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Keith P. West

Bio: Keith P. West is an academic researcher from Johns Hopkins University. The author has contributed to research in topics: Population & Vitamin. The author has an hindex of 65, co-authored 368 publications receiving 16092 citations. Previous affiliations of Keith P. West include Tufts University & University of California, Davis.


Papers
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Journal ArticleDOI
TL;DR: It is widely accepted that intervention in the first 1,000 days is critical to break the cycle of malnutrition; however, a coordinated, sustainable commitment to scaling up nutrition at the global level is still needed.
Abstract: Micronutrients are essential to sustain life and for optimal physiological function. Widespread global micronutrient deficiencies (MNDs) exist, with pregnant women and their children under 5 years at the highest risk. Iron, iodine, folate, vitamin A, and zinc deficiencies are the most widespread MNDs, and all these MNDs are common contributors to poor growth, intellectual impairments, perinatal complications, and increased risk of morbidity and mortality. Iron deficiency is the most common MND worldwide and leads to microcytic anemia, decreased capacity for work, as well as impaired immune and endocrine function. Iodine deficiency disorder is also widespread and results in goiter, mental retardation, or reduced cognitive function. Adequate zinc is necessary for optimal immune function, and deficiency is associated with an increased incidence of diarrhea and acute respiratory infections, major causes of death in those <5 years of age. Folic acid taken in early pregnancy can prevent neural tube defects. Folate is essential for DNA synthesis and repair, and deficiency results in macrocytic anemia. Vitamin A deficiency is the leading cause of blindness worldwide and also impairs immune function and cell differentiation. Single MNDs rarely occur alone; often, multiple MNDs coexist. The long-term consequences of MNDs are not only seen at the individual level but also have deleterious impacts on the economic development and human capital at the country level. Perhaps of greatest concern is the cycle of MNDs that persists over generations and the intergenerational consequences of MNDs that we are only beginning to understand. Prevention of MNDs is critical and traditionally has been accomplished through supplementation, fortification, and food-based approaches including diversification. It is widely accepted that intervention in the first 1,000 days is critical to break the cycle of malnutrition; however, a coordinated, sustainable commitment to scaling up nutrition at the global level is still needed. Understanding the epidemiology of MNDs is critical to understand what intervention strategies will work best under different conditions.

870 citations

Journal ArticleDOI
TL;DR: The results support earlier observations linking mild vitamin A deficiency to increased mortality and suggest that supplements given to vitamin A deficient populations may decrease mortality by as much as 34%.

604 citations

Book
29 Feb 1996
TL;DR: This book on vitamin A deficiency not only addresses ocular manifestations but also the broader context of child health and survival as well as mechanisms of vitamin A and the relationship of xerophthalmia to vitamin A status.
Abstract: This book on vitamin A deficiency not only addresses ocular manifestations but also the broader context of child health and survival. The introduction examines the historical and modern perspectives of vitamin deficiency what vitamin A is and the relationship of xerophthalmia (severe vitamin A deficiency) to vitamin A status. The second section of the book discusses consequences of vitamin A deficiency. Chapter 2 looks at mortality associated with moderate to severe deficiency and the fact that vitamin A supplementation reduces preschool-age mortality and measles mortality. Chapter 3 covers infectious morbidity particularly diarrhea measles respiratory disease urinary tract infection otitis and other infections (e.g. HIV). Chapter 4 examines ocular manifestations (xerophthalmia keratomalacia night blindness and conjunctiva). The effect of vitamin A on anemia and iron metabolism and the extent of vitamin A deficiency-associated anemia are discussed in chapter 5. Chapter 6 examines vitamin As role in growth in animals and children. The third section of the book is dedicated to mechanisms of vitamin A. Chapter 7 looks at contributory and precipitating events (i.e. systemic infections and protein energy malnutrition). Chapter 8 addresses the biochemistry of vitamin A and carotenoids. Chapter 9 examines the relationship between immunocompetence and vitamin A status particularly lymphoid organs and hematopoiesis cell-mediated immunity humoral immunity effect of vitamin A administration on immune response and identification of and requirements for immunoregulatory retinoids. The fourth section chapter 10 is dedicated to treatment of vitamin A deficiency and xerophthalmia. The last section covers assessment and prevention. Chapters 11 and 12 discuss assessment of vitamin A status and epidemiology of deficiency respectively. The last three chapters examine prevention interventions: dietary interventions supplementation and fortification of dietary items with vitamin A.

555 citations

Journal ArticleDOI
TL;DR: VA prophylaxis seems to be preventing the number of deficient preschool children from increasing while probably reducing rates of blindness and mortality, particularly among pregnant and lactating women.
Abstract: Knowledge of the extent of vitamin A (VA) deficiency (D) is critical for identifying high-risk populations and mobilizing resources for prevention. Yet, all estimates are necessarily imperfect, often based on assumptions in the absence of data. In 1995, the World Health Organization estimated 254 million children to be VA-deficient and 2.8 million to have xerophthalmia. Subsequently, estimates were changed to 75-140 million and 3.3 million, respectively. Although both sets are consistent with a problem of enormous magnitude, the discrepancies also created uncertainty. The present analysis indicates there are approximately 127 million and 4.4 million preschool children with VAD (serum retinol 6 million women develop night blindness (XN) during pregnancy annually. Roughly 45% of VA-deficient and xerophthalmic children and pregnant women with low-to-deficient VA status live in South and Southeast Asia. These regions harbor >60% of all cases of maternal XN, three fourths of whom seem to live in India. Africa accounts for 25-35% of the global cases of child and maternal VAD; about 10% of all deficient persons live in the eastern Mediterranean region, 5-15% live in the Western Pacific and approximately 5% live in the Region of the Americas. VA prophylaxis seems to be preventing the number of deficient preschool children from increasing while probably reducing rates of blindness and mortality. Greater effort is needed to assess and prevent VAD and its disorders, particularly among pregnant and lactating women.

511 citations

Journal ArticleDOI
27 Feb 1999-BMJ
TL;DR: A double blind, cluster randomised, placebo controlled field trial was conducted to assess the impact on mortality related to pregnancy of supplementing women of reproductive age each week with a recommended dietary allowance of vitamin A, either preformed or as β-carotene as discussed by the authors.
Abstract: Objective: To assess the impact on mortality related to pregnancy of supplementing women of reproductive age each week with a recommended dietary allowance of vitamin A, either preformed or as βcarotene. Design: Double blind, cluster randomised, placebo controlled field trial. Setting: Rural southeast central plains of Nepal (Sarlahi district). Subjects: 44646 married women, of whom 20119 became pregnant 22189 times. Intervention: 270 wards randomised to 3groups of 90each for women to receive weekly a single oral supplement of placebo, vitamin A (7000¼g retinol equivalents) or βcarotene (42mg, or 7000¼g retinol equivalents) for over 31/2 years. Main outcome measures: All cause mortality in women during pregnancy up to 12weekspost partum (pregnancy related mortality) and mortality during pregnancy to 6weeks postpartum, excluding deaths apparently related to injury (maternal mortality). Results: Mortality related to pregnancy in the placebo, vitamin A, and βcarotene groups was 704,426,and 361deaths per 100000 pregnancies, yielding relative risks (95% confidence intervals) of 0.60(0.37to 0.97) and 0.51(0.30to 0.86). This represented reductions of 40% (P Conclusion: Supplementation of women with either vitamin A or βcarotene at recommended dietary amounts during childbearing years can lower mortality related to pregnancy in rural, undernourished populations of south Asia.

485 citations


Cited by
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Journal ArticleDOI
TL;DR: The high mortality and disease burden resulting from these nutrition-related factors make a compelling case for the urgent implementation of interventions to reduce their occurrence or ameliorate their consequences.

5,634 citations

Journal ArticleDOI
TL;DR: It is estimated that undernutrition in the aggregate--including fetal growth restriction, stunting, wasting, and deficiencies of vitamin A and zinc along with suboptimum breastfeeding--is a cause of 3·1 million child deaths annually or 45% of all child deaths in 2011.

5,574 citations

01 Aug 2001
TL;DR: The study of distributed systems which bring to life the vision of ubiquitous computing systems, also known as ambient intelligence, is concentrated on in this work.
Abstract: With digital equipment becoming increasingly networked, either on wired or wireless networks, for personal and professional use alike, distributed software systems have become a crucial element in information and communications technologies. The study of these systems forms the core of the ARLES' work, which is specifically concerned with defining new system software architectures, based on the use of emerging networking technologies. In this context, we concentrate on the study of distributed systems which bring to life the vision of ubiquitous computing systems, also known as ambient intelligence.

2,774 citations

BookDOI
TL;DR: Global Burden of Disease and Risk Factors examines the comparative importance of diseases, injuries, and risk factors; it incorporates a range of new data sources to develop consistent estimates of incidence, prevalence, severity and duration, and mortality for 136 major diseases and injuries.
Abstract: This volume is a single up-to-date source on the entire global epidemiology of diseases, injuries and risk factors with a comprehensive statement of methods and a complete presentation of results. It includes refined methods to assess data, ensure epidemiological consistency, and summarize the disease burden. Global Burden of Disease and Risk Factors examines the comparative importance of diseases, injuries, and risk factors; it incorporates a range of new data sources to develop consistent estimates of incidence, prevalence, severity and duration, and mortality for 136 major diseases and injuries. Drawing from more than 8,500 data sources that include epidemiological studies, disease registers, and notifications systems, this book incorporates information from more than 10,000 datasets relating to population health and mortality, representing one of the largest syntheses of global information on population health to date.

2,696 citations

Journal ArticleDOI
TL;DR: The importance of undernutrition as an underlying cause of child deaths associated with infectious diseases, the effects of multiple concurrent illnesses, and recognition that pneumonia and diarrhoea remain the diseases that are most often associated with child deaths as mentioned in this paper.

2,680 citations