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. 2015 Dec 16;10(12):e0143497.
doi: 10.1371/journal.pone.0143497. eCollection 2015.

Global Update and Trends of Hidden Hunger, 1995-2011: The Hidden Hunger Index

Julie C Ruel-Bergeron  1 , Gretchen A Stevens  2 , Jonathan D Sugimoto  3 , Franz F Roos  4 , Majid Ezzati  5 , Robert E Black  1 , Klaus Kraemer  1   6
Affiliations

Global Update and Trends of Hidden Hunger, 1995-2011: The Hidden Hunger Index

Julie C Ruel-Bergeron et al. PLoS One. .

Abstract

Background: Deficiencies in essential vitamins and minerals-also termed hidden hunger-are pervasive and hold negative consequences for the cognitive and physical development of children.

Methods: This analysis evaluates the change in hidden hunger over time in the form of one composite indicator-the Hidden Hunger Index (HHI)-using an unweighted average of prevalence estimates from the Nutrition Impact Model Study for anemia due to iron deficiency, vitamin A deficiency, and stunting (used as a proxy indicator for zinc deficiency). Net changes from 1995-2011 and population weighted regional means for various time periods are measured.

Findings: Globally, hidden hunger improved (-6.7 net change in HHI) from 1995-2011. Africa was the only region to see a deterioration in hidden hunger (+1.9) over the studied time period; East Asia and the Pacific performed exceptionally well (-13.0), while other regions improved only slightly. Improvements in HHI were mostly due to reductions in zinc and vitamin A deficiencies, while anemia due to iron deficiency persisted and even increased.

Interpretation: This analysis is critical for informing and tracking the impact of policy and programmatic efforts to reduce micronutrient deficiencies, to advance the global nutrition agenda, and to achieve the Millennium Development Goals (MDGs). However, there remains an unmet need to invest in gathering frequent, nationally representative, high-quality micronutrient data as we renew our efforts to scale up nutrition, and as we enter the post-2015 development agenda.

Funding: Preparation of this manuscript was funded by Sight and Life. There was no funding involved in the study design, data collection, analysis, or decision to publish.

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Conflict of interest statement

Competing Interests: FR is employed by DSM, a manufacturer of vitamins and minerals. KK is employed by Sight and Life, a humanitarian nutrition think tank of DSM, a manufacturer of vitamins and minerals. RB serves on the Boards of the Micronutrient Initiative, Vitamin Angels, and the Nestle Creating Shared Value Advisory Committee. GS is a staff member of the World Health Organization; the author alone is responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the World Health Organization. All other authors declare that they do not have any conflicts of interest. The stated affiliations do not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. a: Global map presenting HHI scores in 1995. b: Global map presenting HHI scores in 2000. c: Global map presenting HHI scores in 2005. d: Global map presenting HHI scores in 2011.
Fig 2
Fig 2. Hidden Hunger Index Score 1995–2011, by Region and Country.
Fig 3
Fig 3. a: Hidden Hunger Index in 1995, by micronutrient deficiency. b: Hidden Hunger Index in 2011, by micronutrient deficiency.
Fig 4
Fig 4. Global map presenting net change in hidden hunger index (HHI) scores, 1995–2011.
Fig 5
Fig 5. a: Correlation between the 2013 Human Development Index and the 2011 Hidden Hunger Index. b: Correlation between the 2014 Global Hunger Index and the 2011 Hidden Hunger Index.
See this image and copyright information in PMC

References

    1. Tulchinsky TH. Micronutrient deficiency conditions: Global health issues. Public Health Rev. 2010;32:243–55. - PMC - PubMed
    1. Black RE, Victora CG, Walker SP, Bhutta Z, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51. 10.1016/S0140-6736(13)60937-X - DOI - PubMed
    1. Muthayya S, Rah JH, Sugimoto JD, Roos FF, Kraemer K, Black RE. The global hidden hunger indices and maps: an advocacy tool for action. PLoS One. 2013;8(6). - PMC - PubMed
    1. Balarajan Y, Ramakrishnan U, Özaltin E, Shankar AH, Subramanian S V. Anaemia in low-income and middle-income countries. Lancet. 2011;378(9809):2123–35. 10.1016/S0140-6736(10)62304-5 - DOI - PubMed
    1. Pasricha SR, Drakesmith H, Black J, Hipgrave D, Biggs BA. Control of iron deficiency anemia in low- and middle-income countries. Blood. 2013;121(14):2607–17. 10.1182/blood-2012-09-453522 - DOI - PubMed

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