Milestones and controversies in maternal and child health: examining a brief history of micronutrient fortification in the US.

Fortification of our food and drinking supply has decreased morbidity rates related to micronutrient deficiencies among mothers and their children, particularly during the perinatal and neonatal periods of development. The purpose of this historical review is to examine the impact of public policy changes related to micronutrient fortification. We provide a historical investigation of achievements and controversies related to iodine, vitamin D, fluoride and folic acid fortifications in our food and drinking supply. We also discuss the current status of fortification recommendations and their significance to maternal and child health.

The Rise and Fall of Universal Salt Iodization in Vietnam: Lessons Learned for Designing Sustainable Food Fortification Programs With a Public Health Impact.

BACKGROUND: In 2005, more than 90% of Vietnamese households were using adequately iodized salt, and urinary iodine concentration among women of reproductive age was in the optimal range. However, household coverage declined thereafter to 45% in 2011, and urinary iodine concentration levels indicated inadequate iodine intake. OBJECTIVE: To review the strengths and weaknesses of the Vietnamese universal salt iodization program from its inception to the current day and to discuss why achievements made by 2005 were not sustained. METHODS: Qualitative review of program documents and semistructured interviews with national stakeholders. RESULTS: National legislation for mandatory salt iodization was revoked in 2005, and the political importance of the program was downgraded with consequential effects on budget, staff, and authority. CONCLUSIONS: The Vietnamese salt iodization program, as it was initially designed and implemented, was unsustainable, as salt iodization was not practiced as an industry norm but as a government-funded activity. An effective and sustainable salt iodization program needs to be reestablished for the long-term elimination of iodine deficiency, building upon lessons learned from the past and programs in neighboring countries. The new program will need to include mandatory legislation, including salt for food processing; industry responsibility for the cost of fortificant; government commitment for enforcement through routine food control systems and monitoring of iodine status through existing health/nutrition assessments; and intersectoral collaboration and management of the program. Many of the lessons would apply equally to universal salt iodization programs in other countries and indeed to food fortification programs in general.

Beyond the 'raw' and the 'cooked': a history of fortified blended foods.

This paper offers a history of fortified blended foods, a humanitarian product that first emerged in the middle of the twentieth century. Tracing its emergence and development, the paper argues that this food was the product of four key historical trends: (i) the search for a compact and efficient diet in the wake of the Second World War; (ii) the high modernist movement that saw science and technology as a way to improve on traditional foods; (iii) the state-led industrialisation of the development decades oriented around the notion of a worldwide 'protein gap'; and (iv) the legacy of 'productivist' agriculture in the United States, generating massive surpluses in certain crops that had to be adapted creatively for a multitude of uses. The paper positions fortified blended foods in these broader historical processes, and asserts that humanitarian techniques are very much rooted in cultural, political, and social conditions.

Malnutrición y desigualdades en la España del franquismo; el impactodel complemento alimenticio lácteo en el crecimiento de los escolares españoles (1954-1978) / Malnutrition and inequalities in francoist Spain; the impact of a milk supplement on the growth of spanish school children (1954-1978)

A lo largo del siglo XX, la población española fue consolidando su proceso de transición nutricional y alimentaria. En la etapa pre-transicional, se produjo un renovado interés por las deficiencias que mostraba la alimentación de los niños y se apostó por la educación alimentaria-nutricional para superarlas. El objetivo del trabajo es analizar el estado nutricional, a través de la talla como parámetro antropométrico, que mostraba la población escolar del ámbito rural español, entre las décadas de 1950 y 1970, su evolución y las diferencias que existían entre regiones. Los resultados ponen de manifiesto que al inicio de la década de 1960 se apreciaban dos patrones: un primer grupo donde la estatura de los niños de la costa cantábrica, zona de Levante, Cataluña y Baleares, mostraba niveles similares a los de niños bien alimentados; y un segundo grupo donde las tallas eran inferiores, en el que se encontraban las regiones de Andalucía, Extremadura y Galicia. Entre 1954 y 1977, las tallas de los niños bien alimentados mostraron un incremento que fue especialmente intenso entre 1954 y la primera mitad de la década de 1960. En el caso de los niños y niñas que acudían a las escuelas nacionales del ámbito rural, también se produjo un significativo incremento en la talla, además de corregirse las diferencias regionales que existían al principio de los años sesenta. En todos aquellos avances habrían influido tanto el complemento alimenticio, como las actividades de educación alimentación y nutrición que se llevaron a cabo en el marco del Programa EDALNU (AU)

The Spanish nutritional and food transition was consolidated over the course of the twentieth century. In the pre-transition stage, a renewed interest emerged in the deficiencies presented by children''s diets, and food and nutritional education was considered the best course of action to correct them. The aim of this study was to analyse the changes over time and regional differences in the nutritional status of Spanish schoolchildren in rural areas in the 1950s and 1970s, using their height as an anthropometric parameter. The results revealed the existence of two categories at the beginning of the 1960s: a first group in which the height of children from the Cantabrian coast, the Levante, Catalonia and the Balearic Islands was similar to that of well-nourished children, and a second group from the regions of Andalusia, Extremadura and Galicia, who were not as tall. Between 1954and 1977, the height of well-nourished children rose, particularly between 1954 and the first half of the 1960s.There was also a significant increase in the height of children attending national schools in rural areas, and the regional differences that had existed at the beginning of the 1960s disappeared. These advances were undoubtedly influenced both by the milk supplement and the food and nutritional education activities carried out within the framework of the Spanish Diet and Nutrition Education programme (EDALNU) (AU)

Folic acid food fortification-its history, effect, concerns, and future directions.

Periconceptional intake of folic acid is known to reduce a woman's risk of having an infant affected by a neural tube birth defect (NTD). National programs to mandate fortification of food with folic acid have reduced the prevalence of NTDs worldwide. Uncertainty surrounding possible unintended consequences has led to concerns about higher folic acid intake and food fortification programs. This uncertainty emphasizes the need to continually monitor fortification programs for accurate measures of their effect and the ability to address concerns as they arise. This review highlights the history, effect, concerns, and future directions of folic acid food fortification programs.

Accounting for the contribution of vitamin B to Canada's WWII effort.

Canada began to fortify its flour and bread with vitamin B when it entered the Second World War. The decision was informed by the biology of vitamin B and therefore I suggest that the complexity of this political maneuver can best be understood by considering the specificity of the biochemistry of vitamin B. In this paper I will show that the specific biology of vitamin B allowed the Canadian government the possibility of a healthier population under wartime conditions but also allowed the government a variety of means by which to develop and organize food processing practices to this end.

INCAP studies of endemic goiter and its prevention.

The high prevalence of goiter among adults in its member countries of Central America and Panama was observed as soon as INCAP began field studies. This led to systematic studies of goiter in schoolchildren in all of the countries as described, beginning with Guatemala where the rate was 38% nationally. However, efforts to eliminate the consequences of iodine with iodized salt using the water soluble potassium iodate and a process that had proved successful in Switzerland and the United States could not be used with the crude moist salt of the region. INCAP identified potassium iodate that is insoluble in water, and in four schools (two each in El Salvador and Guatemala) proved that the iodine in this compound was as available as that in potassium iodate. It remained evenly distributed in moist salt. When added to salt in Guatemala, goiter rate dropped to 15% in four years and less than 5% in eight years. Compulsory iodation of salt in other developing countries followed with comparable results. This method is now used in worldwide campaigns against iodine deficiency in developing countries.

Five decades of vitamin A studies in the region of Central America and Panama.

Vitamin A deficiency in Central America was first identified as a public health problem in the 1950s. It affected primarily children. The main underlying cause was a deficient intake of pre-formed vitamin A, but infection and intestinal parasitism also played important roles. INCAP focused its efforts on overcoming this problem and developed, as a short-term solution, the technology to fortify sugar with vitamin A. Fortification programs were implemented in several Central American countries. Evaluation of these programs revealed a significant impact-not only on vitamin A status, but also on iron nutrition and hematological condition. Longer-term solutions, like increasing the availability and consumption of vitamin A-rich foods, were later suggested and operational tools were developed to assist the countries in the region in the implementation, evaluation and monitoring of their own fortification programs.

INCAP studies of hematologic and gastrointestinal function in healthy individuals and those with protein-energy malnutrition and infection.

Anemia is highly prevalent, especially in poorly nourished populations living in unsanitary conditions. Studies of the Central American population showed that iron was the predominant deficient hematopoietic micronutrient and that correction of nutrient deficiencies led to hematological normality as defined by WHO. The bioavailability of diverse iron compounds added to the mostly vegetable diets of such populations showed the superior absorption of chelated iron (NaFeEDTA) and its strong effectiveness in correcting iron deficiency when added to sugar. The consequences on development and mental behavioral functions as well as on work capacity of iron deficiency and anemia in infants, children and adults, and the positive effects of their correction was demonstrated. In protein-energy malnourished (PEM) children, the deficit in active tissue mass (basal oxygen consumption) and in total hemoglobin content were closely related. This relationship persisted as the rates of active tissue mass repletion was modified by levels of protein intake. This demonstrated the strong adaptive nature of hemoglobin content in response to oxygen needs in PEM and during recovery. Gastrointestinal functions in PEM and in populations demonstrated the bacterial invasion of the upper GI tract and how this resulted in secondary bile acids that are toxic to the intestinal mucosal cells impairing their absorptive functions. Environmental hygiene in populations reversed gut bacterial migration and improved GI function.

The repeating history of objections to the fortification of bread and alcohol: from iron filings to folic acid.

The fortification of staple foods has eliminated many deficiency diseases. Despite this, "tampering" with people's food always provokes opposition, much of it from health professionals. Opposition is often based on self-interest, tunnel vision and theory rather than research. A historical perspective of the patterns of objections to fortification and its outcomes may help resolve the anxieties and opposing ethical positions of advocates and opponents of fortification.

Dietetic practice: the past, present and future.

The history of dietetics can be traced as far back as the writings of Homer, Plato and Hippocrates in ancient Greece. Although diet and nutrition continued to be judged important for health, dietetics did not progress much till the 19th century with the advances in chemistry. Early research focused focuses on vitamin deficiency diseases while later workers proposed daily requirements for protein, fat and carbohydrates. Dietetics as a profession was given a boost during the Second World War when its importance was recognized by the military. Today, professional dietetic associations can be found on every continent, and registered dietitians are involved in health promotion and treatment, and work alongside physicians. The growing need for dietetics professionals is driven by a growing public interest in nutrition and the potential of functional foods to prevent a variety of diet-related conditions.

The history and future of food fortification in the United States: a public health perspective.

For more than 50 years, the United States federal government has regulated food fortification. During this time, the nutritional situation in the United States has improved greatly, whereas scientific information about the role of vitamins and minerals in human growth and development has increased exponentially. Concurrently, government authority to regulate food fortification has declined. This paper provides a brief history of U.S. food fortification policy and describes the contribution of food fortification to U.S. nutrient intakes. The paper highlights future directions of food fortification in the United States in light of these important developments, and addresses the issue of risk and the need to balance deficiency and toxicity in a generally well nourished population.

Infant feeding in the 20th century: formula and beikost.

The early years of the 20th century were notable for improvements in general sanitation, dairying practices and milk handling. Most infants were breast-fed, often with some formula feeding as well. Availability of the home icebox permitted safe storage of milk and infant formula, and by the 1920s, feeding of orange juice and cod liver oil greatly decreased the incidence of scurvy and rickets. Use of evaporated milk for formula preparation decreased bacterial contamination and curd tension of infant formulas. From 1930 through the 1960s, breast-feeding declined and cow's milk and beikost were introduced into the diet at earlier and earlier ages. Although commercially prepared formulas, including iron-fortified formulas replaced home-prepared formulas, few infants were breast-fed or formula fed after 4-6 mo of age. Iron deficiency was prevalent. From 1970 through 1999, a resurgence of breast-feeding was associated with a prolongation of formula feeding and an increase in usage of iron-fortified formulas. By the end of the century, formula feeding of older infants had largely replaced feeding of fresh cow's milk and the prevalence of iron deficiency had greatly decreased.

Feeding the premature infant in the 20th century.

This article reviews the historical development of feeding the premature infant in the 20th century. It describes the early work determining the energy requirements of the preterm infant, the evolution of the use of human milk and its fortification for these infants, the development of special formulas for very-low-birth-weight infants and the various techniques/methods utilized including total parenteral nutrition.

Search for the competitive edge: a history of dietary fads and supplements.

The premise and promise of ergogenic aid use is rooted in antiquity and is based upon superstition and ritualistic behavior of athletes who perceive that past performances were predicated upon unique dietary constituents or dietary manipulation. Accounts from ancient times recommended that athletes and soldiers preparing for battle consume specific animal parts to confer agility, speed or strength associated with that animal. Scientific understanding of the chemical and physiological nature of muscular work in the early 20th century was followed by ergogenic aid use by athletes and rationalized as "scientific" justification. Ergogenic aids such as alkaline salts, caffeine, carbohydrate and protein have been used by athletes with variable success. As nutritionists and exercise physiologists discovered and perfected the scientific understanding of metabolic reactions, athletes in turn experimented with the amount, form and timing of administration in the search for optimal performance. Anabolic steroids and blood doping enhance athletic performance, but health risks, ethics and sportsmanship contravene their use. Popularity and use of ergogenic aids often have preceded scientific substantiation of claims. Current products such as protein isolates and antioxidant nutrients commonly are used by athletes, and many ergogenic aids available today differ little from those used long ago.