Annex II DEFINITIONS OF INDICATORS

Adult obesity

The body mass index (BMI) is the ratio of weight-to-height commonly used to classify the nutritional status of adults. It is calculated as the body weight in kilograms divided by the square of the body height in metres (kg/m2). Obesity is considered present in individuals with a BMI equal to or higher than 30 kg/m2.

Data source: WHO. 2020. Global Health Observatory (GHO) data repository. In: WHO. [Cited 28 April 2020]. https://apps.who.int/gho/data/node.main.A900A?lang=en

Anaemia in women aged 15 to 49 years

This indicator considers the percentage of women aged 15-49 years with a haemoglobin concentration less than 120 g/L (for non-pregnant women and lactating women) or less than 110 g/L (for pregnant women), adjusted for altitude and smoking.

Data sources: WHO. 2021. Vitamin and Mineral Nutrition Information System (VMNIS). In: WHO. Geneva, Switzerland. Cited 25 May 2021. www.who.int/teams/nutrition-and-food-safety/databases/vitamin-and-mineral-nutrition-information-system

WHO. 2021. Global anaemia estimates, Edition 2021. In: WHO I Global Health Observatory (GHO) data repository. [Cited 20 April 2023] www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children

Cost and affordability of a healthy diet

The cost of a healthy diet indicator represents the cost of purchasing the least expensive locally available foods to meet the requirements for energy and food-based dietary guidelines for a representative person within energy balance at 2 330 kcal/day. The cost of a healthy diet is converted to international dollars using purchasing power parity (PPP).

The affordability of a healthy diet indicator measures the percentage and the number of the total population unable to afford a healthy diet. A healthy diet is considered unaffordable in a country when its cost exceeds 52 percent of household income. This percentage accounts for a portion of income that can be credibly reserved for food, based on observations that the population in low-income countries spend, on average, 52 percent of their income on food, as derived from the 2017 national accounts household expenditure data of the World Bank’s International Comparison Programme. Income data are provided by the World Bank’s Poverty and Inequality Platform.

Data source: FAO. 2023. Cost and Affordability of a Healthy Diet (CoAHD). In: FAOSTAT. Rome. [Cited July 2023]. https://www.fao.org/faostat/en/#data/CAHD

Exclusive breastfeeding

Exclusive breastfeeding for infants under 6 months of age is defined as receiving only breastmilk and no additional food or drink, not even water. Exclusive breastfeeding is a cornerstone of child survival. Breastmilk is the best food for newborns, as it shapes the baby’s microbiome, strengthens the immune system and reduces the risk of developing chronic diseases. Breastfeeding also benefits mothers by preventing postpartum haemorrhaging and promoting uterine involution, decreasing the risk of iron-deficiency anaemia, reducing the risk of various types of cancer, and providing psychological benefits.

Data source: UNICEF. 2022. Infant and young child feeding. In: UNICEF. [Cited 6 April 2023]. https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/

Food insecurity as measured by the Food Insecurity Experience Scale

Food insecurity as measured by the Food Insecurity Experience Scale (FIES) indicator refers to limited access to food, at the level of individuals or households, due to a lack of money or other resources. The severity of food insecurity is measured using data collected with the FIES survey module (FIES-SM), a set of eight questions asking respondents to self-report conditions and experiences typically associated with limited access to food. For purposes of annual Sustainable Development Goal (SDG) monitoring, the questions are asked with reference to the 12 months preceding the survey.

FAO provides estimates of food insecurity at two levels of severity: moderate or severe food insecurity and severe food insecurity. People affected by moderate food insecurity face uncertainties about their ability to obtain food and have been forced to reduce, at times during the year, the quality and/or quantity of food they consume due to a lack of money or other resources. Severe food insecurity refers to situations in which individuals have likely run out of food, experienced hunger and, at the most extreme, gone for days without eating. The prevalence of moderate or severe food insecurity is the combined prevalence of food insecurity at both severity levels.

Data source: FAO. 2023. Suite of Food Security Indicators. In: FAOSTAT. Rome. [Cited July 2023]. https://www.fao.org/faostat/en/#data/FS

Low birthweight

Low birthweight is defined as a weight at birth of less than 2 500 g (less than 5.51 lbs), regardless of gestational age. A newborn’s weight at birth is an important marker of maternal and foetal health and nutrition.

Data source: UNICEF & WHO. 2023. Low birthweight joint estimates 2023 edition. [Cited 12 July 2023]. www.who.int/teams/nutrition-and-food-safety/monitoring-nutritional-status-and-food-safety-and-events/joint-low-birthweight-estimates

Stunting, wasting and overweight in children under 5 years of age

Stunting (children under 5 years of age): Height/length (cm) for age (months) < -2 standard deviations of the WHO Child Growth Standards median. Low height-for-age is an indicator that reflects the cumulative effects of undernutrition and infections since and even before birth. It may be the result of long-term nutritional deprivation, recurrent infections, and lack of water and sanitation infrastructures. Stunted children are at greater risk for illness and death. Stunting often adversely affects the cognitive and physical growth of children, making for poor performance in school and reduced intellectual capacity.

Prevalence cutoff values for public health significance are as follows: very low <2.5 percent; low 2.5-<10 percent; medium 10-<20 percent; high 20-<30 percent; very high >=30 percent.

Wasting: Weight (kg) for height/length (cm) < -2 standard deviations of the WHO Child Growth Standards median. Low weight-for-height is an indicator of acute weight loss or a failure to gain weight and can be the result of insufficient food intake and/or an incidence of infectious diseases, especially diarrhoea. Wasting indicates acute malnutrition and increases the risk of death in childhood from infectious diseases such as diarrhoea, pneumonia and measles.

Prevalence cutoff values for public health significance for wasting are as follows: very low <2.5 percent; low 2.5-<5 percent; medium 5-<10 percent; high 10-<15 percent; very high >=15 percent.

Overweight: Weight (kg) for height/length (cm) > +2 standard deviations of the WHO Child Growth Standards median. This indicator reflects excessive weight gain for height generally due to energy intakes exceeding children’s energy requirements. Childhood overweight and obesity are associated with a higher probability of overweight and obesity in adulthood, which can lead to various non-communicable diseases, such as diabetes and cardiovascular diseases.

Prevalence cutoff values for public health significance for child overweight are as follows: very low <2.5 percent; low 2.5-<5 percent; medium 5-<10 percent; high 10-<15 percent; very high >=15 percent.

Data source: UNICEF, WHO & The World Bank. 2023. UNICEF-WHO-The World Bank: Joint child malnutrition estimates - Levels and trends (2023 edition). [Cited 24 April 2023]. https://data.unicef.org/resources/jme-report-2023

Undernourishment

Undernourishment is defined as the condition of an individual whose habitual food consumption is insufficient to provide, on average, the amount of dietary energy required to maintain a normal, active and healthy life. The indicator is reported as a prevalence and is denominated as “prevalence of undernourishment," which is an estimate of the percentage of individuals in the total population who are in a condition of undernourishment.

Data source: FAO. 2023. Suite of Food Security Indicators. In: FAOSTAT. Rome. [Cited July 2023]. https://www.fao.org/faostat/en/#data/FS