Nutrition related health problems in preschool children

Citation

(2006), "Nutrition related health problems in preschool children", Nutrition & Food Science, Vol. 36 No. 3. https://doi.org/10.1108/nfs.2006.01736cab.013

Nutrition related health problems in preschool children

Nutrition related health problems in preschool children

International pre-congress symposium of the 18th International Congress of Nutrition (19 September 2005, Durban) to present nutrition solutions to optimise growth and development of preschool-aged children

Among preschool-aged children, the most prevalent forms of micronutrient deficiencies are those of vitamin A, iron, and iodine which have shown to profoundly affect childhood survival, educational achievement and overall resistance to illness. Calcium, zinc and vitamin D, the so-called neglected micronutrient deficiencies, urgently require immediate attention and action (Table I).

Table I Prevalence of micronutrient deficiencies in preschool children in developing and developed countries/Some key examples

Iron deficiency (ID) is the leading nutritional deficiency in the world. The negative impact of ID on health of children is greatest in the developing world (sub-Saharan Africa, Southeast Asia, the eastern Mediterranean, and some areas of Latin America), where it is estimated that 51 per cent of children younger than four years of age are anaemic.

Today, it is estimated that 127 million preschool children are vitamin A deficient. Another 4.4 million preschool children in the developing world (India, South and Southeast Asia and Africa) suffer from clinical signs of VAD (progressive eye disorders such as xerophthalmia).

The problem of iodine deficiency is especially serious in young children posing health problems in nearly every country of Africa and Southeast Asia, the eastern Mediterranean and more than half the countries of Europe and in the Americas.

The precise extent of calcium, vitamin D and zinc deficiencies are not certain yet, but preschoolers in developing countries (South and Southeast Asia, sub-Saharan Africa, Central and the Andean part of South America) and developed countries (Europe and North America) are most often affected.

One obvious cause of under-nutrition is lack of household access to sufficient food, due to food shortage for economic, environmental or other problems. In this situation, lactating mothers are also likely to be nutrient-depleted, which can lower the amount of nutrients in breast milk and cause very early depletion of the young child. A more common cause of under-nutrition is probably poor dietary quality, either due to lack of animal source foods and a variety of plant source foods at the household level, or to problems related to feeding of young children. These include lack of caretaker awareness of appropriate nutritional practices; provision of important foods in a form that is unacceptable to the infant or difficult to eat (such as pieces of meat); and inappropriate feeding practices. Over-nutrition (obesity) is often associated with socio-economic aspects which lead to nutritional transition or the increased consumption of animal protein and high fat.

Micronutrient deficiencies (under-nutrition) have important immediate effects on growth, intellectual capacity and immunity. Vitamin A Deficiency in children impairs growth, development, vision and the immune system, and in extreme cases leads to blindness and death. Consequences of Iron deficiency include poor cognitive, intellectual and social development. Iodine deficiency can cause severe mental and physical retardation, known as cretinism. In a chronic form iodine deficiency can cause goitre, a disorder characterised by swelling of the thyroid gland. Calcium deficiency does not seem to impair children's growth, but may reduce their bone mineralization and may lead to osteoporosis in later life. Zinc deficiency can contribute to impaired growth, increased susceptibility to infectious diseases and cognitive and motor functioning while deficiency in calcium and vitamin D can lead to rickets. Children with vitamin D deficiency are at greater risk for stunted growth and weakened bones that are prone to fractures and osteoporosis later in life (Table II).

Table II Consequences of micronutrient deficiencies in preschool children

Over-nutrition, or the ingestion of excessive amounts of nutrients, can result in health problems in preschoolers that are just as serious as those caused by vitamin and mineral deficiencies: obesity with the associated risk of hyperlipidemia, hypertension, and abnormal glucose tolerance.

Childhood obesity is a serious problem because it is an important predictor of adult obesity. About one third of obese preschool-aged children become obese adults. The risk of hyperlipidemia, hypertension, and abnormal glucose tolerance is somewhat higher among obese children. Childhood obesity is already epidemic in some areas and on the rise in others. Today, it is estimated that, worldwide, 22 million children under five years of age are overweight.

In the USA over 10 per cent of preschool children between ages 2 and 5 are overweight. Childhood overweight rates in Europe range from 10 to 20 per cent in Northern Europe and higher still in Southern Europe - from 20 per cent to as high as 36 per cent in parts of Southern Italy In developing countries among preschool children, the countries with the highest rate of overweight are located in the Middle East, North Africa and Latin America.

Based on its success in industrialised countries, food fortification, with the support of the food industry, is now considered a long-term intervention to resolve deficiencies. Fortification can contribute to reducing child mortality, optimising child growth and development, enhancing physical and intellectual performance, eliminating nutritional blindness, goitre and cretinism, stunting, anaemia and reducing the risk of chronic disease in later life. Food fortification is a cost-effective solution: It is a small investment (a few cents per person per year) and produces measurable results. Successful examples include vitamin A fortification with milk, margarine and sugar, iron fortification with flours, breakfast cereals, biscuits, infant and dairy foods, iodine fortification with salt, and vitamin D fortification with milk. This year, new food fortification projects for preschoolers were launched in Cote d'Ivoire, Morocco and Uzbekistan.

Supplementation refers to the provision of oral supplements in capsule, tablet or syrup or sachet form. A novel concept for supplementation is Sprinkles: single-dose sachets or packages containing micronutrients (iron, zinc and vitamins A, C and D, and folic acid) in a powder form, which are easily sprinkled onto any foods prepared in the household. Preliminary efficacy studies using Sprinkles conducted in Ghana, West Africa, between 1998 and 2001 have shown successful treatment of anaemia among 60-70 per cent of infants within two months. Nutrition communication should be part of any project with nutrition improvement goals, especially those with less specific nutrition content, such as poverty alleviation, income generation, health reform, food security and female education.

For further information, please contact: Protein Health Communications, Winny Ooms, tel: +32 2 644 26 60, fax: +32 2 646 62 64, e-mail: wooms@protein-healthcom.be