Goiter Assessment: Help or Hindrance in Tracking Progress in Iodine Deficiency Disorders Control Program?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63217/1/10507250152741082.pd

Growth references

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29286/1/0000346.pd

Development of a growth reference for the mid-upper arm circumference (MUAC) as an anthropometric indicator of protein status in marginally nourished populations.

This dissertation focuses on the development of a marker of protein status to identify children with severe negative energy balance and protein deficiency. Such a tool would have considerable value in epidemiological studies since muscle mass is an important indicator of protein-energy malnutrition (PEM). While biochemical measures are available to precisely measure muscle protein status, anthropometry provides an inexpensive practical means for the assessment of muscle mass in developing countries where severe PEM is prevalent. This dissertation addresses the utility of the anthropometric measurement of the mid-upper arm circumference (MUAC) as an indicator of muscle mass for the evaluation of protein status in marginally nourished populations. A standardized reference for MUAC has been developed which takes into account the observed variations in MUAC by age and gender to obtain a biologically meaningful assessment of protein status. Using data from the Second National Health and Nutrition Examination Survey (NHANES II), several polynomial regression models were constructed to compute MUAC z-scores. Poor correspondence between the MUAC z-scores and other anthropometric indices, e.g., WFA, HFA and WFH, was noted which suggests that distinct biological processes and manifestations of malnutrition may be detected by different anthropometric measures. In addition, both age and gender are important covariates in the classification of malnutrition. The association of clinical vitamin A deficiency (VAD) with standardized MUAC as an index of protein deficiency among children was assessed. The MUAC z-score was found to be a more discriminating correlate of clinical VAD (conjunctival xerophthalmia) than other anthropometric indicators in both bivariate and multivariate analyses. Where VAD is endemic, the use of the standardized MUAC may allow for targeting of resources to children with marginal muscle mass. This may ensure the greatest reduction in VAD, along with it's associated morbidity and mortality. Additional studies are proposed to confirm the usefulness and validity of the MUAC z-scores as an independent, and absolute indicator of protein status, and to serve as a screening tool to identify children at risk for protein deficiency.Ph.D.International HealthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/104115/1/9500930.pdfDescription of 9500930.pdf : Restricted to UM users only

Introduction to the programme guidance for the use of iodised salt in processed foods and its pilot implementation, strengthening strategies to improve iodine status.

Efforts to achieve optimal iodine intake through salt iodisation have focussed primarily on iodisation of household salt. However, there is strong evidence that in most regions of the world, industrially processed foods and condiments are an increasingly important source of dietary salt. In this context The Iodine Global Network (IGN) and partners developed programme guidance to help national programme managers assess the potential contribution of widely consumed industrially processed foods and condiments to iodine intake. The programme guidance additionally aimed to facilitate better understanding of iodised salt use by the processed food industry, review existing salt iodisation legislation for inclusion of food industry salt, and investigate how regulatory monitoring of food industry practices could be strengthened if needed. To evaluate the utility of the guidance in practice and identify areas where it could be improved, the IGN requested expressions of interest to pilot test implementation. Five pilots were implemented in Kenya, North Macedonia, The Republic of Moldova, Sri Lanka and Thailand, with remote technical support from IGN. The pilots demonstrated how evidence from implementation could be used to strengthen existing salt iodisation initiatives. In particular, how modelling existing processed food intake data enhanced understanding of potential or actual iodised salt intake and provided an evidence base for strategic change, as well as encouraging alignment with salt reduction programmes. In summary, the guidance provided a useful framework for national teams to conduct a relatively rapid assessment of the existing programme for achieving optimal iodine nutrition and opportunities to strengthen it. National teams involved with the pilot implementation were highly engaged and motivated by the outcomes. The pilot implementation process resulted in the development of strategic recommendations nationally and provided invaluable feedback to IGN on the utility of the guidance, facilitating development of an improved version

Aligning the Epidemiology of Malnutrition with Food Fortification: Grasp Versus Reach

Large-scale food fortification (LSFF) has been recognized as one of the most cost-effective interventions to improve the intake of vitamins and minerals and decrease the burden of micronutrient deficiency. Indeed, the simple addition of micronutrients to staple foods, such as wheat, maize and rice, or condiments, including salt and bouillon, has tremendous potential to impact malnutrition. However, most LSFF programs have been poorly designed and have not taken into consideration critical inputs, including current levels of nutrient inadequacy and per capita consumption of different food vehicles when deciding which nutrients to add and at what concentrations. LSFF programs, like some other nutrition interventions, also tend to have low coverage and reach and lack monitoring to measure this and course correct. These program design flaws have resulted in limited effectiveness and have made it difficult to determine how best to harmonize LSFF with other interventions to reduce micronutrient deficiencies, including efforts to enhance dietary diversity, biofortification and supplementation. Furthermore, LSFF has often been touted as a population-based intervention, but in fact has heterogenous effects among sub-groups, particularly those with limited access to or inability to afford fortified foods, as well as those with higher physiological requirements, such as pregnant and lactating women. This article focuses on these limitations and the concerted efforts underway to improve the collection, analysis, and use of data to better plan LSFF programs, track implementation, and monitor coverage and impact. This includes a more sophisticated secondary analysis of existing data, innovations to increase the frequency of primary data collection and programmatically relevant visualizations of data of sub-national estimates. These improvements will enable better use of data to target resources and programmatic efforts to reach those who stand to benefit most from fortification

Potential and estimated current iodine intake from household salt and five selected processed foods, relative to the EAR and RNI for iodine for non-pregnant adults.

Based on example data. (A). Iodine intake from household salt and from iodised salt in each of the selected processed food. (B). Iodine intake from household salt and from iodised food industry salt for the five selected processed foods combined. Illustrated using EAR = 95μg and RNI = 150 μg iodine for non-pregnant adults. Potential iodine intake represents iodine intake from salt in each product if all salt iodised according to national standards, and accounting for a 30% loss of iodine in the final product. Estimated current iodine intake represents iodine intake from the estimated percent of household salt and salt in each product currently iodised, with iodisation according to national standards, and accounting for a 30% loss of iodine in the final product.</p

Overview of the main purpose of each of the programme guidance modules.

Overview of the main purpose of each of the programme guidance modules.</p

Potential iodine intake from iodised household salt and iodised salt in selected industrially processed foods, based on typical adult daily consumption and 100% salt iodised to national standards.

Potential daily iodine intake assumes all food grade salt iodised to mean of national standard, with a 30% loss of iodine in the final product. Country name (n) = number of processed foods included in the national assessment, not including household salt. The Thai data shows results for top 10 processed foods contributing to daily salt intake (solid bar), and for an additional two salty condiments (hashed bar).</p

Potential and estimated current iodine intake from household salt and five selected processed foods, as a percentage of the EAR, RNI, and UL for iodine for non-pregnant adults.

Based on example data. Illustrated using EAR = 95μg, RNI = 150 μg and UL = 600 μg iodine for non-pregnant adults. Potential iodine intake represents iodine intake from salt in each product if all salt iodised according to national standards, and accounting for a 30% loss of iodine in the final product. Estimated current iodine intake represents iodine intake from the estimated percent of household salt and salt in each product currently iodised, with iodisation according to national standards, and accounting for a 30% loss of iodine in the final product.</p