Malnutrition and the Role of the Soft Drink Industry in Improving Child Health in Sub-Saharan Africa

Abstract

Undernutrition is the single largest risk factor for disease and global child mortality, according to the World Health Organization. In childhood, growth is the most important indicator of health with undernutrition, or an inadequate intake of nutrients, resulting in underweight, wasting, or stunting.1 Improving the world's nutrition is viewed as the most effective form of international aid.2 The effects of undernutrition on childhood growth and development in the first 2 years of life are irreversible. Exclusive breastfeeding, appropriate complementary feeding, adequate nutrient intake by pregnant women, and micronutrient supplementation are viewed as some of best preventive measures to reduce the incidence of undernutrition in children younger than 5 years.2 In the developing world, centralized fortification programs are being developed to address the most commonplace micronutrient deficiencies including vitamin A, iodine, and iron deficiencies.3 The most desired foods for fortification include foodstuffs that the majority of the population regularly consumes, particularly those at greater risk for deficiencies. Vehicles for fortification include wheat flour, maize meal, salt, sugar, and cooking oil. Some African countries have already attained high levels of iodized-salt coverage, and Nigeria and South Africa have begun an iron-fortification program with wheat flour.3 The long-term goal of fortification programs is to fortify multiple staples to have the greatest impact on raising micronutrient levels. Some fortification programs have been shown to have some success, including iron-fortified foods that have resulted in a 70% reduction in the prevalence of anemia in school-aged children and an increase in hemoglobin concentrations by 7.4 g/L in children provided with iron-fortified foods in comparison with control-group children.4 In Central America, vitamin A–fortified sugar contributes to more than 50% of the vitamin intake in preschool-aged children.5 However, one of the greatest roadblocks to successful African food-fortification programs is the limited … Address correspondence to Janet M. Wojcicki, PhD, MPH, Department of Pediatrics, 500 Parnassus Ave, MU 4-East, Box 0136, University of California, San Francisco, CA 94143-0136. E-mail: wojcicki{at}gmail.com