Aga Khan University, Karachi, Pakistan.
Br Med Bull. 2013;106:7-17. doi: 10.1093/bmb/ldt015. Epub 2013 May 3.
Malnutrition still remains one of the major public health challenges, particularly in developing countries. Major risk factors for undernutrition such as suboptimal breastfeeding and micronutrient deficiencies (vitamin A and zinc) are responsible for more than one-third of all under five child deaths and 11% of the global total disease burden.
Several strategies have been employed to supplement micronutrients. These include education, dietary modification, food provision, supplementation and fortification either alone or in combination.
Supplementation is the most widely practiced intervention while fortification can also be a potentially cost-effective public health intervention and target a larger population through a single strategy. Universal coverage with the full bundle of interventions including micronutrient provision, complementary foods, treatments for worms and diarrheal diseases and behavior change programs package could be the way forward in achieving the Millennium Development Goals (MDGs).
Bio-fortification and agricultural interventions including home and school gardening are relatively newer strategies and require further research as they have the potential to impact nutritional status of populations at large.
Effectiveness of the various interventions is well recognized; however, consensus needs to be built around approaches to scale up coverage and delivery strategies to reduce disparities and provide equitable access.
Future studies should focus on evaluating various approaches to address malnutrition with a standard methodology and defined outcomes. This will help gauge the actual morbidity and mortality impacts of these specific interventions and the long-term viability of these programs. On a broader scale, strategies to address food insecurity and poverty alleviation are the key as these are complex sustainable development issues, linked to health through malnutrition, but also to sustainable economic development, environment and trade.
营养不良仍然是主要的公共卫生挑战之一，特别是在发展中国家。营养不良的主要危险因素，如母乳喂养不足和微量营养素缺乏（维生素 A 和锌），导致超过三分之一的五岁以下儿童死亡和全球总疾病负担的 11%。
已经采取了几种策略来补充微量营养素。这些策略包括教育、饮食调整、食品供应、补充和强化，单独或联合使用。
补充是最广泛实施的干预措施，而强化也可以是一种具有成本效益的公共卫生干预措施，可以通过单一策略覆盖更多人群。通过提供全面的干预措施，包括提供微量营养素、补充食品、治疗蠕虫和腹泻疾病以及行为改变方案，可以实现普及覆盖，这可能是实现千年发展目标的途径。
生物强化和农业干预措施，包括家庭和学校园艺，是相对较新的策略，需要进一步研究，因为它们有可能对广大人群的营养状况产生影响。
各种干预措施的有效性已得到广泛认可；然而，需要就扩大覆盖范围和提供策略的方法达成共识，以减少差距，提供公平获取机会。
未来的研究应侧重于评估解决营养不良的各种方法，采用标准方法和明确的结果。这将有助于评估这些特定干预措施的实际发病率和死亡率影响以及这些计划的长期可行性。更广泛地说，解决粮食不安全和减贫的战略是关键，因为这些是与营养不良相关的复杂可持续发展问题，但也与可持续经济发展、环境和贸易相关。
