Hidden hunger and the COVID-19 pandemic

Saskia Osendarp, Aynsley Morris and Reed Atkin

In addition to the immediate impact to health and society, the COVID-19 pandemic may result in significant short- and long-term disruptions to food systems, resulting in decreased availability of nutritious foods, particularly for poor and vulnerable populations and a rise in the global prevalence of all forms of malnutrition, including micronutrient malnutrition or “Hidden Hunger”.

Nutritious foods are generally dense in micronutrients – vitamins and minerals your body requires in small amounts – that are critical for supporting optimal growth and development, and are important at every life stage. Whereas good micronutrient nutrition reduces the risk of infectious and non-communicable diseases; micronutrient malnutrition, also called “Hidden Hunger” impairs optimal growth and development.

Both food insecurity and the expanding availability of energy dense, ultra-processed foods result in micronutrient poor diets. The physiological processes of both undernutrition and overnutrition can further exacerbate the risk of micronutrient malnutrition.  Undernutrition can impair the ability of the gut to absorb micronutrients from the diet, whereas overnutrition may result in excess weight and chronic inflammation, and lead to impaired micronutrient absorption, particularly iron, in overweight individuals.

The COVID-19 pandemic presents both immediate and long-term nutrition challenges.  The pandemic immediately threatens food systems, particularly for vulnerable populations, and in the long run, will challenge the world’s ability to reach the Sustainable Development Goals. However, there are lessons to be learned from the pandemic, that deserves to be replicated for other global challenges. In response to COVID-19, governments have taken swift, drastic, context-specific actions to protect public health. The urgency of the pandemic is forcing the international community to act while building evidence and at the same time collecting, sharing and interpreting data on the pandemic to inform and fine-tune the future response. This is a worthwhile approach to consider for combating the malnutrition crisis as well.

During this crisis, the micronutrient community should take three steps.  First, to ensure all people have access to micronutrients at levels needed to promote health and prevent disease during the pandemic and beyond, the global nutrition and development community must promote effective programs and policies that we know work.  Second, invest in integrated food systems approaches that address all forms of malnutrition, including micronutrient deficiencies. Third, we must collect data to monitor the impact of our interventions, to further build the evidence base and to inform and fine-tune future policies.

To address immediate concerns, we must scale-up known cost-effective programs and interventions.  This includes the promotion of healthy and diverse diets and behavioral interventions such as the promotion of exclusive breastfeeding. In addition, other important evidence-based micronutrient interventions such as bio-fortification, food fortification, and supplementation, need to be scaled-up in specific contexts, as they are critical to support micronutrient nutrition, particularly for population groups with high needs, and in contexts where the required dietary shifts are not available or accessible. Countries currently working on a phasing out of high-dose vitamin A supplementation for young children may need to reconsider this decision during the pandemic, whereas other effective interventions, including maternal micronutrient supplementation, and large-scale flour fortification need to be accelerated.

To prevent a rise in all forms of malnutrition as a result of the pandemic, we need to work on so-called double- or triple-duty actions across the food system that tackle all forms of malnutrition. While we are still collecting evidence on how these integrated, multi-sectoral food system approaches best operate, we should ensure adequate monitoring systems are in place to document evidence on what worked and why. Examples of food system approaches with promise include price policies and cash vouchers, shown to be effective tools to change dietary patterns. These interventions can make micronutrient-dense foods, such as fruits and vegetables, more affordable and accessible to urban and rural poor.  In addition, new promising context-specific and targeted interventions can be made available to vulnerable families and communities to ensure adequate nutrition for specific target groups. For instance, eggs are a good source of essential nutrients for small children and have been shown to improve growth in some studies. Similarly, children 6 to 24 months of age who struggle to achieve adequate intakes from family diets, in addition to breastfeeding, have benefited from small-quantity lipid based nutrient supplements, a 20 g paste mix dense in energy, essential fatty acids and micronutrients that can be added to an infant porridge. Ongoing pilot projects aiming to increase the access to these relatively inexpensive products among low-income populations are worth scaling up at this time.

We have seen the nutrition-related challenges that disease outbreaks, both protracted and long-term, such as HIV and AIDS, and short-term, such as the 2014 Ebola outbreak have had and the long-lasting repercussions, particularly in countries with fragile health systems. If we are not careful, this pandemic may set us back several years in our efforts to deliver on SDG2. But it doesn’t have to – it is our collective responsibility to prevent this from happening and make sure that we continue to make progress on eliminating all forms of malnutrition by 2030.

This blog was first posted at https://nutritionconnect.org/news-events/hidden-hunger-and-covid-19-pandemic and is reposted here with permission

Article by: Saskia Osendarp, Aynsley Morris, Reed Atkin (Nutrition Connect)

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