Newsletter 02 2006.pdf - Sight and Life

SIGHT AND LIFE 

NEWSLETTER 2/2006 

INCORPORATING THE XEROPHTHALMIA CLUB BULLETIN 

Correspondents: Bruno de Benoist, William S. Blaner, George Britton, Omar Dary, Frances 

R. Davidson, John W. Erdman, Jr., Tracey Goodman, Philip Harvey, Richard F. Hurrell, Rolf 

D. W. Klemm, Donald S. McLaren, Regina Moench-Pfanner, Christine Northrop-Clewes, 

Vinodini Reddy, Delia Rodriguez-Amaya, Ram Kumar Shrestha, Noel W. Solomons, Florentino 

S. Solon, Alfred Sommer, Andrew Tomkins, G. Venkataswamy, Emorn Wasantwisut, 

Keith P. West Jr., Yu Xiaodong, Michael B. Zimmermann. Editor: Klaus Kraemer 

yyyyyy 

School Feeding; CARIG 2006; Fat-Soluble Vitamins 2006; 

Micronutrient Premix in WFP Actions; Workshop Nutritional 

Anemia; Reports and Information from Benin, Burkina 

Faso, Dominican Republic, FSM Micronesia, Honduras, 

India, Kenya, Nepal, Sudan, Vietnam 

Children in Madagascar, where the GRET program is running (see article on page 4).

SIGHT AND LIFE 2 


Contents 

The Nutrimad school feeding program: 

Impact on failure rate and nutritional status of 

schoolchildren in Madagascar 4 

Reflections: Four decades with vitamin A and 

carotenoids; James Allen Olsen Memorial 

Lecture, CARIG, 2006 10 

Carotene Research Interaction Group (CARIG) 

Annual Conference 2006, San Francisco 18 

13th European Meeting on Fat-Soluble 

Vitamins 2006 in Jena 23 

Protecting nutritional status and the role 

of micro nutrient premix in the WFP’s 

response to the Indian Ocean Tsunami 25 

Distributing micronutrients and deworming 

medicine in hurricane-ravaged Honduras 27 

Eye care mission to the Dominican Republic, 

March 2006 29 

Update on the status of vitamin A deficiency 

and xerophthalmia in children under five 

treated at hospitals in Vietnam over a 

27-year period (1979 – 2005) 30 

Continuing nutrition education by the 

Youth Volunteer Group, Nepal 31 

The PACHE Trust health program and 

women’s empowerment 32 

An integrated nutrition, training and 

education program 33 

Knowledge and perception of vitamin A 

deficiency in the villages of Burkina Faso 35 

VAD and malnutrition among Sudanese 

children admitted to an urban hospital 36 

The fight against vitamin A deficiency at 

Ouassa-Beket, Benin 36 

Continued activity of the Ramala Women’s 

Group 37 

SIGHT AND LIFE visits Pohnpei, Micronesia, 

and films a nutrition documentary 39 

A digest of recent literature 41 

Letters to the editor 49 

Publications 51 

Micronutrient Forum 53 

SIGHT AND LIFE workshop 

Nutritional Anemia 54 

SIGHT AND LIFE, back cover 

SIGHT AND LIFE is a humanitarian initiative of DSM 

DSM Nutritional Products 

DSM Nutritional Products is the world’s leading supplier of vitamins, carotenoids and other fine 

chemicals to the feed, food, pharmaceutical and personal care industries. The company has a long 

tradition as a pioneer in the discovery of new products, new formulations and attractive applications 

for all industry segments. For further company information please visit 

www.dsmnutritionalproducts.com 

DSM 

DSM is active in nutritional and pharma ingredients, performance materials and industrial chemicals. 

The company creates innovative products and services that help improve the quality of life. DSM’s 

products are used in a wide range of end markets and applications such as human and animal 

nutrition and health, cosmetics, pharmaceuticals, automotive and transport, coatings, housing 

and electrics & electronics (E&E). DSM’s strategy, named Vision 2010 – Building on Strengths, 

focuses on accelerating profitable and innovative growth of the company’s specialties portfolio. 

Market-driven growth, innovation and increased presence in emerging economies are key drivers 

of this strategy. The group has annual sales of over € 8 billion and employs some 22,000 people 

worldwide. DSM ranks among the global leaders in many of its fields. The company is headquartered 

in the Netherlands, with locations in Europe, Asia, Africa and the Americas.


3 


Editorial 

Reflections 

On 29 May 2006, the 59th World 

Health Assembly, the governing 

body of the World Health 

Organization (WHO), adopted a 

resolution on the ‘Prevention of 

avoidable blindness and visual 

impairment’. Given that still more 

than 161 million people worldwide 

are visually impaired, of 

whom 37 million are blind, and 

that about 75% of blindness is 

avoidable, the resolution is timely 

and is expected to strengthen 

the VISION 2020 plans. VISION 

2020: The Right to Sight is a 

global initiative of the WHO and 

the International Agency for the 

Prevention of Blindness (IAPB). 

It comprises governments and 

NGOs committed to the prevention 

and treatment of blindness. 

Among other things, the resolution 

urges member states to 

include Vision 2020 in national 

development plans, and encourages 

partnerships between 

the public and private sectors, 

NGOs and communities. Since 

its inception SIGHT AND LIFE has 

supported IAPB, and now it has 

also become a formal partner of 

Vision 2020. In this way SIGHT 

AND LIFE continues to take 

responsibility for the prevention 

of childhood blindness, as good 

vitamin A nutrition is pivotal for 

the eradication of this scourge. 

As indicated in the previous edition 

of the Newsletter, SIGHT 

AND LIFE’s 20th anniversary year 

will be a year of action. But after 

20 years of work committed to 

the fight against vitamin A and 

other micronutrient deficiencies, 

this should also be a time for reflection. 

We think that we are on 

the right track with our mission 

and the services we provide, but 

I believe we could even do better. 

Therefore we are taking this occasion 

as an opportunity to examine 

our own activities. With the support 

of an international consultancy 

group we are determining 

how we can fully leverage our 

capabilities. The consultants are 

undertaking this project on a pro 

bono basis. Your feedback from 

the questionnaire (see Newsletter 

1/2006) and interviews with some 

of you are a valued contribution 

towards this goal. 

Nutritional anemia remains an 

issue affecting more than two billion 

people worldwide. We have 

decided to bring together leading 

experts to discuss approaches 

to controlling nutritional anemia. 

The program of a corresponding 

workshop on 27 September 

2006 in Barcelona will be found 

on page 54 of this Newsletter. 

There is only limited capacity for 

the workshop and we are already 

almost fully booked. Should we, 

as we hope, succeed in moving 

the meeting to a larger room we 

will make an announcement to 

this effect on our website. 

On 16 June 2006, at the invitation 

of SIGHT AND LIFE, experts of 

the United Nations World Food 

Programme (WFP) came to Switzerland 

to discuss school feeding 

activities with employees of 

DSM Nutritional Products. There 

was an enormous interest in this 

topic. Micronutrient-enhanced 

school feeding in Madagascar is 

also the topic of a contribution 

to this Newsletter by Arnaud 

Laillou and coworkers (page 4). 

On page 25 you can read about 

the role of high-energy nutrient 

dense biscuits in the WFP’s 

tsunami response in South East 

Asia and school feeding. In April 

2006 a team from SIGHT AND 

LIFE visited Micronesia to shoot 

a film documentary on what is 

called by the United Nations 

Standing Committee on Nutrition 

‘the double burden of malnutrition’. 

Under- and overnutrition 

can no longer be regarded in 

isolation – and early intervention 

is key in implementing successful 

preventative strategies. The 

purpose of the film is to create 

awareness and suggest solutions 

for this worldwide nutrition 

problem. Please read the article 

on page 39 by Lois Englberger 

and Adelino Lorens. Finally, I 

would like to call your attention to 

Barbara Underwood’s article on 

four decades of intense vitamin 

A and carotenoid research (page 

10). The article is based on the 

James Olson Memorial Lecture 

at this year’s Carotene Research 

Interaction Group (CARIG) annual 

conference (page 18). It is a very 

stimulating reflection on public 

health interventions to control 

vitamin A deficiency. 

I am convinced that this year’s reflections 

will provide us with clear 

directions for the future, and, 

more importantly, for the benefit 

of billions of people suffering from 

‘hidden hunger’.



The Nutrimad school feeding program: 

Impact on failure rate and nutritional status of 

schoolchildren in Madagascar 

Arnaud Laillou 1 , Luc Arnaud 1 , Menjaharimisa Ramaherisoa 2 , Charlotte Ralison 2 , 

Chantal Monvois 1 and Serge Trèche 3 

1 

The Research and Technological Exchange Group (GRET), Antananarivo and Paris. 2 The Laboratory of Biochemistry 

Applied to the Food Sciences and Nutrition (Labasan), University of Antananarivo, Madagascar 

3 

UR106 “Nutrition, Food, Societies”, Institute of Research for Development (IRD), Montpellier, France 

Introduction 

The Nutrimad school feeding 

program (SFP), co-financed by 

SIGHT AND LIFE and the Ile 

de France regional council, is 

one of the three sections of the 

Nutrimad program, which is run 

by GRET (Research and Technological 

Exchange Group), the 

IRD (Institute of Research for 

Development), and the Labasan 

(Laboratory of Biochemistry Applied 

to the Food Sciences and 

Nutrition, of the University of 

Antananarivo, Madagascar) with 

the aim of contributing to the sustainable 

reduction of malnutrition 

in Madagascar. The objectives 

of the program are to counter 

immediate hunger and school 

failure rates, and to respond to 

the nutritional deficiencies of children 

from public primary schools 

within the framework of a sustainable 

system of school snacks, 

overseen by the local authorities. 

The approach of the Nutrimad 

SFP was to introduce a snack 

that was accessible to everyone, 

i.e. inexpensive, made from local 

raw materials, liked by the 

children, readily obtainable and 

reproducible, i.e. easy to prepare 

within schools, and of good nutritional 

value, i.e. designed so 

that one portion covers a share 

of nutritional requirements corresponding 

to the level of deficiencies 

generally observed in 

schoolchildren in Madagascar. 

The Nutrimad SFP was implemented 

during the 2004 – 2005 

school year in 15 public primary 

schools in underprivileged districts 

of Antananarivo, according 

to the methods described in a 

previous issue of the SIGHT AND 

LIFE Newsletter (1). The program 

comprised two parts. 

The first consisted in providing 

12,893 children from the 15 

schools with a snack in the form 

of a fortified and high-energy 

density gruel over an average of 

110 days (between 101 and 119, 

depending on the school) spread 

over a period of approximately 

6 months of the year. 

This gruel, which was served during 

the first break for the price of 

40 Ariary (approx 1.5 euro cents), 

was prepared in each school using 

a corn meal powder called 

“Koba Tsinjo” (72.6%), peanut 

(8.5%), sugar (14.0%) and a vitamin 

and mineral mixture, to which 

2.0% soybean oil was added during 

the preparation process. The 

quantities served (350 g of gruel 

containing 110 g of powder, or 

380 kcal) were sufficient to cover 

18% of the daily energy requirements 

of a 10-year-old child,


5 


as well as 75% of their RDA of 

micronutrients for which there is 

a major deficiency risk (iron, zinc 

and vitamin A), 60% of their RDA 

of calcium, 40% of their RDA of 

other minerals and vitamins, and 

25% of their RDA of proteins, 

amino acids and essential fatty 

acids. 

The second part consisted in nutrition 

education activities, whose 

purpose was to communicate 

messages aimed at informing 

the pupils and encouraging them 

to adapt their diet to their nutritional 

requirements, and to lead a 

healthy lifestyle. These messages 

were delivered throughout the 

year by specially trained teachers, 

who were also provided with 

educational supports developed 

by the Nutrimad team. 

A first, still incomplete appraisal 

(presented to a meeting of national 

and international interest 

groups on 10 May 2006, at the invitation 

of Madagascar’s National 

Nutrition Office) of the operation 

and effects of the Nutrimad SFP 

during the 2004 – 2005 school 

year has now been drafted, and 

this forms the basis of the present 

article. 

Methodological 

approach implemented 

for follow-up and 

evaluation 

The follow-up and evaluation 

strategy implemented throughout 

the year 2004 – 2005 to check 

the relevance and effectiveness 

of the Nutrimad SFP consisted 

mainly in measuring: 

• pupils’ participation in the 

scheme 

• the effect of nutrition education 

activities on pupils’ nutrition 

knowledge 

• the effect of gruel consumption 

on the frequency and nature 

of pupils’ meals, on their nutritional 

status, and on their 

school performance 

In doing this, we had to take into 

account three main constraints. 

The first of these was the noninclusion 

of control schools in our 

evaluation strategy, which meant 

that we were limited to comparing 

indicator values either recorded 

at the beginning and end of the 

year with the same pupils, or 

calculated for groups of pupils 

put together according to their 

gruel consumption. The second 

constraint was the insufficiency 

of financial resources allocated 

to the evaluation studies, which 

limited our choice of indicators 

for impact on nutritional status to 

those based on anthropometric 

measurements. The third constraint 

was the impossibility of 

gathering, from the relevant services, 

previous years’ statistics on 

absenteeism and graduation into 

higher classes. 

The analyses carried out can be 

divided into three categories: 

• those carried out on the entire 

number (12,893) of pupils 

from 254 classes from the 15 

schools, which consisted in 

creating a typology of schools 

and in recording information 

on the classes and teachers, 

as well as a self-administered 

questionnaire survey of the 

socio-economic situation of 

the families, a daily record of 

information on absenteeism 

and consumption of the snacks, 

anthropometric measurements 

and tests of nutrition knowledge 

taken at the beginning and end 

of the school year, and a record 

of results from the end-of-year 

exam determining whether 

pupils graduate into higher 

classes and which academic 

direction they should take;



• those carried out on reduced 

samples of pupils, in particular 

a measurement of food-intake 

which allowed us to check the 

adequacy of the consumption 

of gruel actually served (2,573 

pupils from 64 classes in 5 

schools), serial data-gathering 

intended to estimate, amongst 

other things, the effects of 

gruel consumption on the 

frequency and composition of 

meals (all pupils from 5 of the 

15 schools), and the share of 

nutritional requirements covered 

(a survey based on recall 

of the past 24 hours carried out 

on 480 children from 9 of the 

15 schools); 

• finally, studies concerning gruel 

preparation, which were carried 

out in 5 schools to ensure 

that preparation guidelines 

were being respected and to 

check the characteristics of the 

gruel being served. 

Confirmation of the poor 

nutritional status and 

low spending power of 

pupils 

In the first place, the surveys and 

measurements taken allowed us 

to confirm the poor nutritional 

status of pupils at the start of the 

school year, before the Nutrimad 

SFP was launched. 

Delayed growth and low weight 

affected 46.0% and 32.8% of 

Figure 1. Prevalence of delayed 

growth, wasting, and low weight 

in children from the 15 schools (the 

figures for wasting are for children 

under 10 only). 

children respectively, although 

there was a low prevalence 

(2.2%) of wasting among children 

under 10 years (Figure 1). 

Moreover, the nutritional status 

of boys is noticeably worse than 

that of girls (49.6% vs. 42.2% 

for delayed growth; 37.8% vs. 

27.3% for low weight), and, while 

the prevalence of malnutrition remains 

relatively constant between 

ages 6 and 10, it increases considerably 

in older children. Furthermore, 

it seems that there is an 

important relationship between 

academic underachievement 

and nutritional status insofar as, 

of the total number of children, 

the prevalence of arrested size 

fits 38% of children who are one 

school year behind, and 55% of 

children who are two school years 

behind in their studies. 

Regarding the sums of money the 

children could afford to spend on 

food each day, the 11,255 children 

who completed the questionnaire 

had received an average 

of 67 Ariary from their parents on 

their most recent day at school. 

A third of the children received 

more than 50 Ariary, while 27% 

received less, of whom 5.1% 

received nothing at all. 

A high rate of pupil 

participation in the 

scheme 

Over the entire gruel distribution 

period, the average rate of pupil 

participation in the scheme, i.e. 

the average percentage of days 

on which they consumed at least 

one serving of gruel during the 

operational period of the Nutrimad 

SFP, was 68.4%. This rate 

was slightly higher in the second 

semester (71%) than in the other 

two (67% and 66%). The older the 

children, the more their participation 

rate went up (from 60% at age 

6 to 77% at age 13), or in other 

words, participation increased in 

direct proportion with the level of 

the school year (Figure 2). 

Ultimately, despite having to pay 

40 Ar for each serving of gruel, 

34.3% of pupils took over 80% of 

the opportunities offered them to 

eat it throughout the year, which 

means that only 9.6% took 20% 

or less of these opportunities.


7 


Gruel prepared and 

consumed according to 

recommendations 

The observations and samples 

taken have shown that gruel 

prepared in the schools did indeed 

contain on average the 

desired concentration of energy 

(108 kcal/100 g of gruel, which 

corresponds to 378 kcal for a 

350 g serving) and, moreover, that 

94.1% of children completely finished 

their plate of gruel, with only 

0.75% of children leaving more 

than 4 soup-spoonfuls, and 2.9% 

sharing their gruel with a friend. 

Under these conditions, we can 

calculate that, over the 6 month 

period (from November 2004 

to May 2005) during which the 

Nutrimad SFP was in operation, 

the snacks provided 23.8% of the 

children with over 40% of their 

RDA in micronutrients for which 

there is a major deficiency risk, 

between 20% and 40% of the 

RDA for 65% of them, and under 

20% for only 11.2%. 

A snack which does not 

take the place of regular 

meals 

Pending the processing of data 

from the survey based on recall of 

the past 24 hours, which should 

allow us to compare percentages 

of nutritional cover between 

children who ate the snacks and 

those who did not, the results 

provided here concern the effect 

of snack consumption on the 

frequency of daily meals. 

The consumption of breakfasts 

(96.3%) and lunches (95.7%) at 

home by the children was just as 

frequent among those who ate 

the snacks as it was among those 

who did not. The consumption 

of dinners was even slightly, but 

significantly (98.1% vs. 96.1%; 

p



Improved nutrition 

knowledge and 

awareness 

The average marks obtained 

from nutrition knowledge tests 

taken before and after the Nutrimad 

SFP’s 6-month operation 

period are given in Figure 5. For 

all the school years there was a 

significant improvement of nutrition 

knowledge during the year, 

although this improvement is 

apparently greater in years CP2, 

CP1 and CE than in CM1 and 

CM2. 

The statistical analyses led to 

the identification of certain factors 

influencing the variations 

in pupils’ nutrition knowledge 

throughout the school year. The 

most important of these, taking 

into account the essential role 

played by the communication 

of messages, was the teachers’ 

motivation. 

Figure 4. Effects of gruel consumption 

on differences in weight, raw or 

adjusted*, between the beginning and 

end of the Nutrimad SFP’s 6-month 

operation period. Groups according 

to gruel consumption: 1) less than 

20%; 2) 20% to 40%; 3) over 40%. 

*Adjusted by analysis of covariance for 

indicator variables of the characteristics 

of the school, characteristics of the 

class (number of children, school year), 

characteristics of the teachers, of the 

children’s family group (index of possessions, 

number of siblings, amount of 

pocket money given them by their parents) 

and of children’s characteristics at 

the start of the year (age, size, Size/age 

and Weight/age Z-scores) 

Figure 5. Comparison of average marks obtained by children in nutrition 

knowledge tests at the beginning and end of the school year (CP–CM2 

refers to primary school grades in French-speaking countries). 

Impact on school 

performance 

An assessment of the effect of 

snack consumption on school 

performance of the total number 

of pupils from the 15 schools was 

based on the decision made at 

the end of the year as to whether 

they should graduate to the next 

class, and on the marks they 

obtained at the end-of-year exams. 

The children from group 3 were 

over 10% more likely to be allowed 

to graduate to the next 

class than those from group 1 

(81% vs. 71%). Moreover, they 

were 6% less likely than group 1 

to obtain below average marks 

at the end-of-year exams (27.1% 

vs. 33.2%). If we adjust, using 

logistical regression, the percentage 

scores of children allowed 

to graduate to the next class 

for potentially confounding variables, 

the differences between 

the groups still remain significant 

(72.6%, 75.6% and 82.5% for 

children from groups 1, 2 and 3 

respectively; p


9 


by the pupils have considerably 

improved their school performance. 

Conclusion 

The follow-up and evaluation 

of the Nutrimad SFP during the 

2004 – 2005 school year has essentially 

allowed us to highlight 

the poor nutritional status of children 

and to establish, or highlight, 

the adequacy of the type of snack 

provided: 

• over the 110 days of the program, 

the children took 68% 

of opportunities offered them 

to eat the gruel; 

• each portion consumed covered 

16% to 22% of their energy 

requirements and 75% of 

their requirements of the main 

micronutrients; 

• the snacks did not take the 

place of regular meals. 

Furthermore, at the end of the 

year the most regular consumers 

had, in comparison with the 

others, a better nutritional status 

(40% vs. 50% delayed growth), 

were less likely to have to repeat 

their school year (20% vs. 30%), 

and did better at the end-of-year 

exams. 

These very encouraging results 

are currently undergoing confirmation 

in the 2005 – 2006 period 

at the same schools. The integration 

of 8 control schools into the 

evaluation process should allow 

us to highlight not only the effect 

of snack consumption and nutrition 

education on the children’s 

nutritional status and school 

performance, but also the effectiveness 

of the present strategy 

within the context of the education 

system concerned. 

References 

Figure 6. Effects of gruel consumption on average marks, raw and adjusted, 

obtained by pupils at the end-of-year exams (averages not accompanied by 

identical letters differ to the level of significance indicated). Groups according 

to gruel consumption: 1) less than 20%; 2) 20% to 40%; 3) over 40%. 

(1) Adjusted for indicator variables of the characteristics of the school, characteristics 

of the class (number of children, school year), characteristics of the teachers (absenteeism, 

mark given by monitors of participation in the scheme), of the children’s 

family group (index of possessions, parents’ level of education), and characteristics 

of the children (gender, age, Size/age Z-score at the start of the year). 

1. Laillou A, de Sesmaisons A, Ralison 

R et al. (2005). Distributing fortified 

and high-energy density gruel to 

reduce the failure rate and improve 

nutritional status of Antananarivo 

schoolchildren. SIGHT AND LIFE 

Newsletter 2: 22–26.



Reflections: Four decades with vitamin A and 

carotenoids; James Allen Olsen Memorial Lecture, CARIG, 2006 

Barbara A Underwood* 1 , PhD, Adjunct Professor of Nutrition, Institute of Human 

Nutrition, Columbia University, New York 

Introduction 

James Allen Olson was a biochemist/nutrition 

scientist, mentor, 

colleague and friend to many 

of us. He was the father of VARIG 

(Vitamin A Research Interactive 

Group) and CARIG (Carotenoid 

Research Interactive Group) at 

the Experimental Biology meetings 

and one of the founding 

members of IVACG (International 

Vitamin A Consultative Group). At 

IVACG he was frequently requested 

to provide updates on vitamin 

A and carotenoid metabolism 

and he carried the torch for foodbased 

approaches to vitamin A 

deficiency as a vital component 

of any micronutrient control program. 

For many years Jim and 

I worked together within IVACG 

and as research colleagues in 

vitamin A metabolism, assessment 

of status and promotion 

of sustainable intervention programs. 

It is a privilege and an 

honor to be asked to speak at this 

memorial lecture and to reflect 

back to some of the significant 

years in vitamin A and carotenoid 

research and programs. 

1960s: Where were we 

then?* 2 

In 1960, Hoffmann-LaRoche organized 

a symposium convened 

in Switzerland on “Vitamin A and 

Metabolism” to honor Professor 

*1 E-mail: bunderwo@adnc.com 

*2 The photos of some of the people 

mentioned are taken from the SIGHT 

AND LIFE slides (02 HI History) on 

our website (http://sightandlife. 

org/slidesNEWppt/mainNEWsl. 

html) and can also be found on our 

CD; editor. 

P. Karrer (1). Karrer had isolated 

and elucidated the structure of 

vitamin A in 1931. The content 

of the symposium was meant to 

sum-up the situation with respect 

to vitamin A and provitamin A 

carotenoids. The “sum-up” revealed 

that there was yet lots to 

be learned, despite the fact that 

deficiency eye symptoms were 

described and a cure known 

(liver extract) from ancient times 

(2); that in the second decade 

of the 20th century these symptoms 

were attributed to lack of 

a fat-soluble substance found in 

some animal foods and butterfat 

(3,4), which McCollum named 

vitamin A (3), or to a lack of carotenoids 

in some plant foods that 

Steenbock suggested in 1919 

could be converted to the active 

component (5); that vitamin A 

was isolated and its structure 

elucidated by Karrer in 1931 

(6); that Wald and colleagues in 

the latter part of the1930s had 

uncovered the functional role of 

the vitamin in vision (7,8); and in 

1960, that Dowling and Wald (9) 

had reviewed the overt systemic 

signs of vitamin A deficiency and 

the role of vitamin A acid (retinoic 

acid) in maintaining growth and 

the health of epithelial tissues, 

though animals were deficient 

in retinol and were night-blind. 

And importantly, Stephenson 

and Clark* 3 as early as 1920 reported 

that rats fed diets void of 

the active fat-soluble substances 

died at a higher rate even before 

eye signs occurred, but that eye 

symptoms in every case cleared 

when a petroleum ether extract 

of dried carrot was incorporated 

into their diet (10). 

James A Olson (http://sightandlife.org/PhotosAll/pic2000-4/ 

NL400p21.jpg) 

In spite of all that was known by 

1960, much remained unknown. 

There was little knowledge of 

the global magnitude of the 

deficiency problem in humans. 

In part this was because there 

was no consensus on how best 

to assess vitamin A deficiency 

either clinically or biochemically 

given that clinical signs were not 

standardized and methodologies 

available for biochemical 

assessment provided uncertain 

results. Detailed information on 

the metabolism of vitamin A was 

limited and the active form and 

*3 The SIGHT AND LIFE slide P35 

refers to the same publication (http:// 

sightandlife.org/slidesSandP/E/ 

Pslides.html)


11 


EV McCollum Paul Karrer Otto Isler (left) 

function of vitamin A outside the 

visual cycle was still speculative 

(11). Analytical methods for quantitative 

analysis existed for both 

the preformed vitamin and for 

provitamin carotenoids, but these 

methods were often tedious, difficult 

to standardize, and frequently 

used toxic chemicals that failed 

to provide reproducible results in 

many laboratories (12–14). There 

were no large-scale intervention 

programs to combat vitamin A 

deficiency and even at the local 

level within hospitals there was 

little appreciation of how to treat 

or prevent the deficiency, which 

often accompanied proteinenergy 

malnutrition (PEM). And 

notably, there was very little political 

interest or will to eliminate 

vitamin A deficiency. 

I saw my first cases of xerophthalmia 

in 1961, more than four 

decades ago, while conducting 

doctoral research among refugee 

children in what was then Jerusalem, 

Jordan. I was midway 

through studies at Columbia 

University Institute of Nutrition 

Sciences, later renamed the Institute 

of Human Nutrition (IHN). 

I went there in 1959 because of 

a deep concern for problems of 

childhood malnutrition in the developing 

world and the desire to 

become professionally involved 

in seeking appropriate solutions. 

The Institute had a newly created 

program led by William Henry 

Sebrell, one of the pioneer nutritionists 

of the 20th century. The 

Institute’s objective was to train 

students to analyze, understand 

and seek solutions to malnutrition 

in the developing world in a holistic 

context (15). My academic 

training within this environment 

and the opportunity to do my 

thesis research in an international 

setting among malnourished children 

set the tone for the rest of 

my professional career. 

2006: Where are we 

today – after 4½ 

decades? 

Prevalence 

No doubt, we have a greater 

appreciation of the magnitude 

of the global problem and the 

epidemiological factors, in addition 

to diet, that contribute to 

its existence. The Micronutrient 

Report published in 2001(16) 

placed the magnitude of the 

problem among preschool-aged 

children at 75 – 140 million; earlier 

estimates by the WHO placed the 

prevalence as high as 230 million 

(17). These prevalence data are 

based on clinical eye signs and/or 

low blood vitamin A levels from a 

database that is far from representative 

and firm. Nonetheless, 

The Micronutrient Report also 

noted a trend toward improvement 

since 1980 in most regions 

of the world, particularly since 

1990, a period when large-scale 

periodic vitamin A distribution programs 

were expanding. Indeed, 

on the public health level, intervention 

by periodic distribution 

of high-dose vitamin A supplements 

now covers an estimated 

70% of preschool-aged children 

in 40 countries with at least one 

dose of vitamin A annually, and 

about 1/3 of these 40 countries 

have achieved 70% coverage 

with the required two doses (18). 

However, now we know that the 

problem extends beyond the preschool 

years to pregnant women 

whose health and survival also are 

compromised in countries where 

deficiency is common (19). The 

magnitude of deficiency among 

pregnant women, however, is 

largely unknown and there are few 

targeted prevention programs in 

effect that reach these vulnerable 

women. 

Metabolism and methods 

Knowledge of the metabolism of 

vitamin A and carotenoids has 

advanced dramatically since 

1960. The active forms and functions 

of vitamin A are established: 

retinol in the visual system and 

retinoic acid in normal growth 

and development by modulation 

of gene actions. And new knowledge 

of non-provitamin A roles of 

carotenoids in the moderation of 

degenerative diseases is evolving 

as definitive analytical techniques 

allow for tracing the metabolism 

of individual carotenoids. Quantitative 

analytical methods for 

retinoids are well advanced (20) 

and this has contributed to a 

variety of new field assessment 

methods, including a more objective 

and reproducible meas-



Richard Kuhn 

George Wald 

ure of night blindness (pupillary 

response) (21), subject-friendly 

collection of blood specimens 

(dry blood spots) for subsequent 

quantitative analysis either in the 

field or at a base laboratory (22) 

and assessing whole body stores 

(isotope dilution) (23). The application 

of new intrinsic carotenoid 

labeling methods offers greater 

ability to trace individual carotenoids 

from vegetables containing 

them in their natural matrices to 

their uptake from the gut and utilization: 

hence, to a more accurate 

measure of bioavailability (24). 

Programs 

Intervention programs are moving 

beyond strictly distributing 

nutrient supplements. These 

programs are becoming more 

integrated and viewed more 

holistically within the context of 

undernutrition, underdevelopment 

and poverty. Micronutrient 

fortified foods that can address 

both specific deficiencies and caloric 

undernutrition are available 

in many countries. They include 

vitamin A fortified sugar, oils, and 

some cereals, to name a few, but 

access by the poor at greatest 

risk still varies greatly, especially 

in rural areas with limited market 

access. And public health measures 

including promotion and 

support for breastfeeding, expanded 

immunization coverage, 

parasite control programs, and 

home-based control of severe diarrheal 

disease have contributed 

to decreased infectious morbidity 

and mortality and, hence, 

improved individual and national 

HAPC Oomen 

development. Although improvements 

are occurring in availability 

of potable water and environmental 

sanitation, the UN reports 

(Los Angeles Times, March 10) 

that over 1.1 billion living in impoverished 

communities remain 

without safe water. Yet in spite of 

all the progress made, including 

distribution of over 400 million 

vitamin A capsules annually (18), 

vitamin A deficiency remains a 

significant public health problem. 

A diet inadequate in vitamin A- 

containing food sources is the 

underlying cause of deficiency. 

Yet until recently food-based approaches 

that impact on underlying 

causes of underdevelopment, 

undernutrition and micronutrient 

deficiencies were the step-child 

intervention least attractive to 

international funding agencies. 

How did we get from 

there (1960) to here 

(2006)? Some significant 

decade milestones 

1960–1970: Progress 

in understanding basic 

metabolism 

The decade of the 1960s was the 

period that in my reflective view 

was noted mostly for advances in 

understanding the basic metabolism 

of vitamin A and provitamin A 

carotenoids. Central cleavage of 

beta-carotene in James Olson’s 

(25) and DeWitt Goodman’s (26) 

laboratories by enzymes isolated 

from the gut and liver of rats advanced 

knowledge of bioconversion 

mechanisms. In humans, 

efficient uptake of dietary retinol 

and conversion of β-carotene to 

retinal, esterification to retinyl 

esters, transport of the esterified 

product in lymph chylomicra and 

hepatic uptake from chylomicra 

remnants were demonstrated (27). 

Retinol binding protein (RBP) was 

isolated and partially characterized 

in 1968, and subsequently 

its role in hepatic mobilization and 

transport of retinol as holo-RBP 

complexed with transthyretin was 

defined (28). Understanding of 

the reversible formation of single, 

bi- and trimolecular complexing 

clarified how the exchange 

of retinol from blood to tissues 

occurred without loss through 

kidney filtration. Furthermore, the 

concepts revealed in defining the 

metabolism of RBP provided the 

basis in the following two decades 

for a new indirect assessment of 

depleted hepatic stores, the relative 

dose response (RDR) in my 

laboratory (29), its modification 

(MRDR) in James Olson’s laboratory 

(30) and its current broad use 

in assessment of vitamin A status 

in human and animal studies. 

On the public health front progress 

was slow. In 1964 the first ‘guestimate’ 

of the global magnitude 

of deficiency was made. The approximation 

of 20,000 to 100,000 

affected children was based 

largely on interviews and subjective 

information on the prevalence 

of eye signs (31), which did not 

generate political support for 

large intervention programs, even 

though severe vitamin A deficiency 

in children was very evident in 

developing countries, often associated 

with PEM, and too often 

inappropriately managed leading 

to irreversible blindness, if the patient 

survived. Many of us involved 

in international child health issues 

during the 1960s were appalled 

by the lack of attention to this 

preventable public health scourge, 

but there was no organized group 

to champion the cause at a political 

level and attract substantial 

funds for prevention.


13 


Donald S McLaren 

1970–1980: Breakthroughs 

in analytical methodology 

and public health 

The decade of the 1970s is 

noteworthy for a major methodological 

breakthrough in retinoid 

analyses, the application of highpressure 

liquid chromatography 

(HPLC). Harold Furr recently 

commented that “Progress in nutritional 

biochemistry has always 

depended on progress in analysis 

of nutrients” (20). That is why the 

advent of HPLC in the mid-1970s 

was such an important addition 

to the analytical assessment 

arsenal (32,33), opening doors 

for progress in both basic and 

applied research. Although the 

instrument originally was too 

expensive to obtain and maintain 

in developing countries, it is now 

broadly available and the method 

of choice for most applications 

requiring quantitative retinoid 

analyses, especially for the analysis 

of vitamin A in blood. 

On the public health platform 

during the 1970s, the most important 

advance in vitamin A 

program applications occurred as 

the result of three seminal meetings. 

The first was a WHO/USAID 

sponsored meeting in Jakarta, 

Indonesia in 1974 (34). The Jakarta 

meeting was notable for 

the heated controversy between 

ophthalmologists, epidemiologists 

and nutritional biochemists 

on the appropriate classification 

criteria for xerophthalmia, cut-off 

points to establish a public health 

problem, the health consequences 

of deficiency beyond the eye, 

reliable assessment methodology 

and efficacy and effectiveness of 

different intervention programs. 

Tentative decisions on these 

issues were published in the 

meeting report but the science 

base was weak and few were 

satisfied. The scientists went 

from this meeting determined 

to provide the missing research 

data to resolve disagreements 

(35). The following year (1975) 

IVACG was formally established 

to maintain momentum toward 

the control of vitamin A deficiency 

diseases by providing an 

annual forum (later changed to 

biannual meetings) for information 

exchange among researchers, 

public health professionals, 

international funding agencies, 

non-governmental agencies and 

private industry (36). Research 

activities did accelerate in subsequent 

years as was obvious in the 

follow-up WHO/UNICEF/USAID/ 

HKI/IVACG-sponsored meeting in 

Jakarta in 1980 (37). The meeting 

was less controversial because 

data were available from the 

considerable amount of research 

that had been completed in the 

previous six years. The result was 

consensus on earlier arguable 

issues, i.e. standardization and 

classification of xerophthalmia 

symptoms and signs, treatment 

and prophylaxis schedules and 

agreement to draw attention to 

the need for large-scale intervention 

programs. 

Creation of IVACG deserves special 

mention. The USAID established 

and sponsored the group 

for 30 years. Administration of 

the program initially was through 

the Nutrition Foundation, which 

was later transformed into the 

International Life Science Institute 

(ILSI). The group began with 

only 17 committed individuals 

and reached as many as 100 over 

the first decade (36). Individuals 

worked voluntarily in task forces 

Alfred Sommer 

between the annual meetings to 

produce guidelines and state-ofthe-art 

reviews, many of which 

remain useful even today. James 

Olson was a charter member of 

IVACG and co-authored many 

of the guidelines and reviews. 

He seldom missed a meeting. 

Frequently he provided the biochemical 

updates because his 

presentations were so lucid and 

understandable by all in the 

diverse group that assembled 

annually. In addition, he usually 

chaired sessions on carotenoid 

biochemistry and conducted focus 

groups on carotenoids and 

food-based issues. The meetings 

grew during the three decades of 

IVACG’s existence to an attendance 

of about 800 delegates at the 

22nd meeting held in Lima, Peru 

in 2004. The 2004 meeting was 

the last before disbandment and 

reorganization, which is currently 

in progress, to form a Micronutrient 

Forum. IVACG during its 30 

years of existence gained respect 

throughout the international community 

and played an influential 

role in international programs to 

control deficiency world-wide. 

Hopefully the reformed Forum 

will continue the momentum of 

IVACG in influencing scientific 

directions and political decisions, 

hence accelerating the elimination 

of micronutrient deficiencies 

as public health problems.



1980–1990: Retinoid 

revolution in the lab and 

recognition that ocular 

signs were the tip of the 

iceberg in the field 

Retinoid biochemistry experienced 

a renaissance late in the 

century when nuclear retinoid 

receptors were identified and 

their pleiotrophic effects recognized 

in 1987 (38). This was the 

beginning of research that has 

identified how retinoic acid influences 

a multitude of gene actions 

that regulate differentiation and 

cellular growth and functions. 

This revolution is on-going with 

new effects on functions being 

reported regularly. 

On the public health scene, 

though nutritional biochemists 

had argued vehemently at the 

1974 meeting in Jakarta that 

health consequences went far 

beyond the eye-based on animal 

studies – ophthalmologists were 

unconvinced. The data systematically 

collected in Indonesia 

by Alfred Sommer (an ophthalmologist/epidemiologist) 

and 

colleagues during the decade of 

the 1980s documented the prevalence 

of vitamin A deficiency in 

the country and provided a firmer 

basis for projecting the extent of 

the problem in four other Asian 

countries, i.e. 200,000–400,000 

corneal cases and 4–8 million 

non-corneal cases (39). The team 

also elucidated the underlying 

epidemiological associations that 

led to clustering of deficiency in 

affected populations. The epidemiologic 

studies associated the 

lack of diversity in child diets, 

including lack of animal products 

and carotenoid-containing fruits 

and vegetables, with deficiency. 

The survey and epidemiological 

studies set the stage for the large 

randomly designed, controlled 

intervention trial that first established 

in humans the mortality 

risk associated with deficiency 

(40,41) that six decades earlier 

had been reported in animals 

(10). The announcement at an 

IVACG meeting late in the 1980s 

of a 27% reduction in mortality 

was met with skepticism by the 

scientific community, including 

myself, who found it difficult to 

believe that such a large effect 

could occur from supplementation 

without also addressing the 

prevalence of other diseases 

and unsanitary environmental 

conditions. Subsequently preschool 

child mortality associated 

with deficiency was confirmed, 

though variable in magnitude, 

in Nepal (42), in Ghana (43), and 

in India (44), but not in Sudan 

(45), after administering highdose 

vitamin A capsules every 

4 or 6 months. Child mortality 

was also reduced in Indonesia 

(46) by regular intake of fortified 

monosodium glutamate, and in 

India (47) by providing a low-dose 

weekly supplement, potentially 

obtainable through food sources. 

Meta-analyses using data from 

the major trials concluded that 

on average, a 23–30% increase 

in mortality is associated with 

deficiency (48-50). 

1990–2000: Progress on the 

political front 

Political progress marked the 

decade of the 1990s. UNICEF’s 

World Summit for Children in 1990 

was the ideal situation to call attention 

to the striking mortality reduction 

benefit expected by correcting 

vitamin A deficiency. All 

the ingredients were assembled 

to launch a major international 

offensive against the deficiency 

as a public health scourge. The 

mortality risk was established 

and a short-term cost-effective 

intervention was available in 

the form of high-dose vitamin A 

supplements. A persuasive, passionate, 

committed champion in 

the person of James Grant, then 

director of UNICEF, was poised to 

effectively mobilize the high-level 

political commitment needed 

from member states to launch 

a major international offensive. 

This broad political commitment 

was achieved. The commitments 

were reinforced at subsequent 

international meetings in Canada 

in 1991, sponsored by several 

bilateral and international groups, 

at the International Conference 

on Nutrition in 1992, sponsored 

by WHO/FAO and in 1996 at the 

WHO/FAO World Food Summit 

in Rome. The emphasis from the 

beginning was on expanding the 

distribution of high-dose vitamin A 

supplements. Little support was 

available for alternative strategies. 

Supplement distribution 

was greatly facilitated when, in 

the latter part of 1990, distribution 

was linked to the WHO Expanded 

Program of Immunization’s (EPI) 

initiative of National Immunization 

Days (NID) for eradication 

of polio. This initiative provided 

a contact with preschool-aged 

children with minimal additional 

resources for delivery of the vitamin 

A capsule and is credited 

with success in greatly expanding 

coverage. NIDs have now ceased 

and countries are finding alternative 

mechanisms for sustaining 

the high coverage rates. 

Food fortification in developing 

countries received minor attention 

until midway in the decade, 

in spite of the successful fortification 

of sugar in Central America 

(51). Primitive development of 

the food industry and absence of 

regulatory controls were considered 

deterrents. But the need for 

a more sustainable intervention 

than periodic supplementation 

was recognized. The initiative 

for universal fortification of salt 

with iodine was making great 

inroads into relieving iodine deficiency 

disorders in developing 

countries, even in remote areas. 

Salt iodination advocates pushed 

their success as a model for vitamin 

A fortification, even though 

no comparable universally safe 

and acceptable food vehicle for 

vitamin A was available. Today, as 

noted earlier, there is momentum 

behind vitamin A fortification pro-


15 


grams using several food vehicles 

adapted to cultural consumption 

habits, such as oils, cereals, 

condiments and dairy products. 

Because supplements in the form 

of vitamin A or β-carotene in doses 

similar to the RDA but given 

weekly reduced maternal mortality 

by 40–50% (19), comparable 

results could be expected by 

appropriately fortifying commonly 

eaten foods incorporated into a 

diversified diet (52). 

Lip-service, but few resources, 

were devoted to food-based 

interventions through the 1990s, 

despite the fact that vitamin A 

deficiency as a public health 

problem is due to an inadequate 

diet. Horticultural or other agricultural 

approaches attracted 

minimal international funding 

support and, therefore, potential 

for food-based approaches was 

not adequately evaluated (53). In 

part this can be attributed to the 

debate in recent years over bioavailabilty 

of provitamin-A carotenoid 

food sources, particularly 

green leafy vegetables that had 

been promoted for many years. 

The late Clive West introduced 

the controversy at a meeting of 

the Sub-Committee on Nutrition 

in Canada where he suggested 

that the 6:1 bioefficacy factor for 

beta-carotene used to evaluate 

food sources vastly overestimated 

its true value. Though the 

6:1 factor was vigorously debated 

and defended, subsequent studies 

by the West group (54) and 

others upheld the claim for a 

less efficient conversion factor 

and forced reevaluation of food 

sources of carotenoids, particularly 

as contenders for elimination 

of vitamin A deficiency. In my 

view, the debate virtually closed 

off international support for horticultural-based 

intervention programs 

in the decade of the1990s 

in spite of the success of the 

large-scale horticultural initiative 

in Bangladesh, sponsored initially 

by Helen Keller International, that 

has expanded in the number of 

Barbara Underwood during her presentation at the CARIG Meeting, see 

page 18. 

communities covered and has 

demonstrated an improvement in 

vitamin A status (52). Agricultural 

approaches through plant breeding 

came onto the horizon in the 

latter part of the decade (56) but 

did not receive substantial support 

until the turn of the century. 

2000 forward: Where are we 

going? 

The end-of-decade goal for elimination 

of vitamin A deficiency was 

widely promoted in the 1990s but, 

although progress was made, 

the goal was not met. To keep 

up the momentum, new goals 

for elimination of micronutrient 

deficiencies were set for 2010 at 

the 2001 UN “World Fit for Children” 

meeting at UNICEF in New 

York. The question for program 

implementers is how to adapt 

existing strategies to assure that 

the extended time frame is met 

in a timely manner and not just 

reset at the end of the decade. 

Supplementation undoubtedly 

will continue for several years in 

certain country situations, but it 

will take resources and an intense 

effort to reach the vulnerable 30% 

who are now missed even in the 

best country distribution scenarios 

(18). Fortification efforts 

also will continue and undoubtedly 

will be increasingly effective 

in reaching rural communities 

and the poor as markets expand 

and economies develop. Public 

health measures through massive 

immunization campaigns, 

particularly for polio and measles, 

have made great inroads into 

control of immunizable infectious 

diseases, but these gains need to 

be complemented by improved 

environmental sanitation and safe 

water to control non-immunizable 

disease. Fortunately, more than 

at any point in my experience 

with vitamin A interventions, integrated 

approaches are gaining 

support, even food-based approaches. 

Indeed, the new kid on the foodbased 

micronutrient intervention 

playing field is biofortification. 

Although introduced in the mid- 

1990s (55) and the potential of 

the approach reviewed in 2000 

(56), substantial funding support 

only became available through 

the Bill and Melinda Gates Foundation 

in 2002. Biofortification is 

the cross-breeding of plants to 

increase the density of one or 

more nutrients, e.g. iron and/or 

zinc or provitamin β-carotene, 

and/or decrease inhibitors to 

absorption, e.g. phytates and/or 

polyphenols. At times, transgenic



methods may be used to introduce 

a nutrient otherwise absent, 

increase nutrient density above 

that achievable by cross-breeding, 

or insert favorable agronomic 

traits (e.g. disease resistance or 

increased yield). The advantage 

of biofortification is that staple 

crops grown and consumed by 

the poor can be enriched with micronutrients 

and be available harvest 

after harvest without added 

cost. β-carotene enriched crops 

currently being pursued include 

maize, cassava and sweet potato 

by traditional cross-breeding and 

rice by transgenic technology. 

Golden Rice produced by Syngenta 

(SGR1) is the most publicized 

example using genetic 

manipulations to introduce genes 

to overcome the impediment to 

synthesis of β-carotene. Carotene 

enrichment of the original 

product was not impressive. It 

was about 1.6 µg/g rice, which 

carried limited potential for making 

significant contributions to 

vitamin A requirements in spite 

of heroic claims to the contrary. 

Announcement in 2005 of 

Golden Rice #2 (SGR2) changed 

the potential: SGR2 contains 

31 µg/g β-carotene (57). This is 

equivalent to 1033 µg RAE in 

400 g uncooked, milled rice (an 

adult male serving size of ~800 

g cooked rice daily) and 516 µg 

RAE in 200 g uncooked, milled 

rice (an estimated serving size of 

400 g cooked rice daily for a child 

> 3 years). These calculations assume 

12:1 conversion efficiency 

for β-carotene to vitamin A. However, 

feeding tests to estimate 

bioequivalence have not been 

reported to date. Nonetheless, 

factoring in an approximate 20% 

loss during cooking, 826 µg RAE 

would remain for an adult and 413 

µg RAE for a child. SGR2, therefore, 

could nearly meet the RDA 

across ages if the daily diet contained 

800 g and 400g of cooked 

rice eaten by adults and children, 

respectively. SGR2 is an example 

of using transgenic technology to 

introduce or improve carotenoids, 

particularly provitamin A, in staple 

crops grown and/or eaten by the 

poor, such as cassava and maize. 

There remains much research 

to be completed before such 

carotenoid enriched crops are 

available for public consumption. 

Bioavailability must be determined 

from the biofortified crops 

prepared for consumption by 

traditional cooking procedures. 

Equally important is gaining acceptance 

by consumers skeptical 

of transgenically produced 

food crops and of more intensely 

colored traditional crops. 

Biofortification, however, is not 

restricted to use of transgenic 

technology. There is potential 

through traditional crossbreeding 

of germ plasma from varieties 

with higher nutrient density and 

other desired agronomic qualities. 

Perhaps the most advanced 

example in carotenoid-containing 

food plants is orange-fleshed 

sweet potato (OFSP) varieties. 

Although white sweet potato 

is the common staple eaten in 

many African countries, yelloworange 

varieties do exist in many 

countries. One particular orange 

variety (Resisto) has already been 

evaluated in a feeding trial among 

primary school children in South 

Africa and found to be acceptable 

and to improve vitamin A 

status (58). 

Some question whether vitamin A 

status can be maintained in a 

population using OFSP-based 

strategies. Jan Low recently completed 

a community intervention 

trial that found OFSP an acceptable 

substitute for white-fleshed 

sweet potato in Mozambique 

(59). An integrated agriculturedemand 

creation-market development 

approach was implemented 

to introduce OFSP into 

intervention areas compared with 

a control community not provided 

OFSP vines. The 24-month study 

provided high-dose vitamin A 

capsules to all children at baseline 

and six months, a placebo 

in the intervention areas at 12 

months, and a high-dose capsule 

after specimen collection at 24 

months. Hence, for 12 months, 

no children in either the intervention 

or control areas received a 

vitamin A capsule. The difference 

was that only children in the intervention 

areas were exposed to 

OFSP and an intensive campaign 

to promote its consumption. At 

the end of the 12 month period, 

a significant difference was seen 

in the percentage of children with 

a serum retinol level less than 

0.7 µmol/l in the intervention 

groups, both before and after 

accounting for infection. Thus, 

vitamin A deficiency was reduced 

up to 24% among healthy children 

and 16% among those with 

evidence of infection. There were 

several other positive spin-offs 

from this integrated intervention, 

such as a substantial increase in 

knowledge of men and women, 

an increase in income for smallscale 

producers and an increase 

in daily caloric intake of the children, 

as well as the intake of other 

micronutrients in the OFSP. 

Biofortification of staple crops 

with micronutrients, including 

provitamin carotenoids, is still 

early in development. Yellow cassava, 

maize and banana/plantain 

are in the developmental stages. 

There is much research remaining 

to pair the best nutrient content 

with most desirable agronomic 

traits, bioavailability from products 

as consumed, consumer 

acceptance and economic advantages 

among other outstanding 

issues. Nonetheless, a comparison 

of bio-fortification with 

fortification and supplementation 

clearly shows the complementary 

benefits of each intervention and 

the potential in the long run of 

meeting the needs of the poor 

economically and safely through 

food, reserving high-dose supplementation 

for medical emergencies.


17 


Conclusions 

Advances in understanding basic 

chemistry and functions of 

retinoids and carotenoids have 

been remarkable over the past 

four decades. This has paralleled 

progress in programs to control 

vitamin A deficiency through 

medical (supplement distribution) 

and market-based (food fortification) 

approaches. Progress has 

also occurred in public health 

programs to control immunilizable 

infectious diseases that drain 

body nutrient reserves, although 

there remain an estimated 1.1 

billion people without safe water. 

Whereas little attention was given 

to food-based approaches until 

recently, the future is promising 

due to breakthroughs that have 

occurred and are on the horizon 

for increasing carotenoids and 

other micronutrient densities in 

staple crops eaten by the poor 

and in improving other agronomic 

characteristics that enhance 

yields through biofortification. For 

carotenoid chemists and program 

enthusiasts, the research opportunities 

are multiple to demonstrate, 

for example, bioavailability, 

cooking and preservation 

stability, acceptability, economic 

gains and biological effectiveness 

of these crops in contributing to 

control of micronutrient deficiencies, 

especially among the poor. 

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Harvey B (1993). Effectiveness of vitamin 

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and child mortality. A meta-analysis. 

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306:366–70. 

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with vitamin A. UNU Food Nutr Bull 

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(1996). Production of fruits and vegetables 

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S62–S67. 

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AL, Drake R (2005). Improving the nutritional 

value of Golden Rice through 

increased pro-vitamin A content. Nature 

Biotechnology 23:482–487. 

58. Van Jaarsveid PJ, Faber M, Tanumihardjo 

SA, et al. (2005). β-carotene-rich 

orange-fleshed sweet potato improves 

the vitamin A status of primary school 

children assessed with the modified-relative-dose 

response test. Am J Clin Nutr 

81:1080–7. 

59. Low J, Arimond M, Osman N, Osei AK 

et al. (2005). Towards sustainable nutrition 

improvement in rural Mozambique: 

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new behaviors. Project Report, December 

2005. 

Carotene Research Interaction Group (CARIG) 

Annual Conference 2006, San Francisco 

Noel W Solomons, Center for Studies of Sensory Impairment, Aging and Metabolism, 

Guatemala City, Guatemala 

The 2006 Carotene Research 

Interaction Group (CARIG) Annual 

Conference was convened 

on Saturday, 1 April at the Argent 

Hotel in San Francisco. It accompanied 

the Experimental Biology 

2006 meetings. This year’s 

conference was organized and 

chaired by Dr. Elizabeth Johnson 

of Tufts University in Boston, a 

member of the CARIG Steering 

Committee. The proceedings 

began with the fifth annual James 

Allen Olson Perspective in Carotenoids 

lecture at CARIG, delivered 

by Dr. Barbara Underwood. 

She was a close associate of the 

late Prof. Olson, including jointly 

working in Brazil and serving as 

colleagues on the International 

Vitamin A Consultative Group 

(IVACG). She spoke on the topic: 

Reflections: Four Decades with 

Vitamin A and Carotenoids. (the 

full text of the James Allen Olson 

memorial lecture appears on 

page 10 of this issue). The significance 

of the talk was, in many 

ways, to show just how recent 

in emergence are the facts and 

principles that we hold in common 

about assessing vitamin A 

status and on the necessity to 

develop public health intervention 

strategies against hypovitaminosis 

A. Dr. Underwood, as well as 

Prof. Olson, a founding member 

of CARIG and the force behind 

VARIG (the Vitamin A Research 

Interaction Group), were part of 

vitamin A discovery and consensus 

development. This was 

inspired by a crucial meeting held 

in Basel, Switzerland in 1960, assessing 

the existing knowledge 

on vitamin A and pointing the way 

to the important next steps in the 

programmatic conquest of hypovitaminosis 

A. Dr. Underwood 

recounted three decades of contributions 

from IVACG, founded in 

1975, with about 35 experts in the 

vitamin A field in attendance. The 

lecture highlighted the steady and 

solid accumulation of accurate 

biological and epidemiological 

knowledge about vitamin A deficiency. 

This would lead to the 

mobilization of a worldwide public 

health effort based primarily on 

high-dose supplement capsules 

or fortification of staple foods 

such as sugar or cooking oil. 

Of special interest for a carotenoid 

biology audience was 

Barbara Underwood’s particular 

point of view regarding public 

health interventions. She accused 

the sometimes rancorous 

discussions in the 1990s 

concerning the true efficiency 

of bioconverting provitamin A to 

yield active vitamin A of retarding 

the progress toward developing


19 


sustainable food-based alternatives 

to alleviate hypovitaminosis 

A. With that issue now resolved 

by a new consensus within the 

Dietary Reference Intakes of 

2001, she pointed to gathering 

momentum in the area of biofortification, 

citing the founding 

of the Harvest Plus Project. The 

emphasis of biofortification is on 

staple crops of abundant and 

regular consumption by developing-country 

populations. Crossbreeding 

for hybrid varieties of 

sweet potato (orange-fleshed 

varieties) and genetic modification 

in the second (high-carotene) 

generation of Golden Rice were 

examples in which daily individual 

vitamin A needs could be met 

from the abundant supplies of 

β-carotene in these biofortified 

tubers and grains. 

A slide from Barbara Underwood 

advocating a holistic approach. 

An important and newsworthy 

note at the end of Dr. Underwood’s 

presentation was her announcement 

of the transformation of 

the IVACG. What began with its 

first meeting in 1975 ended with 

its 22nd meeting in Lima, Peru 

in 2004. A successor, the Micronutrient 

Forum, will be launched 

in Istanbul, Turkey, 16–18 April 

2007, with a broader and integrated 

mandate involving vitamin 

A, iron, zinc, iodine and folic acid 

in a public health context. 

Those of us who care about 

human vitamin A nutriture can 

derive lessons and standards in 

the message of Dr. Underwood’s 

Reflections. Lessons relate to 

how to set an agenda for inquiry 

to rapidly advance basic and applied 

knowledge, and standards 

to gauge the expectations for 

progress in redressing vitamin A 

deficiency problems. Should the 

interests of vitamin A get “lost 

in the shuffle” of multiple micronutrients 

and diluted scientific 

expertise and attention in the 

Forum, these Reflections may 

become the cudgel to demand 

the attention for vitamin A issues 

that were clearly championed by 

Underwood and Olson during the 

past four decades. 

The second plenary lecture on the 

program was delivered by Dr. Earl 

Harrison, senior scientist at the 

USDA Human Nutrition Center at 

Beltsville, Maryland. He spoke on 

the topic of Mechanisms Involved 

in the Intestinal Absorption of 

Dietary Carotenoids. This was a 

fitting and complementary companion 

theme to Dr. Underwood’s 

presentation with her emphasis 

on provitamin A carotenes from 

foods to supply vitamin A to deprived 

populations. To orient the 

audience, Dr. Harrison reviewed 

the conventional schematic aspects 

of dietary carotene uptake 

from the intestinal lumen into 

intestinal cells (enterocytes) and 

the options for its further passage 

either as the intact carotenoid 

or as a derivative retinoid. Dr. 

Harrison and his co-worker have 

advanced evidence that both 

simple diffusion and a receptormediated 

transport (carotene 

transporters) are involved in the 

usual absorptive physiology of 

carotenoids. 

The laboratory at Beltsville has 

used a novel, in-vitro cell culture 

model, that of the Caco cell monolayer 

in a directional absorption 

chamber, to explore the mechanisms 

of absorption of dietary 

carotenoids. The absorption 

chamber experiments revealed 

an 11% fractional absorption for 

β-carotene, which is not so far 

Earl Harrison 

from the rate documented for the 

intact human intestine. Kinetic 

experiments showing saturation 

kinetics under certain conditions, 

however, are a strong argument 

that a “facilitated transport” is 

operating, and this is in line with 

a receptor involvement. A clever 

set of experiments in Caco cell 

cultures, stellate (Ito) cell (hepatic 

fat storage cells) cultures, and 

cell-free microsomes (membrane 

envelopes) add credence to a 

transporter basis by showing 

stereo-specificity in uptake. In all 

three systems, different isomers 

of β-carotene were taken up to 

different extents. In descending 

order of uptake, affinity in the systems 

was revealed to be: all-trans 

β-carotene; 9-cis-β-carotene; 

and 13-cis-β-carotene. 

Bolstered by the coming together 

of cell-system evidence supporting 

a transported mechanism, Dr. 

Harrison’s research group has 

turned to identifying enzymes 

known to be located in the apical 

membrane of intact enterocytes, 

as candidates for involvement in 

the transporter mechanism. Their 

search has centered on so-called 

class-B scavenger receptors, 

extensively studied for their involvement 

in cholesterol uptake. 

This has led pharmacologists 

to develop inhibitory agents for 

receptor uptake. This laboratory 

has also used mouse models 

with deletion of genes of specific



enzymes (the so-called “knock 

out” mouse) to draw inferences 

about pathways in carotene 

metabolism. Geneticist created 

knock-out animals, deprived of 

or suppressed regarding one or 

another receptor. These proved 

to be strong investigative tools 

to use in pursuing the role of 

transporters in carotene uptake. 

In concluding his talk, Dr Harrison 

summarized a series of Beltsville 

laboratory experiments using 

receptor inhibitors, knock-out 

mice and their combination, to 

illustrate a partial dependency of 

carotene uptake on this class of 

membrane-associated enzyme 

as the basis for facilitated cellular 

uptake of carotenoids in the 

intestine. 

Dr Kathleen C Ellwood, of the 

Center for Food Safety and Applied 

Nutrition (CFSAN) of the 

Food and Drug Administration 

(FDA) of the United States presented 

the topical theme Reviewing 

the Scientific Evidence for 

Health Claims. Dr. Ellwood is assigned 

to the Division of Nutrition 

Programs and Labeling, Office 

of Nutritional Products Labeling 

and Dietary Supplements of the 

CFSAN. She provided a lucid 

exposition of the United States 

government’s oversight and regulation 

in the food-labeling area, 

and participated in a lively and 

interactive question and answer 

period thereafter. Need for labeling 

rules came about with the 

expansion of knowledge about 

bioactive substances in foods 

(of which the various carotenoids 

are examples). There came an 

effort by manufacturers of foods 

and supplements in the United 

States to transform findings into 

claims of beneficial effects. This 

led producers and marketers to 

seek to make claims about the 

benefits of consumption of the 

substances, the food containing 

the substances or both. To the 

extent that foods and substances 

are offered as remedies and 

therapies, a specific regulatory 

Kathleen C Ellwood 

handling comes into play. Dr. 

Ellwood correctly presented this 

as a case example of the merger 

of science with policy. 

Claim statements for a product 

are a form of “speech”; within 

the United States of America, 

freedom of speech is protected 

by the First Amendment to the 

Constitution. Provisions for making 

claims for health regarding a 

retail product are now covered by 

legislation (statutes) and the judicial 

precedents (case law). The 

FDA considered disease therapy 

claims for foods in the 1970s and 

1980s, and concluded that food 

must be treated by the same 

standards as any drug. 

Since that era, however, emerging 

scientific discovery has shown a 

series of more subtle diet-health 

relationships including protection 

and preservation of wellbeing 

and function. U.S. consumers 

were interested in seeking the 

potential benefits from dietary 

factors, and there was marketing 

pressure to deliver what the 

consumer demanded. This led to 

the passage in 1990 of the Nutrition 

Labeling and Educational 

Act, which governs the nature of 

claims that could be attached to 

edible products. It was not about 

treating established disease, i.e. 

the drug action, but rather about 

“Health Claims”. The act regulated 

claims of causal relationships 

between a food substance 

and a disease or health-related 

condition in the general US 

population or sub-population, in 

which consumption could reduce 

their risk. For the Health Claim to 

be approved the standard was 

“significant scientific agreement”, 

that is a strong consensus of a 

causal relationship. 

The speaker recounted how 

manufacturers felt constrained 

by having to get over such a high 

bar; they brought suits in court 

claiming that the Act infringed 

upon the First Amendment guarantee 

of freedom of speech. This 

has led, since 1999, to a secondary 

level of regulation for labeling, 

the so-called Qualified Health 

Claim (QHC). These claims include 

qualifying language in order 

to prevent the consumer from being 

misled. QHCs are applied for 

relationships such as that relating 

lycopene or lycopene-containing 

foods to reduced risk of prostate 

cancer and similar assertions. 

The process of evaluation by the 

FDA for a QHC has a defined 

set of steps. The first is literature 

review and selection. Animal 

studies are not relevant. Insofar 

as observational studies can 

indicate association, but not causality, 

the most relevant literature 

is considered to be that from intervention 

trials. The interventions 

can have outcomes of reduced 

incidence of disease/condition 

or favorable modification of a 

validated modifiable risk factor 

related to ill health. 

San Francisco’s famous cable 

cars.


21 


Prof. Erdman’s collaborators. 

Once the trial studies are assembled 

and sorted, those that meet 

inclusion criteria are rated for 

quality in terms of design, inclusion/exclusion 

criteria, balance 

of population characteristics 

across groups, verification of 

compliance with the intervention 

and appropriateness of statistical 

analysis. This is done for each 

study. The CARIG audience was 

particularly intrigued to learn that 

any study without a “validated” 

dietary intake method would be 

excluded from consideration. For 

those who know the limitations 

of dietary method validation/calibration, 

this seems fraught with 

arbitrary possibilities. 

The pre-final step is to rate the 

overall strength of the body of 

evidence in terms of type, quality, 

quantity and studies’ sample size, 

consistency and replication of 

findings, and the relevance to the 

US general population or target 

subgroups. Finally, the claim can 

have three degrees of ranking: 1. 

conclusive; 2. limited; or 3. very 

limited. 

The modifications in the FDA 

procedures derive from the tension 

among consumers’ desire to 

preserve health, producers’ and 

retailers’ desire to exercise free 

speech, and the government’s 

duty to protect the citizenry from 

consumer fraud. Dr. Ellwood’s 

message had shown that the role 

of the scientific community lies in 

how well they design and execute 

studies on causal relationships 

between a dietary substance and 

a beneficial outcome. 

Prof. John Erdman of the University 

of Illinois also spoke in the 

second session of the program 

with a talk entitled: Tomato, Lycopene 

and the Risk of Prostate 

Cancer. He was also awarded 

this year’s Wilbur O. Atwater 

Memorial Lecture, sponsored by 

the United States Department 

of Agriculture on 4 April, which 

had the theme of carotenes at its 

center. His award’s lecture topic 

was Colors, Critters, and Cancer. 

As he explained, the colors refer 

to carotenoid pigments; the critters 

refer to the selection (limits 

and possibilities) with different 

animal models for investigation 

of carotenoid metabolism and 

effects; and cancer is specifically 

prostate cancer. The context is 

the epidemiological evidence that 

suggests that tomato consumption 

is protective against prostate 

cancer. 

The world of colorful carotenoids 

contains over 650 compounds. 

Phytoene and phytofluene are 

simple colorless precursor carotenoids. 

All known members of 

this family of compounds are initially 

synthesized in plant tissues; 

animals cannot form carotenoids. 

Prof. Erdman reminded his audiences 

that the ripeness of fruits 

John Erdman 

and vegetables is reflected in 

their carotenoid content. Carotenes 

contribute to the hues 

of birds’ feathers and insects’ 

coloring. Moreover, carotenes are 

important to aroma compounds 

in nature that have importance for 

interspecies signaling. 

Not all animals handle carotenoids 

in a uniform fashion. 

It has been found for instance 

that, for studies of carotenoid 

metabolism related to human 

physiology, gerbils, ferrets and 

pre-ruminant calves provide the 

best in likeness to human absorptive 

systems. They are capable 

of absorbing the compounds 

both intact and metabolized. As 

herbivores, rats and mice are efficient 

converters of provitamin A 

carotenoids. They are poor at 

absorbing intact carotenoids; 

thus, high feed levels are needed 

for these rodents to replicate the 

tissue concentrations achieved in 

humans. In Prof. Erdman’s view, 

the armamentarium of animal 

models for cancer studies with 

carotenoids includes rats, mice, 

and again ferrets. 

The prostate gland and carotenoid-containing 

foods came 

together in the observations of 

vastly different spontaneous incidence 

rates for prostatic cancer 

with 70 times greater incidence 

rates in North American blacks 

and 50-fold increased rates



Maria Stacewicz-Sapuntzakis receives award from Wendy White. 

in North American whites, as 

compared to peers in Shanghai, 

China. The Physicians’ Health 

Study implicated higher intakes 

of tomato sauce, tomatoes, pizza 

and strawberries, all sources of 

lycopene (a non-provitamin A 

carotenoid), with reduced prostate 

cancer occurrence. Prof. 

Erdman summarized the science 

findings of his group in pursuing 

the bases of these epidemiological 

observations. Using a prostatic 

cancer murine tumor model, 

the combination of broccoli and 

tomato proved to be superior 

to tomato alone, and both were 

superior to isolated lycopene in 

terms of anti-cancer activity in the 

mouse tumors. The conclusion 

is that lycopene is not the only 

preventive substance in broccoli 

or tomatoes. 

At the VARIG/CARIG social event. 

The other basic pursuit involved 

the potential bioactivity of metabolic 

derivatives of lycopene. 

Analogous to the format by which 

retinoids and apo-carotenals 

of different carbon lengths are 

produced by central or eccentric 

cleavage of provitamin A carotenes, 

the search has been joined 

for generation of apo-lycopenals. 

The carotene monoxygenase I 

(CMO I), responsible for central 

cleavage of β-carotene (formerly 

known as 15,15’ monoxygenase) 

is inactive in cleaving lycopene. 

However, the carotene monoxygenase 

II (CMO II), which produces 

eccentric cleavage of β-carotene, 

can also generate apo-lycopenals 

in in-vitro systems. These products 

have recently been detected 

with sensitive assay techniques 

in human plasma and breast milk 

in concentrations over 100 times 

lower than that of lycopene itself. 

Studies documenting the bioactivity 

of lycopene split-products have 

yet to appear, but the fundamentals 

of carotene biology for retinoids 

are a template for inquiry into 

potential anti-cancer mechanisms 

for lycopene. 

The final wisdom from Prof. 

Erdman is not to ignore other 

compounds, even phytoene and 

phytofluene precursors. In the 

ripe tomato, the sum of these 

two compounds is equivalent by 

weight to that of lycopene, and 

these non-aromatic forms are 10 

times more abundant than alphaand 

beta-carotenes combined. 

Heather Mernitz in front of her 

awarded poster. 

Other awards were involved in 

the CARIG meeting arena in San 

Francisco. These included travelawards 

based on the scientific 

merit of the abstracts submitted 

by graduate students for presentation 

in Experimental Biology 

on carotenoids. The winner was 

Francesca Alvarez-Calderon, 

from Florida International University, 

for her free-paper entitled: A 

computational study of end-group 

conformational barriers in carotenoids. 

In addition, a new element 

was brought in for the benefit of 

encouraging and recognizing the 

talent of young trainees this year. 

This was a poster competition as 

part of the VARIG/CARIG social, 

held following the Conference. A 

total of 12 contestants exhibited 

their free-paper posters, brought 

for display in the mini-symposia 

of the EB 2006. Heather Mernitz, 

from the USDA Human Nutrition 

Research Center at Tufts University 

was judged as best in the 

competition with her poster on 

Inhibition of lung carcinogenesis 

by 9-cis retinoic acid and 1,25 

dihydroxyvitamin D3 in the A/J 

mouse model. Finally, the Steering 

Committee of CARIG made 

a “surprise award”, in the form 

of a recognition-of-merit plaque, 

to Maria Stacewicz-Sapuntzakis, 

the tireless and undaunted editor 

of the CARIG Newsletter, who 

has undertaken its semi-annual 

publication since the founding of 

the Group.


23 


13 th European Meeting on Fat-Soluble Vitamins 

2006 in Jena 

Volker Böhm, PD, Institut für Ernährungswissenschaften, Friedrich-Schiller-Universität 

Jena, Germany 

This year, for the first time, this 

European Conference took place 

in Germany. Fat-soluble vitamins 

(FSV) offer a wide field of research 

and have brought together European 

scientists and students every 

three to four years since 1960, 

first in the UK and then touring 

Europe. After Arcachon (1996) 

and Toulouse (2000) in France 

and Rieti (2003) in Italy, this year 

Jena in Germany provided an opportunity 

to listen and to lecture, 

to discuss and to develop stateof-the-art 

and new approaches, 

illuminating the role of these 

compounds for human health and 

more. A very efficient interchange 

of knowledge took place due to 

the traditionally small number of 

around 50 participants. Students, 

in particular, took this opportunity 

to present their work on a European 

level and to talk to experts 

in the field. 

The 13 th FSV meeting was hosted 

by the Institute of Nutrition at 

the renowned Friedrich Schiller 

University in Jena. It took place 

in the Old Castle in Dornburg 

(10 km from Jena), that has just 

been completely refurbished to 

meet the demands of a modern 

meeting place while keeping its 

beautiful historical ambience. 

Accommodation was in Jena, a 

city of 100,000 inhabitants and 

also famous for its optical trade 

(Zeiss, Jenoptik). 

The conference started with a 

plenary lecture by the internationally 

known carotenoid expert 

Steven J Schwartz from the Ohio 

State University in Columbus, 

Ohio, USA. He presented some 

of the results of his group on bioavailability 

of different carotenoids, 

talking also on bioactivity of 

these secondary plant products 

being able to reduce the risks 

for some degenerative diseases. 

The first session followed, reporting 

results with carotenoids. 

Catherine Caris-Veyrat from INRA 

Avignon, France, mainly focused 

on oxidation products of carotenoids, 

discussing some possible 

effects of these metabolites. Yoav 

Sharoni from Beer-Sheva, Israel, 

presented new results on mechanisms 

for cancer prevention by 

carotenoids, while Gordon Lowe 

from Liverpool, UK, explained 

investigations on interactions 

between cigarette smoke and 

β-carotene. 

The second session focussed on 

vitamin E. David Muller, London, 

UK, presented analytical details 

on separation and quantification 

of conjugated vitamin E metabolites 

in sepsis. Andreas Wagner 

from Jena, Germany, showed 

how intervention with α-tocopherol 

and folic acid affected 8- 

oxodG, a biomarker of oxidative 

stress in leukocytes and urine 

in humans. Stefano Manfredini, 

Ferrara, Italy, finished the session, 

comparing the antioxidant 

activity of novel vitamin E based 

antioxidants within several assay 

systems. Afterwards most delegates 

enjoyed typical Thuringian 

sausages, beer and jazz music. 

The second day started with 

results on the structure-activity 

relationship of carotenoid derivatives 

in activation of the antioxidant 

response element transcription 

system, presented by Joseph 

Levy, Beer-Sheva, Israel. Paola



Palozza, Rome, Italy, discussed 

experiments with β-carotene 

in vascular cells exposed to 

oxysterols. Investigations on 

carotenoid metabolism in animals 

were presented by Johannes 

von Lintig, Freiburg, Germany. 

A round-table discussion on 

perspectives for fat-soluble vitamins 

led to an intense exchange 

between the experts, showing a 

lot of interesting tasks to be investigated 

in the next years. The 

discussion closed with the decision 

to continue the meetings in 

the future. Two colleagues offered 

to invite the scientists in 2009 to 

Potsdam, Germany, and in 2012 

to Greece. 

After lunch, Diana Bellovino, 

Rome, Italy, presented investigations 

on the effect of the matrix 

on the bioavailability of carotenoids. 

Anna Iannone, Modena, 

Italy, discussed new results from 

electron spin resonance experiments 

investigating the antioxidant 

potential of α-tocopherol 

and lycopene. After an official 

reception by the Mayor of Jena all 

delegates used the time to have 

a look at the posters. Some delegates 

spent the afternoon break 

walking through the gardens of 

the castle grounds; others enjoyed 

discussing and relaxing 

in small groups. A dinner and 

music event was the highlight of 

the second evening. European 

food prepared by local cooks 

was combined with local wines 

of the most Northern vineyard in 

Germany and European music 

played by mandolins and guitars 

of the group “Lautengilde Jena”, 

conducted by the organizer of 

the meeting – the large hall of the 

castle provided a good ambience 

for the event. 

The last half-day of the conference 

started with an update on 

isomerization of lycopene presented 

by Volker Böhm, Jena, 

Germany. Emmanuelle Reboul, 

Marseille, France, explained 

which transporters are involved 

in the uptake of lycopene and 

β-carotene. Wilhelm Stahl, Düsseldorf, 

Germany, finished the 

carotenoid session with experiments 

showing photoprotective 

effects of carotenoids. In the last 

session of the meeting Hülya 

Sagmanligil Özdemir, Van, Turkey, 

presented results on fat-soluble 

antioxidant vitamin levels in 

newborn babies and their relation 

to the maternal vitamin status. 

Patrick Borel, Marseille, France, 

talked about different lipases being 

responsible for hydrolysis of 

retinyl palmitate. 

Three awards for the best posters, 

elected by all delegates, 

some concluding remarks and a 

farewell finished two very efficient 

days within the old walls of Dornburg 

Castle. All delegates left the 

conference venue more relaxed 

than when they arrived, which 

could well be an additional effect 

of the charming atmosphere and 

the small number of delegates. All 

were invited to come to the 14 th 

European Meeting on Fat-Soluble 

Vitamins that will take place in 

2009 in Potsdam, Germany, organized 

by Florian J. Schweigert 

and his team.


25 


Protecting nutritional status and the role of micronutrient 

premix in the United Nations World Food 

Programme’s response to the Indian Ocean Tsunami 

World Food Programme, Regional Bureau for Asia, Wave Place Building, 7th Floor, 55 

Wireless Road, Pathumwan, Bangkok 10330, Thailand 

Immediate relief 

The Indian Ocean Tsunami of 26 

December 2004 presented the 

humanitarian community with 

one of the largest challenges it 

had ever faced. The United Nations 

World Food Programme responded 

with an immediate and 

massive relief effort that eventually 

became one of the most complex 

operations the organization 

had ever undertaken, spanning 

six countries, two continents, and 

millions of beneficiaries. 

While the primary focus of the immediate 

response was providing 

life-sustaining food aid to those 

whose houses, fields, crops and 

livelihoods had been washed 

away, WFP also sought to shore 

up the nutritional status of groups 

made vulnerable by the tsunami 

– in particular children, new mothers 

and the elderly. 

In such situations, ready-to-eat 

or easy-to-prepare fortified foods 

play a key role. Within days of 

the tsunami, WFP found itself 

required to deliver large quantities 

of such foods to the crisis zone 

in record time. In Aceh and Nias, 

WFP had not been providing fortified 

foods prior to the tsunami, 

so it turned to countries in the region, 

such as Bangladesh, where 

WFP was producing such foods 

in large quantities . 

DSM, which is one of WFP’s 

primary private-sector partners 

in nutrition, responded quickly 

through SIGHT AND LIFE to 

WFP’s requests for assistance 

by donating micronutrient premix 

– enough to fortify over 5,000 

metric tons of high-energy biscuits. 

Such biscuits are used 

primarily in WFP’s school feeding 

programs, as a mid-morning 

snack designed to help prevent 

micronutrient deficiencies among 

school children. They are also 

extremely useful in emergencies, 

as they are lightweight and easy 

to transport, yet provide high nutritional 

and caloric value. 

SIGHT AND LIFE’s donation was 

delivered to factories in Bangladesh 

that produce fortified 

biscuits for WFP. The donation 

allowed WFP to release large 

quantities of fortified biscuits in 

Bangladesh and send them to 

countries across the crisis zone. 

Planes filled with biscuits started 

leaving Dhaka on 13 January. 

By the end of January, 700 metric 

tons of biscuits had been shipped 

to Aceh, Indonesia, by both air 

and sea. This was a major donation, 

representing 15% of the 

total amount of biscuits used in 

the entire tsunami operation in 

2005. The biscuits sent to Indonesia 

were enough to provide 

nutritional supplementation to 

over 300,000 children aged 3 to 

12 years for three months. 

Mid- and long-term relief 

By May 2005, WFP was providing 

daily food rations to 2.25 million 

people across the tsunami zone 

– in Aceh and Nias in Indonesia, 

School feeding in Banda Aceh. WFP/ Barry Came. 

Girls with high-energy biscuits, Aceh, Indonesia. WFP/ 

A K Kimoto.



Sri Lanka, the Maldives, Thailand, 

Myanmar and Somalia. As the 

acute crisis passed, the focus of 

operations shifted from averting 

wide-scale hunger to protecting 

groups left vulnerable by the 

disaster. These groups included 

displaced people, farmers whose 

land had been inundated, and 

fishing families who had lost their 

boats or other means of fishing. 

In many cases, these communities 

had had relatively stable food 

security prior to the tsunami. In 

other cases, the waves had made 

difficult conditions much worse. 

Across the board, however, the 

emphasis was not so much on 

raising pre-existing nutritional 

levels as making sure that nutritional 

levels did not decline as 

a result of the tsunami and its 

after-effects. 

As a recent joint statement by 

WFP, UNICEF and the WHO 

on “Preventing and Controlling 

Micronutrient Deficiencies 

in Populations Affected by an 

Emergency” puts it: “The aim is 

to avert micronutrient deficiencies 

or prevent them from getting 

worse among the affected 

population. Such foods must be 

appropriately fortified, taking into 

account the fact that other unfortified 

foods will meet a share of 

micronutrient needs.” 

Adults who were displaced or 

part of otherwise vulnerable 

groups received daily rations for 

their entire families (generally rice, 

canned fish, fortified noodles 

and oil in Indonesia; rice, pulses, 

sugar and oil in Sri Lanka). Children 

in school received either the 

fortified biscuits (Indonesia and 

Maldives) or a mid-day meal (Sri 

Lanka). New mothers and young 

children received fortified food 

and nutrition education through 

Mother and Child Nutrition (MCN) 

programs. 

Boys at school in Banda Aceh. WFP/ Barry Came. 

By December 2005, school feeding 

programs covered 330,000 

children in Indonesia and 102,000 

in Sri Lanka. Over 143,000 mothers 

and young children were 

enrolled in MCN programmes in 

Sri Lanka, along with 33,000 in 

Indonesia, with plans to expand 

the programs in both countries. 

At the same time, the number of 

beneficiaries receiving general 

food rations was decreasing, as 

homes were built and people returned 

to their old livelihoods. 

Fortified foods such as highenergy 

biscuits played a critical 

role in the early days of the response, 

and in the future-oriented 

programs such as school feeding 

which aimed to shore up the nutritional 

status of communities. 

However, fortified biscuits were 

not used as emergency rations 

in the early stages to the degree 

originally planned. The relatively 

rapid re-opening of land routes 

– in Aceh in particular – meant 

that communities could receive 

standard rations by truck transport, 

rather than having to rely 

on flown-in fortified foods. In the 

end, WFP used approximately 

half of the amount of fortified biscuits 

that it had originally planned 

for the entire tsunami operation. 

Following the initial shipments 

of 700 metric tons of fortified 

biscuits to Indonesia, as well as 

other shipments to the Maldives 

and Sri Lanka, WFP was able to 

source the remaining biscuits that 

it needed locally. As a result, the 

remainder of the SIGHT AND LIFE 

donation was used to produce 

biscuits in Bangladesh for use in 

WFP school feeding programs in 

that country. 

The rapid response of SIGHT 

AND LIFE and other WFP partners 

to the tsunami was critical, 

allowing WFP to provide large 

quantities of fortified foods to the 

affected areas. Without it, certain 

communities might have faced 

a drop in children’s nutritional 

levels, along with all the other 

challenges brought in the wake 

of the waves. 

Additionally, the donation provided 

much-needed support for 

school feeding in Bangladesh. 

WFP plans to provide fortified 

meals or supplementary snacks 

to 300,000 children in Bangladesh 

in 2006. While these programs 

may not be as dramatic 

as the tsunami response, in terms 

of the impact on children’s lives 

they can be more widespread 

and longer-lasting. Long after the 

reconstruction of the tsunami-hit 

areas is over, the world will still 

face the ongoing “silent emergencies” 

of malnourished children, 

and children who are denied an 

education due to poverty.


27 


Distributing micronutrients and deworming 

medicine in hurricane-ravaged Honduras 

Howard B Schiffer, Executive Director, Vitamin Angels Alliance, 

Santa Barbara, CA, USA 

Background 

Hurricane Mitch struck northwestern 

Honduras with devastating 

effects in 1998, setting back 

the remarkable progress that the 

country had been making in addressing 

their problems of health 

care, education and poverty. 

Honduras now faces daunting 

issues as it attempts to address 

serious health conditions such as 

malnutrition, child mortality, dengue 

fever, respiratory infections, 

HIV/AIDS and rapid population 

growth. Malnutrition, coupled 

with infestations of parasites, is 

a serious problem for children. 

Unfortunately, micronutrient deficiencies 

are found at high levels 

in the north and west rural regions 

of Honduras and were made 

worse by the hurricane and its 

aftermath. 

While it is widely understood 

that vitamin A and other micronutrient 

deficiencies are a major 

cause of disease and blindness 

among children, parasites are 

also a leading cause of diseases 

among children and adults in the 

world today. Worms consume 

macro- and micronutrients in the 

gut before children can absorb 

them, and hence impair children’s 

growth and developement. This 

can lead to physical stunting, 

learning problems, illness and 

death. Deworming these children 

is essential for their health and 

well-being and is an essential 

component of a micronutrient 

campaign. 

As was reported in SIGHT AND 

LIFE Newsletter 2/2005 (pp. 20– 

21), Vitamin Angel Alliance (VAA) 

and Cristo Salva are running a 

project to provide basic medical 

services and combat malnutrition 

in Honduras. Now, with the support 

of SIGHT AND LIFE, these 

efforts are continuing in the form 

of the Honduras Micronutrient 

Project. This campaign, which 

is commencing this year, will alleviate 

micronutrient deficiency 

and VAD (vitamin A deficiency), 

and reduce the parasitic worm 

load for 30,000 children from two 

to ten years old in northwestern 

Honduras. We are working with 

local school districts to distribute 

chewable multivitamin and 

micronutrient supplements and 

educate parents to have their 

children take one daily, and we 

are distributing mebendazole 

(500 mg) once every 6 months to 

eliminate parasitic worms. 

The project sites 

The project sites are rural villages 

in northwestern Honduras near 

the Guatemalan border. These 

are the little villages around the 

central village of Macuelizo. 

Hacienda Cristo Salva is located 

in one of the small neighboring 

villages – Las Varas – and the 

Clinica de Cristo Salva is located 

in the center of Macuelizo with 

central access to all the villages. 

Specifically, Cristo Salva distributes 

the micronutrients and 

mebendazole in the towns and 

villages in and surrounding the 

Valley of Macuelizo. 

The villages have no medical care 

whatsoever. The poverty in the 

region is endemic and extreme. 

Many of these children literally 

eat a root on their way to school 

in the morning for their breakfast. 

Professor Oscar Mendoza, the 

former District Officer and current 

head teacher in a local middle 

school, agreed to work with 

Cristo Salva to help mitigate in 

part the sickness and hunger of 

the children. In addition, Cristo 

Salva has a network of people on 

the school boards, village officials 

and even translators who have 

offered to assist us. 

The campaign 

Cristo Salva distributes the products 

to the schools, with school 

officials helping to oversee the 

process. Cristo Salva plans a 

teachers’ meeting in each community 

to educate teachers and 

health workers on how to distrib-



ute the parasitic medicines (along 

with an education program on 

basic hygiene and sanitation) and 

how to educate the parents about 

the daily supplements for their 

children. The periodic, organized 

distribution of mebendazole 

supplements has worked successfully 

in our past experience 

and we are confident about the 

progress of this project. During 

the first year it is planned to 

reach 30,000 children and in the 

second and third year others not 

yet reached will be included. 

A grant to run the project and the 

micronutrients are being donated 

by SIGHT AND LIFE. The tableting 

is being contributed by Anabolic 

Labs with excipient contributions 

from Domino Foods and Mutual 

Foods. The mebendazole is being 

purchased from (and partially donated 

by) MedPharm. PAHO (Pan 

American Health Organization) is 

supplying the Kato Katz test kits 

for the baseline study. Support 

on the baseline study is being 

provided by George Washington 

University and the Ministry of 

Health (MOH) in Honduras. 

The distribution of the products 

follows strict guidelines. The 

in-country partners of the mebendazole 

part of the campaign 

receive WHO survey materials 

and guidelines for administering 

safe and appropriate doses of 

mebendazole to children. Only 

trained healthcare workers or 

volunteers administer the doses 

and maintain accurate record 

sheets about children receiving 

supplements and mebendazole. 

They ascertain the child’s age 

– through discussion with caregiver, 

or by observing the ambulatory 

ability of the child. The 

caregivers are instructed to give 

the children one micronutrient 

vitamin/mineral chewable tablet 

each day. Based on the records of 

individual children an evaluation 

and follow up of the campaign is 

possible. 

Partners 

Vitamin Angel Alliance is the 

lead agency for the program. 

Our mission is to provide basic 

nutrition to people in need. Our 

vision is far reaching. We believe 

that every person has a right to 

basic nutrition; that malnutrition 

linked diseases are preventable 

and that education in addition to 

supplementation is essential for 

long-term health. A more detailed 

scope of the mission of VAA was 

given in SIGHT AND LIFE Newsletter 

2/2005 (pp. 20–21). 

Cristo Salva is implementing 

the program in Honduras. It is 

a non-profit NGO consisting 

of lay people, doctors, nurses, 

teachers, and missionaries. For 

15 years it has been serving the 

people of Honduras, focused 

primarily in the State of Santa 

Barbara. The vision of Cristo 

Salva is to provide basic needs in 

the form of vitamins, clean water, 

hygienic education, agricultural 

education, nutritional education 

and support, medical and dental 

clinics, pre-natal education, eye 

glasses, clothing, and shoes. 

Goals, outcomes and 

reports 

The records kept, using WHO 

survey materials, will give information 

on: 

• Number of community meetings 

held 

• Number of micronutrient supplements 

distributed 

• Number of worm tablets distributed 

• Number and ages of children 

reached 

It is expected that the benefits 

gained will be reduced blindness, 

morbidity, mortality and clinic 

visits as well as improved general 

health. Some of the benefits may 

be difficult to quantify. However, 

there is no doubt that these reductions 

in health problems 

will enable health workers and 

facilities to redirect a substantial 

portion of their resources to other 

public health and socio-economic 

concerns. 

The Honduran Micronutrient 

Campaign will be monitored and 

evaluated by VAA with full participation 

by Cristo Salva and other 

in-country partner organizations. 

The primary emphasis will be on 

the coverage of the program, with 

results largely based on the supplements 

and medication reaching 

the intended beneficiaries.


29 


Eye care mission to the Dominican Republic, 

March 2006 

Sade Kosoko-Lasaki, MD, MSPH, MBA, Creighton University, Omaha, NE, USA 

Introduction 

During our previous trip to the 

Dominican Republic (DR), we 

demonstrated that VAD is a public 

health problem in this country. 

This was reported in SIGHT AND 

LIFE Newsletter 2/2005 (pp. 

35–36) with more details given in 

the 3/2005 issue (pp. 21–23). 

In March 2006, Creighton University 

realized a similar mission with 

the same partners. In addition to 

the screening of children and the 

administration of vitamin A capsules, 

adults were examined for 

glaucoma. Glaucoma is also the 

commonest cause of blindness 

in African-American and Hispanic 

populations. 

The primary health care workers 

(Cooperadores) received a halfday 

review and training session 

on the clinical signs and symptoms 

of vitamin A deficiency, its 

effects on childhood morbidity 

and mortality and preventative 

strategies. Dr. Kosoko-Lasaki 

emphasized the benefits of 

breast-feeding and encouraged 

the consumption of foods rich 

in vitamin A, such as green leafy 

vegetables, carrots, mangoes, 

papaya, etc. The Cooperadores 

also received lectures on the 

importance of adults having their 

eyes screened for glaucoma. All 

the Cooperadores received eye 

exams and screening. Two new 

cases of glaucoma were identified 

amongst the group. 

Other trip activities included 

screening children for the eye 

signs of vitamin A deficiency, 

distributing vitamin A capsules, 

and providing screening and 

ocular examination and treatment 

for adults, specifically for 

glaucoma. In addition, a lecture 

to the Ophthalmology Society on 

the importance of screening for 

glaucoma was delivered by Dr. 

Kosoko-Lasaki. 

Results 

Approximately 200 children, 

ages 3 months to 10 years, were 

screened and received vitamin A. 

A total of 178 adults received visual 

acuity, visual field (using the FDT 

Visual Field Analyzer), slit lamp, 

tonometry and fundus exams. 

Ninety-four patients had complete 

ophthalmologic exams. Thirty new 

cases and 44 existing cases of 

glaucoma were diagnosed, and 

six glaucoma surgeries were performed. 

Follow-up referrals were 

sent to Dr. Sebastian Guzman and 

to the ILAC clinic in Santiago.



Conclusion 

The children, adults, and health 

care personnel in the DR benefited 

from the efforts of the Eye 

Care team and its collaborative 

approach with the local Santiago 

ophthalmologist and ILAC family 

practice physicians. The ILAC 

Cooperadores (health care workers) 

use the “teach-the-teacher” 

strategy. This grass-roots ap- 

proach reaches the poor and 

marginalized residents in the 

remote, underserved areas of the 

Dominican Republic. 

Acknowledgement 

Much-appreciated support was 

provided by: 

SIGHT AND LIFE, New World 

Medical, Inc. (Rancho Cucamonga, 

California), Creighton 

University Institute for Latin 

American Connection (ILAC) Office, 

(Omaha, Nebraska, USA), 

Creighton University Office of 

Health Sciences–Multicultural 

and Community Affairs (HS- 

MACA) (Omaha, Nebraska, USA). 

Dr. Sebastian Guzman and staff 

(Santiago, Dominican Republic), 

ILAC Mission staff (Santiago, 

Dominican Republic). 

The following article is based on a complete report sent to SIGHT AND LIFE. Earlier Newletters (1/1999, pp. 15–17; 

1/2002 pp.12–14) reported previous findings and survey results, as well as detailed recommendations: therefore 

only the most recent comments are given here (editor). 

Update on the status of vitamin A deficiency 

and xerophthalmia in children under five treated 

at hospitals in Vietnam over a 27-year period 

(1979 – 2005) 

Nguyen Chi Dzung MD, PhD, Hanoi National Institute of Ophthalmology, 

Tran Minh Tan MD, Hanoi National Children’s Hospital, Vietnam 

In 2005 cases with eye signs of 

vitamin A deficiency (125 cases 

with XN) were still seen in many 

hospitals in Vietnam, especially in 

remote and mountainous areas. 

Similar findings were published 

in previous issues (see SIGHT 

AND LIFE Newsletter 1/2002 pp. 

12–14). Due to the sporadic cases 

of VAD still found, not only in 

the community but also in some 

hospitals, and the persistent risk 

of blindness for children in some 

remote and mountainous areas, 

the VAD prevention and control 

program needs to be continued, 

with the focus on mountainous, 

remote and economically impoverished 

areas in order to totally 

eliminate xerophthalmia by the 

year 2010. 

Therefore we hope to continue 

to receive support from SIGHT 

AND LIFE in the form of vitamin A 

capsules in order to achieve this 

goal of eliminating xerophthalmia 

and VAD in Vietnam. 

We always highly appreciate international 

assistance, which is 

very valuable. On this occasion, 

we would like to express the 

sincere thanks of our people and 

colleagues to all UN agencies, international 

NGO’s such as CBM, 

FHF, HKI, Orbis, SF, SIGHT AND 

LIFE , and our good friends, who 

have given Vietnam such valuable 

and effective assistance in our 

Blindness Prevention Program 

for so many years. 

Left: The MOH Deputy Minister gives high-dose vitamin A capsules to children. On the right is Dr. Jama Gulaid, 

Head of Health and Nutrition, UNICEF, Hanoi. Right: Dr. Nguyen Cong Khan, Director of National Institute of Nutrition 

(NIN) speaks at the launch of a National Micronutrients Day campaign.


31 


Continuing nutrition education by the Youth 

Volunteer Group, Nepal 

Ashish Sharma, Youth Volunteer Group (YVG), Banepa, Kavrepalanchok, Kathmandu, 

Nepal 

In SIGHT AND LIFE Newsletter 

3/2005 (pp. 27–29) we reported 

on the nutrition education program 

made possible by financial 

and logistical support from SIGHT 

AND LIFE. We were very pleased 

when SIGHT AND LIFE gave us 

the opportunity to continue a 

similar program in another area 

of Nepal. 

About 43% of Nepal’s total population 

of 23.8 million is under the 

age of 16. Of these, 3% suffer 

from vitamin A deficiency xerophthalmia. 

Eye diseases are considered 

to be a vast problem which 

has adverse effects in the mental 

as well as physical development 

of children. This gave us the incentive 

to continue this Nutrition 

Education Campaign. 

Despite the fact that the National 

Vitamin A Program for the prevention 

of vitamin A deficiency has 

been ongoing for many years 

now (editor: see SIGHT AND LIFE 

Newsletter 3/1995 pp. 12–13), 

it seems that knowledge in the 

population is still not sufficient. 

Therefore the YVG started this 

education effort in various areas 

to make people aware of their 

own nutrition situation and that 

of their children. 

From January to March 2006 this 

“Nutrition Education Campaign” 

was carried out in the area of 

the Kavrepalanchok district. The 

direct beneficiaries were 559 children 

and 275 pregnant and nursing 

mothers and their families. 

Objectives, methods and procedures 

were very similar to the 

previous program, with improvements 

where possible (see Newsletter 

3/2005) 

Children’s eye screening 

The eyes of a total of 559 children 

were examined by a senior ophthalmic 

assistant for any signs or 

symptoms of VAD. All affected 

children were given a vitamin A 

capsule and some of them were 

referred to the Nepal Eye Hospital. 

Twenty-six children (4.6%) 

aged 5 months to 5 years were 

found to have eye symptoms (XN 

6; X1B 10: XN+X1B 7; X2+X3 3). 

Conclusions and 

recommendation 

There has been an increase in 

knowledge about vitamin A rich 

food, vitamin A deficiency diseases, 

blindness etc. amongst 

mothers and caretakers, and 

those identified with eye symptoms 

received appropriate care. 

The evaluation showed a very 

positive impact on the people 

with regard to knowledge. 

Although there has been a positive 

response to the program 

in the areas where it is running 

– with an increase in knowledge 

of vitamin A rich food and ways of 

consuming it, as well as more information 

about VAD – this short 

program of three months cannot 

solve the problem completely. If 

the people do not take the initiative 

themselves the problem will 

never be solved. 

Outsiders like us are ever ready 

to work in this field to increase 

people’s awareness, but there are 

many reasons why we cannot do 

this work for very long. So if we 

support and prepare some peer 

groups among the local people 

then they can work in a better and 

more sustainable way.



The PACHE Trust health program and women’s 

empowerment 

P Manoharan, Project Director, Pache Trust, Madurai, Tamil Nadu, India 

Introduction 

The People’s Association for 

Community Health Education 

Trust (PACHE Trust) is a grassroots 

level non-profit and nongovernmental 

organization functioning 

for the dedicated cause 

of uplifting the rural poor with 

due emphasis on the betterment 

of women and children. The organization 

is also involved in a 

considerable number of HIV/AIDS 

prevention projects among the 

highly vulnerable groups. The 

organization has been involved 

in many projects involving community 

health, women’s empowerment 

etc. 

PACHE Trust, in joint venture with 

SIGHT AND LIFE, has been engaged 

in the prevention of vitamin 

A deficiency disorders (VADD) in 

recent years. The SIGHT AND 

LIFE Newsletter 1/2002 contained 

an article from PACHE Trust (pp. 

20–21), and pictures of program 

activities were included in Newsletter 

3/2004, p. 48. The project 

was launched in districts where 

children were found to be prone 

to deficiency diseases. It is one 

of the most significant projects in 

Tamil Nadu addressing the needs 

of children below 10 years of age. 

VADD are a major health concern 

among children, especially the 

rural poor. The project has been 

attaining increasing success with 

every passing year. The community 

has been sensitized and there 

is visibly increased awareness on 

the prevention of VADD. 

The goals, to treat and prevent 

VADD, have not changed over 

the years. The methods of communication, 

training and of raising 

attention for precautionary measures 

have been developed and 

refined. More attention is now 

given to pregnant and lactating 

mothers. 

Achievements include reaching 

more children, the orientation of 

school teachers, regular school 

visits, regular vitamin A supplementation 

(vitamin A capsules), 

health camps, giving attention 

to people with other diseases 

and a strong collaboration with 

authorities. 

Awareness of self-help 

groups (SHG) 

The SHGs play a major role in 

the effective implementation of 

project activities because women 

are highly involved. It is the SHGs 

who disseminate the new messages 

and developmental measures 

to the community, especially 

to the women. Besides dissemination 

of information regarding 

vitamin A, other micronutrients,


33 


macronutrients and the importance 

of a balanced diet were 

emphasized. 

During the past year 30 orientation 

seminars were conducted 

for SHG leaders (many of them 

are women) representing about 

900 groups. The training had a 

wholesome effect and served its 

purpose. The members of the 

SHGs are trained well and the 

success of the project relies on 

them as they have to bring the 

group together and to pass on 

the messages. 

Kitchen gardening 

This proved to be an interesting 

and suitable approach. Besides 

the general public, school children 

showed much interest in planting 

saplings beside the school and in 

other places. It was demonstrated 

how to collect seeds and how to 

handle them to grow plants. 

Cultural programs 

The street plays and other activities 

have their own impact on the program. 

In this way even illiterate people 

can understand the concept. 

Conclusions 

The program is going well and 

developing in the right direction. 

There are more people to 

reach and resources are never 

enough. We thank all those who 

contributed to the success of the 

program especially all the active 

participants, school children, 

women and SHG leaders, but 

also organizations like SIGHT 

AND LIFE, whose contributions 

are essential. We hope to be able 

to continue our work with the 

help of all. 

An integrated nutrition, training and education 

program 

R Ratna Swamy, State Health Coordinator, Population and Environmental Education 

Centre (PEEC), Velgode, Kurnool District, Andhra Pradesh, India. 

Introduction 

PEEC considers itself privileged 

to work hand in hand with SIGHT 

AND LIFE. The support of SIGHT 

AND LIFE over the past years 

has made it possible to develop 

a significant health program covering 

most of the state of Andhra 

Pradesh. Reports about PEEC 

activities were included in SIGHT 

AND LIFE Newsletters 3/2001 

(pp. 34–35) and 1/2004 (p. 17). 

The program is a continuation 

from previous years and it is key 

to sustainability through education, 

counseling and distribution 

of vitamin A capsules. The main 

target groups are community and 

grass-roots people who are given 

adequate knowledge to make use 

of the available natural resources 

to overcome nutritional problems 

in growing children. 

Main activities 

PEEC is a center for the coordination 

of activities for more 

than 110 local NGOs, and even 

more NGOs attend information 

meetings. Orientation and training 

programs for NGO leaders 

on the importance of vitamin A 

deficiency (VAD) are offered, as 

well as awareness camps on 

eye care for schoolchildren, slum 

children and their parents. The 

vitamin A capsules from SIGHT 

AND LIFE are not only important 

for the immediate prevention of 

deficiency, they are also an important 

tool to raise awareness 

and to reach people and finally to 

communicate the message about 

the importance of the vitamin A 

and the various kinds of fruits, 

vegetables and other foods containing 

vitamin A and provitamin 

A carotenoids. 

The financial support from SIGHT 

AND LIFE allows us to give small 

financial contributions to some 

NGOs for their activities and to 

start vegetable gardens. PEEC 

prepares and prints resource materials 

like wall posters, handbills, 

stickers and booklets etc. in the 

local language. Assistance was 

offered to tsunami victim families 

using a special grant from SIGHT 

AND LIFE. 

Training programs 

During 2005 only three training 

programs were conducted. They 

were attended by representatives 

from 85, 90 and 66 NGOs. 

Awareness programs 

Some of the partner NGOs are selected 

for this program to spread 

the message on the need for 

vitamin A and its relation to eye 

care. These NGOs visit schools, 

slum areas, integrated child development 

schools and women’s 

groups, and enlighten them about 

the importance of healthy nutrition. 

Also they inform the children, 

their parents and neighbors 

about the various vegetables and 

fruits. These NGOs also distribute 

resource materials like wall posters, 

handbills, UNICEF materials 

and booklets, and they paste wall 

posters on the walls of important



public places in the villages. It 

is very effective and people are 

interested in participating in such 

meetings. 

A new method of awareness 

campaigning is carried on in the 

districts of Guntur and Krishna. In 

this the local NGOs have formed 

into a committee and engaged a 

motor vehicle with all our slogans, 

symbols of vitamin A deficiency 

and eye care which moves from 

village to village. The local leaders 

in the villages have taken on 

the responsibility of spreading the 

messages. 

Vegetable gardens 

This is an innovative method to 

ensure that vegetables with a 

rich carotenoid content, including 

green leafy vegetables, are made 

available to people in the local 

markets. For this we have given 

some assistance to women farmers 

and women’s self-help groups 

to grow vegetables with more 

provitamin A. This is a revolving 

fund and the partner NGOs will 

be revolving this money among 

the women’s groups. This has 

proved very successful in some 

districts, like Chittoor, Prakasam 

and Guntur. 

PEEC’s sister organization, the 

Rural Development Society, distributes 

vegetable seeds as part 

of the kitchen gardens scheme 

for better nutrition among children. 

This program is linked with 

vitamin A deficiency prevention. 

Thousands of families are given 

the vegetable seeds which they 

plant in kitchen gardens around 

their houses and use for food. 

So this is also indirectly supporting 

the eradication of vitamin A 

deficiency. 

Resource materials 

Wall posters are prepared and 

printed. These are distributed 

to the partner NGOs for display 

on the walls of public places to 

highlight the message. This is 

very informative and people are 

very enthusiastic about it. 

Handbills are distributed to the 

public in the villages during festivals, 

holidays etc. They are very 

effective. Social workers, doctors 

and paramedical staff appreciate 

them as they are another form of 

information material. 

The “SIGHT AND LIFE Guidebook 

on Vitamin A in Health and 

Disease” was translated into the 

local language (Telugu), printed 

and distributed to local leaders, 

teachers, social workers etc. 

through NGOs. This book has 

been well received and needs to 

be reprinted to meet demand. 

Tsunami assistance 

Emergency relief measures were 

carried out in four districts. The 

relief materials distributed during 

the disaster period consisted 

of food grains like rice and dhal; 

aluminum pots for selling fish; 

dress materials for saris and 

dhotis; towels, blankets and 

utensils; and educational materials 

like note books, slates etc. for 

schoolchildren. The aid included 

calcium tables and safe drinking 

water containers. This covered 

440 families altogether and 420 

children benefited. The tsunami 

victims expressed their gratitude 

to SIGHT AND LIFE for the help 

in the emergency. 

Conclusion 

On the whole, the program is 

continuing successfully and no 

major difficulties are faced. Many 

NGOs are interested in participating 

and they are asking us to hold 

meetings every three months. 

The vitamin A capsules are very 

attractive and many NGOs want 

to receive more, but we are not 

able to supply them because the 

stock is very limited. The government 

is not issuing the permission 

necessary to import the 

vitamin A capsules donated by 

SIGHT AND LIFE. The products 

available in the medical stores 

are not comparable and are very 

expensive. PEEC wants to reach 

even more people in Andhra 

Pradesh but due to financial and 

resource restrictions this is not 

always possible.


35 


Knowledge and perception of vitamin A 

deficiency in the villages of Burkina Faso 

Rosemary Fleury Téchoueyres, Youzondo Association, Bordeaux-Caudéran, France 

During missions to the north of 

Burkina Faso, we noticed cases 

of night blindness. This led us to 

found the Youzondo Association, 

whose name, in the Moré language, 

refers to this condition. 

Operation 

In many areas we chose to create 

village associations consisting of 

a committee of eight people and 

two delegates per district. They 

meet every quarter to discuss a 

topic related to nutrition, communication 

or agriculture. Their 

activities are coordinated with the 

national Burkinabé Association 

for the Prevention of Youzondo. 

It all began under the palabras 

tree at Petit Samba. As usual 

between 1pm and 4pm we were 

discussing everyone’s concerns, 

particularly with regard to children’s 

health, and this was how 

we heard about Youzondo sickness. 

Action taken 

With the help of a student pharmacist 

from Ouagadougou, we 

studied the average composition 

of the diets of 80 mothers 

and their children by means of 

a questionnaire. This evaluative 

work also took into account levels 

of plasma retinol and conjunctival 

impression tests. The extent of vitamin 

A deficiency at Petit Samba 

was found to be a serious public 

health problem. 

The second stage was to organize 

a day of festive and sporting 

events, including a bicycle race, 

a football match, and a theatre 

performance given by Hippolyte 

Ouangrawa’s troupe. This show 

portrays a village family whose 

son suffers from night blindness. 

It describes the intervention of 

members of his family, the woman 

next door, the marabout, and the 

nurse at the Centre of Health and 

Social Advancement. The subject 

(i.e. the dangers of vitamin A deficiency, 

the way to deal with it, 

the kinds of food which contain 

it etc.) is treated both accurately 

and humorously. Afterwards, a forum 

allows the audience to react, 

to ask questions, and to give their 

point of view. 

The third part of our approach 

was training. Thanks to subsidies, 

we were able to create health 

broadcasts for local radio. We 

also organized 3 days of training 

with a medical nutritionist and 

a sociologist, aimed at nurses, 

district delegates, and teachers. 

We stressed the importance of 

a varied diet. We recommended 

orange fruits and vegetables 

(mangoes, papayas, carrots, 

and orange sweet potatoes) 

and vegetables with dark green 

leaves (leaves of sorrel, niebe and 

baobab). Other foods, however, 

are not so readily available: eggs, 

liver, milk and related products, 

and red palm oil, the supply of 

which has been stopped from 

Ivory Coast. 

Results 

Three hundred and sixty-five 

mango trees have been planted in 

Petit Samba. At Bonou, we have 

a one-hectare market garden. 

Two other villages are about to 

begin growing for the market. 

At Tiogo, a dispensary has been 

built. Schools are circulating 

health information thanks to the 

educational materials sent by 

SIGHT AND LIFE. 

Conclusions 

We are preparing a 5-year scientific 

evaluation of the effect of 

awareness-raising at the village 

of Petit Samba for 2007. 

We would like to thank the many 

people who help us to do our job, 

whether through work, donations, 

or in other ways.



Vitamin A deficiency and malnutrition among 

Sudanese children admitted to an urban hospital 

Hassan Mohamed Ahmed, Professor of Pediatrics and Dean of the Faculty of Medicine, 

Academy of Medical Sciences and Technology, Khartoum, Sudan 

Protein energy malnutrition (PEM) 

constituted about 10% of total 

admissions to the Academy 

Charity Teaching Hospital (ACTH) 

during the period between December 

2004 and December 

2005. Xerophthalmia was found 

more often in children with malnutrition 

or after measles infection, 

and in children from displaced 

families, among nomads and in 

orphans. 

During the above period a total 

number of 1,420 children under 

five years were admitted to the 

nutrition ward of ACTH, 13 of 

whom had different degrees of 

xerophthalmia. Two children developed 

keratomalacia, which in 

one was bilateral and left the child 

totally blind. The second child 

lost one eye, which had ruptured 

at home before admission. All 

children admitted were given 2 

doses of vitamin A in dosages 

recommended by the WHO. This 

was adopted as a routine on the 

PEM ward. We thank SIGHT AND 

LIFE for providing the vitamin A 

capsules. 

The initial vitamin A level in Sudanese 

children showed wide 

variation, but the important fact 

was that about 42% of them were 

below 40 µg/100ml, and 20% 

were well below 20 µg/100ml. 

This is a level which predisposes 

children to xerophthalmia and 

blindness. 10 days after vitamin 

A supplementation all children 

showed a significant rise in serum 

vitamin A to protective levels of 

above 40 µg/100ml. 

The National Nutritional Programs 

maintain supplementation of vitamin 

A at a community level. They 

conduct home-to-home visits as 

part of an EPI team for immunization 

to eradicate poliomyelitis. 

Vitamin A is supplemented twice 

a year in doses recommended by 

the WHO. 

The fight against vitamin A deficiency at 

Ouassa-Beket, Benin 

Jeremie Orou, Fondation pour l’Aide et l’Autopromotion à la Base en Matière 

de Santé et Développement (FAABA), Bembereke, Bénin 

In 2005 FAABA, in collaboration 

with the Ouassa community 

centre, completed three major 

projects to combat vitamin A 

deficiency: 

• A campaign to distribute 

vitamin A 

• Nutritional education of mothers 

and caregivers 

• Cultivation of vegetables by the 

women 

Campaign to distribute 

vitamin A 

This campaign was announced 

by the town crier, and publicized 

on local radio. On 14 October 

2005, over 500 children aged 

between 6 months and 5 years 

were seen, and each received a 

capsule. 

Nutritional training 

We organized two training sessions 

for mothers, and especially 

grandmothers who take care of 

the children after weaning. The 

latter are often illiterate and the 

guardians of traditional taboos 

surrounding food. We showed 

these women the various foods 

(for growth, energy and protection) 

using posters which stress


37 


the importance of yellow and redcolored 

foods rich in vitamin A. 

Cultivation of vegetables 

After the training sessions by 

our agents, the women of Beket 

decided to start a garden for the 

cultivation of vegetables, especially 

leafy vegetables. This initiative 

will allow the enrichment of 

children’s diets, and will provide 

them with a good source of vitamins 

and minerals. 

Conclusion 

The success of our operation has 

encouraged us to continue in 

2006. We even plan to bring in an 

ophthalmic specialist to diagnose 

the population in our local area. 

We would like to thank SIGHT 

AND LIFE for their help with regard 

to the capsules and educational 

materials. 

Continued activity of the Ramala Women’s Group 

Margaret Anyango, Rongo 40404, PO Box 119, Kenya 

Introduction 

We are glad to be able to continue 

our work in mitigating micronutrient 

deficiencies and related 

dangers as well as to contribute 

to the improved nutrition of all 

those participating in our activities. 

The continued support 

of SIGHT AND LIFE in the form 

of financial assistance, as well 

as with educational materials 

and the links opened to other 

organisations were essential for 

our work within Rongo and its 

neighboring regions, which is 

timely and relevant. Thus it is in 

keeping with the overall mission 

of the group, i.e. to holistically 

enhance, foster, promote, and 

strengthen socio-economic opportunities 

of rural women and 

children. Health-related issues 

including nutrition remain the top 

priority of the group. We strongly 

believe that health is not only the 

absence of ills but also the fight 

for the fullness of life, a life free 

from micronutrient deficiencies. 

Nutrition activities 

Vitamin A capsules received from 

SIGHT AND LIFE were administered 

to 3,673 children below five 

years of age. About 27 days were 

spent on this exercise. The envisaged 

outcome of this exercise 

was to improve retinol levels in 

children under five and to reduce 

episodes of night blindness, 

acute VAD and related disorders, 

and other VAD-related ailments 

among children. Rongo and its 

neighboring regions, such as 

Sakwa, Kamagambo, Randung, 

Opapo, Migori, etc. benefited. 

On various occasions RWG 

distributed about 5.58 tons of 

foodstuffs rich in vitamin A. Such 

vegetables as cabbage, sukumawiki 

(kale), carrots, kiukamba, 

etc. were distributed to women 

of childbearing age and children 

of five years and under. Approximately 

1,500 persons benefited 

from this program. Many of the 

women reached were also trained 

in how to prepare vegetables 

without destroying their nutritious 

value. 

About 63 persons have been 

trained so far. During such training, 

participants are taught how 

to prepare foods without destroying 

vital micronutrients. Demonstrations 

on how to prepare such 

foods were also conducted. Most 

women at the time of the training



were at least breast-feeding their 

babies. It was quite encouraging 

to see some of these women taking 

notes very seriously during 

the demonstrations. 

A wide range of training techniques 

and tools were used, such 

as group-focused discussions, 

roleplay, case study, brainstorming, 

demonstrations, lectures, 

etc. The training emphasized the 

involvement of schoolchildren as 

key informants and educators 

both at family and community 

levels. Participants were informed 

about strategies to involve children, 

such as drawing competitions, 

debates, poems, etc. 

Eye health training 

and door-to-door eye 

screening 

Due to ever-increasing complaints 

about eye-health-related problems 

by community members, 

and childhood blindness due to 

VAD, this training was a necessary 

part of the effort of RWG. 

Five individuals were selected 

for further training on the basis 

of their ability to deliver services 

to the communities, reputation 

and working relationship within 

the communities. They were fully 

aware of the people and their 

needs. Two resource persons invited 

from Tanzania facilitated the 

one-week intensive training. 

Training on poultry 

keeping 

The training was intended to increase 

local participation in direct 

production of locally available 

foods rich in vitamin A. To attend 

the training it was required that 

participants were able to start 

and sustain chicken-rearing to required 

standards which would be 

overseen by a qualified veterinary 

officer. From the local communities 

56 women were trained by 

veterinary officers from the Ministry 

of Livestock Development on 

how to start and manage a small 

poultry farm for family and other 

domestic purposes. The training 

included visits to commercial 

poultry farmers. 

Conclusions 

We are convinced that our efforts 

are going in the right direction. 

However, more is necessary in 

training and communication as 

well as in local production of 

healthy food through food production 

initiatives and encouragement 

of agro-business. 

We cannot finish this report without 

noting that at present the efforts 

are not sufficient to manage 

VAD and other micronutrient deficiencies. 

In this sense we have 

to say the struggle continues 

and we hope for further support, 

including continuing support from 

SIGHT AND LIFE.


39 


SIGHT AND LIFE visits Pohnpei, Micronesia, and 

films a nutrition documentary 

Lois Englberger and Adelino Lorens, Island Food Community of Pohnpei, PO Box 2299, 

Kolonia, Pohnpei, Federated States of Micronesia 

SIGHT AND LIFE visited Pohnpei 

in April 2006 to film a documentary 

about nutrition problems in 

Micronesia and the efforts underway 

for alleviating these problems. 

Their visit was coordinated 

by the Island Food Community of 

Pohnpei. 

Klaus Kraemer, Head of SIGHT 

AND LIFE, and Thomas Breisach, 

Deputy Head of the DSM Nutritional 

Products Communications 

Section, made up the SIGHT 

AND LIFE team. They were in 

Pohnpei from 21 to 27 April, 2006. 

Ulla Lohmann, filmmaker, and her 

camera assistant Markus Hain 

were engaged as consultants 

and were in Pohnpei from 10 to 

27 April, 2006. 

The purpose of the film is to produce 

a documentary about global 

nutrition problems, including micronutrient 

deficiencies and nutrition- 

and lifestyle-related chronic 

diseases such as diabetes, heart 

disease and cancer. Dr. Kraemer 

pointed out that Pohnpei is an 

example of a country having a 

double burden of malnutrition: the 

problem of micronutrient deficiencies 

such as vitamin A deficiency, 

and the problem of overweight 

and chronic diseases. He said, 

The SIGHT AND LIFE team (from left): Markus Hain, Ulla 

Lohmann, Klaus Kraemer, Thomas Breisach. 

“No one would expect an island 

in the Pacific to have the nutrition 

problems of both developing and 

industrialized countries.” 

Over half of Pohnpei’s children 

have vitamin A deficiency, a disorder 

leading to increased infection 

and mortality. Coupled with 

this, there are serious problems 

of obesity and chronic diseases 

such as diabetes, heart disease 

and cancer in Pohnpei, leading 

to higher rates of mortality and 

great suffering among families 

and individuals. 

The group filmed the beauty 

spots of Pohnpei, including the 

lush Pohnpei landscape, the historical 

site of Nan Madol, water 

scenes, and cultural events, first 

portraying aspects of the paradise 

concept that many people 

in other parts of the world have 

about life on a Pacific island. 

The team then filmed aspects 

of the real-life situation relating 

to food, nutrition and health, 

and efforts to improve the nutritional 

situation. These included 

the Pilot Farm in Madolenihmw 

led by Pohnpei Agriculture of 

the Department of Economic 

Affairs, the Pohnpei Traditional 

Foods for Health project led by 

IFCP in collaboration with Mand



The Governeur of Pohnpei, Johnny 

P David with Klaus Kraemer. 

Community and the Centre for 

Indigenous Peoples’ Nutrition 

and Environment (CINE); Mr. Sei 

Uemoto and his plans to develop 

increased marketing of Karat 

banana and other local foods; 

the Youth to Youth project with 

Class 4 of Mand Elementary 

School in collaboration with the 

Conservation Society of Pohnpei; 

Pohnpei Library Week along their 

theme of “GO LOCAL”; and the 

vitamin A supplementation program 

led by the Pohnpei Department 

of Health/FSM Department 

of Health, Education and Social 

Affairs. 

SIGHT AND LIFE has provided 

on-going assistance for many 

years to the Federated States of 

Micronesia, including research on 

the nutrient content of local island 

foods and vitamin A awareness 

materials, such as posters and 

the recent video titled GOING 

YELLOW, which has often been 

shown on Pohnpei 

local television. 

This video was 

prepared last year 

(2005) as a project 

initiated and supported 

by SIGHT 

AND LIFE in conjunction 

with the 

Island Food Community 

of Pohnpei 

and produced by 

Micronesian Seminar 

(see SIGHT 

AND LIFE Newsletter 

1/2006, pp. 

31–33). 

At the farewell luncheon. 

At a farewell luncheon for the 

SIGHT AND LIFE team, Dr. Kraemer 

was invited to give a few 

words of advice to IFCP and their 

efforts to improve health and nutrition 

in Pohnpei. The IFCP board 

members and all present were 

very touched by his insight. His 

three points were as follows: 

• Think about quantities of food 

eaten. There is a serious problem 

of overweight and obesity 

in Micronesia. Fresh local 

foods are generally good, but 

even local foods can lead to 

overweight if eaten in excess or 

if prepared in unhealthy ways 

(adding sugar, frying or using 

excess fat). 

• Focus on the youth. They are 

the future. Their habits are not 

yet fully set. 

• Remember that not all imported 

foods are unhealthy. 

There are some imported foods 

available that are fortified with 

micronutrients. Remember to 

read the labels!! 

IFCP has already started working 

on this advice, talking about 

quantities eaten and working 

with the youth. Also, an email 

message was sent out to the 

IFCP email network to share information 

about fortified instant 

noodles. Although many instant 

noodles sold in Pohnpei contain 

no vitamin A, there are some 

brands that have been fortified 

and contain up to 30% of the 

estimated daily requirements. If 

consumers plan to eat instant 

noodles, they could choose the 

fortified brands in order to get a 

more nutritious food. The same 

message is now being relayed 

to community members in small 

workshops, showing actual examples 

of the fortified and nonfortified 

brands. 

Nutrition education (left) and Lois Englberger weighing and measuring a 

woman. 

Thanks are again extended to 

SIGHT AND LIFE for their visit to 

Pohnpei, making the documentary 

and providing helpful advice. 

The IFCP also thanks their partner 

agencies including Pohnpei Agriculture 

of the Department of Economic 

Affairs, College of Micronesia-FSM 

Land Grant Program, 

Pohnpei Departments of Health 

and Education, and the Pacific 

German Regional Forestry Project, 

for providing transport.


41 


A digest of recent literature 

Donald S McLaren* 

Introduction 

Mention has been made in several 

recent issues of the Newsletter of 

the shift in topic that has gradually 

taken place in the retinoid and carotenoid 

literature. Basic laboratory 

research has far outstripped human 

community and clinical studies 

which are clearly of more concern to 

most readers of the literature digest. 

As a result, abstracts of basic studies 

have had to be strictly limited 

because of restricted space. An 

attempt has been made to include 

those basic studies that seem to be 

of greatest relevance, but this has 

hitherto left a large number of chosen, 

relevant papers excluded. 

A number of readers have expressed 

their appreciation of the 

way in which their attention has 

been drawn by a quick scan of the 

literature digest to topics of special 

interest to them. This would clearly 

be all the more valuable if the coverage 

of the new literature could be 

made more complete. Consequently, 

this issue contains an Appendix 

after the main abstracts. This has 

been compressed to provide only 

essential information on the papers 

it covers in order to include as many 

as possible. The title (sometimes 

abbreviated) is in bold as usual, 

followed by the name and initials of 

the first author and finally the journal 

reference. Abbreviated abstracts 

have been grouped according to 

topic as this seemed the best way 

for readers, if they so wish, to make 

some selection. With use of the 

Internet this should give access to 

more complete information. It would 

be helpful to the editor to learn if this 

change is appreciated. 

* Address for correspondence: 

Prof. Donald S. McLaren 

12 Offington Avenue, Worthing, 

West Sussex BN14 9PE, UK 

mclarendonald@yahoo.co.uk 

Community research 

“Vitamin A supplementation for reducing 

the risk of mother-to-child 

transmission of HIV infection” by 

Wiysonge CS, Shey MS, Sterne 

JAC et al. Cochrane Database 

Syst Rev 2005, No 4, p. CD003648 

(Ministry of Public Health, Central 

Technical Group, EPI c/o BP 25125 

Messa, Yaounde, Cameroon. Email: 

wiysonge@yahoo.com) 

Results of this review did not find 

evidence to support vitamin A supplementation 

of HIV-infected pregnant 

women to reduce mother-tochild 

transmission of HIV, although 

there was evidence of birth weight 

improvement. 

Results of the large trial in Zimbabwe 

(see below) were awaited at 

this time. 

“Effects of a single large dose of 

vitamin A, given during the postpartum 

period to HIV-positive 

women and their infants, on child 

HIV infection, HIV-free survival, 

and mortality” by Humphrey JH, 

Iliff PJ, Marinda ET et al. J Infec 

Dis 2006; 193: 960–971 (JH Humphrey, 

1 Borrowdale Road, Borrowdale, 

Harare, Zimbabwe. Email: 

Humphrey@viambo.co.zw) 

14,110 mother-infant pairs were enrolled. 

Neither maternal nor neonatal 

vitamin A supplementation significantly 

affected postnatal MTCT 

or overall mortality. For several 

reasons the results of this trial raises 

concern about universal maternal or 

neonatal vitamin A supplementation 

in HIV-endemic areas. (This would 

include large areas in the third world 

where maternal vitamin A supplementation 

programs are currently 

recommended by WHO). 

The above concerns are echoed 

by WW Fawzi in an accompanying 

editorial – “The benefits and 

concerns related to vitamin A 

supplementation” J Infec Dis 

2006;193: 756–759 

“Effects of postpartum maternal 

or neonatal vitamin A supplementation 

on infant mortality 

among infants born to HIV-negative 

mothers in Zimbabwe” by 

Malaba LC, Iliff PJ, Nathoo KJ 

et al. Am J Clin Nutr 2005; 81: 

454–460 (JH Humphrey, ZVITAMBO 

Project, 1 Borrowdale Road, Borrowdale, 

Harare, Zimbabwe. Email: 

jhumphrey@zvitambo.co.zw) 

This study was part of the large trial 

described in the previous abstract. 

Mothers who received vitamin A 

received 400,000 IU and infants 

50,000 IU. Over 12 months of follow 

up there was no effect on infant 

mortality in either case. 

“Some dietary and adipose tissue 

carotenoids are associated 

with the risk of nonfatal acute 

myocardial infarction in Costa 

Rica” by Kabagambe EK, Furtado 

J, Baylin A et al. J Nutr 2005; 135: 

1763–1769 (Hannia Campos, Email: 

hcampos@hasph.harvard.edu) 

1456 cases of first acute MI were 

matched with the same number 

of healthy controls. Subjects were 

distributed into quintiles of dietary 

intake or adipose tissue concentration 

of carotenoids or tocopherols. 

Adipose tissue β-carotene content 

was inversely related to MI risk, as 

was intake of fruits and vegetables 

rich in β-carotene. Lutein + zeaxanthin 

content of adipose tissue was 

directly associated with MI risk. 

“Antioxidant vitamins reduce 

oxidative stress and ventricular 

remodeling in patients with 

acute myocardial infarction” by 

Gasparetto C, Malinvorno A, Culacciati 

D et al. Int J Immunopathol- 

Pharmacol 2005; 18: 487–496 (Dept 

of Int Med and Therapy, University 

of Pavia, Italy) 

Various parameters of the antioxidant 

system were monitored from 

shortly after the onset of the acute 

MI until one month later. Vitamin 

treatment improved the antioxidant 

system, reduced the oxidative 

stress, inflammatory process and 

left ventricular modeling. 

“Effect of vitamin A on fracture 

risk” by Jackson HA, Sheehan AH. 

Ann Pharmacother 2005; 39: 2086– 

2090 (HA Jackson, Clarian Health



Partners Pharmacy Dept, 1-65 21 st 

St., Indianapolis, IN 46202-1367, 

USA. Email: hjackson@clarianorg) 

This literature search from 1966 

to March 2005, using vitamin A 

consumption and fracture risk fails 

to provide definitive evidence for a 

causal association. 

“Vitamin supplementation of 

HIV-infected women improves 

postnatal child growth” by Villamor 

E, Saathoff E, Bosch RJ et al. 

Am J Clin Nutr 2005; 81: 880–888 

(Department of Nutrition, Harvard 

School of Public Health, 665 Huntington 

Avenue, Boston, MA 02115, 

USA. Email: evillamo@hsph.harvard.edu) 

Multivitamins (thiamin, riboflavin, 

vitamin B6, niacin, vitamin B12, 

vitamin C, vitamin E and folic acid) 

were tested against vitamin A or 

β-carotene. Multivitamins gave 

significant improvement in attained 

weight, weight for age, and weight 

for length. Vitamin A or β-carotene 

had no such effect, indeed vitamins 

and β-carotene mix seemed to reduce 

benefits on these outcomes. 

“Vitamin A, mastitis, and motherto-child 

transmission of HIV- 

1 through breast-feeding” by 

Dorosko SM. Nutr Rev 2005; 63: 

332–346 

Mastitis is an increased mammary 

permeability and is frequently accompanied 

by bacterial infection. 

Supplementation with vitamin A 

reduces the prevalence of bacterial 

mastitis and the inflammatory 

response. However, studies 

of mother-to-child transmission in 

HIV-positive women have shown 

no reduction with vitamin A supplementation. 

One study in Tanzania 

reported an increase. Possible 

mechanisms for this unexpected 

result are being investigated. One 

way may be the paracellular entry 

of leukocytes affected by retinoic 

acid into breast milk. 

“Diarrhoea and malnutrition in 

children” by Baqui AH, Ahmed T. 

Brit Med J 2006; 332: 378 (Dept 

Int Hlth, Johns Hopkins University, 

Bloomberg School of Public Health, 

Baltimore MD 21205, USA. Email: 

abaqui@jhsph.edu) 

This review follows an international 

meeting in Bangladesh on this 

subject. Oral rehydration has been 

successfully pursued for more than 

three decades and now WHO and 

UNICEF have introduced a new 

reduced osmolarity formulation 

(WHO/UNICEF Joint Statement. 

Clinical management of acute diarrhoea. 

2004). In addition they recommend 

the therapeutic use of zinc 

for 10–14 days at a dose of 10 mg 

daily in infants under 6 months and 

20 mg daily in older children. There 

is no mention of vitamin A. Before 

the beneficial effect of zinc supplementation 

in acute diarrhea was 

discovered there were many reports 

of the efficacy of vitamin A. A recent 

reappraisal (see two abstracts below) 

reported even greater benefit 

of vitamin A than when analysis 

was made previously. Furthermore, 

there is growing acceptance of the 

concept that diarrhea is often an 

integral part of vitamin A deficiency 

and the need for vitamin A replacement 

is evident. Other recent documents, 

especially in connection with 

achievement of some of the Millennium 

Goals have always bracketed 

together vitamin A and zinc in this 

context. This issue requires urgent 

attention; data supporting vitamin A 

supplementation for treatment and 

prevention of diarrheal diseases are 

available. 

“Maternal vitamin A supplementation 

and immunity to malaria 

in pregnancy in Ghanaian primigravids” 

by Cox SE, Staalsoe T, 

Arthur P et al. Trop Med Int Hlth 

2005;10:1286–1297 (Dept Epidemiology 

and Population Health, 

London Sch Hyg & Trop Med, London, 

UK. Email:Sharon.Cox@lshtm. 

ac.uk) 

The pathological effects of malaria 

in pregnancy are believed to be due 

to the sequestration of parasites in 

the placenta, mediated by binding 

of variant surface antigens (VSA) 

expressed on the surface of P. 

falciparum-infected red blood cells 

to placental chondroitin sulfate A 

(CSA). Vitamin A supplementation 

was accompanied by reduced 

levels of anti-VSACSA antibodies 

and may reflect reduced placental 

parasitemia. 

“Random-effects models in investigating 

the effect of vitamin 

A in childhood diarrhea” by 

Andreozzi VL, Bailey TC, Nobre 

FF et al. Ann Epidemiol 2006;16: 

241–247 (VL Andreozzi, Avenida 

Humberto Delgado 33, Alhos Vedros, 

2860-021, Portugal. Email: 

valeska@fiocruz.br) 

Enhanced statistical analysis methods 

were applied to previous studies 

on vitamin A and diarrhea in 

childhood. Levels of significant 

beneficial effects were reached that 

were not attained previously – see 

also comments on WHO/UNICEF 

recommendations that include zinc 

but exclude vitamin A two abstracts 

above. 

“The concentration of free holoretinol-binding 

protein is higher 

in vitamin A-sufficient than in 

deficient Nepalese women in late 

pregnancy” by Sankanarayanan 

S, Suarez M, Taren D et al. J Nutr 

2005;135: 2817–2822 (Penn State 

Univ, Huck Inst Life Sci, University 

Park, PA 16802, USA. Email: 

fxr5@psu.edu) 

The RBP/TTR index (< 0.36 or serum 

retinol < 1.05 µmol/l indicative 

of vitamin A deficiency), introduced 

by FJ Rosales of this group, was 

shown to be a useful proxy for free 

holo-RBP concentration and that 

vitamin A status affects its distribution. 

“Serum carotenoids, vitamins A 

and E, and 8-year lung function 

decline in a general population” 

by Guenegou A, Leynaert B, Pin 

I et al. Thorax 2006; 61: 320–326 

(Dept Epidemiology, INSERM Unit 

700, University of Medicine Bichat, 

16 rue Henry Huchard, 75018 Paris, 

France. Email: guenegou@bichat. 

inserm.fr) 

1194 French subjects aged 20–44 

years were examined in 1992 and 

followed up in 2000. Serum β-carotene 

underwent a steady increase in 

that period and along with this there 

was a similar slower decline in FEV1 

(forced expiratory volume in 1 second) 

– an indicator of lung function. 

In heavy smokers both β-carotene 

and vitamin E were protective. 

“Dietary β-cryptoxanthin and 

inflammatory polyarthritis: re-


43 


sults from a population-based 

prospective study” by Pattison 

DJ, Symmons DPM, Lunt M et al. 

Am J Clin Nutr 2005; 82: 451–455 

(Arthritis Research Campaign, 

Epidemiology Unit, University of 

Manchester, UK) 

A modest increase in β-cryptoxanthin 

intake, equivalent to one glass 

of freshly squeezed orange juice per 

day, is associated with a reduced 

risk of developing inflammatory 

disorders such as rheumatoid arthritis. 

“Serum retinol and total carotene 

concentrations in obese preschool 

children” by Saccardo-Sarni 

RO, De Souza FIS, Ramalho RA et 

al. Med Sci Monit 2005; 11: 510–514 

(RO Saccardo-Sarni, R Zamlutti 94, 

Sao Paulo, CEP: 04116-260, Brazil. 

Email: rssarn@uol.com.br) 

It was found that there was an 

association between obesity and 

hyperlipidemia and low serum level 

of carotenoids; possibly affording 

some antioxidant protection. (It is 

doubtful if total carotenoid levels 

are meaningful; fractionation would 

appear essential.) 

“Momordica cochinchinensis, 

Rosa roxburghii, wolfberry, and 

sea buckthorn – highly nutritional 

fruits supported by tradition and 

science” by Burke DS, Smidt CR, 

Vuong LT. Curr Top Nutraceut Res 

2005; 3: 259–266 (Pharmanex 

Research Institute, LLC, 75 West 

Center Street, Provo, UT 84601, 

USA. Email:dburke@pharmanex. 

com) 

Fruits such as these originate from 

Southeast Asia where their value as 

healthy fruits has been recognized 

for many years. Analysis has shown 

that they are rich in antioxidant 

vitamins, especially lycopene and 

β-carotene. 

“Modification of lymphocyte 

DNA damage by carotenoid supplementation 

in postmenopausal 

women” by Zhao X, Aldini G, 

Johnson EJ et al. Am J Clin Nutr 

2006;83:163–169 (KJ Yeum, Mayer- 

USDA-Human Nutrition Research 

Center on Aging, Tufts University, 

Boston, MA 02111, USA. Email: 

kyungjin.yeum@tufts.edu) 

All carotenoid-supplemented 

groups showed a significant decline 

in endogenous DNA damage. 

4 mg each of lutein, β-carotene and 

lycopene daily, an effective amount, 

can be readily taken orally. 

“Improving the nutritional value 

of Golden Rice through increased 

pro-vitamin A content” by Paine 

JA, Shipton CA, Chaggar S et al. 

Nature Biotech 2005; 23: 482–487 

(Syngenta, Jealott’s Hill Int Res 

Cent, Bracknell, Berkshire, RG42 

6EY, UK) 

It was discovered that the daffodil 

gene that encoded phytoene synthase 

(psy), one of the two genes 

used to develop Golden Rice, 

was the limiting step in β-carotene 

accumulation. A psy from maize 

was substituted. Total carotenoids 

increased up to 23-fold maximum 

with a preferential accumulation of 

β-carotene. 

Multimicronutrient 

research 

“Micronutrients in childhood 

and the influence of subclinical 

inflammation” by Thurnham DI, 

Mburu ASW, De Wagt A. Proc Nutr 

Soc 2005; 64: 502–509 (Univ Ulster, 

Ctr Food & Hlth, Sch Biomed Sci, 47 

Knocknougher Rd, Coleraine BT51 

4LA, Londonderry, Northern Ireland. 

Email:di.thurnham@ulster.ac.uk) 

Attention is drawn in this review to 

the neglected importance of the 

acute phase response (APR) in the 

assessment of nutritional status of a 

number of micronutrients. Vitamin A, 

iron and zinc have been most extensively 

studied in this regard but other 

vitamins and elements are likely to 

be implicated. The phenomenon is 

widespread, especially in childhood, 

as even subclinical infection and inflammation 

are capable of reducing 

the concentration of the nutrient in 

the serum and the effect is evident 

within as little as 24 hours. The 

overall effect is to give the impression 

that deficiency levels are more 

widespread than they really are. 

Attempts are being made to devise 

and introduce correction values for 

routine application. 

“Prevalence of iron deficiency 

and its association with vitamin A 

deficiency in preschool children” 

by Ferraz IS, Daneluzzi JC, Vannucchi 

H et al. J Pediatr 2005; 81: 

169–174 (IS Ferraz, ER Preto/Bonfirm 

Paulista, km 308, CEP 14110- 

000 Ribeiro Preto, SP, Brazil. Email: 

isferraz@uol.com.br) 

179 children aged 24–72 months 

without diarrhea or fever at the 

time of the study were examined 

for vitamin A (30-day dose response 

test) and iron (HB, serum iron, and 

unsaturated iron-binding capacity 

assays) status. 135 had vitamin A 

deficiency and 64 had iron deficiency 

but there was no association 

between the two. 

“Anemia, iron status and vitamin 

A deficiency among adolescent 

refugees in Kenya and Nepal” by 

Woodruff BA, Blanck HM, Slutsker L 

et al. Publ Hlth Nutr 2006; 9: 26–34 

(Ctr Dis Control & Prevent, Ntl Ctr 

Chron Dis Prevent & Hlth Promot, 

Maternal & Child Nutr Branch, 4770 

Buford Highway NE, Mailstop K-25, 

Atlanta, GA 30341, USA. Email: 

BWoodruff@cdc.gov) 

Anemia (hemoglobin 8.3 µg/ml) and vitamin A deficiency 

(serum retinol < 0.7 µmol/l) 

had the following levels of prevalence: 

anemia 46% in Kenya, 24% 

in Nepal; 43% iron deficiency in 

each country; vitamin A deficiency 

15% in Kenya and 30% in Nepal. 

Adolescents tend to be a neglected 

group in refugee situations and 

merit greater care. 

“Only a small proportion of anemia 

in northeast Thai schoolchildren 

is associated with iron 

deficiency” by Thurlow RA, Winichagoon 

P, Green T et al. Am J Clin 

Nutr 2005; 82: 380–387 (Institute 

of Nutrition, Mahidol University, 

Salaya, Thailand) 

567 children aged 6–12.9 years 

were tested for anemia, hemoglobin 

type, iron and vitamin A status. The 

prevalence of anemia overall was 

31%, only 16% of these were iron 

deficient. Hemoglobinopathy and 

vitamin A deficiency played larger 

parts. (The data were not presented 

in a way that showed a relationship 

between iron deficiency and 

vitamin A deficiency. However, the 

study suggests that there is still



much to learn about this area. It 

is interesting to note that those 

with C-reactive concentration ≥10 

mg/l (n=12) were excluded from the 

study, indicating an understanding 

of the APR problem with vitamin A 

– see above.) 

“Anaemia, iron deficiency and 

vitamin A status among schoolaged 

children in rural Kazakhstan” 

by Hashizume M, Chiba M, 

Shinohara A et al. Publ Hlth Nutr 

2005; 8: 564–571 (Univ Tokyo, Dept 

Int Community Hlth, Grad Sch Med, 

Tokyo, Japan. Email: masahiro. 

hashizume@ishtm.ac.uk) 

Among 159 school-age children 

1) anemia, 2) iron deficiency and 

3) vitamin A deficiency were assessed. 

Indicators (but not criteria) 

used were: (1 and 2) HB, serum iron, 

serum ferritin, transferring saturation 

and erythrocyte protoporphyrin; 

and (3) serum retinol 0.5%). The usual 

ratio XN>X1B is reversed. No account 

was taken of APR.) 

“A double-blind, randomized, 

clinical trial of the effect of vitamin 

A and zinc supplementation 

on diarrheal disease and respiratory 

tract infections in children in 

Mexico City, Mexico” by Long KZ, 

Montoya Y, Hertzmark E et al. Am J 

Clin Nutr 2006; 83: 693–700 (Dept 

Nutrition, Harvard School of Public 

Health, Boston MA, USA) 

736 children, aged 6–15 months, 

were assigned to receive 1) vitamin A 

every 2 months, 2) zinc daily, 3) vitamin 

A and zinc, or 4) placebo. Overall 

vitamin A supplementation was 

associated with a 27% increase in 

diarrheal disease and 23% increase 

in cough with fever. Zinc had no effect 

on these outcomes. 

Rates were stratified by household 

and personal characteristics and the 

following results obtained: vitamin A 

decreased diarrhea in children from 

households with dirt floors but increased 

diarrhea in children from 

households with non-dirt floors, 

piped water, and indoor bathrooms. 

Zinc decreased diarrhea in children 

from households with dirt floors and 

whose mothers were more educated. 

Vitamin A increased cough with 

fever in children from less-crowded 

households that lacked indoor bathrooms 

and children of less-educated 

mothers. (The findings have 

been quoted almost word-for-word 

but these complex results are still 

very difficult to interpret. However, 

they should have a bearing on the 

recent UNICEF recommendations 

for the treatment and prevention 

of diarrheal diseases –see above 

under community research.)


45 


“Vitamin A and zinc status in 

patients on maintenance haemodialysis” 

by Cabral PC, Diniz A da S, 

de Arruda IK. Nephrology 2005; 10: 

459–463 (Dept of Nutrition, Federal 

University of Pernambuco, Brazil) 

55 patients and 28 healthy controls 

were compared. The mean 

serum retinol concentration was 

significantly (p



Clinical studies 

“Effects of retinoid therapy on 

insulin sensitivity, lipid profile 

and circulating adipocytokines” 

by Corbetta S, Angioni R, Cattaneo 

A et al. Eur J Endocrin 2006; 154: 

83–86 (Univ Milan, Osped Maggiore, 

IRCCS, Inst Endocrine Sci, 

Via F Storza 25, 1-20122 Milan, Italy. 

Email: sabrina.corbetta@unimi.it) 

Patients with psoriasis who were 

being treated long-term with the 

retinoid acitretin were studied. The 

treatment resulted in a mild, transient 

reduction of insulin sensitivity 

and HDL-cholesterol levels that 

were not related to modifications 

of adiponectin, resistin and tumor 

necrosis factor alpha levels. Although 

the role of resistin in humans 

remains elusive, the levels of this 

adipocytokine seem to be affected, 

at least in part, by retinoids. 

“Synergism of desbutyl-benflumetol 

and retinol against Plasmodium 

falciparum in vitro” 

by Samal D, Rojanawatsirivet C, 

Wernsdorfer G et al. Wien Klin Wochenschr 

2005; 117: Suppl 4, 39–44 

(Dept of Neurology, Medical University 

of Vienna, Vienna, Austria. 

Email: doris.samal@meduniwien. 

ac.) 

This in vitro study demonstrates 

that addition of retinol to DBB 

resulted in a strong inhibition of 

schizont maturation. 

“In vitro activity of artemisinin 

alone and in combination with 

retinol against Plasmodium falciparum” 

by Thriemer K, Wernsdorfer 

G, Rojanawatsirivet C et al. Wien 

Klin Wochenschr 2005; 117: Suppl 

4, 45–48 

A similarly positive result to that 

outlined in the abstract above in 

work by the same experimental 

team. Both studies suggest that 

retinol may be a promising partner 

for antimalarial therapy. 

“Renal pathology and retinol 

status in multiple myeloma” 

by Gavrilov V, Yermiahu T, Gorodischer 

R. Kidney Int 2006; 69: 

173–177 (Biochemistry Laboratory, 

Soroka Medical Center, PO Box 

151, Beer Sheva, Israel. Email: 

vgavrilov@gmail.com) 

Renal dysfunction is a common and 

serious complication in multiple myeloma. 

This group showed: 1) urinary 

retinol is a more reliable marker 

of renal dysfunction than elevated 

serum creatinine; 2) serum retinol 

is decreased with normal or mildly 

elevated serum creatinine, but not 

in patients with moderate/severe 

renal failure; and 3) urinary retinol 

may serve as a diagnostic marker 

of renal proximal tubule dysfunction 

in multiple myeloma. 

“Reductions in serum vitamin 

A arrest accumulation of toxic 

retinal fluorophores: a potential 

therapy for treatment of lipofuscin-based 

retinal diseases” 

by Radu RA, Han Y, Bui TV et al. 

Invest Ophthalmol Vis Sci 2005; 

46: 4393–4401 (Jules Stein Eye Institute, 

University of California, Los 

Angeles, California, USA) 

A toxic vitamin A-based fluorophore 

(A2E) present within lipofuscin has 

been implicated in the death of 

retinal pigment epithelium (RPE) 

and photoreceptor cells in many 

degenerative retinal diseases. In an 

animal model it was shown that HPR 

(N-4-hydroxyphenyl) retinamide potently 

and reversibly reduced serum 

retinol. Accumulation of A2E and 

lipofuscin autofluorescence were 

also reduced. 

“Effect of short-term, high-dose 

retinol on dark adaptation in aging 

and early age-related maculopathy” 

by Owsley C, McGwin G, 

Jackson GR et al. Invest Ophthalmol 

Vis Sci 2006;47:1310–1318 

(C Owsley, Dept Ophthalmology, 

School of Medicine, University of 

Alabama at Birmingham, 700 South 

18 th Street, Suite 609, Birmingham, 

AL 35294-0009, USA. Email: 

Owsley@uab.edu) 

Baseline variables were similar 

in placebo and high-dose retinol 

groups. Those who received retinol 

had an increased rate of rod-mediated 

dark adaptation in older patients 

who were in the early stages 

of ARM (same as AMD). The authors 

suggest these results are consistent 

with the hypothesis that a local deficiency 

of retinol is responsible for 

the disease. (In view of the results 

presented in the abstract above it 

seems unlikely that this alone is 

responsible and much more work 

is needed.) 

“Retinol-binding protein, transthyretin, 

and C-reactive protein 

in extremely low birth weight 

(ELBW) infants” by Ambalavanan 

N, Ross AC, Carlo WA. J Perinatol 

2005; 25: 714–719 (N Ambalavanan, 

University of Alabama at Birmingham, 

619 South 20 th Street, Birmingham, 

AL, USA) 

This highly significant research is 

based, as is so often the case, on 

a simple idea developed in one area 

and neglected in another. Vitamin A 

deficiency reduces RBP (retinolbinding 

protein) but not TTR (transthyretin). 

Inflammation, even at a 

sub-clinical level, reduces both RBP 

and TTR and increases C-reactive 

protein, an acute phase response 

component. In 79 ELBW infants 

higher CRP and RBP/TTR molar ratio 

on day 28 were associated with 

death/bronchopulmonary dysplasia 

(a common association with ELBW) 

at 36 weeks. It was concluded that 

inflammation, rather than vitamin A 

deficiency, was the cause of low 

serum retinol levels. (In other words, 

this suggests that the considerable 

amount of research leading to the 

current practice of administering 

routinely intramuscular vitamin A 

to ELBW infants is fallacious in that 

no true state of vitamin A deficiency 

exists, but only a misleadingly low 

serum retinol attributable to inflammation). 

“Vitamin A and E deficiency and 

lung disease in infants with cystic 

fibrosis” by Bines JE, Truby HD, 

Armstrong DS et al. J Pediatr Child 

Health 2005; 41: 663–668 (Dept 

Gastroenterology and Clinical Nutrition, 

Royal Children’s Hospital, 

Melbourne, Victoria, Australia) 

In this cohort of 39 newly diagnosed 

infants with cystic fibrosis no association 

was found between serum 

vitamin levels at diagnosis and airway 

inflammatory indices at either 

diagnosis or 12 months later. 

“Vitamin A levels in patients with 

CF are influenced by the inflammatory 

response” by Greer RM, 

Buntain HM, Lewindon PJ et al. J 

Cyst Fibros 2004; 3: 143–149 (Dept 

Paediatrics and Child Health, Uni-


47 


versity of Queensland, Brisbane, 

Australia. Email: r.greer@uq.edu. 

au) 

These authors were aware that 

inflammation increases C-reactive 

protein and is associated with depression 

of serum vitamin A in normal 

subjects. They found a similar 

relation to occur in their cystic fibrosis 

patients. This was also found in 

the ELBW infants described in the 

abstract two above. Again, under 

these circumstances it is erroneous 

to assume that vitamin A deficiency 

is present. 

“Vitamin A for treating measles in 

children” by Huiming Y, Chaomin 

W, Meng M. Cochrane Database 

Syst Rev 2005 No 4, p. CD001479 

(West China Second University Hospital, 

Third Section of the People’s 

South Street, Chengdu, Sichuan, 

China 610041. Email: yanghuiming03@163.com) 

There was no significant reduction in 

the risk of mortality in the vitamin A 

group overall. There was evidence 

that when two doses of vitamin A 

were given there was associated 

reduced risk of mortality in children 

under the age of two years. 

“Plasma vitamin A levels in deprived 

children with pneumonia 

during the acute phase and after 

recovery” by Da Silva R, Lopes Jr 

E, Sarni ROS et al. J Pediatr 2005; 

81: 162–168 (JADAC Taddei, Universidade 

Federal de Sao Paulo, 

Brazil. Email:taddei.dped@epm.br) 

Plasma retinol was measured during 

the acute phase of pneumonia 

and after recovery in 40 deprived 

children aged 6 months to 5 years. 

Mean plasma levels were significantly 

higher after recovery, thus 

demonstrating the effect of the 

acute phase response (APR) on 

vitamin A status. (It is encouraging 

to learn from this and other papers 

that recognition of the occurrence 

and significance of the APR effect 

is beginning to be appreciated 

by research workers in this area 

around the world. Efforts are being 

made by Thurnham and his group 

(see Multimicronutrient research 

above) and others to produce correction 

tables. Another approach 

to the problem is to promote tests 

that are not subject to this difficulty. 

The pupillary threshold test and 

conjunctival impression cytology 

come to mind.) 

Appendix 

Experimental research 

Hypervitaminosis in the cat 

Polizopoulou ZS, J Fel Med Surg 

2005; 7: 363 

All-trans-retinoic acid accelerates 

the differentiation of human 

B lymphocytes matur ing into 

plasma cells 

Morikawa K, Int Immunopharma 

2005: 5: 13–14 

The C-terminal region of cis-retinol 

/androgen dehydrogenase 1 

(CRAD1) confers ER localization 

and in vivo enzymatic function 

Liden M, McCarroll JA; Exp Cell Res 

2005: 311; 205–217 

Vitamin A inhibits pancreatic stellate 

cell activation 

McCarroll JA, Gut; 2006; 55: 79– 

89 

Reductions in serum vitamin A arrest 

accumulation of toxic retinal 

fluorophores 

Radu RA, Invest Ophthalmol Vis Sci 

2005; 46: 4393–4401 

Complexes of carbon nanotubules 

with selected carotenoids 

Stobinski, L, J Nanosci Nanotech 

2005; 5: 2121–7 

Selective distribution of β-carotene 

stereoisomers in rat tissue 

Ben-Amotz A, Nutr Res 2005; 25: 

1005–12 

Analysis of ALDH1A2, CYP26A1, 

CYP26B1, and CRABP2 in human 

neural tube defects 

Deak KL, Birth Def Res 2005; 73: 

868–75 

Protective effects of increasing 

vitamin E and A doses on cisplatin-induced 

oxidative damage to 

kidney tissue in rats 

Dillioglugil MO; Urol Int 2005; 75: 

340–44 

Enhanced UV-mediated free radical 

generation 

Klamt F, Photochem Photobiol Sci 

2003; 2: 856–860 

Rapid measurement of retinol, 

retinal, 13-cis-retinoic acid and 

all-trans-retinoic acid by high 

performance liquid chromatography 

Tatum V, J Food Drug Anal 2005; 

13: 256–9 

The enhancing role of vitamin A 

deficiency on chemically induced 

nephroblastoma in rats 

Li K, J Pediatr Surg 2005; 40: 

1951–6 

Lecithin:retinol acyltransfer ase 

is responsible for amida tion of 

retinylamine 

Golczak M; J Biol Chem 2005; 280: 

42263–73 

Retinoid X receptor agonists increase 

Bc12a1 expression and 

decrease apoptosis of naïve T 

lymphocytes 

Rasooly R, J Immunol 2005; 175: 

7916–29 

Diet-related variation in cellular 

retinol-binding protein type II 

gene expression in rat jejunum 

Suruga K, Br J Nutr 2005; 94: 

890–5 

Acetaldehyde inhibits the formation 

of retinoic acid from retinal 

in the rat oesophagus 

Yokoyama S, Scand J Gastro 2006; 

41: 80–6 

Effect of administration of etidro 

nate and retinol on bone 

mechanical properties in ovariectomized 

rats 

Kaczmarczyk SI, Pharmacol Rep 

2005; 57: 203–11 

Retinoids and steroids in bovine 

mammary gland immunobiology 

Meyer E, Livestock Prod Sci 2005; 

98: 33–46 

Dietary vitamin A has both chronic 

and acute effects on vitamin A 

indices in lactating rats and their 

offspring 

Akohoue SA, J Nutr 2006; 136: 

128–32 

The effect of vitamin A on CC1(4)- 

induced hepatic injuries in rats 

Noyan S, Acta Histochem 2006; 

107: 421–34 

The effect of cholesterol in the 

liposome bilayer on the stabilization 

of incorporated retinol 

Cheo LS, J Liposome Res 2005; 

15: 157–66



Megalin-mediated reuptake of 

retinol in the kidneys of mice is 

essential for homeostasis 

Raila J, J Nutr 2005; 135: 2512–6 

Clinical significance of altered 

expression of retinoid receptors 

in oral precancerous and cancerous 

lesions 

Ralhan R, Int J Cancer 2006; 118: 

1077–89 

TBX1, a DiGeorge syndrome 

candidate gene, is inhibi ted by 

retinoic acid 

Zhang LF, Int J Devel Biol 2006; 

50: 55–61 

Retinoic acid amplifies the host 

immune response to LPS through 

increased T lympho cytes number 

and LPS bin ding protein expression 

Devaux S, Mol Cell Endocrin 2005; 

245: 67–76 

Non-classical action of retinoic 

acid on the activation of the 

cAMP response element-binding 

protein in normal human bronchial 

epithelial cells 

Agarwal S, Mol Biol Cell 2006; 17: 

566–575 

Role of retinoic acid receptors alpha 

1 and gamma in the response 

of murine limbs to retinol in vitro 

Galdones E, Birth Def Res 2006; 

76: 39–45 

Inhibitory effects of retinoic acid 

metabolism blocking agents 

(RAMBAs) on the growth of human 

prostate cancer cells 

Huynh CK, Br J Cancer 2006; 94: 

513–23 

Growth stimulation of human 

pulmonary adenocarcinoma cells 

and small airway epithelial cells 

by β-carotene 

Al-Wadei HAN, Int J Cancer 2006; 

118: 1370–80 

Retinoid receptor antagonists 

after the pattern of apoptosis 

in organogenesis stage mouse 

limbs 

Ali-Khan SE, Toxicol Sci 2006; 90: 

208–20 

Retinaldehyde dehydrogenase 2 

(RALDH2)-mediated retinoic acid 

synthesis regulates early mouse 

embryonic forebrain development 

Ribes V, Development 2006; 133: 

351–61 

Expression of nuclear receptor 

and target genes in liver and 

intestine of neonatal calves fed 

colostrum and vitamin A 

Krueger KA, J Dairy Sci 2005; 88: 

3971–81 

Differential teratogenesis of alltrans-retinoic 

acid administered 

on gestational day 9.5 to SWV and 

C57BL/6N mice 

Collins MD, Birth Defec Res 2006; 

76: 96–106 

Impairment of spermatogenesis 

and enhancement of testicular 

germ cell apoptosis 

Comitao R, J Exp Zool 2006; 305A: 

288–298 

Function of retinoid nuclear receptors 

Mark M, Ann Rev Pharmaol Toxicol 

2006; 46: 451–480 

Chronic dietary vitamin A supplementation 

regulates obesity 

in an obese mutant WNIN/Ob rat 

model 

Jeyakumar SM, Obes Res 2006; 

14: 52–59. 

Community research 

Plasma lycopene, other carotenoids, 

and retinol and the risk of 

cardiovascular disease in men 

Sesso HD, Am J Clin Nutr 2005; 

81: 990–7 

Intakes of vitamins A, C and E 

and folate and multivitamins and 

lung cancer 

Cho E, Int J Cancer 2006; 118: 

970–8 

Effect of micronutrient supplement 

on health and nutritional 

status of schoolchildren 

Sivakumar B, Nutr 2006; 22: S15- 

S25 

Low levels of carotenoids 

and retinol in involu tional 

osteoporosis 

Maggio D, Bone 2006; 38: 244–8 

Hypo- and hyperresponse to egg 

cholesterol predicts plasma lutein 

and β-carotene concentrations in 

men and women 

Clark RM, J Nutr 2006; 136: 601–7 

GLV supplements increased 

plasma β-carotene, vit amin C, 

zinc and hemoglobin in young 

healthy adults 

Agte V, Eur J Nutr 2006; 45: 29–36 

Clinical research 

Changes in conjugated linoleic 

acid and palmitoleic acid are correlated 

to retinol levels in chronic 

renal failure 

Lucchi L, Artif Organs 2005; 29: 

413–8 

Serum and CSF vitamin A concentrations 

in idiopathic intracranial 

hypertension 

Tabassi A, Neurology 2005; 64: 

1893–6 

Hypervitaminosis A-induced liver 

fibrosis 

Nollevaux MC, Liver Int 2006; 26: 

182–6 

Serum retinoic acid, retinol and 

retinyl palmitate levels in patients 

with lung cancer 

Moulas AN, Respirology 2006; 11: 

169–74 

Zinc and vitamin A supplementation 

in Indigenous Australian 

children hospitalized with lower 

respiratory tract infection 

Chang AB, Med J Aust 2006; 184: 

107–12 

www.sightandlife.org


49 


Letters to the editor 

Fortification of edible 

oil with vitamin A and 

carotene 

Dear Sir 

Your SIGHT AND LIFE Newsletter 

1/2006 included a paper on 

vitamin A fortification of edible oil 

as a cost-effective and sustainable 

intervention program to supply 

vitamin A to the population. It 

was good to know that vitamin A 

fortification of edible soybean 

oil was voluntarily implemented 

in Bangladesh: I hope the same 

will happen in other countries. In 

the 1990s our Brazilian nutrition 

group started to study and to put 

together scientific data to support 

the utilization of cooking oil as a 

vitamin A and carotene carrier 

to prevent vitamin A deficiency. 

One of the main obstacles for its 

use was the prestige of other vehicles 

like wheat flour and sugar, 

and the fact that vitamin A, being 

heat-sensitive, could not be 

added to a cooking ingredient. 

Our first published paper (1991) 

on the subject studied the stability 

of vitamin A added to refined 

soybean oil during cooking and 

storage. It was shown that, after 

6 – 9 months of storing the oil in 

sealed metal cans at room temperature, 

the content of the vitamin 

A was still 99% of the original 

value. In open cans stored in a 

light environment the vitamin A 

content starts to decrease after 6 

months. When the same fortified 

oil was used for the preparation 

of local rice and bean foods, 

boiling or under pressure, levels 

from 88% to 99% of the original 

vitamin A values were found. 

Levels of vitamin A in potatoes 

deep fried in vitamin A-fortified 

cooking oil at high temperature 

decreased slightly. Repeated 

frying of the same fortified oil at 

high temperature decreased the 

amount of vitamin A incorporated 

into the potatoes (1). Standard 

biological trials on vitamin A 

depleted rats fed non-fortified 

and A-fortified cooking oil confirmed 

its bioavailability based 

on plasma and liver vitamin A 

levels (2). A final confirmation of 

the bio-utilization of the vitamin A 

fortified oil was obtained in normal 

human subjects by adding 

fortified oil to salad or to cooked 

food and measuring the postabsorption 

plasma peak rise and 

the area under the A-serum test 

curve. A control group receiving 

non-fortified oil did not show 

changes in comparison to their 

fasting plasma serum A levels, 

but the postprandial A plasma 

level increased threefold in subjects 

who received fortified oil 

(3). With these scientific studies 

we have provided a background 

of necessary scientific support 

for the use of cooking oil as a 

vitamin A carrier. Other similar 

studies were carried out with 

synthetic carotene also added 

to soybean oil. Rats receiving 

diets with carotene-fortified 

soybean oil increased their liver 

vitamin A levels (4). Higher levels 

of plasma carotene were found 

when healthy adults received rice 

cooked with carotene-enriched 

soybean oil (5). We also advise 

mixing edible soybean and palm 

oil as a way to supply carotene. 

Although we did not explore this 

possibility further, it is certain to 

be effective. Anyway, our experimental 

and clinical studies support 

vegetable oil as an effective 

vehicle to supply vitamin A or 

carotene to the relevant population. 

Unfortunately our studies 

have not received worldwide 

recognition. This is a rational and 

practical intervention and one of 

the best ways to supply people 

at community level with vitamin 

A and carotene. No special 

equipment is needed to add the 

vitamins – it is just adding oil to 

oil. The work in Bangladesh will 

certainly prove again that cooking 

oil has to be accepted and used 

as one of the most effective and 

practical low-cost carriers for the 

control of vitamin A deficiency. I 

hope other countries will follow it 

as a voluntary or compulsory way 

to guarantee the necessary intake 

of vitamin A everywhere. 

Prof. J E Dutra-de-Oliveira, MD 

Medical School of Ribeirão 

Preto, University of São Paulo, 

Brazil, jeddoliv@fmrp.usp.br 

References 

1. Favaro RMD, Ferreira J, Desai ID, 

Dutra-de-Oliveira JE (1991). Studies 

on the fortification of refined soybean 

oil with all-trans-retinyl palmitate in 

Brazil. J Food Comp Anal 4: 237– 

244. 

2. Favaro RMD, Miyassaka C, Desai ID, 

Dutra-de-Oliveira JE (1992). Evaluation 

of the effect of heat treatment on 

the biological value of vitamin A fortified 

soybean oil. Nutrition Research, 

12: 1357–1363. 

3. Dutra-de-Oliveira JE, Desai ID, 

Favaro RMD, Ferreira JF (1994). Effect 

of heat treatment during cooking 

on the biological value of vitamin A 

fortified soybean oil in humans. Int J 

Food Sci Nutr 45: 203–207. 

4. Dutra-de-Oliveira JE, Favaro RMD, 

Leonardo IR, Franco MVMJ, Carvalho 

CG, Jordão Jr AA, Vannucchi H 

(1994). Effect of heat treatment in the 

biological value of carotene added to 

soybean cooking oil in rats. Int J Food 

Sci Nutr 49: 205–209 

5. Dutra-de-Oliveira JE, Favaro RMD, 

Leonardo IR, Jordão Jr AA, Vannucchi 

H (1998). Absorption, by humans, 

of carotene from fortified soybean oil 

added to rice: Effect of heat treatment. 

J Am Coll Nutr 17: 361–365t 

of heat treatment. J Am Coll Nutr 17: 

361–365 

Please update your 

address and help to 

avoid unnecessary 

work and expenses



Continue with support 

Dear Sir 

In my letter printed in the SIGHT 

AND LIFE Newsletter 3/2005 I 

already expressed my thanks to 

SIGHT AND LIFE. Again I would 

like to express how helpful all the 

items I’m receiving are. 

Although we are at quite a remote 

place, we normally follow 

the national campaign to give a 

vitamin A capsule and a deworming 

tablet to all children under 

the age of five years every year, 

in December. Many health units 

here have benefited from this system 

to improve their vaccination 

coverage records. The provision 

of vaccines to all children from 9 

months to five years of age has 

increased from 68% in 2001 to 

87.7% in 2005. The coverage 

of vitamin A supplementation 

increased from 54% (2001) to 

89.4% (2005). 

I ask SIGHT AND LIFE to please 

continue with their support to 

help me gain more knowledge 

and better health education, so 

that I might be able to help the 

Tanzanians more successfully. 

Sincerely, 

AImandus John Bosco, Mtambo 

Dispensary, Mpanda, Tanzania 

Nkhoma Hospital eye 

program 

Dear Sir 

Nkhoma is situated in a rural area 

of Central Malawi with a population 

of predominantly subsistence 

farmers. We serve some of the 

poorest people in the world. I was 

posted to Nkhoma six years ago 

by the Christoffel Blind Mission 

International (CBMI) to implement 

a VISION 2020 Program. 

Malawi has a population of over 

11 million with over 100,000 

blind. Vitamin A deficiency, cataract 

and traditional eye medicine 

account for a high proportion of 

blindness in children. There are 

seven ophthalmologists working 

in Malawi and I am the only one 

working in a Mission Hospital. 

During 2005 a total of 9,865 cataract 

operations were carried out 

in Malawi. Nkhoma accounted 

for 45% of this total. Also, the 

number of outpatients increased 

by more than five times in recent 

years (2005: 23,077) 

The patients are brought to 

Nkhoma and returned home 

in the Eye Department vehicle, 

operated on and provided with 

meals, all free of charge. We are 

dedicated to providing a high 

volume and high quality service. 

This has been achieved by the 

excellent team work and dedication 

of my 27 full time Malawian 

staff. I thank my staff and others 

in Malawi and around the world 

who support us. 

We are receiving financial and 

logistical support through CBMI 

and we are closely cooperating 

with the Malawi Ministry of 

Health and non-governmental 

organizations to ensure the limited 

resources are utilized to the 

maximum. We also thank SIGHT 

AND LIFE for the very useful 

vitamin A capsules. Nevertheless, 

problems remain such as 

management, construction and 

staff problems. Also, for example, 

in the optical department most 

lenses have been out of stock for 

six months. 

Dr. Nick Metcalfe 

Director 

Vitamin A related support 

from SIGHT AND LIFE 

Dear Sir 

We are very thankful for the information 

materials and the vitamin 

A capsules we have received, and 

naturally for the financial support 

from SIGHT AND LIFE. 

We follow the global agreement 

on the need to combat 

vitamin A deficiency by applying 

basic strategies to increase the 

consumption of foods rich in 

vitamin A or to provide periodic 

vitamin A supplements to high 

risk groups. 

Public health and nutrition communities 

should always recognize 

the need to improve the vitamin A 

status of young children. Vitamin A 

supplementation as an approach 

is among the most cost-effective 

health interventions available. 

Therefore, as an organization, we 

are committed to vitamin A deficiency 

prevention programs. 

Mr. Laodicah Nyaribari Nyambati, 

Director, Chelma Advisory Institute, 

Kisii 40200, Kenya


51 


Publications 

SIGHT AND LIFE presents recent publications which may be of particular interest to our readers. 

However, these publications are not available from SIGHT AND LIFE, nor do we have any privileged 

access to them. 

Food and Nutrition: a 

Handbook for Namibian 

Volunteer Leaders 

The Government of the Republic 

of Namibia (GRN), through the 

Technical Co-operation Program 

(TCP) of the Food and Agriculture 

Organization of the United Nations 

(FAO), launched a new program 

called Rural Youth Clubs of 

Namibia (RYCN), as an outreach 

for the Rural Youth Development 

Program. 

This program has been designed 

and tested as a unique methodology 

for reaching large numbers of 

young people, living in even the 

most isolated rural villages of Namibia, 

with leadership development 

and organizational skills as 

well as non-formal education and 

training in agriculture and related 

areas. It has been successfully 

demonstrated that the new RYCN 

is an effective delivery mechanism 

enabling rural young people, 

primarily those who are out of 

school, to gain basic knowledge, 

skills and experiences in agriculture, 

nutrition, health, environment 

and other essential skills 

for living. Education and training 

involves practical, activity-based 

learning and income-generating 

activities. By taking this training 

approach to even the most 

remote villages, large numbers 

of our youth should be empowered 

into making economically 

rewarding and satisfying lives for 

themselves and their families in 

rural Namibia. 

This manual is designed as a field 

handbook and guideline document 

for rural youth club leaders 

to enable them to employ coping 

strategies in nutritional activities 

taking into account the prevailing 

economic patterns in their 

respective communities. It was 

developed through participatory 

and experiential approaches involving 

the rural young people in 

selected communities in northern 

Namibia, a process that involved 

collaboration with other line 

ministries such as the Ministry 

of Agriculture, Water and Rural 

Development and the Ministry of 

Health and Social Services. 

Food and Nutrition: Minister of 

Higher Education, Training and 

Employment, Creation, Private 

Bag 13391, Windhoek, Namibia 

Obesity: Dietary and 

Developmental Influences 

Focusing on prevention rather 

than treatment, Obesity: Dietary 

and Developmental Influences, 

reviews and evaluates the determinants 

of obesity. The book 

uses evidence-based research 

as a basis to define foods and 

dietary behaviors that should be 

supported and encouraged as 

well as those that should be discouraged. 

This comprehensive 

review represents a critical step 

forward in the quest to identify 

feasible strategies to prevent 

obesity. 

The book describes the potential 

role of 26 different dietary factors 

and eight developmental periods 

in the prevention of obesity 

among children and adults. The 

dietary factors examined include 

macronutrients, micronutrients, 

specific types of foods and beverages, 

snack and meal patterns, 

portion size, parenting practices, 

breastfeeding, and more. The factors 

from each developmental period 

in the life cycle are examined 

in the context of the likelihood of 

obesity development. For each 

dietary factor and developmental 

period, four lines of evidence are 

examined: secular trends, plausible 

mechanisms, observational 

studies, and prevention trials. 

Providing easy access to information, 

the book features 38 tables 

that summarize observational 

studies, 38 graphs depicting 

trends in dietary intake, and nine 

tables that summarize preven-



tion trials. It provides a synopsis 

of the latest research on obesity, 

investigating all major lines of 

evidence, and clarifies common 

misconceptions while identifying 

which behaviors to target and 

which dietary factors show the 

most promise for prevention. 

CRC Press, Taylor & Francis, 

New York, 

http://taylorandfrancis.com 

Setting up and running a 

school garden 

Adequate nutrition and education 

are key to the development of children 

and their future livelihoods. 

The reality facing millions of children, 

however, is that these essentials 

are far from being met. 

A country’s future hinges on its 

youth. Yet children who go to 

school hungry cannot learn well. 

They have decreased physical 

activity, diminished cognitive abilities 

and reduced resistance to 

infections. Their school performance 

is often poor and they may 

drop out of school early. In the 

long term, chronic malnutrition 

decreases individual potential 

and has adverse affects on productivity, 

incomes and national 

development. 

Schools can make an important 

contribution to countries’ efforts 

to overcome hunger and malnutrition, 

and school gardens can 

help to improve the nutrition and 

education of children and their 

families in both rural and urban 

areas. 

FAO promotes school gardens 

primarily as a platform for learning, 

as well as a vehicle for better 

nutrition. Schools are encouraged 

to create learning gardens that are 

moderate in size so that they can 

be easily managed by students, 

teachers and parents, but that 

also allow for the production of 

a variety of nutritious vegetables 

and fruits (and where possible, 

some small-scale livestock such 

as chickens or rabbits). Production 

methods are kept simple so 

that they can be easily replicated 

by students and parents at their 

homes. 

In preparing this manual, intended 

to assist school teachers, parents 

and the wider community, FAO 

has drawn upon experiences 

and best practices derived from 

school garden initiatives all over 

the world. Classroom lessons are 

linked with practical learning in 

the garden about nature and the 

environment, food production 

and marketing, food processing 

and preparation, and making 

healthy food choices. 

Setting up and running a school 

garden: FAO, Via Delle Terme di 

Caracalla, 00100 Rome, Italy 

Community Nutrition 

A new CD-ROM intended as a 

teaching material resource has 

just been produced by Teaching-aids 

At Low Cost (TALC), a 

UK-based group, with financial 

support by UNICEF. It contains 

materials from many sources 

around the world. Each item 

(mostly produced between the 

years 2000 and 2005) is presented 

with a short explanation about 

its use. All contributors are listed 

with their contact details. Among 

many others, the SIGHT AND 

LIFE CD was useful as a resource 

and several SIGHT AND LIFE 

publications, Newsletter articles 

and slides are included. 

The introduction states: “This CD- 

ROM ... is intended for you if you 

work with resources-poor communities 

and are training health 

and other types of development 

workers and have limited access 

to nutrition-related materials, 

particularly if you do not have 

access to the Internet... Nutrition 

is a fast-changing world – most 

of us have very heavy workloads 

and it is difficult to keep updated 

with recent developments.” 

Ann Burgess, a nutrition consultant 

who worked intensively on 

this project, commented that the 

contribution from SIGHT AND 

LIFE was very useful. At this time 

5000 copies are being produced. 

For distribution, the priority is to 

get copies to target users such 

as health practitioners and development 

workers in developing 

countries and their trainers who 

have limited access to nutrition 

materials. 

To request a copy of the CD please 

contact TALC at info@talcuk.org 

or visit the TALC website http:// 

www.talcuk.org, which also gives 

information on other TALC nutrition 

related education materials.


53 


Call for abstracts 

Micronutrient Forum 

“Consequences and Control of 

Micronutrient Deficiencies: Science, 

Policy, and Programs – Defining the 

Issues”, 16–18 April 2007, Istanbul, Turkey 

The Micronutrient Forum will hold 

its first international meeting in 

Istanbul, Turkey on 16–18 April 

2007. The theme of the meeting 

is “Consequences and Control 

of Micronutrient Deficiencies: 

Science, Policy, and Programs 

– Defining the Issues”. 

The Micronutrient Forum builds 

on the success of the International 

Vitamin A Consultative Group 

(IVACG) and the International 

Nutritional Anemia Consultative 

Group (INACG), which were both 

established by the United States 

Agency for International Development 

(USAID) in 1975. 

The Micronutrient Forum will serve 

as a stimulus for policy-relevant 

science and as the internationally 

recognized catalyst for moving 

the global community towards 

consensus around evidencebased 

policies and programs that 

reduce micronutrient deficiencies 

around the globe. 

Meeting participants are welcome 

from a wide diversity of relevant 

disciplines such as maternal and 

child health, nutrition, biochemistry, 

agriculture, horticulture, 

education, communications, and 

development. Participants are expected 

to include representatives 

from international agencies, national 

ministries, educational and 

research institutions, food and 

chemical industries, and nongovernmental 

organizations. 

Program managers and researchers 

are encouraged to submit abstracts 

for oral and poster presentations 

describing new data on 

the topics that follow. Abstracts 

must pertain to the micronutrient 

deficiencies of primary interest to 

the Micronutrient Forum, namely 

vitamin A, iron, folate, iodine, 

and/or zinc. 

• Defining “Deficiency Disorders” 

• Systems for increasing multiple 

micronutrient status 

• Health consequences of micronutrient 

deficiencies 

• The relevance of micronutrientmicronutrient 

interactions on micronutrient 

intervention design 

• Cost, coverage, sustainability, 

and impact of micronutrient intervention 

programs 

• The science base needed for 

national policy formulation and 

program commitment 

• The interactions of micronutrients 

with infectious diseases 

Preference will be given to abstracts 

describing well-designed 

studies, providing new and potentially 

important findings with data 

that relate to the above topics. 

For more information and to 

submit your abstract visit: www. 

a2zproject.org 

To submit your abstract directly 

visit: http://ilsi.conference-services.net/authorlogin. 

asp?conferenceID=888&lan 

Abstracts must be received by 15 

August 2006. 

To receive more information about 

the Micronutrient Forum, contact 

the Micronutrient Forum 

Secretariat at the ILSI Research 

Foundation, One Thomas Circle, 

NW, Ninth Floor, Washington, 

DC 20005-5802, USA. Email: 

mnforum@ilsi.org. 

Travel Grants 

A limited number of travel grants 

will be available to help enable 

participation at the Micronutrient 

Forum meeting. Each grant will 

cover some portion of transportation 

to and from the meeting site, 

meals, and/or lodging during the 

event. Preference will be given to 

individuals whose abstracts are 

selected for presentation. 

As one of the sponsors of travel 

grants for the Micronutrient Forum, 

SIGHT AND LIFE encourages 

students and post-docs from 

low-income countries to submit 

abstracts for the Micronutrient 

Forum. 

To apply for a travel grant, please 

write to the Micronutrient Forum 

secretariat at mnforum@ilsi.org. 

In your letter, describe any other 

financial support you expect to 

have for your meeting participation. 

If you are a student or a 

post-doc, please also attach a letter 

of recommendation from your 

advisor or supervisor, providing a 

larger picture of your work. 

The selection of abstracts for 

presentation is the responsibility 

of the organizers of the Micronutrient 

Forum. Some restrictions may 

accompany the grants.



SIGHT AND LIFE Workshop 

Nutritional Anemia 

Anemia is a major health concern 

in developing countries as well 

as in the developed world. It impairs 

growth and development, 

cognition and immune function, 

as well as school and work performance. 

Anemia affects more 

than two billion people worldwide, 

and has a negative impact 

on economic growth, particularly 

in low-income countries. Only 

about half of anemia is thought 

to be related to iron deficiency; 

other micronutrient deficiencies 

such as vitamin A, vitamin C, B- 

vitamins, zinc and copper as well 

as infections and undernutrition 

also play a crucial role. Guidelines 

for supplementation and food 

fortification to address anemia 

usually focus on iron and folic 

acid, however. On this account, 

we feel that it is timely to highlight 

all contributing factors in a workshop 

on Nutritional Anemia. 

Top international experts from different 

fields related to Nutritional 

Anemia have agreed to make 

presentations to the workshop. 

The satellite workshop is being 

organized by Klaus Kraemer 

(SIGHT AND LIFE, Basel) and 

Michael B. Zimmermann (Swiss 

Scientific Program, Session 1: 

Physiology, Metabolism, and Interactions 

Moderators: James Cook, Kansas City (USA); 

John Scott, Dublin (IRL) 

08:30 – 08:40 Welcome – Klaus Kraemer, Basel (CH); Michael B. Zimmermann, 

Zurich (CH) 

08:40 – 09:00 Introduction – Venkatesh Mannar, Toronto (CAN); 

James Cook, Kansas City (USA); Nevin S. Scrimshaw, 

Boston (USA) 

09:00 – 09:15 Iron Metabolism – Sean Lynch, Norfolk (USA) 

09:15 – 09:30 Bioavailability of Iron Forms and Enhancers – Richard 

Hurrell, Ines Egli, Zurich (CH) 

09:30 – 09:45 Copper and Zinc Interactions in Anemia: a Public 

Health Perspective – Ricardo Uauy, London (UK) 

09:45 – 10:00 Folate, Vitamin B12 and other B-Vitamins – John Scott, 

Dublin (IRL) 

10:00 – 10:15 Vitamin A – Keith P. West, Alfred Sommer, Baltimore 

(USA) 

10:15 – 10:30 Vitamin E and other Antioxidants – Maret G. Traber, 

Corvallis (USA) 

10:30 – 11:00 Coffee and Tea 

11:00 – 11:15 Interactions of Micronutrients – Michael B. Zimmermann, 

Zurich (CH) 

11:15 – 11:30 Protein Energy Malnutrition – Alan Jackson, Southampton 

(UK) 

11:30 – 11:45 Effect of Infections on Nutritional Anemia – David 

Thurnham, Coleraine (UK) 

11:45 – 12:00 Diagnosis of Anemia – Hans-Konrad Biesalski, Hohenheim 

(DE); Jürgen Erhardt, Jakarta (IND) 

12:00 – 13:00 Discussion 

13:00 – 14:30 Lunch 

Federal Institute of Technology, 

Zurich). It will be held at the Barcelona 

Hilton Hotel on 27 September 

2006, the day before the 

opening of the I World Congress 

of Public Health Nutrition, Barcelona, 

28–30 September 2006 

(http://www.nutrition2006.com). 

The Nutritional Anemia workshop 

is planned to correspond closely 

with the Congress of Public 

Health Nutrition, and thus to provide 

a forum for networking and 

alliance building. The workshop 

on Nutritional Anemia is an open 

event for those interested in gaining 

insight into the latest developments 

in this topic area. 

The proceedings of the workshop 

will be published early next year. 

We expect this publication to be 

highly authoritative and provide 

expert guidance on the prevention 

and treatment of Nutritional 

Anemia. 

The workshop and publication 

will be sponsored by SIGHT AND 

LIFE, Basel (www.sightandlife. 

org). In focusing on Nutritional 

Anemia SIGHT AND LIFE is 

pursuing its new mission of addressing 

multiple micronutrient 

deficiencies (hidden hunger) related 

to important health issues 

in developing countries. 

For registration please contact 

SIGHT AND LIFE, PO Box 2116, 

4002 Basel, Switzerland. Email: 

abc@sightandlife.org 

SIGHT AND LIFE Workshop Nutritional 

Anemia 

Venue: Hilton Barcelona, 27 September 

2006 

Organizers: Klaus Kraemer, 

SIGHT AND LIFE, Basel, and 

Michael B. Zimmermann, Swiss 

Federal Institute of Technology, 

Zürich


55 


Scientific Program, Session 2: 

Prevalence, Interventions, and Economy 

Moderators: Nevin S. Scrimshaw, Boston (USA); 

Venkatesh Mannar, Toronto (CAN) 

14:30 – 14:45 Worldwide Prevalence of Anemia – Erin McLean, Geneva 

(CH); Ines Egli, Zurich (CH); Bruno de Benoist, 

Geneva (CH) 

14:45 – 15:00 Strategies to Fight Nutritional Anemia – Martin Bloem, 

Rome (I); Regina Moench-Pfanner, Geneva (CH); Richard 

Semba, Baltimore (USA) 

15:00 – 15:15 Successful Approaches with Sprinkles - Stanley Zlotkin, 

Toronto (CAN) 

15:15 – 15:30 Technical Aspects of Programs – Omar Dary, Washington 

(US) 

15:30 – 15:45 Safety of Interventions – Noel Solomons, Guatemala 

City (GUA); Klaus Schümann, Munich (DE) 

15:45 – 16:00 Economic Impact of Anemia and Cost Effectiveness 

of Interventions – Harold Alderman, Meera Shekar, 

Washington (USA); Sue Horton, Waterloo (CAN) 

16:00 – 16:15 Global Perspectives – Ian Darnton-Hill, New York (USA); 

Tommaso Cavalli-Sforza, Manila (PHI) 

16:15 - 16:45 Coffee and Tea 

16:45 – 18:00 Discussion 

18:00 – 18:15 Summary – Klaus Kraemer, Basel (CH); Michael B. 

Zimmermann, Zurich (CH) 

The SIGHT AND LIFE art gallery 

We still have some of the posters presented in the Newsletter 2/2004 

on pp. 50–51. Printable PDFs are on our website at (http://sightandlife. 

org/poSALartGal/aasalpo.html) 

A new issue of the 

SIGHT AND LIFE CD 

The updated CD with almost 

the complete content of the our 

website is in preparation. It will 

be dated of August 2006. As the 

capacity of the disc is limited, 

some adjustments were needed, 

and the new CD does not replace 

the older ones, which may contain 

objects such as the movies 

or some pictures in higher resolution. 

The new CD will be available 

soon from SIGHT AND LIFE. 

www.sightandlife.org

SIGHT AND LIFE NEWSLETTER 2/2006 

Women in Burkina Faso during “good nutrition training”, see article on page 35. 

SIGHT AND LIFE is a humanitarian 

initiative of DSM Nutritional 

Products (for more information 

see the SIGHT AND LIFE website: 

www.sightandlife.org). We are 

committed to the improvement of 

nutrition and health with emphasis 

on children and mothers in developing 

countries. It is the aim of 

SIGHT AND LIFE to combat ‘hidden 

hunger’, and to raise awareness 

of micronutrient deficiencies 

as public health issues. 

Low micronutrient intakes and 

other forms of malnutrition are 

impairing the health of many 

people in numerous developing 

countries. The most vulnerable 

groups are children and mothers. 

Increased health risk with suscep- 

tibility to infections and increased 

child and maternal mortality are 

the consequences. Moreover, this 

impairs growth and development, 

cognition, vision and immune 

function, as well as school and 

work performance. 

For its humanitarian work, SIGHT 

AND LIFE can draw on the 

expertise in nutrition, technology 

and analytics of DSM Nutritional 

Products. SIGHT AND 

LIFE supports many locally and 

internationally active organizations. 

It has sponsored research, 

application projects, training of 

health professionals, and health 

and nutrition education in many 

countries in Africa, Asia and Latin 

America. 

Support is given in the form of 

vitamin A capsules, premixes 

containing micronutrients, grants, 

information and educational materials 

such as manuals, books, 

posters, reprints, etc. Furthermore, 

SIGHT AND LIFE gives 

technical assistance where required 

and promotes training and 

education in order to increase 

local knowledge and expertise, 

and works towards sustainable 

improvement of nutrition. 

SIGHT AND LIFE publishes educational 

materials as well as the 

SIGHT AND LIFE Newsletter to 

increase knowledge on micronutrient 

nutrition and health, and to 

disseminate relevant information 

on programs and scientific news. 

Publisher: SIGHT AND LIFE 

Editor: Klaus Kraemer 

Assistance: Anne-Catherine Frey, 

Martin Frigg 

Translation and language: 

transparent - translation & text 

services, Berlin, Yvonne Bearne 

Printer: Druckerei Dietrich, Basel 

Opinions, compilations and figures 

con tained in the signed articles do 

not necessarily represent the point 

of view of SIGHT AND LIFE and 

are solely the responsibility of the 

authors. 


PO Box 2116, 4002 Basel 

Switzerland. Tel.: +41 61 688 74 94 

Fax: +41 61 688 19 10 

E-mail: abc@sightandlife.org 

http://sightandlife.org 

ISBN 3-906412-31-8

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