Malnutrition remains a formidable challenge in most societies, with less than a tenth of countries in the world not experiencing at least one major malnutrition problem.

In relatively more food secure countries, where almost everyone has enough to eat, and few live in fear of a sudden loss of access to food, micronutrient deficiencies and diet-related non-communicable diseases (NCDs) often still loom large.

Jomo Kwame Sundaram

Malaysia has long been a melting pot of different cultures, resulting in various traditional foods and food customs coming together and changing with new technological, demographic, environmental, market and other behavioural influences.

Like most other societies, Malaysia has not been exempt from global trends, with greater food consumption away from home, and the growing popularity of ‘convenience foods’, deep-frying as well as sugared food and beverages.

Diets must improve
Undernutrition, or nutrient deficiencies, remains high, even though hunger, or dietary energy undernourishment, has greatly declined. However, stunting among children under 5 increased from 17.2% in 2006 to 20.7% in 2016, as the share of underweight children rose from 12.9% to 13.7%.

Public health efforts should ensure adequate micronutrient absorption in daily food consumption as deficiencies causing serious problems are largely ignored. For instance, median Malaysian calcium intake was less than half the recommended level in 2014.

Meanwhile, 4.9 million Malaysians were anaemic, around half women of reproductive age. Temporary supplementation for pregnant women is desperately needed, but anaemia in the general population deserves far more attention.

Wan Manan Muda

In less than two decades, the prevalence of diabetes increased from 6.9% in 1996 to 17.5% in 2015. NCDs reduce productivity and quality of life, and unnecessarily raise health costs, both private and public, with 10–19% of national healthcare spending in 2018 obesity-related.

While dietary energy consumption, mainly of carbohydrates, initially rises with income, further increases in food spending tend to increase dietary diversity.

But without nutrition awareness, changing food behaviours are typically influenced by new cultural norms, e.g., convenience considerations, peer influence, advertising and fads.

Overweight and obesity are also subject to genetics, behaviour, food consumption, physical activity, illness and globalization, e.g., more ‘food processing’ and ‘convenience foods’. Tackling these factors will improve health and use of scarce healthcare resources.

Improving policies
Like others, Malaysia’s nutrition programmes and policies have evolved. Post-independence nutrition programmes initially focused on improving living conditions among rural populations who constituted over two-thirds of its population in the late 1960s.

These efforts have included school feeding programmes, especially for poor children. But such programmes have been undermined by poor intersectoral, multi-stakeholder coordination, inadequate financing, limited human resource capacities and capabilities as well as poor monitoring and evaluation.

A well-organized, government-financed universal school lunch programme can not only improve nutrition for children, but also farmer incomes and food safety. These have successfully inculcated good habits in children, such as better nutrition, health awareness, physical development, learning, academic performance and cooperation.

Tan Zhai Gen

Better food for all
Marketing of ‘junk’ and other unhealthy foods causing malnutrition needs to be restricted, especially to children, e.g., with stricter regulation of food and beverages sold in school canteens.

Food safety will also need to be improved, e.g., by reducing the overuse of antibiotics for animal, including fish breeding, and of pesticides, most of which also harm humans.

The recent California court decision deeming a popular herbicide carcinogenic raises questions about ‘no-till’ agriculture promotion, ostensibly to increase carbon sequestration in farm top soil, to mitigate greenhouse gas contributions to global warming from agriculture.

‘All-of-government’ nutrition strategies are needed to effectively and comprehensively tackle national malnutrition challenges. Sustainable food systems are needed to promote healthy diets, while public nutrition education is badly needed for both children and adults.

Like other middle-income countries, Malaysia has considerably improved food availability, affordability and stability. What remains is to improve nutrition, health and wellbeing, especially by tackling micronutrient deficiencies and diet-related NCDs.

Addressing Malnutrition in Malaysia by the three authors, all associated with the Khazanah Research Institute, is available at: www.krinstitute.org

While US agribusiness has long claimed that GMOs will “save the world”, there has been little compelling evidence to this effect after two decades. Credit: IPS

By Jomo Kwame Sundaram and Tan Zhai Gen
KUALA LUMPUR , May 16 2017 (IPS)

Advocates of genetically engineered (GE) crops have long claimed that genetic engineering is necessary to raise crop yields and reduce human exposure to agrochemicals. Genetic engineering promised two major improvements: improving yields affordably to feed the world, and making crops resistant to pests to reduce the use of commercial chemical herbicides and insecticides.

Genetic modification of crops through natural evolution or artificial crossbreeding has been happening for millennia, giving rise to more productive or resilient crop species. Thus, the term ‘genetic engineering’ more accurately refers to the artificial introduction of genetic material to produce new GE varieties.

Trans-Atlantic divide
A report by the United States National Academy of Sciences, Engineering and Medicine – picked up by the New York Times – found that US GE crop yield gains have slowed over the years, leaving no significant advantage in yield gains compared to non-GE plant varieties. Over two decades ago, Western Europe largely rejected GE crops while North America – the United States and then Canada – embraced them. More than twenty years later, US crop yield gains are not significantly higher than in Western Europe.

Since the adoption of GE crops, US use of herbicides has increased. In the US, decreasing use of some herbicides has involved large increases in the use of glyphosate, a key ingredient in herbicides used for GE crop cultivation. This is in contrast to France, which bans GE crop cultivation, where overall use of herbicides has been reduced due to EU efforts.

Glyphosate-resistant GE crops survive herbicide spraying while killing non-resistant weeds. However, rising weed resistance to glyphosate has led to the application of larger doses. For example, although land planted with GE soybeans has grown by less than a third over the last two decades, herbicide use has doubled. Herbicide use for maize production was declining before the introduction of GE crops, but has increased since 2002.

Glyphosate was assessed as carcinogenic by the International Agency for Research on Cancer (IARC) under the World Health Organization. Some glyphosate-based herbicides also contain other more toxic herbicides – such as 2,4-D, a key ingredient in Agent Orange, the infamous Vietnam War defoliant – to increase their efficacy against resistant weeds.

Diversity declining
GE crops, typically with traits which tend to result in monoculture, have been promoted as more productive than non-GE crops. As farmers adopt GE crop varieties, others varieties are abandoned, and access to such seeds are increasingly in the hands of giant transnational seed companies rather than government facilities.

But when farmers lose confidence in GE crops or wish to turn to non-GE varieties for other reasons, they are no longer able to simply revert to their old non-GE varieties or to crossbreed them. Instead, they now need to buy seeds from these very same monopolistic transnational seed companies.

Similarly, the impact on ecological diversity, important for maintaining fragile ecosystems, cannot be underestimated. Biodiversity reduction fundamentally transforms ecosystems. Rich, diverse traditional farmer knowledge – of the use of plants and other natural resources to maintain soil and plant health, and to conserve water and other natural resources – is also being ignored in favour of ‘hi-tech’, genetically-engineered, agro-chemical and other ‘industrial’ solutions, which invariably engender new problems. For example, pesticides are intended to be toxic only to pests, but not to others, but most are carcinogenic or otherwise dangerous to human health.

While GE crops offer some benefits, unclear productivity advantages and rising pest resistance are reducing the edge it once claimed over conventionally developed crops. GE crops seem to be harmless, but there is still much uncertainty over their longer-term effects, including increased pesticide resistance and reduced diversity. The scientific ethic advising precaution in the face of uncertainty seems to have been abandoned in favour of profitable expediency, ostensibly to increase productivity and reduce agro-chemical reliance, neither of which have been achieved.

Corporate power growing
As many of the same corporations or conglomerates sell both GE seeds as well as the agro-chemicals needed to increase yields, the potential for other types of innovation is inevitably diminished. Recent mergers and acquisitions have further consolidated oligopolies selling both seeds and agrochemicals, exemplified by the acquisition bid for Monsanto by Bayer. Not surprisingly then, companies have less incentive to develop new traits, or to invest heavily in tackling other problems when greater pest resistance increases sales of their pesticides and overall profits.

All this is often justified in terms of the urgent need to feed the hundreds of millions of hungry people in the world. However, although there already is enough food being produced to feed everyone in the world, the real problem is one of access, as most of the hungry do not have the means to buy or produce the food they need.

Therefore, while US agribusiness has long claimed that GMOs will “save the world”, there has been little compelling evidence to this effect after two decades. Proponents select evidence to support their exaggerated claims that GE varieties meet many needs in different parts of the world, although their actual track records are much more modest and chequered.

Much of the resistance against GE crops is due to the interests and methods of the agribusiness transnationals dominating food production, both directly and indirectly through their control and promotion of seeds, agrochemicals, etc.

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Antibiotics are used to ensure better health and survival of animals bred for food, but they are also believed by many farmers to promote growth. Credit: IPS

By Jomo Kwame Sundaram and Tan Zhai Gen
KUALA LUMPUR, Malaysia, Apr 4 2017 (IPS)

The greatly excessive use of antibiotics in food production in recent decades has made many bacteria more resistant to antibiotics. The United States Department of Agriculture (USDA) has estimated that antibiotic use in animal husbandry, poultry farming and aquaculture in the US is over four times USDA recommended levels. Meanwhile, the US Food and Drugs Administration (FDA) has estimated that 80 percent of all antibiotics sold in the USA are used on animals.

Cheap antibiotics prone to abuse
Antibiotics are used to ensure better health and survival of animals bred for food, but they are also believed by many farmers to promote growth. As prices of antibiotics remain attractively low, they offer the prospect of higher earnings from greater output at low cost. Hence, there is little or no market incentive to reduce excessive, if not indiscriminate use, and hence abuse of antibiotics. Thus, such efforts to increase farmer incomes and profitability exacerbate the likelihood and risk of antibiotic resistance.

The widespread use of antibiotics through food chains is thus becoming catastrophic. A review by the FAO explains how antibiotic-resistant bacteria in animals are infecting humans, through direct contact with animals or indirect transmission through the food we eat. Earlier, the spread of bacteria was popularly associated with international travel, but the threat posed by antibiotic-resistant bacteria in our food is now proving to be far more formidable.

‘Recycling’ antibiotics
Ecologically minded activists have long been promoting agricultural recycling, often citing traditional agricultural practices. But adding antibiotics to animal feed has made this a threat to public health. The feed typically contains many drugs, including some only used by humans as antibiotics of last resort.

Much of the antibiotics given to livestock and poultry passes un-degraded through their urine and faeces, directly affecting food from aquaculture. Thus, waste from pigpens flowing into fishponds exposes fish and shrimps to the high doses of antibiotics that livestock get, on top of the antibiotics added to the pond water to prevent or address aquatic diseases. Antibiotic resistant bacteria from this environment then passes to humans who consume such food.

While restrictions have already been widely placed on the use of hormones and steroids to promote growth, the excessive use of antibiotics by farmers has only gained attention in recent years, while a huge reservoir of resistant bacteria was emerging and spreading.

In November 2015, scientists discovered a gene in China that can enable many types of bacteria to become more antibiotic resistant. The gene has since been found in patients, food and animals from more than twenty countries. More worryingly, these bacteria can resist the last line of effective antibiotics available.

Catastrophic threat
A British government report estimates that about 700,000 people worldwide currently die annually due to antibiotic-resistant infections. If current trends continue, this mortality rate will rise to ten million yearly by mid-century, i.e., in just over three decades.

In the near future, antibiotics will become less effective in treating infections as bacteria mutate to become more resistant. Many more people will die of currently antibiotics-curable diseases. New antibiotics may delay this trend, but no new class of antibiotics has been discovered since the 1980s.

In line with the WHO’s global action plan, member nations have pledged to draw up national action plans against antibiotics resistance, as part of a broader effort to tackle antimicrobial resistance (AMR). The lack of effective national surveillance and supervision of antibiotics use in animal products masks the severity of the threat.

Sadly, in most developing countries, the rising threat posed by the exponential growth of dangers due to excessive antibiotic use is mainly of concern to the authorities when it threatens export prospects. As with improper and excessive pesticide use, the abuse of antibiotics is mainly of concern when it affects national reputations abroad and related export earnings, with scant attention given to the threats posed to domestic consumers.

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Health problems stemming from carbohydrates, especially sugar over-consumption are correlated to growing overweight, obesity and non-communicable diseases, such as diabetes, throughout the world. Credit: IPS

By Jomo Kwame Sundaram and Tan Zhai Gen
KUALA LUMPUR, Malaysia, Mar 22 2017 (IPS)

In 2015, Coca Cola’s chief scientist was forced to resign after revelations that the company had funded researchers to present academic papers recommending exercise to address obesity and ill health, while marginalizing the role of dietary consumption. Coca-Cola, the world’s largest producer of sugary beverages, had provided millions of dollars to fund researchers to downplay the links between sugar and obesity, tooth decay and non-communicable diseases (NCDs).

Corrupt research
This was not new. In September 2016, a New York Times article highlighted a JAMA Internal Medicine research article showing that sugar industry interests had paid scientists in the 1960s to do likewise for sugar.

The Sugar Research Foundation, now known as the Sugar Association, paid three Harvard scientists to publish a 1967 review of research chosen by the Foundation on sugar, fat and heart disease in the prestigious New England Journal of Medicine (NEJM). A total of $6500 ($48 900 in 2016 dollars) was paid to the Nutrition Department head and two colleagues including one who went on to draft the first ever US dietary guidelines.

The review article downplayed the link between sugar and heart disease while implicating saturated fats instead. Until recently, subsequent US dietary guidelines reflected these studies’ findings and policy conclusions. As other countries followed, millions have shifted to more low fat, but ‘high-energy (sugar)’ food.

The practice continues. In June 2016, the Associated Press reported that confectionary producers had similarly funded studies claiming that children who eat what Americans call ‘candy’ tend to weigh less than those who do not.

A December 2016 review article in the highly respected Annals of Internal Medicine by researchers linked to the sugar industry claimed that the studies justifying recent reduced sugar intake guidelines are of poor quality. While the World Health Organization (WHO) and governments around the world have begun to promote and implement guidelines on sugar intake, the article claimed there is little scientific basis to expect improved health from lowering sugar intake.

Mars Inc., one of the world’s leading confectioners, has broken ranks with its rivals to denounce the industry funded paper. Top researchers in the field have denounced the article for ignoring the numerous rigorous and high-quality studies finding otherwise, but doubt has been sown to good effect that perhaps sugar is not that bad after all as there is no ‘scientific consensus’ on the issue. Similar arguments have been invoked to try to discredit the near consensus on the human caused acceleration of global warming.

Sugar causes obesity
Sugar, corn syrup and most sweeteners are minor sources of an essential category of nutrients or dietary energy called carbohydrates, measured in terms of calories or joules. Most of our carbohydrate intake comes from food staples such as rice, potatoes and wheat. Sugars are simpler carbohydrates, absorbed by the body at faster and higher rates.

When we consume too much carbohydrate-rich food, the excess carbohydrates not used by the body, e.g., for physical activity, is converted and transported by the blood vessels as glucose (known as blood sugar), and then transformed into fats. Hence, too much carbohydrate – including sugar – in our diets can lead to obesity and diabetes.

The best way to avoid obesity is by limiting calorie intake, i.e., the amount of food we eat, and increasing energy expenditure through physical activity. The publicity given to such research sponsored by the food and beverages industry to absolve sugar is part of a larger public relations effort to mislead the public around the world.

Diets are important in determining the quality of life, especially health. Good health reduces health costs and also raises productivity. Balanced food intake in moderation, dietary diversity and physical activity all contribute to health and wellness.

Developing country menace
Health problems stemming from carbohydrates, especially sugar over-consumption are correlated to growing overweight, obesity and non-communicable diseases, such as diabetes, throughout the world. In the second half of the twentieth century, these were popularly associated with affluence and the US.

Since the turn of the century, the problem has spread to many other ‘middle income countries’, initially especially in Mexico and Central America. These changes are increasingly associated with lifestyle, behavioural and cultural changes associated with urbanization, mechanization and changes in the nature of work.

In Asia, Malaysia has the highest share of overweight and obese people. In 2014, 43.8% of men and 48.6% of women over 20 years of age were overweight, of whom many were obese. Diabetes rates among adults have also increased from 11.6% in 2006 to 15.2% in 2011 and 17.9% in 2015. Recent removal of the sugar subsidy seems to have had little impact on sugar consumption, underscoring the need for non-market interventions.

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