Werner Schultink

Vitamin A and iron supplementation of Indonesian pregnant women benefits vitamin A status of their infants

Many Indonesian infants have an inadequate nutritional status, which may be due in part to inadequate maternal nutrition during pregnancy. This study was designed to investigate whether infant nutritional status could be improved by maternal vitamin A and Fe supplementation during gestation. Mothers of these infants from five villages had been randomly assigned on an individual basis, supervised and double-blind, to receive supplementation once weekly from approximately 18 weeks of pregnancy until delivery. Supplementation comprised 120 mg Fe and 500 microg folic acid with or without 4800 retinol equivalent vitamin A. Mothers of infants from four other villages who participated in the national Fe and folic acid supplementation programme were also recruited; intake of tablets was not supervised. Anthropometric and biochemical parameters of infants and their mothers were assessed approximately 4 months after delivery. Infants of mothers supplemented with vitamin A plus Fe had higher serum retinol concentrations than infants of mothers supplemented with Fe alone. However, the proportion of infants with serum retinol concentrations <0.70 micromol/l was >70 % in all groups. Maternal and infant serum retinol concentrations were correlated. Fe status, weight and length of infants were similar in all groups. Fe status of girls was better than that of boys, but boys were heavier and longer. We conclude that supplementation with vitamin A in conjunction with Fe supplementation of women during pregnancy benefits vitamin A status of their infants. However, considering the large proportion of infants with marginal serum retinol concentrations, it may still be necessary to increase their vitamin A intake.

Validation of Predicted Total Body Water and Extracellular Water by Multi-Frequency Impedance in Young Indonesian Adults

To investigate the validity of the prediction of body water compartments by multi-frequency impedance in Indonesians, 42 adults (19 males and 23 females) were recruited in Jakarta, the capital of Indonesia. Extracellular water (ECW) and total body water (TBW) were measured with dilution techniques and predicted from body impedance at 1 and 100 kHz, respectively, using prediction formulas developed in a Dutch population. Furthermore, body weight, body height and body density were measured and as a measure of body build TBW/height and ECW/height were calculated. Percent ECW of body weight in both males (26 ± 3%) and females (23 ± 2%) was higher compared to the Dutch reference population, and also the body water distribution (ECW/TBW) was higher (0.46 ± 0.04) compared to the reference population. TBW/height and ECW/height appeared to be considerably lower in the Indonesian group compared to the reference group, indicating a more slender body shape. TBW was overestimated by 1.8 ± 2.4 and 2.5 ± 1.3 kg in males and females, respectively. ECW was underestimated in males by 0.1 ± 1.2 kg and slightly overestimated in females (0.1 ± 1.0 kg). After corrections for differences in body build and body water distribution the bias of the predicted TBW was markedly reduced from 2.2 ± 1.9 to 1.3 ± 1.8 kg (males and females combined). For ECW the bias after correction for body water distribution and body build was 0.3 ± 0.6 kg (males and females combined). It is concluded that multi-frequency impedance is suitable for the prediction of body water compartments at the population level but, due to differences in body build and body water distribution, validation in a larger group of Indonesian subjects is needed to avoid systematic prediction errors.

Stunting as an indicator for health and wealth : An Indonesian application

Poverty exists when individuals or groups are not able to satisfy their basic needs, such as food and drinking water, education, health services, adequate housing, and socio-cultural life. Access to resources is determined by level of income, physical or mental disabilities, discrimination and physical distance involved. Income is an inadequate indicator of poverty if this basic need- related definition is accepted. All factors contributing to poverty are determined by nutritional status. The phenomena of stunting has been proposed as a collective indicator for poverty, since a chronic state of nutrition insufficiency is manifested as growth retardation. It has been demonstrated that Indonesian children have the same genetic potential regarding body height as North American children. Therefore, growth retardation in a population of Indonesian children is caused by environmental factors. The detection of stunting provides information concerning the magnitude and severity of poverty, but does not identify the specific resources which are lacking. To determine the causes of poverty and to identify the risk groups, a survey should include contributing indicators in addition to stunting recording. In different Indonesian locations the prevalence of stunting varied between 22.6% (in Jakarta) and 68.8% (in West Kalimantan).

An overview of studies on iron deficiency in Indonesia1

An overview of studies on the prevalence, causes and consequences of iron deficiency from Indonesia is presented. Prevalence of iron deficiency among the Indonesian population remains high, in spite of ongoing programs to reduce the prevalence. Studies demonstrated that among young children iron deficiency anemia reduces cognitive performance. Work productivity is negatively influenced by iron deficiency, not only among workers engaged in heavy physical labor but also among female factory workers engaged in light work. Indonesian studies further demonstrated that anemia may also be influenced by vitamin A deficiency.

Supplementation strategies to alleviate iron deficiency: Experiences from Indonesia

Anemia, mainly caused by iron deficiency, is common in Indonesia, especially among pregnant women and infants. In pregnancy iron deficiency anemia is associated with undesirable birth outcome, and in infants with reduced mental and motor development. Iron status can be improved through dietary changes, food fortification, antehelminthic treatment, and supplementation. Supplementation offers the best chance for improvement on short term, although reported effectiveness of large scale programs is often limited. In Indonesia supplementation programs exist for pregnant women, female factory workers, and under-five children from poor families. Effectiveness of the programs is limited by tablet supply, program coverage, compliance and a possibly by a low vitamin A status, and the following changes should be considered to improve effectiveness. Tablets should also be distributed through channels other than the health sector, such as through traditional birth attendants. In order to decrease the iron deficiency prevalence during pregnancy young women/adolescent girls should be supplemented before they get pregnant. Infants should also be targeted by programs. Supplementation on a weekly in stead of daily basis should be considered especially under conditions where supplementation can be supervised such as in schools or factories. Since intake of vitamin A and zinc are also frequently deficient, a multi-supplementation should be strived for.

Relative bioavailability in adults of iron from a soybean product intended for complementary feeding of infants

The relative bioavailability of iron sulphate added to a soybean product intended for use as a fortified product for complementary feeding of infants was determined. Ten adults received 100mg elemental iron in an aqueous Fe(II)-sulphate solution and 1 week later 100 mg elemental iron mixed into 30 g soybean milk powder. Plasma iron concentrations were measured before, and 1, 2, 4, 6, 8 and 10 h after consumption. The area under the concentration/time curve (AUC+), the peak plasma level (tmax) and the relative bioavailability were determined. The peak of the plasma iron level after receiving 100 mg of iron solution was 176.71 ± 39.05 μg/dl at tmax = 2.8 ± 1.03h while it was 139.82 ± 34.47 μg/dl at tmax = 2.4 ± 1.3 h after consuming 30 g of soybean milk product mixed with 100mg iron solution. The relative bioavailability of iron in the soybean product was 45.8% compared to iron solution. Based on these results it is suggested that the soybean product should be fortified with 10 mg/100 g product of iron sulp...