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Micronutrient deficiency in children

Published online by Cambridge University Press:  09 March 2007

Maharaj K Bhan*
Affiliation:
Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
Halvor Sommerfelt
Affiliation:
Centre for International Health, University of Bergen, Norway Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
Tor Strand
Affiliation:
Centre for International Health, University of Bergen, Norway
*
*Corresponding author: Dr M. K. Bhan, fax +91 11 6016449, email community.research@cih.uib.no
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Abstract

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Malnutrition increases morbidity and mortality and affects physical growth and development, some of these effects resulting from specific micronutrient deficiencies. While public health efforts must be targeted to improve dietary intakes in children through breast feeding and appropriate complementary feeding, there is a need for additional measures to increase the intake of certain micronutrients. Food-based approaches are regarded as the long-term strategy for improving nutrition, but for certain micronutrients, supplementation, be it to the general population or to high risk groups or as an adjunct to treatment must also be considered. Our understanding of the prevalence and consequences of iron, vitamin A and iodine deficiency in children and pregnant women has advanced considerably while there is still a need to generate more knowledge pertaining to many other micronutrients, including zinc, selenium and many of the B-vitamins. For iron and vitamin A, the challenge is to improve the delivery to target populations. For disease prevention and growth promotion, the need to deliver safe but effective amounts of micronutrients such as zinc to children and women of fertile age can be determined only after data on deficiency prevalence becomes available and the studies on mortality reduction following supplementation are completed. Individual or multiple micronutrients must be used as an adjunct to treatment of common infectious diseases and malnutrition only if the gains are substantial and the safety window sufficiently wide. The available data for zinc are promising with regard to the prevention of diarrhea and pneumonia. It should be emphasized that there must be no displacement of important treatment such as ORS in acute diarrhea by adjunct therapy such as zinc. Credible policy making requires description of not only the clinical effects but also the underlying biological mechanisms. As findings of experimental studies are not always feasible to extrapolate to humans, the biology of deficiency as well as excess of micronutrients in humans must continue to be investigated with vigour.

Type
Research Article
Copyright
Copyright © The Nutrition Society 2001

References

ACC/SCN (2000 a) Fourth Report on the World Nutrition Situation: nutrition throughout the life cycle. Geneva: ACC/SCN.Google Scholar
ACC/SCN (2000 b) Nutrition and agriculture. SCN News 20, 07 2000, Geneva.Google Scholar
Allen, LH, Rosado, JL, Casterline, JE, Martinez, H, Lopez, P, Munoz, E & Black, AK (1995) Vitamin B12 deficiency and malabsorption are highly prevalent in rural Mexican communities. American Journal of Clinical Nutrition 62, 10131019.CrossRefGoogle ScholarPubMed
Barry, DM & Reeve, AW (1977) Increased incidence of gram-negative neonatal sepsis with intramuscular iron administration. Pediatrics 60, 908912.CrossRefGoogle Scholar
Beaton, GH, Martorell, R, Aronson, KJ, Edmonston, B, McCabe, G, Ross, AC & Harvey, B (1993) Effectiveness of vitamin A supplementation in the control of young child morbidity and mortality in developing countries. ACC/SCN State-of-the-Arts Series, Nutrition Policy Discussion Paper No. 13. Geneva: ACC/SCN.Google Scholar
Beaton, G & McGable, G (1999) Efficacy of intermittent iron supplementation in the control of iron deficiency anaemia in developing countries: an analysis of experience Micronutrient Initiative.Ontario, Canada.Google Scholar
Becroft, DM, Dix, MR & Farmer, K (1977) Intramuscular iron-dextran and susceptibility of neonates to bacterial infections. In vitro studies. Archives of Diseases in Childhood 52, 778781.CrossRefGoogle ScholarPubMed
Bhan, MK & Bhandari, N (1998) The role of zinc and vitamin A in persistent diarrhea among infants and young children. Journal of Pediatric Gastroenterology & Nutrition 26, 446453.Google ScholarPubMed
Black, RE (1998 a) Therapeutic and preventive effects of zinc on serious childhood infectious diseases in development countries. American Journal of Clinical Nutrition 68(2S), 476S-479S.CrossRefGoogle Scholar
Black, MM (1998 b) Zinc deficiency and child development. American Journal of Clinical Nutrition 68(suppl), 464S-469S.CrossRefGoogle ScholarPubMed
Brown, KH (1998) Effect of infections on plasma zinc concentration and implications for zinc status assessment in low-income countries. American Journal of Clinical Nutrition 68(2S), 425S-429S.CrossRefGoogle ScholarPubMed
Brown, KH, Peerson, JM & Allen, LH (1998) Effect of zinc supplementation on children's growth: a meta-analysis of intervention trials Role of Trace Elements for Health Promotion and Disease Prevention, pp. 7683 [Sandstrom, b & Walter, p, editors]. Bibliography Nutr Dieta Basel Karger, Vol 54.Google Scholar
Child, Health Research Project Special Report (1997) Zinc for child health. Volume 1 (No. 1). http://www.childhealthresearch.org/spec1.pdf.Google Scholar
Delange, F (1985) Physiopathology of iodine nutrition. In Trace elements in nutrition of children, pp. 291299 [Chandra, RK, editor]. Nestle Nutrition Workshop Series, Vol 8 New York: Raven Press.Google Scholar
Delange, F (1999) What do we call a goiter? European Journal of Endocrinology 140, 486488.CrossRefGoogle Scholar
Edgerton, VR, Gardner, GW, Ohira, Y, Gunawardena, KA & Senewiratne, B (1979) Iron deficiency anaemia and its effect on worker productivity and activity patterns. British Medical Journal 2, 15461549.CrossRefGoogle ScholarPubMed
Fairweather-Tait, SJ (1992) Iron deficiency in infancy; easy to prevent — or is it? European Journal of Clinical Nutrition 46 (4 Suppl), S9S14.Google ScholarPubMed
FAO 1988 Requirements of vitamin A, iron, folate and vitamin B12. Food and Agriculture Organization. Rome: WHO.Google Scholar
Farmer, K & Becroft, DM (1976) Letter: Administration of parenteral iron to newborn infants. Archives of Diseases in Childhood 51, 486.CrossRefGoogle ScholarPubMed
Faruque, ASG, Mahalanabis, D, Haque, SS, Fuchs, GJ & Habte, D (1998) Double-blind, randomized, controlled trial of zinc or vitamin A supplementation in young children with acute diarrhea. Acta Pædiatrica 87, 17.Google Scholar
Ge, K & Yang, G (1993) The epidemiology of selenium deficiency in the etiological study of endemic diseases in China. American Journal of Clinical Nutrition 57, 259S-263S.CrossRefGoogle ScholarPubMed
Gillespie, S; 1997 Major issues in developing effective approaches for the prevention and control of iron deficiencyIFPRI mimeo.Google Scholar
Gillespie, S; 1998 Major issues in the control of iron deficiency. Ottawa: Micronturient Initiative/UNICEF.Google Scholar
Gomber, S, Kumar, S, Rusia, U, Gupta, P, Agarwal, KN & Sharma, S (1998) Prevalence and etiology of nutritional anaemias in early childhood in an urban slum. Indian Journal of Medical Research 107, 269273.Google Scholar
Graham, R & Welch, R (1996) Breeding for staple food crops with high micronutrient density. Agricultural Strategies for Micronutrients. Working Paper 3. IFPRI: Washington DC.Google Scholar
Bondevik, GT, Eskeland, B, Ulvik, RJ, Ulstein, M, Lie, RT, Schneede, J & Kvåle, G (2000) Anaemia in pregnancy: possible causes and risk factors in Nepali women. European Journal of Clinical Nutrition 54, 38.CrossRefGoogle ScholarPubMed
HKI(1997) The Central Java Project: Maternal postpartum vitamin A supplementation, increased intake of vitamin A rich foods and early childhood survival in Central Java. Special Report Series, Jakarta: HKI.Google Scholar
ICCIDD(1998) China advances towards IDD elimination. IDD Newsletter 14, 5054.Google Scholar
INACG (1999) INACG Consensus Statement: Safety of iron supplementation programs in malaria-endemic regions.Google Scholar
McCullough, AL, Kirksey, A, Wachs, TD, McCabe, GP, Bassily, NS, Bishry, Z, Galal, OM, Harrison, GG & Jerome, NW (1990) Vitamin B6 status of Egyptian mothers: relation to infant behaviour and maternal infant interactions. American Journal of Clinical Nutrition 51, 10671074.CrossRefGoogle ScholarPubMed
Mejia, LA & Arroyave, G (1982) The effect of vitamin A fortification of sugar on iron metabolism in preschool children in Guatemala. American Journal of Clinical Nutrition 36, 8793.CrossRefGoogle ScholarPubMed
Mejia, LA & Chew, F (1988) Hematological effect of supplementing anemic children with vitamin A alone and in combination with iron. American Journal of Clinical Nutrition 48, 595600.CrossRefGoogle ScholarPubMed
Menendez, C, Kahigwa, E, Hirt, R, Vounatsou, P, Aponte, JJ, Font, F, Acosta, CJ, Schellenberg, DM, Galindo, CM, Kimario, J, Urassa, H, Brabin, B, Smith, TA, Kitua, AY, Tanner, M & Alonso, PL (1997) Randomized placebo-controlled trial of iron supplementation and malaria chemoprophylaxis for prevention of severe anaemia and malaria in Tanzanian infants. Lancet 350, 844850.CrossRefGoogle ScholarPubMed
Moreno-Reyes, R, Suetens, C, Mathieu, F, Begaux, F, Zhu, D, Rivera, MT, Boelaert, M, Neve, J, Perlmutter, N & Vanderpas, J (1998) Kashin-Beck osteoarthropathy in rural Tibet in relation to selenium and iodine status. New England Journal of Medicine 339, 11121120.CrossRefGoogle ScholarPubMed
Muhilal, , Permaesih, D, Idjradinata, YR, Muherdiyantiningsih, ,Karyadi, D (1988) Vitamin A fortified monosodium glutamate and health, growth and survival of children: a controlled field trial. American Journal of Clinical Nutrition 48, 12711276.CrossRefGoogle ScholarPubMed
Oppenheimer, SJ, Macfarlane, SB, Moody, JB & Harrison, C (1986 b) Total dose iron infusion, malaria and pregnancy in Papua New Guinea. Transactions of the Royal Society of Tropical Medicine & Hygiene 80, 818822.CrossRefGoogle ScholarPubMed
Oppenheimer, SJ, Macfarlane, SB, Moody, JB, Bunari, O & Hendrickse, RG (1986 b) Effect of iron prophylaxis on morbidity due to infectious disease: report on clinical studies in Papua New Guinea. Transactions of the Royal Society of Tropical Medicine & Hygiene 80, 596602.CrossRefGoogle ScholarPubMed
Penny, ME, Peerson, JM, Marin, RM, Duran, A, Lanata, CF, Lonnerdal, B, Black, RE & Brown, KH (1999) Randomized community based trial of the effect of zinc supplementation with and without other micronutrients, on the duration of persistent childhood diarrhea in Lima, Peru. Journal of Pediatrics 135, 208217.CrossRefGoogle ScholarPubMed
Roy, SK, Tomkins, AM, Haider, R, Behren, RH, Akramuzzaman, SM, Mahalanabis, D & Fuchs, GJ (1999) Impact of zinc supplementation on subsequent growth and morbidity in Bangladeshi children with acute diarrhea. European Journal of Clinical Nutrition 53, 529534.CrossRefGoogle Scholar
Ruel, M & Bouis, H (1998) Plant breeding: a long term strategy for the control of zinc deficiency in vulnerable populations. American Journal of Clinical Nutrition 68, 2S.CrossRefGoogle ScholarPubMed
Sazawal, S, Black, RE, Bhan, MK, Bhandari, N, Sinha, A & Jalla, S (1995) Zinc supplementation in young children with acute diarrhea in India. New England Journal of Medicine 333, 839844.CrossRefGoogle ScholarPubMed
Sazawal, S, Black, RE, Jalla, S, Mazumdar, S, Sinha, A & Bhan, MK (1998) Zinc supplementation reduces the incidence of acute lower respiratory infections in infants and preschool children: a double blind, controlled trial. Pediatrics 102, 15.CrossRefGoogle ScholarPubMed
Suharno, D & Muhilal, (1996) Vitamin A and nutritional anaemia. Food and Nutrition Bulletin 17, 710.CrossRefGoogle Scholar
UNICEF, , MI, , WHO, , CIDA, , & USAID, , (1998) Vitamin A global initiative: a strategy for acceleration of progress in combating vitamin A deficiency. Consensus of an Informal Technical Consultation convened by UNICEF in association with MI, WHO, CIDA and USAID.Google Scholar
Walter, T (1993) Impact of iron deficiency on cognition in infancy and childhood. Review. European Journal of Clinical Nutrition 47, 307316.Google Scholar
Weinberg, ED (1996) Iron withholding: a defense against viral infections. Biometals 9, 393399.CrossRefGoogle ScholarPubMed
WHO & UNICEF 1998 Guidelines to integrate vitamin A supplementation with immunization: Policies and programme implications. Document no. WHO/EPI/ GEN/98.07WHO.Google Scholar
WHO & UNICEF (2000) Management of the child with a serious infection or severe malnutrition. Guidelines for care at the first referral level in developing countries. Document WHO/FCH/CAH/00.1WHO. Geneva: WHO.Google Scholar
WHO (1998 a) Complementary feeding of young children in developing countries: a review of current scientific knowledge. Document WHO/NUT/98.1WHO. Geneva: WHO.Google Scholar
WHO(1998 b) Randomized trial to assess benefits and safety of vitamin A supplementation linked to immunization in early infancy. Lancet 352, 12571263.CrossRefGoogle Scholar
WHO (2000) Nutrition for health and development. Document WHO/NHD/00.6WHO. Geneva: WHO.Google Scholar
WHO, UNICEF & IVACG (1997) Vitamin A supplements: a guide to their use in the treatment and prevention of VAD and VAD xeropthalmiaSecond edition WHO. Geneva: WHO.Google Scholar
WHO, UNICEF, ICCIDD (1999) Progress towards the elimination of iodine deficiency disorders (IDD). WHO/NHD/99.4WHO. Geneva:WHO.Google Scholar
WHO, UNICEF, MI, The World Bank, CIDA & USAID (1997) Vitamin A global initiative. Development of a strategy for acceleration of progress in combating VAD.Google Scholar
Zinc Investigators' Collaborative Group(1999) Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. Journal of Pediatrics 135, 689697.CrossRefGoogle Scholar