agriculture and nutrition global learning and evidence exchange … · 2019-12-19 · micronutrient...

This presentation is part of the

Agriculture and Nutrition Global Learning and Evidence Exchange

(AgN-GLEE) held in Guatemala City, Guatemala from March 5-7, 2013.

For additional presentations and related event materials, visit: http://spring-nutrition.org/agnglee-lac

http://spring-nutrition.org/agnglee-lac

iLiNS project

Presentation by:

Omar Dary

Place:

AgNGLEE-Central America

Guatemala City,

Guatemala

6-March-2013

Importance of Food Fortification and in-Home “Fortification” to

Complement the Nutrient Adequacy of the Diet

Abt Associates | pg 2 OD-2013-01

Why stunting has changed little in

Guatemala?

Source: ABC News


Guatemala (ENSMI- 2008-2009)

Wasting (w/h) Underweight (w/a) Stunting (h/a)

1.4 % 13.1% 49.8 %

Ghana (2008-DHS) Wasting (w/h) Underweight (w/a) Stunting (h/a)

9.0 % 17.8 % 28.0 %

Anthropometric indicators in pre-school age children < 2 S.D.

Why do not consider other reasons beyond protein-energy undernutrition?


What about breast-feeding practices, use of snacks, or stimulus?

Pictures from Dr. Ram Shrestha, URC, visit to Guatemala 2012.


Causes of stunting and anemia

Type of growth and development

Physical Factors: good

nutrition, good health, disease resistance

Social Factors (Care) : Early stimulation, belonging to a family, attention, love

Genetic, Demographic & Environmental Factors:

Race, gender, ethnicity, altitude, sun-exposure,

intestinal flora

“Food Security” (Foods)

Child/mother health practices,

Immunization (Health)

Safe water and hygienic foods,

healthy environments (Hygiene)

Macronutrients supply: cereals,

pulses, oil and fats, animal protein

Some vitamins and minerals: milk, eggs,

fruits, vegetables, fortified foods

Avoidance of toxins and anti-nutritional

factors: mycotoxins, e.g.

Well absorbed Fe/Zn (fermentation, meat,

fish, fortification, supplementation)

Wasting, underweight and overweight

Essential fatty acids supply, mainly n-3

(fatty fish, and certain vegetable oils)

Non-digestible oligosaccharides

and fiber: healthy intestine status.


Stunting is only an indicator; the

important is to correct its causes.

Taken from: Thompson, R. A., & Nelson, C. A. (2001). Developmental science and the media: Early brain development. American Psychologist, 56(1), 5-15.

Complementary feeding

Nearly half of the “1000 days” depends on the mother nutritional status.

Exclusive lactation

Pregnancy


Nutritional value of breast milk depends

mostly on the mother’s diet

Type I Nutrients (dependent)*

Vit. B-1 60% Choline 56%

Vit. B-2 53% Vit. A¶ 56%

Vit. B-6¶ 80 % Vit. D¶ ? ***

Vit. B-12¶ 16 %** Iodine 6-23 %

Vit. C 50 % Selenium 52 %

Type II Nutrients (independent)

Sufficient Satisfy A.I., but…

Folate Iron

(Niacin)**** Zinc¶

Calcium Copper

Notes: * Estimated proportion of the Adequate Intake (AI) for the child of an under-nourished mother. ** Not possible to increase during the lactation period; it requires good status pre-pregnancy. *** Depends on sun exposure. **** It could be synthetized from the amino-acid tryptophan ¶ Deficiency associated to stunting.

References: Allen LH, Adv Nutr 2012; 3:362-369; and Allen LHGJ, In: Dealange FM WKJ (Ed). Micronutrient deficiencies in the first months of life. Basel: Karger Ag; 2003. pp 55-88.


Dietary sources of some nutrients

Nutrient Milk Meat,

poultry Eggs

Pulses (beans)

Whole cereals

Vege-tables

Fruits & roots

Sugar, oil, pol. rice

ref. flours

Vit. B-1 + ++ + +++ ++ + + -

Vit. B-2 +++ ++ ++ + + ++ + -

Niacin (B-3) + +++ + ++ + ++ + -

Vit. B-6 + ++ ++ ++ ++ ++ ++ -

Folate (B-9) - + ++ ++++ + ++ + -

Vit. B-12 ++ + ++ - - - - -

Vit. C + - - - - +++* +++ -

Vit. A +++** + +++ - - (++) ++ -

Vit. D +++** + + - - - - -

Iron - ++++ (+) (+++) (++) (++) (+) -

Zinc - ++++ - (+++) (++) (+) (+) -

Calcium +++ + + (++) (+) (++) - -


Nutrient inadequacy(%) of the most vulnerable member of

the family in the Dominican Republic -2007

Source: Dominican Republic ENCOVI-2007. RED/USAID and the National Office of Statistics (ONE), 2012

Socio-economic groups

2007 - DHS Stunting: 9.8% Underweight: 3.1% Wasting: 2.2%


Risk of inadequacy during the life course

(relative to energy intake)

Nutrient Children Women Men

1-3 y old 4-6 y old 19-30 y old 60 y old 19-30 y old 60 y old

Vit. B-2 + + + ++ + +++

Folate (B-9) + ++ +++ ++++ + +++

Vit. B-12 + ++ ++ ++++ + ++

Vit. A +++++ ++++ + +++ + ++

Iron +++ + +++++ +++ +++ ++++

Zinc ++++++ +++++ + ++ ++ ++++

Calcium +++++ ++++++ ++ +++++ + +++

Iodine +++++++ ++++++ +++ ++++ + +++


Questions: 1. Why to extend supplementation with iron from 6-24 months of age to 59 months of age? 2. Why to supply additional folic acid to children younger than 36 months of age?


Anemia prevalence on 6-59 m children -

Dominican Republic 2009

Source : Amarilis Then Paulino, MSP. 2011. 2009-Micronutrient Survey


Results of a real fortification program:

Wheat flour in Jordan-2010

Nutrient Additional content (mg/kg) % EAR

Expected Real Children Women

Iron –FeSO4 34 27 52 % 20 %

Vitamin A 1.5 1.2 29 % 52 %

Indicator Children (3-5 years old) Women (15-49 years old)

2002 2010 2002 2010

Iron Def. (ferr.

(<11 & < 12 ng/mL) 10.1 % 4.8 %* 20.0 % 19.8 %

Anemia (<11 &12 g/dL)

20.2 % 17.0 % 29.3 % 30. 6 %

IDA 26.1 % 13.7 %* 38.7 % 35.1 %

Serum retinol (<0.7 mol/L)

15.2 % 18.3 % - 4.8 %


Combining food vehicles to increase coverage

and the solution (additional micronutrient intakes)


Source: Martorell R. Caracterización de los patrones de consumo aparente en Centro América


Theoretical contribution (%EAR) through

fortified food for 1-2 y old children in D.R.

Nutrient Diet

Wheat flour/ Salt (I)

Rice/ sugar (Vit A)

Maize flour Total

(extremes)

P-20 P-80 P-20 P-80 P-20 P-80 P-20 P-80 P-20 P-80

Vit. B-2 85 170 5 22 0 0 0 7 90 198

Folate (B-9) 73 205 13 61 68 193 0 26 155 488

Vit. B-12 61 255 0 0 40 114 0 15 100 384

Vit. A 42 123 0 0 31 131 0 0 73* 254

Iron 77 131 5 24 4 10 0 11 86 176

Zinc 42 101 0 0 3 9 0 5 46 115

Calcium 22 50 0 0 0 0 0 0 22 50

Iodine ? ? 112 224 0 0 0 0 112 224

* Vit.A capsules: 200,000 IU = 60 mg = 0.278 mg/d if 80% absorpt. = 127% EAR of vit. A for 1-2 year old children.


In-home “fortification” (% EAR-INCAP)

for children 1-2 years old in the D.R.

Nutrient Breast milk*

Diet – P-20

Diet + FF P-20

MNP-WHO

MNP- Guate.

MNP- TAG**

LNS***

Vit. B-1 25 106 140 - - 42-125 75

Vit. B-2 50 85 90 - - 42-125 100

Niacin (B-3) 25 149 179 - - 50-150 100

Vit. B-6 100 128 160 - - 42-125 450

Folate (B-9) 117 73 154 - 76 42-125 113

Vit. B-12 100 61 100 - - 43-129 71

Vit. C 169 192 192 - 77 77-231 231

Vit. A 130 42 73+supp 143 48 63-190 190

Iron 9 77 86 231 77 62-185 166

Zinc 94 43 46 93 44 36-108 108

Calcium 44 22 22 - - - 20

* From mother with good nutrition, 39% energy supply; ** Technical advisory group: 60-180 days supply, WHO formula for emergencies; *** Lipid Nutrient Supplements: They also contain n-3 and n-6 essential fatty acids.


Anemia Prevalence in

1999

0

10

20

30

40

1-2

y. o

ld

2-5

y. o

ld

6-11

y. o

ld

Ado

lesc

ents

Wom

en

Wheat Flour

consumption 250 g/day

Iron Fortification

Level

20.0 mg/kg as

Ferrous Sulfate

(+10 intrinsic)

Iron Intake through

wheat flour 5.0 mg/day

Micronutrient Level

% EAR

in 650

mL/day

Iron (As ferrous

sulfate) 10 mg/L 112%

Vitamin A 300 µg/L 68%

Vitamin C 70 mg/L 182%

Zinc 5.0 mg/L 96%

Anemia in 1-2 year old Children

After Fortification of Milk

0

10

20

30

40

1999

2000

Impact of milk fortification in Chile. Skim milk

is a natural source of vit. B-2, B-12, calcium


Population coverage

Additional intake

Target fortification Mass fortification

Supplements for home “fortification”

Supplements

ODM-2011-3-Micr.Mex.

Dietary Diversification

Nutrition specific interventions


The risk of not integrating

ODM-2011-3-Micr.Mex.

Mandatory Voluntary

General population

Specific groups

Coverage

Compliance

Mass

fortification

Target

fortification

Market driven

fortification

And this without considering the supplements

Principles and concepts are UNIVERSAL, but the solutions are LOCAL (need and context)

agriculture and nutrition global learning and evidence exchange … · 2019-12-19 · micronutrient...

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