Maximizing the benefits and minimizing the risks of intervention programs to address micronutrient malnutrition: symposium report

Interventions to address micronutrient deficiencies have large potential to reduce the related disease and economic burden. However, the potential risks of excessive micronutrient intakes are often not well determined. During the Global Summit on Food Fortification, 9–11 September 2015, in Arusha, a symposium was organized on micronutrient risk–benefit assessments. Using case studies on folic acid, iodine and vitamin A, the presenters discussed how to maximize the benefits and minimize the risks of intervention programs to address micronutrient malnutrition. Pre‐implementation assessment of dietary intake, and/or biomarkers of micronutrient exposure, status and morbidity/mortality is critical in identifying the population segments at risk of inadequate and excessive intake. Dietary intake models allow to predict the effect of micronutrient interventions and their combinations, e.g. fortified food and supplements, on the proportion of the population with intakes below adequate and above safe thresholds. Continuous monitoring of micronutrient intake and biomarkers is critical to identify whether the target population is actually reached, whether subgroups receive excessive amounts, and inform program adjustments. However, the relation between regular high intake and adverse health consequences is neither well understood for many micronutrients, nor do biomarkers exist that can detect them. More accurate and reliable biomarkers predictive of micronutrient exposure, status and function are needed to ensure effective and safe intake ranges for vulnerable population groups such as young children and pregnant women. Modelling tools that integrate information on program coverage, dietary intake distribution and biomarkers will further enable program makers to design effective, efficient and safe programs

Vitamin D and pancreas: The role of sunshine vitamin in the pathogenesis of diabetes mellitus and pancreatic cancer

Increasing evidence suggests that vitamin D exerts multiple effects beyond bone and calcium metabolism. Vitamin D seems to play a role in pancreatic disease, including type 1 and type 2 diabetes mellitus as well as pancreatic cancer. Vitamin D's immune-modulatory action suggests that it could help prevent type 1 diabetes. In type 2 diabetes, vitamin D may influence β-cell function, insulin sensitivity, and systematic inflammation-all characteristic pathways of that disease. Data from observational studies correlated vitamin D deficiency with risk of type 1 and type 2 diabetes. Prospective and ecological studies of pancreatic cancer incidence generally support a beneficial effect of higher 25-hydroxyvitamin D concentration as well as inverse correlations between UVB dose or exposure and incidence and/or mortality rate of pancreatic cancer. This review discusses the literature regarding vitamin D's role in risk of diabetes and pancreatic cancer. The results to date generally satisfy Hill's criteria for causality regarding vitamin D and incidence of these pancreatic diseases. However, large randomized, blinded, prospective studies are required to more fully evaluate the potential therapeutic role of vitamin D in preventing pancreatic diseases

Efeito da suplementação com pupunha como fonte de vitamina A em dieta: estudo em ratos Effect of supplementation with peach palm as source of vitamin A: study with rats

Foi estudado o efeito da suplementação com pupunha (Bactris gasipaes H.B.K.), polpa cozida e transformada em farinha, como fonte de vitamina A, em dieta regional de Manaus, AM,Brasil, por meio do ensaio biológico com ratos. A metodologia utilizada foi da depleção dos animais em zinco e vitamina A, seguida da repleção com a dieta regional (DR), DR + pupunha, DR + vitamina A e dieta controle (DC). A dieta foi elaborada para famílias com rendimentos inferiores a dois salários-mínimos. Foram utilizadas ratas albinas adultas pós-parto, cada qual com 6 filhotes machos, que receberam ração à base de caseína lavada com EDTA a 1%, sem adição de Zn e vitamina A, por 25 dias, com a finalidade de obtenção de animais recém-desmamados deficientes nestes dois nutrientes. O período de repleção dos animais, recém-desmamados, foi de 30 dias e o delineamento foi inteiramente casualizado com 4 tratamentos de 8 animais cada. A suplementação efetuada seguiu as recomendações do "Committee on Laboratory Animal Diets". Os parâmetros empregados para a avaliação da utilização de vitamina A foram as concentrações de vitamina A no fígado e plasma e o crescimento dos animais. Ao final do experimento, observou-se que os animais que consumiram a ração à base da dieta regional de Manaus, suplementada com pupunha e vitamina A, apresentaram, respectivamente, concentração significativamente maior de vitamina A no fígado, 43,3 ± 6,5 µg/g e 42,0 ± 4,3 µg/g em relação à dieta regional, 5,5 ± 1,1 µg/g (p<0,05). A quantidade de zinco presente na dieta regional de Manaus, 10,7 mg diários, foi biodisponível quando avaliada pela concentração de zinco nos fêmures. Os resultados sugerem que existe necessidade de suplementação da dieta regional de Manaus com vitamina A para a manutenção das reservas hepáticas, podendo, para tanto, ser utilizada a fonte natural da pupunha.<br>The effect of supplementation with peach palm (Bactris gasipaes H.B.K.), as an alternative source of vit. A, in the regional diet of Manaus, AM, Brazil, in which the pulp was cooked and transformed into flour, was studied. The biological trial involved rats which were depleted in zinc and vitamin A, followed by repletion using the regional diet (RD), RD plus peach palm and RD plus vitamin A. The parameters used to determine the utilization of vitamin A were the vitamin A concentrations in the liver and plasma, and the growth of the animals. The diet was prepared according to the data of Shrimpton and Giugliano for families earning less than two legal minimum salaries. Adult post-partum rats were used, with six male pups each, which received a diet based on casein washed with 1% EDTA, without the addition of zinc or vitamin A for a period of 25 days, for the purpose of obtaining newly-weaned animals which were deficient in Zn and Vit.A. A control group received a diet also based on casein washed with 1% EDTA, but with all the nutrients in the quantities suggested by the Committee on Laboratory Animal Diets. The repletion period of the newly-weaned rats was of 30 days and the experimental design was entirely randomized with four groups of eight rats each. The diet supplementation followed the recommendations of the Committee on Laboratory Animal Diets. At the end of the experiment, it was observed that rats which consumed the diet based on the regional diet of Manaus supplemented with either peach palm or vitamin A showed a significantly greater concentration of vitamin A in the liver, 43.3 ± 6.5 µg/g, 42.0 ± 4.3 µg/g, respectively in relation to the regional diet, 5.5 ± 1.1 µg/g (p<0.05). The amount of zinc present in the regional diet, 10.7 mg per day, was bioavailable as determined by the concentration of zinc in the femurs. The results suggest that the regional diet of Manaus needs to be supplemented with vitamin A to maintain the hepatic reserves, and that such suplementation can be accomplished with peach palm, an abundant local commodity