How science and partnerships can improve theagricultural and nutrition value chain - towards

delivering more nutritious foods for those in need.

Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany

Detection of micronutrient inadequacies andhow to compensate?

• Inadequate supply of micronutrients may have a strong impact on health and development in particular during pregenancy and childhood

• Early detection of dietary gaps are necessary tooptimize the diet and to avoid „hidden hunger“

Sup

ply

Sym

ptoms

No Subclinical/unspecific Clinical

Hidden Hunger describes the inadequate supply withone or more essential nutrients (Vitamins, Minerals, Trace elements, Amino acids)

Hidden hunger becomes „visible“ with the occurence ofclinical symptoms

Reasons: Missing sources (Liver, Eggs, pro-vitamin A ). Low stores at birth. Frequent diarrhoe (Zinc def.)

200 – 500 million children are vitamin A deficient. 5 mi llionper year get blind. High mortality in the first 5 years of live (30-50%). How many children with inadequate intake?

S

Decline of vitamin A status without biochemical signs and occurence

of non-specific and specific symptoms

Clinical consequences

SYSTEMIC (unspecific) COMPLICATIONS

Increased mortalitydue to infections

Increase of anemia/ growth retardation

OCULAR COMPLIKATIONS

NightblindnessOcular infectionsKeratomalacia-Blindness

Vita

min

-A-S

tatu

s

Somer A., Nature Med. 1997

Hidden Hunger and consequences?

How to improve the nutrition value chain withrespect to miconutrients?

• Biochemical data or clinical signs document a moreor less severe deficiency of one or moremicronutrients.

• Prior deficiency signs an inadequate intake ofmicronutrients affects health and development

• The composition of the diet and the micronutrientgaps should be elucidated before clinical symptomsof a deficiency occur!

Objectives for the developement of CIMI(calculator for identification of micronutrient inadequacy)

Fast and easy analysis of micronutrient adequacy on bas is of populationspecific food groups-> time and cost saving data collection and analysis

Comparison of the results to the reference values including the classificationof iron and zinc bioavailability

Self-explanatory presention of the results-> visualisation of micronutient sources and deficits for health education

purposes

Calculation of macro- and micronutrient intakeclassification of zinc and iron bioavailability

is based on dietary pattern

Program structureProgram structure

Total intake and % of FAO/WHO recommendations of energy, protein, carbohydrates, fat, iron, zinc, vitamin A,

ß-carotene, retinol equivalents (1:6 and 1:12 conversion factor)

Food intake in grams per day of a limited number of food groups

Electronic assessment of micronutrientinadequacies on a population level

Algorithm for iron

Program structureBioavailability calculation

Classification to 15%, 12%, 10% or

5% of iron bioavailability

Software determines:% of total energy intake is accounted for all starchy stables% of total energy intake is accounted for protein from fish, eggs, dairy and meat% of total energy intake is accounted for protein from fish and meat…

Electronic assessment of micronutrientinadequacies on a population level

Algorithm for zinc

Classification to high, moderate or low zinc

bioavailability

Food survey data of target populationData of the Indonesian Socio Economic Survey taken

among 68,800 public households in 2008

Program structureProgram development

Micronutrient density of extracted food groups

Calculation of average nutrientdensity per foodgroup based on the typical foodcomposition

Electronic assessment of micronutrientinadequacies on a population level

Program structureCIMI data input

Electronic assessment of micronutrientinadequacies on a population level

Program structureCIMI data input

Electronic assessment of micronutrientinadequacies on a population level

Program structureCIMI data input

Electronic assessment of micronutrientinadequacies on a population level

Program structureCIMI data input

Electronic assessment of micronutrientinadequacies on a population level

Program structureIndonesian children 4-6 years: nutrition data

Electronic assessment of micronutrientinadequacies on a population level

Program structureIndonesian children 4-6 years: results in tables

Electronic assessment of micronutrientinadequacies on a population level

Program structureIndonesian children 4-6 years: results in ring diagram s

Electronic assessment of micronutrientinadequacies on a population level

Iron Zinc

Program structureIndonesian children 4-6 years: results in ring diagram s

Electronic assessment of micronutrientinadequacies on a population level

Vitamin A

Females 20 – 52 years

118 Children 1 – 3 years 128 Females 20 – 40 years

The distribution of the ratio of nutrient intake ca lculated by NS and CIMI

Validation of CIMI using Nutrisurvey programm as a control

Average intake of nutrients calculated by NS and CIMI and number and %of indviduals below the threshold

The CIMI program can be used to

for a rough estimation of micronutrient gaps

in different age and sex groupsin different income groupsin different local dietary diversityin different threshold aproaches

educate people how to compose a diet to reduce gaps

uncover food or food composition related to a specificmicronutrient

The CIMI program will not calculate a risk for deficiency or a levelof adequacy

Science and partnership to improve the nutrtion value chain

Electronic assessment of micronutrientinadequacies on a population level

Micronutrient gaps which, to several reasons, cannot be c losed via optimization of the dietary pattern might be closed with for tifiedfood or with food with improved bioavailability of one or mor emicronutrients.

But

We always must consider that a deficiency of a micronutie nt doesnot mean that only this isolated micronutrient is missing i n the diet. It is the micronutrient containing food which is missing. Consequently all the other essential micronutrients wit hin that foodmight be also missing.Treatment of the symptom (isolated defciency) might be misleading

Thank you

for your attention