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UCLA School of Public Health, Los Angeles, CA 90095
* To whom correspondence should be addressed. E-mail: cneumann{at}mednet.ucla.edu.
Multiple micronutrient (MN) deficiencies are widespread globally and frequently coexist with protein-energy malnutrition, particularly in Southeast Asia, sub-Saharan Africa, and to a lesser extent in Latin America. It is estimated that malnutrition contributes to the high mortality in children <5 y of age (1).
In recent years, the vital role of MN particularly in promoting physical growth, cognitive development, and combating infection in children has come to the forefront; the roles of mainly iron, zinc, vitamins A and B-12 (2–5) have emerged as important to public awareness. Deficiencies of these MN have a large negative societal impact. Insufficient energy and protein quality are additional important coexisting problems (6).
Approaches to multiple MN deficiencies are evolving rapidly. These have largely been in the utilization of "nutriceuticals." Vitamin A capsules have a long proud history in preventing vitamin A deficiency, as do iodine tablets and injections for preventing iodine deficiency. Also, iron and folic acid tablets and solutions have long been used to prevent iron deficiency and anemia, particularly in pregnancy. Of late, sprinkles with multiple micronutrients are added to servings of food and used particularly in several African countries (7). Most recently, zinc treatment has been recommended for treating prolonged diarrheal disease and now as prophylactic treatment to prevent the development of pneumonia (8,9). The above approaches are useful for treating acute and severe deficiencies, over the short term (10).
Food fortification has a considerably longer history, especially iodization of salt, fortification of margarine and cooking oils and fats with vitamin A, and fortification of wheat with iron and occasionally B vitamins (10). Quality control in developing countries has been problematic. Results have been impressive, but so have serious problems. Often, multiple MN deficiencies are present rather than single deficiencies, and the problem arises if multiple tablets needed. Possible negative interactions between iron and zinc have also been reported.
The above "nutriceutical" approach is also problematic in terms of sustainability, reliance on often expensive imported products, and reaching far-flung and isolated rural populations. As for fortified foods, many rural subsistence households have little dealings with the cash economy and grow the bulk of their own food. They rely on small transient markets for purchases and may not have access to fortified products sold mainly in shops where the cost of these fortified items may be prohibitive.
New advances are being made in biofortification, such as growing/breeding high-zinc maize and wheat and high-lysine cereals and vitamin A–rich yellow rice (11). However, except for the yellow rice, this technology is still extremely limited in implementation and far from acceptance.
Food-based solutions for dealing with MN deficiencies are set forth as a potentially sustainable, affordable, effective, and feasible approach to addressing macro- and micronutrient malnutrition. Meat, fish, and fowl of a wide variety and type including organ meats, offal, and a variety of rodents, snails, mollusks, insects, and annelids offer a good source of multiple MN (12,13). This is particularly important for rural areas of developing countries. Meat products are energy-dense and contain relatively high iron and zinc content in bioavailable form (13). Heme protein in meat enhances iron and zinc absorption from plant foods. What are badly needed are services from extension and nongovernmental organizations targeted at women, as they do the bulk of care for small household animals (14,15). These "minilivestock" include rabbits, free-range chickens, fish, etc. Dairy products, although lacking in iron and zinc, are good sources of calcium and vitamins A and B-12.
This symposium includes articles on the designing of snacks containing meat, milk, or added energy to be added to traditional staples. These have been used for supplemental feeding in a controlled intervention study in Kenya, presented by Murphy et al.
Modification of traditional diets in rural Malawi through such traditional methods as soaking, fermentation, germination, and diversification of the household diet to improve MN nutrition is authored by Drs. Hotz and Gibson.
A comprehensive review of the role of zinc in human growth and development and the appreciation of zinc's essential role in immune function and resistance to infection as well as its unique biologic activity in protein synthesis and in gene processes is authored by Drs. Hambidge and Krebs. Their own studies on the introduction of meat and liver, in Denver and Guatemala, as the first weaning food in 7-mo-old infants with excellent acceptance and improvement in zinc status and growth are presented.
Use of locally available small indigenous fish in Bangladesh and Cambodia is detailed by Drs. Roos, Wahab, Chamnan, and Thilsted. These small fish supply nearly complete daily requirements of preformed vitamin A, iron, and calcium (if fish are eaten whole). Dried fish is popular in areas of East Africa.
Drs. Kuhnlein and Receveur present unique data on Canadian Arctic indigenous diets. She compared the macro- and micronutrient contributions from traditional animal foods (such as caribou and fish) to those from purchased market foods, pointing out a large contribution of micronutrients from traditional sources of meat.
A problem with rearing animals for consumption is preservation of meat to prevent spoilage in the absence of refrigeration, etc. Drs. Maretzki, Seetharaman, and Mills present the Nutribusiness project whereby weaning foods were produced by community women's groups using local crops. Solar drying was carried out, and weaning mixes prepared and then sold for income generation. Their group, on a trial basis, has been drying rabbit and chicken, producing finger foods such as chips that can be powdered for inclusion in weaning porridge. This approach is now being carried out in several African countries.
Last, selected findings are presented by Neumann et al. from the first randomized, controlled school feeding intervention study testing the impact of meat vs. milk vs. plant foods on growth, cognition, school performance, behavior, and physical activity. The findings are being presented as evidence for the impact of meat on these important outcomes. The above study has stimulated examination of the possibilities and barriers to acceptance and availability of animal source foods on the household and community levels and the types of meat used in early child feeding.
In conclusion, capital investment in nutrition and health improvement of infants and children will contribute to social and economic development of individuals, communities, and nations.
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FOOTNOTES |
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LITERATURE CITED |
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 TOP LITERATURE CITED |
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3. Brown KH, Peerson JM, Allen LH. Effect of zinc supplementation on children's growth: a meta-analysis of intervention trials. Bibl Nutr Dieta. 1998;54:76–83.[Medline]
4. Chwang LC, Soemantri AG, Pollitt E. Iron supplementation and physical growth of rural Indonesian children. Am J Clin Nutr. 1988;47:496–501.
5. Neumann CG, Stephenson LS. Interaction of nutrition and infection. In: Strickland GT, editor. Hunter's tropical medicine. 7th ed. Philadelphia: W. B. Saunders Co.; 1991.
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7. Zlotkin S, Arthur P, Schauer C, Antwi KY, Yeung G, Piekarz A. Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children. J Nutr. 2003;133:1075–80.
8. Bhandari N, Bahl R, Taneja S, Strand T, Molbak K, Ulvik RJ, Sommerfelt H, Bhan MK. Effect of routine zinc supplementation on pneumonia in children aged 6 months to 3 years: randomised controlled trial in an urban slum. BMJ. 2002;324:1358.
9. Bhandari N, Bahl R, Taneja S, Strand T, Molbak K, Ulvik RJ, Sommerfelt H, Bhan MK. Substantial reduction in severe diarrheal morbidity by daily zinc supplementation in young North Indian children. Pediatrics. 2002;109:e86.
10. Allen LH. Interventions for micronutrient deficiency control in developing countries: past, present and future. J Nutr. 2003;133(11 Suppl 2):3875S–8S.
11. Nestel P, Bouis HE, Meenakshi JV, Pfeiffer W. Biofortification of staple food crops. J Nutr. 2006;136:1064–7.
12. DeFoliart GR. Insects as human food. Crop Prot. 1992;11:395–9.
13. Murphy SP, Allen LH. Nutritional importance of animal source foods. J Nutr. 2003;133(11 Suppl 2):3932S–5S.
14. Ayele Z, Peacock C. Improving access to and consumption of animal source foods in rural households: the experiences of a women-focused goat development program in the highlands of Ethiopia. J Nutr. 2003;133(11 Suppl 2):3981S–6S.
15. Smitasiri S, Chotiboriboon S. Experience with programs to increase animal source food intake in Thailand. J Nutr. 2003;133(11 Suppl 2):4000S–5S.
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