Micronutrient status of populations and preventive nutrition interventions in South East Asia.

Objectives Since the 1990s, programs for the control of micronutrient deficiencies became a public health priority for many governments, including the countries partnering the project "Sustainable Micronutrient Interventions to Control Deficiencies and Improve Nutritional Status and General Health in Asia" (SMILING): Cambodia, Indonesia, Laos-PDR, Thailand and Vietnam. The aim of this study was to map which micronutrient deficiencies have been addressed and which interventions were in place in the SMILING countries. Methods The mapping covered the period up to 2012. Updated information from relevant surveys after 2012 is included in this paper after the completion of the SMILING project. The mapping of micronutrient status was limited to either national or at least large-scale surveys. Information on nutrition interventions obtained through a systematic mapping of national programs combined with a snowball collection from various sources. Results Among the five SMILING countries, Thailand differed historically by an early implementation of a nationwide community-based nutrition program, contributing to reductions in undernutrition and micronutrient deficiencies. For Cambodia, Indonesia, Laos PDR, and Vietnam, some national programs addressing micronutrients have been implemented following adjusted international recommendations. National surveys on micronutrient status were scattered and inconsistent across the countries in design and frequency. Conclusion for practice In conclusion, some micronutrient deficiencies were addressed in national interventions but the evidence of effects was generally lacking because of limited nationally representative data collected. Improvement of intervention programs to efficiently reduce or eliminate micronutrient deficiencies requires more systematic monitoring and evaluation of effects of interventions in order to identify best practices.

Dietary intake of spices and herbs in habitual northeast thai diets.

Spices and herbs are rich in polyphenols and widely used in habitual diets in the tropical regions. To elucidate their effects on human health, intake of the portion of spices and herbs from habitual diets should be determined. Consumption patterns were determined from 24-hour records or recalls of 181 men and 370 women in Khonkaen and Ubon Ratchathani provinces, representing upper and lower northeast Thailand. There was a slight variation in dishes, but twelve spices/herbs were commonly used in the two areas. The amounts of spices/ herbs in the four most common dishes (Somtum, Jaew, Pon and Kang-Nor-Mai) were estimated by weighing ingredients before and after cooking. The average amount of spices/herbs consumed was 4.9, 26.1, 14 and 11 g/meal, contributing 36.6, 43.1, 20.6 and 29.8 mg polyphenols/meal for Somtum, Jaew, Pon and Kang- Nor-Mai, respectively. Chili was common in all recipes, with an average amount of 8.3-27.5 mg polyphenols/meal. In conclusion, habitual northeast Thai diets contain several spices/herbs and a substantial amount of polyphenols was commonly consumed.

Risk of zinc, iodine and other micronutrient deficiencies among school children in North East Thailand.

INTRODUCTION: Micronutrient deficiencies during childhood can contribute to impairments in growth, immune competence, and mental and physical development, and the coexistence of several such deficiencies can adversely affect the efficacy of single micronutrient interventions. OBJECTIVE: To assess the prevalence of zinc and iodine deficiency and their interrelationships with vitamin A deficiency and anemia and associations with socio-economic status, hemoglobin type, and anthropometry in a cross-sectional study. SETTING: A total of 10 primary schools in North East Thailand. METHODS: Non-fasting venipuncture blood samples and casual urine samples were collected from 567 children aged 6-13 years. Anthropometric measures and serum zinc, albumin, C-reactive protein and urinary iodine, are reported here and integrated with published data on vitamin A, anemia, and socio-economic status. RESULTS: Of the children, 57% had low serum zinc and 83% had urinary iodine levels below the 100 microg/l cutoff. Suboptimal serum zinc and urinary iodine concentrations may result from low intakes of zinc and iodized salt. Significant risk factors for low serum zinc were serum retinol <1.05 micromol/l and being male. Those for urinary iodine <100 microg/l were height-for-age score>median and being female. For serum retinol <1.05 micromol/l, risk factors were low hemoglobin, low serum zinc, and <9 years, and for low hemoglobin indicative of anemia risk factors were <9 years, AE hemoglobinopathy, and serum retinol <1.05 micromol/l. Of the children, 60% were at risk of two or more coexisting micronutrient deficiencies, most commonly suboptimal urinary iodine and low serum zinc. CONCLUSION: The findings emphasize the need for multimicronutrient interventions in North East Thailand.

Iron absorption by human subjects from different iron fortification compounds added to Thai fish sauce.

OBJECTIVES: (a) To measure iron absorption by human subjects from citric acid stabilized fish sauce fortified with ferrous sulfate, ferric ammonium citrate or ferrous lactate and (b) to identify the effect of added citric acid (3 g/l) on iron absorption from ferrous sulfate fortified fish sauce. DESIGN: Iron absorption from the intrinsically labeled compounds was determined via erythrocyte incorporation of isotopic labels ((57)Fe and (58)Fe) using a randomized crossover design. In three separate absorption studies, 10 adult women each consumed a basic test meal of rice and vegetable soup seasoned with isotopically labeled, iron fortified fish sauce. RESULTS: Iron absorption was significantly lower from ferrous lactate and from ferric ammonium citrate fortified fish sauce than from ferrous sulfate fortified fish sauce. Fractional iron absorption (geometric mean; -1s.d., +1s.d.) was 8.7(3.6; 21.4)% for ferrous lactate compared to 13.0(5.4; 31.4)% from ferrous sulfate, P = 0.003 (study 1) and 6.0(2.5; 14.3)% from ferric ammonium citrate relative to 11.7(4.4; 30.7)% from ferrous sulfate, P < 0.001, in study 2. Citric acid added at a molar ratio of approximately 2.5 to iron had no effect on iron absorption from ferrous sulfate (study 3). Iron absorption in the presence of citric acid was 14.1(6.4; 30.8)% compared to 12.0(5.8; 24.7)% in its absence (P = 0.26). CONCLUSIONS: Iron absorption was 50-100% higher from ferrous sulphate fortified fish sauce than from fish sauce fortified with ferric ammonium citrate or ferrous lactate. In the presence of citric acid as a chelator, ferrous sulfate would appear to be a useful fortificant for fish sauce. SPONSORSHIP: International Atomic Energy Agency (IAEA), Vienna, Austria.

Nutrition and development: other micronutrients' effect on growth and cognition.

Previous studies have provided strong evidence that protein-energy malnutrition, deficiencies of iron and iodine early on in life led to compromised growth and cognitive functions in young children. Recently, a growing body of knowledge indicated that other micronutrients also play a role in young child development. Severe as well as marginal vitamin A efficiency were shown to lead to an increased risk of morbidity and mortality in children. A meta-analysis of vitamin A intervention trials indicated an overall reduction of 23% in all-cause mortality rate. Delayed growth, especially stunting, was reported in children with clinical signs of vitamin A deficiency. In addition, deficiency of zinc, which is essential for DNA and protein synthesis, leads to growth failure and delayed secondary sexual maturation in man and animals. Preterm infants appear to benefit from zinc administration in terms of growth and development. Supplementation studies in infants and older children revealed that those who manifested overt zinc deficiency through either clinical or biochemical indicators showed an improvement in linear growth and occasionally, an increase in weight gain. Zinc may also play a major role in brain function based on strong evidence from experimental animals. Zinc deficiency gestation in mice, rats, rhesus monkeys caused impaired learning, reduced attention and poor memory in their offspring. Data in humans are few and inconclusive. With respect to brain function alone, other nutrients such as docosahexaenoic acid (DHA, 22:6 n-3 fatty acid) improve visual acuity and mental development in small-for-gestational-age infants, folate supplementation during pregnancy prevents neural tube defect in infants, selenium deficiency in animals affects activities of brain enzymes necessary for brain development and function. Although evidence is accumulating that micronutrients other than iron and iodine may be important for physical growth and brain development in young children, more well-controlled studies in humans are needed. Critical issues to be considered include: single vs multiple limiting nutrients, critical period of deficiency, responsive indicators and variables that may affect the results as environmental, psychological and social factors.

Evaluation of the effect of vitamin A-fortified margarine on the vitamin A status of preschool Filipino children.

OBJECTIVES: This study assessed the effects of consuming a highly hydrogenated, vitamin A (VA)-fortified margarine not requiring refrigeration on VA status of preschool children. DESIGN: A double-masked randomized community trial. SETTING: Six rural villages in Cavite, Southern Luzon, the Philippines. SUBJECTS: 296 and 285 children 3-6 y of age in the VA-fortified (experimental) and non-fortified (control) margarine groups, respectively. INTERVENTION: Each week for 6 months households were given 250 g of VA-fortified margarine [providing 28.8 micrograms retinol equivalents (RE) per g] or non-fortified (0 microgram RE) margarine of identical appearance for each enrolled child. Children's vitamin A status [serum retinol, xerophthalmia, and conjunctival impression cytology (CIC) status] and dietary intake were assessed at baseline and follow-up; margarine intake was monitored throughout the study. RESULTS: Daily margarine intake per child averaged 27 g in the experimental group (providing 776 micrograms RE) and 24 g (0 microgram RE) in the control group. After 6 months, mean serum retinol increased from 26.4 to 28.8 micrograms/dl in the experimental group but decreased from 26.6 to 25.1 micrograms/dl in controls (P < 0.001 at 6 months); the multiple-adjusted increment over controls was 2.4 micrograms/dl (P < 0.01). More importantly, the prevalence of low serum retinol (< 20 micrograms/dl) decreased from 25.7 to 10.1% in the experimental group but remained unchanged in controls (26.7 to 27.7%) (P < 0.01 at 6 months). At follow-up no experimental children had developed xerophthalmia but 1.4 and 1.8% of controls developed nightblindness and Bitot's spots, respectively. There were no differences in CIC between groups. CONCLUSION: Consumption of VA-fortified margarine significantly improved VA status of preschool Filipino children.