Hans Biesalski, University of Hohhenheim "How Science and Partnerships Can Improve the Agricultural and Nutrition Value Chain"
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How science and partnerships can improve theagricultural and nutrition value chain - towards
delivering more nutritious foods for those in need.
Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
Detection of micronutrient inadequacies andhow to compensate?
• Inadequate supply of micronutrients may have a strong impact on health and development in particular during pregenancy and childhood
• Early detection of dietary gaps are necessary tooptimize the diet and to avoid „hidden hunger“
Sup
ply
Sym
ptoms
No Subclinical/unspecific Clinical
Hidden Hunger describes the inadequate supply withone or more essential nutrients (Vitamins, Minerals, Trace elements, Amino acids)
Hidden hunger becomes „visible“ with the occurence ofclinical symptoms
Reasons: Missing sources (Liver, Eggs, pro-vitamin A ). Low stores at birth. Frequent diarrhoe (Zinc def.)
200 – 500 million children are vitamin A deficient. 5 mi llionper year get blind. High mortality in the first 5 years of live (30-50%). How many children with inadequate intake?
S
Decline of vitamin A status without biochemical signs and occurence
of non-specific and specific symptoms
Clinical consequences
SYSTEMIC (unspecific) COMPLICATIONS
Increased mortalitydue to infections
Increase of anemia/ growth retardation
OCULAR COMPLIKATIONS
NightblindnessOcular infectionsKeratomalacia-Blindness
Vita
min
-A-S
tatu
s
Somer A., Nature Med. 1997
Hidden Hunger and consequences?
How to improve the nutrition value chain withrespect to miconutrients?
• Biochemical data or clinical signs document a moreor less severe deficiency of one or moremicronutrients.
• Prior deficiency signs an inadequate intake ofmicronutrients affects health and development
• The composition of the diet and the micronutrientgaps should be elucidated before clinical symptomsof a deficiency occur!
Objectives for the developement of CIMI(calculator for identification of micronutrient inadequacy)
Fast and easy analysis of micronutrient adequacy on bas is of populationspecific food groups-> time and cost saving data collection and analysis
Comparison of the results to the reference values including the classificationof iron and zinc bioavailability
Self-explanatory presention of the results-> visualisation of micronutient sources and deficits for health education
purposes
Calculation of macro- and micronutrient intakeclassification of zinc and iron bioavailability
is based on dietary pattern
Program structureProgram structure
Total intake and % of FAO/WHO recommendations of energy, protein, carbohydrates, fat, iron, zinc, vitamin A,
ß-carotene, retinol equivalents (1:6 and 1:12 conversion factor)
Food intake in grams per day of a limited number of food groups
Electronic assessment of micronutrientinadequacies on a population level
Algorithm for iron
Program structureBioavailability calculation
Classification to 15%, 12%, 10% or
5% of iron bioavailability
Software determines:% of total energy intake is accounted for all starchy stables% of total energy intake is accounted for protein from fish, eggs, dairy and meat% of total energy intake is accounted for protein from fish and meat…
Electronic assessment of micronutrientinadequacies on a population level
Algorithm for zinc
Classification to high, moderate or low zinc
bioavailability
Food survey data of target populationData of the Indonesian Socio Economic Survey taken
among 68,800 public households in 2008
Program structureProgram development
Micronutrient density of extracted food groups
Calculation of average nutrientdensity per foodgroup based on the typical foodcomposition
Electronic assessment of micronutrientinadequacies on a population level
Program structureCIMI data input
Electronic assessment of micronutrientinadequacies on a population level
Program structureCIMI data input
Electronic assessment of micronutrientinadequacies on a population level
Program structureCIMI data input
Electronic assessment of micronutrientinadequacies on a population level
Program structureCIMI data input
Electronic assessment of micronutrientinadequacies on a population level
Program structureIndonesian children 4-6 years: nutrition data
Electronic assessment of micronutrientinadequacies on a population level
Program structureIndonesian children 4-6 years: results in tables
Electronic assessment of micronutrientinadequacies on a population level
Program structureIndonesian children 4-6 years: results in ring diagram s
Electronic assessment of micronutrientinadequacies on a population level
Iron Zinc
Program structureIndonesian children 4-6 years: results in ring diagram s
Electronic assessment of micronutrientinadequacies on a population level
Vitamin A
Females 20 – 52 years
118 Children 1 – 3 years 128 Females 20 – 40 years
The distribution of the ratio of nutrient intake ca lculated by NS and CIMI
Validation of CIMI using Nutrisurvey programm as a control
Average intake of nutrients calculated by NS and CIMI and number and %of indviduals below the threshold
The CIMI program can be used to
for a rough estimation of micronutrient gaps
in different age and sex groupsin different income groupsin different local dietary diversityin different threshold aproaches
educate people how to compose a diet to reduce gaps
uncover food or food composition related to a specificmicronutrient
The CIMI program will not calculate a risk for deficiency or a levelof adequacy
Science and partnership to improve the nutrtion value chain
Electronic assessment of micronutrientinadequacies on a population level
Micronutrient gaps which, to several reasons, cannot be c losed via optimization of the dietary pattern might be closed with for tifiedfood or with food with improved bioavailability of one or mor emicronutrients.
But
We always must consider that a deficiency of a micronutie nt doesnot mean that only this isolated micronutrient is missing i n the diet. It is the micronutrient containing food which is missing. Consequently all the other essential micronutrients wit hin that foodmight be also missing.Treatment of the symptom (isolated defciency) might be misleading
Thank you
for your attention
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