Wheat and Barley Grain Biofortification

Wheat and Barley Grain Biofortification

Edited by

Om Prakash Gupta

Vanita Pandey

Sneh Narwal

Pradeep Sharma

Sewa Ram

Gyanendra Pratap Singh

Contents

Cover

Title page

Copyright

Contributors

Editors biography

Foreword

Preface

1: The unacceptable status quo: malnutrition challenges of the developed and developing world

Abstract

Charting the trends in malnutrition across the globe

Malnutrition challenges across South Asia

Trends in status of malnutrition among Indian population

Lessons learnt and way forward

Disclaimer

2: Role of molecular approaches in improving genetic variability of micronutrients and their utilization in breeding programs

Abstract

Importance of genetic variability of micronutrients

How did genetic variability become a concern?

Agronomic biofortification

Genetic biofortification

Status of genetic variability of micronutrients especially iron and zinc in wheat and barley

Genetic variability in wheat

Genetic variability in barley

Molecular advancement to increase the genetic variability of Zn and Fe content

Molecular mapping and association studies for genetic biofortification

3: Getting more micronutrients from wheat and barley through agronomic biofortification

Abstract

Introduction

Translocation of micronutrients in wheat and barley and accumulation in grain

Biofortification

Soil factors affecting biofortification

Biotic factors affecting biofortification

Advantages and disadvantages of agronomic biofortification

Impact assessment of biofortified crops

Conclusions and prospects

4: Anti-nutritional factors and bioavailability: approaches, challenges, and opportunities

Abstract

Introduction

Phytic acid and micronutrient bioavailability

Protease inhibitors

Tannins

Cyanogenic glycosides

Alkaloids

Lectins in wheat and barley

Oxalate in wheat and barley

5: A decade of progress on genetic enhancement of grain zinc and iron in CIMMYT wheat germplasm

Abstract

Introduction

State-of-the-art breeding and phenotyping for micronutrients at CIMMYT

Germplasm screening and gene discovery

Germplasm deployment and variety release

Mainstreaming of grain zinc in CIMMYT wheat breeding

Conclusions

6: Biofortification of wheat through wide hybridization and molecular breeding

Abstract

Introduction

Micronutrient malnutrition: a global health problem

Role of iron and zinc in plant and human metabolism

Causes of micronutrient deficiency in human being

How to alleviate micronutrient deficiency?

Agronomic biofortification

Strategies used for genetic biofortification

Crop improvement through genetic engineering approaches

Grain micronutrient concentration and bioavailability

Characterization of alien introgression through molecular markers

Characterization of alien introgression through advanced cytological techniques

Biofortification of wheat and related species

Genes involved in metal homeostasis and physiological processes from a biofortification perspective

Iron binding proteome of bread wheat

Limitations and conclusion

7: Exploring genetic variability for developing celiac disease safe wheat

Abstract

Wheat proteins

Celiac disease

Diagnosis of CD

Identification of genetic variation in gliadins in wheat

Conclusions

8: Prospecting plant–microbe interactions for enhancing nutrient availability and grain biofortification

Abstract

Introduction

Plant–microbe interactions

Micronutrient deficiencies in soils

Microbes mediated micronutrient biofortification

Conclusion

Acknowledgments

9: Effect of storage and processing conditions on nutrient composition of wheat and barley

Abstract

Introduction

Effect of storage

Effect of different processing conditions

Summary

10: Advantage of biofortification over fortification technologies

Abstract

Introduction

The difference between traditional fortification and biofortification

Need for biofortification

Advantages of bio-fortification

Conclusion

11: Barley biofortification: present status and future prospects

Abstract

Introduction

Barley: a store house of nutrients

Genetic variability in mineral content

Antinutritional factors

Low phytic acid mutants

Phytases

Antioxidants

Bioavailability

Enhancers

Agronomic biofortification

Genetic/transgenic approach to biofortification

Processing as a mean to enhance the bioavailability

Future prospects

12: Barley grain beta glucan enrichment: status and opportunities

Abstract

Introduction

Barley production and utilization

Nutritional benefits of barley

Cholesterol lowering properties of beta glucans

Regulation of blood glucose levels

Beta glucans of barley

Status of beta glucans content in barley grain and possible ways to increase the concentration

Opportunities for greater utilization of barley in food products

Conclusion

13: Biofortification for enhancing nutritional outcomes and policy imperatives

Abstract

Introduction

Forms of malnutrition

Biofortification: a potential solution to malnutrition

The need for biofortification

Application of biofortification

Comparative advantages

Other considerations

Fortification vis-à-vis biofortification

Biofortification capitalization

Biofortification options and its impact on plant and environment

Scaling-up biofortification

Strategies for enhancing nutritional status and special initiatives in India

Nutri-smart village

National nutrition mission

Agri-Nutri (A2N) smart village

Conclusions and way forward

Approaches for nutrition enrichment

Awareness campaign

Policies for upscaling

Index

Copyright

Woodhead Publishing is an imprint of Elsevier

The Officers’ Mess Business Centre, Royston Road, Duxford, CB22 4QH, United Kingdom

50 Hampshire Street, 5th Floor, Cambridge, MA 02139, United States

The Boulevard, Langford Lane, Kidlington, OX5 1GB, United Kingdom

Copyright © 2020 Elsevier Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

Library of Congress Cataloging-in-Publication Data

A catalog record for this book is available from the Library of Congress

British Library Cataloguing-in-Publication Data

A catalogue record for this book is available from the British Library

ISBN: 978-0-12-818444-8 (print)

ISBN: 978-0-12-818445-5 (online)

For information on all Woodhead publications visit our website at https://www.elsevier.com/books-and-journals

Publisher: Charlotte Cockle

Acquisitions Editor: Nancy Maragioglio

Editorial Project Manager: Sara Valentino

Production Project Manager: Anitha Sivaraj

Designer: Mark Rogers

Typeset by Thomson Digital

Contributors

Jaskaran Kaur Arora,     School of Agricultural Biotechnology, Punjab Agricultural University, Ludhiana, Punjab, India

Sangita Bansal,     Indian Council of Agricultural Research-National Bureau of Plant Genetic Resources, Pusa, New Delhi, India

Parveen Chhuneja,     School of Agricultural Biotechnology, Punjab Agricultural University, Ludhiana, Punjab, India

Ashwin Dapkekar,     Nanobioscience Group, Agharkar Research Institute, Pune, Maharashtra, India

Paresh Deshpande,     Nanobioscience Group, Agharkar Research Institute, Pune, Maharashtra, India

Harcharan Singh Dhaliwal,     Department of Genetics-Plant Breeding and Biotechnology, Dr. Khem Singh Gill Akal College of Agriculture, Eternal University, Sirmour, Himachal Pradesh, India

Sait Gezgin,     Selcuk University, Faculty of Agriculture, Department of Soil Science and Plant Nutrition, Konya, Turkey

Om Prakash Gupta,     Division of Quality and Basic Sciences, ICAR-Indian Institute of Wheat and Barley Research, Karnal, Haryana, India

Sanjaya Gyawali,     International Center for Agricultural Research in the Dry Areas, Rabat, Morocco

Erdogan Esref Hakki,     Selcuk University, Faculty of Agriculture, Department of Soil Science and Plant Nutrition, Konya, Turkey

Mehmet Hamurcu,     Selcuk University, Faculty of Agriculture, Department of Soil Science and Plant Nutrition, Konya, Turkey

Arun K. Joshi,     Borlaug Institute for South Asia, CIMMYT, New Delhi, India

Jaya Jumrani,     ICAR-National Institute of Agricultural Economics and Policy Research, New Delhi, India

Jasnoor Kaur,     Indian Council of Agricultural Research-Central Institute of Post-Harvest Engineering and Technology, Ludhiana, Punjab, India

Mohd. Kamran Khan,     Selcuk University, Faculty of Agriculture, Department of Soil Science and Plant Nutrition, Konya, Turkey

Ajit Singh Kharub,     ICAR-Indian Institute of Wheat and Barley Research, Karnal, Haryana, India

Anuj Kumar,     ICAR-Indian Institute of Wheat and Barley Research, Karnal, Haryana, India

Dinesh Kumar,     ICAR-Indian Institute of Wheat and Barley Research, Karnal, Haryana, India

Sneh Narwal,     Division of Quality and Basic Sciences, ICAR-Indian Institute of Wheat and Barley Research, Karnal, Haryana, India

Sekar Nishanth,     Division of Microbiology, ICAR-Indian Agricultural Research Institute, New Delhi, India

Manoj D. Oak,     Genetics and Plant Breeding, Agharkar Research Institute, Pune, Maharashtra, India

Kishore M. Paknikar,     Nanobioscience Group, Agharkar Research Institute, Pune, Maharashtra, India

Anamika Pandey,     Selcuk University, Faculty of Agriculture, Department of Soil Science and Plant Nutrition, Konya, Turkey

Vanita Pandey,     Division of Quality and Basic Sciences, ICAR-Indian Institute of Wheat and Barley Research, Karnal, Haryana, India

Radha Prasanna,     Division of Microbiology, ICAR-Indian Agricultural Research Institute, New Delhi, India

Vikalp N. Rai,     ICAR-National Institute of Agricultural Economics and Policy Research, New Delhi, India

Mahendra Vikram Singh Rajawat,     ICAR-National Bureau of Agriculturally Important Microorganisms, Kushmaur, Mau Nath Bhanjan, Uttar Pradesh, India.

Jyutika M. Rajwade,     Nanobioscience Group, Agharkar Research Institute, Pune, Maharashtra, India

Sewa Ram,     Division of Quality and Basic Sciences, ICAR-Indian Institute of Wheat and Barley Research, Karnal, Haryana, India

Sendhil Ramadas,     ICAR-Indian Institute of Wheat and Barley Research, Karnal, Haryana, India

Palaniswami Ramasundaram,     ICAR-National Agricultural Higher Education Project, New Delhi, India

Anil Kumar Saxena,     ICAR-National Bureau of Agriculturally Important Microorganisms, Kushmaur, Mau Nath Bhanjan, Uttar Pradesh, India

Kanika Sharma,     Indian Council of Agricultural Research-National Bureau of Plant Genetic Resources, Pusa, New Delhi, India

Vikas Sharma,     Division of Microbiology, ICAR-Indian Agricultural Research Institute, New Delhi, India

Imran Sheikh,     Department of Genetics-Plant Breeding and Biotechnology, Dr. Khem Singh Gill Akal College of Agriculture, Eternal University, Sirmour, Himachal Pradesh, India

Devendra Singh,     Department of Microbiology, College of Basic Sciences Humanities, Dr. Rajendra Prasad Central Agricultural University, Pusa, Samastipur, Bihar, India

Gyanendra Pratap Singh,     Division of Quality and Basic Sciences, ICAR-Indian Institute of Wheat and Barley Research, Karnal, Haryana, India

Ravi P. Singh,     International Maize and Wheat Improvement Center (CIMMYT), Mexico DF, Mexico

Satyavir Singh,     ICAR-Indian Institute of Wheat and Barley Research, Karnal, Haryana, India

Surya Tushir,     Indian Council of Agricultural Research-Central Institute of Post-Harvest Engineering and Technology, Ludhiana, Punjab, India

Sangeetha Vellaichamy,     ICAR-Indian Agricultural Research Institute, New Delhi, India

Govindan Velu,     International Maize and Wheat Improvement Center (CIMMYT), Mexico DF, Mexico

Ramesh Pal Singh Verma,     International Center for Agricultural Research in the Dry Areas, Rabat, Morocco

Shalini Virani,     Department of Pharmacology, Maharaja Aggarsen Medical College, Agroha, Hisar, India

Pritesh Vyas,     Department of Genetics-Plant Breeding and Biotechnology, Dr. Khem Singh Gill Akal College of Agriculture, Eternal University, Sirmour, Himachal Pradesh, India

Deep N. Yadav,     Indian Council of Agricultural Research-Central Institute of Post-Harvest Engineering and Technology, Ludhiana, Punjab, India

Editors biography

Dr. Om Prakash Gupta

Scientist (Sr. Scale), Division of Quality & Basic Science, ICAR-Indian Institute of Wheat and Barley Research (IIWBR), Karnal, Haryana, India

Due to his outstanding meritorious profile, Dr. Gupta has the distinction of receiving numerous honors, fellowships, and awards in recognition to his excellent academic and research contributions. He has been bestowed with Jawaharlal Nehru Award for outstanding Doctoral thesis by ICAR, University Silver Medal, Aspee Gold Medal, and Dr. Kirtikar Memorial Gold Medal during his Bachelor degree program. Dr. Gupta has published many original research and review papers in peer reviewed international journals. He presented his research papers in several national and international symposia/workshops/conferences. He is also editorial board members and reviewers of many international journals. Currently, he is working on identification and characterization of Fe/Zn responsive transporters genes in wheat using NGS approach and in vitro bioavailability analysis of micronutrients such as Fe and Zn in wheat grains.

Dr. Vanita Pandey

Scientist (Plant Biochemistry), Division of Quality & Basic Science, ICAR-Indian Institute of Wheat and Barley Research (IIWBR), Karnal, Haryana, India

Her areas of specialization are molecular biology, transgenics and plant transformation, bioinformatics tools, plant RNAi studies, proteomics, transcriptomics, microarrays, and molecular markers. Dr. Pandey is a part of several projects with key focus on nutritional and processing quality enhancement of wheat using biochemical and molecular approaches with major emphasis on wheat grain biofortification. Dr. Pandey has worked at Indian Agricultural Research Institute (IARI) and National Institute for Plant Biotechnology and had developed tobacco transgenics and nutritionally enhanced soybean low-phytate transgenics. Publications include nine research papers, several technical bulletins, articles, and book chapters.

Dr. Sneh Narwal

Principal Scientist, Division of Quality & Basic Sciences, ICAR-Indian Institute of Wheat and Barley Research (IIWBR), Karnal, Haryana, India

Her main area of research is on nutritional and processing quality of wheat and barley. She has worked on the antioxidant potential and phenolic compounds in wheat and barley including the effect of various processing conditions, cooking methods, and blending on these traits. She is also working on the biofortification of wheat with iron and Zn and is associated with the identification of wheat lines with high phytase and low phytic acid content. She is associated with studies on biochemical parameters of grain in relation to the malting quality of barley especially beta-glucan and proanthocyanidins. She is actively associated with the quality component of All India Coordinated Research Programme on wheat and barley.

Dr. Pradeep Sharma

Principal Scientist (Biotechnology), Division of Crop Improvement, ICAR-Indian Institute of Wheat and Barley Research (IIWBR), Karnal, Haryana, INDIAHis research focuses on agriculture biotechnology, specifically on the characterization of genes and SSRs for abiotic stresses (drought and heat) and understating the role of epigenetics, gene silencing, and small RNAs in for wheat improvement. He has been associated with several networking projects funded as Agri-Bioinformatics Promotion Program, ACIAR-DST, and DBT-BBSRC, ICAR Networking projects on AMMAS, Cabin and AMAAS schemes, etc. He has published 90 peer-reviewed papers, editor of six books published in CRC, Elsevier and Academic Press, and 20 book chapters. Dr. Sharma has been associated with a recently released bread wheat variety DBW71 and three trait specific genetic and has been awarded with ICAR-Lal Bahadur Shastri Outstanding Young Scientist Award, NAAS- Young Scientist 2007, and ISCA-Pran Vohra Awards. Dr. Sharma is Chief Editor of Journal of Cereal Research and editorial of several journals.

Dr. Sewa Ram

Principal Scientist (Plant Biochemistry) and Principal Investigator (Wheat Quality), ICAR-Indian Institute of Wheat and Barley Research, Karnal, Haryana, IndiaDr. Ram has focused on the area of wheat grain quality for the last 22 years. He has contributed significantly in understanding the wheat grain quality at molecular, biochemical, rheological, and baking levels. Knowledge and the material generated have opened new avenues for wheat breeders to improve processing and nutritional quality of wheat. His main area of interest is characterization of biochemical/molecular components associated with processing and nutritional quality of wheat and development of superior wheat cultivars with enhanced nutritional quality traits. He developed micro level tests for various quality traits and characterized genes for grain hardness, glutenins, phytase, and developed functional marker for LMW glutenin Glu-B3b. He developed mutants with high phytase levels in high yielding background in wheat for increasing bioavailability of micronutrients in human beings.

Dr. Gyanendra Pratap Singh

Director, ICAR-Indian Institute of Wheat and Barley Research (IIWBR), Karnal, Haryana, India

Dr. G.P. Singh has vast experience in wheat research for more than 25 years. He has developed 37 wheat varieties and 34 genetic stocks suited to different agro climatic zones of the country. Dr. Singh has published more than 160 research and review papers in reputed peer journals. He is recipient of several prestigious awards such as Rafi Ahmed Kidwai award and BP Pal Gold Medal. He is fellow of many scientific academies and societies such as National Academy of Agricultural Sciences, Indian Society of Genetics and Plant Breeding, Society of Advancement of Wheat Research, Society for Scientific Development in Agriculture and Technology. He has actively organized several workshops and symposia and chaired many scientific sessions. He is actively involved in mobilization of wheat technologies from lab to farmer’s field.

Foreword

Micronutrient malnutrition or hidden hunger is a disquieting public health concern in several parts of the world. About half of the world’s population is iron deficient, while approximately one-third is known to be zinc deficient. These deficiencies cause enormous loss in both quantity and quality in human life and its endeavors to progress and prosper. One of its plausible remedies is in realizing the potential of biofortified crops. As biofortification usually refers to producing staple foods whose edible portions are denser in bioavailable minerals and vitamins, these could revolutionize our efforts in rendering more people free from malnutrition. Transforming India from green revolution to micronutrient rich revolution begins with the eradication of hunger to micronutrient malnutrition.

Wheat and barley are two important cereal crops on a global scale; provide around 50% of the required calories worldwide. Their contribution can even account for up to 70% of calories in least developed countries, primarily in Africa and Asia, where wheat and barley still have a pronounced role as staple food. Moreover, cereals function not only as source for carbohydrates, but also for proteins, fiber, and nutrients, especially in countries where the consumption of animal-based products is limited.

Biofortification circumvents these problems by improving the micronutrient content of the crops themselves by increasing mineral levels and bioavailability along with reduced antinutrient levels in the edible parts. Improving crop varieties by either conventional breeding or transgenic methods to obtain nutritionally enhanced crops has the advantage of making one time investment on research and development to have sustainable products. This book Wheat and Barley Grain Biofortification highlights the role of multidisciplinary approaches to cope up with the challenges of micronutrient malnutrition. In this endeavor, different biofortification approaches such as agronomic, breeding, biotechnological, physiological, microbial, etc., has fulfilled their different mandates of nutrient enrichment of wheat and barley. It has generated necessary impetus among the different stakeholders in jointly putting their efforts for a successful mission toward elimination of malnutrition from our country. I am sure that this publication will be quite useful to all those involved with the larger issues related to malnutrition especially in our clientele and the poor. I urge all stakeholders to be united in our efforts to bolster our support for a strong, healthy, and optimally nourished civil society enabling the nation to be self- and nutritionally sufficient through individual and collective contribution. My compliments to the editors for their efforts and timely completion of this valued publication.

Dr. Trilochan Mohapatra

Secretary (DARE) & Director General (ICAR)

Krishi Bhavan,

New Delhi - 110 001

Preface

Nutrition is one of the potentially strongest amendable factors in the well-being and health of an individual at any stage of his/her life. It is responsible for both the prevention and cure of major causes of morbidity and mortality amongst all populations. Malnutrition is a complex health as well as socio-economic concern having multiple forms and is often accompanied with both communicable and non-communicable disease burdens. Different forms of malnutrition affect almost all the countries irrespective of their economic status, geographic location, levels of food security, and population growth. Hunger and malnutrition (which includes both overnutrition and undernutrition) still affect billions of people globally despite all-time record high levels of food production. Nutritional inequalities are quite evident in both the developed and developing worlds. Malnutrition is responsible for one in every five deaths globally.

Wheat (Triticum aestivum L.) is the major staple providing the bulk of food calories and at least 30% of Fe and Zn intake and 20% dietary energy and protein consumption worldwide; thus it is essential to improve its nutritional quality. With potentially large benefits, fortification of wheat and barley processed foods is limited due to uneasy access by large proportion of socioeconomically deprived target individuals. Therefore, wheat and barley biofortification aims at developing micronutrient rich cultivars using conventional plant breeding along with advanced biotechnological approaches and agronomic practices and is considered to be the most economical solution to human micronutrient’s deficiency. Long-term studies on agronomic approaches such as foliar spray of zinc have shown significant increase of grain zinc content. Owing to sustainable and cost-effective nature, conventional and molecular breeding for micronutrient enrichment of wheat and barley is still preferred over biotechnological approach. The grain Fe and Zn concentration is negatively and positively correlated with grain yield and high grain protein content, respectively. Micronutrients bioavailability in wheat and barley is further challenged by presence of several inhibitors/anti-nutrients, such as phytic acid, fibers, lignins, tannins, oxalic acid, and lectins and promoters such as ascorbic acid, citric acid, fumaric acid, sulfur containing amino acids, short chain fatty acids, and selenium. Among all, phytic acid is major concern that strongly chelates divalent cations such as Zn²+ and Fe²+. Bioavailability can be enhanced by lowering phytic acid in low-phytic-acid mutants or by transgenic expression of phytic acid-degrading enzyme, phytase, in the seeds.

International programs such as Harvest Plus and national initiatives, are acting as pillars to achieve these targets. The biofortification strategy is promising but involves team effort, which must include plant breeders, molecular biologists, agronomists, and nutritionists. At present, more than 20 million farm households in developing countries, grows and consumes bio-fortified crops. Looking into the immense research scope, we proposed an edited book covering the latest update in the area of wheat and barley grain biofortification including agronomic, conventional and molecular breeding, biotechnological, microbiological approaches, hunger and malnutrition status, policy imperatives. This book would serve as a valuable resource to researchers in wheat, barley and cereal science as well as those exploring means of enhancing nutritional value of foods, graduate, and postgraduate student engaged in cereal chemistry, academician, and policy makers.

Editors

Dr. Om Prakash Gupta

Scientist (Sr. Scale), Plant Biochemistry, Division of Quality & Basic Sciences, ICAR-Indian Institute of Wheat & Barley Research (IIWBR), Karnal, Haryana, India

Dr. Vanita Pandey

Scientist (Plant Biochemistry), Division of Quality & Basic Sciences, ICAR-Indian Institute of Wheat & Barley Research (IIWBR), Karnal, Haryana, India

Dr. Sneh Narwal

Principal Scientist (Plant Biochemistry), Division of Quality & Basic Sciences, ICAR-Indian Institute of Wheat & Barley Research (IIWBR), Karnal, Haryana, India

Dr. Pradeep Sharma

Principal Scientist (Biotechnology), Division of Crop Improvement, ICAR-Indian Institute of Wheat & Barley Research (IIWBR), Karnal, Haryana, India

Dr. Sewa Ram

Principal Scientist (Plant Biochemistry), Division of Quality & Basic Sciences, ICAR-Indian Institute of Wheat & Barley Research (IIWBR), Karnal, Haryana, India

Dr. Gyanendra Pratap Singh

Director, ICAR-Indian Institute of Wheat & Barley Research (IIWBR), Karnal, Haryana, India

1

The unacceptable status quo: malnutrition challenges of the developed and developing world

Jaya Jumrani*

Vikalp N. Rai    ICAR-National Institute of Agricultural Economics and Policy Research, New Delhi, India

Abstract

Malnutrition has huge costs associated with it and the global economic costs range from USD 2 to USD 3 trillion annually. Non-economic costs involved are real but are not estimable. Globally, malnutrition is responsible for one in every five deaths. Different forms of malnutrition affect almost all the countries, irrespective of their economic status, geographic location, levels of food security, and population growth. As high as 11% of the global population is undernourished and most of them live in South Asia and Sub-Saharan Africa. The developed world is mainly grappling with overnutrition burden. On the other hand, many developing nations are dealing with the triple burden of malnutrition. Addressing all of these challenges across regions requires a multi-pronged strategy that should span across disciplines and sectors. It calls for innovations and interventions across agriculture, health, educational and environmental domains besides encouraging behavioral changes among the vulnerable populations.

Keywords

malnutrition

undernutrition

overnutrition

DALYs

micronutrient deficiencies

India

Chapter outline

Charting the trends in malnutrition across the globe

Status of malnutrition in developed regions

Status of malnutrition in developing regions

Malnutrition challenges across South Asia

Trends in status of malnutrition among Indian population

Lessons learnt and way forward

Disclaimer

References

Charting the trends in malnutrition across the globe

Nutrition is one of the potentially strongest amendable factors in the well-being and health of an individual at any stage of his/her life. It is responsible for both the prevention and cure of major causes of morbidity and mortality among all populations. In the recent times, diverse modern food environments have put complex demands on each individual to enjoy optimal nutrition and remain healthy (Vorster, 2009). Malnutrition is a complex health as well as socioeconomic concern having multiple forms. It is often accompanied with both communicable and non-communicable disease (NCD) burdens. Different forms of malnutrition affect almost all the countries irrespective of their economic status, geographic location, levels of food security and population growth. All these factors exert respective independent influences on an individual’s as well as a nation’s nutritional situation (Guldan, 2019).

Hunger and malnutrition (which includes both overnutrition and undernutrition) still affect billions of people globally despite the existence of all-time record high levels of food production. Nutritional inequalities are quite evident in both the developed and developing worlds. These, however, are often witnessed more in case of people residing in the developing countries. These inequities depict the double burden of malnutrition (DBM), which is the ironic coexistence of undernutrition and overnutrition. Both of these can manifest either at personal, household or demographic levels (Perez-Escamilla et al., 2018). Hunger and malnutrition have traditionally been considered equivalent to a lack of food. It has now been recognized that these can also emerge due to low-quality diets. The key nutrient needs of a human body can be met by high-quality diets consisting of nutrient-rich foods.

Dietary balance and optimal nutrition are both elusive concepts for many due to the wide-ranging social determinants of health affecting the food environments of different populations. In terms of the cost to the global economy, human capital losses and the direct healthcare costs arising due to undernutrition are estimated to be a staggering USD 3.5 trillion per year (Hoddinott, 2013). Obesity costs about USD 2 trillion annually worldwide (Dobbs et al., 2014) while undernutrition is estimated to reduce the gross domestic product by up to 11% in Africa and Asia (Horton and Steckel, 2013). The human consequences although are real, but not computable.

Findings from the Global Burden of Diseases Study 2017 estimates that diet acted as a risk factor for one out of five worldwide deaths in 2017 (IHME, 2018). Globally, 11 million deaths (22% of all adult deaths) and 255 million disability adjusted life years (DALYs)a (15% of all DALYs among adults) were attributed to dietary risks in 2017. These have increased from 8 million deaths and 184 million DALYs in 1990. About 10 million deaths and 207 million DALYs were caused by cardiovascular diseases (CVDs), which was the major cause of diet-related deaths, followed by cancer (0.91 million deaths and 20 million DALYs) and type-2 diabetes (0.33 million deaths and 24 million DALYs) in 2017.

Food insecurity, which has been increasing across all the regions, is a situation that exists when people lack secure access to sufficient amounts of safe and nutritious food for normal growth and development and an active and healthy life as defined by the Food and Agriculture Organization (FAO). According to the most-often cited and commonly-used indicator of FAO’s prevalence of undernourishment (PoU), that is, the fraction of people whose energy intakes fall below the minimum dietary energy requirement (MDER), there has been a decline from 15% globally in 2000 to under 11% in 2018 (Fig. 1.1). This implies a decline of approximately 87.7 million individuals, while the global population has risen by more than 1.5 billion (United Nations, 2019). Despite such evolvement, the world still has inadmissibly large number of undernourished population—1 out of every 3 people are still undernourished. Africa is the continent with the highest PoU affecting 20% of its population, while in Asia, 11.3% of the population has been estimated to be undernourished in 2018. As high as 514 million Asians are undernourished, making it the region with the highest number of undernourished people in the world. The dynamics of PoU, coupled with rapid population growth, has led to a rise in the overall number of undernourished people both globally and regionally.

Figure 1.1   Prevalence of undernourishment. Source: From FAOSTAT (2019).

The proportion of people living without enough food and/or without adequate dietary balance has started to witness an increase recently (FAO et al., 2019). The prevalence of severe food insecurity (SFI) among the overall population was 9.2% globally in 2018, which has continuously increased from 8.0% in 2014 (Table 1.1). Across regions, Africa has the highest prevalence of SFI where 21.5% population was suffering from SFI. Globally, 704 million people were experiencing SFI in 2018, of which 631 million were living in Asia and Africa. Largest increases have been noted for Africa between 2014 and 2018, wherein 66 million people suffering from SFI were added in just 5 years (Table 1.1).

Table 1.1

Note: Absolute numbers in millions and prevalence in percentage terms within parentheses.

Source: Data from FAOSTAT (2019).

Stunting is defined as the proportion of children that are under 5 years of age and whose height-for-age is below −2 standard deviations from the median height-for-age of the reference population (WHO, 2006). It is one of the major forms of undernutrition, especially in Africa and Asia. Stunting leads to an underdeveloped brain with long-lasting adverse consequences, including poor mental and learning abilities, reduced earnings and increased risks of nutrition-related chronic illnesses such as diabetes, hypertension, and obesity in the future. Stunted growth and development are a consequence of poor maternal health and nutrition, inadequate infant and young child feeding practices and infection (WHA, 2014a). Across the globe, prevalence of stunting among children under 5 years has declined from 32.6% in 2000 to 21.9% in 2018 (Fig. 1.2), with the highest prevalence being observed in Africa (30%), followed by Asia (22.7%). Stunting in children has been declining globally as well as across all regions consistently from 2000 onwards. Globally, around 149 million children were stunted in 2018, of which the major contributors were residents of Asia (81.7 million) and Africa (58.8 million) (FAO et al., 2019).

Figure 1.2   Incidence of stunting among children. Source: From FAOSTAT (2019).

In children under 5 years of age, wasting is defined as the weight-for-height that is below −2 standard deviations from the reference median of the WHO 2006 Child Growth Standards. Wasting in children is a symptom of acute undernutrition that usually occurs as a consequence of insufficient food intake or a high incidence of infectious diseases (WHO, 2010). Wasting contributed to 12.6% of all global deaths among children under 5 in 2011 (Black et al., 2013). About 7.3% of the children under 5 years across the world were suffering from wasting in 2018 (FAOSTAT, 2019). This translates to about 49.5 million wasted children, of whom 35 million were living in Asia in 2018. Meanwhile, globally 16 million children were severely wastedb, of which 75% children were living in Asia (FAO et al., 2019). Improper feeding and care practices, poor access to healthcare, hygiene and sanitation services, low levels of food security, lack of food access and diversity have been the main causes behind wasting in children under 5 years (WHA, 2014b).

Stunting is an outcome of prolonged undernutrition that hinders linear growth and wasting is an outcome of inadequate nutrition over a shorter period. On the other hand, overweight and obesity are an upshot of overnutrition that consequently leads to CVDs, type-2 diabetes, and musculoskeletal disorders (especially osteoarthritis). According to the 2019 flagship report of FAO, The State of Food Security and Nutrition in the World, overweight childrenc under the age of 5 years, along with obesity in adults and anemia in women have been rising consistently across all countries. The proportion of overweight children was 5.9% that accounted for 40 million pre-school aged overweight children globally in 2018. Both Asia (5.2%) and Africa (4.9%) had the lowest prevalence of overweight population in 2018, but together they accounted for nearly 75% of all the overweight under-fives in the world (FAO et al., 2019).

Obesity in adults (having more than 18 years of age) has been characterized of having a body mass index (BMI) equivalent to or greater than 30 kg/m². Globally, prevalence of obesity in adults was 13.2% in 2016, which has consistently increased from 8.3% in 2000 (Fig. 1.3). Obesity in adults has been increasing among all the regions and starkly so for the developed regions. Obesity is often linked with excessive food consumption, but it is also usually related to micronutrient deficiencies and starvation. Prevalence of obesity among the adult population is usually attributed to micronutrient deficiencies such as zinc, iron and vitamins A, C, D, and E. Anemia is defined as hemoglobin levels of less than 110 grams per liter in women during reproductive age (WHO, 2011). It leads to an increase in the risks associated with maternal and neonatal adverse outcomes besides impairing the overall health and well-being among women. Global prevalence of anemia in women was 32.8% in 2016, which indicates that one in every three women was anemic (Fig. 1.3). Iron deficiency is attributed to almost half of the anemia cases, although deficiencies of folate, vitamin A, vitamin B12, chronic inflammations can also cause anemia (WHA, 2014c). Maternal anemia is usually linked to an increased risk of pre-term births and low birth weight rates. These are often one of the key reasons behind higher rates of perinatal morbidity and mortality, higher infant mortality rate and lower mental concentration and productivity (Allen, 1997; Gillespie & Johnston, 1998; Stoltzfus, 1997). Kalaivani (2009) finds that when the hemoglobin level is less than 8 grams per deciliter, one does observe a two-three folds increase in the perinatal mortality rates and doubling of low birth weight rates.

Figure 1.3   Global incidence of adult obesity and anemia among women. Source: From FAOSTAT (2019).

Status of malnutrition in developed regions

Malnutrition in at least one of its forms affects every country across the globe and acts as a major impediment toward achieving global food security, adequate nutrition and sustainable development. Human populations are suffering from a triple burden of malnutrition that is, a paradoxical coexistence of undernutrition and micronutrient deficiencies on one hand, with diet-related NCDs on the other. Overnutrition is a greater problem, which has been observed among the developed regions, along with high prevalence of micronutrient deficiencies (especially iron deficiency). The major consequence of an increased BMI is a significant risk factor for NCDs such as CVDs, musculoskeletal disorders and cancer. Multifactorial reasons are responsible for overweight and obesity, which include an interplay of genetic, nutritional, physical, mental, environmental, and socioeconomic factors. However, excess calorie consumption and low energy expenditure are the most significant variables that underlie the rise in overweight and obesity in the developed countries.

The PoU in the developed regions, which consists of Northern America, Europe, Australia and New Zealand, has been less than 2.5% in 2018 (FAO et al., 2019). About 10.6 million people (1% of its population) were suffering from SFI in Northern America and Europe in 2018 (Table 1.1). The proportion of adults who were obese was highest in Northern America (36.7%), followed by Australia and New Zealand (30.7%) in 2016, which was very high when compared with the global prevalence of obesity of 13.2% (Fig. 1.4). It is clearly indicative from Fig. 1.4 that obesity in adults is rising steadily from 2000 onwards and highest increase has been observed in Northern America where it rose from 25.6% in 2000 to 36.7% in 2016. Intake of energy-dense foods and poor dietary practices, decrease in physical activity due to sedentary forms of occupations, change in transportation modes and increase in urbanization rate are the key plausible causes behind the increase in overweight and obesity in developed regions.

Figure 1.4   Prevalence of obesity among adults in the developed regions. Source: From FAOSTAT (2019).

Meier et al. (2019) estimated that 32 out of 51 countries according to WHO’s classification of European regiond observed an increase in diet-related CVDs’ mortality in adults below 70 years of age. In 2016, 2.1 million cardiovascular deaths in the WHO European region were attributed to dietary risks, which accounted for 22.4% of all deaths and 49.2% of CVD deaths in 2016. The age-standardized death rates have decreased in all the considered subregions of Europe, while absolute number of diet-related premature cardiovascular deaths increased between 2010 and 2016 in 29 (out of 51) countries with largest increases (25,600 deaths) witnessed in Western Europe.

Overweight and obesity pose health problems throughout an individual’s life cycle. High mortality rates are noted among obese adults due to an enhanced risk of CVDs, cancer and diabetes. Overweight children have a higher risk of type-2 diabetes, high blood pressure, asthma, sleep disorders, and liver diseases (Knight, 2011). Modification in lifestyles characterized by an increase in physical activity and an intake of balanced diet can decrease the risk of comorbid circumstances associated with obesity even with minimal or no weight loss (Ross and Bradshaw, 2009).

Nevertheless, the proportion of women suffering from anemia during reproductive age has been rising in developed regions. Within Northern America and European region, the prevalence of anemia has been highest in Europe (20.2%), followed by Northern America (12.9%) in 2016 (Table 1.2). Northern America and Europe jointly have 44.3 million women suffering from anemia, with the highest number of anemic women (33.7 million) in Europe (Table 1.2). During pregnancy, anemia or low hemoglobin concentrations are often associated with an enhanced risk of maternal and perinatal mortality and low size or weight at birth.

Table 1.2

Note: Prevalence in percentage terms and absolute numbers in millions within parentheses.

Source: Data from FAO et al. (2019).

The proportion of women affected by anemia was low in developed regions as compared to the global average of 32.8% in 2016 (Fig. 1.3). But a consistent rise in the prevalence of anemia in these regions and subregions has led anemia toward becoming a mild public health problem in developed regions. Table 1.2 clearly states that anemia in women has been rising consistently in developed regions and across subregions from 2012 onwards.

Overnutrition in the form of overweight/obesity and micronutrient deficiencies in the form of anemia have been observed in the developed regions. The prevalence of caloric deficiencies and stunting and wasting among children are not a serious matter of concern for the developed countries, but rising levels of overweight and obesity are becoming a major public health problem. Rapid increases in excess body weight have led to an increase in the incidence of numerous diseases/disorders, including coronary and cerebrovascular diseases, various kinds of cancers, type-2 diabetes, etc.

Status of malnutrition in developing regions

Malnutrition among developing nations, especially in South Asia and Sub-Saharan Africa, continues to be a significant public health problem. There is a complicated interplay between early undernutrition and subsequent overnutrition that exacerbates the danger of NCDs the incidence of which has been rising rapidly. Nearly half of all nations are facing varied burdens of malnutrition in developing nations, including poor infant development, micronutrient deficiencies and overweight adults (WHO, 2018a). Developing regions are mostly affected by undernutrition as well as micronutrient deficiencies, while overnutrition in the form of overweight and obesity has also been rising steadily.

Globally, 821 million people were estimated to be undernourished in 2018 with a majority of them living in developing nations, especially in the continents of Africa and Asia. PoU in the developing countries, along with the number of people affected by it, has been very high relative to other regions in the world. PoU in Africa (19.9%) is highest among all the regions and is much higher in comparison to the global prevalence of 10.8% in 2018 (Table 1.3).

Table 1.3

Note: PoU and stunting in percentage terms.

Source: Data from FAOSTAT (2019).

From Table 1.3, one can note that the PoU has been declining among all the developing regions, except for Africa. However, the number of people affected by undernourishment has been increasing due to population growth, slowdown in economic growth, decline in wages and income, and conflicts and wars (FAO et al., 2019). At the same time, the number of people affected by undernourishment is highest in Asia, which is home to 514 million undernourished people in 2018 (FAO et al., 2019). Prevalence of SFI in the developing regions has been on the rise, especially in Africa and Asia. The prevalence of SFI is observed to be highest in Africa (21.5%), while Asia has the highest number of population (354 million) suffering from SFI. Within developing regions, Africa has observed highest growth of about 31% in number of people suffering from SFI from 2014 to 2018 (Table 1.1).

Stunting and wasting are nutritional conditions that most commonly affect children in developing countries and have serious consequences for survival, health, and development. Stunting among children is one of the major barriers to human development, which globally affected 21.9% of the children under 5 years of age in 2018 (Table 1.3). However, the proportion of stunted children under 5 years of age was highest in Africa (30%) in 2018. Africa and Asia together accounted for more than 9 out of 10 stunted children globally. In Asia, 81.7 million children under 5 years were stunted, while in Africa 58.8 million were stunted in 2018 (FAO et al., 2019). Stunting is a largely irreversible outcome of inadequate nutritional intake and repeated bouts of infection during the first 1000 days of a child’s life (WHA, 2014a).

Globally, 49.5 million children under 5 years of age were still suffering from wasting with a majority living in developing regions, especially in Asia (33.8 million) and Africa (14 million) in 2018. These constitute 9.4% and 7.1% of Asia’s and Africa’s wasted children, respectively. The proportion of overweight children under 5 years of age has increased from 4.9% in 2000 to 5.9% in 2018 globally. Regionally, Southern Africa has the highest overweight children (13%), followed by Central Asia (9.4%) in 2018. Globally, 40 million children under 5 years of age were overweight, of which 28 million (more than 70%) were living in Asia (18.8 million) and Africa (9.5 million) in 2018 (FAO et al., 2019).

On the other hand, the global prevalence of obesity in the adult population has increased to 13.2% in 2016 from 8.3% in 2000. Obesity was observed to be highest in Latin America and the Caribbean (24%) among developing regions in 2016 (Table 1.4). However, number of people who were obese was 228.7 million in Asia and 73.5 million in Africa in 2016. Within subregions of Asia and Africa, Eastern Asia (81.3 million), and Sub-Saharan Africa (39.5 million) have the highest burden of adult obesity (FAO et al., 2019).

Table 1.4

Note: Prevalence in percentage terms and absolute numbers in millions within parentheses.

Source: Data from FAOSTAT (2019).

Some of the common micronutrient deficiencies in women and children in developing regions include deficiencies of vitamin A, iron, iodine and also folate, zinc, and vitamin D. Many of these deficiencies coexist in the same individuals suggesting that poor-quality diets, poor sanitation, and inadequate healthcare are the major contributory factors. Anemia during pregnancy has been affecting both developed as well as developing countries and is associated with maternal and perinatal adverse consequences (Black et al., 2013). As per the classifications of WHO (2011), anemia is considered to be severe if its prevalence rate exceeds or equals to 40%. In developing regions, the prevalence of anemia is highest among pregnant women in Africa (37.7%), followed by Asia (36.6%), and lowest prevalence (22.0%) was reported among pregnant women in Latin America and the Caribbean in 2016 (Table 1.4). Micronutrient deficiencies of iron, folate, vitamin A and B12, and parasitic infections such as malaria and chronic infections (McClure et al., 2014) and hookworm infection (Brooker et al., 2008) are often the key causes behind anemia during pregnancy in developing countries. The number of women suffering from anemia was highest in Asia, where almost 419.9 million of 613 million women resided, followed by Africa (110 million) in 2016 (Table 1.4). Within subregions of Asia, the number of anemic women was highest in South Asia (234.2 million) followed by Eastern Asia (107.4 million), whereas in subregions of Africa, 91 million women were affected by anemia in Sub-Saharan Africa (FAO et al., 2019).

Developing