Undernutrition, micronutrient deficiencies, and overnutrition are the concerns now

Younten Tshedup  

Hunger is not public health issue in the country. For more than a decade, no one in the country is known to have died of hunger. But Bhutan is at a crossroads of what the experts are now calling “a triple burden of malnutrition, with the co-existence of undernutrition, micronutrient deficiencies, and overnutrition,” brought upon by changes to lifestyle and food consumption trends.

Known as “the hidden hunger”, micronutrient deficiency remains a major concern in the country. Many schools across the country often report outbreaks of vitamin deficiency-related conditions such as glossitis and peripheral neuropathy.

A nutrition survey conducted in 2015 found a high prevalence of anaemia among children in the country. Anaemia, according to Passang Lhamo Sherpa, an assistant professor with the faculty of nursing and public health (FNPH), was a proxy indicator of micronutrient deficiency among people.

The 2015 survey, which is the most recent available compiled data on nutrition, found 43.8 percent of children below the age of five, 27.3 percent of pregnant women, 31.3 percent of adolescent girls (aged 10-19 years), and 34.9 percent (aged 15-49 years) of women were anaemic.

Passang Lhamo Sherpa said that although anaemia is mostly associated with low haemoglobin, which means insufficient healthy red blood cells to carry adequate oxygen to your body’s tissues, there were other possible causes of anaemia, including deficiencies in vitamin B-complex or zinc, or heavy metal poisoning.

“B-complex is a combination of chemicals such as thiamine, riboflavin, niacin, pantothenic acid, biotin, and folic acid, among others. These chemicals are very important, as they are responsible for all metabolism in the body and the deficiency of these chemicals has a direct impact on the brain.”

She said although B-complex vitamins were found in many food items including milk, cheese, eggs, meat, and green vegetables, many Bhutanese did not consume it, or the manner in which these foods were consumed, including cooking and storage methods, interfered with the preservation of the vitamins in the food.

To address these issues, the professor said that the Ministry of Health (MOH) has been providing fortified food in schools and vitamin supplements whenever and wherever outbreaks of certain vitamin deficiency conditions occurred.

“As children are in a stage of growth, they require more of these nutrients and a deficiency of certain vitamins becomes more pronounced among children.” However, she said that micronutrient deficiency was not only prevalent in school-aged children, but was equally affecting the adult population in the country.

She added that it was difficult to diagnose micronutrient deficiencies in adults, as adults require the nutrients in a smaller quantity just to maintain the optimum levels in the body. “So, in adults, these deficiencies are more sub-clinical in nature and can manifest through infections when the body system is affected,” she said, adding that besides alcohol, micronutrient deficiencies can be a cause for fatty liver in some individuals.

“The reason why micronutrient deficiencies are called hidden hunger is because they develop over time and often do not have particular or specific symptoms, especially among adults.”

Meanwhile, to promote dialogue and garner support towards collective action on micronutrient adequacy across multiple sectors, the first-ever conference on micronutrient deficiency was conducted last week in Thimphu.