Global nutrition report 2017

1
GLOBAL
NUTRITION
REPORT
2017
Nourishing the SDGs

2 GLOBAL NUTRITION REPORT 2017
Endorsements
Akinwumi Adesina, President, African Development Bank
Africa’s economic progress is being undermined by hunger, malnutrition and stunting, which cost at least US$25 billion
annually in sub-Saharan Africa, and leave a lasting legacy of loss, pain and ruined potential. Stunted children today
lead to stunted economies tomorrow. The Global Nutrition Report helps us all to maintain focus on and deal with
this wholly preventable African tragedy.
Tedros Adhanom, Director-General, World Health Organization
The Sustainable Development Goals include incredible challenges to the world, including an end to hunger and
improving nutrition for all people by the year 2030. As the Global Nutrition Report 2017 demonstrates, universal
healthy nutrition is inextricably linked to all of the SDGs, and serves as a foundation for Universal Health Coverage,
WHO’s top priority. The United Nations Decade of Action on Nutrition presents a unique opportunity to commit to
end all forms of malnutrition now!
David Beasley, Executive Director, World Food Programme
The Global Nutrition Report confirms why we need to act, because we all stand to benefit from a world without
malnutrition. The devastating humanitarian crises in 2017 threaten to reverse years of hard-won nutrition gains, and
ending these crises – and the man-made conflicts driving many of them – is the first step to ending malnutrition.
Nutrition is an essential ingredient of the Sustainable Development Goals, key to a world with zero hunger.
This report makes clear we must all take action – now – to end malnutrition.
José Graziano da Silva, Director-General, Food and Agriculture Organization
The transformational vision of the 2030 Agenda requires renewed effort and innovative ways of working. Ending
malnutrition in all its forms is necessary for achieving the 2030 Agenda, as the Global Nutrition Report 2017 lays out.
The Second International Conference on Nutrition recommendations provide the framework within which to act.
At the same time, the Decade of Action on Nutrition 2016–2025 provides the platform to move from commitment to
action and impact. FAO is committed to supporting countries to transform their food systems for better nutrition.
We can be the generation to end hunger and malnutrition.
Anthony Lake, Executive Director, UNICEF
Ending malnutrition is one of the greatest investments we can make in the future of children and nations.
As the Global Nutrition Report 2017 makes clear, good data is key to reaching every child – revealing who we
are missing and how we can improve the coverage and quality of essential nutrition interventions for children,
adolescents and women. Investing in robust data can help accelerate our progress towards our global nutrition
goals – and all the SDG targets.
Sania Nishtar, Founder and President, Heartfile Pakistan
The Global Nutrition Report 2017 argues on behalf of more than half of the world’s population. With more than
a third of people living on this planet overweight and obese, over a staggering billion and a half suffering from
anaemia and other micronutrient deficiencies, and around 200 million children stunted or wasted, this report is a
strong call to action. For sustainable impact, it will be essential for us to take a more holistic view and strive for
better nutrition across the entire life course. Political will, partnerships, building on existing policies and developing
evidence to inform action are the building blocks. To do this, we must break down siloed ways of working and
embrace a multisectoral and multi-stakeholder approach.

NOURISHING THE SDGS 3
Paul Polman, Chief Executive Officer, Unilever
This year’s Global Nutrition Report focuses on the interdependence of the SDGs, and how progress against one goal
generates progress for all. Nowhere are these linkages more evident than in the food agenda. As the producers,
manufacturers and retailers of most of the world’s food, business has a responsibility to help drive the food system
transformation. As a progressive food company, we are committed to helping redesign our global food and
agriculture system, to give everyone access to healthy and nutritious food and diets and thereby create a brighter
future for all.
Gunhild Stordalen, Founder and President, EAT Foundation
The Global Nutrition Report provides a compelling argument for why tackling the challenge of malnutrition in all its
forms will be essential to achieving the Sustainable Development Goals. We need to adopt an integrated, cross-
sectoral approach, breaking out of the nutrition silo to address the food system challenges holistically. Feeding the
growing world population a healthy and sustainable diet is one of our greatest challenges, but as the report shows,
the opportunities have never been greater and we can all make a difference.
Gerda Verburg, Coordinator, SUN Movement
Good nutrition is the engine for achieving the Sustainable Development Goals. It is high time for the world to
confront the stark reality that hundreds of millions of women, men and their families are still going hungry.
There is no country without a nutrition challenge today. Many countries still face stunting, whereby both physical and
brain capacity are irreversibly damaged, while other countries see obesity and non-communicable diseases running
rampant. Also, a growing number of countries are facing both challenges – undernutrition during early childhood,
and then obesity and non-communicable diseases during the reproductive age. The Global Nutrition Report
gives us the evidence to act on this injustice. It aids all of us in connecting the dots between the multiple forms of
malnutrition and supports SUN Movement member countries in their efforts to make sustainable improvements in
people’s lives.

This report was produced by an Independent Expert
Group empowered by the Global Nutrition Report
Stakeholder Group. The writing was a collective effort
by the group members, led by the co-chairs and
supplemented by additional analysts and contributors.
Corinna Hawkes (co-chair) City, University of London,
UK; Jessica Fanzo (co-chair) Johns Hopkins University,
Baltimore, US; Emorn Udomkesmalee (co-chair),
Mahidol University, Bangkok, Thailand; Endang Achadi,
University of Indonesia, Jakarta, Indonesia; Arti Ahuja,
State Government, Odisha, India; Zulfiqar Bhutta,
Center for Global Child Health, Toronto, Canada and
the Center of Excellence in Women and Child Health,
Aga Khan University, Karachi, Pakistan; Luz Maria
De-Regil, Nutrition International, Ottawa, Canada;
Patrizia Fracassi, Scaling Up Nutrition Secretariat,
Geneva, Switzerland; Laurence M Grummer-Strawn,
World Health Organization, Geneva, Switzerland; Chika
Hayashi, UNICEF, New York, US; Elizabeth Kimani-
Murage, African Population and Health Research
Center, Nairobi, Kenya; Yves Martin-Prével, Institut de
Recherche pour le Développement, Marseille, France;
Purnima Menon, International Food Policy Research
Institute, New Delhi, India; Stineke Oenema, UN System
Standing Committee on Nutrition, Rome, Italy; Judith
Randel, Development Initiatives, Bristol, UK; Jennifer
Requejo, Johns Hopkins University, Baltimore, US; Boyd
Swinburn, University of Auckland, New Zealand.
We also acknowledge the contributions from
Independent Expert Group member Rafael Flores-Ayala,
Centers for Disease Control and Prevention, Atlanta, US.
Additional analysis and writing support was provided
by Meghan Arakelian, Independent, US; Komal Bhatia,
University College London, UK; Josephine Lofthouse,
Independent, UK; Tara Shyam, Independent, Singapore;
Haley Swartz, Johns Hopkins University, Baltimore, US.
Specific sections of Chapter 4 were written by
Jordan Beecher, Development Initiatives, UK
(donor investments); and Patrizia Fracassi and
William Knechtel, Scaling Up Nutrition, Switzerland
(government investments).
Elaine Borghi, World Health Organization, Switzerland,
and Julia Krasevec, UNICEF, US, provided access
to updated data and technical expert advice for the
sections on the maternal and infant and young child
nutrition targets; Carlo Cafiero, Food and Agriculture
Organization, Italy, provided access to the Food
Insecurity Experience Scale/FIES data and Sara Viviani,
Food and Agriculture Organization, Italy, assisted in
interpreting it.
The following people provided written contributions or
data which were drawn upon in the final text:
Claire Chase, World Bank, US; Kaitlin Cordes, Columbia
Center on Sustainable Investment, US; Mariachiara Di
Cesare and Majid Ezzati, Imperial College London, UK;
Mario Herrero, Commonwealth Scientific and
Industrial Research Organisation, Australia; Andrew
Jones, University of Michigan, US; Purnima Menon,
International Food Policy Research Institute, US; Rachel
Nugent, RTI International, US; Andrew Thorne-Lyman,
Johns Hopkins University, US; Anna Taylor, Food
Foundation, UK; and Fiona Watson, Independent, UK.
Authors of the ‘Spotlight’ panels in this report, and
their affiliations, are as follows: Phil Baker, Deakin
University, Australia; Komal Bhatia, University College
London, UK; Tara Boelsen-Robinson, Deakin University,
Australia; Francesco Branca, World Health Organization,
Switzerland; Angelika De Bree, Unilever, the
Netherlands; Chad Chalker, Emory University, US; Helen
Connolly, American Institutes for Research, US; Kirstan
Corben, Deakin University, Australia; Alexis D’Agostino,
John Snow International, US; Mary D’Alimonte, Results
for Development, US; Alessandro Demaio, World
Health Organization, Switzerland; Augustin Flory,
Results for Development, US; Patrizia Fracassi, Scaling
Up Nutrition, Switzerland; Greg Hallen, International
Development Research Centre, Canada; Corinna
Hawkes, City, University of London, UK; Anna Herforth,
Independent, US; Dan Jones, WaterAid, UK; David Kim,
Independent, US; Kerrita McClaughlyn, Unilever, the
Netherlands; Anna Peeters, Deakin University, Australia;
Ellen Piwoz, the Bill & Melinda Gates Foundation, US;
Neena Prasad, Bloomberg Philanthropies, US; Judith
Randel, Development Initiatives, UK; Rahul Rawat,
the Bill & Melinda Gates Foundation, US; Tara Shyam,
Independent, Singapore; Jonathan Tench, Global
Alliance for Improved Nutrition, London, UK; Megan
Wilson-Jones, WaterAid, UK.

Acknowledgements
The Independent Expert Group, under the leadership of co-chairs Corinna Hawkes, Jessica Fanzo and Emorn
Udomkesmalee, would like to sincerely thank all the people and organisations that supported the development of
the Global Nutrition Report 2017.
The core Global Nutrition Report team of Komal Bhatia, Data Analyst; Josephine Lofthouse, Communications Lead;
Tara Shyam, Coordinating Manager; and Emorn Udomkesmalee, Co-Chair, as well as Meghan Arakelian, Nutrition for
Growth Analyst, Haley Swartz, Researcher, worked closely with Corinna Hawkes and Jessica Fanzo, and in support
of the wider Independent Expert Group, to bring this year's report to life. Additional communications advice on the
report’s messaging and design was provided by Gillian Gallanagh, Laetitia Laporte, Jason Noraika, Helen Palmer and
Brian Tjugum, Weber Shandwick.
We are grateful to the team at Development Initiatives Poverty Research (DI) for providing interim hosting
arrangements for the Report Secretariat and for report design and production: Harpinder Collacott, David Hall-
Matthews (consultant), Rebecca Hills, Alex Miller, Fiona Sinclair, Hannah Sweeney, other DI staff.
Numerous people answered questions we had, including: Laura Caulfield, Johns Hopkins Bloomberg School; Kaitlin
Cordes, Columbia Center on Sustainable Investment; Katie Dain and Alena Matzke, NCD Alliance; Ebba Dohlman,
Organisation for Economic Co-operation and Development; Nora Hobbs, World Food Programme; Diane Holland,
Roland Kupka and Louise Mwirigi, UNICEF; Homi Kharas and John McArthur, Brookings Institution; Carol Levin,
University of Washington; Barry Popkin, University of North Carolina; Abigail Ramage, Independent; Jeffrey Sachs,
Columbia University; Guido Schmidt-Traub, Sustainable Development Solutions Network; Dominic Schofield, Global
Alliance for Improved Nutrition; and Andrew Thorne-Lyman, Johns Hopkins University.
For their helpful and insightful comments on earlier drafts of the report, we thank the following people: Jannie
Armstrong, Yarlini Balarajan, Francesco Branca, Aurélie du Châtelet, Katie Dain, Ariane Desmarais-Michaud, Juliane
Friedrich, Lawrence Haddad, Heike Henn, Kate Houston, Anna Lartey, Florence Lasbennes, Kedar Mankad, Alena
Matzke, Peggy Pascal, Abigail Perry, Ellen Piwoz, Danielle Porfido, Joyce Seto, Meera Shekar, Edwyn Shiell, Lucy
Sullivan, Rachel Toku-Appiah, Gerda Verburg, Neil Watkins, Fiona Watson and Sabrina Ziesemer. We are also grateful
to Dennis Bier, D’Ann Finley, Karen King and Kisna Quimby at the American Journal of Clinical Nutrition, and to the
four anonymous reviewers for carrying out the external peer review of the report again this year.
The Independent Expert Group is guided by the Global Nutrition Report Stakeholder Group, which provided
leadership in building support for the report: Victor Aguayo, UNICEF; Francesco Branca, World Health Organization;
Jésus Búlux, Secretaría de Seguridad Alimentaria y Nutricional, Guatemala; Lucero Rodríguez Cabrera, Ministry
of Health, Mexico; Pedro Campos Llopis, European Commission; John Cordaro, Mars and Scaling Up Nutrition
(SUN) Business Network; Ariane Desmarais-Michaud, Isabelle Laroche and Joyce Seto, Government of Canada;
Sandra Ederveen, Dutch Ministry of Foreign Affairs; Juliane Friedrich, IFAD; Heike Henn and Sabrina Ziesemer,
BMZ, Germany; Chris Osa Isokpunwu, Federal Ministry of Health, Nigeria; Lawrence Haddad, Global Alliance for
Improved Nutrition; Kate Houston, Cargill and SUN Business Network; Abdoulaye Ka, Cellule de Lutte contre la
Malnutrition, Senegal; Lauren Landis, World Food Programme; Anna Lartey, Food and Agriculture Organization;
Ferew Lemma, Ministry of Health, Ethiopia; Edith Mkawa, Office of the President, Malawi; Abigail Perry, Department
for International Development (UK); Anne Peniston, USAID; Milton Rondó Filho, Ministry of Foreign Relations,
Brazil; Nina Sardjunani, Ministry of National Development Planning, Indonesia; Muhammad Aslam Shaheen, Planning
Commission, Pakistan; Meera Shekar, World Bank; Lucy Sullivan, 1,000 Days; Gerda Verburg, SUN Secretariat. We are
particularly grateful to the co-chairs of the Stakeholder Group, Neil Watkins, the Bill & Melinda Gates Foundation
and Rachel Toku-Appiah, Graça Machel Trust, for their advice and unwavering support for the report this year.

The Global Nutrition Report 2017 is a peer-reviewed publication.
Copyright 2017: Development Initiatives Poverty Research Ltd.
Suggested citation: Development Initiatives, 2017. Global Nutrition Report 2017: Nourishing the SDGs. Bristol,
UK: Development Initiatives.
Disclaimer: Any opinions stated herein are those of the authors and are not necessarily representative of or
endorsed by Development Initiatives Poverty Research Ltd or any of the partner organisations involved in the
Global Nutrition Report 2017. The boundaries and names used do not imply official endorsement or acceptance by
Development Initiatives Poverty Research Ltd.
Development Initiatives Poverty Research Ltd
North Quay House, Quay Side, Temple Back, Bristol, BS1 6FL, UK
ISBN:
Copy editing: Jen Claydon, Jen Claydon Editing
Design and layout: Broadley Creative and Definite.design
Acknowledgements (continued)
We also received written contributions from people whose work could not be included in this year’s report but whose
work nevertheless informed our thinking: Alexis D’Agostino and Sascha Lamstein, USAID-funded SPRING; Ty Beal and
Robert Hijmans, University of California, Davis; Jan Cherlet, Lynnda Kiess and Nancy Walters, World Food Programme;
Zach Christensen, Development Initiatives; Colin Khoury, International Center for Tropical Agriculture; Michelle Crino,
Elizabeth Dunford and Fraser Taylor, The George Institute for Global Health; Charlotte Dufour, Food and Agriculture
Organization; Fran Eatwell-Roberts, Jamie Oliver Food Foundation; Augustin Flory, Results for Development; Stuart
Gillespie, International Food Policy Research Institute; Jody Harris and Nick Nisbett, Institute of Development Studies;
Anna Herforth, Independent; Christina Hicks, Lancaster University; Suneetha Kadiyala, London School of Hygiene
and Tropical Medicine; Chizuru Nishida, World Health Organization; Danielle Porfido, 1,000 Days; Dominic Schofield,
Global Alliance for Improved Nutrition; Marco Springmann, University of Oxford.
We thank the following donors for their financial support for this year’s report: Department for International
Development (UK), the Bill & Melinda Gates Foundation, United States Agency for International Development
and Irish Aid.
Finally, we thank you the readers of the Global Nutrition Report for your enthusiasm and constructive feedback
from the Global Nutrition Report 2014 to today. We aim to ensure the report stays relevant using data, analysis and
evidence-based success stories that respond to the needs of your work, from decision-making to implementation,
across the development landscape.

Contents
Executive summary 8
Chapter 1: A transformative agenda for nutrition: For all and by everyone 16
Chapter 2: Monitoring progress in achieving global nutrition targets 26
Chapter 3: Connecting nutrition across the SDGs 44
Chapter 4: Financing the integrated agenda 62
Chapter 5: Nutrition commitments for transformative change: Reflections on the Nutrition for Growth process 80
Chapter 6: Meeting the transformative aims of the SDGs 92
Appendix 1: Assessing progress towards global targets – a note on methodology 96
Appendix 2: Coverage of essential nutrition actions 100
Appendix 3: Country nutrition expenditure methodology 104
Notes 106
Abbreviations 118
Supplementary online materials 119
Spotlights 120
Boxes 120
Figures 121
Tables 121

1. The world faces a grave nutrition
situation – but the Sustainable
Development Goals present an
unprecedented opportunity to
change that.
A better nourished world is a better world. Yet despite
the significant steps the world has taken towards
improving nutrition and associated health burdens over
recent decades, this year’s Global Nutrition Report shows
what a large-scale and universal problem nutrition
is. The global community is grappling with multiple
burdens of malnutrition. Our analysis shows that 88% of
countries for which we have data face a serious burden
of either two or three forms of malnutrition (childhood
stunting, anaemia in women of reproductive age and/or
overweight in adult women).
The number of children aged under five who are
chronically or acutely undernourished (stunted and
wasted) may have fallen in many countries, but our
data tracking shows that global progress to reduce
these forms of malnutrition is not rapid enough to
meet internationally agreed nutrition targets, including
Sustainable Development Goal (SDG) target 2.2 to
end all forms of malnutrition by 2030. Hunger statistics
are going in the wrong direction: now 815 million
people are going to bed hungry, up from 777 million in
2015. The reality of famines in the world today means
achieving these targets, especially for wasting, will
become even more challenging. Indeed, an estimated
38 million people are facing severe food insecurity in
Nigeria, Somalia, South Sudan and Yemen while Ethiopia
and Kenya are experiencing significant droughts. No
country is on track to meet targets to reduce anaemia
among women of reproductive age, and the number of
women with anaemia has actually increased since 2012.
Exclusive breastfeeding of infants aged 0–5 months has
marginally increased, but progress is too slow (up 2%
from baseline). And the inexorable rise in the numbers
of children and adults who are overweight and obese
continues. The probability of meeting the internationally
agreed targets to halt the rise in obesity and diabetes by
2025 is less than 1%.
Too many people are being left behind from the
benefits of improved nutrition. Yet when we look at the
wider context, the opportunity for change has never
been greater. The SDGs, adopted by 193 countries in
2015, offer a tremendous window of opportunity to
reverse or stop these trends. They are an agenda that
aims to ‘transform our world’. Many such aspirational
statements have been made in the past, so what makes
the SDGs different? The promise can be summed up
in two words: universal – for all, in every country – and
integrated – by everyone, connecting to achieve the
goals. This has enormous practical implications for what
we do and how we do it.
First, it means focusing on inequities in low, middle and
high-income countries and between them, to ensure
that everyone is included in progress, and everyone
is counted. Second, it means that the time of tackling
problems in isolation is well and truly over. If we want to
transform our world, for everyone, we must all stop acting
in silos, remembering that people do not live in silos.
We have known for some time that actions delivered
through the ‘nutrition sector’ alone can only go so
far. For example, delivering the 10 interventions that
address stunting directly would only reduce stunting
globally by 20%. The SDGs are telling us loud and
clear: we must deliver multiple goals through shared
action. Nutrition is part of that shared action. Action on
nutrition is needed to achieve goals across the SDGs,
and, in turn, action throughout the SDGs is needed
to address the causes of malnutrition. If we can work
together to build connections through the SDG system,
we will ensure that the 2016–2025 Decade of Action
on Nutrition declared by the UN will be a 'Decade of
Transformative Impact'.
2. Improving nutrition will be
a catalyst for achieving goals
throughout the SDGs.
Translating this vision of shared action into reality means
we all need to know how our work relates to, and can
achieve progress across, the other SDGs. There is huge
potential for making connections between SDGs, but
there is also the potential for incoherence. This is why
the SDGs (target 17.14) call for policy coherence for
development. A first and necessary step is to map these
connections and make them transparent. This is what
we begin to do in the Global Nutrition Report 2017.
Based on the best available evidence, we paint a picture
of these connections so we can better understand how
to take this agenda forward.
Our analysis shows there are five core areas that run
through the SDGs which nutrition can contribute to,
and in turn, benefit from:
• sustainable food production
• strong systems of infrastructure
• health systems
• equity and inclusion
• peace and stability.

NOURISHING THE SDGS 1110 GLOBAL NUTRITION REPORT 2017
The world faces a grave
nutrition situation...1
2 billion people lack key micronutrients like iron and vitamin A
155 million children are stunted
52 million children are wasted
2 billion adults are overweight or obese
41 million children are overweight
88% of countries face a serious burden of either two or
three forms of malnutrition
And the world is off track to meet
all global nutrition targets
Improving nutrition will be a
catalyst for achieving goals
throughout the SDGs…
…but the SDGs present an unprecedented
opportunity for universal and integrated change.
2
...and tackling underlying
causes of malnutrition
through the SDGs will help
to end malnutrition.
3
4
There is significant opportunity for
financing a more integrated approach
to improving nutrition universally
To leave no one behind,
we must fill gaps and
change the way we
analyse and use data
5
$ $ $ $ $
$ $ $ $ $ $
$ $ $ $ $
Malnutrition has a high economic
and health cost and a return of
$16 for every $1 invested.
1 in 3 people are malnourished...
The bigger opportunity is for
governments and others to invest in
nutrition in an integrated way, across
sectors that impact nutrition outcomes
indirectly, like education, climate
change, or water and sanitation.
0.5%
We must make sure
commitments are concrete
pledges that are acted on
6
Deep, embedded political commitment to nutrition will
be key to progress. Commitments need to be ambitious
and relevant to the problem, leaving no-one behind.
There is an exciting opportunity to achieve
global nutrition targets while catalysing other
development goals
7
Ending
malnutrition
in all its forms will catalyse
improved outcomes across the SDGs
Data gaps are hindering accountability and
progress. To improve nutrition universally we
need better, more regular, disaggregated data.
Making connections
SDGs: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Sustainable food production
SDGs: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Strong systems of infrastructure
SDGs: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Health systems
SDGs: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Equity and inclusion
SDGs: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Peace and stability
4 5 6 7 8 9 10 11 12 13 14 15 16 17
The SDGs are brought together into
five areas that nutrition can
contribute to and
benefit from.
Double duty actions Tackle more than one
form of malnutrition
Will increase the effectiveness
and efﬁciency of investment of
time, energy and resources to
improve nutrition
Triple duty actions
Tackle malnutrition
and other development
challenges
Could yield multiple beneﬁts
across the SDGs
...but global spending by donors on
undernutrition is 0.5% of ODA...
...and on NCDs and obesity is
0.01% of global ODA.
$
0.01%
Source: Various (see Notes, page 107).

Through these five areas, the report finds that improving
nutrition can have a powerful multiplier effect across the
SDGs. Indeed, it indicates that it will be a challenge to
achieve any SDG without addressing nutrition.
1. Good nutrition can drive greater environmental
sustainability. Agriculture and food production is the
backbone of our diets and nutrition. Food production
uses 70% of the world’s freshwater supply and 38% of
the world’s land. Current agriculture practices produce
20% of all greenhouse gas emissions, and livestock uses
70% of agricultural land. Eating better is necessary to
ensure that food production systems are more sustainable.
2. Good nutrition is infrastructure for economic
development. Stunting disrupts the critical ‘grey matter
infrastructure’ – brain development – that builds futures
and economies. Investing in this infrastructure supports
human development throughout life and enhances
mental and productive capacity, offering a $16 return
for every $1 invested. Nutrition is linked to GDP growth:
the prevalence of stunting declines by an estimated
3.2% for every 10% increase in income per capita, and a
10% rise in income translates into a 7.4% fall in wasting.
3. Good nutrition means less burden on health
systems. Health is indivisible from nutrition. Good
nutrition means less sickness and thus less demand on
already-stretched health systems to deliver prevention
and treatment.
4. Good nutrition supports equity and inclusion,
acting as a platform for better outcomes in education,
employment, female empowerment and poverty
reduction. Well-nourished children are 33% more likely
to escape poverty as adults, and each added centimetre
of adult height can lead to an almost 5% increase in
wage rate. Nutritious and healthy diets are associated
with improved performance at school. Children who are
less affected by stunting early in their life have higher
test scores on cognitive assessments and activity level.
5. Good nutrition and improved food security
enhances peace and stability. More evidence is
needed to better understand how poor nutrition and
food insecurity influence conflict. However, available
evidence indicates that investing in food and nutrition
resilience also promotes less unrest and more stability.
3. Tackling the underlying causes of
malnutrition through the SDGs will
unlock significant gains in the fight
to end malnutrition.
Nutrition is an indispensable cog without which the
SDG machine cannot function smoothly. We will
not reach the goal of ending malnutrition without
tackling the other important factors that contribute to
malnutrition. Poor nutrition has many and varied causes
which are intimately connected to work being done to
accomplish other SDGs.
1. Sustainable food production is key to nutrition
outcomes. Agricultural yields will decrease as
temperatures increase by more than 3°C. Increased
carbon dioxide will result in decreased protein, iron,
zinc and other micronutrients in major crops consumed
by much of the world. Unsustainable fishing threatens
17% of the world’s protein and a source of essential
micronutrients. Policies and investments to maintain
and increase the diversity of agricultural landscapes are
needed to ensure small and medium-sized farms can
continue to produce the 53–81% of key micronutrients
they do now.
2. Strong systems of infrastructure play key roles in
providing safe, nutritious and healthy diets and clean
water and sanitation. The infrastructure that makes
up ‘food systems’ that take food from farm to fork is
essential if we are to reduce the 30% of food that is
currently wasted and the contamination of food which
leads to diarrhoea and underweight and death among
young children. With unclean water and poor sanitation
associated with 50% of undernutrition, infrastructure
is needed to deliver them, equitably. Special attention
is needed in cities. Urban populations are predicted to
reach 66% by 2050, yet slums and deprived areas are
underserved, while infrastructure has made it easier to
deliver foods that increase the risk of obesity and
diet-related non-communicable diseases (NCDs).
3. Health systems have an important role in promoting
infant and young child feeding, supplementation,
therapeutic feeding, nutrition counselling to manage
overweight and underweight, and screening for diet-
related NCD in patients. Yet our analysis shows that
health systems are not delivering where they should –
only 5% of children aged 0–59 months who need zinc
treatment are receiving it, for example. And half of all
countries have not implemented NCD management
guidelines. Essential nutrition actions with substantive
evidence should be scaled to ensure they are reaching
those who need it the most, and interventions for diet-
related NCDs tested to see what works most effectively
through the health system.

4. Equity and inclusion matter for nutrition outcomes:
ignoring equity in the distribution of wealth, education
and gender will make it impossible to end malnutrition
in all its forms. A fifth of the global population –
767 million people – live in extreme poverty and 46%
of all stunting falls in this group. This group is often
neglected or excluded. At the same time, measures
must be put into place to counteract the risk of growing
obesity as economies develop. It is estimated that a
10% rise in income per capita translates into a 4.4%
increase in obesity, while national burdens of obesity
are rising at lower levels of economic development.
Severe food insecurity remains a problem across the
world – from 30% in Africa to 7% in Europe. Actions to
ensure women are included and treated equitably are
needed to ensure they can breastfeed and look after
their own nutrition.
5. Peace and stability are vital to ending malnutrition.
The proportion of undernourished people living in
countries in conflict and protracted crisis is almost three
times higher than that in other developing countries.
Long-term instability can exacerbate food insecurity
in many ways. In the worst-case scenario, conflicts can
lead to famines. When conflict or emergencies occur,
nutrition must be included in disaster risk reduction and
post-conflict rebuilding.
4. There is significant opportunity
for financing a more integrated
approach to improving nutrition
universally.
Malnutrition has a high economic and health cost,
yet not enough is spent on improving nutrition.
New analysis this year shows domestic spending on
undernutrition varies from country to country, with
some spending over 10% of their budget on nutrition
and others far less. Global spending by donors on
undernutrition increased by 1% (US$5 million) between
2014 and 2015, but fell as a proportion of official
development assistance (ODA) from 0.57% in 2014 to
0.50% in 2015. Spending on prevention and treatment
of obesity and diet-related NCDs represented 0.01%
of global ODA spending to all sectors in 2015, even
though the global burden of these diseases is huge.
Some donors are leading the way in bucking this trend,
but considerably more investment needs to be put on
the table.
The bigger opportunity is for governments and others
to invest in nutrition in an integrated way. Our analysis
this year already shows that governments spend more
on sectors important in the underlying causes of
malnutrition than they do on interventions specific to
nutrition. Opportunities through innovative financing
mechanisms and existing investment flows for multiple
wins in multiple sectors need to be explored. The
world simply cannot afford not to think about a more
integrated approach to investing in nutrition.
5. To leave no one behind, we must
fill gaps and change the way we
analyse and use data.
The Global Nutrition Report has consistently called for
more rigorous data collection to ensure accountability.
This year we highlight that data gaps are hindering
accountability and progress. To improve nutrition
universally, we need better, more regular, detailed
and disaggregated data. We identify lack of data
disaggregated by wealth quintile, gender, geography,
age and disability as a particular barrier. National
averages are not enough to see who is being left
behind. We need disaggregated data for all forms of
malnutrition, in all countries as nutritional levels can
vary even within households. This is needed if we are
to ensure that marginalised, vulnerable populations are
not left behind in the SDG agenda.
Two notable data gaps are around adolescents and
dietary intake. Better data on adolescents is needed
if we are to hold the world accountable for tackling
nutrition in such a critical part of the life course.
Likewise, if we do not know what people are eating,
we will not be able to design effective interventions to
improve diets.
Beyond just collecting data, we need to actively use this
data to make better choices and inform and advocate
decision-making at the policy level. We need data to
be collected, collated and used to build the dialogues,
partnerships, actions and accountability needed to end
malnutrition in all its forms.

6. We must make sure
commitments are concrete pledges
that are acted on.
Without deep political commitment to nutrition rooted
in the way governments govern, multilateral agencies
coordinate, civil society engages and businesses are
run, the act of making pledges to improve nutrition
becomes nothing more than empty rhetoric.
Accountability mechanisms, such as the Global Nutrition
Report, are designed to ensure that stated commitments
are delivered in practice. The commitments made to
the Nutrition for Growth (N4G) process in 2013 aimed
to generate deep commitment. It has made progress.
Of the 203 commitments made at the N4G Summit in
2013, 36% are either on track (n=58) or have already
been achieved (n=16). Yet the N4G process shows we
need to do better. To begin with this means ensuring
we can hold governments, multilateral agencies, civil
society and businesses accountable for delivering their
commitments – and this means making sure they are
SMART (specific, measurable, achievable, relevant and
time-bound). Commitments must be ambitious and
relevant to the problem. Also critical are commitments
that aim to achieve multiple goals and ensure no one is
left behind.
The bottom line is that nutrition needs some staying
power. We need a world where having suboptimal
nutrition is considered completely unacceptable and
good nutrition is the global social norm. Accountability
mechanisms should be designed carefully to ensure
they promote this deeper level of commitment by
all stakeholders.
7. There is an exciting opportunity
to achieve global nutrition targets
while catalysing other development
goals through ‘double duty’ and
‘triple duty’ actions.
No country has been able to stop the rise in obesity.
Countries with burgeoning prevalence should start
early to avoid some of the mistakes of high-income
neighbours. There is an opportunity to identify – and
take – ‘double duty’ actions which tackle more than
one form of malnutrition at once. These will increase
the effectiveness and efficiency of investment of
time, energy and resources to improve nutrition. For
example, actions to promote and protect breastfeeding
in the workplace produce benefits for both sides of
the double burden of malnutrition; city planning can
be leveraged to ensure access to affordable, safe and
nutritious foods in underserved areas and discourage
the provision of foods which raise the risk of obesity;
making clean water available in communities and
settings where people gather reduces the risk of
undernutrition and provides a viable alternative to
sugary drinks; universal healthcare packages can be
redesigned to include both undernutrition and diet-
related NCD prevention; and tracking of aid spending
can be improved to monitor the financing of the double
burden more effectively.
To begin with, programme and policy implementers and
funders concerned with undernutrition should review
their work and ensure that they are taking opportunities
to reduce risks of obesity and diet-related NCDs where
they can, while ensuring we do not reverse the progress
made on tackling undernutrition. They should do this
review in the next 12 months. Researchers, meanwhile,
should work to identify the evidence of where and
how these ‘double duty’ approaches can work
most effectively.
Likewise, ‘triple duty actions’ which tackle malnutrition
and other development challenges could yield multiple
benefits across the SDGs. For example, diversification
of food production landscapes can provide multiple
benefits by: ensuring the basis of a nutritious food
supply essential to address undernutrition and
prevent diet-related NCDs; enabling the selection
of micronutrient-rich crops with ecosystem benefits;
and, if the focus is on women in food production,
empowering women to become innovative food
value chain entrepreneurs while minimising work and
time burden. Scaling up access to efficient cooking
stoves would improve households’ nutritional health,
improve respiratory health, save time, preserve forests
and associated ecosystems, and reduce greenhouse
gas emissions. School meal programmes could be
more effectively structured to reduce undernutrition,
ensure children are not unduly exposed to foods that
increase risk of obesity, provide income to farmers, and
encourage children to stay in school and/or learn better
when at school. Urban food policies and strategies can
be designed to reduce climate change, food waste,
food insecurity and poor nutrition. Humanitarian
assistance could be used as a platform to promote
quality, nutritious diets while also rebuilding resilience
via local institutions and support networks.

Overall, there is an immense opportunity to achieve
the SDGs through greater interaction across silos. This
means we must all transform our ways of working. There
needs to be a critical step-change in how the world
approaches nutrition. It is not just about more money;
it is also about breaking down silos and addressing
nutrition in a joined-up way. Governments, business
and civil society: you must think about what the
connections across the SDGs mean for the investment
and commitments you make and the actions you take.
Then act by identifying one triple duty action and make
delivering it a priority.
Changing the way we work also means that the nutrition
community must transform the way it speaks to other
sectors. We must reach out to ask others “what can we
do to help you?” “how can we help you achieve your
goals?”, and not just say “you should be helping us.” To
make us stronger, the different communities who work
on nutrition – on undernutrition, obesity, diet-related
NCDs, maternal and child health and humanitarian relief
– must come together with a stronger voice. And we
must put people at the centre of everything we do, by
inspiring and rallying around this fundamental right that
impacts every single one of us and our families.
If readers take away one message from this report,
it should be that ending malnutrition in all its forms
will catalyse improved outcomes across the SDGs.
Whoever you are, and whatever you work on, you can
make a difference to achieving the SDGs, and you
can help end malnutrition. You can stop the trajectory
towards at least one in three people suffering from
malnutrition. The challenge is huge, but it is dwarfed
by the opportunity.

16
1 A transformative agenda
for nutrition:
For all and by everyone

The world has taken significant steps towards
improving nutrition over recent decades
but the job is far from done. The number of
children who are chronically undernourished,
or stunted, has fallen in many countries, as
has the number of children who are acutely
malnourished, or wasted. However, the
burden remains high and undernutrition rates
have not fallen fast enough to keep pace
with changing global trends. Obesity remains
a significant challenge, with increasing
numbers of both children and adults who are
overweight and obese.
Malnutrition overall remains an immense and universal
problem, with at least one in three people globally
experiencing malnutrition in some form (Figure 1.2).1
No country is immune: almost every country in the
world is facing a serious nutrition-related challenge.
The 140 countries with data to track childhood stunting,
anaemia in women of reproductive age and overweight
in adult women show that countries experience multiple
burdens of malnutrition (Figure 1.1). All 140 are dealing
with at least one of these major nutritional problems.
And 123 (88%) of these countries face a grave burden
of either two or three of these forms of malnutrition.2
FIGURE 1.1: Number of countries facing burdens of malnutrition
4 38
29
5210 6
1
Countries with a triple burden
of all three indicators
Countries with a double burden:
Overweight and anaemia
Stunting and anaemia
Stunting and overweight
(Stunting total 72)
ANAEMIA
STUNTING
OVERWEIGHT
(Anaemia total 125)(Overweight total 95)
Source: Authors' analysis based on data from United Nations Children's Fund (UNICEF)/World Health Organization (WHO)/World Bank Group Joint
Child Malnutrition Estimates, 2017; WHO, 2017a; WHO, 2017b.3
Note: 72 countries have stunting burden (1 with stunting only; 38 with stunting and anaemia; 4 with stunting and overweight; and 29 with stunting,
overweight and anaemia). 125 countries have anaemia burden (6 with anaemia only; 38 with anaemia and stunting; 52 with anaemia and overweight;
29 with anaemia, stunting and overweight). 95 countries have overweight burden (10 with overweight only; 52 with overweight and anaemia; 4 with
overweight and stunting; 29 with overweight, anaemia and stunting).

PREVALENCE
PREVALENCEPREVALENCE
Sodium
intake
Mean population
2010
Recommended
intake is 2g/day 155 million
23%
52 million
8%
8%
41 million
6%
20 million
15%
15%
Childhood
stunting
Under 5 years
2016
Childhood
wasting
Under 5 years
2016
Childhood
overweight
Under 5 years
2016
TOTAL
613 million women
TOTAL
1,929 million adultsTOTAL
641 million adultsTOTAL
422 million adults
Anaemia
Women of
reproductive age
15–49 years
2016
Adult overweight
Body mass index ≥25
Aged 18+
2014
Women
204 million
Men
218 million
Women
375 million
Men
266 million
Women
982 million
Men
947 millionPregnant
women
35.3 million
Non-pregnant
women
578 million
40% 39%38%
Men
597 million
Women
529 million
20%
Adult obesity
Body mass index ≥ 30
Aged 18+
2014
11%9% 32%24%
Adult hypertension
Raised blood pressure
Aged 18+
2015
Low birth
weight
Newborns
2014
Adult diabetes
Raised blood glucose
Aged 18+
2014
4 g/day
PREVALENCE
PREVALENCEPREVALENCE
Sodium
intake
Mean population
2010
Recommended
intake is 2g/day 155 million
23%
52 million
8%
8%
41 million
6%
20 million
15%
15%
Childhood
stunting
Under 5 years
2016
Childhood
wasting
Under 5 years
2016
Childhood
overweight
Under 5 years
2016
TOTAL
613 million women
TOTAL
641 million adultsTOTAL
422 million adults
Anaemia
Women of
reproductive age
15–49 years
2016
Adult overweight
Body mass index ≥25
Aged 18+
2014
Women
204 million
Men
218 million
Women
375 million
Men
266 million
Women
982 million
Men
947 millionPregnant
women
35.3 million
Non-pregnant
women
578 million
40% 39%38%
Men
597 million
Women
529 million
20%
Adult obesity
Body mass index ≥ 30
Aged 18+
2014
11%9% 32%24%
Adult hypertension
Raised blood pressure
Aged 18+
2015
Low birth
weight
Newborns
2014
Adult diabetes
Raised blood glucose
Aged 18+
2014
4 g/day
FIGURE 1.2: Global statistics for the nutritional status and behavioural
measures adopted as global targets for maternal, infant and young child
nutrition (MIYCN) and diet-related non-communicable diseases (NCDs)
Source: UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates 2017; WHO 2017; UNICEF 2016; WHO Global Health Observatory data repository and NCD Risk Factor Collaboration; Mozaffarian et al, 2014; Zhou B et al, 20174
Notes: *Disaggregation conducted by WHO 20175
and sex-specific numbers are not available. Note: Raised blood glucose is defined as fasting glucose ≥7.0 mmol/L, on medication for raised blood glucose or with a history of diagnosis of diabetes; raised blood pressure is defined as raised blood pressure, systolic and/or diastolic blood pressure
≥140/90 mmHg. Prevalence is the proportion of the population reaching the target.

On top of this, famines are exacerbating malnutrition
among millions of people throughout the world today6
(Figure 1.3). A staggering 38 million people are severely
food insecure in the four countries where famines have
been declared – (northern) Nigeria, Somalia, South Sudan
and Yemen – plus Ethiopia and Kenya, who are also
struggling with drought-like conditions. In these same
places 1.796 million children under five have severe
acute malnutrition while 4.960 million have moderate
acute malnutrition.7
To make matters worse, the Food
and Agriculture Organization (FAO) recently indicated
that the number of people without access to adequate
calories in the world has increased since 2015, reversing
years of progress.8
And the number of chronically
undernourished people in the world is estimated to
have increased to 815 million, up from 777 million
in 2015.9
Famines are exacerbating
malnutrition among millions
of people throughout
the world today
IN THESE 6 COUNTRIES:
38 million people
are severely food insecure
4.960 million people
have moderate acute
malnutrition
Countries with
famines declared
1.796 million
children under five
have severe acute
malnutrition
Countries with
drought-like conditions
NIGERIA
SOMALIA
ETHIOPIA
KENYA
YEMEN
SOUTH SUDAN
FIGURE 1.3: Food insecurity and malnutrition in famines and droughts, figure from July 2017
Source: UNICEF. Famine Response. Progress Update (11 July 2017). New York: UNICEF, 2017.10
But there is hope and commitment to end all forms of
malnutrition. While we can always learn more, we have
extensive evidence on the causes and consequences of
malnutrition, and what we can do to prevent and address
it. In addition, movements and governments have scaled
up efforts to fight malnutrition at multiple levels with
different types of commitments. These commitments to
reduce malnutrition have been made through national-
level policies and plans, and increased funding allocated
from governments but from donors as well.
International processes and global goal setting has
also ramped up. In 2015, the Sustainable Development
Goals (SDGs) included a target to end malnutrition
in all its forms (target 2.2) and other nutrition-related
targets (e.g. target 3.4). The Nutrition for Growth
(N4G) Compact, the follow-up to the UN High-Level
Meeting on Non-communicable Diseases (NCDs) and
the Decade of Action on Nutrition 2016–2025 are all
important political processes for nutrition commitments
and accountability.

“On behalf of the peoples we serve, we have adopted a
historic decision on a comprehensive, far-reaching and
people-centred set of universal and transformative Goals
and targets...
We are resolved to free the human race from the tyranny of
poverty and want and to heal and secure our planet. We are
determined to take the bold and transformative steps which
are urgently needed to shift the world on to a sustainable
and resilient path. As we embark on this collective journey,
we pledge that no one will be left behind...
This is an Agenda of unprecedented scope and significance.
It is accepted by all countries and is applicable to all, taking
into account different national realities, capacities and
levels of development and respecting national policies
and priorities. These are universal goals and targets which
involve the entire world, developed and developing
countries alike. They are integrated and indivisible and
balance the three dimensions of sustainable development...
The interlinkages and integrated nature of the Sustainable
Development Goals are of crucial importance in ensuring
that the purpose of the new Agenda is realised. If we
realise our ambitions across the full extent of the Agenda,
the lives of all will be profoundly improved and our world
will be transformed for the better.
(Italics have been added for emphasis.)
”
This offers a transformative vision for nutrition.
Everyone should have the right to good nutrition, and
everyone should be involved in achieving it. We know
from decades of experience that both universality and
integration are fundamental to improving nutrition
outcomes. To begin with, malnutrition is universal: it is
not confined to one group of countries or one set of
people (Spotlight 1.1). Every country, whether rich or
poor, is grappling with some form of malnutrition.
Even countries with lower levels of malnutrition have
pockets of poverty and inequity associated with
malnutrition. So ending malnutrition in all its forms
means leaving no one behind – ensuring everyone is
included in progress and everyone is counted.
Universality means ‘for all’. The SDG universality
agenda recognises the shared nature of challenges
which are common to many people across all
countries. A universal approach to nutrition
means recognising the different expressions of
poor nutrition, most obviously from obesity to
underweight, and ensuring policies are in place
to address these. It means that businesses and
institutions, governments and non-governmental
organisations (NGOs) need to be sensitive to who is
missing out on progress in their own communities.
And they must embrace their responsibility to work
to prevent them being left further behind.
The universality agenda is about knowing who
is included in progress and who is missing out.
Prevalence (proportion of the population) data
and national averages are not enough. They can
mask very different levels of burden and progress.
To deliver on the universality agenda, each country
has to count people; it has to know who and where
its population is. While that might seem obvious
and basic, the data suggests that one-third of
children worldwide have not even had their birth
registered. Among the poorest children, this rises
to two-thirds.16
Data must be disaggregated so that
it reveals who is being reached and who is missed
out. This is a big challenge, but as a first step, there
are proposals for a set of minimum disaggregations
covering wealth quintile (one of five income
groups), gender, geography, age and disability.17
Universality is not just about data and delivery,
it is also about culture change. It recognises the
21st century world, where the old categories of
'developed' or 'developing', 'North' or 'South'
are less and less relevant. Looking through a
universal lens creates opportunities for learning
about what works across different societies and
making faster, more comprehensive, equitable
and inclusive progress.
SPOTLIGHT 1.1 WHAT IS ‘UNIVERSALITY’
IN THE SDGS AND WHAT DOES IT MEAN
FOR NUTRITION?
Judith Randel
Transforming nutrition
through the SDGs
Recognising the importance of improving nutrition, in
2015 the 193 countries of the United Nations included
a target (2.2) to end malnutrition in all its forms in the
SDGs. The SDGs aim to ‘transform our world’ with a
vision that can be summed up in two words: universal
– for all, in every country – and integrated –
by everyone, connecting to achieve all the goals.11
The
same prerequisites apply to all the SDGs. As put by the
UN General Assembly resolution 70/1: Transforming our
world: the 2030 Agenda for Sustainable Development:12
And to achieve that, to truly address malnutrition, will
require an integrated approach (Spotlight 1.2). Evidence
shows that actions delivered through the ‘nutrition
sector’ alone can only go so far. It is estimated, for
example, that delivering the 10 interventions13
that
tackle stunting directly would only reduce stunting
globally by 20%.14
Actions need to address the root
causes of poor nutrition – issues which are dealt with by
the other SDGs.15

Integrated means that all the goals should be
achieved in an indivisible way ‘by everyone’ – by
people making connections across all sectors and all
parts of society. One aspect of integration has long
been recognised as important in nutrition, NCDs and
health more broadly: multi/inter-sectorality. That is,
actions taken by ‘other’ sectors to support (in this
case) nutrition and health goals.18
In the 1970s, the
recognition that nutrition was “everybody’s business
but nobody’s responsibility” led to the concept of
‘multisectoral nutrition planning’.19
In the 2000s the
term ‘mainstreaming nutrition’ was used to describe
how nutrition interventions should become an integral
part of other development priorities, like poverty
reduction, maternal and child health and agriculture.20
Since 2013, the term ‘nutrition sensitive’ has been
used to describe programmes in other sectors that
address the underlying causes of malnutrition.21
A second aspect of integration has been recognised
in nutrition more recently: policy coherence.
The need for policy coherence was acknowledged
as important during the 2014 Second International
Conference on Nutrition.22
In 2017, the World Health
Organization (WHO) held a Global Conference on
NCDs focused on coherence between different
spheres of policymaking. In these cases, policy
coherence refers to policies across governments
actively supporting, rather than undermining,
nutrition or NCD objectives. In development more
broadly, policy coherence has been discussed for
far longer, and it has been primarily concerned with
ensuring domestic and foreign policies support the
goals of developing countries.23
The SDGs take policy
coherence far further. Through target 17.14 on policy
coherence for sustainable development, the SDGs
call on all of government, as well as civil society and
the private sector, to consider links between different
sectors, across borders and between generations to
achieve their goals.24
This broader approach – recognising multiple levels
of interaction – is at the core of the ‘integrated’
vision of the SDGs: delivering multiple goals
through shared action. It means everyone getting
involved with not just their ‘own’ goal, but delivering
outcomes across the SDGs. This is the aspect of
integration that raises the bar for action in nutrition
and across development. All the SDGs interact in
different ways.25
While tools have been developed to
support countries and other stakeholders to develop
integrated SDG plans, there is a long way to go to
implement actions that leverage these interactions.26
But there is also an opportunity to think and act
differently. For nutrition, it is an opportunity to show
how improving people’s nutrition can be catalyst for
the SDGs as a whole – and to work harder to put that
vision into practice.
SPOTLIGHT 1.2 WHAT IS ‘INTEGRATION’ IN THE SDGS AND WHAT DOES IT MEAN
FOR NUTRITION?
Corinna Hawkes
Truly addressing nutrition also involves thinking about
all the different forms of malnutrition. While each form
is very different, there are shared root causes (Spotlight
1.3). Yet to date, they have typically been dealt with
in silos. An integrated view calls for double wins in the
actions we take, through what the Global Nutrition
Report 2015 first termed ‘double duty’ actions. These
are interventions, programmes and policies that have
the potential to simultaneously reduce the risk or
burden of both undernutrition and overweight, obesity
or diet-related NCDs.27
In the Global Nutrition Report
2017 we also consider the potential for ‘triple duty’
actions, which aim to achieve additional goals based on
common agendas (Chapter 3).
The SDGs raise the bar to deliver on all forms of
malnutrition, for all, and by everyone – acknowledging
the interactions between nutrition and development
goals more broadly. A momentous shift is needed
to move this agenda. It necessitates new thinking,
approaches and action, and brings challenges that we
will need to overcome.28

For example:
• For universality, we often do not know who is left behind
– this information is often missed in national averages
and prevalence rates. Even household-level data does
not reveal inequalities between different household
members whether based on gender, age, disability,
caste, tribe, race or other status.29
While children need
special protection and attention, there is little reliable
and consistent data for children older than 5 years, or
adolescents outside the 15–19 age range. Hence whole
populations are being left behind because nutrition data
is not systematically collected (Spotlight 1.1).
• For integration, we do not know how best to do it.30
While some countries are taking steps to embed the
SDGs across governments,31
very few national SDG
reports include sections on how integration will be
operationalised at the country level.32
Efforts are
being made to integrate sectors and stakeholders
through new initiatives and governance structures.
Yet, national governments, researchers, NGOs,
companies and the UN system still work in silos.
With so many sectors involved, the "biggest misbelief
is that someone else will fix it."33
Despite these challenges, we must seize the
opportunity of the ‘for all and by everyone’ agenda.
This is a unique opportunity to ensure the Decade
of Action on Nutrition 2016–2025, declared by the
193 countries of the UN, becomes a ‘Decade of
Transformative Impact’. The nutrition decade is the
time to catalyse the efforts of all of us to end all forms
of malnutrition as part of the SDG agenda while also
contributing to broader development goals.34
This must also recognise that everyone has a right to
adequate nutrition. Rights related to nutrition have
been directly recognised and protected in a range of
human rights treaties. The 1979 Convention on the
Elimination of All Forms of Discrimination Against
Women underlines women’s right to health, including
“adequate nutrition during pregnancy and lactation”.
Meanwhile the 1989 Convention on the Rights of the
Child obliges governments to “combat disease and
malnutrition, including within the framework of primary
healthcare, through, inter alia, the application of
readily available technology and through the provision
of adequate nutritious foods.”35
Stakeholders are
increasingly recognising that a human rights-based
approach to nutrition is vital for ensuring that everyone
can enjoy the intrinsic benefits of good nutrition.
Yet delivering rights requires accountability.
Accountability matters for nutrition – it is vital for
achieving this ambitious agenda. Good accountability
encourages and enables action. It is about accepting
responsibility for those commitments, delivering them
for impact, and then reporting on the commitments.
Accountability means exercising power responsibly.
The Global Nutrition Report has been working to
enhance accountability for action on nutrition since
2014. In the context of the transformative vision
presented by the SDGs, the Global Nutrition Report
2017 again takes stock of the state of the world’s
nutrition and explores what is needed to achieve
universal outcomes through integrated delivery. It does
so in four ways:
1. Monitoring progress towards achieving nutrition
targets, universally.
The Global Nutrition Report tracks national progress
against globally agreed targets for maternal, infant
and young child nutrition (MIYCN) and those
relevant to diet-related NCDs, as well as the SDG
2.2 and 3.4 targets on nutrition. This year we also
identify the gaps in data and the way it is used that
are curbing our ability to track progress towards
universal improvements. That is, ending malnutrition
in all its forms by 2030, in all countries, for all people
(Chapter 2).
2. Setting out what connecting nutrition across the
SDGs looks like.
This year we provide the basis for acting on nutrition
in a more integrated way to achieve targets across
the SDGs. Chapter 3 explores if and how improved
nutrition has the capacity to be a catalyst for the
SDGs more broadly – and what actions are needed
throughout the SDGs to ensure global nutrition
targets are reached. It exemplifies the kind of
‘double duty’ and ‘triple duty’ actions we can take.
3. Tracking financing as a means of implementing a
universal and integrated vision.
Financing is critical to delivering action: SDG 17
positions financing as a ‘means of implementation’.
Chapter 4 provides the latest data on financing
for nutrition by governments and key donors,
highlighting which key areas across the SDGs need
more investment, and where the finance data
gaps are.
4. Reflecting on progress on commitments made at
the Nutrition for Growth Summit.
In this year’s report, we track the commitments
made in the Nutrition for Growth (‘N4G’) process
– a movement to bring diverse global stakeholders
together to invest in fighting malnutrition. We aim to
show what has been achieved over the last four years
towards their commitments made to 2020. And we
reflect on the implications for commitments needed
to take forward the universal and integrated agenda
to achieve a Decade of Transformative Impact for
nutrition (Chapter 5).

In line with the demands of the SDGs to articulate
frameworks to integrate different problems and goals,
we can identify some shared causes of different forms
of malnutrition. These are articulated in two WHO
policy briefs published in 2017: The Double Burden of
Malnutrition and Double-duty actions for nutrition.37
Epigenetics
Altering the expression of genes (switching them
on or off) is thought to influence the risk of low
birth weight, overweight, obesity and NCDs.
These alterations can be caused by environmental
factors such as diet, exercise, drugs and chemical
exposure. This in turn leads to intergenerational links
in undernutrition, obesity and NCDs. For example,
intrauterine growth restriction resulting from maternal
undernutrition leads to changes in the way the infant’s
body then regulates energy.
Early-life nutrition
The quality and quantity of nutrition during fetal
development and infancy impact on the body’s
immune function, cognitive development and
regulation of energy storage and expenditure.
For example, by providing essential nutrients for
growth and development, colostrum and breast
milk influences infant biology and nutritional habits.
Another link is through poor maternal nutrition before
and during pregnancy, which can lead to increased
risk of maternal anaemia, preterm birth and low infant
birth weight. In turn, low-birth weight infants can be
at higher risk of metabolic disease and abdominal
obesity later in life.
Socioeconomic factors
Socioeconomic factors such as poverty, gender
empowerment and education affect all forms of
malnutrition in different ways (Chapter 3). For example,
income and wealth inequalities are closely associated
with undernutrition. More complex inequality patterns
for obesity and associated health conditions are seen
in low and middle-income countries, and depend
on the economic and epidemiological development
and state of the country. In general, the shift towards
obesity in groups of lower socioeconomic status is
happening more quickly in lower income countries
than it did in higher income countries.
People’s surroundings
The quality of environments around people are
relevant to all forms of malnutrition. For example,
lack of availability of nutritious foods in the ‘food
environments’ around people can affect the risks
of both an inadequate and unbalanced diet. Other
important aspects of people’s surroundings are the
living and working environments that affect access to
improved water and sanitation services, and influence
the ability to breastfeed, and the built environment
that impedes or promotes physical activity.
Food systems
Underpinning what people eat and their food
environments are food systems. They include
the production of food in agriculture (including
horticulture and raising livestock, small animals
and fish), how food is transformed and processed
through the system, its distribution and trade and
how it is made available to people through retail
and other means. Food systems play a crucial role
in what people eat and whether they are at risk of
undernutrition or obesity.
SPOTLIGHT 1.3 SHARED CAUSES OF DIFFERENT FORMS OF MALNUTRITION36
Corinna Hawkes, Alessandro Demaio and Francesco Branca

The Global Nutrition Report is only as strong as its
uptake. We need our audience and partners to use the
evidence we present here to call for swifter progress,
and to hold decision-makers and implementers
accountable for their actions. We see this report as
an intervention: we rely on you – our partners from
governments, donors, business, civil society and
academia to use it to catalyse more effective action
on nutrition, and to take this conversation further.
Everyone has a role to play.
• If you are a decision-maker, budget holder or
implementer, use this report as inspiration for
integrated action on nutrition. Use the approaches
in this report, and beyond, to tackle the current and
future threats of malnutrition which your country,
sector or community faces. Use this report to improve
your ability to deliver universally and leave no one
behind. Use this report as inspiration to increase
your impact on both nutrition outcomes and broader
development outcomes, and increase your ‘bang for
your buck’.38
• If you are an advocate, use this report to shine a
light on the nutrition challenges your country, sector
or community faces. Use it to hold people in positions
of power accountable for tackling all forms of
malnutrition in an integrated manner, leaving no one
behind. Use it to advocate for filling the gaps in data
and the way it is used which make accountability
so challenging.
• If you are a researcher, consider whether the data
and research gaps identified in this report could
inform your future work. Consider how we can dig
deeper into data to analyse how greater integration
can be achieved and find and rectify the situation of
those being left behind.
We call on everyone reading this report to take action
to ensure that the global nutrition targets are achieved
and the Decade of Action on Nutrition is a ‘Decade of
Transformative Impact’. And not just one for nutrition,
but one in which nutrition acts as a catalyst to achieve
development goals across all countries, for all and
by everyone.

26
2 Monitoring progress
in achieving global
nutrition targets
1. Overall, the world is off course to meet global nutrition targets:
• Global progress to reduce stunting among children under age five is not
rapid enough to meet the 2025 target. The number of children under age
five who are overweight is rising.
• The rate of reduction of childhood wasting is also not fast enough to
meet the 2025 target. Famines, brewing conflicts and climate-induced
droughts, floods and other disasters will make wasting much harder to tackle.
• Exclusive breastfeeding of infants aged 0–5 months has marginally
increased (up 2% from baseline). This progress is positive but too slow.
• Anaemia among women of reproductive age has increased since 2012;
no country is on course to meet the target.
• The probability of halting the rise in obesity and diabetes by 2025 is less
than 1%.
2. At a regional level, the number of children who are stunted is increasing in
Africa, and wasting is still high in South Asia.
3. At a country level, no nation is on course to meet all five of the six global
maternal and child nutrition targets, and few have stopped the upward
trends in child and adult overweight and obesity. Three countries are ‘on
course’ for four targets – exclusive breastfeeding and childhood stunting,
wasting and overweight.
4. Data gaps remain a significant obstacle in tracking progress of the multiple
burdens of malnutrition, universally. Disaggregated data is needed to
ensure no one is left behind due to their geography, age, ethnicity or
gender. This data is missing, as is data on adolescents and dietary intake.
5. Better data coordination and its interpretation and use by decision-makers
as part of national priority setting is also needed to track progress against
global nutrition targets.
Key findings

What will it take to end malnutrition
universally by 2030 – in all its forms, in all
countries, for all people? What is needed to
navigate the way towards achieving the two
Sustainable Development Goal (SDG) targets,
2.2 and 3.4, that are directly concerned with
nutrition outcomes?
This chapter describes where we are
globally and nationally in reaching what can
be termed the ‘global nutrition targets.’
It uses available country-level prevalence
data to determine, as best as we can, who
is impacted by undernutrition, overweight/
obesity and diet-related non-communicable
diseases (NCDs), and where. It also highlights
where data gaps are preventing us from
taking on a more universal approach to
tracking improvements in nutrition across
the world.
Global nutrition targets
Progress towards the SDG targets can be tracked
using the voluntary global nutrition targets adopted
by member states of the World Health Organization
(WHO). The Global Nutrition Report has been tracking
these global nutrition targets over the last four years.
These targets comprise:
• maternal infant and young child nutrition (MIYCN)
targets: six global targets on MIYCN adopted at the
World Health Assembly in 2012 to be attained by 20251
• diet-related NCD targets: three of nine NCD targets
adopted at the World Health Assembly in 2013 to be
attained by 2025.2
These ‘MIYCN targets’ and ‘diet-related NCD targets’
overlap significantly with SDG targets 2.2 and 3.4
(Figure 2.1), highlighting the synergies between the
SDGs and current tracking efforts to tackle malnutrition.
While each target is separate and distinct, they are
integrated through basic underlying links which show
that nutritional status is the result of many factors that
come together into an indivisible whole in a person
(Spotlight 1.2, Chapter 1).
The MIYCN targets have the overarching aim of
improving MIYCN by 2025 and are tracked at the global
level by six indicators. The diet-related NCD targets
form part of the Global Monitoring Framework for the
Prevention and Control of NCDs, which sets targets to
monitor progress in achieving targets concerning the
four NCDs that cause the greatest amount of mortality,
three of which have diet-related causes (cardiovascular
disease, diabetes, some cancers), and their risk factors.
The WHO plays a key leadership role in monitoring
the MIYCN and diet-related NCD targets and aligning
them closely with the UN Decade of Action on
Nutrition (2016–2025).3
It has also provided guidance
for countries to set their own national targets in line
with their priorities and resource capacity to address
both MIYCN and NCDs. These are the Comprehensive
Implementation Plan on Maternal, Infant and Young
Child Nutrition4
and the Global Action Plan for the
Prevention and Control of Non-Communicable
Diseases 2013-2020.5
The targets and indicators are
tracked annually in the Global Nutrition Report to instil
accountability in the global nutrition community. These
targets and indicators are shown in Figure 2.1.
Global and country
progress towards global
nutrition targets
The monitoring and assessments presented in this
year’s report show that at the global level, the world is
off course to meet most of the global nutrition targets
for which data is available (Figure 2.2). The analyses
presented supersede numbers given in previous
Global Nutrition Reports. This is because they take
into account new data available in the last year which
reflects improved methodologies and more robust
estimates (see Spotlight 2.2 and Appendix 1).

Under-5
STUNTING
Maternal, infant and young child nutrition targets
NUTRITION-RELATED 2025 TARGETS ADOPTED BY THE MEMBER STATES OF THE WORLD HEALTH ORGANIZATION
Maternal, infant and young child nutrition (MIYCN) targets
Stunting* among children under 5 years of age
TARGET
1
Achieve a 40% reduction in the number of children under 5 who are stunted
Women aged 15–49 years with haemoglobin <12 g/dL (non-pregnant) or <11 g/dL (pregnant)
TARGET
2
Achieve a 50% reduction of anaemia in women of reproductive age
ANAEMIA
Infants born with a birth weight <2,500 g
TARGET
3
Achieve a 30% reduction in low birth weight
LOW BIRTH
WEIGHT
Overweight** among children under 5 years of age
TARGET
4
Ensure that there is no increase in childhood overweight
Under-5
OVERWEIGHT
Infants 0–5 months of age who are fed exclusively with breast milk
TARGET
5
Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%
EXCLUSIVE
BREASTFEEDING
Wasting*** among children under 5 years of age
TARGET
6
Reduce and maintain childhood wasting to less than 5%
WASTING
Under-5
Maternal, infant and young child nutrition targetsNCD Global Monitoring Framework
Age-standardised mean population intake of salt (sodium chloride) in g/day in persons aged 18+ years
TARGET
4
Achieve a 30% relative reduction in mean population intake of salt (sodium chloride)
Age-standardised prevalence of raised blood pressure among persons aged 18+ years, by sex
TARGET
6
Achieve a 25% relative reduction in the prevalence of raised blood pressure or contain the
prevalence of raised blood pressure, according to national circumstances
Age-standardised prevalence of raised blood glucose/diabetes among persons aged 18+ years, or
on medication for raised blood glucose, by sex
Age-standardised prevalence of overweight and obesity+
in persons aged 18+ years, by sex
Age-standardised prevalence of obesity++
in persons aged 18+ years, by sex
TARGET
7
Halt the rise in diabetes and obesity
POPULATION
INTAKE OF SALT
ADULT
HYPERTENSION
ADULT
OBESITY
ADULT
OVERWEIGHT
ADULT DIABETES
Goal 2. End hunger, achieve food security and improved nutrition and promote sustainable agriculture
CORRESPONDING SUSTAINABLE DEVELOPMENT GOALS 2030
Under-5
OVERWEIGHT
Under-5
WASTING
Under-5
STUNTING
2.2.1 Prevalence of stunting among children under 5 years of age
TARGET
2.2
By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally
agreed targets on stunting and wasting in children under 5 years of age, and address the
nutritional needs of adolescent girls, pregnant and lactating women and older persons
2.2.2 Prevalence of wasting and overweight among children under 5 years of age
3.4.1 Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease
TARGET
3.4
By 2030, reduce by one-third premature mortality from NCDs through prevention and
treatment and promote mental health and well-being
Goal 3. Ensure healthy lives and promote well-being for all at all ages
FIGURE 2.1: Global targets and indicators to improve nutritional status and behaviours
Source: Authors, based on World Health Organization (WHO) and UN Statistical Division.6
Notes: *Stunting is defined as length or height-for-age z-score more than 2 standard deviations below the median of the WHO Child Growth
Standards. **Childhood overweight is defined as weight-for-length or height z-score more than 2 standard deviations above the median of the WHO
Child Growth Standards. ***Wasting is defined as weight-for-length or height z-score more than 2 standard deviations below the median of the WHO
Child Growth Standards. +
Overweight and obesity is defined as body mass index (BMI) ≥25. ++
Obesity is defined as BMI ≥30.

TARGET
4
TARGET
2
TARGET
3
TARGET
5
TARGET
6
WASTING
Under-5
OVERWEIGHT
2012
8% <5%
2012
7%
ANAEMIA
2012
29% 15%
LOW BIRTH
WEIGHT
15% 10%
New estimates are forthcoming
Global prevalence
7.7% in 2016.
The baseline proportion for
2012 was revised to 5.7% in
the estimates for 2015, and
the current prevalence is
6%, marginally above this
threshold and therefore
off course.
Global prevalence 32.8% in
2016. (Baseline proportion
for 2012 was revised to 30%
in 2016. Current prevalence
reflects increase since then).
Reduce and
maintain
childhood
wasting at less
than 5%
No increase
in childhood
overweight
50% reduction
of anaemia in
women of
reproductive age
30% reduction
in low birth
weight
2008
TO
2012
No
increase in
prevalence
Under-5
Under-5
STUNTING
Maternal, infant and young child nutrition targets
2012 162
million
~100
million
38% ≥50%
Current average annual rate
of reduction (AARR) (2.3%)
below required AARR (4%).
40% reduction in
the number of
children under 5
who are stunted
EXCLUSIVE
BREAST-
FEEDING
Increase the rate
of exclusive
breastfeeding in
the first six months
to at least 50%
2008
TO
2012
In 2016, 40% of infants 0–5
months were exclusively
breastfed. An increase of
two percentage points over
4 years reflects very limited
progress.
Some
progress
COMMENTSON OR OFF
COURSE
TARGET
FOR 2025
BASELINE
STATUS
BASELINE
YEAR
TARGETINDICATOR
TARGET
1
OFF COURSE
FIGURE 2.2: Global progress towards global nutrition targets
Source: Authors, based on WHO, 2012, 2014, NCD Risk Factor Collaboration, 2016, Stevens GA et al, 2013, Zhou B et al, 2017 and UNICEF, 2016.7
Probability of
meeting the global
target is almost
zero based on
projections to 2025.
Probability of
meeting the global
target low (<1% for
men, 1% for
women) based on
projections to 2025.
Projections not
yet available.
Projections not
yet available.
TARGET
4
TARGET
6
Nutrition-related NCD targets
2014
Men
38%
Women
39%
Men
11%
Women
15%
Men
9%
Women
8%
Men
24%
Women
20%
Men
18%
Women
15%
ADULT
OBESITY
2014
2014
2014
2010
Mean
sodium
intake
4g/day
Mean
sodium
intake
2.8g/day
ADULT
OVERWEIGHT
Halt the rise
in prevalence
Halt the rise
in prevalence
Halt the rise
in prevalence
Halt the rise
in prevalence
Halt the rise
in prevalence
ADULT DIABETES
Raised blood
sugar
ADULT
HYPERTENSION
Raised blood
pressure
25% relative
reduction or no
rise in prevalence,
according to
national
circumstances
Not yet
available
Not yet
available
30% relative
reduction in
mean intake
COMMENTSON OR OFF
COURSE
TARGET
FOR 2025
BASELINE
STATUS
BASELINE
YEAR
TARGETINDICATOR
Halt the rise
in prevalence
POPULATION
INTAKE OF SALT
Sodium chloride
OFF COURSE
TARGET
7
TARGET
7
TARGET
7

Country progress towards
global nutrition targets
At the national level, assessing country progress
towards achieving the global nutrition targets clearly
shows that there are many data gaps holding back
our ability to make robust assessments for four
targets: stunting, wasting, overweight and exclusive
breastfeeding (Figure 2.3). However, several countries
are on course or making some progress towards these.
We present country-level data on prevalence, current
and required rates of change (where applicable), and
an assessment of progress towards global nutrition
targets on our website. The data presented in its tables
is also used in the Global Nutrition Report’s online
Nutrition Country Profiles (see Spotlight 2.1), which
show progress alongside other indicators related to
malnutrition and its determinants.
• For improving MIYCN: Based on available data, 18
countries are on course to meet the stunting target,
29 are for wasting, 31 for overweight and 20 for
exclusive breastfeeding. No country is on course
to reduce anaemia among women of reproductive
age (Figure 2.3). Sadly, the figures also highlight the
lack of data to make robust assessments of progress
towards MIYCN targets, meaning many countries
cannot be classified as on or off course.
• For halting the rise in obesity: All countries for which
data is available had a probability of less than 0.5
(50% chance) of meeting the 2025 target and thus are
off course to meet obesity targets if upward trends in
obesity continue unabated.
• For halting the rise in diabetes: Eight countries
had a probability of at least 0.5 of meeting the 2025
target among men: Australia, Belgium, Denmark,
Finland, Iceland, Nauru, Singapore and Sweden.
These are all high-income countries, except Nauru,
an upper-middle-income country in Oceania. Across
Asia, Africa, Latin America and North America, most
countries will fail to stem the rise in diabetes among
men unless something changes. Progress in halting
the rise in diabetes among women is slightly better:
26 countries have a probability of at least 0.5 of
meeting the target. These are Andorra, Australia,
Austria, Belgium, Brunei Darussalam, Canada,
Democratic People's Republic of Korea, Denmark,
Finland, France, Germany, Iceland, Israel, Italy, Japan,
Luxembourg, Malta, Nauru, Netherlands, Norway,
Portugal, Republic of Korea, Singapore, Spain,
Sweden and Switzerland.
The Global Nutrition Report publishes online
Nutrition Country Profiles for each of the 193 UN
countries. These have been refreshed in 2017 with
new data where available, and align with the data
used in this year’s report. The two-page documents
provide a snapshot of over 80 indicators of
nutrition status and determinants, food availability,
intervention coverage and policies that support
good nutrition for each of the 193 countries, as well
as for the 6 regions and 22 sub-regions.
The profiles are designed to help users easily view
and assess data, or the lack of it, on progress in
reducing malnutrition for a selected geography.
They enable nutrition champions to not only
advocate for greater action for nutrition, but also
support the work of other sectors. The profiles can
also help those working in related sectors to see
shared objectives and challenges, identify ways to
integrate nutrition in your work, and leverage the
multiplier effect that improved nutrition can have in
furthering your goals.
The data used in the profiles is collated from
publicly available datasets provided by numerous
agencies. Survey data is used where available and
methodologically sound, and modelled estimates
are used elsewhere if relevant. While other credible
datasets may be available at the country level,
those included in the profiles are compatible with
internationally agreed standards, allowing for
consistency and comparability across countries. For
more information on the sources and definitions
of the data used in the profiles, see the technical
notes on the Nutrition Country Profiles page of the
Global Nutrition Report website, where a link to
the underlying dataset used to compile individual
profiles can also be found.8
SPOTLIGHT 2.1 GLOBAL NUTRITION
REPORT’S NUTRITION COUNTRY PROFILES
Komal Bhatia and Tara Shyam

FIGURE 2.3: Progress towards global nutrition targets by number of countries in each
assessment category, 2017
Source: Authors using data from UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates 2017, Stevens GA et al, 2013 and NCD Risk
Factor Collaboration, 2017.9
Notes: N=193. Some targets are excluded from analysis as data needs further strengthening or methodological work before they can be used: low
birth weight, adolescent obesity, hypertension and salt intake. Data on anaemia among women of reproductive age is based on modelled estimates;
only 30 countries have at least one survey point after baseline (2012). See Appendix 1 and Spotlight 2.2 for more information.
8
20
31
29
18
49
7
7
24
163
181
189
189
137
16
16
21
9
4
4
4
4
7
150
146
136
142Stunting
Wasting
Overweight
EBF
Anaemia
Obesity, men
Obesity, women
Diabetes, men
Diabetes, women
NUMBER OF COUNTRIES CATEGORISED BY ASSESSMENT CATEGORY FOR GLOBAL TARGETS ON NUTRITION
26
On courseNo progress or worseningNo data/insufﬁcient trend data to make assessment Some progress

The methods used to assess global and country
progress towards MIYCN nutrition targets are
based on revised methodologies developed by
WHO and the United Nations Children’s Fund
(UNICEF) Technical Expert Advisory Group on
Nutrition Monitoring (TEAM).10
They are different to
those used in the Global Nutrition Report 2016.
The rules to track progress towards diet-related
NCD targets have also been modified based
on new data available and methodological
considerations. These methodological changes
present some challenges in maintaining continuity
and making comparisons with assessments in
previous reports. Yet the added value of having more
refined and robust rules to make fair and considered
assessments far outweigh the drawbacks.
Country-level assessments aim to make informed
judgements for countries that have adequate data
of high quality collected frequently. They endeavour
to reserve any unfair critique based on very old
prevalence data or highly unstable estimates of rate
of change which could lead to incorrect conclusions
about progress. Rather, the lack of sufficient data
at country level should spur action to collect
better and more frequent data to aid action
and accountability.
The Global Nutrition Report aims to assess progress
in relation to the baseline and/or target years
(‘endline’) as far as possible rather than compare
status to the previous year of reporting. This allows
us to take into account longer-term data trends
using all available information.
Appendix 1 gives full details of the new methods used
to assess progress towards global nutrition targets –
you are encouraged to refer to it to understand how
assessments were made.
SPOTLIGHT 2.2 METHODS TO TRACK
GLOBAL AND COUNTRY PROGRESS
Komal Bhatia
Prevalence and distribution
of malnutrition across regions
In thinking about universality, it is important to examine
the prevalence of the malnutrition burden, where
it exists and among which sub-populations within
countries. Even better would be to have subnational,
deeper disaggregated-level data to ensure that
no one is left behind. These data gaps are discussed in
the section Data needs for tracking progress towards
universal outcomes (Page 24).
Malnutrition among children
The number of children affected by stunting globally
has decreased drastically since 1990. But trends have
varied across regions, with the rate of decline being
unequal across regions and sub-regions. Africa is the
only region that has seen an increase in the number of
children stunted despite a decrease in the prevalence
of stunting. Together, Africa and Asia account for nearly
all the global burden of stunting (Figure 2.4a). In 2016,
two of every five of the world’s stunted children and
more than half of all wasted children lived in South Asia.
Over the same period, the number of children under
age 5 who are overweight has increased dramatically
worldwide (Figure 2.4b), with 40.6 million overweight in
2016.11
And more than 15% of children under age 5 in
South Asian countries were wasted in 2016 (27.6 million,
Figure 2.4c). This represents a critical public health
emergency (as prevalence more than 10% does) and
reflects a serious and pressing problem.

FIGURE 2.4: Children under 5 affected by a) stunting (1990–2016),
b) overweight (1990–2016) and c) wasting (2016) by region
47 48 50 53 56 59
190
160
134 117 103 87
14
12
11
9
7
6
0.3
0.4
0.4
0.5
0.5
0.5
0
50
100
150
200
250
300
1990 1995 2000 2005 2010 2016
MILLIONSOFCHILDREN
(a) STUNTING
Africa Asia LAC Oceania
MILLIONSOFCHILDREN
(b) OVERWEIGHT
Africa Asia LAC Oceania
6 6 7 7 8 10
16 15 14 15
17
20
4 4 4
4
4
0 0.1 0.1
0.1
0.1
0
5
10
15
20
25
30
35
40
45
50
1990 1995 2000 2005 2010 2016
4
0
(c) WASTING
7.9
7.3
5.5
6.5
3.9
3.8
1.9
15.4
8.9
9.4
1.3
3.0
0.9
0.5
Central
America
Caribbean
Southern
America
Western
Africa
Northern Africa
Middle
Africa
Southern
Africa
Eastern
Africa
Western
Asia
Southern
Asia
Southeastern
Asia
Oceania
Northern
America
Central
Asia Eastern
Asia
8.5
Critical: >15%
Serious: 10 to <15%
Poor: 5 to <10%
Acceptable: <5%
No data
Public health emergency line
Source: Map reproduced from UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates 2017.12
Notes: Europe and North America were not included in the figures because of a lack of data in the database (see also following section). Estimates for
Asia exclude Japan, and for Oceania exclude Australia and New Zealand. LAC: Latin America and the Caribbean.

No data
5–19.9%
20–39.9%
≥40%
Latest prevalence
(women aged 15–49 years)
Malnutrition among adults
Globally, 614 million women aged 15–49 years were
affected by anaemia. India had the largest number of
women impacted, followed by China, Pakistan, Nigeria
and Indonesia. In India and Pakistan, more than half
of all women of reproductive age have anaemia. It is a
global issue that many women in high-income countries
also suffer from; prevalence rates may be as high as 18%
in countries such as France and Switzerland (Figure 2.5).
As Figure 2.6 shows, obesity (body mass index (BMI)
≥30) is most common among North American men
(33%) and women (34%), and lowest among Asian and
African men (6%) and Asian women (9%). Overweight
and obesity are increasing in almost every country and
are a real concern in many low and middle-income
countries, not just high-income ones. The problem
affects more women than men in all the world’s regions,
reflecting a wider global gender disparity.
Source: Map reproduced from the World Health Organization Global Targets 2025 Tracking Tool.13
FIGURE 2.5: Prevalence of anaemia among women aged 15–49 years by country, 2016
Diabetes or raised blood glucose is most common
(10%) among Asian men and Latin American women,
and lowest (6%) among European and North American
women (Figure 2.7). Regional averages for raised
blood pressure among adult men and women aged
over 18 years in 2015 are shown in Figure 2.8.
Hypertension is most common (28%) among African
women and European men, and lowest (11%) among
North American women. A quarter of Asian and Latin
American men suffered from raised blood pressure
in 2015. While more women worldwide are affected
by obesity, the case for diabetes and hypertension is
mixed. There is more diabetes among men than women
in Asia, Europe, Northern America and Oceania, and
more hypertension among men than women in all
regions except Africa (Figure 2.8).

FIGURE 2.6: Prevalence of obesity (BMI ≥30)
among adults aged 18 years and over by
region, 2014
Source: Authors based on data from the World Health Organization
Global Health Observatory data repository and NCD Risk Factor
Collaboration.14
Notes: Population-weighted means for 189 countries. LAC: Latin
America and the Caribbean.
FIGURE 2.7: Prevalence of diabetes among
men and women aged 18 years and over
by region, 2014
Global Health Observatory data repository and NCD Risk Factor
Collaboration, 2016, 2017.15
6
16
6
9
21
23
19
27
33 34
25
28
0
10
20
30
40
PREVALENCE(%)
Africa Asia Europe LAC N America Oceania
ADULT OBESITY (BMI ≥30)
Men Women
8 8
10
9
7
6
9
10
8
6
9
8
0
2
4
6
8
10
PREVALENCE(%)
DIABETES/RAISED BLOOD GLUCOSE
Men Women
FIGURE 2.8: Prevalence of hypertension
among men and women aged 18 years
and over by region, 2015
Global Health Observatory data repository, Zhou B et al, 2017 and NCD
Risk Factor Collaboration, 2017.16
Notes: Population-weighted means for 189 countries. LAC: Latin
America and the Caribbean.
FIGURE 2.9: Mean intake of sodium by
region, 2010
Source: Authors based on data from Mozaffarian D et al, 2014 and
Powles J et al, 2013.17
Notes: Population-weighted means for 185 countries. Blue reference line
refers to World Health Organization-recommended intake of 2 g/day.18
LAC: Latin American and the Caribbean.
27 28
24
21
28
18
24
18
15
11
20
16
0
10
20
30
HYPERTENSION/RAISED BLOOD PRESSURE
PREVALENCE(%)
Men Women
2.7
4.3
4.0
3.5
3.6
3.2
0
1
2
3
4
G/DAY
MEAN POPULATION INTAKE OF SODIUM

FIGURE 2.10: Mean intake of sodium in 193
countries by intake band, 2010
Source: Authors, based on data from Mozaffarian D et al, 2014 and
Powles J et al, 2013.19
Notes: Data is for 2010.
The world consumes too much salt (Figure 2.10).
Intake varies by region but no region had intakes within
the WHO-recommended limits of 2 g/day of sodium
(Figure 2.9). Asia has the highest intake (4.3 g/day of
sodium), followed by Europe (4.0 g/day of sodium).
At national level, only seven countries (Burundi, Comoros,
Gabon, Jamaica, Kenya, Malawi and Rwanda) have
sodium intakes within desirable limits.
Data needs for tracking
progress towards universal
outcomes
This chapter, along with part of every Global Nutrition
Report, tracks progress against the country-level and
global nutrition targets. But the universality agenda
will not be achieved without filling data gaps. Some of
these gaps are about reporting on outcomes, but others
are to do with adequate coverage of key interventions
themselves, and ensuring that these interventions reach
those in need. Appendix 2 shows how countries are
doing in reaching their populations with the ‘essential
nutrition actions’ – interventions for undernutrition
delivered primarily through the health system. Previous
Global Nutrition Reports have, for example, highlighted
the lack of data reporting on low birth weight20
and how
data gaps vary across indicators.21
This year’s report
highlights that data is simply not available from most
countries to track the MIYCN targets (Figure 2.3).
In the context of universality, these data challenges are
hampering the ability to track universal outcomes. And
if we cannot track universal outcomes, we cannot hold
the world accountable for achieving them as part of the
SDG agenda. These challenges include the following,
which are then discussed in turn:
1. knowing who is included in progress (and who is
not) so we can track progress against leaving no one
behind. This requires disaggregated data
2. knowing how well high-income countries (as well as
low and middle-income countries) are doing, so to
ensure all countries are included
3. knowing what progress has been made in
addressing risk factors for nutrition (such as dietary
intake data or behavioural risk factors) across
sectors, to ensure integration (see Chapter 3).
7
127
51
8
MEAN POPULATION INTAKE OF SODIUM
≤2g
2 – ≤4g
>4g
No data

Global nutrition report 2017

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Global nutrition report 2017