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Loechl CU, Datta-Mitra A, Fenlason L, Green R, Hackl L, Itzkowitz L, Koso-Thomas M, Moorthy D, Owino VO, Pachón H, Stoffel N, Zimmerman MB, Raiten DJ. Approaches to Address the Anemia Challenge. J Nutr 2023; 153 Suppl 1:S42-S59. [PMID: 37714779 PMCID: PMC10797550 DOI: 10.1016/j.tjnut.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 09/17/2023] Open
Abstract
Anemia is a multifactorial condition; approaches to address it must recognize that the causal factors represent an ecology consisting of internal (biology, genetics, and health) and external (social/behavioral/demographic and physical) environments. In this paper, we present an approach for selecting interventions, followed by a description of key issues related to the multiple available interventions for prevention and reduction of anemia. We address interventions for anemia using the following 2 main categories: 1) those that address nutrients alone, and, 2) those that address nonnutritional causes of anemia. The emphasis will be on interventions of public health relevance, but we also consider the clinical context. We also focus on interventions at different stages of the life course, with a particular focus on women of reproductive age and preschool-age children, and present evidence on various factors to consider when selecting an intervention-inflammation, genetic mutations, nutrient delivery, bioavailability, and safety. Each section on an intervention domain concludes with a brief discussion of key research areas.
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Affiliation(s)
- Cornelia U Loechl
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Ananya Datta-Mitra
- Department of Pathology and Laboratory Medicine, University of California, Davis, Davis, CA, United States
| | - Lindy Fenlason
- Bureau for Global Health, USAID, Washington, DC, United States
| | - Ralph Green
- Department of Pathology and Laboratory Medicine, University of California, Davis, Davis, CA, United States
| | - Laura Hackl
- USAID Advancing Nutrition, John Snow Inc., Arlington, VA, United States
| | - Laura Itzkowitz
- Bureau for Global Health, USAID, Washington, DC, United States
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health, Bethesda, MD, Unites States
| | - Denish Moorthy
- USAID Advancing Nutrition, John Snow Inc., Arlington, VA, United States.
| | | | - Helena Pachón
- Food Fortification Initiative, Emory University, Atlanta, GA, United States
| | - Nicole Stoffel
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Zu¨rich, Switzerland; MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Michael B Zimmerman
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health, Bethesda, MD, Unites States
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2
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Bremer AA, Raiten DJ. The Reciprocal Relationship between Climate and Environmental Changes and Food Systems and Its Impact on Food/Nutrition Security and Health. Nutrients 2023; 15:2824. [PMID: 37447151 DOI: 10.3390/nu15132824] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
Changes in our climate and physical environments are having profound effects on all aspects of human existence, and the ability to develop sustainable and resilient food systems is critical not just to the environment but to all aspects of human health. The Pediatric Growth and Nutrition Branch (PGNB) of the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the US National Institutes of Health has adopted a new paradigm to undergird the study of nutrition that recognizes the complex and reciprocal nature of the relationships between nutrition and health outcomes. This conceptual framework, termed the "nutritional ecology," views humans as complex biological systems interacting with both their internal and external environments. Herein, we focus on: (i) the reciprocal relationship between climate and environmental changes and food systems and their impact on food/nutrition security and health; and (ii) how PGNB is utilizing the "nutritional ecology" framework to support science addressing the interactions among health, nutrition, food systems, climate, and the environment.
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Affiliation(s)
- Andrew A Bremer
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, 6710B Rockledge Drive-Rm 2444, Bethesda, MD 20892, USA
| | - Daniel J Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, 6710B Rockledge Drive-Rm 2444, Bethesda, MD 20892, USA
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Raiten DJ, Bremer AA. Exploring the intersection of climate/environmental change, food systems, nutrition, and health: global challenge, opportunity, or both? Am J Clin Nutr 2023; 117:224-226. [PMID: 36811569 PMCID: PMC10196608 DOI: 10.1016/j.ajcnut.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Daniel J Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA.
| | - Andrew A Bremer
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
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Vaidya SR, Syed Gaggatur N, Sange AH, Srinivas N, Sarnaik MK, Pisipati Y, Sange I. "Are We Feeding Them Enough?" Micronutrient Deficiency in Children Aged Six Months to Fourteen Years in India. Cureus 2021; 13:e19405. [PMID: 34926007 PMCID: PMC8658046 DOI: 10.7759/cureus.19405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
In this study, we conducted a systematic literature review of the various micronutrient deficiencies (MNDs) that affect children in India and an examination of whether there is a geographic basis for MNDs. MNDs are a common problem in the developing world, in particular, among children in South Asia. According to the United Nations Children’s Fund, millions of children suffer from stunted growth, cognitive delays, weakened immunity, and diseases because of MNDs. These physical ailments have several economic, social, and public health implications, and they can severely hamper a country’s growth. This study aims to clarify existing data on this topic and highlight the disparities between children living in urban and rural areas in India. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to conduct this systematic literature review of a total of five studies. Study quality was assessed using appropriate checklists, and the studies strengthened the hypothesis that MNDs are common among children in India. Because the selected studies were heterogeneous, no statistical conclusions are drawn here. However, a central premise is that MNDs in children are prevalent in India and are related to poverty. No link between geographic location and MNDs is established; rather, recommendations are made for further research on the topic.
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Affiliation(s)
- Sarayoo R Vaidya
- Internal Medicine and Pediatrics, M S Ramaiah Medical College, Bengaluru, IND.,International Health, Charité - Universitätsmedizin Berlin, Berlin, DEU
| | - Naqvi Syed Gaggatur
- Internal Medicine and Pediatrics, M S Ramaiah Medical College, Bengaluru, IND
| | - Aliya H Sange
- Research, K. J. Somaiya Medical College, Mumbai, IND
| | - Natasha Srinivas
- Research, BGS Global Institute of Medical Sciences, Bengaluru, IND
| | - Mubashira K Sarnaik
- Internal Medicine and Pediatrics, M S Ramaiah Medical College, Bengaluru, IND
| | - Yasaswi Pisipati
- Internal Medicine and Pediatrics, M S Ramaiah Medical College, Bengaluru, IND
| | - Ibrahim Sange
- Research, K. J. Somaiya Medical College, Mumbai, IND
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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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Lynch S, Pfeiffer CM, Georgieff MK, Brittenham G, Fairweather-Tait S, Hurrell RF, McArdle HJ, Raiten DJ. Biomarkers of Nutrition for Development (BOND)-Iron Review. J Nutr 2018; 148:1001S-1067S. [PMID: 29878148 PMCID: PMC6297556 DOI: 10.1093/jn/nxx036] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/27/2017] [Accepted: 11/07/2017] [Indexed: 12/20/2022] Open
Abstract
This is the fifth in the series of reviews developed as part of the Biomarkers of Nutrition for Development (BOND) program. The BOND Iron Expert Panel (I-EP) reviewed the extant knowledge regarding iron biology, public health implications, and the relative usefulness of currently available biomarkers of iron status from deficiency to overload. Approaches to assessing intake, including bioavailability, are also covered. The report also covers technical and laboratory considerations for the use of available biomarkers of iron status, and concludes with a description of research priorities along with a brief discussion of new biomarkers with potential for use across the spectrum of activities related to the study of iron in human health.The I-EP concluded that current iron biomarkers are reliable for accurately assessing many aspects of iron nutrition. However, a clear distinction is made between the relative strengths of biomarkers to assess hematological consequences of iron deficiency versus other putative functional outcomes, particularly the relationship between maternal and fetal iron status during pregnancy, birth outcomes, and infant cognitive, motor and emotional development. The I-EP also highlighted the importance of considering the confounding effects of inflammation and infection on the interpretation of iron biomarker results, as well as the impact of life stage. Finally, alternative approaches to the evaluation of the risk for nutritional iron overload at the population level are presented, because the currently designated upper limits for the biomarker generally employed (serum ferritin) may not differentiate between true iron overload and the effects of subclinical inflammation.
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Affiliation(s)
| | - Christine M Pfeiffer
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michael K Georgieff
- Division of Neonatology, Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN
| | - Gary Brittenham
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY
| | - Susan Fairweather-Tait
- Department of Nutrition, Norwich Medical School, Norwich Research Park, University of East Anglia, Norwich NR4 7JT, UK
| | - Richard F Hurrell
- Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Harry J McArdle
- Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen AB21 9SB, UK
| | - Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH)
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Smith MR, Golden CD, Myers SS. Potential rise in iron deficiency due to future anthropogenic carbon dioxide emissions. GEOHEALTH 2017; 1:248-257. [PMID: 32158990 PMCID: PMC7007116 DOI: 10.1002/2016gh000018] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 05/01/2017] [Accepted: 05/05/2017] [Indexed: 05/19/2023]
Abstract
Iron deficiency reduces capacity for physical activity, lowers IQ, and increases maternal and child mortality, impacting roughly a billion people worldwide. Recent studies have shown that certain highly consumed crops-C3 grains (e.g., wheat, rice, and barley), legumes, and maize-have lower iron concentrations of 4-10% when grown under increased atmospheric CO2 concentrations (550 ppm). We examined diets in 152 countries globally (95.5% of the population) to estimate the percentage of lost dietary iron resulting from anthropogenic CO2 emissions between now and 2050, specifically among vulnerable age-sex groups: children (1-5 years) and women of childbearing age (15-49 years), holding diets constant. We also cross-referenced these with the current prevalence of anemia to identify most at-risk countries. We found that 1.4 billion children aged 1-5 and women of childbearing age (59% of global total for these groups) live in high-risk countries, where the prevalence of anemia exceeds 20% and modeled loss in dietary iron would be in the most severe tertile (>3.8%). The countries with the highest anemia prevalence also derive their iron from the fewest number of foods, even after excluding countries consuming large amounts of unaccounted wild-harvest foods. The potential risk of increased iron deficiency adds greater incentive for mitigating anthropogenic CO2 emissions and highlights the need to address anticipated health impacts via improved health delivery systems, dietary behavioral changes, or agricultural innovation. Because these are effects on content rather than yield, it is unlikely that consumers will perceive this health threat and adapt to it without education.
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Affiliation(s)
- M. R. Smith
- Exposure, Epidemiology and Risk Program, Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - C. D. Golden
- Exposure, Epidemiology and Risk Program, Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Harvard University Center for the EnvironmentCambridgeMassachusettsUSA
| | - S. S. Myers
- Exposure, Epidemiology and Risk Program, Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Harvard University Center for the EnvironmentCambridgeMassachusettsUSA
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The intersection of climate/environment, food, nutrition and health: crisis and opportunity. Curr Opin Biotechnol 2016; 44:52-62. [PMID: 27886592 DOI: 10.1016/j.copbio.2016.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/22/2016] [Indexed: 01/22/2023]
Abstract
Climate/environmental change (C-E-C) is affecting human health and quality of life. Significant attention has been given to the impact of C-E-C on food supply, and food as a vehicle for exposure. However, C-E-C has been superimposed on prevalent malnutrition, infectious and non-communicable diseases. We discuss why nutrition is not synonymous with food and must be viewed as a biological variable that affects and is affected by both C-E-C as well as the current global health challenges. The nexus of C-E-C, food, nutrition and health must be considered in the development of safe and efficacious interventions. A case is presented for how the convergence of C-E-C, food/nutrition and health, presents an opportunity for more integrated approaches to achieve global health goals.
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