journal of Human Biology 21 (5), 657-663
Varela-Silva MI et al (2020). Growth stunting and low height-for-age in the Yucatan Peninsula. In Azcorra H, Dickinson, Eds (2020). Culture, Environment and Health in the Yucatan Peninsula: A Human Ecology Perspective. Chapter 4 (pp. 65-75)
Video
Stunting WHO chapter 1
Websites
World Health Organization (2010). Nutrition Landscape Information System (NLIS). Country Profile indicators.
World Health Organization. Nutrition
World Health Organization. Double burden of malnutrition
World Health Organization. Global nutrition report