ABSTRACT
Objectives: SMILING "Sustainable Micronutrient Interventions to Control Deficiencies and Improve Nutritional status and General Health in Asia" (FP7), is a transnational collaboration of research institutions and implementation agencies in five SEA countries: Cambodia, Indonesia, Laos PDR, Thailand and Vietnam, with European partners, to introduce state-of-the-art knowledge into policy to alleviate micronutrient malnutrition in SEA women of reproductive age (WRA) and young children. Objectives were to: build capacity on problem analysis; identify priority interventions and develop roadmaps for national policies. Methods: SMILING has been built around a consortium that worked on Optifood software to identify nutrient gaps; nutritional problem analysis and potential interventions by reviewing current situation and program, and knowledge on effective interventions and multi-criteria mapping for stakeholder analysis to develop national guidelines. Results: Iron, zinc, vitamin A and iodine deficiency remain common in SEA. Even though the five SEA countries differ in nutritional situation and stages of development, iron intake in young children in all countries was inadequate, as folate intake in WRA, even with theoretical best possible diets. Consequently, interventions including supplementation, food-based strategies and public health measures were appraised through multi-stakeholder analysis. Successful experiences and lessons in implementing nutrition programs in these countries were also critically reviewed. Policy roadmaps by country are being drafted accordingly. Conclusions: SMILING conducted an analysis of nutrition situation in each SEA country. Gaps in intake of several micronutrients cannot be currently solved by dietary solution and e.g. food fortification needs to be considered. Roadmaps for each country policy-makers are being formulated. Funding: European Commission-FP7, GA-2896-16.
ABSTRACT
Objectives: To assess the diagnostic performance of serum concentrations of retinol-binding protein (RBP), transthyretin, retinol concentration measured by fluorometry and RBP:transthyretin molar ratio, either alone or in combination, to estimate the prevalence of vitamin A deficiency (serum retinol concentration <0.70 μmol/L measured by high-performance liquid chromatography(HPLC)). Methods: A cross-sectional study was conducted in 15 primary schools in Kibwezi and Makindu districts in Eastern province, Kenya in June 2010 with 375 schoolchildren (6-12 years), 25 randomly selected from each school by lot quality assurance sampling. Results: Complete data were collected for 372 children. Mean serum concentration of retinol (HPLC), RBP and transthyretin were 0.87 (SD 0.19) µmol/L, 0.67 (SD 0.17) µmol/L and 3.0 (SD 0.62) µmol/L. The mean RBP: Transthyretin molar ratio was 0.23. The prevalence of vitamin A deficiency measured with HPLC was 18%. Transthyretin and RBP showed the largest area under the curve (AUCs 0.96 and 0.93, respectively). Logistic regression resulted in a model predicting vitamin A deficiency based on RBP, transthyretin and C-reactive protein (AUC: 0.98) and prevalence depending cutpoints for the linear predictor were calculated. Conclusions: Combination of transthyretin, RBP and C-reactive protein in a linear predictor showed excellent diagnostic performance in assessing vitamin A status, and has great potential to eventually replace serum retinol concentration measured by HPLC as the preferred method to assess the population burden of vitamin A deficiency. Further research is needed to confirm whether this linear predictor yields similar results in different populations and laboratories. Our methodology can be widely applied for other diagnostic aims.