Micronutrient Deficiencies: Effective Approaches to Tackle Hidden Hunger

Introduction

‘Micronutrient deficiencies’ or ‘Hidden hunger’ are a global challenge in today’s era where access to original quality foods with all the micronutrients intact is challenging or is beyond a common man’s purchasing power. Diseases caused by deficiencies of micronutrients such as iron, iodine, vitamin A, and B complex vitamins are major public health concerns that result in poor vision, stunted growth, mental health problems, learning impairments, and early deaths. In India, a recent National Family Health Survey (NFHS-5) reported that the prevalence of anemia among all age groups and all types of malnutrition has increased from the findings reported in NFHS-4 where anemia prevalence among women of reproductive age group raised by 3.9% (from 53.1% to 57.0%). The survey findings raise an alarming concern about addressing these problems through strategic nutritional interventions to reach vulnerable

Determinants of micronutrient deficiencies

The micronutrient composition of the food is adversely affected by the processing due to its heat-labile characteristics or removal of certain parts of grains such as bran and germ. As a result, it could only cater to the macronutrient requirements and causes micronutrient deficiencies despite consuming a balanced diet. Further, geography and geochemistry are the factors that affect the micronutrient content of the food. Villages or remote areas where people can only access locally grown foods narrow down the dietary diversity in their routine diet, and the nutrients present in soil and the crops become the primary source of critical micronutrients. Antinutrient factors of soil, such as thyroid-disrupting pollutants, aggravate iodine deficiency, and fumonisins, a fungal toxin that contaminates crops, arsenic, and phytates, hinder the absorption of folate, iron, and zinc. Moreover, suffering from certain gastrointestinal and neurological diseases and surgeries can make a person lose weight and become severely wasted, especially with an esophageal disease, anorexia nervosa, and gastrectomy resulting in deficiencies of vitamin A, D, B12, zinc, selenium, and copper.

Strategies and Interventions to address micronutrient deficiencies

• Biofortification involves enhancing the concentration of essential vitamins and minerals in crops through plant breeding, genetic modification, or agricultural practices. This approach is practical and cost-efficient, providing vital micronutrients to communities with limited access to varied diets or other nutritional interventions. Being an agriculturally dominated country, biofortification is an effective way for India to enhance the micronutrient content of the crops and, hence, the government of India promotes the use of biofortified crops with improved nutrient content in food supplementation programmes. Some examples of such crops are Rice CR: Dhan 310 (protein), Rice DRR Dhan 45 (zinc), Wheat WB 02 (iron and zinc), and Maize Pusa HM 9 Improved (lysine and tryptophan).
• Fortification as per the Food Safety Standards Authority of India (FSSAI), is the addition of crucial vitamins and minerals such as Iron, Iodine, Zinc, and Vitamins A & D to staple foods such as rice, wheat, oil, milk, and salt to improve certain nutrients’ content which may or may not have been originally present in the food before processing or may have been lost during processing. The large-scale food fortification (LSFF) strategy is being implemented in many countries, including India, under food distribution systems and school meal programs.
• Improving dietary diversity which means creating awareness regarding adding colors to the food plate by incorporating foods from different food groups is one of the cost-effective strategies. Various audio/visual aids or digital platforms such as television, podcasts, videos, text messages, apps, digital sessions, etc. can be used to reach out to the population.
• Specific food interventions in the form of food formulations can be developed to address nutrient-specific deficiencies or overall micronutrient deficiencies. One is micronutrient-rich bouillon cubes, made with palm fat, corn starch, spices, and a micronutrient premix rich in vitamin A, B12, folic acid, iron, zinc, and iodine. The trial for this product is ongoing in Ghana and Africa, and the product’s impact on the nutritional biomarkers is awaited.
• Digital Technology can boost agricultural output. In countries like Africa, it has been estimated that providing mobile phones to women and enabling internet usage could improve agricultural production by 4% and decrease the proportion of the starved population by 17%. The provision of technology helped them to register for digital services such as apps and websites which enhanced their knowledge regarding various agricultural aspects and accessibility to related services. However, the availability of phones and their usage could be a setback with people residing in rural areas. The technology requires a set of skills to use the internet to its full potential.
• Text messaging interventions are becoming acceptable with the increasing use of mobile phones and the internet globally. For instance, the platform can remind pregnant and lactating women to take nutritional supplements or help them change their behaviors. The intervention requires a person to own a mobile phone, operator’s network availability, and achieve literacy to a level to read the sent messages.
• Digital Lifestyle Program- Such initiatives address micronutrient deficiencies along with other lifestyle challenges at an individual level. It includes using a medical device that provides insight into the current health status and at-risk health conditions based on an assessment of body, mind, and lifestyle. The participants are followed up for 3-4 months, during which digital sessions are provided to manage risk factors. While it is an effective way to bring desired behavioral modifications at an individual level, implementing such initiatives at a larger scale could be a challenge due to high budget demands and digital gaps.
• The provision of nutritional supplements to the vulnerable population is another way to address the deficiencies. The approach has been implemented through many national nutrition programmes in India such as Anemia Mukt Bharat Abhiyan and Vitamin A programmes where the beneficiaries receive iron and folic acid supplement pills or biannual vitamin A mega dosages, respectively.

Conclusion

In conclusion, addressing micronutrient deficiencies requires a multifaceted approach that includes biofortification, food fortification, nutrition supplementation, and improving dietary diversity, particularly in countries like India, where the burden of hidden hunger is significant. Strategic nutritional interventions, such as digital technology and targeted food formulations, offer promising solutions to enhance nutrient intake and improve public health outcomes. Continued efforts to integrate these strategies into public health policies are crucial to overcoming the widespread impact of micronutrient deficiencies by improving intervention compliance at the beneficiaries’ end and implementation and monitoring at the grassroots level.

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