Periodic Reporting for period 1 - Zero_HiddenHunger_EU (Tackling micronutrient malnutrition and hidden hunger to improve health in the EU)
Periodo di rendicontazione: 2024-01-01 al 2025-06-30
Micronutrient deficiencies are a form of malnutrition resulting from low intake, low absorption or impaired metabolism of minerals and vitamins. Minerals play central roles in the development and maintenance of healthy brain and neural function, a robust immune system and a strong skeleton. Vitamins are central to development and maintenance of healthy vision, skin integrity and immune function, as well as muscle, bone and connective tissues, energy metabolism and neural development. Classical symptoms of deficiencies of vitamins and minerals are not common among most European populations, and consequently, subclinical deficiencies go unobserved, until the systems they support start to exhibit signs of disease, or in children, of impaired development. As underlying micronutrient deficiencies can exist unaccompanied by obvious clinical signs, they are termed ‘Hidden Hunger’. The silent impacts of Hidden Hunger have a detrimental effect throughout a person’s life - on pregnancy outcomes, growth and development, educational achievement, career opportunities and by accelerating the aging process. By impacting individual work capacity, Hidden Hunger hinders the development potential of societies and countries.
While everyone is at risk of Hidden Hunger, individuals at critical junctures of development, such as children and pregnant women, face higher risk as their micronutrient requirements are relatively high compared with their energy intakes. Those with impaired micronutrient absorption or utilisation, and people who are disadvantaged due to social and economic reasons, or facing unstable food and nutrition security, are at risk.
While some countries have micronutrient-related datasets that inform national policies, Europe lacks an estimate of Hidden Hunger prevalence across the region.
As such, there is no basis to estimate costs, to individuals or society, or to develop effective public health programmes for its prevention and management.
Data requirements to start working towards eradication of Hidden Hunger in Europe are:
1) prevalence of mineral and vitamin deficiencies
2) causes and risk predictors of micronutrient deficiencies and
3) health burdens and costs of hidden hunger
Provision of these data is the first step to developing proposals for micronutrient deficiency prevention that can compel a call to action. As proposals must be context-specific, sustainable, healthy and cost-effective, the Zero_HiddenHunger_EU project will provide data on the prevalence of micronutrient deficiencies, their causes and costs, and start developing evidence-based food-first proposals for prevention.
Nutrients of public health concern prioritised in the project are iron, zinc, iodine, calcium, magnesium, potassium, selenium, vitamins A, D, folate, B12, and riboflavin.
The core objective of the first 30 months of Zero_HiddenHunger_EU is to address the question: What is the true prevalence of Hidden Hunger, what causes it and how much does it cost?
While everyone is at risk of Hidden Hunger, individuals at critical junctures of development, such as children and pregnant women, face higher risk as their micronutrient requirements are relatively high compared with their energy intakes. Those with impaired micronutrient absorption or utilisation, and people who are disadvantaged due to social and economic reasons, or facing unstable food and nutrition security, are at risk.
While some countries have micronutrient-related datasets that inform national policies, Europe lacks an estimate of Hidden Hunger prevalence across the region.
As such, there is no basis to estimate costs, to individuals or society, or to develop effective public health programmes for its prevention and management.
Data requirements to start working towards eradication of Hidden Hunger in Europe are:
1) prevalence of mineral and vitamin deficiencies
2) causes and risk predictors of micronutrient deficiencies and
3) health burdens and costs of hidden hunger
Provision of these data is the first step to developing proposals for micronutrient deficiency prevention that can compel a call to action. As proposals must be context-specific, sustainable, healthy and cost-effective, the Zero_HiddenHunger_EU project will provide data on the prevalence of micronutrient deficiencies, their causes and costs, and start developing evidence-based food-first proposals for prevention.
Nutrients of public health concern prioritised in the project are iron, zinc, iodine, calcium, magnesium, potassium, selenium, vitamins A, D, folate, B12, and riboflavin.
The core objective of the first 30 months of Zero_HiddenHunger_EU is to address the question: What is the true prevalence of Hidden Hunger, what causes it and how much does it cost?
The project pathway to impact is using existing quality data and bio-bank resources collected as part of European surveys and epidemiological life-course and health cohorts to deliver estimates of micronutrient intakes and status.
During the first 18-months, the work has focussed on securing access to data on intakes and status, as well as bio-samples for analysis from existing resources. Populations under-represented in existing cohorts have been identified and additional strategies, including a new dietary study among migrant groups in Greece and Spain, as well as literature-based approaches, are supplementing data acquisition and analysis. Estimates are being generated for the health costs of micronutrient deficiencies with defined and quantified health impacts. Innovative project elements, including novel data modelling approaches, biomarker and algorithm development will be reported in subsequent phases.
Beyond developing protocols for sharing and using these data and samples, we have developed and tested protocols for their analysis. Steering Groups for legal and ethical acquisition, sharing and analysis of micronutrient intake and status data were established. Activities included review of ethical documentation for all studies providing personal data or samples for secondary analysis; development and execution of bespoke data transfer or data usage agreements in compliance with Regulation 2016/679 (GDPR) and development of SOPs for data handling and transfer. Material transfer agreements and procedures for sample transfer and analysis were completed.
Database structures were developed for intake and biomarker status data, and procedures for data preparation and analysis developed and tested. A framework for analysis of usual micronutrient intakes as well as reference values to be applied was written for the 48 dietary intake datasets incorporated. A new study among migrant groups in Greece and Spain was developed and is ongoing. Biomarker data, including newly analysed and pre-existing data, are being collated into a harmonised super-database of individual participant data (IPD), currently incorporating 8 datasets, with 5 in progress. Analytical procedures and reference thresholds have been agreed for new analysis of markers in 3 additional datasets.
Disease-Adjusted Life Years (DALYs) and attributable DALYs for health conditions associated with the prioritised micronutrients for 31 European countries have been identified to underpin a cost-of-illness analysis to provide policymakers estimate of the total economic burden of Hidden Hunger-linked health conditions in Europe.
These activities have developed the groundwork to deliver project objectives and will yield estimates of the prevalence of Hidden Hunger across the continent by European population subgroups at increased risk. Risk factors, including demographic, dietary and the main nutritional drivers, will also be mapped for the region.
During the first 18-months, the work has focussed on securing access to data on intakes and status, as well as bio-samples for analysis from existing resources. Populations under-represented in existing cohorts have been identified and additional strategies, including a new dietary study among migrant groups in Greece and Spain, as well as literature-based approaches, are supplementing data acquisition and analysis. Estimates are being generated for the health costs of micronutrient deficiencies with defined and quantified health impacts. Innovative project elements, including novel data modelling approaches, biomarker and algorithm development will be reported in subsequent phases.
Beyond developing protocols for sharing and using these data and samples, we have developed and tested protocols for their analysis. Steering Groups for legal and ethical acquisition, sharing and analysis of micronutrient intake and status data were established. Activities included review of ethical documentation for all studies providing personal data or samples for secondary analysis; development and execution of bespoke data transfer or data usage agreements in compliance with Regulation 2016/679 (GDPR) and development of SOPs for data handling and transfer. Material transfer agreements and procedures for sample transfer and analysis were completed.
Database structures were developed for intake and biomarker status data, and procedures for data preparation and analysis developed and tested. A framework for analysis of usual micronutrient intakes as well as reference values to be applied was written for the 48 dietary intake datasets incorporated. A new study among migrant groups in Greece and Spain was developed and is ongoing. Biomarker data, including newly analysed and pre-existing data, are being collated into a harmonised super-database of individual participant data (IPD), currently incorporating 8 datasets, with 5 in progress. Analytical procedures and reference thresholds have been agreed for new analysis of markers in 3 additional datasets.
Disease-Adjusted Life Years (DALYs) and attributable DALYs for health conditions associated with the prioritised micronutrients for 31 European countries have been identified to underpin a cost-of-illness analysis to provide policymakers estimate of the total economic burden of Hidden Hunger-linked health conditions in Europe.
These activities have developed the groundwork to deliver project objectives and will yield estimates of the prevalence of Hidden Hunger across the continent by European population subgroups at increased risk. Risk factors, including demographic, dietary and the main nutritional drivers, will also be mapped for the region.
Reporting Period 1 (RP1; covering the first 18 months of the project) has laid the groundwork for results to be realised in RP2 and 3. Activities described will enable delivery of the objectives of the first 30 months of the project as planned, i.e. to yield estimates of the prevalence of Hidden Hunger across the continent and by European population subgroups at increased risk. Risk factors, including demographic, dietary and nutritional drivers, will be mapped.