Opportunities to prevent and manage undernutrition to amplify efforts to end TB.

The bidirectional relationship between TB and nutrition is well recognized - primary undernutrition is a risk factor for developing TB disease, while TB results in wasting. Although nutrition support is acknowledged as an important intervention in TB programmes, it is seldom afforded commensurate priority for action. TB incidence and deaths worldwide are falling too slowly to meet WHO End TB Strategy milestones, and the number of undernourished people is increasing, likely to be further exacerbated by the ongoing COVID-19 pandemic. Undernutrition needs to be more urgently and intensively addressed. This is especially true for the WHO South-East Asia Region, where the high rates of undernutrition are a key driver of the TB epidemic. The evidence base has been sufficiently robust for clear and workable programmatic guidance to be formulated on assessment, counselling and interventions for TB patients. Many high-burden countries have developed policies addressing TB and nutrition. Gaps in research to date have frustrated the development of more refined programmatic approaches related to addressing TB and malnutrition. Future research can be shaped to inform targeted, actionable policies and programmes delivering dual benefits in terms of undernutrition and TB. There are clear opportunities for policy-makers to amplify efforts to end TB by addressing undernutrition.

[Conclusions and recommendations of a WHO expert consultation meeting on iron supplementation for infants and young children in malaria endemic areas]. / Conclusions et recommandations à l'issue de la consultation de l'OMS sur la lutte contre la carence martiale chez le nourrisson et le jeune enfant dans les pays d'endémie palustre.

This article presents the results of an expert consultation meeting aimed at evaluating the safety and public health implications of administering supplemental iron to infants and young children in malaria-endemic areas. Participants at this meeting that took place in Lyon, France on June 12-14, 2006 reached consensus on several important issues related to iron supplementation for infants and young children in malaria-endemic areas. The conclusions in this report apply specifically to regions where malaria is endemic.

Vitamin and iron status in new vegetarians.

This study assessed the biochemical status of a number of vitamins and iron in a group of new vegetarians. Values were compared with a group of omnivores of similar age. Satisfactory to high levels of serum folate, vitamin E, and riboflavin were found, and all were significantly higher in vegetarians than omnivores. Thiamin status was satisfactory in both groups although a small but statistically significant difference in favor of the omnivores was found. Serum vitamin B-12 was significantly lower in vegetarians, and iron status as measured by serum ferritin was very significantly lower in vegetarians. Pyridoxine status was similar in both groups. A number of sex differences were found in the vegetarian sample. New vegetarian women appear to be at particular risk of developing low iron stores.

Lactose malabsorption in Australian Aboriginal children.

The purpose of this study was to determine the prevalence of lactose malabsorption in healthy full-blood Australian Aboriginal children. Sixty-three Aboriginal subjects and forty-six non-Aboriginal controls ranging in age from six to 14 years were tested using the breath hydrogen method. Seventy percent of the Aboriginal subjects were found to be lactose malabsorbers and 9% of the controls. The results provide strong evidence that the majority of full-blood Aboriginal children are lactose malabsorbers and that the characteristic is well-established by 6-7 years of age, in common with most other non-Western populations.

Efficacy of a vitamin A-fortified wheat-flour bun on the vitamin A status of Filipino schoolchildren.

BACKGROUND: Wheat flour is a possible food vehicle for vitamin A fortification. OBJECTIVE: This study assessed the efficacy of consumption of a vitamin A-fortified wheat-flour bun (pandesal) on the vitamin A status of school-age children. DESIGN: This was a double-masked clinical trial conducted in 396 and 439 children aged 6-13 y attending 4 rural schools in the Philippines. The children were randomly assigned to a vitamin A-fortified (experimental) or nonfortified (control) group. A 60-g vitamin A-fortified pandesal (containing approximately 133 microg retinol equivalents) or a nonfortified pandesal was consumed by the children 5 d/wk for 30 wk. Vitamin A status, hemoglobin concentration, anthropometric status, morbidity, and dietary intake were assessed at baseline and 30 wk later. A modified relative dose response (MRDR) was assessed in a subsample of 20% of the children ( approximately 75/group) with the lowest initial serum retinol concentration at the 30-wk follow-up. RESULTS: Baseline serum retinol significantly modified the effect of the intervention. The fortified group, whose initial serum retinol concentrations were below the median, had a 0.07 +/- 0.03-micromol/L greater improvement in serum retinol at the 30-wk follow-up than did the control group (P: = 0.02). Improved vitamin A status was also evident in the MRDR subsample. End-of-study differences in the MRDR showed that vitamin A- fortified pandesal intake decreased the percentage of children with inadequate liver vitamin A stores by 50% (15.3% compared with 28.6%; P: = 0.05). CONCLUSIONS: Daily consumption of vitamin A-fortified pandesal significantly improved the vitamin A status of Filipino school-age children with marginal-to-low initial serum retinol concentrations.

Urine mutagenicity as an indicator of exposure to dietary mutagens formed during cooking of foods.

Studies were undertaken with individuals fed fried bacon meals to determine whether fruit or vegetables, ingested along with bacon, modified uptake and subsequent excretion of bacon mutagen(s). Urinary mutagenic activity was significant in those who had consumed bacon or mixed bacon/vegetable or bacon/fruit meals within the previous 2 to 3 hr period. Although urine activity varied by a factor of 4 among 15 subjects who consumed different meals, there was no evidence from this investigation that fruit or vegetables contributed to the inherent variability in total urinary mutagenic activity. However, some differences in excretion kinetics may be attributable to vegetable or fruit supplements in mixed meals.

Developing industrial-governmental-academic partnerships to address micronutrient malnutrition.

Micronutrient malnutrition affects approximately 2 billion people and has a significant impact on mortality, morbidity, reproductive health, individual growth and development, and economic productivity. The World Bank has suggested that micronutrient interventions are among the most cost-effective of all health interventions. Therefore, greatly increased collaborative efforts are needed to bring about further reductions in micronutrient malnutrition. At the FAO/WHO International Conference on Nutrition, the importance of various partners in improving nutrition was recognized in the World Declaration on Nutrition and adopted unanimously by 159 governments: "Governments, academic institutions and industry should support the development of fundamental and applied research directed towards improving the scientific and technological knowledge base" for addressing malnutrition, including micronutrient malnutrition. Food-based strategies, including fortification, provide a good example.

Iron and folate fortification in the Americas to prevent and control micronutrient malnutrition: an analysis.

Although there has been a remarkable decline in the proportion of malnourished children in Latin America, micronutrient deficiencies, especially iron deficiency anemia, remain significant public health problems. A substantial reduction in the prevalence of iron deficiency anemia is an important goal for the end of the decade. Interest in fortifying wheat flour and dry-milled maize flour is thus growing, and significant experience in the fortification of flours with iron and the B vitamins, including folate, is emerging. It is necessary to ensure that fortification levels and standards, legislation, and quality assurance and control measures are in place nationally and harmonized regionally.

Sociodemographic and health factors in the well-being of homeless men in Sydney, Australia.

Throughout the world, homelessness is generally increasing. This paper examines some of the historical precedents and, in an Australian sample, some of the factors leading to ill-health in this group. All studies have shown the ill-effects on health of being homeless and in this group drinking alcohol and length of time on skidrow appear to be the major factors. It is also suggested that the homeless are generally from comparatively disadvantaged backgrounds before becoming homeless, and more likely to be migrants. They were also less likely to have ever married and more likely to have been in jail or psychiatric institutions.

The challenge to eliminate micronutrient malnutrition.

OBJECTIVE: This paper takes a public health approach to examine briefly: (i) the global magnitude and consequences of deficiencies of iodine, vitamin A and iron; (ii) the intervention options for addressing the deficiencies and associated critical issues; (iii) roles of the main 'players' involved; (iv) current programs and results. METHOD: Analysis of the literature, especially that coming from the UN agencies; distillation of experience from the recently completed OMNI Project, and involvement in relevant international meetings. RESULTS: More than one in three individuals throughout the world are at risk of the health and development consequences of iron, vitamin A and/or iodine deficiencies. There has been a 40% decline in the prevalence of vitamin A deficiency over the last 10 years. More than 60% of all salt is now fortified with iodine. CONCLUSIONS: Significant progress has been made, particularly with the iodine deficiency disorders and vitamin A deficiency. Little apparent progress has been made with iron deficiency anaemia. IMPLICATIONS: National governments, UN multilateral agencies, international consultative groups, bilateral agencies, global and national non-governmental organisations, and increasingly, the private sector need to work together in looking for innovative approaches, especially for iron, increasing awareness of the broader social and public health nutrition context, and supporting increased international funding.

Growth patterns of children in Lagaip, Enga Province.

A nutrition survey was conducted in 1979 in the Lagaip area of Enga Province. On examining 1,739 children under 5 years., it was found that the pattern of their growth was similar to that reported in other highland populations. The high proportion (37%) of the children classified as malnourished results from stunting, not wasting. Most of the children classified as wasted were less than 2 years old. Significant associations were found between reported morbidity and nutritional status when the latter was assessed by weight related indices.

PIP: A nutrition survey was conducted in 1979 in the Lagaip area of Enga Province to establish anthropometric baseline data for children under 5 years of age. Undernourished children are at a greater risk of morbidity and mortality and the numbers at risk and their location need to be known so that adequate preventive resources can be allocated. Data are reported on 1206 children who were selected from the population attending Maternal and Child Health clinics in the area using a stratified sampling procedure. Measurements of weight, length, mid-upper arm circumference, and triceps skin-fold were taken and compared against standards reported by Jelliffe. A morbidity questionnaire was also administered to the guardians of the children. Using the weight for age measurements, 37% of the study children are classified as malnourished. The most prevalent form of malnutrition is stunting (deficit in length for age). Only 3% of the sample are wasted (deficit in weight for length), with a majority, 81%, under 2 years old. The proportion of children neither wasted nor stunted falls steadily with age to 39% in the 5th year of life. Stunting, unlike wasting, is not amenable to nutritional intervention. Preventive programs to increase energy and protein intake should be aimed at children 4 to 15 months old, a critical age range when prevention is important.

Healthy aging and the quality of life.

The size of the elderly population, both in numbers and as a proportion of the whole, is increasing rapidly in most parts of the world. This trend, together with other deep changes in society, has made traditional ways of understanding and accommodating the aging process inadequate. Surveys suggest that economic security, psychosocial well-being, and a sense of being in reasonably good health are the most important values to aim for.

Partnerships in eliminating malnutrition.

PIP: This article highlights the development of partnerships in the elimination of malnutrition. Malnutrition includes undernutrition, overnutrition, and micronutrient malnutrition, resulting in a profound effect even into the next generation. Several methods have been developed in response to the increasing rate of malnutrition. Among these are the prevention and control of micronutrient deficiencies through a simple approach and the focus on nonbiological determinants of malnutrition through a human rights framework. The three universal goals of the World Summit for Children, the International Conference on Nutrition, and the World Food Summit were the elimination of vitamin A deficiency, iodine deficiency disorders and the substantial reduction of iron-deficiency anemia. In addition, partnerships were deemed not only effective but also necessary in the elimination of malnutrition. Partnerships between the UN, particularly the Sub-Committee on Nutrition/Advisory Group on Nutrition, the WHO, nongovernmental organizations, national and international governments have implemented the Interim Programme Steering Committee. The challenge of making individual efforts toward a common goal could be the factor that will aid in the success of malnutrition programs.^ieng

Solving the micronutrient problem in the Asia Pacific region.

Over two billion people, or more than one out of three individuals throughout the world, are at risk of iron, vitamin A and iodine deficiencies. Although countries of the Asia Pacific region have generally shown a remarkable decline in the proportion of malnourished children, micronutrient deficiencies remain significant public health problems. The World Summit for Children in 1990, and the FAO/WHO International Conference on Nutrition held in Rome in 1992, affirmed that the elimination of the various forms of micronutrient malnutrition would constitute a significant contribution to social, economic and public health development. Governments and non-governmental organisations from virtually all nations, together with the international development community, have made the elimination of iodine deficiency disorders and vitamin A deficiency important goals to be achieved by the end of the decade, along with a substantial reduction in the levels of iron deficiency anaemia. A further important factor in implementing multisectoral micronutrient interventions is the cost-effectiveness of such interventions. The three main complementary intervention strategies to controlling and preventing micronutrient deficiencies are: (i) food-based approaches such as fortification and dietary diversification; (ii) supplementation when appropriate; and (iii) public health measures to control infection, including incorporating micronutrients into other child survival activities such as immunisation. Much of the global experience in these strategies comes from countries of the Asia Pacific region, with some significant examples of success.