A. What is good nutrition?

Good nutrition refers to a healthy status of a person in regard to food consumption. It results mainly from adequate diets respectively the quality of different food products consumed. However, especially health and hygiene factors influence strongly the nutritional status of a person as they have a strong impact on digestion and how the body is able to uptake the ingested nutrients.

B. What is malnutrition and undernutrition?

Malnutrition refers to a catch-all term to describe a suboptimal nutritional status. It is little specific as it includes all manifestations of undernutrition and “overnutrition” (i.e. overweight and obesity).

Undernutrition relates to inadequate intake and/or absorption of calories and essential nutrients. To be more precise in regard to causes and manifestations of undernutrition, the following terms are used:

• Acute undernutrition is the result of recent and acute nutrient deficiency. This leads to low weight compared to height ( wasting).
• Chronic undernutrition refers to insufficient nutrient intake over time. This leads to low height compared to age ( stunting).
• Underweight expresses an unfavorable status of weight compared to age (children) and Body Mass Index (adults).
• Micronutrient deficiency relates to an insufficient intake of vitamins and minerals, e.g. iron and Vit A). Micronutrient deficiency often occur alongside with other undernutrition symptoms.

C. How to identify undernutrition?

Measuring the nutritional status refers mainly to three parameters (see figure below): age, size, and weight of a person. Based on these measurements, the following coefficients are calculated:

• Wasting → low weight compared to height
• Stunting → low height compared to age
• Underweight → low weight compared to age

In general, micronutrient deficiencies reduce resistance for infectious diseases like diarrhea and pneumonia. Moreover, specific disease symptoms express certain micronutrient deficiencies. Most relevant ones are:

• Nightblindness and Xerophthalmia → Vitamin A deficiency
• Paleness and extreme fatigue / lethargy → Iron deficiency

In the past, and still in many countries, nutrition programs focus on wasting when analyzing the nutritional status of persons. Why? Wasting is more visible than stunting, i.e. skinny children are easily identified, and many countries work with growth monitoring programs that measure only the weight but not the height. Nevertheless, since stunting is a better indicator for undernutrition (see table below), nutrition-monitoring programs are advised to focus on stunting!

Nutritional statistics from NMA countries:

Source: The global nutrition report 2015

D.  Key target groups: pregnant women and babies – 1000 days approach

The most important target groups in regard to undernutrition are children and women – especially young and pregnant women and babies, respectively children up to the 2nd birthday. The fact is that the 1,000 days from a woman’s pregnancy through her child’s 2nd birthday is the period when nutrition can have a life-changing impact on a child’s future and help break the cycle of poverty! In this period, most organs are developed. Especially the development of the brain is here of greatest importance – having a life-long impact on the intelligence, learning ability, health and productivity of a person!

A. Nutrition-specific versus nutrition-sensitive

Nutrition-specific refers to actions that address immediate causes of malnutrition (see in light blue in figure below). Interventions refer to action that directly enhance and improve intake at the level of individuals.

Examples of interventions, mainly implemented by nutrition and health specialists:

• distribution of vitamins to women and young children
• promotion of breastfeeding
• improved feeding and care taking practices for children, including hygiene
• fortification of salt with iodine
• treatment of undernutrition.

Nutrition-sensitive refers to actions that address underlying causes of malnutrition (see in dark blue below). Interventions target especially assets and behavior at the household and community level to indirectly improve the nutritional status of persons.

Examples of interventions, many times implemented by different cooperating experts relating to nutrition, agriculture, water and hygiene, education, others:

• promotion of production systems and technologies that enhance food diversity
• investments to improve hygiene relating to drinking water and sanitation
• income generation activities or social protection programs for food insecure people
• awareness creation for improved nutrition through special curricula

Source: adapted from UNICEF conceptual framework