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Providing perspectives on recent research into vitamins and nutritionals


Ending Malnutrition and Hidden Hunger

By Michael McBurney

Micronutrient deficiencies co-exist with overweight and obesity in many parts of the world. Hidden Hunger is a term describing the invisible nature of symptoms associated with inadequate micronutrient intake and suboptimal vitamin and mineral status.

A new report finds that the prevalence of hidden hunger (measured by a higher Hidden Hunger Index) continues to worsen in Africa. Improvements in other regions of the world are primarily attributable to reductions in the prevalence of zinc and vitamin A deficiencies. Chile continues to have the lowest score of 138 countries.  

The Hidden Hunger index is calculated with an equal weighting for 3 nutrients. Subclinical vitamin A deficiency is based on a serum retinol threshold of < 0.70 µmol/L. Iron-amenable deficiency is defined as a hemoglobin (Hb) < 110g/L. Zinc deficiency is based on the prevalence of stunting among children 0-5y using a height-for-age Z score (HAZ) threshold of <-2.

A limitation of the Hidden Hunger Index is that it omits other essential nutrients – vitamin B12, folic acid, calcium, vitamin C, D and E which are often underconsumed dietary nutrients.  

As a workshop organized by the University Medical Center Groningen emphasizes, new tools are needed to measure the micronutrient status of individuals and populations using biological samples, i.e. blood, urine or saliva.

With the advent of standards and improved analytical methods to measure vitamin D status, there has been renewed interest in determining vitamin D requirements. Based on an explosion in vitamin D research, dietary recommendations for vitamin D and calcium were updated in 2010.

Similarly, blood concentrations of other vitamins (B9, B12, C, and E), long-chain polyunsaturated omega-3 fatty acids (eicosapentaenoic acid, EPA and docosahexaenoic acid, DHA), and macular pigment density in eyes (lutein and zeaxanthin) need to be routinely measured. By knowing the micronutrient status of individuals and populations, programs can be implemented to end malnutrition.

Main Citations

Ruel-Bergeron JC, Stevens GA, Sugimoto JD, Roos FF, Black RE, Kraemer K. Global update and trends of hidden hunger, 1995-2011, The Hidden Hunger Index. 2015 PLoSONE doi: 10.1371/journal.pone.0143497

Peter S, Saris WHM, Mathers JC, Feskens E, Schols A, Navis G, Kuipers F, Weber P, Eggersdorfer M. Nutrient status assessment in individuals and populations for healthy aging – Statement from an expert workshop. 2015 Nutrients doi: 10.3390/nu7125547

Other Citation

Muthayya S, Rah JH, Sugimoto JD, Roos FF, Kraemer K, Black RE. The global hidden hunger indices and maps: an advocacy tool for action. PLoS One. 2013;8(6). doi: 10.1371/journal.pone.0067860