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Recipe for better nutrition in Guatemala

Double challenge: Chronic malnutrition still a problem even as obesity rates rise

By Ian Mac Arthur

Guatemala’s main nutrition problem isn’t that the low-income population doesn’t eat enough food; rather, it’s the poor quality of its diet and eating habits. This helps to explain how half of the country’s children under the age of 5 can suffer from anemia and stunting, while at the same time, half of the women of reproductive age are overweight or obese.

Dr. Reynaldo Martorell, an international nutrition expert from Emory University, explains: “The Guatemalan diet is excessively high in calories, particularly those derived from sugar and other simple carbohydrates; and the consumption of fats and oils has increased. One of the myths about addressing ‘hunger’ in Guatemala is that people need to eat more. The issue isn’t about eating more; it’s about eating better.” The fact is, acute malnutrition affects just 1.1% of children under the age of 5; it is not a big public health problem, contrary to popular belief and news media reports.

Chronic childhood malnutrition occurring during the “first 1,000 day window,” which consists of pregnancy and the first two years of life, often leads to mortality or significant morbidity, short stature, diminished capacity to work as an adult, reduced intellectual capacity, poorer school performance and diminished future income-earning capacity. Guatemala’s chronic malnutrition rate is among the highest in the world.

The cycle of malnutrition begins in pregnancy, often among women who are stunted, obese and anemic, reflecting their own experience with chronic malnutrition during childhood. Reduced stature can limit intrauterine growth during pregnancy, and it is considered an obstetrical risk factor that can complicate delivery and lead to a low birth-weight baby. Additionally, maternal obesity exposes the fetus to altered metabolism and high glucose levels; increases the risk for gestational diabetes; and leads to higher deposits of adipose tissue. Finally, maternal anemia can slow intrauterine growth; lower the newborn’s iron reserves; and cause maternal and neonatal morbidity, or even death.

After birth, babies are often exposed to very poor nursing and complementary feeding practices, especially those from the lowest-income families. Infections, particularly diarrhea caused by poor hygiene and contaminated drinking water, lead to poor appetite and reduced absorption of nutrients. Combined, these two factors—inadequate diet and infections—are the main causes of chronic childhood malnutrition.

What can be done to reverse the trend?

Luz Lainfiesta, currently the Minister of Social Development, says that the Guatemalan Government’s new proposal for fighting chronic malnutrition will emphasize the window of opportunity found in the first 1,000 days, through interventions that “will ensure that mother and child have what they need to be well nourished.”

For its part, the IDB will support the country’s efforts to implement interventions in the health sector, including: delayed umbilical cord clamping; promotion of good nursing and complementary feeding practices; guidance on food preparation and hygiene; prenatal supplementation with iron and folic acid for mothers; vitamin A supplementation for children; immunizations; the use of zinc and oral rehydration treatments for diarrhea; and distribution of fortified complementary foods or micronutrient powders for children ages 6-24 months, as well as guidance on their use for mothers.

At the organizational level, the IDB will provide support for integrating a community-level counseling system into the comprehensive early childhood and maternal healthcare strategy, in order to improve diet quality. The aim is not just to extend health service quality and availability, but also to promote efforts to increase demand for, and use of, those services.

Along with activities to help lower malnutrition and anemia, additional strategies will be needed to ensure improved eating habits, with a view to controlling the obesity epidemic, which is one of the main causes behind the increase in chronic diseases across Latin America.

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