Nutrient Deficiency: A Bigger Problem Than We Realize?

Robert Thompson, Ph.D.

Robert Thompson, PhD, Visiting Scholar at the Paul H. Nitze School of Advanced International Studies at Johns Hopkins University in Washington, DC and International Food Information Council Foundation Trustee, has a global view when it comes to nutrition. As it is well known that malnutrition is a serious issue in the developing world, Food Insight was interested in his perspective on the severity of the problem and why solving malnutrition goes beyond hunger to addressing nutrient deficiency. In addition, we wanted to know where he thinks the fight to reduce the incidence of non-communicable diseases fits into the equation. IFIC Foundation’s Andy Benson recently caught up with Dr. Thompson, and what he learned may surprise you.

FI: Dr. Thompson, there is a lot of discussion among health agencies and health professionals around the world about reducing the incidence of non-communicable diseases (NCDs) like cancer, cardiovascular disease, diabetes, hypertension, and even Alzheimer’s. 

As the World Health Organization(WHO) and the United Nations (UN) have set a goal for countries to reduce NCD-related deaths by 25 percent by the year 2025 (what they call their “25 by 25” goal), what role should food and nutrition play?

RT: It is worrying that WHO and the UN seem to view NCDs as being caused primarily by “over-nutrition” (i.e. taking in more calories than you burn through physical activity), when in fact one in eight people around the world cannot even afford to consume sufficient calories to sustain a modest level of physical exertion.  Sufficient calorie intake is necessary to stay alive, but for health, one’s diet must include the essential amino acids that the body cannot synthesize, plus a whole complement of essential vitamins and minerals. Currently more people in the world die from nutritional deficiencies than from HIV AIDS, malaria and tuberculosis (all serious public health epidemics) combined.  Nutrient deficiencies are, potentially, more threatening globally than over-nutrition.

I think that the “25 by 25” initiative misses half of the issue – we need to be as committed to reducing nutritional deficiencies as we are to resolving over-nutrition.

FI:  Why is it that some countries around the world have high levels of obesity, while at the same time experiencing high levels of nutrient deficiency?

RT: In many cases, I think  we have done a better job of ensuring an adequate supply of foods containing sufficient calories in developing countries at a  low cost, but not  as well in terms of ensuring adequate availability of foods that are nutrient dense, containing  the necessary levels of amino acids, vitamins and minerals.  It’s unfortunate that we focus so much on levels of obesity to the exclusion of people who cannot afford even  1,800 calories per day, much less a nutritionally balanced diet.

FI: How significant is the problem of “sub-optimal” nutrition in developing countries?

RT: There are several hundreds of millions of people who are suffering from deficiencies in each of a variety of key nutrients, including widespread deficiency of iron, iodine, Vitamin A, and zinc. Other deficiencies include calcium, B vitamins, such as thiamine, niacin, and folate.  The problem affects a significant portion of the population, particularly in the least developed countries and regions where extreme poverty is prevalent.

FI: What related challenges do people in these countries, and particularly children, face?

RT: It is estimated that there are more than two billion people in the world who are anemic, and several hundred million people suffer from blindness as a result of vitamin A deficiency. Perhaps the saddest of all is iodine deficiency in sub-Saharan Africa and parts of Asia, where iodine supplementation is not a common practice (We have it in the form of iodized salt in the U.S.).  Iodine deficiency in the diets of expectant mothers and children under two years of age can cause irreversible stunting in both physical and mental development.  That’s a tragic consequence for society as a whole. 

Often, whoever prepares the food in a household is most concerned with providing enough calories for the principal breadwinner and those who undertake the most physical labor. Therefore, they may not be attentive enough to the specific nutritional needs of children.  Moreover, illiterate parents are often less aware of what is needed for the full physical and intellectual development of their children. 

Poverty is a huge problem, with almost twenty percent of the world’s population living on less than $1.25 per day.  This is the kind of situation where a school breakfast program or a school lunch program can work wonders for providing the nutrition that children need, but just don’t have access to in their homes.

FI: What can health professionals and others do to bring awareness to these issues and improve education on nutrient adequacy on a local, regional, and global scale?

RT: There are a lot of NGOs that are very good at addressing the emergency feeding needs associated with wartime situations and natural disasters, but they generally focus on short-term needs rather than the systemic long-term problems of inadequate nutrition. Extension education and outreach programs need to pay more attention to ensuring that more nutrient-dense foods are produced locally or within a reasonable distance.  While we have placed a considerable focus on staple crops (corn, rice, wheat, etc.), we have not paid as much attention to producing fruits, vegetables, livestock, and poultry products that can provide the necessary levels of essential vitamins, minerals and amino acids.  Moreover, efforts to fortify staple crops with essential nutrients are showing a huge amount of potential to address major public health issues in developing countries.

FI: What is an example of this?

Yellow Rice

Golden Rice
Photo courtesy of IRRI Photos

RT: It is possible to enhance the nutritional content of staple foods using advanced research tools such as genetic engineering, a technique that virtually every scientific authority in the world has looked at and concluded is not dangerous for human health or the environment. 

Consider rice,  the principal staple in the diets of more than two billion people, but which contains virtually no iron or vitamin A and lacks two of the essential amino acids.  Researchers have already demonstrated that the vitamin A content of rice can be increased, producing a nutrient-rich grain called “Golden Rice.”  If available, Golden Rice could help hundreds of millions of people who subsist principally on rice to avoid blindness. Just think of the additional health benefits that could be realized if the nutritional composition of rice could also be boosted to contain adequate levels of iron and the two missing essential amino acids.

FI:  That certainly speaks to the quality and the nature of food production, but what about the question of producing sufficient quantities of food in countries where they are desperately needed?

RT: We need both.  Obviously, we need to continue to increase the nutrient content of foods through fortification, such as increasing the vitamin A and D content of milk, iodizing salt, and incorporating thiamine into wheat flour for bread.

We also need to use the full set of modern research tools to increase agricultural productivity and to increase crop resilience to extreme climatic events.  The world’s farmers are being challenged to double global food production over the next thirty-five years, using at most 10 percent more land and less total fresh water - all while the world’s ecosystems are shifting due to climate change.  If we fail to increase productivity, there will be much greater destruction of forests to secure land on which to produce more food to satisfy the growing demand. When the forested area is reduced, we lose biodiversity, wildlife habitat, and carbon sequestration capacity, accelerating global climate change.  It’s going to take investments in research to develop technologies that increase our food yield per acre and to develop crops that are tolerant to extreme climatic conditions such as drought and flooding, which are expected to occur with greater frequency. 

FI:  Why do you think there is so much controversy and confusion over these issues, and what should we be doing differently to build understanding and agreement on the best way forward?

RT: There seems to be a lot of unfounded fear associated with genetic engineering, yet it has so much potential. What’s striking to me is that many people who draw upon state-of-the-art science – including genetic engineering/biotechnology – when they are considering issues like immunizations and pharmaceuticals, evolution, climate change, or stem cell use, reject the same state-of-the-art science when it comes to our food. Any farming system needs to address six key elements: plant genetics, nutrition, weed control, pest control, disease control, and water availability.  Whether you are talking about organic or conventional agriculture, or food biotechnology and “GMOs,” we must consider how we can maximize the food output per unit of available land and water to provide the food and nutrition we need.  Moreover, we need to give crops their best chance at survival, which means providing plants the nutrients they need and identifying and minimizing crop threats from weeds, diseases and insects.

If a farming system satisfies all of these conditions, regardless of whether it was produced using conventional or organic farming techniques, it helps increase food and nutrient availability safely, sustainably, and affordably, and that puts us on the road to global nutrient adequacy and to meeting the 25 by 25 goal for reducing non-communicable disease.

For more information on nutrition and food production in developing countries, visit:

Is Food Fortification Necessary? An Historical Perspective

Food Fortification in Today’s World 

The Next 40 Years - The Challenge of Feeding 9.6 Billion (Presentation by Dr. Robert Thompson)

IFIC Foundation Modern Food Production resources