© 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
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