Key terms

Hidden Hunger: insufficient dietary quality

Hidden hunger refers to a lack or loss of dietary quality, leaving individuals or populations deficient in essential micronutrients. It impacts negatively on the health, cognition, function, survival, and economic potential. Hidden hunger is a growing and still overlooked problem that affects both the developing and the developed world.  

The most obvious victims are the 2 billion people in developing countries whose diet does not provide them with the vitamins and minerals they need - usually because they cannot afford, cannot access or don’t have the knowledge about the nutritious foods they need. But hidden hunger also claims victims in the developed world: people who certainly do not look hungry. A prime example could be where obesity or being overweight can be a sign that people’s bodies are still hungry for crucial micronutrients.

The impact of hidden hunger is huge. Globally stunted growth and anemia in children are major causes of health problems in later life, particularly the increasing prevalence of overweight/obesity and non-communicable diseases. This has dire personal and social consequences. It also results in a double burden for the health systems, with associated massive health costs and a negative impact on economic productivity.

One major issue with hidden hunger is just that: It is hidden. Sight and Life recently collaborated in a project to quantify global hidden hunger, with the aim of raising awareness of the size of the problem. The project provides a powerful advocacy tool to raise awareness of hidden hunger, and to leverage donors and governments to action on this issue.

Dr Klaus Kraemer, Director of Sight and Life, believes that the ‘missing link‘ between health and food needs addressing as a matter of urgency:

"Micronutrient deficiency is often a hidden problem, where people may have an adequate supply of energy from the food they eat, but the nutritional value is insufficient to meet their needs for optimal growth and development. Hidden hunger is under-recognized. Not enough is being done to combat this problem, which not only results in long-term health problems for individuals but also impacts on the health of communities. Hidden hunger eventually has huge economic consequences, especially for developing countries."

Stunting: serious, irreversible consequences for health and economic development

Recognized as a major public health problem in the developing world, stunting is far more than simply a medical and public health term. Stunting results from both child and maternal undernutrition, and refers to the chronic restriction of nutrients required for healthy growth and development. This typically starts in the womb and continues after birth.

Stunting is assessed by measuring a child’s linear growth and comparing it to the global growth standards. Any child two standard deviations below the global reference mean for a given age is defined as stunted.

Stunting has been recognized as a major public health concern in the developing world.

The need to strive for » ‘zero stunting’, if we are to sustainably address poverty and development, is increasingly gaining support. Stunting is a complex and still poorly understood phenomenon, and while good nutrition during the first 1,000 days of life plays an important role, it is not the only factor involved.

This was already recognized in the first United Nations Children's Fund (UNICEF) Conceptual Framework for the prevention of malnutrition, which was developed in the 1980s. This framework acknowledged that inadequate care, insufficient health services, and an unhealthy environment were also key contributors to malnutrition and thus to stunting.

  Infographic; prevention of stunting in Latin America (PDF)

Sight and Life Director Klaus Kraemer says,

“It is widely understood that high incidence of diarrhea significantly contributes to the development of stunting. But it is not only diarrhea that contributes to stunting. Chronic infections and inflammation of the intestine, not causing diarrhea but affecting nutrient absorption and possibly causing 'leakage' of bacteria into the bloodstream, can also have this effect. This phenomenon is called environmental enteropathy, or EE. It is for this reason that we need to look beyond the nutrition field, and engage in cross sector projects and partnerships at both a research and implementation level to tackle stunting.”

The Double Burden of Malnutrition: when high levels of undernutrition and overnutrition occur concurrently

The double burden of malnutrition refers to concurrent undernutrition and overnutrition in the same population at the country, community, household, or individual level. The double burden can exist in low-income households where the mother is obese and children are stunted.

Many countries, especially those in sub-Saharan Africa and South Asia, have a high prevalence of child stunting, and micronutrient deficiencies continue to be common among women and children. Moreover, developing countries are also experiencing a rapid and dramatic change in the food system and built environment, which leads to changes in dietary patterns and physical activity levels. These environmental changes increase the risk for overweight/obesity and related diseases among individuals.

It is imperative to promote adequate nutrition during the window of opportunity from preconception (adolescent girls and women of child-bearing age) to the child’s second birthday. This is the first step in the life-cycle approach to preventing early malnutrition and non-communicable diseases and their sequalea.

Eliminating malnutrition during the window of opportunity, however, is complex. The social, political, and environmental aspects associated with food systems and access to and availability of nutritious foods must be considered. Innovative strategies that address undernutrition without exacerbating overweight and obesity will require a comprehensive research, implementation, and nutrition policy agenda.

At Sight and Life, we support a comprehensive and coordinated research and policy agenda that promote sustainable food systems that ensure availability and affordability of nutritious foods, support healthy lifestyles, and improve micronutrient status and overall nutrition of women, infants, and young children.  These strategies provide the foundation for the equitable, efficient, and effective reduction of malnutrition in all of its forms for marginalized and vulnerable populations.


  Towards sustainable nutrition for all: Tackling the double burden of malnutrition in Africa (PDF)

Nutritional anemia: significant negative consequences

AAs nutritional anemia affects approximately 1.6 billion people worldwide, especially in the developing world, it has significant negative consequences if left unaddressed. The General Assembly of the United Nations (UN) emphasizes that control of nutritional anemia should be one of the global development goals. Sadly, there has been little documented progress in the global fight against anemia.

World Health Organization data shows that 818 million women and children under the age of five are affected by this public health problem, mainly in developing countries. About one million of them die every year, highlighting the magnitude of the problem and the urgent need for action.

It has become clear that the effective control of anemia requires integrated solutions, and that multiple approaches are needed to prevent anemia, including, for example, food fortification, dietary diversification, and education, as well as control of diseases such as malaria, worm infections, and other chronic endemic infections. Sight and Life has produced a book and guidebook, entitled ‘Nutritional Anemia’, which highlights for the first time all the critical factors in addressing nutritional anemia, with contributions from leading scholars in their respective fields.

  Click here to download Sight and Life's book on Nutritional Anemia

Latest Magazine

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Latest books and technical briefs:

  DSM-WFP: A Partnership to Advance the Global Nutrition Agenda; 2015

  Planning for Program Implementation of Home Fortification with Micronutrient Powders (MNP): A Step-by-Step Manual; Joint publication with HF-TAG, Unicef, MI, SGHI, HKI, and Gain; January 2015

  Scaling Up Rice Fortification in Asia Workshop; Supplement to the Sight and Life Magazine 29(1)/2015

  Bridging Discovery and Delivery; Micronutrient Forum Global Conference Addis Ababa, Ethiopia, 2-6 June 2014; Supplement to the Sight and Life Magazine 28(2)/2014

Find more books, guidebooks and technical briefs in our » Library Archive.

Latest peer-reviewed publications:

Mark HE, Houghton LA, Gibson RS, Monterrosa E, Kraemer K, » Estimating dietary micronutrient supply and the prevalence of inadequate intakes from national Food Balance Sheets in the South Asia region. Asia Pac J Clin Nutr 2016;25(2):368-376.

Semba, Richard D., Shardell, Michelle, Sakr Ashour, Fayrouz A., Moaddel, Ruin, Trehan, Indi, Maleta, Kenneth M., Ordiz, M. Isabel, Kraemer, Klaus, Khadeer, Mohammed A., Ferrucci, Luigi, Manary, Mark J.,  » Child Stunting Is Associated with Low Circulating Essential Amino Acids, EBioMedicine (2016), doi: 10.1016/j.ebiom.2016.02.030

Ruel-Bergeron JC, Stevens GA, Sugimoto JD, Roos FF, Ezzati M, Black RE, Kraemer K.Global Update and Trends of Hidden Hunger, 1995-2011: The Hidden Hunger Index. PLoS One. 2015 Dec 16;10(12):e0143497.

Find more peer-reviewed publications in our » Library Archive.

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