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Raiten DJ, Darnton-Hill I, Tanumihardjo SA, Suchdev PS, Udomkesmalee E, Martinez C, Mazariegos DI, Mofu M, Kraemer K, Martinez H. Perspective: Integration to Implementation (I-to-I) and the Micronutrient Forum-Addressing the Safety and Effectiveness of Vitamin A Supplementation. Adv Nutr 2020; 11:185-199. [PMID: 31566677 PMCID: PMC7442412 DOI: 10.1093/advances/nmz100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/07/2019] [Accepted: 08/27/2019] [Indexed: 01/03/2023] Open
Abstract
An ongoing challenge to our ability to address the role of food and nutrition in health promotion and disease prevention is how to design and implement context-specific interventions and guidance that are safe, efficacious, and avoid unintended consequences. The integration to effective implementation (I-to-I) concept is intended to address the complexities of the global health context through engagement of the continuum of stakeholders involved in the generation, translation, and implementation of evidence to public health guidance/programs. The I-to-I approach was developed under the auspices of the Micronutrient Forum and has been previously applied to the question of safety and effectiveness of interventions to prevent and treat nutritional iron deficiency. The present article applies the I-to-I approach to questions regarding the safety and utility of large-dose vitamin A supplementation programs, and presents the authors' perspective on key aspects of the topic, including coverage of the basic and applied biology of vitamin A nutrition and assessment, clinical implications, and an overview of the extant data with regard to both the justification for and utility of available intervention strategies. The article includes some practical considerations based on specific country experiences regarding the challenges of implementing vitamin A-related programs. This is followed by an overview of some challenges associated with engagement of the enabling communities that play a critical role in the implementation of these types of public health interventions. The article concludes with suggestions for potential approaches to move this important agenda forward.
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Affiliation(s)
- Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Ian Darnton-Hill
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- The Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Sherry A Tanumihardjo
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Parminder S Suchdev
- Department of Pediatrics and Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | - Emorn Udomkesmalee
- Department of Human Nutrition, Institute of Nutrition, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - Carolina Martinez
- Instituto de Nutrición de Centro América y Panamá (INCAP), Guatemala City, Guatemala
| | - Dora Inés Mazariegos
- Instituto de Nutrición de Centro América y Panamá (INCAP), Guatemala City, Guatemala
| | - Musonda Mofu
- National Food and Nutrition Commission, Lusaka, Zambia
| | - Klaus Kraemer
- Sight and Life, Basel, Switzerland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Homero Martinez
- Nutrition International, Ottawa, Ontario, Canada
- Hospital Infantil de México Federico Gomez, Mexico City, Mexico
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52
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Tanumihardjo SA. The Dawn of a New Era in Vitamin A Assessment. J Nutr 2020; 150:185-187. [PMID: 31732738 DOI: 10.1093/jn/nxz283] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/08/2019] [Accepted: 10/28/2019] [Indexed: 12/29/2022] Open
Affiliation(s)
- Sherry A Tanumihardjo
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
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Jha AB, Warkentin TD. Biofortification of Pulse Crops: Status and Future Perspectives. PLANTS (BASEL, SWITZERLAND) 2020; 9:E73. [PMID: 31935879 PMCID: PMC7020478 DOI: 10.3390/plants9010073] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/02/2020] [Accepted: 01/02/2020] [Indexed: 01/08/2023]
Abstract
Biofortification through plant breeding is a sustainable approach to improve the nutritional profile of food crops. The majority of the world's population depends on staple food crops; however, most are low in key micronutrients. Biofortification to improve the nutritional profile of pulse crops has increased importance in many breeding programs in the past decade. The key micronutrients targeted have been iron, zinc, selenium, iodine, carotenoids, and folates. In recent years, several biofortified pulse crops including common beans and lentils have been released by HarvestPlus with global partners in developing countries, which has helped in overcoming micronutrient deficiency in the target population. This review will focus on recent research advances and future strategies for the biofortification of pulse crops.
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Affiliation(s)
| | - Thomas D. Warkentin
- Crop Development Centre/Department of Plant Sciences, University of Saskatchewan, 51 Campus Drive, Saskatoon, SK S7N 5A8, Canada;
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Simkin AJ. Genetic Engineering for Global Food Security: Photosynthesis and Biofortification. PLANTS (BASEL, SWITZERLAND) 2019; 8:E586. [PMID: 31835394 PMCID: PMC6963231 DOI: 10.3390/plants8120586] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 12/18/2022]
Abstract
Increasing demands for food and resources are challenging existing markets, driving a need to continually investigate and establish crop varieties with improved yields and health benefits. By the later part of the century, current estimates indicate that a >50% increase in the yield of most of the important food crops including wheat, rice and barley will be needed to maintain food supplies and improve nutritional quality to tackle what has become known as 'hidden hunger'. Improving the nutritional quality of crops has become a target for providing the micronutrients required in remote communities where dietary variation is often limited. A number of methods to achieve this have been investigated over recent years, from improving photosynthesis through genetic engineering, to breeding new higher yielding varieties. Recent research has shown that growing plants under elevated [CO2] can lead to an increase in Vitamin C due to changes in gene expression, demonstrating one potential route for plant biofortification. In this review, we discuss the current research being undertaken to improve photosynthesis and biofortify key crops to secure future food supplies and the potential links between improved photosynthesis and nutritional quality.
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Affiliation(s)
- Andrew John Simkin
- Genetics, Genomics and Breeding, NIAB EMR, East Malling, Kent, ME19 6BJ, UK
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55
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Bationo JF, Zeba AN, Coulibaly ND, Sheftel J, Davis CR, N Bassole IH, Barro N, Ouedraogo JB, Tanumihardjo SA. Liver retinol estimated by 13C-retinol isotope dilution at 7 versus 14 days in Burkinabe schoolchildren. Exp Biol Med (Maywood) 2019; 244:1430-1437. [PMID: 31547685 PMCID: PMC6900701 DOI: 10.1177/1535370219877132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/16/2019] [Indexed: 12/20/2022] Open
Abstract
Vitamin A status assessment is not straightforward. Retinol isotope dilution (RID) testing requires time for the tracer dose to mix with the total body stores of vitamin A (TBS). Researchers are interested in shortening the time interval between tracer administration and follow-up blood draws, and in re-examining current assumptions about liver mass for calculation of total liver vitamin A reserves (TLR, in µmol/g liver). Schoolchildren (aged 7–12 years; n = 72) were recruited from one school in Burkina Faso. After a baseline blood draw, 1.0 µmol [14,15]-13C2-retinyl acetate was administered to estimate TBS and TLR by retinol isotope dilution with follow-up blood samples at days 7 and 14. Correlations were determined to evaluate if sampling at day 7 could be used to predict TLR compared with day 14. Liver mass was estimated using body surface area and compared with the currently used assumption of liver weight equivalent to 3% of body weight. (This trial was registered at Pan African Clinical Trial Registry: PACTR201702001947398). Liver mass calculated using body surface area did not differ from the standard assumption of 3% of body weight and yielded similar TLR values. The children in this study had mean TLR (0.67 ± 0.35 µmol/g) in the adequate range, while serum retinol concentrations (0.92 ± 0.33 µmol/L) predicted 25% vitamin A deficiency. TLR values at seven days were highly correlated with, but significantly different from day 14 (P < 0.0001, r = 0.85) and needed a correction factor added to the equation to yield equivalency. Blood drawing at day 7, using correction factors in the prediction equation and the current assumption of liver mass as 3% of body weight, can be used to estimate TLR in schoolchildren with adequate vitamin A status in 13 C2-RID applications, but further investigations are needed to verify the seven-day predictive equation.
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Affiliation(s)
| | - Augustin N Zeba
- Institute de Recherche en Sciences
de la Santé, Bobo Dioulasso 01, Burkina Faso
| | - Nadine D Coulibaly
- Institute de Recherche en Sciences
de la Santé, Bobo Dioulasso 01, Burkina Faso
| | - Jesse Sheftel
- Department of Nutritional Sciences,
University of Wisconsin-Madison, WI 53706, USA
| | - Christopher R Davis
- Department of Nutritional Sciences,
University of Wisconsin-Madison, WI 53706, USA
| | | | - Nicolas Barro
- Université Ouaga 1 Joseph Ki-Zerbo,
Ouagadougou 03, Burkina Faso
| | - Jean B Ouedraogo
- Institute de Recherche en Sciences
de la Santé, Bobo Dioulasso 01, Burkina Faso
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Ford JL, Green JB, Green MH. Addition of Vitamin A Intake Data during Compartmental Modeling of Retinol Kinetics in Theoretical Humans Leads to Accurate Prediction of Vitamin A Total Body Stores and Kinetic Parameters in Studies of Reasonable Duration. J Nutr 2019; 149:2065-2072. [PMID: 31187866 PMCID: PMC6825818 DOI: 10.1093/jn/nxz112] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/26/2019] [Accepted: 05/01/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Mathematical modeling of theoretical data has been used to validate experimental protocols and methods in several fields. OBJECTIVES We hypothesized that adding dietary vitamin A intake data as an input during compartmental modeling of retinol kinetics would lead to accurate prediction of vitamin A total body stores (TBS) at 2 specified study lengths and would reduce study duration required to accurately define the system. METHODS We generated reference values for state variables (including TBS and intake) and kinetic parameters for 12 theoretical individuals (4 each of children, younger adults, and older adults) based on modeling plasma retinol tracer data for 365 d. We compared TBS predictions using data to 28 d (children) or 56 d (adults) without and with intake included in the model to reference values for each subject. Then, by truncating data sets from 365 d, we determined the shortest study duration required to accurately define the system without and with inclusion of vitamin A intake. RESULTS Reference values for TBS ranged from 30 to 3023 µmol. Study durations of 28 and 56 d were sufficient to accurately predict TBS for 6 of the 12 subjects without intake; adding intake resulted in accurate predictions of TBS for all individuals. When intake was not included as a modeling input, durations of 35-310 d were required to define the system; inclusion of intake data substantially reduced the time required to 10-42 d. CONCLUSIONS Inclusion of vitamin A intake as additional data input when modeling vitamin A kinetics allows investigators to accurately predict TBS and define the vitamin A system in studies of reasonable length (4 wk in children and 8 wk in adults). Because it is generally possible to obtain estimates/measures of intake, including such data increases confidence in model predictions while also making studies more feasible.
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Affiliation(s)
- Jennifer Lynn Ford
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Joanne Balmer Green
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Michael H Green
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
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57
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Titcomb TJ, Tanumihardjo SA. Global Concerns with B Vitamin Statuses: Biofortification, Fortification, Hidden Hunger, Interactions, and Toxicity. Compr Rev Food Sci Food Saf 2019; 18:1968-1984. [DOI: 10.1111/1541-4337.12491] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/18/2019] [Accepted: 07/11/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Tyler J. Titcomb
- Dept. of Nutritional SciencesUniv. of Wisconsin‐Madison Madison WI 53706 U.S.A
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Gannon BM, Thakker V, Bonam VS, Haas JD, Bonam W, Finkelstein JL, Udipi SA, Mehta S. A Randomized Crossover Study to Evaluate Recipe Acceptability in Breastfeeding Mothers and Young Children in India Targeted for a Multiple Biofortified Food Crop Intervention. Food Nutr Bull 2019; 40:460-470. [PMID: 31359782 PMCID: PMC7473068 DOI: 10.1177/0379572119855588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background A multiple biofortified food crop trial targeting iron, zinc, and vitamin A deficiencies among young children and their breastfeeding mothers is planned in India. Objective To determine the acceptability of recipes prepared with control and biofortified pearl millet, wheat, lentils, and sweet potato. Methods Children (6-24 months) and their mothers were enrolled as pairs (n = 52). Weight and height/length were determined. Mothers and children were separately, individually randomized in a crossover design to control or biofortified recipes. Children’s 3-day intake was measured per recipe and crop variety. For mothers, a 9-point hedonic scale evaluated color, odor, taste, and overall acceptability. Results Children’s mean (SD) length-/height-for-age Z-score was −1.2 (1.7), with 27% < −2 (stunted). Mean weight-for-length Z-score was −0.6 (1.2) with 9.6% < −2 (wasted). Mother’s body mass index showed 17% <18.5 and 38% >25. There was no difference in the children’s intake of biofortified versus control varieties of any recipe (P ≥ .22); overall median daily intake was 75 g (Q1: 61, Q3: 100). Mother’s hedonic scores for color, odor, taste, or overall acceptability did not demonstrate any notable differences (P ≥ .23 for overall acceptability); combined median overall acceptability score was 8.5 (Q1: 8.0, Q3: 9.0). Conclusions Recipes were consumed readily, were rated as highly acceptable, and did not show any differences between biofortified and control varieties.
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Affiliation(s)
- Bryan M Gannon
- Cornell University, Ithaca, NY, USA.,Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, USA
| | - Varsha Thakker
- SNDT Women's University, Mumbai, Maharashtra, India.,Kasturba Health Society, Medical Research Centre, Mumbai, Maharashtra, India
| | - Vincent S Bonam
- Arogyavaram Medical Centre, Madanapalle, Andhra Pradesh, India
| | | | - Wesley Bonam
- Arogyavaram Medical Centre, Madanapalle, Andhra Pradesh, India
| | - Julia L Finkelstein
- Cornell University, Ithaca, NY, USA.,Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, USA
| | - Shobha A Udipi
- SNDT Women's University, Mumbai, Maharashtra, India.,Kasturba Health Society, Medical Research Centre, Mumbai, Maharashtra, India
| | - Saurabh Mehta
- Cornell University, Ithaca, NY, USA.,Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, USA
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van Stuijvenberg ME, Dhansay MA, Nel J, Suri D, Grahn M, Davis CR, Tanumihardjo SA. South African preschool children habitually consuming sheep liver and exposed to vitamin A supplementation and fortification have hypervitaminotic A liver stores: a cohort study. Am J Clin Nutr 2019; 110:91-101. [PMID: 31089689 DOI: 10.1093/ajcn/nqy382] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/12/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND In some regions, multiple vitamin A (VA) interventions occur in the same target groups, which may lead to excessive stores. Retinol isotope dilution (RID) is a more sensitive technique than serum retinol to measure VA status. OBJECTIVE We evaluated VA status before and after a high-dose supplement in preschool children living in a region in South Africa with habitual liver consumption and exposed to VA supplementation and fortification. METHODS After baseline blood samples, subjects (46.7 ± 8.4 mo; n = 94) were administered 1.0 μmol [14,15]-13C2-retinyl acetate to estimate total liver retinol reserves by RID with a follow-up 14-d blood sample. Liver intake was assessed with a frequency questionnaire. In line with current practice, a routine 200,000 IU VA capsule was administered after the RID test. RID was repeated 1 mo later. Serum retinyl esters were evaluated using ultra-performance liquid chromatography. RESULTS At baseline, 63.6% of these children had hypervitaminosis A defined as total liver retinol reserves ≥1.0 μmol/g liver, which increased to 71.6% after supplementation (1.13 ± 0.43 to 1.29 ± 0.46 μmol/g; P < 0.001). Total serum VA as retinyl esters was elevated in 4.8% and 6.1% of children before and after supplementation. The odds of having hypervitaminosis A at baseline were higher in children consuming liver ≥1/mo (ratio 3.70 [95% CI: 1.08, 12.6]) and in children receiving 2 (4.28 [1.03, 17.9]) or 3 (6.45 [0.64, 65.41]) supplements in the past 12 mo. Total body stores decreased after the supplement in children in the highest quartile at baseline compared with children with lower stores, who showed an increase (P = 0.007). CONCLUSIONS In children, such as this cohort in South Africa, with adequate VA intake through diet, and overlapping VA fortification and supplementation, preschool VA capsule distribution should be re-evaluated. This trial was registered at https://clinicaltrials.gov/ct2/show/NCT02915731 as NCT02915731.
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Affiliation(s)
- Martha E van Stuijvenberg
- Non-Communicable Diseases Research Unit, South African Medical Research Council.,Division of Human Nutrition, Cape Town, South Africa
| | - Muhammad A Dhansay
- Burden of Disease Research Unit, South African Medical Research Council.,Division of Human Nutrition, Cape Town, South Africa.,Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Jana Nel
- Integrated Nutrition Programme, Northern Cape Department of Health, Kimberley, South Africa
| | - Devika Suri
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Michael Grahn
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Christopher R Davis
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
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Tanumihardjo SA, Gannon BM, Kaliwile C, Chileshe J, Binkley NC. Restricting vitamin A intake increases bone formation in Zambian children with high liver stores of vitamin. Arch Osteoporos 2019; 14:72. [PMID: 31254130 PMCID: PMC7189610 DOI: 10.1007/s11657-019-0617-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/04/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED This analysis was performed in Zambian children who had a high prevalence of hypervitaminosis A, defined as > 1.0 μmol retinol/g liver. Bone parameters included markers of bone formation (P1NP), bone resorption (CTX), parathyroid hormone, calcium, vitamin A, and vitamin D. Low dietary vitamin A intake increased P1NP. PURPOSE Vitamin A (VA) interacts with bone health, but mechanisms require clarification. In countries where multiple interventions exist to eradicate VA deficiency, some groups are consuming excessive VA. Bone metabolism and inflammatory parameters were measured in Zambian children who had high prevalence of hypervitaminosis A determined by 13C-retinol isotope dilution. METHODS Children (n = 143), 5 to 7 years, were recruited into a placebo-controlled biofortified orange maize feeding study for 90 days. Bone turnover (P1NP and CTX) and inflammatory (C-reactive protein (CRP) and alpha-1-acid glycoprotein) biomarkers were measured in fasting blood samples before and/or after intervention with the following: (1) VA at the recommended dietary allowance (400 μg retinol activity equivalents/day (as retinyl palmitate)), (2) maize enhanced with the provitamin A carotenoid β-carotene (2.86 mg/day), or (3) a placebo. Parathyroid hormone, calcium, and 25(OH)-vitamin D were measured at end line. RESULTS Bone formation, as measured by P1NP, increased (P < 0.0001) in the placebo group who consumed low preformed VA during the intervention. Bone resorption, measured by CTX, was not affected. P1NP and CTX were negatively associated with inflammation, most strongly with CRP. Serum calcium did not differ among groups and was low (7.29 ± 0.87 μg/dL). Serum 25(OH) D did not differ among groups (54.5 ± 15 nmol/L), with 91% < 75 nmol/L and 38% < 50 nmol/L. CONCLUSIONS Reduction of dietary preformed VA in Zambian children for 4 months improved bone formation. Chronic consumption of preformed VA caused hypervitaminosis A and may impair bone formation. In children, this could be associated with failure to accrue optimal peak bone mass. TRIAL REGISTRATION The NIH Clinical Trial registry number is NCT01814891; https://clinicaltrials.gov/ct2/show/NCT01814891 .
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Affiliation(s)
- S A Tanumihardjo
- Department of Nutritional Sciences, University of Wisconsin-Madison, 1415 Linden Dr., Madison, WI, 53706, USA.
| | - B M Gannon
- Department of Nutritional Sciences, University of Wisconsin-Madison, 1415 Linden Dr., Madison, WI, 53706, USA
- Cornell University, Ithaca, NY, USA
| | - C Kaliwile
- National Food and Nutrition Commission of Zambia, P.O. Box 32669, Lusaka, Zambia
| | - J Chileshe
- Tropical Diseases Research Center, Ndola, Zambia
| | - N C Binkley
- Osteoporosis Clinical Research Program, University of Wisconsin-Madison, Madison, WI, USA
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Keats EC, Neufeld LM, Garrett GS, Mbuya MNN, Bhutta ZA. Improved micronutrient status and health outcomes in low- and middle-income countries following large-scale fortification: evidence from a systematic review and meta-analysis. Am J Clin Nutr 2019; 109:1696-1708. [PMID: 30997493 PMCID: PMC6537942 DOI: 10.1093/ajcn/nqz023] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/25/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Micronutrient malnutrition is highly prevalent in low- and middle-income countries (LMICs) and disproportionately affects women and children. Although the effectiveness of large-scale food fortification (LSFF) of staple foods to prevent micronutrient deficiencies in high-income settings has been demonstrated, its effectiveness in LMICs is less well characterized. This is important as food consumption patterns, potential food vehicles, and therefore potential for impact may vary substantially in these contexts. OBJECTIVES The aim of this study was to determine the real-world impact of LSFF with key micronutrients (vitamin A, iodine, iron, folic acid) on improving micronutrient status and functional health outcomes in LMICs. METHODS All applicable published/unpublished evidence was systematically retrieved and analyzed. Studies were not restricted by age or sex. Meta-analyses were performed for quantitative outcomes and results were presented as summary RRs, ORs, or standardized mean differences (SMDs) with 95% CIs. RESULTS LSFF increased serum micronutrient concentrations in several populations and demonstrated a positive impact on functional outcomes, including a 34% reduction in anemia (RR: 0.66; 95% CI: 0.59, 0.74), a 74% reduction in the odds of goiter (OR: 0.26; 95% CI: 0.16, 0.43), and a 41% reduction in the odds of neural tube defects (OR: 0.59; 95% CI: 0.49, 0.70). Additionally, we found that LSFF with vitamin A could protect nearly 3 million children per year from vitamin A deficiency. We noted an age-specific effect of fortification, with women (aged >18 y) attaining greater benefit than children, who may consume smaller quantities of fortified staple foods. Several programmatic/implementation factors were also reviewed that may facilitate or limit program potential. CONCLUSIONS Measurable improvements in the micronutrient and health status of women and children are possible with LSFF. However, context and implementation factors are important when assessing programmatic sustainability and impact, and data on these are quite limited in LMIC studies.
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Affiliation(s)
- Emily C Keats
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | | | - Greg S Garrett
- Global Alliance for Improved Nutrition, Geneva, Switzerland
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Tanumihardjo SA, Kaliwile C, Boy E, Dhansay MA, van Stuijvenberg ME. Overlapping vitamin A interventions in the United States, Guatemala, Zambia, and South Africa: case studies. Ann N Y Acad Sci 2019; 1446:102-116. [PMID: 30265402 PMCID: PMC7999526 DOI: 10.1111/nyas.13965] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/01/2018] [Accepted: 08/15/2018] [Indexed: 01/12/2023]
Abstract
Vitamin A (VA) deficiency is a serious public health problem, especially in preschool children who are at risk of increased mortality. In order to address this problem, the World Health Organization recommends periodic high-dose supplementation to children 6-59 months of age in areas of highest risk. Originally, supplementation was meant as a short-term solution until more sustainable interventions could be adopted. Currently, many countries are fortifying commercialized common staple and snack foods with retinyl palmitate. However, in some countries, overlapping programs may lead to excessive intakes. Our review uses case studies in the United States, Guatemala, Zambia, and South Africa to illustrate the potential for excessive intakes in some groups. For example, direct liver analysis from 27 U.S. adult cadavers revealed 33% prevalence of hypervitaminosis A (defined as ≥1 μmol/g liver). In 133 Zambian children, 59% were diagnosed with hypervitaminosis A using a retinol isotope dilution, and 16% had ≥5% total serum VA as retinyl esters, a measure of intoxication. In 40 South African children who frequently consumed liver, 72.5% had ≥5% total serum VA as retinyl esters. All four countries have mandatory fortified foods and a high percentage of supplement users or targeted supplementation to preschool children.
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Affiliation(s)
| | | | | | - Muhammad A. Dhansay
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Martha E. van Stuijvenberg
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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Engle‐Stone R, Vosti SA, Luo H, Kagin J, Tarini A, Adams KP, French C, Brown KH. Weighing the risks of high intakes of selected micronutrients compared with the risks of deficiencies. Ann N Y Acad Sci 2019; 1446:81-101. [PMID: 31168822 PMCID: PMC6618252 DOI: 10.1111/nyas.14128] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/22/2019] [Accepted: 05/03/2019] [Indexed: 12/31/2022]
Abstract
Several intervention strategies are available to reduce micronutrient deficiencies, but uncoordinated implementation of multiple interventions may result in excessive intakes. We reviewed relevant data collection instruments and available information on excessive intakes for selected micronutrients and considered possible approaches for weighing competing risks of intake above tolerable upper intake levels (ULs) versus insufficient intakes at the population level. In general, population-based surveys in low- and middle-income countries suggest that dietary intakes greater than the UL are uncommon, but simulations indicate that fortification and supplementation programs could lead to high intakes under certain scenarios. The risk of excessive intakes can be reduced by considering baseline information on dietary intakes and voluntary supplement use and continuously monitoring program coverage. We describe a framework for comparing risks of micronutrient deficiency and excess, recognizing that critical information for judging these risks is often unavailable. We recommend (1) assessing total dietary intakes and nutritional status; (2) incorporating rapid screening tools for routine monitoring and surveillance; (3) addressing critical research needs, including evaluations of the current ULs, improving biomarkers of excess, and developing methods for predicting and comparing risks and benefits; and (4) ensuring that relevant information is used in decision-making processes.
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Affiliation(s)
| | - Stephen A. Vosti
- Department of Agricultural and Resource EconomicsUniversity of CaliforniaDavisCalifornia
| | - Hanqi Luo
- Department of NutritionUniversity of CaliforniaDavisCalifornia
| | | | | | | | - Caitlin French
- Department of NutritionUniversity of CaliforniaDavisCalifornia
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Assessment of oxygen sequestration on effectiveness of Purdue Improved Crop Storage (PICS) bags in reducing carotenoid degradation during post-harvest storage of two biofortified orange maize genotypes. J Cereal Sci 2019. [DOI: 10.1016/j.jcs.2019.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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65
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Advocacy for scaling up biofortified crops for improved micronutrient status in Africa: approaches, achievements, challenges and lessons. Proc Nutr Soc 2019; 78:567-575. [PMID: 30887944 DOI: 10.1017/s0029665119000521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Biofortification is an approach used to increase micronutrient content of crops through agronomic practices, conventional or modern biotechnology. Through a plethora of projects, partnerships were formed to advocate for policy changes, and increased investments in research, production and utilisation of biofortified crops. One of such projects is the Building Nutritious Food Baskets project, which has been appraised in order to draw and share successes, challenges and lessons for the improvement of similar future projects to achieve substantial impacts. The paper provides an overview of the role of biofortification in addressing nutritional challenges and highlights the efficacy of biofortified crops in improving micronutrient status. Through advocacy at the African Regional and sub-regional levels, awareness has been created on biofortification among governments, investors, development partners, farmers and consumers. This awareness has resulted in the incorporation of biofortification in some key policies, strategies and investment programmes. Key lessons learnt from regional advocacy are (1) in order to integrate biofortification in regional policies, strategies and programmes, it is important to identify champions from key and strategic regional organisations as they provide information on potential opportunities for influencing policies, (2) having a common advocacy message helps to highlight the role of biofortification in contributing to the prevention of micronutrient problems as well as evidence of impact on nutrition outcome, (3) champions need to be allocated a budget to support their advocacy work and (4) to engender adoption of biofortification, it is important to align biofortification with relevant initiatives as well as ongoing opportunities for advocacy.
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66
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Sheftel J, Surles RL, Tanumihardjo SA. Retinol isotope dilution accurately predicts liver reserves in piglets but overestimates reserves in lactating sows. Exp Biol Med (Maywood) 2019; 244:579-587. [PMID: 30889962 DOI: 10.1177/1535370219838785] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPACT STATEMENT Vitamin A (VA) deficiency and hypervitaminosis A have been reported in groups of people worldwide. Conventional biomarkers of VA deficiency (e.g. serum retinol concentration, dose response tests) are not able to distinguish between sufficiency and hypervitaminosis A. Retinol isotope dilution (RID) predictions of VA status have been validated in humans and animal models from deficiency through toxicity; however, RID during life stages with unique issues related to isotopic tracing, such as infancy and lactation, requires further evaluation. This study investigated RID in piglets and lactating sows as models for human infants and women. In piglets, RID successfully determined VA deficiency (confirmed with liver analysis), and that the tracer mixes quickly. Conversely, in lactating sows, although serum and milk enrichments were similar, traditional RID equations overestimated VA stores, likely due to losses of tracer and higher extrahepatic VA storage than predictions. These data inform researchers about the challenges of using RID during lactation.
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Affiliation(s)
- Jesse Sheftel
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Rebecca L Surles
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Sherry A Tanumihardjo
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
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67
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Guo J, Li B, Zuo Z, Chen M, Wang C. Maternal Supplementation with β‐Carotene During Pregnancy Disturbs Lipid Metabolism and Glucose Homoeostasis in F1 Female Mice. Mol Nutr Food Res 2019; 63:e1900072. [DOI: 10.1002/mnfr.201900072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Jiaojiao Guo
- State Key Laboratory of Cellular Stress BiologySchool of Life SciencesXiamen University Xiamen 36110 P. R. China
| | - Bingshui Li
- State Key Laboratory of Cellular Stress BiologySchool of Life SciencesXiamen University Xiamen 36110 P. R. China
| | - Zhenghong Zuo
- State Key Laboratory of Cellular Stress BiologySchool of Life SciencesXiamen University Xiamen 36110 P. R. China
| | - Meng Chen
- State Key Laboratory of Cellular Stress BiologySchool of Life SciencesXiamen University Xiamen 36110 P. R. China
- Key Laboratory of Ministry of Education for Subtropical Wetland Ecosystem ResearchXiamen University Xiamen 36110 P. R. China
| | - Chonggang Wang
- State Key Laboratory of Cellular Stress BiologySchool of Life SciencesXiamen University Xiamen 36110 P. R. China
- Key Laboratory of Ministry of Education for Subtropical Wetland Ecosystem ResearchXiamen University Xiamen 36110 P. R. China
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68
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Kaliwile C, Arscott SA, Gannon BM, Masi C, Tanumihardjo SA. Community mobilization during biofortified orange maize feeding trials in Zambia. INT J VITAM NUTR RES 2019; 90:257-265. [PMID: 30806607 DOI: 10.1024/0300-9831/a000541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In some societies, studies involving blood draws, oral vaccinations, or supplementation are surrounded by myths and disbeliefs. If not clarified, they may affect study implementation and negatively impact the outcome of well-intended studies from inadequate participation. Through participatory action research, this paper suggests how future trials could be enhanced with reference to community mobilization, drawing from the experience of two interventions in Zambian children with nutritionally enhanced, biofortified orange maize conducted by the National Food and Nutrition Commission and Tropical Diseases Research Center (Zambia), and University of Wisconsin-Madison (USA). The preparatory phase included site visits, signing of a Memorandum of Understanding, equipment inventory, hiring staff, and community meetings. Prior results were shared before the second intervention. After Institutional Review Boards' approval of procedures, written informed consent was obtained from caregivers. There was overwhelming community participation attributed to the demystification that the project was run by satanists prior to and during the study. Participation led to excellent compliance with 92.8 and 96.4% of subjects completing the final blood draw in 2010 and 2012, respectively. The results of the trials were successfully shared with the district officials and communities from where the study participants were drawn. The positive response by partners and communities, including information sharing, suggests that community mobilization, with the use of varied methods, is effective for full participation of the target groups in feeding trials and would be the case in similar trials if effectively carried out. Community participation in research studies may result in long-term adoption of biofortified foods.
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Affiliation(s)
| | | | | | - Cassim Masi
- National Food and Nutrition Commission, Lusaka, Zambia
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69
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Suwarno WB, Hannok P, Palacios-Rojas N, Windham G, Crossa J, Pixley KV. Provitamin A Carotenoids in Grain Reduce Aflatoxin Contamination of Maize While Combating Vitamin A Deficiency. FRONTIERS IN PLANT SCIENCE 2019; 10:30. [PMID: 30778360 PMCID: PMC6369730 DOI: 10.3389/fpls.2019.00030] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/09/2019] [Indexed: 05/25/2023]
Abstract
Aflatoxin contamination of maize grain and products causes serious health problems for consumers worldwide, and especially in low- and middle-income countries where monitoring and safety standards are inconsistently implemented. Vitamin A deficiency (VAD) also compromises the health of millions of maize consumers in several regions of the world including large parts of sub-Saharan Africa. We investigated whether provitamin A (proVA) enriched maize can simultaneously contribute to alleviate both of these health concerns. We studied aflatoxin accumulation in grain of 120 maize hybrids formed by crossing 3 Aspergillus flavus resistant and three susceptible lines with 20 orange maize lines with low to high carotenoids concentrations. The hybrids were grown in replicated, artificially-inoculated field trials at five environments. Grain of hybrids with larger concentrations of beta-carotene (BC), beta-cryptoxanthin (BCX) and total proVA had significantly less aflatoxin contamination than hybrids with lower carotenoids concentrations. Aflatoxin contamination had negative genetic correlation with BCX (-0.28, p < 0.01), BC (-0.18, p < 0.05), and proVA (-0.23, p < 0.05). The relative ease of breeding for increased proVA carotenoid concentrations as compared to breeding for aflatoxin resistance in maize suggests using the former as a component of strategies to combat aflatoxin contamination problems for maize. Our findings indicate that proVA enriched maize can be particularly beneficial where the health burdens of exposure to aflatoxin and prevalence of VAD converge with high rates of maize consumption.
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Affiliation(s)
- Willy B. Suwarno
- International Maize and Wheat Improvement Center, Texcoco, Mexico
- Department of Agronomy and Horticulture, Faculty of Agriculture, Bogor Agricultural University, Bogor, Indonesia
| | - Pattama Hannok
- International Maize and Wheat Improvement Center, Texcoco, Mexico
- Department of Agronomy, University of Wisconsin-Madison, Madison, WI, United States
| | | | - Gary Windham
- Corn Host Plant Resistance Research Unit, United States Department of Agriculture-Agricultural Research Service, Starkville, MS, United States
| | - José Crossa
- International Maize and Wheat Improvement Center, Texcoco, Mexico
| | - Kevin V. Pixley
- International Maize and Wheat Improvement Center, Texcoco, Mexico
- Department of Agronomy, University of Wisconsin-Madison, Madison, WI, United States
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70
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Lockyer S, White A, Buttriss JL. Biofortified crops for tackling micronutrient deficiencies - what impact are these having in developing countries and could they be of relevance within Europe? NUTR BULL 2018. [DOI: 10.1111/nbu.12347] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | - A. White
- British Nutrition Foundation; London UK
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71
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Olsen K, Suri DJ, Davis C, Sheftel J, Nishimoto K, Yamaoka Y, Toya Y, Welham NV, Tanumihardjo SA. Serum retinyl esters are positively correlated with analyzed total liver vitamin A reserves collected from US adults at time of death. Am J Clin Nutr 2018; 108:997-1005. [PMID: 30475970 PMCID: PMC6692705 DOI: 10.1093/ajcn/nqy190] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 07/16/2018] [Indexed: 12/31/2022] Open
Abstract
Background Minimal human data exist on liver vitamin A (VA) compared with serum biomarkers. Cutoffs of 5% and 10% total serum VA as retinyl esters (REs) suggest a VA intoxication diagnosis. Objectives We compared total liver VA reserves (TLRs) with the percentage of total serum VA as REs to evaluate hypervitaminosis with the use of US adult autopsy samples. Secondary objectives evaluated serum retinol sensitivity, TLRs among lobes, and hepatic α-retinol concentrations, an α-carotene cleavage product. Design Matched serum and liver samples were procured from cadavers (n = 27; mean ± SD age: 70.7 ± 14.9 y; range: 49-101 y). TLRs and α-REs were quantified by ultra-performance liquid chromatography. Pearson correlations showed liver and serum associations. Sensitivity and specificity were calculated for >5%, 7.5%, and 10% total serum VA as REs to predict TLRs and for serum retinol <0.7 and 1 μmol/L to predict deficiency. Results Serum RE concentrations were correlated with TLRs (r = 0.497, P < 0.001). Nine subjects (33%) had hypervitaminosis A (≥1.0 μmol VA/g liver), 2 of whom had >7.5% total serum VA as REs; histologic indicators corroborated toxicity at 3 μmol/g liver. No subject had >10% total serum VA as REs. Serum retinol sensitivity to determine deficiency (TLRs <0.1 μmol VA/g) was 83% at 0.7 and 1 μmol/L. Hepatic α-retinol was positively correlated with age (P = 0.047), but removing an outlier nullified significance. Conclusions This study evaluated serum REs as a biomarker of VA status against TLRs (gold standard), and abnormal histology suggested that 7.5% total serum VA as REs is diagnostic for toxicity at the individual level in adults. The long-term impact of VA supplements and fortificants on VA status is currently unknown. Considering the high prevalence of hypervitaminotic TLRs in this cohort, and given that many countries are adding preformed VA to processed products, population biomarkers diagnosing hypervitaminosis before toxicity are urgently needed. This trial was registered at clinicaltrials.govas NCT03305042.
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Affiliation(s)
- Kiersten Olsen
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin–Madison, Madison, WI
| | - Devika J Suri
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin–Madison, Madison, WI
| | - Christopher Davis
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin–Madison, Madison, WI
| | - Jesse Sheftel
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin–Madison, Madison, WI
| | - Kohei Nishimoto
- Division of Otolaryngology, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI,Present address for KN and YT: Department of Otolaryngology, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Yusuke Yamaoka
- Division of Otolaryngology, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI,Present address for YY: Kyoto University Faculty of Medicine, Kyoto, Japan
| | - Yutaka Toya
- Division of Otolaryngology, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI,Present address for KN and YT: Department of Otolaryngology, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Nathan V Welham
- Division of Otolaryngology, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sherry A Tanumihardjo
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin–Madison, Madison, WI,Address correspondence to SAT (e-mail: )
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72
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Garcia‐Casal MN, Mowson R, Rogers L, Grajeda R. Risk of excessive intake of vitamins and minerals delivered through public health interventions: objectives, results, conclusions of the meeting, and the way forward. Ann N Y Acad Sci 2018; 1446:5-20. [DOI: 10.1111/nyas.13975] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/03/2018] [Accepted: 09/08/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Maria Nieves Garcia‐Casal
- Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development World Health Organization Geneva Switzerland
| | - Robin Mowson
- Nutrition and Social Determinants the Pan American Health Organization Washington DC
| | - Lisa Rogers
- Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development World Health Organization Geneva Switzerland
| | - Ruben Grajeda
- Nutrition and Social Determinants the Pan American Health Organization Washington DC
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73
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Titcomb TJ, Sheftel J, Sowa M, Gannon BM, Davis CR, Palacios-Rojas N, Tanumihardjo SA. β-Cryptoxanthin and zeaxanthin are highly bioavailable from whole-grain and refined biofortified orange maize in humans with optimal vitamin A status: a randomized, crossover, placebo-controlled trial. Am J Clin Nutr 2018; 108:793-802. [PMID: 30321275 PMCID: PMC8483000 DOI: 10.1093/ajcn/nqy134] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/24/2018] [Indexed: 01/28/2023] Open
Abstract
Background Biofortification of staple crops with β-carotene is a strategy to reduce vitamin A deficiency, and several varieties are available in some African countries. β-Cryptoxanthin (BCX)-enhanced maize is currently in field trials. To our knowledge, maize BCX bioavailability has not been assessed in humans. Serum retinol 13C content and xanthophyll concentrations are proposed effectiveness biomarkers for biofortified maize adoption. Objective We determined the relative difference in BCX and zeaxanthin bioavailability from whole-grain and refined BCX-biofortified maize during chronic feeding compared with white maize and evaluated short-term changes in 13C-abundance in serum retinol. Design After a 7-d washout, 9 adults (mean ± SD age: 23.4 ± 2.3 y; 5 men) were provided with muffins made from BCX-enhanced whole-grain orange maize (WGOM), refined orange maize (ROM), or refined white maize (RWM) for 12 d in a randomized, blinded, crossover study followed by a 7-d washout. Blood was drawn on days 0, 3, 6, 9, 12, 15, and 19. Carotenoid areas under the curve (AUCs) were compared by using a fixed-effects model. 13C-Abundance in serum retinol was determined by using gas chromatography/combustion/isotope-ratio mass spectrometry on days 0, 12, and 19. Vitamin A status was determined by 13C-retinol isotope dilution postintervention. Results The serum BCX AUC was significantly higher for WGOM (1.70 ± 0.63 μmol ⋅ L-1 ⋅ d) and ROM (1.66 ± 1.08 μmol ⋅ L-1 ⋅ d) than for RWM (-0.06 ± 0.13 μmol ⋅ L-1 ⋅ d; P < 0.003). A greater increase occurred in serum BCX from WGOM muffins (131%) than from ROM muffins (108%) (P ≤ 0.003). Zeaxanthin AUCs were higher for WGOM (0.94 ± 0.33) and ROM (0.96 ± 0.47) than for RWM (0.05 ± 0.12 μmol ⋅ L-1 ⋅ d; P < 0.003). The intervention did not affect predose serum retinol 13C-abundance. Vitamin A status was within an optimal range (defined as 0.1-0.7 μmol/g liver). Conclusions BCX and zeaxanthin were highly bioavailable from BCX-biofortified maize. The adoption of BCX maize could positively affect consumers' BCX and zeaxanthin intakes and associated health benefits. This trial is registered at www.clinicaltrials.gov as NCT02800408.
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Affiliation(s)
- Tyler J Titcomb
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Jesse Sheftel
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Margaret Sowa
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Bryan M Gannon
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Christopher R Davis
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | | | - Sherry A Tanumihardjo
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
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Cabrera-Soto L, Pixley KV, Rosales-Nolasco A, Galicia-Flores LA, Palacios-Rojas N. Carotenoid and Tocochromanol Profiles during Kernel Development Make Consumption of Biofortified "Fresh" Maize an Option to Improve Micronutrient Nutrition. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2018; 66:9391-9398. [PMID: 30130402 DOI: 10.1021/acs.jafc.8b01886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Biofortification is a strategy to reduce micronutrient malnutrition. The aim of this study was to investigate whether consumption of biofortified fresh maize can supply nutritionally meaningful amounts of provitamin A carotenoids (PVA), zinc, lysine, and tryptophan. The accumulation patterns for PVA and tocochromanol compounds in developing grain of 23 PVA hybrids was studied, and nutritionally meaningful amounts of those compounds were found in grain by milk stage, when fresh maize is eaten. The highest PVA and tocochromanol accumulation occurred by physiological maturity. The percent apparent retention in boiled fresh maize was 92%, 117%, 99%, and 66% for PVA, zinc, lysine, and tryptophan, respectively. Consumption of 0.5 to 2 ears of fresh maize daily could supply 33-62.2%, 11-24% and more than 85% of the estimated average requirement of PVA, tryptophan, and zinc, respectively. The results indicate that eating biofortified fresh maize can contribute to improved micronutrient nutrition.
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Affiliation(s)
- Luisa Cabrera-Soto
- International Maize and Wheat Improvement Center (CIMMYT), CIMMYT Research Station , Km. 45 Carretera Mexico-Veracruz, El Batán , Texcoco , CP 56237 Edo. de México , México
| | - Kevin V Pixley
- International Maize and Wheat Improvement Center (CIMMYT), CIMMYT Research Station , Km. 45 Carretera Mexico-Veracruz, El Batán , Texcoco , CP 56237 Edo. de México , México
| | - Aldo Rosales-Nolasco
- International Maize and Wheat Improvement Center (CIMMYT), CIMMYT Research Station , Km. 45 Carretera Mexico-Veracruz, El Batán , Texcoco , CP 56237 Edo. de México , México
| | - Luis A Galicia-Flores
- International Maize and Wheat Improvement Center (CIMMYT), CIMMYT Research Station , Km. 45 Carretera Mexico-Veracruz, El Batán , Texcoco , CP 56237 Edo. de México , México
| | - Natalia Palacios-Rojas
- International Maize and Wheat Improvement Center (CIMMYT), CIMMYT Research Station , Km. 45 Carretera Mexico-Veracruz, El Batán , Texcoco , CP 56237 Edo. de México , México
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Sheftel J, Loechl C, Mokhtar N, Tanumihardjo SA. Use of Stable Isotopes to Evaluate Bioefficacy of Provitamin A Carotenoids, Vitamin A Status, and Bioavailability of Iron and Zinc. Adv Nutr 2018; 9:625-636. [PMID: 30239582 PMCID: PMC6140444 DOI: 10.1093/advances/nmy036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/25/2018] [Accepted: 05/14/2018] [Indexed: 01/25/2023] Open
Abstract
The ability of nutrition scientists to measure the status, bioavailability, and bioefficacy of micronutrients is affected by lack of access to the parts of the body through which a nutrient may travel before appearing in accessible body compartments (typically blood or urine). Stable isotope-labeled tracers function as safe, nonradioactive tools to follow micronutrients in a quantitative manner because the absorption, distribution, metabolism, and excretion of the tracer are assumed to be similar to the unlabeled vitamin or mineral. The International Atomic Energy Agency (IAEA) supports research on the safe use of stable isotopes in global health and nutrition. This review focuses on IAEA's contributions to vitamin A, iron, and zinc research. These micronutrients are specifically targeted by the WHO because of their importance in health and worldwide prevalence of deficiency. These 3 micronutrients are included in food fortification and biofortification efforts in low- and middle-income regions of the world. Vitamin A isotopic techniques can be used to evaluate the efficacy and effectiveness of interventions. For example, total body retinol stores were estimated by using 13C2-retinol isotope dilution before and after feeding Zambian children maize biofortified with β-carotene to determine if vitamin A reserves were improved by the intervention. Stable isotopes of iron and zinc have been used to determine mineral bioavailability. In Thailand, ferrous sulfate was better absorbed from fish sauce than was ferrous lactate or ferric ammonium citrate, determined with the use of different iron isotopes in each compound. Comparisons of one zinc isotope injected intravenously with another isotope taken orally from a micronutrient powder proved that the powder increased total absorbed zinc from a meal in Pakistani infants. Capacity building by the IAEA with appropriate collaborations in low- and middle-income countries to use stable isotopes has resulted in many advancements in human nutrition.
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Affiliation(s)
- Jesse Sheftel
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin–Madison, Madison, WI
| | | | | | - Sherry A Tanumihardjo
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin–Madison, Madison, WI
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Gannon BM, Valentine AR, Davis CR, Howe JA, Tanumihardjo SA. Duration of Retinol Isotope Dilution Studies with Compartmental Modeling Affects Model Complexity, Kinetic Parameters, and Calculated Vitamin A Stores in US Women. J Nutr 2018; 148:1387-1396. [PMID: 30137477 PMCID: PMC6075605 DOI: 10.1093/jn/nxy095] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/26/2018] [Accepted: 04/11/2018] [Indexed: 11/14/2022] Open
Abstract
Background Retinol isotope dilution (RID) indirectly estimates vitamin A (VA) status. Multicompartment modeling of RID data is used to refine study designs and equations to calculate VA stores. Previous studies suggest that VA in slowly turning over pools is not traced if follow-up is not long enough; however, shorter RID studies are being investigated. Few long-term models have been published. Objective We determined the effect of time on mathematical models of VA kinetics, model parameters, and outcomes. Methods In this longitudinal study, women (mean ± SD age: 22 ± 3 y; n = 7) were given 2.0 µmol [14,15]-13C2-retinyl acetate. Blood samples were staggered from 4 h to 152 d; the fraction of dose in serum was modeled with compartmental models. Four model-time categories were created: full models that used all data (median: 137 d; range 97-152 d) and truncated shorter studies of 14, 27, and 52 d (range: 42-62 d). Outcomes included number of compartments to adequately model serum data, kinetic parameters, total traced VA mass, and time-to-dose equilibration. To gain insight into longer follow-up, an additional participant was given 17.5 µmol 13C4-VA, and data were modeled as long as enrichment was above baseline (5 y). Results Longer follow-up times affected kinetic parameters and outcomes. Compared with the 14-d models, long-term full models required an additional compartment for adequate fit (14.3% compared with 100%; P = 0.0056) and had longer [median (quartile 1, quartile 3)] whole-body half-life [15.0 d (10.5, 72.6 d) compared with 135 d (115, 199 d); P = 0.0006], time-to-dose equilibration [3.40 d (3.14, 6.75 d) compared with 18.9 d (11.2, 25.7 d); P < 0.0001], and total traced mass [166 µmol VA (162, 252 µmol VA) compared with 476 µmol VA (290, 752 µmol VA); P = 0.0031]. Conclusions Extended RID sampling alters numerous mathematically modeled, time-dependent outcomes in women. Length of study should be considered when using mathematical models for calculating total-body VA stores or kinetic parameters related to VA turnover. This study is registered at www.clinicaltrials.gov as NCT03248700.
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Affiliation(s)
- Bryan M Gannon
- University of Wisconsin-Madison, Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, Madison, WI
| | - Ashley R Valentine
- University of Wisconsin-Madison, Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, Madison, WI
| | - Christopher R Davis
- University of Wisconsin-Madison, Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, Madison, WI
| | - Julie A Howe
- University of Wisconsin-Madison, Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, Madison, WI
| | - Sherry A Tanumihardjo
- University of Wisconsin-Madison, Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, Madison, WI
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Heying EK, Ziemer KL, Tanumihardjo JP, Palacios-Rojas N, Tanumihardjo SA. β-Cryptoxanthin-Biofortified Hen Eggs Enhance Vitamin A Status When Fed to Male Mongolian Gerbils. J Nutr 2018; 148:1236-1243. [PMID: 30137479 DOI: 10.1093/jn/nxy117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/08/2018] [Indexed: 12/14/2022] Open
Abstract
Background Consumption of provitamin A carotenoid biofortified crops, such as maize, supports vitamin A (VA) status in animals and humans. Laying hens that consume β-cryptoxanthin-biofortified maize deposit β-cryptoxanthin into egg yolk. Objective We investigated whether β-cryptoxanthin-biofortified egg consumption would affect VA status of male Mongolian gerbils (Meriones unguiculatus) compared with white-yolked eggs. Methods β-Cryptoxanthin-biofortified egg yolk, produced in hens fed biofortified orange maize or tangerine-fortified maize feeds, was freeze-dried and fed to gerbils. White-yolked eggs were produced by feeding white maize to hens. Gerbils (n = 57) were fed VA-deficient feed for 28 d. After baseline (n = 7), treatments (n = 10/group) included oil control (VA-); 16.7% orange maize-biofortified, tangerine-fortified, or white-yolk egg feeds; or retinyl acetate as positive control (VA+) matched to daily preformed retinol intake from the eggs for 30 d. Preformed retinol did not differ between the egg yolks. Gerbil liver retinol, lipid, fatty acids, and cholesterol were determined. Results Liver retinol concentration (0.13 ± 0.03 µmol/g) and total hepatic VA (0.52 ± 0.12 µmol) were higher in gerbils fed orange maize-biofortified eggs than in all other groups. The VA- group was severely VA deficient (0.018 ±0.010 µmol/g; P < 0.05). Liver retinol was similar among VA+, tangerine-egg-, and white-egg-fed gerbils, but retinol reserves were higher in tangerine-egg-fed gerbils (0.35 ± 0.11 μmol) than in VA+ or VA- gerbils or at baseline (P < 0.05). Liver fat was 3.6 times (P < 0.0001) and cholesterol was 2.1 times (P < 0.004) higher in egg-fed groups that experienced hepatosteatosis. Liver fatty acid profiles reflected feed, but retinyl ester fatty acids did not. Conclusions The preformed retinol in the eggs enhanced gerbil VA status, and the β-cryptoxanthin-biofortified eggs from hens fed orange maize prevented deficiency. Biofortified maize can enhance VA status when consumed directly or through products from livestock fed orange maize.
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Affiliation(s)
- Emily K Heying
- Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Kaitlin Leary Ziemer
- Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Jacob P Tanumihardjo
- Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | | | - Sherry A Tanumihardjo
- Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
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Dube N, Mashurabad PC, Hossain F, Pullakhandam R, Thingnganing L, Bharatraj DK. β-Carotene bioaccessibility from biofortified maize (Zea mays) is related to its density and is negatively influenced by lutein and zeaxanthin. Food Funct 2018; 9:379-388. [PMID: 29215107 DOI: 10.1039/c7fo01034f] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Biofortification of maize with provitamin A (pro-VA) carotenoids has been successful, but the bioavailability of carotenoids needs to be explored. In the present study, we investigated the carotenoid content, micellarization and intestinal cell uptake of carotenoids from 10 maize hybrids [normal maize, quality protein maize (QPM), pro-VA carotenoid and double biofortified QPM + pro-VA maize hybrids] using a simulated in vitro digestion/Caco-2 cell model. The pro-VA carotenoid content of biofortified maize hybrids is 2-10 fold higher compared to that of normal maize. Furthermore, the ratio of non-pro-VA carotenoids lutein (LUT) plus zeaxanthin (ZEA) to the sum of pro-VA carotenoids β-cryptoxanthin (BCX), α-carotene (AC) and β-carotene (BC) in biofortified maize was much lower compared to that of normal maize. The consumption of 200 g day-1 of biofortified Pusa-PV-16-3 (BC = 808.4 μg per 100 g; AC = 839.3 μg per 100 g; BCX = 59 μg per 100 g) and Pusa-APQH8 (BC = 345.9 μg per 100 g; AC = 1739 μg per 100 g; BCX = 644.2 μg per 100 g) maize would contribute to 52 and 64% of RDAs for adult Indian men, respectively, after adjusting for cooking losses and conversion factors. The mean efficiency of micellarization of LUT (62.2% ± 5.3), ZEA (65% ± 4.7), and BCX (54% ± 9.5) exceeded that of AC (43% ± 8.9) and BC (49.8% ± 7.8) from all the maize hybrids. Furthermore, the micellarization and uptake in Caco-2 cells during a 4 h incubation period showed high correlation (P < 0.05) with the concentration of carotenoids in the maize digesta and micellar fraction, respectively. However, the LUT + ZEA content in the maize digesta and micellar fraction was inversely (p < 0.05) related to the BC micellarization and intestinal cell uptake, respectively. These results together suggest that the enrichment of pro-VA carotenoids together with decreasing the oxygenated carotenoid metabolites such as LUT and ZEA will further improve the bioavailability of BC from maize hybrids.
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Affiliation(s)
- Nivedita Dube
- Food and Drug Toxicology Research Center, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, Telangana, India
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79
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Osendarp SJM, Martinez H, Garrett GS, Neufeld LM, De-Regil LM, Vossenaar M, Darnton-Hill I. Large-Scale Food Fortification and Biofortification in Low- and Middle-Income Countries: A Review of Programs, Trends, Challenges, and Evidence Gaps. Food Nutr Bull 2018; 39:315-331. [PMID: 29793357 PMCID: PMC7473077 DOI: 10.1177/0379572118774229] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Food fortification and biofortification are well-established strategies to address micronutrient deficiencies in vulnerable populations. However, the effectiveness of fortification programs is not only determined by the biological efficacy of the fortified foods but also by effective and sustainable implementation, which requires continual monitoring, quality assurance and control, and corrective measures to ensure high compliance. OBJECTIVE To provide an overview of efficacy, effectiveness, economics of food fortification and biofortification, and status of and challenges faced by large-scale food fortification programs in low- and middle-income countries (LMIC). METHODS A literature review of PubMed publications in English from 2000 to 2017, as well as gray literature, targeting nongovernmental organizations whose work focuses on this topic, complemented by national reports and a "snowball" process of citation searching. The article describes remaining technical challenges, barriers, and evidence gap and prioritizes recommendations and next steps to further accelerate progress and potential of impact. RESULTS The review identifies and highlights essential components of successful programs. It also points out issues that determine poor program performance, including lack of adequate monitoring and enforcement and poor compliance with standards by industry. CONCLUSIONS In the last 17 years, large-scale food fortification initiatives have been reaching increasingly larger segments of populations in LMIC. Large-scale food fortification and biofortification should be part of other nutrition-specific and nutrition-sensitive efforts to prevent and control micronutrient deficiencies. There are remaining technical and food system challenges, especially in relation to improving coverage and quality of delivery and measuring progress of national programs.
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Affiliation(s)
- Saskia J. M. Osendarp
- Osendarp Nutrition, Berkel & Rodenrijs, the Netherlands
- Micronutrient Forum, Ottawa, Ontario, Canada
| | - Homero Martinez
- Micronutrient Forum, Ottawa, Ontario, Canada
- Nutrition International, Ottawa, Ontario, Canada
| | - Greg S. Garrett
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | | | | | | | - Ian Darnton-Hill
- Institute of Obesity, Nutrition and Exercise, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Friedman School of Nutrition Science and Policy, Tufts University, MA, USA
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80
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Titcomb TJ, Schmaelzle ST, Nuss ET, Gregory JF, Tanumihardjo SA. Suboptimal Vitamin B Intakes of Zambian Preschool Children: Evaluation of 24-Hour Dietary Recalls. Food Nutr Bull 2018. [DOI: 10.1177/0379572118760373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Hidden hunger affects individuals who chronically consume an inadequate intake of at least 1 micronutrient and is associated with low dietary diversity. Little data are available on dietary intake or status assessment of B vitamins among preschool children in Zambia. Objectives: The aim of this study was to assess 24-hour dietary recall records obtained from Zambian children aged 3 to 7 years for B vitamin intake in relation to adequacy and change over time in the same community. Methods: Twenty-four-hour dietary recalls were collected from 2 studies that were 2 years apart in the same district of Zambia. Data were retrospectively analyzed for B vitamin intake, that is, biotin, vitamin B12, folate, niacin, pantothenic acid, vitamin B6, riboflavin, and thiamin. The estimated average requirement (EAR) cut point method was used to assess inadequacy prevalence for EARs established by the Institute of Medicine in the United States. Results: For all B vitamins, mean values were below the EARs established for children 4 to 8 years old. Relative to the EAR, children had the highest intakes of vitamin B6 with inadequacies of 77.9% and 60.1% in 2010 and 2012, respectively. The highest prevalence of inadequate intake was associated with folate, where ≥95% of the children had intakes below the EAR in both studies. Conclusions: All median vitamin B intakes were inadequate among these young children in rural Zambia. Future researchers and policy makers may need to consider B vitamin status in resource-poor areas of the country.
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Affiliation(s)
- Tyler J. Titcomb
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Samantha T. Schmaelzle
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Emily T. Nuss
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Jesse F. Gregory
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL, USA. Schmaelzle is now with the University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Sherry A. Tanumihardjo
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
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81
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Zunjare RU, Hossain F, Muthusamy V, Baveja A, Chauhan HS, Bhat JS, Thirunavukkarasu N, Saha S, Gupta HS. Development of Biofortified Maize Hybrids through Marker-Assisted Stacking of β -Carotene Hydroxylase, Lycopene-ε -Cyclase and Opaque2 Genes. FRONTIERS IN PLANT SCIENCE 2018; 9:178. [PMID: 29515602 PMCID: PMC5826225 DOI: 10.3389/fpls.2018.00178] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/30/2018] [Indexed: 05/07/2023]
Abstract
Traditional yellow maize though contains high kernel carotenoids, the concentration of provitamin A (proA) is quite low (<2 μg/g), compared to recommended level (15 μg/g). It also possesses poor endosperm protein quality due to low concentration of lysine and tryptophan. Natural variant of crtRB1 (β-carotene hydroxylase) and lcyE (lycopene-ε-cyclase) cause significant enhancement of proA concentration, while recessive allele, opaque2 (o2) enhances the level of these amino acids. Development of biofortified maize enriched in proA, lysine and tryptophan thus holds significance in alleviation of micronutrient malnutrition. In the present study, marker-assisted stacking of crtRB1, lcyE and o2 was undertaken in the genetic background of four maize hybrids (HQPM1, HQPM4, HQPM5, and HQPM7) popularly grown in India. HP704-22 and HP704-23 were used as donors, while four elite QPM parents viz., HKI161, HKI163, HKI193-1, and HKI193-2 were used as recipients. CrtRB1 showed severe segregation distortion, while lcyE segregated as per the expectation. Recovery of recurrent parent genome (RPG) among selected backcross progenies ranged from 89 to 93%. Introgressed progenies possessed high concentration of proA (7.38-13.59 μg/g), compared to 1.65-2.04 μg/g in the recurrent parents. The reconstituted hybrids showed an average of 4.5-fold increase in proA with a range of 9.25-12.88 μg/g, compared to original hybrids (2.14-2.48 μg/g). Similar plant-, ear-, and grain- characteristics of improved versions of both inbreds and hybrids were observed when evaluated with their respective original versions. Mean lysine (0.334%) and tryptophan (0.080%) of the improved hybrids were at par with the original versions (lysine: 0.340%, tryptophan: 0.083%). Improved hybrids also possessed similar grain yield potential (6,301-8,545 kg/ha) with their original versions (6,135-8,479 kg/ha) evaluated at two locations. This is the first study of staking crtRB1-, lcyE-, and o2-, favorable alleles in single genetic background. The improved inbreds can be effectively used as potential donor for independent and/or simultaneous introgression of crtRB1, lcyE, and o2 in the future breeding programme. These biofortified maize hybrids, rich in proA, lysine and tryptophan will hold great promise for nutritional security.
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Affiliation(s)
- Rajkumar U. Zunjare
- Division of Genetics, ICAR-Indian Agricultural Research Institute, New Delhi, India
| | - Firoz Hossain
- Division of Genetics, ICAR-Indian Agricultural Research Institute, New Delhi, India
| | - Vignesh Muthusamy
- Division of Genetics, ICAR-Indian Agricultural Research Institute, New Delhi, India
| | - Aanchal Baveja
- Division of Genetics, ICAR-Indian Agricultural Research Institute, New Delhi, India
| | - Hema S. Chauhan
- Division of Genetics, ICAR-Indian Agricultural Research Institute, New Delhi, India
| | - Jayant S. Bhat
- Regional Research Centre, ICAR-Indian Agricultural Research Institute, Dharwad, India
| | | | - Supradip Saha
- Division of Agricultural Chemicals, ICAR-Indian Agricultural Research Institute, New Delhi, India
| | - Hari S. Gupta
- Division of Genetics, ICAR-Indian Agricultural Research Institute, New Delhi, India
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Lopez-Teros V, Ford JL, Green MH, Tang G, Grusak MA, Quihui-Cota L, Muzhingi T, Paz-Cassini M, Astiazaran-Garcia H. Use of a "Super-child" Approach to Assess the Vitamin A Equivalence of Moringa oleifera Leaves, Develop a Compartmental Model for Vitamin A Kinetics, and Estimate Vitamin A Total Body Stores in Young Mexican Children. J Nutr 2017; 147:2356-2363. [PMID: 28931584 DOI: 10.3945/jn.117.256974] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/28/2017] [Accepted: 08/21/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Worldwide, an estimated 250 million children <5 y old are vitamin A (VA) deficient. In Mexico, despite ongoing efforts to reduce VA deficiency, it remains an important public health problem; thus, food-based interventions that increase the availability and consumption of provitamin A-rich foods should be considered.Objective: The objectives were to assess the VA equivalence of 2H-labeled Moringa oleifera (MO) leaves and to estimate both total body stores (TBS) of VA and plasma retinol kinetics in young Mexican children.Methods: β-Carotene was intrinsically labeled by growing MO plants in a 2H2O nutrient solution. Fifteen well-nourished children (17-35 mo old) consumed puréed MO leaves (1 mg β-carotene) and a reference dose of [13C10]retinyl acetate (1 mg) in oil. Blood (2 samples/child) was collected 10 times (2 or 3 children each time) over 35 d. The bioefficacy of MO leaves was calculated from areas under the composite "super-child" plasma isotope response curves, and MO VA equivalence was estimated through the use of these values; a compartmental model was developed to predict VA TBS and retinol kinetics through the use of composite plasma [13C10]retinol data. TBS were also estimated with isotope dilution.Results: The relative bioefficacy of β-carotene retinol activity equivalents from MO was 28%; VA equivalence was 3.3:1 by weight (0.56 μmol retinol:1 μmol β-carotene). Kinetics of plasma retinol indicate more rapid plasma appearance and turnover and more extensive recycling in these children than are observed in adults. Model-predicted mean TBS (823 μmol) was similar to values predicted using a retinol isotope dilution equation applied to data from 3 to 6 d after dosing (mean ± SD: 832 ± 176 μmol; n = 7).Conclusions: The super-child approach can be used to estimate population carotenoid bioefficacy and VA equivalence, VA status, and parameters of retinol metabolism from a composite data set. Our results provide initial estimates of retinol kinetics in well-nourished young children with adequate VA stores and demonstrate that MO leaves may be an important source of VA.
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Affiliation(s)
- Veronica Lopez-Teros
- Nutritional Sciences, Department of Chemical and Biological Sciences, University of Sonora, Hermosillo, Sonora, Mexico
| | - Jennifer Lynn Ford
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA
| | - Michael H Green
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA
| | - Guangwen Tang
- Former Carotenoids and Health Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
| | - Michael A Grusak
- USDA Agricultural Research Service, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Luis Quihui-Cota
- Department of Nutrition, Research Center for Food and Development, Hermosillo, Sonora, Mexico; and
| | - Tawanda Muzhingi
- International Potato Centre (CIP), International Livestock Research Institute Campus, Nairobi, Kenya
| | - Mariela Paz-Cassini
- Department of Nutrition, Research Center for Food and Development, Hermosillo, Sonora, Mexico; and
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83
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Martin C, Li J. Medicine is not health care, food is health care: plant metabolic engineering, diet and human health. THE NEW PHYTOLOGIST 2017; 216:699-719. [PMID: 28796289 DOI: 10.1111/nph.14730] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 06/23/2017] [Indexed: 05/03/2023]
Abstract
Contents 699 I. 699 II. 700 III. 700 IV. 706 V. 707 VI. 714 714 References 714 SUMMARY: Plants make substantial contributions to our health through our diets, providing macronutrients for energy and growth as well as essential vitamins and phytonutrients that protect us from chronic diseases. Imbalances in our food can lead to deficiency diseases or obesity and associated metabolic disorders, increased risk of cardiovascular diseases and cancer. Nutritional security is now a global challenge which can be addressed, at least in part, through plant metabolic engineering for nutritional improvement of foods that are accessible to and eaten by many. We review the progress that has been made in nutritional enhancement of foods, both improvements through breeding and through biotechnology and the engineering principles on which increased phytonutrient levels are based. We also consider the evidence, where available, that such foods do enhance health and protect against chronic diseases.
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Affiliation(s)
- Cathie Martin
- Department of Metabolic Biology, John Innes Centre, Norwich Research Park, Norwich, NR4 7UH, UK
| | - Jie Li
- Department of Metabolic Biology, John Innes Centre, Norwich Research Park, Norwich, NR4 7UH, UK
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84
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Sowa M, Yu J, Palacios-Rojas N, Goltz SR, Howe JA, Davis CR, Rocheford T, Tanumihardjo SA. Retention of Carotenoids in Biofortified Maize Flour and β-Cryptoxanthin-Enhanced Eggs after Household Cooking. ACS OMEGA 2017; 2:7320-7328. [PMID: 31457305 PMCID: PMC6645162 DOI: 10.1021/acsomega.7b01202] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/16/2017] [Indexed: 05/23/2023]
Abstract
Biofortification of crops to enhance provitamin A carotenoids is a strategy to increase the intake where vitamin A deficiency presents a widespread problem. Heat, light, and oxygen cause isomerization and oxidation of carotenoids, reducing provitamin A activity. Understanding provitamin A retention is important for assessing efficacy of biofortified foods. Retention of carotenoids in high-xanthophyll and high-β-carotene maize was assessed after a long-term storage at three temperatures. Carotenoid retention in high-β-cryptoxanthin maize was determined in muffins, non-nixtamalized tortillas, porridge, and fried puffs made from whole-grain and sifted flour. Retention in eggs from hens fed high-β-cryptoxanthin maize was assessed after frying, scrambling, boiling, and microwaving. Loss during storage in maize was accelerated with increasing temperature and affected by genotype. Boiling whole-grain maize into porridge resulted in the highest retention of all cooking and sifting methods (112%). Deep-fried maize and scrambled eggs had the lowest carotenoid retention rates of 67-78 and 84-86%, respectively.
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Affiliation(s)
- Margaret Sowa
- Interdepartmental
Graduate Program in Nutritional Sciences, University of Wisconsin—Madison, 1415 Linden Dr., 53706 Madison, Wisconsin, United States
| | - Jiaoying Yu
- Interdepartmental
Graduate Program in Nutritional Sciences, University of Wisconsin—Madison, 1415 Linden Dr., 53706 Madison, Wisconsin, United States
| | - Natalia Palacios-Rojas
- Global
Maize Program, International Center for
Maize and Wheat Improvement (CIMMYT), Km 45, Carr. Mex-Veracruz, Col. El Batan, 56130 Texcoco, Edo. De Mexico, Mexico
| | - Shellen R. Goltz
- Interdepartmental
Graduate Program in Nutritional Sciences, University of Wisconsin—Madison, 1415 Linden Dr., 53706 Madison, Wisconsin, United States
| | - Julie A. Howe
- Interdepartmental
Graduate Program in Nutritional Sciences, University of Wisconsin—Madison, 1415 Linden Dr., 53706 Madison, Wisconsin, United States
| | - Christopher R. Davis
- Interdepartmental
Graduate Program in Nutritional Sciences, University of Wisconsin—Madison, 1415 Linden Dr., 53706 Madison, Wisconsin, United States
| | - Torbert Rocheford
- Department
of Crop Sciences, University of Illinois
at Urbana-Champaign, AW-101 Turner Hall, MC046, 1102 S. Goodwin Avenue, 61801 Urbana, Illinois, United States
| | - Sherry A. Tanumihardjo
- Interdepartmental
Graduate Program in Nutritional Sciences, University of Wisconsin—Madison, 1415 Linden Dr., 53706 Madison, Wisconsin, United States
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Taleon V, Mugode L, Cabrera-Soto L, Palacios-Rojas N. Carotenoid retention in biofortified maize using different post-harvest storage and packaging methods. Food Chem 2017; 232:60-66. [PMID: 28490117 PMCID: PMC5437647 DOI: 10.1016/j.foodchem.2017.03.158] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/17/2017] [Accepted: 03/29/2017] [Indexed: 11/29/2022]
Abstract
Orange maize is being promoted as a source of provitamin A carotenoids (pVAC) in Zambia. Carotenoid retention in orange maize grains stored in metal silos, multilayer polyethylene and common woven bags, and maize meal packaged in single and multilayer polyethylene bags was evaluated. Significant differences in total pVAC retention were found between grain storage methods (48.1-57.2%) after 6months of storage. Total pVAC retention in hammer meal (73.1-73.5%) was higher than in breakfast meal (64.3-69.3%) after 4months of storage; however, no differences in pVAC retention were found between meal types when stored in single and multilayer polyethylene bags. In general, β-cryptoxanthin (βCX) had higher retention than β-carotene (βC). Potential contribution of stored orange maize to the estimated average requirement of children and women was 26.5% and 24.3%, respectively. Orange maize meal can provide significant amounts of provitamin A to diets of Zambians even after 4months of storage.
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Affiliation(s)
- Víctor Taleon
- HarvestPlus, c/o IFPRI 2033 K Street, NW, Washington, DC 20006-1002, USA.
| | - Luke Mugode
- Department of Food Science, Postharvest Technology Research Laboratory, Stellenbosch University, Private Bag X1, Stellenbosch 7602, South Africa
| | - Luisa Cabrera-Soto
- Global Maize Program, International Maize and Wheat Improvement Center (CIMMYT), CIMMYT Research Station, Km. 45 Carretera Mexico-Veracruz, El Batan, Texcoco CP 56237, Edo. de México, Mexico
| | - Natalia Palacios-Rojas
- Global Maize Program, International Maize and Wheat Improvement Center (CIMMYT), CIMMYT Research Station, Km. 45 Carretera Mexico-Veracruz, El Batan, Texcoco CP 56237, Edo. de México, Mexico
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86
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Sheftel J, Gannon BM, Davis CR, Tanumihardjo SA. Provitamin A-biofortified maize consumption increases serum xanthophylls and 13C-natural abundance of retinol in Zambian children. Exp Biol Med (Maywood) 2017; 242:1508-1514. [PMID: 28836851 DOI: 10.1177/1535370217728500] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Plants that undergo C4 photosynthesis, such as maize, are enriched in the stable isotope of carbon (13C) compared with other dietary plants and foods. Consumption of maize that has been biofortified to contain elevated levels of provitamin A carotenoids (orange maize) increased the abundance of 13C in serum retinol of Mongolian gerbils. We evaluated this method in humans to determine if it has potential for further use in intervention effectiveness studies. A random subset of samples from a two-month randomized controlled feeding trial of rural three- to five-year old Zambian children were used to determine the impact of orange maize intake on serum carotenoid concentrations ( n = 88) and 13C-natural abundance in serum retinol ( n = 77). Concentrations of β-cryptoxanthin (a xanthophyll provitamin A carotenoid) and the dihydroxy xanthophylls lutein and zeaxanthin, which do not have vitamin A activity, were elevated in children consuming orange maize compared with those consuming a white maize control ( P < 0.001), while β-carotene was not different ( P > 0.3). Furthermore, 13C natural abundance was higher after two months' intervention in the orange maize group compared with the white maize group ( P = 0.049). Predictions made from equations developed in the aforementioned gerbil study estimated that maize provided 11% (2-21%, 95% confidence interval) of the recent dietary vitamin A to these children. These results demonstrate that orange maize is efficacious at providing retinol to the vitamin A pool in children through provitamin A carotenoids, as monitored by the change in 13C enrichment, which was not reflected in serum β-carotene concentrations. Further effectiveness studies in countries who have adopted orange maize should consider determining differences in retinol 13C-enrichment among target groups in addition to profiling serum xanthophyll carotenoids with specific emphasis on zeaxanthin. Impact statement Maize biofortified with provitamin A carotenoids (orange) has been released in some African markets. Responsive and sensitive methods to evaluate dissemination effectiveness are needed. This study investigated methods to evaluate effectiveness of orange maize consumption using serum from Zambian children fed orange maize for two months. Many varieties of orange maize contain higher amounts of the xanthophyll carotenoids in addition to β-carotene compared with typical varieties. This study uniquely showed higher concentrations of the maize xanthophylls lutein, zeaxanthin, and β-cryptoxanthin in children who consumed orange maize compared with white. Furthermore, maize is a C4 plant and is therefore naturally enriched with 13C. Higher 13C was detected in the serum retinol of the orange maize consumers with no change in serum β-carotene concentration suggesting preferential bioconversion to retinol. The combined analyses of serum zeaxanthin specifically and 13C-natural abundance of retinol could prove useful in effectiveness studies between orange maize adopters and non-adopters.
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Affiliation(s)
- Jesse Sheftel
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Bryan M Gannon
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Christopher R Davis
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Sherry A Tanumihardjo
- Interdepartmental Graduate Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
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87
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Schaub P, Wüst F, Koschmieder J, Yu Q, Virk P, Tohme J, Beyer P. Nonenzymatic β-Carotene Degradation in Provitamin A-Biofortified Crop Plants. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2017; 65:6588-6598. [PMID: 28703588 DOI: 10.1021/acs.jafc.7b01693] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Provitamin A biofortification, the provision of provitamin A carotenoids through agriculture, is regarded as an effective and sustainable intervention to defeat vitamin A deficiency, representing a global health problem. This food-based intervention has been questioned in conjunction with negative outcomes for smokers and asbestos-exposed populations of the CARET and ATBC trials in which very high doses of β-carotene were supplemented. The current notion that β-carotene cleavage products (apocarotenoids) represented the harmful agents is the basis of the here-presented research. We quantitatively analyzed numerous plant food items and concluded that neither the amounts of apocarotenoids nor β-carotene provided by plant tissues, be they conventional or provitamin A-biofortified, pose an increased risk. We also investigated β-carotene degradation pathways over time. This reveals a substantial nonenzymatic proportion of carotene decay and corroborates the quantitative relevance of highly oxidized β-carotene polymers that form in all plant tissues investigated.
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Affiliation(s)
- Patrick Schaub
- Faculty of Biology, University of Freiburg , Schaenzlestrasse 1, D79104 Freiburg, Germany
| | - Florian Wüst
- Faculty of Biology, University of Freiburg , Schaenzlestrasse 1, D79104 Freiburg, Germany
| | - Julian Koschmieder
- Faculty of Biology, University of Freiburg , Schaenzlestrasse 1, D79104 Freiburg, Germany
| | - Qiuju Yu
- Faculty of Biology, University of Freiburg , Schaenzlestrasse 1, D79104 Freiburg, Germany
| | - Parminder Virk
- International Rice Research Institute (IRRI) , Los Baños, 4031 Laguna, Philippines
| | - Joe Tohme
- International Center for Tropical Agriculture (CIAT), Recta Cali-Palmira, CP 763537, Cali, Colombia
| | - Peter Beyer
- Faculty of Biology, University of Freiburg , Schaenzlestrasse 1, D79104 Freiburg, Germany
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88
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Saltzman A, Birol E, Oparinde A, Andersson MS, Asare-Marfo D, Diressie MT, Gonzalez C, Lividini K, Moursi M, Zeller M. Availability, production, and consumption of crops biofortified by plant breeding: current evidence and future potential. Ann N Y Acad Sci 2017; 1390:104-114. [PMID: 28253441 DOI: 10.1111/nyas.13314] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/21/2016] [Accepted: 01/02/2017] [Indexed: 11/28/2022]
Abstract
Biofortification is the process of increasing the density of vitamins and minerals in a crop through plant breeding-using either conventional methods or genetic engineering-or through agronomic practices. Over the past 15 years, conventional breeding efforts have resulted in the development of varieties of several staple food crops with significant levels of the three micronutrients most limiting in diets: zinc, iron, and vitamin A. More than 15 million people in developing countries now grow and consume biofortified crops. Evidence from nutrition research shows that biofortified varieties provide considerable amounts of bioavailable micronutrients, and consumption of these varieties can improve micronutrient deficiency status among target populations. Farmer adoption and consumer acceptance research shows that farmers and consumers like the various production and consumption characteristics of biofortified varieties, as much as (if not more than) popular conventional varieties, even in the absence of nutritional information. Further development and delivery of these micronutrient-rich varieties can potentially reduce hidden hunger, especially in rural populations whose diets rely on staple food crops. Future work includes strengthening the supply of and the demand for biofortified staple food crops and facilitating targeted investment to those crop-country combinations that have the highest potential nutritional impact.
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Affiliation(s)
- Amy Saltzman
- HarvestPlus, International Food Policy Research Institute, Washington, DC
| | - Ekin Birol
- HarvestPlus, International Food Policy Research Institute, Washington, DC
| | - Adewale Oparinde
- HarvestPlus, International Food Policy Research Institute, Washington, DC
| | - Meike S Andersson
- HarvestPlus, International Center for Tropical Agriculture (CIAT), Cali, Colombia
| | - Dorene Asare-Marfo
- HarvestPlus, International Food Policy Research Institute, Washington, DC
| | - Michael T Diressie
- HarvestPlus, International Food Policy Research Institute, Washington, DC
| | - Carolina Gonzalez
- HarvestPlus, International Center for Tropical Agriculture (CIAT), Cali, Colombia
| | - Keith Lividini
- HarvestPlus, International Food Policy Research Institute, Washington, DC
| | - Mourad Moursi
- HarvestPlus, International Food Policy Research Institute, Washington, DC
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89
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Ford JL, Green JB, Green MH. Should We Restrict Vitamin A Intake, a Minor Contributor to Plasma Retinol Turnover, When Using Retinol Isotope Dilution Equations to Estimate an Individual's Vitamin A Status, or Should Vitamin A Balance Be Maintained? J Nutr 2017; 147:1483-1486. [PMID: 28701388 DOI: 10.3945/jn.117.254441] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/02/2017] [Accepted: 06/07/2017] [Indexed: 11/14/2022] Open
Abstract
We discuss whether dietary vitamin A intake should be restricted or maintained at balance when retinol isotope dilution equations are applied to estimate an individual's vitamin A total body stores (TBS) after oral administration of a labeled dose of vitamin A. Although, at first glance, restriction makes sense as a way to prevent dilution of tracer in plasma, further investigation of the assumptions underlying the widely used isotope dilution equation presented by Olson's laboratory in 1989, as well as the compartmental modeling results presented in this article, indicate that, in fact, restriction leads to an incorrect prediction of TBS if steady state retinol isotope dilution equations are applied at the traditional time (21 d). Our results show that newly ingested vitamin A is a minor contributor to total plasma retinol turnover and that restriction of vitamin A intake leads to a higher plasma retinol specific activity than the value obtained when vitamin A input equals output (balance). When that higher specific activity is used in the traditional retinol isotope dilution equation, it results in a small but notable underestimation of vitamin A TBS. We conclude that, especially if blood is sampled at the traditional time, the most accurate results will be obtained when vitamin A balance is maintained. If sampling is done soon after dosing (e.g., 4 d), dietary intake has less effect on plasma retinol specific activity and thus on predictions of vitamin A status. Vitamin A status can also be estimated if intake is completely restricted and a different (non-steady state) equation is applied at an appropriate time after isotopic equilibrium has been reached.
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Affiliation(s)
- Jennifer Lynn Ford
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA
| | - Joanne Balmer Green
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA
| | - Michael H Green
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA
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90
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De Steur H, Mehta S, Gellynck X, Finkelstein JL. GM biofortified crops: potential effects on targeting the micronutrient intake gap in human populations. Curr Opin Biotechnol 2017; 44:181-188. [DOI: 10.1016/j.copbio.2017.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/06/2017] [Accepted: 02/11/2017] [Indexed: 12/16/2022]
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91
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Imdad A, Mayo‐Wilson E, Herzer K, Bhutta ZA. Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. Cochrane Database Syst Rev 2017; 3:CD008524. [PMID: 28282701 PMCID: PMC6464706 DOI: 10.1002/14651858.cd008524.pub3] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Vitamin A deficiency (VAD) is a major public health problem in low- and middle-income countries, affecting 190 million children under five years of age and leading to many adverse health consequences, including death. Based on prior evidence and a previous version of this review, the World Health Organization has continued to recommend vitamin A supplementation for children aged 6 to 59 months. There are new data available from recently published randomised trials since the previous publication of this review in 2010, and this update incorporates this information and reviews the evidence. OBJECTIVES To assess the effects of vitamin A supplementation (VAS) for preventing morbidity and mortality in children aged six months to five years. SEARCH METHODS In March 2016 we searched CENTRAL, Ovid MEDLINE, Embase, six other databases, and two trials registers. We also checked reference lists and contacted relevant organisations and researchers to identify additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-RCTs evaluating the effect of synthetic VAS in children aged six months to five years living in the community. We excluded studies involving children in hospital and children with disease or infection. We also excluded studies evaluating the effects of food fortification, consumption of vitamin A rich foods, or beta-carotene supplementation. DATA COLLECTION AND ANALYSIS For this update, two reviewers independently assessed studies for inclusion and abstracted data, resolving discrepancies by discussion. We performed meta-analyses for outcomes, including all-cause and cause-specific mortality, disease, vision, and side effects. We used the GRADE approach to assess the quality of the evidence. MAIN RESULTS We identified 47 studies (4 of which are new to this review), involving approximately 1,223,856 children. Studies took place in 19 countries: 30 (63%) in Asia, 16 of these in India; 8 (17%) in Africa; 7 (15%) in Latin America, and 2 (4%) in Australia. About one-third of the studies were in urban/periurban settings, and half were in rural settings; the remaining studies did not clearly report settings. Most of the studies included equal numbers of girls and boys and lasted about a year. The included studies were at variable overall risk of bias; however, evidence for the primary outcome was at low risk of bias. A meta-analysis for all-cause mortality included 19 trials (1,202,382 children). At longest follow-up, there was a 12% observed reduction in the risk of all-cause mortality for vitamin A compared with control using a fixed-effect model (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.83 to 0.93; high-quality evidence). This result was sensitive to choice of model, and a random-effects meta-analysis showed a different summary estimate (24% reduction: RR 0.76, 95% CI 0.66 to 0.88); however, the confidence intervals overlapped with that of the fixed-effect model. Nine trials reported mortality due to diarrhoea and showed a 12% overall reduction for VAS (RR 0.88, 95% CI 0.79 to 0.98; 1,098,538 participants; high-quality evidence). There was no significant effect for VAS on mortality due to measles, respiratory disease, and meningitis. VAS reduced incidence of diarrhoea (RR 0.85, 95% CI 0.82 to 0.87; 15 studies; 77,946 participants; low-quality evidence) and measles (RR 0.50, 95% CI 0.37 to 0.67; 6 studies; 19,566 participants; moderate-quality evidence). However, there was no significant effect on incidence of respiratory disease or hospitalisations due to diarrhoea or pneumonia. There was an increased risk of vomiting within the first 48 hours of VAS (RR 1.97, 95% CI 1.44 to 2.69; 4 studies; 10,541 participants; moderate-quality evidence). AUTHORS' CONCLUSIONS Vitamin A supplementation is associated with a clinically meaningful reduction in morbidity and mortality in children. Therefore, we suggest maintaining the policy of universal supplementation for children under five years of age in populations at risk of VAD. Further placebo-controlled trials of VAS in children between six months and five years of age would not change the conclusions of this review, although studies that compare different doses and delivery mechanisms are needed. In populations with documented vitamin A deficiency, it would be unethical to conduct placebo-controlled trials.
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Affiliation(s)
- Aamer Imdad
- Vanderbilt University School of MedicineDepartment of Pediatrics, D. Brent Polk Division of Gastroenterology, Hepatology and NutritionNashvilleTNUSA37212
| | - Evan Mayo‐Wilson
- Johns Hopkins University Bloomberg School of Public HealthDepartment of Epidemiology615 North Wolfe StreetBaltimoreMarylandUSA21205
| | - Kurt Herzer
- Johns Hopkins School of MedicineTower 711600 North Wolfe St.BaltimoreMDUSA21287
| | - Zulfiqar A Bhutta
- Hospital for Sick ChildrenCentre for Global Child HealthTorontoONCanadaM5G A04
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92
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Rubin LP, Ross AC, Stephensen CB, Bohn T, Tanumihardjo SA. Metabolic Effects of Inflammation on Vitamin A and Carotenoids in Humans and Animal Models. Adv Nutr 2017; 8:197-212. [PMID: 28298266 PMCID: PMC5347109 DOI: 10.3945/an.116.014167] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The association between inflammation and vitamin A (VA) metabolism and status assessment has been documented in multiple studies with animals and humans. The relation between inflammation and carotenoid status is less clear. Nonetheless, it is well known that carotenoids are associated with certain health benefits. Understanding these relations is key to improving health outcomes and mortality risk in infants and young children. Hyporetinolemia, i.e., low serum retinol concentrations, occurs during inflammation, and this can lead to the misdiagnosis of VA deficiency. On the other hand, inflammation causes impaired VA absorption and urinary losses that can precipitate VA deficiency in at-risk groups of children. Many epidemiologic studies have suggested that high dietary carotenoid intake and elevated plasma concentrations are correlated with a decreased risk of several chronic diseases; however, large-scale carotenoid supplementation trials have been unable to confirm the health benefits and in some cases resulted in controversial results. However, it has been documented that dietary carotenoids and retinoids play important roles in innate and acquired immunity and in the body's response to inflammation. Although animal models have been useful in investigating retinoid effects on developmental immunity, it is more challenging to tease out the effects of carotenoids because of differences in the absorption, kinetics, and metabolism between humans and animal models. The current understanding of the relations between inflammation and retinoid and carotenoid metabolism and status are the topics of this review.
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Affiliation(s)
- Lewis P Rubin
- Texas Tech Health Sciences Center El Paso, El Paso, TX
| | | | | | - Torsten Bohn
- Luxembourg Institute of Health, Population Health Department, Strassen, Luxembourg; and
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93
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Gannon BM, Pixley KV, Tanumihardjo SA. Maize Milling Method Affects Growth and Zinc Status but Not Provitamin A Carotenoid Bioefficacy in Male Mongolian Gerbils. J Nutr 2017; 147:337-345. [PMID: 28148686 PMCID: PMC5320399 DOI: 10.3945/jn.116.241935] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/26/2016] [Accepted: 12/27/2016] [Indexed: 12/18/2022] Open
Abstract
Background: Vitamin A (VA) and zinc deficiencies are prevalent. Maize is a common staple, and milling affects nutrient and nutrient-modifier profiles.Objective: We investigated the interaction of maize milling methods (i.e., whole grain compared with refined) in male Mongolian gerbils aged 29-35 d with conventionally bred provitamin A-biofortified (orange) or white maize on VA and zinc status.Methods: Study 1 (n = 67) was a 2 × 3 milling (whole compared with refined) by VA [no-vitamin A placebo group (VA-), orange, and VA-supplemented group (VA+)] design, with 4 wk of VA depletion followed by six 4-wk treatments (n = 10/treatment). Study 2 (n = 33) was a 2 × 2 milling-by-zinc [no-zinc placebo group (Zn-) compared with zinc-supplemented group (Zn+)] design, including 2 wk of VA depletion followed by four 3-wk treatments (n = 8-9/treatment). For study 1, positive and negative control groups were given supplemental VA at equimolar amounts to β-carotene equivalents consumed by the orange groups (74 ± 5 nmol/d) or placebo, respectively. For study 2, positive and negative control groups were given 152 μg Zn/d or placebo, respectively.Results: Milling significantly affected zinc concentration, providing 44-45% (whole grain) or 9-14% (refined) NRC requirements. In study 1, orange maize improved liver VA concentrations (mean ± SD: 0.28 ± 0.08 μmol/g) compared with the white maize groups (0.072 ± 0.054 μmol/g). Provitamin A bioefficacy was similar. In study 2, neither zinc nor milling influenced liver retinol. Refined Zn- gerbils weighed less than others by day 14 (46.6 ± 7.1 compared with 56.5 ± 3.5 g, respectively; P < 0.0001). Milling affected pancreas zinc concentrations (refined Zn-: 21.1 ± 1.8 μg Zn/g; whole Zn-: 32.5 ± 5.8 μg Zn/g).Conclusions: Whole-grain intake improved zinc and did not affect provitamin A bioefficacy. Other factors affected by milling (e.g., shelf life, preference, aflatoxin fractioning) need to be considered to maximize health.
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Affiliation(s)
- Bryan M Gannon
- Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, and
| | - Kevin V Pixley
- Department of Agronomy, University of Wisconsin-Madison, Madison, WI; and
- International Maize and Wheat Improvement Center, Texcoco, Mexico
| | - Sherry A Tanumihardjo
- Interdepartmental Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, and
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94
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Bouis HE, Saltzman A. Improving nutrition through biofortification: A review of evidence from HarvestPlus, 2003 through 2016. GLOBAL FOOD SECURITY 2017; 12:49-58. [PMID: 28580239 PMCID: PMC5439484 DOI: 10.1016/j.gfs.2017.01.009] [Citation(s) in RCA: 355] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 01/25/2017] [Accepted: 01/27/2017] [Indexed: 01/14/2023]
Abstract
Biofortification is a feasible and cost-effective means of delivering micronutrients to populations that may have limited access to diverse diets and other micronutrient interventions. Since 2003, HarvestPlus and its partners have demonstrated that this agriculture-based method of addressing micronutrient deficiency through plant breeding works. More than 20 million people in farm households in developing countries are now growing and consuming biofortified crops. This review summarizes key evidence and discusses delivery experiences, as well as farmer and consumer adoption. Given the strength of the evidence, attention should now shift to an action-oriented agenda for scaling biofortification to improve nutrition globally. To reach one billion people by 2030, there are three key challenges: 1) mainstreaming biofortified traits into public plant breeding programs; 2) building consumer demand; and 3) integrating biofortification into public and private policies, programs, and investments. While many building blocks are in place, institutional leadership is needed to continue to drive towards this ambitious goal.
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Affiliation(s)
- Howarth E. Bouis
- International Food Policy Research Institute, Washington, DC, United States
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95
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Wirth JP, Petry N, Tanumihardjo SA, Rogers LM, McLean E, Greig A, Garrett GS, Klemm RDW, Rohner F. Vitamin A Supplementation Programs and Country-Level Evidence of Vitamin A Deficiency. Nutrients 2017; 9:nu9030190. [PMID: 28245571 PMCID: PMC5372853 DOI: 10.3390/nu9030190] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 12/15/2022] Open
Abstract
Vitamin A supplementation (VAS) programs targeted at children aged 6–59 months are implemented in many countries. By improving immune function, vitamin A (VA) reduces mortality associated with measles, diarrhea, and other illnesses. There is currently a debate regarding the relevance of VAS, but amidst the debate, researchers acknowledge that the majority of nationally-representative data on VA status is outdated. To address this data gap and contribute to the debate, we examined data from 82 countries implementing VAS programs, identified other VA programs, and assessed the recentness of national VA deficiency (VAD) data. We found that two-thirds of the countries explored either have no VAD data or data that were >10 years old (i.e., measured before 2006), which included twenty countries with VAS coverage ≥70%. Fifty-one VAS programs were implemented in parallel with at least one other VA intervention, and of these, 27 countries either had no VAD data or data collected in 2005 or earlier. To fill these gaps in VAD data, countries implementing VAS and other VA interventions should measure VA status in children at least every 10 years. At the same time, the coverage of VA interventions can also be measured. We identified three countries that have scaled down VAS, but given the lack of VA deficiency data, this would be a premature undertaking in most countries without appropriate status assessment. While the global debate about VAS is important, more attention should be directed towards individual countries where programmatic decisions are made.
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Affiliation(s)
| | | | - Sherry A Tanumihardjo
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA.
| | - Lisa M Rogers
- Department of Nutrition for Health and Development, World Health Organization, 1207 Geneva, Switzerland.
| | - Erin McLean
- UNICEF Headquarters, New York, NY 10017, USA.
| | - Alison Greig
- Infant and Young Child Nutrition, Micronutrient Initiative, Ottawa, ON K2P 2K3, Canada.
| | - Greg S Garrett
- Global Alliance for Improved Nutrition, 1202 Geneva, Switzerland.
| | - Rolf D W Klemm
- Helen Keller International, New York, NY 10010, USA.
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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96
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Cañete A, Cano E, Muñoz-Chápuli R, Carmona R. Role of Vitamin A/Retinoic Acid in Regulation of Embryonic and Adult Hematopoiesis. Nutrients 2017; 9:E159. [PMID: 28230720 PMCID: PMC5331590 DOI: 10.3390/nu9020159] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 02/05/2017] [Accepted: 02/16/2017] [Indexed: 12/11/2022] Open
Abstract
Vitamin A is an essential micronutrient throughout life. Its physiologically active metabolite retinoic acid (RA), acting through nuclear retinoic acid receptors (RARs), is a potent regulator of patterning during embryonic development, as well as being necessary for adult tissue homeostasis. Vitamin A deficiency during pregnancy increases risk of maternal night blindness and anemia and may be a cause of congenital malformations. Childhood Vitamin A deficiency can cause xerophthalmia, lower resistance to infection and increased risk of mortality. RA signaling appears to be essential for expression of genes involved in developmental hematopoiesis, regulating the endothelial/blood cells balance in the yolk sac, promoting the hemogenic program in the aorta-gonad-mesonephros area and stimulating eryrthropoiesis in fetal liver by activating the expression of erythropoietin. In adults, RA signaling regulates differentiation of granulocytes and enhances erythropoiesis. Vitamin A may facilitate iron absorption and metabolism to prevent anemia and plays a key role in mucosal immune responses, modulating the function of regulatory T cells. Furthermore, defective RA/RARα signaling is involved in the pathogenesis of acute promyelocytic leukemia due to a failure in differentiation of promyelocytes. This review focuses on the different roles played by vitamin A/RA signaling in physiological and pathological mouse hematopoiesis duddurring both, embryonic and adult life, and the consequences of vitamin A deficiency for the blood system.
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Affiliation(s)
- Ana Cañete
- Department of Animal Biology, Faculty of Science, University of Malaga, Campus de Teatinos s/n Malaga 29071, Spain and Andalusian Center for Nanomedicine and Biotechnology (BIONAND), Severo Ochoa 25, Campanillas 29590, Spain.
| | - Elena Cano
- Max-Delbruck Center for Molecular Medicine, Robert Roessle-Strasse 10, 13125 Berlin, Germany.
| | - Ramón Muñoz-Chápuli
- Department of Animal Biology, Faculty of Science, University of Malaga, Campus de Teatinos s/n Malaga 29071, Spain and Andalusian Center for Nanomedicine and Biotechnology (BIONAND), Severo Ochoa 25, Campanillas 29590, Spain.
| | - Rita Carmona
- Department of Animal Biology, Faculty of Science, University of Malaga, Campus de Teatinos s/n Malaga 29071, Spain and Andalusian Center for Nanomedicine and Biotechnology (BIONAND), Severo Ochoa 25, Campanillas 29590, Spain.
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97
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Tanumihardjo SA, Ball AM, Kaliwile C, Pixley KV. The research and implementation continuum of biofortified sweet potato and maize in Africa. Ann N Y Acad Sci 2017; 1390:88-103. [PMID: 28187234 DOI: 10.1111/nyas.13315] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 01/09/2023]
Abstract
The enhancement of sweet potato and maize with provitamin A carotenoids has been part of HarvestPlus's research continuum since the formation of the biofortification project. This review includes case studies of biofortification strategies used for sweet potato in Uganda and orange maize in Zambia. The current status of the science and release of biofortified varieties was reviewed by three scientists who were part of the HarvestPlus program for more than a decade with input from a scientist who experienced orange maize dissemination in Zambia. High β-carotene varieties of sweet potato were introduced into South Africa and Mozambique, and efficacy and effectiveness studies, respectively, showed promise to improve vitamin A status, followed by dissemination efforts in Uganda. A randomized, controlled effectiveness trial tested extension models to promote sweet potato and assessed vitamin A intake among Ugandans. Orange maize breeding was initially a challenge, but considering that the carotenoid biosynthetic pathway was present in maize germplasm, breeders quickly bred higher amounts of provitamin A into the maize that was ultimately released in Zambia. Initial resistance occurred because orange maize was associated with yellow maize, which had negative connotations associated with food aid and animal feed, and consumers preferred white maize. Currently, both orange crops are available on the market.
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Affiliation(s)
- Sherry A Tanumihardjo
- Nutritional Sciences Department, University of Wisconsin-Madison, Madison, Wisconsin
| | | | | | - Kevin V Pixley
- International Maize and Wheat Improvement Center, Texcoco, Mexico
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Bechoff A, Dhuique-Mayer C. Factors influencing micronutrient bioavailability in biofortified crops. Ann N Y Acad Sci 2016; 1390:74-87. [PMID: 28009050 DOI: 10.1111/nyas.13301] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 01/09/2023]
Abstract
Dietary and human factors have been found to be the major factors influencing the bioavailability of micronutrients, such as provitamin A carotenoid (pVAC), iron, and zinc, in biofortified crops. Dietary factors are related to food matrix structure and composition. Processing can improve pVAC bioavailability by disrupting the food matrix but can also result in carotenoid losses. By degrading antinutrients, such as phytate, processing can also enhance mineral bioavailability. In in vivo interventions, biofortified crops have been shown to be overall efficacious in reducing micronutrient deficiency, with bioconversion factors varying between 2.3:1 and 10.4:1 for trans-β-carotene and amounts of iron and zinc absorbed varying between 0.7 and 1.1 mg/day and 1.1 and 2.1 mg/day, respectively. Micronutrient bioavailability was dependent on the crop type and the presence of fat for pVACs and on antinutrients for minerals. In addition to dietary factors, human factors, such as inflammation and disease, can affect micronutrient status. Understanding the interactions between micronutrients is also essential, for example, the synergic effect of iron and pVACs or the competitive effect of iron and zinc. Future efficacy trials should consider human status and genetic polymorphisms linked to interindividual variations.
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Affiliation(s)
- Aurélie Bechoff
- Natural Resources Institute (NRI), University of Greenwich, Kent, UK
| | - Claudie Dhuique-Mayer
- Department of Persyst-UMR Qualisud, Centre de Coopération Internationale en Recherche Agronomique pour le Développement (CIRAD), Montpellier, France
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Garcia-Casal MN, Peña-Rosas JP, Giyose B. Staple crops biofortified with increased vitamins and minerals: considerations for a public health strategy. Ann N Y Acad Sci 2016; 1390:3-13. [PMID: 27936288 DOI: 10.1111/nyas.13293] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/18/2016] [Indexed: 01/21/2023]
Abstract
Biofortification of staple crops has been proposed as a strategy to address micronutrient malnutrition, particularly with respect to insufficient intake of vitamin A, iron, zinc, and folate. The World Health Organization, in collaboration with the Food and Agriculture Organization of the United Nations and the Sackler Institute for Nutrition Science at the New York Academy of Sciences, convened a technical consultation entitled "Staple Crops Biofortified with Vitamins and Minerals: Considerations for a Public Health Strategy" in April 2016. Participants of the consultation reviewed the definition of biofortification of staple crops, patterns of crops production, processing, consumption, seed varieties, and micronutrient stability and bioavailability, as well as farmers' adoption and acceptability of the modified crops. Also discussed were economic, environmental, safety, and equity aspects of biofortified crops, as well as legal, policy, regulatory, and ethical issues for the implementation of biofortification strategies in agriculture and nutrition. Consultation working groups identified important and emerging technical issues, lessons learned, and research priorities to better support the evidence of improved nutrition and unintended adverse effects of biofortification. This paper provides the background and rationale of the technical consultation, synopsizes the presentations, and provides a summary of the main considerations proposed by the working groups.
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Affiliation(s)
- Maria Nieves Garcia-Casal
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Juan Pablo Peña-Rosas
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Boitshepo Giyose
- Division of Nutrition, Food and Agriculture Organization of the United Nations, Rome, Italy
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Palmer AC, Healy K, Barffour MA, Siamusantu W, Chileshe J, Schulze KJ, West KP, Labrique AB. Provitamin A Carotenoid-Biofortified Maize Consumption Increases Pupillary Responsiveness among Zambian Children in a Randomized Controlled Trial. J Nutr 2016; 146:2551-2558. [PMID: 27798345 DOI: 10.3945/jn.116.239202] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/09/2016] [Accepted: 09/14/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Impaired dark adaptation is an early functional indicator of vitamin A deficiency that may be prevented by regular dietary intake of foods containing provitamin A carotenoids. OBJECTIVE We tested the impact of provitamin A carotenoid-biofortified maize consumption (∼15 μg β-carotene/g) on dark adaptation in Zambian children. METHODS We used a cluster-randomized trial of children aged 4-8 y (n = 1024) in Mkushi District, Zambia, and compared the regular consumption (2 meals/d, 6 d/wk for 6 mo) of biofortified orange maize (OM) to white maize (WM). The primary outcome was the serum retinol response. In a random sample (n = 542), we used a digital pupillometer to test pre- and postintervention responses to graded light stimuli (-2.9 to 0.1 log cd/m2) in a dark-adapted state. RESULTS At baseline, 11.7% of the children had serum retinol <0.7 μmol/L, 14.4% had impaired dark adaptation (pupillary threshold ≥ -1.11 log cd/m2), and 2.3% had night blindness. The mean ± SD pupillary responsiveness to light stimuli was poorer at baseline in the OM group (16.1% ± 6.6%) than the WM group (18.1% ± 6.4%) (P = 0.02) but did not differ at follow-up (OM: 17.6% ± 6.5%; WM: 18.3% ± 6.5%). Among children with serum retinol <1.05 μmol/L at baseline, there was greater improvement in pupillary responsiveness in the OM group (2.2%; 95% CI: 0.1%, 4.3%) than the WM group (0.2%; 95% CI: -1.1%, 1.5%; P = 0.01), but there were no differences in children with adequate baseline status. We found no effect of treatment on pupillary threshold or night blindness. CONCLUSIONS The regular consumption of provitamin A carotenoid-biofortified maize increased pupillary responsiveness among children with marginal or deficient vitamin A status, providing evidence of a functional benefit to consuming this biofortified crop. This trial was registered at clinicaltrials.gov as NCT01695148.
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Affiliation(s)
- Amanda C Palmer
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD;
| | - Katherine Healy
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Maxwell A Barffour
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | | | | | - Kerry J Schulze
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Alain B Labrique
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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