Nevin S. Scrimshaw

Lysine fortification of wheat flour improves selected indices of the nutritional status of predominantly cereal-eating families in Pakistan.

Wheat provides more than 50% of the protein and calorie intake of the population of Pakistan. Legumes and animal protein that could complement the amino acid pattern of wheat, in which lysine is the first limiting amino acid for utilization of protein, are not affordable by members of lower socioeconomic groups in developing countries. The purpose of the study was to determine whether lysine fortification of wheat flour would have a positive impact on populations consuming a predominantly wheat-based diet. A double-blind study was carried out for three months on the outskirts of Peshawar, Pakistan. Forty families received wheat flour fortified with lysine, and 40 families received wheat flour without lysine. Wheat provided 59% of the protein for men, 65% for women, and 58% for children. The weight and height of the children in both groups increased during the study, but the increase was significantly greater in the lysine group. Hemoglobin increased significantly in the women receiving lysine-fortified flour. Transferrin levels increased significantly in men, women, and children in the lysine group as compared with those in the control group. Prealbumin increased significantly in adults receiving additional lysine but decreased in children. Men, women, and children in the lysine-supplemented families had significant increases in CD4, CD8, and complement C3 as compared with controls. These results indicate that lysine fortification of wheat flour can significantly improve sensitive indicators of nutritional status in a population consuming a diet in which 58% to 65% of the protein, depending on age and sex, is supplied by wheat.

Nutritional potential of red palm oil for combating vitamin A deficiency.

Although the severe vitamin A deficiency responsible for ocular damage is now rare, subclinical vitamin A deficiency still contributes importantly to high child mortality in the developing countries of Asia. This demands urgent and effective preventive action. Although periodic large doses of vitamin A for this purpose have been a favoured approach of international agencies, the coverage achieved has been inadequate and is usually not sustainable without external support. for this reason, there has been increasing emphasis on a sustainable dietary approach to the prevention of subclinical vitamin A deficiency. One part of this can be the production and use of red palm oil as a salad and cooking oil or blended into other vegetable cooking oils. the latter will also improve the caloric density of the diets, a serious limiting factor for young children in the region. It will also add antioxidant activity to the diet.

Lysine-Fortified wheat Flour Improves the Nutritional and Immunological Status of Wheat-Eating Families in Northern China

The purpose of this study was to determine the impact of the fortification of wheat flour with lysine on selected health indicators among farm families obtaining 58% to 67% of their dietary protein from wheat. A man, a woman, and a child aged 5 to 12 years were studied from each of 88 families in a village near Huixian City, Henan Province, China. Half of the families received wheat flour fortified with 3 g of lysine per kilogram for three months, and the other half received wheat flour without fortification. The results showed a significantly greater gain in the height and weight of children receiving lysine-fortified wheat flour. Hemoglobin values were not affected. The mean prealbumin values of adult men and women were higher in those receiving lysine. The numbers of CD3 T cells increased significantly in women and children, as did the complement fraction C3 and IgG in men, IgA in women, and IgG, IgA, IgM, and C3 in children. These results indicate that lysine fortification of wheat flour can significantly improve some indicators of the nutritional status and immune function of family members consuming a wheat-based diet.

Evaluation of the Potential Effectiveness of Wheat Flour and Salt Fortification Programs in Five Central Asian Countries and Mongolia, 2002–2007

Background A project for universal salt iodation with potassium iodate and wheat flour fortification with a vitamin-mineral premix was implemented in Azerbaijan, Kazakhstan, Kyrgyzstan, Mongolia, Tajikistan, and Uzbekistan between 2002 and 2007. Objective To determine the potential effectiveness of the food fortification programs in improving the micronutrient status of selected families in a sentinel population in each country. Methods An area was selected in each country in a sentinel population expected to have early access to iodated salt and fortified wheat flour. Within this area, an average of 40 families with a woman of reproductive age and two children between 2 and 15 years old were sampled at baseline. All the rounds of the study were carried out in women and children in the same households. Hemoglobin, serum ferritin, folic acid, and urinary iodine excretion were analyzed at baseline, one year, and three years later. Results In the third round in 2007 significant increases were observed in the average levels of blood hemoglobin, serum ferritin and folic acid, and urinary iodine. Corresponding decreases in the prevalence of anemia and increases in serum ferritin levels, folic acid, and iodine were found. Conclusions Salt and wheat flour fortification resulted in a significant improvement in the micronutrient status of children and women living in sentinel households in the countries participating in the Asian Development Bank project. Sentinel studies were a cost-effective way of determining potential national effectiveness.

Quality protein maize.

265 It has been many years since the first demonstration that young children consuming equal amounts of protein at requirement levels from milk or maize with the opaque-2 gene had the same nitrogen retention [1]. The physical and agronomic characteristics of maize with the opaque-2 gene, renamed quality protein maize (QPM), have been steadily improved. Further studies have confirmed that when protein and energy requirements are met, nitrogen retention is similar for QPM and milk, meat, and eggs [2]. This is because, unlike ordinary maize, which is deficient in the essential amino acids lysine and tryptophan, QPM has adequate proportions of both. QPM studies have been summarized in a National Academy of Science publication [3] and in two books [4, 5]. Even though the yields of QPM are as high as those of ordinary maize, and its use for feeding nonruminants decreases the need for protein concentrates such as oilseed or fish meal, QPM has been slow to be adopted. Its use for human consumption in populations that are highly dependent on maize protein has been particularly disappointing. This is due in part to resistance to change, but more to the decrease in interest in protein quality beginning in the 1970s. The change began with the meeting of the Food and Agriculture Organization/World Health Organization (FAO/WHO) Ad Hoc Committee on Energy and Protein Requirements in Rome in 1971 [6]. The lower level of protein this committee proposed as adequate for adults led to the conclusion that energy and not protein was limiting in the diets of developing countries. This nearly ended the QPM program at the International Maize and Wheat Improvement Center in Mexico (CIMMYT) [7]. On the basis of extensive new research, it was subsequently recognized that the 1971 recommendation was erroneously low. The new value confirmed the pre-1971 conclusion that protein was inadequate in the predominantly cereal diets of most developing countries worldwide [8]. A 1985 FAO/WHO/UNU expert group [9] recommended an increase of nearly one-third over the 1971 value. Unfortunately, the damage to the understanding of nutritionists and economists continues, and too often the importance of protein quality in the diets of developing-country populations is not recognized. QPM is now being grown on an increasing scale in a few African and Latin American countries. The discovery of the opaque-2 gene and its incorporation into high-yielding maize varieties was an important achievement and occurred before the availability of modern genetic modification techniques that might have speeded the process. The developers of QPM, Dr. Evangelina Villegas and Dr. Surinder K. Vasal, received the World Food Prize for this achievement in 2000. QPM varieties can make a major contribution to the protein adequacy of maize diets wherever maize is the major dietary protein source for local populations. A 13-page 2002 research report [10] on local infant feeding in Ghana is a valuable and practical demonstration of the value of QPM in the feeding of poorly nourished children in populations without the economic resources to purchase milk and other animal protein sources to feed themselves and their children. It describes four studies that provide compelling evidence for advocating the introduction of QPM. Where it is used in gruels for the complementary feeding of infants and young children, barley malt can be added to the maize flour. The malt provides an enzyme that liquefies the cereal gruel prepared from the maize so that the young children can consume enough to meet their protein needs.* Much greater efforts should be devoted to promoting the production and use of QPM by populations dependent on maize as the staple in their own diets as well as their nonruminant animals.

International Workshop on Multi-Micronutrient Deficiency Control in the Life Cycle Lima Peru May 30-June 1 2001.

Thirty-one representatives from international organizations, nongovernmental organizations, government agencies, universities, and the private sector participated in a three-day workshop in Lima, Peru, organized by the Universidad Nacional Agraria La Molina and supported by the Ministry of Health Peru, UNICEF, and the World Health Organization. The objective of the workshop was to develop a protocol for a comprehensive micronutrient supplementation program for populations in developing countries that suffer from deficiencies of several micronutrients. The workshop consisted of two components: presentation of preliminary results of the multicenter study on infant supplementation and recommendations on the policy and community, monitoring and impact evaluation, and research aspects of supplementation programs. This paper provides the summary reports of the second component.

Commentary on "Studies on the effectiveness of NaFeEDTA-fortified soy sauce in controlling iron deficiency: A population-based intervention trial".

To address micronutrient deficiencies affecting large population groups food fortification is the most costeffective intervention and reaches a higher proportion of the population at risk than any other feasible intervention. Successful examples include the addition of a relatively inexpensive and highly effective iodine compound to salt for human consumption in countries where iodine deficiency is common. Preventing iodine deficiency is important because if present during pregnancy the future cognitive performance of offspring can be negatively affected. A meta-analysis of 18 studies showed an IQ lower by more than 13.5 points in children in iodine-deficient populations compared with non-iodine deficient populations. Fortification of cereal flours with folic acid has been another success. In the United States and Canada the addition of folic acid to wheat flour resulted in a rise in blood levels of folate and a corresponding decrease in congenital neural-tube defects. Folate is now being added to micronutrient fortificant premixes for flour fortification in more than 60 countries. Originally used in Guatemala [4] and now in many other countries the fortification of sugar with vitamin A has been implemented successfully on a national scale. (excerpt)

Book Review: The World Food Problem: Tackling the Causes of Undernutrition in the Third World

Poor nutrition, foodborne disease and lack of secure access to good food make an important contribution to the burden of disease and death in the WHO European Region. Better diets, food safety and food security will not only reduce or prevent suffering to individuals and societies but also help cut costs to health care systems and bring social and economic benefits to countries. Peoples chances for a healthy diet depend less on individual choices than on what food is available and whether it is affordable. Policies to benefit health through good food and nutrition must extend beyond the health sector to include sectors ranging from agriculture and food processing, manufacturing and trade to transport, retailing, catering and advertising. Food and nutrition policies should be coordinated so that public health is given due priority in the making of food policies by non-health sectors. This publication discusses in depth the components of food and nutrition policies and the evidence supporting them. It describes food- and nutrition-related ill health and its costs, shows the need for action and describes the steps for decision-makers to take. This book highlights the urgent need for integrated, multisectoral food and nutrition policies to encourage the sustainable production of food, its safety and the provision of food of high nutritional quality for all.

Book Review: Perinatal Nutrition: Optimizing Infant Health and DevelopmentPerinatal nutrition: Optimizing infant health and development. Edited by BhatiaJatinder. DekkerMarcel, New York, 2004. (ISBN 0-8247-5474-3) 440 pages, hardcover. US

Central Europe, China, the Middle East, North Africa, Southeast Asia, and the Americas. Once implemented, iodization must be sustained permanently. Examples are given of countries that achieved universal salt iodation, thus eliminating IDD, only to have it recur when monitoring and enforcement was discontinued due to political turmoil. An appendix provides valuable documentation of the progress of the campaign to eradicate IDD country by country. The subtitle of the book, “A global program for human development with a model applicable to a variety of health, social and environmental problems” is well justified. It is not only the most complete account available of a remarkable public health campaign, but is also useful to those promoting other public health initiatives. The book is also available as a CD-ROM from the ICCIDD. For information, send e-mail to cpanday@iqplusin.org. For the ICCIDD newsletter, available free of charge, visit http://www.iccidd.org.

179.95.

The big-eye (Brachydeuterus auritus), which is present in a large biomass in the Gulf of Guinea, is generally considered an underutilized fish species. In an attempt to add value, it was used to complement cassava starch (Manihot esculenta Crantz) to produce fish crackers. Three levels of fish (40%, 50%, and 60%) and three levels of starch (60%, 50%, and 40%) were used in the formulations. Proximate analyses and sensory evaluations were carried out. The protein, fat, and ash contents increased with an increase in the proportion of fish. The sensory evaluation tests showed that the most acceptable formulations for the crackers were obtained using 50% fish/50% starch and 40% fish/60% starch combinations. The linear expansion of the fried crackers increased with the increased proportion of fish. Production of fish crackers, apart from its appeal for increasing protein intake, has the potential to support a small regional snack factory in a developing economy.