While Cambodia has taken significant strides to reduce hunger, for the millions still affected, not having food to eat is becoming less of a problem than consuming enough nutrients.

In the latest Global Hunger Index, Cambodia was one of 10 countries lauded for making the largest improvements in its hunger situation since 1990, dropping from “extremely alarming” levels to “serious”.

But while rates of starvation may be declining, and caloric intake may be reaching appreciable figures, Cambodia continues to suffer a stubbornly persistent and devastating “hidden hunger” crisis, the annual index being launched in the capital today reports.

Hidden hunger, a form of malnutrition caused by deficiencies of vitamins and minerals, impairs physical and intellectual growth, weakens the immune system, saps energy and can result in death.

“Where hidden hunger has taken root, it not only prevents people from surviving and thriving as productive members of society, it also holds countries back in a cycle of poor nutrition, poor health, lost productivity, persistent poverty and reduced economic growth,” the index says.

The serious, and often irreversible, consequences of the micronutrient deficiencies afflict more than two billion, or almost one in three people, globally. Children and women tend to bear the brunt of the effects.

“When we think about suffering from hunger the common image is skinny arms and huge bellies, but [hidden hunger] isn’t something you would normally see the effects of at first glance,” said Simone Pott, a spokesperson for Welthungerhilfe, one of the organisations responsible for compiling the index. “It’s difficult to address in part because many people don’t know that they and their children are affected.”

Feeding the population is no longer just a matter of growing and consuming enough food. Cambodia annually produces more than needed to meet the calorie requirements of its

population.

Access to food, however, “is unevenly distributed and public policies still focus on quantity (energy supply) while investments in … improving the quality of diets and access to sanitation are lagging behind.”

“On a national level we have a food surplus, but on the house-to-house level we’re seeing insufficient food varieties and problems with nutrition,” said Sok Silo, deputy director-general of the Council for Agricultural and Rural Development.

Despite robust growth, Cambodia continues to be home to one of the world’s highest rates of chronically malnourished and stunted children under the age of 5.

“For children, it’s very difficult to consume all the essential nutrients needed, and in developing countries … people do not have the means to realistically buy all the nutrients for a healthy and balanced diet,” said Edith Heines, deputy country director at the World Food Programme Cambodia.

Poverty is a major factor inhibiting access to nutritious foods, but is not the sole story. Even among the country’s wealthiest quintile, stunting affects more than 23 per cent of children.

A common factor leading to hidden hunger, diets based mostly on staple crops such as rice provide large quantities of energy, but relatively low amounts of essential vitamins and minerals.

The prevalence of micronutrient deficiencies and the kinds of micronutrients missing from the average Cambodian diet remain unknown. However, the most common deficiencies globally include iodine, iron and zinc.

Fortification, adding micronutrients back into processed foods, is one of the central strategies developing countries including Cambodia have used to combat the problem.

In 2004, the government made it illegal to produce, import or sell non-iodised salt, and rates of goitre plummeted, according to the World Bank.

But Cambodia lacks the capacity to mass produce fortified foods, which cannot, on their own, solve the vitamin and mineral gaps.

“The more long-term interventions have to encourage education and include agriculture and public health measures,” said Pott of Welthungerhilfe. “Eliminating hidden hunger will require getting involved at the community level and changing day-to-day eating and sanitation habits.”