title: Global Update and Trends of Hidden Hunger, 1995-2011: The Hidden Hunger Index.
abstract: BACKGROUND
  Deficiencies in essential vitamins and minerals-also termed hidden hunger-are pervasive and hold negative consequences for the cognitive and physical development of children.
  
  
  METHODS
  This analysis evaluates the change in hidden hunger over time in the form of one composite indicator-the Hidden Hunger Index (HHI)-using an unweighted average of prevalence estimates from the Nutrition Impact Model Study for anemia due to iron deficiency, vitamin A deficiency, and stunting (used as a proxy indicator for zinc deficiency). Net changes from 1995-2011 and population weighted regional means for various time periods are measured.
  
  
  RESULTS
  Globally, hidden hunger improved (-6.7 net change in HHI) from 1995-2011. Africa was the only region to see a deterioration in hidden hunger (+1.9) over the studied time period; East Asia and the Pacific performed exceptionally well (-13.0), while other regions improved only slightly. Improvements in HHI were mostly due to reductions in zinc and vitamin A deficiencies, while anemia due to iron deficiency persisted and even increased.
  
  
  CONCLUSIONS
  This analysis is critical for informing and tracking the impact of policy and programmatic efforts to reduce micronutrient deficiencies, to advance the global nutrition agenda, and to achieve the Millennium Development Goals (MDGs). However, there remains an unmet need to invest in gathering frequent, nationally representative, high-quality micronutrient data as we renew our efforts to scale up nutrition, and as we enter the post-2015 development agenda.
  
  
  BACKGROUND
  Preparation of this manuscript was funded by Sight and Life. There was no funding involved in the study design, data collection, analysis, or decision to publish.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Ruel-Bergeron
authors.affiliation: Department of Health Statistics and Information Services, The World Health Organization, Geneva, Switzerland.
authors.forename: Gretchen A
authors.initials: GA
authors.lastname: Stevens
authors.affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Sugimoto
authors.affiliation: DSM Nutritional Products, Kaiseraugst, Switzerland.
authors.forename: Franz F
authors.initials: FF
authors.lastname: Roos
authors.affiliation: Environmental and Global Health Research Group, Imperial College, London, United Kingdom.
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.|Sight and Life, Kaiseraugst, Switzerland.
authors.forename: Klaus
authors.initials: K
authors.lastname: Kraemer
mesh_terms: D001361:Avitaminosis / Q000453:epidemiology* / Q000266:history; D003677:Deficiency Diseases / Q000453:epidemiology* / Q000266:history; D014943:Global Health; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008903:Minerals; D062486:Public Health Surveillance
chemical_list: D008903:Minerals