Showing papers in "Food and Nutrition Bulletin in 2007"

Iron deficiency and child development.

Abstract: Iron deficiency is widespread in infants and young children, especially in developing countries. Animal models provide convincing evidence that, despite iron repletion, iron deficiency during the brain growth spurt alters metabolism and neurotransmission, myelination, and gene and protein profiles. In the human, there is compelling evidence that 6- to 24-month-old infants with iron-deficiency anemia are at risk for poorer cognitive, motor, social-emotional, and neurophysiologic development in the short- and long-term outcome. In contrast to inconsistent developmental effects of iron therapy for iron-deficient infants, recent large, randomized trials of iron supplementation in developing countries uniformly show benefits of iron, especially on motor development and social-emotional behavior. These results indicate that adverse effects can be prevented and/or reversed with iron earlier in development or before iron deficiency becomes severe or chronic. New findings also point to the need for more attention to the developmental effects of prenatal iron deficiency.

Conclusions of the Joint WHO/UNICEF/IAEA/IZiNCG Interagency Meeting on Zinc Status Indicators.

Abstract: Zinc deficiency is an important cause of morbidity in developing countries, particularly among young children, yet little information is available on the global prevalence of zinc deficiency. A working group meeting was convened by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the International Atomic Energy Agency (IAEA), and the International Zinc Nutrition Consultative Group (IZiNCG) to review methods of assessing population zinc status and provide standard recommendations for the use of specific biochemical, dietary, and functional indicators of zinc status in populations. The recommended biochemical indicator is the prevalence of serum zinc concentration less than the age/sex/time of day-specific cutoffs; when the prevalence is greater than 20%, intervention to improve zinc status is recommended. For dietary indicators, the prevalence (or probability) of zinc intakes below the appropriate estimated average requirement (EAR) should be used, as determined from quantitative dietary intake assessments. Where the prevalence of inadequate intakes of zinc is greater than 25%, the risk of zinc deficiency is considered to be elevated. Previous studies indicate that stunted children respond to zinc supplementation with increased growth. When the prevalence of low height-for-age is 20% or more, the prevalence of zinc deficiency may also be elevated. Ideally, all three types of indicators would be used together to obtain the best estimate of the risk of zinc deficiency in a population and to identify specific subgroups with elevated risk. These recommended indicators should be applied for national assessment of zinc status and to indicate the need for zinc interventions. The prevalence of low serum zinc and inadequate zinc intakes may be used to evaluate their impact on the target population's zinc status.

Use of serum zinc concentration as an indicator of population zinc status.

Abstract: Assessing the prevalence and severity of zinc deficiency in populations is critical to determine the need for and appropriate targeting of zinc intervention programs and to assess their effectiveness for improving the health and well-being of high-risk populations. However, there is very little information on the zinc status of populations worldwide due to the lack of consensus on appropriate biochemical indicators of zinc status. The objective of this review was to evaluate the use of serum zinc concentration as an indicator of population zinc status.We have reviewed the response of serum zinc concentration to dietary zinc restriction and zinc supplementation. In addition, we completed pooled analyses of nine zinc intervention trials in young children to assess the relations between serum zinc concentration of individuals before treatment and their responses to zinc supplementation. Also, in updated combined analyses of previously published data, we investigated the relation between the mean initial seru...

From harvest to health: challenges for developing biofortified staple foods and determining their impact on micronutrient status.

Abstract: BackgroundThe use of conventional breeding techniques and biotechnology to improve the micronutrient quality of staple crops is a new strategy to address micronutrient deficiencies in developing countries. This strategy, referred to as “biofortification,” is being developed and implemented through the international alliance of HarvestPlus to improve iron, zinc, and vitamin A status in low-income populations.ObjectiveThe objective of this paper is to review the challenges faced by nutritionists to determine and demonstrate the ability of biofortified crops to have an impact on the nutritional and health status of target populations.MethodsWe reviewed available published and unpublished information that is needed to design and evaluate this strategy, including issues related to micronutrient retention in staple foods, micronutrient bioavailability from plant foods, and evidence for the efficacy of high-micronutrient-content staple foods to improve micronutrient status.ResultsFurther information is needed on...

The role of diet- and host-related factors in nutrient bioavailability and thus in nutrient-based dietary requirement estimates.

Abstract: To convert physiological requirements into dietary requirements, adjustments are needed for some nutrients that take into account certain diet- and host-related factors specific to a country or region. Nutrients whose requirements should be adjusted in this way include calcium, magnesium, iron, zinc, protein, folate, vitamin A, and carotenoids. The diet-related factors that must be considered depend on the nature of the habitual diet and may include the chemical form of the nutrient and the nature of the dietary matrix, interactions between nutrients and/or organic components, and food preparation and processing practices within the country or region. The host-related factors can be further subdivided into intestinal and systemic factors. Reductions in the secretion of hydrochloric acid, gastric acid, and/or intrinsic factor, together with alterations in the permeability of the intestinal mucosa, are all examples of intestinal factors that can markedly influence the absorption of certain nutrients, but th...

Linking human nutrition and fisheries: incorporating micronutrient-dense, small indigenous fish species in carp polyculture production in Bangladesh.

Abstract: Background. Fish and fisheries are important for the livelihoods, food, and income of the rural population in Bangladesh. Increased rice production and changing agricultural patterns have resulted in a large decline in inland fisheries. Implementation of carp pond polyculture has been very successful, whereas little focus has been given to the commonly consumed small indigenous fish species, some of which are rich in vitamin A and minerals, such as calcium, iron, and zinc, and are an integral part of the rural diet. Objective. The overall objective of the research and capacity-building activities described in this paper is to increase the production, accessibility, and intake of nutrient-dense small indigenous fish species, in particular mola (Amblypharyngodon mola), in order to combat micronutrient deficiencies. The large contribution from small indigenous fish species to recommended intakes of vitamin A and calcium and the perception that mola is good for or protects the eyes have been well documented. Methods. An integrated approach was conducted jointly by Bangladeshi and Danish institutions, linking human nutrition and fisheries. Activities included foodconsumption surveys, laboratory analyses of commonly consumed fish species, production trials of carp–mola pond polyculture, teaching, training, and dissemination of the results. Results. No decline in carp production and thus in income was found with the inclusion of mola, and increased intake of mola has the potential to combat micronutrient deficiencies. Teaching and training of graduates and field staff have led to increased awareness of the role of small indigenous fish species for good nutrition and resulted in the promotion of carp–mola pond polyculture and research in small indigenous fish species. The decline in accessibility, increase in price, and decrease in intake of small indigenous fish species by the rural poor, as well as the increased intake of silver carp (Hypophthalmichthys molitrix), the most commonly cultured fish species, which is poor in micronutrients and not preferred for consumption, are being addressed, and some measures taken by inland fisheries management have been discussed. Conclusions. The successful linking of human nutrition and fisheries to address micronutrient deficiencies has relevance for other countries with rich fisheries resources, such as Cambodia and countries in the Lake Victoria region of Africa.

Iron Metabolism and Infection

Abstract: The review highlights the intrinsic problems in the acquisition of ferric iron (FeIII) by pathogenic microorganisms, and bacteria in particular, during their infection of animals. Acquisition of iron from host sources, such as ferritin, transferrin, and heme compounds, is discussed. Acquisition can be by direct contact, via a surface receptor protein of the bacterium, with one of the iron-containing compounds, but more frequently iron is acquired by the production of a siderophore. Over 500 different siderophores are now known; they work by having a superior binding power to that of the host iron-containing materials. They literally strip the iron out of these molecules. They are low-molecular-weight (< 1,000 Da) compounds that are produced in response to iron deprivation, which is a primary host defense mechanism against infections. The iron-siderophore complex is small enough to be taken up into the bacterial cells, usually via an active transport process; the iron is removed from the siderophore, normally by a reductive process, and is then incorporated into the various apoproteins of the bacterial cell or is stored within the bacteria in the form of bacterioferritin. To combat the effectiveness of the siderophores, animals may synthesize specific proteins to bind and nullify their action. The role of one such protein, siderocalin (= lipocalin 2), is discussed. However, these countermeasures have, in turn, been thwarted by at least one bacterium, Salmonella, glycosylating its siderophore (enterobactin/enterochelin) so that binding of the modified siderophore (now termed salmochelin) with lipocalin can no longer occur.

An Analysis of the Etiology of Anemia and Iron Deficiency in Young Women of Low Socioeconomic Status in Bangalore, India

Abstract: BackgroundAnemia and iron deficiency are significant public health problems in India, particularly among women and children. Recent figures suggest that nearly 50% of young Indian women are anemic....

The Human and Economic Cost of Hidden Hunger

Abstract: BackgroundMicronutrient malnutrition is a public health problem in many developing countries. Its negative impact on income growth is recognized in principle, but there are widely varying estimates of the related economic cost.ObjectiveTo discuss available studies that quantify the cost of micronutrient malnutrition, and to develop an alternative framework and apply it to India.MethodsDetailed burden of disease calculations are used to estimate the economic cost of micronutri- ent malnutrition based on disability-adjusted life years (DALYs) lost.ResultsThe short-term economic cost of micronutri- ent malnutrition in India amounts to 0.8% to 2.5% of the gross domestic product.ConclusionsAlthough the results confirm that micro- nutrient malnutrition is a huge economic problem, the estimates are lower than those of most previous studies. The differences may be due to differences in underlying assumptions, quality of data, and precision of calculation, but also to dynamic interactions between nutrition, health...

Aflatoxin exposure in developing countries: the critical interface of agriculture and health.

Abstract: BackgroundAflatoxins are common contaminants of staple foods in sub-Saharan Africa. These toxins are human liver carcinogens, especially in combination with chronic infection with hepatitis B virus...

Risk factors for moderate to severe anemia among children in Benin and Mali: insights from a multilevel analysis.

Abstract: BackgroundAnemia currently affects 2 billion people throughout the world. Although the immediate causes of anemia among children are known (including malnutrition and infections), the importance of contextual determinants and their relationships with individual effects have rarely been explored.ObjectiveTo identify anemia risk factors at the individual, household, and community levels among Beninese and Malian children, using simple and multilevel regression methods.MethodsAn analysis was undertaken of nationally representative data collected in 2001 in Benin (n = 2,284) and Mali (n = 2,826) by the Demographic and Health Surveys. Sixteen potential risk factors for anemia were considered at the individual, household, and community levels. Comparative analyses were carried out using simple and multilevel logistic regression models.ResultsSimple and multilevel logistic regression analyses yielded broadly similar results. Risk factors for moderate to severe anemia included incomplete immunization, stunted gro...

Breastfeeding and Mixed Feeding Practices in Malawi: Timing, Reasons, Decision Makers, and Child Health Consequences

Abstract: Background. In order to effectively promote exclusive breastfeeding, it is important to first understand who makes child-care and child-feeding decisions, and why those decisions are made; as in most parts of the world, exclusive breastfeeding until 6 months of age is uncommon in Malawi. Objective. To characterize early infant foods in rural northern Malawi, who the decision-makers are, their motivation, and the consequences for child growth, in order to design a more effective program for improved child health and nutrition. Methods. In a rural area of northern Malawi, 160 caregivers of children 6 to 48 months of age were asked to recall the child’s age at introduction of 19 common early infant foods, who decided to introduce the food, and why. The heights and weights of the 160 children were measured. Results. Sixty-five percent of the children were given food in their first month, and only 4% of the children were exclusively breastfed for 6 months. Mzuwula and dawale (two herbal infusions), water, and porridge were common early foods. Grandmothers introduced mzuwula to protect the children from illness; other foods were usually introduced by mothers or grandmothers in response to perceived hunger. The early introduction of porridge and dawale, but not mzuwula, was associated with worse anthropometric status. Mzuwula, which is not associated with poor growth, is usually made with boiled water and given in small amounts. Conversely, porridge, which is associated with poor child growth, is potentially contaminated and is served in larger amounts, which would displace breastmilk. Conclusions. Promoters of exclusive breastfeeding should target their messages to appropriate decision makers and consider targeting foods that are most harmful to child growth.

Iron, Folate, and Vitamin B12 Stores Among Pregnant Women in a Rural Area of Haryana State, India

Abstract: BackgroundIron, folate, and vitamin B12 deficiencies have adverse effects on pregnancy outcome. In India, data on the concomitant prevalence of these deficiencies among pregnant women are meager.Ob...

Prenatal Multiple Micronutrient Supplementation has Greater Impact on Birthweight than Supplementation with Iron and Folic Acid: A Cluster-Randomized, Double-Blind, Controlled Programmatic Study in Rural Niger

Abstract: BackgroundMicronutrient deficiencies during pregnancy are associated with adverse pregnancy outcomes, including reduced birthweight. Low birthweight is associated with increased risk of infant mortality and growth failure.ObjectivesTo assess the effects of prenatal supplementation with UNIMMAP (United Nations International Multiple Micronutrient Preparation) compared with iron/folic acid on average birthweight and incidence of low birthweight.MethodsPregnant women from 78 villages in Niger were included in a cluster-randomized, double-blinded, controlled supplementation trial. Baseline, monthly follow-up, and birth data were collected. Cluster analysis was conducted to assess differences in mean birthweight and incidence of low birthweight between groups using multiple linear regression models. Analyses were stratified by nutrition status and duration of supplementation.ResultsOf the 3,670 women recruited, 2,550 completed the study and provided complete birthweight data (1,328 received multiple micronutri...

Ensuring the Supply of and Creating Demand for a Biofortified Crop with a Visible Trait: Lessons Learned from the Introduction of Orange-Fleshed Sweet Potato in Drought-Prone Areas of Mozambique

Abstract: BACKGROUND: Orange-fleshed sweet potato (OFSP) is a promising biofortified crop for sub-Saharan Africa because it has high levels of provitamin A carotenoids, the formed vitamin A is bioavailable, and white-fleshed sweet potato is already widely grown. OBJECTIVES: To examine whether farmers will adopt varieties with a distinct visible trait, young children will eat OFSP in sufficient quantities to improve vitamin A intake, OFSP can serve as an entry point for promoting a more diversified diet, and lessons can be drawn to assure sustained adoption. METHODS: The 2-year quasi-experimental intervention study followed households and children (n = 741; mean age, 13 months at baseline) through two agricultural cycles in drought prone-areas of Mozambique. RESULTS: OFSP is acceptable to farmers when introduced by using an integrated approach. In the second year, intervention children (n = 498) were more likely than control children (n = 243) to have consumed OFSP (54% vs. 4%), dark-green leaves (60% vs. 46%), or ripe papaya (65% vs. 42%) on 3 or more days in the previous week (p < .001 for all comparisons). Their vitamin A intakes were nearly eight times higher than those of control children (median, 426 vs. 56 1g RAE [retinol activity equivalents], p < .001). Diet diversification was limited by difficult agroecological conditions and low purchasing power. However, dietary diversity was higher among intervention than control children (32% vs. 9% consuming food from more than four groups; p < .001). CONCLUSIONS: An integrated OFSP-based approach had a positive impact on the vitamin A intake of young children. A market development component and improved vine multiplication systems are recommended to assure sustained adoption.

Functional indicators for assessing zinc deficiency.

Abstract: Zinc is an essential micronutrient for growth and proper immune function. There is currently no simple recommendation for the assessment of population-level zinc deficiency. Trials of zinc suppleme...

Prevention of malnutrition among young children in rural Bangladesh by a food-health-care educational intervention: a randomized, controlled trial.

Abstract: Background. As a result of inappropriate feeding, poor health and hygiene, and poor caring practices, the nutritional status of many young infants deteriorates with advancing age. Objective. To explore the effectiveness of a nutrition education package to prevent malnutrition among young children. Methods. A community-based, randomized, controlled trial was conducted among 605 normal and mildly malnourished children aged 6 to 9 months in 121 Community Nutrition Centers (CNCs) of the Bangladesh Integrated Nutrition Project (BINP) in four regions of Bangladesh from 2000 to 2002. The intervention group received weekly nutrition education based on the nutrition triangle concept of UNICEF for 6 months, whereas the control group received regular BINP services. Both groups were observed for a further 6 months to assess the sustainability of the effects. Information on socioeconomic status, feeding patterns, morbidity, and anthropometric features was collected. Results. A significant increase in the frequency of complementary feeding was observed in the intervention group as compared with the control group, and the increase was sustained throughout the observation period. The intervention group had a higher weight gain than the control group after the end of the intervention (0.86 vs. 0.77kg, p = 0.053) and after the end of the observation period (1.81 vs. 1.39 kg, p < .001). The proportion of normal and mildly malnourished children was greater in the intervention group than in the control group after the end of the observations (88.9% vs. 61.5%, p < .001). Nutrition education successfully prevented malnutrition in all the areas. Variation in the outcome of nutrition education among the regions was observed. Conclusions. This culturally appropriate nutrition education package based on the nutrition triangle model effectively prevented growth faltering and malnutrition among young children.

Iron metabolism and malaria.

Abstract: Recent evidence from a large, randomized, controlled trial has suggested that the universal administration of iron to children in malaria-endemic areas is associated with an increase in adverse health outcomes. The purpose of this paper is to summarize the available ecologic and intervention trials related to iron and malaria in children, and to set these against current knowledge of the biology of host-pathogen interactions involving iron metabolism. We conclude that, although not fully consistent, the balance of evidence confirms that administration of iron (usually in combination with folic acid) increases the incidence of malaria when given without prophylaxis and in the absence of universal access to treatment. The mechanisms by which additional iron can benefit the parasite are far from clear. There is evidence to suggest that the apparent detrimental effect of iron supplementation may vary according to levels of antecedent iron status, the presence of hemoglobinopathies and glucose-6-phosphate dehydrogenase (G6PD) deficiency, and other host genetic variants, such as variants in haptoglobin. The effects of malaria on host iron metabolism are also reviewed and reveal that the key cause of malaria-induced anemia is a maldistribution of iron and suppression of erythropoiesis rather than an exacerbation of gross iron deficiency. We tentatively conclude that, if it is to be recommended, universal iron supplementation in malarious areas should only be considered in conjunction with some form of prophylaxis (e.g., intermittent preventive therapy [IPT]) or in the context of good health services with ready access to facilities for malaria diagnosis and treatment. An alternative approach would be to screen for anemia and target supplementation only to anemic children. With regard to treatment, there is good evidence that iron supplementation should be withheld until the treatment schedule is complete, both because iron may inhibit treatment and because the absorption of oral iron is blocked by the inflammatory response.

Promoting healthy diets and tackling obesity and diet-related chronic diseases: what are the agricultural policy levers?

Abstract: BackgroundDiet-related chronic diseases are now a serious global public health problem. Public health groups are calling for the agricultural sector to play a greater role in tackling the threat.ObjectiveTo identify potential points of policy intervention in the agricultural sector that could be leveraged to promote healthy diets and tackle obesity and diet-related chronic diseases.MethodsA review of the literature on the dietary implications of agriculture, a conceptual analysis of the issues, and the identification of relevant examples.ResultsThere are two main potential points of intervention in the agricultural sector that could be leveraged to promote healthy diets: agricultural policies and agricultural production practices. Agricultural policies and practices affect diet through their influence on food availability, price, and nutrient quality, which in turn affects food choices available to consumers. Agricultural policies amenable to intervention include input, production, and trade policies; agr...

Dietary indicators for assessing the adequacy of population zinc intakes.

Abstract: The assessment of dietary zinc intakes is an important component of evaluating the risk of zinc deficiency in populations, and for designing appropriate food-based interventions, including fortification, to improve zinc intakes. The prevalence of inadequate zinc intakes can describe the relative magnitude of the risk of zinc deficiency in the population and identify subpopulations at elevated risk. As a cornerstone to evaluating the adequacy of population zinc intakes globally, a set of internationally appropriate dietary reference intakes must be defined. The World Health Organization/Food and Agriculture Organization/International Atomic Energy Agency (WHO/FAO/IAEA) and the Food and Nutrition Board/US Institute of Medicine (FNB/IOM) have presented estimated average requirements (EAR) for dietary zinc intake, and, more recently, the International Zinc Nutrition Consultative Group (IZiNCG) presented a revised set of recommendations for international use. A prevalence of inadequate zinc intakes greater than 25% is considered to represent an elevated risk of population zinc deficiency. As the requirement estimates are derived from smaller, clinical studies and, for children, most components of the estimates are extrapolated from data for adults, it was desirable to evaluate their internal validity. The estimated physiological requirements for adult men and women appear to adequately predict zinc status as determined by biochemical indicators of status and/or zinc balance. With the use of data from available studies, the reported prevalence of low serum zinc concentration and the estimated prevalence of inadequate zinc intakes predict similar levels of risk of zinc deficiency, particularly among pregnant and nonpregnant women. Conformity between these two indicators is less consistent for children, suggesting that further data and/or direct studies of zinc requirements among children are needed.

Does provision of food in school increase girls' enrollment? Evidence from schools in sub-Saharan Africa.

Abstract: BackgroundThe problem of low female literacy rates in Africa starts with low primary school enrollment, particularly in areas of high food insecurity. The provision of food in, and through, schools is considered to be one way of enrolling more girls in school, keeping them enrolled, and enhancing their adult well-being and pro- ductivity as a result.ObjectiveTo investigate the effects of provision of food and additional take-home rations in schools on girls' enrollment.MethodsA retrospective cross-sectional study was designed based on school-level surveys in 32 African countries between 2002 and 2005. The study population consisted of girls and boys in primary schools targeted by the World Food Programme (WFP) and located in food-insecure areas that also suffered from lack of access to education.ResultsProvision of food in schools through the Food for Education (FFE) program contributed to increasing absolute enrollment in WFP-assisted schools by 28% for girls and 22% for boys in the first year. Post year...

Iron-Deficiency Anemia among Children in Southwest Iran

Abstract: Background. Iron deficiency is a major health problem worldwide and especially in developing countries. Irondeficiency anemia has adverse effects on the development of children. Objective. The purpose of this study was to determine the prevalence of iron-deficiency anemia in children under 5 years of age in southwest Iran. The study also sought to investigate the association between socioeconomic, demographic, cultural, and nutritional factors and iron-deficiency anemia in the selected area. Methods. A randomized, cross-sectional study was performed of children 6 to 59 months of age living in urban and rural areas of Ahwaz District in Khuzestan Province. At eight randomly selected health centers, the children’s height (or length) and weight were measured, and information on length and weight at birth was obtained from growth charts. Blood samples were taken from 337 randomly selected children. Results. The results showed that 43.9% of the children had anemia and 29.1% iron-deficiency anemia. The highest prevalence of iron-deficiency anemia was in the 12- to 24-month age group. In the urban areas, infants 6 to 11 months of age had the highest prevalence of irondeficiency anemia. Conclusions. The high prevalence of iron-deficiency anemia among children in southwest Iran indicates a major nutrition and health problem.

Prevalence of Goiter in Children 6 to 12 Years of Age in Ethiopia

Abstract: BackgroundIodine-deficiency disorders are a major public health problem in Ethiopia. In conjunction with implementing control programs, baseline information needs to be established.ObjectiveTo inve...

Traditional Lebanese recipes based on wild plants: an answer to diet simplification?

Abstract: Background The challenge posed by the nutrition transition occurring throughout the world is enormous: rates of chronic disease, particularly overweight and obesity and cardiovascular disease, have reached alarming levels—often occurring in parallel with high levels of micronutrient deficiencies Lebanon is no exception And yet this Mediterranean country enjoys a rich biodiversity, with thousands of endemic species and an equally rich culinary history, largely based on its local biodiversity, including wild edible plants Objectives To record traditional Lebanese recipes based on wild edible plants and to investigate their potential to contribute to a more diversified diet Methods A series of nine focus group meetings was conducted with key informants knowledgeable in wild edible plant identification, harvesting, and use Results Common recipes based on wild edible plants were collected and standardized from rural communities where collection of wild edible plants is common Nutrient analysis and food-composition analysis were performed, including comparisons with processed dishes that are increasingly common in the Lebanese diet, revealing that the wild edible plant-based dishes offered a healthier alternative Conclusions Since traditional recipes often use items from several food groups in one dish, they can be a good model for diet diversification The promotion of the collection and use of wild edible plants and their derived products can lead to improved nutrition Background

Home fortification in emergency response and transition programming: Experiences in Aceh and Nias, Indonesia

Abstract: BackgroundImproving the nutritional status of an emergency-affected population is essential, because undernutrition increases infection risk and is linked to more than 50% of childhood deaths in developing coun- tries. Emergency food aid addresses nutritional needs, including micronutrient deficiencies, but is provided only for a limited time and uses few items, so the needs of specific target groups are often not fully met.ObjectiveTo describe the post-tsunami experience with distribution of Vitalita Sprinkles in Aceh and Nias and to analyze the monitoring data gathered for the emergency response.MethodsInternational agencies such as Helen Keller International and partners provided micronutrients in response to the tsunami emergency in Aceh and Nias and to analyze the monitoring data gathered for the emergency response.ResultsIn March and April 2006, the percentage of children aged 6 months to 59 months who had consumed Vitalita in the previous month was more than 70% in 5 of 11 districts evaluated, 40% ...

Mechanism of iron toxicity.

Abstract: The subtle balance between proinflammatory and antiinflammatory cytokines plays an important role in determining the severity of the inflammatory reaction and in the anomalous iron handling associated with infection. Conversely, iron deficiency per se appears to limit the severity of the inflammatory response. All of these considerations are at present highly speculative and in need of further experimental and epidemiologic support. If confirmed, the beneficial biological effects of iron depletion may have a defensive role in inflammation and may be perturbed by the nonselective administration of iron to iron-replete patients who would not benefit from such treatment in the first place. In view of the importance of non-transferrin-bound plasma iron (NTBI) in iron toxicity and its rapid cellular uptake, it may play an important role in the harmful effects of iron in infection, and this is illustrated by the infectious complications of parenteral iron therapy in tropical countries.

Iron metabolism in infants and children.

Abstract: Meeting the iron requirements of infants and children is difficult, and supplementation or fortification of food with iron is often recommended. Although iron supplementation of infants and children with iron deficiency and iron-deficiency anemia may be beneficial, recent studies suggest that this may not be the case for those with adequate iron status, and adverse effects have been noted. The recent discoveries of proteins and peptides regulating iron absorption have enhanced our knowledge of iron metabolism in infants and children. Iron is taken up in the small intestine by divalent metal transporter-1 and is either stored by ferritin inside the mucosal cell or transported to the systemic circulation by ferroportin, while being oxidized by hephaestin to be incorporated into transferrin. Hepcidin, a small peptide synthesized by the liver, can sense iron stores and regulates iron transport by inhibition of ferroportin. However, regulation of iron transporters is immature in infants, possibly explaining the adverse effects of iron supplementation. Interactions among iron, vitamin A, zinc, and copper need to be considered when evaluating the effects of iron supplementation on infants and children.

Determining Life-Stage Groups and Extrapolating Nutrient Intake Values (NIVs):

Abstract: The derivation of reference values in 11 current dietary reference standards is often based on methods of extrapolation or interpolation, but these are not consistent across reports. Such methods are frequently employed to derive nutrient intake values (NIVs) for infants and children owing to the paucity of relevant research data available. The most common method is to extrapolate values for children down from those of adults, employing a weight or metabolic factor and adjusting for growth. In some instances, values for young children are extrapolated up from infants, values for adults are extrapolated up from children, or values for older adults are extrapolated up from young adults. Extrapolation is employed to estimate not only nutrient requirement or adequate intake but also the upper tolerable levels of intake. Extrapolation methods may also form the basis of estimates of tissue deposition of nutrients during growth in children and for the maternal/fetal dyad in pregnancy with adjustments for metabol...

Harmonization of nutrient intake values.

Abstract: The conceptual framework for the various NIVs is depicted in figure 1 along with the methodological approaches and applications. The NIVs consist of two values derived from a statistical evaluation of data on nutrient requirements, the average nutrient requirement (ANR), or nutrient toxicities, the upper nutrient level (UNL). The individual nutrient levelx (INLx) is derived from the distribution of average nutrient requirements. The percentile chosen is often 98%, which is equivalent to 2 SD above the mean requirement. Concepts underlying the NIVs include criteria for establishing a nutrient requirement, e.g., ferritin stores, nitrogen balance, or serum vitamin C. Once the requirement for the absorbed nutrient is determined, it may be necessary to adjust the value for food sources, i.e., bioavailability, or host factors, such as the effect of infection on nutrient utilization. Other concepts that committees may want to consider when establishing NIVs include the effects of genetic variation on nutrient requirements and the role of the nutrient in preventing long-term disease. Two fundamental uses of NIVs are for assessing the adequacy of nutrient intakes and for planning diets for individuals and populations. Establishing the NIV using the statistical framework proposed in this report improves the efficacy of the values for identifying risks of nutrient deficiency or excess among individuals and populations. NIVs also are applied to a number of aspects of food and nutrition policy. Some examples include regulatory issues and trade, labeling, planning programs for alleviating public health nutrition problems, food fortification, and dietary guidance.

Iron supplementation of young children: learning from the new evidence.

Abstract: High iron needs and low-iron diets combine to make early childhood one of the highest risk periods for iron deficiency. Recommendations for iron supplementation for this age group have been based on positive effects on anemia and child development. In contrast, the evidence regarding growth and morbidity outcomes has been equivocal, with some evidence of risk. The new evidence from Nepal and Zanzibar is reviewed, and possible interpretations are discussed. The Zanzibar trial found significant adverse effects in the overall population with poor malaria services and substantial benefit to iron-deficient children (the majority) in an area where access to treatments was provided. Cost-effectiveness analysis suggests that targeting supplements to iron-deficient children in Zanzibar may not increase costs (relative to universal supplementation) and would increase benefit. Operations research is needed to test this. We conclude with three options for maximizing the benefits and minimizing the risks of iron supplements.