Abstract
Global data indicate a high prevalence of hidden hunger among population. Deficiencies of certain micronutrients such as folic acid, iodine, iron, and vitamin A have long lasting effects on growth and development and therefore have been a National priority from many decades. The strategy implemented so far limits to the use of supplemental sources or fortified foods in alleviating the burden of deficiencies. These approaches however undermine the food-based strategies involving dietary diversification as the long-term sustainable strategy. There is lack of understanding on the level of evidence needed to implement such strategies and the level of monitoring required for impact evaluation. Dietary diversity concerns how to ensure access for each individual to a quality and safe diet with adequate macro- and micronutrients. The key to success in using dietary diversity as a strategy to tackle hidden hunger is in integrating it with the principles of bioavailability, translated to efficient food synergies with due emphasis on food accessibility, affordability, and outdoor physical activity/life style modifications. Promoting enabling environment and sustainable agriculture is crucial for practicing dietary diversification with behavior change communication as an integral segment. It can be concluded that food-based strategies require careful understanding of the factors associated with it and moderate it to form an effective strategy for controlling multiple micronutrient deficiencies.
Highlights
An estimated two billion people suffer from a chronic deficiency of micronutrients [1]
When dietary diversity score (DDS) developed for schoolchildren in rural Kenya based on various minimum intake amounts from each food group (1 g, 15 g, a variable minimum based on the content of a target nutrient for each group, the median intake level for each group; and the 90th percentile intake level for each group) were compared, the DDS based on a 15-g minimum and DDS based on nutrient content were only significantly associated with mean probability of adequacy (MPA) after adjusting for energy intake [23]
Though isolated attempts have been done, there is a scope for extensive evaluation in these lines since DDS is a relatively less time consuming and easy-to-use intake quantification tool compared to the traditional methods of dietary assessments
Summary
An estimated two billion people suffer from a chronic deficiency of micronutrients [1]. Multiple micronutrient deficiencies often occur concurrently in the same population [(2–5), Table 1]. Even mild to moderate deficiencies of micronutrients lead to impaired physical and cognitive development, poor physical growth, and work capacity and thereby considered as hidden hunger, which impact the nation’s development [6]. Three-pronged strategy has been envisaged for prevention and control of hidden hunger, which can be deployed individually or in combination: short-term supplementation, medium-term food fortification, and a long-term focus on dietary diversification. Success in the past with respect to supplementation or fortification strategies could be attributed to reduction of specific clinical forms of micronutrient deficiency prevalent in the population such as Pellagra (niacin), beri-beri (vitamin B1), rickets (vitamin D), goiter (iodine), and neural tube defects (folic acid).
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