Nutrition, Malnutrition and Food

Security
Basic concepts and current Syria
situation
Food and Nutrition

©FAO/ Sergey Kozmin

Nutrition, Food and Nutrient

Nutrition

“The intake of food, and

the interplay of
biological, social, and
economic processes that
influence the growth,
function and repair of
the body.”
Nutritional Status
Nutritional status

Body’s ability to
Nutrient
Nutrient intake digest, absorb and
requirements
use nutrients
Nutrient Intake
Nutrient intake refers to the different nutrients taken in by the
body.
There are 2 main types of nutrients:
Macronutrients Micronutrients

Fats
Vitamins
Protein
Macrominerals
Water
Microminerals
Carbohydrates (“trace elements”)
Nutrient Requirements
The different nutrients needed by the body for
energy, growth and repair, and protection from
disease.

2’100 Kcal :
• MACRONUTRIENTS
> 50% from carbohydrates
10 - 13% from proteins
< 20 from fat
• MICRONUTRIENTS: Vitamins and minerals
Nutrient Requirements

Differ according to the age, gender,

level of physical activity, height,
weight, stage of life, and health
status of each individual.
A Balanced Diet
A diet that provides an adequate amount and variety of food to meet a
person's energy and nutrient requirements for a healthy and active life.

It must be composed of a variety of foods from different food groups:

Drink plenty of water

Vegetables

Meat, Eggs,
Staples
Fish, Dairy

Fruits
Fats and
Oils
Sugars
Malnutrition

©FAO/Eddie Gerald
Identifying Those with Malnutrition
Below are 4 children who are the same age. Who do you think may be
malnourished?
Identifying Those with Malnutrition

   
What is Malnutrition and What Does it
Include?
Malnutrition

The term malnutrition indicates an inadequate nutritional

status:

“An abnormal physiological condition caused by deficiencies,

excesses or imbalances in energy and/or nutrients necessary
for an active, healthy life.

Malnutrition includes overweight and obesity, undernutrition,

as well as micronutrient deficiencies.”
Overweight and obesity

Malnutrition

Overweight
and obesity

“Body weight that is above normal for height as a

result of an excessive accumulation of fat. It is
usually a result of excessive food intake relative to
dietary nutrient requirements.”
Undernutrition
Malnutrition

Overweight
Undernutrition
and obesity

“The outcome of insufficient food intake to meet

dietary energy requirements, and/or poor absorption
and/or poor biological use of nutrients consumed as a
result of repeated infectious disease.
Micronutrient deficiencies

Malnutrition

Overweight Micronutrient
Undernutrition
and obesity deficiencies

“Lack of vitamins, minerals and/or trace

elements required in small amounts which
are essential for the proper functioning,
growth and metabolism of a living organism.”
Overweight & Obesity in Syria

Pre-crisis Syria
- 45% of deaths
attributable to
Cardiovascular
Disease

- Half of 45-65 year

old women had
hypertension
© WHO, 2011

- 15% of the
population had
type 2 Diabetes
Severe Acute Malnutrition in SYRIA

• Is characterised by extreme weight loss, resulting in low

weight for height, and/or bilateral oedema.
• High risk of morbidity & mortality

• Global Acute Malnutrition Rate : 7.2%

• Northern Syria : Idleb 1.1%, Aleppo 1.3%, Hama 2.4%
• Gaps in current data- Besieged and hard to reach areas
Chronic Malnutrition (or Stunting)

• Long-term malnutrition as a result of

inadequate intake or repeated infections, or
both.

• Low height for age

• Can impair physical and/or mental

development. ©UNICEF, Dragaj

Two girls, both 5 years old, in Kabul.

The girl on the left suffers from stunting.
SYRIA Stunting Rate
Pre-crisis: 23%
Current: 22.3%
Hama: 26%
Micronutrient Deficiencies
Based on the symptoms described, in which
micronutrient is each group deficient?

Iodine Vitamin A Zinc Iron

Group 1 Group 2 Group 3

• Low hemoglobin • Night blindness • Extreme fatigue
• Goiter
• Pale palms and inner • Slow bone
• Severe risk of brain
eyelids development impairment during
• Fatigue and reduced • Weak immune fetal development and
work productivity system in the first few years
of life

Pale palms Night Goiter

blindness
Micronutrient Deficiencies
Based on the symptoms described, in which
micronutrient is each group deficient?

Zinc

Iron Vitamin A Iodine

Group 1 Group 2 Group 3
• Low hemoglobin • Night blindness • Extreme fatigue
• Goiter
• Pale palms and inner • Slow bone
• Severe risk of brain
eyelids development impairment during
• Fatigue and reduced • Weak immune fetal development and
work productivity system in the first few years
of life

Pale palms Night Goiter

blindness
Micronutrient Deficiencies in Syria

Pre-Crisis: Vitamin A Iodine Iron

8.7% 12.9% 29.2%

Current Iron deficiency Anaemia

Situation:
Syrian Refugees, IDPs in Idleb & Aleppo,
children 6-59 months: children 6-59 months:
48.7% 37%
Triple burden of malnutrition in Syria

Malnutrition

Overweight and Micronutrient

Undernutrition
obesity deficiencies

Coronary Heart Stunting Iron

disease Wasting Vitamin A
Hypertension Iodine
Diabetes
Hypertension
Cancer
Malnutrition Throughout the Life Cycle
The 1000 days
PHYSIOLOGICAL Vulnerabilities TO Malnutrition
• The first 1000 days of life
 Pregnant and lactating
women
 Children below 2 years old
• Sick patients:
 chronic (HIV/TB)
 acute (surgery)
• Elderly
SOCIO-ECONOMICAL Vulnerabilities TO
Malnutrition

• Livelihood groups facing a shock

• Cyclical insecurity
• Children in the poorest households are
more than twice as likely to be stunted
as children in the richest households
Causes of Malnutrition
Nutritional status is influenced by
multiple and interrelated factors.

The most important factors can

be grouped under these broad
categories:

• FOOD

• HEALTH AND SANITATION ©FAO/Alberto Conti

• CARE AND FEEDING PRACTICES

UNICEF Malnutrition Conceptual Framework
Nutrition-sensitive interventions

Nutrition-specific interventions address the immediate

causes of malnutrition

Nutrition-sensitive interventions address the underlying

causes of malnutrition
Framework for actions
to achieve optimum foetal and child nutrition and
development, 2013 Lancet series
Take home messages

• Determinants of malnutrition are

multi-sectoral: food intake, access
to food, health, care, water and
sanitation, gender…
• Agreeing on malnutrition causes
leads to design joint actions
Food Security
The Definition of Food Security

“All people, at all times,

have physical and
economic access to
sufficient, safe and
nutritious food to meet
their dietary needs and
food preferences for an
©FAO/IFADWFP/Petterik Wiggers
active and healthy life.”
The Four Pillars of Food Security

The metabolism of food by individuals Food utilization

The ability of an individual or household to obtain food over

Food stability
time

The supply of food through production, distribution, and Food

exchange availability
The affordability and allocation of food, as well as the
Food access
preferences of individuals and households
 From Food Security to Food and
Nutrition Security

Food Security Nutrition Security “All people at all times consume

food of sufficient quantity and
quality in terms of variety,
diversity, nutrient content and
safety to meet their dietary needs
and food preferences for an active
and healthy life, coupled with a
©FAO/Petterik Wiggers
©FAO/Ivan Grifi sanitary environment, adequate
health and care.”
Nutrition Security and How it Differs from
Food Security

Nutrition
Food Security Security
 Causes of Nutrition Insecurity in Syria

FOOD SECURITY
• 8.7 million people are unable to meet their basic food
needs
• Crop production impacted by high labour cost, shortages of
workers, crop destruction and fragmented markets with
disrupted supply chains and severe damage to mills and
bakeries
• Food production is 40% below pre-crisis levels
• In besieged areas, tens of thousands of people subsist on
grass and weeds while warring parties prevent access to
food and essential medicine
 Causes of Nutrition Insecurity in Syria

HEALTH
• June - August 2015, one healthcare facility struck by aerial attacks
every two days, severely Disrupting the provision of services
• 42 per cent of pregnant women scheduling caesarian sections to
plan deliveries rather than risk going into labour amidst conflict
• Only 45 per cent of the pre-conflict health work force is active
inside Syria.
• Over 1 million children under five have not been reached by routine
immunization

WASH
• 70% of the population lacks access to safe drinking water
• There has been an increase of the occurrence and spread of Water Born
Diseases, especially acute bloody diarrhoea, particularly in children < 5 yrs