Invest in Nutrition

Eden, a young boy of 3 years old, was just diagnosed with speech delay. This is one more illness that is affecting him. He also suffers from immune deficiency and deafness. All are related to his first year of life when he has faced severe chronic malnutrition. He looks normal, but the consequences are detrimental; this lack of food (hunger), at a critical moment in his early life, will hamper his ability to learn and hinder opportunities later in life.

This disturbing story may be the intolerable reality of children living in India or Ethiopia; but in fact, this story happens next door to us in America. Eden is one among other protagonists of a provoking documentary launched last month – A Place at the Table.

This documentary is thought-provoking mainly because it shows us that obesity and hunger are neighbours, our neighbours. Access to affordable nutritious foods in a world of plenty seems an unacceptable challenge for too many. In fact, this is increasingly the reality for many children living in both the developing and developed world, mainly because hunger and obesity are globally interconnected. We cannot pretend that it is not visible; it is in fact in our backyard. The burden of malnutrition is one major challenge in the context of the post-MDGs if we really want to achieve sustainable human development for every child in the world.

It is true that we have made significant progress over the past 50 years in the sector of population health. Life expectancies for men and women have increased. A greater proportion of deaths are taking place among people older than 70 years. The burdens of HIV and malaria are falling. Far fewer children younger than five years are dying. But this encouraging picture is being challenged by old and new threats. Africa remains the most afflicted continent, where maternal, newborn, and child mortality, along with a broad array of vaccine-preventable and other communicable diseases, are still urgent concerns. Malnutrition and stunting continue to be a long-term damaging stigma for children in Africa and South East Asia, with an estimated 75% of the world’s 165 million stunted children living there.

The link to extreme poverty is incontestable – as children in the poorest communities are more than twice as likely to be stunted, particularly in rural areas where as many as one third of children are affected.

On the other hand, more young and middle-aged adults in low and middle-income countries are suffering from obesity and diet-related non-communicable diseases (diabetes, hypertension, stoke and cardiovascular disease…). These diseases are driven primarily by phenotypic predisposition and high consumption of ultra-processed foods. With increasing urbanization and shifts in diet and lifestyle, the result could be an escalating epidemic of such conditions in many low- and middle-income countries. This would create new economic and social challenges, especially among vulnerable groups.

Fighting stunting is the emerging battle in the context of optimal human development. It is the irreversible impact of not receiving enough nutrient dense foods within the first 1000 days of life, from pregnancy to a child’s second birthday. But stunting is more than a problem of stature; this lack of nutritious food also impacts the overall physical (organ as well as immune cell function) and cognitive development, and determines the susceptibility to obesity and food-related non communicable diseases later in life.

During the first 1000 days, nutritional requirements to support rapid growth and development are very high, and the baby is totally dependent on others for nutrition, care and social interactions. For example, the first year of life is a time of astonishing change during which babies in normal conditions, on average, grow 55% in length, triple their birth weights and increase head circumference by 40%. Between 1 and 2 years age, an average child grows about 12 cm in length and gains about 3.5 kg in weight. During these crucial days as well as during fetal life, the body is putting together the fundamental human machinery (similar to hardware and software for computer). This process is done over a very short period of time and requires specific nutrients like vitamin A, iron, folic acid, zinc but also protein, long-chain polyunsaturated fatty acids and choline. The immune-system and brain-synapse development are particularly vulnerable. As a result, any disturbance of this frantic activity leaves a terrible mark. Smaller than their non-stunted peers, stunted children are more susceptible to sickness. In school, they often fall behind in class. They enter adulthood more likely to become overweight and more prone to non-communicable diseases. When they start work, they often earn less than their non-stunted co-workers. The drama of this situation is the fact that an undernourished mother is more likely to give birth to a stunted child, perpetuating a vicious cycle of high prevalence of premature death (an estimated 60-80% of neonatal deaths occur among low birth weight babies), undernutrition and poverty.

It is imperative to focus on the first 1000 days of a child’s life as the crucial window of opportunity for change. It is during this time that proper nutrition has the greatest impact on a child’s health and potential future wellbeing and opportunities. A recent publication in Lancet has reinforced this idea, and has showed that attaining optimal growth before 24 months of age is desirable; becoming stunted but then gaining weight disproportionately after 24 months is likely to increase the risk of becoming overweight and developing other health problems. UNICEF’s latest publication “Improving Child Nutrition: The achievable imperative for global progress” is closing the loop. It shows that there are proven low cost solutions for reducing stunting and other forms of undernutrition. These simple and proven nutrition activities need to be integrated together. They include improving women’s nutrition, early and exclusive breastfeeding, providing additional vitamins and minerals as well as giving appropriate nutrient dense foods, especially in pregnancy and the first two years of a child’s life.

Investing in children’s and women’s nutrition is not only the right thing to do from a human right point of view; it is also a cost-effective investment. It can increase a country’s gross domestic product (GDP) by at least 2-3% annually. Every US$1 spent on nutrition activities to reduce stunting will have a return on investment of US$30. This integrated nutritional strategy as proposed by UNICEF and other international stakeholders is the locomotive that can accelerate economic growth and pull millions of people out of poverty.

Let’s work all together to be sure that every children around the world has a place at the table. This is our responsibility!

This article was publish in the Ottawa Citizen last week. This is the link:

Don’t bring me the food that western people love!

Over the past few months, I was busy writing articles for different magazines and newspapers.

This is one of them: Don’t bring me the food that western people love!

OCIC article

This is part of a series of articles on food in the context of global development.

All the articles are really interesting. It will give you a different perspective on some key issues. But not only this, there is more. 

This is the link:

Hope you will enjoy the voyage…  

Focusing on linear growth and relative weight gain during early life – a winner ticket for human capital development and future adult health

We have seen in the previous blog that the children who are suffering from stunting (short stature) may look normal but the consequences of becoming and remaining stunted can be detrimental. In fact, we can observe an increased risk of morbidity and mortality, but also delays in cognitive (ability to think and understand) and physical development, which result in a decreased ability to learn and capacity to work.

In fact, stunted height (and not underweight) is a dreadful marker of multiple deprivations regarding food intake, care and play, clean water, good sanitation and health care. It is an important indicator of child well-being – not only physical growth but also cognitive and socio-emotional development.

These days, not only in the context of post Millennium Development Goals (MDGs) but also because of the importance to focus on sustainable human development, the key questions for nutritionists, pediatricians and policy makers are:

  • What is the optimum age for promotion of growth for enhanced survival and human capital?
  • Will this promotion necessarily lead to an increase in cardio-metabolic disease later in life?  

These aspects have their importance knowing that a lot of feeding programs in developing countries are aimed at older children, at a time where optimal linear growth is already compromise. For example, traditional school feeding programs that increase BMI with little effect on height might be doing more harm than good in terms of future health.


According to a study published in Lancet last month (see reference below), patterns already observed in the Western world are starting to be seen in low- and middle-income countries: i.e. putting on too much weight in relation to height in middle and late childhood (after 2 years old) can increase the risk for chronic diseases, such as diabetes, in later life.

This scientific analysis that involved five prospective birth cohort studies from Brazil, Guatemala, India, the Philippines, and South Africa showed that it is important to focus on improved nutrition in the first few years of life, i.e. the 1,000 days from the start of a woman’s pregnancy until her child’s 2nd birthday.

Their analysis showed that:

  • Higher birth weight is associated with an adult BMI of greater than 25 kg/m² (mostly lean body mass – muscle, which is good), and a reduced likelihood of short stature and of not completing secondary school,
  • Fast linear growth during the first 2 years of life is associated with increased adult height and amount of schooling,
  • Weight gain earlier in infancy is not associated later with any increased risk of chronic disease. In fact, it is good for the child, good for survival, giving some protection from adult chronic disease and better educational attainment,
  • Faster relative weight gain after the age of 2 years has little benefit for human capital, and weight gain after mid-childhood could lead to large adverse effects on later cardiovascular risk factors like elevated blood pressure. Notably, this is particularly true for weight gain that is not accompanied by height gain,
  • In fact, rapid weight gain should not be promoted after the age of 2–3 years in children who are underweight (weight for age) but not wasted (weight for height)

This study shows the importance to promote nutrition and linear growth during the first 1,000 days of life (from conception to age 2 years), and also reinforces the importance of prevention of rapid relative weight gain after age 2 years.

These findings have implications for present practices in low-income and middle-income countries, particularly emphasizing the need to monitor linear growth as well as weight, and to avoid promotion of excess weight gain in children older than 2 years. Optimum growth patterns in early life are likely to lead to less undernutrition, increased human capital, and reduced risks of obesity and non-communicable diseases, thus addressing both components of the double burden of nutrition.

According to one of the authors, Dr Fall: One of the challenges we are facing is the fact that we need to find ways to get very small children to be taller, and we don’t really know how to do it. More work is needed on imaginative interventions to specifically promote height growth, instead of weight gain. These could include exclusive breast-feeding, long-chain polyunsaturated fatty acids like DHA, high-quality protein, and micronutrients.

Mortality and undernutrition are falling substantially in most parts of the world, except for Sub-Saharan Africa, and new targets are being formulated to replace the present set of 2015 MDGs. A new goal for optimum linear growth that is expressed as a reduction in stunting can replace the present target of a reduction in underweight alone, which is one of the indicators for the first MDGs towards the eradication of extreme poverty. This new target can be associated with the assessment of developmental functioning using a set of indicators based on the Psychomotor Development Index (PDI) and Mental Development Index (MDI) of the Bayley Scales of Infant Development. This integrated approach will help to evaluate appropriately physical as well as cognitive and socio-emotional development, which is so important when building human capital.



Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Adair LS et al, Lancet 28th March 2013 (


The Toxic Truth About Sugar

Last September, for the first time in human history, the UN declared chronic non-communicable diseases as a greater health burden worldwide than infectious diseases.  This is a worldwide issue, with trends indicating that countries who have adopted Westernized diets (low cost, highly processed foods) are suffering from higher rates of obesity and related diseases.

Although obesity often is thought of as the root cause of the increase of non-communicable diseases, stats indicate that there are other culprits.  Since 20% of obese people have normal metabolism and will have a normal lifespan while 40% of normal-weight people will develop the diseases that constitute the metabolic syndrome indicating that obesity is not the main culpritObesity is not a cause, but a marker for metabolic dysfunction.  The announcement from the UN targets tobacco, alcohol and diet as the central risk for non-communicable diseases, yet governments are only regulating 2 (tobacco, and alcohol) to protect public health. The regulation of tobacco and alcohol, being that they are non-essential consumables, is easier than regulating food; a required human need.  What needs to be questioned is which aspect of the Western diet should be the focus of intervention?

The consumption of sugar has tripled worldwide in the past 50 years. Countries are relying on high fructose corn syrup (HFCS) and sucrose- equal parts glucose and fructose mixtures. Sugar is not just “empty calories”. Scientific evidence has showing that fructose can trigger processes that lead to liver toxicity and other chronic diseases.  International bodies must consider limiting fructose, HFCS, and sucrose as they pose a major threat to individuals and society as a whole.  Our whole food system is saturated with sugar laden foods.  As discussed in an earlier post corporate giants are saturating the global food market with toxic levels of glucose.

If one applies the same criteria that are widely accepted by the public-health community to justify the regulation of tobacco and alcohol, sugar consumption warrants some form of social intervention.  There are 4 criteria:

1) Unavoidable (pervasiveness in society)

Sugar was only available to our ancestors for a couple of months per year at harvest time or as honey. Now, sugar is just about added to all processed food.  On average we are consuming 500 calories of added sugar per day.

2) Toxicity

Epidemiological evidence suggests that excessive sugar impacts ones health more than just adding excessive calories but also induces all of the diseases associated with metabolic syndrome- hypertension, high triglycerides, insulin resistance, diabetes, aging. It can also be argued that fructose exerts toxic effects on the liver that are similar to those of alcohol.  This is no surprise since alcohol is derived from the fermentation of sugar.  Some early studies have also linked sugar consumption to human cancer and cognitive decline.

3) Potential for abuse

Like alcohol and tobacco, sugars act on the brain to encourage increased intake.  Sugar consumption suppresses the hormone ghrelin (signals hunger in the brain) and interferes with the normal signals of leptin (feeling of satiety).

4) Negative impact on society

Just as dunk driving and second hand smoking are reasons for alcohol and tobacco control, high sugar consumption has a long term economic, healthcare, and human cost of metabolic syndrome lending to reasons for higher levels of government control.   In the US, 75% of healthcare dollars are being spent on treating metabolic diseases and their resultant disabilities.


Sugar is a naturally occurring nutrient, but in excess it can become toxic.  When looking at successful tobacco and alcohol control strategies,there have been propositions to add taxes to processed foods (sugar-sweetened beverages, sugared cereals).  Already, Canada and European countries have imposed small additional taxes on some sweetened foods.  Another strategy is to limit hours of distribution through retailors and who can legally purchase the products.  With sugar, a parallel approach to this would mean tightening licensing requirements on vending machines and snack bars that sell sugary products in schools and workplaces.  But the question still exists as to the efficacy of this approach.


Government-imposed regulations on the marketing of alcohol to young people have been quite effective, but there is no attempt to follow suite with sugar.  A limit, or ideally a ban, on television commercials for products with added sugars could further protect children’s health.  Reduced fructose consumption could also be fostered through changes in subsidization towards more wholefoods instead of processed foods.

Ultimately, it comes down to a need for food producers and distributors to commit to reducing the amount of sugar added to foods.  Large government food agencies (ex:FDA, Health Canada) must commit to adjusting regulations and consider removing fructose from the Generally Regarded as Safe List (GRAS) that allows manufacturers to add an unlimited amounts of sugar to any food.  This larger industry change must be initiated through regulations because sugar is cheap, sugar tastes good, and sugar sells, so companies have little incentive to change unless required by policies.

Reducing sugar will not be easy, especially within the emerging markets of developing countries where soft drinks are often cheaper than potable water or milk.  For change to happen, all stakeholders must become actively engaged.   Population wide alterations to sugar consumption can occur just as bans on smoking in public spaces and the use of designated drivers has become the norm. With enough clamor for change, major adjustments with policy becomes possible.  It is critical for attention to be put towards sugar and its consumption in order to improve the state of public health and well being of populations .

Information from this post comes from an article in Nature titled The toxic truth about sugar.

ALARM: Corporate Giants Target Developing Countries

We all know that diabetes, obesity, and heart disease rates are soaring in developed countries. One major cause is related to the high consumption of processed foods and lack of physical activity. What you perhaps don’t know is the fact that multinational corporations are finding new ways of selling processed food to the poor.

As affluent western markets reach their saturation point, global food and drink firms like Nestle, Unilever, SABMiller, and Coca-Cola have been opening up new frontiers among people living on $2 a day in low- and middle-income countries. The world’s poor have become their vehicle for growth.

To achieve their business objectives, they deploy innovative strategies to target and reach the poor, even in the most remote areas. One of their slogans emphasizes the fact that they bring the kind of choices that the rich have enjoyed for years. Who can resist this argument when we know the attraction of the American and European lifestyle amongst people living in developing countries.  We know that highly processed food and drink are a vector for related lifestyle diseases in the USA and Europe; the impact will be more dramatic in developing countries.

As diets and lifestyles in developing countries change, their patterns of disease are following those seen in industrialized countries just as quickly. But for poor countries there is a double whammy: they will be faced with the non-communicable disease that result from caloric over-consumption before they can deal with hunger and malnutrition. The double burden is having a devastating impact on both economic growth and health care budgets.

Are food producers moving developing countries toward a model of society where the hole in one’s belly is filled with cheap, low-nutrient, empty-calorie foods to satisfy one’s hunger while neglecting to meet the body’s long-term nutritional needs?

In the food market, is the appeal of fortified foods greater to the consumers than fresh food?

Are human lives worthy of disregard in the pursuit of profit?

To read more about this important issue through the example of South Africa and the radical action plans that must  be put in place, go to:

To create positive changes within the current food system we must value tradition and culture around food, emphasize diversity in food, and see cooking as culinary art.  This mission of change needs to start at the school level with the young generation.

CKi is taking steps in this direction.