© Borgis - Postępy Nauk Medycznych 12/2012, s. 958-964
*Eliza Konecka-Matyjek1, Mirosław Jarosz2, Krzysztof Kołomyjski
Niedożywienie a marnowanie żywności
Undernutrition, malnutrition and wastage of food
1Department of Food and Food Supplements, National Food and Nutrition Institute, Warsaw
Head of Department: Katarzyna Stoś, PhD
2Department of Dietetic and Nutrition in Hospitals with Clinic of Metabolic Diseases and Gastroenterology, National Food and Nutrition Institute, Warsaw
Head of Department: prof. Mirosław Jarosz, MD, PhD
Według statystyk, w roku 2010 na świecie z jednej strony było 925 milionów ludzi niedożywionych, a z drugiej strony corocznie 1,3 miliarda ton żywności (około jedna trzecia globalnej produkcji żywności) jest tracona lub marnowana. Najwięcej ludzi głoduje w krajach rozwijających się, ale przypadki głodu, na mniejszą skalę, spotykane są również w krajach rozwiniętych. Problem niedożywienia dotyczy głównie populacji ubóstwa i osób ze skrajnych grup wiekowych oraz hospitalizowanych pacjentów przewlekle chorych lub z poważnymi zaburzeniami układu immunologicznego. Niedożywienie wpływa na funkcjonowanie i rekonwalescencję każdego ludzkiego narządu.
Marnowanie żywności ma miejsce na każdym etapie w całym łańcuchu żywnościowym „od pola – do stołu”. Procent żywności marnowanej przez konsumentów w krajach uprzemysłowionych jest bardzo wysoki (222 milionów ton) i jest porównywalny z wielkością produkcji żywności w Afryce Subsaharyjskiej (230 milionów ton). W odpowiedzi na marnowanie żywności i rosnący problem głodu/niedożywienia, 19 stycznia 2012 roku. Parlament Europejski wydał rezolucję, której celem jest przyjęcie strategii w kierunku efektywniejszego gospodarowania żywnością w łańcuchu żywnościowym w krajach UE. Rezolucja wskazuje, że ograniczenie marnowania żywności jest ważnym wstępnym krokiem w walce z głodem na świecie oraz poprawą stanu odżywienia ludzi.
On the one hand, there were 925 million people undernourished worldwide in 2010, and on the other hand, 1.3 billion tons of food (about one third of global food production) are lost or wasted annually. The biggest number of hungry people is located in developing countries but hunger, on a minor scale, is also known in developed countries. Malnutrition applies mainly to population of poverty and people in extreme age groups, as well as hospitalized patients chronically ill, or with serious compromised immune systems. Malnutrition affects the function and recovery of every human’s organ system.
Wastage of food occurs in each step of entire food supply chain “from farm-to fork”. The percentage of food being wasted by consumers, in industrialized countries, is very high (222 million ton) and is almost comparable to the total net food production in sub-Saharan Africa (230 million ton). In response to the problem of food wastage and increasing problem of hunger/ /undernutrition, on 19th of January 2012, the European Parliament adopted resolution towards more efficient food chain in the EU. The resolution notes that reducing food wastage is a significant preliminary step in combating hunger in the world and improving people’s nutritional state.
Hunger, undernutrition and malnutrition aspects, next to food wastage, are the most discussed topics nowadays. On the one hand, there are almost one billion of people suffering from hunger, and on the other hand, 1.3 billion tons of edible food is wasted annually (1, 2). Predicted statistics show that the problem arises. This paper is devoted to the problem. It discusses also prevention programmes undertaken in the EU countries designed to reduce the scale of the phenomenon.
UNDERNUTRITION WORLDWIDE, IN EUROPE AND POLAND
According to Food and Agriculture Organization of the United Nations (FAO) the most recent statistics, in 2010 there were 925 million people undernourished worldwide, which is slightly above 13.6% of 6.8 billion world population. That means, almost 1 in 7 people are hungry in the world. The biggest number of hungry people is located in Asia and the Pacific (578 million people), Sub-Saharan Africa (239 million people), Latin America and the Caribbean (53 million), Near East and North Africa (37 million people). Hunger is also known in developed countries but on a minor scale – 19 million people. The number of hungry people worldwide has increased since period of 1995-1997. The increase has been due to three main factors, which the first is – a neglect of agriculture by governments and international agencies, the second – the current worldwide economic crisis, and the third – the significant increase of food prices in the last several years (1, 3-6).
There are a few underlined causes of hunger: poverty, harmful economic systems which are actually the principal cause of poverty and hunger, conflict connected with increasing number of refugees which causes a poverty followed by a hunger, and the last but not least – climate change. Three main groups of population are most at risk of hunger: the rural poor, the urban poor, and victims of catastrophes (3, 7).
Children are the most visible victims of undernutrition. It was estimated that poorly nourished children suffer up to 160 days of illness each year. Annually, there are 5 million children’s deaths from undernutrition (3, 8-10).
According to the most recent data of statistic office of European Union – Eurostat, in 2010, 115 million of European population (23.4%) was at risk of poverty or social exclusion. For comparison, in Poland, that year, there was 10.4 million of people at the poverty risk which was 27.8% of total Polish population. Children were the most affected, as 30.8% of them were at risk of poverty (11, 12). In Europe, it was estimated that undernutrition affects approximately of 20 million citizens and costs EU governments up to 120 million euros each year (13, 14).
In Poland, in turn, it was assessed by WHO (14), that level of undernutrition for the whole population was 2.5%, and among children before ages of 15, increased to 15%. Numerous studies clearly show a significant scale of undernutrition among children in Poland. In 2010, over 130 thousands of children required a supplementary nutrition in Poland, therefore Poland is in third place in the European Union after Bulgaria and Romania (11, 16-19) According to Central Statistical Office’s survey on the living conditions of the Poles in 2005, there were 36% of the families in Poland, which could not afford to eat meals involving meat other than poultry, poultry or fish (or their vegetarian equivalent) every two days. Over 26% of households stated that, comparing to 2005, meeting the needs of the foodstuffs has deteriorated, and only 12% of households reported improvement in this field. However, the situation has not changed in 62% of households (20).
In a study conducted by the Institute for Market Research and Public Opinion – Millward Brown, commissioned by “Danone” and the Polish Banks of Food in 2011, as part of the „Share a meal” Programme, it was demonstrated that there were 130 thousands of undernourished children in Poland in ages of 7-12 or 6% of the total primary school students. 220 thousand of primary school students ate improperly. In 40% of primary schools, at least one child was undernourished. 13% of children requiring supplementary nutrition and weren’t covered by any support social assistance (21, 22).
UNDERNUTRITION, MALNUTRITION AND HUNGER
There are several terms describing problem of “hunger” which are very often use as synonymous in publications but actually differ. “Undernutrion” is defined by FAO (23) as “the result of prolonged low levels of food intake and/or low absorption of food consumed. Generally applied to energy (or protein and energy) deficiency, but it may also relate to vitamin and mineral deficiencies”. Furthermore, term of “undernourishment or chronic hunger” is defined as “the status of persons, whose food intake regularly provides less than their minimum energy requirements” having regard “the average minimum energy requirement per person is about 1800 kcal per day” but “the exact requirement is determined by a person’s age, body size, activity level and physiological conditions such as illness, infection, pregnancy and lactation”. The third term, the most popular indeed, and uses in medical publications is “malnutrition”. It is defined by FAO (23) as “a broad term for a range of conditions that hinder good health, caused by inadequate or unbalanced food intake or from poor absorption of food consumed. It refers to both undernutrition (food deprivation) and overnutrition (excessive food intake in relation to energy requirements)”. The more simple and clear definition was provided by Malnutrition Advisory Group (24, 25) which stated that term of malnutrition supposed to be used “to describe a deficiency, excess or imbalance of a wide range of nutrients, resulting in measurable adverse effects on body composition, function and clinical outcome”. Protein-energy malnutrition (PEM), in turn, refers to a form of malnutrition where there is inadequate protein intake. Actually, it is the most lethal form of malnutrition/hunger. As it was assessed, in the United States 25-50% of hospital patients suffer from PEM (26). PEM includes the following types: kwashiorkor (protein malnutrition predominant), marasmus (deficiency in calorie intake) as well as marasmic kwashiorkor (marked protein deficiency and marked calorie insufficiency signs present, sometimes referred to as the most severe form of malnutrition) (27).
Malnutrition, similarly to infection, applies mainly to population of poverty and people in extreme age groups, as well as hospitalized patients chronically ill, or with serious compromised immune systems (28-31).
Malnutrition can refer to individuals who are either over – or under – nourished and, in contrary to typical hunger prevalence, in developed countries, except to poverty, it occurs for psychological reasons like for instance social isolation, substance misuse, and as a consequence of disease. These diseases arise from several sources divided into several groups, which first is inadequate intake involving poor diet (resulting very often from age, dementia, physical disability and inability to nourish self), poor appetite, pain/nausea with food, dysphagia, depression and unconsciousness. The second – altered nutrient processing including increased/altered, metabolic demands, liver dysfunction. The third, in turn – excess losses involving vomiting, NG tube drainage, diarrhoea, surgical drains, fistulae, stomas, and the last one group of diseases – malabsorption including pathology of stomach, intestine, pancreas and liver (25).
MALNUTRITION RELATED DISEASES
Malnutrition predisposes to infection, leads to serious complications such as septic, respiratory failure and cardiac and sudden cardiac arrest. It also increases the risk of mortality. Malnourished patients’ stay at hospital prolongs for 6-7 days (28, 32).
In the developed countries of Europe and North America, a nutritional state of hospitalized patients is assessed as unsatisfactory. There are 35-55% malnourished patients admitted to hospitals (32).
Malnutrition affects the function and recovery of every organ system. Loss of weight connected with not enough of food intake, cause depletion of fat and muscle mass involving internal organs. Loss of bone mass is also observed, especially when intakes of calcium, magnesium and/or vitamin D are insufficient (25). Malnutrition causes negative changes also in gastrointestinal function, nervous system, heart and kidney disorders and as a consequence, the improper physical and mental development (22). Chronic malnutrition results in impaired pancreatic (pancreatic exocrine function). Dysfunction of colon may lead to diarrhoea and as a consequence, result in mortality (25). Malnutrition can also lead to impaired liver function and necrosis. It devastates function of gut manifested as impaired gut integrity and immunity. Furthermore, malnutrition may cause impaired renal function. Dysfunction of cardiovascular and respiratory are also one of malnutrition consequences. Loss of respiratory muscle mass may lead to hypoxic responses and a reduction in cardiac muscle mass resulted in reduced cardiac output (25). Delay of wound healing is also known as a consequence of improper nutritional state (25, 33). It is also proved, that malnutrition decreases immunity and organism’s resistance to infection (25, 28). Malnutrition, except physical consequences, affect mental condition demonstrated as apathy, depression, anxiety and self-neglect. As “Maillard Brown” study states (22), malnourished children have problems with learning, concentration and relationships with peers. They manifest aggression or raise aggression within a group they play. They are not accepted by their peers.
Malnutrition increases the effect of many diseases, including measles and malaria. As mentioned before malnutrition, quite often, results in deaths. The estimated proportions of deaths as a consequence of malnutrition are roughly comparable to those involving diarrhea (61%), malaria (57%), pneumonia (52%), and measles (45%) (34, 35).
Some cancer statistics show that undernutrition is responsible for 22% up to 67% of all cancer deaths (33).
WASTAGE OF FOOD
Wastage of food is the second important subject, except to hunger being discussed nowadays worldwide. It was assessed that 1.3 billion tons of food (about one third of global food production) are lost or wasted annually (1, 2). In Europe, more and more food is wasted or lost. According to European Commission data, there is 89 million tons of food wasted in Europe each year. European Commission assessed that, within next 8 years, the amount of wasted food will rise up to 126 million tons while there are still 79 million of people living below the poverty in EU countries (12, 36).
Wastage of food occurs in each step of entire food supply chain “from farm-to fork”. These include primary production (rearing, harvesting or hunting animals or producing primary products of animal origin, as well as producing or harvesting plant products), as well as secondary production – production, processing and distribution of food to the final consumer. Food is also wasted in households. There are two main terms use to describe food wastage – food losses and food waste conducted by Swedish Institute for Food and Biotechnology (SIK) on behalf of FAO, where food loss supposed to be used to describe a decrease of edible food mass with exclusion of inedible by-products and seed, throughout the whole food supply chain. Food loss refers to edible food, which is losing during its postharvest – production and processing stages. In turn, food waste is more related to food loss during retail: retail, mass catering and consumption in households. Food waste refers to throwing away of food (2, 37). There is observed a tendency, that in developing countries most wastage occurs during the production and processing of food, while in developed countries more food is wasted at the consumption stage of food chain (2). As FAO in 2011 assessed, in Europe and North-America, per capita, food loss and food waste was 280-300 kg/year whereas, in Sub-Saharan Africa and South/Southeast Asia it was 120-170 kg/year, taking into consideration, that the total per capita production of edible parts of food for human consumption, in Europe and North-America, was about 900 kg/year and, in sub-Saharan Africa and South/Southeast Asia – 460 kg/year. The only food waste produced by the consumer, in Europe and North-America, per capita is 95-115 kg/year and in sub-Saharan Africa and South/Southeast Asia – only 6-11 kg/year (2). Thus, the percentage of food waste by consumers in industrialized countries is very high (222 million ton) and is almost comparable to the total net food production in sub-Saharan Africa (230 million ton).
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Płatny dostęp do wszystkich zasobów Czytelni Medycznej
1. Food and Agriculture Organization 2010. The State of Food Insecurity in the World 2010; http://www.fao.org/docrep/013/i1683e/i1683e.pdf.
2. Gustavson J, Cederberg Ch, Sonesson U et al.: Global Food Losses and Food Waste. FAO 2011.
3. World Hunger and Poverty Facts and Statistics. World Hunger Education Service 2012; http://www.worldhunger.org/articles/Learn/world%20hunger%20facts%202002.htm.
4. Cafiero C, Gennari C, Gennari P: The FAO indicator of the prevalence of undernourishment FAO 2011.
5. Food and Agriculture Organization 2011. The State of Food Insecurity in the World 2011; http://www.fao.org/docrep/013/i1683e/i1683e.pdf.
6. Masset E: A review of hunger indices and methods to monitor country commitment to fighting hunger. Food Policy 2011; 36.
7. Statistical Yearbook 2006 “Main Findings” United Nations High Commissioner on Refugees 2007.
8. Caulfield LE, de Onis M, Ezzati M et al.: Maternal and child undernutrition: global and regional exposures and health consequences. The Lancet 2008; 371 (Issue 9608): 243-260.
9. Caulfield LE, de Onis M, Blössner M et al.: Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr 2004; 80: 193-198.
10. World Health Organization: Comparative Quantification of Health Risks: Childhood and Maternal Undernutition. World Health Organization. Geneva 2004.
11. Strona internetowa Europejskiego Urzędu Statystycznego; http://epp.eurostat.ec.europa.eu/portal/page/portal/eurostat/home/.
12. Pomarańczowe drzewo. Energetyczny Kwartalnik Sieci Polskich Banków Żywności 2012; 3.
13. Ljungqvist O, van Gossum A, Sanz M et al.: The European fight against malnutrition. Clin Nutr 2010; 29:149-150.
14. The fight against malnutrition. Declaration. Four key actions to address disease-related malnutrition screening, awareness, reimbursement and education. Warszawa 2011; http://www.polspen.pl/assets/files/Polish%20Declaration-wersja%20polska.pdf.
15. World Health Statistics. WHO 2010.
16. Tarkowska E: Ubóstwo dzieci w Polsce. Ubóstwo i wykluczenie społeczne w Polsce: Raport krajowy Polskiej Koalicji Social Watch i Polskiego Komitetu European Anti-Poverty Network. Warszawa 2011; 57-62.
17. Child Poverty and Well-Being In the EU: Current Status and Way Forward, European Commission General for Employment, Social Affairs and Equal Opportunities, Luxemburg 2008.
18. Strona internetowa Głównego Urzędu Statystycznego; http://www.stat.gov.pl/gus.
19. The children left behind. Unicef. 2011; http://www.unicef.pl/images/stories/publikacje/publikacje/pdfs/rc9-final.pdf.
20. Czapiński J, Panek T (red.). Diagnoza społeczna 2007. Warunki i jakość życia Polaków. Raport. Rada Monitoringu Społecznego, Wyższa Szkoła Finansów i Zarządzania w Warszawie 2007.
21. Niedożywienie dzieci w Polsce – na drodze do skutecznego rozwiązania problemu. Raport otwarcia. Danone 2007.
22. Informacja o niedożywieniu – Millward Brown dla Danone i Baków Żywności. Danone 2012; http://podzielsieposilkiem.pl/user_files/Materialy2011/2011_Informacja_o_niedo%C5%BCywieniu_dzieci_w_Polsce.pdf.
23. FAO Hunger Portal; http://www.fao.org/hunger/en/.
24. Elia M (ed.): Guidelines for detection and management of malnutrition. Maidenhead: Malnutrition Advisory Group, Standing Committee of BAPEN 2000.
25. Saunders J, Smith T, Stroud M: Malnutrition and undernutrition. Medicine 2010, 39(1): 45-50.
26. Quillin P, Quillin N: Beating Cancer With Nutrition. Malnutrition among cancer patients Nutrition Times Press 2007. Chapter 8: 91-97.
27. Jarosz M, Grodowska A: Wpływ stanu odżywienia na występowanie zakażeń szpitalnych. [W:] Jarosz M (red.): Zasady prawidłowego żywienia chorych w szpiatalch. Warszawa, IŻŻ 2011; 32-40.
28. Macallan D: Infection and malnutrition. Medicine 2009; 37(10): 525-528.
29. Bloomfield SF, Aiello AE, Cookson B et al.: The effectiveness of hand hygiene procedures in reducing the risk of infections in home and community settings including handwashing and alcohol-based hand sanitizers. Am J Infect Control 2007; 35: S27-64.
30. Buccheri C, Casuccio A, Giammanco S et al.: Food Safety in hospital: Knowledge, attitudes and practices of nursing staff of two hospitals in Sicily. BMC Health Serv Res 2007; 7: 45-56.
31. Food safety issues. WHO Global Strategy for Food Safety. Safer food for better health. WHO 2002.
32. Jarosz M, Respondek W: Wpływ stanu odżywienia skuteczność i koszty leczenia. [W:] Jarosz M (red.): Zasady prawidłowego żywienia chorych w szpiatalch. Warszawa, IŻŻ 2011; 26-31.
33. Haydock DA, Hill GL: Impaired wound healing in surgical patients with varying degrees of malnutrition. J Parenter Enteral Nutr 1986; 10: 550e4.
34. Black RE, Morris SS, Bryce J: Where and why are 10 million children dying every year? Lancet 2003; 28, 361(9376): 2226-2234.
35. Bryce J, Boschi-Pinto C, Shibuya K et al.: WHO estimates of the causes of death in children. Lancet 2005; 365: 1147-1152.
36. European Parliament resolution of 19 January 2012 on how to avoid food wastage: strategies for more efficient food chain in the EU (2011/2175(INI)).
37. Parfitt J, Barthel M, Macnaughton S: Food waste within food supply chains: quantification and potential for change to 2050. Phil Trans R Soc 2010; 365: 3065-3081.
38. Code of hygienic practice for precooked and cooked foods in mass catering. CAC/RCP 39-1993.
39. Zalewski S: Podstawy technologii gastronomicznej. Warszawa, WNT 1997.
40. Evans JA: Frozen Food Science and Technology. Blackwell Publishing Ltd 2008.