Reduce Malnutrition in All Its Forms to Improve Health at Scale

While the world has made great progress in reducing infectious diseases like HIV and malaria, chronic noncommunicable diseases (NCDs) are on the rise as people live longer and diets and lifestyles shift. Formerly, these trends were strongest in upper-middle and high-income countries as dietary-related NCDs like heart disease, diabetes, and cancer became a major cause of death and disability.

Now it is clear that low- and middle-income countries (LMICs) are no exception. Over three-quarters of deaths from heart disease in 2019 occurred in LMICs and over 80% of the world’s adults with type-2 diabetes live in these countries as well. Cancer is projected to increase more rapidly in LMICs than in high-income countries over the next 50 years.

The adage holds true that what got us here won’t get us there. Health systems have made great progress in responding to infectious diseases and sharply curbing child and maternal mortality through targeted prevention measures, but they are woefully behind in preventing and reducing the impact of NCDs.

Integrating a broader approach to nutrition in health systems is one avenue that offers great promise for tackling NCDs—a promise that includes reducing strain on these systems, such as lowering unsustainable costs, while accelerating progress on global and national health and development goals. Addressing NCDs through a broader approach to nutrition within existing programs would extend benefits for maternal and child health, infectious disease treatment, and primary health care.

LMICs that are seeing the largest increase in NCDs have already incorporated commitments to curb this growing burden into their national health plans. Donor strategies and funding need to also shift to fully unlock nutrition’s promise for health.

The role of nutrition in NCDs 

For many decades, the global community has worked to reduce undernutrition to save lives and ensure children thrive. Recently, this same community expanded the definition of malnutrition to include all its forms, not just undernutrition. This shift recognizes that the health of both adults and children is threatened by serious nutrition risks that extend beyond undernutrition to include overweight, obesity, and resulting NCDs.

In many LMIC communities, undernutrition now exists alongside diet related NCDs, a phenomenon known as the “double burden of malnutrition.” How the global community addresses malnutrition needs to shift to respond to this problem.

Take, for example, the surge in type-2 diabetes as both a primary disease and a co-morbid condition with other NCDs. An unhealthy diet is a major contributing factor to cardiovascular disease, type-2 diabetes, and hypertension, which—alongside cancer and musculoskeletal problems—are now leading causes of death and disability in LMICs.

Unlocking and scaling nutrition action for better health

In many countries, maternal and child health, community, and school-based programs have recognized the importance of nutrition for health and sought to reduce undernutrition. A tremendous opportunity exists for these programs to address all forms of malnutrition.

For example, maternal, newborn, and child health programs already include counseling for undernutrition. Incorporating evidence-based interventions that address all forms of malnutrition and training practitioners to provide appropriate guidance, coaching, and support to parents can reduce the life-threatening NCD risks that more and more mothers and children face. Among pregnant women, this would also reduce the risk of preterm birth, preeclampsia, gestational diabetes, cesarean delivery, and poor breastfeeding outcomes, thus saving the lives of more mothers and young children and setting them up to thrive for a lifetime.

Likewise, community and school-based programs are well-suited to address unhealthy diets. School feeding programs could reorient to include prevention and reduction of diet related NCD risks in children and adolescents, alongside reducing undernutrition. For example, some middle-income countries are adjusting their school lunch programs to reduce unhealthy foods and beverages, reduce portion sizes, and regulate what can be sold in, or near, to schools. These exceptions need to become the rule.

Health systems could also do more to integrate a multifaceted view of nutrition into care beyond mothers and young children. Adding nutrition counseling to consultations related to NCDs like heart disease and type-2 diabetes, as well as patient education during primary care visits, has been shown to improve health outcomes. Primary care has a wide reach and is often the first point of contact for health issues, making it a key avenue for nutrition promotion and NCD prevention. Practitioners need the skills, knowledge, and training to identify nutrition risks and provide appropriate guidance to patients.

Infectious disease programs and care would also benefit, as NCDs increasingly occur alongside conditions like HIV and tuberculosis. Kenya serves as a great, though rare, example. Its Academic Model Providing Access to Healthcare program found that nutrition interventions can change the trajectory of infectious diseases. Integrating nutrition into care protocols for patients and increasing staff awareness are key starting points to better manage infectious diseases amid this new NCD reality.

Reorienting for progress to prevent malnutrition and its effects

While nutrition has been a priority for many donors, funding and programming has focused almost exclusively on undernutrition – with little change in recent years despite rising diet related NCDs. As a result, global nutrition funding has failed to respond to the shifting priorities of LMICs to address nutritional risks and associated NCDs. Broadening and reorienting bilateral and multilateral donor nutrition strategies, programs, and funding to align with LMICs requests and needs will be essential for addressing the rising burdens of NCDs around the world and achieving global goals.

Integrating a broader approach to nutrition and NCDs will enable countries to save lives, improve health outcomes, manage infectious diseases, and reduce the burden and costs of chronic ill health. To realize these benefits, health systems need to broaden their objectives, specifications, and training to integrate nutrition into primary care, disease-specific, and other programs to prevent and reduce NCDs. This will have far-reaching benefits for countries’ health systems and their economies by simultaneously reducing strain and improving health.

The science on the connection of nutrition to NCDs and its ability to reduce them is strong. Now is the time for the global community to act on this knowledge to reorient health systems and donor strategies to unlock the promise of nutrition for health for all. 

Learn more about RTI’s Center for Global Noncommunicable Diseases.