Reflections on the 2005 World Food Prize Symposium: Nevin S. Scrimshaw, PhD, MD, MPH President, International Nutrition Foundation

THE LIFE CYCLE APPROACH TO NUTRITION AND FOOD NEEDS At the moment of conception nearly everyone has the genotype for a long and healthy life. At the moment of conception nearly everyone has the genotype for a long and healthy life. From the this time onward environmental factors damage this potential to produce a far different phenotype than at conception. From the this time onward environmental factors damage this potential to produce a far different phenotype than at conception. Malnutrition and overnutrition are the most common and consistent factors responsible, for this damage. Malnutrition and overnutrition are the most common and consistent factors responsible, for this damage.

The Life Cycle Approach Involves Nutrition at All Ages Pregnant & lactating women Pregnant & lactating women Infant & toddler Infant & toddler School child & adolescents School child & adolescents Adults at all ages Adults at all ages Women of child bearing age Women of child bearing age

Pregnancy Folic acid deficiency in early pregnancy increases neural tube defects. Folic acid deficiency in early pregnancy increases neural tube defects. Iodine deficiency impairs fetal brain development Iodine deficiency impairs fetal brain development Protein-energy deficiency lowers birthweight with multiple consequences. Protein-energy deficiency lowers birthweight with multiple consequences. Iron deficiency lowers infant iron stores at birth. Iron deficiency lowers infant iron stores at birth..

Infancy When breast milk is no longer sufficient, appropriate complementary feeding is essential or physical and mental stunting results. When breast milk is no longer sufficient, appropriate complementary feeding is essential or physical and mental stunting results. Iron deficiency and protein-calorie malnutrition are the main risks. Iron deficiency and protein-calorie malnutrition are the main risks.

Lactation/Infant Feeding Breast feeding provides only half the daily iron required in infancy; the balance must come from the stores at birth Breast feeding provides only half the daily iron required in infancy; the balance must come from the stores at birth These are exhausted by about 6 months, by 4 months if mother is anemic, by 2 months for low birth weight infants. These are exhausted by about 6 months, by 4 months if mother is anemic, by 2 months for low birth weight infants. Without supplementation or iron fortified food permanent impairment of myelenation of cranial nerves and dopamine neurons inevitable when stores at birth are exhausted. Without supplementation or iron fortified food permanent impairment of myelenation of cranial nerves and dopamine neurons inevitable when stores at birth are exhausted.

Toddler/Pre-school Child PEM can permanently reduce physical and mental development. PEM can permanently reduce physical and mental development. Vitamin D deficiency leads to rickets. Vitamin D deficiency leads to rickets. Iron deficiency anemia causes reduced cognitive and motor performance. Iron deficiency anemia causes reduced cognitive and motor performance.

PEM affects physical growth and behavior. PEM affects physical growth and behavior. Iron deficiency impairs school performance. Iron deficiency impairs school performance. Vitamin D deficiency leads to rickets. Vitamin D deficiency leads to rickets. Low calcium intakes predispose to adult osteoporosis Low calcium intakes predispose to adult osteoporosis School child and adolescent

Adult Poor diet and life style lead to the early development of: Poor diet and life style lead to the early development of:  Diabetes type II  Hypertension  Heart disease  Increased susceptibility to cancer  Less resistance to infection

Elderly Adult Partially preventable declines in: Partially preventable declines in:  Physical strength (sarcopenia)  Cognitive function and dementia  Mobility and independence Partially preventable increases in: Partially preventable increases in:  Malignancies  Infections  Dependency

Still neglected: Women of Child-bearing Age Women must enter pregnancy with adequate folic acid status to avoid fetal neural tube defects Women must enter pregnancy with adequate folic acid status to avoid fetal neural tube defects Iron supplementation during pregnancy is too late! Iron supplementation during pregnancy is too late! Good weight gain is essential to normal infant birth weight. Good weight gain is essential to normal infant birth weight.

Examples of Destructive Non Nutritional Factors : Use of Tobacco Use of Tobacco Use of Narcotics Use of Narcotics Alcohol Medication Abuse Alcohol Medication Abuse Trauma Trauma Heavy metal poisoning – lead, arsenic fluoride Heavy metal poisoning – lead, arsenic fluoride Radiation Radiation

New insights into global hunger Agronomic Characteristics and Nutritional Value Agronomic Characteristics and Nutritional Value Overt Hunger and Hidden Hunger Overt Hunger and Hidden Hunger Nutritional Deficiency and Nutritional Excesses Nutritional Deficiency and Nutritional Excesses The triple burden of Nutritional Disease The triple burden of Nutritional Disease (Due to Fetal Origins of Adult Disease) (Due to Fetal Origins of Adult Disease)

Challenges to Agriculturists Plant breeding Plant breeding  Improve protein quality  Improve beta carotene content  Improve availability of non-heme iron Animal husbandry Animal husbandry  Lower proportion of total fat  More healthful fatty acid composition

Challenges to the Nutritionists By developing international consensus By developing international consensus priorities to avoid waste of financial and human resources due to conflicting or poor nutritional advice to agriculturists. priorities to avoid waste of financial and human resources due to conflicting or poor nutritional advice to agriculturists. Be advocates for maximizing the qualitative as well as quantitative contributions of agriculture to feeding the human population. Be advocates for maximizing the qualitative as well as quantitative contributions of agriculture to feeding the human population.

Don’t depend on any one solution! Protein quality can be assured from genetically improved cereals such as QPM or by legumes or oil seed protein to complement a cereal staple or by adding animal protein to the diet. Protein quality can be assured from genetically improved cereals such as QPM or by legumes or oil seed protein to complement a cereal staple or by adding animal protein to the diet. Vitamin A activity can come from the beta carotene of yellow vegetables and be enhanced by genetic engineering as well as animals. Vitamin A activity can come from the beta carotene of yellow vegetables and be enhanced by genetic engineering as well as animals. B vitamins and minerals can be provided cheaply and effectively by universal multiple fortification of the cereal staple so that breeding for them may not be worthwhile. B vitamins and minerals can be provided cheaply and effectively by universal multiple fortification of the cereal staple so that breeding for them may not be worthwhile.

 Target the process, not just the problem: Mainstreaming in development, PRSPs  Challenge the ‘invisibility of malnutrition: ‘forgotten emergencies’, ‘hidden hunger’,  Address all aspects (lifecycle) of malnutrition: Wasting, stunting, micronutrients, obesity  Protect investments against shocks: Multiple inputs, links with all MDGs  Legislated empowerment (rights): Meeting demand requires funds for nutrition Conclusions

Thank you