Kenya kids suffer malnutrition despite food fortification

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Four years after the introduction of fortified foods, just over a quarter of Kenyan children below five years are suffering from malnutrition bringing into question the efficacy of the food fortification.

Between 2005 and 2008, the Ministry of Health began developing food fortification standards which was later implemented in 2012. They introduced fortification for wheat and maize flour, sugar, oils and fats, inserting a range of vitamins and minerals into the foods, including vitamin A.

However, a World Bank study released this year stated that just over one quarter of Kenyan children under the age of five are stunted. This means that the height and weight of these children was below international standards for their age, and is a sign of chronic malnutrition.

Dr Mohamed Abdi, General Practitioner and co-founder of Ladnan Hospital, cites food such as ugali and sukuma wiki as a major reason for this problem, the lack of vitamins and minerals in the staple dish poses a significant threat to our health.

“It is not healthy just eating plain ugali alone – you are missing proteins and minerals,” he said.

He goes on to add that despite the sukuma wiki being full of vitamins and minerals, this is not the case once the dish is on our plates.

“Sukuma loses minerals because it is over-cooked, which means it loses its [nutritional] benefits,” said Dr Abdi.

Vitamins and minerals are substances which we only need in really small amounts. Vitamins come from plants and animals we eat, and minerals come from the soil or water, also absorbed by the food we eat. They may be small, but they are extremely important in helping our bodies to work properly.

In theory, we should be able to get all of the vitamins and minerals we need by eating a varied and balanced diet – particularly including lots of different vegetables. However, in practice, this is not always possible.

According to Dr John Wachira, consulting paediatrician and treasurer for the Kenya Paediatric Association, one third of under-fives in Kenya suffer from nutrient deficiencies. This is mostly caused by a lack of dietary intake, disease, and poor infant feeding practices, all closely linked to poverty.

It is for this reason that the Kenyan government introduced food fortification in 2012.

Dr Abdi suggested that eating these fortified foods can be a good idea when we are not getting enough from our natural diet.

“Fortified foods are good for the reason that most people will not be able to get access to these minerals [and vitamins] because it is mostly carbohydrates we eat,” he said. “They are generally good for a balanced diet.”

However, if the nutrients we need are actually included in the staples most of us eat every day, then why is malnutrition still such a serious public health problem? Dr Abdi cited ugali as part of the problem when it comes to poor diets, but as a dish generally made using maize flour – one of the foods fortified with vitamins and minerals, as directed by the government – it seems it should be part of the solution.

Yet, perhaps this solution does not involve synthetic nutrients at all. According to Dr Wachira, “our dietary requirements should be met by eating natural foods as much as possible”, however, he added that “in some communities, not all food is available, for example, fish, or certain types of vegetables, which may lead to deficiency and a need for supplements.” He also suggested that those with higher metabolic needs, for example, pregnant women, require extra supplementation in their diets.

Dr Abdi also agreed that wherever possible, fresh food as the source of a balanced diet is the healthiest choice. “Natural is always the best,” he said, adding that it can be difficult, however, to get every single nutrient from your food: “the challenge is the type of food you have to eat to get the vitamins and minerals.”

Although our bodies might process supplements differently to fresh food, Dr Wachira said, “it depends on how they are made – if the vitamin is from the natural source it should be the same [as fresh food]”. “However”, he added, “the advantage of natural food [over synthetic supplements] is that they have the fibre and extra nutrients not found in the vitamin”.

As well as contributing to a well-rounded diet, all of these extra ingredients help us to digest the food and nutrients better, something which supplements cannot replace. Dr Wachira goes on to say that synthetic vitamins may also contain additives or preservatives, making them an unhealthy choice.

Although they do not tend to have an effect on the ability of our body to absorb the nutrient, additives and preservatives can be harmful, stated Dr Abdi.

“You will be absorbing [the additives and preservatives] too,” he said.

Although most additives are not harmful to our bodies, they are a few which can be. When asked how they might affect the body, Dr Abdi said, “it’s mainly through the kidneys. It will affect your kidneys.”

When tested, the amount of nutrients in supplements and fortified foods can range wildly from being completely ineffective to resulting in excessive levels. Excess amounts of certain vitamins and minerals can be equally as dangerous as the deficiencies which they combat. For example, too much vitamin A, or ‘vitamin A toxicity’, can lead to drowsiness, nausea, vomiting and increased pressure on the brain.

A 2009 European report entitled ‘Intake of selected nutrients from foods, from fortification and from supplements in various European Countries’ suggests that there is a low, but general, risk of excessive intake of nutrients from synthetic sources. It states that “children are the most vulnerable group as they are more likely to exhibit high intakes relative to the UL [Upper Intake Level of vitamins and minerals].”

When it comes to the body’s reactions, a 2013 New Zealand study on vitamin C by Anitra C. Carr and Margreet C. M. Vissers found that there was no difference between taking synthetic versus natural sources. However, they concluded that “ingesting vitamin C as part of a whole food is considered preferable” due to the health benefits which taking in all the additional nutrients could provide.

Most schemes aimed at combatting deficiency tend to focus on synthetic supplements or fortification. However, there has been growing interest in recent years in the adoption of food-based solutions: one focus in particular is the use orange-fleshed sweet potatoes as a source of vitamin A.

A 2006 study for the American Society of Nutrition, conducted by Jan W. Low among others, suggested that orange-fleshed sweet potatoes can contribute to reducing the prevalence of vitamin A deficiency, through results gathered in populations of young children in rural Mozambique. The success of this study has begun to pave the way for different approaches in targeting widespread malnutrition across the world.

Last year, the World Bank news desk called the orange-fleshed sweet potatoes a “solution” to malnutrition and childhood stunting, as well a potential boost to women’s economic independence. Focusing on real food seems to be not only a potential solution to malnutrition, but also a means of promoting a better quality of life and business too.

“The basis of a healthy diet [is] food, not supplements”, says Joyce Obulutsa-Odoyo, a nutrition consultant. She also states that although “it doesn’t matter whether you get your micronutrients from supplements or from real foods”, there are multiple benefits to eating fresh foods: “foods have much more to offer than essential nutrients, including various bioactive compounds and dietary fibre. And, not to forget, foods are tasty and provide pleasure.”

In relying on vitamin supplements and fortified foods, we risk forgetting to maintain a balanced diet, which can result in further health implications. When we take the vitamin in via its natural source, we are also taking in numerous other nutrients which all work to promote the well-being of our bodies. And as the movement of the orange-fleshed sweet potato shows us, this can have a positive impact on not only our health and our children’s health, but on our communities too.

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