ALLEVIATING Hidden Hunger Approaches that work

by Eileen Kennedy, Venkatesh Mannar & Venkatesh Iyengar

he world has come a long way at the national level. The payoff for in understanding the nature, eliminating hidden hunger through Tmagnitude and range of nutrient fortification is enormous and solutions to few other public health interventions – often called “hidden hunger”. The offer such a promising health, most sustainable solutions – that is nutrition and economic success story. those that are likely to be maintained Nuclear and isotopic techniques in the long term – almost surely will are valuable tools in helping to meet include food-based approaches the multifaceted challenges posed by including diet diversity, food nutritional disorders affecting the fortification and biofortification. Food entire human life span (embryonic to fortification and biofortification could elderly). Among the numerous be some of the most cost-effective of applications available, isotopic all public health interventions and techniques are uniquely well suited thus within the economic reach of for targeting and tracking progress in even the world’s poorest. In order to food and nutrition development implement them in a sustainable programmes (See box: How Nutrients manner, a combination of technical, are Tracked). These include: use of operational, economic, behavioural the stable isotopes of iron (Fe) and Despite abundant global and political factors need to be zinc (Zn) as a kind of gold standard in food supplies widespread addressed. In some ways the studies of their bioavailability from technological issues are the easiest. foods; trace element bioavailability malnutrition persists in Because of attention to research, we and pool sizes for measuring the many developing countries now have a variety of ways for both effectiveness of nutrition supple- Micronutrient malnutrition single and multiple to mentation or fortification trials; reach the target population. We also isotope dilution methods used in the is particularly damaging know what is needed in order to assessment of vitamin A status tracing but it can with relative ensure delivery systems. The key through carbon-13 (13C) carotenoids. ease be eradicated factor for continued success in Further, specialized applications reducing micronutrient malnutrition – namely neutron activation analysis through fortification is a political and inductively coupled plasma mass commitment at the national and spectrometry – permit simultaneous international level and creating analysis of a range of minor and trace effective public-private partnerships elements in foods and beverages.

54 IAEA BULLETIN 45/1 Hunger pains Alleviating the entire child bearing age (especially during pregnancy) needs In the early 1990s the problem of “hidden hunger” to be continued indefinitely. A clear “hidden hunger” commanded The basic objective of all national “success story” is the improvement in worldwide attention. Through a series micronutrient programs is to ensure the vitamin A status of preschool-aged of high-level conferences, including that needed micronutrients are children using high dose the 1992 international conference on available and consumed by vulnerable supplementation. nutrition in Rome, it became apparent populations. Programmes directed At least 90 countries routinely that large parts of the developing towards the sustained elimination of provide vitamin A supplements to world were plagued by micronutrient micronutrient deficiencies need to be young children in developing malnutrition which could not be seen broadly based so that interventions countries. Using the National but which had devastating health and become accepted community practices. Immunization Day’s (NID) infra- nutritional consequences. The Hence, program strategies need to go structure, countries have been able to problem not only is an impediment to well beyond conventional health and provide vitamin A supplements in health but also compromises nutrition systems and be based upon efficient and cost effective ways. socioeconomic development, learning empowering people and communities More than 75% of all young children ability and productivity. to be capable of arranging for and in countries where vitamin A The numbers of affected people sustaining an adequate intake of deficiency is known to be common worldwide are staggering. Globally micronutrients, independent of external received high-dose vitamin A some 250 million children are at risk of support. Such strategies must be capsules in 2002, compared to only – a leading cause multi-sectoral and integrate interventions about one-third in 1994. However, of childhood blindness. And, in with social communications, evaluation with the virtual elimination of polio in countries where immunization and surveillance components. many developing countries, NID’s are programs are not widespread and In addressing micronutrient being phased out over time. vitamin A deficiency is common, malnutrition in a country, a Governments and international millions of children die each year from combination of strategies involving institutions are turning to alternative complications of infectious diseases the promotion of breast feeding, supplement delivery channels as a such as measles with 2.8 million dietary modification (e.g., improving means of sustaining these gains. showing frank signs of xerophthalmia; food availability and micronutrient However, in the medium to long term, two billion people suffer from anemia bioavailability, and increasing food the objective should be to increase or which the World consumption), and daily intake of all micronutrients Health Organization (WHO) cites as the pharmaceutical supplementation needs through food either in natural forms or most widespread nutritional disorder in to be emphasized and implemented. through fortification. the world and 1.5 billion people live in The different complementary approaches Food fortification is not a new areas where disorders are often implemented in three phases: nutritional intervention. Post World continue to be a threat. Insufficient a) to ensure relief to vulnerable groups War II, fortification with a range of iodine in the diet is the most common – through supplementation, b) to improve nutrients became common in the yet also most preventable – cause of micronutrient intakes across the United States and some parts of brain damage throughout the world. population in the medium-term Europe. Food fortification was a key While the numbers are staggering based through food fortification and c) to factor in eliminating (vitamin on deficiencies of iron, iodine and ensure sustained, long-term outcome D in milk), goitre (iodine in salt) and vitamin A, it has become apparent that a through dietary diversity coupled with (niacin fortification of cereals range of other micronutrients are also biofortification of staple crops. and other grains) and has also been lacking in the diets of low-income Supplements provide immediate effective in reducing the incidence of households such as zinc and folic acid. relief to vulnerable populations and iron deficiency. Worldwide, Particularly vulnerable within the low- age groups with special micronutrient fortification of salt with iodine has income population are infants, needs, e.g. pregnant and lactating produced major reductions in iodine children, pregnant women and the mothers and pre-school age children. deficiency disorders. However, with elderly given their special nutritional In some cases supplementation for the exception of iodine in salt, food and health needs. women during adolescence through fortification has not yet been used

June 2003 55 he major cause of micronutrient deficiencies is of excess phytates and fibres that influence a lack of adequate intake of bioavailable mineral absorption. Tminerals and vitamins from the staple diets. Importantly, such techniques also help to identify This is exacerbated by the fact that commonly those foods or fortificant-based interventions most consumed foods and beverages (such as , , likely to succeed in target populations. Stable isotopes corn, legumes, tea and coffee) are high in inhibitors are safe for use in children and pregnant women, and low in enhancers of micronutrient absorption. feasible for field application and assess changes Thus, these staple foods such as cereals and legumes within reasonable time and cost. In the food are not only poor sources of bioavailable micronutrients fortification area the use of isotopic techniques is now but also interfere with the absorption of the well established for enhancing sensitivity of nutrition micronutrients added during the process of intervention trials. fortifying foods. Using the isotopic approach (in vivo and in vitro), Biochemical processes influencing the determinations of bioavailability can be carried out. bioavailability (or the fraction of a nutrient our body’s Laboratory assessment of bioavailability (in vitro) – by metabolism absorbs) are inherently complex. That is simulating the human stomach – measures the why the choice of the compound to be used as a percentage of iron that is potentially available. It is the fortificant is critical. This depends in part on its only rapid tool using radioactive isotopes to compare solubility in the gastric juice, besides its impact on bioavailability from different foods and diets. It can sensorial characteristics of the food itself. Ultimately, also be used to investigate different promoters and both of these parameters can affect the outcome of a inhibitors and the effect of food processing methods nutritional intervention strategy and therefore, it is on iron bioavailability. necessary to understand the factors involved. The most common method is to directly assess the Iron compounds used as fortifying agents provide human body’s nutritional status (in vivo). It is based on the best examples. From a practical point of view, incorporation of radioactive (55Fe and 59Fe) and stable many types of iron compounds exist and have been iron isotopes (54Fe, 57Fe and 58Fe) into red blood cells classified. They include: compounds soluble to some following extrinsic labelling (mixing the isotope directly degree in water and/or in acidic solutions such as with the food) and feeding to test subjects. Since newly gastric juice. Similar factors are at play for the relative absorbed iron is primarily used for haemoglobin bioavailability of zinc from two potential sources, zinc synthesis, iron bioavailability from a specific diet can be oxide and zinc sulphate, among others. determined simply by measuring the incorporation of an To track nutritional processes, conventional iron isotope into the red blood cell haemoglobin 14 days chemical techniques measure the difference between after the ingestion of the test meal. the amount of mineral ingested and the amount in the In the case of zinc, zinc sulphate and zinc oxide faeces. But these methods have limited accuracy and are commonly used and are both absorbed quite well validity besides being laborious. By contrast, and isotopic techniques (e.g. 67Zn) are applicable. isotope techniques directly and accurately measure However, in most food fortification programs when iron and other mineral bioavailability found in the multi-nutrients are involved, inter-nutrient interactions human body. This is the case whether the have to be anticipated. For example, in the case of minerals derive from either single foods or total diets. iron and zinc, using zinc in the sulphate form Isotopic techniques also facilitate reliable significantly reduces iron absorption in contrast to evaluations of numerous factors such as the presence fortification with zinc as oxide. Credit: Photodisc

more extensively in developing Dietary diversity is accomplished diversity strategies be given first countries. Fortification as a nutrition by promoting consumption of foods priority for alleviating micronutrient intervention offers clear advantages in that are naturally rich in deficiencies because these dietary that foods commonly consumed can micronutrients or are enriched approaches were seen as the most be fortified without requiring changes through fortification. The 1992 sustainable in the long term. Diet in consumption behaviour on the part International Conference on Nutrition, diversity has been overlooked by of the consumer. The costs of jointly run by the UN Food and many governments and public health fortification are modest and a variety Agriculture Organization (FAO) and groups, in part, because they are of technologies now exist. WHO, stressed food-based diet viewed as more difficult to implement

56 IAEA BULLETIN 45/1 and thus not likely to produce quick, Fortification: one support mechanisms, standards, short-term results. However, varied part of a whole quality assurance, product diets are a key reason why most of the certification, social communications world’s population are free from Among the different interventions, food and demand creation, monitoring and micronutrient malnutrition. Therefore, fortification plays an important role in evaluation. diet diversity should be seen as an meeting a demonstrable need for New efforts to enhance the essential part of an integrated strategy particular nutrients in a population micronutrient content of staple foods relying on a menu of interventions to perceived to be suffering from that are predominantly consumed by improve micronutrient status. deficiency. Fortification involves poor people in developing countries The biofortification approach aims identifying commonly eaten foods that through are showing at enhancing the nutrient content of can act as vehicles for one or more promise. Research so far has focused staple foods by conventional plant micronutrients and lend themselves to on five crops (rice, wheat, , breeding. This opens a feasible means centralized processing on an cassava, and common beans) and of reaching malnourished populations economical scale. Fortification, when three nutrients (iron, zinc, and beta- even in relatively remote rural areas, imposed on existing food patterns, may carotene). For all of these crops, there and delivering naturally fortified not necessitate changes in the is adequate genetic variation in foods to people with limited access to customary diet of the population and concentrations of beta-carotene, other supplements or to commercially does not call for individual compliance. functional carotenoids, iron, zinc, and marketed fortified foods. Thus, the Frequently, it could be dovetailed into other trace minerals. Varieties are breeding strategy will complement existing food production and available in germplasm banks to other successful ongoing inter- distribution systems. For these reasons, increase micronutrient densities ventions to reduce micronutrient fortification can often be implemented through conventional breeding by a malnutrition. and yield quick results and be sustained multiple of two for trace minerals and In order to provide immediate over long periods of time. It can thus be by higher multiples for vitamin A. relief and at the same time ensure the most cost-effective means of Under a new 10-year challenge long-term impact and sustainability of overcoming micronutrient malnutrition. program of the Consultative Group on interventions, a combination of Fortification is obviously one part International Agricultural Research interventions need to be planned. of a range of measures that influence (CGIAR) it is proposed to further Certain vulnerable groups may need the quality of food that include increase the micronutrient content of supplements for an indefinite period improved agricultural practices, these crops through conventional of time. “Safe Motherhood” programs enhanced food processing and storage, breeding, have their nutritional need to address the multiple and consumer education leading to efficacy tested and then widely deficiencies that women face through adopting good food preparation disseminate them in developing improvements in intake, preferably practices. Fortification efforts need to countries for adoption by farmers. through optimal diets (see box: A be integrated within the context of a Good Start). However where dietary country’s public health and nutrition Making the right intake is unable to meet women’s situation and as part of an overall requirements, multiple vitamin and micronutrient strategy that takes food choice mineral supplements should be advantage of other interventions as The success of fortification in considered as an intervention to well – specifically providing adequate improving micronutrient status and/or improve safe motherhood, pregnancy nutrition to children under the age of in eliminating a micronutrient outcome and the health of breastfed two years. Fortification calls for a deficiency depends on three key infants and their mothers. multi-sectoral partnership between factors: In parallel, an overall strategy that industry, national governments, There must be a specific food or includes dietary improvement, food international agencies, expert groups foods consumed by the target fortification and supportive public and other players. They need to work population in great enough quantities health measures should be developed closely on specific issues relating to to affect the intake of the target to improve and sustain the overall technology development, food nutrient; micronutrient status of the entire processing and marketing, free-market The fortification process should not population. approaches with minimum price affect the organoleptic characteristics

June 2003 57 breastfeeding. The IAEA, in hydrogen that pose no risk to the collaboration with governments and woman or the unborn baby. donor agencies, is developing and The IAEA has already helped in two transferring tools, based on nuclear important ways to improve the global science and technology, that can be information-base on maternal energy used to evaluate nutritional status and requirements. First, a report on the nutrients in foods around the world theoretical and practical aspects of the aimed at eliminating this hidden hunger doubly-labelled water method for — starting with the very young. measuring energy expenditure was One such project focuses attention published in collaboration with The on the increased energy needs of International Dietary Energy Consultancy pregnant and lactating mothers. Dietary Group (IDECG). This report has been any victims of malnutrition energy requirements increase markedly distributed to researchers in more than start life already hungry in the during pregnancy and lactation. 40 countries and has served widely as a Mwomb – before their first Normally, a pregnant woman or nursing central reference for studies utilizing the cries. And for countless pregnant mother either increases food energy 2H218O method. women in developing countries, their intake or reduces physical activity, or Second, the IAEA has supported growing belly belies the fact that they both. But when resources are limited several multi-centre analyses of energy are severely malnourished. When a and the demands on women’s labour expenditure during pregnancy and pregnant woman is malnourished, she are great, unmet energy needs result in lactation. Results have been used in a runs the very real risk of giving birth to low birth weight infants and reduced new evaluation of dietary energy a low-birth weight baby – a prime cause maternal work capacity and fat stores, requirements which is being conducted of infant mortality in developing which limits the success of by the Food and Agricultural countries – and jeopardizes her own breastfeeding. Organization (FAO), the World Health health. Furthermore, lactation increases Until the advent of isotopic methods, Organization (WHO), the United Nations maternal nutrient needs and chronic it was impossible to accurately assess University (UNU) and the IDECG. nutrient deficiencies place mothers at energy needs and nutrient stores in Together with its partners, the IAEA increased risk for cancer and pregnant or lactating women. The can help the world’s most precious degenerative diseases later in life. doubly-labelled water method is the resource – our children. In countries plagued by malnutrition, only technique that can accurately —Staff Report the most critically vulnerable groups are determine energy needs of people in developing fetuses, children up to the their own environments. The method is More information on the Agency’s age of three and women before, during non-intrusive and non-invasive and programs in nutrition is available at: and after pregnancy while they are employs stable isotopes of oxygen and http://www.iaea.org/worldatom/Programmes

of the food, i.e. taste, colour, odour form. However, until recently, low- diversity that may take years to evolve and should not decrease its shelf life; income populations lived in rural as a reasonable intervention, The process of fortifying should not areas with much of the basic staple fortification techniques can be significantly raise the price of the consumed by households home- implemented as both a short and fortified food. The fortified food(s) produced, making the fortification medium term strategy to improve diets. must be affordable. process implausible. Now, with the There are a number of countries The first condition – that the target global demographic trend from rural to that have been successful in fortifying population consume a food in urban areas, a larger proportion of the sugar with vitamin A, including sufficient quantity – should be easier low-income population can now be Guatemala, Nicaragua, Honduras, to achieve than it has been. easily reached via commercially Vietnam and Zambia. Other countries Historically the diets of low-income processed foods. This has raised the are fortifying oils, fats and populations have been heavily based prospect of fortification as an effective condiments. As the macronutrient on staple grains, which are easy food and crucial strategy for improving content of the diets of low-income carriers for the fortificant in the milled nutrition and health. Unlike dietary households shift, some public health

58 IAEA BULLETIN 45/1 officials argue that more attention Regulatory Analytical quality control needs to be given to the type of foods framework As regulatory monitoring and other that are to be fortified. They argue that surveillance activities increase, the it is no longer sufficient to ascertain Surveillance and evaluation demands for generating reliable whether the food is consumed in A key to controlling micronutrient analytical data will increase further. sufficient quantity but, in addition, deficiency is to establish effective Importantly, the regulatory monitoring they caution that other characteristics assessment and surveillance able to practices have instilled a quantitative such as the macronutrient composition identify populations at risk and dimension to the nutrient profile of of the food must be considered. The monitor progress over time. To processed and other foods. This has issue of which foods to fortify is not a develop effective surveillance, resulted in impressive developments in scientific one but rather a policy program managers must define the the area of food standards. For decision. target groups, the indicators to be used example, following the regulatory to assess micronutrient status, and the directives of the U.S. Infant Formula strategies by which surveillance will Act of 1981 and the Nutrition Public awareness be organized and co-ordinated. Labelling and Education act of 1990, a Even when there is little or no cost Epidemiological surveillance includes variety of reference materials differential between a fortified and an monitoring and evaluation of representing food matrices such as unfortified food, consumer awareness micronutrient status of the population frozen food composite (for fatty may still be an important issue in the to identify the impact of the acids), infant formula (nutrients) and overall acceptance of a newly fortified intervention strategy. Since food typical diet and milk powder (for a product. Consumers must be made fortification is a medium- to long-term both organic and inorganic aware of the benefits of fortified foods strategy, epidemiological surveillance constituents) among many others, and this information needs to come should be conducted every two years. have been introduced. In order for this from a source that is viewed as For example, a specified system of to happen, several U.S. government credible. Effective communication to quality assurance and complementary agencies, university laboratories and consumers is an often overlooked but epidemiological surveillance activities private industry laboratories an essential part of effective are necessary in every program or (industrial laboratories associated with fortification interventions. This is process of iron fortification. infant formula council) pooled their where public-private and government A network of certified analytical resources collaboratively, partnerships can be particularly laboratories (public/private) should led by the National Institute of valuable. be established, within the context of Standards and Technology. The impact Hand-in-hand with interventions compliance with food safety is that these standards are being used to improve micronutrient intake is regulations, to certify the quality of as primary validation sources in working to eliminate other underlying both the premix and the final several developing countries preparing causes of the deficiency. For example, product. For evaluating a nutritional their own secondary food reference improvements in sanitation, which monitoring program in the context materials to meet their specific needs. result in decreasing hookworm of micronutrients, factors affecting For the many developing countries infection, may lead to improvements efficacy (can the intervention lead that do not yet have the resources to in iron uptake (through reduced iron to the expected results under chosen develop their own fortification losses). Malaria control may lead to conditions?), effectiveness (does standards, the Codex Alimentarius improved folic acid status. the intervention provide the (Codex) has been very helpful. FAO Vaccinations against measles may expected result under real and WHO took the lead in protect against infection caused by conditions?) and efficiency (is the establishing Codex to address reduced resistance due to vitamin A intervention able to generate concerns over food additives and deficiency. Birth control will expected outcome with a reasonable pesticide use and differing country ultimately improve the standard of cost-benefit ratio?) should be and regional food standards. Codex living of a family making food more scrutinized. Multiple methods provides a sound basis for food available and help to prevent iron and should be considered to provide standards for promoting consumer iodine deficiency in both women and greater evidence that results found health and encourages global food children. are due to intervention. trade.

June 2003 59 fortification policies and standards. In approaches with minimum price turn, this may make administration of support mechanisms, standards, quality their fortification programs more assurance, product certification, social

Supplementation burdensome. communications and demand creation, Public Health Measures The food and food-processing monitoring and evaluation. Guidelines Fortification Dietary improvement sector is rapidly expanding in the on these issues should then gain developing world and will play an acceptance and be implemented at the increasingly important role in country level. A multi-sectoral group influencing consumer diets. Food within each country should define a enrichment offers a unique feasible and affordable fortification opportunity for the industry to strategy designed for the target simultaneously expand its market and population, identify opportunities for 2000 2005 2010 profitability while playing a key role the involvement of the food industry Year The graph shows the relative contributions of in improving the physical, social and and assist in promotional and different interventions to eliminate economic well being of the nation. educational efforts to reach the target micronutrient deficiencies. population. Public-private partnerships Such collaboration could benefit Cross-border food movements Food fortification efforts need to be all sectors: national governments As governments intensify and expand integrated within the context of a could reap national health, economic fortification efforts, it is time to be country’s public health and nutrition and political benefits; food companies aware of the trade requirements that situation and as part of an overall could gain a competitive advantage in may affect fortification policies and micronutrient strategy that uses other an expanding consumer marketplace; standards. The rules under the World interventions as well. Effective and the scientific, development and donor Trade Agreement (WTA) offer both sustainable fortification will be community could gain impact and benefits and pitfalls when it comes to possible only if the public sector (that recognition for achieving global goals food fortification. Generally, the WTA has the mandate and responsibility to to eliminate micronutrient malnutrition. requires that imported goods receive improve the health of population), the With adequate awareness to no less favourable treatment than private sector (that has experience and balanced nutrition and by choosing domestic products, that domestic expertise in food production and foods fortified at appropriate nutrient measures not restrict trade marketing) and the social sector (that levels, consumers empower them- unnecessarily, and that only the least has the grass-roots contact with the selves to achieve their full social, trade-restrictive measures be adopted. consumer) collaborate to develop, physiological and economic potential. The resulting reduction in unnecessary produce and promote micronutrient- differences in standards, bureaucratic fortified foods. red tape, and associated costs offers What is urgently needed is to Eileen Kennedy is the Global benefits that should promote the identify a set of priority actions and Executive Director at the International export of fortified foods. initiate a continuous dialogue between Life Sciences Institute in Washington D.C. On the other hand, even neutral the public and private sectors and other E-mail: [email protected]. requirements that have the effect of key stakeholders. They should be restricting trade may be found to encouraged to move quickly towards Venkatesh Mannar is President of violate the WTA. Although the implementation of schemes that will Micronutrient Initiative in Ontario, governments are given specific permanently eliminate micronutrient Canada. E-mail: authorization to deviate from the malnutrition. Specifically, a multi- [email protected]. above principles when necessary to sectoral partnership needs to be built protect the health and safety of their between industry, national Venkatesh Iyengar is Head of the populations, many technical regulations governments, international agencies, IAEA’s Nutritional and Health Related have the potential to restrict trade. As expert groups and other players, to Environmental Studies Section. a result, governments may find work closely on specific issues relating E-mail [email protected]. themselves relieved of some of their to technology development, food For a full listing of references, please discretion to set their own food processing and marketing, free-market contact the authors.

60 IAEA BULLETIN 45/1 Havana — Dr. Manuel Hernandez- Studies of preschool children, for Triana is a man on a mission, striving to example, show that those living in the help Cubans live longer and healthier country expend far more energy than lives. He’s fortunately in good company. youngsters in cities because they’re Cuba’s longstanding emphasis on more physically active. “It’s an important health care, he says, surrounds him finding,” says Dr. Hernandez-Triana. with people looking to build on a pretty “Cuba’s feeding programme is more strong record. Rankings for just two geared toward supplementing the diets measures – the rates for life expectancy of highly active children. We now know and infant mortality – place the adjustments are needed for less active Cuba’s nutrition studies focus on the young and old alike. (Credit: Wedekind/IAEA) developing country among far richer city children, to prevent problems of nations. Cubans can expect to reach overweight and obesity. We already see 76, rivaling Sweden’s 79-plus, and the tendency.” fewer babies are lost at birth than in Studies of the elderly in urban and most neighboring countries, including rural settings also detect trouble spots, the United States. with one in five men and about half of “We’re a poor country facing rich all women found to be overweight. country problems when it comes to Excess weight is a leading factor in diet- health,” says Dr. Santa Jimenez, Dr. related chronic diseases such as Hernandez-Triana’s boss and Vice- hypertension and diabetes, which stand Director of Nutrition at Cuba’s Institute among Cuba’s major health problems. of Nutrition and Food Hygiene in Nutrition programmes are being directed Havana. Problems related to nutrition – accordingly as part of preventive efforts, including obesity, hypertension, and particularly targeting children in time to diabetes – are commanding increasing reverse course. Worldwide, obesity attention, she notes. trends are alarming, the World Health Over the past several years, Cuba Organization (WHO) reports, with an has learned more about the connections estimated 300 million adults now between nutrition and health. Through considered clinically obese, about a Dr. Santa Jimenez (center front) and Dr. Hernandez- Triana (left top) with colleagues at Cuba’s Institute IAEA projects, the country’s researchers third of them in developing countries. of Nutrition and Food Hygiene in Havana. are using sensitive techniques, including Cuba’s results are critical to the (Credit: Wedekind/IAEA) isotopes (forms of chemical elements success of school nutrition such as oxygen and hydrogen) and programmes in which it invests more nuclear analytical techniques to track than $80 million annually. The data are and evaluate the body’s energy contributing to reviews of national expenditure in children and adults, policies and — for the first time — to set including the elderly, as part of overall baseline nutritional guidelines tailored to nutrition studies. local conditions and needs. The results As head of the Institute’s of the children field studies also are biochemistry and physiology arm, being used by the Expert Committee of Dr. Hernandez-Triana knows the work the UN Food and Agriculture can pay big dividends. Together with Organization (FAO), WHO, and United project partners, Cuba already is Nations University to set new gaining key analytical support for its recommended standards for the region. subsidized feeding programme. It “The big contribution of the IAEA provides daily food baskets of fortified projects is that we’re obtaining the milk, fruit puree, and other foods to concrete data we need,” says Dr. more than 1.7 million children, including Hernandez-Triana, “so we can decide nearly 150,000 pre-schoolers. on changes helping our own people live Several field studies – involving longer and healthier lives.” counterparts at Cuba’s ministries of education and health, and the atomic —Lothar Wedekind, IAEA Division of energy commission – are adding to the Public Information, whose report first knowledge base. appeared on the IAEA’s web site.