Nutritional Anemia - Sight and Life

414 Pages·2007·4.21 MB·English

Nutritional
Anemia
Edited by
Klaus Kraemer
Michael B. Zimmermann
SIGHT AND LIFE
Press
Preface 1
Nutritional Anemia

Nutritional
Anemia
Edited by
Klaus Kraemer
SIGHTAND LIFE, Basel, Switzerland
Michael B. Zimmermann
Swiss Federal Institute of Technology, Zurich, Switzerland
SIGHT AND LIFE
Press
IV
SIGHTAND LIFE Mission Statement
SIGHTAND LIFE is a humanitarian initiative of DSM. It aims to ensure a sustainable and significant
improvement in human nutrition and health by encouraging partnerships with universities and intergov-
ernmental and governmental agencies, by generating and exchanging scientific information and by
forming networks.
Copyright©SIGHTAND LIFE 2007
All rights reserved. Publications from SIGHTAND LIFE can be obtained from
SIGHTAND LIFE Press
c/o SIGHTAND LIFE / DSM Nutritional Products Ltd
PO Box 2116
4002 Basel
Switzerland
Phone: [phone]
Fax: [phone]
Email: [email protected]
Internet: www.sightandlife.org
Requests for permission to reproduce or translate SIGHTAND LIFE publications should be submitted
to the address above.
Opinions, compilations, tables and figures contained in this publication do not necessarily represent
the point of view of SIGHTAND LIFE and are the sole responsibility of the authors. The mention of
specific companies and trademarks does not imply that they are endorsed by SIGHTAND LIFE. All
reasonable precautions have been taken by SIGHTAND LIFE to verify the content of this publication.
However, this publication does not constitute or provide scientific or medical advice and is distributed
without warranty of any kind, either express or implied. The reader shall be solely responsible for any
interpretation or use of the material contained herein. In no event shall SIGHTAND LIFE be liable for
any damages arising from the reader's reliance upon, or use of, these materials.
The paper used in this book is acid-free and falls within the guidelines established to ensure perma-
nence and durability.
Cover photo by Ulla Lohmann, Germany
Cover illustration by graphic art studio, Grenzach-Wyhlen, Germany
Proofreading by transparent – translation & text services, Berlin, Germany
Typeset and print by Burger Druck, Waldkirch, Germany
ISBN 3-906412-33-4
Preface 1
PREFACE
For half a billion women in developing these can help reduce the burden of anemia,
regions worldwide, anemia is a life-long bur- none is capable of doing the job on its own.
den, one which affects most of their infants
and young children as well. Controlling ane- The chapters of this book offer an account
mia in these vulnerable groups could signifi- of the information that was presented and
cantly reduce maternal and infant morbidity. comprehensively discussed at a workshop on
It would also enhance intellectual and work Nutritional Anemia in Barcelona, Spain, on
capacity, thereby improving family, commu- September 27, 2006, in which all the contribu-
nity and national socioeconomic development. tors to this volume themselves took part. This
event was co-organized by the editors of this
In May 2002, the General Assembly of volume. We sought the timely publication of
the United Nations reemphasized that control this book in order to provide the latest update
of nutritional anemia should be one of the on the complex causes and consequences of
global Development Goals to be achieved in nutritional anemia, and the effectiveness of
the early years of this new millennium. Despite current control strategies. The field of anemia
this, the global prevalence of anemia has is clearly of great interest to scientists, policy
hardly declined in the past decade, although makers and program mangers. We hope this
considerable programmatic experience exists volume will help point the way forward in con-
and a vast amount of scientific data has been trolling this major global health problem. The
compiled on iron metabolism. Much is still introductory chapters in this book give an
unknown, however, and many new issues overview of the global burden of anemia
continue to emerge from the ongoing research, prevalence, the economic implications and
both basic and programmatic. The reasons for functional consequences, and the significance
this lack of improvement include the multi- of these factors for policy makers. Subsequent
factorial etiology of anemia, underfunding and chapters provide basic scientific information
poor program implementation, often designed on iron metabolism and interactions with
on the assumption that the sole cause of macronutrients and micronutrients as well as
anemia is iron deficiency. the role of infections in fostering anemia.
Other chapters address the information needs
It is increasingly clear that effective con- of program managers, detailing programmatic
trol of anemia requires integrated solutions approaches and outlining the safety and techni-
that are tailored to the particular needs and cal aspects of interventions.
opportunities in each country. Components of
such an approach include food fortification, Weare particularly grateful to the authors,
micronutrient supplementation of vulnerable who are all leading scholars from UN agencies
groups (particularly children and women of and the wider academic world, for their excel-
childbearing age), education, and dietary lent contributions. Aspecial acknowledgement
diversification, as well as control of diseases is also due to all reviewers whose valuable
such as malaria, worm infections, and other comments have helped to improve the quality
chronic endemic infections. While each of of the chapters. We would like to give a very
VI Preface
special thanks to the SIGHTAND LIFE team, tance with the editing of the chapters. Lastly,
Svenia Sayer-Ruehmann and Anne-Catherine we wish to thank SIGHTAND LIFE and DSM,
Frey, for assisting with the workshop as well as in particular its President and incoming CEO,
for all their technical support in finalizing this Feike Sijbesma, for his continuing support of
book. Svenia devoted much of her time and our work and the publication of this book.
energies to corresponding with the authors to
ensure that our tight timeline was met. We
would also like to express our deep apprecia- Klaus Kraemer
tion to Jane Badham for her invaluable assis- Michael B. Zimmermann
Preface 1
FOREWORD
Every year hunger and undernutrition claim anemia. This condition, which claims one million
more than 10 million lives – more than the deaths lives each year, is associated with increased child
from AIDS, malaria and tuberculosis combined. and maternal mortality, stillbirths, low-birth-
Many of these people are affected by “hidden weight and premature babies. It is one of the
hunger,” a lack of essential vitamins and miner- world's leading causes of disability and can cause
als, known as micronutrient deficiencies, which mild mental retardation and decreased work per-
do not necessarily result in the swollen bellies and formance.
stick-like limbs many associate with serious mal-
nutrition. Caused predominantly by iron-deficiency,
anemia is inextricably linked with people's nutri-
The effects of poor nutrition are not always tional status and hunger. In 2000, the United
easy to spot. Undernourished children are less Nations Sub-Committee on Nutrition reported
likely to attend school, more likely to have learn- that 43% of people in developing countries cur-
ing difficulties, are more susceptible to disease. rently suffer from anemia2.In spite of the signifi-
They are more likely to die young. Undernour- cant burden anemia places on health systems and
ished adults are less capable of providing suffi- economies, it has often been overlooked by the
cient food and other necessities for their families. international and public health communities.
Their immune systems may be compromised.
Their productivity and income is invariably This book assembles some of the leading
lower. research on health and nutrition. The evidence
clearly points to the benefits – and feasibility – of
Poor nutrition impacts the health and devel- reducing the prevalence of anemia and combating
opment of individuals. It also retards the eco- undernutrition. This textbook also serves as a
nomic and social development of nations. For guide for how government, international agen-
instance, it is estimated that anemia alone causes cies, and non-governmental organizations can
US $50 billion in gross domestic product losses work together to decrease rates of nutritional ane-
annually.1 Reducing the number of hungry and mia worldwide. It reviews the most effective
malnourished people translates into a better qual- ways of measuring and monitoring the prevalence
ity of life for individuals, as well as narrowing of nutritional anemia and the most successful pro-
national disparities in health, education, and gram designs for public health interventions.
wealth.
International organizations, such as the World
Infants, young children and women of child- Food Programme, depend on such research in
bearing age are those at greatest risk of nutritional order to deliver the best possible assistance to
1MacDonald B, Haddad L, Gross R, McLachlan M. Afoundation for development.
Administrative Committee on Coordination/Subcommittee on Nutrition. Accessed July 24, 2005.
Available at: http://www.ifpri.org/pubs/books/intnut/intnut.pdf
2ibid
VIII Foreword
hungry and malnourished poor people. These are infectious disease control, nutrition education,
the people who have least choice in their diet, and food security, and poverty-reduction programs –
who are at tremendous risk of anemia and other is required.
micronutrient deficiencies. The World Food Pro-
gramme and its partners help to provide iron sup- Together with partners like DSM and SIGHT
plements and fortified foods in developing coun- AND LIFE, we can and must do more to reduce
tries around the world. micronutrient deficiencies such as nutritional
anemia. This textbook, which focuses on re-
Iron fortification is one of the most cost- ducing the prevalence of nutritional anemia, is
effective interventions and nutrition education key to reducing overall hunger and malnutrition
programs have reduced the prevalence of anemia rates. It is incumbent upon us to use this informa-
among infants and young children by increasing tion to combat nutritional anemia, improve the
their consumption of fortified foods. Presently, nutritional status of those in developing countries,
the World Food Programme is the world's largest and mitigate one of today's greatest public health
purchaser of vitamin- and mineral-fortified blended problems.
foods.
The health and well being of millions of
Fortified foods alone are not enough. Suc- hungry women and children depends on it.
cessful delivery of such interventions requires the
strengthening of health systems, increased aware- James T.Morris
ness, and financial investment. An integrated Executive Director
approach – including better water and sanitation, World Food Programme
Preface IX
CONTRIBUTORS
HAROLDALDERMAN INESEGLI
Africa Region of the World Bank, Washington, Institute of Food Science and Nutrition, Swiss
DC, USA; [email protected] Federal Institute of Technology (ETH), Zurich,
Switzerland; [email protected]
JANEBADHAM
JB Consultancy, Health Communication and JÜRGENERHARDT
Strategy Consultants, Johannesburg, South University of Indonesia, SEAMEO-TROPMED,
Africa; [email protected] Jakarta, Indonesia; [email protected]
HANS-KONRADBIESALSKI ALISOND. GERNAND
Institute for Biological Chemistry and Nutrition Bloomberg School of Public Health, Johns Hopkins
at the University of Hohenheim, Hohenheim, University, Baltimore, USA; [email protected]
Germany; [email protected]
GARYR. GLEASON
MARTINBLOEM Friedman School of Nutrition Science and Policy,
World Food Programme (WFP), Rome, Italy; Tufts University, Boston, USA;
[email protected] [email protected]
TOMMASOCAVALLI-SFORZA EVAHERTRAMPFDÍAZ
Nutrition and Food Safety,WHO Regional Office Institute of Nutrition and Food Technology
for the Western Pacific, Manila, Philippines; (INTA), University of Chile, Santiago, Chile;
[email protected] [email protected]
MARYCOGSWELL SUSANHORTON
Division of Nutrition and Physical Activity, Cen- Wilfrid Laurier University, Waterloo, Canada;
ters for Disease Control and Prevention, Atlanta; [email protected]
USA
RICHARDHURRELL
IANDARNTON-HILL Institute of Food Science and Nutrition, Swiss
Nutrition Section, UNICEF, New York, USA; Federal Institute of Technology (ETH), Zurich,
[email protected] Switzerland; [email protected]
OMARDARY ALANJACKSON
A2Z Project, Academy for Educational Develop- Institute of Human Nutrition, University of
ment, Washington, DC, USA; [email protected] Southampton, Southampton, UK; [email protected]
BRUNODEBENOIST AFAFKAMAL-ELDIN
World Health Organization (WHO), Geneva, Department of Food Science, Swedish University
Switzerland; [email protected] of Agricultural Sciences, Uppsala, Sweden;
[email protected]
SASKIADEPEE
World Food Programme (WFP), Rome, Italy; KLAUSKRAEMER
[email protected] SIGHT AND LIFE, Basel, Switzerland; klaus.
[email protected]