Understanding Micronutrient Deficiency: A Public Health Crisis
Nutrients are the chemical compounds in food that are used by the body to function properly and maintain health. Examples include proteins, fats, carbohydrates, vitamins, and minerals. The relationship between nutrition and health is 2-way; health status can be affected by nutrient deficiency and vice versa. Vitamins and minerals are micronutrients that are responsible for many life-sustaining biological processes. Each vitamin and mineral plays a different role in bodily processes. Consuming enough of the required vitamins and minerals is an essential part of eating a balanced diet. A healthy diet helps people grow and develop properly and reduces their risk of various diseases. Individuals who eat a healthy diet live longer and have a lower risk of obesity, heart disease, type 2 diabetes, and certain cancers. [1]
Nutrients are the nourishing substances one must obtain from food. These essential substances are vital for growth and maintenance from infancy to adulthood. For a nutrient to be considered essential, two characteristics are needed. First, its omission from the diet must lead to a decline in certain aspects of human health, such as the function of the nervous system. Second, if the omitted nutrient is restored to the diet before permanent damage occurs, those aspects of human health hampered by its absence should regain normal function. [1]
Role Of Micronutrients In Health
Essential Nutrients – 2 Categories- The six essential nutrients are vitamins, minerals, carbohydrates, protein, fats and water.
· Micronutrients: Vitamins and Minerals are the nutrients that a person needs in small doses. Although the body only needs small amounts of them, a deficiency can cause ill health.
· Macronutrients: Carbohydrates, Proteins, Fats, and Water are the nutrients that a person needs in larger amounts.
Role Of Vitamins
· Vitamins: Typically, a person who eats a diet rich in vegetables, fruits, and lean proteins can get all the vitamins they need in their food. However, those who eat less fruit and vegetables, and those with digestive conditions may need to take a vitamin supplement to reduce or avoid a deficiency.
Vitamins are micronutrients that offer a range of health benefits, including boosting the immune system, helping prevent or delay certain cancers, such as prostate cancer, strengthening teeth and bones, aiding calcium absorption, maintaining healthy skin, helping the body metabolize proteins and carbs, supporting healthy blood and aiding brain and nervous system functioning.
There are 13 essential vitamins that nutritionists divide into two groups: fat-soluble and water-soluble.
Water Soluble Vitamins
· Vitamin B-1 (thiamine)
· Vitamin B-2 (riboflavin)
· Vitamin B-3 (niacin)
· Vitamin B-5 (pantothenic acid)
· Vitamin B-6
· Vitamin B-7 (biotin)
· Vitamin B-9 (folate, folic acid)
· Vitamin B-12 (cyanocobalamin)
· Vitamin C
Fat Soluble Vitamins
· Vitamin A, Vitamin D, Vitamin E,
Vitamin K
Minerals are the second type of micronutrients. There are two groups of minerals and the body needs a balance of minerals from both groups for optimal health.
Major Minerals
· Magnesium, Calcium,
Phosphorus,
Sulfur,
Sodium,
Potassium,
Chloride
Trace Minerals
· Iron, Selenium, Zinc, Manganese, Chromium, Copper, Iodine, Fluoride
Role Of Minerals
Major minerals help the body to do the following: balance water levels, maintain healthy skin, hair, and nails, and improve bone health.
Trace minerals help with strengthening bones, preventing tooth decay, aiding in blood clotting, helping to carry oxygen, supporting the immune system, and supporting healthy blood pressure.
Micronutrient Deficiencies -The Next Challenge For The Global Health System[2]
Micronutrient Deficiencies (MNDs) are of great public health and socioeconomic importance worldwide. They affect low-income countries but are also a significant factor in health problems in industrialized societies with impacts among wide vulnerable groups in the population, including women, children, the middle-aged, and the elderly. They can result in poor physical and mental development in children, vulnerability or exacerbation of diseases, mental retardation, blindness, and general losses in productivity and potential. The World Health Organization (WHO) considers that more than 2 billion people worldwide suffer from vitamin and mineral deficiencies, primarily iodine, iron, vitamin A, and zinc, with important health consequences. They significantly contribute to chronic diseases as the major causes of morbidity and mortality globally. Micronutrient deficiency conditions relate to many chronic diseases, such as osteoporosis, osteomalacia, thyroid deficiency colorectal cancer, and cardiovascular diseases. They increase the severity of infectious diseases, such as measles, HIV/AIDS, and tuberculosis.
Micronutrient malnutrition leads to high social and public costs, reduced work capacity in populations due to high rates of illness and disability, and tragic loss of human potential. Poverty, lack of access to a variety of foods, lack of knowledge of optimal dietary practices, and high incidence of infectious diseases are some of the factors that lead to Micronutrient malnutrition. Policies and programs must be developed to assure the availability of and access to an adequate variety and quantity of safe, good-quality foods for all people of the world.
Strategies – To Control Micronutrient Malnutrition[3]
Four main strategies - dietary improvement, including increased production and consumption of micronutrient-rich foods; food fortification; supplementation; and global public health and other disease control measures - can be implemented to overcome micronutrient malnutrition. Food-based strategies, which include food production, dietary diversification, and food fortification, are the most sustainable approaches to increasing the micronutrient status of populations. These approaches not only prevent micronutrient deficiency problems but also contribute to general malnutrition prevention.
Most people can get these vitamins and minerals from a varied, balanced diet, which includes fruit, vegetables, whole grains, lean meat, healthy fats, and dairy products. However, there are many reasons a person may not be able to get the nutrients they need through diet alone. Micronutrient malnutrition, particularly vitamin A deficiency (VAD), iron deficiency anemia (IDA), and iodine deficiency disorders (IDD), poses a serious threat to the health of vulnerable segments of the population. Dietary Inadequacy is the primary cause of VAD and IDA, while poor iodine content of soil and water due to environmental iodine deficiency is the main determinant of IDD. The major intervention strategies being practiced globally for the control of micronutrient malnutrition include supplementation of the specific micronutrients; fortification of foods with micronutrients; and horticulture intervention to increase production and nutrition-education to ensure regular consumption of micronutrient-rich foods.
Currently, the national nutrition programs being implemented globally for preventing these deficiencies are based on short-term supplementation like periodic mega dosing of vitamin A, distribution of iron and folic acid tablets, and salt iodization. Though these have been in operation for over two decades, there has been limited perceptible biological impact on the prevalence of micronutrient malnutrition. Among the constraints, the most important are lack of coordination, shortage of resources and manpower, inadequate and irregular supplies, lack of proper orientation and training for the functionaries, poor monitoring and supervision, and absence of nutrition education. Integrated and multi-sectoral approaches are required to achieve the goals set under the National Nutrition Policies. These should include community-friendly nutrition education to increase awareness and motivation; active people's participation to get educated on food fortification; nutrient supplementation; nutrition-oriented horticulture programs; orientation of functionaries, and establishment of integrated micronutrient surveillance. Concerted and focused efforts are needed to strengthen various state government programs and role of NGOs to combat micronutrient malnutrition
Typically, a person who eats a healthful, balanced diet that includes lean proteins, vegetables, fruits, complex carbohydrates, and water will get the nutrients they need. People with digestive issues, who take certain medications, or who have other conditions may require supplements to help them get the body’s essential nutrients. An individual should speak to their doctor about any medical conditions and the medications they are taking before they start to take any supplements. Also, they may want to see a dietitian or nutritionist to discuss their nutritional intake before they begin taking any supplements.
A good, varied diet could help get most of the world's population free from micronutrient deficiency. The elimination of these deficiencies on a sustainable basis will occur only when the diets of vulnerable groups provide all required nutrients in the proper amounts. A person can ensure they consume enough minerals by including the following foods in their diet: Nuts and seeds, vegetables, leafy greens, fruits, beans and legumes, seafood, poultry, whole grain, fortified bread and cereals, egg yolks, milk, and other dairy products, red meats (limit their use and choose lean cuts) and iodized table salt (less than 2,300 milligrams a day.
Public health nutrition addresses individual and population health needs including those of groups at high risk for micronutrient deficiency conditions. A comprehensive food policy must include food security and distribution with special emphasis on the elderly and low-income populations. Food fortification is necessary for developed and developing countries to ensure essential nutrients in processed foods, improving their suitability for human nutrition. Vitamin and mineral fortification and supplementation policies need to be promoted as the epidemiologic, nutritional, and sociological scientific basis of human nutrition expands, specifically addressing widespread deficiencies of micronutrients essential for individual and population health.
References
1. Tulchinsky TH, Varavikova EA. The New Public Health, Second Edition. San Diego (CA): Academic Press/Elsevier. 2009. Chapter 8.
2. Allen L, de Benoist B, Dary O, Hurrell R. Guidelines on food fortification with micronutrients. World Health Organization and Food and Agricultural
3. Organization of the United Nations. Geneva: World Health Organization; 2006. Harrison GG. Public health interventions to combat micronutrient deficiencies. Public Health Reviews 2010;32:256-266.