Nutrition through the life-course
- 187,000 preventable under five deaths in the Region due to undernutrition
- Undernutrition during pregnancy increases the risk of intrauterine growth retardation in babies which will increase children’s risk of obesity and of developing noncommunicable diseases (NCD), such as cardiovascular diseases and type 2 diabetes later in life.
- About 12 million children are stunted in the Western Pacific Region (1)
- More 6.5 million children under five are overweight, a number that keeps growing. (1)
- One in four pregnant women and one in five women of reproductive age in the region are anaemic (2)
- The noncommunicable disease epidemic begins with undernutrition in the first 1000 days during pregnancy, infancy and young childhood. Overweight and Obesity continues to fuel the epidemic.
- One in four adults is overweight and one in three adults has high blood pressure in the Region. Over consumption of salt is a key risk factor for high blood pressure, and most countries in the Region exceed the recommended maximum limit for daily salt consumption, some by more than four times.
- Reducing the double burden is critical to meet MDG 1 and 4, will support the post-MDG agenda, reduce economic and social burden hospital costs, lost wages, reduced productivity
Key interventions to create supportive environments
Taking a life course perspective, therefore, has great potential for improving the health and nutritional well-being of the population. For all age groups a balanced diet is recommended to ensure good nutritional status. While nutrition education remains important, a balanced diet can only be achieved if healthy alternatives are available for all.
Creating supportive environments to protect, promote and support optimal breastfeeding and healthy diets, include for example:
- Full adoption, enforcement and monitoring of the International Code of Marketing of Breast-Milk Substitutes and subsequent World Health Assembly Resolutions into effective national measures.
- Institutionalize Baby Friendly Hospital Initiative (BFHI), including assessment and reaccreditation into health care system structures.
- Develop and align maternity protection as a minimum with International Labour Organization Maternity Protection Convention, 2000 (No. 183).
- Support optimal and appropriate complementary feeding practices of locally available and acceptable foods.
- Implement measures to prohibit inappropriate promotion of complementary foods
- Implement measures to protect dietary guidance and food policy from undue commercial and other vested interests.
- Incorporate the WHO Set of Recommendations on the Marketing of Foods and Non-Alcoholic Beverages to Children into effective national measures.
- Incorporate nutrition labelling, including front of pack labelling into effective national measures.
Key interventions during various stages of the life course:
Women of reproductive age should have a balanced diet to ensure good nutritional status prior to conception. In settings where the prevalence of anaemia among women of reproductive age is 20% or higher, intermittent iron and folic acid supplementation is recommended as a public health intervention in menstruating women, to improve haemoglobin concentrations, iron status and reduce anaemia.
A balanced diet is important for adequate nutrition to address common nutrient deficiencies among pregnant women that include iodine, iron, vitamin A and zinc. Deficiency of iodine causes retarded foetal brain development. Iodized salt should be taken to prevent iodine deficiency. If iodized salt is not available, iodine supplements should be administered.
Deficiency of iron causes anaemia, which increases the risk of maternal mortality, fetal growth retardation, and prenatal mortality. Intermittent iron and folic acid supplementation is recommended in non-anaemic pregnant women to prevent development of anaemia and to improve gestational outcomes. Routine daily oral iron and folic acid supplementation is recommended in pregnant women to reduce the risk of having a low-birth-weight baby and maternal anaemia and iron deficiency at term.
Deficiency of vitamin A leads to poor reproductive health, slow growth and development. Pregnant women should consume foods high in beta-carotene and vitamin A, such as red, orange and yellow fruits and vegetables. In areas where vitamin A deficiency is a severe public health problem, vitamin A supplementation in pregnancy is recommended for the prevention of night blindness.
An infant should be exclusively breastfed for the first six months, which should be initiated within the first hour after birth.
Exclusive breastfeeding, meaning no additional food or drink, meets all energy and nutrient requirements of the baby, and promotes optimal cognitive and sensory development. It also protects babies from diseases caused by unclean food and water. Exclusive breastfeeding also reduces the risk of obesity and other NCDs later in life. A child’s growth should be monitored from birth to help determine if interventions are required. The WHO Child Growth Standards, based on the growth path of exclusively breastfed children, are referred to as normative growth standard and should be used to monitor the child’s growth.
Other interventions that will help babies develop immunity include delayed clamping of the umbilical cord, immediate drying of the baby, immediate skin to skin contact with the mother, and a delayed bath (six hours after birth).
Energy-and nutrients-appropriate safe complementary foods should be introduced at six months. Breastfeeding, still a major source of nutrients for infants, should be continued until 2 years and beyond. In populations where the prevalence of anaemia in children under 2 or under 5 years of age is 20% or higher, home fortification of foods with micronutrient powders containing at least iron, vitamin A and zinc is recommended to improve iron status and reduce anaemia. Growth monitoring should be continued to track the child’s developmental path.
Pre-school age (2-5 years)
At preschool age, children should be provided with an adequate diet. In settings where the prevalence of anaemia in preschool or school-age children is 20% or higher, intermittent use of iron supplements is recommended as a public health intervention to prevent anaemia and improve the iron status among these children. In settings where vitamin A deficiency is a public health problem, vitamin A supplementation is recommended in infants and children 6–59 months of age as a public health intervention to reduce child morbidity and mortality Children should be dewormed 2-3 times a year to eliminate worm infections that may reduce their capacity to absorb necessary nutrients and exacerbate undernutrition. Growth monitoring should be continued, to track the child’s developmental path.
School age (5-10~12 years)
Balanced diets should be promoted to ensure that the nutritional needs of school-age are met, for a healthy growth. School feeding programmes may help to achieve this. In settings where the prevalence of anaemia in preschool or school-age children is 20% or higher, intermittent use of iron supplements is recommended as a public health intervention to prevent anaemia and improve the iron status among these children. Deworming may still be necessary in this age group.
Nutrition education should be built into school curricula to enhance students’ knowledge of nutrition, healthy diet and physical activity. Pre-schools and schools offer many opportunities to promote healthy dietary and physical activity patterns for children and are also a potential access point for engaging parents and community members in preventing child malnutrition in all its forms (i.e. undernutrition, micronutrient deficiencies, and obesity and nutrition-related noncommunicable disease). Encouraging children to tend a vegetable garden at school is a useful way to provide nutrition education to children. Schools should be free from all forms of marketing of foods high in saturated fats, trans-fatty acids, free sugars or salt.
Adolescence (10-12-18 years)
Nutrition education should be continued in school curriculum. In settings where the prevalence of anaemia among women of reproductive age is 20% or higher, intermittent iron and folic acid supplementation is recommended as a public health intervention in menstruating women, to improve haemoglobin concentrations, iron status and reduce anaemia. Schools should also be free from all forms of marketing of foods high in saturated fats, trans-fatty acids, free sugars or salt.
Improving the nutritional status of school-age children is an effective investment for:
- improving educational outcomes of school children
- establishing healthy dietary and physical activity patterns among young people thereby promoting health and nutritional well-being and preventing obesity and various noncommunicable diseases, and
- improving nutrition among adolescent girls – considered in a life course perspective, this will benefit the health and nutrition of the next generation.
Adults should consume a balanced diet to maintain a healthy and active lifestyle. This is essential for preventing various diet-related noncommunicable diseases such as diabetes, hypertension, and cardiovascular diseases.
Supportive environments, in which the healthy options are made the easier options, are important to enable consumption of a balanced diet.
(1) United Nations Children's Fund, World Heatlh Organization, The World Bank. UNICEF-WHO-World Bank Joint Child Malnutrition Estimates. (UNICEF, New York; WHO, Geneva; The World Bank, Washington, DC; 2012)
(2) World Health Organization. Global Anaemia Report, 2014. WHO, Geneva.