IRD Seminar Food and Nutrition Security Andrew Speedy – Visiting Professor, School of Agriculture Overcoming Poverty and Ensuring Food Security 2016

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Protein – Energy malnutrition

Kwashiorkor Kwashiorkor /kwɑːʃiˈɔrkər/ or Ga k is a form of severe protein–energy malnutrition characterized by edema, irritability, anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates. Sufficient calorie intake, but with insufficient protein consumption, distinguishes it from marasmus. Kwashiorkor cases occur in areas of famine or poor food supply. Cases in the developed world are rare.

Nutrition Energy Protein Minerals Vitamins Essential oils

VITAMINS Vitamins are organic compounds needed for normal function, growth and maintenance Cofactors, not energy

10 Fat Soluble Vitamins A – orange, carotenoids, vision, antioxidant- used as color and antioxidant D – we make it with sunlight, rickets, milk, Ca:P ratios E – tocopherols, antioxidants, role in preventing stroke, cancer, heart disease- used as antioxidant K – contributes to blood clotting factor

11 Vitamin A Used in food industry as a colorant (orange) Antioxidant Stored in liver Important for sight Deficiency causes ~ – 500,000 cases of “night blindness” worldwide – Xeropthalmia, dry eyes ， dry skin etc Genetically engineered rice with high Vitamin A can prevent night blindness

12 Vitamin D Also known as calciferol due to its role in calcium absorption Main role is to maintain calcium and potassium levels Only fat soluble vitamin we can make in the presence of sunlight Can be made from cholesterol

13 Vitamin D Can be stored in fat tissues Elderly are at risk Targeting on intestinal mucous, kidney and renal tubular Promoting absorbance of calcium and phosphor ， Being beneficial to formation and calcification of new bone Deficiency children—— rickets adults——osteomalacia Toxicity -Can lead to calcium deposits in kidneys, heart and blood vessels

14 Vitamin D deficiency

15 Vitamin E A family of eight naturally occurring compounds Used as an anti-oxidant in foods Since aging is considered an “oxidation” reaction, many “anti-oxidants” are used as dietary supplements Deficiencies are not well understood Role is stroke, cancer, heart, and immune response

16 Vitamin K Contributes to synthesis of seven blood clotting factors Can be reactivated to continue biological action Works as a cofactor for an enzyme that makes two bone proteins

17 Water Soluble Vitamins B 1, THIAMINE B 2, RIBOFLAVIN B 6, PYRIDOXAMINE B 12 BIOTIN PANOTHENIC ACID NIACIN FOLACIN VITAMIN C

Water Soluble Vitamins Vitamin B 1 – Thiamine – Involved in carbohydrate metabolism – Helps body metabolize glucose, affects central nervous system – Deficiency causes Beri beri B 2 - riboflavin – Energy metabolism

19 Water Soluble Vitamins B 6 - Pyridoxamine – Neurotransmitter, co-enzyme in over 100 reactions B 12 – – Development of red blood cells – Hard for vegetarians to get

Folic Acid Recently shown as very important for pregnant females to avoid birth defects function: synthesis of purines, pyrimidines, nucleic acids sources: yeast, alfalfa meal, full-fat soybeans deficiencies: anemia, large erythrocytes, pale gills (fish) requirements: 1-4 mg/kg (fish, shrimp)

21 Water Soluble Vitamins Biotin – – Involved in fatty acid synthesis – Deficiency causes skin disease and hair loss Panthothenic acid – Found in many foods – Essential for metabolism of carbohydrates, protein, alcohol and fat

22 Vitamin C Ascorbic acid Very inexpensive to add to food, marketing tool. Antioxidant Deficiency leads to bleeding gums, hemorrhages High in citrus fruits, limes

23 Vitamin C - Scurvy

24 Niacin (B3) Energy metabolism Disease – pellagra – The Four D’s – Dermatitis – Diarrhea – Dementia – Death

25 Minerals Percent of Body weight – Calcium2% – Phosphorus1% – Potassium0.3% – Sulfur0.2% – Sodium0.1% – Chloride0.1% – Magnesium0.05% – Iron 0.04%

26 Minerals Calcium – 99% is structural – ~25% absorption – Vitamin D aids absorption – 75% is obtained form dairy products – Many products are fortified with it – Built in youth, lost in maturity

27 Calcium Osteoporosis – a pediatric disease with geriatric consequences – 1.5 million fractures each year – 14 billion in direct health cost – 25 million women at risk – DRI women 600 – 800 mg/day

28 Minerals PHOSPHORUS – Easily absorbed by the body – Enhanced by Vitamin D – Deficiency are rare POTASSIUM – A primary electrolyte in blood – Associated with lower blood pressure – Athletes

29 Minerals SODIUM AND CHLORIDE – Added during processing – Enhances flavor – We consume 2X of what we need – Excess Sodium can lead to hypertension High blood pressure

30 Minerals SULFUR – Necessary for collagen formation MAGNESIUM – Abundant in plants

31 Minerals IRON – Most common and easily preventable deficiency – Needed for oxygen absorption, immune function, developmental performance – Poor absorption from plant sources – Low iron causes anemia, especially in menstruating women – Toxicity

32 Minerals Iodine Thyroid hormones thyroxine and triiodothyronine contain iodine Deficiency gives rise to goiter According to World Health Organization, in 2007, nearly 2 billion individuals had insufficient iodine intake, a third being of school age Thus iodine deficiency, as the single greatest preventable cause of mental retardation, is an important public-health problem.

33 Food Security in Viet Nam – Total food production in Viet Nam is around 50 million tons per year, including 36 million tons of rice, 4 million tons of corn, 8 million tons of cassava, 2 million tons of potatoes and sweet potatoes. – In 2007, cereals per capita was kg/yr, rice per capita 421 kg/yr – National food security is assured – But the proportion of poor people still accounted for 14,8% in – Food shortage in poor households happens at certain times of year, especially for households in remote and natural disaster affected areas. – The population continues to increase greatly and is forecast to increase to over 100 million people in 2020 and 110 million people in 2030

34 Underweight, Stunting and Wasting by Region (2007, WHO standard) Karen Codling 2008 International PAARS Consultant for Viet Nam Nutrition Partners Group

35 Disparities in Prevalence of Stunting and Underweight (2007, WHO) Karen Codling 2008 International PAARS Consultant for Viet Nam Nutrition Partners Group

36 Anaemia Prevalence Over Time Karen Codling 2008 International PAARS Consultant for Viet Nam Nutrition Partners Group

37 % of mothers with BMI <18.5 (2007) Karen Codling 2008 International PAARS Consultant for Viet Nam Nutrition Partners Group

38 Integrated Nutrition and Food Security Strategies for Children and Vulnerable Groups in Viet Nam National Institute of Nutrition, MOH Maternal and Child Health Dept, MOH Crop Production Dept, MARD FAO UNICEF WHO

39 Outcomes Improved monitoring system on food, health and nutrition status Reduction of under-nutrition, anaemia and stunting among under-five children Increased proportion of infants being initially breastfed Significant improvements in vitamin A and iron supplementation programmes Improvements in food production and food stocks in the highland and mountainous regions in Viet Nam

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42 Improved monitoring systems on food, health and nutrition status of mothers and children Technical support for strengthening the existing nutrition data collection and utilization system on food-health-nutrition Improved information on food production, stocks, availability and market prices at national, provincial and local levels Establish a sustainable tracking system to monitor the impact of the food crisis on nutrition status of mothers and children Improved food and nutrition information through updated Food Insecurity and Vulnerability Information Mapping System (FIVIMS) National policies, strategies and actions relating to protecting and promoting the nutrition of infants, children, pregnant women and mothers developed and implemented Implementation of pro-poor agriculture and rural development policies for better nutrition

43 Improved infant and young child feeding practices Intensive BF promotion/advocacy campaigns through mass media and community-based activities and for medical professionals Integrated BF promotion with ANC, FP and delivery and postpartum care media and community-based activities and for medical professionals Increased number of health facilities introduced to Mother-Baby Friendly Hospital Initiative and granted MBFH certificate Enhanced implementation of national code for marketing and trading breast milk substitutes

44 Reduction of micronutrient deficiencies Supplies of vitamin A capsules, iron folic tablets, zinc and de-worming drugs are available to all targeted children and women within the programme area Capacity of local health workers in implementation of the micro-nutrient deficiency control activities (vitamin A, iron anemia and IDD) improved

45 Improved care and treatment for malnourished children and in emergency situations Capacity of health workers on care and treatment of children with severe acute malnutrition (SAM) and with special needs in community and hospital systems improved Provision of key supplies to support nutrition services for selected provinces and localities at high risk, including micronutrient supplements and ready to eat therapeutic foods

46 Availability, access and consumption of a more diverse food supply Increased efficiencies in rice production in the highland and mountainous regions in Vietnam through building capacity in rice integrated crop management systems (RICM) Improved homestead food production including animal sourced foods (small livestock, poultry, fisheries and aquaculture), processing and preservation, and nutrition education

47 Summary Nutrition and food information National policies, guidelines and legislation Capacity building Breast feeding promotion Mother-baby friendly hospitals Micronutrient supplementation Improved quality rice production Fish and animal source foods Pro-poor policy formulation in agriculture and RD

Countries (N = 53) with regulations for fortification of wheat flour with folic acid*, by program status --- worldwide, June 2010

Percentage of households consuming iodized salt. With exception of New Zealand, this indicator is not formally measured in industrialized nations. However, examples of effective iodized salt regulation in the Western world include Austria, Czech Republic, Belgium, Canada, Denmark, the Netherlands and Switzerland.

 g/g, DH homozygous lines developed Datta K et al PBJ, 2003/2005,2006 Parkhi et al MGG, 2005,2006 Rai et al 2003,2006 Ye et al Science, 2000 Painie et al Nature Biotech, 2005 Golden Rice (BR29) developed at IRRI is now in Bangladesh soil Syngenta-Golden Rice (GR2) is now in field at Louisiana, USA Commercial right of GR remains with Syngenta

HarvestPlus Program Strategy Develop micronutrient dense staple crops using the best traditional breeding practices and modern biotechnology to achieve provitamin A, iron, and zinc concentrations that can have measurable effects on nutritional status

Nutrients Targeted in Crops Rice - Zinc and Iron Wheat - Zinc and Iron Maize -  -carotene and zinc Cassava –  -Carotene Beans - Iron Sweetpotato -  -carotene Pearl Millet - Iron and zinc Banana and Plantain -  -carotene Lentil - Iron Potato - Iron Sorghum - Iron

Phase II Crops Potato Barley Cowpeas Groundnuts Lentils Millet Plantain Sorghum Pigeon Peas Yams Rice Wheat Maize Cassava Sweet Potato Beans Phase I Crops

CGIAR Research Centers CIAT Tropical agriculture Cali, Colombia CIMMYT Maize and wheat Mexico City, Mexico IFPRI Food policy Washington, D.C., USA CIP Roots and tubers Lima, Peru IITA Tropical agriculture Ibadan, Nigeria IPGRI Agricultural biodiversity Rome, Italy ICARDA Agriculture in the dry areas Aleppo, Syria IWMI Water resources Colombo, Sri Lanka ICRAF Agroforestry and ILRI Livestock Nairobi,Kenya CIFOR Forestry Bogor, Indonesia IRRI Rice Los Baños, Philippines ICRISAT Semi-arid tropical agriculture Patancheru, India ICLARM Fisheries Penang, Malaysia WARDA Rice in West Africa Benin CIAT and IFPRI are the co-convening Centers of HarvestPlus

Obesity Sugar Corn syrup Fats Salt Processed food

Nutrition from rice

“Food related illness is a major problem [in Cambodia and Laos]. One Australian report states that up to 40% of tourists in these countries may develop three or more loose bowel motions a day within the first week of travel. “ Food Safety

Safe food Hazards – Biological – Chemical – Physical Risk analysis – Risk assessment – Risk management – Risk communication