Hidden hunger: Your child could have a food and nutrition crisis

Parents may not be aware that their children are suffering from a lack of micronutrients, also known as hidden hunger.

IF parents think their children are eating well, it is time to think again. Experts are now telling us that it’s not enough to eat different foods in the right quantities.

It seems that many of us are not feeding our children enough micronutrients such as vitamins and minerals, and this leads to a condition called hidden hunger.

One in three people in the world suffer from micronutrient deficiency and may not even know it.

Contrary to popular belief, fighting hunger isn’t about reducing hunger pangs but to ensure the body has sufficient vitamins and minerals to avoid stunting and blindness and to increase resistance to diseases and retardation in children.

International Medical University school of health sciences dean Prof Dr Khor Geok Lin said it is difficult to diagnose hidden hunger as there is often no visible warning signs, or external clinical manifestations. This makes it difficult for parents to detect hidden hunger, especially when children seem healthy and active. Visible clinical signs are usually detected only at the severe stages of a micronutrient deficiency.

When children don't eat enough vegetables and fruits, they could suffer from hidden hunger, which is a deficiency in micronutrients.
When children don’t eat enough vegetables and fruits, they could suffer from hidden hunger, which is a deficiency in micronutrients.

“While children’s basic diet may provide enough calories (obtained mainly from carbohydrates and fat), it often lacks sufficient micronutrients that allow them to be mentally and physically healthy.

“Mild to moderate stages of a micronutrient deficiency may not be accompanied by clinical signs.

“Symptoms of children suffering from iron deficiency include flat or conclave nails, inflammatory lesion at the corner of the mouth or swollen reddish tongue,” explained Dr Khor during the launch of Horlicks Chocolate beverage recently.

The 2007 World Health Organisation report states that over two billion people – 30% of the world’s population – are anaemic, many due to iron deficiency. Between 30% and 50% of anaemia cases are caused by iron deficiency. Parents and caregivers should ensure children have a balanced diet to avoid suffering from hidden hunger, says Dr Khor.

“Women and children from the lower income groups in developing countries are often most affected. However, local studies have shown that even schoolchildren in Kuala Lumpur and Petaling Jaya have micronutrient deficiencies, such as of zinc, iron and iodine,” Dr Khor explained.

A 2011 study – funded by Britain-based GlaxoSmithKline Nutritional Healthcare – shows there is high prevalence of Vitamin D insufficiency among primary schoolchildren in Kuala Lumpur, aged between seven and 12 years old. While the children have adequate concentrations of serum iron, folate, zinc and vitamin B12, over 65% had sub-optimal concentrations of serum Vitamin D.

Vitamin D is important for calcium absorption and decreasing the risk of fractures. Prolonged vitamin D deficiency can lead to rickets, where bones are soft and deformed.

“Vitamin D is obtained primarily from sunlight exposure. The research findings were unexpected as we live in sunny Malaysia.

“However, people prefer to spend time indoors as they are concerned about the damaging effects of the sun, including skin cancer and pigmentation.

“Children are not getting enough sun exposure as physical education tends to be held before it is ‘too hot’, or indoors,” said Dr Khor, adding it is advisable to expose the face, hands and arms to the sun for at least 10-15 minutes, between 10am to 2pm, two to three times a week.

The amount of sun exposure required to provide adequate vitamin D depends on the amount of skin exposed, skin pigmentation, a person’s age.

The 2013 Nutrition Survey of Malaysian Children – which studied the nutritional status and dietary intake of children aged between six months and 12 years – found that 4.4% of the 3,542 people in the sample population had iron and vitamin A deficiency.        

To address the problem, Dr Khor advised parents to identify their children’s nutritional needs and provide them with adequate nutrients to stay healthy.

“Parents and caregivers need to know the needs of children. Take extra effort to talk to your children to find out their food preferences.

“Be creative and innovative with your children’s favourite food too. Ensure kids have a balanced meal comprising a variety of vegetables, protein, carbohydrates and fruits,” said Dr Khor, who is the chief editor of the Malaysian Journal Of Nutrition, adding parents should refer to reliable sources to build up their knowledge on feeding their children.

Eating a balanced diet means consuming a wide variety of foods. But apart from knowing the basic food groups, parents must also actively include food rich in micronutrients in their children’s diet to ensure they don’t suffer from hidden hunger. Food rich in iron includes vegetables such as broccoli, spinach and brussels sprouts.

Dietician Goo Chui Hoong explained that eating a variety of foods can ensure you get all the nutrients you need. Consume a variety of fruits and vegetables. The more colourful your plate, the better.

“The idea is for kids to eat a balanced diet. Parents should offer healthy foods and the child decides the amount to consume based on hunger and fullness cues.

“Children naturally can identify when satiety kicks in. Forcing a child to eat when they are full makes them lose touch with their own hunger cues.

“Serve your child regular meals and snacks about three hours apart. Allow your child a chance to feel hungry – if they are snacking all the time, they will not be hungry at meal times,” said Goo, author of Lite Malaysian Favourites.

The 2013 Malaysian Dietary Guidelines for Children and Adolescents summary states that children between three and nine should consume two servings of fruits and milk daily. Kids aged between three and six years should eat two servings of vegetables while those between seven and nine should have three servings.

For meat and poultry, it’s half a serving for children below six and one serving for those below nine.

The Recommended Nutrient Intakes for Malaysia 2005 reports that children’s calcium requirement of 500-700mg can be met if they consume at least two servings of dairy products.

For Vitamin C, a sliced guava provides about 100mg, papaya 120mg, kiwi fruit 86 mg and a medium orange 30mg. Children require between 30mg-35mg of Vitamin C daily.

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