micronutrients - who · 2/1/2010 · guideline: vitamin a supplementation for infants and children...

MICRONUTRIENTS2010 - 2011

Department of Nutrition for Health and Development

WHONMHNHDEPG121

SUMMARYDuring 2010-2011 major efforts of WHO headquarters in collaboration with WHO regions

were focused on establishing a process for developing and updating evidenceinformed

guidelines for micronutrient interventions and biomarkers as well as upgrading and expand-

ing the Vitamin and Mineral Nutrition Information System (VMNIS) Sixteen evidence-informed

guidelines for micronutrient interventions were published during this biennium and new tools

and resources were developed to support Member States and their partners in successfully

implementing effective micronutrient interventions Furthermore research studies were

initiated with collaborating institutions on the biological and biochemical pathways underlying

neonatal vitamin A supplementation and on the development of models to assess the burden

of vitamin and mineral deficiencies

WHO has now published the VMNIS website and over 100 documents related to

micronutrients in 6 WHO official languages This allows WHO to more effectively guide

public health practices reach out international audiences who need it and achieve

better health outcomes worldwide In this way multilingual communication is an

essential tool for improving global health

WHO continues its commitment to coordinate the universal call to scale up nutrition

actions by increasing multilateral work on technical and policy agendas at the global

regional and country level with the core group of United Nations agencies and interna-

tional partners dealing with micronutrient interventions in public health

Micronutrients 2010-2011Department of Nutrition for Health and Development

2DRAFT

1 EVIDENCE-INFORMED GUIDELINE DEVELOPMENT 3

Supplementation

Point-of-use fortification of foods

Others

2 SCIENTIFIC PUBLICATIONS AND REPORTS 4

Technical Reports

WHO micronutrients mailing list

3 MULTILINGUALISM 7

4 WHO VITAMIN AND MINERAL NUTRITION INFORMATION SYSTEM 8

5 OUR TEAM 10

6 RESEARCH 12

7 OUR PARTNERS 13

8 FINANCIAL SUPPORT 16

9 WHO MEETINGS 18

TABLE OF CONTENTS


3DRAFT

1 EVIDENCE-INFORMED GUIDELINE DEVELOPMENT

A WHO guideline is any document containing WHO recommendations about health interventions whether they are clinical public

health or policy interventions A recommendation provides information about what policy-makers health-care providers or patients

should do It implies a choice between different interventions that have an impact on health and that have ramifications for the

use of resources As of 2009 all publications containing WHO recommendations are approved by the WHO Guidelines Review

Committee WHO has developed the evidence-informed recommendations for micronutrients interventions in public health using the

procedures outlined in the WHO Handbook for guideline development The steps in this process include (i) identification of priority

questions and outcomes (ii) evidence retrieval (iii) assessment and synthesis of the evidence (iv) formulation of recommendations

including research priorities and (v) planning for dissemination implementation impact evaluation and updating Using the Grading

of Recommendations Assessment Development and Evaluation (GRADE) methodology evidence profiles related to preselected

topics are prepared based on up-to-date systematic reviews During 2010-2011 WHO Headquarters updated or developed the

following guidelines on micronutrient interventions

SUPPLEMENTATION

Guideline Neonatal vitamin A supplementation

Guideline Vitamin A supplementation for infants 1ndash5 months of age

Guideline Vitamin A supplementation for infants and children 6-59 months of age

Guideline Vitamin A supplementation in pregnant women

Guideline Vitamin A supplementation in postpartum women

Guideline Vitamin A supplementation during pregnancy for reducing the risk of

mother-to-child transmission of HIV

Guideline Intermittent iron supplementation in preschool and school-age children

Guideline Intermittent iron and folic acid supplementation in menstruating women

Guideline Daily iron and folic acid supplementation in pregnant women (in press)

Guideline Intermittent iron and folic acid supplementation in non-anaemic

pregnant women (in press)

Guideline Calcium supplementation in pregnant women (in press)

Guideline Vitamin D supplementation in pregnant women (in press)

POINT-OF-USE FORTIFICATION OF FOODS

Guideline Use of multiple micronutrient powders for home fortification of foods consumed

by infants and children 6ndash23 months of age


by pregnant women

OTHERS

WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia

Guideline Iron interventions in areas where malaria transmission occurs (in press)

These guidelines are available on the WHO website and the eLibrary of Evidence for Nutrition Actions

(wwwwhointelena)

1

Guideline

Vitamin A

supplementation in

infants 1ndash5 months of age

Guideline Vitamin A supplementation in pregnancy for reducing the risk of mother-to-child transmission of HIV


Guideline

Vitamin A

supplementation in

infants and children

6ndash59 months of age


4DRAFT

1 SCIENTIFIC PUBLICATIONS AND REPORTSPeer review and publication in scientific journals help ensure that

sound methods are appropriately utilized in the development of

guidelines They serve as a means of quality control a term which

also includes the transparency and repeatability of research

for independent verification the validity of the conclusions

and interpretations drawn from the reported data the overall

importance for advancement within the field of nutrition

and public health novelty as well as applicability The WHO

guideline development process calls for a systematic review

of the evidence related to a particular intervention undergoing

evaluation For micronutrient interventions technical staff

from NHD have prepared many of these systematic reviews

while WHO has commissioned the Cochrane Collaboration to

complete other reviews Other publications referred to vitamin

and mineral nutrition surveillance and research area related

to micronutrient interventions in public health As part of the

Cochrane pre-publication editorial process protocols and

reviews are commented on by external peers (an editor and

two referees external to the editorial team) and the grouprsquos

statistical adviser before publication httpwwwcochraneorg

The Cochrane handbook for systematic reviews of interventions

describes in detail the process of preparing and maintaining

Cochrane systematic reviews on the effects of healthcare

interventions

Disclaimer The authors in bold are staff members of the

World Health Organization The authors alone are responsible

for the views expressed in this publication and they do not

necessarily represent the decisions or policies of the World

Health Organization

Andersson M de Benoist B Rogers L Epidemiology of iodine

deficiency Salt iodisation and iodine status Best Practice amp

Research Clinical Endocrinology amp Metabolism 2010 Feb

24(1)1-11 httpwwwncbinlmnihgovpubmed20172466

Palacios C Pentildea-Rosas JP Calcium supplementation during

pregnancy for preventing hypertensive disorders and related

problems RHL commentary (last revised 1 February 2010)

The WHO Reproductive Health Library Geneva World Health

Organization httpappswhointrhlpregnancy_childbirth

antenatal_carenutritioncd001059_penasrosasjp_comen

indexhtml

Serdula M Pentildea-Rosas JP Maberly GF Aburto NJ Perrine

CG Mei Z (eds) Flour fortification with iron folic acid vitamin

B12 vitamin A and zinc Proceedings of the Second Technical

Workshop on Wheat Flour Fortification Food and Nutrition

Bulletin vol 31 no 1 (supplement) United Nations University

Press 2010 httpwwwfoodandnutritionbulletinorg

downloadsFNB_v31n1_suppl_webpdf

Bojorquez-Chapela I Mendoza-Flores ME Morales RM

Tolentino MC De-Regil LM Risky eating behaviours are

not associated with micronutrients deficiencies in women

from Mexico City (Spanish) Archivos Latinoamericanos

de Nutricioacuten 201060(1)64-69 httpwwwncbinlmnih

govpubmedterm=Bojorquez-Chapela20I2C2020

Mendoza-Flores20ME2C20Morales20RM2C20

Tolentino20MC2C20De-Regil20LM

De-Regil LM Jamous O Mendoza-Flores ME Morales RM

Tolentino MC Casanueva E Perception of menstrual bleeding

and its asociacioacuten with iron folate and vitamin B12 deficiencies

in women of reproductive age from Mexico City (Spanish)

Anales Venezolanos de Nutricioacuten 201023 (1) 5-9 http

analesfundacionbengoaorganales-nutricion20101i=art1

Pentildea-Rosas JP Rogers LM De-Regil LM Bopardikar A

Panisset U WHO from Research to Action Developing evidence-

informed guidelines and policies for interventions in vitamin and

mineral nutrition (abstract) Evidence in multiple micronutrient

nutrition from history to science to effective programs Public

Health Nutrition 2010 Sept13(9A)17

De-Regil LM Fernaacutendez-Gaxiola AC Dowswell T Pentildea-

Rosas JP Effects and safety of periconceptional folate

supplementation for preventing birth defects Cochrane

Database of Systematic Reviews 2010 (Issue 10) Art No

CD007950 DOI 10100214651858CD007950pub2

httponlinelibrarywileycomdoi10100214651858

CD007950pub2pdf Available in Spanish at httpwww

bibliotecacochranecomBCPGetDocumentaspSessionID=36

22858ampDocumentID=CD007950

Ansary A Palacios C De-Regil LM Pentildea-Rosas JP Vitamin

D supplementation for women during pregnancy [Protocol]

Cochrane Database of Systematic Reviews 2010 Issue 12 Art

No CD008873 DOI 10100214651858CD008873


CD008873pdf

2


5DRAFT

Vist GE Suchdev PS De-Regil LM Walleser S Pentildea-Rosas JP

Home fortification of foods with multiple micronutrient powders

for health and nutrition in children under 2 years of age [Protocol]


No CD008959 DOI 10100214651858CD008959 http

onlinelibrarywileycomdoi10100214651858CD008959pdf

Sylvetsky AC Jefferds MED De-Regil LM Dowswell T Intermittent

iron supplementation for improving nutrition and developmental

outcomes in children [Protocol] Cochrane Database of

Systematic Reviews 2011 Issue 4 Art No CD009085 DOI

10100214651858CD009085 httponlinelibrarywileycom

doi10100214651858CD009085pdf

Fernaacutendez-Gaxiola AC De-Regil LM Nasser M Intermittent

iron supplementation for reducing anaemia and its associated

impairments in menstruating women [Protocol] Cochrane

Database of Systematic Reviews 2011 Issue 7 Art No

CD009218 DOI 10100214651858CD009218 http


De-Regil LM Suchdev PS Vist GE Walleser S Pentildea-Rosas

JP Home fortification of foods with multiple micronutrient

powders for health and nutrition in children under two years

of age Cochrane Database of Systematic Reviews 2011

Sep 79CD008959 httpwwwupdate-softwarecomBCP

WileyPDFENCD008959pdf Available in Spanish here

Summary in Portuguese here

Wong EM Sullivan KM Perrine CG Rogers LM Pentildea-Rosas

JP Comparison of median urinary iodine concentration as an

indicator of iodine status among pregnant women school-age

children and nonpregnant women Food and Nutrition Bulletin

Volume 32 Number 3 September 2011 pp 206-212(7)

httpwwwncbinlmnihgovpubmedterm=wong20pena-rosas20jp20

Suchdev PS De-Regil LM Walleser S Vist GE Pentildea-Rosas

JP Multiple micronutrient powders for home (point of use)

fortification of foods in pregnant women a systematic review

WHO e-Library of Evidence for Nutrition Actions Geneva

World Health Organization 2011 httpwhqlibdocwhoint

publications20119789241502559_engpdf

De-Regil LM Jefferds MED Sylvetsky AC Dowswell T

Intermittent iron supplementation for improving nutrition and

development in children under 12 years of age Cochrane


CD009085 DOI 10100214651858CD009085pub2


CD009085pub2pdf Available in Spanish here

Fernaacutendez-Gaxiola AC De-Regil LM Intermittent iron

supplementation for reducing anaemia and its associated

impairments in menstruating women Cochrane Database of Systematic Reviews 2011 Issue 12 Art No CD009218 DOI

10100214651858CD009218pub2 httponlinelibrary

wileycomdoi10100214651858CD009218pub2pdf

Available in Spanish at httpwwwbibliotecacochranecom

BCPGetDocumentaspSessionID=3622858ampDocumentID=

CD009218

De-Regil LM Palacios C Ansary A Kulier R Pentildea-Rosas

JP Vitamin D supplementation for women during pregnancy

Cochrane Database of Systematic Reviews 2012 Issue 2

Art No CD008873 DOI 10100214651858CD008873

pub2 httponlinelibrarywileycomdoi10100214651858

CD008873pub2pdf

Home fortification of foods with multiple micronutrient


of age (Review)

De-Regil LM Suchdev PS Vist GE Walleser S Pentildea-Rosas JP

This is a reprint of a Cochrane review prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library

2011 Issue 9httpwwwthecochranelibrarycom

Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age (Review)

Copyright copy 2011 The Cochrane Collaboration Published by John Wiley amp Sons Ltd

Intermittent iron supplementation for reducing anaemia and

its associated impairments in menstruating women (Review)Fernaacutendez-Gaxiola AC De-Regil LM


2011 Issue 12

httpwwwthecochranelibrarycom

Intermittent iron supplementation for reducing anaemia and its associated impairments in menstruating women (Review)



6DRAFT

TECHNICAL REPORTS

Disclaimer These technical reports contain discussions and presentation from the meetings and do

not necessarily represent the decisions or policies of the World Health Organization Similarly they may

contain background papers commissioned for these meetings The named authors alone are responsible

for the views expressed in this publication

WHO Technical consultation on neonatal vitamin A supplementation research priorities meeting report

Geneva World Health Organization 2009 (httpwhqlibdocwhointpublications20099789241599597_

engpdf) Published in 2010

WHO Estimating appropriate levels of vitamins and minerals for food fortification programmes The WHO Intake

Monitoring Assessment and Planning Program (IMAPP) meeting report Geneva World Health Organization 2010

(httpwwwwhointnutritionpublicationsmicronutrients9789241599603pdf)

WHO Technical consultation on vitamin A in newborn health mechanistic studies Geneva World Health Organization

2012 (httpwhqlibdocwhointpublications20129789241503167_engpdf)

WHO MICRONUTRIENTS MAILING LIST

The WHO Micronutrients Mailing List was developed in order to allow subscribers to receive periodic information on WHOrsquos work

in the area of vitamins and minerals The list was established in 2009 with 990 subscribers There are currently over 3100

subscribers and the list continues to grow Anyone may subscribe to the list by sending an E-mail to micronutrientswhoint with

the following text in the subject and body of the message ldquoSUBSCRIBE MICRONUTRIENTS LISTrdquo

Who Technical

consulTaTion

on ViTamin a

in neWborn

healTh

mechanisTic

sTudies

REPORT

R E P O R T

WHO Me e t i n g O n es t i M at i n g ap p rO p r i ate Leve L s O f vi t a M i n s a n d Mi n e ra L s fO r fO O d fO r t i f i c at i O n prO gra M M e s tH e WHO int a ke MO n i tO r i n g as s e s s M e nt a n d pL a n n i n g prO gra M (iMapp)Ge n e va Sw i t ze r l a n d 22 Ju l y 2009


7DRAFT

WHOrsquos publications and other resources that are produced in several

languages help to ensure that health information reaches those who need it

in the language they can understand This makes access to health information

both more equitable and effective Communicating in different languages

bridges gaps and fosters understanding between people It allows WHO to more

effectively guide public health practices reach out to audiences worldwide

and achieve better global health outcomes The six official languages of WHO

- Arabic Chinese English French Russian and Spanish - were established by

a 1978 World Health Assembly resolution turning multilingualism into a WHO

policy Since the adoption of a 1998 resolution all Governing bodies documents

and corporate materials have been made available online in all official languages

Many of the WHO publications in micronutrients have been translated into these languages Samples of the work on micronutrients

in the WHO official languages includes the translation of the website of the Vitamin and Mineral Nutrition Information System the

recent WHO evidence-informed guidelines in micronutrient interventions the WHOCDC logic model for micronutrient interventions

and summaries of the indicators used in assessing vitamin and mineral nutritional status Efforts will be made in making more

resources available in the six WHO official languages

1 MULTILINGUALISM3


8DRAFT

The WHO Vitamin and Mineral Nutrition Information System (VMNIS) was initially established in 1991 and has now been expanded

into a more comprehensive vitamin and mineral nutrition information system Evaluations of epidemiological and informatics

capabilities of the system in 2009 guided the upgrade and expansion of VMNIS to include a more comprehensive micronutrients

database and additional resources and tools for vitamin and mineral nutrition surveillance by Member States and their partners as

well as the incorporation and utilization of advances in information technology to disseminate the information A new website is now

online for VMNIS that includes the following sections 1) micronutrients database 2) indicators 3) laboratory capacity 4) monitoring

and evaluation and 5) publications The website is now available in all six WHO official languages

The Micronutrients Database of the VMNIS is now upgraded and expanded This process is occurring in three phases two of which

are already completed During phase I the database was restructured to make it more efficient exploit new innovations in information

technology and include more nutritional indicators In collaboration with the Information Technology and Telecommunications Unit

of WHO and with support from CDC partners from the Office of Informatics and Information Resources Management and other

colleagues from the National Center for Chronic Disease Prevention and Health Promotion the new database platform is functioning

During phase II -data migration- all the survey information available from the previous database and an additional systematic

search for data that included scientific literature and communication with WHO Regional Offices relevant UN agencies and other

partner organizations to solicit information on nutritionmicronutrient surveys was included Additionally all surveys reports have

been digitalized to make an electronic repository instead of paper printed documents Phase III data display is expected to be

completed in 2012 and will allow users to create maps tables and access data directly from the internet

The Indicators section includes information on the biomarkers used in assessing vitamin and

mineral status in populations and used in surveys collected in VMNIS

These documents are a compilation of current WHO recommendations on the topic from different sources They summarize the

currently recognized cut-offs for defining deficiencies and their severity at the individual and population level and the chronology of

their establishment These are not new or updated recommendations but compilations of existing guidelines that were dispersed

in several WHO references and reports These summaries that are available in the six WHO official languages will serve as a

starting point for updating current recommendations on the use of these indicators

Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity

Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations

Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations

The Monitoring and Evaluation section of the VMNIS contains resources that can be useful

for monitoring andor evaluating interventions that have a focus on outcomes related to vitamin

and mineral nutrition Notable are the following

The WHOCDC logic model for micronutrient interventions in public health depicts the programme theory and plausible

relationships between inputs and expected MDGs and can be adapted to different contexts Member States can

adjust this proposed generic logic model and use it as part of the continuous quality improvement cycle for planning

performance measurement or evaluation

The WHOCDC indicators e-Catalogue for micronutrient interventions platform has been completed and it intends to be

an up-to-date interactive user-friendly and comprehensive resource of indicators for those who are actively engaged in

providing technical assistance in evaluation of micronutrient interventions There is considerable variation in indicators

used to define micronutrient deficiency limiting comparability across programs and over time

Anaemia is a condition in which the number of red blood cells (and

consequently their oxygen-carrying capacity) is insufficient to meet the

bodyrsquos physiologic needs Specific physiologic needs vary with a personrsquos

age gender residential elevation above sea level (altitude) smoking

behaviour and different stages of pregnancy Iron deficiency is thought to

be the most common cause of anaemia globally but other nutritional

deficiencies (including folate vitamin B12 and vitamin A) acute and chronic

inflammation parasitic infections and inherited or acquired disorders that

affect haemoglobin synthesis red blood cell production or red blood cell

survival can all cause anaemia Haemoglobin concentration alone cannot

be used to diagnose iron deficiency However the concentration of

haemoglobin should be measured even though not all anaemia is caused

by iron deficiency The prevalence of anaemia is an important health

indicator and when it is used with other measurements of iron status the

haemoglobin concentration can provide information about the severity of

iron deficiency (1)

Inside

Background

Scope and purpose This document aims to provide users of the Vitamin and Mineral Nutrition

Information System (VMNIS) with information about the use of

haemoglobin concentration for diagnosing anaemia It is a compilation of

current World Health Organization (WHO) recommendations on the topic

and summarizes the cut-offs for defining anaemia and its severity at the

population level as well as the chronology of their establishment

The use of the cut-off points derived from the referenced publications

permits the identification of populations at greatest risk of anaemia and

priority areas for action especially when resources are limited They also

facilitate the monitoring and assessment of progress towards international

goals of preventing and controlling iron deficiency and further provide the

basis for advocacy for the prevention of anaemia

Haemoglobin concentrations for the diagnosis of anaemia and

assessment of severity

VMNIS | Vitamin and Mineral Nutrition Information System

WHONMHNHDMNM111 Background 1

Description of technical consultation 2

Recommendations 3

Summary development

Acknowledgements 5

Plans for update 5

References 6

4

Scope and purpose 1

VMNIS | 1

4

Retinol is the predominant circulating form of vitamin A in the blood In

response to tissue demand it is released from the liver in a 11 ratio with its

carrier protein retinol-binding protein (1) In the blood this complex

combines with transthyretin (2) Specific receptors on target cell surfaces or

nuclei bind this complex or its active metabolites thereby regulating many

critical functions in the body including vision epithelial tissue integrity

and the expression of several hundred genes (2) Serum retinol levels reflect

liver vitamin A stores only when they are severely depleted (lt 007 micromolg

liver) or extremely high (gt 105 micromolg liver) (1) Between these extremes

serum retinol is homeostatically controlled and thus not always correlated

with vitamin A intake or clinical signs of deficiency Consequently serum

retinol is not useful for assessing the vitamin A status of individuals and

may not respond to interventions Rather the distribution of serum retinol

values in a population and the prevalence of individuals with serum retinol

values below a given cut-off can provide important information on the

vitamin A status of a population and may reflect the severity of vitamin A

deficiency as a public health problem (3) especially when the degree of

underlying infection or inflammation is taken into account Serum retinol

values are most often measured in young children a group highly

vulnerable to deficiency (3) Deficiency of vitamin A is associated with significant morbidity and

mortality from common childhood infections and is the worldrsquos leading

preventable cause of childhood blindness (3)

Inside

Background

Scope and Purpose This document aims to provide users of the Vitamin and Mineral Nutrition

Information System (VMNIS) with information about the use of serum

retinol for assessing the prevalence of vitamin A deficiency in populations

It is a compilation of the current World Health Organization (WHO)

recommendations on the topic and summarizes from the three documents

VMNIS | Vitamin and Mineral Nutrition Information System Background

1

Description of Technical Consultation 2

Recommendations 2

Summary Development

Acknowledgements 4

Plans for Update 4

References 5

4

Scope and Purpose 1

VMNIS | 1


WHONMHNHDMNM113

Iron stores in the body exist primarily in the form of ferritin The ferritin

molecule is an intracellular hollow protein shell composed of 24 subunits

surrounding an iron core that may contain as many as 4000-4500 iron

atoms In the body small amounts of ferritin are secreted into the plasma

The concentration of this plasma (or serum) ferritin is positively correlated

with the size of the total body iron stores in the absence of inflammation A

low serum ferritin value reflects depleted iron stores but not necessarily

the severity of the depletion as it progresses

Normal ferritin concentrations vary by age and sex Concentrations are

high at birth rise during the first two months of life and then fall

throughout later infancy (1) At about one year of age concentrations

begin to rise again and continue to increase into adulthood (2) Beginning

in adolescence however males have higher values than females a trend

that persists into late adulthood Values among men peak between 30ndash39

years of age and then tend to remain constant until about 70 years of age

Among women serum ferritin values remain relatively low until

menopause and then rise (2)

Body ferritin levels in contrast to haemoglobin are not affected by

residential elevation above sea level or smoking behaviour However

ferritin is a positive acute phase response protein whereby concentrations

increase during inflammation and thereby no longer reflect the size of the

iron store This makes the interpretation of normal or high serum ferritin

values difficult in areas of widespread infection or inflammation (3) In the

absence of inflammation or liver disease high serum ferritin concentrations

indicate iron overload

Inside

Background

Serum ferritin concentrations

for the assessment of iron

status and iron deficiency in

populations

Background

1

Description of

Technical Consultation 2

Recommendations 2

Summary

Development

Acknowledgements 5

Plans for Update 5


References

5

WHONMHNHDMNM112

5

VMNIS | 1

Scope and Purpose

2

VITAMIN AND MINERAL NUTRITION INFORMATION SYSTEM


9DRAFT

Ideally dissemination and wide-spread use of the WHOCDC indicators eCatalogue will increase the standardization

of indicators and increase consistency and comparability across programmes A Technical Consultation ldquoldquoInventory of

indicators for monitoring and evaluation of micronutrient interventionsrdquo was held in Atlanta United States of America

in 6-7 January 2010 The objectives were to fine tune the details of the logic model for monitoring and evaluation of

micronutrient interventions refine search criteria and to validate the usefulness of the indicators web-tool The team is

currently working in the compilation of these indicators using the logic model as a framework to organizing the different

types of indicators currently used in public health programmes involving micronutrient interventions


10

MAIN

Dr Francesco Branca is the Director of

the Department of Nutrition for Health and

Development in the World Health Organization

Geneva He graduated in Medicine and Surgery

and specialized in Diabetology and Metabolic

Diseases at the Universitarsquo Cattolica del Sacro

Cuore Roma He obtained a PhD in Nutrition at

Aberdeen University He was a Senior Scientist

at the Italian Food and Nutrition research

Institute where he was responsible for the

design and implementation of several studies

on the effects of food and nutrients on human

health at the different stages of the life cycle

and for the design management and evaluation

of public health nutrition programmes He

was been President of the Federation of the

European Nutrition Societies in 2003-2007

Dr JP Pena-Rosas is the Coordinator Evidence

and Programme Guidance Department of

Nutrition for Health and Development at the

World Health Organization (WHO) in Geneva

Switzerland He joined WHO on July 2008 and

now oversees the Evidence and Programme

Guidance workplan in the development of

evidence-informed guidelines for interventions

addressing the double burden of malnutrition

for neonates infants children and women in

stable and emergency settings under the WHO

Research Strategy umbrella He is an Adjunct

Assistant Professor at Emory University Rollins

School of Public Health in Atlanta United States

since 2011 Previously he worked several

years in the Division of Nutrition Physical

Activity and Obesity at the Centers for Disease

Control and Prevention (CDC) in Atlanta United

States He was involved in nutrition surveys

and programme monitoring and evaluation for

nutrition interventions in Uzbekistan Morocco

Egypt Peru Nicaragua Georgia and Dominican

Republic In the private sector Dr Pena-Rosas

worked at Kellogg Company Latin America

and the Caribbean Headquarters where he

served several positions including Manager of

Scientific and Regulatory Affairs for the regional

operations He received his Medical Degree from

Universidad Central de Venezuela in his native

country and a Masterrsquos Degree in Public Health

Nutrition from University of Puerto Rico in San

Juan He holds a PhD in Human Nutrition and

Epidemiology from Cornell University Ithaca NY

United States of America He is a member of the

American Society for Nutrition Latin American

Society of Nutrition the American Evaluation

Association the Cochrane Collaboration and

the WHO Guidelines Review Committee

Dr Lisa Rogers is the technical officer for

the Evidence and Programme Guidance Unit

in the Department of Nutrition for Health and

Development She has been working at the


Switzerland since April 2006 She is primarily

responsible for managing a grant for mechanistic

studies on neonatal vitamin A supplementation

and coordinating the completion of evidence

reviews and guideline groups to inform vitamin

and mineral intervention guidelines She holds

a PhD in Nutrition on International Nutrition

from the University of California Davis United

States of America Her work included research

in Guatemala investigating the causes of vitamin

B12 deficiency in school age children and

laboratory research involving the optimization of

an immunological assay for holotranscobalamin

II and the analysis of methylmalonic acid

homocysteine vitamin B12 and folate She

received a Master of Science in Nutritional

Sciences from the University of Florida where

she conducted research involving the analysis of

the stability of folic acid added to cereal-grain

products the bioavailability of stable-isotopically

labeled folic acid added to these products and

conducted several human subject studies She

is a member of the American Society for Nutrition

and the Academy of Nutrition and Dietetics

Dr Luz Maria De-Regil is epidemiologist at the

World Health Organization with the Evidence

and Programme Guidance Unit since September

2009 She is responsible for coordinating the

development of global guidelines on nutrition

interventions for different age groups and

settings updating and expanding the Vitamin and

Mineral Nutrition Information System (VMNIS)

developing tools for monitoring and evaluation

of nutrition interventions leading international

and multidisciplinary review teams to assess the

evidence and translating knowledge into global

public policy With more than 50 publications in

5 OUR TEAM


11DRAFT

English and Spanish for different audiences Luz Maria has been involved in community programmes and designed and implemented

research focused on maternal and infant nutrition and health She has experience in applying in vitro and in vivo laboratory techniques

in combination with food science and epidemiology She is an active member of the WHO Research and Ethics Committee the

GRADE working group four groups within the Cochrane Collaboration the American Society for Nutrition the Latin American

Society of Nutrition the Mexican Pediatric Research Association and a former vice-president of the Mexican Society of Nutrition

Ms Grace Rob is a technical assistant in the Evidence and Programme Guidance Unit department of Nutrition for Health and

Development She has been working at the World Health Organization (WHO) in Geneva Switzerland since 2000 She holds a

Bachelors of Science in Home Economics major in food and nutrition and minor in business administration from University of

Eastern Africa Baraton Eldoret in her native Kenya

Mrs Paule Pillard is the Assistant to Coordinator in the Evidence and Programme Guidance Unit Department of Nutrition for Health

and Development and provides administrative support to the coordinator and the unit staff since 2007


12DRAFT

NEONATAL VITAMIN A SUPPLEMENTATION MECHANISTIC STUDIES

There is considerable interest in vitamin A supplementation during the neonatal period as an intervention for reducing infant

mortality The efficacy of this intervention is still to be determined NHD along with the Department of Maternal Newborn Child

and Adolescent Health (MCA) have received funding to conduct studies for the generation of evidence to inform global policy on

the efficacy of neonatal vitamin A supplementation in improving child survival In support of uncovering biological mechanisms

by which neonatal vitamin A supplementation may be acting NHD is coordinating the conduct of one animal study and two human

studies to understand the biological mechanisms through which neonatal vitamin A supplementation can potentially have an

impact on infant survival when given at birth The animal study is being conducted at the University of Wisconsin-Madison USA

(PI S Tanumihardjo) and is using the sow-piglet dyad model The two human studies are double blind randomized controlled

trials to determine the effect of vitamin A supplementation on immune responses in early infancy One study is being conducted

in Bangladesh (n=300) by the USDA-ARS Western Human Nutrition Research Center University of California Davis CA USA (PI

C Stephensen) and the other in The Gambia (n=200) by the Medical Research Council London UK and Keneba Gambia (PI A

Prentice)

The three proposals were reviewed at a WHO Technical Consultation on Vitamin A in Newborn Health - Mechanistic Studies in

December 2009 Final proposals were approved by the WHO Ethics Review Committee (ERC) and the studies are now in progress

NUTRITION IMPACT MODEL-STUDY (NIMS)

This study is funded by a grant from The Bill amp Melinda Gates Foundation to the Harvard School of Public Health and aims to

develop empirically parameterize apply and make publicly available a policy-relevant analytical tool for estimating the health

impacts of undernutrition exposures and interventions

Representatives of the Department of Nutrition for Health and Development work closely with partners to select appropriate

exposure metrics and develop and apply statistical methods for sparse time-space data in order to estimate current levels and past

trends of anaemia and vitamin A deficiency

6 RESEARCH


13DRAFT

The Department of Nutrition for Health and Development works closely with internal collaborators at WHO and with various external

organizations on topics related to micronutrients

COCHRANE COLLABORATION

Over 28000 contributors worldwide work together to help health care providers policy-makers patients their advocates and

carers make well-informed decisions about health care based on the best available research evidence by preparing updating

and promoting the accessibility of Cochrane Reviews ndash over 4600 so far published online in The Cochrane Library In 2010 the

Cochrane Database of Systematic Reviews achieved a top-10 ISI Impact Factor for an outstanding achievement The work of the

Cochrane Collaboration is internationally recognised as the benchmark for high-quality information about the effectiveness of

health care In January 2011 The Cochrane Collaboration was accepted as a Non-Governmental Organization in Official Relations

with the World Health Organization (WHO) the public health arm of the United Nations establishing formalised communication

between our two organisations

This collaboration supports the development of the WHO Library of Evidence for Nutrition Actions (eLENA) and grants open access

to all Member States For the work in micronutrients we have closely collaborated with the following Cochrane groups

Cochrane Editorial Unit (wwweditorial-unitcochraneorg)

Developmental Psychosocial and Learning Problems Group (wwwdplpgcochraneorg)

Infectious Diseases Group (wwwcidgcochraneorgenindexhtml)

Pregnancy and Childbirth Group (wwwpregnancycochraneorg)

Public Health Group (wwwphcochraneorg)

Our Department has also supported the update or undertake of systematic reviews within the following groups

HIVAIDS Group (hivcochraneorg)

Metabolic and Endocrine Disorders Group (wwwendoccochraneorg)

Neonatal Group (wwwneonatalcochraneorg)

Iberoamerican Cochrane Center (wwwcochranees)

GRADE WORKING GROUP

The Grading of Recommendations Assessment Development and Evaluation (GRADE) Working Group began in the year 2000

as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health

care The working group has developed a common sensible and transparent approach to grading the quality of evidence

and the strength of recommendations Many international organizations have provided input into the development of the

approach and have started using it

A representative of our team joined the working group in 2010 to discuss issues related to the normative work in

micronutrients at WHO

CENTERs fOR DIsEAsE CONTROL AND PREVENTION (CDC)

The International Micronutrient Malnutrition Prevention and Control (IMMPaCt) programme works with global partners to

contribute CDC skills and resources to eliminate vitamin and mineral deficiencies (micronutrient malnutrition) among vulnerable

populations throughout the world Established by the CDC in 2000 IMMPaCt focuses primarily on helping eliminate deficiencies in

iron vitamin A iodine and folate

Through a 2009-2014 agreement IMMPaCt supports WHO in various selected projects including providing technical assistance

and subject matter expertise to help design implement and maintain new and current micronutrient databases as well as assist

with processes promoting new WHO guidelines and recommendations

The CDC Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects provides the scientific and programmatic

expertise to build upon and strengthen global neural tube defect surveillance systems and expand the reach of global folic acid

fortification for neural tube defect prevention Expansion of global folic acid fortification efforts can have a significant impact on

infant mortality and childhood morbidity worldwide

7 OUR PARTNERS


14DRAFT

CDCrsquos National Center on Birth Defects and Developmental Disabilities has developed a global initiative to significantly reduce infant

mortality and childhood morbidity resulting from the more than 300000 neural tube defects worldwide each year and contribute

to the achievement of United Nations Millennium Development Goal 4 help to meet the Global Health Initiative Child Health Goal

and support the 63rd World Health Assembly Resolution on Birth Defects

The initiative aims to expand the number of developing countries with mandatory folic acid fortification of high penetrance staples

and provide sustainable support of long-term interventions to eliminate folic acid-preventable neural tube defects worldwide CDC

works with WHO and others to support and advance country-level fortification efforts and to provide needed technical expertise for

surveillance of neural tube defects monitor fortification efforts and improve laboratory capacity on folate-preventable birth defects

THE MICRONUTRIENT INITIATIVE

The Micronutrient Initiative (MI) is an independent not-for-profit organization committed to promoting simple cost-effective

solutions to hidden hunger combat vitamin and mineral deficiency and developing innovative new solutions where needed based in

Ottawa Canada MI is working to end hidden hunger end vitamin and mineral deficiency by helping governments food producers

and partner organizations like WHO develop implement and monitor and evaluate innovative culturally appropriate and cost-

effective programmes to get essential vitamins and minerals to the people who need them most by providing technical and

financial assistance offering procurement and quality control services for highly specialized supplies and equipment needed to

prevent hidden hunger advocating for micronutrient programmes and educating government bodies around the world on policies

legislation and programs to ensure the sustained delivery of essential vitamins and minerals

THE EUNICE KENNEDy sHRIVER NATIONAL INsTITUTE Of CHILD HEALTH AND HUMAN DEVELOPMENT

The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health

(NIH)US Department of Health and Human Services in collaboration with partners representing the breadth of the global food and

nutrition enterprise including WHO created the Biomarkers of Nutrition for Development (BOND) Program to meet the growing

need for discovery development and implementation of reliable and valid biomarkers to assess nutrient exposure status function

and effect Also with co-funding from the Bill amp Melinda Gates Foundation has developed the Iron and Malaria Project to address

the safe and effective use of iron interventions in areas of malaria burden Both projects have been done with involvement of and

in support of WHO work in the area of micronutrients

WHO NUTRITION GUIDANCE ExPERT ADVIsORy GROUP MEMBERs

Micronutrients

Ms Deena AlasfoorProfessor Beverley-Ann BiggsDr Heacutector Bourges RodriacuteguezProfessor Norm CampbellProfessor Susan Fairweather-Tait Dr Rafael Flores-AyalaProfessor Malik GoonewardeneDr Junsheng HuoDr Janet C KingDr Marzia Lazzerini Professor Malcolm E Molyneux Eng Wisam QarqashDr Mahdi Ramsan Mohamed Dr Daniel RaitenDr Meera ShekarDr Rebecca Joyce StoltzfusMs Carol TomDr David Tovey Mrs Vilma Qahoush TylerDr Gunn Elisabeth VistDr Emorn Wasantwisut

Monitoring and Evaluation

Dr Lindsay AllenDr Deborah AshDr France BeginDr Zulfiqar BhuttaDr Christine Clewes Professor Susan Fairweather-TaitDr Jonathan GorsteinDr Junsheng HuoDr Ibrahim MD KhatibDr Roland KupkaDr Christine PfeifferDr Rob JPM ScholtenDr Holger SchuumlnemannDr Ismaeumll Ngnieacute TeacutetaDr Emorn Wasantwisut

Vitamin A supplementation

Professor Hany Abdel-AleemProfessor Michael ClarkeDr Anna CoutsoudisDr M Monir HossainDr Jean HumphreyDr Yustina Anie IndriastutiDr Marzia LazzeriniDr Pavitra MohanDr Rintaro MoriDr A Catherine RossDr Isabella Sagoe-MosesDr Claudia SaundersDr Prak SophonnearyDr Charles StephensenDr Sherry TanumihardjoDr Khalid Yunis


15DRAFT

INTERNsHIPs

WHO is committed to building future leaders in public health and WHOrsquos Internship Programme provides a wide range of

opportunities for graduate and post-graduate students to gain insight into the work of WHO Although WHO receives a large

number of intern applications each year only a limited number of places for internships are available Internships are available for

work in micronutrients at WHO for a minimum of 6 weeks and a maximum of 3 months to allow the internship to be both worthwhile

and effective The following selected interns were hosted by NHD during the biennium 2010-2011 to work on topics related to

micronutrients

Ms Alison Sylvetsky 7 June - 13 August 2010 - EMORY UNIVERSITY ATLANTA USA

Ms Aida Victoria Campos 1 March - 31 May 2010 - UNIVERSIDAD LA SALLE MExICO DF MExICO

Mrs Sarah Pedersen 14 June - 13 August 2010- CORNELL UNIVERSITY ITHACA NEW YORK USA

Mr Joseph Ashong1 March 2011 - 1 July 2011 - CORNELL UNIVERSITY ITHACA NEW YORK USA

Dr Saint-Rayn Pasricha 14 February 2011 - 17 June 2011 - UNIVERSITY OF MELBOURNE VICTORIA AUSTRALIA

Ms Ellie Souganidis 20 June 2011 - 12 August 2011 - JOHNS HOPKINS UNIVERSITY BALTIMORE MARYLAND USA

Mr Raheel Arif 15 August - 4 November 2011- UNIVERSITY OF THE SCIENCES PHILADELPHIA PENNSYLVANIA USA

ADVOCACy AND NETWORKs

Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource

allocation decisions within political economic and social systems and institutions Advocacy in WHO for vitamin and mineral

nutrition includes many activities such as media campaigns public speaking commissioning and publishing research as well as

participation in several groups and networks

Home Fortification Technical Advisory Group (HFTAG) (httpwwwgainhealthorghftag)

The Network For Sustained Elimination of Iodine Deficiency (httpwwwiodinenetworknet)

International Council for the Control of Iodine Deficiency Disorders (wwwicciddorg)

Rice Fortification Technical Group (httpwwwgainhealthorgriforg)

Global Alliance for Vitamin A (GAVA)

Flour Fortification Initiative (httpwwwsphemoryeduwheatflour)

International Zinc Nutrition Consultative Group (wwwizincgorg)

United Nations World Food Programme (httpwwwwfporg)

United Nations Childrenrsquos Fund (httpwwwuniceforg)

United Nations High Commissioner for Refugees (httpwwwunhcrorg)

Food and Agriculture Organization of the United Nations (httpwwwfaoorg)

The World Bank (httpwwwworldbankorg)

United Nations Standing Committee on Nutrition (httpwwwunscnorg)


16DRAFT

WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients

during the biennium 2010-2011

US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms

project name Global prevention of non-communicable disease prevention and promotion of health

The Micronutrient Initiative (MI) wwwmicronutrientorg

project name e-Library of nutrition programme guidance

The Government of Luxembourghttpwwwetatlu

project name Support for the update and dissemination of evidence-based nutrition programme

The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg

project name Efficacy of newborn vitamin A supplementation in improving child survival

WHO also thanks the following organizations for their support through small grants

US Agency for International Development (USAID) httpwwwusaidgov

project name Update WHO evidence based position statements on relevant and priority micronutrient interventions

The Global Alliance for Improved Nutrition (GAIN)

httpwwwgainhealthorg

project name Systematic review of evidence of micronutrient interventions and management of moderate

malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification

project name Systematic review of evidence of rice fortification as a public health intervention and consultation on

rice fortification programs implementation

Harvard University

project name Nutrition impact model study (NIM Study)

Sight amp Life

httpwwwsightandlifeorg

project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System

MEMBERsHIPs

De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013

Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014

Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011

De-Regil LM GRADE working group 2010-present

WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs

Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for

Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2

February 2010 Geneva Switzerland

8 FINANCIAL SUPPORT


17DRAFT

Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C

King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland

Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue

University West Lafayette IN USA 4 June 2010 Geneva Switzerland

Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate

School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland

Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West

Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland

An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional

Products LLC 13 July 2011 Geneva Switzerland

Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology

University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland


18DRAFT

A ATLANTA january amp december 2010

WASHINGTON DC november 2011

AMMAN november 2010 PANAMA september 2010

GENEVA february 2010

1 WHO MEETINGS9

Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and

Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City

Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet

WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010

WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010

Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010

Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan

American Health Organization (PAHO) Washington DC USA 7-9 November 2011

GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011

Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010

GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011

WHONMHNHDEPG121


2DRAFT

1 EVIDENCE-INFORMED GUIDELINE DEVELOPMENT 3

Supplementation

Point-of-use fortification of foods

Others

2 SCIENTIFIC PUBLICATIONS AND REPORTS 4

Technical Reports

WHO micronutrients mailing list

3 MULTILINGUALISM 7

4 WHO VITAMIN AND MINERAL NUTRITION INFORMATION SYSTEM 8

5 OUR TEAM 10

6 RESEARCH 12

7 OUR PARTNERS 13

8 FINANCIAL SUPPORT 16

9 WHO MEETINGS 18

TABLE OF CONTENTS


3DRAFT













SUPPLEMENTATION



















by pregnant women

OTHERS




(wwwwhointelena)

1

Guideline

Vitamin A

supplementation in




Guideline

Vitamin A

supplementation in




4DRAFT
























interventions





Health Organization











indexhtml
































CD007950 DOI 10100214651858CD007950pub2








No CD008873 DOI 10100214651858CD008873


CD008873pdf

2


5DRAFT





No CD008959 DOI 10100214651858CD008959 http







doi10100214651858CD009085pdf





CD009218 DOI 10100214651858CD009218 http

























CD009085 DOI 10100214651858CD009085pub2










CD009218




Art No CD008873 DOI 10100214651858CD008873


CD008873pub2pdf



of age (Review)









2011 Issue 12





6DRAFT

TECHNICAL REPORTS


















Who Technical

consulTaTion

on ViTamin a

in neWborn

healTh

mechanisTic

sTudies

REPORT

R E P O R T



7DRAFT

















1 MULTILINGUALISM3


8DRAFT






















































iron deficiency (1)

Inside

Background


















Recommendations 3

Summary development

Acknowledgements 5

Plans for update 5

References 6

4

Scope and purpose 1

VMNIS | 1

4























Inside

Background







1


Recommendations 2

Summary Development

Acknowledgements 4

Plans for Update 4

References 5

4

Scope and Purpose 1

VMNIS | 1


WHONMHNHDMNM113


























Inside

Background




populations

Background

1

Description of


Recommendations 2

Summary

Development

Acknowledgements 5

Plans for Update 5


References

5

WHONMHNHDMNM112

5

VMNIS | 1

Scope and Purpose

2



9DRAFT









10

MAIN


































































































5 OUR TEAM


11DRAFT













12DRAFT













Prentice)










6 RESEARCH


13DRAFT
























GRADE WORKING GROUP




















7 OUR PARTNERS


14DRAFT



























Micronutrients







15DRAFT

INTERNsHIPs






micronutrients



























16DRAFT




















Harvard University


Sight amp Life



MEMBERsHIPs









8 FINANCIAL SUPPORT


17DRAFT














18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121


3DRAFT













SUPPLEMENTATION



















by pregnant women

OTHERS




(wwwwhointelena)

1

Guideline

Vitamin A

supplementation in




Guideline

Vitamin A

supplementation in




4DRAFT
























interventions





Health Organization











indexhtml
































CD007950 DOI 10100214651858CD007950pub2








No CD008873 DOI 10100214651858CD008873


CD008873pdf

2


5DRAFT





No CD008959 DOI 10100214651858CD008959 http







doi10100214651858CD009085pdf





CD009218 DOI 10100214651858CD009218 http

























CD009085 DOI 10100214651858CD009085pub2










CD009218




Art No CD008873 DOI 10100214651858CD008873


CD008873pub2pdf



of age (Review)









2011 Issue 12





6DRAFT

TECHNICAL REPORTS


















Who Technical

consulTaTion

on ViTamin a

in neWborn

healTh

mechanisTic

sTudies

REPORT

R E P O R T



7DRAFT

















1 MULTILINGUALISM3


8DRAFT






















































iron deficiency (1)

Inside

Background


















Recommendations 3

Summary development

Acknowledgements 5

Plans for update 5

References 6

4

Scope and purpose 1

VMNIS | 1

4























Inside

Background







1


Recommendations 2

Summary Development

Acknowledgements 4

Plans for Update 4

References 5

4

Scope and Purpose 1

VMNIS | 1


WHONMHNHDMNM113


























Inside

Background




populations

Background

1

Description of


Recommendations 2

Summary

Development

Acknowledgements 5

Plans for Update 5


References

5

WHONMHNHDMNM112

5

VMNIS | 1

Scope and Purpose

2



9DRAFT









10

MAIN


































































































5 OUR TEAM


11DRAFT













12DRAFT













Prentice)










6 RESEARCH


13DRAFT
























GRADE WORKING GROUP




















7 OUR PARTNERS


14DRAFT



























Micronutrients







15DRAFT

INTERNsHIPs






micronutrients



























16DRAFT




















Harvard University


Sight amp Life



MEMBERsHIPs









8 FINANCIAL SUPPORT


17DRAFT














18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121


4DRAFT
























interventions





Health Organization











indexhtml
































CD007950 DOI 10100214651858CD007950pub2








No CD008873 DOI 10100214651858CD008873


CD008873pdf

2


5DRAFT





No CD008959 DOI 10100214651858CD008959 http







doi10100214651858CD009085pdf





CD009218 DOI 10100214651858CD009218 http

























CD009085 DOI 10100214651858CD009085pub2










CD009218




Art No CD008873 DOI 10100214651858CD008873


CD008873pub2pdf



of age (Review)









2011 Issue 12





6DRAFT

TECHNICAL REPORTS


















Who Technical

consulTaTion

on ViTamin a

in neWborn

healTh

mechanisTic

sTudies

REPORT

R E P O R T



7DRAFT

















1 MULTILINGUALISM3


8DRAFT






















































iron deficiency (1)

Inside

Background


















Recommendations 3

Summary development

Acknowledgements 5

Plans for update 5

References 6

4

Scope and purpose 1

VMNIS | 1

4























Inside

Background







1


Recommendations 2

Summary Development

Acknowledgements 4

Plans for Update 4

References 5

4

Scope and Purpose 1

VMNIS | 1


WHONMHNHDMNM113


























Inside

Background




populations

Background

1

Description of


Recommendations 2

Summary

Development

Acknowledgements 5

Plans for Update 5


References

5

WHONMHNHDMNM112

5

VMNIS | 1

Scope and Purpose

2



9DRAFT









10

MAIN


































































































5 OUR TEAM


11DRAFT













12DRAFT













Prentice)










6 RESEARCH


13DRAFT
























GRADE WORKING GROUP




















7 OUR PARTNERS


14DRAFT



























Micronutrients







15DRAFT

INTERNsHIPs






micronutrients



























16DRAFT




















Harvard University


Sight amp Life



MEMBERsHIPs









8 FINANCIAL SUPPORT


17DRAFT














18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121


5DRAFT





No CD008959 DOI 10100214651858CD008959 http







doi10100214651858CD009085pdf





CD009218 DOI 10100214651858CD009218 http

























CD009085 DOI 10100214651858CD009085pub2










CD009218




Art No CD008873 DOI 10100214651858CD008873


CD008873pub2pdf



of age (Review)









2011 Issue 12





6DRAFT

TECHNICAL REPORTS


















Who Technical

consulTaTion

on ViTamin a

in neWborn

healTh

mechanisTic

sTudies

REPORT

R E P O R T



7DRAFT

















1 MULTILINGUALISM3


8DRAFT






















































iron deficiency (1)

Inside

Background


















Recommendations 3

Summary development

Acknowledgements 5

Plans for update 5

References 6

4

Scope and purpose 1

VMNIS | 1

4























Inside

Background







1


Recommendations 2

Summary Development

Acknowledgements 4

Plans for Update 4

References 5

4

Scope and Purpose 1

VMNIS | 1


WHONMHNHDMNM113


























Inside

Background




populations

Background

1

Description of


Recommendations 2

Summary

Development

Acknowledgements 5

Plans for Update 5


References

5

WHONMHNHDMNM112

5

VMNIS | 1

Scope and Purpose

2



9DRAFT









10

MAIN


































































































5 OUR TEAM


11DRAFT













12DRAFT













Prentice)










6 RESEARCH


13DRAFT
























GRADE WORKING GROUP




















7 OUR PARTNERS


14DRAFT



























Micronutrients







15DRAFT

INTERNsHIPs






micronutrients



























16DRAFT




















Harvard University


Sight amp Life



MEMBERsHIPs









8 FINANCIAL SUPPORT


17DRAFT














18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121


6DRAFT

TECHNICAL REPORTS


















Who Technical

consulTaTion

on ViTamin a

in neWborn

healTh

mechanisTic

sTudies

REPORT

R E P O R T



7DRAFT

















1 MULTILINGUALISM3


8DRAFT






















































iron deficiency (1)

Inside

Background


















Recommendations 3

Summary development

Acknowledgements 5

Plans for update 5

References 6

4

Scope and purpose 1

VMNIS | 1

4























Inside

Background







1


Recommendations 2

Summary Development

Acknowledgements 4

Plans for Update 4

References 5

4

Scope and Purpose 1

VMNIS | 1


WHONMHNHDMNM113


























Inside

Background




populations

Background

1

Description of


Recommendations 2

Summary

Development

Acknowledgements 5

Plans for Update 5


References

5

WHONMHNHDMNM112

5

VMNIS | 1

Scope and Purpose

2



9DRAFT









10

MAIN


































































































5 OUR TEAM


11DRAFT













12DRAFT













Prentice)










6 RESEARCH


13DRAFT
























GRADE WORKING GROUP




















7 OUR PARTNERS


14DRAFT



























Micronutrients







15DRAFT

INTERNsHIPs






micronutrients



























16DRAFT




















Harvard University


Sight amp Life



MEMBERsHIPs









8 FINANCIAL SUPPORT


17DRAFT














18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121


7DRAFT

















1 MULTILINGUALISM3


8DRAFT






















































iron deficiency (1)

Inside

Background


















Recommendations 3

Summary development

Acknowledgements 5

Plans for update 5

References 6

4

Scope and purpose 1

VMNIS | 1

4























Inside

Background







1


Recommendations 2

Summary Development

Acknowledgements 4

Plans for Update 4

References 5

4

Scope and Purpose 1

VMNIS | 1


WHONMHNHDMNM113


























Inside

Background




populations

Background

1

Description of


Recommendations 2

Summary

Development

Acknowledgements 5

Plans for Update 5


References

5

WHONMHNHDMNM112

5

VMNIS | 1

Scope and Purpose

2



9DRAFT









10

MAIN


































































































5 OUR TEAM


11DRAFT













12DRAFT













Prentice)










6 RESEARCH


13DRAFT
























GRADE WORKING GROUP




















7 OUR PARTNERS


14DRAFT



























Micronutrients







15DRAFT

INTERNsHIPs






micronutrients



























16DRAFT




















Harvard University


Sight amp Life



MEMBERsHIPs









8 FINANCIAL SUPPORT


17DRAFT














18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121


8DRAFT






















































iron deficiency (1)

Inside

Background


















Recommendations 3

Summary development

Acknowledgements 5

Plans for update 5

References 6

4

Scope and purpose 1

VMNIS | 1

4























Inside

Background







1


Recommendations 2

Summary Development

Acknowledgements 4

Plans for Update 4

References 5

4

Scope and Purpose 1

VMNIS | 1


WHONMHNHDMNM113


























Inside

Background




populations

Background

1

Description of


Recommendations 2

Summary

Development

Acknowledgements 5

Plans for Update 5


References

5

WHONMHNHDMNM112

5

VMNIS | 1

Scope and Purpose

2



9DRAFT









10

MAIN


































































































5 OUR TEAM


11DRAFT













12DRAFT













Prentice)










6 RESEARCH


13DRAFT
























GRADE WORKING GROUP




















7 OUR PARTNERS


14DRAFT



























Micronutrients







15DRAFT

INTERNsHIPs






micronutrients



























16DRAFT




















Harvard University


Sight amp Life



MEMBERsHIPs









8 FINANCIAL SUPPORT


17DRAFT














18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121


9DRAFT









10

MAIN


































































































5 OUR TEAM


11DRAFT













12DRAFT













Prentice)










6 RESEARCH


13DRAFT
























GRADE WORKING GROUP




















7 OUR PARTNERS


14DRAFT



























Micronutrients







15DRAFT

INTERNsHIPs






micronutrients



























16DRAFT




















Harvard University


Sight amp Life



MEMBERsHIPs









8 FINANCIAL SUPPORT


17DRAFT














18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121


10

MAIN


































































































5 OUR TEAM


11DRAFT













12DRAFT













Prentice)










6 RESEARCH


13DRAFT
























GRADE WORKING GROUP




















7 OUR PARTNERS


14DRAFT



























Micronutrients







15DRAFT

INTERNsHIPs






micronutrients



























16DRAFT




















Harvard University


Sight amp Life



MEMBERsHIPs









8 FINANCIAL SUPPORT


17DRAFT














18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121


11DRAFT













12DRAFT













Prentice)










6 RESEARCH


13DRAFT
























GRADE WORKING GROUP




















7 OUR PARTNERS


14DRAFT



























Micronutrients







15DRAFT

INTERNsHIPs






micronutrients



























16DRAFT




















Harvard University


Sight amp Life



MEMBERsHIPs









8 FINANCIAL SUPPORT


17DRAFT














18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121


12DRAFT













Prentice)










6 RESEARCH


13DRAFT
























GRADE WORKING GROUP




















7 OUR PARTNERS


14DRAFT



























Micronutrients







15DRAFT

INTERNsHIPs






micronutrients



























16DRAFT




















Harvard University


Sight amp Life



MEMBERsHIPs









8 FINANCIAL SUPPORT


17DRAFT














18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121


13DRAFT
























GRADE WORKING GROUP




















7 OUR PARTNERS


14DRAFT



























Micronutrients







15DRAFT

INTERNsHIPs






micronutrients



























16DRAFT




















Harvard University


Sight amp Life



MEMBERsHIPs









8 FINANCIAL SUPPORT


17DRAFT














18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121


14DRAFT



























Micronutrients







15DRAFT

INTERNsHIPs






micronutrients



























16DRAFT




















Harvard University


Sight amp Life



MEMBERsHIPs









8 FINANCIAL SUPPORT


17DRAFT














18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121


15DRAFT

INTERNsHIPs






micronutrients



























16DRAFT




















Harvard University


Sight amp Life



MEMBERsHIPs









8 FINANCIAL SUPPORT


17DRAFT














18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121


16DRAFT




















Harvard University


Sight amp Life



MEMBERsHIPs









8 FINANCIAL SUPPORT


17DRAFT














18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121


17DRAFT














18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121


18DRAFT





1 WHO MEETINGS9












WHONMHNHDEPG121

micronutrients - who · 2/1/2010 · guideline: vitamin a supplementation for infants and children...

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