A retrospective analysis of nutritional security in the Republic of Moldova

Journal of Social Sciences Vol. VIII, no. 1 (2025), pp. 105 - 115 Fascicle Social Science ISSN 2587-3490 Topic Sociology eISSN 2587-3504 Journal of Social Sciences March, 2025, Vol. 8 https://doi.org/10.52326/jss.utm.2025.8(1).07 UDC 338.439.02:; 613.2(478)"; 2015/2024" A RETROSPECTIVE ANALYSIS OF NUTRITIONAL SECURITY IN THE REPUBLIC OF MOLDOVA Rodica Siminiuc *, ORCID: 0000-0003-4257-1840, Dinu Țurcanu, ORCID: 0000-0001-5540-4246, Sergiu Siminiuc, ORCID: 0000-0002-1531-1560 Technical University of Moldova, 168, Stefan cel Mare Blvd, Chisinau, Republic of Moldova * Corresponding author: Rodica Siminiuc, rodica.simini[email protected]tm.md Received: 02. 24. 2025 Accepted: 03. 22. 2025 Abstract. Nutritional security is crucial for public health in Moldova, a country facing a dual burden of malnutrition - undernutrition alongside rising obesity and non-communicable diseases (NCDs). Despite progress in food availability, challenges in dietary quality and health outcomes remain. This study evaluates Moldova's nutritional profile using national and international data. The main goal is to assess the current state of nutritional security in Moldova, identify policy and data gaps, and propose recommendations to improve dietary quality and combat NCDs through effective policies and data-driven actions. A systematic review of reports from international organizations, such as the Global Nutrition Report (GNR) and The State of Food Security and Nutrition in the World (SOFI), as well as national policy documents, was conducted for the period 2015–2024. Key indicators such as food insecurity, obesity, anemia, and micronutrient deficiencies were analyzed. The effectiveness of national programs like the National Program in the Field of Food and Nutrition (2014–2020) was also assessed. Moldova shows high rates of food insecurity (24.7%), anemia in women (26.1%), and obesity (23.0% in 2022). Fragmented data and the lack of a centralized monitoring system hinder progress. Addressing Moldova's nutritional challenges requires a centralized monitoring system, improved data collection, and a comprehensive national nutrition strategy aligned with global standards. Keywords: anemia, food insecurity, national nutrition strategy, non-communicable diseases, obesity, public health. Rezumat. Securitatea nutrițională este esențială pentru sănătatea publică în Republica Moldova, o țară care se confruntă cu o dublă povară a malnutriției - subnutriție, alături de creșterea obezității și a bolilor netransmisibile (BNT). În ciuda progreselor în disponibilitatea alimentelor, persistă provocări legate de calitatea alimentației și rezultatele în materie de sănătate. Acest studiu evaluează profilul nutrițional al Moldovei, utilizând date naționale și internaționale. Scopul principal este de a evalua starea actuală a securității nutriționale în Moldova, identificând lacunele din politici și date, și de a propune recomandări pentru îmbunătățirea calității alimentației și combaterea BNT prin politici eficiente și acțiuni bazate 106 R. Siminiuc, D. Țurcanu, S. Siminiuc Journal of Social Sciences March, 2025, Vol. 8 pe date concrete. A fost realizată o revizuire sistematică a rapoartelor organizațiilor internaționale, precum Global Nutrition Report (GNR) și The State of Food Security and Nutrition in the World (SOFI), precum și a documentelor de politici naționale, pentru perioada 2015– 2024. Au fost analizați indicatori-cheie precum insecuritatea alimentară, obezitatea, anemia și deficiențele de micronutrimente. Eficiența programelor naționale, cum ar fi Programul Național în Domeniul Alimentației și Nutriției (2014–2020), a fost de asemenea evaluată. Moldova prezintă rate ridicate de insecuritate alimentară (24,7%), anemie la femei (26,1%) și obezitate (23,0% în 2022). Fragmentarea datelor și lipsa unui sistem centralizat de monitorizare împiedică progresul. Abordarea provocărilor nutriționale ale Moldovei necesită un sistem centralizat de monitorizare, îmbunătățirea colectării datelor și o strategie națională cuprinzătoare în domeniul nutriției, aliniată la standardele globale. Cuvinte cheie: anemie, insecuritate alimentară, strategie nutrițională națională, boli netransmisibile, obezitate, sănătate publică. 1. Introduction Nutritional insecurity is increasingly recognized as a key determinant of human development, affecting public health and societal well-being globally development [1,2]. The ongoing global nutrition crisis has brought to light the fragility of food systems and the increasing prevalence of all forms of malnutrition, including hunger, micronutrient deficiencies, and obesity [3,4]. These issues are exacerbated by inequities in access to nutritious food, particularly in developing and transition economies like the Republic of Moldova, where the challenges of ensuring nutritional security are multifaceted and deeply rooted in systemic economic, social, and political factors. Globally, various strategies and interventions have been implemented to address food insecurity and malnutrition, with an emphasis on promoting sustainable agri-food systems, enhancing policy frameworks, and improving public health through nutrition [5–7]. However, the Republic of Moldova has seen limited progress in aligning its national policies with international goals, such as the Sustainable Development Goals (SDGs), particularly SDG 2 (Zero Hunger) and SDG 3 (Good Health and Well-being). The country's inclusion in a few international food security reports reveals fragmented data and inconsistent progress in addressing key nutrition indicators [8]. Despite some improvements in food availability and access, the double burden of malnutrition in Moldova - where undernutrition and obesity coexist - reflects deeper issues in diet quality and public health. Moldova’s food security is often evaluated in terms of caloric intake rather than nutritional quality, leading to a lack of focus on addressing micronutrient deficiencies and chronic diseases associated with poor dietary habits. Recent data from international reports indicate high rates of anemia in women, rising obesity prevalence, and continued food insecurity in significant portions of the population [8,9]. The purpose of this study is to conduct a comprehensive evaluation of the nutritional profile of the Republic of Moldova, using both national and international sources. By assessing the nutritional security landscape through a systematic review of reports and policy frameworks, this research aims to identify the gaps, challenges, and opportunities for improving diet quality, food security, and public health outcomes in Moldova. This research is particularly relevant in the context of Moldova’s ongoing struggles with nutritional security, as the country faces a growing public health burden related to both malnutrition and non-communicable diseases (NCDs). Although some progress has been A retrospective analysis of nutritional security in the Republic of Moldova 107 Journal of Social Sciences March, 2025, Vol. 8 made in food availability and caloric intake, there has been limited attention paid to improving the nutritional quality of diets. Furthermore, the lack of a centralized, coordinated entity responsible for monitoring and evaluating food and nutrition security hinders the country’s ability to address these challenges effectively. The novelty of this study lies in its comprehensive approach to analyzing both national and international data sources, combining a detailed review of international food security assessments with an in-depth evaluation of Moldova’s national policies and programs. By doing so, this research provides a holistic view of the nutritional challenges facing Moldova and offers recommendations for policy improvements. The study also highlights the need for improved data collection and monitoring systems to ensure that future interventions are informed by accurate, up-to-date information on dietary trends and nutritional outcomes. In light of the global focus on achieving food security and improving public health, this study aims to contribute to the understanding of Moldova’s unique nutritional challenges. The findings are expected to inform policy recommendations and contribute to the development of more effective national strategies for addressing nutritional insecurity. Furthermore, the research highlights the critical need for coordinated action at the national level to align Moldova’s food security goals with global targets. 2. Research methodology This study aimed to evaluate the nutritional profile of the Republic of Moldova, utilizing a systematic review of reports and data from both global and national platforms. The review focused on food and nutritional security indicators, assessing their representation in international and national reports. The review was conducted between March 2022 and May 2024. Data Sources. Data was gathered from the official websites of relevant international organizations, including Food and Agriculture Organization (FAO), United Nations International Children's Emergency Fund (UNICEF), International Fund for Agricultural Development (IFAD), World Food Programme (WFP), World Health Organization (WHO), the Global Food Security Index (GFSI) [10], and other national entities. A comprehensive review of available reports and platforms was conducted, as outlined in Table 1. These included notable reports such as The State of Food Security and Nutrition in the World (SOFI), the Global Nutrition Report (GNR), and the Global Report on Food Crises (GRFC). These sources were chosen for their authoritative standing in assessing food and nutritional security, with particular attention to the Republic of Moldova's inclusion in their evaluations. Table 1 International organizations that assess food and nutritional security Reports and platform Managing entity Last update Number of countries evaluated Targets 1. The State of Food Security and Nutrition in the World (SOFI) [11]. FAO, UNICEF, IFAD, WFP, WHO etc. 2024 119 Food and nutrition security. Nutrition targets: prevalence of undernourishment; moderate or severe food insecurity, selected forms of malnutrition, exclusive breastfeeding and low birthweight. 108 R. Siminiuc, D. Țurcanu, S. Siminiuc Journal of Social Sciences March, 2025, Vol. 8 Continuation Table 1 2. Global Nutrition Report (GNR) [12]. The government of Japan, the SUN Movement, the WHO, UNICEF, USAID etc. 2022 195 A platform for registering SMART nutrition commitments and monitoring nutrition action. Nutritional security: Chilldhood stunting; Anaemia; Low birth weight; Childhood overweight; Exclusive breastfeeding; Childhood wasting; Sodium intake, Raised blood pressure, Obesity, Diabet (women and men). 3. Global Report on Food Crises (GRFC) [13]. FAO, IFPRI, WFP, UNICEF Food Security Cluster etc. 46 (from 2023) Food security and malnutrition in countries/territories identified as being in a food crisis in 2023. Moldova was selected for inclusion in the GRFC 2024 but did not have data that met GRFC technical requirements. 4. European Health Information Gateway [14]. WHO 2015 53 The indicators explorer contains indicators from WHO Europe’s Health for All family of databases. WHO Europe collects the data in collaboration with the Member States in the WHO European region, and from other relevant international data sources. Note: FAO-Food and Agriculture Organisation of the United Nation; IFPRIInternational Food policy Research Institute; GNRGlobal, Nutrition Report; WFPWorld Food Programme; UNICEF - The United Nations International Children's Emergency Fund; IFAD - International Fund for Agricultural Development; SUN - Scale Up Nutrition Framework; USAID - United States Agency for International Development. National Policy Review. In parallel, we conducted a thorough review of national policies, strategies, and programs aimed at addressing food and nutritional security in Moldova (Table 2). Key documents included the National Program in the Field of Food and Nutrition, the National Development Plan for 2023-2025, and the Food Security Strategy of Moldova for 2023-2030. These documents were analyzed to identify key policy measures, strategic objectives, and the overall approach of Moldova toward ensuring food security and improving public health outcomes. Table 2 National normative acts analyzed to identify the state of nutritional security in the Republic of Moldova No. Normative acts, strategies Sources 1. World Bank and World Food Program (WFP) report, 2015 [15] 2. Voluntary National Progress Report on the Implementation of the 2030 Agenda [16] 3. Food Security Strategy in the Republic of Moldova 2023-2030 [17] 4. National program in the field of food and nutrition [18] 5. The national development plan for the years 2023-2025 [19] 6. Government activity program "Prosperous, safe, European Moldova" [20] 7. Moldova 2030 national development strategy [21,22] 8. National health policies [23] 9. "One fruit a day" program [17] 10. STEP 2014 and 2021 reports [24,25]23/04/2025 10:16:00 A retrospective analysis of nutritional security in the Republic of Moldova 109 Journal of Social Sciences March, 2025, Vol. 8 Evaluation Criteria. The evaluation focused on key nutrition security indicators such as food availability, accessibility, and utilization, alongside specific health outcomes like malnutrition, obesity, and anemia. The study also considered Moldova’s progress in meeting international nutrition targets, including those set forth in the SDGs related to food security and health (SDG 2 and SDG 3). Time Frame. The data reviewed spanned the years 2015 to 2024, with particular emphasis on data updated as of 2023 and 2024. Data gaps and inconsistencies were noted, particularly where information on Moldova was limited or fragmented. 3. Results 3.1. The nutritional profile of the Republic of Moldova through the lens of international organizations The Republic of Moldova is featured in a limited number of international reports concerning food and nutritional security. However, several key reports and platforms do provide valuable insights. These include the GNR, the SOFI, and the Global Report on Food Crises (GRFC) (Table 1) [7,11,12]. In the 2024 SOFI Report, the Republic of Moldova exhibited a moderate or severe food insecurity rate of 24.7%, a value that places it among the most food-insecure countries in Eastern Europe. Among 10 Eastern European nations, only Ukraine surpasses Moldova’s food insecurity rate (31.0%). Additionally, the report highlights Moldova's alarmingly high anemia prevalence among women, which stands at 26.1%, the highest in the region [13]. Figure 1. The prevalence of food and nutritional security indicators in the Republic of Moldova (Global Network Against Food crises, 2024). Prevalence of undernourishment, prevalence of severe and moderate FI - average values for the years 2021-2023. Prevalence of wasting, stunting, overweight in children - values for the year 2022; prevalence of obesity in the adults - values for the year 2022; prevalence of anemia in the women - values for the year 2022; prevalence of low birth weight; FI - food insecurity. 2,5 5,3 24,7 3,9 2,9 23 26,1 6,5 2,5 1,8 10,6 5,3 7,4 25,5 20,5 7 % Republic of Moldova Eastern Europe 110 R. Siminiuc, D. Țurcanu, S. Siminiuc Journal of Social Sciences March, 2025, Vol. 8 The incidence of obesity among adults in Moldova has also seen a significant rise. Data from 2022 shows that the obesity rate increased from 18.9% in 2021 to 23.0%, surpassing the European average of 21.4%, though still lower than the Eastern European average of 25.5%. This trend underscores a growing public health challenge concerning lifestyle-related diseases such as obesity and the associated risk of non-communicable diseases (NCDs) (Figure 1). Despite this, international organizations working with Moldova frequently operate with outdated data. For example, current global reports often rely on data from 2016 for obesity and overweight metrics due to the unavailability of updated national data. For subsequent years (2021–2022), estimates were made using predictive models, further emphasizing the need for more accurate and updated data collection systems. The GNR, which serves as an independent assessment of global nutrition progress, indicates that Moldova is "on track" to meet several targets in maternal nutrition, as well as infant and young child nutrition [12,26]. Nevertheless, significant disparities remain in various nutrition-related indicators, particularly regarding malnutrition and micronutrient deficiencies [12,26,27]. Data gaps and limitations. One major limitation identified in this review is the fragmented nature of data pertaining to Moldova’s nutrition and health indicators. Data collected by UNICEF, WHO, and other international entities is often incomplete, and many important indicators, such as childhood obesity and stunting, have not been systematically updated since 2015. This lack of updated, robust data complicates efforts to monitor Moldova’s progress toward global nutrition and food security targets. 3.2. The nutritional profile of the Republic of Moldova through the lens of national organizations Within the Republic of Moldova, there is no singular entity responsible for the comprehensive evaluation and monitoring of nutritional security. Data concerning various nutritional indicators is fragmented, and in several instances, lacks the robustness necessary for informed decision-making. Several national policies, strategies, and programs have been established to address food and nutritional security; however, their implementation remains inconsistent (Table 2). A notable example is the 2015 report by the World Bank and WFP, which provides one of the most comprehensive assessments of Moldova’s food security at the national level [15]. This report highlighted Moldova's progress in reducing malnutrition, particularly in ensuring adequate intake of proteins, carbohydrates, and overall caloric intake. Despite these advancements, the report also raised concerns about the excessive intake of fats, which remains a critical risk factor for chronic diseases in the population [8]. More recently, the 2021 population study (WHO STEPS) conducted by the Ministry of Health in collaboration with the World Health Organization (WHO) and with financial support from the World Bank, focused on non-communicable disease (NCD) risk factors among adults aged 18-69 years. The study reported that 63.4% of the population consumed fewer than five servings of fruits and vegetables per day, significantly below the WHO recommendations. This dietary pattern places the population at increased risk for NCDs such as hypertension, diabetes, and obesity [24,28]. A retrospective analysis of nutritional security in the Republic of Moldova 111 Journal of Social Sciences March, 2025, Vol. 8 In addition to these reports, the Voluntary National Progress Report on the Implementation of the 2030 Agenda (2021) noted that while Moldova’s national political agenda partially aligns with the SDGs, the specific goals related to nutrition (SDG 2: Zero Hunger and SDG 3: Good Health and Well-being) have seen only moderate progress [16]. Notably, the report indicates that reforms and interventions related to SDG 2 (nutrition) were not thoroughly addressed. The Food Security Strategy for 2023-2030, while making some mention of nutrition, focuses primarily on strategic food security aspects, particularly those related to food availability and access. The specific nutrition-related objective concerning the “utilization of food” is not comprehensively covered. This omission leaves significant gaps in Moldova's efforts to address the broader dimensions of nutritional security, including food quality and dietary health [17]. Among the programs targeting population-level nutritional improvements is the “One Fruit a Day” program, designed to improve dietary diversity and support local agricultural producers. This program aimed at ensuring combined benefits for vulnerable groups by promoting the consumption of local, nutritious produce. While well-intentioned, evaluations show that Moldova's nutritional policies are not sufficiently aligned to promote healthy diets at a national level. In some cases, these policies may even undermine nutritional security efforts (Figure 1), as they fail to address the broader issues of dietary quality and food consumption patterns. 3.3. National Policies and Strategic Frameworks National Program in the Field of Food and Nutrition (2014-2020): This program was introduced to enhance strategic planning in the areas of food safety and nutrition. The program aimed to reduce the consumption of saturated fats by 3%, added sugars by 5%, and salt by 30%, with expected outcomes such as lowering systolic blood pressure (SBP) by 2-3 mmHg, cholesterol by 5%, and blood glucose by 5%. However, the program's targets were not fully achieved by the end of the period, and no clear updates or new initiatives have been introduced to extend or replace it since its conclusion (Table 3). Table 3 The dynamics of some indicators - risk factors of NCDs in the Republic of Moldova Indicators 2013 year 2021 year Reference values DBP 85.0 mm/Hg 84.2 mm/Hg 80 mm/Hg SBP 132.8 mm/Hg 129.2 mm/Hg 120 mm/Hg Blood glucose 5.2 mmol/L 5.3 mmol/L 5.6 mmol/L Total cholesterol 4.5 mmol/L 4.4 mmol/L 5.0 mmol/L Note: DBPdiastolic blood pressure; SBPsystolic blood pressure. Sources: [24,25] National Development Plan for 2023-2025. This plan focuses on key development priorities, including public health and food security, yet nutrition is mentioned only tangentially. The emphasis is placed on creating an inclusive social protection system that addresses malnutrition among children in kindergartens and nursery schools. Although the plan touches upon nutrition, it lacks a comprehensive strategy for addressing broader issues of nutritional security (Table 2) [19]. The government activity program "Prosperous, safe, European Moldova". Approved in 2023, this program outlines the Government’s vision for improving Moldova’s overall prosperity and security. Despite its broad scope, the program does not set any explicit targets 112 R. Siminiuc, D. Țurcanu, S. Siminiuc Journal of Social Sciences March, 2025, Vol. 8 for nutritional improvement. Instead, its focus remains on economic modernization and infrastructure development, which are indirectly linked to food security and health. The absence of specific nutritional goals reveals a gap in the program’s ability to address malnutrition and dietary quality in a targeted manner [20]. The Moldova 2030 national development strategy. This strategy includes ten dimensions aimed at improving the quality of life for Moldovans, but it does not include a separate objective regarding nutrition. However, it indirectly touches upon nutrition within the dimension of physical and mental health, emphasizing the prevention of diseases related to unhealthy eating and promoting healthy behaviors. This lack of direct focus on nutrition suggests that while the strategy aims to improve health, it falls short in addressing specific nutritional challenges [8,21]. National health policies. First established in 2007, the National Health Policy of Moldova highlights nutrition as a critical factor in public health. The policy prioritizes the nutrition of vulnerable groups, including infants, preschoolers, and adolescents, by encouraging balanced diets in educational institutions and public awareness campaigns on healthy eating. The promotion of rational nutrition is outlined through various initiatives, such as the creation of a national food pyramid. However, many of these objectives remain outdated and in need of revision to reflect current global dietary guidelines [23]. 4. Discussions The nutritional profile of the Republic of Moldova, as evaluated through both national and international lenses, reveals significant challenges and gaps in the country's approach to achieving food and nutritional security. While various national programs and international assessments highlight certain progress in areas such as food availability and caloric intake, deeper issues persist related to dietary quality, malnutrition, and non-communicable diseases (NCDs). One of the key findings from both national and international reports is the persistent issue of malnutrition, particularly regarding micronutrient deficiencies and the high prevalence of anemia among women. This problem is compounded by the country's rising rates of obesity and diet-related NCDs, which suggests a dual burden of malnutrition where undernutrition and overnutrition coexist. The SOFI Report (2024) and the Global Nutrition Report (GNR) underscore Moldova’s struggles with food insecurity, as evidenced by the 24.7% moderate or severe food insecurity rate and the alarming anemia rates, which are among the highest in Eastern Europe. These trends indicate that despite improvements in food availability, the quality of diets remains poor. National efforts, such as the National Program in the Field of Food and Nutrition (2014-2020), were intended to address these dietary imbalances. However, the program's results fell short of expectations, and its termination without clear continuity indicates a lack of sustained commitment to addressing nutritional health in the country. The absence of updated or extended programs since 2020 leaves a critical policy gap that needs to be addressed. Although the program aimed to reduce the intake of unhealthy nutrients like fats, sugars, and salt, its impact on actual dietary changes appears limited, as evidenced by the continued rise in obesity rates. Additionally, the fragmented nature of data collection regarding nutrition in Moldova presents a significant barrier to assessing the full extent of the problem. Reports from international organizations often rely on outdated data, with some key indicators, such as A retrospective analysis of nutritional security in the Republic of Moldova 113 Journal of Social Sciences March, 2025, Vol. 8 childhood obesity and stunting, lacking updates since 2015. This data fragmentation complicates efforts to monitor progress and limits the ability of national policymakers to develop effective interventions based on current trends. Improving data collection systems and ensuring more frequent updates is essential for effective policymaking. The national strategies that address food security, such as the Food Security Strategy for 2023-2030 and the National Development Plan for 2023-2025, reflect the government's focus on broader food security goals. However, these strategies often neglect the utilization dimension of food security, which pertains to the nutritional quality and health impacts of the food consumed. While there is some mention of improving food access, the absence of specific, measurable targets related to nutrition highlights a critical gap in the current strategic approach. The government’s “One Fruit a Day” program, although aimed at improving dietary diversity and supporting local agriculture, remains insufficient in addressing the broader challenges of dietary quality at a national level. Furthermore, the National Health Policy, which promotes rational nutrition and targets vulnerable populations such as children and adolescents, also requires modernization. Many of the policy’s objectives, established in 2007, are now outdated and do not fully align with current global dietary guidelines. This misalignment suggests that Moldova’s public health efforts are not adequately addressing the emerging trends in diet-related diseases or the growing burden of NCDs. 5. Conclusions This study provides a comprehensive evaluation of the nutritional profile of the Republic of Moldova through both national and international assessments. The findings reveal that while Moldova has made strides in improving food availability and caloric intake, significant challenges persist in ensuring nutritional security. The double burden of malnutrition - the coexistence of undernutrition and obesity - remains a critical issue, driven by poor dietary quality and a fragmented approach to nutritional policy. One of the key insights from this analysis is the urgent need for coordinated national efforts to improve data collection and monitoring systems. Current data on nutrition in Moldova is often outdated or incomplete, hindering the development of effective, evidencebased policies. Establishing a centralized body responsible for overseeing nutrition-related programs and tracking national progress is essential to addressing these challenges. Moreover, the study highlights the gaps in national policies, such as the National Program in the Field of Food and Nutrition (2014-2020), which, although well-intentioned, has not fully achieved its goals. The lack of subsequent initiatives to replace or extend this program leaves Moldova vulnerable to the continued rise of non-communicable diseases (NCDs) such as obesity, hypertension, and diabetes. This research underscores the importance of addressing diet quality, particularly focusing on micronutrient deficiencies and promoting healthy eating habits. Current government strategies, including the National Development Plan for 2023-2025 and the Food Security Strategy for 2023-2030, do not sufficiently prioritize nutrition, which leaves significant gaps in tackling malnutrition and improving public health outcomes. To achieve its national and international nutrition targets, Moldova must adopt a multisectoral approach that involves all relevant stakeholders, from government and civil society to international organizations. The development of a comprehensive national nutrition strategy, coupled with robust data systems and targeted interventions, is critical to