The WHO, World Health Organisation, has released a new report stressing the importance of nutrition in healthcare. “Stronger focus on nutrition within health services could save 3.7 million lives by 2025”, the organisation states. This new report complies the most relevant nutrition interventions that could contribute to the achievement of the Sustainable Development Goals relevant to the nutritional field, and associated targets. Those are:
- SDG2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture.
- SDG3: Ensure healthy lives and promote well-being for all at all ages.
However, healthier populations are achieved through multisectoral actions, states the organisation. This means that agriculture, water, sanitation and hygiene, education, trade, labour and industry should work together to accomplish these goals. This article reviews the main WHO’s interventions, giving special attention to those interventions that have a direct application for the nutraceutical industry and research.
Nowadays nutrition must face a double burden: a combination of undernutrition and non-communicable diseases. The recent advances in nutrition research have been in line to this double concern, and they have shown that food and diet patterns, rather than nutrient focused metrics, may explain many effects on diseases or malnutrition.
Malnutrition, in one form or another, is estimated to affect one in three people globally* and is linked to morbidity and mortality. Malnutrition is present in all the stages of the life cycle; the main forms are presented below:
Malnutrition in all its forms and associated diet-related noncommunicable diseases
- Child stunting: Low height-for-age
- Child wasting: Low weight-for-height
- Child overweight: High weight-for-height
- Micronutrient deficiency or insufficiency: Iron, folate, vitamin A, zinc, iodine
- Adult obesity: Carrying excess body fat with a body mass index equal to or higher than 30 kg/m2
- Noncommunicable diseases: Many conditions, including heart disease, stroke, cancer, diabetes and chronic lung disease
Micronutrient malnutrition predominate as significant public health challenge, since The WHO estimated that 32.9% of the population suffered from anaemia on 2010. The most vulnerable groups are children under 5 years of age (41.7% with anaemia), particularly infants and children under 2 years of age; non-pregnant women (15–49 years; 32.5% with anaemia); and pregnant women (40.1% with anaemia). This translates to roughly 800 million women and children with anaemia globally. However, from the total of clinical trials registered under the portal Clinical trials.gov, 316464 studies, just the 1% tackle anaemia, 3299 studies.
The WHO essential nutrition actions for healthier populations applicable to the nutraceutical industry and nutrition research fields can be categorised in three groups: fortification of condiments and staple foods with vitamins and minerals, Vitamin and minerals supplementation, and appropriate complementary feeding.
Fortification of condiments and staple foods with vitamin and minerals
The reinforcement of maize flour and corn meal with iron is recommended to prevent iron deficiency in populations, particularly in vulnerable groups such as children and women. The addition of vitamin C and the removal of phytates in maize flour and corn meal could increase the bioavailability of iron. However, the evidence in maize flour or corn meal is rather limited. A combined fortification strategy seems to be an effective option for reaching all segments.
The main conclusions that could be drawn are that fortified staple foods are required as well as more clinical studies on vitamins/ minerals bioavailability in maize flour or corn meals.
Where rice is the staple food, the focus varies slightly. The inclusion of vitamin B12 is recommended when rice is fortified with folic acid, to avoid its masking effect on vitamin B12 deficiency. It is also highlighted that the restoration of thiamine, niacin, riboflavin and vitamin B6 (pyridoxine) in the fortification profile should remain a regular practice since some of the fat- and micronutrient-rich bran layers are removed during rice milling. They also remark that the fortification of rice with iron has been a challenge, since the most bioavailable iron powders are coloured, which changes the aspect of fortified kernels compared to unfortified ones. An opportunity rises for rice producers or iron powder manufacturers to develop a variant of iron fortified rice uncoloured, thanks to an uncoloured iron powder.
In the case of wheat flour as a staple food, the fortification with minerals and vitamins follows a preventive approach. The WHO also urges to public health institutions to monitor the nutrient content of wheat flour. This recommendation targets institution, but it could potentially impact the industry since institutions might start requiring bioavailability studies for this product category.
Vitamin and minerals supplementation
Unfortunately, locally available foods do not always satisfy the population nutritional requirements. In this case, fortified foods, micronutrient powders for point-of-use fortification and lipid based nutrient supplements are contemplated as a valid alternative. The recommendations vary depending on the life-cycle stage and the specific settings. The main highlights in this category are:
- Zinc supplementation for diarrhoea management in infants and children.
- Iron supplementation for the prevention of anaemia and iron deficiency in non-pregnant adolescent girls where anaemia is highly extensive (40% anaemia prevalence).
- Oral supplementation for the treatment of undernutrition (BMI lower than 18.5 kg/m2) in older adults. Ready to-eat forms were mentioned as the most relevant opportunity in this segment.
- Some other supplementation is currently not encouraged by the WHO due the lack of scientific evidence at the moment in certain vulnerable populations. Some examples are: high-protein supplementation in pregnant women, the optimal timing of calcium supplementation during pregnancy, the benefits and side effects of vitamin B6 supplementation in pregnancy, the combination of vitamin C and E in the context of preventing preeclampsia, the benefits and side effects of vitamin D supplementation alone in pregnancy, and combined with calcium supplementation, or the dose or timing of zinc supplementation for pregnant women.
Appropriate complementary feeding
Some cohort studies have confirmed that early stunting and micronutrient deficiencies may lead to permanent intellectual and developmental outcomes. The WHO strongly recommends breastfeeding, however, when low-birth-weight infants, born with a weight of between 1 and 2.5 kg, are under resource-limited settings, appropriate complimentary infant formulas should be provided. Additional guidelines can be found on The Guiding Principles for Complementary feeding of the Breastfed Child (2003). Infant formula suppliers would find their niche market in those countries with specific settings in which infants cannot be fed with their mother’s own milk or donor human milk. Alternatively, other settings such as infants struggling to gain weight with just breastmilk could additional become an opportunity for this segment.
The nutraceutical market is considered a highly competitive market, for instance, companies are looking to diversify their offering applying many heterogeneous strategies. Why not tackle the malnutrition market? The data seem to provide some clarity on the potential demand of this segment: It has been estimated that stunting affects to 149.0 million children and wasting still impacts 49.5 million children aged under 5 years. Among adults, the most recent data available from 2014, indicate that 462 million are underweight, while 1.9 billion are overweight and 600 million of those are obese, the report states. The “double burden of malnutrition”, previously mentioned, raises concerning challenges, nevertheless those also can be translated into the opportunities listed on this article. Clinical validation seems to be a central key point common all through the different recommendations. The WHO is reticent to encourage actions that do not have enough available data, which seems adequate considering that those actions are focusing on vulnerable populations.
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 Search result consulted on ClinicalTrials.gov (16/09/2019 at 16:00 GMT+1)
 Am J Public Health. 2010 June; 100(6): 974–980.