Search

With a fast-approaching post-Millennium Development Goal era, there is an urgent need to boost global investment in efforts to reduce child malnutrition. Critical to the management of moderate malnutrition, and therefore to the new Sustainable Development Goals, is addressing severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). Despite the considerable difference in the approximate number of children affected by MAM (33 million) compared with SAM (19 million), there is currently no standardized approach to the management of MAM. In partnership with Valid International, the World Food Programme, and the Micronutrient Initiative, the International Atomic Energy Agency hosted the International Symposium on Understanding Moderate Malnutrition in Children for Effective Interventions in Vienna, Austria, 26–29 May 2014. This symposium focused on the management (prevention and treatment) of MAM in children. The symposium convened over 350 participants from 63 countries, the majority of whom represented governments responding to moderate malnutrition in their populations, nearly 70 national and international organizations from the United Nations and nongovernmental sectors, and universities from around the world, as well as donor governments and private-sector entities. The symposium was structured around nine sessions over a 3-day period, progressing from a global analysis of the scale of the problem to recent research findings relevant to designing effective interventions. This Supplement contains a series of papers that summarize the symposium sessions and other fundamental aspects important to improving the management of moderate malnutrition in children.

Background: Vitamin A (VA) deficiency (VAD) is still a concern in many parts of the world, and multiple intervention strategies are being implemented to reduce the prevalence of VAD and associated morbidity and mortality. Because some individuals within a population may be exposed to multiple VA interventions, concerns have been raised about the possible risk of hypervitaminosis A. Objectives: A consultative meeting was held in Vienna, Austria, in March 2014 to (1) review current knowledge concerning the safety and effectiveness of large-scale programs to control VAD, (2) develop a related research agenda, and (3) review current available methods to assess VA status and risk of hypervitaminosis A. Methods: Multiple countries were represented and shared their experiences using a variety of assessment methods, including retinol isotope dilution (RID) techniques. Discussion included next steps to refine assessment methodology, investigate RID limitations under different conditions, and review programmatic approaches to ensure VA adequacy and avoid excessive intakes. Results: Fortification programs have resulted in adequate VA status in Guatemala, Zambia, and parts of Cameroon. Dietary patterns in several countries revealed that some people may consume excessive preformed VA from fortified foods. Conclusion: Additional studies are needed to compare biomarkers of tissue damage to RID methods during hypervitaminosis A and to determine what other biomarkers can be used to assess excessive preformed VA intake.

Background In the search for cost-effective interventions to reduce morbidity and mortality in HIV disease, the identification of nutritional status and levels of micronutrients is very important. Objective To generate information on the level of energy malnutrition and on vitamin A, zinc, and hemoglobin levels and their relationships with disease status in HIV-infected adults in Addis Ababa, Ethiopia. Methods A cross-sectional study was carried out on 153 HIV-positive adults (19% male, 81% female) living in Addis Ababa. The nutritional status and the levels of zinc, retinol, and hemoglobin were determined by anthropometric and biochemical methods. CD4+ counts and C-reactive protein levels were measured by standard methods. Results Of the patients, 18% were chronically energy deficient, 71% were normal, and 11% were overweight. Serum zinc levels were low (< 10.7 μmol/L) in 53% of subjects, and serum retinol levels were low (< 30 μg/dL) in 47% of subjects. Low hemoglobin levels (< 12 g/dL) were observed in only 4.72% of the study population. CD4+ counts under 200/mm3 and elevated C-reactive protein levels were both found in 21% of the subjects. CD4+ counts were positively and significantly correlated with hemoglobin ( r = 0.271, p < .001), zinc ( r = 0.180, p < .033), and body mass index ( r = 0.194, p < .017). There were significant negative associations between levels of C-reactive protein and levels of zinc ( r = −0.178, p < 0.036 and hemoglobin ( r = −0.253, p < .002). Conclusions Our results provide evidence that compromised nutritional and micronutrient status begins early in the course of HIV-1 infection. Low serum zinc and vitamin A levels were observed in almost half of the subjects. The clinical significance of low serum zinc and vitamin A levels is unclear, and more research is required.

The Kingdom of Morocco launched the flour and oil fortification stage of its National Micronutrient Program in December 2000. The vitamin A (oil) and iron (flour) fortification components of the program are based on the 1994 and 1996 national and regional surveys, which showed that 38% and 40.6% of children under five years of age, respectively, were iron and vitamin A deficient. Morocco is following the example of many countries that fortify their salt with iodine and flour with iron, folate, and/or B vitamins. In addition, it is innovative in including vitamin A–fortified oil in its pioneering fortification program, the first in North Africa. This paper concerns the advocacy and consensus-building components in support of iron, vitamin B, and folatefortified flour and for vitamin A–fortified oil (iodized salt began in 1996). As part of its efforts to implement a sustainable food-fortification strategy, the Ministry of Health has already launched a series of activities. The selection of flour and oil to fortify is based on food-consumption patterns. Hydrogenated cooking oil was identified as a good vehicle for fortification because it is centrally processed and over 90% of households use it daily for a variety of cooking purposes. Oil is an excellent fortification vehicle for vitamin A because it is a fat-soluble vitamin. Flour was identified as a good vehicle for iron fortification because 95% of households use it as the main ingredient in bread. The entire population consumes centrally processed flour, even households that also use homemade flour. This is because about one million metric tons of centrally processed flour are subsidized by the Government, at a savings of at least 50% compared with nonsubsidized flour. One innovation of the program is to launch fortification for the general public at the beginning of Ramadan, a month-long religious period, when oil and flour consumption increase significantly.