Project Type
Coordinated Research Project
Project Code
E43021
CRP
1493
Approved Date
31 March 2008
Start Date
15 September 2008
Expected End Date
15 September 2013
Completed Date
8 January 2014
Description
The high prevalence of micronutrient deficiencies, in particular deficiencies of iron, zinc and vitamin A, is contributing significantly to the unacceptably high childhood morbidity and mortality observed in developing countries. Food fortification and biofortification are potentially useful strategies to prevent and control these deficiencies, however, limited data are available on the efficacy of these public health interventions in infants and children. Stable isotope techniques can be used in the development and evaluation of nutritional strategies by the assessment of bioavailability of iron, zinc and pro-vitamin A carotenoids as well as by monitoring changes in body pools of vitamin A to evaluate efficacy. This CRP will generate new information on the usefulness of food fortification and biofortification to improve micronutrient status in infants and children. The project will build on an ongoing CRP, in close collaboration with HarvestPlus, generating data on biofortification as a strategy to combat micronutrient deficiencies in adults.
Objectives
To generate new information on the efficacy of food fortification and/or biofortification interventions to improve micronutrient status in children
Specific objectives
To assess the change in vitamin A pool size in children consuming 140 g/d rice triple-fortified with Fe, Zn and Vitamin A for 60 days, and compare the results between assessment by the isotopic method to assessment by serum retinol concentration (THA 15426).
To assess the vitamin A status and body pool size in children using the modified relative dose response tests and stable 13C2 retinyl acetate as a tracer among children who receive Sprinkles with or without vitamin A through home fortification of complementary foods (GHA 15199).
To determine absorption of Fe and Zn from Fe & Zn-biofortfied and Zn-fortified pearl millet in young Indian children (IND 15205).
To estimate the amount of zinc absorbed (bioavailability) from zinc biofortified rice and compare that with absorption from conventional rice and zinc-fortified conventional rice using the triple stable isotope tracer ratio technique in children (BGD 15197).
To evaluate the impact of daily consumption of vitamin A fortified oil on vitamin A consumption from breast milk vitamin A during the first 6 months post-partum in breastfed babies from low-income communities (MOR 15815).
To investigate a) if the effect of bean polyphenols previously seen in a single meal study can be confirmed with multiple bean meals as part of a complex diet; b) human iron absorption from different bean varieties consumed with other meal components; c) if phytic acid in beans is the inhibitor responsible for equal iron bioavailability from high iron and normal iron beans observed in the multiple meal study (RWA 16152).
To investigate the impact of daily consumption of vitamin A-fortified milk on vitamin A status in preschool-children (MEX 15198).
Impact
Observations from this CRP will influence fortification and biofortification nutrition interventions in areas where the knowledge can be applied to promote adequate nutrition and prevent nutrient deficiencies using foods indigenous to the local diets. For example, the demonstration that phytic acid content is a primary factor in the iron absorption from beans should redirect research to concentrate on this factor for improvement of iron bioavailability from foods. The demonstrated effectiveness of both iron and zinc fortification of pearl millet has the potential to provide a sustainable source of these nutrients where this food is a staple, namely, semi-arid regions of India and Africa, and according to HarvestPlus, "more than 30,000 Indian farmers have purchased and planted this new variety marketed as Dhanshakti (meaning prosperity and strength)".
The demonstration that isotope dilution methods provided a much more sensitive measure than serum retinol of the effectiveness of vitamin A fortification in both Thailand and Mexico serves as a foundation for further work with this method to evaluate the effectiveness of multiple vitamin A interventions around the world. However, in the study in Mexican children, even though 50% of children may be considered vitamin A deficient by serum retinol concentrations <0.7 µmol/L, liver vitamin A reserves were more than adequate when assessed by stable isotope retinol methods. This raises concerns about the possible over-use of some nutrition interventions, and the need to use sensitive assessment methods to evaluate public health nutrition programs to prevent deficiencies while avoiding excessive levels of vitamin A. At the International Congress of Nutrition where the Mexico results were reported, our IAEA section head was approached by a representative of the Bill and Melinda Gates foundation to organize a further meeting and research on "Assessing the risk of vitamin A toxicity due to large scale intervention programmes".
The long-term impact of the CRP will be most evident in future years, as the peer-reviewed publications increase in number and influence further scientific effort.
Relevance
The enthusiastic acceptance of the results of these studies, including publication in top peer-reviewed nutrition journals, and results that serve as the basis for additional work that has already begun (see impact above) demonstrates that this topic remains highly relevant in applying stable isotope techniques in human nutritional assessment, to help solve world food and nutrition problems.
CRP Publications
Type
Peer reviewed journal article
Year
2012
Publication URL
http://www.ncbi.nlm.nih.gov/pubmed/22298572
Description
PETRY, N., et al., Stable iron isotope studies in Rwandese women indicate that the common bean has limited potential as a vehicle for iron biofortification, J Nutr 142 (2012) 492-497. Biofortification of plants is a new approach to combat iron deficiency. Common beans (Phaseolus vulgaris) can be bred with a higher iron concentration but are rich in iron absorption inhibitors, phytic acid (PA), and polyphenols (PP). To evaluate the potential of beans to combat iron deficiency, three iron absorption studies were carried out in 61 Rwandese women with low iron status. Studies 1 and 2 compared iron absorption from high and low PP beans, similar in PA and iron, fed as bean puree in a double meal design or with rice and potatoes as multiple meals. Study 3 compared iron absorption from high and normal iron beans with similar PP levels and a PA: iron molar ratio, fed with potatoes or rice in multiple meals. Iron absorption was measured as erythrocyte incorporation of stable iron isotopes. In study 1, iron absorption from the high PP bean (3.4%) was 27% lower (P < 0.01) than from low PP bean (4.7%), but when fed in multiple meals (study 2), there was no difference (7 and 7.4%, respectively; P > 0.05). In study 3, iron absorption from the high iron bean (3.8%) was 40% lower (P < 0.001) than from the normal iron bean (6.3%), resulting in equal amounts of iron absorbed. When beans were combined with other meal components in multiple meals, high PP concentration had no negative impact on iron absorption. However, the quantity of iron absorbed from composite meals with high iron beans was no higher than with normal iron beans, indicating that efficacious iron biofortification may be difficult to achieve in beans rich in PA and PP.
Country/Organization
Rwanda
Type
Peer reviewed journal article
Year
2013
Description
ISLAM, M. M., WOODHOUSE, L. R., HOSSAIN, M. B., et al., Total Zinc Absorption from a Diet Containing either Conventional Rice or Higher-Zinc Rice Does Not Differ among Bangladeshi Preschool Children, J Nutr 143 (2013) 519-525. Information is needed on zinc absorption from grain cultivars having higher zinc content. Total absorbed zinc (TAZ) from mixed diets containing high-zinc rice (HZnR), conventional rice (CR), or CR plus zinc fortificant (CR+Zn) was measured. Forty-two non-malnourished preschool-aged children were enrolled in 1 of 2 groups. Using a crossover design, children in group A (n = 22) received for 1 d each a mixed diet containing 150 g CR or HZnR. Children in group B (n = 20) received HZnR on 1 d and CR+Zn on the other day. Fractional zinc absorption (FZA) was measured during each dietary period by using a dual-isotope tracer ratio technique; TAZ was calculated as the product of zinc intake [total dietary zinc (TDZ)] and FZA. TDZ was 3.83, 4.83, and 6.03 mg/d when the children were fed the CR, HZnR, and CR+Zn-containing diets, respectively. Mean FZA from the CR diet was greater than from the HZnR diet (25.1 vs. 20.1%, P < 0.001), and the mean FZA from the CR+Zn diet (18.8%) was less than from both the CR diet (P < 0.001) and the HZnR diet (P = 0.014). The mean TAZ was 0.96 +/- 0.16, 0.97 +/- 0.18, and 1.13 +/- 0.20 mg/d from the CR, HZnR and CR +Zn diets, respectively. TAZ was not different for the CR and HZnR diets (P = 0.99) but was significantly greater from the CR+Zn diet compared with the other 2 diets (P < 0.001). Rice cultivars with higher zinc and/or lower phytate content are needed to increase TAZ by young children consuming this amount of rice.
Country/Organization
Bangladesh
Type
Peer reviewed journal article
Year
2013
Publication URL
http://www.ncbi.nlm.nih.gov/pubmed/23843474
Description
KODKANY, B. S., et al., Biofortification of pearl millet with iron and zinc in a randomized controlled trial increases absorption of these minerals above physiologic requirements in young children, J Nutr 143 (2013) 1489-1493. Millet is unusually drought resistant and consequently there is a progressive increase in the use of these grains as a human food staple, especially in large areas of India and sub-Saharan Africa. The purpose of this study was to determine the absorption of iron and zinc from pearl millet biofortified with 2 micronutrients that are typically deficient in nonfortified, plant-based diets globally. The study was undertaken in 40 children aged 2 y in Karnataka, India (n = 21 test/19 controls). Three test meals providing approximately 84 +/- 17 g dry pearl millet flour were fed on a single day for zinc and 2 d for iron between 0900 and 1600 h. The quantities of zinc and iron absorbed were measured with established stable isotope extrinsic labelling techniques and analyses of duplicate diets. The mean (+/- SD) quantities of iron absorbed from test and control groups were 0.67 +/- 0.48 and 0.23 +/- 0.15 mg/d, respectively (P < 0.001). The quantities of zinc absorbed were 0.95 +/- 0.47 and 0.67 +/- 0.24 mg/d, respectively (P = 0.03). These data did not include absorption of the modest quantities of iron and zinc contained in snacks eaten before and after the 3 test meals. In conclusion, quantities of both iron and zinc absorbed when iron and zinc biofortified pearl millet is fed to children aged 2 y as the major food staple is more than adequate to meet the physiological requirements for these micronutrients.
Country/Organization
India
Type
Peer reviewed journal article
Year
2013
Publication URL
http://www.ncbi.nlm.nih.gov/pubmed/23256139
Description
LOPEZ-TEROS, V., et al., Vitamin A fortified milk increases total body vitamin A stores in Mexican preschoolers, J Nutr 143 (2013) 221-226.Vitamin A (VA) deficiency (VAD) continues to be a major nutritional problem in developing countries, including Central America. In Mexico, milk is a well-accepted vehicle for the administration of micronutrients, including VA, to preschoolers. Thus, we conducted a randomized, controlled, clinical trial to investigate the efficacy of daily consumption of 250 mL of VA-fortified milk (which provided 196 retinol equivalents/d) for 3 mo on VA stores in mildly to moderately VAD (serum retinol concentration 0.35-0.7 mumol/L) preschoolers who were not enrolled in a food assistance program. Twenty-seven mildly to moderately VAD children were randomly assigned based on screening measurements to either the intervention (n = 14) or control group (n = 13) (children in the control group did not receive placebo). All children in the control group and 79% (n = 11) of the children in the intervention group completed the study. The total body VA (TBVA) pool size was estimated using the deuterated retinol dilution technique before and after the intervention. After 3 mo, median changes in the serum retinol concentration for the intervention and control groups were 0.13 and -0.21 mumol/L, respectively (P = 0.009). Median changes in the TBVA stores were 0.06 and 0.01 mmol, respectively (P = 0.006) and estimated median changes in the liver VA concentration were 0.09 and 0.01 mumol/g, respectively (P = 0.002). The VA-fortified milk was well accepted among preschoolers and significantly increased TBVA stores, liver VA stores, and serum retinol concentration, indicating that it may be an effective means to ameliorate VAD in young Mexican children.
Country/Organization
Mexico
Type
Local
Year
2012
Description
Lopez-Teros, V, QUIHUI-COTA, L., GUTIERREZ-RIVERA, M. A., DUARTE-FIGUEROA, M. E., ESPARZA-ROMERO, J., PACHECO-MORENO, B.I., TORTOLEDO-ORITZ, O., RASCON-DURAN, L., ASTIAZARAN-GARCIA, H. Patrones y componentes alimentarios y su asociación con indicadores antropométricos en preescolares de Hermosillo, Sonora (Food components and dietary habits and their association with anthropometric indices in preschoolers from Hermosillo, Sonora). BIOtecnia 14 (2012) 44-53.
Country/Organization
Mexico
