3. Marco de Referencia
3.1 Antecedentes o Estudios Previos
Undernutrition is clearly a major contributing factor to child death, illness and disability. Child malnutrition, including fetal malnutrition caused by maternal undernutrition, was estimated by the Lancet to be the cause of 45% of global child deaths in 2011.28 Child undernutrition also increases the risk of death from infectious
diseases, such as diarrhoea, pneumonia and measles, but not malaria. Fetal growth restriction causes 12% of neonatal deaths, while stunting and wasting cause 14% and 13% of under-five child deaths, respectively.28
Children with severe wasting represented 7.4% of under-five deaths, based on their 11.6 times greater risk of dying compared to non-wasted children, while children with moderate wasting have an approximately three times greater risk of dying.6
Suboptimal breastfeeding practices in the first two years also contribute to a significant portion (11.6%) of under-five deaths, which in 2011 was equivalent to 804 000 child deaths.28 Adequate breastfeeding practices
consist of early initiation of breastfeeding during the first hour after birth, exclusive breastfeeding during the first six months of life and continued breastfeeding (with appropriate complementary feeding) for up to two years of age or beyond.29 An infant who is not breastfed is more than 14 times more likely to die from all
causes than an infant exclusively fed breast milk in the first six months of life.30 Infants who are exclusively
Figure 3: One example of the causes and effects of the double burden of malnutrition across the life-course of an individual
ADULTS Overweight and obese with increased
risk of chronic diseases
Higher mortality Increased risk of adults chronic diseases Poor breastfeeding practices and frequent infections BABY Low birth weight YOUNG CHILD Stunted Inadequate length growth Accelerated weight growth Insufficient exercise Increased consumption of energy-dense snacks ADOLESCENT Stunted TEENAGE pregnancy Malnourished MOTHER Inadequate foetal growth Increased consumption of obeseogenic foods and
insufficient exercise
Note: Figure adapted from Shrimpton R and Rokx C. The Double Burden of Malnutrition: a review of global evidence. HNP Discussion Paper. World Bank, June 2012, for the UNICEF EAPRO Approach to Nutrition Programming in the East Asia and Pacific Region 2014-2025.
breastfed are 11 times less likely to die from diarrhoea and 15 times less likely to die from pneumonia, the two leading killers of children under five.30 Initiating breastfeeding within the first hour after birth can reduce
newborn mortality by up to 20%, an important consideration in middle-income countries where neonatal factors are the main causes of child deaths.31 32 Some of the factors associated with the low rates of exclusive
breastfeeding are caregiver beliefs favouring mixed feeding, hospital and health-care practices and policies that are not supportive of breastfeeding, lack of adequate skilled support, aggressive promotion of breast- milk substitutes (BMS) and lack of knowledge on the dangers of not exclusively breastfeeding.29
Undernutrition early in life also has major consequences for future educational, income and productivity outcomes. It is associated with poor school achievement and performance.33 Reduced school attendance
and educational outcomes result in diminished income-earning capacity in adulthood. A 2007 study
estimated an average 22% loss of yearly income in adulthood.34 At the level of nations, the economic costs of
undernutrition are estimated in the 2015 Global Nutrition Report to be 8–11% of the Gross National Product (GNP).35 Lao People’s Democratic Republic and Cambodia conducted analyses of the costs of undernutrition
and estimated the impacts to amount to 2.4% of the Gross Domestic Product (GDP)36 and 2.6%, respectively.37
The economic costs of malnutrition and the benefits of investing in nutrition improvement are discussed in detail in Chapter 7.
Some NCDs are a consequence of overweight and obesity. However, not all NCDs are diet-related NCDs. The four main types of NCDs are cardiovascular diseases, cancer, chronic respiratory diseases and diabetes (see Figure 4). NCDs are the leading causes of death and disability, responsible for 80% of all deaths in many Asian and Pacific countries. Of particular concern is the high level of premature mortality from NCDs (deaths before 70 years of age): they account for 50% of such deaths in low- and middle-income countries. The four common modifiable risk factors for NCDs are unhealthy diets (particularly diets that are high in salt, sugar and fat, and low in dietary fibre), physical inactivity, tobacco use, and the harmful use of alcohol. Unhealthy diets increase the intermediate risk factors for NCDs, namely hypertension, high blood glucose and abnormal blood lipids.
Figure 4: Causes of NCDs COMMON MODIFIABLE RISK FACTORS Unhealthy diet Physical inactivity Tobacco use NON-MODIFIABLE RISK FACTORS Age Heredity UNDERLYING SOCIOECONOMIC, CULTURAL, POLITICAL AND ENVIRONMENTAL DETERMINANTS Globalization Urbanization Population ageing INTERMEDIATE RISK FACTORS
Raised blood pressure Raised blood glucose Abnormal blood lipids Overweight/obesity MAIN CHRONIC DISEASES Heart disease Stroke Cancer Chronic respiratory diseases Diabetes
Note: Figure adapted from WHO (2005). Preventing chronic diseases: a vital investment.38
31 Edmond KM, Zandoh C, Quigley MA, Amenga-Etego S, Owusu-Agyei S, Kirkwood BR (2006). Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics 117(3):e380-6.
32 Mullany LC, Katz J, Li YM, Khatry SK, LeClerq SC, Darmstadt GL, Tielsch JM (2008). Breastfeeding Patterns, Time to initiation and mortality risk among newborns in southern Nepal. The Journal of Nutrition 138: 599-603.
33 Victora CG, Adair L, Fall C, Hallal PC, et al (2008). Maternal and child undernutrition: consequences for adult health and human capital. Lancet, vol. 371, no. 9609.
34 Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, et al (2007). Developmental potential in the first 5 years for children in developing countries. Lancet, vol. 369, no. 9555, p. 67.
35 Global Nutrition Report 2015 (http://globalnutritionreport.org/the-report/, accessed on October 1, 2015).
36 NERI /UNICEF (2013). The economic consequences of malnutrition in Lao People’s Democratic Republic: a damage assessment report. 37 CARD/UNICEF/WFP (2013). The economic consequences of malnutrition in Cambodia: a damage assessment report.
38 WHO (2005). Preventing chronic diseases: a vital investment. Geneva; World Health Organization (http://www.who.int/chp/chronic_disease_report/contents/en/, accessed January 7, 2016).