Malnutrition & Cognitive Function in Developing Countries

Conquering malnutrition is a ‘smart’ move for the nutraceuticals industry and consumers.

By Paul Altaffer &
Grant Washington-Smith

While the advances in brain health research and product development are staggering, much of the developing world can hardly afford to consume these products and benefit from breakthrough technologies. This is unfortunate, especially considering that malnourished children are at a serious cognitive disadvantage. More specifically, they suffer from learning and cognitive problems, reduced attention, and a variety of mood-related disorders. This column analyzes the state of nutrition and cognition around the world and investigates the opportunities for the nutra­ceuticals industry.

The Sad Truth

According to the World Health Or­ganization (WHO), malnutrition is the third leading cause of death worldwide, affecting a third of the world’s population. Perhaps even more shocking, it is estimated that close to one-third of infant and child deaths are associated with malnutrition. This means 27,000 children per day or 9.8 million children each year die from malnutrition. It is also widely known that of the principal killers in the world, malnutrition is by far the easiest and cheapest to remedy.

As shocking as these facts are, very few people are aware of this health crisis. The global community should be proud of its capacity to rally around important health causes like heart disease, cancer and AIDS. Indeed there are many billions of dollars raised and spent each year to research and find cures for these diseases, and there should be even more. But surprisingly, and sadly, the total spending worldwide to promote nutrition programs is $134 million per year.

According to Howard Schiffer, founder and president of the non-profit organization Vitamin Angels, about half of the children living in third world countries have iron deficiency. Without iron, proper muscle and circulatory development is impossible. This in turn has a major impact on cognitive development.

The Army Against Malnutrition

The Copenhagen Consensus is an initiative that was created to identify the world’s greatest challenges and outline solutions for them. It is comprised of a group of renowned economists that meet every four years to establish new priorities. The 2008 edition lists micronutrient supplementation (with vitamin A and zinc) as the number one solution and malnutrition as the number one problem in the world.

So who are the leaders in this malnutrition battle? There are actually several important initiatives led by highly ambitious organizations performing the equivalent of economic miracles. What follows are snapshots of some of the commanders on the field of this battle

Vitamin Angels was founded in 1994 in response to the Northridge earthquake in Southern California. The initial goal was to provide supplement relief for people affected by the earthquake. Soon after it became apparent that one of the most effective means of fighting malnutrition is through direct supplementation, as opposed to food fortification. Today, Vitamin Angels is dedicated to eliminating malnutrition through the distribution of supplement micronutrients to people around the world.

Mr. Schiffer believes supplementation with five or six basic micronutrients will resolve most of the chronic malnutrition issues around the globe. The five undisputed nutrients include: iron, iodine, folate, vitamin A and zinc. These are widely recognized and identified as the basic elements needed for improved nutrition. Mr. Schiffer also believes that fish oil—a great source of omega 3 fatty acids, especially DHA—should be added to the list. Vitamin Angels distributes fish oil supplements where permitted. Other nutrients up for consideration in the near future include phosphatidylserine, phosphatidylcholine and antioxidants like vitamins C and E, as well as polyphenols from a variety of sources.

The Micronutrient Initiative, a Canadian nonprofit organization based in Ottawa, whose goal is to eradicate vitamin and mineral deficiencies (VMD) worldwide, and Unicef, published a report on the importance of supplementation and diet around the world. This report outlines some of the most significant nutritional challenges and offers an outline of solutions. The Micronutrient Initiative, which also receives support from the World Bank and U.S. Agency for International Development (USAID) is responsible for nearly all the vitamin A distribution programs worldwide.

Other important organizations dedicated to malnutrition issues through supplementation include the Global Alliance for Improved Nutrition (GAIN), Sight and Life, which is sponsored by DSM, Nourish America and Action for Healthy Kids. The latter two initiatives are committed to finding solutions to malnutrition and under-nutrition (too much bad nutrition and not enough good nutrition) in the U.S., especially for school children.

Larger, more global organizations like UNICEF, Helen Keller International and Save The Children have developed nutrition portfolios, although supplementation per se is not their main focus.

The Importance of Prenatal
Vitamins & Breastfeeding

Perhaps one of the most obvious op­portunities for improving cognitive function is in ensuring adequate nutrition to women who are lactating. This may be one of the easiest and most cost effective methods for optimizing the cognitive development of infants.

Most women in the developed world are aware of the importance of prenatal vitamin supplementation. The consumption of folate is vital for the proper development of any infant, particularly brain development.

In 1999, a landmark (and controversial) study conducted by Anderson and colleagues, was published in the American Journal of Clinical Nutrition. The study concluded the following; “Meta-analysis indicated that, after adjustment for appropriate key cofactors, breastfeeding was associated with significantly higher scores for cognitive development than was formula feeding.”

For many emerging economies around the world it would appear that “breastfeeding is best” when it comes to optimal brain development. The economic value of breastfeeding is also clearly evident. In the U.S., several studies have reviewed the direct economic benefit of breastfeeding vs. bottle-feeding, showing that breastfeeding will save families between $200 and $400 per year. The economic benefit of breastfeeding to both the family and society is even greater when one considers in the first year of life it has significant protective effects against conditions such as otitis media, respiratory infections and gastrointestinal (GI) illnesses, according to the preponderance of data.

Tackling Nutritional Problems
Big & Small

The ability to influence cognitive development doesn’t just apply to babies, however. Further supplementation of omega 3s in children, ages 2 to 16, could offer additional developmental benefits. The Oxford-Durham (U.K.) study of omega 3 supplementation in 40% of underachieving children (kindergarten through 16 years of age) showed improvements in reading, spelling and behavior.

The focus of cognitive improvement moves from that of “cognitive development” to “cognitive conservation” as we age. Omega 3s will continue to play a significant role, but the attention turns to mitigating or even reversing the effects of aging. Specific antioxidants that can cross the blood-brain barrier may play a role in protecting delicate neurological tissue against oxidative stress. Other products have been shown to improve blood flow and micro-vascular perfusion in the brain.

In December 2005, a major epidemiological study was published in Lancet by the Section of Epidemiology, Institute of Psychiatry, King’s College, London, U.K. The study was led by Dr. Ferri, and looked at the prevalence of dementia for each region of the world. Dementia, which is an extreme form of loss of cognitive function (and includes Alz­heimer’s disease), is one of the most disabling and burdensome health conditions worldwide.

The research group concluded that 24.3 million people have dementia today, with 4.6 million new cases of dementia diagnosed each year—or one new case every seven seconds. The number of people affected is on track to double every 20 years, reaching 81.1 million by 2040. Most people with dementia live in developing countries (60% in 2001, rising to 71% by 2040). Rates of increase are not uniform; numbers in developed countries are forecast to increase by 100% between 2001 and 2040, but by more than 300% in India, China, South East Asia and the Western Pacific.

The Costs of Winning this War

The nutraceuticals industry supports and advocates for many important causes. And malnutrition is another to take to heart. Vitamin Angels’ current annual budget is $1 million, which is allowing the organization to reach seven million children this year. “We must look at this as a global campaign and as an industry-wide initiative,” Mr. Schiffer said. “These are problems that can be solved. For every cause of malnutrition, there is a solution that is relatively easy to establish and affordable. We have the means to bring the solutions to the people that need them.”

The evidence clearly shows that a relatively minor investment into nutrition programs in the present, demonstrates broad scale effects within one generation.

The Spoils of War

Beyond the feel-good reasons for helping poor people in faraway places, what is the benefit to the industry of getting behind such programs? The answer is simple: nothing validates the importance of nutrition and the nutraceuticals industry more than saving lives. And these programs save lives, have decades of strong research and have clear, measurable effects.

The message seems to be getting through to supporters of Vitamin Angels. Donor companies such as the Vitamin Shoppe feel this cause closely relates to its customers’ core values, as well as its own. Similarly, Rainbow Light’s sales of prenatal vitamins rose 20% in its first year of involvement with this program—consumers really bought into the idea that by buying their vitamin women around the world are receiving benefits.

Companies selling products worldwide will also be able to leverage this good will and branding to establish themselves in new markets. Product developers will benefit from the considerable research being undertaken on nutrition issues to find out which ingredients have the most effect. And successful companies will be those focused on developing products that are efficacious and available at price points the consumers in each market can bear.NW


The authors wish to thank Mr. Howard Schiffer for his contribution of time and insight into this article and for his excellent work in helping to eradicate malnutrition worldwide.