Opinion: What can be done to address widespread 'hidden hunger'?

Imagine tossing a coin — if it lands on heads you will develop a condition that may compromise your immune system, impair your cognition and school performance, and decrease your work productivity. Those are disheartening odds for developing a condition that may prevent you from reaching your potential: micronutrient deficiency. Yet there are some very concrete policy steps that governments the world over can take to lower the burden of this hidden hunger.

A new study shows that the chances of having a deficiency in one or more micronutrients — vitamins and minerals — is higher than a coin toss for children less than 5 years of age and women between 15-49 years of age. In fact, 2 in 3 women of this age group are deficient worldwide. In some countries, this number is as high as 9 in 10 women.

No one should be deficient in essential micronutrients. But our collective food system does not currently provide enough affordable, accessible nutritious foods to ensure that everyone everywhere can consume a healthy diet containing all of the micronutrients in adequate densities to meet requirements.

For decades it was widely believed that 2 billion suffer from this hidden hunger. But these new findings on just women and young children suggest the number is far greater once we include all the school-age children, adolescents, men, and older adults excluded from this analysis due to data gaps.

The lack of data on these population groups makes it challenging to produce a total estimate. In the future, we plan to quantify the total number of people affected by micronutrient deficiencies worldwide. Is it 3 billion? 4 billion? Or more? We don’t yet know exactly but it’s clear that 2 billion is a major underestimate if data from all population subgroups could be considered.

The research “Micronutrient Deficiencies Among Preschool-aged Children and Women of Reproductive Age Worldwide” was a collaborative project led by the Global Alliance for Improved Nutrition, through the U.S. Agency for International Development’s Advancing Nutrition project, along with a team of global micronutrient experts, including an advisory aanel brought together by the Micronutrient Forum.

Regionally, the prevalence of micronutrient deficiency is highest in Sub-Saharan Africa, South Asia, East Asia, and Asia-Pacific , where over 1 billion women and children are affected by micronutrient deficiencies. Micronutrient deficiencies are generally highest in low-income and lower-middle-income countries, where the diets of many lack diversity and tend to rely on a large share of calories from staple foods such as rice, wheat, or maize.

What can be done to address this hidden hunger of micronutrient deficiencies? 

Key strategies, among others, to reduce hidden hunger include improving diet quality through increased consumption of micronutrient-dense foods and fortifying staple foods and condiments that are otherwise nutrient-poor. But it’s not that simple.

Poor access to nutritious foods is a major driver of this hidden hunger. And this has only been exacerbated by the COVID-19 pandemic as well as the food and fuel price crises resulting from the war in Ukraine, droughts, and other extreme weather events. We need to ensure that nutritious foods are affordable to all so that all people can have adequate access year-round and worldwide.

Where meeting all micronutrient needs for all people is not feasible, we need to strengthen complementary efforts, such as food fortification, to ensure those people most at risk of deficiency can obtain the nutrients they need to thrive, even when their dietary diversity is less than optimal. Health programs can provide supplements to those with extra needs, such as pregnant women and malnourished children.

What might be surprising to many is that the study found a high prevalence of micronutrient deficiencies even in high-income countries, where food affordability and access are — at face value — less of a concern.

For example, 1 in 2 women of 15-49 years of age in the United Kingdom and 1 in 3 in the United States have one or more micronutrient deficiencies — iron deficiency alone is over 20% in both countries. In the U.K., folate and vitamin D deficiencies among women are also high, at around 20% each. This is likely due, at least in part, to the high consumption of highly processed, micronutrient poor foods, often referred to as ultra-processed foods.

These, in turn, pose significant risks for noncommunicable diseases such as diabetes and heart disease. In fact, over half of calories in the U.K. and U.S. come from these ultra-processed foods. As we see a rise in consumption of these foods across the globe, the burden of hidden hunger will not necessarily be addressed as states strive to lift populations out of poverty.

Top sources of the micronutrients

These vary by nutrient but in general, research finds that the most micronutrient-dense foods include organ meats, small and fatty fish, shellfish, dark green leafy vegetables, unprocessed red meat, eggs, dairy, and pulses (beans, peas, and lentils). Many of these foods, especially those of animal origin, are expensive. They may also be less accessible — due to lack of refrigeration in markets, for example — and may have higher environmental impacts, unless produced with sustainable production practices.

Efforts are thus needed to make micronutrient-dense foods more accessible, affordable, and sustainable. Accessibility and affordability can be addressed by increasing productivity and diversity of nutritious crops and livestock, developing crops that are more nutritious and drought resilient — a term called biofortification — reducing trade and transportation costs, and improving markets.

Those in situations of vulnerability often require direct assistance through social protection programs such as cash transfers and subsidies for micronutrient-dense foods. Sustainability concerns can be addressed to some extent, for example, by producing nutritious crops and livestock at the appropriate scale that are suited to the local ecosystem and capturing and making use of waste and by-products through diverse, circular agroecosystems.

It is also vital to ensure holistic efforts that address both micronutrient deficiencies and diet-related NCDs, which are afflicting societies across the globe to varying degrees. For this reason, it is prudent to keep the focus on nourishing diets containing a diversity of minimally processed, nutrient-rich foods.

Concerted action is needed to change this hidden hunger that affects so many regardless of geography. Every one of us deserves access to a healthy diet, to be free from deficiencies, and have the opportunity to thrive.