Hidden hunger - a narrative review

Weffort, Virgínia Resende Silva; Lamounier, Joel Alves

doi:10.1016/j.jped.2023.08.009

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Sumário

Review article • J. Pediatr. (Rio J.) 100 (suppl 1) • Mar-Apr 2024 • https://doi.org/10.1016/j.jped.2023.08.009 copy

Hidden hunger - a narrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

Malnutrition is characterized by situations of undernutrition and obesity resulting from the lack of micronutrients with the greatest impact on children. The objective of this review was to highlight inadequate food consumption, food security, and nutritional inadequacy leading to hidden hunger and the prevention and treatment of the main micronutrient deficiencies in Brazil.

Data source

Literature review carried out through a bibliographic survey in PubMed (National Library of Medicine, United States), Lilacs (Latin American and Caribbean Literature in Health Sciences), and SciELO (Scientific Electronic Library Online) databases. The search used the terms Occult hunger, (hidden hunger), and Child, in articles published between 2013 and 2023 in Portuguese, English and Spanish. The search was performed on 06/25/2023.

Data synthesis

The lack of micronutrients can occur insidiously and without clinical manifestations, being called hidden hunger. The prevention of nutritional deficiencies is part of the recommended actions in childcare, with healthy eating. Studies were cited related to macro and micronutrient intake deficiencies, both national and international, and strategies to improve micronutrient intake, including routine supplementation of iron, and vitamins D and A. The diagnosis, prevention, and treatment of the main deficiencies in Brazil (iron, vitamin A, vitamin D, zinc), currently adopted, concluded the topic.

Conclusion

Zero hunger and zero obesity must be part of the same policy, together with a nutritional education program.

Keywords
Micronutrients; Pediatrics; Hidden hunger

AGE	AI mg/day	EAR mg/day	RDA mg/day	UL mg/day
0-7 months	0.27	-	-	40
7-12 months	-	6.9	11.0	40
1 to 3 years	-	3.0	7.0	40
4 to 8 years	-	4.1	10.0	40
9 to 13 years	-	5.7 F/5.9M	8.0 F/8.0M	40
14 to 18 years	-	7.9F/7.7M	15.0F/11.0M	45

Age range	EAR (mcg)RAE	AI* or RDA (mcg)RAE	UL (mcg)RAE
0 to 6 months	-	400*	600
7 to 12 months	-	500*	600
1 to 3 years	210	300	600
4 to 8 years	275	400	900
9 to 13 years	445 M/420F	600	1700
14 to 18 years	630 M/485F	900 M/700F	2800
Pregnant woman 14 to 18 years	530	750	2800
Lactating woman 14 to 18 years	885	1200	2800

Period	Dose	Frequency
Children aged 6-11 months	100.000 UI	Single dose
Children aged 12-59 months	200.000 UI	One dose every 6 months

AGE	AI	RDA	UL
0 to 6 months	400 UI - 10 µg/d	-	1000
6 to 12 months	400 UI - 10 µg/d		1500
1 to 3 years	-	600 UI - 15 µg/d	2500
4 to 8 years	-	600 UI - 15 µg/d	3000

AGE	AI mg/day	EAR mg/day	RDA mg/day
0 to 6 months	2.0	-	-
7 to 12 months	-	2.5	3.0
1 to 3 years	-	2.5	3.0
4 to 8 years	-	4.0	5.0
9 to 13 years	-	7.0M	8.0M
14 to 18 years	-	8.5 M/7.3F	11.0 M/9.0F

Laboratory assessment of the different stages of iron deficiency
	Depletion of iron stores	Iron deficiency	Iron-deficiency anemia
Red blood cell morphology (MCV, MHC, RDW)	Normal	Normal	↓ MVC^* ⁎ Vary with age. (microcytosis) ↓ MCH^* ⁎ Vary with age. (hypochromia) ↑ RDW
Ferritin	Decreased	Decreased	Decreased
Serum iron	Normal	Decreased	Decreased
TIBC	Normal	Increased	Increased
Transferrin saturation index ^⁎⁎ ** Calculation of the transferrin saturation index = (Iron/TIBC) x 100 Fonte: WHO, 2020;35 SBP, 2021.37	Normal	Decreased	Decreased

Infants WITHOUT risk factors
Situation	Recommendation
Full-term newborns, appropriate weight for gestational age, exclusively breastfed until the 6th month	1 mg of elemental iron/kg/day, starting at 180 days of life until the 24th month of life.

Infants WITH risk factors
Situation	Recommendation
Full-term newborns, appropriate weight for gestational age, exclusively breastfed	1 mg of elemental iron/kg/day, starting at 90 days of life until the 24th month of life.
Full-term newborns, appropriate weight for gestational age, regardless of type of feeding	1 mg of elemental iron/kg/day, starting at 90 days of life until the 24th month
Full-term newborns weighing less than 2500 g.	2 mg of elemental iron/kg/day, starting at 30 days of life, for one year. After this period, 1 mg/kg/day for another year
Preterm newborns weighing more than 1,500 g	2 mg of elemental iron/kg/day, starting at 30 days of life, for one year. After this period, 1 mg/kg/day for another year
Preterm newborns weighing between 1500 and 1000 g	3 mg of elemental iron/kg/day, starting at 30 days of life, for one year. After this period, 1 mg/kg/day for another year
Preterm newborns weighing less than 1000 g	4 mg of elemental iron/kg/day, starting at 30 days of life, for one year. After this period, 1 mg/kg/day for another year
Preterm newborns who received more than 100 mL of packed red blood cells during hospitalization	They must be evaluated individually as they may not require iron supplementation at 30 days of age, but rather later.

Diagnosis	Clinical Guidelines by The Endocrine Society - 2011	American Academy of Pediatrics - IOM 2011
Sufficient	30 to 100 ng/mL	21-100 ng/mL
Insufficient	21-29 ng/mL	16-20 ng/mL
Deficient	< 20 ng/mL	< 15 ng/mL
Toxicity	150 ng/mL	> 150 ng/mL

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E-mail: jped@jped.com.br

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[1] ⁎ Corresponding author. E-mail:virginiaweffort@gmail.com (V.R. Weffort)