Brazil has tremendous success in reducing stunting in children under the age of five. This successful path took more than 30 years. While in 1975 about 37 % of under-five-year-old Brazilian children were affected by physical and mental growth retardation, their share in 2007 was only 7 %. In parallel, the number of infants fed exclusively by breastfeeding (younger than 6 months) increased from 4.7 % in 1986 to 37 % in 2006 and then stabilized at this level.
A case study that challenges these remarkable advances shows that nutritional approaches are needed to improve breastfeeding rates and reduce growth retardation. This means that measures have to be developed and implemented that directly address food deficiencies (nutrition-specific), for example, the iodine deficiency of the German population could be significantly reduced by the enrichment of salt with iodine. In addition measures are needed, that directly influence the nutritional situation (nutrition sensitive), for example, by better informing and educating people on this topic or promoting the cultivation of micronutrient-rich plants. These measures can only be implemented comprehensively if appropriate social and health policy conditions are in place. Brazil initiated wealth redistribution reforms at the end of the 20th century, established public health programs, including water and sanitation, and implemented nationwide mandatory health and nutrition policies for mothers and children, including paid maternity leave. However, the Brazilian success story cannot be transferred completely to the situation of other countries.
Further scientific based experiments in different cultural contexts are needed to better understand how cost-effective multisectoral measures can be used regionally and specifically to effectively combat growth disorders, overweight and micronutrient deficiencies.
R. Perez-Escamilla et al. Nutrition disparities and the global burden of malnutrition. BMJ 2018; 361. Published 13 June 2018. Available at https://doi.org/10.1136/bmj.k2252