The Importance of Protein in the Developing World

– A Solution to Food and Nutrition Insecurity

Originally published August 2018.

Marianne Smith Edge, MS, RD, FAND
Former President, Academy of Nutrition & Dietetics
Senior Associate, The Context Network

Tiffany Agard,
Program Analyst, Context Global Development

Executive Summary

The next 30 years will be a time of incredible importance and change in the world’s history. Recent estimates project that the world’s population will rise to 9.8 billion by 2050 with almost 80% of that population coming from Asia (5.2 billion) and Africa (2.5 billion). With the increased population comes the continued need to increase food production and availability that will not only feed but nourish the world’s population.

Today, 800 million people are chronically hungry and two billion suffer micronutrient deficiencies, a form of “hidden hunger”. Food and nutrition security are identified as one of the world’s “most serious but least addressed health problems” by global organizations such as the Food and Agricultural Organization and the Academy of Nutrition and Dietetics, as well as the consensus report, “Scaling Up Nutrition: A Framework for Action” from over 100 public, private and government agencies

Addressing food and nutrition insecurity are at the crossroads of human health, economics and agriculture production. Despite current efforts, under-nutrition (lack of adequate protein and micronutrients) still impacts over 680 million individuals, including 159 million children who suffer from stunting. Although the number is scheduled to drop in the next 30 years, it is not slowing as quickly as planned and is expected to still plague 370 million people in developing countries in 2050. With concern over future food supply, this number is at risk of growing, particularly in areas currently experiencing the impacts of undernutrition and hidden hunger. Nearly half of all child deaths in Southern Ethiopia are associated with deficiencies in protein and micronutrients. Adequate protein intake is imperative in the first 1000 days of life as it is the foundation for healthy children, mothers, and communities.

Concerted and collaborative efforts of public and private partnerships are vital to finding solutions to resolve one of the costliest problems in developing countries. Nutrition-focused agricultural systems through a multi-stakeholder approach can address the current hunger and malnutrition issues and ultimately improve the quality of life for the world’s seven billion plus inhabitants.

Understanding the First 1000 Days of Life

It is estimated there are 3.5 million preventable maternal and child deaths annually due to the interaction of undernutrition with repeated bouts of infectious disease. Protein−energy malnutrition (i.e., inadequate intake of protein and/or energy over prolonged periods of time) is assessed through various physical measurements. A child can be too short for their age (stunted), have low weight for their height (wasted), and/or have low weight for their age (underweight). Stunting (reduced growth) is an indicator of chronic exposure to nutrient deficiencies and infections. Presently, 159 million children under the age of five are stunted with 75 percent living in Sub-Saharan Africa or South Asia. Nutrient deficiencies that lead to stunting can reduce a country’s productivity and GDP by as much as 7% globally, and up to 9–10% in African and South Asian countries.

Ten years ago, the Lancet — one of the world’s most highly respected medical journals — issued a nutrition series of systematic evidence showing the impact of undernutrition on infant and child mortality and its largely irreversible long-term effects on health and on cognitive and physical development. The Lancet set of interventions focused on the “window of opportunity” in the first 1000 days (pregnancy to two years old) for high impact in reducing death and disease and avoiding irreversible harm. In 2010, the non-profit organization, 1,000 Days, supported by the Bill & Melinda Gates Foundation along with various governments and non-profits, was developed based on the scientific evidence that early nutrition drives the long-term health of women, children and societies.

The Importance of Protein Throughout the Lifecycle

Protein plays a significant role within the human body including building muscle, bone, and brain development. Its components, amino acids, are the building blocks of this development and are critically important in the first 1,000 days of life and throughout the lifecycle. Proteins also serve as a secondary source of energy when amounts of carbohydrates and fat in the diet are inadequate to provide sufficient energy. If a child‘s diet is adequate in protein without the needed carbohydrates or fat for energy, the full benefit benefits for growth development will not be achieved as it be used as an energy source.

Beyond the First 1000 days, protein and nutrition remain critical to health and success. As young adolescents and particularly young girls, transition through a rapid period of growth and, at times into motherhood, protein intake supports healthy bone and muscle development. Pregnancies during adolescence cause the body to divide nutritional needs between maternal and fetal growth and adolescent girls often enter pregnancy with inadequate nutritional stores. These pregnancies, more common in low, middle-income countries and particularly Sub-Saharan Africa, are associated with higher rates of labor, delivery, and birth complications such as low birth weight, preterm birth, and neonatal and infant death. ,, The age of the mother also increases mortality rate. The maternal mortality ratio (MMR) for 15–19 year olds is 28% higher than those from 20 to 24 years of age. In Africa, the continent with the highest proportion of its population under 25 and a fertility rate twice as high as the global average (4.8 vs 2.4), ensuring adequate protein and nutrition is of the utmost concern for young mothers in the youngest continent.,

Later in life, protein needs re-ignite a growing concern. Sarcopenia, the loss of skeletal muscle due to aging, can cause healthy adults to lose 8% of muscle every decade beyond 40, and 15% every decade beyond 70. Reduced muscle mass in older adults can lead to reduced recovery from illness and are associated with insulin resistance and type II diabetes. As adults age they become at risk of “nutritional frailty,” which can compromise their ability to meet nutritional requirements at a time when specific nutrient needs may be high. Difficulty eating, loss of appetite, or lack of access and transport to food may impact an older adult’s ability to consume an adequate amount of nutrients. Although difficult to measure, aging populations may need to consume up to a third more or even twice the protein of average adults. Nutrient-rich foods can help, both young and old, achieve their nutritional needs more efficiently. The population aged 60 or over is growing faster than all younger age groups and is expected to double by 2050. 65% of global increase will occur in Asia and 14% in Africa. Although Africa currently has the youngest age distribution, the continent will experience a rapid aging of its population over the coming decades, with its population aged 60 or over expected to increase from 5% in 2017 to 9% in 2050. With the projected increase of life expectancy of global populations, including low- and middle-income countries, the demand for protein rich foods will continue to rise.

Of the twenty amino acids that make up proteins, nine are known as essential amino acids because the human body cannot synthesize them. In turn, they must be obtained from an individual’s diet. The relative proportions of the various essential amino acids in animal foods such as meat, fish, eggs and milk are very similar to those needed for humans and are identified as complete proteins. However, the protein content of plant-based foods varies and often contains lower amounts of one or more essential amino acids. A combination of plant proteins, known as complementary proteins, need to be consumed together to achieve a complete protein. For example, the combination of beans and rice would be a complete protein as the amino acid profile of each are complementary. The protein efficiency (or the ability to promote growth) of animal-based foods, including meat, fish, eggs and milk, is close to 100 percent. To achieve a similar efficiency rate with plant-based proteins, a combination of complementary proteins needs to be consumed.

Bridging the Gap

Agricultural production in the last half century has largely focused on cereal crops such as rice, wheat, and maize. The Green Revolution and subsequent periods have led to a three-fold increase in the production of cereal crops. Price reductions in these crops increased overall calorie intake; however dietary diversity suffered for many poor people, as traditional, nutritionally-diverse foods became relatively more expensive. Presently, countries in Asia and Sub-Saharan Africa rely on starchy staple crops as the main energy and protein source of their diet. For West and East Africa, starchy roots like cassava are a major source of calories yet provide very little protein (3% of total energy in cassava). Roots, tubers, and plantains account for at least 20% of all calories for sixteen countries in Sub-Saharan Africa. In Asia, and particularly South Asia, rice is the dominant staple crop, providing 62% of total energy in Bangladesh. And while this crop does have high protein digestibility, the overall protein content is low from 3–7%. Diversification of diet through the production of legumes such as groundnuts in Zambia or the combination of groundnuts and beans in Uganda has helped improve protein adequacy in local diets. Compared to countries in the developing world, countries in the West, including the USA and Europe, consume a more varied diet. In addition to the starchy crops, such as wheat and corn, the plant proportion of the Western diet includes more fruit and vegetables. More than 20% of total energy intake comes from nutrient-dense animal-based protein, of which beef consumption plays an important part.

The Future of Protein

Globally, the world consumes about 57% of its protein from plant-based foods (wheat, rice, and corn) and the remainder from animal-based foods — meat 18%, dairy 10%, fish 6%, and others. The next food movement will have to include more sources of protein produced in a sustainable manner. While plant sources account for a majority of the protein consumption for 76% of the global population, it is still expected that the need for meat production will increase by 200 MMT. Animal-based foods are excellent sources of protein but contribute 14.5% of all greenhouse gas emissions (Beef and milk production in particular account for 41% and 20%, respectively, of the sector’s total emissions). Innovative production in animal agriculture methods as well as production of alternative sources of protein can help attack the dual challenge of increasing supply in a sustainable manner.

Although it is clear that protein needs will increase, the discussion as to how it will change remains open. Low and middle-income countries are increasingly adopting a Western diet, yet full adoption and growth may be slow in certain countries and regions.

Future protein supply will be impacted by natural constraints as well as changing trends. A climate increase above 1.5oC or 2oC is expected to have significant impact on agricultural production, with regions like Sub-Saharan Africa feeling the effects most. Changing arable land, water supply, and rising CO2 will impact not only agricultural production, but nutrition as well. With the CO2 levels expected in 2050, wheat will produce 6% less protein, rice 3% less, and similar levels in maize are projected. With the expected climate changes, approximately 150 million more people will be at risk of protein deficiency by 2050.

Water resources will also play into the availability of protein rich crops. Rain-dependent agriculture will become riskier and could lead to increased hunger and undernutrition in areas that depend on rain to determine planting and harvesting seasons. Increasing demands on water supply from other sources such as urban populations coupled with strained supply will require systems that rely on irrigation to enhance precision and efficiency. Innovative crop breeding programs and production systems will help agriculture and livestock production to improve efficiency in their use of water and other natural resources.

Time for Action

As 2050 approaches, the global economies must be critically aware of the dynamics that are impacting global food production and consumption trends, creating a pressing need to transform our current food system. Ongoing population shifts are continuing to surface as key determinants of how future food production might be impacted. The population is growing, largely in Africa and Asia, and is moving to urban centers, providing more opportunities for access to food retail and foodservice establishments. Overall, rising affluence will lead to increased demand for high-quality protein as well as the development of an infrastructure that can support the demand. However, the urgency to address the chronic issues of protein-energy malnutrition is of critical importance today as the “hidden hunger” is limiting productivity and economic growth opportunities for developing countries. More importantly, the most vulnerable members of society — children and their mothers- are affected. Malnourished mothers and children suffering from the effects of malnutrition (stunting) are specifically in need of changes to the food system to ensure appropriate and nutritious food options are available during their critical life phases.

Agricultural systems can be the pathway to reversing the problems of malnutrition. Current estimates show agriculture contributes to the livelihood of 40% of the world’s population with 90% of farmers owning <5 acres. Agriculture is multifunctional because it produces or contributes to food, medicines, nonfood items, ecological services, livelihoods, social stability, culture, and tradition.

Of the approximately 30,000 edible plants identified, only 7,000 have been used for human food consumption., Three crops (wheat, rice, and maize) provide more than half of the global plant-derived energy intake and 30 crops provide 95% of caloric energy and/or protein. Agricultural research is beginning to focus on traditional root, tubers, and banana crops to improve the production systems of these staple crops with a focus on nutrition. However, it will be important to look at new crop breeding programs and production through the lens of environmental and health sustainability while ensuring availability of high-quality protein to meet the needs of all, especially the most vulnerable populations.

Nutrition-focused agricultural systems working in tandem with NGOs, governments, research institutions, and the private sector can provide the sustainable strategies that are required to address the current hunger and malnutrition issues and ultimately improve the quality of life for the world’s seven billion-plus inhabitants.

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