Nutrition today matters tomorrow
An estimated 132 million babies were born worldwide in 1998. In the cycle of life, a baby's birth marks a new beginning; but unfortunately, not every baby has an equal chance for optimal growth or survival. Optimal human development is dependent on several factors, including socioeconomic status, genetics, the environment and nutrition. Nutritional status impacts an individual's ability to grow, to learn, to work, and to fight disease.
Worldwide, improvements in national and household incomes have contributed to improved nutritional status over the past 50 years. In addition, nutrition interventions, particularly those targeted at vulnerable groups, have resulted in significant improvements in nutritional status.
However, most of these successful nutrition interventions were originally implemented with a specific focus on undernutrition and/or specific nutrient deficiencies. In the past several decades, nutrition problems worldwide have expanded to include both concerns of underconsumption and problems of imbalances and excesses. While undernutrition and food insecurity are still massive problems in many developing countries, health data also indicate soaring rates of diabetes, obesity, cancer and cardiovascular disease. In order to respond to these new "faces of nutrition," we need a paradigm shift in our interventions. Interventions in the 21st century will differ in three key aspects.
First, interventions must now focus on strategies to promote healthful living by concentrating primarily on healthy eating and physical activity. Interventions will need to build on past successes but go beyond a direct service model; it's not enough to provide a meal or a pill. Models of successful, sustainable interventions for healthy lifestyles will need to draw heavily on social marketing and the health communications fields to mount interventions that are effective in promoting behavior change.
Second, the new nutrition paradigms will need to focus on prevention rather than cure. Most of the earlier successes in nutrition focused on an underlying therapeutic model. Stunted children or children with low weight for age were the targets for nutrition services. We now know from vast scientific literature summarized in this report that dramatic improvements in nutritional status worldwide will occur from preventive nutrition efforts.
Third, if policymakers and implementers are truly interested in preventive nutrition, the target of interventions needs to shift to a different part of the life cycle. Investment in the preconceptional female will yield enormous nutritional benefits in other parts of the life cycle. We know unequivocally that healthier females—before pregnancy — are more likely to produce healthier babies, who develop into healthier children. This last point is critical. Most previous interventions have not effectively reached preconceptional females.
The newer paradigms of nutrition — promoting healthy lifestyles, focusing on prevention, and targeting the preconceptional female—offer enormous potential for achieving significant improvements in health and nutrition worldwide. That is why in 1999, the March of Dimes, driven by its mission to improve the health of babies, convened a 29-member international task force of nutrition scientists, administrators and policy-makers. The report, Nutrition Today Matters Tomorrow, is the outcome of two years work by Task Force members.
For whom is the report intended?
The report will be useful for those who make or influence policies that affect nutrition and health at the community, regional or national levels and for those who provide nutrition or health services to women, infants, and young children or who supervise those who do. Examples of individuals who could make a difference include: state nutritionists, hospital administrators, nurses and physicians, public health managers and policy-makers at all levels, and managers working for government and nongovernment organizations. Working collaboratively at all levels, it will take a variety of individuals, organizations, and interventions to improve health outcomes for women and children around the world.
Nutrition is everyone's challenge, but no one's sole responsibility. To help our target audience understand their potential contributions, the Task Force identified five types of actions that can lead to optimal nutrition for women and children, including:
- Personal actions such as food choices, food safety practices, and physical activity
- Community actions such as the availability of nutritious and safe foods, outreach services and educational opportunities
- Health care provider actions such as the reinforcement of community health messages and the acquisition and use of knowledge related to the life cycle perspective and nutritional influences on health
- Regional actions such as the dissemination of this report, an action-oriented agenda and educational tools; technical assistance in developing community-specific food-based healthy eating guidelines and intervention strategies
- National and international actions such as the development of nutrition and food safety policies; infrastructure to provide a nutritionally adequate and safe food supply, education, supplementation and/or fortification if necessary; and the implementation of appropriate world health resolutions and codes
What are the goals of the report?
The report is the blueprint to tackle the new "faces of nutrition" by providing information and implementation steps to help prevent the major nutrition problems of preconceptional, pregnant and lactating women, and of children under 2 years of age. Specifically, the Task Force carefully considered how to provide recommendations and implementation strategies that would incorporate food-based healthy eating recommendations and a life cycle perspective focused on women and very young children.
What is a lifecycle perspective?
A life cycle perspective, in physiological terms, is an important public health concept because conditions early in life — even before birth — may affect an individual’s health, growth and development over his or her life span. Similarly, certain health conditions may affect the health and growth of a woman’s offspring as well.
Women’s nutritional status before conception may contribute to positive or negative outcomes during pregnancy and in the infant. For example:
- Women with low folate status in the periconceptional period are at significantly elevated risk of giving birth to a child with spina bifida or a related neurological defect.
- Women who are underweight before pregnancy, particularly immature adolescents, have a higher risk of giving birth to a low-birthweight infant.
- Women who are obese before conception may experience complications during pregnancy and childbirth. In addition, they are at higher risk of having babies with congenital malformations.
In addition, many of the health problems faced by women and their young children are interrelated, such as the following:
- Vitamin and mineral deficiencies and low birthweight contribute to the impaired growth and development of infants and young children.
- Mothers who were low-birthweight at birth are at increased risk of delivering a low birthweight infant.
- Mothers who are overweight/obese prior to conception or as a result of excessive weight retention after pregnancy are at an increased risk for a variety of diseases later in life.
Good nutrition at each of these stages of the life cycle contributes to optimal growth and development of infants and children and a healthier adult population. The Task Force fully recognizes that the nutrition of older children is important, as is the nutrition of adolescent boys and of men. Nonetheless, it is the women, infants, and very young children who are most vulnerable. Attending to their nutrition is most crucial for ensuring a healthy start.
How is the report organized?
The report reviews central themes, issues or problems that are particularly important for women and very young children. These include:
- Nutritious and safe food matters
- Healthy eating matters
- Healthy weight matters
- Early nutrition matters
Each section answers a series of questions to help readers understand why action is needed and why certain types of action are helpful in preventing or alleviating selected public health problems. The report closes with steps for implementing recommendations and selected international examples of programs that address one or more of the report’s recommendations.
What are the key messages and recommendations?
The recommendations throughout this report support a food-based approach. Emphasizing food rather than nutrients or pills helps make people self-reliant in terms of meeting their nutritional needs. Food-based healthy eating guidelines that may include fortified foods offer a feasible, effective and sustainable approach to promote healthy eating by the population in general and to address nutrition problems in vulnerable groups. Recommendations for supplementation strategies are described where found to be effective in improving health status.
The report builds on work done by researchers and providers around the world and conveys the following major nutrition and implementation messages:
- Nutritious and safe food matters: Food-based healthy eating guidelines that address women’s and young children’s nutritional needs, combined with food safety messages and policies, are critically important to improve health outcomes.
- Healthy eating matters: Sufficient intake of important vitamins and minerals support growth and development, both today and in the future.
- Healthy weight matters: Maintaining a healthy weight can benefit women and their potential offspring.
- Early nutrition matters: Adequate nutrition very early in life can help to avoid adverse consequences now and in the future.
- Sustainable action plans: These plans require involvement from the target population, community leaders, health care providers and policymakers; review of existing nutrition interventions; constructive partnerships; and tailored project plans to address local needs.