PROGRAMME NEWS

Agencies and Governments report on their activities in nutrition.

AUSTRALIA

Australia’s Food and Nutrition Policy Three Years Down The Track

Australia launched its National Food and Nutrition Policy in September 1992, just prior to the ICN in Rome in December. While many of the strategies in the Australian Policy match very well with the ICN Plan of Action for Nutrition, Australia never developed a National Plan of Action (NPAN), choosing rather to use the momentum that the Policy and the ICN engendered to commence work on priority strategies in the Policy.

Achievements of the Policy to date include planning for a National Nutrition Survey which commenced in February this year. This will be the first national nutrition survey to provide both nutritional status and dietary intake data on age groups two years and upwards - essential baseline data for monitoring program impacts. Other major projects include the development of a national monitoring and surveillance system; a national nutrition education curriculum with complementary resources on health promoting schools, for both primary and secondary schools; the development and promotion of resources to promote the Australian Dietary Guidelines; projects to improve the availability and accessibility of nutritious foods in remote parts of the country; as well as a number of projects which target particular at risk groups.

At present an independent evaluation of the extent to which the various strategies have been addressed, as well as processes used in implementing the policy, is underway. The evaluation will involve widespread consultation with stakeholders in all relevant sectors across the country. The results of this evaluation will be used to guide the next phase of implementation. Already it is apparent that a plan of action is vital to provide a clear blueprint for future activities. Having a well-developed food and nutrition monitoring plan should greatly assist in developing the NPAN.

Along with Australia, many countries will no doubt have experienced the challenge of achieving sustainable effective intersectoral committees to guide policy implementation. We in Australia might do well to look across to our Pacific neighbours, many of whom have had food and nutrition policies for a decade or so, and who have thought long and hard about overcoming the difficulties of achieving effective multisectoral food and nutrition committees. In the next phase, we will be looking to increased leadership from such key sectors as primary industry and education, in addressing those strategies that they are in a much better position to address, than is the health sector.

For further information please contact: Paul van Belkom, Director, Nutrition Section, Commonwealth Department of Human Services & Health, GPO Box 9848, Canberra, ACT 6201, Australia. Phone: (06) 289 8651 Fax: (06) 289 8121.

(Source: Communication with Paul van Belkom, Director, Nutrition Section, Commonwealth Dept. of Human Services and Health, 25 August 1995)

FAO

FAO’s Director General Calls for a World Food Summit

Currently, an estimated 800 million people in developing countries are chronically malnourished. By the year 2030, the world’s population will rise to 8.7 billion, increasing demands for resources and heightening the need to intensify agricultural production. Yet, the agricultural sector’s share in total development finance has fallen from 24% in 1982 to 16% in 1992; external assistance for improving agriculture in developing countries has declined from US $10 billion to US$7.2 billion during the same period.

The Director General of the Food and Agriculture Organization of the United Nations, Mr. Jacques Diouf, has proposed to convene a World Food Summit in November 1996 in Rome, with the aim of renewing the commitment of world leaders to eradicate hunger and malnutrition and achieving food security for all. As of June 1995, 75 Governments in all regions of the world had expressed their commitment to support the Summit and further commitments are expected.

The summit would provide a forum for Heads of Governments to assess the state of global food security and focus their attention on securing the most basic of human needs, food. Through the personal participation of Heads of State and Government, the Summit will mobilize all the relevant government departments to provide comprehensive solutions to food insecurity.

It is anticipated that the summit will lead to the adoption of concerted policies and actions by governments and international institutions. The high visibility of the Summit is expected to raise awareness in the public and private sectors, as well as among the communications media and public.

FAO is exploring all appropriate avenues to make the World Food Summit a true milestone in pursuit of the fundamental right to sufficient access to food. The preparation for the Summit involves consultations with governments, intergovernmental and non-governmental organizations, and the private sector. A wide-ranging series of technical background papers dealing with agricultural production, marketing, trade, population, nutrition and the environment are being prepared.

UN Food Standards Body Approves Use of Growth-Promoting Hormones in Meat Products

The Codex Alimentarius Commission, the joint FAO/WHO body responsible for international food standards, has adopted recommendations on the Maximum Residue Limits for growth-promoting hormones used in food production, despite a European Union ban on the use of these substances in its member countries.

Veterinary drugs which promote growth in animals are used in major meat producing countries such as the United States of America and Australia. The Codex Commission approved these maximum residue levels after extensive reviewing of scientific information had shown their safety to the consumer.

The Commission met at FAO Headquarters in Rome from 3 to 8 July. It discussed principles for Codex procedures to assure the quality and safety of the food supply. The Commission had previously adopted guidelines on measures to combat the illegal use of non-approved or unsafe drugs used in food production. In addition, this meeting confirmed that all Codex decisions on food safety must be based on sound scientific analysis and evidence.

In other developments, the Commission adopted standards for food additives and revised those for commodities including rice, wheat flour, couscous, canned frozen and salted fish and weight reduction formula foods. New rules for food inspection and certification at entry points were also adopted.

The Codex Alimentarius Commission has a membership of 151 countries which account for 98 percent of the world’s trade in food products. The value of these products in 1993 was around 220 billion dollars. FAO expects the value of world agricultural exports to rise 20 percent from the 1993 figure by the year 2000, partly as a result of the liberalization of trade policies arising from the GATT Uruguay Round agreements.

The Commission’s standards have been recognized by the World Trade Organization (WTO) Agreement on Sanitary and Phytosanitary Measures and the Agreement on Technical Barriers to Trade. These agreements call on WTO members to base their national food safety and quality standards and technical regulations on Codex standards.

“FAO will continue its efforts in assisting member countries to strengthen food safety and quality standards, inspection and quality control, production and harvesting, storage, post-harvest protection, transportation and marketing”, said Mr. Howard Hjort, FAO Deputy Director-General, in a statement to the Commission.

Codex and the World Trade Organization

The Uruguay Round of Multilateral Trade Negotiations which began in Punta del Este in 1986, concluded in Marrakech in 1994. These talks were the first GATT negotiations to deal with the liberalization of trade in agricultural products. The Uruguay Round also included negotiations on reducing non-tariff barriers to international trade in agricultural products and concluded with two binding Agreements: the Agreement on the Application of Sanitary and Phytosanitary Measures (the SPS Agreement) and the Agreement on Technical Barriers to Trade (the TBT Agreement).

The Marrakech Agreement established a new World Trade Organization (WTO) to succeed the former GATT, the General Agreement on Tariffs and Trade. The Agreements will be applied by Members of the WTO.

The Agreement on Sanitary and Phytosanitary Measures

The SPS Agreement confirms the right of WTO Member countries to apply measures necessary to protect human, animal and plant life and health. The purpose of the SPS Agreement is to ensure that these measures are consistent with obligations prohibiting arbitrary or unjustifiable discrimination on trade between countries where the same conditions prevail, or which are a disguised restriction on international trade. It requires that, with regard to food safety measures, WTO Members base their national measures on international standards, guidelines and other recommendations adopted by the FAO/WHO Codex Alimentarius Commission, where they exist, except they may adopt stricter measures if there is a scientific justification for doing so or if the level of protection afforded by the Codex standard is inconsistent with the level of protection generally applied and deemed appropriate by the country concerned. The SPS Agreement covers all food hygiene measures and food safety measures such as the control of residues of veterinary drugs, pesticides or other chemicals used in meat production.

The SPS Agreement states that any measures taken which conform to international Codex standards, guidelines or other recommendations are deemed to be appropriate, necessary and non-discriminatory. Furthermore, the SPS Agreement calls for a programme of harmonization of national requirements based on international standards. This work is guided by a WTO Committee on Sanitary and Phytosanitary Measures to which representatives of Codex Alimentarius, the Office International des Epizes (OIE) and the International Plant Protection Convention (IPPC) are invited.

The Agreement on Technical Barriers to Trade

The Agreement on Technical Barriers to Trade (the TBT Agreement) is a revision of the Agreement of the same name first developed under the Tokyo Round of GATT Negotiations in the 1970’s. The objective of the Agreement is to prevent the use of national or regional technical requirements, or standards in general, as unjustified technical barriers to trade. It covers all types of standards including quality requirements for foods except requirements related to Sanitary and Phytosanitary Measures and includes a very large number of measures designed to protect the consumer against deception and economic fraud. The Agreement basically provides that all technical standards and regulations must have a legitimate purpose and that the impact or cost of implementing the standard must be proportional to the purpose of the standard. It also says that if there are two or more ways of achieving the same objective, the least trade-restrictive alternative should be followed.

The TBT Agreement places emphasis on international standards, WTO Members being obliged to use international standards or parts of them except where the international standard would be ineffective or inappropriate in the national situation. The TBT Agreement does not include a programme of harmonizing national standards.

The main body of Codex work concerns “Technical Regulations” and “Standards” as defined by the WTO TBT Agreement. These standards have been established by the Codex Alimentarius Commission to assist in the harmonization of national requirements and therefore facilitate fair practices in international trade. Very simply, all of the information in the Codex Alimentarius which does not fall within the scope of the SPS Agreement, falls within the scope of the TBT Agreement. This covers the technological provisions of Codex standards and the product and commercial quality descriptions built into some of the standards. It also covers provisions in Codex Standards meant to promote nutrition or to provide nutrition and other important information to consumers.

Codex standards, guidelines and codes of technological practice covering these matters are international reference points for the TBT Agreement.

Expert Meeting and Training on HACCP in Food Control

A great deal of national and international activity related to the utilization of the Hazard Analysis Critical Control Point (HACCP) based systems in food safety assurance is under way. HACCP was initially developed by the food industry for use by food processors to prevent and control food hazards, thereby improving food safety. Today, the HACCP principles and method are considered to be among the most effective and efficient ways to enhance food safety and they have direct application to official food control and the establishing of food safety standards in the international food trade.

FAO has recognised the need for food safety standards for both national and international trade and for facilitating trade as an important aspect of national development. To gain further insight into the problems of improving food safety and the usefulness of the HACCP based systems to assist in resolving food safety problems, FAO sponsored an “Expert Technical Meeting on the Use of HACCP Principles in Food Control”, held in Vancouver Canada from 12-16 December 1994. Among the experts’ important recommendations was the suggestion that FAO establish an inventory of HACCP models and training materials and prepare a core curriculum for a practical HACCP training programme. This HACCP training programme was to take into consideration the many significant aspects discussed by the experts related to existing deficiencies in current training in HACCP, cultural and language sensitivities, skills and technical knowledge deficits and resource constraints experienced by many developing countries.

In keeping with this recommendation, FAO established a temporary technical working group to assist in developing the training programme. Consideration was given to pilot testing the training programme in cooperation with the government of Thailand and the food industry of Thailand. The Centre of Export Inspection and Certification of Agricultural Products (CEICAP), Ministry of Agriculture and representatives of the Thai Industry welcomed the suggestions and agreed to test the training programme once developed.

The working group consisted of representatives from CEICAP, Thai Industry, HACCP experts, HACCP training experts and training experts. The meeting was convened at FAO Headquarters, Rome, Italy, from 13-17 February 1995. The Working Group formulated a two week HACCP Training of Trainers core curricula which was subsequently tested at a training programme for government and industry representatives in Cha-Am, Thailand from 31 July - 11 August 1995 with a greater than anticipated success. This curricula will now be considered for expansion to other countries within the Asian and Pacific region, and will be modified as needed to apply to other regions of the world.

Nutrition Education

Concerning nutrition education activities, FAO has prepared and published basic documents and materials for a nutrition education programme. The title of the materials provided in a package is “Get the Best from your Food.” This material has been distributed worldwide to all countries, FAO offices, International Conference on Nutrition focal points, Codex focal points, NGOs and industry associations.

An Expert Consultation on Nutrition Education for the Public was held in Rome from 18-22 September 1995.

FAO Publications

Codex Facts and Notes: Involving people in the FAO/WHO Codex Alimentarius Commission

The Codex Alimentarius Commission works to protect consumer’s health and ensure fair practices in international food trade. Codex Facts and Notes are being issued by the Secretariat of the Joint FAO/WHO Food Standards Programme to inform the public about Codex. Codex Facts and Notes will be issued through national Codex Contact Points on a regular basis.

The fact sheets will contain information about the Codex Alimentarius Commission and its work. They will announce the publication of Codex food standards, describe the work of the Codex specialist Committees, and provide general factual information. Up-to-date information about important developments within Codex, especially for topics that are under debate by Codex Member Countries will be provided.

The Codex Secretariat hopes that Codex Facts and Notes will help people understand the work of the Joint FAO/WHO Food Standards Programme and encourage them to become involved through their national Codex Contact Points with the Commission’s work.

For more information, contact:

Secretariat of the Joint FAO/WHO
Food Standards Programme, Food and Agriculture Organization of the United Nations,
Viale delle Terme di Caracalla 00100 Rome, Italy

Telephone: (39-6) 5225.1
Telefax: (39-6) 5225.3152/5225.4593
Telex: 610181 FAO I
E-mail (INTERNET): [email protected]

Publications in Spanish

A training publication in Spanish on Food and Nutrition Project Development for Communities, entitled Manejo de proyectos de alimentaci nutricin comunidades has been released. The Spanish language version of the FAO Guidelines for Participatory Nutrition Projects is now available.

For further information on all the above please contact: Director, Food Policy and Nutrition Division, FAO, Via delle Terme di Caracalla, 00100 Rome, Italy. Phone: (39 6) 52251 Fax: (39 6) 52253162.

(Source: FAO, 1995)

INTERNATIONAL ATOMIC ENERGY AUTHORITY

In a number of ways, the work of the IAEA is contributing to efforts directed at overcoming hidden hunger and other nutrition problems. The rationale for the IAEA’s involvement is twofold. First, adequate nutrition is an essential component of any strategy for improving health, and the IAEA’s Statute specifically identified “enlarging the contribution of atomic energy to peace, health and prosperity” as the major objective of programmes. Second, isotope techniques have a wide variety of applications - some of them unique - for targeted research in human nutrition, for assessing nutritional status, and for monitoring the effectiveness of nutritional intervention programmes.

IAEA Programmes and Plans in Areas of Micronutrient Malnutrition

Since 1990, the IAEA has been supporting a co-ordinated research programme (CRP) in 11 countries on “Isotope-Aided Studies of the Bioavailability of Iron and Zinc from Human Diets”. Its main focus has been to obtain critical information needed for planning and implementing national nutrition programmes on dietary diversification and modification, food fortification, and micronutrient supplementation and in assessing the efficacy of intervention efforts.

Continuing work is forseen, in collaboration with WHO. It is being done to obtain a better understanding of the quantitative relationships between the absorption of food iron from a meal and the amounts of the main food components that are known to affect iron bioavailability. (One simple example of the importance of these interactions is that drinking tea with a meal blocks iron absorption almost completely.)

It is also expected that the IAEA will support several technical co-operation projects in Africa and Latin America during 1995-1996. Among other objectives, they will seek to develop iron-rich weaning foods for babies using local food products. A variety of in vivo and in vitro isotope techniques are needed for this work, using both radioactive and stable isotope tracers.

With respect to iodine nutrition, the IAEA has not yet directly supported work on this subject. However, many programmes have provided indirect support, particularly in relation to the use of RIA for the diagnosis of neonatal hypothyroidism (which is generally caused by nutritional iodine deficiency in the mother).

Several new IAEA programmes on vitamin-A malnutrition are planned. They include a CRP in 1995 to develop new methods for assessing vitamin-A status, to apply existing methods when feasible, and to develop new models for interpreting isotope kinetic data. Secondly, a new area of investigation will be supported which includes the production of foods intrinsically labelled with isotopes of carbon and hydrogen to assess the bioconversion of carotenoids under specific dietary and physiologic conditions. Thirdly, the IAEA will support the use of some techniques in a joint nutrition intervention project with WHO beginning late in 1994 or early 1995 in Latin America.

Concerning trace elements, the data generated through IAEA-supported research covering 25 study groups in 16 countries has already been used in the preparation of working documents for the WHO/FAO/IAEA Expert Consultation on Trace Elements in Human Nutrition (A soon-to-be-published report will propose new values for the dietary intakes of trace elements required to sustain good health.) The data also have served as input to a database on dietary intakes of 35 minor and trace elements in 47 different countries.

IAEA-supported Maternal Nutrition Programmes

The IAEA has contributed in two important ways to improving maternal nutrition during pregnancy. The first was its joint support, with the International Dietary Energy Consultancy Group (IDECG), of a report on the scientific basis and practical application of the doubly labelled water (DLW) method for measuring energy expenditure. Furthermore, the IAEA has supported several multi-centre and individual studies of energy expenditure during pregnancy. The results of some of these studies provide part of the basis of a reevaluation of dietary energy requirements which is being conducted by FAO, WHO, IDECG, and the UNU.

The DLW method, which was developed by Nathan Lifson and modified by investigators worldwide, is a form of direct calorimetry. It is based on the differential elimination of deuterium and oxygen-18 from body water subsequent to a loading dose of these stable isotopes. Once the two isotopes are administered, their fates are different; they are eliminated at different rates - deuterium only as water, and oxygen-18 as water plus carbon dioxide. The difference between the two elimination rates is therefore a measure of carbon dioxide production during the observation period, typically four to 21 days.

Measurement of the body’s energy expenditure is important for several reasons. Specifically, it provides very useful information for a wide variety of assessment concerning nutritional interventions. For example, dietary supplements to previously undernourished children may increase the energy available not only for growth but also for activity, which could have great relevance in terms of school or athletic performance. In pregnant or lactating mothers, the drive to sustain pregnancy and lactation may reduce energy available for other functions, including physical activity.

In children with respiratory disorders such as allergies or cystic fibrosis, medications are prescribed which facilitate their breathing. However, as a secondary effect, the treatment may increase energy expenditure and therefore have an indirect and negative effect on weight gain.

Understanding the interactions between the various human functions that are energy-demanding is a key to providing adequate dietary intake. Meeting this need requires measurements of energy expenditure.

IAEA-Supported Child Nutrition Programmes

The IAEA has contributed in some important ways to the improvement of dietary formulations for severely malnourished children through applications involving deuterium, oxygen-18, and carbon-13. Measurements of body composition, protein deposition, and energy expenditure were used in defining a dietary treatment for undernourished children which fosters substantial accelerations in weight gain without compromising the quantity of lean tissue. The result of using the dietary intervention was to reduce hospitalization time by 50%.

Particularly in children of developing countries, under nutrition and infection act synergistically to reduce nutrients available for growth, deplete energy reserves, and significantly increase morbidity and mortality. By better understanding the metabolic effects of infection in undernourished populations, we strengthen our ability to provide the appropriate foods for reducing morbidity and mortality. Stable isotope methods afford us this opportunity. Isotopic methods are being utilized in the new programmes to measure synthetic rates of specific nutrient transport proteins, and synthetic rates of proteins manufactured by the body in response to immunogenic stimuli. Both of these kinds of studies are currently being carried out by teams of scientists from developing and industrialized countries.

One team of investigators, for example, is working to find out how infection may alter children’s dietary requirements for protein and amino acids. The work involves quantifying the relative impact of specific infections on protein metabolism and protein anabolism using amino acids labelled with carbon-13 and nitrogen-15. Isotopic enrichments are measured either by gas chromatography-mass spectometry (GCMS), by combustion GCMS, or by isotope ratio mass spectrometry. The team is also assessing the impact of high altitude living on protein metabolism in undernourished children. They have developed and are validating a basic protocol for assessing rates of protein and amino acid metabolism in the field using non-invasive procedures that can be carried out under field conditions. The team intends to use the data in developing a food supplement that will most efficiently meet requirements for protein and specific amino acids, thereby resulting in the efficient utilization of nutrients for growth.

Nutrition and the Elderly

Another population group heavily affected by nutritionally related problems is the elderly. A special concern in many countries is the disease known as osteoporosis. This serious bone disease of the elderly (particularly post-menopausal women) severely limits their quality of life and is placing an increasing burden on the health-care systems in many countries. It is characterized by low bone mass, and microarchitectural deterioration of bone tissue, leading to enhanced fragility and a subsequent increase in the frequency of occurrence of hip and vertebral fractures.

Much still remains to be learned about the aetiology of the disease, about differences in incidence and severity between population groups living in different countries, as well as how to prevent the disease and optimize diagnosis and therapy when it occurs. Although it is generally agreed that osteoporosis is a multifactorial disease, there is little doubt that nutrition is one of the most important of the factors that needs to be taken into account. Included in the many components of the diet that may be important are a variety of minor elements (e.g. calcium, magnesium and sodium) and trace elements (e.g. cadmium, copper, manganese and zinc). Nuclear analytical techniques such as NAA are particularly suitable for the determination of these elements in foods, diets and human tissues, including bone.

The IAEA has just started a new coordinated research programme on this topic. It will focus on determining the age of peak bone mass in each study group, and quantifying differences in bone density as functions of the age and sex of persons in the study groups. It will also quantify differences between the study groups in different countries. Supplementary studies will be conducted using NAA relative to the trace-element nutrition of persons in the respective study groups.

For further information please contact: Dr Carla R. Fjeld, Senior Scientist, Section of Nutritional and Health-Related Environmental Studies, IAEA, PO Box 100, A-1400 Vienna, Austria. Phone: 43 1 2360/1680 Fax: 43 1 234564. Email: [email protected]

(Source: Parr, R. & Fjeld, C. (1994). Human Health and Nutrition: How Isotopes are Helping to Overcome “Hidden Hunger”. IAEA Bulletin, 4/1994, 18-27.)

ICCIDD

ThyroMobil Project

The ThyroMobil project has been developed and conducted by a core group of 12 European thyroidologists from the 12 countries involved in the project, Germany, Austria, Poland, Romania, the Czech Republic, the Slovak Republic, Hungary, Italy, France, Belgium, Luxembourg, and The Netherlands. Its main objectives have been to update information on the iodine supply in Europe, to increase awareness of IDD in the affected countries, and to stimulate the prevention and treatment of IDD in the continent. The project, with Professor F. Delange, Executive Director of ICCIDD and Regional coordinator for Europe, as the principal investigator, has been carried out under the auspices of ICCIDD and sponsored by the E. Merck Company, Darmstadt, Germany (Project Manager: Dr. Ott). The European offices of UNICEF and WHO supported the public interest objectives of the project.

A mobile unit (“ThyroMobil” van) equipped with an ultrasonograph supplied by Siemens visited at least two sites in each of the countries under investigation. Some had been studied in the past and were selected to recognize possible changes in the iodine supply, while others had not been previously investigated.

Following the recommendations of ICCIDD, WHO, and UNICEF, the assessment of iodine supply included the determination of thyroid volume by ultrasonography and of the urinary concentration of iodine in groups of at least 100 school-children of both sexes aged 6-17 years in each site. Iodine deficiency was considered to be present if more than 5% of subjects had a thyroid volume above the 97th percentile for age and/or if the median urinary iodine concentration was below 10 µg/dl. To ensure technical uniformity, all ultrasonographies were performed by the same experienced physician (Dr Jan Podoba, University of Bratislava, Slovak Republic) and all urine samples were analyzed in the same laboratory (Department of Clinical Chemistry, University Hospital Saint-Pierre, Brussels, Belgium, Professor F. Vertongen and Mrs. D. Gnat). In addition to data on thyroid size and urinary iodine, we obtained information on the use of iodized salt, sea fish, and milk. Any thyroid abnormality detected by ultrasonography was communicated to local practitioners for prompt action. Field investigations begin in 1994 and were completed by March 1995. A total of 7,601 schoolchildren aged 6-17 years from 57 different sites in the twelve countries were examined, and statistical analyses were performed in Bratislava by Mr Srbeky and Dr Podoba, in close coordination with the principal investigator. Urinary iodine concentrations were determined in 5,728 samples.

The results indicate marked regional patterns for both variables: the median urinary iodine values were normal in almost all sites investigated in the Netherlands, the Slovak Republic, Germany, Austria and France, borderline in Luxembourg and the Czech Republic, low (with a few exceptions) in Italy, Hungary Belgium, and Romania, and very low in the three sites investigated in Poland, which were situated in the endemic goitre areas of the country.

There was a significant inverse relationship between the median urinary iodine and the frequency of goiter (defined as a thyroid volume above the 97th percentile according to the criteria originally proposed by WHO, UNICEF, and ICCIDD).

However, by these criteria, the frequency of goiter was also high even in communities with entirely normal urinary iodine concentrations. Therefore, the criteria for a normal thyroid volume as a function of age and sex in children, and, from them the definition of goiter, have been re-evaluated from the data collected in children living in iodine replete areas in Europe. These new criteria will be officially communicated to the international organizations.

While the ThyroMobil van was in each country, a press conference was organized, usually in the capital. The conference included reports on the status of iodine nutrition in each country by the national representative of the ThyroMobil project, by the principal investigator and, as much as possible, by representatives of the national Ministries of Health and national UNICEF committees. Extensive coverage by TV, radio, and the press were arranged in all countries.

The following conclusions can be drawn from the ThyroMobil project:

1. A method allowing standardized evaluation of the status of iodine nutrition in different European countries has been developed.

2. The status of iodine nutrition has markedly improved in many European countries compared to the situation reported in 1992.

3. The changes are probably due to the implementation of programs of universal salt iodization and/or to improvement in the food habits.

4. The volume of the thyroid in schoolchildren in iodine replete areas in Europe has been established as a function of age, sex, and body surface area, as well as the criteria of goiter based on ultrasonographic investigation. A further report will provide details for each country.

For further information please contact: Dr Francois Delange, Executive Director, ICCIDD, Avenue de la Fauconnerie 153, 1170 Brussels, Belgium. Fax: 32 2 675 1898.

(Source: Delange, F., Podoba, J., Vertongen, F., Ott, W. (1995). ThyroMobil Project Standardizes Iodine Deficiency Evaluation in Europe. IDD Newsletter, 11(3), 33-34.)

IDECG

Undernutrition and Behavioural Development in Children

In June 1973, a committee of the National Academy of Sciences in the USA published a position paper on “The Relationships of Nutrition to Brain Development and Behaviour”. Since then, a great deal of new information has accumulated from different studies, and important theoretical concepts regarding long-term developmental consequences of early undernutrition have undergone considerable change. IDECG therefore appointed a task force with the mandate to assess current knowledge of the relationship between undernutrition and behavioural development in children and to interpret it in the context of current theory. This task force met at the University of California, Davis, from December 6-10, 1993.

The traditional model, suggesting that during critical periods protein-energy malnutrition (PEM) affects brain growth and thereby has a direct and independent effect on child development, appears no longer to be tenable. Gross morphologic changes, observed in brain structures after severe PEM may be reversible, whereas more subtle perturbations at the subcellular level, as suggested by alterations in sensitivity to pharmacological challenges, remain after rehabilitation. PEM coexists with other nutritional deficiencies that also have significant developmental consequences. Besides the covariations and interactions of nutritional deficiencies, the contextual conditions in which malnutrition occurs must be accounted for, since they can increase or buffer the developmental risk of malnourished children. Outcome variables need to be more theory-based and specific in the cognitive domain and ought to include affective and motivational processes as well.

The papers prepared by task force members appeared as a supplement to the August 1995 issue of The Journal of Nutrition; single copies are available from the IDECG secretariat free of charge.

The proceedings of a workshop on the effects of improved nutrition in early childhood: the Institute of Nutrition of Central America and Panama (INCAP) follow-up study appeared as a supplement to the April 1995 issue of The Journal of Nutrition. Single copies can be obtained free of charge from the IDECG secretariat.

Updating of Selected Parts of the 1985 FAO/WHO/UNU Expert Consultation Report on Energy and Protein Requirements

IDECG has taken the initiative in an effort to update selected parts of the 1985 FAO/WHO/UNU report on energy and protein requirements. To provide a basis for discussion and decision, experts were asked to write position papers on: (1) energy requirements: general principles, (2) energy requirements of infants; (3) energy requirements of children; (4) energy requirements of pregnant and lactating women; (5) protein requirements of infants and children; (6) requirements for indispensable amino acids in adults; and (7) energy and protein requirements of older individuals. These papers were discussed at an IDECG workshop from October 31 to November 4,1994, at the London School of Hygiene and Tropical Medicine.

The proceedings of the workshop have been submitted for publication and are scheduled to appear as a supplement to the January 1996 issue of the European Journal of Clinical Medicine.

Reanalysis of Basal Metabolic Rate (BMR) Data of Humans

Estimates of energy requirements are generally based on estimates of energy expenditure. Under most circumstances, the BMR is the most important component of energy expenditure, and allowances made to cover additional expenses according to circumstances are most conveniently expressed as multiples of BMR. It is therefore of great importance to have valid BMR data and equations allowing to predict BMR from other, simpler parameters.

A large number of new BMR data have been obtained since Schofield & James published their analysis and predictive equations in the European Journal of Clinical Nutrition in 1985. A considerable amount of BMRs have also been collected in population groups that were underrepresented in the data pool up to that time. The IDECG Advisory Group therefore concluded that a re-analysis of BMR data, meeting very stringent criteria, would be desirable, and the Nestle Foundation agreed to fund this project. The scientists supervising the project are C.J.K. Henry at Oxford Brookes University and J.V.G.A. Durnin from the University of Glasgow. Over 13,000 BMR data meeting stringent criteria have been identified and included in the data base. An annotated bibliography of the publications, from which these BMR data were taken, has also been compiled. The reanalysis of the BMR data is not complete and should be published during 1996.

Energy Cost of Physical Activity

It is now generally accepted that estimates of energy requirements should be based on estimates of energy expenditure, which is commonly expressed as the basal metabolic rate, multiplied by a factor which reflects primarily energy expenditure for physical activity. As mentioned above, BMR data are being re-analyzed, and the next limiting factor will be inadequate data on the energy cost of a wide variety of physical activities. Such data, obtained by indirect calorimetry, exist, but there is no recent, systematic and comprehensive compilation of this information. A research assistant at the London School of Hygiene and Tropical Medicine under the direction of P.S. Shetty and J.V.G.A. Durnin is carrying out an extensive re-analysis of all the information currently available in this area.

For further information please contact: Dr Beat SchInternational Dietary Energy Consultative Group (IDECG) Secretariat, c/o Nestle Foundation, PO Box 581, 1001 Lausanne, Switzerland. Phone: (41 21) 320 33 51 Fax: (41 21) 320 33 92.

(Source: IDECG Annual Report, 1994)

NORDIC COUNTRIES

The Nordic Network on International Nutrition

The Nordic Network on International Nutrition was initiated in 1992 by institutions at Nordic universities with interest and experience in research and framing in nutrition and related areas in low income countries. Some of the nutrition institutions in the Nordic countries have well-established contacts with scientists and institutions in low income countries and graduate students from these countries regularly receive training at Nordic institutions. However, as the number of researchers and students working in nutrition in low income countries in the Nordic institutions is small, the Nordic Network was established to take advantage of enhanced collaboration between the institutions.

Aim of the Network

The aim of the Nordic Network is to establish a forum for strengthening and improving advanced training and research in international human nutrition with a focus on the nutritional problems of low income countries.

Role of the Network

The role of the network is to:

- stimulate and facilitate the exchange of experience between scientists and research students involved in nutrition research of relevance for low income countries;

- facilitate a more effective utilization of existing graduate/postgraduate courses at the participating institutions through coordination and joint marketing of programmes and courses;

- jointly identify and develop additional training opportunities for relevant research training together with collaborating institutions in low income countries;

- strengthen the interest in and opportunities for research collaboration among the participating institutions and their collaborators in low income countries.

Network Activities

During the initial phase, the network has carried out the following activities:

- an annual Symposium on Advanced Training and Research in International Nutrition. The first symposium was held in Denmark, the second in Sweden and the third in Finland from 30th August - 1st September, 1995. The symposium acts as a forum for exchange of information on training needs and strategies, research training and current research by students at the network institutions;

- compilation of a Course Catalogue, which is an inventory of relevant graduate/postgraduate courses related to International Nutrition offered by institutions in the Nordic countries (available on request);

- review of ongoing research collaboration and contacts with training/research institutions in low income countries and discussions on strategies for strengthening such collaboration;

- regular meeting of the steering committee of the network.

Support of the Network Activities

The network has received financial support from NorFa (Nordic Academy for Advanced Study), DANIDA (Danish International Development Assistance), SIDA (Swedish International Development Authority) and the Norwegian Nutrition Council. The activities have also been supported by the institutions of the steering committee.

Steering Committee of the Network

Professor Antii AhlstrDepartment of Nutrition, University of Helsinki, PI. 27, FIN-00014 University of Helsinki, Finland. Phone: 358 0 7085270 Fax: 358 0 7085269

Professor Leif Hambraeus, Department of Nutrition, Uppsala University, 21 Dag Hammarskj v S-752 37 Uppsala, Sweden. Phone: 46 18182220 Fax: 46 18559505 Email: [email protected] (Secretariat of the Network).

Ms Britta Antonsson-Ogle, International Rural Development Centre, Swedish University of Agricultural Sciences, PO Box 7005, S-750 07 Uppsala, Sweden. Phone: 46 18671953 Fax: 46 673420 Email: [email protected]

Associate Professor Arne Oshaug, Nutrition Research Institute, University of Oslo, PO Box 1046, Blindern, N-316 Oslo 3, Norway. Phone: 47 22 856622 Fax: 47 22 854194 Email: [email protected]

Associate Professor Hans Rosling, International Child Health Unit, Department of Pediatrics, Uppsala University Children’s Hospital, S-751 85 Uppsala, Sweden. Phone: 46 18665984 Fax: 46 18508013.

Associate Professor Shakuntala Haraksingh Thilsted, Research Department of Human Nutrition, The Royal Veterinary and Agricultural University, Rolighedsvej 30, 1958 Frederiksberg C, Denmark. Phone: 45 35282497 Fax: 45 35282483.

(Source: Communication with Professor Shakuntala Haraksingh Thilstead, 24th August 1995)

UNICEF

Malnutrition

UNICEF has continued to be at the forefront of advocacy and support for the implementation of programmes to combat child malnutrition. A condition for designing effective programmes to fight malnutrition is understanding the causes of the problem and recognising how complex they are. UNICEF country programmes have continued to fight the “food bias” - the idea that malnutrition is only caused by a lack of food - and also the tendency to regard malnutrition as a clinical or medical problem. Rather, UNICEF programmes have been based on the idea that family access to food, access to health services and sanitation, and meeting the special care and feeding needs of young children - food, health and care - are all essential to fight malnutrition.

Because nutrition problems result from processes in all sectors of society, it is impossible to understand them without the active participation of people who are most at risk of the problem. In many countries, UNICEF supports the involvement of communities and households in participatory processes of problem assessment and analysis leading to action (Triple A processes). The UNICEF regional office for South Asia recently evaluated 21 community-based projects in the region, including at least 8 in which good processes of empowering the poor as key actors contributed to marked declines in child malnutrition. In Bangladesh, UNICEF worked with the Government and the World Bank to design a programme to improve nutrition based on the Triple A process and the involvement of communities. The Bangladesh Nutrition Programme will be partly implemented by the Government with the assistance of a local NGO, BRAC. UNICEF will continue to support the programme and look for opportunities to replicate it elsewhere in the country.

Micronutrients

IODINE: Some of the most rapid and important progress in UNICEF programmes are in the area of salt iodisation. The strategy of universal salt iodisation (USI) has been widely accepted in all regions, and the goal of USI by end-1995 has been met in virtually all of Latin America and in many countries in other regions. During the year, a number of countries with a high prevalence of iodine deficiency in which salt iodisation was previously thought to be virtually impossible, such as Pakistan and Indonesia, started to iodise at least half of all salt reaching consumers. To achieve this, UNICEF offices supported a range of innovative and flexible approaches, for example, the establishment of an “Iodised Salt support Facility” in Pakistan, to provide training, supplies and quality control to the 800 or so small salt crushers in the country.

Enormous progress was seen not only in getting iodine into salt but in the promulgation of laws to give teeth to monitoring and quality control efforts. UNIcEF, WHO and the International Council for the Control of IOdine Deficiency Disorders (ICCIDD) sponsored a forum in 1995 to consider the iodisation and monitoring challenges faced by countries in which salt is brought to market by many small producers rather than larger enterprises.

A technical monograph on practical ways of monitoring salt iodisation programmes was developed jointly with WHO, ICCIDD and PAMM and widely distributed. Many UNICEF country programmes are monitoring household availability of iodised salt, utilising a simple test kit, as part of the Multi-Indicator Cluster Surveys being undertaken to assess progress in meeting the goals of the World Summit.

VITAMIN A: WHO-UNICEF estimates now indicate that over 250 million children still suffer from vitamin A deficiency (VAD) with many millions more at risk. The known effects of VAD on the immune system and thus on child mortality make this a high-priority challenge for UNICEF. In 1995, UNICEF supported surveys of vitamin A status that resulted in widespread deficiency being recognised for the first time in Egypt, South Africa, Kenya and Botswana.

With support from the Micronutrient Initiative in Canada, UNICEF launched projects in 14 countries that will enable innovation in systems of distribution of vitamin A supplements and improvements in monitoring the mortality and morbidity impact of supplementation. A number of countries are building on the successful experience of Guatemala in fortification of sugar with vitamin A. Bolivia and Brazil both launched sugar fortification with vitamin A on a pilot basis in 1995. In Namibia and South Africa, the feasibility of fortifying maize meal with vitamin A is being considered.

UNICEF supports dietary diversification and the consumption of appropriate fruits and vegetables as one of the most potentially sustainable ways for communities to overcome micronutrient malnutrition. Research completed in 1995 with UNICEF assistance pointed to the need to pay further attention to the types of vegetables grown and the type of cooking in order to maximise the impact of home gardening on the vitamin A status of children. In Bangladesh, UNICEF is collaborating with Helen Keller International to assess the impact of a large home gardening project on the vitamin A status of mothers and young children. This information should help to ensure that future programmes of this type are designed in the most cost effective way.

IRON: The statement on strategies for reducing iron deficiency anaemia, developed and adopted by WHO and UNICEF in 1995, calls for general supplementation with iron in any population or pregnant women or young children where the prevalence of anaemia exceeds 30%. The results of research trials investigating the impact on anaemia of weekly iron supplements have started to become available. Weekly iron or orion and vitamin A supplements now appear to be a feasible intervention to combat iron deficiency anaemia on a population basis in some vulnerable groups.

UNICEF supported a meeting, jointly with the Thrasher Research Fund and Cornell University, to explore ways of increasing the micronutrient content of foods commonly consumed in countries where micronutrient malnutrition is common. Plant breeders, soil scientists and human nutritionists met to consider the problem and agreed that the micronutrient content of foods had been neglected in the breeding of high yielding (green revolution) varieties of cereals such as rice. With the realisation of the tremendous importance of the micronutrient content of staple foods crops to human development, plant breeders agreed that future breeding work should take micronutrient goals into account. The participants also called for research in other priority areas to exploit the potential food-based systems, including the development of programs and policies that influence the choices of consumers and producers to increase the supply and consumption of micronutrient-rich foods.

UNICEF supported a number of country participants to the “Ottawa Forum” in December, which sought to strengthen collaboration between the private and public sectors for the fortification of staple foods in developing countries.

Infant Feeding and Care

BFHI: The benefits of breastfeeding are well known, thanks in part to UNICEF’s work with WHO and many NGO partners in this area. The keystone of UNICEF programming in support of breastfeeding has been the Baby-Friendly Hospital Initiative (BFHI) through which health workers are trained and supported to understand breastfeeding and help mothers to practice it. In 1995, BFHI reached the milestone of 4000 Baby-Friendly hospitals. After a slow start, countries of Central and Eastern Europe have joined the Initiative and are making considerable progress.

Technical assistance was provided to governments in implementing the International Code of Marketing of Breastmilk Subsitutes (BMS), with particular emphasis on ending the practice of the donation of free or subsidised supplies of BMS within health care systems. The number of countries that adopted a law or some provisions of the Code increased by 10 in 1995, and four more countries adopted actions to end the practice of free and low-cost supplies.

Breastfeeding promotion beyond BFHI, with a focus on promotion of exclusive breastfeeding for about 6 months and continued breastfeeding with appropriate complementary feeding for 2 years and beyond, has become an important aspect of the guidelines for country offices on “care for nutrition” that UNICEF is developing.

UNICEF spearheaded the development of a proposed policy framework for HIV and breastfeeding. This new framework, to be considered in an interagency consultation in December 1995, takes as its premise the right of women at risk of HIV to make infant feeding choices based on full information as well as the rights of children to be protected from disease. The proposal takes advantage of advances in the understanding of HIV transmission and in global consensus on human rights issues that have occurred since the formulation of the 1992 WHO statement on this subject.

Complementary Feeding: UNICEF and WHO commissioned a review on key issues related to complementary feeding as a key component of “care for nutrition”. The draft document, which was reviewed at a meeting with international experts in November, made conclusions on ways that UNICEF-supported programmes can improve infant and young child feeding by ensuring that breastmilk is complemented with appropriate foods from the age of about six months. The review makes recommendations on frequency of feeding, composition of complementary foods, micronutrient needs and food hygiene and safety. It is expected to be finalised for widespread distribution early next year. It will form the basis for a series of regional workshops that will seek to put the recommendations into practice.

Household Food Security (HFS)

Country programmes in several regions seek to improve access of households to food. In many countries, UNICEF’s contribution is to focus on women as the guardians of HFS. Small credit programmes for women supported by UNICEF as HFS measures grew in several countries in East and West Africa and the Middle East. UNICEF-Indonesia is working to ensure that government food diversification and production activities account for the many demands on women’s time, and UNICEF supports activities to reduce rural women’s workload in Niger and Ethiopia. Home gardens to improve household access to micronutrient-rich crops were supported in a dozen countries from Bolivia to Cambodia. Unfortunately, ten country programmes had to focus their food-related activities on short-term relief in emergency situations. Guidelines on conceptualisation and evaluation of HFS activities were developed by the Nutrition Section and are being revised for distribution in 1996.

Training in Nutrition

UNICEF provided follow-up support to a global initiative launched in late 1994 in Bellagio to combat malnutrition by increasing and strengthening the links between training, research and programmes to foster, among others, more practical training for nutrition-related practitioners and community nutrition workers. For example, UNICEF supported an exercise led by Mahidol University in Thailand to analyze training and operational research needs in eight East Asian countries to facilitate successful community-based nutrition programmes. In Indonesia alone, there are 3 million community-level volunteers who could benefit from practical training. UNICEF will continue to support networking of relevant training and research institutions in the region and sharing of experiences in programme-based training and research from other regions.

For further information on any of the above please contact: Dr Micheline Beaudry, Chief, Nutrition Section, UNICEF, UNICEF House, H-10F, 3 UN Plaza, New York, NY 10017, USA. Phone: 212 326 7772 Fax: 212 326 7336 Email: [email protected].

(Source: UNICEF, 1995)

UNU

International Network of Food Data Systems (INFOODS)

The International Network of Food Data Systems (INFOODS) activities relate to food composition data, which underpin many diverse activities including public health nutrition; agricultural, environmental and health research; food industry and trade decisions; governments’ strategies and policies concerning nutrition and agriculture; and global endeavours related to sustainability and food security.

Meetings

Several regional and international meetings have taken place in the past year.

ASEANFOODS held a meeting in May 1995 during the Asia Pacific Food Analysis Conference in Manila. A proposal was developed for a workshop to be held in early 1996, for the production of the first ASEANFOODS Food Composition Tables and data files. A pre-workshop schedule of activities has begun.

OCEANIAFOODS held their fourth meeting in Fiji in April 1995. Significant advances in food composition data dissemination have been achieved, including the three party collaboration with INFOODS, resulting in the publication in November 1994 of the Pacific Islands Food Composition Tables, and data tiles used in the applications software package DIET1/Pacific. Data generation projects are in place involving the University of the South Pacific and sample collection from many different islands. The next meeting is planned for mid-1997.

The AFROFOODS organisational meeting was held in Accra, Ghana, in September 1994. It was agreed that there would be four sub-regional groupings: ECSAFOODS - Eastern, Central and Southern Africa (18 countries): WAFOODS - Western Africa (5 countries); OCAFOODS - Francophone Western and Central Africa (23 countries); NAFOODS - Northern Africa (5 countries). OCAFOODS held a meeting in Senegal in May, 1995; and a fellowship has been awarded for postgraduate study to a researcher from ECSAFOODS (Zimbabwe), where the regional data centre will be established.

LATINFOODS organized a three-week long workshop in Santiago in October. The content of the workshop included training in the areas of laboratory-based data generation, computer-based data compilation, and multimedia approaches to data dissemination.

The first organisational meetings of MASIAFOODS, SAARCFOODS and GULFOODS took place in October and November 1995.

Two international meetings took place under the auspices of INFOODS: an expert committee meeting on data quality indicators; and a meeting on food nomenclature and terminology. These meetings were hosted by the US Dept of Agriculture at their offices, on 14-16 June, 1995.

Participants from the USA, New Zealand, Thailand, Chile and Zimbabwe covered much ground. Some of the issues examined the applications of data quality indicators in retrospective data evaluation, and production and evaluation of new data; their advantages/uses; the different types of component values in a food composition data base to which they could be applied; the baseline data quality parameters for analytic data and derived data; and how data quality should be represented in a food composition data system. Surveys are being undertaken where data quality information is currently supplied to users, to determine how widely the information is used and how it is applied; and where they are not used, to determine how the food composition data users would make use of data quality indicators if supplied. The Food Terminology and Nomenclature meeting was convened for the purpose of developing a series of recommendations to be further addressed by an appropriate IUNS committee. It was recommended that the appropriate committee should: review of systems currently in use to determine the feasibility of linking them; determine if it is possible for a single food description language or a set of minimum criteria to be adopted among various countries; assume responsibility for the compilation of an electronic international food description dictionary/thesaurus/concordance, complete with food images; describe and contrast the various systems for users, perhaps on the internet, to see where the systems are complementary and where they are in conflict; and prepare an update, as a continuation of the development of the INFOODS system, previously published in the Journal of Food Composition and Analysis.

Reports on the results of these meetings are being prepared for publication and/or presentation.

Laboratories

The ASEANFOODS Interlaboratory trial has been completed, and the results have been presented and published Rice flour, soybean flour, cereal soy and fish meal are now available as the ASEANFOODS Food Reference Materials, for proficiency testing in laboratories. The materials are available at a subsidised cost from Dr Prapasri Puwastein, Institute of Nutrition, Mahidol University of Salaya, Nakhon Chaisri, Nakhon Pathom 73170, Thailand.

Electronic Communications

INFOODS has developed three electronic information/communications resources which operate via the Internet: the FOOD-COMP list, the FOOD-TAG list, and a WorldWideWeb server.

The FOOD-COMP group is operated for the purpose of discussing issues and disseminating information to the entire food composition professional community. The requirement for joining this list is an electronic mail address with Internet access. The procedure for joining this list is to send an email to the following address:

[email protected]

No other information or text is required, and you are promptly added to the list. Alternatively, you can contact the New Zealand office by more conventional means, and supply your email address. Discussions on this list cover a spectrum of topics from sampling, sample preparation and methodological details, to naming conventions, and data presentation formats and expressions. Other information is often transmitted on this list, including announcements of conferences and meetings, availability of resource materials, and other notices of relevance to those engaged in food composition activities.

The FOOD-TAG Registration List involves a very small group which works together to update the food component identifiers. New tagnames are proposed according to an established formula. They are posted to the list, discussion is called for, and, if no discussion or dispute occurs within 30 days, the tag is officially registered and added to the master list. Participation is by invitation, or by special request to the Secretariat. Internet connections are not essential because dissemination of the contributions is via fax to those not equipped with Email.

The WWW Server contains a collection of news, data, and documents relating to INFOODS and the regional data centres. It can be accessed using Gopher or almost any Web browser, as follows:

http://www.crop.cri.nz/crop/infoods/infoods.html

Figure

Fellowships: During the last year, many fellowships were awarded. Among them were the following: Claudio Telha of the University of Chile to work on nutritional information systems at the NZ Institute for Crop and Food Research; several to attend the 2nd International Postgraduate Course on the Production and Use of Food Composition Data in Nutrition, held in Wageningen, The Netherlands, from 3-21 October 1994.

For further information please contact: Barbara Burlingame, INFOODS Secretariat, c/o NZ Institute for Crop & Food Research, Private Bag 11030, Palmerston North, New Zealand. Phone: 64 6 356 8300 Fax: 64 6 351 7050 Email: [email protected].

(Source: Communication with Barbara Burlingame, INFOODS Secretariat, 11 September, 1995)

WHO

The WHO/HQ Nutrition Programme reviews the latest scientific data and hence renews and develops guidelines, scientific criteria and methodologies, for widespread dissemination. These normative functions are important to ensure that WHO’S nutrition-related programmes, policies and plans of action are scientifically sound and effective and also to provide Member States, as well as WHO’S sister agencies, with scientifically sound and effective advice.

The Nutrition Programme, in view of the enormous burden of malnutrition, continues to accord high priority to its normative functions, on behalf of the Member States, in the following five areas:

· protein-energy malnutrition: its assessment, prevention, surveillance and management;

· micronutrient malnutrition: its prevention and control;

· infant and young-child feeding and nutrition, including technical support to Member States in their efforts to implement and monitor the International Code of Marketing of Breastmilk Substitutes;

· diet-related noncommunicable diseases: their prevention and management;

· nutritional emergencies, including preparedness for and care during.

This normative work is achieved through the following three main action areas:

(i) the holding of expert or technical meetings;

(ii) the production and publication of technical publications and documents; and

(iii) the monitoring of global trends in nutrition through a series of databanks. These are briefly described here.

Development and Maintenance of Global Nutrition Data Banks

In collaboration with various other WHO programmes, the Nutrition Programme has established and is currently operating the following data banks. These are crucial for the international sharing of information and support for countries in monitoring progress towards the goals of the World Declaration and Plan of Action for Nutrition as well as those of the Children’s Summit; and in stimulating, planning and guiding the implementation and evaluation of the impact of national policies and local programmes for nutritional improvement. Currently operating data banks are as follows:

· Protein-Energy Malnutrition (Child Growth)
· Iodine Deficiency
· Vitamin A Deficiency
· Anaemia in Women
· Anaemia in Children
· Breastfeeding
· Implementation of the World Declaration and Plan of Action for Nutrition: Country Progress

The database on Protein-Energy Malnutrition documents malnutrition in terms of weight-for-age, height-for-age and weight-for-height in under-five infants and children worldwide. Maps on “Prevalence of underweight children in developing countries” are produced using this database. This database currently covers 87% of the total population of infants and young children in developing countries.

The Iodine Deficiency database provides prevalence of IDD and estimates of at-risk populations for all affected countries worldwide, while the Vitamin A Deficiency database provides prevalence of VAD in pre-school children worldwide. Countries categorized by degree of public health importance of vitamin A deficiency are mapped using the Vitamin A Deficiency database.

The data bank on Anaemia in Women (maintained in the Division of Family Health in collaboration with the Nutrition Programme) provides prevalence rates for anaemia in pregnant and non-pregnant women worldwide, whereas the database on Anaemia in Children provides prevalence of anaemia in children of various ages (infants, preschool age, school age and adolescents) in 85 countries.

The Breastfeeding database has been updated according to the new breastfeeding indicators and definitions. The bank pools information mainly from national and regional nutrition surveys and studies dealing specifically with breastfeeding prevalence and duration. The aim is to achieve worldwide coverage to enable comparison of data, assessment of breastfeeding trends and practices as a basis for future action, and evaluation of the progress of promotional programmes.

One of the most recent developments concerning breastfeeding is the change of the indicators and definitions to assess trends and practices and, the development of the new WHO Global Data Bank on Breastfeeding. The old data base included data from 151 out of 189 member countries of WHO compared with only 54 countries reporting data using new definitions and indicators. This is 80% vs. 28% of member states respectively.

Implementation of the World Declaration and Plan of Action for Nutrition is a global monitoring system on country progress for developing and finalizing their national plans of action for nutrition, including the information on national mechanism established. It also contains information on WHO’S support, both technical and financial, as well as of the support provided by FAO and other agencies (as available) to countries, and the summary of progress of ICN activities in various WHO regions. This monitoring system is currently being expanded to include the information on the components of, and the progress in, national plans of action for each country.

For further information please contact: Dr Graeme Clugston, Head, Nutrition Unit, WHO, 20, Avenue Appia, CH 1211 Geneva 27, Switzerland. Phone: 41 22 791 2761 Fax: 41 22 791 0746

(Source: WHO, 1995)

WORLD BANK

New Nutrition Projects

Three World Bank-assisted freestanding nutrition projects have recently been approved: the Senegal Community Nutrition Project; the Bangladesh Integrated Nutrition Project, and the China Iodine Deficiency Disorders Control Project. The Senegal project is being implemented by a unique public works-type agency with a history of success in mobilizing communities. Portions of the Bangladesh project are going through BRAC, the renowned NGO, and feature a new targeting technique focusing on newly married women. China’s operation is the first freestanding Bank-assisted project aimed solely at micronutrient deficiencies (a similar project is being planned in Indonesia). Ten other nutrition projects are also at some stage of preparation or appraisal, and nutrition components are currently being prepared or appraised for 31 projects in other sectors.

Primary Education

Nutrition is, or soon will be, a component in 19 Bank-assisted primary education projects. The purpose is not just to improve nutrition and health, but also to raise returns on investment in education.

Consultative Group to Assist the Poorest

Following the World Bank’s “Overcoming Global Hunger” conference in November/December 1993, a Consultative Group to Assist the Poorest (CGAP) was formed. This new interagency undertaking is now well on the way to generating US $100 million to provide as microcredit to the very poor. The World Bank’s Board of Executive Directors approved a contribution of 30 percent of total funding - up to $30 million.

Project Evaluation Results

A recent midterm evaluation of the nutrition component of the Janasaviya Trust/Poverty Alleviation Project in Sri Lanka has shown a substantial reduction in underweight children (almost half of the 84 areas reported a greater than 15 percent reduction in malnutrition in the under-five age group: several areas had reductions of over 40 percent). Three levels of program intensity were tested in the project. It was found that the slower, more methodical approach of empowering women and concentrating on the poorest produced the best nutrition results. The nutrition component is considered the most effective part of that multisector project, being particularly effective at mobilizing communities.

New anthropometric surveys coming out of the Madagascar Nutrition and Food Security Project show reduction of more than a third (from 19 to 13 percent) in rates of malnutrition in communities covered by the project. In a control sample, where children have access to growth monitoring but no other nutrition services, malnutrition hovers around 20 percent.

For further information please contact: Human Development Department, The World Bank, 1818 H Street, N.W., Washington, D.C., USA. Phone: (202) 473 3782 Fax: (202) 522 3234.

(Source: Alan Berg’s New & Noteworthy in Nutrition No. 26, June 13, 1995, World Bank Office Memorandum)