On how to overcome 'hidden hunger'

Malnutrition can be very deceptive. Being malnourished is not just about not getting enough calories or protein in the diet, it can also mean chronic micronutrient deficiencies.

Unfortunately, the statistics are scary: malnutrition afflicts more than two billion individuals or one in three people globally, which is more than double the 805 million people who do not have enough calories to eat and not many people know about this. Due to this lack of information and the fact that symptoms are not very clear, micronutrient deficiencies often stay undetected for long and that is why they are also classified as ‘hidden hunger’.

Hidden hunger is defined as a form of under-nutrition that occurs when intake and absorption of vitamins and minerals is too low to sustain good health. It doesn’t depend on quantity but type of food intake. The term micronutrient refers to a broad list of vitamins and minerals required for sustained growth and development.

Even though they are needed only in minuscule amounts, the consequences of their deficiency can be severe. These substances are the “magic wands” that enable the body to produce enzymes, hormones and other subst­ances without which proper growth and development is impossible.

One clear difference is that while malnourishment is clinic­ally evident in impoverished children living in rural areas, malnutrition is the “hidden hunger” in an urban setting. We may thi­nk that infants are eating healthy as their weight, height parameters are on track, but they may not be consuming the required amount of vitamins and minerals on a daily basis, which often is the primary reason for their nutritional deficiencies.

A larger proportion of the burden of hidden hunger is found in the developing world.  Micronutrient deficiency, particularly of iron, is widespread especially amongst the urban kids. That’s because in urban areas, we are increasingly moving towards highly processed, energy-dense, micronutrient-poor foods and drinks. This shift is leading to co-existence of both obesity and diet-related hidden hunger. So, while it may seem paradoxical, an obese child can also suffer from hidden hunger.

According to WHO, iodine, vitamin A and iron are most important in global public health terms and their shortage represents a major threat to health and development. Low intakes of other essential micronutrients such as calcium, vitamin D and B vitamins, such as folate are also common. Vitamin A and zinc deficiencies adversely affect child health and survival by weakening immune system.

Lack of zinc impairs growth and can lead to stunting in children. Iron deficits prevent children from reaching their physical and intellectual potential. The problem is that clinical signs of hidden hunger, such as night blindness due to vitamin A deficiency or anaemia due to iron deficiency, become visible only after deficiencies turn severe.

According to the National Nutrition Monitoring Bureau, over 50% of apparently healthy looking children have sub-clinical and biochemical deficiencies of micronutrients (like vita­min A, B2, B12, vitamin C, iron, and trace minerals like zinc).

Common source

Poor diet is a common source of hidden hunger. Another source of micronutrient deficiency is impaired absorption or use of nutrients, which may be impaired by infection or a parasite spread easily in unhealthy environments with poor water, sanitation and hygiene conditions. Increasing dietary diversity by providing foods with adequate amounts of micronutrients is one of the most effective ways to sustainably prevent hidden hunger.

It is important to fulfil the micronutrients’ need through nutrient-dense complementary food. In India, infants are usually fed whatever is consumed by elders in the family. Indian diets are majorly grain and plant-based, with little intake of iron rich pulses, green leafy vegetables and meat.

The Indian grain and plant diets are high in macronutrients like carbohydrates, fats and proteins, but are very low in micro­nutrients such as iron and zinc, leading to deficiencies. Additionally, infants need nutrient dense food since their stomach size is too small to take in the amount of food that is required to meet the daily micronutrient needs.

For this, ensuring intake of a diverse diet with a balanced and adequate combination of mac-ronutrients (carbohydrates, fats, and protein), essential micronutrients and other food-based substances such as dietary fibre are the solutions. And this is wh­ere interventions such as readymade mineral and vitamin rich foods, fortified foods, fortified cereals, iron/vitamin supplementation etc can come handy.

(The writer is Consultant – Paediatric Intensivist and Neonatologist, ASTER CMI Hospital, Bengaluru)

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