Multi-stakeholder’s Analysis of Micronutrient Intervention Strategies and Public Health Measures to Prevent Micronutrient Deficiencies in South East Asia (SMILING Project).

Objectives: The SMILING EU project aims at introducing state-of-the-art knowledge into policy to alleviate micronutrient malnutrition in women of reproductive age (WRA) and young children in five SEA countries: Cambodia, Indonesia, Laos PDR, Thailand and Vietnam. The objective of the present study was to appraise multi-stakeholders viewpoints on intervention strategies to prevent micronutrient deficiencies. Methods: Multi criteria mapping (MCM) was used to evaluate stakeholder’s point of views on asset of priority interventions for an appropriate, timely, feasible and effective prevention of micronutrient deficiencies. MCM technique was realized through a face-to-face computer-assisted interview. Twenty interviews have been conducted in each 5 SEA countries. Stakeholders were selected: government, academic, civil society, NGO, private sector and international institutions. Results: The number of interventions presented to stakeholders differed between SEA countries (6 in Indonesia, 8 in Lao PDR, 9 in Cambodia and Thailand and 11 in Vietnam) and was country specific. Interventions were grouped into 6 clusters; supplementation, fortification, food based approach, educational initiatives, indirect interventions and global strategies, allowing comparison among countries. Cambodia included specific options on education; Lao PDR appraised the homestead food production system and Vietnam the intermittent supplementation. Conclusions: Each SEA country had specific approach and focused on different strategies to prevent micronutrients deficiencies. Stakeholder’s analysis allowed to underline consensus and differences between the different groups of stakeholders and to define the best strategy to be implemented in each of the five SEA countries. Funding: European Commission, FP7, GA-2896-16.

A North-South-South Collaborative Action to Prevent Micronutrient Deficiencies in Women and Young Children in South-East Asia: The SMILING Project.

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.

Influence of Micronutrient Status during Infancy and Middle Childhood on Cognition at Middle Childhood.

Objectives: To evaluate the relationship between micronutrient status during infancy and middle childhood on cognition at middle childhood. Methods: A longitudinal study was conducted in apparent healthy children in the northeast of Thailand. Intelligence Quotient (IQ) was measured using the Wechsler Intelligence Scale for Children, III (Thai) at 9 y. Hemoglobin, serum ferritin, and serum zinc (sZn) were assessed at early infancy (4 mo), late infancy (1 y), and middle childhood (9 y). Serum transferrin receptor and urine iodine (UI) were assessed at 9 y. Using multiple regression, the relationship between micronutrient status during infancy and middle childhood and cognition at middle childhood was ascertained. Results: Full scale IQ and performance IQ at 9 y was influenced by sZn at 1 y (β = 0.4 μmol/L, p = 0.011 and β = 0.6 μmol/L, p = 0.001). The influence of UI at 9 y on Verbal IQ at 9 was small but significant (β = 0.02 μg/L, p = 0.024). None of the iron status at 4 mo, 1 y, and 9 y were associated with IQ. Conclusions: In apparent healthy children, zinc status at late infancy and iodine status at middle childhood were associated with IQ at middle childhood. Further analyses are needed to understand this relationship.

Maternal Thyroid Function and Birth Outcomes after Iodine Supplementation in Mild-to-moderately Iodine-deficient Pregnant Women in Thailand.

Objectives: To evaluate the effects of iodine supplementation in mild-to-moderately iodinedeficient pregnant Thai women on maternal thyroid function and birth outcomes. Methods: An RCT with 200 μg KI per day was conducted among 514 mild-to-moderately iodinedeficient pregnant Thai women. Blood samples were collected at baseline (<14 weeks of gestation), and follow up samples were collected in the 2nd, and 3rd trimester and at delivery in cord blood. Free T4 (fT4), thyroglobulin (TG) and thyroid-stimulating hormone (TSH) concentration were measured. Neonatal data was obtained from hospital records. Thyroid volume of the newborns was measured using ultrasonography. Data were analyzed per protocol by linear mixed models and linear regression models. Results: Cumulative loss to follow up was 20% in the 2nd trimester, 23% in the 3rd trimester, and 28% at delivery. Median maternal fT4, TG and TSH concentration did not differ significantly between treatment groups (p>0.05). Mean birth weight was 3150±410 g in the iodine group as compared to 3088±473 g in the placebo group (p>0.05); 4.8% of infants in the iodine group were low birth weight versus 7.9% in the placebo group. There were no significant differences in median fT4, TG and TSH concentration, and mean thyroid volume of the newborns between treatment groups (p>0.05). Conclusions: Maternal iodine supplementation normalized iodine status and resulted in lower maternal TSH concentrations during pregnancy. Further data analysis should reveal whether iodine supplementation has led to any improvement in child development in this population.