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Working Group on Nutrition throughout the Life Cycleheld during the ACC/SCN's 30th Session in Chennai, India, March 2003 Co-Chaired by Ricardo Uauy (UNU) and Ted Greiner (Sida) The meeting was opened by Ted Greiner (Sida) with a brief reminder of the purpose of this new working group and a request that participants give thought to whether any modifications are needed in the way in which the working group could best achieve its purpose. In particular, what are the specific needs for harmonization? How can we work from a human rights and equity perspective? Ricardo Uauy (UNU) provided background on the implications and challenges of a lifecycle or life course approach to nutrition. The latter includes the elderly and thus is broader. We have done a good job in the past century in reducing early life deaths but less so in reducing preventable deaths in adulthood. A large range of conditions causing a large proportion of death and disability can be prevented through improved diet and physical activity. Developing countries face the double burden of disease linked to malnutrition and nutrition-related chronic disease. Transitional countries are now faced with the consequences of obesity, diabetes, heart disease in the absence of preventive strategies. There is a clear intergenerational effect of early malnutrition, thus the urgency in protecting the fetus and promoting good nutrition in infancy and early childhood. A lifecycle approach is critical and meaningful to avoid the consequences both in terms of undernutrition and adult chronic disease. Kathy Kurz and Kavita Sethuraman (ICRW) described the new Initiative on Gender and Nutrition initiated with seed funds from the World Bank Development Grant Facility. It will build on existing programs, focusing on women’s roles and status, that is, on empowerment and other issues broader than just nutrition. For example, if women are the main caretakers of their children, the initiative asks how we can strengthen their roles and resources. This will increase program effectiveness. Attention will probably focus more on under- than over-weight. Early plans include participatory project development in first West Africa and later South Asia. In discussion it was pointed out that while the specific stages in the lifecycle/course approach are meaningful from a scientific perspective, in public communication an integrated approach focusing on the different members of the family unit will be more understandable. Chiruzu Nishida (WHO) presented UN perspectives on diet and nutrition in the prevention of non-communicable diseases in the life course. She presented the methodology for developing the newly released WHO/FAO report on diet, nutrition and the prevention of chronic diseases. The process for this science based report included examining the evidence, categorizing the strength of it, and defining population nutrient intake goals to achieve optimal health and prevent the consequences of nutrition-related chronic disease. The best way to introduce this concept in developing countries is to use the lifecourse perspective, given the long term effects of early malnutrition. The strategy to implement the recommendations of this report includes not only examining the factors that condition individual food choices and limit physical activity but also the social, economic and political factors that determine the progressive increase in consumption of energy dense foods and promote physical inactivity. This report will serve as one of the key background documents to initiate a series of regional consultations with national governments leading to the development of a global strategy to be presented to the WHO Executive Board meeting in January, 2004. FAO indicated that the summary of the Report of the Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases will be discussed at the Committee on Agriculture in early April 2003, looking at agricultural and food safety implications of the report, for example how to meet the recommendation to eat 400g/day of fruits and vegetables. What should be done to assure availability, access and safety of such products? Attention is also needed on alternative approaches towards meeting the recommendation for increased fish intake, since sea fish are now progressively being depleted. This may require aqua- and marine-culture. Trade implications must be examined. For example, inadequate availability and access to fruits and vegetables in low-income countries could lead to pressure on local prices if there is an increased demand in rich countries. Patrick Webb (WFP) reviewed the agency’s expanding efforts to break the inter-generational cycle of malnutrition. While most WFP resources must be utilized for emergencies, he pointed out that low-income people are dealing with many shocks throughout life, for which various kinds of support are required (only one of which is food) if severe consequences are to be avoided. A lifecycle approach has gradually evolved which seems to be a better way of assisting in this. Vulnerability analysis and mapping is leading to better targeting and thus a more efficient use of resources. Roger Shrimpton reviewed UNICEF’s Low Birthweight Initiative implemented in 15 projects in several countries and reported on the status of five controlled studies of micronutrient interventions to reduce LBW. We need to reduce low birthweight, to shift the entire curve. The optimal range for the distribution of weights at birth should be 3.5-4.0 kg. Female stunting continues to be relevant in this context, as many small women are worried about the risks of delivering larger babies. Indeed obstetrical complications are higher in women of low stature The IAEA mandate is not directly linked to the solution of health and nutrition but it contributes to the work of the UN agencies and governments charged with that responsibility. Venkatesh Iyengar (IAEA) reviewed how reliable laboratory techniques, including nuclear and isotopic ones, can assist in assessing nutritional status throughout the lifecycle and contribute in defining program effectiveness in the field. These techniques are currently utilized in projects in some 50 low-income countries focusing for example on low birthweight, bioavailability and utilization of iron, zinc, vit A, stunting, obesity and its consequences, and body composition of the elderly. Sultana Khanum (WHO) reviewed the present WHO global data base on low birthweight and intrauterine growth retardation (IUGR) and the impact of these conditions on infant mortality, stunting and nutrition related chronic disease in adult life. She indicated that WHO will carry out a consultation on Low Birthweight later this year and requested those with access to the information documenting the effect of nutrition on the fetal growth and pregnancy outcomes to make it available. The discussion of this presentation revealed the urgent need for clear guidelines on how to reduce LBW/IUGR in developing countries. In fact doing so is crucial to achieve MDGs 1-5. It was noted that the SCN had pioneered the focus on nutrition in pregnancy and fetal growth and that UNICEF had multiple activities in progress, thus the urgent need for the consultation. Discussion points from the floorSeveral of the over 100 participants in the working group session expressed the opinion that this working group should be given high priority on the SCN agenda in the coming years because of the urgency of the ongoing work. Examples include LBW/IUGR prevention trials, and the need to give attention to neglected aspects such as adolescents and the elderly. Several participants indicated the need to link with other working groups, for example with the Micronutrient Working Group which is promoting the lifecycle approach to the prevention and control of iron deficiency anemia. It is also important to identify where capacity strengthening is needed and to make appropriate linkages with the Working Group on Capacity Development in Food and Nutrition. Clearly the Working Groups on Nutrition of School-Age Children and Breastfeeding and Complementary Feeding are involved with important parts of the life course and coordination with them is needed. Regarding which issues should receive priority attention for the program of the working group, a show of hands indicated that low birthweight and associated gender issues (adolescent pregnancy) was deemed of greatest importance. Nutritional damage to the fetus is often irreversible. Written comments on priorities for future activities were submitted by 17 participants. Topics included:
There is a need to look at these problems beyond the medical/public health approach, i.e. examine gender issues, underlying causes, equity, access to healthy foods, global market forces, factors that condition food production and distribution, marketing and consumption patterns, social policies and governance. The working group co-chairs felt that the most immediate potential for interagency coordination would be some kind of collaboration between the Gender and Nutrition Initiative and the ongoing work on the Low Birthweight Initiative. Both might want to consider ways in which they could incorporate the issue of teenage pregnancies into their work in countries where this is a major factor contributing to low birthweight.
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