![[Feedback]](/icons/banner/feedbackACT.gif){kind=icon}
![[For Subscribers]](/icons/banner/subscriberACT.gif){kind=icon}
![[Archive]](/icons/banner/archiveACT.gif){kind=icon}
![[Search]](/icons/banner/searchACT.gif){kind=icon}
![[Contents]](/icons/banner/tocACT.gif){kind=icon}
|
|
|
|
|
||
Office of Analysis, Nutrition and Evaluation, Food and Nutrition Service, U.S. Department of Agriculture, Alexandria, VA 22302
2To whom correspondence should be addressed. E-mail: julie.kresge{at}fns.usda.gov
 |
INTRODUCTION |
|---|
 TOP INTRODUCTION REFERENCES |
|---|
The agenda for this symposium was the work of the Children’s Nutrition Research Center of Baylor College of Medicine, the Centers for Disease Control and Prevention and staff from Agriculture Research Service and the Food and Nutrition Service (FNS)3 of the U.S. Department of Agriculture. Initial ideas for agenda items included a broad range of topics, such as breath tests for gastrointestinal function; dietary intake; urinary analytes; gene array chips for nutritional status correlation; scans for organ function and for muscle actions; hemoglobin, blood sugar, cardiovascular function via echocardiogram and ultrasound; serum triglyceride-rich lipoproteins via brachial artery ultrasound; body composition methods; physical maturity scales relating to bone density; physical activity measurement via accelerometers, biomarkers of food intake behavior; computerized methods for validation of food intake, fetal metabolism and anemia studies; essential fatty acid status and buccal smears; hormonal status; micronutrient status such as iron, vitamin A, folate and iodine; and antibody measures for intake or exposure to proteins.
Clearly a large number of scientists could and should be involved in bringing focus to the potential use of these technologies and setting priorities for targeting them to the greatest health needs of the U.S. population and elsewhere. This symposium only touched the surface of the potential for information sharing, exchange of methodologies and testing and mutual support that is emerging across scientific disciplines.
Facilitation of this process will need be to greatly increased with emphasis from areas of government that have resources to speed development, develop test environments and to broadly communicate observed health needs of particular groups. This facilitation is of particular interest to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).
WIC, administered by the U.S. Department of Agriculture via grants to
state health departments, is a front-line defense in the nation’s
food security safety net. The WIC program is targeted to deliver
nutritional benefits to those in the U.S. population who are most
vulnerable to nutritional risk: low income pregnant, breastfeeding and
postpartum women; infants; and preschool children (1)
. WIC
provides nutritious foods, nutrition education, breastfeeding support
and referrals to health and social service programs as an adjunct to
good health care during the critical early years of growth and
development. WIC currently provides service to over 7 million persons a
year and at a federal cost of $4 billion.
Although many WIC participants are extremely poor, poverty alone is not sufficient in determining eligibility for WIC benefits. WIC eligibility determination includes both an income test to determine that an individual has family income at or below 185% of poverty and a determination of nutritional risk. WIC food benefits and other nutrition counseling are targeted to the individual’s nutritional risk.
For WIC, nutritional risk is established based upon determination of at
least one anthropometric, biochemical, clinical, dietary or significant
predisposing condition (e.g., homelessness). The anthropometric testing
has primarily been based on measures of height (or length) and weight,
and the biochemical screening has primarily been blood tests for
hemoglobin and/or hematocrit to identify anemia (2)
.
The most commonly recorded nutritional risks for participants served by WIC are:
.
During the decade of the 1990s, U.S. Department of Agriculture’s
FNS has sponsored a series of steps to improve the WIC approach to
nutritional risk determination. In 1993 FNS sponsored a project by the
Institute of Medicine that resulted in the landmark 377-page
publication "WIC Nutrition Risk Criteria: A Scientific Assessment"
(4)
. This review created a scientific framework for
assessing the appropriateness and usefulness of nutritional risk
criteria, as they are needed for the WIC program. A review of
scientific literature following this framework provided consensus in
scientific support for most of the nutritional risk criteria in use by
WIC state agencies. It also revealed the need for improvement of the
scientific basis for risk determination in a number of areas
(4)
. FNS worked cooperatively with the WIC community
through the National Association of WIC Directors to interpret the
findings of this report and in April of 1998 issued a policy to
increase conformity of WIC nutritional risk criteria across the
country. This policy became effective in 1999, and a process has been
established for continuous improvement of the nutritional risk
component of WIC through the FNS-National Association of WIC
Directors Risk Identification and Selection Collaborative.
As WIC experienced substantial program growth throughout the 1990s and
WIC clinics grew more crowded, local WIC staff described increasing
stress levels in these clinics. Finger sticks to draw a blood sample
for anemia screening are painful and often lead to crying and
disruptions by young children at the WIC sites and doctors offices
where the tests are performed. WIC expansion in these years also placed
WIC service sites in a wide variety of environments beyond traditional
public health settings. The cost of providing blood analyses for WIC
participants still includes selecting WIC sites that are suited for
blood testing; obtaining supplies; maintaining (and sometimes
transporting) equipment; and management and disposal of hazardous waste
as well as employment of specially trained and certified technicians.
Currently WIC uses results from over 5 million blood tests each year as
part of its nutritional risk assessment at WIC certification
(5)
.
This August 2000 symposium pulled together a small group of experts from government, academia and industry to share information about existing and emerging technologies that could assist WIC in meeting the challenges ahead. WIC’s challenge is to provide participants served in the next generation with the best information and best service that medical science will allow. Ideally, this would include:
The manuscripts that have been presented here offer considerable
hope for improvement in these areas over the next decade through the
use of new technologies. Some, such as orthogonal polarization spectral
imaging as presented by Dr. Richard Nadeau, offer hope of minimally
invasive measurement of hemoglobin in the relatively near future
(6)
. Over a longer period, new types of observations
allowed by this technology, such as vessel density, may lead to earlier
and different insights regarding disease states. The use of the imagery
depends on knowledge gained in other research that allows statistical
correlations and standardized interpretations to be developed.
Optical technology and multivariate statistical techniques discussed by
Dr. Gerard Cote have combined to open the field of absorption
spectroscopy for assessment of iron, vitamin A, iodine and folate,
which are key to health risks experienced by pregnant women, new
mothers and their young children (7)
. Challenges remain in
addressing overlapping spectra for various substances and variability
of optical properties of body tissues within and between patients.
Development of software to provide quantifiable and interpretable data
are essential to continued progress in this field.
Saliva testing as described by Dr. Lindsay Hofman shows promise for
assessing real as opposed to reported smoking behaviors or in
predicting preterm delivery for pregnant women (8)
. Blood
spots dried on filter paper as reported by Dr. Joanne Mei
(9)
and Dr. Neal Craft (10)
can be used for
infant screening for metabolic and heritable disorders and for
assessment of vitamin A status. Dr. Kenneth Ellis (11)
compared new technologies for assessing body composition, such as
air-displacement plethysmograph, three-dimensional photonic
scanning and bioelectrical impedance spectroscopy, with established
reference methods.
Dr. Dietrich Matern has shown ways that mass spectrometry offers
opportunity for high volume testing of single or related groups of
metabolites using a growing variety of media (12)
.
However, lack of easy maintenance of equipment and labor-intensive
nonstandardized methods for interpretation are key barriers to
widespread use. Other approaches such as breath testing discussed by
Dr. Peter Klein seem more distant in their widespread application due
to the narrow range of conditions that they address (13)
.
Deoxyribonucleic acid microarray technologies as presented by Drs.
Karen and Kendal Hirschi suggest new paths for observing patterns that
can assist in modeling human regulatory mechanisms and networks as well
as mapping disease progression (14)
. The understanding of
nutrition, as well as many other fields, is expected to be
fundamentally changed as it becomes possible to address cellular level
actions of specific nutrients. In time, this will allow selection of
the most effective interventions for individual patients.
As WIC continues to address the nutrition needs of those at greatest risk in our population, these technologies will open new doors for coordination with other stakeholders in this growing ability toward health assessment. The Food and Nutrition Service and the Agriculture Research Service extend appreciation to these authors and to the many researchers who are working to improve the ability to assess nutritional status and to create appropriate interventions for those at nutritional risk.
|
FOOTNOTES |
|---|
3 Abbreviations used: FNS, Food and Nutrition Service; WIC, Special Supplemental Nutrition Program for Women, Infants and Children.
|
REFERENCES |
|---|
|
TOPINTRODUCTIONREFERENCES |
|---|
1. Rush D., Horvitz D. G., Seaver W. B., et al Evaluation of the Special Supplemental Food Program for Women, Infants, and Children (WIC) 1986;I:1-5 U.S. Department of Agriculture Washington, D.C.
2. Fox M. K., Fowler A., Burstein N., et al WIC Nutrition Education Assessment Study Final Report 1999 U.S. Department of Agriculture Washington, D.C.
3. Bartlett S., Brown-Lyons M., Moore D., et al WIC Participant and Program Characteristics 1998 2000:71-125 U.S. Department of Agriculture Washington, D.C.
4. Behrman R., Abrams B., Brown A. S., et al WIC Nutrition Risk Criteria: A Scientific Assessment 1996:1-22 National Academy Press Washington, D.C.
5. Bartlett S., Brown-Lyons M., Moore D., et al WIC Participant and Program Characteristics 1998 2000 U.S. Department of Agriculture Washington, D.C.
6.
Nadeau R. G., Groner W. The role of non-invasive imaging technology in the diagnosis of anemia. J. Nutr. 2001;131:1610S-1614S
7.
Cote G. L. Noninvasive and minimally invasive optical monitoring technologies. J. Nutr. 2001;131:1596S-1604S
8.
Hofman L. Human saliva as a diagnostic specimen. J. Nutr. 2001;131:1621S-1625S
9.
Mei J. V., Alexander R., Adam B. W., Hannon W. H. The use of filter paper for the collection and analysis of human whole blood specimens. J. Nutr. 2001;131:1631S-1636S
10.
Craft N. Innovative approaches to vitamin A assessment. J. Nutr. 2001;131:1626S-1630S
11.
Ellis K. Selected body composition methods can be used in field studies. J. Nutr. 2001;131:1589S-1595S
12.
Matern D., Magera M. J. Mass spectrometry methods for metabolic and health assessment. J. Nutr. 2001;131:1615S-1620S
13.
Klein P. 13C Breath tests: visions and realities. J. Nutr. 2001;131:1637S-1642S
14.
Hirschi K. D., Kreps J. A., Hirschi K. K. Molecular approaches to studying nutrient metabolism and function: an array of possibilities. J. Nutr. 2001;131:1605S-1609S
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
