Malnourished yet obese
Prevalence of overweight and obesity
Keeping a balanced diet is somewhat challenging in Mongolia with the relatively high commodity prices and limited diversity of food available. It wouldn’t be an exaggeration to say that these factors attributed to the “alarmingly” high prevalence of obesity and micronutrient deficiencies in the country.
On most occasions, I don’t know what to buy when I’m at a store for groceries because small stores display limited choices of goods which I can probably name by heart, and while the larger shops and markets have a better selection, they are often overpriced. By the time I’m at the counter, I realize that I have bought the same goods as last time. I’m sure that I’m not the only one with this problem because studies show that 76.6 percent of women and less than 60 percent of men in Mongolia achieved the minimum dietary diversity goal.
The minimum dietary diversity is an indicator in the latest Nutrition Status of Mongolian Population (NSMP) report, which assesses the micronutrient adequacy of men and women of all ages based on whether they consume at least five out of 10 food groups each day.
Authors of the report card on Mongolia’s nutrition situation wrote, “The pastoral system in Mongolia is associated with unique food consumption patterns, with high intake of proteins from meat and milk products, but little dietary diversity, leaving the population increasingly susceptible to micronutrient deficiencies and excess weight gain.”
In addition to the disparities in nutrition indicators, the report revealed that overweight and obesity has dramatically hiked since 2010 with nearly half of adults and a quarter of school-aged children overweight. The prevalence of overweight and obesity among adults, and increasingly among children, in all regions of Mongolia has reached “epidemic proportions” and is likely the greatest public health challenge facing the country, experts say.
Let’s take a closer look at how dire the situation is in terms of obesity and micronutrient deficiency.
MICRONUTRIENT DEFICIENCY IS PRIORITY PUBLIC HEALTH CONCERN
Vitamin D status
Vitamin D deficiency has historically been a public health concern in Mongolia due to low consumption of vitamin D-rich foods, low availability of vitamin D-fortified foods, and low exposure to ultraviolet B (UVB) radiation from sunlight.
Deficiency in vitamin D affects bone formation, leading to growth retardation in children and osteoporosis in adults. Recent research also indicates adequate vitamin D status is associated with a reduced risk of heart attack and mortality from heart disease. Due to their higher vitamin D requirements, pregnant and lactating mothers, infants and young children are at highest risk of vitamin D deficiency.
Experts advised the public to consume more foods containing vitamin D, including fatty fish, fish liver oils, beef liver, and egg yolks, as well as naturally get it through exposure to sunlight.
NSMP confirmed very poor vitamin D status with 90 percent of children under five years of age, 95 percent of pregnant women, and 82 percent of men having insufficient vitamin D levels. In all regions and socio-economic groups in Mongolia, a high percentage of adults and children lacked sufficient vitamin D.
Achieving a reduction of vitamin D deficiency and insufficiency in all age groups will require a multifaceted approach of supplementation and fortification strategies, according to experts. Pregnant women and children below the age offive, with high vitamin D requirements due to their rapid growth, require targeted interventions such as supplementation to ensure adequate intake of vitamin D.
The report read, “Children under five should receive either monthly high-dose vitamin D supplements or multiple micronutrient powders, containing vitamin D and other essential nutrients, at home. Pregnant women should receive multiple micronutrient supplements containing vitamin D and other essential nutrients at regular antenatal care visits. To meet the vitamin D requirements of the general population, government-mandated fortification of domestically-produced and imported wheat flour and government-mandated use of fortified flour in commercial food production should be implemented.”
Mandatory fortification of wheat flour is recommended for providing essential vitamin D to men, adolescents and the elderly who do not receive supplementation through policies. Implementation of both a population-based approach through wheat flour fortification and a targeted approach through supplementation is expected to improve vitamin D status and decrease the related morbidity and mortality impacting all population groups in Mongolia.
Vitamin A status
Vitamin A deficiency, on the other hand, is a moderate public health problem with 9.5 percent of children under five deficient and 60 percent of children having vitamin A insufficiency. The prevalence of vitamin A deficiency and insufficiency in children under five years was found to be elevated in all regions.
Deficiency in vitamin A increases risk of illness due to a weakened immune system, leaving children particularly vulnerable to common childhood infections such as diarrhea and measles. In severely deficient children, inability to fight off infection and illness, blindness and even death are possible.
In men and pregnant women, the prevalence of vitamin A deficiency and insufficiency was found to be low. Analysis of dietary intake in Mongolia reveals that despite widespread consumption of vitamin A-rich foods by men and women in most households, consumption of vitamin A-rich foods is low in children. This discrepancy in consumption suggests that changes in awareness and behavior are necessary to encourage caregivers to feed young children animal liver, carrots, eggs and sweet potato.
Iodine status
According to the report, 78.9 percent of families have adequate intake of iodized salt, with the lowest intake in the western (60.4 percent) and Khangai regions (70.6 percent), and highest intake was in the eastern region (92.4 percent).
Iodine is essential to producing thyroid hormones which regulate the body’s metabolism and is also essential for proper fetal and infant brain development and growth. As iodine deficiency has serious lifelong health impacts for children’s physical and mental development, prevention is crucial during pregnancy, lactation, and early childhood.
The major dietary sources of iodine are seafood and sea vegetables which are not commonly consumed in Mongolia. Salt iodization, a longstanding and successful strategy to control iodine deficiency in Mongolia, is the main source of iodine for Mongolians.
At the national level, iodine status in schoolaged children was adequate at 144.6 g/l (adequate status for school age children: 100–199
g/l) while school children in the western region had insufficient iodine status, indicating iodine deficiency. Pregnant women were found to have insufficient iodine status nationwide (adequate status for pregnant women: 150–249 g/l), with poorest iodine status in Western and Khangai regions.
The national salt iodization program in Mongolia
to ensure households in the Khangai and Western regions have affordable access to imported iodized salt and increased availability of local salt that has been iodized.
Iron status
NSMP revealed that anemia and iron deficiency were high among children under five and pregnant women in all regions, with 27 percent of children aged between two and 59 months and 21 percent of pregnant women anemic, and 21 percent of children of the said age group and 30 percent of pregnant women were iron deficient. In men aged 15 to 49, there was little prevalence of anemia and iron deficiency, and no incidence of iron overload.
To ensure that the daily requirements of iron and other essential nutrients are met, all pregnant women should eat a varied diet plentiful in iron rich foods and receive daily multiple micronutrient supplements through antenatal care (ANC) services as part of the existing national health program. Although ANC attendance is very high in Mongolia, only 11 percent of women receive the government-mandated multiple micronutrient supplements through ANC with the majority of women purchasing prenatal supplementation through private pharmacies.
The high cost of privately-purchased pre-natal is vitally important to ensure adequate iodine status in the population. Findings from NSMP support the continuation of the salt iodization program with increased efforts towards achieving universal salt iodization through strong monitoring and enforcement of the Salt Iodization Law. Focused efforts are reportedly needed supplements may discourage pregnant women from taking supplements daily and their inferior formulation means they do not provide some essential nutrients including iodine and vitamin D. Based on this, universal scale-up of the government-mandated multiple micronutrient supplements along with counselling to improve on low
compliance is a key strategy to address anemia and iron deficiency in pregnant women.
NEARLY HALF OF ADULTS AND QUARTER OF CHILDREN ARE OVERWEIGHT
The rapidly increasing prevalence of overweight and obese adults and children is inarguably the greatest public health concern facing Mongolia. This problem is largely attributed to the “nutrition transition” with increasingly sedentary lifestyles and a shift from traditional diets to inexpensive, high-energy, low-nutrient foods containing high amounts of fat, sugar, and salt.
People who are overweight or obese have a higher risk of developing serious health problems including hypertension, heart disease, stroke, diabetes, some cancers, and osteoarthritis.
According to the recent NSMP, overweight is high in all regions and population groups in Mongolia with 46 percent of women and 49 percent of men overweight. The prevalence of overweight has increased most dramatically among school-age children from 4.3 percent in 2010 to 28.6 percent in 2017, with nearly one in every four being overweight. Slightly more than one in three school-age children are overweight in Ulaanbaatar, accounting for 34 percent.
The report indicated that the prevalence of overweight begins at a young age with 12 percent of children under five overweight.
Experts stated, “The reduction and prevention of overweight and obesity in Mongolia requires a multi-faceted strategy to address the lifecycle factors contributing to excess weight gain. Good nutrition practices by women prior to conception, during gestation, and throughout infancy and childhood are important to reducing children’s risk of becoming overweight.
“Key priorities for action are decreased consumption of unhealthy ‘junk’ foods and drinks, increased physical fitness through school programs, and healthy home environments. Government policies should be designed to make these ‘junk’ foods less desirable, including the introduction of taxes on sugar-sweetened beverages and foods and restrictions on the marketing of junk foods to children. These government policies should be complemented by programs to increase production of nutritious foods, increasing their availability, affordability and demand.”
CONCLUSION
Findings in the latest NSMP should not be ignored. They are alarming and urge everyone -- individuals, organizations and the government – to pay greater attention to the public nutrition status. The report needs to be used as a report card for identifying, addressing and resolving pressing challenges concerning diets and nutrition intake of Mongolians.
Good nutrition is the basic component of good health and a healthy population will stimulate the national development. The relationship between nutrition and human resource development was best described by the 1992 International Conference on Nutrition (ICN) held in Rome, which in its World Declaration and Plan of Action for Nutrition, stated that nutritional well-being of all people is a pre-condition for the development of societies and is a key objective of progress in human development.
A well-nourished, healthy workforce is a precondition for sustainable development. At the same time, the nutritional well-being of a population is a reflection of the performance of its social and economic sectors, and to a large extent, an indicator of the efficiency of national resource allocation. In order for national social and economic development programs to be successful and sustainable, the whole community and population should participate in the process. This means that at least more than half of the population needs to be in good health and have good nutritional status to actively contribute to the national development.
Obesity and malnutrition can be tackled with intersectoral programs and policies aimed at improving nutrition status through increasing household food security, promoting year-round consumption of nutritionally-adequate diets, carrying out infant and young child feeding practices, providing family counseling on healthy eating and lifestyles, distributing micronutrient supplementation, and adding micronutrients through food fortification.