Are low tolerable upper intake levels for vitamin a undermining effective food fortification efforts?

Vitamin A deficiency (VAD) is a major health problem, particularly in low-resource countries, putting an estimated 125-130 million preschool-aged children at increased risk of morbidity and mortality from infectious diseases. Vitamin A supplementation reduces VAD and increases child survival; it is complemented by fortifying foods with vitamin A. Concern over increased risk of bone fracture associated with vitamin A intakes below the tolerable upper intake level (UL) among populations in affluent countries conflicts with the need to increase intakes in less developed countries, where populations are at greater risk of VAD and intakes are unlikely to reach the UL as diets include fewer foods containing retinol while vitamin A from carotenoids poses no risk of overdose. With the implementation of recently developed risk management tools, vitamin A can be used safely in food fortification, including point-of-use fortification in the context of supplementation among specific target groups in low-resource countrie

Relationship of homestead food production with night blindness among children below 5 years of age in Bangladesh

Abstract Objective To examine the relationship between homestead food production and night blindness among pre-school children in rural Bangladesh in the presence of a national vitamin A supplementation programme. Design A cross-sectional study. Setting A population-based sample of six rural divisions of Bangladesh assessed in the Bangladesh Nutrition Surveillance Project 2001-2005. Subjects A total of 158 898 children aged 12-59 months. Results The prevalence rates of night blindness in children among those who did and did not receive vitamin A capsules in the last 6 months were 0·07 % and 0·13 %, respectively. Given the known effect of vitamin A supplementation on night blindness, the analysis was stratified by children's receipt of vitamin A capsules in the last 6 months. Among children who did not receive vitamin A capsules in the last 6 months, the lack of a home garden was associated with increased odds of night blindness (OR = 3·16, 95 % CI 1·76, 5·68; P = 0·0001). Among children who received vitamin A capsules in the last 6 months, the lack of a home garden was not associated with night blindness (OR = 1·28, 95 % CI 0·71, 2·31; P = 0·4). Conclusions Homestead food production confers a protective effect against night blindness among pre-school children who missed vitamin A supplementation in rural Banglades

Micronutrient Deficits Are Still Public Health Issues among Women and Young Children in Vietnam

Background: The 2000 Vietnamese National Nutrition Survey showed that the population’s dietary intake had improved since 1987. However, inequalities were found in food consumption between socioeconomic groups. As no national data exist on the prevalence of micronutrient deficiencies, a survey was conducted in 2010 to assess the micronutrient status of randomly selected 1526 women of reproductive age and 586 children aged 6–75 mo. Principal Findings: In women, according to international thresholds, prevalence of zinc deficiency (ZnD, 67.262.6%) and vitamin B12 deficiency (11.761.7%) represented public health problems, whereas prevalence of anemia (11.661.0%) and iron deficiency (ID, 13.761.1%) were considered low, and folate (,3%) and vitamin A (VAD,,2%) deficiencies were considered negligible. However, many women had marginal folate (25.1%) and vitamin A status (13.6%). Moreover, overweight (BMI$23 kg/m 2 for Asian population) or underweight occurred in 20 % of women respectively highlighting the double burden of malnutrition. In children, a similar pattern was observed for ZnD (51.963.5%), anemia (9.161.4%) and ID (12.961.5%) whereas prevalence of marginal vitamin A status was also high (47.362.2%). There was a significant effect of age on anemia and ID prevalence, with the youngest age group (6–17 mo) having the highest risk for anemia, ID, ZnD and marginal vitamin A status as compared to other groups. Moreover, the poorest groups of population had a higher risk for zinc, anemia and ID

The Economic Burden of Malnutrition in Pregnant Women and Children under 5 Years of Age in Cambodia

Malnutrition is locked in a vicious cycle of increased mortality, poor health, impaired cognitive development, slow physical growth, reduced learning capacity, inferior performance, and ultimately lower adult work performance and productivity. The consensus of global scientific evidence indicates that lowering the rates of malnutrition will be an indispensable component of any successful program to raise the quality of human capital and resources. This study used a “consequence model” to apply the coefficient risk-deficit on economic losses, established in the global scientific literature, to Cambodian health, demographic, and economic data to develop a national estimate of the value of economic losses due to malnutrition. The impact of the indicators of malnutrition analyzed represent a burden to the national economy of Cambodia estimated at 266 million USD annually (1.7% of GDP). Stunting is reducing the Cambodian economic output by more than 120 million USD, and iodine deficiency disorders alone by 57 million USD. This economic burden is too high in view of Cambodia’s efforts to drive economic development. The government should rapidly expand a range of low-cost effective nutrition interventions to break the current cycle of increased mortality, poor health and ultimately lower work performance, productivity, and earnings

Optimizing health and nutrition status of migrant construction workers consuming multiple micronutrient fortified rice in Singapore.

IntroductionA well-nourished workforce is instrumental in eradicating hunger, alleviating poverty, and spurring economic growth. A fifth of the total workforce in high-income countries are migrant workers. Despite the accessibility of nutritious foods in high-income countries, migrant workers often rely on nutrient-poor diets largely consisting of empty calories, which in turn leads to vitamin and mineral deficiency, also called hidden hunger, and resultant productivity loss. Here, we study the magnitude of hidden hunger in male migrant construction workers in Singapore and investigate the impact of consuming fortified rice for 6 consecutive months on the nutrition and health status of these workers.Methods140 male migrant workers aged 20-51 years of either Bangladeshi or Indian ethnicity from a single dormitory in Singapore volunteered to participate in the study. In total, 133 blood samples were taken at the start of the study and were used to assess vitamin B12, hemoglobin, ferritin, folate, and zinc levels; a sub-sample underwent for homocysteine testing. Anthropometric measurements and vital signs, such as blood pressure, were recorded before and after the intervention.ResultsThe results show that vitamin and mineral deficiency was present, especially folate (59% of workers deficient) and vitamin B12 (7% deficient, 31% marginally deficient). The consumption of fortified rice significantly improved the vitamin, iron and zinc level in the workers and significantly reduced the systolic blood pressure amongst the Bangladeshi migrant workers, specifically.ConclusionOur study demonstrates that fortified rice may have a positive impact on male migrant construction worker health and nutrition status at the workplace

Les carences en micronutriments (de l'épidémiologie à une stratégie d'enrichissement des aliments)

Contexte: L'enrichissement des aliments est une stratégie efficace pour lutter contre les carences en micronutriments. Toutefois, il existe de nombreuses étapes critiques, tels que l'évaluation des besoins de la population, l'obtention de l'appui du gouvernement et de l'industrie, le choix du véhicule alimentaire, la sélection des bons micronutriments (s) et son dosage, et enfin le suivi. Objectif: Cette thèse évalue et de discute les défis de l'enrichissement des aliments au Vietnam. Méthodologie: Les méthodes suivantes ont été utilisées: une étude transversale, une enquête sur la consommation, une étude d'impact, une étude de stabilité, une étude coût-conséquences, deux revues de littérature, une étude de validation, et les leçons tirées de programmes d'enrichissement financés par GAIN. Résultats: Les carences en micronutriments chez les femmes et les enfants au Vietnam sont encore très répandues et se chevauchent souvent. Bien qu'il n'y ait pas de consensus sur le meilleur indicateur pour déterminer le statut en zinc, la prévalence du déficit en zinc semble être élevée par example. De nombreuses initiatives d'enrichissement ont montré que le soutien du gouvernement et de l'industrie est essentiel pour réussir. Le gouvernement vietnamien a reconnu la nécessité de lutter contre les carences en micronutriments. Les véhicules appropriés pour l'enrichissement des aliments au Vietnam sont les huiles végétales et le riz, ainsi que la sauce de poisson, la sauce soja, les bouillons cubes et les aliments de complément. Cependant, il y a des questions qui doivent être soigneusement étudiés, tels que le niveau de peroxyde dans l'huile, la présence d'inhibiteurs de l'absorption du fer, ou le risque de sédimentation dans les sauces. Lors de l'ajout de micronutriments aux aliments, des facteurs tels que les coûts, la qualité et la sécurité doivent être pris en considération. Enfin, l'enrichissement doit être soigneusement surveillés pour s'assurer de la qualité et de surveiller les effets sur la santé de la population. Conclusion: Avant que la fortification des aliments puisse être mise en œuvre et être efficace au Vietnam, une série de défis devront être surmontés.Background: Food fortification is an effective strategy to combat micronutrient deficiencies. However, there are many critical steps, such as assessing the population's needs, obtaining support from the government and industries, choosing the food vehicle, selecting the right micronutrient(s) and the dosage and finally monitoring. Objective: The overall objective of this thesis is to assess and discuss the challenges of food fortification in Vietnam. Methodology: The following methods were used: a cross-sectional study, a consumption survey, an impact study, a stability study, a cost-implication study, two literature reviews, a validation study, and lessons learned from GAIN funded fortification programs. Results: Micronutrient deficiencies in women and children in Vietnam are still widespread and often overlap. Although there is no consensus on which indicator is best to use to determine zinc status, zinc deficiency prevalence seems to be high. Numerous fortification initiatives have shown that the support from the government and the industry is essential in order to be successful. The Vietnamese government has recognized the need to fight micronutrient deficiencies. Suitable food vehicles for fortification in Vietnam are vegetable oil and rice, as well as fish sauce, soy sauce, wheat flour and possibly flavoring powders and complementary foods. However, there are issues that need to be carefully studied, such as the peroxide level in the oil, the presence of absorption inhibitors in the flour, or the risk of sedimentation in sauces. When adding micronutrients to foods, factors such as costs, quality and safety need to be considered. Finally, fortification needs to be carefully monitored to assure quality and to supervise the effect on the population's health. Conclusion: Before food fortification can be implemented and be effective in Vietnam, a series of challenges will need to be overcome.MONTPELLIER-BU Sciences (341722106) / SudocSudocFranceF

Influence of storage conditions and packaging of fortified wheat flour on microbial load and stability of folate and vitamin B12

International audienc

The Economic Burden of Malnutrition in Pregnant Women and Children under 5 Years of Age in Cambodia

Malnutrition is locked in a vicious cycle of increased mortality, poor health, impaired cognitive development, slow physical growth, reduced learning capacity, inferior performance, and ultimately lower adult work performance and productivity. The consensus of global scientific evidence indicates that lowering the rates of malnutrition will be an indispensable component of any successful program to raise the quality of human capital and resources. This study used a “consequence model” to apply the coefficient risk-deficit on economic losses, established in the global scientific literature, to Cambodian health, demographic, and economic data to develop a national estimate of the value of economic losses due to malnutrition. The impact of the indicators of malnutrition analyzed represent a burden to the national economy of Cambodia estimated at 266 million USD annually (1.7% of GDP). Stunting is reducing the Cambodian economic output by more than 120 million USD, and iodine deficiency disorders alone by 57 million USD. This economic burden is too high in view of Cambodia’s efforts to drive economic development. The government should rapidly expand a range of low-cost effective nutrition interventions to break the current cycle of increased mortality, poor health and ultimately lower work performance, productivity, and earnings

Are low tolerable upper intake levels for vitamin A undermining effective food fortification efforts?

Vitamin A deficiency (VAD) is a major health problem, particularly in low-resource countries, putting an estimated 125-130 million preschool-aged children at increased risk of morbidity and mortality from infectious diseases. Vitamin A supplementation reduces VAD and increases child survival; it is complemented by fortifying foods with vitamin A. Concern over increased risk of bone fracture associated with vitamin A intakes below the tolerable upper intake level (UL) among populations in affluent countries conflicts with the need to increase intakes in less developed countries, where populations are at greater risk of VAD and intakes are unlikely to reach the UL as diets include fewer foods containing retinol while vitamin A from carotenoids poses no risk of overdose. With the implementation of recently developed risk management tools, vitamin A can be used safely in food fortification, including point-of-use fortification in the context of supplementation among specific target groups in low-resource countrie