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Department of Pediatrics, McMaster University, Hamilton, ON, Canada;
* Laboratory for Human Nutrition, Swiss Federal Institute of Technology, Zurich, Switzerland;
Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO;
** Department of Nutrition and Department of Internal Medicine, University of California Davis, Davis, CA;
Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark; and
Center for Studies of Sensory Impairment, Aging and Metabolism (CESSIAM), Guatemala
1To whom correspondence should be addressed. E-mail: bllonnerdal{at}ucdavis.edu.
Brittmarie Sandström, Professor, Research Department of Human Nutrition, at the Royal Veterinary and Agricultural University in Copenhagen, Denmark died on 22 October 2002, at the age of 57 years. She had fought a valiant battle against cancer for two years, and remained professionally active until the time of her death.
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In her Ph.D. project, entitled "Zinc Absorption from Composite Meals," Brittmarie developed a radioisotope method for studying zinc absorption in human subjects (1). This method was based on extrinsic labeling of meals with the radioisotope 65Zn and the use of a very sensitive whole-body counter. By using a retention function derived from giving the isotope intravenously, initial absorption could be calculated from whole-body retention measurements. She then applied this method to answer several very relevant questions in human nutrition, such as the following: would the extraction rate of wheat flour, protein source and amount, and quantity of zinc in the meal affect the utilization of zinc? In a series of well-designed studies (2,3), Brittmarie addressed these questions and the results formed much of the basis of our understanding of dietary influences on zinc bioavailability. Her thesis demonstrated two of her many strengths, i.e., her strong dedication to developing solid and valid methodology, which is the cornerstone of quality research, and her deep understanding of the issues of human diets, i.e. applying scientific methodology to questions of practical relevance to human populations.
She next moved on to a collaborative study on zinc absorption from infant diets with Bo Lönnerdal. In this effort, Brittmarie investigated zinc absorption from breast milk, cow’s milk and infant formulas in human adults (4), as well as the effect of individual factors in such diets affecting zinc absorption. The results from these studies were of major importance for future studies on the role of zinc in infant nutrition and in establishing zinc requirements of infants. She subsequently was awarded a Throne-Holst fellowship from Sweden to spend time as a post-doctoral student with Bo Lönnerdal’s research group at UC Davis. There she developed a suckling rat pup model and was able to show that results obtained from rat pups, but not from adult rats, corresponded to findings in adult humans. This provided a useful, rapid and inexpensive way in which to assess zinc bioavailability from larger numbers of diets before human studies were done; the method is still being used for biological screening.
Upon her return to Gothenburg, Brittmarie systematically investigated zinc absorption from a variety of test meals and, in particular, the effect of phytate and the phytate:zinc ratio on zinc absorption. She explored how various processing methods, such as milling, fermentation and cooking techniques affect zinc bioavailability and how different protein sources influence zinc absorption. By this time, in the 1980s, zinc supplements had become more popular, and she investigated how long-term zinc supplementation affects zinc absorption.
Early on, Brittmarie recognized the potential risk of trace element interactions. Because it had become increasingly clear that large population groups require additional iron and zinc, the potential for these two elements to interact negatively with each other had to be studied. She found that iron, given in excess of zinc, can inhibit the absorption of zinc if these two elements are given in a water solution, but not when given in a composite meal (5). This observation explains why negative interactions are observed in supplementation trials, but not when the elements are given as food fortificants. These findings are of great importance when designing programs for alleviating micronutrient deficiencies. She further demonstrated that 2 wk of previous iron supplementation had no inhibitory effect on zinc absorption; the two elements have to be given together, strongly suggesting that the interaction occurs at the mucosal level. In collaboration with Leif Hallberg (6), she also showed the reverse competition, i.e., zinc inhibiting iron uptake when given together in an aqueous solution; once again, however, the interaction did not occur when both elements were given with a meal.
At this point in her career, Brittmarie turned her attention to the absorption of manganese and with Bo Lönnerdal obtained multiyear funding from the USDA to develop a method for studying manganese absorption from composite diets. Working with a jointly supervised graduate student, Lena Davidsson, they developed a radioisotope method for studying manganese absorption in human adults (7). Brittmarie’s previous experience with developing methods for studying zinc absorption in humans and her close collaboration with the Department of Radiation Physics at the University of Gothenburg proved invaluable for these studies. A series of experiments were conducted to establish the technique, including studies providing opportunities to validate the extrinsic labeling method (8). These studies are unique because dual radioisotopes of manganese were used, one of which was produced at the Department of Physics, University of Oslo. This interdisciplinary approach to study trace element metabolism was of major importance in these studies and clearly demonstrated Brittmarie’s innovative and creative skills. The newly developed technique based on whole-body retention was used to evaluate manganese absorption from infant diets, such as human milk and infant formulas, in adult humans (9).
Brittmarie Sandström moved from Gothenburg to Copenhagen, Denmark in 1987 where she was appointed as a Research Associate Professor and asked to assist in establishing an Institute of Research on Human Nutrition at the Royal Veterinary and Agricultural University together with her former mentor professor Björn Isaksson. She was appointed as a research professor in 1991 and became full professor of preventive nutrition in 1995, a position she kept until her death. On the basis of her strong background in dietetics and human clinical nutrition, Brittmarie initiated randomized controlled dietary intervention studies in which she examined the effects of individual dietary components on human nutrition and health. She made sure that the new institute was equipped with excellent kitchen facilities for preparing study diets, including a special kitchen for preparing diets with a controlled content of trace elements. One of her first studies in Copenhagen was a strictly controlled dietary intervention study in which young adults consumed a low fat, high fiber diet or their habitual diet for 8 mo. Brittmarie continued to have an interest in trace minerals, but took up other areas within preventive nutrition as well. Together with Tine Tholstrup, she performed several studies on the effect of fat quality on cardiovascular risk markers (10); in collaboration with Peter Marckman (11), she undertook inquiries into the effect of diet on coagulation and fibrinolysis. More recently, she developed an interest in antioxidants and other bioactive food components such as isoflavones and phytoestrogens. However, minerals and trace elements continued to be her main interest.
Apart from zinc, Brittmarie had a strong interest in iron, especially dietary factors affecting iron absorption. One of her last projects was a collaboration with the Food Science Department at her university with the aim of identifying the "meat-factor" responsible for improved absorption of nonheme iron. Together with Kim Fleischer Michaelsen she participated in studies on the effect of meat intake on iron absorption and iron status during late infancy (12). She had a long-standing collaboration with the Department of Nuclear Medicine at the Copenhagen University hospital where she used the whole-body counters to study mineral absorption using her radioisotope methods. In Copenhagen she established a strong group around her including Marianne Hansen, Tina Tholstrup and Susanne Højbjerg Bugel. She was very successful in attracting large grants from the Danish FØTEK Programme (Food Technology Research and Development Programme) and from the EU research programs.
Brittmarie participated in many EU research projects and concerted actions including studies on the effect of copper in the prevention of cardiovascular disease, the effect of an altered lipid profile in pork for prevention of cardiovascular disease and the interactions of diet and osteoporosis. Up until her untimely death, she served as coordinator for two EU projects: "Improving the Quality and Nutritional Value of Processed Foods by Optimal Use of Food Antioxidants" and "Isoflavones for Reducing Risk of Coronary Heart Disease Among Postmenopausal Women (ISOHEART)." Brittmarie also had a strong interest in public health nutrition, demonstrated by her organization of a course on this topic in her department. She was member of the Steering Committee of the EURODIET Project, and served on its subproject "Nutrition and Diet for Healthy Lifestyles in Europe," developing a framework of European dietary guidelines that could serve for the development of national food-based dietary targets.
Brittmarie’s expertise was frequently sought after, and she participated in executive committees and councils at the WHO and for the European Union, as well as on national and international expert committees, including the executive committees of the International Life Science Institute (ILSI, Europe) and the Danish Nutrition Council. Brittmarie had primary responsibility for the extraordinarily comprehensive zinc chapter in the WHO publication on "Trace Elements in Human Health and Disease" in 1996. This has been and continues to be a landmark contribution to our comprehension of human zinc requirements. She had a close affiliation with the Swedish National Food Administration and was part of the Swedish Expert Group for Food and Physical Exercise and Health 1987. She was one of the authors of the much appreciated reference book Diet, Physical Exercise and Health. She was also a key member of a Committee under the Nordic Council of Ministers, with the mandate to establish Nordic Nutrition Recommendations (NNR). She chaired this Committee from 1992 to1996. Brittmarie’s high level of proficiency and enthusiasm gained a reputation for the 1996 NNR similar to that of its major international counterparts.
The International Zinc Nutrition Consultative Group (IZiNCG) was formed to critically evaluate our knowledge about zinc nutrition of human populations, to assess zinc status and absorption, to establish zinc requirements and to devise strategies for zinc fortification and supplementation. It was very clear from the beginning that Brittmarie should be part of the Steering Committee of this group. She participated at the formative meeting but was unfortunately too ill to travel to the subsequent IZiNCG events. However, from her office and home in Copenhagen she very actively contributed to the working documents. The final comprehensive document is now under review by WHO and will, without doubt, prove to be the guide for nutritionists, program planners and health administrators for the foreseeable future.
During the years of her terminal illness, she was ever assisted and accompanied by her partner and husband, Dietrich Hornig, whose love, devotion and encouragement was a moving factor in the spirit of dedication and courage that Brittmarie manifested to the end of her inspiring life and career.
Brittmarie’s high capacity for work, her extraordinary productivity, her deep fund of knowledge and her willingness to share her knowledge are widely recognized, and she will be sorely missed as a friend, colleague and leader in the field of human nutrition. Her research inspired others and will remain of considerable importance in the field of human nutrition for many years to come.
Manuscript received 6 September 2003.
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LITERATURE CITED |
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 TOP LITERATURE CITED |
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1. Arvidsson, B., Björn-Rasmussen, E., Cederblad, Å. & Sandström, B. (1978) A radionuclide technique for studies of zinc absorption in man. Int. J. Nucl. Med. Biol. 5:104-109.[Medline]
2. Sandström, B., Arvidsson, B., Cederblad, Å. & Björn-Rasmussen, E. (1980) Zinc absorption from composite meals. I. The significance of wheat extraction rate, zinc, calcium and protein content in meals based on bread. Am. J. Clin. Nutr. 33:739-745.
3. Sandström, B. & Cederblad, Å. (1980) Zinc absorption from composite meals. II. Influence of the main protein source. Am. J. Clin. Nutr. 33:1778-1783.
4. Sandström, B., Cederblad, Å. & Lönnerdal, B. (1983) Zinc absorption from human milk, cow’s milk, and infant formulas. Am. J. Dis. Child. 137:726-729.[Abstract]
5. Sandström, B., Davidsson, L., Cederblad, Å. & Lönnerdal, B. (1985) Oral iron, dietary ligands and zinc absorption. J. Nutr. 115:411-414.
6. Rossander-Hulthén, L., Brune, M., Sandström, B., Lönnerdal, B. & Hallberg, L. (1991) Competitive inhibition of iron absorption by manganese and zinc in humans. Am. J. Clin. Nutr. 54:152-156.
7. Davidsson, L., Cederblad, Å, Lönnerdal, B. & Sandström, B. (1989) Manganese retention in man: a method for estimating manganese absorption in man. Am. J. Clin. Nutr. 49:170-179.
8. Davidsson, L., Cederblad, Å., Hagebø, E., Lönnerdal, B. & Sandström, B. (1988) Intrinsic and extrinsic labeling for studies of manganese absorption in humans. J. Nutr. 118:517-521.
9. Davidsson, L., Cederblad, , Å, L, önnerdal, B. & Sandström, B. (1989) Manganese absorption from human milk, cow’s milk, and infant formulas in humans. Am. J. Dis. Child. 143:823-827.[Abstract]
10. Tholstrup, T., Marckmann, P., Jespersen, J. & Sandström, B. (1994) Fat high in stearic acid favorably affects blood lipids and factor VII coagulant activity in comparison with fats high in palmitic acid or high in myristic and lauric acids. Am. J. Clin. Nutr. 59:371-377.
11. Marckmann, P., Sandström, B. & Jespersen, J. (1994) Low-fat, high-fiber diet favorably affects several independent risk markers of ischemic heart disease: observations on blood lipids, coagulation, and fibrinolysis from a trial of middle-aged Danes. Am. J. Clin. Nutr. 59:935-939.
12. Engelmann, M.D.M., Sandström, B. & Michaelsen, K. F. (1998) Meat intake and iron status in late infancy: an intervention study. J. Pediatr. Gastroenterol. Nutr. 26:26-33.[Medline]
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