Reflections on the 2005 World Food Prize Symposium:

1. Reflections on the 2005 World Food Prize Symposium: Nevin S. Scrimshaw, PhD, MD, MPH President, International Nutrition Foundation

2. THE LIFE CYCLE APPROACH TO NUTRITION AND FOOD NEEDS • At the moment of conception nearly everyone has the genotype for a long and healthy life. • From the this time onward environmental factors damage this potential to produce a far different phenotype than at conception. • Malnutrition and overnutrition are the most common and consistent factors responsible, for this damage.

3. The Life Cycle Approach Involves Nutrition at All Ages • Pregnant & lactating women • Infant & toddler • School child & adolescents • Adults at all ages • Women of child bearing age

4. Pregnancy • Folic acid deficiency in early pregnancy increases neural tube defects. • Iodine deficiency impairs fetal brain development • Protein-energy deficiency lowers birthweight with multiple consequences. • Iron deficiency lowers infant iron stores at birth. .

5. Infancy • When breast milk is no longer sufficient, appropriate complementary feeding is essential or physical and mental stunting results. • Iron deficiency and protein-calorie malnutrition are the main risks.

6. Lactation/Infant Feeding • Breast feeding provides only half the daily iron required in infancy; the balance must come from the stores at birth • These are exhausted by about 6 months, by 4 months if mother is anemic, by 2 months for low birth weight infants. • Without supplementation or iron fortified food permanent impairment of myelenation of cranial nerves and dopamine neurons inevitable when stores at birth are exhausted.

7. Toddler/Pre-school Child • PEM can permanently reduce physical and mental development. • Vitamin D deficiency leads to rickets. • Iron deficiency anemia causes reduced cognitive and motor performance.

8. School child and adolescent PEM affects physical growth and behavior. Iron deficiency impairs school performance. Vitamin D deficiency leads to rickets. Low calcium intakes predispose to adult osteoporosis

9. Adult • Poor diet and life style lead to the early development of: • Diabetes type II • Hypertension • Heart disease • Increased susceptibility to cancer • Less resistance to infection

10. Elderly Adult • Partially preventable declines in: • Physical strength (sarcopenia) • Cognitive function and dementia • Mobility and independence • Partially preventable increases in: • Malignancies • Infections • Dependency

11. Still neglected:Women of Child-bearing Age • Women must enter pregnancy with adequate folic acid status to avoid fetal neural tube defects • Iron supplementation during pregnancy is too late! • Good weight gain is essential to normal infant birth weight.

12. Examples of Destructive Non Nutritional Factors : • Use of Tobacco • Use of Narcotics • Alcohol Medication Abuse • Trauma • Heavy metal poisoning – lead, arsenic fluoride • Radiation

13. New insights into global hunger • Agronomic Characteristics and Nutritional Value • Overt Hunger and Hidden Hunger • Nutritional Deficiency and Nutritional Excesses • The triple burden of Nutritional Disease (Due to Fetal Origins of Adult Disease)

14. Challenges to Agriculturists • Plant breeding • Improve protein quality • Improve beta carotene content • Improve availability of non-heme iron • Animal husbandry • Lower proportion of total fat • More healthful fatty acid composition

15. Challenges to the Nutritionists • By developing international consensus priorities to avoid waste of financial and human resources due to conflicting or poor nutritional advice to agriculturists. • Be advocates for maximizing the qualitative as well as quantitative contributions of agriculture to feeding the human population.

16. Don’t depend on any one solution! • Protein quality can be assured from genetically improved cereals such as QPM or by legumes or oil seed protein to complement a cereal staple or by adding animal protein to the diet. • Vitamin A activity can come from the beta carotene of yellow vegetables and be enhanced by genetic engineering as well as animals. • B vitamins and minerals can be provided cheaply and effectively by universal multiple fortification of the cereal staple so that breeding for them may not be worthwhile.

17. Conclusions • Target the process, not just the problem: Mainstreaming in development, PRSPs • Challenge the ‘invisibility of malnutrition: ‘forgotten emergencies’, ‘hidden hunger’, • Address all aspects (lifecycle) of malnutrition: Wasting, stunting, micronutrients, obesity • Protect investments against shocks: Multiple inputs, links with all MDGs • Legislated empowerment (rights): Meeting demand requires funds for nutrition

18. Thank you Thank you