Driving Policy Change to Improve Micronutrient Status in Women of Reproductive Age and Children in Southeast Asia: The SMILING Project

Objective The SMILING (Sustainable Micronutrient Interventions to Control Deficiencies and Improve Nutritional Status and General Health in Asia) project aimed at creating awareness and improving policies around micronutrient deficiencies in five Southeast Asian countries (Vietnam, Laos, Thailand, Cambodia and Indonesia). Results The project showed large gaps in recent data on micronutrient status in most of the five countries. By updating existing, or creating national food composition tables, the SMILING project enabled analyses of food consumption in women of reproductive age and young children. Linear programming showed a high risk for multiple micronutrient deficiencies in these groups, and especially in pregnant women. Most programs to improve micronutrient status target iodine, iron and vitamin A deficiency. However, the high prevalence of zinc, vitamin D, thiamine and folate deficiency in the region warrant interventions too. For certain micronutrients (zinc, iron, calcium), dietary changes alone appeared not enough to fulfill requirements. Food fortification was identified to be a sustainable, long-term solution to improve micronutrient intake. Multiple criteria mapping by stakeholders in each country resulted in a list of country-specific priority interventions. Surprisingly, food fortification was ranked low, due to concerns on quality control and organoleptic changes of the fortified food. More advocacy is needed for new, innovative interventions such as delayed cord clamping. Conclusions for practice The SMILING project recommends regular surveys to monitor micronutrient status of population, to measure impact of interventions and to guide nutrition policies.

     

Improving Micronutrient Status of Vulnerable Groups in South-East Asia: The SMILING Experience

Introduction

The purpose of this commentary is to start a national conversation about the future of maternal and child health (MCH). In the coming decades, we will have unprecedented opportunities to improve MCH, but will also face unprecedented threats.

Methods

This paper examines emerging opportunities and threats to MCH, and discusses strategies for leading the future of MCH.

Results

Scientific advancements will continue to drive improvements in MCH, but to unleash its full potential for improving population health future MCH research must become more transdisciplinary, translational, and precise. Technological innovations could dramatically transform our work in MCH while big data could enhance predictive analytics and precision health; our challenge will be to assure equitable access. The greatest gains in MCH will continue to come from improving social conditions, which will require advancing MCH in all policies. Climate change, infectious outbreaks and antimicrobial resistance pose increasing threats to MCH, which can be averted by reducing global warming, implementing global early warning systems, and instituting responsible antimicrobial stewardship. The growing burden of chronic diseases in children and adults need to be addressed from an ecological and life course perspective. The water crisis in Flint shined a spotlight on the growing health threats from America’s decaying infrastructure.

Discussion

We can lead the future of MCH by starting a national conversation, improving MCH research, and preparing future MCH workforce, but the future of MCH will depend on our effectiveness in bringing about social and political change in the coming decades.

     

The Food Environments of Fruit and Vegetable Consumption in East and Southeast Asia: A Systematic Review

Fruit and vegetable (FV) consumption benefits the health of populations. This can be especially the case in locations which have undergone significant changes in their food environments, such as East and Southeast Asian countries. This current systematic review is the first to study the food environments—facilitators, barriers, and moderators—associated with FV consumption in East and Southeast Asia. We consulted five electronic academic databases of English peer-reviewed papers published between 2010 and 2020 and found 31 studies. Results of these studies show that individuals strongly perceive FVs as being high-quality and safe, and having trust in their benefits. Food businesses with modernized systems have significantly fostered the consumption of FVs. A main barrier to FV consumption, however, is financial concerns, exacerbated by food businesses with FV unavailability and urbanization-induced FV price inflation and dietary patterns. Demographics and shopping patterns further hinder FV consumption. The fragmented and conditionalized findings of the 31 studies require standardized FV consumption measurements. Unlike the impact of FV consumption determinants and their interactions in Western countries, those in Asia, particularly countries other than China, have been substantially understudied. Therefore, as the research gaps in studies of food environments and FV consumption in East and Southeast Asia urgently demand scholarly attention, this paper proposes recommendations that favour the consumption of FVs.     

McCance & Widdowson's Tables of Food Composition: origins and clarification of the Fifth edition

The evolution of the McCance and Widdowson's Tables of Food Composition is briefly described and some confusions that exist over the Fifth edition are clarified.     

Quality assurance with an informatics auditing process for Food Composition Tables

A 6-step auditing process was developed to detect unlikely nutrient values in a Nutrient Composition Data Bank for Foods (NCDBF) in Taiwan. Preference was given to finding errors in the database, rather than to determining significant differences in the biological characteristics of the individual nutrients. There were 239 compositionally similar subgroups categorized within the NCDBF. The coefficient of variation (CV) of nutrient values for each subgroup provided the first-order sorting instrument. Nutrient CVs were ranked in rows for food subgroup (x) and in columns for nutrient type (y) and their product (x,y) in descending order. When the rank was in the top 2 or the product was ≤20, the Excel “cell” was regarded as a “hit”. The “hit rate” (2.6%, 777 hits/29,424 pieces of information) of the computerized analysis was verified through an expert panel review to provide a “satisfied hit rate (SHR)” (agreed errors/total food group hits). The mean SHR was 14.9% (range: 1.4%–37.6%) for the various food groups. The computerized process performed with a 38-fold increase in likelihood of error detection compared with what manual assessment alone would have produced. This low-cost approach could be applied in various jurisdictions or with other digitized food composition tables.     

东南亚地区旅行健康危害因素分析

国际旅行已成为我国一项新兴的第三产业,目前正以迅猛的速度发展.据统计,近年来我国居民到国外旅行每年超过500万人次[1],而到国外旅游中尤以东南亚地区,特别是新加坡、马来西亚、泰国(简称新马泰)旅游线最热门.广大旅游者都希望"乘兴前往、平安归来",但往往却忽视了国际旅行中容易感染疾病的危险因素,如传染病、食源性疾病等外源性感染,高血压、冠心病忽发等非传染病的发生,还有旅行伤害等[2].     

Assessing and Improving the Quality of Food Composition Databases for Nutrition and Health Applications in Europe: The Contribution of EuroFIR

Food composition databases (FCDBs) form an integral part of nutrition and health research, patient treatment, manufacturing processes, and consumer information. FCDBs have traditionally been compiled at a national level; therefore, until recently, there was limited standardization of procedures across different data sets. Digital technologies now allow FCDB users to access a variety of information from different sources, which has emphasized the need for greater harmonization. The European Food Information Resource (EuroFIR) Network of Excellence and Nexus projects (2005–2013) has been instrumental in addressing differences in FCDBs and in producing standardized protocols and quality schemes to compile and manage them. A formal, recognized European standard for food composition data has been prepared, which will further assist in the production of comparable data. Quality schemes need to address both the composition data, plus the methods of sampling, analysis, and calculation, and the documentation of processes. The EuroFIR data exchange platform provides a wealth of resources for composition compilers and end users and continues to develop new and innovative tools and methodologies. EuroFIR also is working in collaboration with the European Food Safety Authority, and as a partner in several European projects. Through such collaborations, EuroFIR will continue to develop FCDB harmonization and to use new technologies to ensure sustainable future initiatives in the food composition activities that underpin food and health research in Europe.     

Recommended dietary allowances harmonization in Southeast Asia

Issues and opportunities for RDA harmonization within the SEA region were first raised during the First Regional Forum and Workshop "RDAs: Scientific Basis and Future Directions", held in Singapore in March 1997. A regional review on RDAs in SEA showed general similarities for the different RDAs, although in some cases a country listed an exceptionally high or low RDA for a particular nutrient for a specific group. It also revealed differences in physiologic groupings and reference body weights, nutrients included and units of expression. Realizing these differences in RDA components between countries which makes technical composition different, a consensus on the need for regional collaboration and harmonization of RDAs was reached by participants from Indonesia, Malaysia, Philippines, Singapore, Thailand and Vietnam. A follow-up workshop was organized to work towards agreement throughout the region on common approaches, concepts and terminologies; application and uses, format and a research agenda. Round table discussions were held to arrive at specific recommendations for achieving harmonization. While divergence in opinions were expected, some clear-cut agreements were settled. Globalization envisions to achieve economic growth and development, with the effects expected to ripple through health, nutrition and welfare improvements. The harmonization of RDAs in SEA seeks to reach this vision by strengthening R and D capabilities (both logistic and manpower) within the region and within the countries in the region, as well as harmonizing the efforts of governments and industry within the region to reduce potential trade barriers such as those relating to food and nutrition quality assurance standards.     

To strengthen and refresh: herbal therapy in Southeast Asia

Throughout Southeast Asia herbal tonic drinks are a long established part of the health adaptation system of both rural and urban households. A recent study on infant feeding practices in urban poor households revealed a differential use of postpartum herbal tonics in Bangkok, Thailand and Semarang, Indonesia. This paper explores the cultural meaning of this difference between comparable groups of mothers, focussing on the colonial and neocolonial development of the medical systems, the transmission of knowledge about herbal therapies, and how the tonics fit into the food-drug classification system in both countries.     

Dengue in the Americas and Southeast Asia: do they differ?

The populations of Southeast Asia (SE Asia) and tropical America are similar, and all four dengue viruses of Asian origin are endemic in both regions. Yet, during comparable 5-year periods, SE Asia experienced 1.16 million cases of dengue hemorrhagic fever (DHF), principally in children, whereas in the Americas there were 2.8 million dengue fever (DF) cases, principally in adults, and only 65,000 DHF cases. This review aims to explain these regional differences. In SE Asia, World War II amplified Aedes aegypti populations and the spread of dengue viruses. In the Americas, efforts to eradicate A. aegypti in the 1940s and 1950s contained dengue epidemics mainly to the Caribbean Basin. Cuba escaped infections with the American genotype dengue-2 and an Asian dengue-3 endemic in the 1960s and 1970s. Successive infections with dengue-1 and an Asian genotype dengue-2 resulted in the 1981 DHF epidemic. When this dengue-2 virus was introduced in other Caribbean countries, it encountered populations highly immune to the American genotype dengue-2. During the 1980s and 1990s, rapidly expanding populations of A. aegypti in Brazil permitted successive epidemics of dengue-1, -2, and -3. These exposures, however, resulted mainly in DF, with surprisingly few cases of DHF. The absence of high rates of severe dengue disease in Brazil, as elsewhere in the Americas, may be partly explained by the widespread prevalence of human dengue resistance genes. Understanding the nature and distribution of these genes holds promise for containing severe dengue. Future research on dengue infections should emphasize population-based designs.     

Rabies control in South and Southeast Asia

We have the knowledge and tools to eliminate the threat of canine rabies but this disease, nevertheless, remains a public health threat in many parts of the world. Lack of motivation by governments, cultural issues and inadequate funding remain barriers. This is amazing since the number of human rabies deaths worldwide is greater than that from polio, meningococcal meningitis, Japanese encephalitis, yellow fever, SARS, bird flue and other scourges that attract more attention. Safe and effective vaccines are now widely available. Reduced dose effective and less expensive post-exposure vaccination regimens have helped eliminate nerve tissue vaccines in Thailand, Philippines and Sri Lanka. India and Pakistan, the major users of dangerous nerve tissue derived Semple type vaccine, are now considering following suite. Immediate wound care and prompt use of a potent vaccine will save a majority of infected persons. Rabies immunoglobulin, injected into and around bite wounds, provides added safety for the severely exposed. The high cost of rabies immunoglobulin and tissue culture vaccines are remaining barriers, but new manufacturers and the use of intradermal vaccination schedules can reduce costs. Ultimately, it is the need to control rabies in dogs that must occupy most of our attention. The tools are available, but attitudes must change before they can be applied. There have been many new developments since publication of the last WHO rabies expert committee report in 1992 (new version in print)] and we will address those that have practical applicability.