Interventions for Micronutrient Deficiency Control in Developing Countries: Past, Present and Future
TL;DR: Why nutrition programs have shifted their primary emphasis from control of protein deficiency, to energy deficiency, and now to micronutrient deficiencies is discussed.
Abstract: There has been an evolution in our understanding of the causes of undernutrition and of the nutrition intervention programs that should be prioritized. This article discusses why nutrition programs have shifted their primary emphasis from control of protein deficiency, to energy deficiency, and now to micronutrient deficiencies. It has become recognized by the nutrition community that micronutrient malnutrition is very widespread, and is probably the main nutritional problem in the world. The most commonly used strategies for micronutrient deficiency control are supplementation and fortification, because they are cost-effective and to some extent, relatively easy to deliver. They have important limitations, however. Relatively little emphasis has been placed on food-based approaches to control micronutrient malnutrition. Evidence from several past studies, including the Nutrition Collaborative Research Support Program (N-CRSP), indicated a strong positive association between animal source food (ASF) intake, micronutrient status, and many human functions. This association motivated the intervention studies supported by the Global Livestock CRSP and described in this supplement, which found benefits of increasing ASF intake. In contrast to the common assumption that increasing consumption of ASF in poor communities is infeasible, and will only cause environmental problems, the articles in this supplement show the potential economic benefits of animal ownership in poor communities, and provide examples of innovative programs that have increased local production and consumption. Much more communication is needed among the nutrition, agriculture and development communities to achieve improved dietary quality for poor populations.
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TL;DR: It is concluded that maternal nutrition is a modifiable risk factor of public health importance that can be integrated into efforts to prevent adverse birth outcomes, particularly among economically developing/low-income populations.
Abstract: In this review, the authors summarize current knowledge on maternal nutritional requirements during pregnancy, with a focus on the nutrients that have been most commonly investigated in association with birth outcomes. Data sourcing and extraction included searches of the primary resources establishing maternal nutrient requirements during pregnancy (e.g., Dietary Reference Intakes), and searches of Medline for "maternal nutrition"/[specific nutrient of interest] and "birth/pregnancy outcomes," focusing mainly on the less extensively reviewed evidence from observational studies of maternal dietary intake and birth outcomes. The authors used a conceptual framework which took both primary and secondary factors (e.g., baseline maternal nutritional status, socioeconomic status of the study populations, timing and methods of assessing maternal nutritional variables) into account when interpreting study findings. The authors conclude that maternal nutrition is a modifiable risk factor of public health importance that can be integrated into efforts to prevent adverse birth outcomes, particularly among economically developing/low-income populations.
498 citations
Cites background from "Interventions for Micronutrient Def..."
...Allen (136) has argued that the global focus on supplementation programs is a ‘‘top-down’’ orientation toward inadequate nutrient intakes, which has diverted attention from considering sustainable food-based approaches....
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...Allen (136) highlighted the option of increasing the production and consumption of animal-source foods as another method of increasing overall diet quality at the household level, which some models have shown to be both economically beneficial and sustainable....
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TL;DR: China's food consumption patterns and eating and cooking behaviours changed dramatically between 1991 and 2011, leading to what might be characterized as an unhealthy Western type of diet, often based on traditional recipes with major additions and changes.
Abstract: China's food consumption patterns and eating and cooking behaviours changed dramatically between 1991 and 2011. Macronutrient composition has shifted towards fats, and protein and sodium intakes remain high and potassium intake low. The rapid decline in intake of coarse grains and, later, of refined grains and increases in intake of edible oils and animal-source foods accompanied by major eating and cooking behaviour shifts are leading to what might be characterized as an unhealthy Western type of diet, often based on traditional recipes with major additions and changes. The most popular animal-source food is pork, and consumption of poultry and eggs is increasing. The changes in cooking and eating styles include a decrease in the proportion of food steamed, baked, or boiled, and an increase in snacking and eating away from home. Prior to the last decade, there was essentially no snacking in China except for hot water or green tea. Most recently, the intake of foods high in added sugar has increased. The dietary shifts are affected greatly by the country's urbanization. The future, as exemplified by the diet of the three mega cities, promises major growth in consumption of processed foods and beverages.
387 citations
TL;DR: This paper used data from the Mexican poverty alleviation program called PROGRESA (Programa de Educacion, Salud y Alimentacion) to examine whether eligibility for a cash transfer provided by the program conditional on children's regular school attendance and regular visits to health centers is also associated with increased consumption of food.
Abstract: In this article we used data from the Mexican poverty alleviation program called PROGRESA (Programa de Educacion, Salud y Alimentacion) to examine whether eligibility for a cash transfer provided by the program conditional on children’s regular school attendance and regular visits to health centers is also associated with increased consumption of food. We used a longitudinal sample of approximately 24,000 households from 506 communities. A distinguishing characteristic of this sample was that some of the communities were randomly selected for participation in PROGRESA, while the rest were introduced into the program at later phases. Exploiting this feature in our analysis, we found that eligible households in the villages covered by PROGRESA increased caloric acquisition compared with eligible households not receiving these benefits. By November 1999, median beneficiary households in treatment localities obtained 6.4% more calories than did comparable households in control localities. Perhaps eve...
338 citations
TL;DR: This review focuses on another, more particular and “hidden” form of malnutrition, namely mineral malnutrition, and illustrates the burden of disease that is caused by mineral deficiencies and the social and economic consequences they bring about.
Abstract: Malnutrition—in the form of insufficient energy intakes—affects millions of people worldwide and the negative impact of this kind of hunger is well acknowledged, not least by agronomists trying to increase yields to ensure a sufficient supply of food This review focuses on another, more particular and “hidden” form of malnutrition, namely mineral malnutrition It illustrates the burden of disease that is caused by mineral deficiencies and the social and economic consequences they bring about Mineral malnutrition has a considerable negative impact on individual well-being, social welfare and economic productivity Agricultural scientists should keep the nutritional qualities of food in mind and—next to optimizing the agricultural properties of crops that are paramount for their adoption by farmers—in particular try to increase the micronutrient content in major staple crops as one way to address vitamin and mineral malnutrition in humans; especially plant breeding approaches promise to be very cost-effective
332 citations
Cites background from "Interventions for Micronutrient Def..."
...…against mineral malnutrition lie outside the sphere of agronomy and are already discussed to various degrees elsewhere (e.g. GAIN 2009; Horton et al. 2008; WFP 2007; Stein 2006; MI/UNICEF 2004; Allen 2003b; Kennedy et al. 2003a, b; WHO 2002; Ruel 2001; FAO 2001; Underwood and Smitasiri 1999)....
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...…concerned and to their social environment—over the last two decades the definition of malnutrition increasingly also covers so-called “hidden hunger” (Allen 2003a; WHO 2004).1 This form of hunger is caused by a chronic lack of vitamins and minerals that is called “hidden” because people who…...
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TL;DR: These results indicate that specific changes in the transfer and initial establishment of bifidobacteria in neonates take place as consequence of the consumption of L. rhamnosus GG by the mothers.
Abstract: Background:Establishment of the gut microbiota at birth provides a substantial source of microbial stimuli for the maturation of the immune system. Deviations in this process precede the development of specific diseases providing the rationale for the use of probiotics to counteract them.Obj
307 citations
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TL;DR: Evidence from a multicountry analysis suggests that household-level DD diversity is strongly associated with household per capita income and energy availability, suggesting that DD could be a useful indicator of food security.
Abstract: Dietary diversity (DD) is universally recognized as a key component of healthy diets There is still, however, a lack of consensus on how to measure and operationalize DD This article reviews published literature on DD, with a focus on the conceptual and operational issues related to its measurement in developing countries Findings from studies of the association between DD and individual nutrient adequacy, child growth and/or household socioeconomic factors are summarized DD is usually measured using a simple count of foods or food groups over a given reference period, but a number of different groupings, classification systems and reference periods have been used This limits comparability and generalizability of findings The few studies that have validated DD against nutrient adequacy in developing countries confirm the well-documented positive association observed in developed countries A consistent positive association between dietary diversity and child growth is also found in a number of countries Evidence from a multicountry analysis suggests that household-level DD diversity is strongly associated with household per capita income and energy availability, suggesting that DD could be a useful indicator of food security The nutritional contribution of animal foods to nutrient adequacy is indisputable, but the independent role of animal foods relative to overall dietary quality for child growth and nutrition remains poorly understood DD is clearly a promising measurement tool, but additional research is required to improve and harmonize measurement approaches and indicators Validation studies are also needed to test the usefulness of DD indicators for various purposes and in different contexts
828 citations
TL;DR: By 2020, developing countries will consume 107 million metric tons (mmt) more meat and 177 mmt more milk than they did in 1996/1998, dwarfing developed-country increases of 19 mmt for meat and 32mmt for milk.
Abstract: People in developing countries currently consume on average one-third the meat and one-quarter of the milk products per capita compared to the richer North, but this is changing rapidly. The amount of meat consumed in developing countries over the past has grown three times as much as it did in the developed countries. The Livestock Revolution is primarily driven by demand. Poor people everywhere are eating more animal products as their incomes rise above poverty level and as they become urbanized. By 2020, the share of developing countries in total world meat consumption will expand from 52% currently to 63%. By 2020, developing countries will consume 107 million metric tons (mmt) more meat and 177 mmt more milk than they did in 1996/1998, dwarfing developed-country increases of 19 mmt for meat and 32 mmt for milk. The projected increase in livestock production will require annual feed consumption of cereals to rise by nearly 300 mmt by 2020. Nonetheless, the inflation-adjusted prices of livestock and feed commodities are expected to fall marginally by 2020, compared to precipitous declines in the past 20 y. Structural change in the diets of billions of people is a primal force not easily reversed by governments. The incomes and nutrition of millions of rural poor in developing countries are improving. Yet in many cases these dietary changes also create serious environmental and health problems that require active policy involvement to prevent irreversible consequences.
673 citations
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%.
Abstract: 450 villages in northern Sumatra were randomly assigned to either participate in a vitamin A supplementation scheme (n = 229) or serve for 1 year as a control (n = 221). 25 939 preschool children were examined at baseline and again 11 to 13 months later. Capsules containing 200 000 IU vitamin A were distributed to preschool children aged over 1 year by local volunteers 1 to 3 months after baseline enumeration and again 6 months later. Among children aged 12-71 months at baseline, mortality in control villages (75/10 231, 7.3 per 1000) was 49% greater than in those where supplements were given (53/10 919, 4.9 per 1000) (p less than 0.05). The impact of vitamin A supplementation seemed to be greater in boys than in girls. These 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
01 Jan 1992
TL;DR: Vitamin A probably has more of an effect on the processes linked to response to infection than to those linked to resistance to infection, and does not appear to improve general morbidity but does have a beneficial effect on severe morbidity.
Abstract: Researchers affiliated with the International Nutrition Program at the University of Toronto reviewed 20 trials of vitamin A and morbidity and 10 trials of vitamin A and young child mortality to determine the effectiveness of vitamin A supplementation on reducing mortality and morbidity in children from developing countries. All the populations were characterized by general poverty high prevalence of stunting and clinical manifestations of vitamin A deficiency sufficiently prevalent to be considered a public health problem. The analysis using the random effect model confirmed that vitamin A supplementation does indeed reduce mortality rates in young children (by about 23%) (relative risk = 0.77 confidence interval = 0.68-0.88; p < 0.001). The 10 trials reported reductions in mortality associated with vitamin A supplementation ranging from 0 to 50%. Vitamin A supplementation reduced mortality rates regardless of gender and age between 6 months and 5 years. It had clear effects on mortality linked to diarrhea and measles. It apparently had no effect on mortality linked to respiratory infections and malaria. None of the mortality studies included children with biochemical evidence of vitamin A depletion with associated evidence of at least a low prevalence of xerophthalmia. The effect of vitamin A supplementation on morbidity is less clear than its effect on mortality. Vitamin A supplementation does not appear to improve general morbidity but does have a beneficial effect on severe morbidity. In the case of measles the evidence suggests that even after the onset of infection vitamin A supplementation can improve the course of the episode and the case fatality rate. In conclusion vitamin A probably has more of an effect on the processes linked to response to infection than to those linked to resistance to infection.
527 citations
TL;DR: An index that estimates nutrient adequacy based on adherence to food guide recommendations may provide a useful method of quickly evaluating dietary quality in both developing and developed countries.
Abstract: Animal source foods can provide a variety of micronutrients that are difficult to obtain in adequate quantities from plant source foods alone. In the 1980s, the Nutrition Collaborative Research Support Program identified six micronutrients that were particularly low in the primarily vegetarian diets of schoolchildren in rural Egypt, Kenya and Mexico: vitamin A, vitamin B-12, riboflavin, calcium, iron and zinc. Negative health outcomes associated with inadequate intake of these nutrients include anemia, poor growth, rickets, impaired cognitive performance, blindness, neuromuscular deficits and eventually, death. Animal source foods are particularly rich sources of all six of these nutrients, and relatively small amounts of these foods, added to a vegetarian diet, can substantially increase nutrient adequacy. Snacks designed for Kenyan schoolchildren provided more nutrients when animal and plant foods were combined. A snack that provided only 20% of a child's energy requirement could provide 38% of the calcium, 83% of the vitamin B-12 and 82% of the riboflavin requirements if milk was included. A similar snack that included ground beef rather than milk provided 86% of the zinc and 106% of the vitamin B-12 requirements, as well as 26% of the iron requirement. Food guides usually recommend several daily servings from animal source food groups (dairy products and meat or meat alternatives). An index that estimates nutrient adequacy based on adherence to such food guide recommendations may provide a useful method of quickly evaluating dietary quality in both developing and developed countries.
444 citations