BRAZIL THE CHANGING FACE OF MALNUTRITION Almost every country in the world, low-, middle- or high-income, faces some form of malnutrition including undernutrition, overweight/ obesity, or a combination of these conditions. This overlap of different types of malnutrition — undernutrition (e.g., stunting, vitamin and mineral deficiencies) co-existing with increasing rates of overweight and obesity — is known as the double burden of malnutrition. While stunting and vitamin and mineral deficiencies remain high in many low- and middle-income countries, rising income, urbanization, changes in diet and reductions in physical activity also are driving a transition to the co-existence of undernutrition and overweight/obesity. The double burden presents enormous health, social and economic challenges to countries and action is needed now to address this changing face of malnutrition. Stunting (being too short for age) in young children is the result of undernutrition in the womb and early in life. In young children, stunting also is associated with poor brain development and educational performance, which leads to lower adult wages and lost productivity. When accompanied by excessive weight gain later in childhood, stunting is associated with increased risk of nutrition-related chronic diseases, such as diabetes. BRAZIL TRENDS FROM 1980 - 2013 Nutritional transition in Brazil 60% has resulted in an increase in overweight and obesity in adults by at least three-fold compared with that of undernutrition3 50% 40% STUNTING IN CHILDREN UNDER AGE 5: 5.6%2 30% 20% 1,055,000 CHILDREN 10% OVERWEIGHT IN CHILDREN UNDER AGE 5: 7.1%2 0% 1980s 1990s 2000s 2010-2013 Overweight and obesity in girls younger than 20 increased 74%1 Overweight and obesity in boys younger than 20 increased 83%1 Overweight and obesity in women age 20 and older increased 34%1 Overweight and obesity in men age 20 and older increased 39%1 Stunting in children under 5 has decreased from 19.4% in 1989 to 7.1% in 20072 1,085,000 CHILDREN CHILDHOOD MALNUTRITIONBriefIN BRAZIL overview of hurdles, causes, contributors to malnutrition CAUSES Vitamin and mineral deficiencies Breastfeeding practices A lack of essential vitamins and minerals increases the risk of infectious illnesses and can lead to anemia, poor growth and nutritionrelated diseases such as blindness, rickets, goiter and neural tube defects. Iron deficiency can lead to anemia, impaired physical and cognitive development and increased risk of morbidity in children. Maternal iron deficiency can cause anemia and is associated with increased risk of maternal mortality and delivering a low birth weight baby, which can cause further childhood growth restrictions. Optimal breastfeeding can prevent undernutrition and can potentially prevent obesity and non-communicable diseases later in life. Vitamin A deficiency can lead to decreased immune function, increased morbidity and mortality, and blindness. Exclusive breastfeeding (breast milk only) for the first six months of life followed by continued breastfeeding until two years of age and beyond gives babies the foundation for optimal health and development. 13% 2 20% 2 41% 2 22% 4 of women of reproductive age are anemic of preschool-age children are vitamin A deficient of babies were exclusively breastfed for the first six months of life of children under five are anemic EFFECTS Non-communicable diseases 19% 5 of premature deaths These non-communicable diseases are associated with unhealthy diet, sedentary lifestyles and overweight/obesity. Ischemic heart disease, stroke, and diabetes are among the leading causes of loss of healthy life in Brazil.6 Undernutrition in the form of stunting is associated with increased risk of nutritionrelated non-communicable diseases when accompanied by excessive weight gain later in childhood. High blood pressure High blood pressure is a leading cause of death and a major risk factor for heart disease. Sources: 1 Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 6736: 766–81. 2 International Food Policy Research Institute. Nutrition Country Profile: Brazil. 2014. http:// globalnutritionreport.org/files/2014/11/ gnr14_cp_brazil.pdf (accessed Jan 15, 2015) 3 Conde WL, Monteiro CA. Nutrition transition and double burden of undernutrition and excess of weight in Brazil. Am J Clin Nutr 2014; 100: 1617S – 22S. 48% 5 in men Stevens, G. A., et al. 2013. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: A systematic analysis of population-representative data. The Lancet Global Health 2013: 1: e16-e25. 4 37% 5 in women World Health Organization. Noncommunicable Diseases Country Profiles: Brazil. 2014. http:// www.who.int/nmh/countries/bra_en.pdf?ua=1 (accessed Jan 15, 2015) 5 Victora CG, Barreto ML, Do Carmo Leal M, et al. Health conditions and health-policy innovations in Brazil: The way forward. Lancet 2011; 377: 2042–53. 6 Scaling Up Nutrition, or SUN, is founded on the principle that all people have a right to food and good nutrition. It unites people—from governments, civil society, the United Nations, donors, businesses and researchers—in a collective effort to improve nutrition. Nutrilite™ is the world’s number one selling vitamins and dietary supplements brand*. For more information, please visit globalnews.amway.com. *Euromonitor International Limited, www.euromonitor.com/amwayclaims Thanks to The Global Alliance for Improved Nutrition (GAIN) for providing technical assistance.