DSM Nutritional Products

SIGHT AND LIFE NEWSLETTER 1/2006 INCORPORATING THE XEROPHTHALMIA CLUB BULLETIN

Correspondents: Bruno de Benoist, William S. Blaner, George Britton, Omar Dary, Frances R. Davidson, John W. Erdman, Jr., Tracey Goodman, Philip Harvey, Richard F. Hurrell, Rolf D. W. Klemm, Donald S. McLaren, Regina Moench-Pfanner, Christine Northrop-Clewes, Vin- odini Reddy, Delia Rodriguez-Amaya, Ram Kumar Shrestha, Noel W. Solomons, Florentino S. Solon, Alfred Sommer, Andrew Tomkins, G. Venkataswamy, Emorn Wasantwisut, Keith P. West Jr., Yu Xiaodong, Michael B. Zimmermann. Editor: Klaus Kraemer

Lycopene function Community research in Bangladesh Micronutrient information at WHO IUNS Nutrition Congress Drawing contest Reader survey Annual report

Ms Albertine Ramazani from the PROSEVITA project with a refugee family receiving help. Affected by war and social changes, refugee children are particularly vulnerable. They are among the ‘excluded and invisible’ addressed in UNICEF’s annual State of the World’s Children report (see page 47). SIGHT AND LIFE has been supporting Ms Ramazani‘s project for a long time (see article on page 23). SIGHT AND LIFE 2 NEWSLETTER 1/2006

Contents Lycopene intake and prostate cancer risk 4 Inauguration of the extension to the Red Cross Eye Hospital in Janakpur, Nepal; The JiVitA Bangladesh Project: Research to a successful investment against poverty- improve nutrition and health among mothers induced blindness 28 and infants in rural South Asia 10 Edible oil fortification in Bangladesh 29 The micronutrient deficiency information system at the World Health Organization 15 Rural and urban Targeted Initiative Programs in Calcutta 31 Low-income South African consumers’ understanding of vitamins and minerals and Going Yellow video promotes healthy food fortification 17 food in Micronesia 31 18th International Congress of Nutrition held A digest of recent literature 34 in Durban, South Africa 19 Letters to the editor 42 A campaign to raise awareness of and Publications 44 combat vitamin A deficiency 23 Drawing contest on nutrition for health 48 Vision screening and vitamin A distribution in Achina and Owerre Akokwa, Nigeria 25 SIGHT AND LIFE Annual Report 2005 49 Questionnaire survey of our readers 55 A mother and child health care project in Endaselassie, Ethiopia 26 SIGHT AND LIFE, back cover

SIGHT AND LIFE is a humanitarian initiative of DSM Nutritional Products

DSM Nutritional Products DSM Nutritional Products is the world‘s leading supplier of vitamins, carotenoids and other fine chemicals to the feed, food, pharmaceutical and personal care industries. The company has a long tradition as a pioneer in the discovery of new products, new formulations and attractive applications for all industry segments. For further company information please visit www.dsmnutritionalproducts.com DSM DSM is active in nutritional and pharma ingredients, performance materials and industrial chemicals. The company creates innovative products and services that help improve the quality of life. DSM’s products are used in a wide range of end markets and applications such as human and animal nutrition and health, cosmetics, pharmaceuticals, automotive and transport, coatings, housing and electrics & electronics (E&E). DSM’s strategy, named Vision 2010 – Building on Strengths, focuses on accelerating profitable and innovative growth of the company’s specialties portfolio. Market-driven growth, innovation and increased presence in emerging economies are key drivers of this strategy. The group has annual sales of over € 8 billion and employs some 22,000 people worldwide. DSM ranks among the global leaders in many of its fields. The company is headquartered in the Netherlands, with locations in Europe, Asia, Africa and the Americas. NEWSLETTER 1/2006 3 SIGHT AND LIFE

Editorial Micronutrient deficiencies are will gain momentum during 2006, largely responsible for maternal as the World Bank has given and infant mortality in developing malnutrition top priority in a new countries. Population-based ap- report ‘Repositioning Nutrition as proaches to control deficiencies Central to Development’. Malnu- in vitamin A, iron, folate and other trition has been known for a long micronutrients do, however, need time to increase poverty, and the to be based on scientific evidence. fight against malnutrition is crucial One example of a high-quality for economic growth. The World community research program is Bank cautions that malnutrition the JiVitA Bangladesh Project in poor countries may cost them (page 10). In January, I had an up to 3% of their yearly GDP and opportunity to join Alfred Sommer, mean children losing more than Keith West, Parul Christian and 10% of their lifetime income po- Alain Labrique of the Johns Hop- tential. “Put nutrition at the center kins Bloomberg School of Public of development so that a wide Health on a trip to ‘JiVitA-land’ in range of economic and social The time for talking Bangladesh, and to see for myself improvements that depend on nu- should be over a very dedicated local team doing trition can be realized”, the report outstanding research. says. The report also tells us that The year 2005 was a year of big malnutrition has its most damag- speeches by the world’s leaders Undernutrition and micronutrient ing effect between conception in the fight against poverty in the deficiencies are still prevalent in and the first two years in the life developing world, so it follows that developing countries, even as of a child. During this early period 2006 should be a year of action. Western-type food habits and malnutrition causes irreversible By coincidence, this year we are sedentary lifestyles are increas- damage to health and brain devel- celebrating the 20th anniversary ingly being adopted. This leads to opment, increasing school failure of SIGHT AND LIFE, and action overweight and chronic diseases. and reducing work performance. is exactly what we expect of our- Micronesia is a typical example of Moreover, at this early stage in life selves, within the realms of our this dual burden. The increasing malnutrition programs the risk for possibilities. We will align our problems with overweight and obesity and the chronic diseases activities to our new vision (to diabetes and the concomitant vi- of adulthood. The report also combat all types of micronutrient tamin A deficiency are featured in suggests solutions for tackling deficiencies), and we aim to serve a humorous film from Micronesia malnutrition and highlights that your needs even better than be- ‘Going Yellow’, communicated by many developing countries have fore. To this end we are seeking Lois Englberger in this edition of made impressive progress in your feedback on SIGHT AND the Newsletter (page 31). spite of economic setbacks and LIFE. This edition of the Newslet- poor governance. ter contains a questionnaire which The contribution by Jane Badham we kindly ask you to fill in and re- (page 17) on South African con- Is there hope that the time for turn to us. Furthermore, we shall sumers’ knowledge of vitamins talking is over and that action will in future be focusing on health and minerals and food fortification follow? As far as SIGHT AND issues rather than on specific highlights what we often neglect: LIFE is concerned, I am confident vitamin or mineral deficiencies. well-designed communication that we are on the right track. But One of the most important health strategies. Communication also besides sound science and eco- issues is anemia, which affects brings me to the SIGHT AND LIFE nomic incentives this will require more that 2 billion people world- Drawing Contest for children to good communication strategies wide. A SIGHT AND LIFE manual increase awareness of Nutrition to make programs really suc- on ‘Nutritional Anemia’, address- for Health (page 48). Children do cessful. ing contributing factors other than have excellent communication iron, is in preparation. Top experts skills and get down to the nitty- from different fields have agreed gritty immediately. Please help us to contribute chapters. You will to make the contest a success by find these and other examples of advertising the competition. our planned activities for 2006, as well as the Annual Report 2005, There is good reason to think that on page 49 of the Newsletter. the fight against hidden hunger

SIGHT AND LIFE 4 NEWSLETTER 1/2006

Lycopene intake and prostate cancer risk Nikki A Ford and John W Erdman Jr., Division of Nutritional Sciences, University of Illinois, Urbana Champaign

Introduction The red pigment lycopene, the most abundant carotenoid in tomatoes, is also found in lesser amounts in guava, pink grapefruit, papaya, and watermelon. Upon consumption, it accumulates in tissues including liver, adrenals, testes, and prostate (1). Lycopene is a 40 carbon atom, acyclic, open chain polyisoprenoid with 11 conjugated double bonds (2). All-trans lycopene is the predomi- nant isomer found in plants, but cis isomers are the form most The dominating red pigment of tomatoes is lycopene. At a vegetable market commonly found in human tissues in Bangladesh. suggesting preferential absorption of cis isomers (3). of prostate cancer. This paper will Tomatoes also contain a variety review the composition of toma- of carotenoids in addition to lyco- Nearly all men will develop some toes and the epidemiological and pene. While lycopene comprises form of prostate cancer if they experimental evidence regarding approximately 60–64% of the live long enough (4). With a 32% the association between lyco- total carotenoids found in tomato mortality rate, prostate cancer is pene and tomato consumption products, phytoene, phytofluene, the second most abundant cancer and prostate cancer risk. Finally, neurosporene and γ-carotene are world-wide (5). North America potential mechanisms of action the next most abundant caroten- and Australia, along with parts and metabolites and oxidative oids (Figure 2). of South America and Europe, products of lycopene will be dis- have the highest incidence rates cussed. One in vitro study suggests that of prostate cancer (Table 1). Its lycopene works synergistically with occurrence is also high in parts of Tomato composition other tomato components to exert Africa, and Central America. North an effect upon prostate cancer Africa and Eastern Asia have the Tomatoes contain significant risk. Lycopene alone did not affect lowest age standardized prostate amounts of provitamin A carote- growth of prostate cancer cells, cancer risk rate worldwide (5). noids, α-tocopherol, fiber, potas- but when used in combination sium, and folate. Tomato paste is with α-tocopherol, cell proliferation Epidemiological studies suggest very rich in vitamin E. It also con- decreased by up to 90% (9). that increased intake of tomato tains the most fiber of all tomato products and higher blood levels products (8). However, the nutri- Polyphenols, potentially benefi- of lycopene reduce risk of pros- ent content of tomato products cial anti-cancer compounds, are tate cancer (6). Lycopene and varies widely depending upon also found in tomato products, tomatoes have been proposed to variety, ripeness of the fruit, and predominantly in the skin and play a crucial role in the reduction processing methods. seeds. Specifically, quercetin and

Figure 1. Structure of all-trans lycopene. NEWSLETTER 1/2006 5 SIGHT AND LIFE

kaempferol are found in significant amounts in tomato products (10).

Epidemiological studies suggest that thermal processing may enhance the impact of tomato products upon the risk of prostate cancer (11). Heating and processing of tomato products increases the amount of cis isomers of lycopene. Cis isomers of lycopene are more soluble in bile acid mi- celles and may be preferentially integrated into chylomicrons of the small intestinal mucosa, thus potentially increasing bioavailability of lycopene (3, 12, 13). Ther- mal processing also increases bioavailability by breaking down the tomato cell matrix and decreasing food particle size (14). Additionally, a tomato has a very high water weight while thermal Figure 2. Carotenoid composition of a raw, ripe tomato (%), adapted from (7). processing of tomatoes causes water loss so lycopene becomes prostate cancer (11, 15, 16). decreased risk of prostate cancer. more concentrated (8). Increased consumption of to- Conversely, increased consump- matoes, carotenoids, vitamin E, tion of milk, calcium, zinc, meat, Prostate cancer selenium, cruciferous vegetables, and fat has been associated with polyphenols, soy, fish, green tea or increased risk of prostate cancer Many risk factors are associated vitamin D have all been linked to a (4, 17–20). Lycopene, vitamin E, with prostate cancer including family history, hormone status, Table 1. Incidence of prostate cancer worldwide 2002 race, age, diet, and environmental (100,000 person-years). agents. Family history is strongly associated with an increased Geography Age standar- Cumulative risk Annual risk of prostate cancer especially dized rates (0–64 yrs) % cases when close family members develop cancer early in life or the ag- Eastern Africa 13.8 0.4 7054 gressive forms of cancer (4). Most Middle Africa 24.5 0.5 4975 prostate cancer cases are found Northern Africa 5.8 0.2 2908 in men over the age of 65 years Southern Africa 40.5 1.6 4778 (4). Hormonal status also plays an Western Africa 19.3 0.9 9947 important role in prostate cancer Caribbean 52.4 1.4 9154 risk. Epidemiological studies have Central America 30.6 0.8 13014 shown that increased concentra- South America 47.0 1.4 60098 tions of serum testosterone or North America 119.9 5.5 257943 dihydrotestosterone over long Eastern Asia 3.8 0.1 29472 periods of time may increase the South-Eastern Asia 7.0 0.2 11834 risk of prostate cancer. Race is South Central Asia 4.4 0.1 22093 also a risk factor. This may be due Western Asia 10.9 0.4 6872 to genetics and/or exogenous fac- Eastern Europe 17.3 0.5 32891 tors. African-American men have Northern Europe 57.4 1.7 46974 the highest risk of prostate cancer Southern Europe 35.5 1.0 47279 in the world (4). Western Europe 61.6 2.2 98083 Australia 79.9 2.9 13486 A variety of epidemiological studies have suggested dietary fac- Adapted from Globocan 2002 Database. http://www-dep.iarc.fr/globocan/ tors may decrease the risk of database.htm. SIGHT AND LIFE 6 NEWSLETTER 1/2006

Table 2. Selected epidemiological studies evaluating the effects of tomato consumption or serum lycopene on prostate cancer risk.

Study Focus Conclusions Mills et al. (1989) Dietary and lifestyle changes were An increased consumption of beans, lentils (15) studied in relation to prostate cancer and peas, tomatoes, raisins, dates, and risk in a population of 14,000 Seventh- other dried fruit were all associated with a day Adventist men decreased prostate cancer risk Giovannucci et al. A prospective study of 47,894 health The intake of lycopene or other compounds (1995) (6) professional subjects analyzed the in tomatoes may reduce the risk of prostate relationship between the intake cancer (MRR = 0.65, p = 0.01) of carotenoids, retinol, fruits, and vegetables and the risk of prostate cancer (HPFS) Gann et al. (1999) A prospective study that analyzed Increased plasma lycopene reduced the (25) the relationship between plasma risk of all prostate cancers (p = 0.12), but concentrations of antioxidants there was a stronger inverse association for (carotenoids, tocopherols, and retinols) aggressive prostate cancer (p=0.05) and the risk of prostate cancer Giovannucci et al. Further analysis of the 1995 HPFS A relative risk of 0.77 was observed with the (2002) (26) study with updated information for highest intake of tomato paste in association subjects to determine whether the with prostate cancer risk (p<0.001) association would persevere Wu et al.(2004) (16) Using the HPFS, a case-control study An inverse relationship was observed observed the association between between increased plasma lycopene plasma carotenoids and prostate cancer concentrations and reduced risk of prostate risk cancer in older men and men without a family history of prostate cancer Etminan et al. Use of MEDLINE and EMBASE to The association between reduced prostate (2004) (27) perform a meta-analysis which may cancer risk and tomato product consumption identify associations between intake of was marginal and restricted to only high tomato products and prostate cancer risk intakes and selenium have been shown fective way to reduce cancer reduces the incidence of prostate to inhibit the development of growth rate (23). Prostate cancer cancer (6, 11, 15, 17). Lycopene prostate cancer in a transgenic therapies greatly add to national and tomato products appear to mouse model (21). These dietary health care budgets and human reduce the risk of prostate cancer components may additively or suffering, while alternative treat- in epidemiological studies (Table synergistically reduce the risk of ments may offer a way to ease 2). In a pivotal study using the prostate cancer. the burden. One study estimated Health Professional Follow-up that in the United States the aver- Study (HPFS) cohort, lycopene Men diagnosed with prostate age prostate cancer patient paid and tomato product intakes were cancer often require surgery, $2187 per month in 1999 for treat- associated with a decreased risk radiation, or chemotherapy. Non- ment (24). The ideal intervention of prostate cancer (6). One study invasive tumors may be treated for prevention of cancer would suggests a strong inverse asso- with high intensity ultrasound. be convenient and non-toxic or ciation between the aggressive- Radiation or surgical treatment exhibit few side effects (2). ness of the cancer and plasma generally offers the best chance lycopene (25). Another study of survival from prostate cancer. Epidemiology showed an inverse association Unfortunately, about 50% of pa- between plasma lycopene con- tients have a recurrence of cancer Many studies have shown that centrations and risk of prostate within 15 years (22). Hormone an increased consumption of cancer only in older men without a therapy has also proved an ef- fruits and vegetables significantly family history of the disease (16). NEWSLETTER 1/2006 7 SIGHT AND LIFE

produces the most potent androgen (39). Additionally, reducing androgens by castration changes the metabolism of lycopene and increases lycopene liver stores (1, 35). Potential interactions of these mechanisms are displayed in Figure 3.

Clinical human trials There have been a few, small clinical trials that have evaluated the effects of short-term tomato product or lycopene feeding on risk factors of prostate cancer in men with existing disease. One study observed the effects of feeding diets high in tomato product to a population of predominantly African-American men diagnosed with prostate cancer Figure 3. Proposed mechanisms of reduction of prostate cancer risk by who were awaiting prostatectomy lycopene, adapted from (36). (removal of the prostate). Serum and prostate tissue lycopene concentrations significantly increased In summary, the results of these to interact with each other via within the 3 weeks of intervention. epidemiological studies support a gap-junctional cell communica- Levels of oxidative DNA damage hypothesis that tomato products tions to maintain proper growth and prostate-specific antigen and lycopene consumption re- rates. This communication can (PSA) (a biochemical marker duce the risk of prostate cancer be silenced in cancer cells and often increased in patients with and supports further testing of thus cells divide uncontrollably. prostate cancer) significantly de- this relationship with animal and Lycopene has been suggested to creased in men receiving dietary human trials. increase gap-junctional commu- intervention (37). Another study nication and therefore potentially suggested that tomato product Potential mechanisms of reduce the incidence of prostate consumption for 15 days signifi- action cancer (30, 31). Another hallmark cantly protected against markers of cancer is an insensitivity to of oxidative stress (38). Many potential mechanisms have antigrowth signals which in turn been proposed for the effect of allows for cancer cells to multiply A third clinical trial observed lyco- lycopene on prostate cancer risk. quickly. Studies show that lycopene supplementation before rad- Reactive oxygen species (ROS) pene may reduce rapid cell divi- ical prostatectomy. PSA levels in are naturally produced in cells. An sion by inhibiting different growth the intervention group decreased imbalanced production of ROS factors (1, 32, 33). 14% while the PSA levels in the causes oxidative stress which is untreated group increased 18%. believed to be one of the major Phase II enzymes help to provide Growth factors decreased signifi- causes of cancer. Lycopene due a first barrier defense against car- cantly in both groups. Although a to its many double bonds is a cinogens and are often downreg- small sample size, these results potent antioxidant and is the most ulated in cancer cells. Lycopene suggest an inverse relationship efficient biological carotenoid sin- has been suggested to increase between lycopene supplementa- glet oxygen quencher (28). the activity of phase II enzymes tion and prostate cancer growth (34). Evidence also suggests that (40). In support of these findings, Studies suggest that lycopene increased androgen levels are re- a further study suggests an in- has been shown to inhibit or slow lated to increased prostate cancer verse relationship between the cell cycle progression, thus reduc- risk. In one study, lycopene was intake of cooked tomatoes and ing cancer cell proliferation rate shown to reduce the expression growth factor regulation of pros- (1, 29). Cells must also be able of the enzyme in the prostate that tate cancer (41). SIGHT AND LIFE 8 NEWSLETTER 1/2006

Rodent experimental lycopene, significantly inhibited Conclusion models used to evaluate cancer growth. This suggests that tomato products contain The encouraging relationship the effects of tomato / other compounds that may work between consumption of tomato lycopene consumption independently, synergistically or products and lycopene and re- on prostate cancer additively with lycopene in the duced risk of prostate cancer reduction of prostate cancer risk. is evident in epidemiological Recently in our lab, we observed Energy restriction also reduced studies and through the use of the effects of different dietary prostate cancer risk (44). animal and cell culture models. treatments or the use of a che- Animal models are limited and Studies using isolated lycopene mopreventive agent, finasteride, not without interpretation prob- have only recently been reported. upon the growth of the Dunning lems; therefore other studies are Many different mechanisms of R-3327-H transplantable prostate necessary to better understand action have been suggested for carcinoma over a 16 week treat- the complex aspects of diet and the reduction of prostate cancer ment period. Treatments included prostate cancer. Ultimately, long risk with increased consumption 10% tomato powder, 10% broccoli term clinical human trials could of tomato products or lycopene. powder, 0.025% lycopene from provide the best insight into the Lycopene does not appear to be commercial beadlets, a combi- effects of diet upon the reduction the only anticancer factor in toma- nation of the tomato and broccoli of prostate cancer risk. toes. Further research is needed diets, or 5 mg of finasteride/kg to determine which components body weight (orally gavaged). Metabolites and within tomatoes may work in isola- Finasteride, an androgen forma- oxidation products tion, in addition, or synergistically tion inhibitor, did not have an with lycopene to reduce the risk effect on tumor growth in rats, Our laboratory and others have of prostate cancer. while the diets containing broccoli found that the consumption of and combination of broccoli and tomato-based diets results in a References tomato were effective in growth protective effect against prostate reduction of the tumors (42). cancer in rat models. Lycopene 1. Wertz K, Siler U and Goralczyk R (2004). Lycopene: modes of action Lycopene feeding resulted in a has been studied in vivo and in to promote prostate health. Arch non-significant reduction in tumor vitro but studies have been in- Biochem Biophys 430(1): 127–34. growth. conclusive. Preliminary studies in 2. Hadley CW et al. (2002). Tomatoes, our lab have shown that lycopene lycopene, and prostate cancer: The MatLyLu Dunning prostate reduces proliferation of tumor progress and promise. Exp Biol Med cancer model was used to ex- cells when the cell culture me- (Maywood) 227(10): 869–80. amine the mechanisms by which dium is unchanged as opposed to 3. Erdman JW Jr (2005). How do nutri- vitamin E and/or lycopene reduce changed daily. This may suggest tional and hormonal status modify the the risk of prostate cancer. Rats that metabolites or oxidative prod- bioavailability, uptake, and distribu- were fed for 4 weeks with diets tion of different isomers of lycopene? ucts of lycopene are responsible J Nutr 135(8): 2046S–7S. containing lycopene or vitamin E for inhibition of cell growth instead or a combination. Lycopene and 4. Bostwick DG et al. (2004). Human of simply lycopene. prostate cancer risk factors. Cancer vitamin E downregulated genes 101(10 Suppl): 2371–490. within the prostate that are po- Our lab has recently identified 5. Parkin DM et al. (2005). Global cancer tentially important in slowing the apo-8’-lycopenal, an oxidative statistics. CA Cancer J Clin 55(2): development of prostate cancer. and chain-shortened metabo- 74–108. Although further investigation lite of lycopene, in the liver of 6. Giovannucci E et al. (1995). Intake of is needed, this study provided F344 male rats that were prefed carotenoids and retinol in relation to insight into the link between lyco- lycopene and given a single oral risk of prostate cancer. J Natl Cancer pene and vitamin E consumption dose of 14C-labeled lycopene. Inst 87(23): 1767–76. and reduced risk of prostate can- Thus, apo-lycopenals appear to 7. Clinton SK (1998). Lycopene: chem- cer (43). be some of the more prevalent istry, biology, and implications for human health and disease. Nutr Rev metabolites of lycopene in rat liver 56(2 Pt 1): 35–51. A study conducted in our lab in vivo (45). Further analysis of observed the effects of diets con- 8. U.S. Department USDA National lycopene metabolic products and Nutrient Database for Standard taining tomato powder, lycopene, their effects on prostate cancer Reference of Agriculture, A.R.S.O., or energy restriction upon the risk is currently being pursued by accessed December 12, 2005. risk of prostate cancer in the N- our lab. methyl-N-nitrosourea (NMU) rat model. Tomato powder, but not NEWSLETTER 1/2006 9 SIGHT AND LIFE

9. Pastori M et al. (1998). Lycopene in 22. Uchida T et al. (2006). Treatment of oxidant enzymes in the rat. Cancer association with alpha-tocopherol in- localized prostate cancer using high- Lett 154(2): 201–10. hibits at physiological concentrations intensity focused ultrasound. BJU Int 35. Boileau TW, Clinton SK and Erdman proliferation of prostate carcinoma 97(1): 56–61. JW Jr (2000). Tissue lycopene con- cells. Biochem Biophys Res Com- 23. Fuse H et al. (2006). Treatment with centrations and isomer patterns are mun 250(3): 582–5. prednisolone of hormone-refractory affected by androgen status and di- 10. Stewart AJ et al. (2000). Occurrence prostate cancer. Arch Androl 52(1): etary lycopene concentration in male of flavonols in tomatoes and tomato- 35–38. F344 rats. J Nutr 130(6): 1613–8. based products. J Agric Food Chem 24. Chang S et al. (2004). Estimating the 36. Agarwal S and Rao AV (2000). To- 48(7): 2663–9. cost of cancer: results on the basis mato lycopene and its role in human 11. Giovannucci E (2002). A review of of claims data analyses for cancer health and chronic diseases. CMAJ epidemiologic studies of tomatoes, patients diagnosed with seven types 163(6): 739–44. lycopene, and prostate cancer. of cancer during 1999 to 2000. J Clin 37. Chen L et al. (2001). Oxidative DNA Exp Biol Med (Maywood) 227(10): Onco 22(17): 3524–30. damage in prostate cancer patients 852–9. 25. Gann PH et al. (1999). Lower pros- consuming tomato sauce-based en- 12. Boileau AC et al. (1999). Cis-lyco- tate cancer risk in men with elevated trees as a whole-food intervention. J pene is more bioavailable than plasma lycopene levels: results of a Natl Cancer Inst 93(24): 1872–9. trans-lycopene in vitro and in vivo prospective analysis. Cancer Res 38. Hadley CW, Clinton SK and Schwartz in lymph-cannulated ferrets. J Nutr 59(6): 1225–30. SJ (2003). The consumption of proc- 129(6): 1176–81. 26. Giovannucci E et al. (2002). A pro- essed tomato products enhances 13. Gartner C, Stahl W and Sies H spective study of tomato products, plasma lycopene concentrations in (1997). Lycopene is more bioavail- lycopene, and prostate cancer risk. association with a reduced lipopro- able from tomato paste than from J Natl Cancer Inst 94(5): 391–8. tein sensitivity to oxidative damage. fresh tomatoes. Am J Clin Nutr 66(1): 27. Etminan M, Takkouche B and Caa- J Nutr 133(3): 727–32. 116–22. mano-Isorna F (2004). The role of 39. Herzog A et al. (2005). Lycopene 14. Fielding JM et al. (2005). Increases in tomato products and lycopene in reduced gene expression of steroid plasma lycopene concentration after the prevention of prostate cancer: a targets and inflammatory markers in consumption of tomatoes cooked meta-analysis of observational stud- normal rat prostate. FASEB J 19(2): with olive oil. Asia Pac J Clin Nutr ies. Cancer Epidemiol Biomarkers 272–4. 14(2): 131–6. Prev 13(3): 340–5. 40. Kucuk O et al. (2001). Phase II 15. Mills PK et al. (1989). Cohort study 28. Di Mascio P, Kaiser S and Sies H randomized clinical trial of lycopene of diet, lifestyle, and prostate cancer (1989). Lycopene as the most ef- supplementation before radical in Adventist men. Cancer 64(3): ficient biological carotenoid singlet prostatectomy. Cancer Epidemiol 598–604. oxygen quencher. Arch Biochem Biomarkers Prev 10(8): 861–8. Biophys 274(2): 532–8. 16. Wu K et al. (2004). Plasma and 41. Mucci LA et al. (2001). Are dietary influ- 29. Hanahan D and Weinberg RA (2000). dietary carotenoids, and the risk ences on the risk of prostate cancer The hallmarks of cancer. Cell 100(1): of prostate cancer: a nested case- mediated through the insulin-like growth 57–70. control study. Cancer Epidemiol factor system? BJU Int 87(9): 814–20. Biomarkers Prev 13(2): 260–9. 30. Habermann H et al. (2001). Altera- 42. Canene-Adams K et al. (2004). The tions in gap junction protein expres- effect of diets containing tomato, 17. Chan JM, Gann PH and Giovannucci sion in human benign prostatic broccoli, lycopene, or finasteride EL (2005). Role of diet in prostate hyperplasia and prostate cancer. J treatment on the growth of Dunning cancer development and progres- Urol 166(6): 2267–72. R-3327-H transplantable prostate sion. J Clin Oncol 23(32): 8152–60. 31. Livny O et al. (2002). Lycopene adenocarcinoma in rats. J. Nutr 18. Sonn GA, Aronson W and Litwin MS inhibits proliferation and enhances 134(suppl.): 3535S (abs.). (2005). Impact of diet on prostate gap-junction communication of KB- 43. Siler U et al. (2005). Lycopene ef- cancer: a review. Prostate Cancer 1 human oral tumor cells. J Nutr fects on rat normal prostate and Prostatic Dis 8(4): 304–310. 132(12): 3754–9. prostate tumor tissue. J Nutr 135(8): 19. Hodge AM et al. (2004). Foods, nu- 32. De Marzo AM et al. (2003). Human 2050S–2S. trients and prostate cancer. Cancer prostate cancer precursors and 44. Boileau TW et al. (2003). Prostate Causes Control 15(1): 11–20. pathobiology. Urology 62(5 Suppl 1): carcinogenesis in N-methyl-N-nitro- 20. Qin LQ et al. (2004). Milk consump- 55–62. sourea (NMU)-testosterone-treated tion is a risk factor for prostate can- 33. Furstenberger G and Senn HJ rats fed tomato powder, lycopene, or cer: meta-analysis of case-control (2002). Insulin-like growth factors energy-restricted diets. J Natl Cancer studies. Nutr Cancer 48(1): 22–7. and cancer. Lancet Oncol 3(5): Inst 95(21): 1578–86. 21. Venkateswaran V et al. (2004). 298–302. 45. Gajic M (2005). Identification of the Antioxidants block prostate cancer 34. Breinholt V et al. (2000). Dose- metabolic products of lycopene in rat in Lady transgenic mice. Cancer Res response effects of lycopene on tissue. Thesis: University of Illinois at 64(16): 5891–6. selected drug-metabolizing and anti- Urbana-Champaign. SIGHT AND LIFE 10 NEWSLETTER 1/2006

The JiVitA Bangladesh Project: Research to improve nutrition and health among mothers and infants in rural South Asia Keith P West Jr*, Parul Christian*, Rolf Klemm*, Alain Labrique*, Mahbubur Rashid**, Abu Ahmed Shamim**, Joanne Katz* and Alfred Sommer* for the JiVitA Bangladesh Project * Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. ** The JiVitA Bangladesh Research Project, Keranipara, Rangpur, Bangladesh

More than half of pregnant women to be known about the efficacy of in rural South Asia are likely to be micronutrient supplementation in affected by multiple micronutrient improving health and the public deficiencies (1) presumably aris- health approaches that optimize ing from demands of pregnancy benefit, minimize risk and remain and lactation superimposed on di- feasible and low cost. ets chronically lacking in vegetables, fruit, and animal products (2, The JiVitA 3). This same region also harbors Bangladesh risks of mortality that claim over Project (the 40% of all maternal and infant term “JiVitA”, deaths in the world each year. De- pronounced ficiencies in vitamin A, iron, folate jiveeta, is and other nutrients can have based on the deleterious effects on the health Bangla word of mothers and their offspring and jibheetoh, Figure 2. Mother participating in may account for substantial ma- which means JiVitA-1 receiving a weekly capsule ternal morbidity and mortality in “alive”) was established in 1998 from a field worker. undernourished and underserved to improve the health and sur- settings (4–6), yet much remains vival of women of reproductive age, infants, and young children in South Asia through community-based micronutrient trials and supportive epidemiologic research. The Project is a research component of the Government of Bangladesh’s Ministry of Health and Family Welfare under its Na- tional Integrated Population and Health Program (NIPHP) which is jointly administered with the United States Agency for Inter- national Development (USAID). The Project seeks to evaluate the efficacy and safety of micronutrient interventions for reducing maternal morbidity and mortality, fetal malnutrition and loss, and infant morbidity and mortality. It is motivated by a need to inform and guide policies and programs in this area of public health. The first major trial, called JiVitA-1, began Figure 1. JiVitA-1 is a cluster-randomized, double-masked, placebo con- in August 2001 and is ongoing. trolled community trial This 67,000-pregnancy, placebo- NEWSLETTER 1/2006 11 SIGHT AND LIFE

controlled trial is testing the effects of maternal supplementation with the weekly equivalent of a recommended dietary allowance (RDA, estimated for pregnant or lactating women to be ~23,300 IU (7000 µg retinol equivalents)) of vitamin A, either preformed or as provitamin β-carotene, on mortality of women related to pregnancy, and on fetal loss and infant mortality (Figure 1). In doing so, JiVitA-1 is seeking to extend previous findings from a similar Figure 3. Maternal mortality rate (per 100,000) in response to vitamin A trial in Nepal to a broader South (7000 µg RE/wk) and β-carotene (42 mg/wk) in Nepal. Asian context (Figure 2). This earlier trial observed a ~40% reduc- and Bangladesh has developed management station, biospeci- tion in mortality of women related this research site. This process men processing laboratory, and to pregnancy (7–8) (Figure 3). has included (a) establishing a a project headquarters housing Although there was no overall ef- network of national and local administrative, data management fect on infant mortality (9), there institutional linkages; (b) recruit- and GIS facilities. The JiVitA data appeared to be a survival advan- ing and training over 850 staff, management center has 24 staff tage to babies born to women ~90% of whom are local women, and is capable of processing up at risk of night blindness (10). A to fill technical, administrative and to 20,000 records each week second ongoing placebo-control- logistical needs; (c) mapping and (Figure 7). led trial, called JiVitA-2, is nested addressing over 130,000 house- into the first (Figure 4). This study holds, adapting maps drawn The need for units of randomiza- seeks to confirm previous work in from aerial photography in the tion smaller than a union led us Indonesia (11) and India (12) that 1930s that are now supported to create 596 “sectors” of similar newborn receipt of ~50,000 IU of by a global positioning system size (each with ~250 households) vitamin A can reduce mortality in (GPS)-based geographic informa- that also serve as individual “work South Asian infants. The trial is tion system (GIS) to enhance field units” for each of our sector-based designed to enroll ~23,100 infants efficiency and epidemiologic stud- local staff (Figure 2). In order to born to JiVitA-1 mothers, supple- ies; and (d) establishing a network launch JiVitA-1 in August 2001, ment them within the 1st two days of 70 field offices, a central field over 120,000 women of reproduc- of life and follow their health and survival through six months of age (Figure 5). Evaluating effects of interventions on mortality typically require enrolling, supplementing, and following large numbers of subjects, as in these two trials.

Located in the rural, rice-growing, population-dense northern districts of Gaibandha and Rang- pur, the JiVitA Project covers 19 unions with an area of ~650 km2 and population of nearly 650,000 people (Figure 6). The area in which JiVitA operates lies at roughly the 25th percentile of the country with regard to many of its health, nutrition, vital, so- cioeconomic and development statistics (13). Since 1998, a joint team of researchers from Figure 4. The JiVitA-2 trial is designed to enroll about 23,100 infants born Johns Hopkins University (USA) to JiVitA-1 mothers. SIGHT AND LIFE 12 NEWSLETTER 1/2006

tive age were initially registered and a five-weekly, home-based surveillance system was implemented that annually detects ~5000 newly married women and recruits into the trial up to 18,000 1st trimester pregnancies that are confirmed by urine testing. The system is complemented by a weekly home-visiting program during which consenting pregnant women are given study supplements under supervision, and Figure 5. A newborn receiving a JiVitA-2 study capsule. pregnancy outcomes and births are recorded. Within two days of birth, infants are given a JiVitA-2 supplement, consisting of either 50,000 IU of vitamin A or a placebo, and assessed for size by anthropometry in the home. Vital events of enrolled mothers and infants continue to be monitored during weekly home visits for the 1st three months after childbirth, and periodically thereafter.

Large trials offer opportunities to conduct enhanced substudies to assess changes in more involved indicators of nutritional status, morbidity and function that can be evaluated in relation to an intervention. These intensive protocols aim to complement periodic interview-based assessments of morbidity and diet carried out Figure 6. The JiVitA study area is located in 19 unions (highlighted to the in the general trial population. right), mostly in the District of Gaibandha. The area is further divided into For example, in a designated nearly 600 “sectors” (not shown) that serve as units of randomization and substudy area in JiVitA, involv- staff assignment. ing ~3% of all pregnant women, we conduct an array of maternal assessments during the 1st and 3rd trimester visits and at three months postpartum. These include anthropometry, phlebotomy for later vitamin A, carotenoid, and other micronutrient, antioxidant and immune assays, urine collec- tion for iodine and other analytic studies, vaginal smears for assessments of bacterial vaginosis risk and response, and maternal body composition analysis by bioelectrical impedance. Sub- studies in infants obtain detailed Figure 7. The JiVitA data management center in Rangpur enters up to 20,000 anthropometry at birth, 3 and 6 records each week at an error rate of <4 per 10,000 keystrokes, interacts months of age (Figure 8) and weekly with the field to solve queries and maintains a GIS mapping unit. seek to reveal potential disease NEWSLETTER 1/2006 13 SIGHT AND LIFE

mechanisms that may be respon- sive to supplementation of either the mother or infant. For example, one JiVitA-2 substudy is assessing rates of nasopharyngeal colonization with Haemophilus influenza B and Streptococcus pneumoniae at three months of age, both being causes of acute respiratory infections in early infancy against which vitamin A may offer some protection (14). Another study is being planned to examine effects of vitamin A on neonatal sepsis and related com- plications. Across the larger trial population, a field worker-based birth defect surveillance system, backed by physician exam and Figure 8. A JiVitA-2 infant in the substudy area being measured for chest digital-photography, is being circumference using an adapted “Zerfas” insertion tape. tested and evaluated for its ability to generate reliable estimates of can inform policy. The current tional Health of the Johns Hopkins anatomical defects, for rate esti- trials are due to be completed Bloomberg School of Public Health mation and responses to this or during 2007. Additional research in Baltimore, Maryland (USA) in subsequent interventions. is being planned, guided by collaboration with several expert emerging findings elsewhere in partners, including the Institute of The JiVitA Project continues to the region (15–17), that may help Nutrition at Mahidol University in learn a great deal from meeting to advance maternal and infant Thailand, the Institute of Nutrition the challenges of setting up a micronutrient deficiency preven- and Food Sciences, Dhaka Univer- modern, collaborative research tion in South Asia in the future. sity, the Shishu (Children’s) Hospi- program in a rural South Asian tal in Dhaka, the Institute for Child setting – one that is capable of The JiVitA Project is implemented and Maternal Health in Dhaka and conducting large nutrition and by the Center for Human Nutri- the Bangladesh Atomic Energy health care intervention trials that tion in the Department of Interna- Commission in Dhaka. Protocols SIGHT AND LIFE 14 NEWSLETTER 1/2006

for all JiVitA trials and substudies References cluster randomised trial of low dose are reviewed and approved by supplementation with vitamin A or β- the Johns Hopkins Committee 1. Jiang T et al. (2005). Micronutrient carotene on mortality related to preg- deficiencies in early pregnancy are nancy in Nepal. BMJ 318:570–575. on Human Research and the common, concurrent, and vary by Bangladesh Medical Research season among rural Nepali pregnant 8. Christian P et al. (2000). Vitamin A or Committee. The JiVitA Project women. J Nutr 135:1106–1112. β-carotene supplementation reduces symptoms of illness in pregnant is made possible through the 2. Ahmed F et al. (2003). Anaemia and and lactating Nepali women. J Nutr generous support of the Office of vitamin A deficiency in poor urban 130:2675–2682. Health, Infectious Diseases and pregnant women of Bangladesh. Asia Pac J Clin Nutr 2:460–466. 9. Katz J et al. (2000). Maternal low- Nutrition, USAID (Washington dose vitamin A or β-carotene sup- DC, USA), the USAID Mission in 3. Khan MR and Ahmed F. (2005). plementation has no effect on fetal Physical status, nutrient intake and loss and early infant mortality: a Dhaka, The Bill & Melinda Gates dietary pattern of adolescent female Foundation (Seattle, WA, USA) randomized cluster trial in Nepal. Am factory workers in urban Bangladesh. J Clin Nutr 71:1570–1576. and the Government of Bang- Asia Pac J Clin Nutr 14:19–26. 10. Christian P et al. (2001). Maternal ladesh, with additional financial 4. Bhaskaram P. (2002). Micronutrient night blindness increases risk of in- and technical assistance from malnutrition, infection, and immunity: fant mortality in the first 6 months of SIGHT AND LIFE and the SIGHT an overview. Nutr Rev 60:S40–S45. life in Nepal. J Nutr 131:1510–1512. AND LIFE Research Institute 5. Christian P. (2002). Maternal nutri- 11. Humphrey JH et al. (1996). Impact of (Baltimore, MD, USA), the Cana- tion, health, and survival. Nutr Rev neonatal vitamin A supplementation dian International Development 60:S59–S63. on infant morbidity and mortality. J Agency and Micronutrient Initia- 6. West KP Jr. (2004). Vitamin A de- Ped 128:489–496. ficiency as a preventable cause of tive (CIDA, Ottawa, Canada), the 12. Rahmathullah L et al. (2003). Im- maternal mortality in undernourished pact of supplementing newborn Nutrilite Health Institute of Am- societies: plausibility and next steps. infants with vitamin A on early infant way Corporation and the Access Intl J Gynecol Obstet 85:S24–S27. mortality: community based ran- Business Group (Buena Park, 7. West KP Jr. et al. and the NNIPS-2 domised trial in southern India. BMJ CA, USA). Study Group (1999). Double blind, 327:254–259. 13. UNICEF. Progotir Pathey 2003. On the road to progress. Dhaka: Bang- ladesh Bureau of Statistics 2004. 14. Coles CL et al. (2001). Vitamin A supplementation at birth delays pneumococcal colonization in South Indian infants. J Nutr 131:255–261. 15. Christian P et al. (2003). Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal. A double-masked randomized community trial. BMJ 326:571–576. 16. Christian P et al. (2003). Effects of maternal micronutrient supplementation on fetal loss and infant mortality: a cluster-randomized trial in Nepal. Am J Clin Nutr 78:1194–1202. 17. Christian P et al. (2005). Antenatal micronutrient supplements in Nepal. Lancet 366:711–712. NEWSLETTER 1/2006 15 SIGHT AND LIFE

The micronutrient deficiency information system at the World Health Organization Bruno de Benoist and Erin McLean, Department of Nutrition for Health and Development, the World Health Organization, Geneva, Switzerland.

The Micronutrient Deficiency between WHO headquarters and its own national and international Information System (MDIS), a Regional Offices who liaise with goals, in addition to assessing database for indicators of micro- the WHO Country Offices and the how the world is faring as a whole. nutrient malnutrition, was devel- respective Ministries of Health. The importance of sharing this oped in 1992 in the Department of valuable health information is Nutrition for Health and Develop- MDIS assesses the prevalence recognized by WHO, and for this ment (NHD) of the World Health of disease as a primary func- reason efforts are made to publish Organization (WHO). Focusing on tion, but can also be used as the data through the World Wide three micronutrient deficiencies a tool to monitor and evaluate Web. The databases on anemia of demonstrated public health the effectiveness of programs and iodine deficiency can be importance, Vitamin A Deficiency in eliminating diseases since accessed at http://www3.who. (VAD), Iodine Deficiency Disor- historical data remain available int/whosis/micronutrient*. The vi- ders (IDD), and Iron Deficiency/ as new data are inputted. Thus, tamin A database will be available Anemia (IDA), the MDIS is main- MDIS can track how successfully on the website soon. tained through a collaboration a country is progressing towards

Table 1. Number of surveys in the database as of January 2006, by level of survey (% of total).

Database Total Level of Survey1 In the last 10 years2 National Regional State District Local

Vitamin A Sub-clinical3 383 82 (21.4) 15 (3.9) 45 (11.7) 32 (8.4) 209 (54.6) 197 (51.4)

Clinical4 362 111 (30.7) 16 (4.4) 93 (25.7) 45 (12.4) 97 (26.8) 162 (44.8)

Iodine Goiter 754 185 (24.5) 89 (11.8) 113 (15.0) 87 (11.5) 280 (37.1) 204 (27.1)

Urinary 565 136 (24.1) 56 (9.9) 60 (10.6) 51 (9.0) 262 (46.3) 277 (49.0) Iodine Anemia Hemoglobin 1356 249 (18.4) 58 (4.3) 121 (8.9) 106 (7.8) 822 (60.6) 568 (41.9)

1 This refers to the administrative level for which the survey is representative: state is representative at the first administrative level of a country and district at the second administrative level, while region is multiple states and local is all other surveys. 2 The number of surveys in the database carried out since 1995. 3 Includes serum retinol data. 4 Includes data on xerophthalmia and night blindness.

* Should you be aware of any surveys which are not in the database, please notify us and, if possible, send the surveys to: Dr. Erin McLean, Reduction of Micronutrient Malnutrition Unit (MNM), Nutrition for Health and Develop- ment (NHD), World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland email: [email protected] SIGHT AND LIFE 16 NEWSLETTER 1/2006

Included in the MDIS are data In 1993, the first MDIS working With so many agencies and or- from complete original survey paper “Global prevalence of io- ganizations fighting against mi- reports or publications, which pro- dine deficiency disorders” was cronutrient malnutrition, the data vide details on the sampling meth- published (1). At that time, 655 provided by the MDIS and the od. The sampling frame must be million people were affected by estimates of the number and lo- population-based or, in the case goiter and 1.57 billion people cation of the people most likely to of school-age children, pregnant were estimated to be at risk since be affected are critical to identify women and newborns, the survey they were living in an area with the areas where programs may may be facility-based. In addition a total goiter rate >5%. The first be most needed. to surveys designed specifically estimates on vitamin A deficiency to assess the micronutrient status were released in 1995 and it Acknowledgements of a specified population, data was estimated that, globally, 250 SIGHT AND LIFE is gratefully may come from cross-sectional million people were at risk of acknowledged for their financial surveys or baseline values for VAD (serum retinol <0.70 µmol/l) support to the vitamin A data- intervention studies designed for while 2.8 million had clinical VAD base. other purposes. The prevalence eye signs or night blindness (2). of xerophthalmia, night blindness In 2004, the second set of esti- References and/or concentration of serum mates on IDD were generated 1. WHO, UNICEF, ICCIDD (1993). Glo- retinol, the prevalence of goiter and it was estimated that 36.5 bal prevalence of iodine deficiency and/or urinary iodine concentra- million school-age children and disorders. Micronutrient Deficiency tion, and/or hemoglobin concen- 285 million people in total had Information System Working Paper trations of any population group insufficient iodine intake and were No.1. Geneva, World Health Organi- must be reported to be included in therefore at risk of IDD (urinary zation the VAD, IDD and IDA databases iodine concentration <100µg/l) 2. WHO, UNICEF (1995). Global Preva- respectively. Information on the (3). Anemia estimates are cur- lence of Vitamin A Deficiency. Mi- number of surveys in the database rently being generated and are cronutrient Deficiency Information System working paper No. 2. WHO/ as of January 2006, and the level expected to be released in late NUT/95.3. Geneva, World Health for which they are representative, 2006. Further, NHD is preparing Organization is displayed in Table 1. to make new estimates on the 3. WHO Global Database on Iodine global prevalence of VAD, which Deficiency Iodine status worldwide Surveys are obtained through should be available by late 2006, (2004). Geneva, World Health Or- Ministries of Health by WHO Re- and to update the IDD database ganization gional and Country Offices, vari- and estimates of IDD prevalence ous national and international or- to report at the World Health As- ganizations and agencies, NGOs sembly in 2007. and academic institutions who perform surveys, and systematic searches of the published scientific literature through online databases, including Medline, CAB Abstracts, EMBASE and various regional databases. Where possible and necessary, the data holders are contacted for clarifica- tion of any queries, and to obtain additional information.

In addition to disseminating the information, the databases serve to provide the data for global estimates of the prevalence of deficiency. The methodology for generating the estimates differ for each database, but the methods are peer reviewed and result from a collaboration between NHD and research experts in the respective micronutrient fields. NEWSLETTER 1/2006 17 SIGHT AND LIFE

Low-income South African consumers’ understanding of vitamins and minerals and food fortification

Jane Badham, Registered Dietitian, MSc Nutrition, Bryanston, South Africa

Mandatory food fortification is It is internationally accepted that becoming increasingly common in developing countries, the group in developing countries and is that has the most to gain from seen as one of the key strate- fortification programs is the poor. gies to reduce the incidence of In South Africa, it is estimated that micronutrient malnutrition, which half the population can be classi- has a proven negative impact on fied as being poor and that 57% both individual health and future of households have a monthly and the growth and development income of between R100 (±€14) of the country’s economy. There and R1000 (±€140) and can is little doubt as to the efficacy of therefore be classified as being food fortification programs and it low-income. Not all low-income is a given that the micronutrients consumers live in rural areas, added must be those shown to and with economic development be deficient and that they must be an increasing number of poor added to foods that are commonly move from rural areas to the ur- eaten by the targeted group. ban/metropolitan areas seeking However, it would seem from ex- employment and an improved perience that there are significant quality of life. differences between what the should be carried out in South scientists know and understand It was thus decided that in order Africa. Following interviews with around the role of vitamins and to better understand the views four focus groups to assess the minerals and fortification, and of metropolitan low-income con- questionnaire, a representa- what the consumers perceive and sumers on health and the role of tive sample of 400 low-income or understand. vitamins and minerals and food consumers living in metropolitan fortification, consumer research areas across South Africa was interviewed. The data gathered has been able to give insight into the knowledge and perceptions of these consumers and increase our total understanding of the complexities involved with any fortification program, especially when the communication strategy component of such a program is developed.

One of the greatest lessons learnt was that scientists and health professionals seem to underestimate the knowledge of low-income consumers on health matters. There was overall agreement from the scientists interviewed before the research was undertaken that a key problem to be overcome is consumers’ lack of understanding, awareness and knowledge. Typical neighbourhood of study participants. Yet the research showed that low- SIGHT AND LIFE 18 NEWSLETTER 1/2006

Table 1. Knowledge of specific vitamin functions. Function % of respondents associating function with vitamin A B B2 B6 B12 C D E Don’t know Good for eyesight 26 16 4 4 4 26 10 5 31 Boosts energy 20 23 10 7 3 31 14 8 22 Protects against colds and flu 9 10 9 7 5 50 12 6 23 Protects skin against the sun 10 12 7 9 4 15 24 17 31 Prevents night blindness 13 9 5 6 8 12 6 6 50 Strengthens bones 18 18 6 4 8 24 16 7 27 Gives energy 22 19 7 7 7 23 18 9 25 Heals wounds 8 10 5 8 8 13 7 9 48 Keeps skin healthy 15 14 7 5 4 18 15 1 35 Builds the body 24 24 8 6 8 22 15 9 28 Replaces worn out tissue 10 10 8 6 7 11 5 10 50 Boosts the immune system 11 14 6 7 8 13 10 7 49 Prevents disease 9 10 3 3 4 13 7 5 72 income consumers had a very cepted by organizations such as body. Vitamin C and vitamin A holistic definition of health and a the World Health Organization were the best-known vitamins, good knowledge of the role and – “Health is a state of complete and fruit and vegetables were function of many of the vitamins physical, mental and social well- named as the best sources of and minerals. being and not merely the absence vitamins. These answers are sur- of disease or infirmity.” prisingly accurate and reflect the The most important aspects information that has been taught of health were perceived to be The research also revealed that in school curriculums and health ‘eating the right food’, ‘free of the statements that respondents centers. There does, however, disease’, ‘strong body’ and ‘being most strongly associated with seem to be a lesser understand- happy’. These cover the physi- vitamins were: keep the body ing about minerals. Iron and cal, psychological and lifestyle strong and healthy; protect the calcium were the most spontane- aspects of health widely ac- body from disease and build the ously mentioned and they were

Table 2. Knowledge of specific mineral functions. Function % of respondents associating function with mineral Calcium Iodine Iron Magnesium Salt Zinc Don’t know Boosts the blood system 18 8 32 9 4 7 35 Prevents tiredness 22 10 18 15 6 7 41 Strengthens immune system 13 14 17 14 7 8 47 Strengthens the body 28 8 20 17 10 8 33 Strengthens bones 41 9 19 7 14 7 28 Strengthens teeth 44 6 10 9 11 8 33 Makes the brain work better 12 15 19 13 6 8 47 Strengthens nails 17 8 11 7 6 9 53 Prevents disease 12 6 11 8 3 5 74 NEWSLETTER 1/2006 19 SIGHT AND LIFE

considered as being most com- fied’ meant. More respondents processed foods. The acceptance monly found in meat and dairy thought they knew what ‘enriched by younger people of added as foods, although many could not foods’ meant and ‘with added being acceptable indicates that name any source of minerals. Of vitamins and minerals’ was also this could be a growing trend or concern however, considering understood. This is a clear indica- at least an opportunity to shape a that there has been mandatory tion that anyone embarking on a trend that does not carry a nega- fortification of salt with iodine for fortification program would be well tive association. Good news. a number of years, was the fact advised to investigate and make that iodine was not recognized as use of terminology not decided on The outcome of the research a mineral. by the scientists, but understood shows that although fortification by those whom the program is is well accepted amongst the Although one third of the respond- designed to benefit. scientists as being a key factor in ents did not know the specific the eradication of micronutrient functions of the most commonly Only one third of respondents malnutrition, and even though mentioned individual vitamins thought that raw, natural food low-income consumers in South (Table 1) and minerals (Table 2), was the best source of vitamins Africa have a surprisingly com- for those who did the knowledge and minerals. This indicates that prehensive and accurate know- was surprisingly good and the two thirds of respondents either ledge, a mandatory or voluntary younger age group had a better already believed that vitamins fortification program has to have knowledge than the older group. and minerals that are added to a well-designed communication There was little consensus on food are the best source or could strategy. This communication specific problems associated with be educated to understand the strategy should be based on a lack of vitamins and minerals valuable role of vitamins and consumer research and not sci- but the associations made were minerals added to foods. It can entific understanding. Only then positive. be extrapolated that this group of will fortification really have the im- consumers have less preoccupa- pact to change lives and improve Of concern was the fact that most tion with the raw, natural versus economies. respondents did not know what processed food debate and are fortified foods were or what ‘forti- less skeptical of technology and

18th International Congress of Nutrition held in Durban, South Africa Noel W Solomons, Center for Studies of Sensory Impairment, Aging and Metabolism, Guatemala City, Guatemala

The 18th International Congress Australia and initiated that of Prof. Galal of California, USA, retains of Nutrition (ICN), the quadren- Ricardo Uauy of Chile, leading the post of Secretary General. nial gathering of the International up to the next ICN in Bangkok, The remaining council members Union on Nutritional Sciences, Thailand. A new group of IUNS can be viewed on the IUNS web- was held at the International Officers and Councilors, repre- site (www.iuns.org). Conference Center in Durban in senting each of the geographical the province of KwaZulu-Natal, regions of the globe, was elected In order for visitors to get a better South Africa, 19 – 23 September by the Assembly, which also appreciation of the African coun- 2005. The general theme was chose Granada, Spain, as the tryside and its natural wonders, a Nutrition Safari for Innovative venue for the 20th ICN in 2013. number of pre-Congress satellite Solutions. The setting in southern Prof. Ibrahim Elmadfa of Austria meetings were convened in vari- Africa allowed the IUNS Council is the President-Elect, to assume ous settings across the Republic and the local organizers to project Council leadership in 2009. Prof. of South Africa. On the first day and highlight a conscious and Lindsay Allen of California, USA of the Congress a total of 10 full- comprehensive concentration on is the Vice-President on the IUNS day or half-day workshops were issues of this continent. The meet- Council. The Treasurer post offered. Of particular interest to ing concluded the four-year presi- passes to Dr. Suzanne Murphy of the readership of this Newslet- dency of Prof. Mark Wahlqvist of Hawaii, USA, while Prof. Osman ter, for their emphasis on micro- SIGHT AND LIFE 20 NEWSLETTER 1/2006

nutrients and bioactive dietary constituents, were the following offerings: Nutrition and cognition; Food-based approaches to combating micronutrient deficiencies in children of developing countries; International workshop on fruit and vegetable consumption for health and nutrition and Cocoa flavanoids and cardiovascular health: Translating fundamental science into nutritional action.

The heart of the Scientific Pro- gram had three components: 1. The plenary series, a total of 11 plenary sessions with 22 lecturers • Responding to the HIV/AIDS Head-table guests, including five present or past IUNS Presidents, Drs pandemic with evidence-based Barbara Underwood, Mark Wahlqvist, Ricardo Uauy, Nevin Scrimhaw, nutrition interventions Mohammed Gabr (standing), are welcomed at the inaugural meeting of the • Global strategy to prevent non- Federation of African Nutrition Societies by its founding chairman, Prof. Tola Atinmo. Seated is Dr. Rekia Belahsen of Morocco. communicable diseases • Poverty and food and nutrition security 2. The pathway symposia The E.V. McCollum International • Nutrition science and food poli- • Global and international nutri- Lecture of the American Society for cy according to new principles tion and new developments Nutrition was delivered by outgoing • Econutrition: Safe and sustain- • Micronutrients IUNS President, Prof. Mark Wahl- able food supplies • Non-communicable diseases qvist, and addressed the progress • The role of polyphenols in • Nutrition interventions in nutritional science through the health and disease • Immunology, HIV/AIDS and vision of the IUNS. His theme • Nutrigenomics nutrition focused on a new generation of • Evidence-based nutrition • Nutrition status assessment nutritional science and scientists • Nutrition in transition • Nutrition support, cancer, the who seek to reverse environmen- • Process for the assessment of GI system and nutrient require- tal impoverishment, restore and scientific support for claims on ments support integrative food systems, foods • Nutrition through the life cycle and harness nutritional science for • Nutrition in children – an invest- • Indigenous foods, functional human and community development in human capital foods and safe foods ment. He outlined a series of innovative unifying concepts, which 3. The poster program, similarly included: epigenetics and genomic organized around the same path- expression; socio-environ mental way cluster system. injury and nutritional modulation of the inflammatory process; A total of three memorial ses- sensory nutrition (conservation of sions and five awards ceremonies traditional cuisine); host-parasite complemented the program. The dysbiosis (compromised nutritional former were dedicated to the resistance and infection); and nu- memory of three distinguished trition, wellness and well-being, investigators, deceased during and planetary health (biodiversity, 2004: Prof. Peter Fürst of Ger- food variety, health). The fulcrum many; Prof. Vernon R. Young of for concerted action, moreover, the USA; and Prof. Clive E. West should be Africa, according to the of the Netherlands. Prof. West McCollum International Award had been a long-time Contributing winner. Editor for the SIGHT AND LIFE Newsletter. (See also Newsletter The International Prize for Nutri- Durban Hilton Hotel. 3/2004) tion of the Danone Institute went NEWSLETTER 1/2006 21 SIGHT AND LIFE

to Prof. David Barker of South- ampton, UK, who summarized the growing evidence-base for a crucial role of early-life nutrition as a determinant of health in later life. He recounted findings linking smaller birth size in a cohort of men born in Sheffield to greater susceptibility to morbidity and early mortality from coronary disease, stroke, hypertension and diabetes. This is ascribed to the programming of the metabolic system (metabolic imprinting) in African student awardees of the International Nutrition Foundation the nutritionally deprived early - Kraft Foods Fellows travel awards receive their certificates of attend- internal environment to avidly ance at the Congress at an inaugural reception. retain macronutrients and electro- lytes. The consequences of Prof. vitamin A. Good governance was prevent cancers with β-carotene Barker‘s hypothesis give rise to demonstrated by a partnership in high doses, researchers were several unanswered questions for between government and the astounded by the unexpected those interested in micronutrient private sector, with food manu- evidence for apparently exacer- nutrition. The first relates to the facturers adding value to their bated risk. The DSM Award win- role of micronutrient supplemen- products in the form of vitamin ner proposed some guidance for tation to mothers in breaking the and mineral fortification and the resolution of the quandaries in inter-generational cycle through government contributing inspec- these paradoxical epidemiological improved intrauterine nutrition tion and certification, providing findings. Dosage and tissue levels of the fetus. The second is the quality assurance to the Filipino of β-carotene appear to be the degree to which adequate nutri- consumer. The laudable result of critical factor; high concentrations ent intakes and healthful dietary these initiatives in the Philippines interacting with oxygen produce practices in childhood and adult- has been a marked reduction in pro-oxidant effects, whereas hood can mitigate the adverse micronutrient malnutrition com- lower dosages as well as com- consequences of inadequate bined with a heightened know- binations with other antioxidants early nutrition. ledge and awareness of nutrition such as the vitamins C and E in the lay public. provide the expected protection The IUNS International Nutrition against oxidative damage to the Prize of the International Nutri- The inaugural DSM Human Nutri- chromosomes. tion Foundation was awarded tion Award went to Prof. Robert to Dr. Florentino Solon of the M. Russell, Director of the USDA Finally, the Nestlé Nutrition Insti- Philippines, also a long-time cor- Human Nutrition Research Center tute Africa provides awards for respondent for the SIGHT AND on Aging at Tufts University in research publications, community LIFE Newsletter. His lecture Boston, USA. His discourse ad- service to nutrition and sustained provided a perspective on “good dressed the link between anti- nutrition leadership. This last governance” in a case-study from oxidants and cancer risk. Short- went to Prof. Esté Vorster of the his Southeast Asian country. It term intervention studies with Northwest University at Potchef- highlighted the broad testing of antioxidant nutrients, such as the strom, South Africa, who had also and support for fortification of combination of vitamins C and E, chaired the Organizing Commit- the food supply in the Philippines β-carotene, lycopene and lutein, tee of the ICN event. with micronutrients. The micronu- or with fruits and vegetables have trients of interest were iron and lowered biomarkers of oxidative The traditional focus of SIGHT DNA damage. In theory, over the AND LIFE has been on fostering long term, such protection from improvement in micronutrient nu- oxidation of genetic material trition and combating the adverse should result in reduced cancer consequences of vitamin and risk. Prof. Russell asserted, how- mineral deficiencies. In order that ever, that “we have no idea of the attendees of the ICN with a spe- cancer-lowering predictive values cific disciplinary interest would not of these assays.” Reviewing the find sessions of interest compet- results of intervention trials to ing with one another in the same SIGHT AND LIFE 22 NEWSLETTER 1/2006

conceded that considerations of environmental pollution, physical inactivity and genetic constitu- tions are essential components of the public health equation. Hence, most had to admit that optimizing diet and nutrition would, at best, only contribute to the general so- lution, but that nutritional science could not single-handedly clarify nor resolve all of the burden(s) of ill health. The contentions were first over the manner to engage the other disciplines in the scientific inquiry (through partnerships or by reinventing nutritional sci- A group of professionals involved with publishing international nutrition ence?) and second about how to journals (Drs D’Ann Finley, Noel W Solomons, Ruth Oniang’o, Jaap Seidell, build inter-sectorial alliances for Robert M Russell, Mark L Wahlqvist, and Barrie Margetts) meet for breakfast public health actions at local, na- in Durban. tional and bilateral or multilateral agency levels. time slot, a series of eight topic Intertwined underlying themes ran pathway clusters was created, through the majority of the plenary The discussions and debates one of which was designated sessions and the two controversy- about means, values and priorities Micronutrients. With special refer- debate sessions (named Indaba set a stage for reassessing the vi- ence to micronutrient metabolism for the local African term), and sion, mission, scope and mandate and nutrition, there were sessions signaled a tension between the for nutritional sciences and for the on the following topics: process of scientific discovery worldwide community of the IUNS. and the implementation of re- What are the relative roles and • Overcoming micronutrient defi- medial actions to alleviate health responsibilities of academia, civil ciency through food fortification problems across the world. The society and the food industry for • Strategies to alleviate micronu- larger of these themes related to the correction of epidemic health trient malnutrition the United Nations’ Millennium and nutritional imbalances across • Multiple micronutrient dietary Development Goals and their societies? It was heartening that supplements to control defi- relatively sparse attention to re- Prof. Ricardo Uauy, the incoming ciencies solving nutritional problems; this President of the IUNS for 2005 • Building on the food we eat: was commented upon in multiple – 2009, took this reassessment Biofortification and food fortifi- plenary lectures. The other issue as the four-year challenge. He cation in Africa related to the nature and com- also supported the inclusion of the • Specific micronutrient deficien- plexity of the world’s nutritional younger generation of nutrition- cies problems (are they simple and ists across the regions to work • Zinc in health and disease straight-forward or convoluted and through the regional Nutrition complex?), and the correspond- Leadership Programs in con- However, the micronutrient clus- ing considerations for applied cert with the IUNS. Renovation ter did not completely satisfy the solutions and actions to address of thinking and rejuvenation of situation of students and profes- these problems. Frequent refer- leadership were the goals which sionals dedicated to the study of ence was made to the paradigm Dr. Uauy would have the Council vitamins, minerals and bioactive of a “dual burden” for public health and its constituencies pursue components, as symposia among – of problems of deficiency and during his tenure. We would hope the other topic pathway clusters deprivation alongside issues of that the report that will grace the offered important and substantial excess consumption and dietary pages of this Newsletter in 2009 new information related to the imbalance – inclining the balance can record progress both in the broad area of micronutrient nutri- of consensus to an acceptance advance of nutritional science and tion. Direct on-line viewing of the of growing complexity. Some in our understanding of its role in Scientific Program is available on speakers even formulated “triple” the campaign for better human the Congress website for as long and “quadruple” burdens for the health and well-being. as it is to be posted: www.puk. epidemiology of human illness. ac.za/iuns. Within this context, it was widely NEWSLETTER 1/2006 23 SIGHT AND LIFE

A campaign to raise awareness of and combat vitamin A deficiency Albertine Ramazani, PROSEVITA, B.P. 2964, Bujumbura, Burundi

Introduction prepare foods rich in vitamin A, especially for infants. Despite the unstable social and sanitary conditions which we During these meetings, we lec- have encountered in our coun- tured the 4,100 repatriate families try, particularly in the Uvira and surveyed on the importance of Walungu territories, a collabora- vitamin A to the immune system tion has been organized between of children aged between 6 and the Junior Medical Center (“CMJ” 59 months. We explained how in French) and the Association vitamin A is essential for the for the Prevention of Nutritional healthy development of children, Diseases (“ALMA” in French) to and how important it is to protect combat malnutrition and, in par- them. We made the repatriate ticular, vitamin A deficiency. parents aware of how to rely on themselves for food, of how to We are grateful to SIGHT AND combat malnutrition in children LIFE for financial and material and pregnant women, or those assistance in the realization of breast-feeding, as well as in the Of the 4,100 families surveyed, this program in aid of children of entire population of our region. with 19,500 children aged be- voluntary repatriates returning tween 6 and 59 months, children from refugee camps in Tanzania, 2. Distribution of accounted for a much greater Zambia and Burundi. capsules proportion than expected.

1. Nutritional instruction Owing to the lack of humanitar- The project was carried out in a ian aid in the transit camps, the targeted way, door-to-door, in or- We organized 60 teaching ses- repatriates preferred to move in der to better identify the children sions on nutrition in various villag- with host families. At the time of voluntary repatriates in the ter- es, churches, schools, and inter- of the first distribution-round of ritories of Uvira and Walungu. community markets. After each vitamin A capsules, this was the meeting, time was devoted either situation across all the sites. The For the second distribution-round to question-and-answer sessions, numbers of children were: we had reserved the administra- or to cooking demonstrations. Night blindness: 2,800 tion of vitamin A capsules for We showed participants how to Gastroenteritis: 8,500 children suffering from various cultivate dark green vegetables, Measles: 4,000 diseases, including diarrhea, how to fish (for those living near Respiratory infections: 3,000 measles, and vitamin A defi- Lake Tanganyika) or breed fish Fever, malaria: 6,900 ciency. in ponds (for those living further Total: 25,200 away from the lake), and how to SIGHT AND LIFE 24 NEWSLETTER 1/2006

3. Results and impact Poverty forces repatriates either In view of the sudden arrival of to beg for food or to steal it from repatriates who move in with host The teaching sessions on nutri- other people’s fields. families, and in order to prevent tion and the supplements of vita- The lack of seed and of plowing relapses in children suffering from min A capsules to children aged equipment is an obstacle to the vitamin A deficiency, we should between 6 months and 5 years successful cultivation of vegeta- train the agents who will be re- had significant consequences, bles. sponsible for social mobilization, notably: The continual increase in the and whose task it will be to raise • a decrease in the infant mor- number of voluntary repatriates awareness among families about tality and morbidity rates; 128 in the region compromises the ef- how to fight and prevent vitamin repatriate children had been fectiveness of measures taken. A deficiency and malnutrition in reported dead on arrival. general. • a decrease in epidemics of Conclusion measles, cholera, respiratory They should identify children infections, malaria, and HIV/ All the main aims of this program aged between 6 and 59 months, AIDS. for 2005 were achieved. Certain lead the teaching sessions on • an increase in the participation measures were carried out to a nutrition for the voluntary repatri- of repatriates in the teaching greater extent than anticipated. ates, cultivate vegetables, and sessions on nutrition. This was true of the campaign to follow up on and evaluate the distribute vitamin A capsules to nutritional state of repatriated 4. Observations children aged between 6 and 59 children (to control epidemics). months, in which we supplied sup- Furthermore, they should dis- The unexpected return of refu- plements not just to the 19,500 tribute vitamin A capsules to the gees affected the distribution of children targeted, but to a total of children concerned and carry out vitamin A capsules. 25,200 children. cooking demonstrations. NEWSLETTER 1/2006 25 SIGHT AND LIFE

Vision screening and vitamin A distribution in Achina and Owerre Akokwa, Nigeria Okechukwu Egboluhe, MD, Rimi, General Hospital, Katsina, Northern Nigeria

The towns of Achina and Owerre and management of any problem; of free vitamin A capsules espe- Akowa are located in the south prescription (and dispensing) of cially to children. Children were eastern part of Nigeria, where I drugs and eye glasses; and edu- excited by the colorful and pot-like worked before. People there will cation and counseling of patients. shape of the vitamin A capsule remember for a long time the days We were armed with basic equip- as they kept reciting what was in April 2005 when the eye care ment for eye care such as trial on one of our posters “vitamin A team visited the places for a broad cases, visual acuity charts, near for healthy eyes”. Mothers made vision screening program in the charts, ophthalmoscopes, sphyg- sure that their children who were community. The team was a part momanometer, stethoscopes, not present were brought to get of the organization “Eye Care Re- tonometer, pen touch, etc. their own vitamin A dose. lief Unit”, a self-help group of eye care practitioners, optometrists Many pathologic and refractive In Akokwa community due to the and doctors. problems were managed, while large number of patients there some more complex eye prob- were follow up vision screenings Prior to the visits, the program lems such as mature cataract and in May and June. At the end of the was repeatedly publicized in the acute glaucoma were referred. program, we want to say thanks parishes and local churches, a fact Before commencement of eye ex- to SIGHT AND LIFE for the help. that gave it a great boost. Also the amination and during the course I hope that in my present place of supply of 1,500 vitamin A capsules of the program the patients were work in Rimi, General Hospital, by SIGHT AND LIFE helped to give educated on preventive and basic Katsina, Northern Nigeria, SIGHT a good start for the program. eye care. Posters and leaflets on AND LIFE will help me again, for the importance of vitamin A, sup- my personal community develop- The Eye Care Relief Unit program plied by SIGHT AND LIFE, were ment project in eye care in the had four cardinal steps: eye ex- distributed but the high point of National Youth Service Corps amination; diagnosis, treatment the program was the distribution scheme. SIGHT AND LIFE 26 NEWSLETTER 1/2006

A mother and child health care project in Endaselassie, Ethiopia Gangolf Florack-Genotte, Project Supervisor of the Initiative for Children in Misery (Kinder unserer Welt), Wiesbaden, Germany

Since its foundation in 1987 by a small group of German parents who had adopted children from Ethiopia, Kinder unserer Welt has not only been assisting in further adoption but has also expanded its activities to help the Ethiopian people in their home country.

Kinder unserer Welt now has more than 500 members. Except for one part-time employee in the project office, the work of Kinder unserer Welt is carried out entirely by volunteers. For this reason all financial resources can be spent directly on the activities. Three major projects have been set up Mothers with children enlisting medical services. and are now running: a Voca- tional Training Center for women After the political changes in 1990 ance with WHO guidelines we living in miserable conditions we signed a contract with REST developed a Mother and Child in Endaselassie (NW Tigray), a (Relief Society of Tigray) which Health centre in cooperation with Street Children Project in Jimma had already started to restore our Ethiopian partners. After a (SW) and our Mother and Child the infrastructure in the north of construction phase of one year Health Care Center (MCHC) in Ethiopia. The provision of public the project was inaugurated 1994 Endaselassie (Tigray) which will utilities in this region had been in Endaselassie, the capital of the be presented here. completely destroyed in the civil western zone of Tigray. war which had been waged for With the focus on children in mis- 15 years there. In this context The MCHC has been fully in- ery and their families, we began there was a great need to install tegrated into the governmental to plan our first relief project and a preventive health program for health system, and meanwhile started fundraising 18 years ago. children and families. In accord- more than 60,000 people per year receive medical services. Pregnant mothers take part in ante- and postnatal care and they are attended when giving birth. Babies and young children are integrated into the prevention program regularly. This “Under-Fives Well-Baby Clinic” includes immunization (DPT, polio, measles, BCG), growth monitoring (road to health chart) and vitamin A distribution. For example from July to September 2005 vitamin A was given to 777 measles-immunized children and to more than 2,250 children affected by different Mother and Child Health Center in Endaselassie. diseases. NEWSLETTER 1/2006 27 SIGHT AND LIFE

Furthermore our “Under-Fives Sick-Baby Clinic” is highly fre- quented. In the above-mentioned 3-month period we have seen more than 7,000 children, with around 14,500 visits. Malnutri- tion, diarrheal diseases, malaria, intestinal parasites and upper respiratory tract infections were the primary causes for the visits. In general the data indicate that the major reasons for under-five morbidity are not only poor nutrition but also poor sanitation. In consequence we added a “Com- munity-Based Preventive Health Program”: we select families, give them advice and concrete support to work as model households in the community. This has generated a “snowball effect” and creates self-reliance and initiative.

As prevention is the most impor- and restricted financial capacity, One health officer and 18 nurses tant aspect of our project, health we have to give priority to families work in the medical area of the education and family planning are and single mothers. project, and 10 non-technical staff regularly offered to our clients. Im- are employed: all are Ethiopians. munization of women of child-bear- Our overall activities are sup- A regular upgrading is part of the ing age and health education at ported by a well-equipped labora- project scheme. REST monitors schools have also been given. The tory and we are planning to build the MCH activities via its health rapidly growing problem of sexually a new maternity ward because department and regular visits transmitted diseases (STD) and the number of women giving birth (twice a year) are conducted by HIV has affected our project, too. It has increased rapidly. In addition Kinder unserer Welt supervision has forced us to enlarge our sched- to our central activities, our pro- teams. The project is funded by ule for medical services. One year grams are conducted at nearly Kinder unserer Welt with a 25% ago, we opened an STD ward for all 17 outreach sites which are share covered from our partner mothers who take part in the MCH regularly visited by mobile staff REST. The relationship with the service and have been identified teams. They get support from community and the health insti- as STD affected. We encouraged traditional birth attendants who tutions is very constructive and them to come along with their part- are well trained and equipped to cooperative. Drugs and other im- ners for treatment and advice. But attend deliveries and to give basic portant materials are supplied by because of our association’s rules advice on MCH related issues. the health department of REST. The shortage of vitamin A is regularly compensated by a donation from SIGHT AND LIFE and this has helped enormously to reduce the incidence of vitamin A related diseases.

We would like to express our thanks to SIGHT AND LIFE for their support in enabling us to improve the health situation of the people in our target area. SIGHT AND LIFE 28 NEWSLETTER 1/2006

The long-term collaboration of SIGHT AND LIFE with the Swiss Red Cross has already been documented in several articles in SIGHT AND LIFE Newsletters. We are very glad that the project mentioned here has been completed successfully (editor). Inauguration of the extension to the Red Cross Eye Hospital in Janakpur, Nepal; a successful investment against poverty-induced blindness Beatrix Spring, Swiss Red Cross, Bern, Switzerland

Thanks to the support given by SIGHT ANDLIFE for the extension to the inadequately small eye hospital in Janakpur, Nepal, work was started on the urgently needed out-patient department two years ago. Despite challenging circumstances owing to extreme weather conditions and political turmoil, work was only delayed a few months and finally the high- quality and earthquake-resistant building could be inaugurated on 11 November 2005. It contains an out-patient department with a refraction service, examination and treatment rooms, laboratory, pharmacy, library, training rooms and offices. The eye hospital is visited each year by 65,000 Hundreds of people have their eyesight tested at eye camps in outlying patients and numbers are in- districts. Patients requiring an operation are referred to the eye hospital in creasing. Red Cross assistance Janakpur (more pictures on next page). is directed mainly at the poorest rural sectors of the Nepalese population.

The new extension to the hospital is also a sight for sore eyes. NEWSLETTER 1/2006 29 SIGHT AND LIFE

Edible oil fortification in Bangladesh Shamim Ahmed, Consultant, The Micronutrient Initiative, Bangladesh

Bangladesh is one of the signa- plementation has been identified fortification of edible oil has been tories of the Millennium Develop- as an indispensable child survival considered as a cost effective ment Goals aiming to reduce child strategy to reduce the incidence and sustainable intervention. mortality by two thirds by 2015 of these diseases in Bangladesh Regardless of social, economi- and is on track to achieve the goal and elsewhere (see SIGHT AND cal, age and gender differences as early as 2010. Reducing vita- LIFE Newsletter 3/2005, p. 30). food is cooked and eaten with min A deficiency (VAD) has been oil. The present per capita oil identified as one of the key fac- Clearly more efforts are required consumption in Bangladesh is tors in improving child morbidity in order to eliminate VAD as a 5 litres/year, i.e. 14 grams per and mortality. The infant mortality public health problem in Bang- day. The most popular oil used rate is still high in Bangladesh ladesh. Food fortification is a is soybean oil. After years of (56/1000 live births), as is the sustainable approach to provide dialogue, voluntary fortification of child mortality rate (77/1000 live micronutrients lacking in the diet. edible oil with vitamin A has been births) among children aged 1–5 Vehicles for fortification with vi- implemented in Bangladesh. years (1). Given that diarrhea and tamin A include oil, wheat flour The Micronutrient Initiative (MI) measles are still leading causes and sugar. After investigating all has successfully spearheaded of child mortality, vitamin A sup- the alternatives for fortification, the campaign. One of the goals SIGHT AND LIFE 30 NEWSLETTER 1/2006

Edible oil bottled from a drum (left), and a bottle with commercially available oil fortified with vitamins A and D (right). of the MI is to increase access ing cooking, depending on time ternational Development Agency. of the target population to foods and temperature. The common The MI is going to share the cost fortified with vitamins and miner- methods of cooking in our country of the premix initially. The for- als. The first consensus building are frying and simmering. Favaro tification level with vitamin A is workshop on fortification was held et al. found 99% retention when 25,000 IU/kg and with vitamin D2 in 1989 and this was followed by oil was added to rice and cooked is 200 IU/kg. another in 2002. On both occa- for 15 minutes (3). During deep- sions, MI played a pivotal role. A frying vitamin A losses can be The formal launching ceremony feasibility study of oil fortification quite significant, however. was held in November 2005. with vitamin A in Bangladesh The launching was done by the was undertaken in 2003 and an Over 65 percent of edible oil in Honorable Minister, Ministry of assessment study of the edible Bangladesh is imported and re- Law, Justice and Parliamentary oil refineries in the country was fined centrally in a limited number Affairs, Government of the Peo- carried out in 2004. of oil refineries, suggesting that ple’s Republic of Bangladesh. efforts to introduce fortification The participants included, among Vegetable oil is an effective ve- in refineries could result in high others, health professionals, high hicle for vitamin A and retains coverage of edible oil consumed government officials and repre- potency if protected from light in Bangladesh. A local vegetable sentatives of the nutrition industry, or packed in sealed and opaque oil refinery has taken the initiative media, and national/international containers (2). Moreover oil en- and built fortification equipment NGOs. hances the absorption of vitamin under the technical guidance A from the gut. There is a wide of the MI and with the financial References variation in vitamin A stability dur- assistance of the Canadian In- 1. State of the World’s Children 2006, Excluded and invisible. UNICEF, 2005 2. SUSTAIN, Vitamin A fortification of PL 480 vegetable oil. SUSTAIN, Wash- ington DC, 1998 3. Favaro RMD et al. (1991). Studies on fortification of refined soybean oil with all-trans-retinyl palmitate in Brazil: stability during cooking and storage. J Food Compos Anal 4: 237–244. NEWSLETTER 1/2006 31 SIGHT AND LIFE

Rural and urban Targeted Initiative Programs in Calcutta Christoph Schaefer, Calcutta Rescue, Calcutta, India

We would like to thank SIGHT all our activities are also aimed at Programs (TIP), which we divide AND LIFE and at the same time preventing vitamin A deficiency. into rural TIPs and urban TIPs. explain how we use our vitamin A The vitamin A capsules from capsules. In addition to our aims SIGHT AND LIFE in particular The free programs include health to improve health and well-being, are used in the Targeted Initiative consultation and treatment of minor diseases, treatment for lice and worms as well as general health education. Camps are held every six months, and this is when the vitamin A capsules are given.

Calcutta Rescue gives children from poor backgrounds a chance of education and to learn about essential topics such as health and prevention measures, and they receive basic health services. Another important aspect is the well-structured day plan. All these services are provided by professional teachers, doctors, nurses, cooks etc.

In this way Calcutta Rescue is The two collaborators of the Calcutta Rescue pharmacy holding vitamin A glad to be able to contribute to bottles. They are responsible for the procurement and management of all the health and well-being of many medicines needed for the four clinics and the schools. children and other people.

Going Yellow video promotes healthy food in Micronesia Lois Englberger, Nutritional Advisor, Island Food Community of Pohnpei, Kolonia, FSM

Micronesia has serious problems The information-packed and hu- of vitamin A deficiency, accom- morous video titled Going Yellow panied by increasing problems and produced in Pohnpei, Micro- of non-communicable diseases, nesia, was completed in October in particular diabetes. Because 2005. It has met with amazing of this, a video was produced to success. When released, it was raise awareness of locally-grown broadcast on local television foods that might be consumed to three times daily for a month, due alleviate these nutrition-related to popular demand. The televi- diseases. sion operator said, “People really liked it!” SIGHT AND LIFE 32 NEWSLETTER 1/2006

Its popularity continued in De- cember 2005, the local television broadcasting it daily for another 2-week period. One local entre- preneur started selling copies. A Pohnpei woman who bought it told how her children had watched it over and over.

Dr. Martin Frigg, SIGHT AND LIFE, first initiated efforts for developing the video in 2003. He contacted Dr. Lois Englberger of the Island Food Community of Pohnpei (IFCP) and asked her to develop a draft script and con- sider how it might be produced. She contacted Father Fran Hezel of the Micronesian Seminar organization based in Pohnpei and he enthusiastically took up the idea, created new script ideas, and involved his staff. Mr. Erik Steffen did the filming and co- ordinated the work, assisted by Mr. Eugene Augustine, and Ms. Eugenia Samuel, who completed the script writing.

A drama was developed around the “Yellow Family”. The wacky set of characters included two daughters, a brother, mother, father, grandmother, Miss Pacifica (a Micronesian beauty queen who attributes her beauty secrets to Karat banana and other yellow- fleshed local foods), Mr. Bubba (an American who travels all the way from Texas to Pohnpei in order to see and taste the famous but neglected carotenoid-rich Karat), and a television news- caster.

The story opens with the family watching a television news report on the serious problem of vitamin A deficiency in Micronesia. Then the story becomes dramatic. Grandma starts crying (in a comi- cal and nostalgic way) because she misses her local food, which used to be so plentiful. The family was now eating mainly imported rice, instant noodles, and fatty meats including turkey tail. The mother reads IFCP materials on NEWSLETTER 1/2006 33 SIGHT AND LIFE

for copies so that they could show it in their respective communities. Almost 100 copies were distributed by Micronesia Seminar to groups throughout Micronesia, including the Republic of Mar- shall Islands, where there is also a serious problem of vitamin A deficiency.

Warm thanks are given to SIGHT AND LIFE for initiating and providing funds for the production of Going Yellow, and to Micronesian Seminar, Island Food Community of Pohnpei, KP Studios, the actors and all those involved in developing and producing the video. It is hoped that the video may lead to greater awareness and an improved diet and health for many people, young and old. nutrient-rich local food recipes and decides to provide her family with a more nutritious diet. A theme song “Go Local!” written by Mr. Gibson Santos helps relay the health messages. At the end the family starts eating many of the local yellow-fleshed foods, including yellow-fleshed banana varieties, giant swamp taro, pan- danus and papaya.

Exciting aspects of this video include the combination of scientific health messages with an entertaining humorous drama, and the unique presentation of indigenous foods, cultural values, and impact of analyzing local foods and varieties for nutrient content. Various activities of the Pohnpei vitamin A and local food promotion program are also discussed and presented, including the Mand Community local food project, carried out as a collaborative project by Mand Community, IFCP, and the Centre for Indigenous Peoples’ Nutrition and Environment.

Going Yellow has created interest and awareness beyond Pohnpei, as it was shown in October 2005 at a regional meeting with participants from many Pacific Island countries. The participants asked SIGHT AND LIFE 34 NEWSLETTER 1/2006

A digest of recent literature Donald S McLaren*

Introduction on xerophthalmia have dwindled Retinoid research away to almost zero, while all as- Search of the literature during the pects of vitamin A and infections and “Effect of vitamin A content in past few months in preparation immunology are being thoroughly cafeteria diet on the expression of for selection of those papers that explored. nuclear receptors in rat subcuta- might be of most interest and sig- neous adipose tissue” by Bairras nificance for our readers resulted About this same time, general inter- C, Menard L, Redonnet A et al. J in a very high proportion of them est arose in antioxidants and many Physiol Biochem 2005; 61: 353–362 being on topics of a basic science kinds of disease. Prominent among (C Atgie, UNSC (Agen), Université and laboratory experimental nature; antioxidants studied have been Bordeaux 1, DUSA, Avenue Michel about 70 per cent. This represents vitamin A and more recently caro- Serres, 47000 Agen, France. E-mail: a considerable shift away from the tenoids, both provitamin and non- [email protected]) community-based projects and provitamin. Much of the community Eight week exposure to cafeteria epidemiological studies that tended and epidemiological interest now diets with normal or higher levels of to dominate some years ago. This concerns carotenoids in relation to vitamin A led to an increase in adi- is reminiscent of changes that oc- diseases like cancers, cardiovascu- posity, associated, only in the group curred in earlier years and it may be lar and other diseases. fed with the higher vitamin A level, profitable to review them briefly. with an increase of PPAR(gamma) Finally, within the past decade or and RXR(alpha) expressions in In the early years of the 20th century, so there have been two significant subcutaneous adipose tissue. leading up to and following upon the areas of advance. The first of these discovery of “fat soluble A” in 1913, has given a boost to the literature in “Effects of prenatal vitamins A, E, almost all reports were chemical, community studies of vitamin A de- and C on the hypoplastic hearts of biochemical, or animal experimen- ficiency associated with deficiency fetal rats with diaphragmatic her- tal in nature. In the middle of the of other micronutrients, in particu- nia” by Gonzalez-Reyes S, Martinez century numerous reports began to lar iron, zinc and iodine in various L, Tovar JA. J Pediatr Surg 2005; appear about blinding malnutrition, combinations. Already some studies 40: 1269–1274 (JA Tovar, Dept Ped especially in young children, recog- include up to a dozen or so essential Surg, Res Lab, Hosp Univ La Paz, nized to be due to severe vitamin A elements and vitamins. 28046 Madrid, Spain. E-mail: jatovar. deficiency and termed xerophthal- [email protected]) mia. This was an essential part of a However, far outstripping this trend Nitrogen induces heart hypoplasia worldwide movement of increased is a second veritable outburst of with congenital diaphragmatic hernia interest and concern that led, by the knowledge that stems from the dis- in rats. Intracellular oxidative stress later years of the 20th century, to the covery of the fundamental functions might be one of the mechanisms virtual control of xerophthalmia. of vitamin A, especially in the form and vitamin A has been shown to of retinoic acid, and in particular the reverse in part these effects. Here At about the same time, a notion roles it plays in gene transcription it was shown that vitamins A, E, and that had surfaced briefly decades attached to nuclear receptors to be C given late in gestation alleviate before – that deficiency of vitamin A found in every cell. Many of these heart hypoplasia that accompanies predisposed to increased morbidity reports appear to have implications congenital diaphragmatic hernia. and mortality, especially through of great significance for the use of impairment of response to serious retinoids in many branches of clini- “Retinoids and retinol differen- infections – was put thoroughly cal medicine in the years to come. tially regulate steroid biosynthe- to the test in large field trials, and sis in ovarian theca cells isolated shown to be true. It is particularly something of the from normal cycling women and possible implications for human women with polycystic ovary The effect of this shift in emphasis of health of this new wave of molecular syndrome” by Wickenheisser JK, research and practice had a predict- biological advance that it is hoped Nelson DVL, Hendricks KL et al. able impact on the literature: papers will be conveyed by many of the J Clin Endocrinol Metab 2005; 90: abstracts that follow. In many cases 4858–4865 (Dept Cell Mol Physiol, the impression left will be fleeting; Penn State Hershey Coll Med, 500 Univ Dr, C4723, Hershey, Penn * Address for correspondence: but after all, that is often how inspi- Prof. Donald S. McLaren ration comes. 17033, USA) 12 Offington Avenue, Worthing, Polycystic Ovary Syndrome (PCOS) West Sussex BN14 9PE, UK is characterized by ovarian an- [email protected] drogen excess and infertility. Here NEWSLETTER 1/2006 35 SIGHT AND LIFE

differential responses to retinol supplementation” by Garcia AL, modulus and elastic fiber con- and retinoids in normal and PCOS Ruhl R, Schweigert FJ. Ann Nutr centration in rats” by McGowan theca suggest that altered retinoic Metab 2005; 49: 333–341 (Ger- SE, Takle EJ, Holmes AJ. Respir acid synthesis and action may be man Inst Human Nutr Potsdam Res 2005; 6: 77 (SE McGowan, involved in augmented CYP17 gene Rehbrucke, Dept Intervent Studies, Dept Vet Affairs Res Serv, Roy A. expression and androgen produc- Arthur Scheunert Allee 114-116, DE- and Lucille J.Carver Coll Med, Univ tion in PCOS. 14558 Nuthetal, Germany. E-mail: of Iowa, Iowa City, IA, USA. E-mail: [email protected]) [email protected]) “Retinoic acid formation from This work shows for the first time It was shown that alterations in pa- retinol in the human gastric that supplementation with high renchymal mechanics and structure mucosa: role of class IV alcohol doses of VA during the lactation pe- contribute to bronchial hyperactivity dehydrogenase and its relevance riod in mice can affect serum retinol in VAD but they are not reversed by to morphological changes” by concentrations in the neonates. Day RA treatment. This is in contrast to Matsumo M, Yokoyama H, Suzuki, H 7 after birth is a critical time in the the VAD-related alterations in the et al. Am J Physiol Gastrointest Liver tissue distribution of retinoids during airways. Physiol 2005; 289: G429–433) postnatal development. Class IV ADH is a major enzyme in “Hypervitaminosis A resulting in the retinoic acid supply in the human “Pathways of vitamin A delivery DNA aberration in fetal transgenic gastric mucosa and the reduction to the embryo: insights from a mice (Muta Mouse)” by Inomata of its activity was associated with new tunable model of embryonic T, Kiuchi A, Yoshida T et al. Mutat decreasing retinoic acid supply and vitamin A deficiency” by Quadro Res 2005; 586: 58–67 (Dept Lab progression of inflammation, atro- L, Hamberger L, Gottesman ME et Anim Sci, Sch Vet Med, Azabu Univ, phy and intestinal metaplasia. al. Endocrinology 2005; 146: 4479– 1-17-71 Fuchinobe, Sagamihara, 4490 (Columbia Univ Coll Phys Surg, Kanagawa 229-8501, Japan. E- “Photodecomposition of retinyl Dept Urol, New York, NY 10032 USA. mail: [email protected]) palmitate in ethanol by UVA light- E-mail: [email protected]) Large amounts of vitamin A were formation of photodecomposition These studies indicate the impor- given during pregnancy and it was products, reactive oxygen species tance of embryonic RBP in distributing observed whether gene mutations and lipid peroxides” by Cherng SH, vitamin A to certain developing tissues occurred in fetal tissues. Mutation Xia Q, Blankenship LR et al. Chem under restrictive diets. Moreover they frequencies were significantly high- Res Toxicol 2005; 18: 129–138 (Nat show differences among developing er in vitamin A-treated mice than in Ctr Toxicol Res, USFDA, Jefferson, tissues in their dependency on the controls, especially fetuses obtained Arkansas 72079, USA) embryonic retinol-RBP pathway. on day 14 of the pregnancy. This study suggested that retinyl They also show that accumulation of palmitate and its decomposition embryonic vitamin A stores does not “DNA methylation of genes linked products are not genotoxic: how- depend on the expression of RBP in with retinoid signaling in gastric ever, photoirradiation of retinyl the fetal liver. carcinoma: expression of the palmitate, 5,6-epoxy-RP, and anhy- retinoic acid receptor beta, cel- droretinol with UVA in the presence “Biochemical basis for retinol de- lular retinol-binding protein 1, of methyl linoleate resulted in lipid ficiency induced by the 141N and and tazarotene-induced gene 1 peroxide formation. G75D mutations in human plasma genes is associated with DNA retinol-binding protein” by Folli C, methylation” by Shutoh M, Oue “Distinct roles for hindbrain and Viglione S, Busconi M et al. Biochem N, Aung PP et al. Cancer 2005; paraxial mesoderm in the induc- Biophys Res Commun 2005; 336: 104: 1609–1619 (Hiroshima Univ, tion and patterning of the inner 1017–1022 (R Berni, Dept Biochem Grand Sch Biomed Sci, Dept Mol ear revealed by study of vitamin Mol Biol, Univ Parma, Viale delle Pathol, Minami Ku, 1-2-3 Kasumi, A-deficient quail” by Kil SH, Streit Scienze 23/A, 43100 Parma, Italy. Hiroshima 734-8551, Japan. E-mail: A, Brown ST et al. Dev Biol 2005; E-mail: [email protected]) [email protected]) 285: 252–271 (House Ear Res Inst, Recently, depressed plasma retinol Hypermethylation of CpG islands Gonda Dept Cell Mol Biol, 2100 W and retinol-binding protein levels has been associated with silencing 3rd St, Los Angeles, CA 90057 USA. in carriers of the 141N ad G75D of various tumor suppressor genes. E-mail: [email protected]) RBP point mutations have been The retinoic acid receptor beta (RAR By performing rescue experiments reported. Here it is shown that Beta), cellular retinol-binding protein before and after 30h of develop- although recombinant human N41 1 (CRBP 1), and tazarotene-induced ment, it was shown that the inner ear and D75 RBPs can form complexes gene 1 (TIG1) genes have been as- defects of VAD embryos correlate with retinol and TTR in vitro, the sociated with retinoic acid signaling. with the absence of the posterior retinol-mutated RBP complexes are This research suggested that gastric hindbrain. significantly less stable than human carcinogenesis involves transcrip- normal holo-RBP. tional inactivation by aberrant DNA “Retinoid concentrations in the methylation of genes related to mouse during postnatal develop- “Vitamin A deficiency alters the retinoid signaling. ment and after maternal vitamin A pulmonary parenchymal elastic SIGHT AND LIFE 36 NEWSLETTER 1/2006

“DNA methylation of genes linked decline in drug levels. The present E-mail: [email protected]) to retinoid signaling in squamous study suggests upregulation of The chemopreventive actions were cell carcinoma of the esophagus: CYP26A1 expression in intestinal, shown to vary: ATRA, 9cRA, ROL DNA methylation of CRBP1 and endothelial, liver and APL cells and and β-carotene showed inhibition TIG1 is associated with tumor metabolism of ATRA may play a of cell proliferation, but not induction stage” by Mizuiri H, Yoshida K, role in rapid clearance of ATRA after of apoptosis. Increased remodeling Toge T et al. Cancer Science 2005; continuous administration. of GST-P positive preneoplastic 96: 571–577 (address and e-mail: lesions relates to 9cRA, ROL and as above) “Developmental changes of the β-carotene actions. This research is related to the work expression of the genes regu- on gastric carcinoma abstracted lated by retinoic acid in the “Effect of retinoic acid on gene above. It shows that inactivation of small intestine of rats” by Ogura expression in human conjunctival the retinoic acid signaling-associ- Y, Suruga K, Takase S et al. Life epithelium: secretory phospholi- ated genes RAR-beta, CRBP1, and Sciences 2005; 77: 2804–2813 ( pase A(2) mediates retinoic acid TIG1 by DNA methylation occurs Univ Shizuoka, Sch Food & Nutr induction of MUC16” by Hori Y, frequently in squamous cell carci- Sci, Lab Nutr Physiol, 52-1 Yada, Spurr-Michaud SJ, Russo CL et al. noma of the esophagus. Shizuoka 4228526, Japan. E-mail: Invest Ophthalmol Vis Sci 2005; 46: [email protected]) 4050–4061 (Harvard Univ, Sch Med, “Retinoid status and respon- Changes in expression of several Schepens Eye Res Inst, 20 Stanford siveness to 2,3,7,8-tetrachlorod- genes regulated by RA were stud- St, Boston, MA 02114 USA. E-mail: ibenzo-p-dioxin (TCDD) in mice ied. It is suggested that the possible [email protected],harvard.edu) lacking retinoid-binding protein perinatal RA production by retinal The RA-associated upregulation or retinoid receptor forms” by dehydrogenases (RALDHs) might of membrane-associated mucin Hoegberg P, Schmidt CK, Fletcher regulate various RA-target genes, MUC16 at late phase appears to N et al. Chem Biol Interact 2005; including CRBP11 and RAR alpha be through the gene sPLA(2)-IIA. 156: 25–39 (Karolinska Inst, Inst through RXR alpha or HN-4 in the Upregulation of this hydrophilic Environm Med, S-17177 Stock- small intestine. membrane-associated mucin may holm, Sweden. E-mail: helen. be one of the important mecha- [email protected]) “Hepatocyte growth factor re- nisms by which vitamin A facilitates It was shown that an abnormal retin- ceptor signaling mediates the maintenance of the wet-surfaced oid profile was produced in triple anti-fibrotic action of 9-cis-retin- phenotype on the ocular surface. (but not in double) knock-out mice. oic acid in glomerular mesangial This suggests that a loss of CRBP1 cells” by Wen XY, Li YJ, Hu KB et “Physiological and receptor- may account for this difference. It is al. Am J Path 2005; 167: 947–957 selective retinoids modulate likely to result in an increased sus- (Univ Pittsburgh, Sch Med, Dept interferon gamma signaling by ceptibility to hepatic retinoid deple- Pathol, Div Cell Mol Pathol, S-405 increasing the expression, nu- tion following dioxin exposure. Bomed Sci Tower, 200 Lothrop St, clear localization, and functional Pittsburgh,PA 15261 USA. E-mail: activity of interferon regulatory “Regulation of a highly spe- [email protected]) factor-1” by Luo XM, Ross AC. J cific retinoic acid-4-hydroxylase These studies indicate that 9-cis- Biol Chem 2005; 280: 36228–36236 (CYP26A1) enzyme and all-trans RA possesses anti-fibrotic abil- (Penn State Univ, Dept Nutr Sci, retinoic acid metabolism in hu- ity by antagonizing TGF-beta 1 in 126-S Henderson Bldg, Univ Park, man intestinal, liver, endothelial, mesangial cells and that 9-cis-RA PA 16802 USA. E-mail: acr6@psu. and acute promyelocytic leuke- activity is likely mediated through a edu) mia cells” by Ozpolat B, Mehta mechanism dependent on HGF/c- This research suggested that ATRA, K, Lopez-Berestein G. Leukemia met receptor signaling. an RARalpha ligand, regulates IFN & Lymphoma 2005; 46: 1497– gamma-induced IRF-1 by affecting 1506 (Univ Texas, MD Anderson “All-trans and 9-cis retinoic acids, multiple components of the IFN Cancer Ctr, Dept Exp Therapeut, retinol and β-carotene chemopre- gamma signaling pathway, from the Sect Immunobiol & Drug Carriers, ventive activities during the initial plasma membrane to the nuclear Unit 422, 1515 Holcombe Blvd, phases of hepatocarcinogenesis transcription factors. Houston, TX 77030 USA. E-mail: involve distinct actions on glu- [email protected]) tathione S-transferase positive “Retinoic acid is a potential nega- The recently identified retinoic preneoplastic lesions remodeling tive regulator for differentiation acid (RA)-metabolizing cytochrome and DNA damage” by de Almeida of human periodontal ligament P450RA1-1 (CYP26A1) has been Vasconcelos Fonseca EM, Chagas cells” by Shibuya N, Nemoto E, implicated in accelerated metabo- CEA, Mazzantini RP et al. Carcino- Kanaya S et al. J Periodont Res lism and rapid clearance of all- genesis 2005; 26: 1940–1946 (Univ 2005: 40: 432–440 (Tohoku Univ, trans-retinoic acid (ATRA) during Sao Paulo, Fac Ciencias Farmaceut, Div Periodont & Endoc, Grad Sch prolonged oral administration in Dept Alimentos & Nutr Expt, BIoco Dent, Aoba Ku, 4-1 Seiryo Machi, patients with acute promyelocytic 14, Ave Prof. Lineu Prestes 580, Sendai Miyagi 9808575, Japan. E- leukemia, leading to a progressive BR-05508900 Sao Paulo, Brazil. mail: [email protected]) NEWSLETTER 1/2006 37 SIGHT AND LIFE

RA receptor(RAR)-alpha agonist “Vitamin A supplementation c release. This group showed that (AM-580), but not retinoid X receptor induces adipose tissue loss retinol induces mitochondria oxida- agonist (methoprene acid), inhibited through apoptosis in lean but tive damage, leading to mitochon- mineralization. not in obese rats of the WNIN/ drial permeability transition and Ob strain” by Jayakumar SM, cytochrome c release. This might “The interphotoreceptor retin- Vajreswari A, Sesikeran B et al. J be a means of apoptosis activation oid-binding protein (IRBP) of the Mol Endocrin 2005; 35: 391–398 (A by retinol. chicken (Gallus gallus domesti- Vajreswari, Dept Biochem, Nat Inst cus)” by Stenkamp DL, Calderwood Nutr, Jamai-Osmania, Hyderabad- “Development of a versatile JL, van Niel EE et al. Mol Vis 2005; 500 007, Andhra Pradesh, India. reporter assay of retinol uptake 11: 833–845 (Univ Idaho, Dept Biol E-mail: [email protected]) and metabolism in vivo” by Liden Sci, Moscow, ID 83844-3051, USA. Vitamin A is a known regulator of M, Eriksson U. Exp Cell Res 2005; E-mail: [email protected]) adipose tissue growth. Feeding a 310: 401–408 (Eriksson U, Ludwig The special distribution of IRBP high but non-toxic level of vitamin A Inst Cancer Res, Stockholm Branch, suggests an association with cone for 2 months resulted in a significant Box 240, S-171 77 Stockholm, outer segments. The high degree reduction in the adiposity index and Sweden. E-mail: ulf.eriksson@licr. of conservation of IRBP’s primary retroperitoneal white adipose tis- ki.se) structure, genomic organization, sue weight in obese rats, but not in There is good reason to believe that and cell-specific expression within lean rats. This treatment resulted in the cellular uptake and metabolic the retinas of all vertebrates exam- increased apoptotic index and Bax activation of retinol, precursor of ined to date implies a conserved role protein expression and decreased the two isomers of RA, all-trans RA for IRBP in photoreceptor function expression of Bc12 in lean rats, but and 9-cis RA, should be a highly and/or health. not in adipose. It is suggested that regulated process. A new assay has chronic dietary vitamin A effectively been devised to learn more about “All-trans retinoic acid biases im- regulates adipose tissue mass in this process. mune response induced by DNA lean and obese rats, but by different vaccine in a Th2 direction” by Yu mechanisms. “Vitamin A and immune func- SH, Xia MC, Xu W et al. Vaccine tion: retinoic acid modulates 2005; 23: 5160–5167 (Fudan Univ, “Pulse radiolysis study of the population dynamics in antigen Shanghai Med Coll, Dept Immunol, interaction of retinoids with per- receptor and CD38-stimulated Shanghai, 200032, China. E-mail: oxyl radicals” by Rozanowska M, splenic B cells” by Chen Q, Ross [email protected]) Cantrell A, Edge R et al. Free Radic AC. Proc Natl Acad Sci USA 2005; It was concluded that ATRA biases Biol Med 2005; 39: 1399–1405 (M 102: 14142–14149 (AC Ross, Dept the immune response to Th2 direc- Rozanowska, School of Optom- Nutr Sci, Huck Inst Life Sci, Penn tion induced by DNA vaccine and etry and Vision Sci, Cardiff Univ, State Univ, Univ Park, PA 16802, acts as a candidate adjuvant and Cardiff CF10 3NB, UK. E-mail: USA. E-mail: [email protected]) immunomodulatory molecule. [email protected]) This study showed that RA regulat- Vitamin A and its derivatives are ed factors known to be required for “Retinoid absorption and stor- known for their ability to inhibit Ig class switch recombination and age is impaired in mice lacking lipid peroxidation, possibly by chain- modulated the population dynamics lecithin:retinol acyltransferase breaking by scavenging of peroxide of ligation-stimulated B cells. The (LRAT)” by O’Byme SM, Wongsiriroj radicals. In these studies interaction progression of a fraction of B cells N, Libien J et al. J Biol Chem 2005; occurred with peroxyl radicals. One was promoted into differentiated 280: 35647–35657 (Columbia Univ, product was identified as retinoid cat- sIgG-expressing cells. Coll Phys & Surg, Dept Med, 701 ion radical. It is postulated that apart W 168yj St, New York 10032, USA. from formation of radical adducts, “Expression of keratinocyte E-mail: [email protected]) retinoids may also scavenge peroxyl trans-glutaminase in cornea LRAT is believed to be the pre- radicals by electron transfer. of vitamin A-deficient rats” by dominant, if not the only, enzyme Toshino A, Shiraishi A, Zhang W et in the body responsible for the “Retinol induces permeability al. Curr Eye Res 2005; 30: 731–739 physiological esterification of retinol. transition and cytochrome C re- (A Shiraishi, Dept Ophthal, Ehime LRAT-deficient (LRAT-/-) mice have lease from rat liver mitochondria” Univ Sch Med, Shigenobu-Cho, On- very little retinyl esters in the usual by Klamt F, Roberto De Oliviera M, sen-Gun, Ehime 791-0295, Japan. tissues, but they have 2–3 fold the Moreira JCF. Biochim Biophys Acta E-mail: [email protected]) amount normal in adipose tissue. Gen Subj 2005; 1726: 14–20 (F As the VAD developed on the The composition of retinyl esters in Klamt, FDA/CBER, Building 29A, 29 surface of the cornea the expres- chylomicrons suggests their synthe- Lincoln Drive, Bethesda MD 20892, sion and enzyme activity of TG1 sis has resulted via an acyl-CoA- USA. E-mail: [email protected]) (transglutaminase) mRNA were dependent process, indicating that a Retinoids induce apoptosis in tumor significantly upregulated. This was physiologically significant acyl-CoA: cells by an unknown mechanism. followed by expression on corneal retinol acyltransferase is present. Mitochondria play a key role in epithelial cells of abnormal proteins controlling apoptosis by cytochrome involucrin, loricrin, and keratin 10. SIGHT AND LIFE 38 NEWSLETTER 1/2006

“Histological evaluation of a retinoic acid receptor-independ- “Disruption of the lecithin:retinol topically applied retinol-vitamin C ent mechanism” by Park EY, Dil- acyltransferase gene makes mice combination” by Seite S, Bredoux lard A, Williams A et al. Cancer Res more susceptible to vitamin A C, Compan D et al. Skin Pharmacol 2005; 65: 9923–9933 (Univ Texas, deficiency” by Liu LM, Gudas LJ. J Physiol 2005; 18: 81–87 (L’Oreal Div Nutr Sci, Dept Human Ecol, Biol Chem 2005; 280: 40226–40234 Recherche, 90 rue du Général Gearing Hall Room 115, Mail Stop (Cornell Univ, Dept Pharmacol, Roguet, F-92583 Clichy Cedex, A2700, Austin, TX 7812, USA. E- Weill Med Coll, 1300 York Ave, France. E-mail: [email protected]. mail: [email protected]) New York, NY 10021, USA. E-mail: com) This study examined the ability [email protected]) Two double-blind studies were car- of retinol to inhibit the growth of Lecithin:retinol acyltransferase ried out to investigate the effects all-trans retinoic acid-sensitive and (LRAT) catalyzes the esterifica- on epidermal and dermal compart- resistant human colon cancer cell tion of retinol in the liver and some ments of aged or photoaged human lines. Retinol did not induce ap- other tissues including lung. This skin. Repeated application of the optosis, differentiation or necrosis, study showed that LRAT (-/-) mice retinol-vitamin C preparation was but affected cell cycle progression. are much more susceptible to VAD able to reverse, at least in part, skin The data show that retinol acts and should be a good model for changes of chronologic aging and through a novel, RAR-independent research. Serum retinol levels in- photoaging. mechanism to inhibit colon cancer crease rapidly in these mice upon cell growth. re-feeding, showing that serum “Photo-induced DNA damage and levels can be conveniently modu- photocytotoxicity of retinyl palmi- “Expression of retinoid recep- lated by quantitative manipulation tate and its photodecomposition tors in multiple cell lineages in of dietary retinol. products” by Yan J, Xia Q, Cherng the gastric mucosae of mice and SH et al. Toxicol Ind Hlth 2005; 21: humans” by Karam SM, Hassan “Megalin-mediated reuptake of 167–175 (Nat Ctr for Toxicol Res, WM, John R. J Gastroent & Hepa retinol in the kidneys of mice US Food Drug Admin, Jefferson, 2005; 20: 1892–1899 (UAE Univ, is essential for vitamin A home- AR, USA. E-mail: [email protected]. Fac Med Hlth Sci, Dept Anat, POB ostasis” by Raila J, Willnow TE, edu) 17666, Al Ain, U Arab Emirates. E- Schweigert FJ. J Nutr 2005; 135: Retinyl palmitate (RP) is the pre- mail: skaram@uaeu,ac.ae) 2512–2516 (Univ Potsdam, Inst Nutr dominant form of vitamin A in the Retinoids have long been known Sci, D-14458 Bergholz Rehbrucke, skin. These studies showed that as chemopreventive agents against Germany. E-mail: [email protected] RP and its photodecomposition gastric mucosal damage and car- potsdam.de) products, anhydroretinol and 5,6- cinogenesis. It was found that The reuptake of retinol and retinol- epoxy-RP induce DNA damage and retinoid receptors are expressed binding protein in the kidneys is cytotoxicity when irradiated with in multiple cell lineages of mouse mediated by the endocytic receptor UVA plus visible light. Generation of and human gastric epithelium. They megalin. In mice with a kidney- free radicals appears to initiate DNA may therefore account for pos- specific megalin gene defect it strand cleavage. sible effects of retinoids on gastric was shown that retinol excretion epithelial cell proliferation and dif- caused by megalin deficiency re- “Specificity of binding of all- ferentiation. quires accelerated mobilization of trans-retinyl ester to RPE65” by hepatic VA stores to maintain normal Maiti P, Gollapalli D, Rando RR. Bio- “A comparative study of the ef- retinol levels. Megalin appears to chemistry 2005; 44:14463–14469 fects of oral amiodarone and play an essential role in vitamin A (Harvard Univ, Sch Med,Dept Biol trimeprazine, two in vitro retinyl homeostasis. Chem & Mol Pharmacol, 45 Shat- ester hydrolase inhibitors, on the tuck St, Boston, MA 02115, USA. metabolic availability of vitamin A “Transthyretin constitutes a E-mail: [email protected] in rats” by Schindler R, Fielenbach functional component in pancre- vard.edu) T, Rave G. Brit J Nutr 2005; 94: atic beta-cell stimulus-secretion RPE65 is a binding protein for 675–683 (Univ Kiel, Dept Food Sci & coupling” by Refai E, Dekki N, all-trans retinyl esters in the visual Hum Nutr, D-24116 Kiel, Germany. Yang SN et al. cycle. This study explored the E-mail: rschindler@nutrfoodsci. Proc Natl Acad Sci USA 2005; 102: overall binding specificity of RPE65 uni-kiel.de) 17020–17025 (Karolinska Inst, Rolf with respect both to retinoids and Amiodarone, an antiarrhythmic Luft Ctr Diabet Res, Dept Mol Med, other isoprenoids. It was shown drug, and trimeprazine, an an- SE-17177 Stockholm, Sweden. E- that RPE65 is a moderately specific tipsychotic drug, are both in vitro mail: lisa.junti-berggren@molmed. retinoid-binding protein directed at inhibitors of retinyl ester hydrolase. ki.se) long chain all-trans retinyl esters. In this study they were both shown Transthyretin (TTR) is a transport to interfere with retinoid absorption, protein for thyroxin and retinol, in as- “Retinol inhibits the growth of storage and transport. In clinical use sociation with RBP, mainly existing all-trans-retinoic acid-sensitive the unmonitored use and the taking as a tetramer in vivo. It is shown that and all-trans-retinoic acid-resist- of these agents with food are not TTR tetramer has a positive role in ant colon cancer cells through a recommended. pancreatic P-cell stimulus-secretion NEWSLETTER 1/2006 39 SIGHT AND LIFE

coupling. TTR tetramer constitutes “Plasma appearance of labeled genase in human tissues” by a component in normal beta-cell beta-carotene, lutein, and retinol Lindqvist A, He YG, Andersson S. function. Conversion of tetramer to in humans after consumption J Histochem Cytochem 2005; 53: monomer may be involved in devel- of isotopically labeled kale” by 1403–1412 (Univ Texas, SW Med opment of beta-cell failure/destruc- Novotny JA, Kurilich AC, Britz SJ et Ctr, Dept Obstet Gynecol, F2-106 tion in type 1 diabetes. al. J Lipid res 2005; 46: 1896–1903 S323 Harry Hines Blvd, Dallas (USDA, ARS, Beltsville Human TX 75390, USA. E-mail: stefan. “Formation of retinoylated pro- Nutr Res Ctr, Beltsville, MD 20705, [email protected]) teins from retinoyl-CoA in rat USA. E-mail: [email protected]. β-carotene 9’,10’-monooxygenase tissues” by Kubo Y, Wada M, usda.gov) (BCO2) is a newly discovered en- Ohba T et al. J Biochem 2005; 138: Bioavailability of carotenoids from zyme that catalyzes asymmetric 493–500 (Hoshi Univ, Physiol Chem kale was investigated by labeling cleavage of carotenoids in the small Lab, Inst Med Chem, Shinagawa nutrients with C-13, feeding kale intestine and some other tissues. Ku, Tokyo 1429501, Japan. E-mail: to 7 volunteers, and analyzing se- It is described as being found in [email protected]) rial plasma samples. Average peak some tissues that are not sensitive Retinoylation (acylation of proteins plasma concentrations were: 0.38; to vitamin A deficiency and where no by retinoic acid) is considered to be 0.068; and 0.079 µM; areas under BC01 (β-carotene 15,15’-monooxy- one mechanism of retinoic acid ac- plasma concentration time curves genase) has been found. tion in cells in vitro and in vivo. were µM h : 42.8; 13.6; 13.2 ; and These experiments showed that percentage dose recovered at peak “Use of a 13C tracer to investi- retinoylation in rat tissues occurs plasma concentrations were: 3.6; gate lutein as a ligand to plasma via retinoyl-CoA formed from RA. 0.7; and 0.7% – for lutein; β-caro- transthyretin in humans” by This process may play a significant tene, and retinol respectively. Chen LW, Collins XH, Tabatabai LB physiological role in cells. et al. Lipids 2005; 40: 1013–1022 “β-carotene attenuates the para- (Iowa State Univ, Dept Food Sci & “A novel retinoic acid receptor doxical effect of tobacco smoke Human Nutr, Ctr Designing Food beta isoform and retinoid resist- on the mortality of rats after Improve Nutr, 1111 Human Nutr Sci ance in lung carcinogenesis” by experimental myocardial infarc- Bldg, Ames, IA 50011, USA. E-mail: Petty WJ, Li N, Biddle A et al. J Natl tion” by Paiva SAR, Novo R, Mat- [email protected]) Cancer Inst 2005; 97: 1645–1651 subara BB et al. J Nutr 2005; 135: Lutein selectively accumulates in (Wake Forest Univ, Sch Med, Dept 2109–2113 (Univ Estadual Pau- the macula of the retina and may be Pharmacol & Toxicol, Med Ctr Blvd, lista, Fac Med Botucatu, Dept Clin related to prevention of the disease Winston Salem, NC 27157, USA. Med, Botucatu, SP, Brazil. E-mail: age-related macular degeneration. E-mail: [email protected]) [email protected]) It was shown that TTR does not bind It was previously shown that all- It was found that previous exposure lutein in human plasma. trans-retinoic acid treatment can to tobacco smoke induced a proc- prevent in vitro transformation of ess of cardiac remodeling after MI. “Kinetics of 14C distribution af- immortalized human bronchial There is a paradoxical protector ef- ter trace dose of 14C-lutein in an epithelial cells. Restoration of RAR fect with tobacco smoke exposure, adult woman” by de Moura FF, beta 1’ expression, a novel retinoic characterized by low mortality, Ho CC, Getachew G et al. Lipids acid beta isoform, appeared to which is offset by β-carotene sup- 2005; 40: 1069–1073 (Univ Calif overcome retinoid resistance in lung plementation. Davis, Dept Nutr, 1 Shields Ave, carcinogenesis. Davis, CA 95616, USA. E-mail: “Impact of genetic and environ- [email protected]) Carotenoid experimental mental variation on development The plasma pattern of 14C did not of flavonoids and carotenoids in include a chylomicrons/VDL (intes- studies pepper (Capsicum spp.)” by Lee tinal) peak, suggesting that lutein is “Effects of dietary protein, fat and JJ, Crosby KM, Pike LM et al. Scien- handled differently from β-carotene β-carotene levels on β-carotene tia Hort 2005; 106: 341–352 (Texas by plasma lipoproteins. Lutein had absorption in rats” by Hosotani A & M Univ, Texas Agr Exp Sta, an elimination half-life of approx. 10 K, Kitagawa M. Int J Vitam Nutr 2415 E Hwy 83, Weslaco, TX 78596, days. 45% of the dose of 14C was Res 2005; 75: 274–280 (Wakayama USA. E-mail: [email protected]) eliminated in feces and 10% in urine Univ, Fac Edu, 930 Sakaedani, Results obtained for several of the in the first 2 days after dosing. Wakayama 6408510, Japan. E-mail: families tested have enabled them [email protected]) to be tested for impact of specific Community studies Each of the dietary constituents environmental factors and identify had a significant influence on either genes involved in regulatory syn- “Daily consumption of Indian activity of the enzyme β-carotene theses of certain phytochemicals spinach (Basella alba) or sweet 15,15’-dioxygenase, absorption or beneficial for human health. potatoes has a positive effect storage of β-carotene. The actual on total-body vitamin A stores effects are complex. “Cell type-specific expression in Bangladeshi men” by Haskell of β-carotene 9’,10’-monooxy- MJ, Jamil KM, Hassan F et al. Am SIGHT AND LIFE 40 NEWSLETTER 1/2006

J Clin Nutr 2004; 80: 705–714 (MJ Hlth Int., Arlington, VA 22201, USA. previously proposed. Food matrices Haskell, Univ Calif, Progr Int Nutr, E-mail: [email protected]) greatly affect the bioavailability of 3217A Meyer Hall, One Shields The objective was to assess the plant carotenoids, their efficacy of Ave, Davis CA 95616, USA. E-mail: effect of the vitamin A supplemen- conversion to vitamin A, or both. [email protected]) tation program on child mortality at Total body vitamin A stores were age 12–59 mo. After a number of “Changes in cholesterol and estimated by the deuterated-reti- potentially confounding variables triglyceride concentrations in nol-dilution technique. Vitamin A are controlled, the effect of 100% the Vanguard Population of the equivalency factors (β-carotene: community-level vitamin A coverage Carotene and Retinol Efficacy retinol, wt:wt) were estimated as since birth, relative to no coverage, Trial (CARET)” by Cartmel B, (almost equal to) 10:1 for Indian is to reduce the odds of dying at age Dziura J, Cullen MR et al. Eur J spinach, (almost equal to) 13:1 for 12–59 mo by slightly more than half Clin Nutr 2005; 59: 1173–1180 (Yale sweet potato, and (almost equal (OR = 0.47, P = 0.03). The estimat- Univ, Sch Med, Dept Epidemiol & to) 6:1 for isolated β-carotene. It ed beneficial effect is larger than in Publ Hlth, 200 Coll St, New Haven, was concluded that daily consump- most previous clinical studies. The CT 06510, USA. E-mail: brenda. tion of cooked, pureed green leafy larger effect may be partly due to [email protected]) vegetables or sweet potatoes has a other health-related activities under- This is the latest of many stud- positive effect on vitamin A stores in taken by community health workers ies of CARET in which mortality populations at risk of VAD. who distribute the capsules. was higher in the group receiving vitamin A and/or a combination of “Effect of vitamin A supplemen- “Nutrition knowledge and prac- vitamin A and β-carotene. In this tation to HIV-infected pregnant tices, and consumption of vita- group cholesterol (p< 0.0003) and women on the micronutrient sta- min A-rich plants by rural Nepali triglycerides (p< 0.0001 were higher tus of their infants” by Baylin A, participants and non-participants than in the placebo group. This may Villamor E, Rifai N et al. Eur J Clin in a kitchen-garden program” by account in part for the unexpected Nutr 2005; 59: 960–968 (A Baylin, Jones KM, Specio SE, Shrestha excess in cardiovascular deaths Dept Nutr, Harvard Sch Publ Hlth, P et al. Food Nutr Bull 2005; 26: seen in the active intervention arm 665 Huntington Ave, Boston MA 198–208 (Program in Int Nutr, Dept of CARET. 02115, USA. E-mail: abaylin@hsph. Nutr, Univ Calif, Davis, CA 95616 harvard.edu) USA) Clinical studies The effects of vitamins A, C, E, and A nutrition program, consisting of B12 were examined in this regard. increasing vitamin A and iron intakes “Effects of moderate doses of In each instance vitamin levels by promoting kitchen gardens, was vitamin A as an adjunct to the were highly significantly increased added to a market access rural de- treatment of pneumonia in under- in infants during the first 6 months velopment (MARD) project. The two weight and normal-weight chil- of age. groups were evaluated after 36 mo. dren: a randomized, double-blind, The group with the added program placebo-controlled trial” by Rod- “Dietary vitamin A may be a had significantly better nutrition riguez A, Hamer DH, Rivera J et al. cardiovascular risk factor in a knowledge, were more likely to Am J Clin Nutr 2005; 82: 1090–1096 Saudi population” by Alissa EM, feed special complementary foods ( Corp Ecouatoriana Biotecnol, Ave Bahjri SM, Al Ama N et al. Asia Pac to infants, to preserve food, and Colon N1468 |& Nueve Octubre, J Clin Nutr 2005; 14: 137–144 (Fac consumed more of home-produced Of 508, Quito, Ecuador. E-mail: Med, King Abdul Aziz Univ, Jeddah, vegetables and fruits. [email protected]) Kingdom of Saudi Arabia. E-mail: Overall there was no effect of a [email protected]) “Spinach or carrots can supply moderate (50,000 or 100,000 IU) In conditional logistic regression significant amounts of vitamin dose of vitamin A supplementation analysis the most significant charac- A as assessed by feeding with on the duration of uncomplicated teristics differentiating CVD patients intrinsically deuterated vegeta- pneumonia in underweight or nor- from controls were: diabetes mel- bles” by Tang G, Qin J, Dolnikowski mal-weight children < 5yrs. How- litus, total dietary fat intake, serum GG et al. Am J Clin Nutr 2005; 82: ever, a beneficial effect was seen vitamin A, and the vitamin A/total fat 821–828 (Tufts Univ, Jean-Mayer in children with high basal serum intake ratio. This is the first report USDA Human Nutr Res Ctr Aging, retinol concentrations (> 200 µg/l). of a potentially deleterious effect of 711 Washington St, Boston, MA This seems a remarkably high level, dietary vitamin A in a non-Caucasian 02111, USA. E-mail: guangwen. especially for children with a severe population. [email protected]) infection. The objective was to determine “Effects of vitamin A supplemen- the vitamin A value of intrinsically “Vitamin A supplementation tation on child mortality: evidence labeled dietary spinach and carrots does not affect infants’ immune from Nepal’s 2001 Demographic in humans. It was found that these responses to polio and tetanus and Health Survey” by Thapa S, items can provide a significant vaccines” by Newton S, Cousens Choe MK, Retherford RD. Trop Med amount of vitamin A even though the S, Owusu-Agyei S et al. J Nutr 2005; Int Health 2005; 10: 782–789 (Fam amount available is not as great as 135: 2669–2673 (London Sch Hyg NEWSLETTER 1/2006 41 SIGHT AND LIFE

Trop Med, Nutr & Publ Hlth Intervent Sch Publ Hlth, Baltimore, MD,USA. 2005; 15: S 140–149 (Dept Publ Hlth, Res Unit, London WC1, UK. E-mail: E-mail: [email protected]) Fujita Hlth Univ Sch Hlth Sci, Japan. [email protected]) Plasmodium falciparum decreases E-mail: [email protected]) It has been suggested that admin- erythropoietin production while vita- For men the risk of lung cancer death istering vitamin A with the measles min A stimulates it in vitro. However, was significantly lower for the highest vaccine may reduce the vaccine’s contrary to this hypothesis, it was quartile of serum α- and β-carotenes, immunogenicity. Polio and tetanus found that erythropoietin production lycopene, and β-cryptoxanthin than vaccines were tested similarly and was significantly decreased by vita- for the lowest quartile. The OR, found not to be affected. min A. Both vitamin A and the anti- adjusted for smoking and other co- malarial drug sulfadoxine pyrameth- variates, was 0.41, 0.28, 0.46, and “Use of serum retinol-binding amine rapidly reduced inflammation. 0.39 respectively. No similar sig- protein for prediction of vitamin A Vitamin A also mobilized iron from nificant associations occurred among deficiency: effects of HIV-1 infec- stores and stimulated production of women (the numbers of women were tion, protein malnutrition, and the erythrocytes. smaller). acute phase response” by Baeten JM, Richardson BA, Bankson DD et “Transient bulging fontanelle af- “Effects of separate delivery of al. Am J Clin Nutr 2004 (JM Baeten, ter vaccination: case report and zinc or zinc and vitamin A on Univ Wash, Box 359909, 325 Ninth review of the vaccine adverse hemoglobin response, growth, Ave, Seattle, WA 98104-2499, USA. event reporting system” by Freed- and diarrhea in young Peruvian E-mail: [email protected]) man SB, Reed J, Burwen DR et al. children receiving iron therapy 600 Kenyan women were studied. J Pediatr 2005; 147: 640–644 (US for anemia” by Alarcon K, Kol- It was reported that equimolar RBP FDA, CBER, Off Biostat & Epide- steren PW, Prada AM et al. Am J cutoffs predicted vitamin A deficiency miol, HFM 225, 1401 Rockville Pike, Clin Nutr 2004; 80: 1276–1282 (PW with high sensitivity and specificity. In Rockville, MD 20852, USA. E-mail: Kolsteren, Nationalestraat 155, the context of infection and protein [email protected]) 2000 Antwerpen, Belgium E- mail: malnutrition, both of which were The authors define transient bulg- [email protected]) common, RBP, like retinol, did not ing fontanelle (TBF) and a literature Adding zinc to iron treatment in- accurately identify true vitamin A search revealed 18 cases or prob- creased hemoglobin response, im- status. able cases following immunization. proved iron indexes, and had positive Average age was 4.5 mo, interval effects on diarrhea. No additional “Altered retinoid homeostasis from immunization was 18 h, and effect of vitamin A was found. catalyzed by a nicotine metabolite: resolution 3 days. 15 were febrile. implications in macular degen- Further studies are needed, but ben- “Micronutrient malnutrition and eration and normal development” efits greatly outweigh dangers. wasting in adults with pulmonary by Janda KD, Dickerson TJ, Boldt tuberculosis with and without HIV GE et al. Proc Natl Acad Sci USA Multi-micronutrients co-infection in Malawi” by van Let- 2005;102:10433–10438 (KD Janda, tow M, Harries AD, Kumwenda JJ Skaggs Inst Chem Biol, Dept Chem, “Effect of a fortified maize-meal et al. BMC Infect Dis 2004; 4: 8p (M Scripps Res Inst, 10550 North Tor- porridge on anemia, micronutrient van Lettwo, Johns Hopkins Univ Sch rey Pines Rd, San Diego, CA 92037 status, and motor development of Med, Baltimore MD, USA. E-mail: USA. E-mail: kdjanda@scripps. infants” by Faber M, Kvalsvig JD, [email protected]) edu) Lombard CJ et al. Am J Clin Nutr This study found that wasting and It was demonstrated that nor-nico- 2005; 82: 1032–1039 (S Afr MRC, higher HIV load in pulmonary tuber- tine, a nicotine metabolite and com- Nutr Interven Res Unit, POB 19070, culosis were associated with micro- ponent of cigarette smoke, catalyzes ZA-7505 Tygerberg, RSA. E-mail: nutrient malnutrition. the Z-to-E alkene isomerization of [email protected]) unsaturated aldehydes and ketones, Infants aged 6–12 mo (n=361) were “Zinc plus β-carotene supplemen- including retinals. The product of randomly assigned to receive forti- tation of pregnant women is supe- retinal isomerization is all-E-retinal, fied or unfortified porridge for 6 mo. rior to b-carotene supplementation which in the eye is a biosynthetic There was significant improvement alone in improving vitamin A sta- precursor to N-retinylidene-N-reti- in iron status, anemia, and motor tus in both mothers and infants” nylethanolamine, a hall-mark of age- development with the fortified por- by Dijkhuizen MA, Wieringa FT, West related macular degeneration. ridge. Zinc content may need to be CE et al. Am J Clin Nutr 2004; 80: adjusted (although 100% RDA was 1299–1307 (FT Wieringa, Dept Int “Short-term effects of vitamin A included). Med, Univ Med Ctr Nijmegen, 1053 and anti-malarial treatment on AZ Amsterdam, Netherlands. E-mail: erythropoiesis in severely anemic “Lung cancer mortality and serum [email protected]) Zanzibari preschool children” by levels of carotenoids, retinol, to- The conclusion, stated in the title, is Cusick SE, Tielsch JM, Ramsan copherols, and folic acid in men interpreted by the authors as imply- M et al. Am J Clin Nutr 2005; 82: and women: a case-control study ing “a specific role of zinc in vitamin A 406–412 (Ctr Hum Nutr, Dept Int nested in the JACC Study” by Ito Y, metabolism”. Hlth, Johns Hopkins Bloomberg Wakai K, Suzuki K et al. J Epidemiol SIGHT AND LIFE 42 NEWSLETTER 1/2006

the prevention of childhood blind- Letters to the editor ness. It has also provided literature and information on this topic as well as on nutrition and ways to prevent children going blind due to this sad disease.

We will therefore be very happy to continue displaying and distributing your material every year, and to make the resources you provide known to many people, so that all ophthalmologists and other visitors committed to helping people in developing countries can use them for our common goal of preventing avoidable blindness.

Jacques Renk at the CBM booth with prevention of blindness materials. Thank you for your unfailing support, with kind regards, Christoffel Blindenmission AND LIFE has provided, year after at SSO year, the whole supply of vitamin Jacques Renk, Regional Director A needed by the numerous CBM Dear Editor, CBM, Suisse Romande, responsi- programs engaged worldwide in ble for Projects Co-ordination At the Annual Congress 2005 of the Swiss Society of Ophthalmol- ogy (SSO), the Christian Blind Mission (Christoffel Blindenmis- Prevention of Blindness in sion – CBM), the Swiss Red Myanmar Cross and the Commission for Ophthalmology for Developing Dear Editor Countries again shared a booth, thanks to the generosity of the A decade ago, vitamin A deficien- SSO. Our programs for the pre- cy was a public health problem in vention of childhood blindness Myanmar, with clinical symptoms have long enjoyed the support in 0.26% of children under five of SIGHT AND LIFE, and it was years old. The administration of important to us to include informa- vitamin A was incorporated into tion about your activities in our national immunization days twice display and to disseminate your a year. Standard dosages were very useful documentation. given. In addition, the Nutrition We had a good number of visitors, many of whom took the SIGHT AND LIFE Newsletter, and we gave your CD to several ophthalmologists who are active in, or come from, developing countries. The excellent Healthy Eyes Ac- tivity Book, which we had in the English and French versions, also attracted quite some attention and we distributed all the copies available.

For as long as I remember, prob- ably for almost 20 years, SIGHT NEWSLETTER 1/2006 43 SIGHT AND LIFE

Program also supplied vitamin A in cases of deficiency within the micronutrient supply to children under three years of age. At present, the deficiency rate is quite low, at 0.03% in children under five years old.

In recent years the Prevention of Blindness project received all the necessary vitamin A capsules for 16 secondary centers from SIGHT AND LIFE. These centers perform routine village and school surveys, and provide health services for various eye problems.

We thank SIGHT AND LIFE for the continuing support.

Dr Nyunt Maung, Deputy Director, TC&BPL

Announcement Clive West Micronutrient Fund (CWMF)

This fund was initiated in 2004 by the Division of Human Nutrition, Wageningen University, the Netherlands, to honor Clive E West for his contribution to a better understanding of the importance of micronutrients in human health worldwide. In his spirit this fund is created for excellent young fellows in micronutrient research especially tar- could be applied for. The target group could also geted towards developing countries. apply for financial support up to € 2500 for a contribution in the area of micronutrient research. Aim and terms of reference As there will only be limited funds available in the The aim of the fund will be to stimulate research CWMF no support is available for major research and capacity building in the field of micronutrients, projects. especially micronutrient deficiency in developing countries. The fund will offer financial support to Persons who wish to be considered for one of the students and/or young researchers from these above-mentioned grants could apply by sending countries who are studying or dealing with this in the application form to be found on the website: subject. www.westmicronutrient.nl. Alternatively, contact the secretary of the fund for more information by Since the establishment of the fund there have email: [email protected], or by post: Mrs L.A. been many applications for funding, especially Duym, Division of Human Nutrition, Wageningen from Africa. However, the Board of the Fund University, P.O. Box 8129, 6700 EV Wageningen, would also welcome applications from persons the Netherlands. or groups from other developing regions like South East Asia. Donations to the fund are of course much ap- preciated. Information can also be found at the Small travel grants up to € 1000 to attend e.g. an website or by contacting the secretary of the international meeting dealing with micronutrients fund. SIGHT AND LIFE 44 NEWSLETTER 1/2006

Publications SIGHT AND LIFE presents recent publications which may be of particular interest to our readers. However, these publications are not available from SIGHT AND LIFE, nor do we have any privileged access to them.

vances in nutrition. More than 120 among new beneficiaries, and chapters and appendices were provide beneficiaries with pos- written by over 175 contributing sibilities for increasing variation authors. in their diets. Lippincott Williams & Wilkins, NY The recipes are simple, require www.LWW.com little preparation time, and the addition of only a limited number of other foods. Some of the recipes indicate how they can be adapted to the requirements of different regions, cultural habits, and locally available foods. This book is available in French and Spanish too. World Food Programme, Rome, Italy www.wfp.org [email protected] Modern Nutrition in Health and Disease This book is considered to be the Family Nutrition Guide most complete, authoritative reference on nutrition and its role in The Family Nutrition Guide is a dietetics, contemporary medicine, practical guide that aims to im- nursing, public health, and public Fortified Blended Foods prove the feeding and nutrition of families in developing countries. policy (2070 pages, 4 kg!). Inter- Recipes nationally known experts deliver Facts and Practical Uses in-depth information and insights It is primarily written for health on specific dietary components, Fortified blended foods (FBFs) workers, nutritionists, agricultural nutrition in integrated biological are commodities that provide es- extensionists or other develop- systems, nutritional assessment sential micronutrients as well as ment workers who design nutri- through the life cycle, nutrition protein and energy to many popu- tion education materials and in various clinical disorders, and lations served by the World Food activities and work with people at public health and policy issues. Programme (WFP). Over the community level. It should also be It reflects current research in years, many countries through- useful to mothers or other caregiv- the field, focusing on the close out the world have gained wide ers who want to know more about interconnection of nutrition with experience of using these foods, family feeding, as well as anyone various chronic diseases. Major and have developed numerous training health staff and other attention is given to the increas- methods of preparation. This community-level workers. ing importance of obesity and booklet was prepared in response its role in a variety of disorders. to the marked increase in the use The guide is divided into 11 topics Special emphasis is placed on of FBFs in countries throughout that cover basic nutrition, family the need for different approaches the world as a way of sharing food security, meal planning, food in the understanding, evaluation, experiences among WFP staff, hygiene and the special feeding prevention, and management of counterparts, and beneficiaries. needs of children, women and interrelated diseases. Tutorial It is hoped that this booklet will men, and of old, sick and mal- chapters provide an orientation contribute to improving the utili- nourished people. Each topic to the history, terminology, key zation and acceptability of FBFs, provides a summary of up-to- concepts, and most recent ad- facilitate the introduction of FBFs date technical nutrition facts that NEWSLETTER 1/2006 45 SIGHT AND LIFE

can be used to prepare various health. Practical applications nutrition education activities and and treatment of pathologies materials: face-to-face education with nutritional components are sessions with families and other stressed. In addition, basic sci- community-level groups; nutrition entific information is introduced education print material or mate- to understand nutritional issues rial for other media (such as radio reported in the mass media. Of talks); or training material for staff particular note is the evidence in different sectors who deal with showing genetic differences in family nutrition. individuals’ metabolism of nutrients. Such instances are woven into the relevant chapters and offer insight into the long history of contradictory reports concerning the effect of foods and nutrients on health outcomes.

Of particular interest in the context of SIGHT AND LIFE are the chapters 7 and 8 on vitamins and minerals. www.fadavis.com of experimental, epidemiological, and clinical research. For each micronutrient, you’ll find information on function, deficiency, VITAMINS dietary reference intakes, dis- Their Role in the Human Body ease prevention and treatment, sources, and safety issues. The Current knowledge of the vita- book has been endorsed by the mins’ biological properties in The nutrition facts of each topic internationally acclaimed Linus the context of human nutrition are complemented by commu- Pauling Institute at Oregon State is drawn together. Vitamins are nication suggestions for people University. co-enzymes, antioxidants or working directly with families Thieme NY, www.thieme.com precursors of hormones and and community groups. These are therefore involved in a great suggestions describe the steps many biochemical and physi- needed to prepare an education ological processes. They play a session, encourage participation vital role in the maintenance of and make the session more fun. health, and there is evidence that FAO, Rome, Italy dietary sources of vitamins have [email protected] beneficial effects in the prevention of heart-related diseases, bone diseases and possibly cancer.

An Evidence-Based Following introductory chapters Approach to Vitamins and on historical and nutritional as- Minerals pects of vitamins, the next four chapters cover relevant and de- Health Benefits and Intake Rec- tailed aspects of physiology and ommendations functional anatomy, biochemistry, immunology and the regulation This book provides a valuable of protein synthesis by nuclear review of the most current scien- Nutrition and Diet Therapy hormone receptors. These back- tific information on vitamins and Evidence-Based Applications ground chapters, supported by nutritionally relevant minerals and a glossary of terms, provide the their roles in health and disease. This book is designed to provide scientific principles upon which It provides a well-organized ref- knowledge of the fundamentals vitamin functions are based. erence on micronutrient science, of nutrition related to the promo- The following thirteen chapters synthesizing an extensive amount tion and maintenance of optimal deal with each vitamin in turn. SIGHT AND LIFE 46 NEWSLETTER 1/2006

cer, diabetes and osteoporosis. who major in other subjects that Other important nutritional issues have a nutrition component, such are for example managing the hu- as food science, medicine, phar- man gut flora, vegetarianism and macy and nursing. Professionals the role of phytoprotectants. in nutrition, dietetics, food science, medicine, health sciences Blackwell Publishing and many related areas will also www.blackwellpublishing.com find much of great value. It provides students with the required scientific basics of nutrition in the context of a systems and health approach.

Blackwell Publishing www.nutritiontexts.com

Subject areas include chemical structure, intestinal absorption, transport, metabolism, biochemical and physiological actions, immunoregulatory properties, deficiency-related diseases and potential toxicity. An extensive bibliography refers the reader to the original research literature.

VITAMINS is aimed at nutrition- Introduction to Human ists, biochemists, physiologists Nutrition and physicians whether they be researchers, teachers or students, As an academic subject, nutrition food scientists, food technologists has grown enormously in recent and many others working in the years and with it the need for spe- health professions. cialist textbooks on the subject.

Blackwell Publishing This book is intended for teachers CRC Desk Reference for www.blackwellpublishing.com and students of nutrition and die- Nutrition tetics, and also for those students This second edition explains hun- Nutrition & Health dreds of terms commonly used in medicine, food science, metabo- Continuing accumulation of sci- lism, physiology, and nutrition. entific evidence demonstrates Thoroughly updated and expand- that nutrition is one of the most ed to reflect major advances over important determinants of health the past decade, this reference for the individual, and that specific lists entries alphabetically and nutrition habits of various popula- cross-references them when mul- tions can significantly decrease tiple terms are used for the same the overall risk of several chronic definition. Each entry is followed diseases. either by a definition, paragraph, essay, composition, article, or This publication covers the major feature article. Many of the more topics relating to nutritional as- complex entries are supported pects of health, including details with figures or tables. The first of the links between diet and car- appendix contains general infor- diovascular disease, obesity, can- mation about meal planning and NEWSLETTER 1/2006 47 SIGHT AND LIFE

food selection, while the second tality and HIV/AIDS and other on non-income poverty, and mal- provides a variety of metabolic diseases, while promoting uni- nutrition remains the world’s most maps that illustrate the pathways versal primary education, gender serious health problem – as well involved in major metabolic sys- equality, environmental sustain- as the single largest contributor tems. Many web addresses that ability and a global partnership for to child mortality. Nearly one- provide access to the extensive development by 2015. The MDGs third of children in the developing Table of Food Composition and serve as a framework to make the world are underweight or stunted, the Dietary Reference Intakes Millennium Declaration’s vision of and more than 30 percent of the are listed. a world of peace, security, soli- developing world‘s population suf- darity and shared responsibility fers from micronutrient deficien- CRC Taylor & Francis a reality. cies. Moreover, new malnutrition www. taylorandfrancisgroup.com problems are emerging: the epi- Reaching these children – many demic of obesity and diet-related of whom are currently beyond non-communicable diseases the reach of laws, programmes, is spreading to the developing research and budgets – is a world, and malnutrition is linked challenge. And yet, meeting our to the HIV/AIDS pandemic. commitments to children will be possible only if we approach the Repositioning Nutrition as Central challenge head-on. to Development: A Strategy for www.unicef.org Large-Scale Action makes the case that development partners and developing countries must increase investment in nutrition programs. This case is based on evidence that the scale of the problem is very large and that nutrition interventions are essential for speeding poverty reduction, have high benefit-cost ratios, and can improve nutrition much faster than reliance on economic growth alone. Moreover, improved nutrition can drive economic growth. Excluded and invisible The report proposes to the international development community In the past, UNICEF’s annual and national governments a glo- State of the Worlds Children bal strategy for accelerated action report has focused on specific in nutrition. issues. This year light is shed on the millions of children who are excluded or “invisible”, children without adequate access to education, to life-saving vaccines, to PPleaselease protection. Despite enormous ef- Repositioning forts to reach children with needed Nutrition as Central to uupdatepdate yyourour services, millions continue to die Development every year. aaddressddress andand Persistent malnutrition contributes The world has agreed upon a not only to widespread failure to hhelpelp ttoo aavoidvoid road map to a better future in the meet the first Millennium Develop- form of the Millennium Develop- ment Goal – to halve poverty and uunnecessarynnecessary ment Goals (MDGs), which stem hunger – but also to meet other from the Millennium Declaration, goals related to maternal and child wworkork aandnd adopted in 2000 by 189 countries. health, HIV/AIDS, education, and The goals set quantitative targets gender equity. Underweight prev- eexpensesxpenses to address extreme poverty and alence among children is the key hunger, child and maternal mor- indicator for measuring progress SIGHT AND LIFE 48 NEWSLETTER 1/2006

Drawing contest on nutrition for health

The SIGHT AND LIFE’s Drawing name and the name and address The decision of the jury regarding Contest is dedicated to increasing of the school. All techniques on the awards will be final and legal awareness of the importance of paper (e.g. colored crayons, wa- recourse will not be applicable. Nutrition for Health. tercolor, pencil, etc.) in a format The participants of the contest not exceeding 42x30 cm (A3) are assign and transfer automatically After the success of the SIGHT welcome. to SIGHT AND LIFE all rights and AND LIFE Drawing Competition interests related to the copyright in 2000, we have decided to or- A jury will select the best of the in the drawings, and SIGHT AND ganize a new Drawing Contest submitted artwork from each LIFE is entitled to use them within for children. We are convinced class. Awards will honor those its activities. that all children of the world have school classes who have the talent and are creative artists. We best and most creative young If you have children, brothers or invite school classes to participate artists among them. One hundred sisters of the indicated age, or are in the contest. Children aged participating school classes will even a school teacher yourself, from 5 to 15 years are eligible receive writing materials as a gift. then please help us to make the to participate. They should draw The artists of the 25 best drawings contest a success and advertise their personal understanding of will receive a special award with the competition. The deadline the impact of nutrition on health. colored crayons or a paint box. for submitting the drawings is The five best drawings from each All students of his/her class can 31 July 2006. Please send the class should be selected and expect SIGHT AND LIFE bags in artwork to: submitted to SIGHT AND LIFE. addition to the writing materials. Each drawing should have a title We will use selected drawings in SIGHT AND LIFE and be accompanied by a written the design of SIGHT AND LIFE P.O. Box 2116 description of the content (e.g. greeting cards. These cards will 4002 Basel, Switzerland on the back). It must be clearly be used to create awareness labeled with the grade, name and about the humanitarian work of Please visit our website at age of the artist, the teacher’s SIGHT AND LIFE. sightandlife.org for news.

Some of the drawings we received during the drawing competition in 2000. NEWSLETTER 1/2006 49 SIGHT AND LIFE

SIGHT AND LIFE Annual Report 2005

Klaus Kraemer, SIGHT AND LIFE

It is a pleasure and a privilege tion, we will provide vitamin and to report on SIGHT AND LIFE mineral mixes for food fortification activities in 2005. This year was and supplementation programs. very eventful and brought quite We take this new responsibility a few changes to SIGHT AND very seriously and are committed LIFE. My predecessor Dr. Martin to helping implement sustainable Frigg retired last year but he is solutions for the reduction of mi- still supporting us as a consult- cronutrient malnutrition. We are ant. Under his leadership SIGHT especially prepared to support AND LIFE has developed into an small nutrition research programs internationally well-respected hu- related to micronutrient nutrition. manitarian program. When I took over responsibility for SIGHT AND Recently, a new Steering Com- LIFE I found it to have a strong mittee has been established to commitment to the prevention and oversee the activities of SIGHT eradication of nutritional blind- AND LIFE. For more information ness and of vitamin A deficiency on our new structure and mission in developing countries. In the please visit our website (www. meantime, we have modified our sightandlife.org). mission in line with the general trend in international nutrition re- Grants search towards addressing com- bined micronutrient deficiencies. Right at the beginning of the year Our vision is to combat all types SIGHT AND LIFE was extremely of micronutrient deficiencies and active in providing nutritional sup- to raise awareness of “hidden port and advice in those areas of hunger” as a public health issue Southeast Asia affected by the in developing countries. Indeed, December 2004 tsunami. We we have moved the focus from provided grants to Helen Keller SIGHT to LIFE. This does not International (HKI), the UN World mean however that we are no Food Program (WFP) and the longer interested in vitamin A or Vitamin Angel Alliance (VAA), as that we will stop donating vitamin well as several locally operating A capsules. They remain indis- NGOs for immediate relief (see pensable in the treatment and box Facts and Figures 2005). prevention of vitamin A deficiency in children under 5 years and We reported in Newsletter 2/2005 postpartum women where vitamin about the tsunami relief activi- A rich foods are not accessible ties of HKI in the Indonesian or affordable. But now, in addi- provinces of Aceh and North SIGHT AND LIFE 50 NEWSLETTER 1/2006

Sumatra. The fight of the VAA pursued with the WFP. A larger against micronutrient deficiencies quantity of premix was donated around the world was featured for the fortification of biscuits. in the same edition of the News- High-energy biscuits fortified with letter. HKI initiated assistance micronutrients have proven very focusing on dispensing vitamin A effective in reducing micronutri- capsules, zinc supplements and ent deficiencies during emergen- multimicronutrient sprinkles. This cies as well as in school feeding has likely mitigated the spread of programs. SIGHT AND LIFE will communicable diseases. In April support a new WFP school feed- 2005, at the invitation of SIGHT ing program with sprinkles which AND LIFE, representatives of HKI will be launched in the second came to Switzerland to present half of 2006. their relief activities in Asia to the employees of DSM Nutritional In collaboration with Prof. R.R. Products. The presentation and Swamy, State Health Coordinator discussion was very well received in the State of Andhra Pradesh, and employees and management and several locally operating were impressed by the dedication NGOs, we provided assistance of the HKI team to providing relief to the people affected by the to the tsunami victims. tsunami in South India. Surviving the tsunami meant loss of mother, Another avenue to provide sup- father, children or relatives and port related to the tsunami was all belongings. In addition to vi-

Impressions from South India in July 2005. Prof. Swamy (top left) speaking to village leaders in Andhra Pradesh coordinating a vitamin A capsule distribution campaign; and people affected by the tsunami of December 2004. NEWSLETTER 1/2006 51 SIGHT AND LIFE

Facts and figures for the year 2005 Three issues of the Newsletter, a total of 25,000 copies, were sent out. Informa- 167 projects supported in 39 countries. tion materials mailed in 584 shipments Among them: contained: • 178 Vitamin A capsule donations for 140 1644 Posters projects 4141 Brochures • 1 Research grant 903 Books • 4 Technical support grants 1291 CDs • 25 Training and education grants 112 Slide sets • 15 Grants for tsunami victims Vitamin A capsules: 2.01 million Activities by regions: standard capsules were donated. 54% in Africa, 9% in the Americas, 37% in Asia tamin A capsules, beneficiaries received staple foods such as rice and dhal, clothing, toiletries, blankets, etc. During a trip to India in July I had the opportunity to see for myself the progress made by relief activities at a tribal village of inland fishermen who lived a few kilometers from the coast. The disadvantaged had lost all their houses and belongings and their source of livelihood through the loss of boats and nets. At the time of my visit palm-thatch huts had already been rebuilt, but there was still a lot to do including the procurement of boats and nets to generate income and the building of new houses. Due to the far-seeing use of the grant by Fortified salt used in school feeding programs in Tamil Nadu (South India). Prof. Swamy, we were able to put Use of fortified salt is reported to increase attention of pupils. a well-pump into operation during our visit. Before that the people had only had access to unclean water.

Dried blood spots have become a simple method for collecting blood specimens under field conditions. With the support of SIGHT AND LIFE this methodology has been further improved for the determination of vitamin A status. The method was described in Newsletter 1/2005 by Dr. Juergen Erhardt.

School feeding has become an important approach to developing communities and countries. Poverty and inadequate food supply lacking protein, energy SIGHT AND LIFE 52 NEWSLETTER 1/2006

and micronutrients lead to mal- core element of DSM’s stakehold- nutrition. School-age children are er dialogue on Corporate Social particularly vulnerable, compro- Responsibility (CSR) issues, and mising physical and intellectual have contributed to the recogni- development. GRET reported in tion of DSM as the world leader Newsletter 2/2005 about a sus- in the Dow Jones Sustainability tainable reduction of malnutrition Index for the second consecu- among Madagascan school chil- tive year. dren which reduced school failure by the distribution of fortified In China, SIGHT AND LIFE part- high-energy gruel. The program ners with UNICEF, the Center for with fortified biscuits in Vietnam Public Nutrition and Development is still ongoing, and a new school of China (PNDC) and the Ministry feeding program in Burkina Faso of Health (MOH) on a flour pilot supported by SIGHT AND LIFE is fortification project in Lanzhou, currently being worked out. Gansu province. PNDC is a government-sponsored institution Information, training and actively involved in the design and education implementation of national nutrition programs. At the state-owned In June a press trip to Beijing flour mill Lanzhou Hongmei Flour and Lanzhou in China with Chi- Co. Ltd. wheat flour is fortified with nese and European journalists the vitamins A, B1, B2, B6, niacin, was organized to present DSM’s folic acid, iron and zinc. The flour triple P activities. Triple P stands is primarily used for the prepara- for People, Plant and Profit and tion of noodles which are popular reflects DSM’s ambitions to take in Gansu province. People using the obligations of good corporate the fortified flour reported fewer citizenship seriously. SIGHT AND infections and an overall improve- LIFE´s activities have become a ment in health. Efficacy data related to the use of the flour will be published shortly. The visit to the flour mill and communities using the fortified flour was rounded off by intensive discussions about micronutrient nutrition and health with representatives of UNICEF, the PNDC and MOH in Beijing. Other sites visited included DSM operations in Shanghai, present- ing DSM´s concern about safety and environmental issues.

In October, I was invited by the Impressions from a trip to Bangladesh and ‘JiVitA-land’ in January 2006 Chinese Food and Drug Admin- when research was discussed (top right Alfred Sommer and Keith West) istration to an expert workshop and the practical work in the study area was seen. to talk about safety and maximal NEWSLETTER 1/2006 53 SIGHT AND LIFE

Impressions from China gathered during a trip in June 2005. In the Lanzhou levels of vitamins and minerals Hongmei Flour Mill fortified flour is produced. in food supplements and for food fortification. Many governments request guidance on maximal The film documents our efforts in Swamy’s work is still in progress levels for vitamins and minerals. collaboration with Prof. Swamy but the studies in schools with Scientific risk assessment and (and local NGOs) and Dr. Vinod multimicronutrient supplements risk management are valuable Kumar to reduce vitamin A and and fortified salt have been suc- approaches to derive maximal other micronutrient deficiencies in cessfully completed and are levels for daily vitamin and min- communities of Andhra Pradesh currently being written up for eral consumption which should be and schools in Tamil Nadu. Prof. publication. We reported on these translated into regulation. SIGHT AND LIFE takes an active role in the scientific discussion on this topic.

SIGHT AND LIFE’s operations in Andhra Pradesh and Tamil Nadu, where we have been active for many years, were featured in a documentary series broadcast by the Dutch TV channel TROS in August which featured the CSR programs of Dutch transnational companies. Prof. R.R. Swamy and Dr. Malavika Vinod Kumar, Sundar Serendipity Foundation, Chennai, had been enormously helpful with organizing the shoot- ings. Thanks again from here. SIGHT AND LIFE 54 NEWSLETTER 1/2006

trials in Newsletter 3/2004. The nar and IFCP and was funded by Medicine (LSHTM), SIGHT AND schools still use the fortified salt, SIGHT AND LIFE. The film has LIFE is again co-funding the train- and other trials with the salt and been repeatedly broadcast by ing of MSc students in Community multimicronutrient supplements a Micronesian TV channel, and Eye Health. SIGHT AND LIFE has are in preparation. was only recently requested by been supporting students since another Pacific State. The film 1990 and has sponsored almost We continue to support the work was also big success when it 40 students from 20 different na- of the Island Food Community of was presented to the employees tions. In Newsletter 3/2005, Adri- Pohnpei (IFCP), Federal States of of DSM Nutritional Products in enne Burrough reported about Micronesia, under the leadership November. During the 2005 World capacity building for VISION 2020 of Dr. Lois Englberger. Among Food Day in Pohnpei the provi- at the ICEH at the LSHTM. In the Micronesians, overweight and tamin-A carotenoid-rich banana meantime, a third candidate from obesity and related ailments such cultivar Karat was proclaimed the Bangladesh has been identified as diabetes and cardiovascular Pohnpei State Banana. and participates in the program. diseases have become prevalent, while micronutrient malnutrition An interesting approach to training Publications still persists. Changes in dietary traditional healers as multipliers is habits and lifestyle with a shift in being pursued by the Community We have started to align and consumption towards high-caloric Health Institute (CHINST) in Ne- update our materials and website imported food and a sedentary pal. CHINST decided to educate to our new mission. This includes, lifestyle have primarily contributed traditional healers because peo- among others, a 3rd edition of to the epidemic. The reasons for ple still have more faith in them the ‘SIGHT AND LIFE Manual on this are plentiful but include a than in modern health services. Vitamin A Deficiency Disorders’, lack of awareness of nutrient-rich We reported about the activities under the leadership of Dr. Donald indigenous food and the relation- of CHINST and other educational McLaren. The release can be ex- ship between diet and health in campaigns in Nepal in Newsletter pected for the second half of 2006. general. An entertaining film with 3/2005. This publication will include new the title ‘Going Yellow’, which data on the worldwide prevalence highlighted these interdependen- At the International Centre for of VAD, as SIGHT AND LIFE has cies, was produced in collabora- Eye Health (ICEH) at the London given a grant to the WHO to up- tion between Micronesian Semi- School of Hygiene and Tropical date the database recently. NEWSLETTER 1/2006 55 SIGHT AND LIFE

The Healthy Eye Activity Book is thought to be related to iron nutrition2006.org) we will discuss (HEAB) was translated into Urdu deficiency. Other micronutrient guidelines for interventions and and will be available electronically deficiencies such as of vitamins gaps in research with all contribu- from our website soon. A and C, B-vitamins, copper and tors to the book. The publication zinc, and protein and energy can be expected in early 2007. A new SIGHT AND LIFE publi- malnutrition as well as infectious cation is planned on ‘Nutritional diseases are also involved. In a Acknowledgements Anemia’. More than two billion comprehensive monograph to people of the world’s population be edited by Dr. Michael Zim- We would like to take this oppor- are affected by anemia. Anemia is mermann, ETH Zurich, and my- tunity to thank all contributors to a major constraint in the develop- self we want to address major the Newsletter and partners we ment of nations because anemia factors related to the problem. In worked with in 2005, particularly compromises cognition and leads a pre-congress workshop on 27 those who could not be mentioned to fatigue. This leads to school September 2006 to the 1st World personally in this overview. failure and weak work perform- Congress on Public Health Nutri- ance. Only about half of anemia tion in Barcelona, Spain (www.

Questionnaire survey of our readers

As a supplement to this issue of our newsletter, on this envelope; we will pay the cost of we are enclosing a questionnaire that we kindly mailing. Please fold the form so that the ask you to fill in and return to us. SIGHT AND LIFE address is visible.

We value your opinion and want to make this 2. Fax the questionnaire to: +41 61 688 19 10 magazine better – for you! 3. Use the online questionnaire on the SIGHT AND LIFE homepage: DEADLINE: Please return the form www.sightandlife.org by 30 June 2006 4. Email the scanned document as a PDF to: for a CHANCE TO WIN: [email protected] All returned questionnaires will be entered in a No matter how you return the questionnaire: raffle for 100 small surprise rewards!

Don’t forget to include your full name, affilia- How can you return the questionnaire to us? tion and address on the form – this is essen- There are four ways to send the completed ques- tial for your participation in the raffle. tionnaire back to us: SIGHT AND LIFE thanks all those who participate 1. For your convenience we have enclosed an this survey very much and we wish you envelope for you to return the questionnaire by mail. You do not need to pay postage GOOD LUCK! SIGHT AND LIFE NEWSLETTER 1/2006

Children of the Calcutta Rescue School saying thanks in German to SIGHT AND LIFE. It was quite an event before all the children could hold the characters correctly (see article on page 31).

SIGHT AND LIFE is a humanitar- infections and increased child Support is given in the form of ian initiative of DSM Nutritional and maternal mortality are the vitamin A capsules, premixes Products (for more information consequences. Moreover, this containing micronutrients, grants, see the SIGHT AND LIFE website: impairs growth and development, information and educational ma- www.sightandlife.org). We are cognition, vision and immune func- terials such as manuals, books, committed to the improvement of tion, as well as school and work posters, reprints, etc. Furthermore, nutrition and health with emphasis performance. SIGHT AND LIFE gives technical on children and mothers in devel- assistance where required and oping countries. It is the aim of For its humanitarian work, SIGHT promotes training and education SIGHT AND LIFE to combat ‘hid- AND LIFE can draw on the in order to increase local knowl- den hunger’, and to raise aware- expertise in nutrition, technol- edge and expertise, and works ness of micronutrient deficiencies ogy and analytics of DSM Nu- towards sustainable improvement as public health issues. tritional Products. SIGHT AND of nutrition. LIFE supports many locally and Low micronutrient intakes and internationally active organiza- SIGHT AND LIFE publishes edu- other forms of malnutrition are im- tions. It has sponsored research, cational materials as well as the pairing the health of many people application projects, training of SIGHT AND LIFE Newsletter to in numerous developing countries. health professionals, and health increase knowledge on micronu- The most vulnerable groups are and nutrition education in many trient nutrition and health, and to children and mothers. Increased countries in Africa, Asia and Latin disseminate relevant information health risk with susceptibility to America. on programs and scientific news.

Publisher: SIGHT AND LIFE Opinions, compilations and figures SIGHT AND LIFE Editor: Klaus Kraemer con tained in the signed articles do PO Box 2116, 4002 Basel Assistance: Anne-Catherine Frey, not necessarily represent the point Switzerland. Tel.: +41 61 688 74 94 Martin Frigg of view of SIGHT AND LIFE and Fax: +41 61 688 19 10 Translation: transparent - transla- are solely the responsibility of the E-mail: [email protected] tions GbR, Berlin, Yvonne Bearne authors. http://sightandlife.org Printer: Druckerei Dietrich, Basel ISBN 3-906412-30-X