Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-22T15:51:56.423Z Has data issue: false hasContentIssue false
  • English
  • Français

Can supplements help meet the micronutrient needs of the developing world?

Published online by Cambridge University Press:  27 March 2009

Roger Shrimpton  and
Werner Schultink
Roger Shrimpton*
Affiliation:
Helen Keller International and Centre for International Child Health, Institute of Child Health, University College, London, 30 Guilford Street, London WCIN IEH, UK
Werner Schultink
Affiliation:
Nutrition Section, Programme Division, UNICEF, New York, USA
*
*Roger Shrimpton, fax +44 1904 425 998, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Supplementation has many potential advantages over fortification and dietary approaches for improving micronutrient intake. Pregnant and lactating women and infants are most likely to benefit from supplementation. Recent experience with vitamin A supplementation in young children has proved to be remarkably successful. Demonstrated efficacy of vitamin A supplements for improved child survival in many settings and a technical consensus on how to implement interventions were major factors in achieving this success. Bilateral and UN agencies worked together so that in 1999 80 % of children under 5 years of age in the least-developed countries received a vitamin A capsule in the last 6 months. At least one million child lives saved were associated with the increase in coverage in the last 2 years of the 1990s. Experience with Fe-folate supplements has not been as successful. Whilst a technical consensus has been reached on how to implement programmes to control Fe deficiency, the lack of convincing evidence of efficacy of Fe-folate supplements in terms of maternal and child survival outcomes has undoubtedly contributed to the limited pursuit of effective action. A new multiple micronutrient supplement for se amongst women of reproductive age in developing countries has been formulated. UNICEF is employing the supplement in programmes aimed at helping to prevent low birth weight. The new supplement is likely to be more efficacious than Fe-folate supplements for both maternal and child survival and development outcomes. Successful completion of rigorous efficacy trials will be critical for creating the political support needed to achieve universal coverage.

Type
International and Public Health Nutrition Group Symposium on ‘Achieving a balanced diet in the developing world: strategies to meet micronutrient needs’
Information
Proceedings of the Nutrition Society , Volume 61 , Issue 2 , May 2002 , pp. 223 - 229
Copyright
Copyright © The Nutrition Society 2002

References

ACC/SCN (2000 a) Fourth Report on the World Nutrition Situation. Geneva: ACC/SCN IFPRI.Google Scholar
ACC/SCN (2000 b) Low Birthweight: Report of a Meeting in Dhaka. Bangladesh on 14–17 06 1999. Nutrition Policy Paper no. 18. [Pojda, J & Kelly, L, editors]. Geneva: ACC/SCN ICDDR.Google Scholar
Ahmed, F, Khan, MR & Jackson, AA (2001) Concomitant supplemental vitamin A enhances the response to weekly supplemental iron and folic acid in anemic teenagers in urban Bangladesh. American Journal of Clinical Nutrition 74, 108–115.CrossRefGoogle ScholarPubMed
Allen, LH (1995) Malnutrition and human function: a comparison of conclusions from the INCAP and nutrition CRSP studies. Journal of Nutrition 125, Suppl. 4, 1119S–1126S.Google ScholarPubMed
Alnwick, DJ (1998) Combating micronutrient deficiencies: problems and perspectives. Proceedings of the Nutrition Society 57, 137–147.CrossRefGoogle ScholarPubMed
Beaton, GH, Martorell, R, Aronson, KA, Edmonston, B, McCabe, G, Ross, AC & Harvey, B (1994) Vitamin A supplementation and child morbidity and mortality in developing countries. Food and Nutrition Bulletin 15, 133–148.CrossRefGoogle Scholar
Dwyer, JT, Garcea, AO, Evans, M, Li, D, Lytle, L, Hoelscher, D, Nicklas, TA & Zive, M (2001) Do adolescent vitamin-mineral supplement users have better nutrient intakes than nonusers? Observations from the CATCH tracking study. Journal of the American Dietetic Association 101, 1340–1346.CrossRefGoogle ScholarPubMed
Ekstrom, E-CM, Kavishe, FP, Habicht, J-P, Frongillo, EA, Rasmussen, KM & Hemed, L (1996) Adherence to iron supplementation during pregnancy in Tanzania: determinants and haematological consequences. American Journal of Clinical Nutrition 64, 368–374.CrossRefGoogle Scholar
Galloway, R & McGuire, J (1995) Determinants of compliance with iron supplementation: supplies, side effects, or psychology? Social Science and Medicine 39, 381–390.CrossRefGoogle Scholar
Gillespie, S (1998) Major Issues in the Control of Iron Deficiency. Ottawa, Ont: Micronutrient Initiative and UNICEF.Google Scholar
Gillespie, S & Johnston, J (1998) Proceedings of an Expert Consultation on Anaemia Determinants and Interventions. Ottawa, Ont.: Micronutrient Initiative.Google Scholar
Gillespie, S, Kevany, J & Mason, J (1991) Controlling Iron Deficiency: A Report Based on an ACC/SCN Workshop. Nutrition Policy Discussion Paper no. 9. Geneva: ACC/SCN.Google Scholar
Goldenberg, RL, Tamura, T, Neggers, Y, Copper, RL, Johnston, KE, DuBard, MB & Hauth, JC (1995) The effect of zinc supplementation on pregnancy outcome. Journal of the American Medical Association 274, 463–468.CrossRefGoogle ScholarPubMed
Habicht, JP, Victora, CG & Vaughan, JP (1999) Evaluation designs for adequacy, plausibility and probability of public health programme performance and impact. International Journal of Epidemiology 28, 10–18.CrossRefGoogle ScholarPubMed
Huffman, SL, Baker, J, Shuman, J & Zehner, ER (1998) The Case for Promoting Multiple Vitamin/Mineral Supplements for Women of Reproductive Age in Developing Countries. Washington, DC: Linkages Project, Academy for Educational Development.Google Scholar
Institute of Medicine (1997) Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D and Fluoride. Washington, DC: National Academy Press.Google Scholar
Institute of Medicine (1999) Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Panthothenic acid, Biotin and Choline. Washington, DC: National Academy Press.Google Scholar
International Nutritional Anaemia Consultative Group/World Health Organization/UNICEF (1998) Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia. Washington, DC: ILSI Press.Google Scholar
James, J, Norum, KR, Smitasiri, S, Swaminathan, MS, Tagwireyi, J, Uauy, R & ul Haq, M (2000) Ending Malnutrition by 2020: An Agenda for Change in the Millennium. Final Report to the ACC/SCN by the Commission on the Nutrition Challenges of the 21st Century. Geneva: ACC/SCN.Google Scholar
Kant, AK (2000) Consumption of energy-dense, nutrient-poor foods by adult Americans: nutritional and health implications. The third National Health and Nutrition Examination Survey, 1988–1994. American Journal of Clinical Nutrition 72, 929–936.CrossRefGoogle ScholarPubMed
Kiely, M, Flynn, A, Harrington, KE, Robson, PJ, O'Connor, N, Hannon, EM, O'Brien, MM, Bell, S & Strain, JJ (2001) The efficacy and safety of nutritional supplement use in a representative sample of adults in the North/South Ireland Food Consumption Survey. Public Health Nutrition 4, 1089–1097.CrossRefGoogle Scholar
Ladipo, O (2000) Nutrition in pregnancy: mineral and vitamin supplements. American Journal of Clinical Nutrition 72, Suppl., 280S–290S.CrossRefGoogle ScholarPubMed
Mason, JB, Lotfi, M, Dalmiya, N, Sethuraman, K & Deitchler, M (2001) The Micronutrient Report: Current Progress and Trends in the Control of Vitamin A, Iodine, and Iron Deficiencies. Ottawa, Ont.: Micronutrient Initiative.Google Scholar
Morrow, O (1990) Iron Supplementation During Pregnancy: Why Aren't Women Complying? A Review of Available Information. WHO/MCH/90.5. Geneva: WHO.Google Scholar
National Research Council (1989) Recommended Dietary Allowances, 10th ed. Report of the Subcommittee on the tenth edition of ROAS. Food and Nutrition Board, Commission on Life Sciences. Washington, DC: National Academy Press.Google Scholar
Rasmussen, K (2001) Is there a causal relationship between iron deficiency or iron-deficiency anemia and weight at birth, length of gestation and perinatal mortality? Journal of Nutrition 131, Suppl. 2, 590S–603S.CrossRefGoogle ScholarPubMed
Ross, J & Horton, S (1998) Economic Consequences of Iron Deficiency. Ottawa, Ont.: Micronutrient Initiative.Google Scholar
Rush, D (2001) Nutrition and maternal mortality in the developing world. American Journal of Clinical Nutrition 72, Suppl. 1, 212S–240S.CrossRefGoogle Scholar
Schultink, W, van der Ree, M, Matulessi, P & Gross, R (1993) Low compliance with an iron-supplementation program: a study among pregnant women in Jakarta, Indonesia. American Journal of Clinical Nutrition 57, 135–139.CrossRefGoogle Scholar
Shrimpton, R, Victora, CG, de Onis, M, Costa, Lima R, Blossner, M & Clugston, G (2001) Worldwide timing of growth faltering: implications for nutritional interventions. Pediatrics 107, E75.CrossRefGoogle ScholarPubMed
Sloan, NL, Jordan, E & Winikoff, B (2002) Effects of iron supplementation on maternal hematologic status in pregnancy. American Journal of Public Health 92, 288–293.CrossRefGoogle ScholarPubMed
Stevens-Simon, C & Orleans, M (1999) Low-birthweight prevention programs: the enigma of failure. Birth 26, 184–191.CrossRefGoogle ScholarPubMed
Suharno, D, West, CE, Muhilal, Karyadi D & Hautvast, JGAJ (1993) Supplementation with vitamin A and iron for nutritional anaemia in pregnant women in West Java Indonesia. Lancet i, 1593–1596.Google Scholar
UNICEF (1990 a) Strategy for Improved Nutrition of Children and Women in Developing Countries. New York: UNICEF.Google Scholar
UNICEF (1990 b) World Declaration and Plan of Action on the Survival Protection and Development of Children in the 1990's. New York: UNICEF.Google Scholar
UNICEF/Micronutrient Initiative/World Health Organization/ CIDA/USAID (1997) Vitamin A Global Initiative: A Strategy for A celeration of Progress in Combating Vitamin A Deficiency. Consensus of an Informal Technical Consultation. New York: UNICEF.Google Scholar
UNICEF/United Nations University/World Health Organization (2001) Iron Deficiency Anaemia: Assessment, Prevention and Control. A Guide for Programme Managers. WHO/NHD/01.3. Geneva: WHO.Google Scholar
UNICEF/United Nations University/World Health Organization/ Micronutrient Initiative (1999) Preventing Iron Deficiency in Women and Children: Background and Consensus on Key Technical Issues and Resources for Advocacy, Planning, and Implementing National Programmes. Ottawa, Ont.: International Nutrition Foundation and Micronutrient Initiative.Google Scholar
UNICEF/World Health Organization/United Nations University (2000) Composition of a Multi-Micronutrient Supplement to be u ed in Pilot Programmes among Pregnant Women in Developing Countries. Report of a Workshop held at UNICEF, New York, July 1999. New York: UNICEF.Google Scholar
West, KP, Katz, J, Khatry, SK, LeClerq, SC, Pradhan, EK, Shrestha, SR, Connor, PB, Dali, SM, Christian, P, Pokhrel, RP & Sommer, A (1999). Double blind, cluster randomised trial of low dose supplementation with vitamin A or beta-carotene on mortality related to pregnancy in Nepal. British Medical Journal 318, 570–575.CrossRefGoogle ScholarPubMed
World Bank (1993) The World Development Report. Washington, DC: World Bank.Google Scholar
World Bank (1994) Enriching Lives: Overcoming Vitamin and Mineral Malnutrition in Developing Countries. Washington, DC: World Bank.Google Scholar
World Health Organization (1972) Report of a WHO Group of Experts on Nutritional Anaemias. WHO Technical Report Series no. 503. Geneva: WHO.Google Scholar
World Health Organization (1992) The Prevalence of Anaemia in Women: A Tabulation of Available Information. WHO/MCH/ MSM/92.2. Geneva: WHO.Google Scholar
World Health Organization (1996) Control of Iron Deficiency Anaemia in South-East Asia. Report of an Inter-country Workshop held at the Institute of Nutrition, Mahidol University, December 1995: New Delhi, India: WHO Regional Office for South East Asia.Google Scholar
World Health Organization (1998) Integration of Vitamin A Supplementation with Immunization: Policy and Programme Implications. Report of a Meeting held at UNICEF, 12–13 January 1998. WHO/EPI/GEN/98.07. Geneva: WHO.Google Scholar