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IUNS president's report

The present status of nutrition worldwide

Mamdouth Gabr

At this 14th International Congress of Nutrition of the International Union of Nutritional Sciences it may be opportune to consider the present status of the science of nutrition worldwide. Where does it stand among the growing body of human sciences? What can it accomplish towards the welfare of humankind? Why are we still short of achieving adequate nutrition on a global level? How can the IUNS help, and what has it done in this respect?

In spite of great scientific achievements in the food and nutrition sciences, various constraints still exist that hamper our progress towards achieving optimal nutrition for all. There have been great advances in our knowledge of food availability, processing, preservation, composition, and nutritive value. There is also a clearer picture of requirements for macro-and micro-nutrients under various physiological and pathological conditions. There is growing scientific evidence on the relationship between diet and various diseases as well as on the effects of both over- and under-nutrition on human functions and capabilities. Nutrition is gradually being recognized by both decision makers and the public as a leading scientific entity affecting human health and productivity. More emphasis is being given to all levels of nutrition education and training.

Why is it that, in spite of all this, many of us, especially those from developing countries, feel that little has been achieved at the grass-roots level? What are the constraints?

Socio-economic situations, food shortages, and food availability are most important factors, especially for the underprivileged. Much attention is needed to find the most cost-effective way to obtain better nutrition from limited resources. We must learn how to make the best use of recent technical advances to maximize food resources and use the food resources that are available more efficiently.

No other science is so dependent on environmental, geographical, regional, and cultural factors as is nutrition. Apart from the extreme forms of malnutrition during natural catastrophes, prevailing cultural, health, and sanitary situations greatly influence food availability as well as nutritional requirements. Overcoming these factors has to be tailored to each country and even to each region. Intervention is not easy in many developing countries that lack manpower, tools, and resources. Small pilot intervention projects successful in one area may not be replicable nationwide.

Although nutrition is more and more recognized as a separate entity, it is and always will remain multidisciplinary. This makes it difficult for those who fund nutritional activities to identify to whom the funds should be allocated. Where nutrition is involved, competition between different departments as well as within various disciplines frequently affects its hierarchy in a particular discipline. This is true not only for academic and service departments but also in certain international organizations. Furthermore, competition between different nutritionists belonging to different disciplines can result in scientific imbalances that hamper achievement of our common goal, which is better nutrition for all.

Although training in nutritional sciences is receiving more and more attention, the balance between training in basic and applied nutritional sciences is not always optimal. This is especially so in developing countries, where frustrations face young nutritionists, who are unable to apply the basic principles in nutrition they have learned, either in their own country or abroad, because of local realities and limitations.

How can the IUNS partially overcome some of these constraints? I shall give a few examples from IUNS activities in the last four years. Being international and non-governmental, the IUNS is free to choose as members of its commissions and committees those individual scientists from both developed and developing worlds who are able to fulfil its goals in the different disciplines of nutrition. It constitutes the most appropriate medium for co-operation and co-ordination nationally and internationally. Through exchange of information on research results, developing countries benefit from the scientific knowledge available in developed countries. On the other hand, scientists from the West can better evaluate the efficiency of various intervention programmes in the field situation as it exists in developing countries. To this end, the lUNS held an important meeting in 1986, "Fostering Nutrition between Countries." Adhering bodies from developing countries were encouraged to join the [UNS family, and the United Nations Children's Fund (UNICEF) and certain other organizations lent their support. Seven additional developing countries are on their way to full membership.

IUNS meetings were held in more than 30 countries, on all the continents. The IUNS has continued its policy of granting an award sponsored by the International Nutrition Foundation for Developing Countries (INFDC) to outstanding scientists from developing countries. This year the award was given to Professor C. Gopalan from India.

These activities did not divert IUNS from its basic scientific purposes. New committees, such as those on Nutrition and Biotechnology, Animal Models in Human Nutrition, and the Use of Computers in Nutrition, were formed; and several reports have been published on topics including the nutritional regulation of immunity and infection, iron deficiency and brain function, health effects of fish and fish oils, energy and protein requirements, and geriatric nutrition.

The IUNS has continued its policy of encouraging training in different disciplines. Manuals and reports have been published on training clinicians for academic research, teaching clinical nutrition, patient problems, guidelines for nurses and midwives, growth monitoring, etc. Also, an international directory of programmes for advanced training has been published.

The IUNS is keen to co-operate and co-ordinate its activities with all United Nations, international, and regional organizations working in nutrition. It has sponsored various regional nutrition congresses in the Americas, Europe, Africa, and Asia. It also participated in the International Congress on Clinical Nutrition held in San Diego, California, USA, in 1986 and the Congress of the International Dietetic Association in Paris in 1988. Its strong liaison with the World Health Organization, the Food and Agriculture Organization of the United Nations, the United Nations Children's Fund, and the United Nations University continues, and during the past year we have been in the process of establishing an official relationship with the Sub-committee on Nutrition of the United Nations Administrative Committee on Co-ordination (SCN). Dialogue with the World Bank is in progress, and there is also close co-operation with various other international, non-governmental organizations working in nutrition as well as various national institutions. Instead of duplicating activities, the IUNS Council has substituted corresponding committees with liaison officers to such organizations as the International Vitamin A Consultative Group (IVACG), the International Anaemia Consultative Group (INACG), the International Union of Pure and Applied Chemistry (IUPAC), the International Council for Control of Iodine Deficiency Disorders (ICCIDD), and the International Dietary Energy Consultative Group (IDECG). The relationship with the International Union of Food Science and Technology (lUFoST) has been expanding through several meetings between the joint committees, and publication of a joint periodical is being planned.

The relationship of the International Council of Scientific Unions (ICSU) with the IUNS is also growing. Through the ICSU, several IUNS committees have received special grants in the fields of training, newer technology, nutrition in developed countries, and primary health care. We are co-operating with the ICSU in its lectureship programme with the Third World Academy as well as in its programmes on the geosphere and the biosphere and in its recent project with the United Nations Development Programme on the effect of scientific progress on development.

As is the case in most international organizations, financing is a continuing problem. We have partially overcome this during the past four years by cutting down administrative expenses through combining council meetings with scientific activities to which many council members are invited, as well as by close follow-up and encouragement of adhering bodies to pay their dues. We are grateful to several donors, especially the Japanese Nutrition Society for its generous contribution during the last Asian Nutrition Congress. The International Life Sciences Institute and certain food firms helped to support the joint workshop on "IUNS and the Food Processing Industry." This allowed the IUNS to support the activities of several committees with seed money.

More important, this stimulated the various committees involved to seek more financial support from various funding organizations, so that indirect donations to the IUNS committees were far greater than the direct support described above. More than 35 workshops and committee meetings have been held in the last four years, and more will be held during this congress. In this respect, I would like to express appreciation for the zeal and enthusiasm of all IUNS officers, council members, committee chairpersons, and members who really initiated or participated in all of these activities.

We still have much to do. Nutrition as a science needs greater visibility. Although human well-being depends primarily on better nutrition, neither decision makers nor lay people give nutrition the priority and prestige it deserves. The IUNS should bring this about. The best way to do so is through the coordinated scientific activities of all of us gathered here.

This gives us hope of reaching the grass-roots level - but, more than that: it can be done. Several scenarios of how to improve nutrition under different environmental, socio-economic, and cultural conditions should be planned, tried, and evaluated. The present congress is a good start. The workshops supported by WHO, UNICEF, the World Bank, and the SCN on economic adjustment and nutrition, on evaluation of successes and failures of nutrition projects, and on nutrition and primary health care are initiatives on the right track. They should continue to be implemented.

Book reviews and notices

Research methods in nutritional anthropology. Edited by Gretel H. Pelto, Pertti J. Pelto, and Ellen Messer. United Nations University, Tokyo, 1989. (WHTR-9/UNUP-632, ISBN 92-808-0632-7) 218 pages. Paperback, US$15.

In recent years a multidisciplinary approach to problems of nutrition has developed. Out of the collaboration between nutritionists and anthropologists and other social scientists has emerged the new discipline of nutritional anthropology, whose theory and methodologies are having an important influence on the methods used in nutrition field studies.

Research Methods in Nutritional Anthropology is a unique guide for applying anthropological methods in studies related to nutrition-programme planning, development, and evaluation. The book's emphasis is on specific methodological problems likely to be important in field-based nutrition studies. Following a general discussion of the methodological options and strategies for field research, the authors concentrate on specialized issues such as methods for studying nutritionally related social behavior and household functioning, the determinants and cultural components of food intake, analysis of energy expenditure, and statistical methodologies.

This volume is a valuable contribution to further developing and refining methodological design and application for nutrition research.


Protecting, promoting and supporting breast-feeding: The special role of maternity services. A joint WHO/UNICEF statement. World Health Organization, Geneva, 1989. (ISBN 92-4-156130-0; order no. 1150326) Available in English and French; Arabic and Spanish editions in preparation. 32 pages. SwF 6; US$4.80.

This booklet sets out facts and lines of action to enable health services to achieve their full potential as part of society's first line of support to breastfeeding. It translates up-to-date scientific knowledge and practical experience about lactation into precise recommendations on care for mothers before. during, and after pregnancy and delivery. Information is addressed to health workers, particularly clinicians, midwives, and nursing personnel, but also to policy-makers and managers of maternal and child health and family-planning facilities.

The statements lists ten important steps to successful breast-feeding, intended for application in every facility providing maternity services and care for newborn infants. In unequivocal terms, readers are told that mothers should be helped to breast-feed within a half hour of birth, that newborn infants should be given no food or drink other than breast milk, unless medically indicated, and that rooming-in should be practiced 24 hours a day.

These and other key messages are then carefully elaborated in sections explaining what needs to be done - during health-worker training, when organizing health services, and in providing care for mothers and infants - to foster breast-feeding. The statement emphasizes the importance of correct attitudes, routines, and procedures for the normal initiation and establishment of breast-feeding.

Examples to avoid include indiscriminate use of medication during labour and delivery, administration of glucose water by bottle and teat before breast-feedings, separating mothers and infants, and providing feeding bottles and teats, infant formula, or pacifiers to mothers upon discharge.

The end of each section is punctuated by a shaded box that summarizes the main points just treated, further enhancing the booklet's value as a teaching tool. It concludes with a 20-point synthesis in the form of a check-list that maternity wards and clinics can use to gauge how well they are protecting, promoting, and supporting breast-feeding.

African crisis and food security. Special issue of the International Labour Review (vol. 127, no. 6). International Labour Organisation (ILO), Geneva, 1988.

This special issue on food security during the African crisis is a result of a two-year policy-review project on agricultural performance in African countries. Five country case studies (on Ghana, Madagascar, Nigeria, Somalia, and Uganda) are included, along with a synthesis chapter, entitled `'Getting the Crisis Right: Perspective on the African Crisis," which probes further into aggregate production data to establish the extent of production falls in African countries. Rising food imports are discussed in the context of rapid urbanization and changing diet patterns in urban areas. Copies can be obtained from the ILO.

Drought relief in Ethiopia: Planning and management of feeding programmes - A practical guide. Compiled by Judith Appleton, with the Save the Children Fund Ethiopia Team. Save the Children, London, 1987. 186 pages.

This extremely practical handbook, based on experience in Ethiopia, offers both dos and don'ts for feeding programmes under drought conditions and provides the guidance that planners and managers of drought-relief programmes need. For those faced with providing food relief in any disaster or refugee situation it will be invaluable.

The prevention and control of iodine deficiency disorders: A state-of-the-art review. By B. S. Hetzel, with discussions by F. Delange, J. B. Stanbury, and F. E. Viteri and an introduction by Mahshid Lotfi and J. B. Mason. ACC/SCN, Geneva, 1988.

This nutrition-policy discussion paper focuses particularly on measures for the prevention and control of iodine-deficiency disorders through the use of iodized oil and salt supplementation. Country control programmes and global strategy for the eradication of iodine-deficiency disorders are also emphasized.

The third publication in the ACC/SCN's state-oft-he-art series, it is available from the ACC/SCN Secretariat, c/o World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.

Cassava toxicity and food security. 2nd revised edition. Hans Rasling. UNICEF, New York, 1988. 40 pages.

The aim of this review, published by UNICEF's African Household Food Security Programme, is to summarize the available knowledge on the effects on humans of exposure to cyanide from cassava and to recommend ways to prevent these effects. Intended primarily for those involved in agriculture and health programmes with little previous knowledge of the subject, it discusses the nature of cassava toxicity, its determinants, and methods for the estimation of cyanide exposure as well as related diseases. Its recommendations will contribute to an understanding of the positive and negative effects of cassava in a broad perspective and also to defining areas for future research.

Guidelines for the use of vitamin A in emergency relief operations. International Vitamin A Consultative Group (IVACG), 1988.

This report was published in recognition of the special needs of malnourished populations during famine and the logistical constraints on relief operations. It gives the necessary measures for the prevention and treatment of vitamin-A deficiency in populations at risk - in particular, pregnant women and high-priority risk groups - and summarizes the information in tables. It will be a valuable reference for those involved in relief operations.

Available from the IVACG Secretariat, c/o International Life Sciences Institute/Nutrition Foundation' 1126 Sixteenth Street, NW, Washington, DC 20036, USA.

Chronic energy deficiency: Consequences and related issues. Edited by Beat Schürch and Nevin S. Scrimshaw. International Dietary Energy Consultative Group (IDECG). 200 pages.

This book contains background papers and working-group reports of the IDECG meeting held in Guatemala City in 1987. Copies are available without charge from the IDECG Secretariat, c/o Nestlé Foundation, PO Box 582, 1001 Lausanne, Switzerland.

Educational handbook for nutritionists. A. Oshang, D. Benbouzid, and J. J. Guilbert. 1988.

This draft handbook, taking advantage of new material developed in recent years, is intended as a tool for teachers of teachers and not as a self-learning instrument, although a handful of committed workers in the health sciences have used it for the latter purpose. As a draft, it is intended for testing by users during workshops. Comments are welcome.

Copies can be obtained from, and comments addressed to: Dr. D. Benbouzid, Nutrition Unit, Division of Family Health, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.

News and notes

IDECG news

A workshop on Activity, Energy Expenditure, and Energy Requirements of Infants and Children was held by the International Dietary Energy Consultative Group (IDECG) at Harvard University, in Cambridge, Massachusetts, USA, from 14 to 17 November 1989.

The committee responsible for the 1985 FAO/ WHO/UNU report Energy and Protein Requirements defined energy requirements for adults as "the amount needed to maintain health, growth, and an appropriate level of physical activity." The "appropriate" level of physical activity depends on a person's occupational and other activities which are part of his or her lifestyle and may be quite difficult to define, but the committee maintained that a definition of energy requirements makes sense only if one specifies "what for?" - i.e., an appropriate or desirable level of physical activity and energy expenditure for the particular population group under consideration.

When turning to the energy requirements of infants, children, and adolescents, the committee stated: "Although, in principle, it would be desirable to determine the requirements of children in the same way as for adults, from measurements of energy expenditure, this approach involves many difficulties in practice." Since the necessary information on energy expenditure in that age group was not available at that time, the determination of energy requirements continued to be based on information on the energy intakes of infants and children growing normally.

Thanks to the development of the doubly-labelled water method and renewed interest in that area, a considerable amount of new information on children's activities and energy expenditure has become available since then. The Steering Committee of IDECG therefore concluded that it would be useful and timely to reanalyse the energy requirements of infants and children from this new perspective.

Thirty scientists from 10 countries participated in the workshop. The meeting began with the presentation of 16 commissioned papers dealing with physiological methods used to assess the different components of energy expenditure in infants and children, new data obtained by these methods and their limitations, responses and adaptations to disease, under- and over-nutrition, the relevance of physical activity to cognitive and socio-emotional development, and temperamental and socio-cultural variations in activity. One and a half days were devoted to discussions of the implications of new findings in this area for various aspects of public health policy, and of needs and priorities for further research and action.

The last afternoon began with discussion of the medium- and long-term plans of IDECG, based on a report on this subject by Prof. G. Beaton. Later, IDECG's Advisory Group met to discuss objectives and activities for the next two years and to make its recommendations to the Steering Committee.

The report of the workshop should be available from the Nestlé Foundation, Lausanne, Switzerland, and the UNU in the autumn of 1990.

Course on nutritional epidemiology

The European postgraduate summer course in public health, Nutritional Epidemiology, Theory and Application, will be held at the University of Southampton, Southampton, UK, 9-27 July 1990, under the auspices of the University of Southampton Nutritional Epidemiology Group, with EURONUT Concerted Action on Nutrition and Health in the European Community, the WHO Collaborating Centre on Nutritional Epidemiology, West Berlin, and the Wessex Medical School Trust.

The course will have a distinguished faculty from many different European countries.

The emphasis in its structure will be on the application of theory to the practical organization and completion of different types of epidemiological studies. Each session in the morning and afternoon will consist of a lecture before participants break into small groups. Small-group activities will involve discussion of material covered in the lectures, critical reviews of literature, and practical activities designing studies in the light of concepts covered.

The course will be arranged around five broad topics: basic issues in nutrition epidemiology, descriptive epidemiological studies, case-control studies, cohort studies, and intervention studies. In these areas, systematic attention will be given to: objectives of research, causation, sample selection, study design, study planning and management, measures of disease, measures of effect, power, strength of association, measurement error, misclassification, confounding, validity, bias, dietary methods, food tables, data aggregation, data bases, types of dietary data, validation of intakes, biochemical markers, nutritional-status assessment (anthropometric, biochemical and clinical), principles of RDA's, and requirements of ethical issues.

The course, which will be given in English, will be restricted to 30 participants. All applicants should have some experience in nutritional-epidemiological research. The course fee is £1,250, which includes a nonrefundable deposit of £150. This fee covers full board in university accommodation and tuition fees.

For further information write to: Dr. B. M. Margetts, Course Director, MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO9 4XY, UK. Telephone: 0703-777624. Fax: 0703704062.

M.Sc. course in food technology in developing countries

King's College London has recently launched a new M.Sc. course in Food Technology in Developing Countries, which offers a completely new approach to this important area. Conventional courses tend to concentrate on food science, processing techniques, equipment, and financial management without taking into account the social and economic context in which these are to be applied. In contrast, this new course directs half of the teaching time to the social and economic contexts of food technology and includes a project (dissertation) in which course participants investigate both the scientific/technical and the social context of a chosen food technology, including its impact on nutrition. The aim of the course is thus to develop expertise to choose technology and assess or predict the consequences of technological change.

Modernization has often been seen in terms of transferring technologies from the industrial countries. Although in some situations large-scale, capital-intensive projects may well be appropriate, in many others they have turned out to be costly mistakes in terms both of finance and of food security. Many are working far below capacity or have even had to be closed down altogether because of inadequate foreign exchange to purchase imported inputs or spare parts and are therefore not contributing to economic development. Meanwhile, strategies for developing a network of smaller-scale industries, which could improve food security by extending the shelf-life of local food commodities through processing or by improving food entitlements through income generation, have been neglected.

This course focuses on "best-practice" cases of food-technology development based on locally available sources of finance and technology, taking into account transport constraints and the widely dispersed nature of potential raw material supply. It promotes the view that the design and implementation of the most appropriate technology for a given situation requires expertise in both food science/ technology and social/economic analysis of food systems, including causes of poor nutrition in individuals and communities.

The course is taught by staff who have considerable work experience in developing countries and who come from the fields of food technology, food policy and marketing, nutrition, and social anthropology. It includes the following elements:

- food science,
- principles of food processing and preservation,
- principles of nutrition and applied nutrition,
- applied statistics,
- food and agricultural policies,
- food, society, and culture,
- agricultural production and agricultural ecology,
- food-systems analysis, indigenous technical knowledge, and technological transfer,
- food technology in developing countries,
- a research project.

The course has already attracted a considerable amount of interest internationally. It is anticipated that successful candidates will take up positions of considerable responsibility in the fields of food-technology development and evaluation, including posts as administrators of food-security and income-generating programmes, small-business development schemes, and women's programmes; planners or managers in food-processing industries, co-operatives, banks and other financial agencies, and non-government organizations; staff members of training institutions for food technologists, agricultural-extension and community-development officers, home economists, and nutritionists; and university-based or other research and development workers in food technology.

Further details and application forms are available from: Dr. J. V. S. Jones, Course Director, M.Sc. in Food Technology in Developing Countries, King's College London, Campden Hill Road, London W8 7AH, UK.

Directory of social scientists concerned with food and nutrition

Since 1985 the Cambridge Programme Office of the United Nations University has maintained a computerized directory of anthropologists and sociologists concerned with food and nutrition. In January of this year a mailing was sent to all of the 337 persons from 54 countries listed in the directory, requesting them to update the information therein.

In addition, new sections will be added to the directory for behavioural scientists and economists concerned with food and nutrition issues. Forms for inclusion in the directory have been sent to a number of individuals identified on the basis of their publications, but the lists are very incomplete.

Social scientists in any of these categories concerned with food and nutrition issues who are not currently listed or have not received forms for inclusion are requested to write to the address below asking for a form. Anyone aware of persons who should be included in the directory is asked to bring this announcement to their attention.

Address all correspondence to:

Directory of Social Scientists
Food, Nutrition, and Development Programme
United Nations University Programme Office 9 Bow Street
Cambridge, MA 02138, USA

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