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Goji Berry versus PlumpyNut & Why Knowledge is Key

A bitter newsitem reaches the eye: increasing numbers of Dutch children are admitted to the hospital due to malnourishment. Pediatricians are worried by the trend that especially highly educated parents subject their children to popular diets without grains or dairy, but filled with the so called ‘superfoods‘. These pricey parts of plants, such as goji berries and chia seed, are believed to be super healthy according to diets that are popular among some that have money to spend. More common foods, such as wheat, dairy and potatoes are sometimes portrayed as poison in these diets that often have hints of scientific basis. However: Consensus among scientists and doctors, wrapped in a less popular and more pragmatic sauce, points at the direct opposite: no evidence for the proclaimed magical powers of superfood. The result of these myths and diets so far, malnourished children in a country where healthy food is such widely available, leaves a bitter taste.

Initially, malnourishment reminds of countries where a variety of healthy food is not available, due to for example droughts, war and displacement. Countries such as Afghanistan, where over 50 percent of children are stunted, and in the worst affected regions, 29.5 % children suffer from acute malnourishment.

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This picture shows a simplification of three types of malnutrition and combinations of these three types are possible. (Specific micronutrient deficiencies and overweight are not included (1). It is important to realize that stunting starts from conception: an underfed mother gives birth to a stunted baby.

Worldwide, acute malnutrition affects 20 million children in preschool-age, mostly in Africa and South East Asia. Worldwide, 195 million children are stunted, and stunting affects 800 million people. The effects? Among others:

  • increased risk of chronic disease later in life
  • less cognitive growth, resulting in:
  • complete fewer years of schooling
  • earn less income as adults (also referred to as lower economic potential)
  • give birth to smaller children

This lower income, poor health and reduced access to proper nutrition, influences the way the next generation is fed and raised: a cycle is born.(2) To break this cycle, mothers need to be properly fed as well: since stunting starts in the whomb and the effects are irreversible.

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What is being done? Acute malnutrition asks for a direct intervention: therapeutic feeding. These children are fed with for example PlumpyNut, a high calorie peanut paste. Unfortunately not all children that need this recovery are reached at the moment. Scaling up of interventions is needed. Prevention is needed.

Here we address the topic of knowledge. Just as in the Netherlands, a lot of children in the world are malnourished, not because of a lack of food, but because of a lack of knowledge about the importance suitable feeding for children (3).

Acute malnourishment is just a terrible tip of the iceberg, when looking at malnourishment. Breaking it down:


This pyramid shows, in a situation where food is available: knowledge is key.(4,5)

Yes: PlumpyNut and other interventions are needed for regions that have a lack of suitable food. But knowledge is needed worldwide. As the effect of super foods on highly educated in one of the world’s richest countries shows: knowledge about how to feed one’s child is essential for a nourished, healthy future.


1.For a very clear and complete oversight on different types of malnourishment, I recommend this Unicef learning module. 

2.A short clip that shows the cycle of malnutrition and also gives a view on the costs of prevention:

3. This includes knowledge about  breastfeeding and complementary feeding. Attitudes towards breastfeeding are a major problem contributing to malnourishment in for example Afghanistan.

4. The breaking down pyramid is a very simplified version. The topic of food security asks for a whole post. Also, since micronutrients deficients were not included, the fortification of food is also left out in this post. Related information can be found on the website of the World Food Program.

5. Pictures for the breaking down pyramid were taken from (from up-down, from left-right:1mychildmagazine, 2planinternational, 3,informafrica 4biodiversity, 5.unfccc



The United States of Obesity

While US citizens are widely known to have a sweet tooth, newest data is more alarming than ever: 2/3 of Americans are considered either overweight or obese according to the National Health and Nutrition Examination Survey. And while some fast food stores start to understand that plentiful, cheap and easily accessible calories are contributing to obesity and that adding them freely to children menus will backfire, the overall trend is a rather negative one.

2Most US industries have quietly adapted to customers with expanding waistlines: a dress size of 4 would be considered a size 8 just 20 years ago! Or as researcher Charles Courtemanche says: “With 20 years of data, you can really identify the exact moment when a new Wal-Mart or new restaurants came in and you saw the rise in BMI.”Obesity dress size developmentsBut let us not forget where it all starts: an obese child is much more likely to grow to an obese adult. About 30 percent of low-income preschoolers are overweight or obese (Centers for Disease Control and Prevention, 2011) with obesity rates being higher and having increased more rapidly among Africachild menu caloriesn-American and Hispanic children (Freedman et al., 2006).

Looking at impressive 570 calories per child menu, one cannot really speak of being surprised. The consequences of overweight and obesity are well know: osteoarthritis, an increased risk of cancer of the breast, colon, prostate, endometroium, kidney and gallbladder, and many many more. According to the American Cancer Society, obesity cost an estimated $75 billion in 2003 because of the long and expensive treatment for several of its complications.

However, a change of lifestlye does not seem to be an option. At least not when looking at statistics about money spent to reverse the effects of diabetes.

reversing diabetesFor those who can afford a quick liposuction, Bon Appetit!

Other Sources:

Staff at a hospital in Ganta, Liberia, have to rely on mobile phone flashlights for illumination much of the time. © Henrik Kastenskov/The ENERGY ACTION Projec

Liberia: Ladies are Leading

Ebola had the opportunity to become widespread in Liberia. When looking at the current health care system, this was no surprise. An academic doctor referred to the situation before the outbreak as ‘from the 18th century’: too few doctors, too few materials and no sustainable and fair payment system. However: health indicators were showing a positive trend: which was brutally interrupted by the ebola outbreak.

After the first recommendations from Global Alert and Response (GAR) in 2014 for rebuilding Liberia and other affected states the practical question rises: Where to start?

Here is your answer: with the ladies of Liberia.

As three young Liberian female professionals went viral to address the stigma of ebola,

Liberian women can be the key to the enhancement of health care. Also, they can play a major role in closing the gate for another disastrous disease outbreak.

Why women? Women are recognized as the agents for sustainable development. In Liberia, government commitment to women empowerment is given and illustrated by the proactive role of the female president. A positive trend is observed, yet there is still a world to gain. For example, the mortality around birth in Liberia is still among the highest in the world, girls are receiving less education than boys and often deliver their the first born at a very young age.

The ebola epidemic is a disaster that demands rebuilding of the health care system. This new start can be an opportunity to prioritize mother and child health services such as access to essential medicines, vaccinations and treatments by health care professionals. Simple basic interventions targeting the health of mother and child have proven to have enormous effect that is beneficial to the whole society:

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These examples illustrate how simple interventions in health services for mothers and children can have a huge impact on both the short- and the long run, functioning as a basis for quality care for the whole population.

In rebuilding Liberia’s health care system, the starting point is clear: prioritizing on evidence based healthcare for mothers and children, which enables this powerful group to lead further sustainable development of the country.

IFFR Film recommendations

Upcoming Wednesday 21 January until 1 February 2015 is the 44th edition of the International Film Festival Rotterdam (IFFR).

The festival program is filled with great cinema from talents all over the world. Although there are a lot of must sees, if you’re interested in films that cover health, inequality, poverty, here are some recommendations:

Aïssa – A film about the clinical examination of a female Ghanaian immigrant.

Alive – A dark film that tells an impressive story about poverty, inequality and human suffering in today’s South Korea.

Court – The film reflects on the painful inequalities in the judicial system in contemporary India.

The Normal Heart – The film looks back at the AIDS crisis in the early 1980s in New York.