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Nutrition Issues and Challenges in Asia

S297 In September 2000, representatives of 189 countries attended the millennium summit to adopt the United Nations Millennium Development Goals as a framework for measuring progress in development by the year 2015. The first goal calls for the eradication of extreme poverty and hunger, including malnutrition in children. Another two out of eight goals specify reduction in child mortality and improvement in maternal health as benchmarks for achievement. Childhood and maternal undernutrition represent major health risk factors that stem from inadequate protein and energy intake as well as deficiencies of micronutrients, especially iodine, iron, vitamin A, and zinc. Asian countries represent a wide spectrum with respect to the magnitude and severity of the problems. The rate of child mortality in Southeast Asia is twice as high as the rate in the Western Pacific Region. In Southeast Asia, the prevalence of underweight children in countries with low child mortality is 26%, and the prevalence in countries with high child mortality is 46%. Even children with mild to moderate undernutrition are at increased risk of mortality from infectious diseases such as diarrhea, pneumonia, measles, and malaria. Vitamin A deficiency affects 30% to 48% of young children as well as a large proportion of pregnant women in parts of Asia with high maternal mortality rates. Iodine-deficiency disorders and iron deficiency continue to be significant problems in Southeast Asia. The prevalence of a low intake of bioavailable zinc, as an estimate of zinc deficiency, ranges from 4% to 73% across Asia. These micronutrient deficiencies continue to have adverse consequences, such as retarded physical and mental development, impaired resistance to infection, and reduced work capacity. It is estimated that the cost of iron deficiency alone is as much as 2% of the gross domestic product. When the disease burden is calculated according to disability-adjusted life years (DALYs), which can be thought of as lost years of healthy life, nutritional deficiencies account for 33 million DALYs per year worldwide, half of which are in Asia. The rapid transition in diet and lifestyle in Asia has resulted in a double burden of malnutrition. Excessive consumption of foods high in saturated fat and free sugar, combined with reduced physical activity, results in an increase in the prevalence of overweight and obesity, especially in more developed countries in Asia. Values of body-mass index (BMI) above 21 kg/m2 elevate the risk of noncommunicable diseases such as type 2 diabetes mellitus, ischemic heart disease, and certain cancers. Although the burden of these diseases is high in developed countries, recent data indicate that as much as 50% of the adult disease burden in countries with high mortality can be attributed to noncommunicable diseases. One possible explanation for this lies in the fetal origin of insulin resistance and diabetes, such as occurs, for example, when small Indian babies born with higher body fat and visceral fat undergo accelerated growth during childhood. The challenges in Asia to addressing these problems include implementing cost-effective interventions, optimizing the use of science and technology, promoting cooperation among development sectors beyond the health sector, and strengthening capacity in research as well as in program counterparts. Abstract