Nutrition and Health in Developing Countries (Nutrition and Health)

588 Pages·2001·5.4 MB·English

by  Richard D. Semba

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N H D C
UTRITION AND EALTH IN EVELOPING OUNTRIES
N H
UTRITION AND EALTH
(cid:57) (cid:57)
Adrianne Bendich, Series Editor
The Management of Eating Disorders and Obesity,
edited by David J. Goldstein
Vitamin D: Physiology, Molecular Biology, and Clinical Applications,
edited by Michael F. Holick
Preventive Nutrition: The Comprehensive Guide for Health Professionals,
edited by Adrianne Bendich and Richard J. Deckelbaum
N H
UTRITION AND EALTH
D
IN EVELOPING
C
OUNTRIES
Edited by
R D. S , ,
ICHARD EMBA MD MPH
Department of Ophthalmology, Division of Ocular
Immunology, Johns Hopkins School of Medicine,
Baltimore, MD
and
M W. B , ,
ARTIN LOEM MD P D
H
Helen Keller International - Regional Headquarters,
Jakarta, Indonesia
Foreword by
N S. S , , ,
EVIN CRIMSHAW MD P D MPH
H
H P
UMANA RESS
T , N J
OTOWA EW ERSEY
© 2001 Humana Press Inc.
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Library of Congress Cataloging-in-Publication Data
Nutrition and health in Developing countries / edited by Richard D. Semba and Martin
W. Bloem.
p.cm.
Includes bibliograpical references and index.
ISBN 0-89603-806-8 (alk. paper)
1. Malnutrition--Developing countries. 2.Nutrition--Developing countries. 3. Public
health--Developing countries. I. Semba, Richard D. II. Bloem, Martin W.
RA645.N87 N847 2001
613.2’09172’4--dc21 2001024072
DEDICATION
To our parents, who struggled to bring a better life for the next generation: Hannah
Semba and the late Thomas T. Semba, Japanese-Americans interned in the Tule Lake and
Heart Mountain “relocation” camps, and Alexander and Jacqueline Bloem, Dutch-Indo-
nesians and survivors of the Sumatra railway “work camp”, the Kramat camp, and the
sinking of the Junyo Maruby the British submarine, HMS Tradewind, off the west coast
of Sumatra.
v

SERIES INTRODUCTION
The Nutrition and Health series of books have, as an overriding mission, to provide
health professionals with texts that are considered essential because each includes: 1) a
synthesis of the state of the science, 2) timely, in-depth reviews by the leading researchers
in their respective fields, 3) extensive, up-to-date fully annotated reference lists, 4) a
detailed index, 5) relevant tables and figures, 6) identification of paradigm shifts and the
consequences, 7) virtually no overlap of information between chapters, but targeted,
inter-chapter referrals, 8) suggestions of areas for future research and 9) balanced, data-
driven answers to patient /health professionals questions which are based upon the total-
ity of evidence rather than the findings of any single study.
The series volumes are not the outcome of a symposium. Rather, each editor has the
potential to examine a chosen area with a broad perspective, both in subject matter as well
as in the choice of chapter authors. The international perspective, especially with regard
to public health initiatives, is emphasized where appropriate. The editors, whose trainings
are both research and practice oriented, have the opportunity to develop a primary objec-
tive for their book; define the scope and focus, and then invite the leading authorities from
around the world to be part of their initiative. The authors are encouraged to provide an
overview of the field, discuss their own research and relate the research findings to
potential human health consequences. Because each book is developed de novo, the
chapters can be coordinated so that the resulting volume imparts greater knowledge than
the sum of the information contained in the individual chapters.
“Nutrition and Health in Developing Countries”, edited by Richard D. Semba and
Martin W. Bloem represents, what I believe to be, the most comprehensive overview of
the state of the field of international nutrition available to date. Both editors have exten-
sive field as well as laboratory bench expertise; thus their in-depth knowledge of the
interactions of nutritional status and its impact on global health provide them with the
insights to biological as well as public health issues. Of equal importance, as leaders of
this field, they have been able to include chapters by the world’s greatest experts.
The editors have achieved their goal of providing readers with comprehensive chap-
ters that are internally consistent in their style and format, that build upon the knowledge
in prior chapters while educating the reader to better comprehend the information in
subsequent chapters. Each author also provides an historic perspective as well as high-
lighting important areas for future research. This volume concentrates on five of the most
critical questions in public health nutrition today. These questions include: who is af-
fected and secondly what diseases are of greatest importance with regard to A) effects on
nutritional status as well as B) effects of nutritional status on increasing the risk of disease
acquisition? The editors have developed these sections so that readers, who are new to
this area of nutrition, can begin with examination of the major health, and thus nutrition-
related problems seen in developing countries and the population groups most affected.
These chapters include well-organized information on malaria, tuberculosis, HIV,
measles, diarrhea, and lower respiratory tract infections and the populations at greatest
risk for these adverse health conditions. Readers who are knowledgeable will also benefit
from these and all other chapters because each contains well-organized tables and rel-
evant figures and an extensive bibliography that helps to synthesize the complexities
vii
viii Series Introduction
inherent in the review of fifty or more years of research. Thirdly, what are the major
nutritional deficits? Separate chapters are devoted to vitamin A, iron, iodine, zinc, mul-
tiple micronutrient deficiencies as well as overall macronutrient undernutrition. Next,
there are critical reviews of the current and future scenarios that include the shifting
importance between under and overnutrition (obesity), rural to urban shifts in popula-
tions, increased exposure to environmental hazards including pollution, food- and water
borne contaminants and other factors that are affected by changes in socioeconomic
factors. Finally, there are critical insights into the relevance of nutritional interventions
in developing countries. The chapters include a systematic cost effectiveness analysis of
intervention programs, two sensitive reviews of the difficulties of both implementing as
well as then analyzing the effectiveness of nutrition programs. The concluding chapter
places in perspective the multifaceted requirements to affect global policies, even in areas
of agreement, such as the improvement of the nutritional status of individuals at greatest
risk in developing countries.
Nutrition and Health in Developing Countries, as the most comprehensive reference
text in the field, provides health professionals at all levels of care as well as policy makers
and program designers and implementers with balanced, referenced facts and data on
which to base sound recommendations. This volume is of equal importance in the edu-
cation of the next generation of health care professionals interested in improving global
health, as nutrition remains the key to success.
Adrianne Bendich, PhD
GlaxoSmithKline,
Parsippany, NJ
FOREWORD
The most significant advance over the past two centuries has been the improvement
in human health as judged by mortality rates, life expectancy and gains in height. Although
this has been most dramatic in the industrialized countries, it has already extended to the
more advanced developing countries and influenced even the most backward. Most of
this improvement has been in mortality attributed to infectious diseases. It is not suffi-
ciently recognized, however, that in Europe and other advanced regions in the past
century most of the spectacular decreases in mortality from pneumonia, bronchitis, influ-
enza, diphtheria and the other common communicable diseases of childhood occurred
largely before the availability of vaccines and specific therapies.
A thorough analysis of possible factors has led to the conclusion that improvements
in nutrition were primarily responsible. In developing countries today most deaths attrib-
uted to diarrheal and respiratory disease would not have occurred in well nourished
children. The classical nutritional deficiency diseases of scurvy, beri-beri, pellagra, and
most recently kwashiorkor have also largely disappeared from the world. It is significant
that these and other clinical nutritional disorders are usually precipitated by episodes of
infectious disease superimposed on an already inadequate diet.
This is a new kind of nutrition book. It not only examines all of the nutritional disorders
prevalent in developing countries but also recognizes the synergistic interactions of
nutrition and infections. It is quite appropriate that chapters deal with diarrheal diseases,
acute respiratory infections, measles, malaria, tuberculosis, and human immunodefi-
ciency virus infections. Other chapters explore major new problems for developing coun-
tries, that include the increase in chronic degenerative diseases, such as coronary heart
disease, hypertension, and adult onset diabetes that are a consequences of growing afflu-
ence. These diseases will increasingly plague the developing countries in this century.
Maternal, fetal, perinatal, and child nutrition issues are also well covered.
A book is needed at the beginning of this new century that examines nutrition and
health, past, present, and future in developing countries. This volume does so
comprehensivel and authoritatively. It provides clear guidelines for improving nutrition
and health in developing countries in the 21st century. It goes well beyond examining the
epidemiology of acute and chronic nutrition-related disorders including infectious dis-
eases. It also explores issues, urbanization, food, and nutrition security, the impact of
nutrition and health programs, the economics of nutritional intervention, planning and
policy development, and the nutritional and health significance of the epidemiological
and demographic transition in developing countries.
While improvements in health are to a major degree the result of social and economic
development, they also contribute to further development by enabling populations to
utilize better education and technology. Evidence is mounting that fetal and infant mal-
nutrition can permanently affect cognitive performance and increase susceptibility to the
chronic degenerative diseases of later life. Extending the improvements in nutrition,
health and life expectancy in the industrialized countries during late 19thand 20thcen-
turies to developing countries is a major challenge of the 21stcentury. Achieving peace
within and among developing countries is another major challenge but as long as there
are large differences in the health of populations, peace will continue to be elusive.
ix