The Journal of Nutrition Vol. 128 No. 2 February 1998, pp. 145-151

From Research to Global Reality: The Micronutrient Story¹

Barbara A. Underwood

National Eye Institute, National Institutes of Health, Bethesda, MD 20814

	ABSTRACT

Abstract Introduction References

The professional life history of E. V. McCollum exemplifies how sound nutrition-related laboratory research was translated into practical realities that influenced individual and national nutrition-related decisions. Public health and educational programs emerging in the first third of this century improved health and nutritional well-being in the United States. Characteristics that surrounded pioneering efforts early in the century are similar to those that have reinvigorated global micronutrient concerns in the last third of the century. Sound community-oriented scientific research revealed the true consequences of iodine, vitamin A and iron micronutrient malnutrition. Repositioning the image of these three micronutrients from that of a clinical problem affecting relatively few to one with consequences for individual, national and global development affecting many more, and disseminating these facts through high-level political forums incited attention, commitment and actions. As in the early days of McCollum and his contemporaries, current nutrition scientists played a significant role, interacting with politically oriented counterparts, in taking micronutrient research to reality for improving health and quality of life globally. Lessons learned from the process, both past and present, should guide future nutrition-oriented endeavours in moving research to reality for betterment of global community health.

	INTRODUCTION

Abstract Introduction References

The Nutritional Science community is indebted to the foresight of the founding committee of the Commemorative McCollum International Lectureship. The program is intended to encourage sound advancements in nutritional science and their application for improving health and well-being on a global scale and to commemorate the life of E. V. McCollum. Our professional community is particularly indebted to Dr. Harry Day whose insightful biographical writings have captured for the archives of nutrition Dr. McCollum's personal character as well as his scientific and public contributions to the betterment of human health (Day 1974, 1979, 1987 and 1996). I found this record to be fascinating reading and recommend it to both young and older nutrition scientists because the personal qualities and professional principles recorded are truly ones to emulate. In Dr. Day's words, "No other nutritional scientist probably rendered greater service in influencing the dietary practices of the people and the thinking of scientific bodies and public officials in matters concerning human nutrition than did E. V. McCollum" (Day 1974).

The late Dr. Jean Mayer, who also knew Dr. McCollum personally, presented the first McCollum lecture at the National Academy of Sciences in 1979, a centennial celebration of McCollum's birth. In the printed record of the first McCollum lecture Jean Mayer noted that "To McCollum application of new knowledge and its dissemination to the policy-makers, and to the general public, with the end result a more nutritious diet, was as important as acquisition of knowledge itself" (Mayer 1982). A reading of Dr. McCollum's autobiography will make it obvious that this philosophy characterized his lifetime professional journey from research to reality (McCollum 1964).

Dr. McCollum's life journey has influenced many nutrition scientists, even those who did not know him, including myself. First, I am privileged to be involved in the evolving micronutrient story, to the greatest extent with the vitamin-A tale, whose scientific base began with Dr. McCollum's seminal discovery of "fat-soluble A" (McCollum and Davies 1913). Second, I share his views that sound scientific knowledge acquired by nutrition scientists should be applied practically and disseminated widely to both private and public program and policy decision makers. Third, as did McCollum, I believe that nutritional programs that influence health and well-being should be implemented in a manner that empowers individuals to make informed practical decisions about daily nutrition-related practices. Last, to achieve the goal of a more nutritious diet and better health, McCollum believedand so do Ithat sound scientific research should be the foundation for all subsequent steps to its realization in better human health and well-being.

In January 1991, armed with this noble philosophy, I went on assignment from the National Institutes of Health (NIH)the pinnacle for support of scientific research in the United Statesto the World Health Organization (WHO)the Mecca for global health-related public policy. I thought that my experience as a nutritional research scientist and teacher at four U.S. universities and the NIH, and as one involved internationally over a 30-year period in both laboratory and applied field research in Africa, Asia, Latin America and the Middle East, qualified me to influence global nutrition-related policy. I perceived that appropriate global policy and programs would follow a well-documented critical review of the scientific basis of the nutrition-related issue being presented to decision makers. This, I thought, would lead to an incremental improvement in global nutrition, the goal of all politicians and professionals in the health-related system. Obviously, I had much to learn about taking research to global reality. Before going to WHO, had I been more familiar with Dr McCollum's career progressionand his reflections recorded in his autobiography (McCollum 1964)perhaps my initial baptism as a nutrition researcher into the political world would have been less traumatic.

	MCCOLLUM'S EARLY EXPERIENCES: PIVOTAL POINTS IN MOVING NUTRITION RESEARCH TO NATIONAL REALITY

Acquisition.  The first three decades of the 20th century were a most exciting period for nutritional research and an enormously productive period for E. V. McCollum. Two thirds of the more than 300 scientific journal and professional articles McCollum published in his lifetime had appeared by 1935 (Day 1974). Seminal highlights from these many contributions are noted in Table 1.

Application.  The concept of the supplementary relationship among dietary constituents was an especially important contribution emerging from McCollum's research in which he fed animals restricted rations derived from single-plant sources. He fed rats and other animal models cereal-based diets containing lard or olive oil. These animals were deprived of what McCollum first called "protective foods," those containing fat-soluble vitamin A, e.g., milk, butterfat or egg-yolk fat and green leafy vegetables. The deprived animals grew poorly and were in inferior nutritional condition. He showed that the addition of the nonsaponifiable fraction of butterfator of ether extracts of green leavesto olive oil-containing cereal diets, restored growth and protected against eye lesions that Osborn and Mendel (1913) had identified as xerophthalmia (McCollum 1957). Soon after, Stephenson and Clark (1920) showed that rats deprived of McCollum's fat-soluble A frequently died even before they developed eye signs.

McCollum translated observations on the growth and health emerging from laboratory animal feeding experiments into their significance for human diets. He categorized foods into five groups and conceptualized doable, self-empowering guidelines for nutritionally sound food-choice decisions. This basic concept formed the substance of McCollum's presentation in 1917 at the prestigious Harvey Society Lecture in New York"The Supplementary Relations Among our Common Foodstuffs." The concept was new and thought provoking for the time, i.e., observations and knowledge acquired from experimental animal studies could be interpreted as guidance for daily-life eating experiences of humans. In 1918, the USDA adapted McCollum's five food groups into practical dietary guidelines, a concept that the department has continued to modify and use for public education even to the present.

Dissemination to decision makers.  McCollum's zeal for widely disseminating the application of newer knowledge of nutrition extended to household decision makers in 169 articles he published between 1922 and 1946 in McCall's magazine. Dr. McCollum advocated a rationale for eating that reflected his confidence in the supplementary relationship among constituents of the diet. He stressed the health-related merits of choosing from each food group in composing menus to fill nutritional gaps left when sweets, cereals, breads and muscular meats formed the bulk of the diet to the exclusion of "protective foods." His philosophy for enjoyment of eating has been paraphrased as follows: "Eat what you want AFTER you have eaten what you should."

McCollum's educational zeal extended to many different groups influential in guiding the American food supply, such as decision makers on farms. For example, he published articles in the well-established Hoard's Dairyman in which he captured the interest dairy farmers by addressing the then current situation in animal nutrition as evolved through laboratory animal feeding experiments. He applied the findings to their animal husbandry concerns, which, of course, had economic implications for dairy farmers. He then linked these concerns to human nutrition in a final article entitled "The Relation of the Dairy Industry to the Public Health."

McCollum disseminated newly acquired knowledge among professional colleagues in overviews in five successive editions of "The Newer Knowledge of Nutrition" and in six editions of "Food, Nutrition and Health." The publication we know today as "Present Knowledge in Nutrition," now authored by many contributors, has continued this tradition of periodic scientific updates.

McCollum played an active role throughout his lifetime in influencing nutrition-related public policy, both nationally and internationally. The United States in 1917 had entered World War I, and soon thereafter a new entity, the U.S. Food Administration, was created and headed by Herbert Hoover. Its mission was to ensure the nutritional well being of our nation, and to respond to the critical food shortages in Europe (Day 1996). McCollum, who had just delivered the Harvey Lecture based on the supplementary relationship of foods, was brought to the attention of Hoover. Hoover, an astute politician, saw that this concept was ready made for the politics of the time. The political climate in 1917 was patriotic and receptive to calls for conservation and physical fitnessan opportune time for McCollum to put nutrition concerns at the forefront of national and global political agendas. For Hoover it was a win/win situation with political, physiologic and economic benefits to individuals, the nation and a war-torn world. Hoover appointed McCollum to his Nutrition Advisory Group and sent him around the country to disseminate his practical guidelines for a nutritious diet.

Impact.  Changes in U.S. food policy and in agricultural and food-consumption practices occurred in the decade and a half that followed, i.e., 1920-1935. Many attribute this success largely to the pioneering effort of Dr. McCollum to move sound nutritional research through political channels at an opportune time to foster reliable nutrition policy and practices. Furthermore, the programs implemented under the crisis conditions of war that led to betterment of nutritional well-being in the U.S. have had a sustained effect on maintaining a healthier U.S. population. Some examples of public health programs established by about 1935 include micronutrient fortification of flour, cereals and dairy products, iodization of salt (Mertz 1997) and propagation of practical guidelines for sound selection of food groups one should choose from daily while still having the pleasure of eating what one wants.

	PIVOTAL POINTS IN MOVING MICRONUTRIENT RESEARCH TO GLOBAL REALITY

Six decades after major acquisitions of knowledge provided a sound scientific basis for public health actions to eliminate micronutrient deficiencies in the U.S. a global micronutrient renaissance is occurring. Elimination of micronutrient deficienciesparticularly of iodine, vitamin A and ironappears to have suddenly leaped to the forefront of international political agendas and into the plans for national nutrition strategies. Since 1990, heads of state and government ministers, representatives of bilateral agencies and nongovernmental organizations and public health professionals around the world who have attended international forums have pledged to purge or substantially reduce populations of these deficienciesboth overt and hiddenwithin the decade. Did this occur as suddenly as it might seem, or are there identifiable events that facilitated incremental advancements in the last three decades that are similar to those that charted McCollum's successful journey in the first three decades of the century? If such pivotal milestones can be identified, the global community can be encouraged that lofty goals are achievable, if not in the next three years through crash programs internationally driven, soon thereafter by well-planned, sustainable national programs.

[Parenthetically, the micronutrient renewal on the public health side has paralleled a micronutrient revolution on the molecular biology side, most notably for the retinoids (Bollag 1996) and iron (Beard et al. 1997)].

Knowledge acquired up to about 1980.  As noted, the end of the first third of the twentieth century had established linkage between clinical signs of micronutrient deficiencies and their nutrient-specific causes. Iodine deficiency was shown to depress thyroid hormone production and result in cretinism and goiter (Matovinovic 1983). Vitamin A deficiency (VAD)² was demonstrated to disrupt epithelial tissue integrity and ocular health resulting in increased morbidity and blindness (Wolf 1996). Iron deficiency was shown to interfere with hemoglobin synthesis that resulted in the well-recognized fatigue and pallor of anemia (Beard et al. 1997).

The next half-century, 1930-1980, saw nutritional epidemiologists focusing their efforts on determining how many were affected by deficiencies of these three micronutrients, who they were and where they lived. Population-based studies are expensive, however, thus most of the studies conducted during this period lacked the statistical power or the representative sampling required to chart the problem accurately. By 1980, however, "ball park" global prevalence estimates existed. Dr. DeMaeyer and colleagues canvassed WHO member states to obtain estimates of the prevalence of goiter and cretinism. A prevalence of 20-60% was found, occurring mostly in developing countries; prevalence in the developed world where iodization programs had been instituted was as low as 5% (WHO 1993).

WHO was also instrumental in obtaining estimates of anemia prevalence, particularly in pregnant women among whom 30-75% prevalence was found in most of the developing world, with particularly high figures in South Asia (DeMaeyer and Adiels-Tegman 1985). Globally, over a billion people were projected to be afflicted by anemia, with prevalence being much lower in developed countries where iron fortification and supplementation programs targeted to pregnant women were in effect.

The initial "guestimates" of the prevalence of VAD from the mid-1960s WHO-sponsored global survey was 20,000-100,000 affected children based on clinic records, anecdotal reports and personal interviews (Oomen et al. 1964). That this was an underestimate became obvious about a decade later when results from the first carefully conducted national representative survey in Indonesia revealed that about 60,000 corneal and 1.3 million noncorneal cases of xerophthalmia occurred annually in this one country (Sommer 1982). This statistic led to extrapolated estimates for four South and East Asia countries of 500,000 corneal, and 4-8 million noncorneal xerophthalmia cases annually (Sommer et al. 1981). The global estimate was 13 million with xerophthalmia and 40-80 million at risk of subclinical deficiency.

Partnerships for advocacy, technical and financial support for interventions.  The 1974 Rome-based World Food Conference called for action to alleviate global food shortages and micronutrient malnutrition, but follow-up activities on a global scale were minimal. Between 1975 and 1985, as data from scientifically sound epidemiologic surveys clearly delineated the magnitude of clinically evident micronutrient deficiencies, concern intensified. New alliances of professional groups were formedInternational Vitamin A Consultative Group (IVACG), International Nutritional Anemia Consultative Group (INACG) and the International Council for Control of Iodine Deficiency Disorders (ICCIDD)and some international and bilateral donor agencies, national program managers and the private sector. Muted alarm bells began to ring in international agencies such as WHO, FAO and the World Food Programme (WFP). In 1985, a 10-year UN agency plan for elimination of iodine and vitamin A deficiencies and a reduction in iron-deficiency anemia was launched (Table 2).

The UN call for actions, however, failed to generate sufficient resources to mount a coordinated global attack, and few countries gave high priority to micronutrients in allotment of their own very limited health budgets. Although a clinically evident health problem was acknowledged, it was not perceived as a micronutrient deficiency crisis affecting global development that was of sufficient magnitude to draw political attention and action. Goiter was widely recognized as a lump in the neck primarily of cosmetic concern, and nutritional blindness was viewed as an unfortunate tragedy affecting relatively few when compared with other blinding conditions such as cataract and trachoma. Significant debilitating iron-deficiency anemia concerned public health officials because of its contribution to maternal mortality. Because severe anemia was seen as limited to reproductive-age women, mainly during pregnancy, the perception was that they could be treated through existing maternal child services without need for new population-based control measures. Hence, up to the 1980s, the public and professional images associated with deficiency of these three micronutrients were stereotyped and not of resource-capturing political concern. Obviously, there was need for clarifying and repositioning the images of micronutrients to demonstrate their true implications for economic and social development.

Repositioning the micronutrient images to a development perspective  1975-1990.  Evidence needed to reposition stereotyped micronutrient images was accumulated between 1975 and 1990 as a result of scientifically sound, community-based studies that delineated the magnitude, consequences and implication of micronutrient deficiencies.

Epidemiologic studies revealed that micronutrient deficiencies, controllable by inexpensive practical interventions, were issues not only of physiologic consequences to humans, but issues that also had serious implications for economic and social development of affected nations and the world. For example, field studies demonstrated that iodine-deficient populations responded to simple iodine supplementation in the form of concentrated oil or iodized salt by eliminating the incidence of cretinism and reducing the prevalence and size of goiter (Hetzel 1983, Pharoah et al. 1971). Beyond these clinically obvious benefits of iodine prophylaxis to humans, there were unexpected detrimental effects from not treating less obvious deficiency on the viability and quality of animals produced for domestic and export markets (Hetzel 1976) and on mental performance of school-aged children (Bautista et al. 1982). Iodine deficiency, therefore, had economic and social consequences detrimental to national development that were far greater than previously appreciated. To acknowledge expanded consequences of less obvious deficiency, the term iodine deficiency disorders (IDD) was coined (Hetzel 1983).

Community-based studies of vitamin A-deficient child populations documented response to vitamin A given as concentrate in periodic high (Sommer et al. 1986) as well as frequent low (Ramathullah et al. 1990) doses, or in fortified foods (Muhilal et al. 1988), not only by decreased prevalence of eye signs, but also by an average 23% reduced mortality risk (Beaton et al. 1993). These findings had resource-saving implications for institutional care because the severity of common childhood diseases such as diarrhea and measles was reduced by inexpensive vitamin A intervention (Ghana VAST Study Team 1993, Underwood and Arthur 1996).

Studies also showed not only that anemic pregnant women responded to iron supplementation, as expected, but unexpectedly, untreated moderately anemic Costa Rican (Lozoff et al. 1991) and Chilean (Walters 1995) infants, even after achieving adequate iron status after infancy, showed continued retarded mental and psychomotor development deficits at 5-6 years of age. Also unexpected was improved worker productivity among iron-treated female Chinese cotton workers only mildly or moderately anemic, which translated into increased personal as well as corporate earnings (Li et al. 1994).

Previously, underappreciated consequences for physiologic development for all three micronutrients were shown by carefully designed scientific studies to have obvious associated consequences for economic and social development of individuals, nations and the world. Hence, sound epidemiologic research provided the information needed to reposition the image of micronutrients into one with obvious political appeal because human, economic and social consequences could be averted by low-cost available intervention programs (Hetzel 1996, Underwood 1996, Yip 1994).

Hence, iodine deficiency was repositioned (Fig. 1A) from a lump in the neck affecting 600-700 million to a range of iodine-deficiency-related disorders (IDD; Hetzel 1983) with a risk of loss of up to 10-13 IQ points affecting 1.5 billion humans (WHO 1993) and innumerable potentially marketable animals (Hetzel 1995); VAD was repositioned (Fig. 1B) from a defect in the eye affecting 13-14 million children with an additional 40-80 million at risk (Sommer 1981), to 250 million at risk for their survival (WHO 1995); iron-deficiency anemia was repositioned (Fig. 1C) from a life-threatening problem for a half-billion pregnant women (WHO 1992) to poor cognitive performance and work productivity affecting at least another one and a half billion children and adults (WHO 1997).

View larger version (38K): [in this window] [in a new window]   Fig 1. Repositioning of the images of micronutrient deficienciesA) iodine, B) vitamin A, and C) ironfrom an overt clinical problem affecting relatively few to the veiled consequences for development of many individuals, nations and the world. Numbers are estimated prevalence based largely on clinical signs and symptoms before 1990 (small triangles to left); after 1990, numbers are based on estimates of affected and "at risk" of health consequences (larger triangles to right).

Logical thinking would lead to the conclusion that if implications from these findings known by the late 1980s became broadly disseminatedand the public realized that the devastating effects were preventable by available and affordable intervention programsit would be political suicide and unethical to allow continued inaction or muted preventive and control efforts on a global scale.

Politically receptive environment  1990 to present.  Creating a receptive environment for this politically sensitive information required wide dissemination and strong advocacy. Partnerships formed among scientists, program and policy makers and private sector representatives during 1975-1985 when the critical epidemiologic studies were in progress, i.e., IVACG, INACG and ICCIDD, had the objective to provide both scientifically sound advocacy and technical guidance toward the control and elimination of micronutrient deficiencies. These groups provided periodic forums for dissemination of ongoing research findings and produced technical guidelines for program development, implementation, monitoring and evaluation. Their advocacy voices, however, had little effect on high level politicians until late in the 1980s. From among several competent spokespersons in each of the three groups, three scientists are worthy of special note, Alfred Sommer of IVACG (Sommer 1989), the late Edward DeMaeyer of INACG and WHO (DeMaeyer and Adiels-Tegman 1985) and Basel Hetzel of ICCIDD (Hetzel 1995). These three stepped forward at a politically opportune time to carry the torch into the political arena, as had McCollum and his contemporaries (Markel 1987, Mastovinovic 1978) six decades earlier.

Fortunately, there was a counterpart champion for children in the political world, the late James Grant, Executive Director of UNICEF. His politically sensitive eyes and ears were receptive to the scientists' message-bearers with their respective repositioned micronutrient images, particularly for IDD and VAD. Mr. Grant, like Herbert Hoover, saw the political implication of the micronutrient messages and envisioned how these fit into the very high profile political milieu surrounding the seminal UNICEF World Summit for Children, which was in the planning stage. The issues were placed on the agenda of the forum held in New York, and commitment to action was pledged at the highest political level at the end of the 1990 conference (Table 2). This commitment was reinforced at levels progressively closer to the community in subsequent conferences over the succeeding two years, i.e., Policy Conference on Ending Hidden Hunger held in Montreal, Canada in 1991 and the International Conference on Nutrition held in Rome, Italy in 1992, and national planning meetings that are ongoing. These activities were reinforced by FAO convening the World Food Summit in 1996 in Rome, Italy.

Conventional wisdom is that when the bosses make commitments, even if a bit ethereal, those answerable are more likely to respond as requested. Hence, these conferences provided the hierarchical structure of commitment most favorable to implementation of policies and programs, i.e., translation of research into global realities. Micronutrientsiodine, vitamin A and ironwere both scientifically and politically positioned for action. The yet unanswered crucial question, however, is whether in the next few years intended program recipients will partake, or more importantly will be empowered with the information needed to become active participants in making decisions necessary for the betterment of their own health.

Windows of opportunity for scientifically sound intervention programs.  Activities involved in preparation and follow-up of the international conferences engaged a wide range of individuals and groups. Their involvement has created unusual opportunities to acquire, apply and disseminate nationally relevant information for appropriate actions incorporating available, affordable interventions adaptable to local conditions and sustainable resources. As of the end of 1996, national follow-up plans of action for achieving improved nutrition-related commitments have been developed in more than half of WHO's 192 member states (WHO 1997), and the international political climate continues to be supportive. For example, the First Lady of Bolivia placed micronutrients on the agenda of the First Ladies Summit held in Bolivia in December 1996. To sustain this high level of commitment, however, today's recipients of intervention efforts have to be transformed into knowledgeable consumers demanding from those who make policy and program decisions continued access to adequate micronutrients for their health. The strategies embraced, therefore, should have the critical components experience has shown to be essential to sustained progress, e.g., continued political and financial commitment from highest ministerial to local implementing administrative units; community participation and program ownership; timely process and impact monitoring; politically timely reporting of progress; continued advocacy by international, national and local program "champions"; communication and education programs to create informed clients.

Reflections on the role of the nutrition scientist in going from research to reality.  Policy and program decisions are usually not made by scientists. Fortunately, however, decision makersat least in the developed worldnormally decide in partnership with the scientific community. In the U.S. we are fortunate to have many advocacy bodiesAmerican Society for Nutritional Sciences (ASNS), American Society for Clinical Nutrition (ASCN), Food and Nutrition Board (FNB), Institute of Medicine (IOM), university groups and many others. International groups such as UN-affiliated agencies, professional societies, such as the International Union Nutritional Sciences (IUNS) and its adhering and affiliated bodies, and others [e.g., Programme Against Micronutrient Malnutrition (PAMM), Micronutrient Initiative (MI), Opportunities for Micronutrient Interventions (OMNI), and other bilateral aid programs] are also available to assist in-country nutrition scientists and their partners.

Reflecting on my active participation with micronutrients as a nutrition scientist involved in basic to community studies for over 35 years, my relatively brief encounter with micronutrient politics representing WHO and my review of Dr. McCollum's remarkably successful life-journey from research to reality leads me to share critical lessons learned from these interwoven exposures. Nearly five years at WHO taught me patience but not complacency in moving research to sustainable global reality. Rarely does this transition occur by quantum leaps, but by carefully orchestrated persistent, scientifically sound incremental steps. Nutrition scientists have a role in orchestrating those steps as follows: 1) in the acquisition of scientifically sound information; 2) in applying it in the appropriate politically relevant terms in a development perspective; 3) in seeking out and working with political counterparts to create receptive climates for dissemination to decision makers from households to national planners; 4) in participating then in partnerships for program design, implementation and monitoring; and 5) in documenting incremental progress in politically expedient time-frames.

Obviously, to mount each of those steps from research to realizing a healthier global population requires many talents. The nutritional sciences are most fortunate because of the broad perspective and talents encompassed by our profession, from the molecular biologist to the anthropologist to the nutrition education and communication specialists. Few individuals embrace all of the talents needed, but as teams under the umbrella of professional groups we can and have a responsibility to contribute.

	CONCLUSION

McCollum's life journey exemplifies how sound nutrition-related laboratory research can be translated into a realistic perspective for those whose daily decisions affect both animal and human health. His scientific contributions were implemented in ways that empowered both politicians and people with the knowledge needed to make nutritionally sound dietary decisions that carried personal benefits and improved the health of the nation. McCollum's experiences, and those of his contemporaries in micronutrient research, illustrate the importance of politically opportune timing for science to influence national and global policy and the availability of effective, affordable and sustainable public health interventions.

Micronutrient concerns on a global scale experienced a political renaissance less than a decade ago, and the story has not ended. Micronutrients are on a path marked by signs that would look familiar to Dr. McCollum, e.g., politically timely, doable programs and commitments to action. Only well-timed future assessments will reveal whether the course taken will eliminate iodine and vitamin A malnutrition as public health problems, and if iron deficiency will be substantially reduced, and whether continued monitoring will assure that such achievements are sustained.

The future will uncover many more journeys for nutrition scientists in translating nutrition research into the reality of more nutritious diets and improved global health. A reminder from a reviewer of the IDD story is in order. It was noted that "numerous announcements from scientific laboratories of today sound like elaborate statements made by David Marine long ago" (Matovinovic 1978). The same could be said for E. V. McCollum and for many past giants and champions of nutritional sciences. Too seldom do we look to seasoned experiences for guidance in interpreting the present before launching journeys into the future.

	FOOTNOTES

Manuscript received 25 July 1997. Initial reviews completed 25 August 1997. Revision accepted 19 September 1997.

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