Introduction to Human Nutrition

354 Introduction to Human Nutrition

association between undernutrition and poverty in
developing countries.
Figure 15.1 illustrates this relationship, also showing
some of the mechanisms responsible for perpetuating
the relationship over generations.
Approximately 243 million adults in developing
countries are severely undernourished, with a body
mass index less than 17 kg/m^2. This means that high
proportions of especially Asian and African preg-
nant women are undernourished. Intrauterine (fetal)
growth retardation is common in these women,
leading to low birthweight babies (weight at full term
less than 2500 g). Almost a quarter of newborns in the
developing world (30 million of the 126 million babies
born each year) have low birth weights compared with
only 2% in the developed world. These babies, espe-
cially when exposed to inappropriate breastfeeding
and weaning practices, leading to further nutritional
insults, have growth impairment and mental under-
development. In addition, because of undernutrition,
their immune systems are compromised. The result is
stunted children that cannot benefi t optimally from
education and with an increased risk of infectious

disease. In 2000, more than 150 million preschool

children in the developing world were underweight,

while approximately 200 million were stunted.

Figure 15.1 also shows that these physically and

mentally underdeveloped children eventually develop

into adults with “decreased human capital” and

decreased competence. These adults are often not able

to create enabling environments for themselves or

their children to escape poverty and undernutrition

in the next generation. But moreover, these “under-

developed” adults are at increased risk of obesity and

other NCDs because of early programming (possibly

through epigenetic or DNA methylation changes) in

the undernourished fetus. It is especially when these

adults are exposed to low micronutrient quality and

high energy-dense diets that they rapidly become

overweight and obese. This phenomenon explains to

a certain extent the coexistence of under- and over-

nutrition in the same household with undernour-

ished, wasted, and stunted children being cared for by

an overweight or obese mother or care-giver.

Obesity and noncommunicable diseases in

developing countries

Obesity and other NCDs are increasingly becoming

major public health problems in the developing

world. The WHO estimates that almost 80% of all

deaths worldwide that are attributable to NCDs are

already occurring in developing countries. A disturb-

ing observation is that they often occur at younger

ages than in the developed world. Obesity and other

NCDs have similar biological risk factors in devel-

oped and developing countries (and will not be dis-

cussed in detail here). However, the context in which

they develop may differ, being linked with fetal and

infant undernutrition. Also, underdevelopment and a

lack of resources in developing countries limit the

availability of diagnostic and therapeutic care of

people suffering from NCDs, leading to increased

morbidity and mortality.

The other two groups of nutrition-related diseases

in developing countries are nutrient defi ciency dis-

eases and infectious diseases, which will now be briefl y

discussed.

Major nutrient defi ciency diseases in

developing countries

It is estimated that nearly 30% of humanity suffer

from one or more forms of malnutrition. About 60%

UNDERNUTRITION

(undernourished pregnant mothers;

Fetal growth restriction)

Low birthweight babies

Undernourished infants

Adults with decreased

human capital and competence

obesity and other NCDsIncreased risk of

Increased risk of infectious

disease

Increased morbidity andmortality

Inappropriate

breastfeeding

and weaning

Micronutrient

(Fe, Zn, Vit A)deficiencies

•Growth impairment

(underweight; stunting)

•Mental underdevelopment

•Compromised immune system

Lack of care

Unhygienic environments

Food insecurity

POVERTY

Figure 15.1 The intergenerational vicious cycle between undernutri-
tion and poverty.