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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
×

Prevention of Micronutrient Deficiencies

Tools for Policymakers and Public Health Workers

Committee on Micronutrient Deficiencies

Board on International Health

Food and Nutrition Board

INSTITUTE OF MEDICINE

Christopher P. Howson, Eileen T. Kennedy, and Abraham Horwitz, Editors

NATIONAL ACADEMY PRESS
Washington, D.C.
1998

Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

This study was supported by the U.S. Agency for International Development. The views presented in this report are those of the Institute of Medicine Board on International Health and are not necessarily those of the funding organization.

International Standard Book No. 0-309-06029-X

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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
×

Committee On Micronutrient Deficiencies

ABRAHAM HORWITZ (Chair),

Pan American Health Organization, Washington, D.C.

JOSEPH A. COOK,

Program for Tropical Disease Research, The Edna McConell Clark Foundation, New York City

JOHN DUNN,

University of Virginia Health Sciences Center

JOHN W. ERDMAN, JR.,

Division of Nutritional Sciences, College of Agriculture, University of Illinois at Urbana-Champaign

OSMAN M. GALAL,

Department of Community Health Services, School of Public Health, University of California at Los Angeles

JAMES GREENE,

Chevy Chase, Maryland

E. C. HENLEY,

Protein Technologies International, St. Louis, Missouri

EILEEN T. KENNEDY,

Center for Nutrition Policy and Promotion, U.S. Department of Agriculture, Washington, D.C.

REYNALDO MARTORELL,

Department of International Health, The Rollins School of Public Health, Emory University

NEVIN S. SCRIMSHAW,*

The United Nations University, Food and Nutrition Program for Human and Social Development, Boston

KEITH P. WEST, JR.,

Division of Human Nutrition, The Johns Hopkins University School of Hygiene and Public Health

Staff

CHRISTOPHER P. HOWSON, Director,

Board on International Health

STEPHANIE Y. SMITH, Administrative/Research Assistant

SHARON GALLOWAY, Financial Associate

*  

Member, Institute of Medicine.

  

Member, National Academy of Sciences.

Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
×

Board On International Health

BARRY R. BLOOM (Cochair),*

Howard Hughes Medical Institute, Albert Einstein College of Medicine

HARVEY V. FINEBERG (Cochair),*

Harvard University School of Public Health

JACQUELYN CAMPBELL,

The Johns Hopkins University School of Nursing

JULIO FRENK,*

Fundación Mexicana para la Salud, Mexico, D.F.

DEAN T. JAMISON,*

Center for Pacific Rim Studies, University of California at Los Angeles

EILEEN T. KENNEDY,

Center for Nutrition Policy and Promotion, U.S. Department of Agriculture, Washington, D.C.

ARTHUR KLEINMAN,*

Harvard University Medical School

BERNARD LIESE,

Health Services Department, The World Bank, Washington, D.C.

WILLIAM E. PAUL,*

National Institute of Allergy and Infectious Diseases and Office of AIDS Research, National Institutes of Health, Bethesda, Maryland

ALLAN ROSENFIELD,

Columbia University School of Public Health

PATRICIA ROSENFIELD,

The Carnegie Corporation of New York, New York City

THOMAS J. RYAN,

Boston University School of Medicine, and Senior Consultant in Cardiology, Boston University Medical Center

JUNE E. OSBORN (Institute of Medicine Liaison),*

Josiah Macy, Jr., Foundation, New York City

JOHN H. BRYANT* (Ex-Officio),

Moscow, Vermont

WILLIAM H. FOEGE* (Ex-Officio),

Task Force on Child Survival, The Carter Center, Emory University

DAVID P. RALL (Institute of Medicine Foreign Secretary),*

National Institute of Environmental Health Sciences (retired), Washington, D.C.

Staff

CHRISTOPHER P. HOWSON, Director

STEPHANIE Y. SMITH, Administrative/Research Assistant

SHARON GALLOWAY, Financial Associate

*  

Member, Institute of Medicine.

Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
×

Food And Nutrition Board

CUTBERTO GARZA (Chair),

Division of Nutrition, Cornell University

JOHN W. ERDMAN, JR. (Vice Chair),

Division of Nutritional Sciences, College of Agriculture, University of Illinois

LINDSAY H. ALLEN,

Department of Nutrition, University of California at Davis

BENJAMIN CABALLERO,

Center for Human Nutrition, The Johns Hopkins University School of Hygiene and Public Health

FERGUS M. CLYDESDALE,

Department of Food Science, University of Massachusetts, Amherst

ROBERT J. COUSINS,

Center for Nutritional Sciences, University of Florida

MICHAEL P. DOYLE,

Department of Food Science and Technology, Center for Food Safety and Quality Enhancement, The University of Georgia, Griffin

JOHANNA T. DWYER,

Frances Stern Nutrition Center, New England Medical Center Hospital, Boston, and Departments of Medicine and Community Health, Tufts University Medical School and School of Nutrition Science and Policy

SCOTT M. GRUNDY,*

Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas

CHARLES H. HENNEKENS,

Harvard University Medical School and Brigham and Women's Hospital, Boston

JANET C. KING,*

University of California at Berkeley, and U.S. Department of Agriculture Western Human Nutrition Research Center, San Francisco

SANFORD A. MILLER,

Graduate School of Biomedical Sciences, University of Texas Health Science Center, San Antonio

ROSS L. PRENTICE,

Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington

A. CATHERINE ROSS,

Department of Nutrition, The Pennsylvania State University

ROBERT E. SMITH,

R. E. Smith Consulting, Inc., Newport, Vermont

VIRGINIA A. STALLINGS,

Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia

VERNON R. YOUNG,

Laboratory of Human Nutrition, School of Science, Massachusetts Institute of Technology

STEVE L. TAYLOR (Ex-Officio),

Department of Food Science and Technology and Food Processing Center, University of Nebraska at Lincoln

*  

Member, Institute of Medicine.

  

Member, National Academy of Sciences.

Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
×

HARVEY R. COLTEN* (Institute of Medicine Council Liaison),

Northwestern University Medical School

Staff

ALLISON A. YATES, Director

GAIL A. SPEARS, Administrative Assistant

CARLOS GABRIEL, Financial Associate

Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
×

Acknowledgments

The committee is grateful to the many individuals who made substantive and productive contributions to this project. Particular thanks are in order to the authors of the background papers, whose effective efforts provided important information bearing on the topic of this report: John Stanbury; Barbara Underwood, National Institutes of Health; and Fernando Viteri, University of California-Berkeley. The committee gives special thanks to the following workshop participants: Lindsay Allen, University of California at Davis; Frances Davidson, USAID; Johanna Dwyer, New England Medical Center; Miguel Gueri, Pan American Health Organization; Suzanne Harris, International Life Sciences Institute; James Olson, Iowa State University; Margaret Burns Parlato, Academy for Educational Development; Soekirman, World Bank; and Rebecca Stoltzfus, Johns Hopkins School of Hygiene and Public Health. The committee would also like to thank Christopher Howson, project director; Stephanie Smith, project assistant; Sharon Galloway, financial associate; Michael Edington, managing editor; Claudia Carl, staff associate for report review; and Caroline McEuen, contract editor.

Page viii Cite
Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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This page in the original is blank.
Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
×

DEDICATED TO

Abraham Horwitz, M.D.

For his extraordinary commitment to this report and to the ideal of health for all.

Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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This page in the original is blank.
Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
×

 

 

Prevention of Iron Deficiency in At-Risk Groups

 

54

 

 

Sustainable Approaches to the Elimination of Iron Deficiency

 

67

 

 

Benefits and Costs of Preventing Iron Deficiency

 

79

 

 

Suggested National Goals

 

81

 

 

Appendix

 

83

4
PREVENTION OF VITAMIN A DEFICIENCY

Barbara A. Underwood

 

103

 

 

Major Health Consequences

 

103

 

 

Magnitude and Epidemiology of the Problem

 

105

 

 

Economic Costs of VAD

 

111

 

 

Indicators of VAD

 

111

 

 

Critical Elements for Successful Nutrition Intervention Programs

 

115

 

 

Approaches to the Prevention or Correction of VAD

 

115

 

 

Other Countries' Experiences

 

120

 

 

Complementarity of Interventions

 

143

 

 

Costs and Benefits

 

145

 

 

Balancing Approaches to Country-Specific Circumstances

 

148

 

 

Summary

 

152

5
PREVENTION OF IODINE DEFICIENCY

John B. Stanbury

 

167

 

 

Requirements for Iodine

 

167

 

 

Consequences of Iodine Deficiency and Its Correction

 

168

 

 

Consequences of the Correction of Iodine Deficiency

 

170

 

 

Interaction with Other Micronutrients

 

171

 

 

Extent of Iodine Deficiency

 

171

 

 

Indicators of Iodine Deficiency and Impact of Prevention

 

175

 

 

Prevention and Correction

 

176

 

 

National Programs: Some Examples of Success and Failure

 

180

 

 

Structure of Preventive Programs

 

186

 

 

Impediments to IDD Control

 

188

 

 

Action Plans for the International Agencies

 

192

 

 

Summary

 

195

 

 

Appendix: ICCIDD Guidelines for Assessment of Progress Toward IDD Elimination

 

196

APPENDIX: WORKSHOP AGENDA

 

203

Page xiii Cite
Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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Prevention of Micronutrient Deficiencies Tools for Policymakers and Public Health Workers

Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
×
This page in the original is blank.
Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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Page viii Cite
Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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Page xiii Cite
Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1998. Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, DC: The National Academies Press. doi: 10.17226/5962.
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Micronutrient malnutrition affects approximately 2 billion people worldwide. The adverse effects of micronutrient deficiencies are profound and include premature death, poor health, blindness, growth stunting, mental retardation, learning disabilities, and low work capacity. Preventing Micronutrient Deficiencies provides a conceptual framework based on past experience that will allow funders to tailor programs to existing regional/country capabilities and to incorporate within these programs the capacity to address multiple strategies (i.e., supplementation/fortification/food-based approaches/public health measures) and multiple micronutrient deficiencies.

The book does not offer recommendations on how to alleviate specific micronutrient deficiencies—such recommendations are already available through the publications of diverse organizations, including the U.S. Agency for International Development, the Micronutrient Initiative, World Bank, United Nations Childrens' Fund, and the World Health Organization. Instead, this volume examines key elements in the design and implementation of micronutrient interventions, including such issues as:

The importance of iron, vitamin A, and iodine to health. Populations at risk for micronutrient deficiency. Options for successful interventions and their cost. The feasibility of involving societal sectors in the planning and implementation of interventions. Characteristics of successful interventions.

The book also contains three in-depth background papers that address the prevention of deficiencies of iron, vitamin A, and iodine.

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