CENF 2017

Impressions from the Central Eurasian Nutrition Forum

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Sight and Life was a major sponsor of the first Central Eurasian Nutrition Forum (CENF), which was held in Ulaanbaatar, Mongolia from June 7 to 9, 2017. The three-day forum was hosted by the Mongolian Ministry of Health and the Mongolian Ministry of Food, Agriculture & Light Industry, Standing Committee on Social Policy, Education, Culture and Science of Mongolia, and was excellently organized by the Mongolian Health Initiative (MHI). CENF 2017 builds on a workshop at the Radcliffe Institute for Advanced Study at Harvard University, which took place in October 2016 and was organized by Radcliffe Institute Fellow Dr. Ganmaa Davaasambuu.

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Dr. Undraa and Dr. Ganmaa at the Central Eurasian Nutrition Forum

Dr. Ganmaa (as she is known by her Mongolian fellow citizens) is a long-time collaborator with Sight and Life in assessing the micronutrient situation in Mongolia, and is the founder of the MHI, which has conducted a nationwide micronutrient survey among Mongolian adults. The forum was attended by about 200 representatives from the government (ministers and members of parliament), academia (domestic and international), the private sector, and technical partners such as GAIN, UNICEF, FFI, FAO, WHO and Sight and Life

MHI created a first-class dramaturgy, taking the forum to the relevant political decision-makers. The first day took place in the Ministry of Health, the second in the Ministry of Food, Agriculture & Light Industry, and the last day in the Mongolian Parliament. The organizers kept me very busy not only with a presentation entitled “Central Eurasia’s Position in the Global Nutrition Ecosystem”, but also as a panelist and moderator, and invited me to provide the closing remarks on day one, right after my midnight arrival in Ulaanbaatar.      

A Look at the Mongolian Diet

Mongolia has made major progress in terms of reducing stunting and low birth-weight over the last two decades. However, Mongolians still face significant deficiencies in micronutrients, particularly vitamins A, D, C, B1, B2, B6, and folate, as well as rising rates of overweight and obesity, and related non-communicable diseases.

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Mongolia is a typical example of the so-called double burden of malnutrition, viz. concurrent under- and over nutrition. The diet is dominated by flour, meat, and dairy products, with very poor fruit and vegetable consumption, and is high in salt, sugar, and saturated and trans fats. According to FAO statistics, Mongolia is the country with the second-highest levels of meat consumption, the eleventh-highest levels of milk consumption, and the ninth-lowest levels of fruit and vegetable consumption and the third-lowest levels of seafood consumption per capita. The poor dietary diversity (see Graph 1) explains much of the malnutrition situation in the country. Moreover, the latitude (Ulaanbaatar is 47°6′ N) only allows for vitamin D production in the skin during the few summer months and, due to the high altitude (a large part of the country is over 1,000 m above sea-level), the cold requires warm clothes covering the skin.

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Graph 1: Sources of Calories among Urban Male Adults

Still, the high prevalence of vitamin D and A deficiency came as a surprise to me, because of the high levels of consumption of dairy, which is usually a good source for these vitamins. This may be due to the production system: The majority of Mongolian milk is produced by pastoralists dependent on arid grassland (the Mongolian Steppe and the Gobi Desert) yielding dry pasture with a low provitamin A carotenoid content, and the livestock suffers from the same limited vitamin D synthesis as do humans. (When I sent a picture of what I called the Mongolian grassland to the Sight and Life team, the immediate question was, “Where is the grass?”) Milk production ceases in the winter due to the limited availability of feed, and milk consumption becomes even more dependent on imports, which are primarily supplied to the urban area.

A view of the Mongolian grassland. Where is the grass?

Stunting prevalence is moderate, at 10.8%, but is a public health concern, with 20% in Western Mongolia reflecting significant inequalities in the country. Another matter of concern is the declining breastfeeding rate. This was at 57% in 2005, and at only 47% in 2013, which is below the World Health Assembly (WHA) target of 50%.

Progress in Mongolia

But there is very good news! Since the workshop at Harvard last October, there has been significant progress. Today, the Mongolian Parliament has a fortification working committee, and a draft fortification law, which is considering wheat flour, milk, and vegetable oil for fortification. However, I would hope that fortification becomes mandatory, and that there is scope for other staples to be considered.

Next steps include the passing of the fortification bill in Fall by parliament, the establishment of comprehensive fortification standards, and investment in laboratory capacity to ensure that foods are adequately fortified.

Impressions from CENF 2017

I believe that the CENF provides an excellent platform for developing the nutritional agenda, not only in Mongolia, but also across Central Eurasia, recognizing that food fortification is a cost-effective strategy for tackling the ailments from micronutrient deficiencies throughout the region.

My personal takeaway from the CENF is that it requires vision, passion, scientific evidence, and inspirational leadership to make a difference, and that Mongolia has two great female leaders in Dr. Ganmaa and Dr. Undraa, Member of the Hural (Parliament) of Mongolia, both of whom champion the mitigation of micronutrient malnutrition in their home country. The 2018 forum will be organized in Tajijikstan and will continue the discussions regarding the nutritional priorities for the Central Eurasian region.

Download the declaration for further details here.

Take a look at a few moments from CENF 2017 captured by Mr. Gerelbadrakh.

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