Stunting

Stunting, or being too short for one’s age, is a largely irreversible outcome of maternal malnutrition, faulty breastfeeding and suboptimal infant feeding practices. Maternal undernutrition contributes to 800,000 neonatal deaths annually through small–for–gestational–age births, and nearly 3.1 million child deaths per year are caused by stunting, wasting, and micronutrient deficiencies. The 2020 UNICEF-WHO–WB Joint Child Malnutrition Estimates highlights that in 2019, 21% of children (144 million) under the age of 5 years were stunted, with the vast majority living in Asia (54%) and Africa (40%). Stunting causes long-term negative impacts on individuals and societies, including:  

• Diminished cognitive development: Early childhood stunting negatively impacts the cognitive performance of children, leading to impaired socioemotional skills, lower levels of educational attainment and reduced outcomes in adult life (WHO, 2014; PLOS ONE, 2020). 
• Increased risk of disease: Stunting increases the risk of morbidity and mortality from infections such as pneumonia and diarrhea, creating a cycle of worsening nutritional status and increasing susceptibility to infection (Matern. Child Nutr., 2016). Stunted children who experience rapid weight gain have an increased risk of becoming overweight or obese later in life, which brings the associated higher risk of cardiometabolic diseases (WHO, 2014).  
• Reduced productive capacity: Stunted children are estimated to earn 20% less as adults compared to non-stunted individuals, leading to a reduction in a country’s income. On average, the per capita income penalty is around 7%; Africa and South Asia incur larger penalties of around 9-10% (Lancet 2007; World Bank, 2016). 

Reducing the prevalence of stunting requires effective interventions and programs that deliver and support food and nutritional security during the 1,000 days between a woman’s pregnancy and her child’s 2nd birthday. The Periodic Table of Food Initiative can play a crucial role by guiding nutritious diets from local and available foods, as well as the use of agricultural processes, food preparation and processing methods that can optimize nutritional content for the growing child.

“Current nutritional interventions employed to reduce child stunting are having limited success. The number of stunted children is rising in Africa and while there is a decreasing trend in Asia, the levels are still unacceptably high. Progress towards the 2025 Sustainable Development Goal target of a 40% reduction in stunting from 2012 levels is not on track.” reports Dr T. Longvah, a Director Grade Scientist of the National Institute of Nutrition and Head of the Food Chemistry Division, Hyderabad, India. His extensive research on micronutrient deficiencies, indigenous foods, food composition and biodiversity is aimed at reducing malnutrition and stunting, which is particularly prevalent in India.

“We need to enlarge the evidence base on the composition of food to provide policy-makers with information that can vastly improve public health nutrition programs. A better understanding of the biochemical composition of food, and how this can vary across crop varieties as well as production and processing methods, can be used to promote healthy diets and put more effective intervention programs into place. For example, this knowledge could guide the production of crops rich in specific nutrients, as well as home-stead food production, to provide the nutritional diversity that is crucial for a mother and her growing child,” Longvah explains. His recent research has highlighted where some of this evidence is lacking, for instance, we don’t know how processing can affect the nutritional benefits of β-glucan and other bioactive compounds in barley, an important cereal crop.

“Several studies have documented the many varieties of indigenous foods and their importance for enhancing food and nutrition security, and many of these foods also have therapeutic value, however, there is a lack of detailed information on their nutritional content and health-promoting components. The absence of such information remains an obstacle in their uptake and the potential benefits that can be derived from their use.”

Proposed Solution: A Periodic Table of Food

The strong association of stunting with dietary intake and nutritional status during pregnancy and the first two years of a child’s life necessitates a comprehensive understanding of the composition of our food, if effective interventions are to be put in place. Currently, we do not have this level of detailed information. Only a fraction of the total component parts of a relatively small number of foods have been recorded and the variable methods used to get this data reduces its comparability.

The Periodic Table of Food Initiative is a global effort to greatly expand our understanding of the biochemical composition of our food. By creating standardized kits and methods, the initiative will enable researchers to categorize tens of thousands of compounds, creating large datasets stored in a public database. This nutritional profiling will highlight inadequacies in diets, to guide targeted evidence-based nutritional interventions. It can go beyond the traditional basic nutrient composition of foods into the hitherto unknown “nutritional dark matter”, to provide a greater understanding of how to prevent malabsorption of nutrients while also increasing their bioavailability, which is deeply important in regions of low food and nutritional security.

Health and Nutrition:

• Providing nutrient security and weaning foods that truly nourish. Nutritional interventions and programs can be based upon rigorous scientific evidence enabled by the Periodic Table of Food Initiative. Detailed food composition data will help identify the most nutritious combinations of local foods, providing the dietary diversity needed to alleviate stunting. Moving further forward, it will provide the means to assemble and integrate local foods into complete diets that will achieve all infant nutritional goals at each stage of development.
• Achieving the SDG target of a 40% reduction in stunting. By assessing the detailed composition of diets in areas of high stunting prevalence, and matching deficiencies with available foods and supplements, more effective and targeted nutritional interventions and programs than currently deployed can be implemented to reach this SDG goal.
• Increasing resilience against infectious disease. Children who are undernourished and stunted are prone to repeated infections (Curr. Opin. Infect. Dis., 2018). The Periodic Table of Food Initiative will not only help to decipher the underlying mechanisms that cause this negative feedback system, but also provide the data for national dietary guidelines promoting nutritious diets and interventions that can break this cycle.

Sustainability:

• Advancing nutritious foods from local sources. Providing dietary diversity from local and available foods will be key to reducing stunting in many regions. Knowledge of the total nutritional content and functions of these foods in raw, cooked and processed forms will guide diets for optimal nutrition, while also ensuring environmental sustainability.
• Promoting the environmental benefits of new crops. When value related to the alleviation of stunting is placed on an array of new crops that are profiled as nutritious, including indigenous foods and those with therapeutic value, the agricultural landscape will be diversified, helping to bring environmental benefits related to soil health and biodiversity.

Economic Opportunities:

• Increasing productivity. A reduction in the prevalence of stunting through interventions enabled by the Periodic Table of Food will not only improve the income of individuals, their households and societies, but also a country’s economy as a whole (Int. J. Epidemiol., 2017).
• Catalyzing nutrition innovation. Cataloging the biochemical properties in foods will enable the innovation of processed foods that can help to provide the essential nutritional components missing from diets in regions affected by stunting.
• Increasing economic development. Highlighting the beneficial nutritional and health-promoting properties of underutilized indigenous crops will increase their global market value, providing regions reliant on agricultural activities with more choice of what to grow in their fields.

Longvah believes the Periodic Table of Food Initiative will be key to bolstering the nutritional health of typically malnourished populations around the globe. “We will be able to compile diets that adhere to recommended dietary allowances and nutrient intake for the different ages and stages of our lives. The Indian National Institute of Nutrition has recently created a mobile app that offers comprehensive nutrition-related information on a wide range of Indian foods. Detailed food composition data enabled by the Periodic Table of Food Initiative could feed into technology like this and guide users towards available foods that will alleviate nutrient deficiencies and ultimately the prevalence of undernourishment and stunting.”