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Nutritional Anemia Nutritional Anemia Edited by Klaus Kraemer Michael B. Zimmermann SIGHT AND LIFE Press Preface 1 Nutritional Anemia Nutritional Anemia Edited by Klaus Kraemer SIGHT AND LIFE, Basel, Switzerland Michael B. Zimmermann Swiss Federal Institute of Technology, Zurich, Switzerland SIGHT AND LIFE Press IV SIGHT AND LIFE Mission Statement SIGHT AND 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© SIGHT AND LIFE 2007 All rights reserved. Publications from SIGHT AND LIFE can be obtained from SIGHT AND LIFE Press c/o SIGHT AND LIFE / DSM Nutritional Products Ltd PO Box 2116 4002 Basel Switzerland Phone: +41 61 68 87494 Fax: +41 61 68 81910 Email: [email protected] Internet: www.sightandlife.org Requests for permission to reproduce or translate SIGHT AND 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 SIGHT AND LIFE and are the sole responsibility of the authors. The mention of specific companies and trademarks does not imply that they are endorsed by SIGHT AND LIFE. All reasonable precautions have been taken by SIGHT AND 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 SIGHT AND 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, We are 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. A special 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 SIGHT AND LIFE team, tance with the editing of the chapters. Lastly, Svenia Sayer-Ruehmann and Anne-Catherine we wish to thank SIGHT AND 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 1 MacDonald B, Haddad L, Gross R, McLachlan M. A foundation for development. Administrative Committee on Coordination/Subcommittee on Nutrition. Accessed July 24, 2005. Available at: http://www.ifpri.org/pubs/books/intnut/intnut.pdf 2 ibid 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
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