Newsletter 02 2006.pdf - Sight and Life
Newsletter 02 2006.pdf - Sight and Life
Newsletter 02 2006.pdf - Sight and Life
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SIGHT AND LIFE<br />
NEWSLETTER 2/2006<br />
INCORPORATING THE XEROPHTHALMIA CLUB BULLETIN<br />
Correspondents: Bruno de Benoist, William S. Blaner, George Britton, Omar Dary, Frances<br />
R. Davidson, John W. Erdman, Jr., Tracey Goodman, Philip Harvey, Richard F. Hurrell, Rolf<br />
D. W. Klemm, Donald S. McLaren, Regina Moench-Pfanner, Christine Northrop-Clewes,<br />
Vinodini Reddy, Delia Rodriguez-Amaya, Ram Kumar Shrestha, Noel W. Solomons, Florentino<br />
S. Solon, Alfred Sommer, Andrew Tomkins, G. Venkataswamy, Emorn Wasantwisut,<br />
Keith P. West Jr., Yu Xiaodong, Michael B. Zimmermann. Editor: Klaus Kraemer<br />
yyyyyy<br />
School Feeding; CARIG 2006; Fat-Soluble Vitamins 2006;<br />
Micronutrient Premix in WFP Actions; Workshop Nutritional<br />
Anemia; Reports <strong>and</strong> Information from Benin, Burkina<br />
Faso, Dominican Republic, FSM Micronesia, Honduras,<br />
India, Kenya, Nepal, Sudan, Vietnam<br />
Children in Madagascar, where the GRET program is running (see article on page 4).
SIGHT AND LIFE 2<br />
NEWSLETTER 2/2006<br />
Contents<br />
The Nutrimad school feeding program:<br />
Impact on failure rate <strong>and</strong> nutritional status of<br />
schoolchildren in Madagascar 4<br />
Reflections: Four decades with vitamin A <strong>and</strong><br />
carotenoids; James Allen Olsen Memorial<br />
Lecture, CARIG, 2006 10<br />
Carotene Research Interaction Group (CARIG)<br />
Annual Conference 2006, San Francisco 18<br />
13th European Meeting on Fat-Soluble<br />
Vitamins 2006 in Jena 23<br />
Protecting nutritional status <strong>and</strong> the role<br />
of micro nutrient premix in the WFP’s<br />
response to the Indian Ocean Tsunami 25<br />
Distributing micronutrients <strong>and</strong> deworming<br />
medicine in hurricane-ravaged Honduras 27<br />
Eye care mission to the Dominican Republic,<br />
March 2006 29<br />
Update on the status of vitamin A deficiency<br />
<strong>and</strong> xerophthalmia in children under five<br />
treated at hospitals in Vietnam over a<br />
27-year period (1979 – 2005) 30<br />
Continuing nutrition education by the<br />
Youth Volunteer Group, Nepal 31<br />
The PACHE Trust health program <strong>and</strong><br />
women’s empowerment 32<br />
An integrated nutrition, training <strong>and</strong><br />
education program 33<br />
Knowledge <strong>and</strong> perception of vitamin A<br />
deficiency in the villages of Burkina Faso 35<br />
VAD <strong>and</strong> malnutrition among Sudanese<br />
children admitted to an urban hospital 36<br />
The fight against vitamin A deficiency at<br />
Ouassa-Beket, Benin 36<br />
Continued activity of the Ramala Women’s<br />
Group 37<br />
SIGHT AND LIFE visits Pohnpei, Micronesia,<br />
<strong>and</strong> films a nutrition documentary 39<br />
A digest of recent literature 41<br />
Letters to the editor 49<br />
Publications 51<br />
Micronutrient Forum 53<br />
SIGHT AND LIFE workshop<br />
Nutritional Anemia 54<br />
SIGHT AND LIFE, back cover<br />
SIGHT AND LIFE is a humanitarian initiative of DSM<br />
DSM Nutritional Products<br />
DSM Nutritional Products is the world’s leading supplier of vitamins, carotenoids <strong>and</strong> other fine<br />
chemicals to the feed, food, pharmaceutical <strong>and</strong> personal care industries. The company has a long<br />
tradition as a pioneer in the discovery of new products, new formulations <strong>and</strong> attractive applications<br />
for all industry segments. For further company information please visit<br />
www.dsmnutritionalproducts.com<br />
DSM<br />
DSM is active in nutritional <strong>and</strong> pharma ingredients, performance materials <strong>and</strong> industrial chemicals.<br />
The company creates innovative products <strong>and</strong> services that help improve the quality of life. DSM’s<br />
products are used in a wide range of end markets <strong>and</strong> applications such as human <strong>and</strong> animal<br />
nutrition <strong>and</strong> health, cosmetics, pharmaceuticals, automotive <strong>and</strong> transport, coatings, housing<br />
<strong>and</strong> electrics & electronics (E&E). DSM’s strategy, named Vision 2010 – Building on Strengths,<br />
focuses on accelerating profitable <strong>and</strong> innovative growth of the company’s specialties portfolio.<br />
Market-driven growth, innovation <strong>and</strong> increased presence in emerging economies are key drivers<br />
of this strategy. The group has annual sales of over € 8 billion <strong>and</strong> employs some 22,000 people<br />
worldwide. DSM ranks among the global leaders in many of its fields. The company is headquartered<br />
in the Netherl<strong>and</strong>s, with locations in Europe, Asia, Africa <strong>and</strong> the Americas.
NEWSLETTER 2/2006<br />
3<br />
SIGHT AND LIFE<br />
Editorial<br />
Reflections<br />
On 29 May 2006, the 59th World<br />
Health Assembly, the governing<br />
body of the World Health<br />
Organization (WHO), adopted a<br />
resolution on the ‘Prevention of<br />
avoidable blindness <strong>and</strong> visual<br />
impairment’. Given that still more<br />
than 161 million people worldwide<br />
are visually impaired, of<br />
whom 37 million are blind, <strong>and</strong><br />
that about 75% of blindness is<br />
avoidable, the resolution is timely<br />
<strong>and</strong> is expected to strengthen<br />
the VISION 2<strong>02</strong>0 plans. VISION<br />
2<strong>02</strong>0: The Right to <strong>Sight</strong> is a<br />
global initiative of the WHO <strong>and</strong><br />
the International Agency for the<br />
Prevention of Blindness (IAPB).<br />
It comprises governments <strong>and</strong><br />
NGOs committed to the prevention<br />
<strong>and</strong> treatment of blindness.<br />
Among other things, the resolution<br />
urges member states to<br />
include Vision 2<strong>02</strong>0 in national<br />
development plans, <strong>and</strong> encourages<br />
partnerships between<br />
the public <strong>and</strong> private sectors,<br />
NGOs <strong>and</strong> communities. Since<br />
its inception SIGHT AND LIFE has<br />
supported IAPB, <strong>and</strong> now it has<br />
also become a formal partner of<br />
Vision 2<strong>02</strong>0. In this way SIGHT<br />
AND LIFE continues to take<br />
responsibility for the prevention<br />
of childhood blindness, as good<br />
vitamin A nutrition is pivotal for<br />
the eradication of this scourge.<br />
As indicated in the previous edition<br />
of the <strong>Newsletter</strong>, SIGHT<br />
AND LIFE’s 20th anniversary year<br />
will be a year of action. But after<br />
20 years of work committed to<br />
the fight against vitamin A <strong>and</strong><br />
other micronutrient deficiencies,<br />
this should also be a time for reflection.<br />
We think that we are on<br />
the right track with our mission<br />
<strong>and</strong> the services we provide, but<br />
I believe we could even do better.<br />
Therefore we are taking this occasion<br />
as an opportunity to examine<br />
our own activities. With the support<br />
of an international consultancy<br />
group we are determining<br />
how we can fully leverage our<br />
capabilities. The consultants are<br />
undertaking this project on a pro<br />
bono basis. Your feedback from<br />
the questionnaire (see <strong>Newsletter</strong><br />
1/2006) <strong>and</strong> interviews with some<br />
of you are a valued contribution<br />
towards this goal.<br />
Nutritional anemia remains an<br />
issue affecting more than two billion<br />
people worldwide. We have<br />
decided to bring together leading<br />
experts to discuss approaches<br />
to controlling nutritional anemia.<br />
The program of a corresponding<br />
workshop on 27 September<br />
2006 in Barcelona will be found<br />
on page 54 of this <strong>Newsletter</strong>.<br />
There is only limited capacity for<br />
the workshop <strong>and</strong> we are already<br />
almost fully booked. Should we,<br />
as we hope, succeed in moving<br />
the meeting to a larger room we<br />
will make an announcement to<br />
this effect on our website.<br />
On 16 June 2006, at the invitation<br />
of SIGHT AND LIFE, experts of<br />
the United Nations World Food<br />
Programme (WFP) came to Switzerl<strong>and</strong><br />
to discuss school feeding<br />
activities with employees of<br />
DSM Nutritional Products. There<br />
was an enormous interest in this<br />
topic. Micronutrient-enhanced<br />
school feeding in Madagascar is<br />
also the topic of a contribution<br />
to this <strong>Newsletter</strong> by Arnaud<br />
Laillou <strong>and</strong> coworkers (page 4).<br />
On page 25 you can read about<br />
the role of high-energy nutrient<br />
dense biscuits in the WFP’s<br />
tsunami response in South East<br />
Asia <strong>and</strong> school feeding. In April<br />
2006 a team from SIGHT AND<br />
LIFE visited Micronesia to shoot<br />
a film documentary on what is<br />
called by the United Nations<br />
St<strong>and</strong>ing Committee on Nutrition<br />
‘the double burden of malnutrition’.<br />
Under- <strong>and</strong> overnutrition<br />
can no longer be regarded in<br />
isolation – <strong>and</strong> early intervention<br />
is key in implementing successful<br />
preventative strategies. The<br />
purpose of the film is to create<br />
awareness <strong>and</strong> suggest solutions<br />
for this worldwide nutrition<br />
problem. Please read the article<br />
on page 39 by Lois Englberger<br />
<strong>and</strong> Adelino Lorens. Finally, I<br />
would like to call your attention to<br />
Barbara Underwood’s article on<br />
four decades of intense vitamin<br />
A <strong>and</strong> carotenoid research (page<br />
10). The article is based on the<br />
James Olson Memorial Lecture<br />
at this year’s Carotene Research<br />
Interaction Group (CARIG) annual<br />
conference (page 18). It is a very<br />
stimulating reflection on public<br />
health interventions to control<br />
vitamin A deficiency.<br />
I am convinced that this year’s reflections<br />
will provide us with clear<br />
directions for the future, <strong>and</strong>,<br />
more importantly, for the benefit<br />
of billions of people suffering from<br />
‘hidden hunger’.
SIGHT AND LIFE 4<br />
NEWSLETTER 2/2006<br />
The Nutrimad school feeding program:<br />
Impact on failure rate <strong>and</strong> nutritional status of<br />
schoolchildren in Madagascar<br />
Arnaud Laillou 1 , Luc Arnaud 1 , Menjaharimisa Ramaherisoa 2 , Charlotte Ralison 2 ,<br />
Chantal Monvois 1 <strong>and</strong> Serge Trèche 3<br />
1<br />
The Research <strong>and</strong> Technological Exchange Group (GRET), Antananarivo <strong>and</strong> Paris. 2 The Laboratory of Biochemistry<br />
Applied to the Food Sciences <strong>and</strong> Nutrition (Labasan), University of Antananarivo, Madagascar<br />
3<br />
UR106 “Nutrition, Food, Societies”, Institute of Research for Development (IRD), Montpellier, France<br />
Introduction<br />
The Nutrimad school feeding<br />
program (SFP), co-financed by<br />
SIGHT AND LIFE <strong>and</strong> the Ile<br />
de France regional council, is<br />
one of the three sections of the<br />
Nutrimad program, which is run<br />
by GRET (Research <strong>and</strong> Technological<br />
Exchange Group), the<br />
IRD (Institute of Research for<br />
Development), <strong>and</strong> the Labasan<br />
(Laboratory of Biochemistry Applied<br />
to the Food Sciences <strong>and</strong><br />
Nutrition, of the University of<br />
Antananarivo, Madagascar) with<br />
the aim of contributing to the sustainable<br />
reduction of malnutrition<br />
in Madagascar. The objectives<br />
of the program are to counter<br />
immediate hunger <strong>and</strong> school<br />
failure rates, <strong>and</strong> to respond to<br />
the nutritional deficiencies of children<br />
from public primary schools<br />
within the framework of a sustainable<br />
system of school snacks,<br />
overseen by the local authorities.<br />
The approach of the Nutrimad<br />
SFP was to introduce a snack<br />
that was accessible to everyone,<br />
i.e. inexpensive, made from local<br />
raw materials, liked by the<br />
children, readily obtainable <strong>and</strong><br />
reproducible, i.e. easy to prepare<br />
within schools, <strong>and</strong> of good nutritional<br />
value, i.e. designed so<br />
that one portion covers a share<br />
of nutritional requirements corresponding<br />
to the level of deficiencies<br />
generally observed in<br />
schoolchildren in Madagascar.<br />
The Nutrimad SFP was implemented<br />
during the 2004 – 2005<br />
school year in 15 public primary<br />
schools in underprivileged districts<br />
of Antananarivo, according<br />
to the methods described in a<br />
previous issue of the SIGHT AND<br />
LIFE <strong>Newsletter</strong> (1). The program<br />
comprised two parts.<br />
The first consisted in providing<br />
12,893 children from the 15<br />
schools with a snack in the form<br />
of a fortified <strong>and</strong> high-energy<br />
density gruel over an average of<br />
110 days (between 101 <strong>and</strong> 119,<br />
depending on the school) spread<br />
over a period of approximately<br />
6 months of the year.<br />
This gruel, which was served during<br />
the first break for the price of<br />
40 Ariary (approx 1.5 euro cents),<br />
was prepared in each school using<br />
a corn meal powder called<br />
“Koba Tsinjo” (72.6%), peanut<br />
(8.5%), sugar (14.0%) <strong>and</strong> a vitamin<br />
<strong>and</strong> mineral mixture, to which<br />
2.0% soybean oil was added during<br />
the preparation process. The<br />
quantities served (350 g of gruel<br />
containing 110 g of powder, or<br />
380 kcal) were sufficient to cover<br />
18% of the daily energy requirements<br />
of a 10-year-old child,
NEWSLETTER 2/2006<br />
5<br />
SIGHT AND LIFE<br />
as well as 75% of their RDA of<br />
micronutrients for which there is<br />
a major deficiency risk (iron, zinc<br />
<strong>and</strong> vitamin A), 60% of their RDA<br />
of calcium, 40% of their RDA of<br />
other minerals <strong>and</strong> vitamins, <strong>and</strong><br />
25% of their RDA of proteins,<br />
amino acids <strong>and</strong> essential fatty<br />
acids.<br />
The second part consisted in nutrition<br />
education activities, whose<br />
purpose was to communicate<br />
messages aimed at informing<br />
the pupils <strong>and</strong> encouraging them<br />
to adapt their diet to their nutritional<br />
requirements, <strong>and</strong> to lead a<br />
healthy lifestyle. These messages<br />
were delivered throughout the<br />
year by specially trained teachers,<br />
who were also provided with<br />
educational supports developed<br />
by the Nutrimad team.<br />
A first, still incomplete appraisal<br />
(presented to a meeting of national<br />
<strong>and</strong> international interest<br />
groups on 10 May 2006, at the invitation<br />
of Madagascar’s National<br />
Nutrition Office) of the operation<br />
<strong>and</strong> effects of the Nutrimad SFP<br />
during the 2004 – 2005 school<br />
year has now been drafted, <strong>and</strong><br />
this forms the basis of the present<br />
article.<br />
Methodological<br />
approach implemented<br />
for follow-up <strong>and</strong><br />
evaluation<br />
The follow-up <strong>and</strong> evaluation<br />
strategy implemented throughout<br />
the year 2004 – 2005 to check<br />
the relevance <strong>and</strong> effectiveness<br />
of the Nutrimad SFP consisted<br />
mainly in measuring:<br />
• pupils’ participation in the<br />
scheme<br />
• the effect of nutrition education<br />
activities on pupils’ nutrition<br />
knowledge<br />
• the effect of gruel consumption<br />
on the frequency <strong>and</strong> nature<br />
of pupils’ meals, on their nutritional<br />
status, <strong>and</strong> on their<br />
school performance<br />
In doing this, we had to take into<br />
account three main constraints.<br />
The first of these was the noninclusion<br />
of control schools in our<br />
evaluation strategy, which meant<br />
that we were limited to comparing<br />
indicator values either recorded<br />
at the beginning <strong>and</strong> end of the<br />
year with the same pupils, or<br />
calculated for groups of pupils<br />
put together according to their<br />
gruel consumption. The second<br />
constraint was the insufficiency<br />
of financial resources allocated<br />
to the evaluation studies, which<br />
limited our choice of indicators<br />
for impact on nutritional status to<br />
those based on anthropometric<br />
measurements. The third constraint<br />
was the impossibility of<br />
gathering, from the relevant services,<br />
previous years’ statistics on<br />
absenteeism <strong>and</strong> graduation into<br />
higher classes.<br />
The analyses carried out can be<br />
divided into three categories:<br />
• those carried out on the entire<br />
number (12,893) of pupils<br />
from 254 classes from the 15<br />
schools, which consisted in<br />
creating a typology of schools<br />
<strong>and</strong> in recording information<br />
on the classes <strong>and</strong> teachers,<br />
as well as a self-administered<br />
questionnaire survey of the<br />
socio-economic situation of<br />
the families, a daily record of<br />
information on absenteeism<br />
<strong>and</strong> consumption of the snacks,<br />
anthropometric measurements<br />
<strong>and</strong> tests of nutrition knowledge<br />
taken at the beginning <strong>and</strong> end<br />
of the school year, <strong>and</strong> a record<br />
of results from the end-of-year<br />
exam determining whether<br />
pupils graduate into higher<br />
classes <strong>and</strong> which academic<br />
direction they should take;
SIGHT AND LIFE 6<br />
NEWSLETTER 2/2006<br />
• those carried out on reduced<br />
samples of pupils, in particular<br />
a measurement of food-intake<br />
which allowed us to check the<br />
adequacy of the consumption<br />
of gruel actually served (2,573<br />
pupils from 64 classes in 5<br />
schools), serial data-gathering<br />
intended to estimate, amongst<br />
other things, the effects of<br />
gruel consumption on the<br />
frequency <strong>and</strong> composition of<br />
meals (all pupils from 5 of the<br />
15 schools), <strong>and</strong> the share of<br />
nutritional requirements covered<br />
(a survey based on recall<br />
of the past 24 hours carried out<br />
on 480 children from 9 of the<br />
15 schools);<br />
• finally, studies concerning gruel<br />
preparation, which were carried<br />
out in 5 schools to ensure<br />
that preparation guidelines<br />
were being respected <strong>and</strong> to<br />
check the characteristics of the<br />
gruel being served.<br />
Confirmation of the poor<br />
nutritional status <strong>and</strong><br />
low spending power of<br />
pupils<br />
In the first place, the surveys <strong>and</strong><br />
measurements taken allowed us<br />
to confirm the poor nutritional<br />
status of pupils at the start of the<br />
school year, before the Nutrimad<br />
SFP was launched.<br />
Delayed growth <strong>and</strong> low weight<br />
affected 46.0% <strong>and</strong> 32.8% of<br />
Figure 1. Prevalence of delayed<br />
growth, wasting, <strong>and</strong> low weight<br />
in children from the 15 schools (the<br />
figures for wasting are for children<br />
under 10 only).<br />
children respectively, although<br />
there was a low prevalence<br />
(2.2%) of wasting among children<br />
under 10 years (Figure 1).<br />
Moreover, the nutritional status<br />
of boys is noticeably worse than<br />
that of girls (49.6% vs. 42.2%<br />
for delayed growth; 37.8% vs.<br />
27.3% for low weight), <strong>and</strong>, while<br />
the prevalence of malnutrition remains<br />
relatively constant between<br />
ages 6 <strong>and</strong> 10, it increases considerably<br />
in older children. Furthermore,<br />
it seems that there is an<br />
important relationship between<br />
academic underachievement<br />
<strong>and</strong> nutritional status insofar as,<br />
of the total number of children,<br />
the prevalence of arrested size<br />
fits 38% of children who are one<br />
school year behind, <strong>and</strong> 55% of<br />
children who are two school years<br />
behind in their studies.<br />
Regarding the sums of money the<br />
children could afford to spend on<br />
food each day, the 11,255 children<br />
who completed the questionnaire<br />
had received an average<br />
of 67 Ariary from their parents on<br />
their most recent day at school.<br />
A third of the children received<br />
more than 50 Ariary, while 27%<br />
received less, of whom 5.1%<br />
received nothing at all.<br />
A high rate of pupil<br />
participation in the<br />
scheme<br />
Over the entire gruel distribution<br />
period, the average rate of pupil<br />
participation in the scheme, i.e.<br />
the average percentage of days<br />
on which they consumed at least<br />
one serving of gruel during the<br />
operational period of the Nutrimad<br />
SFP, was 68.4%. This rate<br />
was slightly higher in the second<br />
semester (71%) than in the other<br />
two (67% <strong>and</strong> 66%). The older the<br />
children, the more their participation<br />
rate went up (from 60% at age<br />
6 to 77% at age 13), or in other<br />
words, participation increased in<br />
direct proportion with the level of<br />
the school year (Figure 2).<br />
Ultimately, despite having to pay<br />
40 Ar for each serving of gruel,<br />
34.3% of pupils took over 80% of<br />
the opportunities offered them to<br />
eat it throughout the year, which<br />
means that only 9.6% took 20%<br />
or less of these opportunities.
NEWSLETTER 2/2006<br />
7<br />
SIGHT AND LIFE<br />
Gruel prepared <strong>and</strong><br />
consumed according to<br />
recommendations<br />
The observations <strong>and</strong> samples<br />
taken have shown that gruel<br />
prepared in the schools did indeed<br />
contain on average the<br />
desired concentration of energy<br />
(108 kcal/100 g of gruel, which<br />
corresponds to 378 kcal for a<br />
350 g serving) <strong>and</strong>, moreover, that<br />
94.1% of children completely finished<br />
their plate of gruel, with only<br />
0.75% of children leaving more<br />
than 4 soup-spoonfuls, <strong>and</strong> 2.9%<br />
sharing their gruel with a friend.<br />
Under these conditions, we can<br />
calculate that, over the 6 month<br />
period (from November 2004<br />
to May 2005) during which the<br />
Nutrimad SFP was in operation,<br />
the snacks provided 23.8% of the<br />
children with over 40% of their<br />
RDA in micronutrients for which<br />
there is a major deficiency risk,<br />
between 20% <strong>and</strong> 40% of the<br />
RDA for 65% of them, <strong>and</strong> under<br />
20% for only 11.2%.<br />
A snack which does not<br />
take the place of regular<br />
meals<br />
Pending the processing of data<br />
from the survey based on recall of<br />
the past 24 hours, which should<br />
allow us to compare percentages<br />
of nutritional cover between<br />
children who ate the snacks <strong>and</strong><br />
those who did not, the results<br />
provided here concern the effect<br />
of snack consumption on the<br />
frequency of daily meals.<br />
The consumption of breakfasts<br />
(96.3%) <strong>and</strong> lunches (95.7%) at<br />
home by the children was just as<br />
frequent among those who ate<br />
the snacks as it was among those<br />
who did not. The consumption<br />
of dinners was even slightly, but<br />
significantly (98.1% vs. 96.1%;<br />
p
SIGHT AND LIFE 8<br />
NEWSLETTER 2/2006<br />
Improved nutrition<br />
knowledge <strong>and</strong><br />
awareness<br />
The average marks obtained<br />
from nutrition knowledge tests<br />
taken before <strong>and</strong> after the Nutrimad<br />
SFP’s 6-month operation<br />
period are given in Figure 5. For<br />
all the school years there was a<br />
significant improvement of nutrition<br />
knowledge during the year,<br />
although this improvement is<br />
apparently greater in years CP2,<br />
CP1 <strong>and</strong> CE than in CM1 <strong>and</strong><br />
CM2.<br />
The statistical analyses led to<br />
the identification of certain factors<br />
influencing the variations<br />
in pupils’ nutrition knowledge<br />
throughout the school year. The<br />
most important of these, taking<br />
into account the essential role<br />
played by the communication<br />
of messages, was the teachers’<br />
motivation.<br />
Figure 4. Effects of gruel consumption<br />
on differences in weight, raw or<br />
adjusted*, between the beginning <strong>and</strong><br />
end of the Nutrimad SFP’s 6-month<br />
operation period. Groups according<br />
to gruel consumption: 1) less than<br />
20%; 2) 20% to 40%; 3) over 40%.<br />
*Adjusted by analysis of covariance for<br />
indicator variables of the characteristics<br />
of the school, characteristics of the<br />
class (number of children, school year),<br />
characteristics of the teachers, of the<br />
children’s family group (index of possessions,<br />
number of siblings, amount of<br />
pocket money given them by their parents)<br />
<strong>and</strong> of children’s characteristics at<br />
the start of the year (age, size, Size/age<br />
<strong>and</strong> Weight/age Z-scores)<br />
Figure 5. Comparison of average marks obtained by children in nutrition<br />
knowledge tests at the beginning <strong>and</strong> end of the school year (CP–CM2<br />
refers to primary school grades in French-speaking countries).<br />
Impact on school<br />
performance<br />
An assessment of the effect of<br />
snack consumption on school<br />
performance of the total number<br />
of pupils from the 15 schools was<br />
based on the decision made at<br />
the end of the year as to whether<br />
they should graduate to the next<br />
class, <strong>and</strong> on the marks they<br />
obtained at the end-of-year exams.<br />
The children from group 3 were<br />
over 10% more likely to be allowed<br />
to graduate to the next<br />
class than those from group 1<br />
(81% vs. 71%). Moreover, they<br />
were 6% less likely than group 1<br />
to obtain below average marks<br />
at the end-of-year exams (27.1%<br />
vs. 33.2%). If we adjust, using<br />
logistical regression, the percentage<br />
scores of children allowed<br />
to graduate to the next class<br />
for potentially confounding variables,<br />
the differences between<br />
the groups still remain significant<br />
(72.6%, 75.6% <strong>and</strong> 82.5% for<br />
children from groups 1, 2 <strong>and</strong> 3<br />
respectively; p
NEWSLETTER 2/2006<br />
9<br />
SIGHT AND LIFE<br />
by the pupils have considerably<br />
improved their school performance.<br />
Conclusion<br />
The follow-up <strong>and</strong> evaluation<br />
of the Nutrimad SFP during the<br />
2004 – 2005 school year has essentially<br />
allowed us to highlight<br />
the poor nutritional status of children<br />
<strong>and</strong> to establish, or highlight,<br />
the adequacy of the type of snack<br />
provided:<br />
• over the 110 days of the program,<br />
the children took 68%<br />
of opportunities offered them<br />
to eat the gruel;<br />
• each portion consumed covered<br />
16% to 22% of their energy<br />
requirements <strong>and</strong> 75% of<br />
their requirements of the main<br />
micronutrients;<br />
• the snacks did not take the<br />
place of regular meals.<br />
Furthermore, at the end of the<br />
year the most regular consumers<br />
had, in comparison with the<br />
others, a better nutritional status<br />
(40% vs. 50% delayed growth),<br />
were less likely to have to repeat<br />
their school year (20% vs. 30%),<br />
<strong>and</strong> did better at the end-of-year<br />
exams.<br />
These very encouraging results<br />
are currently undergoing confirmation<br />
in the 2005 – 2006 period<br />
at the same schools. The integration<br />
of 8 control schools into the<br />
evaluation process should allow<br />
us to highlight not only the effect<br />
of snack consumption <strong>and</strong> nutrition<br />
education on the children’s<br />
nutritional status <strong>and</strong> school<br />
performance, but also the effectiveness<br />
of the present strategy<br />
within the context of the education<br />
system concerned.<br />
References<br />
Figure 6. Effects of gruel consumption on average marks, raw <strong>and</strong> adjusted,<br />
obtained by pupils at the end-of-year exams (averages not accompanied by<br />
identical letters differ to the level of significance indicated). Groups according<br />
to gruel consumption: 1) less than 20%; 2) 20% to 40%; 3) over 40%.<br />
(1) Adjusted for indicator variables of the characteristics of the school, characteristics<br />
of the class (number of children, school year), characteristics of the teachers (absenteeism,<br />
mark given by monitors of participation in the scheme), of the children’s<br />
family group (index of possessions, parents’ level of education), <strong>and</strong> characteristics<br />
of the children (gender, age, Size/age Z-score at the start of the year).<br />
1. Laillou A, de Sesmaisons A, Ralison<br />
R et al. (2005). Distributing fortified<br />
<strong>and</strong> high-energy density gruel to<br />
reduce the failure rate <strong>and</strong> improve<br />
nutritional status of Antananarivo<br />
schoolchildren. SIGHT AND LIFE<br />
<strong>Newsletter</strong> 2: 22–26.
SIGHT AND LIFE 10<br />
NEWSLETTER 2/2006<br />
Reflections: Four decades with vitamin A <strong>and</strong><br />
carotenoids; James Allen Olsen Memorial Lecture, CARIG, 2006<br />
Barbara A Underwood* 1 , PhD, Adjunct Professor of Nutrition, Institute of Human<br />
Nutrition, Columbia University, New York<br />
Introduction<br />
James Allen Olson was a biochemist/nutrition<br />
scientist, mentor,<br />
colleague <strong>and</strong> friend to many<br />
of us. He was the father of VARIG<br />
(Vitamin A Research Interactive<br />
Group) <strong>and</strong> CARIG (Carotenoid<br />
Research Interactive Group) at<br />
the Experimental Biology meetings<br />
<strong>and</strong> one of the founding<br />
members of IVACG (International<br />
Vitamin A Consultative Group). At<br />
IVACG he was frequently requested<br />
to provide updates on vitamin<br />
A <strong>and</strong> carotenoid metabolism<br />
<strong>and</strong> he carried the torch for foodbased<br />
approaches to vitamin A<br />
deficiency as a vital component<br />
of any micronutrient control program.<br />
For many years Jim <strong>and</strong><br />
I worked together within IVACG<br />
<strong>and</strong> as research colleagues in<br />
vitamin A metabolism, assessment<br />
of status <strong>and</strong> promotion<br />
of sustainable intervention programs.<br />
It is a privilege <strong>and</strong> an<br />
honor to be asked to speak at this<br />
memorial lecture <strong>and</strong> to reflect<br />
back to some of the significant<br />
years in vitamin A <strong>and</strong> carotenoid<br />
research <strong>and</strong> programs.<br />
1960s: Where were we<br />
then?* 2<br />
In 1960, Hoffmann-LaRoche organized<br />
a symposium convened<br />
in Switzerl<strong>and</strong> on “Vitamin A <strong>and</strong><br />
Metabolism” to honor Professor<br />
*1 E-mail: bunderwo@adnc.com<br />
*2 The photos of some of the people<br />
mentioned are taken from the SIGHT<br />
AND LIFE slides (<strong>02</strong> HI History) on<br />
our website (http://sight<strong>and</strong>life.<br />
org/slidesNEWppt/mainNEWsl.<br />
html) <strong>and</strong> can also be found on our<br />
CD; editor.<br />
P. Karrer (1). Karrer had isolated<br />
<strong>and</strong> elucidated the structure of<br />
vitamin A in 1931. The content<br />
of the symposium was meant to<br />
sum-up the situation with respect<br />
to vitamin A <strong>and</strong> provitamin A<br />
carotenoids. The “sum-up” revealed<br />
that there was yet lots to<br />
be learned, despite the fact that<br />
deficiency eye symptoms were<br />
described <strong>and</strong> a cure known<br />
(liver extract) from ancient times<br />
(2); that in the second decade<br />
of the 20th century these symptoms<br />
were attributed to lack of<br />
a fat-soluble substance found in<br />
some animal foods <strong>and</strong> butterfat<br />
(3,4), which McCollum named<br />
vitamin A (3), or to a lack of carotenoids<br />
in some plant foods that<br />
Steenbock suggested in 1919<br />
could be converted to the active<br />
component (5); that vitamin A<br />
was isolated <strong>and</strong> its structure<br />
elucidated by Karrer in 1931<br />
(6); that Wald <strong>and</strong> colleagues in<br />
the latter part of the1930s had<br />
uncovered the functional role of<br />
the vitamin in vision (7,8); <strong>and</strong> in<br />
1960, that Dowling <strong>and</strong> Wald (9)<br />
had reviewed the overt systemic<br />
signs of vitamin A deficiency <strong>and</strong><br />
the role of vitamin A acid (retinoic<br />
acid) in maintaining growth <strong>and</strong><br />
the health of epithelial tissues,<br />
though animals were deficient<br />
in retinol <strong>and</strong> were night-blind.<br />
And importantly, Stephenson<br />
<strong>and</strong> Clark* 3 as early as 1920 reported<br />
that rats fed diets void of<br />
the active fat-soluble substances<br />
died at a higher rate even before<br />
eye signs occurred, but that eye<br />
symptoms in every case cleared<br />
when a petroleum ether extract<br />
of dried carrot was incorporated<br />
into their diet (10).<br />
James A Olson (http://sight<strong>and</strong>life.org/PhotosAll/pic2000-4/<br />
NL400p21.jpg)<br />
In spite of all that was known by<br />
1960, much remained unknown.<br />
There was little knowledge of<br />
the global magnitude of the<br />
deficiency problem in humans.<br />
In part this was because there<br />
was no consensus on how best<br />
to assess vitamin A deficiency<br />
either clinically or biochemically<br />
given that clinical signs were not<br />
st<strong>and</strong>ardized <strong>and</strong> methodologies<br />
available for biochemical<br />
assessment provided uncertain<br />
results. Detailed information on<br />
the metabolism of vitamin A was<br />
limited <strong>and</strong> the active form <strong>and</strong><br />
*3 The SIGHT AND LIFE slide P35<br />
refers to the same publication (http://<br />
sight<strong>and</strong>life.org/slidesS<strong>and</strong>P/E/<br />
Pslides.html)
NEWSLETTER 2/2006<br />
11<br />
SIGHT AND LIFE<br />
EV McCollum Paul Karrer Otto Isler (left)<br />
function of vitamin A outside the<br />
visual cycle was still speculative<br />
(11). Analytical methods for quantitative<br />
analysis existed for both<br />
the preformed vitamin <strong>and</strong> for<br />
provitamin carotenoids, but these<br />
methods were often tedious, difficult<br />
to st<strong>and</strong>ardize, <strong>and</strong> frequently<br />
used toxic chemicals that failed<br />
to provide reproducible results in<br />
many laboratories (12–14). There<br />
were no large-scale intervention<br />
programs to combat vitamin A<br />
deficiency <strong>and</strong> even at the local<br />
level within hospitals there was<br />
little appreciation of how to treat<br />
or prevent the deficiency, which<br />
often accompanied proteinenergy<br />
malnutrition (PEM). And<br />
notably, there was very little political<br />
interest or will to eliminate<br />
vitamin A deficiency.<br />
I saw my first cases of xerophthalmia<br />
in 1961, more than four<br />
decades ago, while conducting<br />
doctoral research among refugee<br />
children in what was then Jerusalem,<br />
Jordan. I was midway<br />
through studies at Columbia<br />
University Institute of Nutrition<br />
Sciences, later renamed the Institute<br />
of Human Nutrition (IHN).<br />
I went there in 1959 because of<br />
a deep concern for problems of<br />
childhood malnutrition in the developing<br />
world <strong>and</strong> the desire to<br />
become professionally involved<br />
in seeking appropriate solutions.<br />
The Institute had a newly created<br />
program led by William Henry<br />
Sebrell, one of the pioneer nutritionists<br />
of the 20th century. The<br />
Institute’s objective was to train<br />
students to analyze, underst<strong>and</strong><br />
<strong>and</strong> seek solutions to malnutrition<br />
in the developing world in a holistic<br />
context (15). My academic<br />
training within this environment<br />
<strong>and</strong> the opportunity to do my<br />
thesis research in an international<br />
setting among malnourished children<br />
set the tone for the rest of<br />
my professional career.<br />
2006: Where are we<br />
today – after 4½<br />
decades?<br />
Prevalence<br />
No doubt, we have a greater<br />
appreciation of the magnitude<br />
of the global problem <strong>and</strong> the<br />
epidemiological factors, in addition<br />
to diet, that contribute to<br />
its existence. The Micronutrient<br />
Report published in 2001(16)<br />
placed the magnitude of the<br />
problem among preschool-aged<br />
children at 75 – 140 million; earlier<br />
estimates by the WHO placed the<br />
prevalence as high as 230 million<br />
(17). These prevalence data are<br />
based on clinical eye signs <strong>and</strong>/or<br />
low blood vitamin A levels from a<br />
database that is far from representative<br />
<strong>and</strong> firm. Nonetheless,<br />
The Micronutrient Report also<br />
noted a trend toward improvement<br />
since 1980 in most regions<br />
of the world, particularly since<br />
1990, a period when large-scale<br />
periodic vitamin A distribution programs<br />
were exp<strong>and</strong>ing. Indeed,<br />
on the public health level, intervention<br />
by periodic distribution<br />
of high-dose vitamin A supplements<br />
now covers an estimated<br />
70% of preschool-aged children<br />
in 40 countries with at least one<br />
dose of vitamin A annually, <strong>and</strong><br />
about 1/3 of these 40 countries<br />
have achieved 70% coverage<br />
with the required two doses (18).<br />
However, now we know that the<br />
problem extends beyond the preschool<br />
years to pregnant women<br />
whose health <strong>and</strong> survival also are<br />
compromised in countries where<br />
deficiency is common (19). The<br />
magnitude of deficiency among<br />
pregnant women, however, is<br />
largely unknown <strong>and</strong> there are few<br />
targeted prevention programs in<br />
effect that reach these vulnerable<br />
women.<br />
Metabolism <strong>and</strong> methods<br />
Knowledge of the metabolism of<br />
vitamin A <strong>and</strong> carotenoids has<br />
advanced dramatically since<br />
1960. The active forms <strong>and</strong> functions<br />
of vitamin A are established:<br />
retinol in the visual system <strong>and</strong><br />
retinoic acid in normal growth<br />
<strong>and</strong> development by modulation<br />
of gene actions. And new knowledge<br />
of non-provitamin A roles of<br />
carotenoids in the moderation of<br />
degenerative diseases is evolving<br />
as definitive analytical techniques<br />
allow for tracing the metabolism<br />
of individual carotenoids. Quantitative<br />
analytical methods for<br />
retinoids are well advanced (20)<br />
<strong>and</strong> this has contributed to a<br />
variety of new field assessment<br />
methods, including a more objective<br />
<strong>and</strong> reproducible meas-
SIGHT AND LIFE 12<br />
NEWSLETTER 2/2006<br />
Richard Kuhn<br />
George Wald<br />
ure of night blindness (pupillary<br />
response) (21), subject-friendly<br />
collection of blood specimens<br />
(dry blood spots) for subsequent<br />
quantitative analysis either in the<br />
field or at a base laboratory (22)<br />
<strong>and</strong> assessing whole body stores<br />
(isotope dilution) (23). The application<br />
of new intrinsic carotenoid<br />
labeling methods offers greater<br />
ability to trace individual carotenoids<br />
from vegetables containing<br />
them in their natural matrices to<br />
their uptake from the gut <strong>and</strong> utilization:<br />
hence, to a more accurate<br />
measure of bioavailability (24).<br />
Programs<br />
Intervention programs are moving<br />
beyond strictly distributing<br />
nutrient supplements. These<br />
programs are becoming more<br />
integrated <strong>and</strong> viewed more<br />
holistically within the context of<br />
undernutrition, underdevelopment<br />
<strong>and</strong> poverty. Micronutrient<br />
fortified foods that can address<br />
both specific deficiencies <strong>and</strong> caloric<br />
undernutrition are available<br />
in many countries. They include<br />
vitamin A fortified sugar, oils, <strong>and</strong><br />
some cereals, to name a few, but<br />
access by the poor at greatest<br />
risk still varies greatly, especially<br />
in rural areas with limited market<br />
access. And public health measures<br />
including promotion <strong>and</strong><br />
support for breastfeeding, exp<strong>and</strong>ed<br />
immunization coverage,<br />
parasite control programs, <strong>and</strong><br />
home-based control of severe diarrheal<br />
disease have contributed<br />
to decreased infectious morbidity<br />
<strong>and</strong> mortality <strong>and</strong>, hence,<br />
improved individual <strong>and</strong> national<br />
HAPC Oomen<br />
development. Although improvements<br />
are occurring in availability<br />
of potable water <strong>and</strong> environmental<br />
sanitation, the UN reports<br />
(Los Angeles Times, March 10)<br />
that over 1.1 billion living in impoverished<br />
communities remain<br />
without safe water. Yet in spite of<br />
all the progress made, including<br />
distribution of over 400 million<br />
vitamin A capsules annually (18),<br />
vitamin A deficiency remains a<br />
significant public health problem.<br />
A diet inadequate in vitamin A-<br />
containing food sources is the<br />
underlying cause of deficiency.<br />
Yet until recently food-based approaches<br />
that impact on underlying<br />
causes of underdevelopment,<br />
undernutrition <strong>and</strong> micronutrient<br />
deficiencies were the step-child<br />
intervention least attractive to<br />
international funding agencies.<br />
How did we get from<br />
there (1960) to here<br />
(2006)? Some significant<br />
decade milestones<br />
1960–1970: Progress<br />
in underst<strong>and</strong>ing basic<br />
metabolism<br />
The decade of the 1960s was the<br />
period that in my reflective view<br />
was noted mostly for advances in<br />
underst<strong>and</strong>ing the basic metabolism<br />
of vitamin A <strong>and</strong> provitamin A<br />
carotenoids. Central cleavage of<br />
beta-carotene in James Olson’s<br />
(25) <strong>and</strong> DeWitt Goodman’s (26)<br />
laboratories by enzymes isolated<br />
from the gut <strong>and</strong> liver of rats advanced<br />
knowledge of bioconversion<br />
mechanisms. In humans,<br />
efficient uptake of dietary retinol<br />
<strong>and</strong> conversion of β-carotene to<br />
retinal, esterification to retinyl<br />
esters, transport of the esterified<br />
product in lymph chylomicra <strong>and</strong><br />
hepatic uptake from chylomicra<br />
remnants were demonstrated (27).<br />
Retinol binding protein (RBP) was<br />
isolated <strong>and</strong> partially characterized<br />
in 1968, <strong>and</strong> subsequently<br />
its role in hepatic mobilization <strong>and</strong><br />
transport of retinol as holo-RBP<br />
complexed with transthyretin was<br />
defined (28). Underst<strong>and</strong>ing of<br />
the reversible formation of single,<br />
bi- <strong>and</strong> trimolecular complexing<br />
clarified how the exchange<br />
of retinol from blood to tissues<br />
occurred without loss through<br />
kidney filtration. Furthermore, the<br />
concepts revealed in defining the<br />
metabolism of RBP provided the<br />
basis in the following two decades<br />
for a new indirect assessment of<br />
depleted hepatic stores, the relative<br />
dose response (RDR) in my<br />
laboratory (29), its modification<br />
(MRDR) in James Olson’s laboratory<br />
(30) <strong>and</strong> its current broad use<br />
in assessment of vitamin A status<br />
in human <strong>and</strong> animal studies.<br />
On the public health front progress<br />
was slow. In 1964 the first ‘guestimate’<br />
of the global magnitude<br />
of deficiency was made. The approximation<br />
of 20,000 to 100,000<br />
affected children was based<br />
largely on interviews <strong>and</strong> subjective<br />
information on the prevalence<br />
of eye signs (31), which did not<br />
generate political support for<br />
large intervention programs, even<br />
though severe vitamin A deficiency<br />
in children was very evident in<br />
developing countries, often associated<br />
with PEM, <strong>and</strong> too often<br />
inappropriately managed leading<br />
to irreversible blindness, if the patient<br />
survived. Many of us involved<br />
in international child health issues<br />
during the 1960s were appalled<br />
by the lack of attention to this<br />
preventable public health scourge,<br />
but there was no organized group<br />
to champion the cause at a political<br />
level <strong>and</strong> attract substantial<br />
funds for prevention.
NEWSLETTER 2/2006<br />
13<br />
SIGHT AND LIFE<br />
Donald S McLaren<br />
1970–1980: Breakthroughs<br />
in analytical methodology<br />
<strong>and</strong> public health<br />
The decade of the 1970s is<br />
noteworthy for a major methodological<br />
breakthrough in retinoid<br />
analyses, the application of highpressure<br />
liquid chromatography<br />
(HPLC). Harold Furr recently<br />
commented that “Progress in nutritional<br />
biochemistry has always<br />
depended on progress in analysis<br />
of nutrients” (20). That is why the<br />
advent of HPLC in the mid-1970s<br />
was such an important addition<br />
to the analytical assessment<br />
arsenal (32,33), opening doors<br />
for progress in both basic <strong>and</strong><br />
applied research. Although the<br />
instrument originally was too<br />
expensive to obtain <strong>and</strong> maintain<br />
in developing countries, it is now<br />
broadly available <strong>and</strong> the method<br />
of choice for most applications<br />
requiring quantitative retinoid<br />
analyses, especially for the analysis<br />
of vitamin A in blood.<br />
On the public health platform<br />
during the 1970s, the most important<br />
advance in vitamin A<br />
program applications occurred as<br />
the result of three seminal meetings.<br />
The first was a WHO/USAID<br />
sponsored meeting in Jakarta,<br />
Indonesia in 1974 (34). The Jakarta<br />
meeting was notable for<br />
the heated controversy between<br />
ophthalmologists, epidemiologists<br />
<strong>and</strong> nutritional biochemists<br />
on the appropriate classification<br />
criteria for xerophthalmia, cut-off<br />
points to establish a public health<br />
problem, the health consequences<br />
of deficiency beyond the eye,<br />
reliable assessment methodology<br />
<strong>and</strong> efficacy <strong>and</strong> effectiveness of<br />
different intervention programs.<br />
Tentative decisions on these<br />
issues were published in the<br />
meeting report but the science<br />
base was weak <strong>and</strong> few were<br />
satisfied. The scientists went<br />
from this meeting determined<br />
to provide the missing research<br />
data to resolve disagreements<br />
(35). The following year (1975)<br />
IVACG was formally established<br />
to maintain momentum toward<br />
the control of vitamin A deficiency<br />
diseases by providing an<br />
annual forum (later changed to<br />
biannual meetings) for information<br />
exchange among researchers,<br />
public health professionals,<br />
international funding agencies,<br />
non-governmental agencies <strong>and</strong><br />
private industry (36). Research<br />
activities did accelerate in subsequent<br />
years as was obvious in the<br />
follow-up WHO/UNICEF/USAID/<br />
HKI/IVACG-sponsored meeting in<br />
Jakarta in 1980 (37). The meeting<br />
was less controversial because<br />
data were available from the<br />
considerable amount of research<br />
that had been completed in the<br />
previous six years. The result was<br />
consensus on earlier arguable<br />
issues, i.e. st<strong>and</strong>ardization <strong>and</strong><br />
classification of xerophthalmia<br />
symptoms <strong>and</strong> signs, treatment<br />
<strong>and</strong> prophylaxis schedules <strong>and</strong><br />
agreement to draw attention to<br />
the need for large-scale intervention<br />
programs.<br />
Creation of IVACG deserves special<br />
mention. The USAID established<br />
<strong>and</strong> sponsored the group<br />
for 30 years. Administration of<br />
the program initially was through<br />
the Nutrition Foundation, which<br />
was later transformed into the<br />
International <strong>Life</strong> Science Institute<br />
(ILSI). The group began with<br />
only 17 committed individuals<br />
<strong>and</strong> reached as many as 100 over<br />
the first decade (36). Individuals<br />
worked voluntarily in task forces<br />
Alfred Sommer<br />
between the annual meetings to<br />
produce guidelines <strong>and</strong> state-ofthe-art<br />
reviews, many of which<br />
remain useful even today. James<br />
Olson was a charter member of<br />
IVACG <strong>and</strong> co-authored many<br />
of the guidelines <strong>and</strong> reviews.<br />
He seldom missed a meeting.<br />
Frequently he provided the biochemical<br />
updates because his<br />
presentations were so lucid <strong>and</strong><br />
underst<strong>and</strong>able by all in the<br />
diverse group that assembled<br />
annually. In addition, he usually<br />
chaired sessions on carotenoid<br />
biochemistry <strong>and</strong> conducted focus<br />
groups on carotenoids <strong>and</strong><br />
food-based issues. The meetings<br />
grew during the three decades of<br />
IVACG’s existence to an attendance<br />
of about 800 delegates at the<br />
22nd meeting held in Lima, Peru<br />
in 2004. The 2004 meeting was<br />
the last before disb<strong>and</strong>ment <strong>and</strong><br />
reorganization, which is currently<br />
in progress, to form a Micronutrient<br />
Forum. IVACG during its 30<br />
years of existence gained respect<br />
throughout the international community<br />
<strong>and</strong> played an influential<br />
role in international programs to<br />
control deficiency world-wide.<br />
Hopefully the reformed Forum<br />
will continue the momentum of<br />
IVACG in influencing scientific<br />
directions <strong>and</strong> political decisions,<br />
hence accelerating the elimination<br />
of micronutrient deficiencies<br />
as public health problems.
SIGHT AND LIFE 14<br />
NEWSLETTER 2/2006<br />
1980–1990: Retinoid<br />
revolution in the lab <strong>and</strong><br />
recognition that ocular<br />
signs were the tip of the<br />
iceberg in the field<br />
Retinoid biochemistry experienced<br />
a renaissance late in the<br />
century when nuclear retinoid<br />
receptors were identified <strong>and</strong><br />
their pleiotrophic effects recognized<br />
in 1987 (38). This was the<br />
beginning of research that has<br />
identified how retinoic acid influences<br />
a multitude of gene actions<br />
that regulate differentiation <strong>and</strong><br />
cellular growth <strong>and</strong> functions.<br />
This revolution is on-going with<br />
new effects on functions being<br />
reported regularly.<br />
On the public health scene,<br />
though nutritional biochemists<br />
had argued vehemently at the<br />
1974 meeting in Jakarta that<br />
health consequences went far<br />
beyond the eye-based on animal<br />
studies – ophthalmologists were<br />
unconvinced. The data systematically<br />
collected in Indonesia<br />
by Alfred Sommer (an ophthalmologist/epidemiologist)<br />
<strong>and</strong><br />
colleagues during the decade of<br />
the 1980s documented the prevalence<br />
of vitamin A deficiency in<br />
the country <strong>and</strong> provided a firmer<br />
basis for projecting the extent of<br />
the problem in four other Asian<br />
countries, i.e. 200,000–400,000<br />
corneal cases <strong>and</strong> 4–8 million<br />
non-corneal cases (39). The team<br />
also elucidated the underlying<br />
epidemiological associations that<br />
led to clustering of deficiency in<br />
affected populations. The epidemiologic<br />
studies associated the<br />
lack of diversity in child diets,<br />
including lack of animal products<br />
<strong>and</strong> carotenoid-containing fruits<br />
<strong>and</strong> vegetables, with deficiency.<br />
The survey <strong>and</strong> epidemiological<br />
studies set the stage for the large<br />
r<strong>and</strong>omly designed, controlled<br />
intervention trial that first established<br />
in humans the mortality<br />
risk associated with deficiency<br />
(40,41) that six decades earlier<br />
had been reported in animals<br />
(10). The announcement at an<br />
IVACG meeting late in the 1980s<br />
of a 27% reduction in mortality<br />
was met with skepticism by the<br />
scientific community, including<br />
myself, who found it difficult to<br />
believe that such a large effect<br />
could occur from supplementation<br />
without also addressing the<br />
prevalence of other diseases<br />
<strong>and</strong> unsanitary environmental<br />
conditions. Subsequently preschool<br />
child mortality associated<br />
with deficiency was confirmed,<br />
though variable in magnitude,<br />
in Nepal (42), in Ghana (43), <strong>and</strong><br />
in India (44), but not in Sudan<br />
(45), after administering highdose<br />
vitamin A capsules every<br />
4 or 6 months. Child mortality<br />
was also reduced in Indonesia<br />
(46) by regular intake of fortified<br />
monosodium glutamate, <strong>and</strong> in<br />
India (47) by providing a low-dose<br />
weekly supplement, potentially<br />
obtainable through food sources.<br />
Meta-analyses using data from<br />
the major trials concluded that<br />
on average, a 23–30% increase<br />
in mortality is associated with<br />
deficiency (48-50).<br />
1990–2000: Progress on the<br />
political front<br />
Political progress marked the<br />
decade of the 1990s. UNICEF’s<br />
World Summit for Children in 1990<br />
was the ideal situation to call attention<br />
to the striking mortality reduction<br />
benefit expected by correcting<br />
vitamin A deficiency. All<br />
the ingredients were assembled<br />
to launch a major international<br />
offensive against the deficiency<br />
as a public health scourge. The<br />
mortality risk was established<br />
<strong>and</strong> a short-term cost-effective<br />
intervention was available in<br />
the form of high-dose vitamin A<br />
supplements. A persuasive, passionate,<br />
committed champion in<br />
the person of James Grant, then<br />
director of UNICEF, was poised to<br />
effectively mobilize the high-level<br />
political commitment needed<br />
from member states to launch<br />
a major international offensive.<br />
This broad political commitment<br />
was achieved. The commitments<br />
were reinforced at subsequent<br />
international meetings in Canada<br />
in 1991, sponsored by several<br />
bilateral <strong>and</strong> international groups,<br />
at the International Conference<br />
on Nutrition in 1992, sponsored<br />
by WHO/FAO <strong>and</strong> in 1996 at the<br />
WHO/FAO World Food Summit<br />
in Rome. The emphasis from the<br />
beginning was on exp<strong>and</strong>ing the<br />
distribution of high-dose vitamin A<br />
supplements. Little support was<br />
available for alternative strategies.<br />
Supplement distribution<br />
was greatly facilitated when, in<br />
the latter part of 1990, distribution<br />
was linked to the WHO Exp<strong>and</strong>ed<br />
Program of Immunization’s (EPI)<br />
initiative of National Immunization<br />
Days (NID) for eradication<br />
of polio. This initiative provided<br />
a contact with preschool-aged<br />
children with minimal additional<br />
resources for delivery of the vitamin<br />
A capsule <strong>and</strong> is credited<br />
with success in greatly exp<strong>and</strong>ing<br />
coverage. NIDs have now ceased<br />
<strong>and</strong> countries are finding alternative<br />
mechanisms for sustaining<br />
the high coverage rates.<br />
Food fortification in developing<br />
countries received minor attention<br />
until midway in the decade,<br />
in spite of the successful fortification<br />
of sugar in Central America<br />
(51). Primitive development of<br />
the food industry <strong>and</strong> absence of<br />
regulatory controls were considered<br />
deterrents. But the need for<br />
a more sustainable intervention<br />
than periodic supplementation<br />
was recognized. The initiative<br />
for universal fortification of salt<br />
with iodine was making great<br />
inroads into relieving iodine deficiency<br />
disorders in developing<br />
countries, even in remote areas.<br />
Salt iodination advocates pushed<br />
their success as a model for vitamin<br />
A fortification, even though<br />
no comparable universally safe<br />
<strong>and</strong> acceptable food vehicle for<br />
vitamin A was available. Today, as<br />
noted earlier, there is momentum<br />
behind vitamin A fortification pro-
NEWSLETTER 2/2006<br />
15<br />
SIGHT AND LIFE<br />
grams using several food vehicles<br />
adapted to cultural consumption<br />
habits, such as oils, cereals,<br />
condiments <strong>and</strong> dairy products.<br />
Because supplements in the form<br />
of vitamin A or β-carotene in doses<br />
similar to the RDA but given<br />
weekly reduced maternal mortality<br />
by 40–50% (19), comparable<br />
results could be expected by<br />
appropriately fortifying commonly<br />
eaten foods incorporated into a<br />
diversified diet (52).<br />
Lip-service, but few resources,<br />
were devoted to food-based<br />
interventions through the 1990s,<br />
despite the fact that vitamin A<br />
deficiency as a public health<br />
problem is due to an inadequate<br />
diet. Horticultural or other agricultural<br />
approaches attracted<br />
minimal international funding<br />
support <strong>and</strong>, therefore, potential<br />
for food-based approaches was<br />
not adequately evaluated (53). In<br />
part this can be attributed to the<br />
debate in recent years over bioavailabilty<br />
of provitamin-A carotenoid<br />
food sources, particularly<br />
green leafy vegetables that had<br />
been promoted for many years.<br />
The late Clive West introduced<br />
the controversy at a meeting of<br />
the Sub-Committee on Nutrition<br />
in Canada where he suggested<br />
that the 6:1 bioefficacy factor for<br />
beta-carotene used to evaluate<br />
food sources vastly overestimated<br />
its true value. Though the<br />
6:1 factor was vigorously debated<br />
<strong>and</strong> defended, subsequent studies<br />
by the West group (54) <strong>and</strong><br />
others upheld the claim for a<br />
less efficient conversion factor<br />
<strong>and</strong> forced reevaluation of food<br />
sources of carotenoids, particularly<br />
as contenders for elimination<br />
of vitamin A deficiency. In my<br />
view, the debate virtually closed<br />
off international support for horticultural-based<br />
intervention programs<br />
in the decade of the1990s<br />
in spite of the success of the<br />
large-scale horticultural initiative<br />
in Bangladesh, sponsored initially<br />
by Helen Keller International, that<br />
has exp<strong>and</strong>ed in the number of<br />
Barbara Underwood during her presentation at the CARIG Meeting, see<br />
page 18.<br />
communities covered <strong>and</strong> has<br />
demonstrated an improvement in<br />
vitamin A status (52). Agricultural<br />
approaches through plant breeding<br />
came onto the horizon in the<br />
latter part of the decade (56) but<br />
did not receive substantial support<br />
until the turn of the century.<br />
2000 forward: Where are we<br />
going?<br />
The end-of-decade goal for elimination<br />
of vitamin A deficiency was<br />
widely promoted in the 1990s but,<br />
although progress was made,<br />
the goal was not met. To keep<br />
up the momentum, new goals<br />
for elimination of micronutrient<br />
deficiencies were set for 2010 at<br />
the 2001 UN “World Fit for Children”<br />
meeting at UNICEF in New<br />
York. The question for program<br />
implementers is how to adapt<br />
existing strategies to assure that<br />
the extended time frame is met<br />
in a timely manner <strong>and</strong> not just<br />
reset at the end of the decade.<br />
Supplementation undoubtedly<br />
will continue for several years in<br />
certain country situations, but it<br />
will take resources <strong>and</strong> an intense<br />
effort to reach the vulnerable 30%<br />
who are now missed even in the<br />
best country distribution scenarios<br />
(18). Fortification efforts<br />
also will continue <strong>and</strong> undoubtedly<br />
will be increasingly effective<br />
in reaching rural communities<br />
<strong>and</strong> the poor as markets exp<strong>and</strong><br />
<strong>and</strong> economies develop. Public<br />
health measures through massive<br />
immunization campaigns,<br />
particularly for polio <strong>and</strong> measles,<br />
have made great inroads into<br />
control of immunizable infectious<br />
diseases, but these gains need to<br />
be complemented by improved<br />
environmental sanitation <strong>and</strong> safe<br />
water to control non-immunizable<br />
disease. Fortunately, more than<br />
at any point in my experience<br />
with vitamin A interventions, integrated<br />
approaches are gaining<br />
support, even food-based approaches.<br />
Indeed, the new kid on the foodbased<br />
micronutrient intervention<br />
playing field is biofortification.<br />
Although introduced in the mid-<br />
1990s (55) <strong>and</strong> the potential of<br />
the approach reviewed in 2000<br />
(56), substantial funding support<br />
only became available through<br />
the Bill <strong>and</strong> Melinda Gates Foundation<br />
in 20<strong>02</strong>. Biofortification is<br />
the cross-breeding of plants to<br />
increase the density of one or<br />
more nutrients, e.g. iron <strong>and</strong>/or<br />
zinc or provitamin β-carotene,<br />
<strong>and</strong>/or decrease inhibitors to<br />
absorption, e.g. phytates <strong>and</strong>/or<br />
polyphenols. At times, transgenic
SIGHT AND LIFE 16<br />
NEWSLETTER 2/2006<br />
methods may be used to introduce<br />
a nutrient otherwise absent,<br />
increase nutrient density above<br />
that achievable by cross-breeding,<br />
or insert favorable agronomic<br />
traits (e.g. disease resistance or<br />
increased yield). The advantage<br />
of biofortification is that staple<br />
crops grown <strong>and</strong> consumed by<br />
the poor can be enriched with micronutrients<br />
<strong>and</strong> be available harvest<br />
after harvest without added<br />
cost. β-carotene enriched crops<br />
currently being pursued include<br />
maize, cassava <strong>and</strong> sweet potato<br />
by traditional cross-breeding <strong>and</strong><br />
rice by transgenic technology.<br />
Golden Rice produced by Syngenta<br />
(SGR1) is the most publicized<br />
example using genetic<br />
manipulations to introduce genes<br />
to overcome the impediment to<br />
synthesis of β-carotene. Carotene<br />
enrichment of the original<br />
product was not impressive. It<br />
was about 1.6 µg/g rice, which<br />
carried limited potential for making<br />
significant contributions to<br />
vitamin A requirements in spite<br />
of heroic claims to the contrary.<br />
Announcement in 2005 of<br />
Golden Rice #2 (SGR2) changed<br />
the potential: SGR2 contains<br />
31 µg/g β-carotene (57). This is<br />
equivalent to 1033 µg RAE in<br />
400 g uncooked, milled rice (an<br />
adult male serving size of ~800<br />
g cooked rice daily) <strong>and</strong> 516 µg<br />
RAE in 200 g uncooked, milled<br />
rice (an estimated serving size of<br />
400 g cooked rice daily for a child<br />
> 3 years). These calculations assume<br />
12:1 conversion efficiency<br />
for β-carotene to vitamin A. However,<br />
feeding tests to estimate<br />
bioequivalence have not been<br />
reported to date. Nonetheless,<br />
factoring in an approximate 20%<br />
loss during cooking, 826 µg RAE<br />
would remain for an adult <strong>and</strong> 413<br />
µg RAE for a child. SGR2, therefore,<br />
could nearly meet the RDA<br />
across ages if the daily diet contained<br />
800 g <strong>and</strong> 400g of cooked<br />
rice eaten by adults <strong>and</strong> children,<br />
respectively. SGR2 is an example<br />
of using transgenic technology to<br />
introduce or improve carotenoids,<br />
particularly provitamin A, in staple<br />
crops grown <strong>and</strong>/or eaten by the<br />
poor, such as cassava <strong>and</strong> maize.<br />
There remains much research<br />
to be completed before such<br />
carotenoid enriched crops are<br />
available for public consumption.<br />
Bioavailability must be determined<br />
from the biofortified crops<br />
prepared for consumption by<br />
traditional cooking procedures.<br />
Equally important is gaining acceptance<br />
by consumers skeptical<br />
of transgenically produced<br />
food crops <strong>and</strong> of more intensely<br />
colored traditional crops.<br />
Biofortification, however, is not<br />
restricted to use of transgenic<br />
technology. There is potential<br />
through traditional crossbreeding<br />
of germ plasma from varieties<br />
with higher nutrient density <strong>and</strong><br />
other desired agronomic qualities.<br />
Perhaps the most advanced<br />
example in carotenoid-containing<br />
food plants is orange-fleshed<br />
sweet potato (OFSP) varieties.<br />
Although white sweet potato<br />
is the common staple eaten in<br />
many African countries, yelloworange<br />
varieties do exist in many<br />
countries. One particular orange<br />
variety (Resisto) has already been<br />
evaluated in a feeding trial among<br />
primary school children in South<br />
Africa <strong>and</strong> found to be acceptable<br />
<strong>and</strong> to improve vitamin A<br />
status (58).<br />
Some question whether vitamin A<br />
status can be maintained in a<br />
population using OFSP-based<br />
strategies. Jan Low recently completed<br />
a community intervention<br />
trial that found OFSP an acceptable<br />
substitute for white-fleshed<br />
sweet potato in Mozambique<br />
(59). An integrated agriculturedem<strong>and</strong><br />
creation-market development<br />
approach was implemented<br />
to introduce OFSP into<br />
intervention areas compared with<br />
a control community not provided<br />
OFSP vines. The 24-month study<br />
provided high-dose vitamin A<br />
capsules to all children at baseline<br />
<strong>and</strong> six months, a placebo<br />
in the intervention areas at 12<br />
months, <strong>and</strong> a high-dose capsule<br />
after specimen collection at 24<br />
months. Hence, for 12 months,<br />
no children in either the intervention<br />
or control areas received a<br />
vitamin A capsule. The difference<br />
was that only children in the intervention<br />
areas were exposed to<br />
OFSP <strong>and</strong> an intensive campaign<br />
to promote its consumption. At<br />
the end of the 12 month period,<br />
a significant difference was seen<br />
in the percentage of children with<br />
a serum retinol level less than<br />
0.7 µmol/l in the intervention<br />
groups, both before <strong>and</strong> after<br />
accounting for infection. Thus,<br />
vitamin A deficiency was reduced<br />
up to 24% among healthy children<br />
<strong>and</strong> 16% among those with<br />
evidence of infection. There were<br />
several other positive spin-offs<br />
from this integrated intervention,<br />
such as a substantial increase in<br />
knowledge of men <strong>and</strong> women,<br />
an increase in income for smallscale<br />
producers <strong>and</strong> an increase<br />
in daily caloric intake of the children,<br />
as well as the intake of other<br />
micronutrients in the OFSP.<br />
Biofortification of staple crops<br />
with micronutrients, including<br />
provitamin carotenoids, is still<br />
early in development. Yellow cassava,<br />
maize <strong>and</strong> banana/plantain<br />
are in the developmental stages.<br />
There is much research remaining<br />
to pair the best nutrient content<br />
with most desirable agronomic<br />
traits, bioavailability from products<br />
as consumed, consumer<br />
acceptance <strong>and</strong> economic advantages<br />
among other outst<strong>and</strong>ing<br />
issues. Nonetheless, a comparison<br />
of bio-fortification with<br />
fortification <strong>and</strong> supplementation<br />
clearly shows the complementary<br />
benefits of each intervention <strong>and</strong><br />
the potential in the long run of<br />
meeting the needs of the poor<br />
economically <strong>and</strong> safely through<br />
food, reserving high-dose supplementation<br />
for medical emergencies.
NEWSLETTER 2/2006<br />
17<br />
SIGHT AND LIFE<br />
Conclusions<br />
Advances in underst<strong>and</strong>ing basic<br />
chemistry <strong>and</strong> functions of<br />
retinoids <strong>and</strong> carotenoids have<br />
been remarkable over the past<br />
four decades. This has paralleled<br />
progress in programs to control<br />
vitamin A deficiency through<br />
medical (supplement distribution)<br />
<strong>and</strong> market-based (food fortification)<br />
approaches. Progress has<br />
also occurred in public health<br />
programs to control immunilizable<br />
infectious diseases that drain<br />
body nutrient reserves, although<br />
there remain an estimated 1.1<br />
billion people without safe water.<br />
Whereas little attention was given<br />
to food-based approaches until<br />
recently, the future is promising<br />
due to breakthroughs that have<br />
occurred <strong>and</strong> are on the horizon<br />
for increasing carotenoids <strong>and</strong><br />
other micronutrient densities in<br />
staple crops eaten by the poor<br />
<strong>and</strong> in improving other agronomic<br />
characteristics that enhance<br />
yields through biofortification. For<br />
carotenoid chemists <strong>and</strong> program<br />
enthusiasts, the research opportunities<br />
are multiple to demonstrate,<br />
for example, bioavailability,<br />
cooking <strong>and</strong> preservation<br />
stability, acceptability, economic<br />
gains <strong>and</strong> biological effectiveness<br />
of these crops in contributing to<br />
control of micronutrient deficiencies,<br />
especially among the poor.<br />
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rats <strong>and</strong> its application to humans for the<br />
measurement of vitamin A status. Eur J<br />
Clin Nutr 44:219–24.<br />
31. Oomen HAPC, McLaren DS, Escapini H<br />
(1964). Epidemiology <strong>and</strong> public health<br />
aspects of hypovitaminosis A. A global<br />
survey on xerophthalmia. Trop Geograph<br />
Med 16:271–315.<br />
32. McCormick AM, Napoli JL & DeLuca<br />
HF (1978). High-pressure liquid chromatographic<br />
resolution of vitamin A<br />
compounds. Anal Biochem 86:25–33.<br />
33. Roberts AB, Nichols MD, Frolik CA,<br />
Newton DL & Sporn MB (1978). Assay of<br />
retinoids in biological samples by reversephase<br />
high-pressure liquid chromatography.<br />
Cancer Res 38:3327–32.<br />
34. Report of a Joint WHO/USAID meeting<br />
(1976). Vitamin A deficiency <strong>and</strong> xerophthalmia.<br />
Tech Rept Ser 590. World Health<br />
Org., Geneva.<br />
35. Underwood B (2004). Vitamin A deficiency<br />
disorders: International efforts to<br />
control a preventable “pox”. J Nutr 134:<br />
231S–236S.<br />
36. McLaren DS (1987). A decade of achievement:<br />
The International Vitamin A Consultative<br />
Group (IVACG) 1975–1985. International<br />
<strong>Life</strong> Science Institute-Nutrition<br />
Foundation, Washington, D.C.<br />
37. WHO/UNICEF/USAID/Helen Keller International/IVACG<br />
(1982). Control of vitamin<br />
A deficiency <strong>and</strong> xerophthalmia. Tech<br />
Rept Ser 672, World Health Organization,<br />
Geneva.<br />
38. Chambon P (1996). A decade of molecular<br />
biology of retinoic acid receptors.<br />
FASEB J 10:940–54.<br />
39. Sommer A (1982). Nutritional Blindness.<br />
New York: Oxford University Press, Inc.<br />
40. Sommer A, Tarwotjo L, Djunadi E, West<br />
KP, Loeden AA, Tilden R, Mele L & Aced<br />
study group (1986). Impact of vitamin A<br />
supplementation on childhood mortality.<br />
A r<strong>and</strong>omized controlled community trial.<br />
Lancet 327:1169–73.<br />
41. Sommer A & West KP, Jr (1996). Vitamin<br />
A Deficiency Health, Survival, <strong>and</strong> Vision.<br />
New York: Oxford University Press, Inc.,<br />
pp 438.<br />
42. West KP, Jr, Pokhrel RP, Katz J, LeClercq<br />
SC, Khatry SK, Shrestha SR, Pradhan<br />
EK, Tielsch JM, P<strong>and</strong>ey MR, Sommer A<br />
(1991). Efficacy of vitamin A in reducing<br />
preschool child mortality in Nepal. Lancet<br />
338:67–71.<br />
43. Ghana Vast Study Team (1993). Vitamin
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A supplementation in northern Ghana:<br />
effects on clinic attendance, hospital<br />
admissions, <strong>and</strong> child mortality. Lancet<br />
342:7–12.<br />
44. Vijayaraghavan K., Radhaiah G, Prakasam<br />
BS, Sarma KVR, Reddy V (1990). Effect<br />
of massive dose vitamin A on morbidity<br />
<strong>and</strong> mortality in Indian children. Lancet<br />
336:1342–45.<br />
45. Herrera MG, Nestel P, El Amin A, Fawzi<br />
WW, Mohamed KA, Weld L (1992). Vitamin<br />
A supplementation <strong>and</strong> child survival.<br />
Lancet 340:267–71.<br />
46. Muhilal, Permeisih D, Idjradinata YR,<br />
Muherdiyantiningsih, Karyadi D (1988).<br />
Vitamin A-fortified monosodium glutamate<br />
<strong>and</strong> health, growth, <strong>and</strong> survival of<br />
children: a controlled field trial. Am J Clin<br />
Nutr 48:1271–6.<br />
47. Rahmathullah L, Underwood BA, Thulasiraj<br />
RD, Milton RC, Ramaswamy K,<br />
Rahmathullah R, Babu G (1990). Reduced<br />
mortality among children in southern<br />
India receiving a small weekly dose of<br />
vitamin A. New Engl J Med 325:929–35.<br />
48. Beaton GH, Martorell R, Aronson KJ,<br />
Edmonston B, McCabe G, Ross AC &<br />
Harvey B (1993). Effectiveness of vitamin<br />
A supplementation on childhood morbidity<br />
<strong>and</strong> mortality in developing countries.<br />
ACC/SCN State-of-the-art series, Nutrition<br />
Policy Discussion Paper No. 13.<br />
ACC/SCN, Geneva.<br />
49. Fawzi WW, Chalmers TC, Herrera G &<br />
Mosheller F (1993). Vitamin A supplementation<br />
<strong>and</strong> child mortality. A meta-analysis.<br />
J Am Med Assoc 269: 896–903.<br />
50. Glasziou PP & Mackerras DWM (1993).<br />
Vitamin A supplementation in infectious<br />
diseases: a meta-analysis. Brit Med J<br />
306:366–70.<br />
51. Pineda O (1998). Fortification of sugar<br />
with vitamin A. UNU Food Nutr Bull<br />
19:131–6.<br />
52. Bloem MW, Huq N, Gorstein J et al.<br />
(1996). Production of fruits <strong>and</strong> vegetables<br />
on the homestead is an important<br />
source of vitamin A among women in rural<br />
Bangladesh. Eur J Clin Nutr 50 (Suppl 3):<br />
S62–S67.<br />
53. Underwood BA (2001). Vitamin A-related<br />
childhood blindness, mortality, <strong>and</strong> morbidity.<br />
Interventions for prevention. In:<br />
Primary <strong>and</strong> Secondary Preventive Nutrition.<br />
Eds: A. Bendich & RJ Deckelbaum,<br />
Totowa, NJ: Humana Press Inc.<br />
54. Castenmiller JM, West CE (1998). Bioavailability<br />
<strong>and</strong> bioconversion of carotenoids.<br />
Ann Rev Nutr 18:19–38.<br />
55. CGIAR Micronutrients Project. Update<br />
No. 1, October, 1996 <strong>and</strong> Update No. 2,<br />
October 1997, IFPRI, Washington D.C.<br />
56. Bouis HS (Guest Editor) (2000). Special<br />
issue on improving human nutrition<br />
through agriculture. Food & Nutr Bull<br />
21:252–567.<br />
57. Paine JA, Shipton CA, Chaggar S, Howells<br />
RM, Kennedy MJ, Vernon G, Weight<br />
SY, Hinchliffe E, Adams JL, Silverstone<br />
AL, Drake R (2005). Improving the nutritional<br />
value of Golden Rice through<br />
increased pro-vitamin A content. Nature<br />
Biotechnology 23:482–487.<br />
58. Van Jaarsveid PJ, Faber M, Tanumihardjo<br />
SA, et al. (2005). β-carotene-rich<br />
orange-fleshed sweet potato improves<br />
the vitamin A status of primary school<br />
children assessed with the modified-relative-dose<br />
response test. Am J Clin Nutr<br />
81:1080–7.<br />
59. Low J, Arimond M, Osman N, Osei AK<br />
et al. (2005). Towards sustainable nutrition<br />
improvement in rural Mozambique:<br />
Addressing macro- <strong>and</strong> micro-nutrient<br />
malnutrition through new cultivars <strong>and</strong><br />
new behaviors. Project Report, December<br />
2005.<br />
Carotene Research Interaction Group (CARIG)<br />
Annual Conference 2006, San Francisco<br />
Noel W Solomons, Center for Studies of Sensory Impairment, Aging <strong>and</strong> Metabolism,<br />
Guatemala City, Guatemala<br />
The 2006 Carotene Research<br />
Interaction Group (CARIG) Annual<br />
Conference was convened<br />
on Saturday, 1 April at the Argent<br />
Hotel in San Francisco. It accompanied<br />
the Experimental Biology<br />
2006 meetings. This year’s<br />
conference was organized <strong>and</strong><br />
chaired by Dr. Elizabeth Johnson<br />
of Tufts University in Boston, a<br />
member of the CARIG Steering<br />
Committee. The proceedings<br />
began with the fifth annual James<br />
Allen Olson Perspective in Carotenoids<br />
lecture at CARIG, delivered<br />
by Dr. Barbara Underwood.<br />
She was a close associate of the<br />
late Prof. Olson, including jointly<br />
working in Brazil <strong>and</strong> serving as<br />
colleagues on the International<br />
Vitamin A Consultative Group<br />
(IVACG). She spoke on the topic:<br />
Reflections: Four Decades with<br />
Vitamin A <strong>and</strong> Carotenoids. (the<br />
full text of the James Allen Olson<br />
memorial lecture appears on<br />
page 10 of this issue). The significance<br />
of the talk was, in many<br />
ways, to show just how recent<br />
in emergence are the facts <strong>and</strong><br />
principles that we hold in common<br />
about assessing vitamin A<br />
status <strong>and</strong> on the necessity to<br />
develop public health intervention<br />
strategies against hypovitaminosis<br />
A. Dr. Underwood, as well as<br />
Prof. Olson, a founding member<br />
of CARIG <strong>and</strong> the force behind<br />
VARIG (the Vitamin A Research<br />
Interaction Group), were part of<br />
vitamin A discovery <strong>and</strong> consensus<br />
development. This was<br />
inspired by a crucial meeting held<br />
in Basel, Switzerl<strong>and</strong> in 1960, assessing<br />
the existing knowledge<br />
on vitamin A <strong>and</strong> pointing the way<br />
to the important next steps in the<br />
programmatic conquest of hypovitaminosis<br />
A. Dr. Underwood<br />
recounted three decades of contributions<br />
from IVACG, founded in<br />
1975, with about 35 experts in the<br />
vitamin A field in attendance. The<br />
lecture highlighted the steady <strong>and</strong><br />
solid accumulation of accurate<br />
biological <strong>and</strong> epidemiological<br />
knowledge about vitamin A deficiency.<br />
This would lead to the<br />
mobilization of a worldwide public<br />
health effort based primarily on<br />
high-dose supplement capsules<br />
or fortification of staple foods<br />
such as sugar or cooking oil.<br />
Of special interest for a carotenoid<br />
biology audience was<br />
Barbara Underwood’s particular<br />
point of view regarding public<br />
health interventions. She accused<br />
the sometimes rancorous<br />
discussions in the 1990s<br />
concerning the true efficiency<br />
of bioconverting provitamin A to<br />
yield active vitamin A of retarding<br />
the progress toward developing
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sustainable food-based alternatives<br />
to alleviate hypovitaminosis<br />
A. With that issue now resolved<br />
by a new consensus within the<br />
Dietary Reference Intakes of<br />
2001, she pointed to gathering<br />
momentum in the area of biofortification,<br />
citing the founding<br />
of the Harvest Plus Project. The<br />
emphasis of biofortification is on<br />
staple crops of abundant <strong>and</strong><br />
regular consumption by developing-country<br />
populations. Crossbreeding<br />
for hybrid varieties of<br />
sweet potato (orange-fleshed<br />
varieties) <strong>and</strong> genetic modification<br />
in the second (high-carotene)<br />
generation of Golden Rice were<br />
examples in which daily individual<br />
vitamin A needs could be met<br />
from the abundant supplies of<br />
β-carotene in these biofortified<br />
tubers <strong>and</strong> grains.<br />
A slide from Barbara Underwood<br />
advocating a holistic approach.<br />
An important <strong>and</strong> newsworthy<br />
note at the end of Dr. Underwood’s<br />
presentation was her announcement<br />
of the transformation of<br />
the IVACG. What began with its<br />
first meeting in 1975 ended with<br />
its 22nd meeting in Lima, Peru<br />
in 2004. A successor, the Micronutrient<br />
Forum, will be launched<br />
in Istanbul, Turkey, 16–18 April<br />
2007, with a broader <strong>and</strong> integrated<br />
m<strong>and</strong>ate involving vitamin<br />
A, iron, zinc, iodine <strong>and</strong> folic acid<br />
in a public health context.<br />
Those of us who care about<br />
human vitamin A nutriture can<br />
derive lessons <strong>and</strong> st<strong>and</strong>ards in<br />
the message of Dr. Underwood’s<br />
Reflections. Lessons relate to<br />
how to set an agenda for inquiry<br />
to rapidly advance basic <strong>and</strong> applied<br />
knowledge, <strong>and</strong> st<strong>and</strong>ards<br />
to gauge the expectations for<br />
progress in redressing vitamin A<br />
deficiency problems. Should the<br />
interests of vitamin A get “lost<br />
in the shuffle” of multiple micronutrients<br />
<strong>and</strong> diluted scientific<br />
expertise <strong>and</strong> attention in the<br />
Forum, these Reflections may<br />
become the cudgel to dem<strong>and</strong><br />
the attention for vitamin A issues<br />
that were clearly championed by<br />
Underwood <strong>and</strong> Olson during the<br />
past four decades.<br />
The second plenary lecture on the<br />
program was delivered by Dr. Earl<br />
Harrison, senior scientist at the<br />
USDA Human Nutrition Center at<br />
Beltsville, Maryl<strong>and</strong>. He spoke on<br />
the topic of Mechanisms Involved<br />
in the Intestinal Absorption of<br />
Dietary Carotenoids. This was a<br />
fitting <strong>and</strong> complementary companion<br />
theme to Dr. Underwood’s<br />
presentation with her emphasis<br />
on provitamin A carotenes from<br />
foods to supply vitamin A to deprived<br />
populations. To orient the<br />
audience, Dr. Harrison reviewed<br />
the conventional schematic aspects<br />
of dietary carotene uptake<br />
from the intestinal lumen into<br />
intestinal cells (enterocytes) <strong>and</strong><br />
the options for its further passage<br />
either as the intact carotenoid<br />
or as a derivative retinoid. Dr.<br />
Harrison <strong>and</strong> his co-worker have<br />
advanced evidence that both<br />
simple diffusion <strong>and</strong> a receptormediated<br />
transport (carotene<br />
transporters) are involved in the<br />
usual absorptive physiology of<br />
carotenoids.<br />
The laboratory at Beltsville has<br />
used a novel, in-vitro cell culture<br />
model, that of the Caco cell monolayer<br />
in a directional absorption<br />
chamber, to explore the mechanisms<br />
of absorption of dietary<br />
carotenoids. The absorption<br />
chamber experiments revealed<br />
an 11% fractional absorption for<br />
β-carotene, which is not so far<br />
Earl Harrison<br />
from the rate documented for the<br />
intact human intestine. Kinetic<br />
experiments showing saturation<br />
kinetics under certain conditions,<br />
however, are a strong argument<br />
that a “facilitated transport” is<br />
operating, <strong>and</strong> this is in line with<br />
a receptor involvement. A clever<br />
set of experiments in Caco cell<br />
cultures, stellate (Ito) cell (hepatic<br />
fat storage cells) cultures, <strong>and</strong><br />
cell-free microsomes (membrane<br />
envelopes) add credence to a<br />
transporter basis by showing<br />
stereo-specificity in uptake. In all<br />
three systems, different isomers<br />
of β-carotene were taken up to<br />
different extents. In descending<br />
order of uptake, affinity in the systems<br />
was revealed to be: all-trans<br />
β-carotene; 9-cis-β-carotene;<br />
<strong>and</strong> 13-cis-β-carotene.<br />
Bolstered by the coming together<br />
of cell-system evidence supporting<br />
a transported mechanism, Dr.<br />
Harrison’s research group has<br />
turned to identifying enzymes<br />
known to be located in the apical<br />
membrane of intact enterocytes,<br />
as c<strong>and</strong>idates for involvement in<br />
the transporter mechanism. Their<br />
search has centered on so-called<br />
class-B scavenger receptors,<br />
extensively studied for their involvement<br />
in cholesterol uptake.<br />
This has led pharmacologists<br />
to develop inhibitory agents for<br />
receptor uptake. This laboratory<br />
has also used mouse models<br />
with deletion of genes of specific
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NEWSLETTER 2/2006<br />
enzymes (the so-called “knock<br />
out” mouse) to draw inferences<br />
about pathways in carotene<br />
metabolism. Geneticist created<br />
knock-out animals, deprived of<br />
or suppressed regarding one or<br />
another receptor. These proved<br />
to be strong investigative tools<br />
to use in pursuing the role of<br />
transporters in carotene uptake.<br />
In concluding his talk, Dr Harrison<br />
summarized a series of Beltsville<br />
laboratory experiments using<br />
receptor inhibitors, knock-out<br />
mice <strong>and</strong> their combination, to<br />
illustrate a partial dependency of<br />
carotene uptake on this class of<br />
membrane-associated enzyme<br />
as the basis for facilitated cellular<br />
uptake of carotenoids in the<br />
intestine.<br />
Dr Kathleen C Ellwood, of the<br />
Center for Food Safety <strong>and</strong> Applied<br />
Nutrition (CFSAN) of the<br />
Food <strong>and</strong> Drug Administration<br />
(FDA) of the United States presented<br />
the topical theme Reviewing<br />
the Scientific Evidence for<br />
Health Claims. Dr. Ellwood is assigned<br />
to the Division of Nutrition<br />
Programs <strong>and</strong> Labeling, Office<br />
of Nutritional Products Labeling<br />
<strong>and</strong> Dietary Supplements of the<br />
CFSAN. She provided a lucid<br />
exposition of the United States<br />
government’s oversight <strong>and</strong> regulation<br />
in the food-labeling area,<br />
<strong>and</strong> participated in a lively <strong>and</strong><br />
interactive question <strong>and</strong> answer<br />
period thereafter. Need for labeling<br />
rules came about with the<br />
expansion of knowledge about<br />
bioactive substances in foods<br />
(of which the various carotenoids<br />
are examples). There came an<br />
effort by manufacturers of foods<br />
<strong>and</strong> supplements in the United<br />
States to transform findings into<br />
claims of beneficial effects. This<br />
led producers <strong>and</strong> marketers to<br />
seek to make claims about the<br />
benefits of consumption of the<br />
substances, the food containing<br />
the substances or both. To the<br />
extent that foods <strong>and</strong> substances<br />
are offered as remedies <strong>and</strong><br />
therapies, a specific regulatory<br />
Kathleen C Ellwood<br />
h<strong>and</strong>ling comes into play. Dr.<br />
Ellwood correctly presented this<br />
as a case example of the merger<br />
of science with policy.<br />
Claim statements for a product<br />
are a form of “speech”; within<br />
the United States of America,<br />
freedom of speech is protected<br />
by the First Amendment to the<br />
Constitution. Provisions for making<br />
claims for health regarding a<br />
retail product are now covered by<br />
legislation (statutes) <strong>and</strong> the judicial<br />
precedents (case law). The<br />
FDA considered disease therapy<br />
claims for foods in the 1970s <strong>and</strong><br />
1980s, <strong>and</strong> concluded that food<br />
must be treated by the same<br />
st<strong>and</strong>ards as any drug.<br />
Since that era, however, emerging<br />
scientific discovery has shown a<br />
series of more subtle diet-health<br />
relationships including protection<br />
<strong>and</strong> preservation of wellbeing<br />
<strong>and</strong> function. U.S. consumers<br />
were interested in seeking the<br />
potential benefits from dietary<br />
factors, <strong>and</strong> there was marketing<br />
pressure to deliver what the<br />
consumer dem<strong>and</strong>ed. This led to<br />
the passage in 1990 of the Nutrition<br />
Labeling <strong>and</strong> Educational<br />
Act, which governs the nature of<br />
claims that could be attached to<br />
edible products. It was not about<br />
treating established disease, i.e.<br />
the drug action, but rather about<br />
“Health Claims”. The act regulated<br />
claims of causal relationships<br />
between a food substance<br />
<strong>and</strong> a disease or health-related<br />
condition in the general US<br />
population or sub-population, in<br />
which consumption could reduce<br />
their risk. For the Health Claim to<br />
be approved the st<strong>and</strong>ard was<br />
“significant scientific agreement”,<br />
that is a strong consensus of a<br />
causal relationship.<br />
The speaker recounted how<br />
manufacturers felt constrained<br />
by having to get over such a high<br />
bar; they brought suits in court<br />
claiming that the Act infringed<br />
upon the First Amendment guarantee<br />
of freedom of speech. This<br />
has led, since 1999, to a secondary<br />
level of regulation for labeling,<br />
the so-called Qualified Health<br />
Claim (QHC). These claims include<br />
qualifying language in order<br />
to prevent the consumer from being<br />
misled. QHCs are applied for<br />
relationships such as that relating<br />
lycopene or lycopene-containing<br />
foods to reduced risk of prostate<br />
cancer <strong>and</strong> similar assertions.<br />
The process of evaluation by the<br />
FDA for a QHC has a defined<br />
set of steps. The first is literature<br />
review <strong>and</strong> selection. Animal<br />
studies are not relevant. Insofar<br />
as observational studies can<br />
indicate association, but not causality,<br />
the most relevant literature<br />
is considered to be that from intervention<br />
trials. The interventions<br />
can have outcomes of reduced<br />
incidence of disease/condition<br />
or favorable modification of a<br />
validated modifiable risk factor<br />
related to ill health.<br />
San Francisco’s famous cable<br />
cars.
NEWSLETTER 2/2006<br />
21<br />
SIGHT AND LIFE<br />
Prof. Erdman’s collaborators.<br />
Once the trial studies are assembled<br />
<strong>and</strong> sorted, those that meet<br />
inclusion criteria are rated for<br />
quality in terms of design, inclusion/exclusion<br />
criteria, balance<br />
of population characteristics<br />
across groups, verification of<br />
compliance with the intervention<br />
<strong>and</strong> appropriateness of statistical<br />
analysis. This is done for each<br />
study. The CARIG audience was<br />
particularly intrigued to learn that<br />
any study without a “validated”<br />
dietary intake method would be<br />
excluded from consideration. For<br />
those who know the limitations<br />
of dietary method validation/calibration,<br />
this seems fraught with<br />
arbitrary possibilities.<br />
The pre-final step is to rate the<br />
overall strength of the body of<br />
evidence in terms of type, quality,<br />
quantity <strong>and</strong> studies’ sample size,<br />
consistency <strong>and</strong> replication of<br />
findings, <strong>and</strong> the relevance to the<br />
US general population or target<br />
subgroups. Finally, the claim can<br />
have three degrees of ranking: 1.<br />
conclusive; 2. limited; or 3. very<br />
limited.<br />
The modifications in the FDA<br />
procedures derive from the tension<br />
among consumers’ desire to<br />
preserve health, producers’ <strong>and</strong><br />
retailers’ desire to exercise free<br />
speech, <strong>and</strong> the government’s<br />
duty to protect the citizenry from<br />
consumer fraud. Dr. Ellwood’s<br />
message had shown that the role<br />
of the scientific community lies in<br />
how well they design <strong>and</strong> execute<br />
studies on causal relationships<br />
between a dietary substance <strong>and</strong><br />
a beneficial outcome.<br />
Prof. John Erdman of the University<br />
of Illinois also spoke in the<br />
second session of the program<br />
with a talk entitled: Tomato, Lycopene<br />
<strong>and</strong> the Risk of Prostate<br />
Cancer. He was also awarded<br />
this year’s Wilbur O. Atwater<br />
Memorial Lecture, sponsored by<br />
the United States Department<br />
of Agriculture on 4 April, which<br />
had the theme of carotenes at its<br />
center. His award’s lecture topic<br />
was Colors, Critters, <strong>and</strong> Cancer.<br />
As he explained, the colors refer<br />
to carotenoid pigments; the critters<br />
refer to the selection (limits<br />
<strong>and</strong> possibilities) with different<br />
animal models for investigation<br />
of carotenoid metabolism <strong>and</strong><br />
effects; <strong>and</strong> cancer is specifically<br />
prostate cancer. The context is<br />
the epidemiological evidence that<br />
suggests that tomato consumption<br />
is protective against prostate<br />
cancer.<br />
The world of colorful carotenoids<br />
contains over 650 compounds.<br />
Phytoene <strong>and</strong> phytofluene are<br />
simple colorless precursor carotenoids.<br />
All known members of<br />
this family of compounds are initially<br />
synthesized in plant tissues;<br />
animals cannot form carotenoids.<br />
Prof. Erdman reminded his audiences<br />
that the ripeness of fruits<br />
John Erdman<br />
<strong>and</strong> vegetables is reflected in<br />
their carotenoid content. Carotenes<br />
contribute to the hues<br />
of birds’ feathers <strong>and</strong> insects’<br />
coloring. Moreover, carotenes are<br />
important to aroma compounds<br />
in nature that have importance for<br />
interspecies signaling.<br />
Not all animals h<strong>and</strong>le carotenoids<br />
in a uniform fashion.<br />
It has been found for instance<br />
that, for studies of carotenoid<br />
metabolism related to human<br />
physiology, gerbils, ferrets <strong>and</strong><br />
pre-ruminant calves provide the<br />
best in likeness to human absorptive<br />
systems. They are capable<br />
of absorbing the compounds<br />
both intact <strong>and</strong> metabolized. As<br />
herbivores, rats <strong>and</strong> mice are efficient<br />
converters of provitamin A<br />
carotenoids. They are poor at<br />
absorbing intact carotenoids;<br />
thus, high feed levels are needed<br />
for these rodents to replicate the<br />
tissue concentrations achieved in<br />
humans. In Prof. Erdman’s view,<br />
the armamentarium of animal<br />
models for cancer studies with<br />
carotenoids includes rats, mice,<br />
<strong>and</strong> again ferrets.<br />
The prostate gl<strong>and</strong> <strong>and</strong> carotenoid-containing<br />
foods came<br />
together in the observations of<br />
vastly different spontaneous incidence<br />
rates for prostatic cancer<br />
with 70 times greater incidence<br />
rates in North American blacks<br />
<strong>and</strong> 50-fold increased rates
SIGHT AND LIFE 22<br />
NEWSLETTER 2/2006<br />
Maria Stacewicz-Sapuntzakis receives award from Wendy White.<br />
in North American whites, as<br />
compared to peers in Shanghai,<br />
China. The Physicians’ Health<br />
Study implicated higher intakes<br />
of tomato sauce, tomatoes, pizza<br />
<strong>and</strong> strawberries, all sources of<br />
lycopene (a non-provitamin A<br />
carotenoid), with reduced prostate<br />
cancer occurrence. Prof.<br />
Erdman summarized the science<br />
findings of his group in pursuing<br />
the bases of these epidemiological<br />
observations. Using a prostatic<br />
cancer murine tumor model,<br />
the combination of broccoli <strong>and</strong><br />
tomato proved to be superior<br />
to tomato alone, <strong>and</strong> both were<br />
superior to isolated lycopene in<br />
terms of anti-cancer activity in the<br />
mouse tumors. The conclusion<br />
is that lycopene is not the only<br />
preventive substance in broccoli<br />
or tomatoes.<br />
At the VARIG/CARIG social event.<br />
The other basic pursuit involved<br />
the potential bioactivity of metabolic<br />
derivatives of lycopene.<br />
Analogous to the format by which<br />
retinoids <strong>and</strong> apo-carotenals<br />
of different carbon lengths are<br />
produced by central or eccentric<br />
cleavage of provitamin A carotenes,<br />
the search has been joined<br />
for generation of apo-lycopenals.<br />
The carotene monoxygenase I<br />
(CMO I), responsible for central<br />
cleavage of β-carotene (formerly<br />
known as 15,15’ monoxygenase)<br />
is inactive in cleaving lycopene.<br />
However, the carotene monoxygenase<br />
II (CMO II), which produces<br />
eccentric cleavage of β-carotene,<br />
can also generate apo-lycopenals<br />
in in-vitro systems. These products<br />
have recently been detected<br />
with sensitive assay techniques<br />
in human plasma <strong>and</strong> breast milk<br />
in concentrations over 100 times<br />
lower than that of lycopene itself.<br />
Studies documenting the bioactivity<br />
of lycopene split-products have<br />
yet to appear, but the fundamentals<br />
of carotene biology for retinoids<br />
are a template for inquiry into<br />
potential anti-cancer mechanisms<br />
for lycopene.<br />
The final wisdom from Prof.<br />
Erdman is not to ignore other<br />
compounds, even phytoene <strong>and</strong><br />
phytofluene precursors. In the<br />
ripe tomato, the sum of these<br />
two compounds is equivalent by<br />
weight to that of lycopene, <strong>and</strong><br />
these non-aromatic forms are 10<br />
times more abundant than alpha<strong>and</strong><br />
beta-carotenes combined.<br />
Heather Mernitz in front of her<br />
awarded poster.<br />
Other awards were involved in<br />
the CARIG meeting arena in San<br />
Francisco. These included travelawards<br />
based on the scientific<br />
merit of the abstracts submitted<br />
by graduate students for presentation<br />
in Experimental Biology<br />
on carotenoids. The winner was<br />
Francesca Alvarez-Calderon,<br />
from Florida International University,<br />
for her free-paper entitled: A<br />
computational study of end-group<br />
conformational barriers in carotenoids.<br />
In addition, a new element<br />
was brought in for the benefit of<br />
encouraging <strong>and</strong> recognizing the<br />
talent of young trainees this year.<br />
This was a poster competition as<br />
part of the VARIG/CARIG social,<br />
held following the Conference. A<br />
total of 12 contestants exhibited<br />
their free-paper posters, brought<br />
for display in the mini-symposia<br />
of the EB 2006. Heather Mernitz,<br />
from the USDA Human Nutrition<br />
Research Center at Tufts University<br />
was judged as best in the<br />
competition with her poster on<br />
Inhibition of lung carcinogenesis<br />
by 9-cis retinoic acid <strong>and</strong> 1,25<br />
dihydroxyvitamin D3 in the A/J<br />
mouse model. Finally, the Steering<br />
Committee of CARIG made<br />
a “surprise award”, in the form<br />
of a recognition-of-merit plaque,<br />
to Maria Stacewicz-Sapuntzakis,<br />
the tireless <strong>and</strong> undaunted editor<br />
of the CARIG <strong>Newsletter</strong>, who<br />
has undertaken its semi-annual<br />
publication since the founding of<br />
the Group.
NEWSLETTER 2/2006<br />
23<br />
SIGHT AND LIFE<br />
13 th European Meeting on Fat-Soluble Vitamins<br />
2006 in Jena<br />
Volker Böhm, PD, Institut für Ernährungswissenschaften, Friedrich-Schiller-Universität<br />
Jena, Germany<br />
This year, for the first time, this<br />
European Conference took place<br />
in Germany. Fat-soluble vitamins<br />
(FSV) offer a wide field of research<br />
<strong>and</strong> have brought together European<br />
scientists <strong>and</strong> students every<br />
three to four years since 1960,<br />
first in the UK <strong>and</strong> then touring<br />
Europe. After Arcachon (1996)<br />
<strong>and</strong> Toulouse (2000) in France<br />
<strong>and</strong> Rieti (2003) in Italy, this year<br />
Jena in Germany provided an opportunity<br />
to listen <strong>and</strong> to lecture,<br />
to discuss <strong>and</strong> to develop stateof-the-art<br />
<strong>and</strong> new approaches,<br />
illuminating the role of these<br />
compounds for human health <strong>and</strong><br />
more. A very efficient interchange<br />
of knowledge took place due to<br />
the traditionally small number of<br />
around 50 participants. Students,<br />
in particular, took this opportunity<br />
to present their work on a European<br />
level <strong>and</strong> to talk to experts<br />
in the field.<br />
The 13 th FSV meeting was hosted<br />
by the Institute of Nutrition at<br />
the renowned Friedrich Schiller<br />
University in Jena. It took place<br />
in the Old Castle in Dornburg<br />
(10 km from Jena), that has just<br />
been completely refurbished to<br />
meet the dem<strong>and</strong>s of a modern<br />
meeting place while keeping its<br />
beautiful historical ambience.<br />
Accommodation was in Jena, a<br />
city of 100,000 inhabitants <strong>and</strong><br />
also famous for its optical trade<br />
(Zeiss, Jenoptik).<br />
The conference started with a<br />
plenary lecture by the internationally<br />
known carotenoid expert<br />
Steven J Schwartz from the Ohio<br />
State University in Columbus,<br />
Ohio, USA. He presented some<br />
of the results of his group on bioavailability<br />
of different carotenoids,<br />
talking also on bioactivity of<br />
these secondary plant products<br />
being able to reduce the risks<br />
for some degenerative diseases.<br />
The first session followed, reporting<br />
results with carotenoids.<br />
Catherine Caris-Veyrat from INRA<br />
Avignon, France, mainly focused<br />
on oxidation products of carotenoids,<br />
discussing some possible<br />
effects of these metabolites. Yoav<br />
Sharoni from Beer-Sheva, Israel,<br />
presented new results on mechanisms<br />
for cancer prevention by<br />
carotenoids, while Gordon Lowe<br />
from Liverpool, UK, explained<br />
investigations on interactions<br />
between cigarette smoke <strong>and</strong><br />
β-carotene.<br />
The second session focussed on<br />
vitamin E. David Muller, London,<br />
UK, presented analytical details<br />
on separation <strong>and</strong> quantification<br />
of conjugated vitamin E metabolites<br />
in sepsis. Andreas Wagner<br />
from Jena, Germany, showed<br />
how intervention with α-tocopherol<br />
<strong>and</strong> folic acid affected 8-<br />
oxodG, a biomarker of oxidative<br />
stress in leukocytes <strong>and</strong> urine<br />
in humans. Stefano Manfredini,<br />
Ferrara, Italy, finished the session,<br />
comparing the antioxidant<br />
activity of novel vitamin E based<br />
antioxidants within several assay<br />
systems. Afterwards most delegates<br />
enjoyed typical Thuringian<br />
sausages, beer <strong>and</strong> jazz music.<br />
The second day started with<br />
results on the structure-activity<br />
relationship of carotenoid derivatives<br />
in activation of the antioxidant<br />
response element transcription<br />
system, presented by Joseph<br />
Levy, Beer-Sheva, Israel. Paola
SIGHT AND LIFE 24<br />
NEWSLETTER 2/2006<br />
Palozza, Rome, Italy, discussed<br />
experiments with β-carotene<br />
in vascular cells exposed to<br />
oxysterols. Investigations on<br />
carotenoid metabolism in animals<br />
were presented by Johannes<br />
von Lintig, Freiburg, Germany.<br />
A round-table discussion on<br />
perspectives for fat-soluble vitamins<br />
led to an intense exchange<br />
between the experts, showing a<br />
lot of interesting tasks to be investigated<br />
in the next years. The<br />
discussion closed with the decision<br />
to continue the meetings in<br />
the future. Two colleagues offered<br />
to invite the scientists in 2009 to<br />
Potsdam, Germany, <strong>and</strong> in 2012<br />
to Greece.<br />
After lunch, Diana Bellovino,<br />
Rome, Italy, presented investigations<br />
on the effect of the matrix<br />
on the bioavailability of carotenoids.<br />
Anna Iannone, Modena,<br />
Italy, discussed new results from<br />
electron spin resonance experiments<br />
investigating the antioxidant<br />
potential of α-tocopherol<br />
<strong>and</strong> lycopene. After an official<br />
reception by the Mayor of Jena all<br />
delegates used the time to have<br />
a look at the posters. Some delegates<br />
spent the afternoon break<br />
walking through the gardens of<br />
the castle grounds; others enjoyed<br />
discussing <strong>and</strong> relaxing<br />
in small groups. A dinner <strong>and</strong><br />
music event was the highlight of<br />
the second evening. European<br />
food prepared by local cooks<br />
was combined with local wines<br />
of the most Northern vineyard in<br />
Germany <strong>and</strong> European music<br />
played by m<strong>and</strong>olins <strong>and</strong> guitars<br />
of the group “Lautengilde Jena”,<br />
conducted by the organizer of<br />
the meeting – the large hall of the<br />
castle provided a good ambience<br />
for the event.<br />
The last half-day of the conference<br />
started with an update on<br />
isomerization of lycopene presented<br />
by Volker Böhm, Jena,<br />
Germany. Emmanuelle Reboul,<br />
Marseille, France, explained<br />
which transporters are involved<br />
in the uptake of lycopene <strong>and</strong><br />
β-carotene. Wilhelm Stahl, Düsseldorf,<br />
Germany, finished the<br />
carotenoid session with experiments<br />
showing photoprotective<br />
effects of carotenoids. In the last<br />
session of the meeting Hülya<br />
Sagmanligil Özdemir, Van, Turkey,<br />
presented results on fat-soluble<br />
antioxidant vitamin levels in<br />
newborn babies <strong>and</strong> their relation<br />
to the maternal vitamin status.<br />
Patrick Borel, Marseille, France,<br />
talked about different lipases being<br />
responsible for hydrolysis of<br />
retinyl palmitate.<br />
Three awards for the best posters,<br />
elected by all delegates,<br />
some concluding remarks <strong>and</strong> a<br />
farewell finished two very efficient<br />
days within the old walls of Dornburg<br />
Castle. All delegates left the<br />
conference venue more relaxed<br />
than when they arrived, which<br />
could well be an additional effect<br />
of the charming atmosphere <strong>and</strong><br />
the small number of delegates. All<br />
were invited to come to the 14 th<br />
European Meeting on Fat-Soluble<br />
Vitamins that will take place in<br />
2009 in Potsdam, Germany, organized<br />
by Florian J. Schweigert<br />
<strong>and</strong> his team.
NEWSLETTER 2/2006<br />
25<br />
SIGHT AND LIFE<br />
Protecting nutritional status <strong>and</strong> the role of micronutrient<br />
premix in the United Nations World Food<br />
Programme’s response to the Indian Ocean Tsunami<br />
World Food Programme, Regional Bureau for Asia, Wave Place Building, 7th Floor, 55<br />
Wireless Road, Pathumwan, Bangkok 10330, Thail<strong>and</strong><br />
Immediate relief<br />
The Indian Ocean Tsunami of 26<br />
December 2004 presented the<br />
humanitarian community with<br />
one of the largest challenges it<br />
had ever faced. The United Nations<br />
World Food Programme responded<br />
with an immediate <strong>and</strong><br />
massive relief effort that eventually<br />
became one of the most complex<br />
operations the organization<br />
had ever undertaken, spanning<br />
six countries, two continents, <strong>and</strong><br />
millions of beneficiaries.<br />
While the primary focus of the immediate<br />
response was providing<br />
life-sustaining food aid to those<br />
whose houses, fields, crops <strong>and</strong><br />
livelihoods had been washed<br />
away, WFP also sought to shore<br />
up the nutritional status of groups<br />
made vulnerable by the tsunami<br />
– in particular children, new mothers<br />
<strong>and</strong> the elderly.<br />
In such situations, ready-to-eat<br />
or easy-to-prepare fortified foods<br />
play a key role. Within days of<br />
the tsunami, WFP found itself<br />
required to deliver large quantities<br />
of such foods to the crisis zone<br />
in record time. In Aceh <strong>and</strong> Nias,<br />
WFP had not been providing fortified<br />
foods prior to the tsunami,<br />
so it turned to countries in the region,<br />
such as Bangladesh, where<br />
WFP was producing such foods<br />
in large quantities .<br />
DSM, which is one of WFP’s<br />
primary private-sector partners<br />
in nutrition, responded quickly<br />
through SIGHT AND LIFE to<br />
WFP’s requests for assistance<br />
by donating micronutrient premix<br />
– enough to fortify over 5,000<br />
metric tons of high-energy biscuits.<br />
Such biscuits are used<br />
primarily in WFP’s school feeding<br />
programs, as a mid-morning<br />
snack designed to help prevent<br />
micronutrient deficiencies among<br />
school children. They are also<br />
extremely useful in emergencies,<br />
as they are lightweight <strong>and</strong> easy<br />
to transport, yet provide high nutritional<br />
<strong>and</strong> caloric value.<br />
SIGHT AND LIFE’s donation was<br />
delivered to factories in Bangladesh<br />
that produce fortified<br />
biscuits for WFP. The donation<br />
allowed WFP to release large<br />
quantities of fortified biscuits in<br />
Bangladesh <strong>and</strong> send them to<br />
countries across the crisis zone.<br />
Planes filled with biscuits started<br />
leaving Dhaka on 13 January.<br />
By the end of January, 700 metric<br />
tons of biscuits had been shipped<br />
to Aceh, Indonesia, by both air<br />
<strong>and</strong> sea. This was a major donation,<br />
representing 15% of the<br />
total amount of biscuits used in<br />
the entire tsunami operation in<br />
2005. The biscuits sent to Indonesia<br />
were enough to provide<br />
nutritional supplementation to<br />
over 300,000 children aged 3 to<br />
12 years for three months.<br />
Mid- <strong>and</strong> long-term relief<br />
By May 2005, WFP was providing<br />
daily food rations to 2.25 million<br />
people across the tsunami zone<br />
– in Aceh <strong>and</strong> Nias in Indonesia,<br />
School feeding in B<strong>and</strong>a Aceh. WFP/ Barry Came.<br />
Girls with high-energy biscuits, Aceh, Indonesia. WFP/<br />
A K Kimoto.
SIGHT AND LIFE 26<br />
NEWSLETTER 2/2006<br />
Sri Lanka, the Maldives, Thail<strong>and</strong>,<br />
Myanmar <strong>and</strong> Somalia. As the<br />
acute crisis passed, the focus of<br />
operations shifted from averting<br />
wide-scale hunger to protecting<br />
groups left vulnerable by the<br />
disaster. These groups included<br />
displaced people, farmers whose<br />
l<strong>and</strong> had been inundated, <strong>and</strong><br />
fishing families who had lost their<br />
boats or other means of fishing.<br />
In many cases, these communities<br />
had had relatively stable food<br />
security prior to the tsunami. In<br />
other cases, the waves had made<br />
difficult conditions much worse.<br />
Across the board, however, the<br />
emphasis was not so much on<br />
raising pre-existing nutritional<br />
levels as making sure that nutritional<br />
levels did not decline as<br />
a result of the tsunami <strong>and</strong> its<br />
after-effects.<br />
As a recent joint statement by<br />
WFP, UNICEF <strong>and</strong> the WHO<br />
on “Preventing <strong>and</strong> Controlling<br />
Micronutrient Deficiencies<br />
in Populations Affected by an<br />
Emergency” puts it: “The aim is<br />
to avert micronutrient deficiencies<br />
or prevent them from getting<br />
worse among the affected<br />
population. Such foods must be<br />
appropriately fortified, taking into<br />
account the fact that other unfortified<br />
foods will meet a share of<br />
micronutrient needs.”<br />
Adults who were displaced or<br />
part of otherwise vulnerable<br />
groups received daily rations for<br />
their entire families (generally rice,<br />
canned fish, fortified noodles<br />
<strong>and</strong> oil in Indonesia; rice, pulses,<br />
sugar <strong>and</strong> oil in Sri Lanka). Children<br />
in school received either the<br />
fortified biscuits (Indonesia <strong>and</strong><br />
Maldives) or a mid-day meal (Sri<br />
Lanka). New mothers <strong>and</strong> young<br />
children received fortified food<br />
<strong>and</strong> nutrition education through<br />
Mother <strong>and</strong> Child Nutrition (MCN)<br />
programs.<br />
Boys at school in B<strong>and</strong>a Aceh. WFP/ Barry Came.<br />
By December 2005, school feeding<br />
programs covered 330,000<br />
children in Indonesia <strong>and</strong> 1<strong>02</strong>,000<br />
in Sri Lanka. Over 143,000 mothers<br />
<strong>and</strong> young children were<br />
enrolled in MCN programmes in<br />
Sri Lanka, along with 33,000 in<br />
Indonesia, with plans to exp<strong>and</strong><br />
the programs in both countries.<br />
At the same time, the number of<br />
beneficiaries receiving general<br />
food rations was decreasing, as<br />
homes were built <strong>and</strong> people returned<br />
to their old livelihoods.<br />
Fortified foods such as highenergy<br />
biscuits played a critical<br />
role in the early days of the response,<br />
<strong>and</strong> in the future-oriented<br />
programs such as school feeding<br />
which aimed to shore up the nutritional<br />
status of communities.<br />
However, fortified biscuits were<br />
not used as emergency rations<br />
in the early stages to the degree<br />
originally planned. The relatively<br />
rapid re-opening of l<strong>and</strong> routes<br />
– in Aceh in particular – meant<br />
that communities could receive<br />
st<strong>and</strong>ard rations by truck transport,<br />
rather than having to rely<br />
on flown-in fortified foods. In the<br />
end, WFP used approximately<br />
half of the amount of fortified biscuits<br />
that it had originally planned<br />
for the entire tsunami operation.<br />
Following the initial shipments<br />
of 700 metric tons of fortified<br />
biscuits to Indonesia, as well as<br />
other shipments to the Maldives<br />
<strong>and</strong> Sri Lanka, WFP was able to<br />
source the remaining biscuits that<br />
it needed locally. As a result, the<br />
remainder of the SIGHT AND LIFE<br />
donation was used to produce<br />
biscuits in Bangladesh for use in<br />
WFP school feeding programs in<br />
that country.<br />
The rapid response of SIGHT<br />
AND LIFE <strong>and</strong> other WFP partners<br />
to the tsunami was critical,<br />
allowing WFP to provide large<br />
quantities of fortified foods to the<br />
affected areas. Without it, certain<br />
communities might have faced<br />
a drop in children’s nutritional<br />
levels, along with all the other<br />
challenges brought in the wake<br />
of the waves.<br />
Additionally, the donation provided<br />
much-needed support for<br />
school feeding in Bangladesh.<br />
WFP plans to provide fortified<br />
meals or supplementary snacks<br />
to 300,000 children in Bangladesh<br />
in 2006. While these programs<br />
may not be as dramatic<br />
as the tsunami response, in terms<br />
of the impact on children’s lives<br />
they can be more widespread<br />
<strong>and</strong> longer-lasting. Long after the<br />
reconstruction of the tsunami-hit<br />
areas is over, the world will still<br />
face the ongoing “silent emergencies”<br />
of malnourished children,<br />
<strong>and</strong> children who are denied an<br />
education due to poverty.
NEWSLETTER 2/2006<br />
27<br />
SIGHT AND LIFE<br />
Distributing micronutrients <strong>and</strong> deworming<br />
medicine in hurricane-ravaged Honduras<br />
Howard B Schiffer, Executive Director, Vitamin Angels Alliance,<br />
Santa Barbara, CA, USA<br />
Background<br />
Hurricane Mitch struck northwestern<br />
Honduras with devastating<br />
effects in 1998, setting back<br />
the remarkable progress that the<br />
country had been making in addressing<br />
their problems of health<br />
care, education <strong>and</strong> poverty.<br />
Honduras now faces daunting<br />
issues as it attempts to address<br />
serious health conditions such as<br />
malnutrition, child mortality, dengue<br />
fever, respiratory infections,<br />
HIV/AIDS <strong>and</strong> rapid population<br />
growth. Malnutrition, coupled<br />
with infestations of parasites, is<br />
a serious problem for children.<br />
Unfortunately, micronutrient deficiencies<br />
are found at high levels<br />
in the north <strong>and</strong> west rural regions<br />
of Honduras <strong>and</strong> were made<br />
worse by the hurricane <strong>and</strong> its<br />
aftermath.<br />
While it is widely understood<br />
that vitamin A <strong>and</strong> other micronutrient<br />
deficiencies are a major<br />
cause of disease <strong>and</strong> blindness<br />
among children, parasites are<br />
also a leading cause of diseases<br />
among children <strong>and</strong> adults in the<br />
world today. Worms consume<br />
macro- <strong>and</strong> micronutrients in the<br />
gut before children can absorb<br />
them, <strong>and</strong> hence impair children’s<br />
growth <strong>and</strong> developement. This<br />
can lead to physical stunting,<br />
learning problems, illness <strong>and</strong><br />
death. Deworming these children<br />
is essential for their health <strong>and</strong><br />
well-being <strong>and</strong> is an essential<br />
component of a micronutrient<br />
campaign.<br />
As was reported in SIGHT AND<br />
LIFE <strong>Newsletter</strong> 2/2005 (pp. 20–<br />
21), Vitamin Angel Alliance (VAA)<br />
<strong>and</strong> Cristo Salva are running a<br />
project to provide basic medical<br />
services <strong>and</strong> combat malnutrition<br />
in Honduras. Now, with the support<br />
of SIGHT AND LIFE, these<br />
efforts are continuing in the form<br />
of the Honduras Micronutrient<br />
Project. This campaign, which<br />
is commencing this year, will alleviate<br />
micronutrient deficiency<br />
<strong>and</strong> VAD (vitamin A deficiency),<br />
<strong>and</strong> reduce the parasitic worm<br />
load for 30,000 children from two<br />
to ten years old in northwestern<br />
Honduras. We are working with<br />
local school districts to distribute<br />
chewable multivitamin <strong>and</strong><br />
micronutrient supplements <strong>and</strong><br />
educate parents to have their<br />
children take one daily, <strong>and</strong> we<br />
are distributing mebendazole<br />
(500 mg) once every 6 months to<br />
eliminate parasitic worms.<br />
The project sites<br />
The project sites are rural villages<br />
in northwestern Honduras near<br />
the Guatemalan border. These<br />
are the little villages around the<br />
central village of Macuelizo.<br />
Hacienda Cristo Salva is located<br />
in one of the small neighboring<br />
villages – Las Varas – <strong>and</strong> the<br />
Clinica de Cristo Salva is located<br />
in the center of Macuelizo with<br />
central access to all the villages.<br />
Specifically, Cristo Salva distributes<br />
the micronutrients <strong>and</strong><br />
mebendazole in the towns <strong>and</strong><br />
villages in <strong>and</strong> surrounding the<br />
Valley of Macuelizo.<br />
The villages have no medical care<br />
whatsoever. The poverty in the<br />
region is endemic <strong>and</strong> extreme.<br />
Many of these children literally<br />
eat a root on their way to school<br />
in the morning for their breakfast.<br />
Professor Oscar Mendoza, the<br />
former District Officer <strong>and</strong> current<br />
head teacher in a local middle<br />
school, agreed to work with<br />
Cristo Salva to help mitigate in<br />
part the sickness <strong>and</strong> hunger of<br />
the children. In addition, Cristo<br />
Salva has a network of people on<br />
the school boards, village officials<br />
<strong>and</strong> even translators who have<br />
offered to assist us.<br />
The campaign<br />
Cristo Salva distributes the products<br />
to the schools, with school<br />
officials helping to oversee the<br />
process. Cristo Salva plans a<br />
teachers’ meeting in each community<br />
to educate teachers <strong>and</strong><br />
health workers on how to distrib-
SIGHT AND LIFE 28<br />
NEWSLETTER 2/2006<br />
ute the parasitic medicines (along<br />
with an education program on<br />
basic hygiene <strong>and</strong> sanitation) <strong>and</strong><br />
how to educate the parents about<br />
the daily supplements for their<br />
children. The periodic, organized<br />
distribution of mebendazole<br />
supplements has worked successfully<br />
in our past experience<br />
<strong>and</strong> we are confident about the<br />
progress of this project. During<br />
the first year it is planned to<br />
reach 30,000 children <strong>and</strong> in the<br />
second <strong>and</strong> third year others not<br />
yet reached will be included.<br />
A grant to run the project <strong>and</strong> the<br />
micronutrients are being donated<br />
by SIGHT AND LIFE. The tableting<br />
is being contributed by Anabolic<br />
Labs with excipient contributions<br />
from Domino Foods <strong>and</strong> Mutual<br />
Foods. The mebendazole is being<br />
purchased from (<strong>and</strong> partially donated<br />
by) MedPharm. PAHO (Pan<br />
American Health Organization) is<br />
supplying the Kato Katz test kits<br />
for the baseline study. Support<br />
on the baseline study is being<br />
provided by George Washington<br />
University <strong>and</strong> the Ministry of<br />
Health (MOH) in Honduras.<br />
The distribution of the products<br />
follows strict guidelines. The<br />
in-country partners of the mebendazole<br />
part of the campaign<br />
receive WHO survey materials<br />
<strong>and</strong> guidelines for administering<br />
safe <strong>and</strong> appropriate doses of<br />
mebendazole to children. Only<br />
trained healthcare workers or<br />
volunteers administer the doses<br />
<strong>and</strong> maintain accurate record<br />
sheets about children receiving<br />
supplements <strong>and</strong> mebendazole.<br />
They ascertain the child’s age<br />
– through discussion with caregiver,<br />
or by observing the ambulatory<br />
ability of the child. The<br />
caregivers are instructed to give<br />
the children one micronutrient<br />
vitamin/mineral chewable tablet<br />
each day. Based on the records of<br />
individual children an evaluation<br />
<strong>and</strong> follow up of the campaign is<br />
possible.<br />
Partners<br />
Vitamin Angel Alliance is the<br />
lead agency for the program.<br />
Our mission is to provide basic<br />
nutrition to people in need. Our<br />
vision is far reaching. We believe<br />
that every person has a right to<br />
basic nutrition; that malnutrition<br />
linked diseases are preventable<br />
<strong>and</strong> that education in addition to<br />
supplementation is essential for<br />
long-term health. A more detailed<br />
scope of the mission of VAA was<br />
given in SIGHT AND LIFE <strong>Newsletter</strong><br />
2/2005 (pp. 20–21).<br />
Cristo Salva is implementing<br />
the program in Honduras. It is<br />
a non-profit NGO consisting<br />
of lay people, doctors, nurses,<br />
teachers, <strong>and</strong> missionaries. For<br />
15 years it has been serving the<br />
people of Honduras, focused<br />
primarily in the State of Santa<br />
Barbara. The vision of Cristo<br />
Salva is to provide basic needs in<br />
the form of vitamins, clean water,<br />
hygienic education, agricultural<br />
education, nutritional education<br />
<strong>and</strong> support, medical <strong>and</strong> dental<br />
clinics, pre-natal education, eye<br />
glasses, clothing, <strong>and</strong> shoes.<br />
Goals, outcomes <strong>and</strong><br />
reports<br />
The records kept, using WHO<br />
survey materials, will give information<br />
on:<br />
• Number of community meetings<br />
held<br />
• Number of micronutrient supplements<br />
distributed<br />
• Number of worm tablets distributed<br />
• Number <strong>and</strong> ages of children<br />
reached<br />
It is expected that the benefits<br />
gained will be reduced blindness,<br />
morbidity, mortality <strong>and</strong> clinic<br />
visits as well as improved general<br />
health. Some of the benefits may<br />
be difficult to quantify. However,<br />
there is no doubt that these reductions<br />
in health problems<br />
will enable health workers <strong>and</strong><br />
facilities to redirect a substantial<br />
portion of their resources to other<br />
public health <strong>and</strong> socio-economic<br />
concerns.<br />
The Honduran Micronutrient<br />
Campaign will be monitored <strong>and</strong><br />
evaluated by VAA with full participation<br />
by Cristo Salva <strong>and</strong> other<br />
in-country partner organizations.<br />
The primary emphasis will be on<br />
the coverage of the program, with<br />
results largely based on the supplements<br />
<strong>and</strong> medication reaching<br />
the intended beneficiaries.
NEWSLETTER 2/2006<br />
29<br />
SIGHT AND LIFE<br />
Eye care mission to the Dominican Republic,<br />
March 2006<br />
Sade Kosoko-Lasaki, MD, MSPH, MBA, Creighton University, Omaha, NE, USA<br />
Introduction<br />
During our previous trip to the<br />
Dominican Republic (DR), we<br />
demonstrated that VAD is a public<br />
health problem in this country.<br />
This was reported in SIGHT AND<br />
LIFE <strong>Newsletter</strong> 2/2005 (pp.<br />
35–36) with more details given in<br />
the 3/2005 issue (pp. 21–23).<br />
In March 2006, Creighton University<br />
realized a similar mission with<br />
the same partners. In addition to<br />
the screening of children <strong>and</strong> the<br />
administration of vitamin A capsules,<br />
adults were examined for<br />
glaucoma. Glaucoma is also the<br />
commonest cause of blindness<br />
in African-American <strong>and</strong> Hispanic<br />
populations.<br />
The primary health care workers<br />
(Cooperadores) received a halfday<br />
review <strong>and</strong> training session<br />
on the clinical signs <strong>and</strong> symptoms<br />
of vitamin A deficiency, its<br />
effects on childhood morbidity<br />
<strong>and</strong> mortality <strong>and</strong> preventative<br />
strategies. Dr. Kosoko-Lasaki<br />
emphasized the benefits of<br />
breast-feeding <strong>and</strong> encouraged<br />
the consumption of foods rich<br />
in vitamin A, such as green leafy<br />
vegetables, carrots, mangoes,<br />
papaya, etc. The Cooperadores<br />
also received lectures on the<br />
importance of adults having their<br />
eyes screened for glaucoma. All<br />
the Cooperadores received eye<br />
exams <strong>and</strong> screening. Two new<br />
cases of glaucoma were identified<br />
amongst the group.<br />
Other trip activities included<br />
screening children for the eye<br />
signs of vitamin A deficiency,<br />
distributing vitamin A capsules,<br />
<strong>and</strong> providing screening <strong>and</strong><br />
ocular examination <strong>and</strong> treatment<br />
for adults, specifically for<br />
glaucoma. In addition, a lecture<br />
to the Ophthalmology Society on<br />
the importance of screening for<br />
glaucoma was delivered by Dr.<br />
Kosoko-Lasaki.<br />
Results<br />
Approximately 200 children,<br />
ages 3 months to 10 years, were<br />
screened <strong>and</strong> received vitamin A.<br />
A total of 178 adults received visual<br />
acuity, visual field (using the FDT<br />
Visual Field Analyzer), slit lamp,<br />
tonometry <strong>and</strong> fundus exams.<br />
Ninety-four patients had complete<br />
ophthalmologic exams. Thirty new<br />
cases <strong>and</strong> 44 existing cases of<br />
glaucoma were diagnosed, <strong>and</strong><br />
six glaucoma surgeries were performed.<br />
Follow-up referrals were<br />
sent to Dr. Sebastian Guzman <strong>and</strong><br />
to the ILAC clinic in Santiago.
SIGHT AND LIFE 30<br />
NEWSLETTER 2/2006<br />
Conclusion<br />
The children, adults, <strong>and</strong> health<br />
care personnel in the DR benefited<br />
from the efforts of the Eye<br />
Care team <strong>and</strong> its collaborative<br />
approach with the local Santiago<br />
ophthalmologist <strong>and</strong> ILAC family<br />
practice physicians. The ILAC<br />
Cooperadores (health care workers)<br />
use the “teach-the-teacher”<br />
strategy. This grass-roots ap-<br />
proach reaches the poor <strong>and</strong><br />
marginalized residents in the<br />
remote, underserved areas of the<br />
Dominican Republic.<br />
Acknowledgement<br />
Much-appreciated support was<br />
provided by:<br />
SIGHT AND LIFE, New World<br />
Medical, Inc. (Rancho Cucamonga,<br />
California), Creighton<br />
University Institute for Latin<br />
American Connection (ILAC) Office,<br />
(Omaha, Nebraska, USA),<br />
Creighton University Office of<br />
Health Sciences–Multicultural<br />
<strong>and</strong> Community Affairs (HS-<br />
MACA) (Omaha, Nebraska, USA).<br />
Dr. Sebastian Guzman <strong>and</strong> staff<br />
(Santiago, Dominican Republic),<br />
ILAC Mission staff (Santiago,<br />
Dominican Republic).<br />
The following article is based on a complete report sent to SIGHT AND LIFE. Earlier Newletters (1/1999, pp. 15–17;<br />
1/20<strong>02</strong> pp.12–14) reported previous findings <strong>and</strong> survey results, as well as detailed recommendations: therefore<br />
only the most recent comments are given here (editor).<br />
Update on the status of vitamin A deficiency<br />
<strong>and</strong> xerophthalmia in children under five treated<br />
at hospitals in Vietnam over a 27-year period<br />
(1979 – 2005)<br />
Nguyen Chi Dzung MD, PhD, Hanoi National Institute of Ophthalmology,<br />
Tran Minh Tan MD, Hanoi National Children’s Hospital, Vietnam<br />
In 2005 cases with eye signs of<br />
vitamin A deficiency (125 cases<br />
with XN) were still seen in many<br />
hospitals in Vietnam, especially in<br />
remote <strong>and</strong> mountainous areas.<br />
Similar findings were published<br />
in previous issues (see SIGHT<br />
AND LIFE <strong>Newsletter</strong> 1/20<strong>02</strong> pp.<br />
12–14). Due to the sporadic cases<br />
of VAD still found, not only in<br />
the community but also in some<br />
hospitals, <strong>and</strong> the persistent risk<br />
of blindness for children in some<br />
remote <strong>and</strong> mountainous areas,<br />
the VAD prevention <strong>and</strong> control<br />
program needs to be continued,<br />
with the focus on mountainous,<br />
remote <strong>and</strong> economically impoverished<br />
areas in order to totally<br />
eliminate xerophthalmia by the<br />
year 2010.<br />
Therefore we hope to continue<br />
to receive support from SIGHT<br />
AND LIFE in the form of vitamin A<br />
capsules in order to achieve this<br />
goal of eliminating xerophthalmia<br />
<strong>and</strong> VAD in Vietnam.<br />
We always highly appreciate international<br />
assistance, which is<br />
very valuable. On this occasion,<br />
we would like to express the<br />
sincere thanks of our people <strong>and</strong><br />
colleagues to all UN agencies, international<br />
NGO’s such as CBM,<br />
FHF, HKI, Orbis, SF, SIGHT AND<br />
LIFE , <strong>and</strong> our good friends, who<br />
have given Vietnam such valuable<br />
<strong>and</strong> effective assistance in our<br />
Blindness Prevention Program<br />
for so many years.<br />
Left: The MOH Deputy Minister gives high-dose vitamin A capsules to children. On the right is Dr. Jama Gulaid,<br />
Head of Health <strong>and</strong> Nutrition, UNICEF, Hanoi. Right: Dr. Nguyen Cong Khan, Director of National Institute of Nutrition<br />
(NIN) speaks at the launch of a National Micronutrients Day campaign.
NEWSLETTER 2/2006<br />
31<br />
SIGHT AND LIFE<br />
Continuing nutrition education by the Youth<br />
Volunteer Group, Nepal<br />
Ashish Sharma, Youth Volunteer Group (YVG), Banepa, Kavrepalanchok, Kathm<strong>and</strong>u,<br />
Nepal<br />
In SIGHT AND LIFE <strong>Newsletter</strong><br />
3/2005 (pp. 27–29) we reported<br />
on the nutrition education program<br />
made possible by financial<br />
<strong>and</strong> logistical support from SIGHT<br />
AND LIFE. We were very pleased<br />
when SIGHT AND LIFE gave us<br />
the opportunity to continue a<br />
similar program in another area<br />
of Nepal.<br />
About 43% of Nepal’s total population<br />
of 23.8 million is under the<br />
age of 16. Of these, 3% suffer<br />
from vitamin A deficiency xerophthalmia.<br />
Eye diseases are considered<br />
to be a vast problem which<br />
has adverse effects in the mental<br />
as well as physical development<br />
of children. This gave us the incentive<br />
to continue this Nutrition<br />
Education Campaign.<br />
Despite the fact that the National<br />
Vitamin A Program for the prevention<br />
of vitamin A deficiency has<br />
been ongoing for many years<br />
now (editor: see SIGHT AND LIFE<br />
<strong>Newsletter</strong> 3/1995 pp. 12–13),<br />
it seems that knowledge in the<br />
population is still not sufficient.<br />
Therefore the YVG started this<br />
education effort in various areas<br />
to make people aware of their<br />
own nutrition situation <strong>and</strong> that<br />
of their children.<br />
From January to March 2006 this<br />
“Nutrition Education Campaign”<br />
was carried out in the area of<br />
the Kavrepalanchok district. The<br />
direct beneficiaries were 559 children<br />
<strong>and</strong> 275 pregnant <strong>and</strong> nursing<br />
mothers <strong>and</strong> their families.<br />
Objectives, methods <strong>and</strong> procedures<br />
were very similar to the<br />
previous program, with improvements<br />
where possible (see <strong>Newsletter</strong><br />
3/2005)<br />
Children’s eye screening<br />
The eyes of a total of 559 children<br />
were examined by a senior ophthalmic<br />
assistant for any signs or<br />
symptoms of VAD. All affected<br />
children were given a vitamin A<br />
capsule <strong>and</strong> some of them were<br />
referred to the Nepal Eye Hospital.<br />
Twenty-six children (4.6%)<br />
aged 5 months to 5 years were<br />
found to have eye symptoms (XN<br />
6; X1B 10: XN+X1B 7; X2+X3 3).<br />
Conclusions <strong>and</strong><br />
recommendation<br />
There has been an increase in<br />
knowledge about vitamin A rich<br />
food, vitamin A deficiency diseases,<br />
blindness etc. amongst<br />
mothers <strong>and</strong> caretakers, <strong>and</strong><br />
those identified with eye symptoms<br />
received appropriate care.<br />
The evaluation showed a very<br />
positive impact on the people<br />
with regard to knowledge.<br />
Although there has been a positive<br />
response to the program<br />
in the areas where it is running<br />
– with an increase in knowledge<br />
of vitamin A rich food <strong>and</strong> ways of<br />
consuming it, as well as more information<br />
about VAD – this short<br />
program of three months cannot<br />
solve the problem completely. If<br />
the people do not take the initiative<br />
themselves the problem will<br />
never be solved.<br />
Outsiders like us are ever ready<br />
to work in this field to increase<br />
people’s awareness, but there are<br />
many reasons why we cannot do<br />
this work for very long. So if we<br />
support <strong>and</strong> prepare some peer<br />
groups among the local people<br />
then they can work in a better <strong>and</strong><br />
more sustainable way.
SIGHT AND LIFE 32<br />
NEWSLETTER 2/2006<br />
The PACHE Trust health program <strong>and</strong> women’s<br />
empowerment<br />
P Manoharan, Project Director, Pache Trust, Madurai, Tamil Nadu, India<br />
Introduction<br />
The People’s Association for<br />
Community Health Education<br />
Trust (PACHE Trust) is a grassroots<br />
level non-profit <strong>and</strong> nongovernmental<br />
organization functioning<br />
for the dedicated cause<br />
of uplifting the rural poor with<br />
due emphasis on the betterment<br />
of women <strong>and</strong> children. The organization<br />
is also involved in a<br />
considerable number of HIV/AIDS<br />
prevention projects among the<br />
highly vulnerable groups. The<br />
organization has been involved<br />
in many projects involving community<br />
health, women’s empowerment<br />
etc.<br />
PACHE Trust, in joint venture with<br />
SIGHT AND LIFE, has been engaged<br />
in the prevention of vitamin<br />
A deficiency disorders (VADD) in<br />
recent years. The SIGHT AND<br />
LIFE <strong>Newsletter</strong> 1/20<strong>02</strong> contained<br />
an article from PACHE Trust (pp.<br />
20–21), <strong>and</strong> pictures of program<br />
activities were included in <strong>Newsletter</strong><br />
3/2004, p. 48. The project<br />
was launched in districts where<br />
children were found to be prone<br />
to deficiency diseases. It is one<br />
of the most significant projects in<br />
Tamil Nadu addressing the needs<br />
of children below 10 years of age.<br />
VADD are a major health concern<br />
among children, especially the<br />
rural poor. The project has been<br />
attaining increasing success with<br />
every passing year. The community<br />
has been sensitized <strong>and</strong> there<br />
is visibly increased awareness on<br />
the prevention of VADD.<br />
The goals, to treat <strong>and</strong> prevent<br />
VADD, have not changed over<br />
the years. The methods of communication,<br />
training <strong>and</strong> of raising<br />
attention for precautionary measures<br />
have been developed <strong>and</strong><br />
refined. More attention is now<br />
given to pregnant <strong>and</strong> lactating<br />
mothers.<br />
Achievements include reaching<br />
more children, the orientation of<br />
school teachers, regular school<br />
visits, regular vitamin A supplementation<br />
(vitamin A capsules),<br />
health camps, giving attention<br />
to people with other diseases<br />
<strong>and</strong> a strong collaboration with<br />
authorities.<br />
Awareness of self-help<br />
groups (SHG)<br />
The SHGs play a major role in<br />
the effective implementation of<br />
project activities because women<br />
are highly involved. It is the SHGs<br />
who disseminate the new messages<br />
<strong>and</strong> developmental measures<br />
to the community, especially<br />
to the women. Besides dissemination<br />
of information regarding<br />
vitamin A, other micronutrients,
NEWSLETTER 2/2006<br />
33<br />
SIGHT AND LIFE<br />
macronutrients <strong>and</strong> the importance<br />
of a balanced diet were<br />
emphasized.<br />
During the past year 30 orientation<br />
seminars were conducted<br />
for SHG leaders (many of them<br />
are women) representing about<br />
900 groups. The training had a<br />
wholesome effect <strong>and</strong> served its<br />
purpose. The members of the<br />
SHGs are trained well <strong>and</strong> the<br />
success of the project relies on<br />
them as they have to bring the<br />
group together <strong>and</strong> to pass on<br />
the messages.<br />
Kitchen gardening<br />
This proved to be an interesting<br />
<strong>and</strong> suitable approach. Besides<br />
the general public, school children<br />
showed much interest in planting<br />
saplings beside the school <strong>and</strong> in<br />
other places. It was demonstrated<br />
how to collect seeds <strong>and</strong> how to<br />
h<strong>and</strong>le them to grow plants.<br />
Cultural programs<br />
The street plays <strong>and</strong> other activities<br />
have their own impact on the program.<br />
In this way even illiterate people<br />
can underst<strong>and</strong> the concept.<br />
Conclusions<br />
The program is going well <strong>and</strong><br />
developing in the right direction.<br />
There are more people to<br />
reach <strong>and</strong> resources are never<br />
enough. We thank all those who<br />
contributed to the success of the<br />
program especially all the active<br />
participants, school children,<br />
women <strong>and</strong> SHG leaders, but<br />
also organizations like SIGHT<br />
AND LIFE, whose contributions<br />
are essential. We hope to be able<br />
to continue our work with the<br />
help of all.<br />
An integrated nutrition, training <strong>and</strong> education<br />
program<br />
R Ratna Swamy, State Health Coordinator, Population <strong>and</strong> Environmental Education<br />
Centre (PEEC), Velgode, Kurnool District, Andhra Pradesh, India.<br />
Introduction<br />
PEEC considers itself privileged<br />
to work h<strong>and</strong> in h<strong>and</strong> with SIGHT<br />
AND LIFE. The support of SIGHT<br />
AND LIFE over the past years<br />
has made it possible to develop<br />
a significant health program covering<br />
most of the state of Andhra<br />
Pradesh. Reports about PEEC<br />
activities were included in SIGHT<br />
AND LIFE <strong>Newsletter</strong>s 3/2001<br />
(pp. 34–35) <strong>and</strong> 1/2004 (p. 17).<br />
The program is a continuation<br />
from previous years <strong>and</strong> it is key<br />
to sustainability through education,<br />
counseling <strong>and</strong> distribution<br />
of vitamin A capsules. The main<br />
target groups are community <strong>and</strong><br />
grass-roots people who are given<br />
adequate knowledge to make use<br />
of the available natural resources<br />
to overcome nutritional problems<br />
in growing children.<br />
Main activities<br />
PEEC is a center for the coordination<br />
of activities for more<br />
than 110 local NGOs, <strong>and</strong> even<br />
more NGOs attend information<br />
meetings. Orientation <strong>and</strong> training<br />
programs for NGO leaders<br />
on the importance of vitamin A<br />
deficiency (VAD) are offered, as<br />
well as awareness camps on<br />
eye care for schoolchildren, slum<br />
children <strong>and</strong> their parents. The<br />
vitamin A capsules from SIGHT<br />
AND LIFE are not only important<br />
for the immediate prevention of<br />
deficiency, they are also an important<br />
tool to raise awareness<br />
<strong>and</strong> to reach people <strong>and</strong> finally to<br />
communicate the message about<br />
the importance of the vitamin A<br />
<strong>and</strong> the various kinds of fruits,<br />
vegetables <strong>and</strong> other foods containing<br />
vitamin A <strong>and</strong> provitamin<br />
A carotenoids.<br />
The financial support from SIGHT<br />
AND LIFE allows us to give small<br />
financial contributions to some<br />
NGOs for their activities <strong>and</strong> to<br />
start vegetable gardens. PEEC<br />
prepares <strong>and</strong> prints resource materials<br />
like wall posters, h<strong>and</strong>bills,<br />
stickers <strong>and</strong> booklets etc. in the<br />
local language. Assistance was<br />
offered to tsunami victim families<br />
using a special grant from SIGHT<br />
AND LIFE.<br />
Training programs<br />
During 2005 only three training<br />
programs were conducted. They<br />
were attended by representatives<br />
from 85, 90 <strong>and</strong> 66 NGOs.<br />
Awareness programs<br />
Some of the partner NGOs are selected<br />
for this program to spread<br />
the message on the need for<br />
vitamin A <strong>and</strong> its relation to eye<br />
care. These NGOs visit schools,<br />
slum areas, integrated child development<br />
schools <strong>and</strong> women’s<br />
groups, <strong>and</strong> enlighten them about<br />
the importance of healthy nutrition.<br />
Also they inform the children,<br />
their parents <strong>and</strong> neighbors<br />
about the various vegetables <strong>and</strong><br />
fruits. These NGOs also distribute<br />
resource materials like wall posters,<br />
h<strong>and</strong>bills, UNICEF materials<br />
<strong>and</strong> booklets, <strong>and</strong> they paste wall<br />
posters on the walls of important
SIGHT AND LIFE 34<br />
NEWSLETTER 2/2006<br />
public places in the villages. It<br />
is very effective <strong>and</strong> people are<br />
interested in participating in such<br />
meetings.<br />
A new method of awareness<br />
campaigning is carried on in the<br />
districts of Guntur <strong>and</strong> Krishna. In<br />
this the local NGOs have formed<br />
into a committee <strong>and</strong> engaged a<br />
motor vehicle with all our slogans,<br />
symbols of vitamin A deficiency<br />
<strong>and</strong> eye care which moves from<br />
village to village. The local leaders<br />
in the villages have taken on<br />
the responsibility of spreading the<br />
messages.<br />
Vegetable gardens<br />
This is an innovative method to<br />
ensure that vegetables with a<br />
rich carotenoid content, including<br />
green leafy vegetables, are made<br />
available to people in the local<br />
markets. For this we have given<br />
some assistance to women farmers<br />
<strong>and</strong> women’s self-help groups<br />
to grow vegetables with more<br />
provitamin A. This is a revolving<br />
fund <strong>and</strong> the partner NGOs will<br />
be revolving this money among<br />
the women’s groups. This has<br />
proved very successful in some<br />
districts, like Chittoor, Prakasam<br />
<strong>and</strong> Guntur.<br />
PEEC’s sister organization, the<br />
Rural Development Society, distributes<br />
vegetable seeds as part<br />
of the kitchen gardens scheme<br />
for better nutrition among children.<br />
This program is linked with<br />
vitamin A deficiency prevention.<br />
Thous<strong>and</strong>s of families are given<br />
the vegetable seeds which they<br />
plant in kitchen gardens around<br />
their houses <strong>and</strong> use for food.<br />
So this is also indirectly supporting<br />
the eradication of vitamin A<br />
deficiency.<br />
Resource materials<br />
Wall posters are prepared <strong>and</strong><br />
printed. These are distributed<br />
to the partner NGOs for display<br />
on the walls of public places to<br />
highlight the message. This is<br />
very informative <strong>and</strong> people are<br />
very enthusiastic about it.<br />
H<strong>and</strong>bills are distributed to the<br />
public in the villages during festivals,<br />
holidays etc. They are very<br />
effective. Social workers, doctors<br />
<strong>and</strong> paramedical staff appreciate<br />
them as they are another form of<br />
information material.<br />
The “SIGHT AND LIFE Guidebook<br />
on Vitamin A in Health <strong>and</strong><br />
Disease” was translated into the<br />
local language (Telugu), printed<br />
<strong>and</strong> distributed to local leaders,<br />
teachers, social workers etc.<br />
through NGOs. This book has<br />
been well received <strong>and</strong> needs to<br />
be reprinted to meet dem<strong>and</strong>.<br />
Tsunami assistance<br />
Emergency relief measures were<br />
carried out in four districts. The<br />
relief materials distributed during<br />
the disaster period consisted<br />
of food grains like rice <strong>and</strong> dhal;<br />
aluminum pots for selling fish;<br />
dress materials for saris <strong>and</strong><br />
dhotis; towels, blankets <strong>and</strong><br />
utensils; <strong>and</strong> educational materials<br />
like note books, slates etc. for<br />
schoolchildren. The aid included<br />
calcium tables <strong>and</strong> safe drinking<br />
water containers. This covered<br />
440 families altogether <strong>and</strong> 420<br />
children benefited. The tsunami<br />
victims expressed their gratitude<br />
to SIGHT AND LIFE for the help<br />
in the emergency.<br />
Conclusion<br />
On the whole, the program is<br />
continuing successfully <strong>and</strong> no<br />
major difficulties are faced. Many<br />
NGOs are interested in participating<br />
<strong>and</strong> they are asking us to hold<br />
meetings every three months.<br />
The vitamin A capsules are very<br />
attractive <strong>and</strong> many NGOs want<br />
to receive more, but we are not<br />
able to supply them because the<br />
stock is very limited. The government<br />
is not issuing the permission<br />
necessary to import the<br />
vitamin A capsules donated by<br />
SIGHT AND LIFE. The products<br />
available in the medical stores<br />
are not comparable <strong>and</strong> are very<br />
expensive. PEEC wants to reach<br />
even more people in Andhra<br />
Pradesh but due to financial <strong>and</strong><br />
resource restrictions this is not<br />
always possible.
NEWSLETTER 2/2006<br />
35<br />
SIGHT AND LIFE<br />
Knowledge <strong>and</strong> perception of vitamin A<br />
deficiency in the villages of Burkina Faso<br />
Rosemary Fleury Téchoueyres, Youzondo Association, Bordeaux-Caudéran, France<br />
During missions to the north of<br />
Burkina Faso, we noticed cases<br />
of night blindness. This led us to<br />
found the Youzondo Association,<br />
whose name, in the Moré language,<br />
refers to this condition.<br />
Operation<br />
In many areas we chose to create<br />
village associations consisting of<br />
a committee of eight people <strong>and</strong><br />
two delegates per district. They<br />
meet every quarter to discuss a<br />
topic related to nutrition, communication<br />
or agriculture. Their<br />
activities are coordinated with the<br />
national Burkinabé Association<br />
for the Prevention of Youzondo.<br />
It all began under the palabras<br />
tree at Petit Samba. As usual<br />
between 1pm <strong>and</strong> 4pm we were<br />
discussing everyone’s concerns,<br />
particularly with regard to children’s<br />
health, <strong>and</strong> this was how<br />
we heard about Youzondo sickness.<br />
Action taken<br />
With the help of a student pharmacist<br />
from Ouagadougou, we<br />
studied the average composition<br />
of the diets of 80 mothers<br />
<strong>and</strong> their children by means of<br />
a questionnaire. This evaluative<br />
work also took into account levels<br />
of plasma retinol <strong>and</strong> conjunctival<br />
impression tests. The extent of vitamin<br />
A deficiency at Petit Samba<br />
was found to be a serious public<br />
health problem.<br />
The second stage was to organize<br />
a day of festive <strong>and</strong> sporting<br />
events, including a bicycle race,<br />
a football match, <strong>and</strong> a theatre<br />
performance given by Hippolyte<br />
Ouangrawa’s troupe. This show<br />
portrays a village family whose<br />
son suffers from night blindness.<br />
It describes the intervention of<br />
members of his family, the woman<br />
next door, the marabout, <strong>and</strong> the<br />
nurse at the Centre of Health <strong>and</strong><br />
Social Advancement. The subject<br />
(i.e. the dangers of vitamin A deficiency,<br />
the way to deal with it,<br />
the kinds of food which contain<br />
it etc.) is treated both accurately<br />
<strong>and</strong> humorously. Afterwards, a forum<br />
allows the audience to react,<br />
to ask questions, <strong>and</strong> to give their<br />
point of view.<br />
The third part of our approach<br />
was training. Thanks to subsidies,<br />
we were able to create health<br />
broadcasts for local radio. We<br />
also organized 3 days of training<br />
with a medical nutritionist <strong>and</strong><br />
a sociologist, aimed at nurses,<br />
district delegates, <strong>and</strong> teachers.<br />
We stressed the importance of<br />
a varied diet. We recommended<br />
orange fruits <strong>and</strong> vegetables<br />
(mangoes, papayas, carrots,<br />
<strong>and</strong> orange sweet potatoes)<br />
<strong>and</strong> vegetables with dark green<br />
leaves (leaves of sorrel, niebe <strong>and</strong><br />
baobab). Other foods, however,<br />
are not so readily available: eggs,<br />
liver, milk <strong>and</strong> related products,<br />
<strong>and</strong> red palm oil, the supply of<br />
which has been stopped from<br />
Ivory Coast.<br />
Results<br />
Three hundred <strong>and</strong> sixty-five<br />
mango trees have been planted in<br />
Petit Samba. At Bonou, we have<br />
a one-hectare market garden.<br />
Two other villages are about to<br />
begin growing for the market.<br />
At Tiogo, a dispensary has been<br />
built. Schools are circulating<br />
health information thanks to the<br />
educational materials sent by<br />
SIGHT AND LIFE.<br />
Conclusions<br />
We are preparing a 5-year scientific<br />
evaluation of the effect of<br />
awareness-raising at the village<br />
of Petit Samba for 2007.<br />
We would like to thank the many<br />
people who help us to do our job,<br />
whether through work, donations,<br />
or in other ways.
SIGHT AND LIFE 36<br />
NEWSLETTER 2/2006<br />
Vitamin A deficiency <strong>and</strong> malnutrition among<br />
Sudanese children admitted to an urban hospital<br />
Hassan Mohamed Ahmed, Professor of Pediatrics <strong>and</strong> Dean of the Faculty of Medicine,<br />
Academy of Medical Sciences <strong>and</strong> Technology, Khartoum, Sudan<br />
Protein energy malnutrition (PEM)<br />
constituted about 10% of total<br />
admissions to the Academy<br />
Charity Teaching Hospital (ACTH)<br />
during the period between December<br />
2004 <strong>and</strong> December<br />
2005. Xerophthalmia was found<br />
more often in children with malnutrition<br />
or after measles infection,<br />
<strong>and</strong> in children from displaced<br />
families, among nomads <strong>and</strong> in<br />
orphans.<br />
During the above period a total<br />
number of 1,420 children under<br />
five years were admitted to the<br />
nutrition ward of ACTH, 13 of<br />
whom had different degrees of<br />
xerophthalmia. Two children developed<br />
keratomalacia, which in<br />
one was bilateral <strong>and</strong> left the child<br />
totally blind. The second child<br />
lost one eye, which had ruptured<br />
at home before admission. All<br />
children admitted were given 2<br />
doses of vitamin A in dosages<br />
recommended by the WHO. This<br />
was adopted as a routine on the<br />
PEM ward. We thank SIGHT AND<br />
LIFE for providing the vitamin A<br />
capsules.<br />
The initial vitamin A level in Sudanese<br />
children showed wide<br />
variation, but the important fact<br />
was that about 42% of them were<br />
below 40 µg/100ml, <strong>and</strong> 20%<br />
were well below 20 µg/100ml.<br />
This is a level which predisposes<br />
children to xerophthalmia <strong>and</strong><br />
blindness. 10 days after vitamin<br />
A supplementation all children<br />
showed a significant rise in serum<br />
vitamin A to protective levels of<br />
above 40 µg/100ml.<br />
The National Nutritional Programs<br />
maintain supplementation of vitamin<br />
A at a community level. They<br />
conduct home-to-home visits as<br />
part of an EPI team for immunization<br />
to eradicate poliomyelitis.<br />
Vitamin A is supplemented twice<br />
a year in doses recommended by<br />
the WHO.<br />
The fight against vitamin A deficiency at<br />
Ouassa-Beket, Benin<br />
Jeremie Orou, Fondation pour l’Aide et l’Autopromotion à la Base en Matière<br />
de Santé et Développement (FAABA), Bembereke, Bénin<br />
In 2005 FAABA, in collaboration<br />
with the Ouassa community<br />
centre, completed three major<br />
projects to combat vitamin A<br />
deficiency:<br />
• A campaign to distribute<br />
vitamin A<br />
• Nutritional education of mothers<br />
<strong>and</strong> caregivers<br />
• Cultivation of vegetables by the<br />
women<br />
Campaign to distribute<br />
vitamin A<br />
This campaign was announced<br />
by the town crier, <strong>and</strong> publicized<br />
on local radio. On 14 October<br />
2005, over 500 children aged<br />
between 6 months <strong>and</strong> 5 years<br />
were seen, <strong>and</strong> each received a<br />
capsule.<br />
Nutritional training<br />
We organized two training sessions<br />
for mothers, <strong>and</strong> especially<br />
gr<strong>and</strong>mothers who take care of<br />
the children after weaning. The<br />
latter are often illiterate <strong>and</strong> the<br />
guardians of traditional taboos<br />
surrounding food. We showed<br />
these women the various foods<br />
(for growth, energy <strong>and</strong> protection)<br />
using posters which stress
NEWSLETTER 2/2006<br />
37<br />
SIGHT AND LIFE<br />
the importance of yellow <strong>and</strong> redcolored<br />
foods rich in vitamin A.<br />
Cultivation of vegetables<br />
After the training sessions by<br />
our agents, the women of Beket<br />
decided to start a garden for the<br />
cultivation of vegetables, especially<br />
leafy vegetables. This initiative<br />
will allow the enrichment of<br />
children’s diets, <strong>and</strong> will provide<br />
them with a good source of vitamins<br />
<strong>and</strong> minerals.<br />
Conclusion<br />
The success of our operation has<br />
encouraged us to continue in<br />
2006. We even plan to bring in an<br />
ophthalmic specialist to diagnose<br />
the population in our local area.<br />
We would like to thank SIGHT<br />
AND LIFE for their help with regard<br />
to the capsules <strong>and</strong> educational<br />
materials.<br />
Continued activity of the Ramala Women’s Group<br />
Margaret Anyango, Rongo 40404, PO Box 119, Kenya<br />
Introduction<br />
We are glad to be able to continue<br />
our work in mitigating micronutrient<br />
deficiencies <strong>and</strong> related<br />
dangers as well as to contribute<br />
to the improved nutrition of all<br />
those participating in our activities.<br />
The continued support<br />
of SIGHT AND LIFE in the form<br />
of financial assistance, as well<br />
as with educational materials<br />
<strong>and</strong> the links opened to other<br />
organisations were essential for<br />
our work within Rongo <strong>and</strong> its<br />
neighboring regions, which is<br />
timely <strong>and</strong> relevant. Thus it is in<br />
keeping with the overall mission<br />
of the group, i.e. to holistically<br />
enhance, foster, promote, <strong>and</strong><br />
strengthen socio-economic opportunities<br />
of rural women <strong>and</strong><br />
children. Health-related issues<br />
including nutrition remain the top<br />
priority of the group. We strongly<br />
believe that health is not only the<br />
absence of ills but also the fight<br />
for the fullness of life, a life free<br />
from micronutrient deficiencies.<br />
Nutrition activities<br />
Vitamin A capsules received from<br />
SIGHT AND LIFE were administered<br />
to 3,673 children below five<br />
years of age. About 27 days were<br />
spent on this exercise. The envisaged<br />
outcome of this exercise<br />
was to improve retinol levels in<br />
children under five <strong>and</strong> to reduce<br />
episodes of night blindness,<br />
acute VAD <strong>and</strong> related disorders,<br />
<strong>and</strong> other VAD-related ailments<br />
among children. Rongo <strong>and</strong> its<br />
neighboring regions, such as<br />
Sakwa, Kamagambo, R<strong>and</strong>ung,<br />
Opapo, Migori, etc. benefited.<br />
On various occasions RWG<br />
distributed about 5.58 tons of<br />
foodstuffs rich in vitamin A. Such<br />
vegetables as cabbage, sukumawiki<br />
(kale), carrots, kiukamba,<br />
etc. were distributed to women<br />
of childbearing age <strong>and</strong> children<br />
of five years <strong>and</strong> under. Approximately<br />
1,500 persons benefited<br />
from this program. Many of the<br />
women reached were also trained<br />
in how to prepare vegetables<br />
without destroying their nutritious<br />
value.<br />
About 63 persons have been<br />
trained so far. During such training,<br />
participants are taught how<br />
to prepare foods without destroying<br />
vital micronutrients. Demonstrations<br />
on how to prepare such<br />
foods were also conducted. Most<br />
women at the time of the training
SIGHT AND LIFE 38<br />
NEWSLETTER 2/2006<br />
were at least breast-feeding their<br />
babies. It was quite encouraging<br />
to see some of these women taking<br />
notes very seriously during<br />
the demonstrations.<br />
A wide range of training techniques<br />
<strong>and</strong> tools were used, such<br />
as group-focused discussions,<br />
roleplay, case study, brainstorming,<br />
demonstrations, lectures,<br />
etc. The training emphasized the<br />
involvement of schoolchildren as<br />
key informants <strong>and</strong> educators<br />
both at family <strong>and</strong> community<br />
levels. Participants were informed<br />
about strategies to involve children,<br />
such as drawing competitions,<br />
debates, poems, etc.<br />
Eye health training<br />
<strong>and</strong> door-to-door eye<br />
screening<br />
Due to ever-increasing complaints<br />
about eye-health-related problems<br />
by community members,<br />
<strong>and</strong> childhood blindness due to<br />
VAD, this training was a necessary<br />
part of the effort of RWG.<br />
Five individuals were selected<br />
for further training on the basis<br />
of their ability to deliver services<br />
to the communities, reputation<br />
<strong>and</strong> working relationship within<br />
the communities. They were fully<br />
aware of the people <strong>and</strong> their<br />
needs. Two resource persons invited<br />
from Tanzania facilitated the<br />
one-week intensive training.<br />
Training on poultry<br />
keeping<br />
The training was intended to increase<br />
local participation in direct<br />
production of locally available<br />
foods rich in vitamin A. To attend<br />
the training it was required that<br />
participants were able to start<br />
<strong>and</strong> sustain chicken-rearing to required<br />
st<strong>and</strong>ards which would be<br />
overseen by a qualified veterinary<br />
officer. From the local communities<br />
56 women were trained by<br />
veterinary officers from the Ministry<br />
of Livestock Development on<br />
how to start <strong>and</strong> manage a small<br />
poultry farm for family <strong>and</strong> other<br />
domestic purposes. The training<br />
included visits to commercial<br />
poultry farmers.<br />
Conclusions<br />
We are convinced that our efforts<br />
are going in the right direction.<br />
However, more is necessary in<br />
training <strong>and</strong> communication as<br />
well as in local production of<br />
healthy food through food production<br />
initiatives <strong>and</strong> encouragement<br />
of agro-business.<br />
We cannot finish this report without<br />
noting that at present the efforts<br />
are not sufficient to manage<br />
VAD <strong>and</strong> other micronutrient deficiencies.<br />
In this sense we have<br />
to say the struggle continues<br />
<strong>and</strong> we hope for further support,<br />
including continuing support from<br />
SIGHT AND LIFE.
NEWSLETTER 2/2006<br />
39<br />
SIGHT AND LIFE<br />
SIGHT AND LIFE visits Pohnpei, Micronesia, <strong>and</strong><br />
films a nutrition documentary<br />
Lois Englberger <strong>and</strong> Adelino Lorens, Isl<strong>and</strong> Food Community of Pohnpei, PO Box 2299,<br />
Kolonia, Pohnpei, Federated States of Micronesia<br />
SIGHT AND LIFE visited Pohnpei<br />
in April 2006 to film a documentary<br />
about nutrition problems in<br />
Micronesia <strong>and</strong> the efforts underway<br />
for alleviating these problems.<br />
Their visit was coordinated<br />
by the Isl<strong>and</strong> Food Community of<br />
Pohnpei.<br />
Klaus Kraemer, Head of SIGHT<br />
AND LIFE, <strong>and</strong> Thomas Breisach,<br />
Deputy Head of the DSM Nutritional<br />
Products Communications<br />
Section, made up the SIGHT<br />
AND LIFE team. They were in<br />
Pohnpei from 21 to 27 April, 2006.<br />
Ulla Lohmann, filmmaker, <strong>and</strong> her<br />
camera assistant Markus Hain<br />
were engaged as consultants<br />
<strong>and</strong> were in Pohnpei from 10 to<br />
27 April, 2006.<br />
The purpose of the film is to produce<br />
a documentary about global<br />
nutrition problems, including micronutrient<br />
deficiencies <strong>and</strong> nutrition-<br />
<strong>and</strong> lifestyle-related chronic<br />
diseases such as diabetes, heart<br />
disease <strong>and</strong> cancer. Dr. Kraemer<br />
pointed out that Pohnpei is an<br />
example of a country having a<br />
double burden of malnutrition: the<br />
problem of micronutrient deficiencies<br />
such as vitamin A deficiency,<br />
<strong>and</strong> the problem of overweight<br />
<strong>and</strong> chronic diseases. He said,<br />
The SIGHT AND LIFE team (from left): Markus Hain, Ulla<br />
Lohmann, Klaus Kraemer, Thomas Breisach.<br />
“No one would expect an isl<strong>and</strong><br />
in the Pacific to have the nutrition<br />
problems of both developing <strong>and</strong><br />
industrialized countries.”<br />
Over half of Pohnpei’s children<br />
have vitamin A deficiency, a disorder<br />
leading to increased infection<br />
<strong>and</strong> mortality. Coupled with<br />
this, there are serious problems<br />
of obesity <strong>and</strong> chronic diseases<br />
such as diabetes, heart disease<br />
<strong>and</strong> cancer in Pohnpei, leading<br />
to higher rates of mortality <strong>and</strong><br />
great suffering among families<br />
<strong>and</strong> individuals.<br />
The group filmed the beauty<br />
spots of Pohnpei, including the<br />
lush Pohnpei l<strong>and</strong>scape, the historical<br />
site of Nan Madol, water<br />
scenes, <strong>and</strong> cultural events, first<br />
portraying aspects of the paradise<br />
concept that many people<br />
in other parts of the world have<br />
about life on a Pacific isl<strong>and</strong>.<br />
The team then filmed aspects<br />
of the real-life situation relating<br />
to food, nutrition <strong>and</strong> health,<br />
<strong>and</strong> efforts to improve the nutritional<br />
situation. These included<br />
the Pilot Farm in Madolenihmw<br />
led by Pohnpei Agriculture of<br />
the Department of Economic<br />
Affairs, the Pohnpei Traditional<br />
Foods for Health project led by<br />
IFCP in collaboration with M<strong>and</strong>
SIGHT AND LIFE 40<br />
NEWSLETTER 2/2006<br />
The Governeur of Pohnpei, Johnny<br />
P David with Klaus Kraemer.<br />
Community <strong>and</strong> the Centre for<br />
Indigenous Peoples’ Nutrition<br />
<strong>and</strong> Environment (CINE); Mr. Sei<br />
Uemoto <strong>and</strong> his plans to develop<br />
increased marketing of Karat<br />
banana <strong>and</strong> other local foods;<br />
the Youth to Youth project with<br />
Class 4 of M<strong>and</strong> Elementary<br />
School in collaboration with the<br />
Conservation Society of Pohnpei;<br />
Pohnpei Library Week along their<br />
theme of “GO LOCAL”; <strong>and</strong> the<br />
vitamin A supplementation program<br />
led by the Pohnpei Department<br />
of Health/FSM Department<br />
of Health, Education <strong>and</strong> Social<br />
Affairs.<br />
SIGHT AND LIFE has provided<br />
on-going assistance for many<br />
years to the Federated States of<br />
Micronesia, including research on<br />
the nutrient content of local isl<strong>and</strong><br />
foods <strong>and</strong> vitamin A awareness<br />
materials, such as posters <strong>and</strong><br />
the recent video titled GOING<br />
YELLOW, which has often been<br />
shown on Pohnpei<br />
local television.<br />
This video was<br />
prepared last year<br />
(2005) as a project<br />
initiated <strong>and</strong> supported<br />
by SIGHT<br />
AND LIFE in conjunction<br />
with the<br />
Isl<strong>and</strong> Food Community<br />
of Pohnpei<br />
<strong>and</strong> produced by<br />
Micronesian Seminar<br />
(see SIGHT<br />
AND LIFE <strong>Newsletter</strong><br />
1/2006, pp.<br />
31–33).<br />
At the farewell luncheon.<br />
At a farewell luncheon for the<br />
SIGHT AND LIFE team, Dr. Kraemer<br />
was invited to give a few<br />
words of advice to IFCP <strong>and</strong> their<br />
efforts to improve health <strong>and</strong> nutrition<br />
in Pohnpei. The IFCP board<br />
members <strong>and</strong> all present were<br />
very touched by his insight. His<br />
three points were as follows:<br />
• Think about quantities of food<br />
eaten. There is a serious problem<br />
of overweight <strong>and</strong> obesity<br />
in Micronesia. Fresh local<br />
foods are generally good, but<br />
even local foods can lead to<br />
overweight if eaten in excess or<br />
if prepared in unhealthy ways<br />
(adding sugar, frying or using<br />
excess fat).<br />
• Focus on the youth. They are<br />
the future. Their habits are not<br />
yet fully set.<br />
• Remember that not all imported<br />
foods are unhealthy.<br />
There are some imported foods<br />
available that are fortified with<br />
micronutrients. Remember to<br />
read the labels!!<br />
IFCP has already started working<br />
on this advice, talking about<br />
quantities eaten <strong>and</strong> working<br />
with the youth. Also, an email<br />
message was sent out to the<br />
IFCP email network to share information<br />
about fortified instant<br />
noodles. Although many instant<br />
noodles sold in Pohnpei contain<br />
no vitamin A, there are some<br />
br<strong>and</strong>s that have been fortified<br />
<strong>and</strong> contain up to 30% of the<br />
estimated daily requirements. If<br />
consumers plan to eat instant<br />
noodles, they could choose the<br />
fortified br<strong>and</strong>s in order to get a<br />
more nutritious food. The same<br />
message is now being relayed<br />
to community members in small<br />
workshops, showing actual examples<br />
of the fortified <strong>and</strong> nonfortified<br />
br<strong>and</strong>s.<br />
Nutrition education (left) <strong>and</strong> Lois Englberger weighing <strong>and</strong> measuring a<br />
woman.<br />
Thanks are again extended to<br />
SIGHT AND LIFE for their visit to<br />
Pohnpei, making the documentary<br />
<strong>and</strong> providing helpful advice.<br />
The IFCP also thanks their partner<br />
agencies including Pohnpei Agriculture<br />
of the Department of Economic<br />
Affairs, College of Micronesia-FSM<br />
L<strong>and</strong> Grant Program,<br />
Pohnpei Departments of Health<br />
<strong>and</strong> Education, <strong>and</strong> the Pacific<br />
German Regional Forestry Project,<br />
for providing transport.
NEWSLETTER 2/2006<br />
41<br />
SIGHT AND LIFE<br />
A digest of recent literature<br />
Donald S McLaren*<br />
Introduction<br />
Mention has been made in several<br />
recent issues of the <strong>Newsletter</strong> of<br />
the shift in topic that has gradually<br />
taken place in the retinoid <strong>and</strong> carotenoid<br />
literature. Basic laboratory<br />
research has far outstripped human<br />
community <strong>and</strong> clinical studies<br />
which are clearly of more concern to<br />
most readers of the literature digest.<br />
As a result, abstracts of basic studies<br />
have had to be strictly limited<br />
because of restricted space. An<br />
attempt has been made to include<br />
those basic studies that seem to be<br />
of greatest relevance, but this has<br />
hitherto left a large number of chosen,<br />
relevant papers excluded.<br />
A number of readers have expressed<br />
their appreciation of the<br />
way in which their attention has<br />
been drawn by a quick scan of the<br />
literature digest to topics of special<br />
interest to them. This would clearly<br />
be all the more valuable if the coverage<br />
of the new literature could be<br />
made more complete. Consequently,<br />
this issue contains an Appendix<br />
after the main abstracts. This has<br />
been compressed to provide only<br />
essential information on the papers<br />
it covers in order to include as many<br />
as possible. The title (sometimes<br />
abbreviated) is in bold as usual,<br />
followed by the name <strong>and</strong> initials of<br />
the first author <strong>and</strong> finally the journal<br />
reference. Abbreviated abstracts<br />
have been grouped according to<br />
topic as this seemed the best way<br />
for readers, if they so wish, to make<br />
some selection. With use of the<br />
Internet this should give access to<br />
more complete information. It would<br />
be helpful to the editor to learn if this<br />
change is appreciated.<br />
* Address for correspondence:<br />
Prof. Donald S. McLaren<br />
12 Offington Avenue, Worthing,<br />
West Sussex BN14 9PE, UK<br />
mclarendonald@yahoo.co.uk<br />
Community research<br />
“Vitamin A supplementation for reducing<br />
the risk of mother-to-child<br />
transmission of HIV infection” by<br />
Wiysonge CS, Shey MS, Sterne<br />
JAC et al. Cochrane Database<br />
Syst Rev 2005, No 4, p. CD003648<br />
(Ministry of Public Health, Central<br />
Technical Group, EPI c/o BP 25125<br />
Messa, Yaounde, Cameroon. Email:<br />
wiysonge@yahoo.com)<br />
Results of this review did not find<br />
evidence to support vitamin A supplementation<br />
of HIV-infected pregnant<br />
women to reduce mother-tochild<br />
transmission of HIV, although<br />
there was evidence of birth weight<br />
improvement.<br />
Results of the large trial in Zimbabwe<br />
(see below) were awaited at<br />
this time.<br />
“Effects of a single large dose of<br />
vitamin A, given during the postpartum<br />
period to HIV-positive<br />
women <strong>and</strong> their infants, on child<br />
HIV infection, HIV-free survival,<br />
<strong>and</strong> mortality” by Humphrey JH,<br />
Iliff PJ, Marinda ET et al. J Infec<br />
Dis 2006; 193: 960–971 (JH Humphrey,<br />
1 Borrowdale Road, Borrowdale,<br />
Harare, Zimbabwe. Email:<br />
Humphrey@viambo.co.zw)<br />
14,110 mother-infant pairs were enrolled.<br />
Neither maternal nor neonatal<br />
vitamin A supplementation significantly<br />
affected postnatal MTCT<br />
or overall mortality. For several<br />
reasons the results of this trial raises<br />
concern about universal maternal or<br />
neonatal vitamin A supplementation<br />
in HIV-endemic areas. (This would<br />
include large areas in the third world<br />
where maternal vitamin A supplementation<br />
programs are currently<br />
recommended by WHO).<br />
The above concerns are echoed<br />
by WW Fawzi in an accompanying<br />
editorial – “The benefits <strong>and</strong><br />
concerns related to vitamin A<br />
supplementation” J Infec Dis<br />
2006;193: 756–759<br />
“Effects of postpartum maternal<br />
or neonatal vitamin A supplementation<br />
on infant mortality<br />
among infants born to HIV-negative<br />
mothers in Zimbabwe” by<br />
Malaba LC, Iliff PJ, Nathoo KJ<br />
et al. Am J Clin Nutr 2005; 81:<br />
454–460 (JH Humphrey, ZVITAMBO<br />
Project, 1 Borrowdale Road, Borrowdale,<br />
Harare, Zimbabwe. Email:<br />
jhumphrey@zvitambo.co.zw)<br />
This study was part of the large trial<br />
described in the previous abstract.<br />
Mothers who received vitamin A<br />
received 400,000 IU <strong>and</strong> infants<br />
50,000 IU. Over 12 months of follow<br />
up there was no effect on infant<br />
mortality in either case.<br />
“Some dietary <strong>and</strong> adipose tissue<br />
carotenoids are associated<br />
with the risk of nonfatal acute<br />
myocardial infarction in Costa<br />
Rica” by Kabagambe EK, Furtado<br />
J, Baylin A et al. J Nutr 2005; 135:<br />
1763–1769 (Hannia Campos, Email:<br />
hcampos@hasph.harvard.edu)<br />
1456 cases of first acute MI were<br />
matched with the same number<br />
of healthy controls. Subjects were<br />
distributed into quintiles of dietary<br />
intake or adipose tissue concentration<br />
of carotenoids or tocopherols.<br />
Adipose tissue β-carotene content<br />
was inversely related to MI risk, as<br />
was intake of fruits <strong>and</strong> vegetables<br />
rich in β-carotene. Lutein + zeaxanthin<br />
content of adipose tissue was<br />
directly associated with MI risk.<br />
“Antioxidant vitamins reduce<br />
oxidative stress <strong>and</strong> ventricular<br />
remodeling in patients with<br />
acute myocardial infarction” by<br />
Gasparetto C, Malinvorno A, Culacciati<br />
D et al. Int J Immunopathol-<br />
Pharmacol 2005; 18: 487–496 (Dept<br />
of Int Med <strong>and</strong> Therapy, University<br />
of Pavia, Italy)<br />
Various parameters of the antioxidant<br />
system were monitored from<br />
shortly after the onset of the acute<br />
MI until one month later. Vitamin<br />
treatment improved the antioxidant<br />
system, reduced the oxidative<br />
stress, inflammatory process <strong>and</strong><br />
left ventricular modeling.<br />
“Effect of vitamin A on fracture<br />
risk” by Jackson HA, Sheehan AH.<br />
Ann Pharmacother 2005; 39: 2086–<br />
2090 (HA Jackson, Clarian Health
SIGHT AND LIFE 42<br />
NEWSLETTER 2/2006<br />
Partners Pharmacy Dept, 1-65 21 st<br />
St., Indianapolis, IN 462<strong>02</strong>-1367,<br />
USA. Email: hjackson@clarianorg)<br />
This literature search from 1966<br />
to March 2005, using vitamin A<br />
consumption <strong>and</strong> fracture risk fails<br />
to provide definitive evidence for a<br />
causal association.<br />
“Vitamin supplementation of<br />
HIV-infected women improves<br />
postnatal child growth” by Villamor<br />
E, Saathoff E, Bosch RJ et al.<br />
Am J Clin Nutr 2005; 81: 880–888<br />
(Department of Nutrition, Harvard<br />
School of Public Health, 665 Huntington<br />
Avenue, Boston, MA <strong>02</strong>115,<br />
USA. Email: evillamo@hsph.harvard.edu)<br />
Multivitamins (thiamin, riboflavin,<br />
vitamin B6, niacin, vitamin B12,<br />
vitamin C, vitamin E <strong>and</strong> folic acid)<br />
were tested against vitamin A or<br />
β-carotene. Multivitamins gave<br />
significant improvement in attained<br />
weight, weight for age, <strong>and</strong> weight<br />
for length. Vitamin A or β-carotene<br />
had no such effect, indeed vitamins<br />
<strong>and</strong> β-carotene mix seemed to reduce<br />
benefits on these outcomes.<br />
“Vitamin A, mastitis, <strong>and</strong> motherto-child<br />
transmission of HIV-<br />
1 through breast-feeding” by<br />
Dorosko SM. Nutr Rev 2005; 63:<br />
332–346<br />
Mastitis is an increased mammary<br />
permeability <strong>and</strong> is frequently accompanied<br />
by bacterial infection.<br />
Supplementation with vitamin A<br />
reduces the prevalence of bacterial<br />
mastitis <strong>and</strong> the inflammatory<br />
response. However, studies<br />
of mother-to-child transmission in<br />
HIV-positive women have shown<br />
no reduction with vitamin A supplementation.<br />
One study in Tanzania<br />
reported an increase. Possible<br />
mechanisms for this unexpected<br />
result are being investigated. One<br />
way may be the paracellular entry<br />
of leukocytes affected by retinoic<br />
acid into breast milk.<br />
“Diarrhoea <strong>and</strong> malnutrition in<br />
children” by Baqui AH, Ahmed T.<br />
Brit Med J 2006; 332: 378 (Dept<br />
Int Hlth, Johns Hopkins University,<br />
Bloomberg School of Public Health,<br />
Baltimore MD 21205, USA. Email:<br />
abaqui@jhsph.edu)<br />
This review follows an international<br />
meeting in Bangladesh on this<br />
subject. Oral rehydration has been<br />
successfully pursued for more than<br />
three decades <strong>and</strong> now WHO <strong>and</strong><br />
UNICEF have introduced a new<br />
reduced osmolarity formulation<br />
(WHO/UNICEF Joint Statement.<br />
Clinical management of acute diarrhoea.<br />
2004). In addition they recommend<br />
the therapeutic use of zinc<br />
for 10–14 days at a dose of 10 mg<br />
daily in infants under 6 months <strong>and</strong><br />
20 mg daily in older children. There<br />
is no mention of vitamin A. Before<br />
the beneficial effect of zinc supplementation<br />
in acute diarrhea was<br />
discovered there were many reports<br />
of the efficacy of vitamin A. A recent<br />
reappraisal (see two abstracts below)<br />
reported even greater benefit<br />
of vitamin A than when analysis<br />
was made previously. Furthermore,<br />
there is growing acceptance of the<br />
concept that diarrhea is often an<br />
integral part of vitamin A deficiency<br />
<strong>and</strong> the need for vitamin A replacement<br />
is evident. Other recent documents,<br />
especially in connection with<br />
achievement of some of the Millennium<br />
Goals have always bracketed<br />
together vitamin A <strong>and</strong> zinc in this<br />
context. This issue requires urgent<br />
attention; data supporting vitamin A<br />
supplementation for treatment <strong>and</strong><br />
prevention of diarrheal diseases are<br />
available.<br />
“Maternal vitamin A supplementation<br />
<strong>and</strong> immunity to malaria<br />
in pregnancy in Ghanaian primigravids”<br />
by Cox SE, Staalsoe T,<br />
Arthur P et al. Trop Med Int Hlth<br />
2005;10:1286–1297 (Dept Epidemiology<br />
<strong>and</strong> Population Health,<br />
London Sch Hyg & Trop Med, London,<br />
UK. Email:Sharon.Cox@lshtm.<br />
ac.uk)<br />
The pathological effects of malaria<br />
in pregnancy are believed to be due<br />
to the sequestration of parasites in<br />
the placenta, mediated by binding<br />
of variant surface antigens (VSA)<br />
expressed on the surface of P.<br />
falciparum-infected red blood cells<br />
to placental chondroitin sulfate A<br />
(CSA). Vitamin A supplementation<br />
was accompanied by reduced<br />
levels of anti-VSACSA antibodies<br />
<strong>and</strong> may reflect reduced placental<br />
parasitemia.<br />
“R<strong>and</strong>om-effects models in investigating<br />
the effect of vitamin<br />
A in childhood diarrhea” by<br />
Andreozzi VL, Bailey TC, Nobre<br />
FF et al. Ann Epidemiol 2006;16:<br />
241–247 (VL Andreozzi, Avenida<br />
Humberto Delgado 33, Alhos Vedros,<br />
2860-<strong>02</strong>1, Portugal. Email:<br />
valeska@fiocruz.br)<br />
Enhanced statistical analysis methods<br />
were applied to previous studies<br />
on vitamin A <strong>and</strong> diarrhea in<br />
childhood. Levels of significant<br />
beneficial effects were reached that<br />
were not attained previously – see<br />
also comments on WHO/UNICEF<br />
recommendations that include zinc<br />
but exclude vitamin A two abstracts<br />
above.<br />
“The concentration of free holoretinol-binding<br />
protein is higher<br />
in vitamin A-sufficient than in<br />
deficient Nepalese women in late<br />
pregnancy” by Sankanarayanan<br />
S, Suarez M, Taren D et al. J Nutr<br />
2005;135: 2817–2822 (Penn State<br />
Univ, Huck Inst <strong>Life</strong> Sci, University<br />
Park, PA 168<strong>02</strong>, USA. Email:<br />
fxr5@psu.edu)<br />
The RBP/TTR index (< 0.36 or serum<br />
retinol < 1.05 µmol/l indicative<br />
of vitamin A deficiency), introduced<br />
by FJ Rosales of this group, was<br />
shown to be a useful proxy for free<br />
holo-RBP concentration <strong>and</strong> that<br />
vitamin A status affects its distribution.<br />
“Serum carotenoids, vitamins A<br />
<strong>and</strong> E, <strong>and</strong> 8-year lung function<br />
decline in a general population”<br />
by Guenegou A, Leynaert B, Pin<br />
I et al. Thorax 2006; 61: 320–326<br />
(Dept Epidemiology, INSERM Unit<br />
700, University of Medicine Bichat,<br />
16 rue Henry Huchard, 75018 Paris,<br />
France. Email: guenegou@bichat.<br />
inserm.fr)<br />
1194 French subjects aged 20–44<br />
years were examined in 1992 <strong>and</strong><br />
followed up in 2000. Serum β-carotene<br />
underwent a steady increase in<br />
that period <strong>and</strong> along with this there<br />
was a similar slower decline in FEV1<br />
(forced expiratory volume in 1 second)<br />
– an indicator of lung function.<br />
In heavy smokers both β-carotene<br />
<strong>and</strong> vitamin E were protective.<br />
“Dietary β-cryptoxanthin <strong>and</strong><br />
inflammatory polyarthritis: re-
NEWSLETTER 2/2006<br />
43<br />
SIGHT AND LIFE<br />
sults from a population-based<br />
prospective study” by Pattison<br />
DJ, Symmons DPM, Lunt M et al.<br />
Am J Clin Nutr 2005; 82: 451–455<br />
(Arthritis Research Campaign,<br />
Epidemiology Unit, University of<br />
Manchester, UK)<br />
A modest increase in β-cryptoxanthin<br />
intake, equivalent to one glass<br />
of freshly squeezed orange juice per<br />
day, is associated with a reduced<br />
risk of developing inflammatory<br />
disorders such as rheumatoid arthritis.<br />
“Serum retinol <strong>and</strong> total carotene<br />
concentrations in obese preschool<br />
children” by Saccardo-Sarni<br />
RO, De Souza FIS, Ramalho RA et<br />
al. Med Sci Monit 2005; 11: 510–514<br />
(RO Saccardo-Sarni, R Zamlutti 94,<br />
Sao Paulo, CEP: 04116-260, Brazil.<br />
Email: rssarn@uol.com.br)<br />
It was found that there was an<br />
association between obesity <strong>and</strong><br />
hyperlipidemia <strong>and</strong> low serum level<br />
of carotenoids; possibly affording<br />
some antioxidant protection. (It is<br />
doubtful if total carotenoid levels<br />
are meaningful; fractionation would<br />
appear essential.)<br />
“Momordica cochinchinensis,<br />
Rosa roxburghii, wolfberry, <strong>and</strong><br />
sea buckthorn – highly nutritional<br />
fruits supported by tradition <strong>and</strong><br />
science” by Burke DS, Smidt CR,<br />
Vuong LT. Curr Top Nutraceut Res<br />
2005; 3: 259–266 (Pharmanex<br />
Research Institute, LLC, 75 West<br />
Center Street, Provo, UT 84601,<br />
USA. Email:dburke@pharmanex.<br />
com)<br />
Fruits such as these originate from<br />
Southeast Asia where their value as<br />
healthy fruits has been recognized<br />
for many years. Analysis has shown<br />
that they are rich in antioxidant<br />
vitamins, especially lycopene <strong>and</strong><br />
β-carotene.<br />
“Modification of lymphocyte<br />
DNA damage by carotenoid supplementation<br />
in postmenopausal<br />
women” by Zhao X, Aldini G,<br />
Johnson EJ et al. Am J Clin Nutr<br />
2006;83:163–169 (KJ Yeum, Mayer-<br />
USDA-Human Nutrition Research<br />
Center on Aging, Tufts University,<br />
Boston, MA <strong>02</strong>111, USA. Email:<br />
kyungjin.yeum@tufts.edu)<br />
All carotenoid-supplemented<br />
groups showed a significant decline<br />
in endogenous DNA damage.<br />
4 mg each of lutein, β-carotene <strong>and</strong><br />
lycopene daily, an effective amount,<br />
can be readily taken orally.<br />
“Improving the nutritional value<br />
of Golden Rice through increased<br />
pro-vitamin A content” by Paine<br />
JA, Shipton CA, Chaggar S et al.<br />
Nature Biotech 2005; 23: 482–487<br />
(Syngenta, Jealott’s Hill Int Res<br />
Cent, Bracknell, Berkshire, RG42<br />
6EY, UK)<br />
It was discovered that the daffodil<br />
gene that encoded phytoene synthase<br />
(psy), one of the two genes<br />
used to develop Golden Rice,<br />
was the limiting step in β-carotene<br />
accumulation. A psy from maize<br />
was substituted. Total carotenoids<br />
increased up to 23-fold maximum<br />
with a preferential accumulation of<br />
β-carotene.<br />
Multimicronutrient<br />
research<br />
“Micronutrients in childhood<br />
<strong>and</strong> the influence of subclinical<br />
inflammation” by Thurnham DI,<br />
Mburu ASW, De Wagt A. Proc Nutr<br />
Soc 2005; 64: 5<strong>02</strong>–509 (Univ Ulster,<br />
Ctr Food & Hlth, Sch Biomed Sci, 47<br />
Knocknougher Rd, Coleraine BT51<br />
4LA, Londonderry, Northern Irel<strong>and</strong>.<br />
Email:di.thurnham@ulster.ac.uk)<br />
Attention is drawn in this review to<br />
the neglected importance of the<br />
acute phase response (APR) in the<br />
assessment of nutritional status of a<br />
number of micronutrients. Vitamin A,<br />
iron <strong>and</strong> zinc have been most extensively<br />
studied in this regard but other<br />
vitamins <strong>and</strong> elements are likely to<br />
be implicated. The phenomenon is<br />
widespread, especially in childhood,<br />
as even subclinical infection <strong>and</strong> inflammation<br />
are capable of reducing<br />
the concentration of the nutrient in<br />
the serum <strong>and</strong> the effect is evident<br />
within as little as 24 hours. The<br />
overall effect is to give the impression<br />
that deficiency levels are more<br />
widespread than they really are.<br />
Attempts are being made to devise<br />
<strong>and</strong> introduce correction values for<br />
routine application.<br />
“Prevalence of iron deficiency<br />
<strong>and</strong> its association with vitamin A<br />
deficiency in preschool children”<br />
by Ferraz IS, Daneluzzi JC, Vannucchi<br />
H et al. J Pediatr 2005; 81:<br />
169–174 (IS Ferraz, ER Preto/Bonfirm<br />
Paulista, km 308, CEP 14110-<br />
000 Ribeiro Preto, SP, Brazil. Email:<br />
isferraz@uol.com.br)<br />
179 children aged 24–72 months<br />
without diarrhea or fever at the<br />
time of the study were examined<br />
for vitamin A (30-day dose response<br />
test) <strong>and</strong> iron (HB, serum iron, <strong>and</strong><br />
unsaturated iron-binding capacity<br />
assays) status. 135 had vitamin A<br />
deficiency <strong>and</strong> 64 had iron deficiency<br />
but there was no association<br />
between the two.<br />
“Anemia, iron status <strong>and</strong> vitamin<br />
A deficiency among adolescent<br />
refugees in Kenya <strong>and</strong> Nepal” by<br />
Woodruff BA, Blanck HM, Slutsker L<br />
et al. Publ Hlth Nutr 2006; 9: 26–34<br />
(Ctr Dis Control & Prevent, Ntl Ctr<br />
Chron Dis Prevent & Hlth Promot,<br />
Maternal & Child Nutr Branch, 4770<br />
Buford Highway NE, Mailstop K-25,<br />
Atlanta, GA 30341, USA. Email:<br />
BWoodruff@cdc.gov)<br />
Anemia (hemoglobin 8.3 µg/ml) <strong>and</strong> vitamin A deficiency<br />
(serum retinol < 0.7 µmol/l)<br />
had the following levels of prevalence:<br />
anemia 46% in Kenya, 24%<br />
in Nepal; 43% iron deficiency in<br />
each country; vitamin A deficiency<br />
15% in Kenya <strong>and</strong> 30% in Nepal.<br />
Adolescents tend to be a neglected<br />
group in refugee situations <strong>and</strong><br />
merit greater care.<br />
“Only a small proportion of anemia<br />
in northeast Thai schoolchildren<br />
is associated with iron<br />
deficiency” by Thurlow RA, Winichagoon<br />
P, Green T et al. Am J Clin<br />
Nutr 2005; 82: 380–387 (Institute<br />
of Nutrition, Mahidol University,<br />
Salaya, Thail<strong>and</strong>)<br />
567 children aged 6–12.9 years<br />
were tested for anemia, hemoglobin<br />
type, iron <strong>and</strong> vitamin A status. The<br />
prevalence of anemia overall was<br />
31%, only 16% of these were iron<br />
deficient. Hemoglobinopathy <strong>and</strong><br />
vitamin A deficiency played larger<br />
parts. (The data were not presented<br />
in a way that showed a relationship<br />
between iron deficiency <strong>and</strong><br />
vitamin A deficiency. However, the<br />
study suggests that there is still
SIGHT AND LIFE 44<br />
NEWSLETTER 2/2006<br />
much to learn about this area. It<br />
is interesting to note that those<br />
with C-reactive concentration ≥10<br />
mg/l (n=12) were excluded from the<br />
study, indicating an underst<strong>and</strong>ing<br />
of the APR problem with vitamin A<br />
– see above.)<br />
“Anaemia, iron deficiency <strong>and</strong><br />
vitamin A status among schoolaged<br />
children in rural Kazakhstan”<br />
by Hashizume M, Chiba M,<br />
Shinohara A et al. Publ Hlth Nutr<br />
2005; 8: 564–571 (Univ Tokyo, Dept<br />
Int Community Hlth, Grad Sch Med,<br />
Tokyo, Japan. Email: masahiro.<br />
hashizume@ishtm.ac.uk)<br />
Among 159 school-age children<br />
1) anemia, 2) iron deficiency <strong>and</strong><br />
3) vitamin A deficiency were assessed.<br />
Indicators (but not criteria)<br />
used were: (1 <strong>and</strong> 2) HB, serum iron,<br />
serum ferritin, transferring saturation<br />
<strong>and</strong> erythrocyte protoporphyrin;<br />
<strong>and</strong> (3) serum retinol 0.5%). The usual<br />
ratio XN>X1B is reversed. No account<br />
was taken of APR.)<br />
“A double-blind, r<strong>and</strong>omized,<br />
clinical trial of the effect of vitamin<br />
A <strong>and</strong> zinc supplementation<br />
on diarrheal disease <strong>and</strong> respiratory<br />
tract infections in children in<br />
Mexico City, Mexico” by Long KZ,<br />
Montoya Y, Hertzmark E et al. Am J<br />
Clin Nutr 2006; 83: 693–700 (Dept<br />
Nutrition, Harvard School of Public<br />
Health, Boston MA, USA)<br />
736 children, aged 6–15 months,<br />
were assigned to receive 1) vitamin A<br />
every 2 months, 2) zinc daily, 3) vitamin<br />
A <strong>and</strong> zinc, or 4) placebo. Overall<br />
vitamin A supplementation was<br />
associated with a 27% increase in<br />
diarrheal disease <strong>and</strong> 23% increase<br />
in cough with fever. Zinc had no effect<br />
on these outcomes.<br />
Rates were stratified by household<br />
<strong>and</strong> personal characteristics <strong>and</strong> the<br />
following results obtained: vitamin A<br />
decreased diarrhea in children from<br />
households with dirt floors but increased<br />
diarrhea in children from<br />
households with non-dirt floors,<br />
piped water, <strong>and</strong> indoor bathrooms.<br />
Zinc decreased diarrhea in children<br />
from households with dirt floors <strong>and</strong><br />
whose mothers were more educated.<br />
Vitamin A increased cough with<br />
fever in children from less-crowded<br />
households that lacked indoor bathrooms<br />
<strong>and</strong> children of less-educated<br />
mothers. (The findings have<br />
been quoted almost word-for-word<br />
but these complex results are still<br />
very difficult to interpret. However,<br />
they should have a bearing on the<br />
recent UNICEF recommendations<br />
for the treatment <strong>and</strong> prevention<br />
of diarrheal diseases –see above<br />
under community research.)
NEWSLETTER 2/2006<br />
45<br />
SIGHT AND LIFE<br />
“Vitamin A <strong>and</strong> zinc status in<br />
patients on maintenance haemodialysis”<br />
by Cabral PC, Diniz A da S,<br />
de Arruda IK. Nephrology 2005; 10:<br />
459–463 (Dept of Nutrition, Federal<br />
University of Pernambuco, Brazil)<br />
55 patients <strong>and</strong> 28 healthy controls<br />
were compared. The mean<br />
serum retinol concentration was<br />
significantly (p
SIGHT AND LIFE 46<br />
NEWSLETTER 2/2006<br />
Clinical studies<br />
“Effects of retinoid therapy on<br />
insulin sensitivity, lipid profile<br />
<strong>and</strong> circulating adipocytokines”<br />
by Corbetta S, Angioni R, Cattaneo<br />
A et al. Eur J Endocrin 2006; 154:<br />
83–86 (Univ Milan, Osped Maggiore,<br />
IRCCS, Inst Endocrine Sci,<br />
Via F Storza 25, 1-20122 Milan, Italy.<br />
Email: sabrina.corbetta@unimi.it)<br />
Patients with psoriasis who were<br />
being treated long-term with the<br />
retinoid acitretin were studied. The<br />
treatment resulted in a mild, transient<br />
reduction of insulin sensitivity<br />
<strong>and</strong> HDL-cholesterol levels that<br />
were not related to modifications<br />
of adiponectin, resistin <strong>and</strong> tumor<br />
necrosis factor alpha levels. Although<br />
the role of resistin in humans<br />
remains elusive, the levels of this<br />
adipocytokine seem to be affected,<br />
at least in part, by retinoids.<br />
“Synergism of desbutyl-benflumetol<br />
<strong>and</strong> retinol against Plasmodium<br />
falciparum in vitro”<br />
by Samal D, Rojanawatsirivet C,<br />
Wernsdorfer G et al. Wien Klin Wochenschr<br />
2005; 117: Suppl 4, 39–44<br />
(Dept of Neurology, Medical University<br />
of Vienna, Vienna, Austria.<br />
Email: doris.samal@meduniwien.<br />
ac.)<br />
This in vitro study demonstrates<br />
that addition of retinol to DBB<br />
resulted in a strong inhibition of<br />
schizont maturation.<br />
“In vitro activity of artemisinin<br />
alone <strong>and</strong> in combination with<br />
retinol against Plasmodium falciparum”<br />
by Thriemer K, Wernsdorfer<br />
G, Rojanawatsirivet C et al. Wien<br />
Klin Wochenschr 2005; 117: Suppl<br />
4, 45–48<br />
A similarly positive result to that<br />
outlined in the abstract above in<br />
work by the same experimental<br />
team. Both studies suggest that<br />
retinol may be a promising partner<br />
for antimalarial therapy.<br />
“Renal pathology <strong>and</strong> retinol<br />
status in multiple myeloma”<br />
by Gavrilov V, Yermiahu T, Gorodischer<br />
R. Kidney Int 2006; 69:<br />
173–177 (Biochemistry Laboratory,<br />
Soroka Medical Center, PO Box<br />
151, Beer Sheva, Israel. Email:<br />
vgavrilov@gmail.com)<br />
Renal dysfunction is a common <strong>and</strong><br />
serious complication in multiple myeloma.<br />
This group showed: 1) urinary<br />
retinol is a more reliable marker<br />
of renal dysfunction than elevated<br />
serum creatinine; 2) serum retinol<br />
is decreased with normal or mildly<br />
elevated serum creatinine, but not<br />
in patients with moderate/severe<br />
renal failure; <strong>and</strong> 3) urinary retinol<br />
may serve as a diagnostic marker<br />
of renal proximal tubule dysfunction<br />
in multiple myeloma.<br />
“Reductions in serum vitamin<br />
A arrest accumulation of toxic<br />
retinal fluorophores: a potential<br />
therapy for treatment of lipofuscin-based<br />
retinal diseases”<br />
by Radu RA, Han Y, Bui TV et al.<br />
Invest Ophthalmol Vis Sci 2005;<br />
46: 4393–4401 (Jules Stein Eye Institute,<br />
University of California, Los<br />
Angeles, California, USA)<br />
A toxic vitamin A-based fluorophore<br />
(A2E) present within lipofuscin has<br />
been implicated in the death of<br />
retinal pigment epithelium (RPE)<br />
<strong>and</strong> photoreceptor cells in many<br />
degenerative retinal diseases. In an<br />
animal model it was shown that HPR<br />
(N-4-hydroxyphenyl) retinamide potently<br />
<strong>and</strong> reversibly reduced serum<br />
retinol. Accumulation of A2E <strong>and</strong><br />
lipofuscin autofluorescence were<br />
also reduced.<br />
“Effect of short-term, high-dose<br />
retinol on dark adaptation in aging<br />
<strong>and</strong> early age-related maculopathy”<br />
by Owsley C, McGwin G,<br />
Jackson GR et al. Invest Ophthalmol<br />
Vis Sci 2006;47:1310–1318<br />
(C Owsley, Dept Ophthalmology,<br />
School of Medicine, University of<br />
Alabama at Birmingham, 700 South<br />
18 th Street, Suite 609, Birmingham,<br />
AL 35294-0009, USA. Email:<br />
Owsley@uab.edu)<br />
Baseline variables were similar<br />
in placebo <strong>and</strong> high-dose retinol<br />
groups. Those who received retinol<br />
had an increased rate of rod-mediated<br />
dark adaptation in older patients<br />
who were in the early stages<br />
of ARM (same as AMD). The authors<br />
suggest these results are consistent<br />
with the hypothesis that a local deficiency<br />
of retinol is responsible for<br />
the disease. (In view of the results<br />
presented in the abstract above it<br />
seems unlikely that this alone is<br />
responsible <strong>and</strong> much more work<br />
is needed.)<br />
“Retinol-binding protein, transthyretin,<br />
<strong>and</strong> C-reactive protein<br />
in extremely low birth weight<br />
(ELBW) infants” by Ambalavanan<br />
N, Ross AC, Carlo WA. J Perinatol<br />
2005; 25: 714–719 (N Ambalavanan,<br />
University of Alabama at Birmingham,<br />
619 South 20 th Street, Birmingham,<br />
AL, USA)<br />
This highly significant research is<br />
based, as is so often the case, on<br />
a simple idea developed in one area<br />
<strong>and</strong> neglected in another. Vitamin A<br />
deficiency reduces RBP (retinolbinding<br />
protein) but not TTR (transthyretin).<br />
Inflammation, even at a<br />
sub-clinical level, reduces both RBP<br />
<strong>and</strong> TTR <strong>and</strong> increases C-reactive<br />
protein, an acute phase response<br />
component. In 79 ELBW infants<br />
higher CRP <strong>and</strong> RBP/TTR molar ratio<br />
on day 28 were associated with<br />
death/bronchopulmonary dysplasia<br />
(a common association with ELBW)<br />
at 36 weeks. It was concluded that<br />
inflammation, rather than vitamin A<br />
deficiency, was the cause of low<br />
serum retinol levels. (In other words,<br />
this suggests that the considerable<br />
amount of research leading to the<br />
current practice of administering<br />
routinely intramuscular vitamin A<br />
to ELBW infants is fallacious in that<br />
no true state of vitamin A deficiency<br />
exists, but only a misleadingly low<br />
serum retinol attributable to inflammation).<br />
“Vitamin A <strong>and</strong> E deficiency <strong>and</strong><br />
lung disease in infants with cystic<br />
fibrosis” by Bines JE, Truby HD,<br />
Armstrong DS et al. J Pediatr Child<br />
Health 2005; 41: 663–668 (Dept<br />
Gastroenterology <strong>and</strong> Clinical Nutrition,<br />
Royal Children’s Hospital,<br />
Melbourne, Victoria, Australia)<br />
In this cohort of 39 newly diagnosed<br />
infants with cystic fibrosis no association<br />
was found between serum<br />
vitamin levels at diagnosis <strong>and</strong> airway<br />
inflammatory indices at either<br />
diagnosis or 12 months later.<br />
“Vitamin A levels in patients with<br />
CF are influenced by the inflammatory<br />
response” by Greer RM,<br />
Buntain HM, Lewindon PJ et al. J<br />
Cyst Fibros 2004; 3: 143–149 (Dept<br />
Paediatrics <strong>and</strong> Child Health, Uni-
NEWSLETTER 2/2006<br />
47<br />
SIGHT AND LIFE<br />
versity of Queensl<strong>and</strong>, Brisbane,<br />
Australia. Email: r.greer@uq.edu.<br />
au)<br />
These authors were aware that<br />
inflammation increases C-reactive<br />
protein <strong>and</strong> is associated with depression<br />
of serum vitamin A in normal<br />
subjects. They found a similar<br />
relation to occur in their cystic fibrosis<br />
patients. This was also found in<br />
the ELBW infants described in the<br />
abstract two above. Again, under<br />
these circumstances it is erroneous<br />
to assume that vitamin A deficiency<br />
is present.<br />
“Vitamin A for treating measles in<br />
children” by Huiming Y, Chaomin<br />
W, Meng M. Cochrane Database<br />
Syst Rev 2005 No 4, p. CD001479<br />
(West China Second University Hospital,<br />
Third Section of the People’s<br />
South Street, Chengdu, Sichuan,<br />
China 610041. Email: yanghuiming03@163.com)<br />
There was no significant reduction in<br />
the risk of mortality in the vitamin A<br />
group overall. There was evidence<br />
that when two doses of vitamin A<br />
were given there was associated<br />
reduced risk of mortality in children<br />
under the age of two years.<br />
“Plasma vitamin A levels in deprived<br />
children with pneumonia<br />
during the acute phase <strong>and</strong> after<br />
recovery” by Da Silva R, Lopes Jr<br />
E, Sarni ROS et al. J Pediatr 2005;<br />
81: 162–168 (JADAC Taddei, Universidade<br />
Federal de Sao Paulo,<br />
Brazil. Email:taddei.dped@epm.br)<br />
Plasma retinol was measured during<br />
the acute phase of pneumonia<br />
<strong>and</strong> after recovery in 40 deprived<br />
children aged 6 months to 5 years.<br />
Mean plasma levels were significantly<br />
higher after recovery, thus<br />
demonstrating the effect of the<br />
acute phase response (APR) on<br />
vitamin A status. (It is encouraging<br />
to learn from this <strong>and</strong> other papers<br />
that recognition of the occurrence<br />
<strong>and</strong> significance of the APR effect<br />
is beginning to be appreciated<br />
by research workers in this area<br />
around the world. Efforts are being<br />
made by Thurnham <strong>and</strong> his group<br />
(see Multimicronutrient research<br />
above) <strong>and</strong> others to produce correction<br />
tables. Another approach<br />
to the problem is to promote tests<br />
that are not subject to this difficulty.<br />
The pupillary threshold test <strong>and</strong><br />
conjunctival impression cytology<br />
come to mind.)<br />
Appendix<br />
Experimental research<br />
Hypervitaminosis in the cat<br />
Polizopoulou ZS, J Fel Med Surg<br />
2005; 7: 363<br />
All-trans-retinoic acid accelerates<br />
the differentiation of human<br />
B lymphocytes matur ing into<br />
plasma cells<br />
Morikawa K, Int Immunopharma<br />
2005: 5: 13–14<br />
The C-terminal region of cis-retinol<br />
/<strong>and</strong>rogen dehydrogenase 1<br />
(CRAD1) confers ER localization<br />
<strong>and</strong> in vivo enzymatic function<br />
Liden M, McCarroll JA; Exp Cell Res<br />
2005: 311; 205–217<br />
Vitamin A inhibits pancreatic stellate<br />
cell activation<br />
McCarroll JA, Gut; 2006; 55: 79–<br />
89<br />
Reductions in serum vitamin A arrest<br />
accumulation of toxic retinal<br />
fluorophores<br />
Radu RA, Invest Ophthalmol Vis Sci<br />
2005; 46: 4393–4401<br />
Complexes of carbon nanotubules<br />
with selected carotenoids<br />
Stobinski, L, J Nanosci Nanotech<br />
2005; 5: 2121–7<br />
Selective distribution of β-carotene<br />
stereoisomers in rat tissue<br />
Ben-Amotz A, Nutr Res 2005; 25:<br />
1005–12<br />
Analysis of ALDH1A2, CYP26A1,<br />
CYP26B1, <strong>and</strong> CRABP2 in human<br />
neural tube defects<br />
Deak KL, Birth Def Res 2005; 73:<br />
868–75<br />
Protective effects of increasing<br />
vitamin E <strong>and</strong> A doses on cisplatin-induced<br />
oxidative damage to<br />
kidney tissue in rats<br />
Dillioglugil MO; Urol Int 2005; 75:<br />
340–44<br />
Enhanced UV-mediated free radical<br />
generation<br />
Klamt F, Photochem Photobiol Sci<br />
2003; 2: 856–860<br />
Rapid measurement of retinol,<br />
retinal, 13-cis-retinoic acid <strong>and</strong><br />
all-trans-retinoic acid by high<br />
performance liquid chromatography<br />
Tatum V, J Food Drug Anal 2005;<br />
13: 256–9<br />
The enhancing role of vitamin A<br />
deficiency on chemically induced<br />
nephroblastoma in rats<br />
Li K, J Pediatr Surg 2005; 40:<br />
1951–6<br />
Lecithin:retinol acyltransfer ase<br />
is responsible for amida tion of<br />
retinylamine<br />
Golczak M; J Biol Chem 2005; 280:<br />
42263–73<br />
Retinoid X receptor agonists increase<br />
Bc12a1 expression <strong>and</strong><br />
decrease apoptosis of naïve T<br />
lymphocytes<br />
Rasooly R, J Immunol 2005; 175:<br />
7916–29<br />
Diet-related variation in cellular<br />
retinol-binding protein type II<br />
gene expression in rat jejunum<br />
Suruga K, Br J Nutr 2005; 94:<br />
890–5<br />
Acetaldehyde inhibits the formation<br />
of retinoic acid from retinal<br />
in the rat oesophagus<br />
Yokoyama S, Sc<strong>and</strong> J Gastro 2006;<br />
41: 80–6<br />
Effect of administration of etidro<br />
nate <strong>and</strong> retinol on bone<br />
mechanical properties in ovariectomized<br />
rats<br />
Kaczmarczyk SI, Pharmacol Rep<br />
2005; 57: 203–11<br />
Retinoids <strong>and</strong> steroids in bovine<br />
mammary gl<strong>and</strong> immunobiology<br />
Meyer E, Livestock Prod Sci 2005;<br />
98: 33–46<br />
Dietary vitamin A has both chronic<br />
<strong>and</strong> acute effects on vitamin A<br />
indices in lactating rats <strong>and</strong> their<br />
offspring<br />
Akohoue SA, J Nutr 2006; 136:<br />
128–32<br />
The effect of vitamin A on CC1(4)-<br />
induced hepatic injuries in rats<br />
Noyan S, Acta Histochem 2006;<br />
107: 421–34<br />
The effect of cholesterol in the<br />
liposome bilayer on the stabilization<br />
of incorporated retinol<br />
Cheo LS, J Liposome Res 2005;<br />
15: 157–66
SIGHT AND LIFE 48<br />
NEWSLETTER 2/2006<br />
Megalin-mediated reuptake of<br />
retinol in the kidneys of mice is<br />
essential for homeostasis<br />
Raila J, J Nutr 2005; 135: 2512–6<br />
Clinical significance of altered<br />
expression of retinoid receptors<br />
in oral precancerous <strong>and</strong> cancerous<br />
lesions<br />
Ralhan R, Int J Cancer 2006; 118:<br />
1077–89<br />
TBX1, a DiGeorge syndrome<br />
c<strong>and</strong>idate gene, is inhibi ted by<br />
retinoic acid<br />
Zhang LF, Int J Devel Biol 2006;<br />
50: 55–61<br />
Retinoic acid amplifies the host<br />
immune response to LPS through<br />
increased T lympho cytes number<br />
<strong>and</strong> LPS bin ding protein expression<br />
Devaux S, Mol Cell Endocrin 2005;<br />
245: 67–76<br />
Non-classical action of retinoic<br />
acid on the activation of the<br />
cAMP response element-binding<br />
protein in normal human bronchial<br />
epithelial cells<br />
Agarwal S, Mol Biol Cell 2006; 17:<br />
566–575<br />
Role of retinoic acid receptors alpha<br />
1 <strong>and</strong> gamma in the response<br />
of murine limbs to retinol in vitro<br />
Galdones E, Birth Def Res 2006;<br />
76: 39–45<br />
Inhibitory effects of retinoic acid<br />
metabolism blocking agents<br />
(RAMBAs) on the growth of human<br />
prostate cancer cells<br />
Huynh CK, Br J Cancer 2006; 94:<br />
513–23<br />
Growth stimulation of human<br />
pulmonary adenocarcinoma cells<br />
<strong>and</strong> small airway epithelial cells<br />
by β-carotene<br />
Al-Wadei HAN, Int J Cancer 2006;<br />
118: 1370–80<br />
Retinoid receptor antagonists<br />
after the pattern of apoptosis<br />
in organogenesis stage mouse<br />
limbs<br />
Ali-Khan SE, Toxicol Sci 2006; 90:<br />
208–20<br />
Retinaldehyde dehydrogenase 2<br />
(RALDH2)-mediated retinoic acid<br />
synthesis regulates early mouse<br />
embryonic forebrain development<br />
Ribes V, Development 2006; 133:<br />
351–61<br />
Expression of nuclear receptor<br />
<strong>and</strong> target genes in liver <strong>and</strong><br />
intestine of neonatal calves fed<br />
colostrum <strong>and</strong> vitamin A<br />
Krueger KA, J Dairy Sci 2005; 88:<br />
3971–81<br />
Differential teratogenesis of alltrans-retinoic<br />
acid administered<br />
on gestational day 9.5 to SWV <strong>and</strong><br />
C57BL/6N mice<br />
Collins MD, Birth Defec Res 2006;<br />
76: 96–106<br />
Impairment of spermatogenesis<br />
<strong>and</strong> enhancement of testicular<br />
germ cell apoptosis<br />
Comitao R, J Exp Zool 2006; 305A:<br />
288–298<br />
Function of retinoid nuclear receptors<br />
Mark M, Ann Rev Pharmaol Toxicol<br />
2006; 46: 451–480<br />
Chronic dietary vitamin A supplementation<br />
regulates obesity<br />
in an obese mutant WNIN/Ob rat<br />
model<br />
Jeyakumar SM, Obes Res 2006;<br />
14: 52–59.<br />
Community research<br />
Plasma lycopene, other carotenoids,<br />
<strong>and</strong> retinol <strong>and</strong> the risk of<br />
cardiovascular disease in men<br />
Sesso HD, Am J Clin Nutr 2005;<br />
81: 990–7<br />
Intakes of vitamins A, C <strong>and</strong> E<br />
<strong>and</strong> folate <strong>and</strong> multivitamins <strong>and</strong><br />
lung cancer<br />
Cho E, Int J Cancer 2006; 118:<br />
970–8<br />
Effect of micronutrient supplement<br />
on health <strong>and</strong> nutritional<br />
status of schoolchildren<br />
Sivakumar B, Nutr 2006; 22: S15-<br />
S25<br />
Low levels of carotenoids<br />
<strong>and</strong> retinol in involu tional<br />
osteoporosis<br />
Maggio D, Bone 2006; 38: 244–8<br />
Hypo- <strong>and</strong> hyperresponse to egg<br />
cholesterol predicts plasma lutein<br />
<strong>and</strong> β-carotene concentrations in<br />
men <strong>and</strong> women<br />
Clark RM, J Nutr 2006; 136: 601–7<br />
GLV supplements increased<br />
plasma β-carotene, vit amin C,<br />
zinc <strong>and</strong> hemoglobin in young<br />
healthy adults<br />
Agte V, Eur J Nutr 2006; 45: 29–36<br />
Clinical research<br />
Changes in conjugated linoleic<br />
acid <strong>and</strong> palmitoleic acid are correlated<br />
to retinol levels in chronic<br />
renal failure<br />
Lucchi L, Artif Organs 2005; 29:<br />
413–8<br />
Serum <strong>and</strong> CSF vitamin A concentrations<br />
in idiopathic intracranial<br />
hypertension<br />
Tabassi A, Neurology 2005; 64:<br />
1893–6<br />
Hypervitaminosis A-induced liver<br />
fibrosis<br />
Nollevaux MC, Liver Int 2006; 26:<br />
182–6<br />
Serum retinoic acid, retinol <strong>and</strong><br />
retinyl palmitate levels in patients<br />
with lung cancer<br />
Moulas AN, Respirology 2006; 11:<br />
169–74<br />
Zinc <strong>and</strong> vitamin A supplementation<br />
in Indigenous Australian<br />
children hospitalized with lower<br />
respiratory tract infection<br />
Chang AB, Med J Aust 2006; 184:<br />
107–12<br />
www.sight<strong>and</strong>life.org
NEWSLETTER 2/2006<br />
49<br />
SIGHT AND LIFE<br />
Letters to the editor<br />
Fortification of edible<br />
oil with vitamin A <strong>and</strong><br />
carotene<br />
Dear Sir<br />
Your SIGHT AND LIFE <strong>Newsletter</strong><br />
1/2006 included a paper on<br />
vitamin A fortification of edible oil<br />
as a cost-effective <strong>and</strong> sustainable<br />
intervention program to supply<br />
vitamin A to the population. It<br />
was good to know that vitamin A<br />
fortification of edible soybean<br />
oil was voluntarily implemented<br />
in Bangladesh: I hope the same<br />
will happen in other countries. In<br />
the 1990s our Brazilian nutrition<br />
group started to study <strong>and</strong> to put<br />
together scientific data to support<br />
the utilization of cooking oil as a<br />
vitamin A <strong>and</strong> carotene carrier<br />
to prevent vitamin A deficiency.<br />
One of the main obstacles for its<br />
use was the prestige of other vehicles<br />
like wheat flour <strong>and</strong> sugar,<br />
<strong>and</strong> the fact that vitamin A, being<br />
heat-sensitive, could not be<br />
added to a cooking ingredient.<br />
Our first published paper (1991)<br />
on the subject studied the stability<br />
of vitamin A added to refined<br />
soybean oil during cooking <strong>and</strong><br />
storage. It was shown that, after<br />
6 – 9 months of storing the oil in<br />
sealed metal cans at room temperature,<br />
the content of the vitamin<br />
A was still 99% of the original<br />
value. In open cans stored in a<br />
light environment the vitamin A<br />
content starts to decrease after 6<br />
months. When the same fortified<br />
oil was used for the preparation<br />
of local rice <strong>and</strong> bean foods,<br />
boiling or under pressure, levels<br />
from 88% to 99% of the original<br />
vitamin A values were found.<br />
Levels of vitamin A in potatoes<br />
deep fried in vitamin A-fortified<br />
cooking oil at high temperature<br />
decreased slightly. Repeated<br />
frying of the same fortified oil at<br />
high temperature decreased the<br />
amount of vitamin A incorporated<br />
into the potatoes (1). St<strong>and</strong>ard<br />
biological trials on vitamin A<br />
depleted rats fed non-fortified<br />
<strong>and</strong> A-fortified cooking oil confirmed<br />
its bioavailability based<br />
on plasma <strong>and</strong> liver vitamin A<br />
levels (2). A final confirmation of<br />
the bio-utilization of the vitamin A<br />
fortified oil was obtained in normal<br />
human subjects by adding<br />
fortified oil to salad or to cooked<br />
food <strong>and</strong> measuring the postabsorption<br />
plasma peak rise <strong>and</strong><br />
the area under the A-serum test<br />
curve. A control group receiving<br />
non-fortified oil did not show<br />
changes in comparison to their<br />
fasting plasma serum A levels,<br />
but the postpr<strong>and</strong>ial A plasma<br />
level increased threefold in subjects<br />
who received fortified oil<br />
(3). With these scientific studies<br />
we have provided a background<br />
of necessary scientific support<br />
for the use of cooking oil as a<br />
vitamin A carrier. Other similar<br />
studies were carried out with<br />
synthetic carotene also added<br />
to soybean oil. Rats receiving<br />
diets with carotene-fortified<br />
soybean oil increased their liver<br />
vitamin A levels (4). Higher levels<br />
of plasma carotene were found<br />
when healthy adults received rice<br />
cooked with carotene-enriched<br />
soybean oil (5). We also advise<br />
mixing edible soybean <strong>and</strong> palm<br />
oil as a way to supply carotene.<br />
Although we did not explore this<br />
possibility further, it is certain to<br />
be effective. Anyway, our experimental<br />
<strong>and</strong> clinical studies support<br />
vegetable oil as an effective<br />
vehicle to supply vitamin A or<br />
carotene to the relevant population.<br />
Unfortunately our studies<br />
have not received worldwide<br />
recognition. This is a rational <strong>and</strong><br />
practical intervention <strong>and</strong> one of<br />
the best ways to supply people<br />
at community level with vitamin<br />
A <strong>and</strong> carotene. No special<br />
equipment is needed to add the<br />
vitamins – it is just adding oil to<br />
oil. The work in Bangladesh will<br />
certainly prove again that cooking<br />
oil has to be accepted <strong>and</strong> used<br />
as one of the most effective <strong>and</strong><br />
practical low-cost carriers for the<br />
control of vitamin A deficiency. I<br />
hope other countries will follow it<br />
as a voluntary or compulsory way<br />
to guarantee the necessary intake<br />
of vitamin A everywhere.<br />
Prof. J E Dutra-de-Oliveira, MD<br />
Medical School of Ribeirão<br />
Preto, University of São Paulo,<br />
Brazil, jeddoliv@fmrp.usp.br<br />
References<br />
1. Favaro RMD, Ferreira J, Desai ID,<br />
Dutra-de-Oliveira JE (1991). Studies<br />
on the fortification of refined soybean<br />
oil with all-trans-retinyl palmitate in<br />
Brazil. J Food Comp Anal 4: 237–<br />
244.<br />
2. Favaro RMD, Miyassaka C, Desai ID,<br />
Dutra-de-Oliveira JE (1992). Evaluation<br />
of the effect of heat treatment on<br />
the biological value of vitamin A fortified<br />
soybean oil. Nutrition Research,<br />
12: 1357–1363.<br />
3. Dutra-de-Oliveira JE, Desai ID,<br />
Favaro RMD, Ferreira JF (1994). Effect<br />
of heat treatment during cooking<br />
on the biological value of vitamin A<br />
fortified soybean oil in humans. Int J<br />
Food Sci Nutr 45: 203–207.<br />
4. Dutra-de-Oliveira JE, Favaro RMD,<br />
Leonardo IR, Franco MVMJ, Carvalho<br />
CG, Jordão Jr AA, Vannucchi H<br />
(1994). Effect of heat treatment in the<br />
biological value of carotene added to<br />
soybean cooking oil in rats. Int J Food<br />
Sci Nutr 49: 205–209<br />
5. Dutra-de-Oliveira JE, Favaro RMD,<br />
Leonardo IR, Jordão Jr AA, Vannucchi<br />
H (1998). Absorption, by humans,<br />
of carotene from fortified soybean oil<br />
added to rice: Effect of heat treatment.<br />
J Am Coll Nutr 17: 361–365t<br />
of heat treatment. J Am Coll Nutr 17:<br />
361–365<br />
Please update your<br />
address <strong>and</strong> help to<br />
avoid unnecessary<br />
work <strong>and</strong> expenses
SIGHT AND LIFE 50<br />
NEWSLETTER 2/2006<br />
Continue with support<br />
Dear Sir<br />
In my letter printed in the SIGHT<br />
AND LIFE <strong>Newsletter</strong> 3/2005 I<br />
already expressed my thanks to<br />
SIGHT AND LIFE. Again I would<br />
like to express how helpful all the<br />
items I’m receiving are.<br />
Although we are at quite a remote<br />
place, we normally follow<br />
the national campaign to give a<br />
vitamin A capsule <strong>and</strong> a deworming<br />
tablet to all children under<br />
the age of five years every year,<br />
in December. Many health units<br />
here have benefited from this system<br />
to improve their vaccination<br />
coverage records. The provision<br />
of vaccines to all children from 9<br />
months to five years of age has<br />
increased from 68% in 2001 to<br />
87.7% in 2005. The coverage<br />
of vitamin A supplementation<br />
increased from 54% (2001) to<br />
89.4% (2005).<br />
I ask SIGHT AND LIFE to please<br />
continue with their support to<br />
help me gain more knowledge<br />
<strong>and</strong> better health education, so<br />
that I might be able to help the<br />
Tanzanians more successfully.<br />
Sincerely,<br />
AIm<strong>and</strong>us John Bosco, Mtambo<br />
Dispensary, Mp<strong>and</strong>a, Tanzania<br />
Nkhoma Hospital eye<br />
program<br />
Dear Sir<br />
Nkhoma is situated in a rural area<br />
of Central Malawi with a population<br />
of predominantly subsistence<br />
farmers. We serve some of the<br />
poorest people in the world. I was<br />
posted to Nkhoma six years ago<br />
by the Christoffel Blind Mission<br />
International (CBMI) to implement<br />
a VISION 2<strong>02</strong>0 Program.<br />
Malawi has a population of over<br />
11 million with over 100,000<br />
blind. Vitamin A deficiency, cataract<br />
<strong>and</strong> traditional eye medicine<br />
account for a high proportion of<br />
blindness in children. There are<br />
seven ophthalmologists working<br />
in Malawi <strong>and</strong> I am the only one<br />
working in a Mission Hospital.<br />
During 2005 a total of 9,865 cataract<br />
operations were carried out<br />
in Malawi. Nkhoma accounted<br />
for 45% of this total. Also, the<br />
number of outpatients increased<br />
by more than five times in recent<br />
years (2005: 23,077)<br />
The patients are brought to<br />
Nkhoma <strong>and</strong> returned home<br />
in the Eye Department vehicle,<br />
operated on <strong>and</strong> provided with<br />
meals, all free of charge. We are<br />
dedicated to providing a high<br />
volume <strong>and</strong> high quality service.<br />
This has been achieved by the<br />
excellent team work <strong>and</strong> dedication<br />
of my 27 full time Malawian<br />
staff. I thank my staff <strong>and</strong> others<br />
in Malawi <strong>and</strong> around the world<br />
who support us.<br />
We are receiving financial <strong>and</strong><br />
logistical support through CBMI<br />
<strong>and</strong> we are closely cooperating<br />
with the Malawi Ministry of<br />
Health <strong>and</strong> non-governmental<br />
organizations to ensure the limited<br />
resources are utilized to the<br />
maximum. We also thank SIGHT<br />
AND LIFE for the very useful<br />
vitamin A capsules. Nevertheless,<br />
problems remain such as<br />
management, construction <strong>and</strong><br />
staff problems. Also, for example,<br />
in the optical department most<br />
lenses have been out of stock for<br />
six months.<br />
Dr. Nick Metcalfe<br />
Director<br />
Vitamin A related support<br />
from SIGHT AND LIFE<br />
Dear Sir<br />
We are very thankful for the information<br />
materials <strong>and</strong> the vitamin<br />
A capsules we have received, <strong>and</strong><br />
naturally for the financial support<br />
from SIGHT AND LIFE.<br />
We follow the global agreement<br />
on the need to combat<br />
vitamin A deficiency by applying<br />
basic strategies to increase the<br />
consumption of foods rich in<br />
vitamin A or to provide periodic<br />
vitamin A supplements to high<br />
risk groups.<br />
Public health <strong>and</strong> nutrition communities<br />
should always recognize<br />
the need to improve the vitamin A<br />
status of young children. Vitamin A<br />
supplementation as an approach<br />
is among the most cost-effective<br />
health interventions available.<br />
Therefore, as an organization, we<br />
are committed to vitamin A deficiency<br />
prevention programs.<br />
Mr. Laodicah Nyaribari Nyambati,<br />
Director, Chelma Advisory Institute,<br />
Kisii 4<strong>02</strong>00, Kenya
NEWSLETTER 2/2006<br />
51<br />
SIGHT AND LIFE<br />
Publications<br />
SIGHT AND LIFE presents recent publications which may be of particular interest to our readers.<br />
However, these publications are not available from SIGHT AND LIFE, nor do we have any privileged<br />
access to them.<br />
Food <strong>and</strong> Nutrition: a<br />
H<strong>and</strong>book for Namibian<br />
Volunteer Leaders<br />
The Government of the Republic<br />
of Namibia (GRN), through the<br />
Technical Co-operation Program<br />
(TCP) of the Food <strong>and</strong> Agriculture<br />
Organization of the United Nations<br />
(FAO), launched a new program<br />
called Rural Youth Clubs of<br />
Namibia (RYCN), as an outreach<br />
for the Rural Youth Development<br />
Program.<br />
This program has been designed<br />
<strong>and</strong> tested as a unique methodology<br />
for reaching large numbers of<br />
young people, living in even the<br />
most isolated rural villages of Namibia,<br />
with leadership development<br />
<strong>and</strong> organizational skills as<br />
well as non-formal education <strong>and</strong><br />
training in agriculture <strong>and</strong> related<br />
areas. It has been successfully<br />
demonstrated that the new RYCN<br />
is an effective delivery mechanism<br />
enabling rural young people,<br />
primarily those who are out of<br />
school, to gain basic knowledge,<br />
skills <strong>and</strong> experiences in agriculture,<br />
nutrition, health, environment<br />
<strong>and</strong> other essential skills<br />
for living. Education <strong>and</strong> training<br />
involves practical, activity-based<br />
learning <strong>and</strong> income-generating<br />
activities. By taking this training<br />
approach to even the most<br />
remote villages, large numbers<br />
of our youth should be empowered<br />
into making economically<br />
rewarding <strong>and</strong> satisfying lives for<br />
themselves <strong>and</strong> their families in<br />
rural Namibia.<br />
This manual is designed as a field<br />
h<strong>and</strong>book <strong>and</strong> guideline document<br />
for rural youth club leaders<br />
to enable them to employ coping<br />
strategies in nutritional activities<br />
taking into account the prevailing<br />
economic patterns in their<br />
respective communities. It was<br />
developed through participatory<br />
<strong>and</strong> experiential approaches involving<br />
the rural young people in<br />
selected communities in northern<br />
Namibia, a process that involved<br />
collaboration with other line<br />
ministries such as the Ministry<br />
of Agriculture, Water <strong>and</strong> Rural<br />
Development <strong>and</strong> the Ministry of<br />
Health <strong>and</strong> Social Services.<br />
Food <strong>and</strong> Nutrition: Minister of<br />
Higher Education, Training <strong>and</strong><br />
Employment, Creation, Private<br />
Bag 13391, Windhoek, Namibia<br />
Obesity: Dietary <strong>and</strong><br />
Developmental Influences<br />
Focusing on prevention rather<br />
than treatment, Obesity: Dietary<br />
<strong>and</strong> Developmental Influences,<br />
reviews <strong>and</strong> evaluates the determinants<br />
of obesity. The book<br />
uses evidence-based research<br />
as a basis to define foods <strong>and</strong><br />
dietary behaviors that should be<br />
supported <strong>and</strong> encouraged as<br />
well as those that should be discouraged.<br />
This comprehensive<br />
review represents a critical step<br />
forward in the quest to identify<br />
feasible strategies to prevent<br />
obesity.<br />
The book describes the potential<br />
role of 26 different dietary factors<br />
<strong>and</strong> eight developmental periods<br />
in the prevention of obesity<br />
among children <strong>and</strong> adults. The<br />
dietary factors examined include<br />
macronutrients, micronutrients,<br />
specific types of foods <strong>and</strong> beverages,<br />
snack <strong>and</strong> meal patterns,<br />
portion size, parenting practices,<br />
breastfeeding, <strong>and</strong> more. The factors<br />
from each developmental period<br />
in the life cycle are examined<br />
in the context of the likelihood of<br />
obesity development. For each<br />
dietary factor <strong>and</strong> developmental<br />
period, four lines of evidence are<br />
examined: secular trends, plausible<br />
mechanisms, observational<br />
studies, <strong>and</strong> prevention trials.<br />
Providing easy access to information,<br />
the book features 38 tables<br />
that summarize observational<br />
studies, 38 graphs depicting<br />
trends in dietary intake, <strong>and</strong> nine<br />
tables that summarize preven-
SIGHT AND LIFE 52<br />
NEWSLETTER 2/2006<br />
tion trials. It provides a synopsis<br />
of the latest research on obesity,<br />
investigating all major lines of<br />
evidence, <strong>and</strong> clarifies common<br />
misconceptions while identifying<br />
which behaviors to target <strong>and</strong><br />
which dietary factors show the<br />
most promise for prevention.<br />
CRC Press, Taylor & Francis,<br />
New York,<br />
http://taylor<strong>and</strong>francis.com<br />
Setting up <strong>and</strong> running a<br />
school garden<br />
Adequate nutrition <strong>and</strong> education<br />
are key to the development of children<br />
<strong>and</strong> their future livelihoods.<br />
The reality facing millions of children,<br />
however, is that these essentials<br />
are far from being met.<br />
A country’s future hinges on its<br />
youth. Yet children who go to<br />
school hungry cannot learn well.<br />
They have decreased physical<br />
activity, diminished cognitive abilities<br />
<strong>and</strong> reduced resistance to<br />
infections. Their school performance<br />
is often poor <strong>and</strong> they may<br />
drop out of school early. In the<br />
long term, chronic malnutrition<br />
decreases individual potential<br />
<strong>and</strong> has adverse affects on productivity,<br />
incomes <strong>and</strong> national<br />
development.<br />
Schools can make an important<br />
contribution to countries’ efforts<br />
to overcome hunger <strong>and</strong> malnutrition,<br />
<strong>and</strong> school gardens can<br />
help to improve the nutrition <strong>and</strong><br />
education of children <strong>and</strong> their<br />
families in both rural <strong>and</strong> urban<br />
areas.<br />
FAO promotes school gardens<br />
primarily as a platform for learning,<br />
as well as a vehicle for better<br />
nutrition. Schools are encouraged<br />
to create learning gardens that are<br />
moderate in size so that they can<br />
be easily managed by students,<br />
teachers <strong>and</strong> parents, but that<br />
also allow for the production of<br />
a variety of nutritious vegetables<br />
<strong>and</strong> fruits (<strong>and</strong> where possible,<br />
some small-scale livestock such<br />
as chickens or rabbits). Production<br />
methods are kept simple so<br />
that they can be easily replicated<br />
by students <strong>and</strong> parents at their<br />
homes.<br />
In preparing this manual, intended<br />
to assist school teachers, parents<br />
<strong>and</strong> the wider community, FAO<br />
has drawn upon experiences<br />
<strong>and</strong> best practices derived from<br />
school garden initiatives all over<br />
the world. Classroom lessons are<br />
linked with practical learning in<br />
the garden about nature <strong>and</strong> the<br />
environment, food production<br />
<strong>and</strong> marketing, food processing<br />
<strong>and</strong> preparation, <strong>and</strong> making<br />
healthy food choices.<br />
Setting up <strong>and</strong> running a school<br />
garden: FAO, Via Delle Terme di<br />
Caracalla, 00100 Rome, Italy<br />
Community Nutrition<br />
A new CD-ROM intended as a<br />
teaching material resource has<br />
just been produced by Teaching-aids<br />
At Low Cost (TALC), a<br />
UK-based group, with financial<br />
support by UNICEF. It contains<br />
materials from many sources<br />
around the world. Each item<br />
(mostly produced between the<br />
years 2000 <strong>and</strong> 2005) is presented<br />
with a short explanation about<br />
its use. All contributors are listed<br />
with their contact details. Among<br />
many others, the SIGHT AND<br />
LIFE CD was useful as a resource<br />
<strong>and</strong> several SIGHT AND LIFE<br />
publications, <strong>Newsletter</strong> articles<br />
<strong>and</strong> slides are included.<br />
The introduction states: “This CD-<br />
ROM ... is intended for you if you<br />
work with resources-poor communities<br />
<strong>and</strong> are training health<br />
<strong>and</strong> other types of development<br />
workers <strong>and</strong> have limited access<br />
to nutrition-related materials,<br />
particularly if you do not have<br />
access to the Internet... Nutrition<br />
is a fast-changing world – most<br />
of us have very heavy workloads<br />
<strong>and</strong> it is difficult to keep updated<br />
with recent developments.”<br />
Ann Burgess, a nutrition consultant<br />
who worked intensively on<br />
this project, commented that the<br />
contribution from SIGHT AND<br />
LIFE was very useful. At this time<br />
5000 copies are being produced.<br />
For distribution, the priority is to<br />
get copies to target users such<br />
as health practitioners <strong>and</strong> development<br />
workers in developing<br />
countries <strong>and</strong> their trainers who<br />
have limited access to nutrition<br />
materials.<br />
To request a copy of the CD please<br />
contact TALC at info@talcuk.org<br />
or visit the TALC website http://<br />
www.talcuk.org, which also gives<br />
information on other TALC nutrition<br />
related education materials.
NEWSLETTER 2/2006<br />
53<br />
SIGHT AND LIFE<br />
Call for abstracts<br />
Micronutrient Forum<br />
“Consequences <strong>and</strong> Control of<br />
Micronutrient Deficiencies: Science,<br />
Policy, <strong>and</strong> Programs – Defining the<br />
Issues”, 16–18 April 2007, Istanbul, Turkey<br />
The Micronutrient Forum will hold<br />
its first international meeting in<br />
Istanbul, Turkey on 16–18 April<br />
2007. The theme of the meeting<br />
is “Consequences <strong>and</strong> Control<br />
of Micronutrient Deficiencies:<br />
Science, Policy, <strong>and</strong> Programs<br />
– Defining the Issues”.<br />
The Micronutrient Forum builds<br />
on the success of the International<br />
Vitamin A Consultative Group<br />
(IVACG) <strong>and</strong> the International<br />
Nutritional Anemia Consultative<br />
Group (INACG), which were both<br />
established by the United States<br />
Agency for International Development<br />
(USAID) in 1975.<br />
The Micronutrient Forum will serve<br />
as a stimulus for policy-relevant<br />
science <strong>and</strong> as the internationally<br />
recognized catalyst for moving<br />
the global community towards<br />
consensus around evidencebased<br />
policies <strong>and</strong> programs that<br />
reduce micronutrient deficiencies<br />
around the globe.<br />
Meeting participants are welcome<br />
from a wide diversity of relevant<br />
disciplines such as maternal <strong>and</strong><br />
child health, nutrition, biochemistry,<br />
agriculture, horticulture,<br />
education, communications, <strong>and</strong><br />
development. Participants are expected<br />
to include representatives<br />
from international agencies, national<br />
ministries, educational <strong>and</strong><br />
research institutions, food <strong>and</strong><br />
chemical industries, <strong>and</strong> nongovernmental<br />
organizations.<br />
Program managers <strong>and</strong> researchers<br />
are encouraged to submit abstracts<br />
for oral <strong>and</strong> poster presentations<br />
describing new data on<br />
the topics that follow. Abstracts<br />
must pertain to the micronutrient<br />
deficiencies of primary interest to<br />
the Micronutrient Forum, namely<br />
vitamin A, iron, folate, iodine,<br />
<strong>and</strong>/or zinc.<br />
• Defining “Deficiency Disorders”<br />
• Systems for increasing multiple<br />
micronutrient status<br />
• Health consequences of micronutrient<br />
deficiencies<br />
• The relevance of micronutrientmicronutrient<br />
interactions on micronutrient<br />
intervention design<br />
• Cost, coverage, sustainability,<br />
<strong>and</strong> impact of micronutrient intervention<br />
programs<br />
• The science base needed for<br />
national policy formulation <strong>and</strong><br />
program commitment<br />
• The interactions of micronutrients<br />
with infectious diseases<br />
Preference will be given to abstracts<br />
describing well-designed<br />
studies, providing new <strong>and</strong> potentially<br />
important findings with data<br />
that relate to the above topics.<br />
For more information <strong>and</strong> to<br />
submit your abstract visit: www.<br />
a2zproject.org<br />
To submit your abstract directly<br />
visit: http://ilsi.conference-services.net/authorlogin.<br />
asp?conferenceID=888&lan<br />
Abstracts must be received by 15<br />
August 2006.<br />
To receive more information about<br />
the Micronutrient Forum, contact<br />
the Micronutrient Forum<br />
Secretariat at the ILSI Research<br />
Foundation, One Thomas Circle,<br />
NW, Ninth Floor, Washington,<br />
DC 20005-58<strong>02</strong>, USA. Email:<br />
mnforum@ilsi.org.<br />
Travel Grants<br />
A limited number of travel grants<br />
will be available to help enable<br />
participation at the Micronutrient<br />
Forum meeting. Each grant will<br />
cover some portion of transportation<br />
to <strong>and</strong> from the meeting site,<br />
meals, <strong>and</strong>/or lodging during the<br />
event. Preference will be given to<br />
individuals whose abstracts are<br />
selected for presentation.<br />
As one of the sponsors of travel<br />
grants for the Micronutrient Forum,<br />
SIGHT AND LIFE encourages<br />
students <strong>and</strong> post-docs from<br />
low-income countries to submit<br />
abstracts for the Micronutrient<br />
Forum.<br />
To apply for a travel grant, please<br />
write to the Micronutrient Forum<br />
secretariat at mnforum@ilsi.org.<br />
In your letter, describe any other<br />
financial support you expect to<br />
have for your meeting participation.<br />
If you are a student or a<br />
post-doc, please also attach a letter<br />
of recommendation from your<br />
advisor or supervisor, providing a<br />
larger picture of your work.<br />
The selection of abstracts for<br />
presentation is the responsibility<br />
of the organizers of the Micronutrient<br />
Forum. Some restrictions may<br />
accompany the grants.
SIGHT AND LIFE 54<br />
NEWSLETTER 2/2006<br />
SIGHT AND LIFE Workshop<br />
Nutritional Anemia<br />
Anemia is a major health concern<br />
in developing countries as well<br />
as in the developed world. It impairs<br />
growth <strong>and</strong> development,<br />
cognition <strong>and</strong> immune function,<br />
as well as school <strong>and</strong> work performance.<br />
Anemia affects more<br />
than two billion people worldwide,<br />
<strong>and</strong> has a negative impact<br />
on economic growth, particularly<br />
in low-income countries. Only<br />
about half of anemia is thought<br />
to be related to iron deficiency;<br />
other micronutrient deficiencies<br />
such as vitamin A, vitamin C, B-<br />
vitamins, zinc <strong>and</strong> copper as well<br />
as infections <strong>and</strong> undernutrition<br />
also play a crucial role. Guidelines<br />
for supplementation <strong>and</strong> food<br />
fortification to address anemia<br />
usually focus on iron <strong>and</strong> folic<br />
acid, however. On this account,<br />
we feel that it is timely to highlight<br />
all contributing factors in a workshop<br />
on Nutritional Anemia.<br />
Top international experts from different<br />
fields related to Nutritional<br />
Anemia have agreed to make<br />
presentations to the workshop.<br />
The satellite workshop is being<br />
organized by Klaus Kraemer<br />
(SIGHT AND LIFE, Basel) <strong>and</strong><br />
Michael B. Zimmermann (Swiss<br />
Scientific Program, Session 1:<br />
Physiology, Metabolism, <strong>and</strong> Interactions<br />
Moderators: James Cook, Kansas City (USA);<br />
John Scott, Dublin (IRL)<br />
08:30 – 08:40 Welcome – Klaus Kraemer, Basel (CH); Michael B. Zimmermann,<br />
Zurich (CH)<br />
08:40 – 09:00 Introduction – Venkatesh Mannar, Toronto (CAN);<br />
James Cook, Kansas City (USA); Nevin S. Scrimshaw,<br />
Boston (USA)<br />
09:00 – 09:15 Iron Metabolism – Sean Lynch, Norfolk (USA)<br />
09:15 – 09:30 Bioavailability of Iron Forms <strong>and</strong> Enhancers – Richard<br />
Hurrell, Ines Egli, Zurich (CH)<br />
09:30 – 09:45 Copper <strong>and</strong> Zinc Interactions in Anemia: a Public<br />
Health Perspective – Ricardo Uauy, London (UK)<br />
09:45 – 10:00 Folate, Vitamin B12 <strong>and</strong> other B-Vitamins – John Scott,<br />
Dublin (IRL)<br />
10:00 – 10:15 Vitamin A – Keith P. West, Alfred Sommer, Baltimore<br />
(USA)<br />
10:15 – 10:30 Vitamin E <strong>and</strong> other Antioxidants – Maret G. Traber,<br />
Corvallis (USA)<br />
10:30 – 11:00 Coffee <strong>and</strong> Tea<br />
11:00 – 11:15 Interactions of Micronutrients – Michael B. Zimmermann,<br />
Zurich (CH)<br />
11:15 – 11:30 Protein Energy Malnutrition – Alan Jackson, Southampton<br />
(UK)<br />
11:30 – 11:45 Effect of Infections on Nutritional Anemia – David<br />
Thurnham, Coleraine (UK)<br />
11:45 – 12:00 Diagnosis of Anemia – Hans-Konrad Biesalski, Hohenheim<br />
(DE); Jürgen Erhardt, Jakarta (IND)<br />
12:00 – 13:00 Discussion<br />
13:00 – 14:30 Lunch<br />
Federal Institute of Technology,<br />
Zurich). It will be held at the Barcelona<br />
Hilton Hotel on 27 September<br />
2006, the day before the<br />
opening of the I World Congress<br />
of Public Health Nutrition, Barcelona,<br />
28–30 September 2006<br />
(http://www.nutrition2006.com).<br />
The Nutritional Anemia workshop<br />
is planned to correspond closely<br />
with the Congress of Public<br />
Health Nutrition, <strong>and</strong> thus to provide<br />
a forum for networking <strong>and</strong><br />
alliance building. The workshop<br />
on Nutritional Anemia is an open<br />
event for those interested in gaining<br />
insight into the latest developments<br />
in this topic area.<br />
The proceedings of the workshop<br />
will be published early next year.<br />
We expect this publication to be<br />
highly authoritative <strong>and</strong> provide<br />
expert guidance on the prevention<br />
<strong>and</strong> treatment of Nutritional<br />
Anemia.<br />
The workshop <strong>and</strong> publication<br />
will be sponsored by SIGHT AND<br />
LIFE, Basel (www.sight<strong>and</strong>life.<br />
org). In focusing on Nutritional<br />
Anemia SIGHT AND LIFE is<br />
pursuing its new mission of addressing<br />
multiple micronutrient<br />
deficiencies (hidden hunger) related<br />
to important health issues<br />
in developing countries.<br />
For registration please contact<br />
SIGHT AND LIFE, PO Box 2116,<br />
40<strong>02</strong> Basel, Switzerl<strong>and</strong>. Email:<br />
abc@sight<strong>and</strong>life.org<br />
SIGHT AND LIFE Workshop Nutritional<br />
Anemia<br />
Venue: Hilton Barcelona, 27 September<br />
2006<br />
Organizers: Klaus Kraemer,<br />
SIGHT AND LIFE, Basel, <strong>and</strong><br />
Michael B. Zimmermann, Swiss<br />
Federal Institute of Technology,<br />
Zürich
NEWSLETTER 2/2006<br />
55<br />
SIGHT AND LIFE<br />
Scientific Program, Session 2:<br />
Prevalence, Interventions, <strong>and</strong> Economy<br />
Moderators: Nevin S. Scrimshaw, Boston (USA);<br />
Venkatesh Mannar, Toronto (CAN)<br />
14:30 – 14:45 Worldwide Prevalence of Anemia – Erin McLean, Geneva<br />
(CH); Ines Egli, Zurich (CH); Bruno de Benoist,<br />
Geneva (CH)<br />
14:45 – 15:00 Strategies to Fight Nutritional Anemia – Martin Bloem,<br />
Rome (I); Regina Moench-Pfanner, Geneva (CH); Richard<br />
Semba, Baltimore (USA)<br />
15:00 – 15:15 Successful Approaches with Sprinkles - Stanley Zlotkin,<br />
Toronto (CAN)<br />
15:15 – 15:30 Technical Aspects of Programs – Omar Dary, Washington<br />
(US)<br />
15:30 – 15:45 Safety of Interventions – Noel Solomons, Guatemala<br />
City (GUA); Klaus Schümann, Munich (DE)<br />
15:45 – 16:00 Economic Impact of Anemia <strong>and</strong> Cost Effectiveness<br />
of Interventions – Harold Alderman, Meera Shekar,<br />
Washington (USA); Sue Horton, Waterloo (CAN)<br />
16:00 – 16:15 Global Perspectives – Ian Darnton-Hill, New York (USA);<br />
Tommaso Cavalli-Sforza, Manila (PHI)<br />
16:15 - 16:45 Coffee <strong>and</strong> Tea<br />
16:45 – 18:00 Discussion<br />
18:00 – 18:15 Summary – Klaus Kraemer, Basel (CH); Michael B.<br />
Zimmermann, Zurich (CH)<br />
The SIGHT AND LIFE art gallery<br />
We still have some of the posters presented in the <strong>Newsletter</strong> 2/2004<br />
on pp. 50–51. Printable PDFs are on our website at (http://sight<strong>and</strong>life.<br />
org/poSALartGal/aasalpo.html)<br />
A new issue of the<br />
SIGHT AND LIFE CD<br />
The updated CD with almost<br />
the complete content of the our<br />
website is in preparation. It will<br />
be dated of August 2006. As the<br />
capacity of the disc is limited,<br />
some adjustments were needed,<br />
<strong>and</strong> the new CD does not replace<br />
the older ones, which may contain<br />
objects such as the movies<br />
or some pictures in higher resolution.<br />
The new CD will be available<br />
soon from SIGHT AND LIFE.<br />
www.sight<strong>and</strong>life.org
SIGHT AND LIFE NEWSLETTER 2/2006<br />
Women in Burkina Faso during “good nutrition training”, see article on page 35.<br />
SIGHT AND LIFE is a humanitarian<br />
initiative of DSM Nutritional<br />
Products (for more information<br />
see the SIGHT AND LIFE website:<br />
www.sight<strong>and</strong>life.org). We are<br />
committed to the improvement of<br />
nutrition <strong>and</strong> health with emphasis<br />
on children <strong>and</strong> mothers in developing<br />
countries. It is the aim of<br />
SIGHT AND LIFE to combat ‘hidden<br />
hunger’, <strong>and</strong> to raise awareness<br />
of micronutrient deficiencies<br />
as public health issues.<br />
Low micronutrient intakes <strong>and</strong><br />
other forms of malnutrition are<br />
impairing the health of many<br />
people in numerous developing<br />
countries. The most vulnerable<br />
groups are children <strong>and</strong> mothers.<br />
Increased health risk with suscep-<br />
tibility to infections <strong>and</strong> increased<br />
child <strong>and</strong> maternal mortality are<br />
the consequences. Moreover, this<br />
impairs growth <strong>and</strong> development,<br />
cognition, vision <strong>and</strong> immune<br />
function, as well as school <strong>and</strong><br />
work performance.<br />
For its humanitarian work, SIGHT<br />
AND LIFE can draw on the<br />
expertise in nutrition, technology<br />
<strong>and</strong> analytics of DSM Nutritional<br />
Products. SIGHT AND<br />
LIFE supports many locally <strong>and</strong><br />
internationally active organizations.<br />
It has sponsored research,<br />
application projects, training of<br />
health professionals, <strong>and</strong> health<br />
<strong>and</strong> nutrition education in many<br />
countries in Africa, Asia <strong>and</strong> Latin<br />
America.<br />
Support is given in the form of<br />
vitamin A capsules, premixes<br />
containing micronutrients, grants,<br />
information <strong>and</strong> educational materials<br />
such as manuals, books,<br />
posters, reprints, etc. Furthermore,<br />
SIGHT AND LIFE gives<br />
technical assistance where required<br />
<strong>and</strong> promotes training <strong>and</strong><br />
education in order to increase<br />
local knowledge <strong>and</strong> expertise,<br />
<strong>and</strong> works towards sustainable<br />
improvement of nutrition.<br />
SIGHT AND LIFE publishes educational<br />
materials as well as the<br />
SIGHT AND LIFE <strong>Newsletter</strong> to<br />
increase knowledge on micronutrient<br />
nutrition <strong>and</strong> health, <strong>and</strong> to<br />
disseminate relevant information<br />
on programs <strong>and</strong> scientific news.<br />
Publisher: SIGHT AND LIFE<br />
Editor: Klaus Kraemer<br />
Assistance: Anne-Catherine Frey,<br />
Martin Frigg<br />
Translation <strong>and</strong> language:<br />
transparent - translation & text<br />
services, Berlin, Yvonne Bearne<br />
Printer: Druckerei Dietrich, Basel<br />
Opinions, compilations <strong>and</strong> figures<br />
con tained in the signed articles do<br />
not necessarily represent the point<br />
of view of SIGHT AND LIFE <strong>and</strong><br />
are solely the responsibility of the<br />
authors.<br />
SIGHT AND LIFE<br />
PO Box 2116, 40<strong>02</strong> Basel<br />
Switzerl<strong>and</strong>. Tel.: +41 61 688 74 94<br />
Fax: +41 61 688 19 10<br />
E-mail: abc@sight<strong>and</strong>life.org<br />
http://sight<strong>and</strong>life.org<br />
ISBN 3-906412-31-8