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MICRONUTRIENTS2010 - 2011
Department of Nutrition for Health and Development
WHONMHNHDEPG121
SUMMARYDuring 2010-2011 major efforts of WHO headquarters in collaboration with WHO regions
were focused on establishing a process for developing and updating evidenceinformed
guidelines for micronutrient interventions and biomarkers as well as upgrading and expand-
ing the Vitamin and Mineral Nutrition Information System (VMNIS) Sixteen evidence-informed
guidelines for micronutrient interventions were published during this biennium and new tools
and resources were developed to support Member States and their partners in successfully
implementing effective micronutrient interventions Furthermore research studies were
initiated with collaborating institutions on the biological and biochemical pathways underlying
neonatal vitamin A supplementation and on the development of models to assess the burden
of vitamin and mineral deficiencies
WHO has now published the VMNIS website and over 100 documents related to
micronutrients in 6 WHO official languages This allows WHO to more effectively guide
public health practices reach out international audiences who need it and achieve
better health outcomes worldwide In this way multilingual communication is an
essential tool for improving global health
WHO continues its commitment to coordinate the universal call to scale up nutrition
actions by increasing multilateral work on technical and policy agendas at the global
regional and country level with the core group of United Nations agencies and interna-
tional partners dealing with micronutrient interventions in public health
Micronutrients 2010-2011Department of Nutrition for Health and Development
2DRAFT
1 EVIDENCE-INFORMED GUIDELINE DEVELOPMENT 3
Supplementation
Point-of-use fortification of foods
Others
2 SCIENTIFIC PUBLICATIONS AND REPORTS 4
Technical Reports
WHO micronutrients mailing list
3 MULTILINGUALISM 7
4 WHO VITAMIN AND MINERAL NUTRITION INFORMATION SYSTEM 8
5 OUR TEAM 10
6 RESEARCH 12
7 OUR PARTNERS 13
8 FINANCIAL SUPPORT 16
9 WHO MEETINGS 18
TABLE OF CONTENTS
Micronutrients 2010-2011Department of Nutrition for Health and Development
3DRAFT
1 EVIDENCE-INFORMED GUIDELINE DEVELOPMENT
A WHO guideline is any document containing WHO recommendations about health interventions whether they are clinical public
health or policy interventions A recommendation provides information about what policy-makers health-care providers or patients
should do It implies a choice between different interventions that have an impact on health and that have ramifications for the
use of resources As of 2009 all publications containing WHO recommendations are approved by the WHO Guidelines Review
Committee WHO has developed the evidence-informed recommendations for micronutrients interventions in public health using the
procedures outlined in the WHO Handbook for guideline development The steps in this process include (i) identification of priority
questions and outcomes (ii) evidence retrieval (iii) assessment and synthesis of the evidence (iv) formulation of recommendations
including research priorities and (v) planning for dissemination implementation impact evaluation and updating Using the Grading
of Recommendations Assessment Development and Evaluation (GRADE) methodology evidence profiles related to preselected
topics are prepared based on up-to-date systematic reviews During 2010-2011 WHO Headquarters updated or developed the
following guidelines on micronutrient interventions
SUPPLEMENTATION
Guideline Neonatal vitamin A supplementation
Guideline Vitamin A supplementation for infants 1ndash5 months of age
Guideline Vitamin A supplementation for infants and children 6-59 months of age
Guideline Vitamin A supplementation in pregnant women
Guideline Vitamin A supplementation in postpartum women
Guideline Vitamin A supplementation during pregnancy for reducing the risk of
mother-to-child transmission of HIV
Guideline Intermittent iron supplementation in preschool and school-age children
Guideline Intermittent iron and folic acid supplementation in menstruating women
Guideline Daily iron and folic acid supplementation in pregnant women (in press)
Guideline Intermittent iron and folic acid supplementation in non-anaemic
pregnant women (in press)
Guideline Calcium supplementation in pregnant women (in press)
Guideline Vitamin D supplementation in pregnant women (in press)
POINT-OF-USE FORTIFICATION OF FOODS
Guideline Use of multiple micronutrient powders for home fortification of foods consumed
by infants and children 6ndash23 months of age
Guideline Use of multiple micronutrient powders for home fortification of foods consumed
by pregnant women
OTHERS
WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia
Guideline Iron interventions in areas where malaria transmission occurs (in press)
These guidelines are available on the WHO website and the eLibrary of Evidence for Nutrition Actions
(wwwwhointelena)
1
Guideline
Vitamin A
supplementation in
infants 1ndash5 months of age
Guideline Vitamin A supplementation in pregnancy for reducing the risk of mother-to-child transmission of HIV
Guideline Vitamin A supplementation in postpartum women
Guideline
Vitamin A
supplementation in
infants and children
6ndash59 months of age
Micronutrients 2010-2011Department of Nutrition for Health and Development
4DRAFT
1 SCIENTIFIC PUBLICATIONS AND REPORTSPeer review and publication in scientific journals help ensure that
sound methods are appropriately utilized in the development of
guidelines They serve as a means of quality control a term which
also includes the transparency and repeatability of research
for independent verification the validity of the conclusions
and interpretations drawn from the reported data the overall
importance for advancement within the field of nutrition
and public health novelty as well as applicability The WHO
guideline development process calls for a systematic review
of the evidence related to a particular intervention undergoing
evaluation For micronutrient interventions technical staff
from NHD have prepared many of these systematic reviews
while WHO has commissioned the Cochrane Collaboration to
complete other reviews Other publications referred to vitamin
and mineral nutrition surveillance and research area related
to micronutrient interventions in public health As part of the
Cochrane pre-publication editorial process protocols and
reviews are commented on by external peers (an editor and
two referees external to the editorial team) and the grouprsquos
statistical adviser before publication httpwwwcochraneorg
The Cochrane handbook for systematic reviews of interventions
describes in detail the process of preparing and maintaining
Cochrane systematic reviews on the effects of healthcare
interventions
Disclaimer The authors in bold are staff members of the
World Health Organization The authors alone are responsible
for the views expressed in this publication and they do not
necessarily represent the decisions or policies of the World
Health Organization
Andersson M de Benoist B Rogers L Epidemiology of iodine
deficiency Salt iodisation and iodine status Best Practice amp
Research Clinical Endocrinology amp Metabolism 2010 Feb
24(1)1-11 httpwwwncbinlmnihgovpubmed20172466
Palacios C Pentildea-Rosas JP Calcium supplementation during
pregnancy for preventing hypertensive disorders and related
problems RHL commentary (last revised 1 February 2010)
The WHO Reproductive Health Library Geneva World Health
Organization httpappswhointrhlpregnancy_childbirth
antenatal_carenutritioncd001059_penasrosasjp_comen
indexhtml
Serdula M Pentildea-Rosas JP Maberly GF Aburto NJ Perrine
CG Mei Z (eds) Flour fortification with iron folic acid vitamin
B12 vitamin A and zinc Proceedings of the Second Technical
Workshop on Wheat Flour Fortification Food and Nutrition
Bulletin vol 31 no 1 (supplement) United Nations University
Press 2010 httpwwwfoodandnutritionbulletinorg
downloadsFNB_v31n1_suppl_webpdf
Bojorquez-Chapela I Mendoza-Flores ME Morales RM
Tolentino MC De-Regil LM Risky eating behaviours are
not associated with micronutrients deficiencies in women
from Mexico City (Spanish) Archivos Latinoamericanos
de Nutricioacuten 201060(1)64-69 httpwwwncbinlmnih
govpubmedterm=Bojorquez-Chapela20I2C2020
Mendoza-Flores20ME2C20Morales20RM2C20
Tolentino20MC2C20De-Regil20LM
De-Regil LM Jamous O Mendoza-Flores ME Morales RM
Tolentino MC Casanueva E Perception of menstrual bleeding
and its asociacioacuten with iron folate and vitamin B12 deficiencies
in women of reproductive age from Mexico City (Spanish)
Anales Venezolanos de Nutricioacuten 201023 (1) 5-9 http
analesfundacionbengoaorganales-nutricion20101i=art1
Pentildea-Rosas JP Rogers LM De-Regil LM Bopardikar A
Panisset U WHO from Research to Action Developing evidence-
informed guidelines and policies for interventions in vitamin and
mineral nutrition (abstract) Evidence in multiple micronutrient
nutrition from history to science to effective programs Public
Health Nutrition 2010 Sept13(9A)17
De-Regil LM Fernaacutendez-Gaxiola AC Dowswell T Pentildea-
Rosas JP Effects and safety of periconceptional folate
supplementation for preventing birth defects Cochrane
Database of Systematic Reviews 2010 (Issue 10) Art No
CD007950 DOI 10100214651858CD007950pub2
httponlinelibrarywileycomdoi10100214651858
CD007950pub2pdf Available in Spanish at httpwww
bibliotecacochranecomBCPGetDocumentaspSessionID=36
22858ampDocumentID=CD007950
Ansary A Palacios C De-Regil LM Pentildea-Rosas JP Vitamin
D supplementation for women during pregnancy [Protocol]
Cochrane Database of Systematic Reviews 2010 Issue 12 Art
No CD008873 DOI 10100214651858CD008873
httponlinelibrarywileycomdoi10100214651858
CD008873pdf
2
Micronutrients 2010-2011Department of Nutrition for Health and Development
5DRAFT
Vist GE Suchdev PS De-Regil LM Walleser S Pentildea-Rosas JP
Home fortification of foods with multiple micronutrient powders
for health and nutrition in children under 2 years of age [Protocol]
Cochrane Database of Systematic Reviews 2011 Issue 1 Art
No CD008959 DOI 10100214651858CD008959 http
onlinelibrarywileycomdoi10100214651858CD008959pdf
Sylvetsky AC Jefferds MED De-Regil LM Dowswell T Intermittent
iron supplementation for improving nutrition and developmental
outcomes in children [Protocol] Cochrane Database of
Systematic Reviews 2011 Issue 4 Art No CD009085 DOI
10100214651858CD009085 httponlinelibrarywileycom
doi10100214651858CD009085pdf
Fernaacutendez-Gaxiola AC De-Regil LM Nasser M Intermittent
iron supplementation for reducing anaemia and its associated
impairments in menstruating women [Protocol] Cochrane
Database of Systematic Reviews 2011 Issue 7 Art No
CD009218 DOI 10100214651858CD009218 http
onlinelibrarywileycomdoi10100214651858CD009218pdf
De-Regil LM Suchdev PS Vist GE Walleser S Pentildea-Rosas
JP Home fortification of foods with multiple micronutrient
powders for health and nutrition in children under two years
of age Cochrane Database of Systematic Reviews 2011
Sep 79CD008959 httpwwwupdate-softwarecomBCP
WileyPDFENCD008959pdf Available in Spanish here
Summary in Portuguese here
Wong EM Sullivan KM Perrine CG Rogers LM Pentildea-Rosas
JP Comparison of median urinary iodine concentration as an
indicator of iodine status among pregnant women school-age
children and nonpregnant women Food and Nutrition Bulletin
Volume 32 Number 3 September 2011 pp 206-212(7)
httpwwwncbinlmnihgovpubmedterm=wong20pena-rosas20jp20
Suchdev PS De-Regil LM Walleser S Vist GE Pentildea-Rosas
JP Multiple micronutrient powders for home (point of use)
fortification of foods in pregnant women a systematic review
WHO e-Library of Evidence for Nutrition Actions Geneva
World Health Organization 2011 httpwhqlibdocwhoint
publications20119789241502559_engpdf
De-Regil LM Jefferds MED Sylvetsky AC Dowswell T
Intermittent iron supplementation for improving nutrition and
development in children under 12 years of age Cochrane
Database of Systematic Reviews 2011 Issue 12 Art No
CD009085 DOI 10100214651858CD009085pub2
httponlinelibrarywileycomdoi10100214651858
CD009085pub2pdf Available in Spanish here
Fernaacutendez-Gaxiola AC De-Regil LM Intermittent iron
supplementation for reducing anaemia and its associated
impairments in menstruating women Cochrane Database of Systematic Reviews 2011 Issue 12 Art No CD009218 DOI
10100214651858CD009218pub2 httponlinelibrary
wileycomdoi10100214651858CD009218pub2pdf
Available in Spanish at httpwwwbibliotecacochranecom
BCPGetDocumentaspSessionID=3622858ampDocumentID=
CD009218
De-Regil LM Palacios C Ansary A Kulier R Pentildea-Rosas
JP Vitamin D supplementation for women during pregnancy
Cochrane Database of Systematic Reviews 2012 Issue 2
Art No CD008873 DOI 10100214651858CD008873
pub2 httponlinelibrarywileycomdoi10100214651858
CD008873pub2pdf
Home fortification of foods with multiple micronutrient
powders for health and nutrition in children under two years
of age (Review)
De-Regil LM Suchdev PS Vist GE Walleser S Pentildea-Rosas JP
This is a reprint of a Cochrane review prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2011 Issue 9httpwwwthecochranelibrarycom
Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age (Review)
Copyright copy 2011 The Cochrane Collaboration Published by John Wiley amp Sons Ltd
Intermittent iron supplementation for reducing anaemia and
its associated impairments in menstruating women (Review)Fernaacutendez-Gaxiola AC De-Regil LM
This is a reprint of a Cochrane review prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2011 Issue 12
httpwwwthecochranelibrarycom
Intermittent iron supplementation for reducing anaemia and its associated impairments in menstruating women (Review)
Copyright copy 2011 The Cochrane Collaboration Published by John Wiley amp Sons Ltd
Micronutrients 2010-2011Department of Nutrition for Health and Development
6DRAFT
TECHNICAL REPORTS
Disclaimer These technical reports contain discussions and presentation from the meetings and do
not necessarily represent the decisions or policies of the World Health Organization Similarly they may
contain background papers commissioned for these meetings The named authors alone are responsible
for the views expressed in this publication
WHO Technical consultation on neonatal vitamin A supplementation research priorities meeting report
Geneva World Health Organization 2009 (httpwhqlibdocwhointpublications20099789241599597_
engpdf) Published in 2010
WHO Estimating appropriate levels of vitamins and minerals for food fortification programmes The WHO Intake
Monitoring Assessment and Planning Program (IMAPP) meeting report Geneva World Health Organization 2010
(httpwwwwhointnutritionpublicationsmicronutrients9789241599603pdf)
WHO Technical consultation on vitamin A in newborn health mechanistic studies Geneva World Health Organization
2012 (httpwhqlibdocwhointpublications20129789241503167_engpdf)
WHO MICRONUTRIENTS MAILING LIST
The WHO Micronutrients Mailing List was developed in order to allow subscribers to receive periodic information on WHOrsquos work
in the area of vitamins and minerals The list was established in 2009 with 990 subscribers There are currently over 3100
subscribers and the list continues to grow Anyone may subscribe to the list by sending an E-mail to micronutrientswhoint with
the following text in the subject and body of the message ldquoSUBSCRIBE MICRONUTRIENTS LISTrdquo
Who Technical
consulTaTion
on ViTamin a
in neWborn
healTh
mechanisTic
sTudies
REPORT
R E P O R T
WHO Me e t i n g O n es t i M at i n g ap p rO p r i ate Leve L s O f vi t a M i n s a n d Mi n e ra L s fO r fO O d fO r t i f i c at i O n prO gra M M e s tH e WHO int a ke MO n i tO r i n g as s e s s M e nt a n d pL a n n i n g prO gra M (iMapp)Ge n e va Sw i t ze r l a n d 22 Ju l y 2009
Micronutrients 2010-2011Department of Nutrition for Health and Development
7DRAFT
WHOrsquos publications and other resources that are produced in several
languages help to ensure that health information reaches those who need it
in the language they can understand This makes access to health information
both more equitable and effective Communicating in different languages
bridges gaps and fosters understanding between people It allows WHO to more
effectively guide public health practices reach out to audiences worldwide
and achieve better global health outcomes The six official languages of WHO
- Arabic Chinese English French Russian and Spanish - were established by
a 1978 World Health Assembly resolution turning multilingualism into a WHO
policy Since the adoption of a 1998 resolution all Governing bodies documents
and corporate materials have been made available online in all official languages
Many of the WHO publications in micronutrients have been translated into these languages Samples of the work on micronutrients
in the WHO official languages includes the translation of the website of the Vitamin and Mineral Nutrition Information System the
recent WHO evidence-informed guidelines in micronutrient interventions the WHOCDC logic model for micronutrient interventions
and summaries of the indicators used in assessing vitamin and mineral nutritional status Efforts will be made in making more
resources available in the six WHO official languages
1 MULTILINGUALISM3
Micronutrients 2010-2011Department of Nutrition for Health and Development
8DRAFT
The WHO Vitamin and Mineral Nutrition Information System (VMNIS) was initially established in 1991 and has now been expanded
into a more comprehensive vitamin and mineral nutrition information system Evaluations of epidemiological and informatics
capabilities of the system in 2009 guided the upgrade and expansion of VMNIS to include a more comprehensive micronutrients
database and additional resources and tools for vitamin and mineral nutrition surveillance by Member States and their partners as
well as the incorporation and utilization of advances in information technology to disseminate the information A new website is now
online for VMNIS that includes the following sections 1) micronutrients database 2) indicators 3) laboratory capacity 4) monitoring
and evaluation and 5) publications The website is now available in all six WHO official languages
The Micronutrients Database of the VMNIS is now upgraded and expanded This process is occurring in three phases two of which
are already completed During phase I the database was restructured to make it more efficient exploit new innovations in information
technology and include more nutritional indicators In collaboration with the Information Technology and Telecommunications Unit
of WHO and with support from CDC partners from the Office of Informatics and Information Resources Management and other
colleagues from the National Center for Chronic Disease Prevention and Health Promotion the new database platform is functioning
During phase II -data migration- all the survey information available from the previous database and an additional systematic
search for data that included scientific literature and communication with WHO Regional Offices relevant UN agencies and other
partner organizations to solicit information on nutritionmicronutrient surveys was included Additionally all surveys reports have
been digitalized to make an electronic repository instead of paper printed documents Phase III data display is expected to be
completed in 2012 and will allow users to create maps tables and access data directly from the internet
The Indicators section includes information on the biomarkers used in assessing vitamin and
mineral status in populations and used in surveys collected in VMNIS
These documents are a compilation of current WHO recommendations on the topic from different sources They summarize the
currently recognized cut-offs for defining deficiencies and their severity at the individual and population level and the chronology of
their establishment These are not new or updated recommendations but compilations of existing guidelines that were dispersed
in several WHO references and reports These summaries that are available in the six WHO official languages will serve as a
starting point for updating current recommendations on the use of these indicators
Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity
Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations
Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations
The Monitoring and Evaluation section of the VMNIS contains resources that can be useful
for monitoring andor evaluating interventions that have a focus on outcomes related to vitamin
and mineral nutrition Notable are the following
The WHOCDC logic model for micronutrient interventions in public health depicts the programme theory and plausible
relationships between inputs and expected MDGs and can be adapted to different contexts Member States can
adjust this proposed generic logic model and use it as part of the continuous quality improvement cycle for planning
performance measurement or evaluation
The WHOCDC indicators e-Catalogue for micronutrient interventions platform has been completed and it intends to be
an up-to-date interactive user-friendly and comprehensive resource of indicators for those who are actively engaged in
providing technical assistance in evaluation of micronutrient interventions There is considerable variation in indicators
used to define micronutrient deficiency limiting comparability across programs and over time
Anaemia is a condition in which the number of red blood cells (and
consequently their oxygen-carrying capacity) is insufficient to meet the
bodyrsquos physiologic needs Specific physiologic needs vary with a personrsquos
age gender residential elevation above sea level (altitude) smoking
behaviour and different stages of pregnancy Iron deficiency is thought to
be the most common cause of anaemia globally but other nutritional
deficiencies (including folate vitamin B12 and vitamin A) acute and chronic
inflammation parasitic infections and inherited or acquired disorders that
affect haemoglobin synthesis red blood cell production or red blood cell
survival can all cause anaemia Haemoglobin concentration alone cannot
be used to diagnose iron deficiency However the concentration of
haemoglobin should be measured even though not all anaemia is caused
by iron deficiency The prevalence of anaemia is an important health
indicator and when it is used with other measurements of iron status the
haemoglobin concentration can provide information about the severity of
iron deficiency (1)
Inside
Background
Scope and purpose This document aims to provide users of the Vitamin and Mineral Nutrition
Information System (VMNIS) with information about the use of
haemoglobin concentration for diagnosing anaemia It is a compilation of
current World Health Organization (WHO) recommendations on the topic
and summarizes the cut-offs for defining anaemia and its severity at the
population level as well as the chronology of their establishment
The use of the cut-off points derived from the referenced publications
permits the identification of populations at greatest risk of anaemia and
priority areas for action especially when resources are limited They also
facilitate the monitoring and assessment of progress towards international
goals of preventing and controlling iron deficiency and further provide the
basis for advocacy for the prevention of anaemia
Haemoglobin concentrations for the diagnosis of anaemia and
assessment of severity
VMNIS | Vitamin and Mineral Nutrition Information System
WHONMHNHDMNM111 Background 1
Description of technical consultation 2
Recommendations 3
Summary development
Acknowledgements 5
Plans for update 5
References 6
4
Scope and purpose 1
VMNIS | 1
4
Retinol is the predominant circulating form of vitamin A in the blood In
response to tissue demand it is released from the liver in a 11 ratio with its
carrier protein retinol-binding protein (1) In the blood this complex
combines with transthyretin (2) Specific receptors on target cell surfaces or
nuclei bind this complex or its active metabolites thereby regulating many
critical functions in the body including vision epithelial tissue integrity
and the expression of several hundred genes (2) Serum retinol levels reflect
liver vitamin A stores only when they are severely depleted (lt 007 micromolg
liver) or extremely high (gt 105 micromolg liver) (1) Between these extremes
serum retinol is homeostatically controlled and thus not always correlated
with vitamin A intake or clinical signs of deficiency Consequently serum
retinol is not useful for assessing the vitamin A status of individuals and
may not respond to interventions Rather the distribution of serum retinol
values in a population and the prevalence of individuals with serum retinol
values below a given cut-off can provide important information on the
vitamin A status of a population and may reflect the severity of vitamin A
deficiency as a public health problem (3) especially when the degree of
underlying infection or inflammation is taken into account Serum retinol
values are most often measured in young children a group highly
vulnerable to deficiency (3) Deficiency of vitamin A is associated with significant morbidity and
mortality from common childhood infections and is the worldrsquos leading
preventable cause of childhood blindness (3)
Inside
Background
Scope and Purpose This document aims to provide users of the Vitamin and Mineral Nutrition
Information System (VMNIS) with information about the use of serum
retinol for assessing the prevalence of vitamin A deficiency in populations
It is a compilation of the current World Health Organization (WHO)
recommendations on the topic and summarizes from the three documents
VMNIS | Vitamin and Mineral Nutrition Information System Background
1
Description of Technical Consultation 2
Recommendations 2
Summary Development
Acknowledgements 4
Plans for Update 4
References 5
4
Scope and Purpose 1
VMNIS | 1
Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations
WHONMHNHDMNM113
Iron stores in the body exist primarily in the form of ferritin The ferritin
molecule is an intracellular hollow protein shell composed of 24 subunits
surrounding an iron core that may contain as many as 4000-4500 iron
atoms In the body small amounts of ferritin are secreted into the plasma
The concentration of this plasma (or serum) ferritin is positively correlated
with the size of the total body iron stores in the absence of inflammation A
low serum ferritin value reflects depleted iron stores but not necessarily
the severity of the depletion as it progresses
Normal ferritin concentrations vary by age and sex Concentrations are
high at birth rise during the first two months of life and then fall
throughout later infancy (1) At about one year of age concentrations
begin to rise again and continue to increase into adulthood (2) Beginning
in adolescence however males have higher values than females a trend
that persists into late adulthood Values among men peak between 30ndash39
years of age and then tend to remain constant until about 70 years of age
Among women serum ferritin values remain relatively low until
menopause and then rise (2)
Body ferritin levels in contrast to haemoglobin are not affected by
residential elevation above sea level or smoking behaviour However
ferritin is a positive acute phase response protein whereby concentrations
increase during inflammation and thereby no longer reflect the size of the
iron store This makes the interpretation of normal or high serum ferritin
values difficult in areas of widespread infection or inflammation (3) In the
absence of inflammation or liver disease high serum ferritin concentrations
indicate iron overload
Inside
Background
Serum ferritin concentrations
for the assessment of iron
status and iron deficiency in
populations
Background
1
Description of
Technical Consultation 2
Recommendations 2
Summary
Development
Acknowledgements 5
Plans for Update 5
VMNIS | Vitamin and Mineral Nutrition Information System
References
5
WHONMHNHDMNM112
5
VMNIS | 1
Scope and Purpose
2
VITAMIN AND MINERAL NUTRITION INFORMATION SYSTEM
Micronutrients 2010-2011Department of Nutrition for Health and Development
9DRAFT
Ideally dissemination and wide-spread use of the WHOCDC indicators eCatalogue will increase the standardization
of indicators and increase consistency and comparability across programmes A Technical Consultation ldquoldquoInventory of
indicators for monitoring and evaluation of micronutrient interventionsrdquo was held in Atlanta United States of America
in 6-7 January 2010 The objectives were to fine tune the details of the logic model for monitoring and evaluation of
micronutrient interventions refine search criteria and to validate the usefulness of the indicators web-tool The team is
currently working in the compilation of these indicators using the logic model as a framework to organizing the different
types of indicators currently used in public health programmes involving micronutrient interventions
Micronutrients 2010-2011Department of Nutrition for Health and Development
10
MAIN
Dr Francesco Branca is the Director of
the Department of Nutrition for Health and
Development in the World Health Organization
Geneva He graduated in Medicine and Surgery
and specialized in Diabetology and Metabolic
Diseases at the Universitarsquo Cattolica del Sacro
Cuore Roma He obtained a PhD in Nutrition at
Aberdeen University He was a Senior Scientist
at the Italian Food and Nutrition research
Institute where he was responsible for the
design and implementation of several studies
on the effects of food and nutrients on human
health at the different stages of the life cycle
and for the design management and evaluation
of public health nutrition programmes He
was been President of the Federation of the
European Nutrition Societies in 2003-2007
Dr JP Pena-Rosas is the Coordinator Evidence
and Programme Guidance Department of
Nutrition for Health and Development at the
World Health Organization (WHO) in Geneva
Switzerland He joined WHO on July 2008 and
now oversees the Evidence and Programme
Guidance workplan in the development of
evidence-informed guidelines for interventions
addressing the double burden of malnutrition
for neonates infants children and women in
stable and emergency settings under the WHO
Research Strategy umbrella He is an Adjunct
Assistant Professor at Emory University Rollins
School of Public Health in Atlanta United States
since 2011 Previously he worked several
years in the Division of Nutrition Physical
Activity and Obesity at the Centers for Disease
Control and Prevention (CDC) in Atlanta United
States He was involved in nutrition surveys
and programme monitoring and evaluation for
nutrition interventions in Uzbekistan Morocco
Egypt Peru Nicaragua Georgia and Dominican
Republic In the private sector Dr Pena-Rosas
worked at Kellogg Company Latin America
and the Caribbean Headquarters where he
served several positions including Manager of
Scientific and Regulatory Affairs for the regional
operations He received his Medical Degree from
Universidad Central de Venezuela in his native
country and a Masterrsquos Degree in Public Health
Nutrition from University of Puerto Rico in San
Juan He holds a PhD in Human Nutrition and
Epidemiology from Cornell University Ithaca NY
United States of America He is a member of the
American Society for Nutrition Latin American
Society of Nutrition the American Evaluation
Association the Cochrane Collaboration and
the WHO Guidelines Review Committee
Dr Lisa Rogers is the technical officer for
the Evidence and Programme Guidance Unit
in the Department of Nutrition for Health and
Development She has been working at the
World Health Organization (WHO) in Geneva
Switzerland since April 2006 She is primarily
responsible for managing a grant for mechanistic
studies on neonatal vitamin A supplementation
and coordinating the completion of evidence
reviews and guideline groups to inform vitamin
and mineral intervention guidelines She holds
a PhD in Nutrition on International Nutrition
from the University of California Davis United
States of America Her work included research
in Guatemala investigating the causes of vitamin
B12 deficiency in school age children and
laboratory research involving the optimization of
an immunological assay for holotranscobalamin
II and the analysis of methylmalonic acid
homocysteine vitamin B12 and folate She
received a Master of Science in Nutritional
Sciences from the University of Florida where
she conducted research involving the analysis of
the stability of folic acid added to cereal-grain
products the bioavailability of stable-isotopically
labeled folic acid added to these products and
conducted several human subject studies She
is a member of the American Society for Nutrition
and the Academy of Nutrition and Dietetics
Dr Luz Maria De-Regil is epidemiologist at the
World Health Organization with the Evidence
and Programme Guidance Unit since September
2009 She is responsible for coordinating the
development of global guidelines on nutrition
interventions for different age groups and
settings updating and expanding the Vitamin and
Mineral Nutrition Information System (VMNIS)
developing tools for monitoring and evaluation
of nutrition interventions leading international
and multidisciplinary review teams to assess the
evidence and translating knowledge into global
public policy With more than 50 publications in
5 OUR TEAM
Micronutrients 2010-2011Department of Nutrition for Health and Development
11DRAFT
English and Spanish for different audiences Luz Maria has been involved in community programmes and designed and implemented
research focused on maternal and infant nutrition and health She has experience in applying in vitro and in vivo laboratory techniques
in combination with food science and epidemiology She is an active member of the WHO Research and Ethics Committee the
GRADE working group four groups within the Cochrane Collaboration the American Society for Nutrition the Latin American
Society of Nutrition the Mexican Pediatric Research Association and a former vice-president of the Mexican Society of Nutrition
Ms Grace Rob is a technical assistant in the Evidence and Programme Guidance Unit department of Nutrition for Health and
Development She has been working at the World Health Organization (WHO) in Geneva Switzerland since 2000 She holds a
Bachelors of Science in Home Economics major in food and nutrition and minor in business administration from University of
Eastern Africa Baraton Eldoret in her native Kenya
Mrs Paule Pillard is the Assistant to Coordinator in the Evidence and Programme Guidance Unit Department of Nutrition for Health
and Development and provides administrative support to the coordinator and the unit staff since 2007
Micronutrients 2010-2011Department of Nutrition for Health and Development
12DRAFT
NEONATAL VITAMIN A SUPPLEMENTATION MECHANISTIC STUDIES
There is considerable interest in vitamin A supplementation during the neonatal period as an intervention for reducing infant
mortality The efficacy of this intervention is still to be determined NHD along with the Department of Maternal Newborn Child
and Adolescent Health (MCA) have received funding to conduct studies for the generation of evidence to inform global policy on
the efficacy of neonatal vitamin A supplementation in improving child survival In support of uncovering biological mechanisms
by which neonatal vitamin A supplementation may be acting NHD is coordinating the conduct of one animal study and two human
studies to understand the biological mechanisms through which neonatal vitamin A supplementation can potentially have an
impact on infant survival when given at birth The animal study is being conducted at the University of Wisconsin-Madison USA
(PI S Tanumihardjo) and is using the sow-piglet dyad model The two human studies are double blind randomized controlled
trials to determine the effect of vitamin A supplementation on immune responses in early infancy One study is being conducted
in Bangladesh (n=300) by the USDA-ARS Western Human Nutrition Research Center University of California Davis CA USA (PI
C Stephensen) and the other in The Gambia (n=200) by the Medical Research Council London UK and Keneba Gambia (PI A
Prentice)
The three proposals were reviewed at a WHO Technical Consultation on Vitamin A in Newborn Health - Mechanistic Studies in
December 2009 Final proposals were approved by the WHO Ethics Review Committee (ERC) and the studies are now in progress
NUTRITION IMPACT MODEL-STUDY (NIMS)
This study is funded by a grant from The Bill amp Melinda Gates Foundation to the Harvard School of Public Health and aims to
develop empirically parameterize apply and make publicly available a policy-relevant analytical tool for estimating the health
impacts of undernutrition exposures and interventions
Representatives of the Department of Nutrition for Health and Development work closely with partners to select appropriate
exposure metrics and develop and apply statistical methods for sparse time-space data in order to estimate current levels and past
trends of anaemia and vitamin A deficiency
6 RESEARCH
Micronutrients 2010-2011Department of Nutrition for Health and Development
13DRAFT
The Department of Nutrition for Health and Development works closely with internal collaborators at WHO and with various external
organizations on topics related to micronutrients
COCHRANE COLLABORATION
Over 28000 contributors worldwide work together to help health care providers policy-makers patients their advocates and
carers make well-informed decisions about health care based on the best available research evidence by preparing updating
and promoting the accessibility of Cochrane Reviews ndash over 4600 so far published online in The Cochrane Library In 2010 the
Cochrane Database of Systematic Reviews achieved a top-10 ISI Impact Factor for an outstanding achievement The work of the
Cochrane Collaboration is internationally recognised as the benchmark for high-quality information about the effectiveness of
health care In January 2011 The Cochrane Collaboration was accepted as a Non-Governmental Organization in Official Relations
with the World Health Organization (WHO) the public health arm of the United Nations establishing formalised communication
between our two organisations
This collaboration supports the development of the WHO Library of Evidence for Nutrition Actions (eLENA) and grants open access
to all Member States For the work in micronutrients we have closely collaborated with the following Cochrane groups
Cochrane Editorial Unit (wwweditorial-unitcochraneorg)
Developmental Psychosocial and Learning Problems Group (wwwdplpgcochraneorg)
Infectious Diseases Group (wwwcidgcochraneorgenindexhtml)
Pregnancy and Childbirth Group (wwwpregnancycochraneorg)
Public Health Group (wwwphcochraneorg)
Our Department has also supported the update or undertake of systematic reviews within the following groups
HIVAIDS Group (hivcochraneorg)
Metabolic and Endocrine Disorders Group (wwwendoccochraneorg)
Neonatal Group (wwwneonatalcochraneorg)
Iberoamerican Cochrane Center (wwwcochranees)
GRADE WORKING GROUP
The Grading of Recommendations Assessment Development and Evaluation (GRADE) Working Group began in the year 2000
as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health
care The working group has developed a common sensible and transparent approach to grading the quality of evidence
and the strength of recommendations Many international organizations have provided input into the development of the
approach and have started using it
A representative of our team joined the working group in 2010 to discuss issues related to the normative work in
micronutrients at WHO
CENTERs fOR DIsEAsE CONTROL AND PREVENTION (CDC)
The International Micronutrient Malnutrition Prevention and Control (IMMPaCt) programme works with global partners to
contribute CDC skills and resources to eliminate vitamin and mineral deficiencies (micronutrient malnutrition) among vulnerable
populations throughout the world Established by the CDC in 2000 IMMPaCt focuses primarily on helping eliminate deficiencies in
iron vitamin A iodine and folate
Through a 2009-2014 agreement IMMPaCt supports WHO in various selected projects including providing technical assistance
and subject matter expertise to help design implement and maintain new and current micronutrient databases as well as assist
with processes promoting new WHO guidelines and recommendations
The CDC Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects provides the scientific and programmatic
expertise to build upon and strengthen global neural tube defect surveillance systems and expand the reach of global folic acid
fortification for neural tube defect prevention Expansion of global folic acid fortification efforts can have a significant impact on
infant mortality and childhood morbidity worldwide
7 OUR PARTNERS
Micronutrients 2010-2011Department of Nutrition for Health and Development
14DRAFT
CDCrsquos National Center on Birth Defects and Developmental Disabilities has developed a global initiative to significantly reduce infant
mortality and childhood morbidity resulting from the more than 300000 neural tube defects worldwide each year and contribute
to the achievement of United Nations Millennium Development Goal 4 help to meet the Global Health Initiative Child Health Goal
and support the 63rd World Health Assembly Resolution on Birth Defects
The initiative aims to expand the number of developing countries with mandatory folic acid fortification of high penetrance staples
and provide sustainable support of long-term interventions to eliminate folic acid-preventable neural tube defects worldwide CDC
works with WHO and others to support and advance country-level fortification efforts and to provide needed technical expertise for
surveillance of neural tube defects monitor fortification efforts and improve laboratory capacity on folate-preventable birth defects
THE MICRONUTRIENT INITIATIVE
The Micronutrient Initiative (MI) is an independent not-for-profit organization committed to promoting simple cost-effective
solutions to hidden hunger combat vitamin and mineral deficiency and developing innovative new solutions where needed based in
Ottawa Canada MI is working to end hidden hunger end vitamin and mineral deficiency by helping governments food producers
and partner organizations like WHO develop implement and monitor and evaluate innovative culturally appropriate and cost-
effective programmes to get essential vitamins and minerals to the people who need them most by providing technical and
financial assistance offering procurement and quality control services for highly specialized supplies and equipment needed to
prevent hidden hunger advocating for micronutrient programmes and educating government bodies around the world on policies
legislation and programs to ensure the sustained delivery of essential vitamins and minerals
THE EUNICE KENNEDy sHRIVER NATIONAL INsTITUTE Of CHILD HEALTH AND HUMAN DEVELOPMENT
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health
(NIH)US Department of Health and Human Services in collaboration with partners representing the breadth of the global food and
nutrition enterprise including WHO created the Biomarkers of Nutrition for Development (BOND) Program to meet the growing
need for discovery development and implementation of reliable and valid biomarkers to assess nutrient exposure status function
and effect Also with co-funding from the Bill amp Melinda Gates Foundation has developed the Iron and Malaria Project to address
the safe and effective use of iron interventions in areas of malaria burden Both projects have been done with involvement of and
in support of WHO work in the area of micronutrients
WHO NUTRITION GUIDANCE ExPERT ADVIsORy GROUP MEMBERs
Micronutrients
Ms Deena AlasfoorProfessor Beverley-Ann BiggsDr Heacutector Bourges RodriacuteguezProfessor Norm CampbellProfessor Susan Fairweather-Tait Dr Rafael Flores-AyalaProfessor Malik GoonewardeneDr Junsheng HuoDr Janet C KingDr Marzia Lazzerini Professor Malcolm E Molyneux Eng Wisam QarqashDr Mahdi Ramsan Mohamed Dr Daniel RaitenDr Meera ShekarDr Rebecca Joyce StoltzfusMs Carol TomDr David Tovey Mrs Vilma Qahoush TylerDr Gunn Elisabeth VistDr Emorn Wasantwisut
Monitoring and Evaluation
Dr Lindsay AllenDr Deborah AshDr France BeginDr Zulfiqar BhuttaDr Christine Clewes Professor Susan Fairweather-TaitDr Jonathan GorsteinDr Junsheng HuoDr Ibrahim MD KhatibDr Roland KupkaDr Christine PfeifferDr Rob JPM ScholtenDr Holger SchuumlnemannDr Ismaeumll Ngnieacute TeacutetaDr Emorn Wasantwisut
Vitamin A supplementation
Professor Hany Abdel-AleemProfessor Michael ClarkeDr Anna CoutsoudisDr M Monir HossainDr Jean HumphreyDr Yustina Anie IndriastutiDr Marzia LazzeriniDr Pavitra MohanDr Rintaro MoriDr A Catherine RossDr Isabella Sagoe-MosesDr Claudia SaundersDr Prak SophonnearyDr Charles StephensenDr Sherry TanumihardjoDr Khalid Yunis
Micronutrients 2010-2011Department of Nutrition for Health and Development
15DRAFT
INTERNsHIPs
WHO is committed to building future leaders in public health and WHOrsquos Internship Programme provides a wide range of
opportunities for graduate and post-graduate students to gain insight into the work of WHO Although WHO receives a large
number of intern applications each year only a limited number of places for internships are available Internships are available for
work in micronutrients at WHO for a minimum of 6 weeks and a maximum of 3 months to allow the internship to be both worthwhile
and effective The following selected interns were hosted by NHD during the biennium 2010-2011 to work on topics related to
micronutrients
Ms Alison Sylvetsky 7 June - 13 August 2010 - EMORY UNIVERSITY ATLANTA USA
Ms Aida Victoria Campos 1 March - 31 May 2010 - UNIVERSIDAD LA SALLE MExICO DF MExICO
Mrs Sarah Pedersen 14 June - 13 August 2010- CORNELL UNIVERSITY ITHACA NEW YORK USA
Mr Joseph Ashong1 March 2011 - 1 July 2011 - CORNELL UNIVERSITY ITHACA NEW YORK USA
Dr Saint-Rayn Pasricha 14 February 2011 - 17 June 2011 - UNIVERSITY OF MELBOURNE VICTORIA AUSTRALIA
Ms Ellie Souganidis 20 June 2011 - 12 August 2011 - JOHNS HOPKINS UNIVERSITY BALTIMORE MARYLAND USA
Mr Raheel Arif 15 August - 4 November 2011- UNIVERSITY OF THE SCIENCES PHILADELPHIA PENNSYLVANIA USA
ADVOCACy AND NETWORKs
Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource
allocation decisions within political economic and social systems and institutions Advocacy in WHO for vitamin and mineral
nutrition includes many activities such as media campaigns public speaking commissioning and publishing research as well as
participation in several groups and networks
Home Fortification Technical Advisory Group (HFTAG) (httpwwwgainhealthorghftag)
The Network For Sustained Elimination of Iodine Deficiency (httpwwwiodinenetworknet)
International Council for the Control of Iodine Deficiency Disorders (wwwicciddorg)
Rice Fortification Technical Group (httpwwwgainhealthorgriforg)
Global Alliance for Vitamin A (GAVA)
Flour Fortification Initiative (httpwwwsphemoryeduwheatflour)
International Zinc Nutrition Consultative Group (wwwizincgorg)
United Nations World Food Programme (httpwwwwfporg)
United Nations Childrenrsquos Fund (httpwwwuniceforg)
United Nations High Commissioner for Refugees (httpwwwunhcrorg)
Food and Agriculture Organization of the United Nations (httpwwwfaoorg)
The World Bank (httpwwwworldbankorg)
United Nations Standing Committee on Nutrition (httpwwwunscnorg)
Micronutrients 2010-2011Department of Nutrition for Health and Development
16DRAFT
WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients
during the biennium 2010-2011
US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms
project name Global prevention of non-communicable disease prevention and promotion of health
The Micronutrient Initiative (MI) wwwmicronutrientorg
project name e-Library of nutrition programme guidance
The Government of Luxembourghttpwwwetatlu
project name Support for the update and dissemination of evidence-based nutrition programme
The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg
project name Efficacy of newborn vitamin A supplementation in improving child survival
WHO also thanks the following organizations for their support through small grants
US Agency for International Development (USAID) httpwwwusaidgov
project name Update WHO evidence based position statements on relevant and priority micronutrient interventions
The Global Alliance for Improved Nutrition (GAIN)
httpwwwgainhealthorg
project name Systematic review of evidence of micronutrient interventions and management of moderate
malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification
project name Systematic review of evidence of rice fortification as a public health intervention and consultation on
rice fortification programs implementation
Harvard University
project name Nutrition impact model study (NIM Study)
Sight amp Life
httpwwwsightandlifeorg
project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System
MEMBERsHIPs
De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013
Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014
Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011
De-Regil LM GRADE working group 2010-present
WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs
Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for
Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2
February 2010 Geneva Switzerland
8 FINANCIAL SUPPORT
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
2DRAFT
1 EVIDENCE-INFORMED GUIDELINE DEVELOPMENT 3
Supplementation
Point-of-use fortification of foods
Others
2 SCIENTIFIC PUBLICATIONS AND REPORTS 4
Technical Reports
WHO micronutrients mailing list
3 MULTILINGUALISM 7
4 WHO VITAMIN AND MINERAL NUTRITION INFORMATION SYSTEM 8
5 OUR TEAM 10
6 RESEARCH 12
7 OUR PARTNERS 13
8 FINANCIAL SUPPORT 16
9 WHO MEETINGS 18
TABLE OF CONTENTS
Micronutrients 2010-2011Department of Nutrition for Health and Development
3DRAFT
1 EVIDENCE-INFORMED GUIDELINE DEVELOPMENT
A WHO guideline is any document containing WHO recommendations about health interventions whether they are clinical public
health or policy interventions A recommendation provides information about what policy-makers health-care providers or patients
should do It implies a choice between different interventions that have an impact on health and that have ramifications for the
use of resources As of 2009 all publications containing WHO recommendations are approved by the WHO Guidelines Review
Committee WHO has developed the evidence-informed recommendations for micronutrients interventions in public health using the
procedures outlined in the WHO Handbook for guideline development The steps in this process include (i) identification of priority
questions and outcomes (ii) evidence retrieval (iii) assessment and synthesis of the evidence (iv) formulation of recommendations
including research priorities and (v) planning for dissemination implementation impact evaluation and updating Using the Grading
of Recommendations Assessment Development and Evaluation (GRADE) methodology evidence profiles related to preselected
topics are prepared based on up-to-date systematic reviews During 2010-2011 WHO Headquarters updated or developed the
following guidelines on micronutrient interventions
SUPPLEMENTATION
Guideline Neonatal vitamin A supplementation
Guideline Vitamin A supplementation for infants 1ndash5 months of age
Guideline Vitamin A supplementation for infants and children 6-59 months of age
Guideline Vitamin A supplementation in pregnant women
Guideline Vitamin A supplementation in postpartum women
Guideline Vitamin A supplementation during pregnancy for reducing the risk of
mother-to-child transmission of HIV
Guideline Intermittent iron supplementation in preschool and school-age children
Guideline Intermittent iron and folic acid supplementation in menstruating women
Guideline Daily iron and folic acid supplementation in pregnant women (in press)
Guideline Intermittent iron and folic acid supplementation in non-anaemic
pregnant women (in press)
Guideline Calcium supplementation in pregnant women (in press)
Guideline Vitamin D supplementation in pregnant women (in press)
POINT-OF-USE FORTIFICATION OF FOODS
Guideline Use of multiple micronutrient powders for home fortification of foods consumed
by infants and children 6ndash23 months of age
Guideline Use of multiple micronutrient powders for home fortification of foods consumed
by pregnant women
OTHERS
WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia
Guideline Iron interventions in areas where malaria transmission occurs (in press)
These guidelines are available on the WHO website and the eLibrary of Evidence for Nutrition Actions
(wwwwhointelena)
1
Guideline
Vitamin A
supplementation in
infants 1ndash5 months of age
Guideline Vitamin A supplementation in pregnancy for reducing the risk of mother-to-child transmission of HIV
Guideline Vitamin A supplementation in postpartum women
Guideline
Vitamin A
supplementation in
infants and children
6ndash59 months of age
Micronutrients 2010-2011Department of Nutrition for Health and Development
4DRAFT
1 SCIENTIFIC PUBLICATIONS AND REPORTSPeer review and publication in scientific journals help ensure that
sound methods are appropriately utilized in the development of
guidelines They serve as a means of quality control a term which
also includes the transparency and repeatability of research
for independent verification the validity of the conclusions
and interpretations drawn from the reported data the overall
importance for advancement within the field of nutrition
and public health novelty as well as applicability The WHO
guideline development process calls for a systematic review
of the evidence related to a particular intervention undergoing
evaluation For micronutrient interventions technical staff
from NHD have prepared many of these systematic reviews
while WHO has commissioned the Cochrane Collaboration to
complete other reviews Other publications referred to vitamin
and mineral nutrition surveillance and research area related
to micronutrient interventions in public health As part of the
Cochrane pre-publication editorial process protocols and
reviews are commented on by external peers (an editor and
two referees external to the editorial team) and the grouprsquos
statistical adviser before publication httpwwwcochraneorg
The Cochrane handbook for systematic reviews of interventions
describes in detail the process of preparing and maintaining
Cochrane systematic reviews on the effects of healthcare
interventions
Disclaimer The authors in bold are staff members of the
World Health Organization The authors alone are responsible
for the views expressed in this publication and they do not
necessarily represent the decisions or policies of the World
Health Organization
Andersson M de Benoist B Rogers L Epidemiology of iodine
deficiency Salt iodisation and iodine status Best Practice amp
Research Clinical Endocrinology amp Metabolism 2010 Feb
24(1)1-11 httpwwwncbinlmnihgovpubmed20172466
Palacios C Pentildea-Rosas JP Calcium supplementation during
pregnancy for preventing hypertensive disorders and related
problems RHL commentary (last revised 1 February 2010)
The WHO Reproductive Health Library Geneva World Health
Organization httpappswhointrhlpregnancy_childbirth
antenatal_carenutritioncd001059_penasrosasjp_comen
indexhtml
Serdula M Pentildea-Rosas JP Maberly GF Aburto NJ Perrine
CG Mei Z (eds) Flour fortification with iron folic acid vitamin
B12 vitamin A and zinc Proceedings of the Second Technical
Workshop on Wheat Flour Fortification Food and Nutrition
Bulletin vol 31 no 1 (supplement) United Nations University
Press 2010 httpwwwfoodandnutritionbulletinorg
downloadsFNB_v31n1_suppl_webpdf
Bojorquez-Chapela I Mendoza-Flores ME Morales RM
Tolentino MC De-Regil LM Risky eating behaviours are
not associated with micronutrients deficiencies in women
from Mexico City (Spanish) Archivos Latinoamericanos
de Nutricioacuten 201060(1)64-69 httpwwwncbinlmnih
govpubmedterm=Bojorquez-Chapela20I2C2020
Mendoza-Flores20ME2C20Morales20RM2C20
Tolentino20MC2C20De-Regil20LM
De-Regil LM Jamous O Mendoza-Flores ME Morales RM
Tolentino MC Casanueva E Perception of menstrual bleeding
and its asociacioacuten with iron folate and vitamin B12 deficiencies
in women of reproductive age from Mexico City (Spanish)
Anales Venezolanos de Nutricioacuten 201023 (1) 5-9 http
analesfundacionbengoaorganales-nutricion20101i=art1
Pentildea-Rosas JP Rogers LM De-Regil LM Bopardikar A
Panisset U WHO from Research to Action Developing evidence-
informed guidelines and policies for interventions in vitamin and
mineral nutrition (abstract) Evidence in multiple micronutrient
nutrition from history to science to effective programs Public
Health Nutrition 2010 Sept13(9A)17
De-Regil LM Fernaacutendez-Gaxiola AC Dowswell T Pentildea-
Rosas JP Effects and safety of periconceptional folate
supplementation for preventing birth defects Cochrane
Database of Systematic Reviews 2010 (Issue 10) Art No
CD007950 DOI 10100214651858CD007950pub2
httponlinelibrarywileycomdoi10100214651858
CD007950pub2pdf Available in Spanish at httpwww
bibliotecacochranecomBCPGetDocumentaspSessionID=36
22858ampDocumentID=CD007950
Ansary A Palacios C De-Regil LM Pentildea-Rosas JP Vitamin
D supplementation for women during pregnancy [Protocol]
Cochrane Database of Systematic Reviews 2010 Issue 12 Art
No CD008873 DOI 10100214651858CD008873
httponlinelibrarywileycomdoi10100214651858
CD008873pdf
2
Micronutrients 2010-2011Department of Nutrition for Health and Development
5DRAFT
Vist GE Suchdev PS De-Regil LM Walleser S Pentildea-Rosas JP
Home fortification of foods with multiple micronutrient powders
for health and nutrition in children under 2 years of age [Protocol]
Cochrane Database of Systematic Reviews 2011 Issue 1 Art
No CD008959 DOI 10100214651858CD008959 http
onlinelibrarywileycomdoi10100214651858CD008959pdf
Sylvetsky AC Jefferds MED De-Regil LM Dowswell T Intermittent
iron supplementation for improving nutrition and developmental
outcomes in children [Protocol] Cochrane Database of
Systematic Reviews 2011 Issue 4 Art No CD009085 DOI
10100214651858CD009085 httponlinelibrarywileycom
doi10100214651858CD009085pdf
Fernaacutendez-Gaxiola AC De-Regil LM Nasser M Intermittent
iron supplementation for reducing anaemia and its associated
impairments in menstruating women [Protocol] Cochrane
Database of Systematic Reviews 2011 Issue 7 Art No
CD009218 DOI 10100214651858CD009218 http
onlinelibrarywileycomdoi10100214651858CD009218pdf
De-Regil LM Suchdev PS Vist GE Walleser S Pentildea-Rosas
JP Home fortification of foods with multiple micronutrient
powders for health and nutrition in children under two years
of age Cochrane Database of Systematic Reviews 2011
Sep 79CD008959 httpwwwupdate-softwarecomBCP
WileyPDFENCD008959pdf Available in Spanish here
Summary in Portuguese here
Wong EM Sullivan KM Perrine CG Rogers LM Pentildea-Rosas
JP Comparison of median urinary iodine concentration as an
indicator of iodine status among pregnant women school-age
children and nonpregnant women Food and Nutrition Bulletin
Volume 32 Number 3 September 2011 pp 206-212(7)
httpwwwncbinlmnihgovpubmedterm=wong20pena-rosas20jp20
Suchdev PS De-Regil LM Walleser S Vist GE Pentildea-Rosas
JP Multiple micronutrient powders for home (point of use)
fortification of foods in pregnant women a systematic review
WHO e-Library of Evidence for Nutrition Actions Geneva
World Health Organization 2011 httpwhqlibdocwhoint
publications20119789241502559_engpdf
De-Regil LM Jefferds MED Sylvetsky AC Dowswell T
Intermittent iron supplementation for improving nutrition and
development in children under 12 years of age Cochrane
Database of Systematic Reviews 2011 Issue 12 Art No
CD009085 DOI 10100214651858CD009085pub2
httponlinelibrarywileycomdoi10100214651858
CD009085pub2pdf Available in Spanish here
Fernaacutendez-Gaxiola AC De-Regil LM Intermittent iron
supplementation for reducing anaemia and its associated
impairments in menstruating women Cochrane Database of Systematic Reviews 2011 Issue 12 Art No CD009218 DOI
10100214651858CD009218pub2 httponlinelibrary
wileycomdoi10100214651858CD009218pub2pdf
Available in Spanish at httpwwwbibliotecacochranecom
BCPGetDocumentaspSessionID=3622858ampDocumentID=
CD009218
De-Regil LM Palacios C Ansary A Kulier R Pentildea-Rosas
JP Vitamin D supplementation for women during pregnancy
Cochrane Database of Systematic Reviews 2012 Issue 2
Art No CD008873 DOI 10100214651858CD008873
pub2 httponlinelibrarywileycomdoi10100214651858
CD008873pub2pdf
Home fortification of foods with multiple micronutrient
powders for health and nutrition in children under two years
of age (Review)
De-Regil LM Suchdev PS Vist GE Walleser S Pentildea-Rosas JP
This is a reprint of a Cochrane review prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2011 Issue 9httpwwwthecochranelibrarycom
Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age (Review)
Copyright copy 2011 The Cochrane Collaboration Published by John Wiley amp Sons Ltd
Intermittent iron supplementation for reducing anaemia and
its associated impairments in menstruating women (Review)Fernaacutendez-Gaxiola AC De-Regil LM
This is a reprint of a Cochrane review prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2011 Issue 12
httpwwwthecochranelibrarycom
Intermittent iron supplementation for reducing anaemia and its associated impairments in menstruating women (Review)
Copyright copy 2011 The Cochrane Collaboration Published by John Wiley amp Sons Ltd
Micronutrients 2010-2011Department of Nutrition for Health and Development
6DRAFT
TECHNICAL REPORTS
Disclaimer These technical reports contain discussions and presentation from the meetings and do
not necessarily represent the decisions or policies of the World Health Organization Similarly they may
contain background papers commissioned for these meetings The named authors alone are responsible
for the views expressed in this publication
WHO Technical consultation on neonatal vitamin A supplementation research priorities meeting report
Geneva World Health Organization 2009 (httpwhqlibdocwhointpublications20099789241599597_
engpdf) Published in 2010
WHO Estimating appropriate levels of vitamins and minerals for food fortification programmes The WHO Intake
Monitoring Assessment and Planning Program (IMAPP) meeting report Geneva World Health Organization 2010
(httpwwwwhointnutritionpublicationsmicronutrients9789241599603pdf)
WHO Technical consultation on vitamin A in newborn health mechanistic studies Geneva World Health Organization
2012 (httpwhqlibdocwhointpublications20129789241503167_engpdf)
WHO MICRONUTRIENTS MAILING LIST
The WHO Micronutrients Mailing List was developed in order to allow subscribers to receive periodic information on WHOrsquos work
in the area of vitamins and minerals The list was established in 2009 with 990 subscribers There are currently over 3100
subscribers and the list continues to grow Anyone may subscribe to the list by sending an E-mail to micronutrientswhoint with
the following text in the subject and body of the message ldquoSUBSCRIBE MICRONUTRIENTS LISTrdquo
Who Technical
consulTaTion
on ViTamin a
in neWborn
healTh
mechanisTic
sTudies
REPORT
R E P O R T
WHO Me e t i n g O n es t i M at i n g ap p rO p r i ate Leve L s O f vi t a M i n s a n d Mi n e ra L s fO r fO O d fO r t i f i c at i O n prO gra M M e s tH e WHO int a ke MO n i tO r i n g as s e s s M e nt a n d pL a n n i n g prO gra M (iMapp)Ge n e va Sw i t ze r l a n d 22 Ju l y 2009
Micronutrients 2010-2011Department of Nutrition for Health and Development
7DRAFT
WHOrsquos publications and other resources that are produced in several
languages help to ensure that health information reaches those who need it
in the language they can understand This makes access to health information
both more equitable and effective Communicating in different languages
bridges gaps and fosters understanding between people It allows WHO to more
effectively guide public health practices reach out to audiences worldwide
and achieve better global health outcomes The six official languages of WHO
- Arabic Chinese English French Russian and Spanish - were established by
a 1978 World Health Assembly resolution turning multilingualism into a WHO
policy Since the adoption of a 1998 resolution all Governing bodies documents
and corporate materials have been made available online in all official languages
Many of the WHO publications in micronutrients have been translated into these languages Samples of the work on micronutrients
in the WHO official languages includes the translation of the website of the Vitamin and Mineral Nutrition Information System the
recent WHO evidence-informed guidelines in micronutrient interventions the WHOCDC logic model for micronutrient interventions
and summaries of the indicators used in assessing vitamin and mineral nutritional status Efforts will be made in making more
resources available in the six WHO official languages
1 MULTILINGUALISM3
Micronutrients 2010-2011Department of Nutrition for Health and Development
8DRAFT
The WHO Vitamin and Mineral Nutrition Information System (VMNIS) was initially established in 1991 and has now been expanded
into a more comprehensive vitamin and mineral nutrition information system Evaluations of epidemiological and informatics
capabilities of the system in 2009 guided the upgrade and expansion of VMNIS to include a more comprehensive micronutrients
database and additional resources and tools for vitamin and mineral nutrition surveillance by Member States and their partners as
well as the incorporation and utilization of advances in information technology to disseminate the information A new website is now
online for VMNIS that includes the following sections 1) micronutrients database 2) indicators 3) laboratory capacity 4) monitoring
and evaluation and 5) publications The website is now available in all six WHO official languages
The Micronutrients Database of the VMNIS is now upgraded and expanded This process is occurring in three phases two of which
are already completed During phase I the database was restructured to make it more efficient exploit new innovations in information
technology and include more nutritional indicators In collaboration with the Information Technology and Telecommunications Unit
of WHO and with support from CDC partners from the Office of Informatics and Information Resources Management and other
colleagues from the National Center for Chronic Disease Prevention and Health Promotion the new database platform is functioning
During phase II -data migration- all the survey information available from the previous database and an additional systematic
search for data that included scientific literature and communication with WHO Regional Offices relevant UN agencies and other
partner organizations to solicit information on nutritionmicronutrient surveys was included Additionally all surveys reports have
been digitalized to make an electronic repository instead of paper printed documents Phase III data display is expected to be
completed in 2012 and will allow users to create maps tables and access data directly from the internet
The Indicators section includes information on the biomarkers used in assessing vitamin and
mineral status in populations and used in surveys collected in VMNIS
These documents are a compilation of current WHO recommendations on the topic from different sources They summarize the
currently recognized cut-offs for defining deficiencies and their severity at the individual and population level and the chronology of
their establishment These are not new or updated recommendations but compilations of existing guidelines that were dispersed
in several WHO references and reports These summaries that are available in the six WHO official languages will serve as a
starting point for updating current recommendations on the use of these indicators
Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity
Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations
Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations
The Monitoring and Evaluation section of the VMNIS contains resources that can be useful
for monitoring andor evaluating interventions that have a focus on outcomes related to vitamin
and mineral nutrition Notable are the following
The WHOCDC logic model for micronutrient interventions in public health depicts the programme theory and plausible
relationships between inputs and expected MDGs and can be adapted to different contexts Member States can
adjust this proposed generic logic model and use it as part of the continuous quality improvement cycle for planning
performance measurement or evaluation
The WHOCDC indicators e-Catalogue for micronutrient interventions platform has been completed and it intends to be
an up-to-date interactive user-friendly and comprehensive resource of indicators for those who are actively engaged in
providing technical assistance in evaluation of micronutrient interventions There is considerable variation in indicators
used to define micronutrient deficiency limiting comparability across programs and over time
Anaemia is a condition in which the number of red blood cells (and
consequently their oxygen-carrying capacity) is insufficient to meet the
bodyrsquos physiologic needs Specific physiologic needs vary with a personrsquos
age gender residential elevation above sea level (altitude) smoking
behaviour and different stages of pregnancy Iron deficiency is thought to
be the most common cause of anaemia globally but other nutritional
deficiencies (including folate vitamin B12 and vitamin A) acute and chronic
inflammation parasitic infections and inherited or acquired disorders that
affect haemoglobin synthesis red blood cell production or red blood cell
survival can all cause anaemia Haemoglobin concentration alone cannot
be used to diagnose iron deficiency However the concentration of
haemoglobin should be measured even though not all anaemia is caused
by iron deficiency The prevalence of anaemia is an important health
indicator and when it is used with other measurements of iron status the
haemoglobin concentration can provide information about the severity of
iron deficiency (1)
Inside
Background
Scope and purpose This document aims to provide users of the Vitamin and Mineral Nutrition
Information System (VMNIS) with information about the use of
haemoglobin concentration for diagnosing anaemia It is a compilation of
current World Health Organization (WHO) recommendations on the topic
and summarizes the cut-offs for defining anaemia and its severity at the
population level as well as the chronology of their establishment
The use of the cut-off points derived from the referenced publications
permits the identification of populations at greatest risk of anaemia and
priority areas for action especially when resources are limited They also
facilitate the monitoring and assessment of progress towards international
goals of preventing and controlling iron deficiency and further provide the
basis for advocacy for the prevention of anaemia
Haemoglobin concentrations for the diagnosis of anaemia and
assessment of severity
VMNIS | Vitamin and Mineral Nutrition Information System
WHONMHNHDMNM111 Background 1
Description of technical consultation 2
Recommendations 3
Summary development
Acknowledgements 5
Plans for update 5
References 6
4
Scope and purpose 1
VMNIS | 1
4
Retinol is the predominant circulating form of vitamin A in the blood In
response to tissue demand it is released from the liver in a 11 ratio with its
carrier protein retinol-binding protein (1) In the blood this complex
combines with transthyretin (2) Specific receptors on target cell surfaces or
nuclei bind this complex or its active metabolites thereby regulating many
critical functions in the body including vision epithelial tissue integrity
and the expression of several hundred genes (2) Serum retinol levels reflect
liver vitamin A stores only when they are severely depleted (lt 007 micromolg
liver) or extremely high (gt 105 micromolg liver) (1) Between these extremes
serum retinol is homeostatically controlled and thus not always correlated
with vitamin A intake or clinical signs of deficiency Consequently serum
retinol is not useful for assessing the vitamin A status of individuals and
may not respond to interventions Rather the distribution of serum retinol
values in a population and the prevalence of individuals with serum retinol
values below a given cut-off can provide important information on the
vitamin A status of a population and may reflect the severity of vitamin A
deficiency as a public health problem (3) especially when the degree of
underlying infection or inflammation is taken into account Serum retinol
values are most often measured in young children a group highly
vulnerable to deficiency (3) Deficiency of vitamin A is associated with significant morbidity and
mortality from common childhood infections and is the worldrsquos leading
preventable cause of childhood blindness (3)
Inside
Background
Scope and Purpose This document aims to provide users of the Vitamin and Mineral Nutrition
Information System (VMNIS) with information about the use of serum
retinol for assessing the prevalence of vitamin A deficiency in populations
It is a compilation of the current World Health Organization (WHO)
recommendations on the topic and summarizes from the three documents
VMNIS | Vitamin and Mineral Nutrition Information System Background
1
Description of Technical Consultation 2
Recommendations 2
Summary Development
Acknowledgements 4
Plans for Update 4
References 5
4
Scope and Purpose 1
VMNIS | 1
Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations
WHONMHNHDMNM113
Iron stores in the body exist primarily in the form of ferritin The ferritin
molecule is an intracellular hollow protein shell composed of 24 subunits
surrounding an iron core that may contain as many as 4000-4500 iron
atoms In the body small amounts of ferritin are secreted into the plasma
The concentration of this plasma (or serum) ferritin is positively correlated
with the size of the total body iron stores in the absence of inflammation A
low serum ferritin value reflects depleted iron stores but not necessarily
the severity of the depletion as it progresses
Normal ferritin concentrations vary by age and sex Concentrations are
high at birth rise during the first two months of life and then fall
throughout later infancy (1) At about one year of age concentrations
begin to rise again and continue to increase into adulthood (2) Beginning
in adolescence however males have higher values than females a trend
that persists into late adulthood Values among men peak between 30ndash39
years of age and then tend to remain constant until about 70 years of age
Among women serum ferritin values remain relatively low until
menopause and then rise (2)
Body ferritin levels in contrast to haemoglobin are not affected by
residential elevation above sea level or smoking behaviour However
ferritin is a positive acute phase response protein whereby concentrations
increase during inflammation and thereby no longer reflect the size of the
iron store This makes the interpretation of normal or high serum ferritin
values difficult in areas of widespread infection or inflammation (3) In the
absence of inflammation or liver disease high serum ferritin concentrations
indicate iron overload
Inside
Background
Serum ferritin concentrations
for the assessment of iron
status and iron deficiency in
populations
Background
1
Description of
Technical Consultation 2
Recommendations 2
Summary
Development
Acknowledgements 5
Plans for Update 5
VMNIS | Vitamin and Mineral Nutrition Information System
References
5
WHONMHNHDMNM112
5
VMNIS | 1
Scope and Purpose
2
VITAMIN AND MINERAL NUTRITION INFORMATION SYSTEM
Micronutrients 2010-2011Department of Nutrition for Health and Development
9DRAFT
Ideally dissemination and wide-spread use of the WHOCDC indicators eCatalogue will increase the standardization
of indicators and increase consistency and comparability across programmes A Technical Consultation ldquoldquoInventory of
indicators for monitoring and evaluation of micronutrient interventionsrdquo was held in Atlanta United States of America
in 6-7 January 2010 The objectives were to fine tune the details of the logic model for monitoring and evaluation of
micronutrient interventions refine search criteria and to validate the usefulness of the indicators web-tool The team is
currently working in the compilation of these indicators using the logic model as a framework to organizing the different
types of indicators currently used in public health programmes involving micronutrient interventions
Micronutrients 2010-2011Department of Nutrition for Health and Development
10
MAIN
Dr Francesco Branca is the Director of
the Department of Nutrition for Health and
Development in the World Health Organization
Geneva He graduated in Medicine and Surgery
and specialized in Diabetology and Metabolic
Diseases at the Universitarsquo Cattolica del Sacro
Cuore Roma He obtained a PhD in Nutrition at
Aberdeen University He was a Senior Scientist
at the Italian Food and Nutrition research
Institute where he was responsible for the
design and implementation of several studies
on the effects of food and nutrients on human
health at the different stages of the life cycle
and for the design management and evaluation
of public health nutrition programmes He
was been President of the Federation of the
European Nutrition Societies in 2003-2007
Dr JP Pena-Rosas is the Coordinator Evidence
and Programme Guidance Department of
Nutrition for Health and Development at the
World Health Organization (WHO) in Geneva
Switzerland He joined WHO on July 2008 and
now oversees the Evidence and Programme
Guidance workplan in the development of
evidence-informed guidelines for interventions
addressing the double burden of malnutrition
for neonates infants children and women in
stable and emergency settings under the WHO
Research Strategy umbrella He is an Adjunct
Assistant Professor at Emory University Rollins
School of Public Health in Atlanta United States
since 2011 Previously he worked several
years in the Division of Nutrition Physical
Activity and Obesity at the Centers for Disease
Control and Prevention (CDC) in Atlanta United
States He was involved in nutrition surveys
and programme monitoring and evaluation for
nutrition interventions in Uzbekistan Morocco
Egypt Peru Nicaragua Georgia and Dominican
Republic In the private sector Dr Pena-Rosas
worked at Kellogg Company Latin America
and the Caribbean Headquarters where he
served several positions including Manager of
Scientific and Regulatory Affairs for the regional
operations He received his Medical Degree from
Universidad Central de Venezuela in his native
country and a Masterrsquos Degree in Public Health
Nutrition from University of Puerto Rico in San
Juan He holds a PhD in Human Nutrition and
Epidemiology from Cornell University Ithaca NY
United States of America He is a member of the
American Society for Nutrition Latin American
Society of Nutrition the American Evaluation
Association the Cochrane Collaboration and
the WHO Guidelines Review Committee
Dr Lisa Rogers is the technical officer for
the Evidence and Programme Guidance Unit
in the Department of Nutrition for Health and
Development She has been working at the
World Health Organization (WHO) in Geneva
Switzerland since April 2006 She is primarily
responsible for managing a grant for mechanistic
studies on neonatal vitamin A supplementation
and coordinating the completion of evidence
reviews and guideline groups to inform vitamin
and mineral intervention guidelines She holds
a PhD in Nutrition on International Nutrition
from the University of California Davis United
States of America Her work included research
in Guatemala investigating the causes of vitamin
B12 deficiency in school age children and
laboratory research involving the optimization of
an immunological assay for holotranscobalamin
II and the analysis of methylmalonic acid
homocysteine vitamin B12 and folate She
received a Master of Science in Nutritional
Sciences from the University of Florida where
she conducted research involving the analysis of
the stability of folic acid added to cereal-grain
products the bioavailability of stable-isotopically
labeled folic acid added to these products and
conducted several human subject studies She
is a member of the American Society for Nutrition
and the Academy of Nutrition and Dietetics
Dr Luz Maria De-Regil is epidemiologist at the
World Health Organization with the Evidence
and Programme Guidance Unit since September
2009 She is responsible for coordinating the
development of global guidelines on nutrition
interventions for different age groups and
settings updating and expanding the Vitamin and
Mineral Nutrition Information System (VMNIS)
developing tools for monitoring and evaluation
of nutrition interventions leading international
and multidisciplinary review teams to assess the
evidence and translating knowledge into global
public policy With more than 50 publications in
5 OUR TEAM
Micronutrients 2010-2011Department of Nutrition for Health and Development
11DRAFT
English and Spanish for different audiences Luz Maria has been involved in community programmes and designed and implemented
research focused on maternal and infant nutrition and health She has experience in applying in vitro and in vivo laboratory techniques
in combination with food science and epidemiology She is an active member of the WHO Research and Ethics Committee the
GRADE working group four groups within the Cochrane Collaboration the American Society for Nutrition the Latin American
Society of Nutrition the Mexican Pediatric Research Association and a former vice-president of the Mexican Society of Nutrition
Ms Grace Rob is a technical assistant in the Evidence and Programme Guidance Unit department of Nutrition for Health and
Development She has been working at the World Health Organization (WHO) in Geneva Switzerland since 2000 She holds a
Bachelors of Science in Home Economics major in food and nutrition and minor in business administration from University of
Eastern Africa Baraton Eldoret in her native Kenya
Mrs Paule Pillard is the Assistant to Coordinator in the Evidence and Programme Guidance Unit Department of Nutrition for Health
and Development and provides administrative support to the coordinator and the unit staff since 2007
Micronutrients 2010-2011Department of Nutrition for Health and Development
12DRAFT
NEONATAL VITAMIN A SUPPLEMENTATION MECHANISTIC STUDIES
There is considerable interest in vitamin A supplementation during the neonatal period as an intervention for reducing infant
mortality The efficacy of this intervention is still to be determined NHD along with the Department of Maternal Newborn Child
and Adolescent Health (MCA) have received funding to conduct studies for the generation of evidence to inform global policy on
the efficacy of neonatal vitamin A supplementation in improving child survival In support of uncovering biological mechanisms
by which neonatal vitamin A supplementation may be acting NHD is coordinating the conduct of one animal study and two human
studies to understand the biological mechanisms through which neonatal vitamin A supplementation can potentially have an
impact on infant survival when given at birth The animal study is being conducted at the University of Wisconsin-Madison USA
(PI S Tanumihardjo) and is using the sow-piglet dyad model The two human studies are double blind randomized controlled
trials to determine the effect of vitamin A supplementation on immune responses in early infancy One study is being conducted
in Bangladesh (n=300) by the USDA-ARS Western Human Nutrition Research Center University of California Davis CA USA (PI
C Stephensen) and the other in The Gambia (n=200) by the Medical Research Council London UK and Keneba Gambia (PI A
Prentice)
The three proposals were reviewed at a WHO Technical Consultation on Vitamin A in Newborn Health - Mechanistic Studies in
December 2009 Final proposals were approved by the WHO Ethics Review Committee (ERC) and the studies are now in progress
NUTRITION IMPACT MODEL-STUDY (NIMS)
This study is funded by a grant from The Bill amp Melinda Gates Foundation to the Harvard School of Public Health and aims to
develop empirically parameterize apply and make publicly available a policy-relevant analytical tool for estimating the health
impacts of undernutrition exposures and interventions
Representatives of the Department of Nutrition for Health and Development work closely with partners to select appropriate
exposure metrics and develop and apply statistical methods for sparse time-space data in order to estimate current levels and past
trends of anaemia and vitamin A deficiency
6 RESEARCH
Micronutrients 2010-2011Department of Nutrition for Health and Development
13DRAFT
The Department of Nutrition for Health and Development works closely with internal collaborators at WHO and with various external
organizations on topics related to micronutrients
COCHRANE COLLABORATION
Over 28000 contributors worldwide work together to help health care providers policy-makers patients their advocates and
carers make well-informed decisions about health care based on the best available research evidence by preparing updating
and promoting the accessibility of Cochrane Reviews ndash over 4600 so far published online in The Cochrane Library In 2010 the
Cochrane Database of Systematic Reviews achieved a top-10 ISI Impact Factor for an outstanding achievement The work of the
Cochrane Collaboration is internationally recognised as the benchmark for high-quality information about the effectiveness of
health care In January 2011 The Cochrane Collaboration was accepted as a Non-Governmental Organization in Official Relations
with the World Health Organization (WHO) the public health arm of the United Nations establishing formalised communication
between our two organisations
This collaboration supports the development of the WHO Library of Evidence for Nutrition Actions (eLENA) and grants open access
to all Member States For the work in micronutrients we have closely collaborated with the following Cochrane groups
Cochrane Editorial Unit (wwweditorial-unitcochraneorg)
Developmental Psychosocial and Learning Problems Group (wwwdplpgcochraneorg)
Infectious Diseases Group (wwwcidgcochraneorgenindexhtml)
Pregnancy and Childbirth Group (wwwpregnancycochraneorg)
Public Health Group (wwwphcochraneorg)
Our Department has also supported the update or undertake of systematic reviews within the following groups
HIVAIDS Group (hivcochraneorg)
Metabolic and Endocrine Disorders Group (wwwendoccochraneorg)
Neonatal Group (wwwneonatalcochraneorg)
Iberoamerican Cochrane Center (wwwcochranees)
GRADE WORKING GROUP
The Grading of Recommendations Assessment Development and Evaluation (GRADE) Working Group began in the year 2000
as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health
care The working group has developed a common sensible and transparent approach to grading the quality of evidence
and the strength of recommendations Many international organizations have provided input into the development of the
approach and have started using it
A representative of our team joined the working group in 2010 to discuss issues related to the normative work in
micronutrients at WHO
CENTERs fOR DIsEAsE CONTROL AND PREVENTION (CDC)
The International Micronutrient Malnutrition Prevention and Control (IMMPaCt) programme works with global partners to
contribute CDC skills and resources to eliminate vitamin and mineral deficiencies (micronutrient malnutrition) among vulnerable
populations throughout the world Established by the CDC in 2000 IMMPaCt focuses primarily on helping eliminate deficiencies in
iron vitamin A iodine and folate
Through a 2009-2014 agreement IMMPaCt supports WHO in various selected projects including providing technical assistance
and subject matter expertise to help design implement and maintain new and current micronutrient databases as well as assist
with processes promoting new WHO guidelines and recommendations
The CDC Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects provides the scientific and programmatic
expertise to build upon and strengthen global neural tube defect surveillance systems and expand the reach of global folic acid
fortification for neural tube defect prevention Expansion of global folic acid fortification efforts can have a significant impact on
infant mortality and childhood morbidity worldwide
7 OUR PARTNERS
Micronutrients 2010-2011Department of Nutrition for Health and Development
14DRAFT
CDCrsquos National Center on Birth Defects and Developmental Disabilities has developed a global initiative to significantly reduce infant
mortality and childhood morbidity resulting from the more than 300000 neural tube defects worldwide each year and contribute
to the achievement of United Nations Millennium Development Goal 4 help to meet the Global Health Initiative Child Health Goal
and support the 63rd World Health Assembly Resolution on Birth Defects
The initiative aims to expand the number of developing countries with mandatory folic acid fortification of high penetrance staples
and provide sustainable support of long-term interventions to eliminate folic acid-preventable neural tube defects worldwide CDC
works with WHO and others to support and advance country-level fortification efforts and to provide needed technical expertise for
surveillance of neural tube defects monitor fortification efforts and improve laboratory capacity on folate-preventable birth defects
THE MICRONUTRIENT INITIATIVE
The Micronutrient Initiative (MI) is an independent not-for-profit organization committed to promoting simple cost-effective
solutions to hidden hunger combat vitamin and mineral deficiency and developing innovative new solutions where needed based in
Ottawa Canada MI is working to end hidden hunger end vitamin and mineral deficiency by helping governments food producers
and partner organizations like WHO develop implement and monitor and evaluate innovative culturally appropriate and cost-
effective programmes to get essential vitamins and minerals to the people who need them most by providing technical and
financial assistance offering procurement and quality control services for highly specialized supplies and equipment needed to
prevent hidden hunger advocating for micronutrient programmes and educating government bodies around the world on policies
legislation and programs to ensure the sustained delivery of essential vitamins and minerals
THE EUNICE KENNEDy sHRIVER NATIONAL INsTITUTE Of CHILD HEALTH AND HUMAN DEVELOPMENT
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health
(NIH)US Department of Health and Human Services in collaboration with partners representing the breadth of the global food and
nutrition enterprise including WHO created the Biomarkers of Nutrition for Development (BOND) Program to meet the growing
need for discovery development and implementation of reliable and valid biomarkers to assess nutrient exposure status function
and effect Also with co-funding from the Bill amp Melinda Gates Foundation has developed the Iron and Malaria Project to address
the safe and effective use of iron interventions in areas of malaria burden Both projects have been done with involvement of and
in support of WHO work in the area of micronutrients
WHO NUTRITION GUIDANCE ExPERT ADVIsORy GROUP MEMBERs
Micronutrients
Ms Deena AlasfoorProfessor Beverley-Ann BiggsDr Heacutector Bourges RodriacuteguezProfessor Norm CampbellProfessor Susan Fairweather-Tait Dr Rafael Flores-AyalaProfessor Malik GoonewardeneDr Junsheng HuoDr Janet C KingDr Marzia Lazzerini Professor Malcolm E Molyneux Eng Wisam QarqashDr Mahdi Ramsan Mohamed Dr Daniel RaitenDr Meera ShekarDr Rebecca Joyce StoltzfusMs Carol TomDr David Tovey Mrs Vilma Qahoush TylerDr Gunn Elisabeth VistDr Emorn Wasantwisut
Monitoring and Evaluation
Dr Lindsay AllenDr Deborah AshDr France BeginDr Zulfiqar BhuttaDr Christine Clewes Professor Susan Fairweather-TaitDr Jonathan GorsteinDr Junsheng HuoDr Ibrahim MD KhatibDr Roland KupkaDr Christine PfeifferDr Rob JPM ScholtenDr Holger SchuumlnemannDr Ismaeumll Ngnieacute TeacutetaDr Emorn Wasantwisut
Vitamin A supplementation
Professor Hany Abdel-AleemProfessor Michael ClarkeDr Anna CoutsoudisDr M Monir HossainDr Jean HumphreyDr Yustina Anie IndriastutiDr Marzia LazzeriniDr Pavitra MohanDr Rintaro MoriDr A Catherine RossDr Isabella Sagoe-MosesDr Claudia SaundersDr Prak SophonnearyDr Charles StephensenDr Sherry TanumihardjoDr Khalid Yunis
Micronutrients 2010-2011Department of Nutrition for Health and Development
15DRAFT
INTERNsHIPs
WHO is committed to building future leaders in public health and WHOrsquos Internship Programme provides a wide range of
opportunities for graduate and post-graduate students to gain insight into the work of WHO Although WHO receives a large
number of intern applications each year only a limited number of places for internships are available Internships are available for
work in micronutrients at WHO for a minimum of 6 weeks and a maximum of 3 months to allow the internship to be both worthwhile
and effective The following selected interns were hosted by NHD during the biennium 2010-2011 to work on topics related to
micronutrients
Ms Alison Sylvetsky 7 June - 13 August 2010 - EMORY UNIVERSITY ATLANTA USA
Ms Aida Victoria Campos 1 March - 31 May 2010 - UNIVERSIDAD LA SALLE MExICO DF MExICO
Mrs Sarah Pedersen 14 June - 13 August 2010- CORNELL UNIVERSITY ITHACA NEW YORK USA
Mr Joseph Ashong1 March 2011 - 1 July 2011 - CORNELL UNIVERSITY ITHACA NEW YORK USA
Dr Saint-Rayn Pasricha 14 February 2011 - 17 June 2011 - UNIVERSITY OF MELBOURNE VICTORIA AUSTRALIA
Ms Ellie Souganidis 20 June 2011 - 12 August 2011 - JOHNS HOPKINS UNIVERSITY BALTIMORE MARYLAND USA
Mr Raheel Arif 15 August - 4 November 2011- UNIVERSITY OF THE SCIENCES PHILADELPHIA PENNSYLVANIA USA
ADVOCACy AND NETWORKs
Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource
allocation decisions within political economic and social systems and institutions Advocacy in WHO for vitamin and mineral
nutrition includes many activities such as media campaigns public speaking commissioning and publishing research as well as
participation in several groups and networks
Home Fortification Technical Advisory Group (HFTAG) (httpwwwgainhealthorghftag)
The Network For Sustained Elimination of Iodine Deficiency (httpwwwiodinenetworknet)
International Council for the Control of Iodine Deficiency Disorders (wwwicciddorg)
Rice Fortification Technical Group (httpwwwgainhealthorgriforg)
Global Alliance for Vitamin A (GAVA)
Flour Fortification Initiative (httpwwwsphemoryeduwheatflour)
International Zinc Nutrition Consultative Group (wwwizincgorg)
United Nations World Food Programme (httpwwwwfporg)
United Nations Childrenrsquos Fund (httpwwwuniceforg)
United Nations High Commissioner for Refugees (httpwwwunhcrorg)
Food and Agriculture Organization of the United Nations (httpwwwfaoorg)
The World Bank (httpwwwworldbankorg)
United Nations Standing Committee on Nutrition (httpwwwunscnorg)
Micronutrients 2010-2011Department of Nutrition for Health and Development
16DRAFT
WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients
during the biennium 2010-2011
US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms
project name Global prevention of non-communicable disease prevention and promotion of health
The Micronutrient Initiative (MI) wwwmicronutrientorg
project name e-Library of nutrition programme guidance
The Government of Luxembourghttpwwwetatlu
project name Support for the update and dissemination of evidence-based nutrition programme
The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg
project name Efficacy of newborn vitamin A supplementation in improving child survival
WHO also thanks the following organizations for their support through small grants
US Agency for International Development (USAID) httpwwwusaidgov
project name Update WHO evidence based position statements on relevant and priority micronutrient interventions
The Global Alliance for Improved Nutrition (GAIN)
httpwwwgainhealthorg
project name Systematic review of evidence of micronutrient interventions and management of moderate
malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification
project name Systematic review of evidence of rice fortification as a public health intervention and consultation on
rice fortification programs implementation
Harvard University
project name Nutrition impact model study (NIM Study)
Sight amp Life
httpwwwsightandlifeorg
project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System
MEMBERsHIPs
De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013
Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014
Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011
De-Regil LM GRADE working group 2010-present
WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs
Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for
Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2
February 2010 Geneva Switzerland
8 FINANCIAL SUPPORT
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
3DRAFT
1 EVIDENCE-INFORMED GUIDELINE DEVELOPMENT
A WHO guideline is any document containing WHO recommendations about health interventions whether they are clinical public
health or policy interventions A recommendation provides information about what policy-makers health-care providers or patients
should do It implies a choice between different interventions that have an impact on health and that have ramifications for the
use of resources As of 2009 all publications containing WHO recommendations are approved by the WHO Guidelines Review
Committee WHO has developed the evidence-informed recommendations for micronutrients interventions in public health using the
procedures outlined in the WHO Handbook for guideline development The steps in this process include (i) identification of priority
questions and outcomes (ii) evidence retrieval (iii) assessment and synthesis of the evidence (iv) formulation of recommendations
including research priorities and (v) planning for dissemination implementation impact evaluation and updating Using the Grading
of Recommendations Assessment Development and Evaluation (GRADE) methodology evidence profiles related to preselected
topics are prepared based on up-to-date systematic reviews During 2010-2011 WHO Headquarters updated or developed the
following guidelines on micronutrient interventions
SUPPLEMENTATION
Guideline Neonatal vitamin A supplementation
Guideline Vitamin A supplementation for infants 1ndash5 months of age
Guideline Vitamin A supplementation for infants and children 6-59 months of age
Guideline Vitamin A supplementation in pregnant women
Guideline Vitamin A supplementation in postpartum women
Guideline Vitamin A supplementation during pregnancy for reducing the risk of
mother-to-child transmission of HIV
Guideline Intermittent iron supplementation in preschool and school-age children
Guideline Intermittent iron and folic acid supplementation in menstruating women
Guideline Daily iron and folic acid supplementation in pregnant women (in press)
Guideline Intermittent iron and folic acid supplementation in non-anaemic
pregnant women (in press)
Guideline Calcium supplementation in pregnant women (in press)
Guideline Vitamin D supplementation in pregnant women (in press)
POINT-OF-USE FORTIFICATION OF FOODS
Guideline Use of multiple micronutrient powders for home fortification of foods consumed
by infants and children 6ndash23 months of age
Guideline Use of multiple micronutrient powders for home fortification of foods consumed
by pregnant women
OTHERS
WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia
Guideline Iron interventions in areas where malaria transmission occurs (in press)
These guidelines are available on the WHO website and the eLibrary of Evidence for Nutrition Actions
(wwwwhointelena)
1
Guideline
Vitamin A
supplementation in
infants 1ndash5 months of age
Guideline Vitamin A supplementation in pregnancy for reducing the risk of mother-to-child transmission of HIV
Guideline Vitamin A supplementation in postpartum women
Guideline
Vitamin A
supplementation in
infants and children
6ndash59 months of age
Micronutrients 2010-2011Department of Nutrition for Health and Development
4DRAFT
1 SCIENTIFIC PUBLICATIONS AND REPORTSPeer review and publication in scientific journals help ensure that
sound methods are appropriately utilized in the development of
guidelines They serve as a means of quality control a term which
also includes the transparency and repeatability of research
for independent verification the validity of the conclusions
and interpretations drawn from the reported data the overall
importance for advancement within the field of nutrition
and public health novelty as well as applicability The WHO
guideline development process calls for a systematic review
of the evidence related to a particular intervention undergoing
evaluation For micronutrient interventions technical staff
from NHD have prepared many of these systematic reviews
while WHO has commissioned the Cochrane Collaboration to
complete other reviews Other publications referred to vitamin
and mineral nutrition surveillance and research area related
to micronutrient interventions in public health As part of the
Cochrane pre-publication editorial process protocols and
reviews are commented on by external peers (an editor and
two referees external to the editorial team) and the grouprsquos
statistical adviser before publication httpwwwcochraneorg
The Cochrane handbook for systematic reviews of interventions
describes in detail the process of preparing and maintaining
Cochrane systematic reviews on the effects of healthcare
interventions
Disclaimer The authors in bold are staff members of the
World Health Organization The authors alone are responsible
for the views expressed in this publication and they do not
necessarily represent the decisions or policies of the World
Health Organization
Andersson M de Benoist B Rogers L Epidemiology of iodine
deficiency Salt iodisation and iodine status Best Practice amp
Research Clinical Endocrinology amp Metabolism 2010 Feb
24(1)1-11 httpwwwncbinlmnihgovpubmed20172466
Palacios C Pentildea-Rosas JP Calcium supplementation during
pregnancy for preventing hypertensive disorders and related
problems RHL commentary (last revised 1 February 2010)
The WHO Reproductive Health Library Geneva World Health
Organization httpappswhointrhlpregnancy_childbirth
antenatal_carenutritioncd001059_penasrosasjp_comen
indexhtml
Serdula M Pentildea-Rosas JP Maberly GF Aburto NJ Perrine
CG Mei Z (eds) Flour fortification with iron folic acid vitamin
B12 vitamin A and zinc Proceedings of the Second Technical
Workshop on Wheat Flour Fortification Food and Nutrition
Bulletin vol 31 no 1 (supplement) United Nations University
Press 2010 httpwwwfoodandnutritionbulletinorg
downloadsFNB_v31n1_suppl_webpdf
Bojorquez-Chapela I Mendoza-Flores ME Morales RM
Tolentino MC De-Regil LM Risky eating behaviours are
not associated with micronutrients deficiencies in women
from Mexico City (Spanish) Archivos Latinoamericanos
de Nutricioacuten 201060(1)64-69 httpwwwncbinlmnih
govpubmedterm=Bojorquez-Chapela20I2C2020
Mendoza-Flores20ME2C20Morales20RM2C20
Tolentino20MC2C20De-Regil20LM
De-Regil LM Jamous O Mendoza-Flores ME Morales RM
Tolentino MC Casanueva E Perception of menstrual bleeding
and its asociacioacuten with iron folate and vitamin B12 deficiencies
in women of reproductive age from Mexico City (Spanish)
Anales Venezolanos de Nutricioacuten 201023 (1) 5-9 http
analesfundacionbengoaorganales-nutricion20101i=art1
Pentildea-Rosas JP Rogers LM De-Regil LM Bopardikar A
Panisset U WHO from Research to Action Developing evidence-
informed guidelines and policies for interventions in vitamin and
mineral nutrition (abstract) Evidence in multiple micronutrient
nutrition from history to science to effective programs Public
Health Nutrition 2010 Sept13(9A)17
De-Regil LM Fernaacutendez-Gaxiola AC Dowswell T Pentildea-
Rosas JP Effects and safety of periconceptional folate
supplementation for preventing birth defects Cochrane
Database of Systematic Reviews 2010 (Issue 10) Art No
CD007950 DOI 10100214651858CD007950pub2
httponlinelibrarywileycomdoi10100214651858
CD007950pub2pdf Available in Spanish at httpwww
bibliotecacochranecomBCPGetDocumentaspSessionID=36
22858ampDocumentID=CD007950
Ansary A Palacios C De-Regil LM Pentildea-Rosas JP Vitamin
D supplementation for women during pregnancy [Protocol]
Cochrane Database of Systematic Reviews 2010 Issue 12 Art
No CD008873 DOI 10100214651858CD008873
httponlinelibrarywileycomdoi10100214651858
CD008873pdf
2
Micronutrients 2010-2011Department of Nutrition for Health and Development
5DRAFT
Vist GE Suchdev PS De-Regil LM Walleser S Pentildea-Rosas JP
Home fortification of foods with multiple micronutrient powders
for health and nutrition in children under 2 years of age [Protocol]
Cochrane Database of Systematic Reviews 2011 Issue 1 Art
No CD008959 DOI 10100214651858CD008959 http
onlinelibrarywileycomdoi10100214651858CD008959pdf
Sylvetsky AC Jefferds MED De-Regil LM Dowswell T Intermittent
iron supplementation for improving nutrition and developmental
outcomes in children [Protocol] Cochrane Database of
Systematic Reviews 2011 Issue 4 Art No CD009085 DOI
10100214651858CD009085 httponlinelibrarywileycom
doi10100214651858CD009085pdf
Fernaacutendez-Gaxiola AC De-Regil LM Nasser M Intermittent
iron supplementation for reducing anaemia and its associated
impairments in menstruating women [Protocol] Cochrane
Database of Systematic Reviews 2011 Issue 7 Art No
CD009218 DOI 10100214651858CD009218 http
onlinelibrarywileycomdoi10100214651858CD009218pdf
De-Regil LM Suchdev PS Vist GE Walleser S Pentildea-Rosas
JP Home fortification of foods with multiple micronutrient
powders for health and nutrition in children under two years
of age Cochrane Database of Systematic Reviews 2011
Sep 79CD008959 httpwwwupdate-softwarecomBCP
WileyPDFENCD008959pdf Available in Spanish here
Summary in Portuguese here
Wong EM Sullivan KM Perrine CG Rogers LM Pentildea-Rosas
JP Comparison of median urinary iodine concentration as an
indicator of iodine status among pregnant women school-age
children and nonpregnant women Food and Nutrition Bulletin
Volume 32 Number 3 September 2011 pp 206-212(7)
httpwwwncbinlmnihgovpubmedterm=wong20pena-rosas20jp20
Suchdev PS De-Regil LM Walleser S Vist GE Pentildea-Rosas
JP Multiple micronutrient powders for home (point of use)
fortification of foods in pregnant women a systematic review
WHO e-Library of Evidence for Nutrition Actions Geneva
World Health Organization 2011 httpwhqlibdocwhoint
publications20119789241502559_engpdf
De-Regil LM Jefferds MED Sylvetsky AC Dowswell T
Intermittent iron supplementation for improving nutrition and
development in children under 12 years of age Cochrane
Database of Systematic Reviews 2011 Issue 12 Art No
CD009085 DOI 10100214651858CD009085pub2
httponlinelibrarywileycomdoi10100214651858
CD009085pub2pdf Available in Spanish here
Fernaacutendez-Gaxiola AC De-Regil LM Intermittent iron
supplementation for reducing anaemia and its associated
impairments in menstruating women Cochrane Database of Systematic Reviews 2011 Issue 12 Art No CD009218 DOI
10100214651858CD009218pub2 httponlinelibrary
wileycomdoi10100214651858CD009218pub2pdf
Available in Spanish at httpwwwbibliotecacochranecom
BCPGetDocumentaspSessionID=3622858ampDocumentID=
CD009218
De-Regil LM Palacios C Ansary A Kulier R Pentildea-Rosas
JP Vitamin D supplementation for women during pregnancy
Cochrane Database of Systematic Reviews 2012 Issue 2
Art No CD008873 DOI 10100214651858CD008873
pub2 httponlinelibrarywileycomdoi10100214651858
CD008873pub2pdf
Home fortification of foods with multiple micronutrient
powders for health and nutrition in children under two years
of age (Review)
De-Regil LM Suchdev PS Vist GE Walleser S Pentildea-Rosas JP
This is a reprint of a Cochrane review prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2011 Issue 9httpwwwthecochranelibrarycom
Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age (Review)
Copyright copy 2011 The Cochrane Collaboration Published by John Wiley amp Sons Ltd
Intermittent iron supplementation for reducing anaemia and
its associated impairments in menstruating women (Review)Fernaacutendez-Gaxiola AC De-Regil LM
This is a reprint of a Cochrane review prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2011 Issue 12
httpwwwthecochranelibrarycom
Intermittent iron supplementation for reducing anaemia and its associated impairments in menstruating women (Review)
Copyright copy 2011 The Cochrane Collaboration Published by John Wiley amp Sons Ltd
Micronutrients 2010-2011Department of Nutrition for Health and Development
6DRAFT
TECHNICAL REPORTS
Disclaimer These technical reports contain discussions and presentation from the meetings and do
not necessarily represent the decisions or policies of the World Health Organization Similarly they may
contain background papers commissioned for these meetings The named authors alone are responsible
for the views expressed in this publication
WHO Technical consultation on neonatal vitamin A supplementation research priorities meeting report
Geneva World Health Organization 2009 (httpwhqlibdocwhointpublications20099789241599597_
engpdf) Published in 2010
WHO Estimating appropriate levels of vitamins and minerals for food fortification programmes The WHO Intake
Monitoring Assessment and Planning Program (IMAPP) meeting report Geneva World Health Organization 2010
(httpwwwwhointnutritionpublicationsmicronutrients9789241599603pdf)
WHO Technical consultation on vitamin A in newborn health mechanistic studies Geneva World Health Organization
2012 (httpwhqlibdocwhointpublications20129789241503167_engpdf)
WHO MICRONUTRIENTS MAILING LIST
The WHO Micronutrients Mailing List was developed in order to allow subscribers to receive periodic information on WHOrsquos work
in the area of vitamins and minerals The list was established in 2009 with 990 subscribers There are currently over 3100
subscribers and the list continues to grow Anyone may subscribe to the list by sending an E-mail to micronutrientswhoint with
the following text in the subject and body of the message ldquoSUBSCRIBE MICRONUTRIENTS LISTrdquo
Who Technical
consulTaTion
on ViTamin a
in neWborn
healTh
mechanisTic
sTudies
REPORT
R E P O R T
WHO Me e t i n g O n es t i M at i n g ap p rO p r i ate Leve L s O f vi t a M i n s a n d Mi n e ra L s fO r fO O d fO r t i f i c at i O n prO gra M M e s tH e WHO int a ke MO n i tO r i n g as s e s s M e nt a n d pL a n n i n g prO gra M (iMapp)Ge n e va Sw i t ze r l a n d 22 Ju l y 2009
Micronutrients 2010-2011Department of Nutrition for Health and Development
7DRAFT
WHOrsquos publications and other resources that are produced in several
languages help to ensure that health information reaches those who need it
in the language they can understand This makes access to health information
both more equitable and effective Communicating in different languages
bridges gaps and fosters understanding between people It allows WHO to more
effectively guide public health practices reach out to audiences worldwide
and achieve better global health outcomes The six official languages of WHO
- Arabic Chinese English French Russian and Spanish - were established by
a 1978 World Health Assembly resolution turning multilingualism into a WHO
policy Since the adoption of a 1998 resolution all Governing bodies documents
and corporate materials have been made available online in all official languages
Many of the WHO publications in micronutrients have been translated into these languages Samples of the work on micronutrients
in the WHO official languages includes the translation of the website of the Vitamin and Mineral Nutrition Information System the
recent WHO evidence-informed guidelines in micronutrient interventions the WHOCDC logic model for micronutrient interventions
and summaries of the indicators used in assessing vitamin and mineral nutritional status Efforts will be made in making more
resources available in the six WHO official languages
1 MULTILINGUALISM3
Micronutrients 2010-2011Department of Nutrition for Health and Development
8DRAFT
The WHO Vitamin and Mineral Nutrition Information System (VMNIS) was initially established in 1991 and has now been expanded
into a more comprehensive vitamin and mineral nutrition information system Evaluations of epidemiological and informatics
capabilities of the system in 2009 guided the upgrade and expansion of VMNIS to include a more comprehensive micronutrients
database and additional resources and tools for vitamin and mineral nutrition surveillance by Member States and their partners as
well as the incorporation and utilization of advances in information technology to disseminate the information A new website is now
online for VMNIS that includes the following sections 1) micronutrients database 2) indicators 3) laboratory capacity 4) monitoring
and evaluation and 5) publications The website is now available in all six WHO official languages
The Micronutrients Database of the VMNIS is now upgraded and expanded This process is occurring in three phases two of which
are already completed During phase I the database was restructured to make it more efficient exploit new innovations in information
technology and include more nutritional indicators In collaboration with the Information Technology and Telecommunications Unit
of WHO and with support from CDC partners from the Office of Informatics and Information Resources Management and other
colleagues from the National Center for Chronic Disease Prevention and Health Promotion the new database platform is functioning
During phase II -data migration- all the survey information available from the previous database and an additional systematic
search for data that included scientific literature and communication with WHO Regional Offices relevant UN agencies and other
partner organizations to solicit information on nutritionmicronutrient surveys was included Additionally all surveys reports have
been digitalized to make an electronic repository instead of paper printed documents Phase III data display is expected to be
completed in 2012 and will allow users to create maps tables and access data directly from the internet
The Indicators section includes information on the biomarkers used in assessing vitamin and
mineral status in populations and used in surveys collected in VMNIS
These documents are a compilation of current WHO recommendations on the topic from different sources They summarize the
currently recognized cut-offs for defining deficiencies and their severity at the individual and population level and the chronology of
their establishment These are not new or updated recommendations but compilations of existing guidelines that were dispersed
in several WHO references and reports These summaries that are available in the six WHO official languages will serve as a
starting point for updating current recommendations on the use of these indicators
Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity
Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations
Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations
The Monitoring and Evaluation section of the VMNIS contains resources that can be useful
for monitoring andor evaluating interventions that have a focus on outcomes related to vitamin
and mineral nutrition Notable are the following
The WHOCDC logic model for micronutrient interventions in public health depicts the programme theory and plausible
relationships between inputs and expected MDGs and can be adapted to different contexts Member States can
adjust this proposed generic logic model and use it as part of the continuous quality improvement cycle for planning
performance measurement or evaluation
The WHOCDC indicators e-Catalogue for micronutrient interventions platform has been completed and it intends to be
an up-to-date interactive user-friendly and comprehensive resource of indicators for those who are actively engaged in
providing technical assistance in evaluation of micronutrient interventions There is considerable variation in indicators
used to define micronutrient deficiency limiting comparability across programs and over time
Anaemia is a condition in which the number of red blood cells (and
consequently their oxygen-carrying capacity) is insufficient to meet the
bodyrsquos physiologic needs Specific physiologic needs vary with a personrsquos
age gender residential elevation above sea level (altitude) smoking
behaviour and different stages of pregnancy Iron deficiency is thought to
be the most common cause of anaemia globally but other nutritional
deficiencies (including folate vitamin B12 and vitamin A) acute and chronic
inflammation parasitic infections and inherited or acquired disorders that
affect haemoglobin synthesis red blood cell production or red blood cell
survival can all cause anaemia Haemoglobin concentration alone cannot
be used to diagnose iron deficiency However the concentration of
haemoglobin should be measured even though not all anaemia is caused
by iron deficiency The prevalence of anaemia is an important health
indicator and when it is used with other measurements of iron status the
haemoglobin concentration can provide information about the severity of
iron deficiency (1)
Inside
Background
Scope and purpose This document aims to provide users of the Vitamin and Mineral Nutrition
Information System (VMNIS) with information about the use of
haemoglobin concentration for diagnosing anaemia It is a compilation of
current World Health Organization (WHO) recommendations on the topic
and summarizes the cut-offs for defining anaemia and its severity at the
population level as well as the chronology of their establishment
The use of the cut-off points derived from the referenced publications
permits the identification of populations at greatest risk of anaemia and
priority areas for action especially when resources are limited They also
facilitate the monitoring and assessment of progress towards international
goals of preventing and controlling iron deficiency and further provide the
basis for advocacy for the prevention of anaemia
Haemoglobin concentrations for the diagnosis of anaemia and
assessment of severity
VMNIS | Vitamin and Mineral Nutrition Information System
WHONMHNHDMNM111 Background 1
Description of technical consultation 2
Recommendations 3
Summary development
Acknowledgements 5
Plans for update 5
References 6
4
Scope and purpose 1
VMNIS | 1
4
Retinol is the predominant circulating form of vitamin A in the blood In
response to tissue demand it is released from the liver in a 11 ratio with its
carrier protein retinol-binding protein (1) In the blood this complex
combines with transthyretin (2) Specific receptors on target cell surfaces or
nuclei bind this complex or its active metabolites thereby regulating many
critical functions in the body including vision epithelial tissue integrity
and the expression of several hundred genes (2) Serum retinol levels reflect
liver vitamin A stores only when they are severely depleted (lt 007 micromolg
liver) or extremely high (gt 105 micromolg liver) (1) Between these extremes
serum retinol is homeostatically controlled and thus not always correlated
with vitamin A intake or clinical signs of deficiency Consequently serum
retinol is not useful for assessing the vitamin A status of individuals and
may not respond to interventions Rather the distribution of serum retinol
values in a population and the prevalence of individuals with serum retinol
values below a given cut-off can provide important information on the
vitamin A status of a population and may reflect the severity of vitamin A
deficiency as a public health problem (3) especially when the degree of
underlying infection or inflammation is taken into account Serum retinol
values are most often measured in young children a group highly
vulnerable to deficiency (3) Deficiency of vitamin A is associated with significant morbidity and
mortality from common childhood infections and is the worldrsquos leading
preventable cause of childhood blindness (3)
Inside
Background
Scope and Purpose This document aims to provide users of the Vitamin and Mineral Nutrition
Information System (VMNIS) with information about the use of serum
retinol for assessing the prevalence of vitamin A deficiency in populations
It is a compilation of the current World Health Organization (WHO)
recommendations on the topic and summarizes from the three documents
VMNIS | Vitamin and Mineral Nutrition Information System Background
1
Description of Technical Consultation 2
Recommendations 2
Summary Development
Acknowledgements 4
Plans for Update 4
References 5
4
Scope and Purpose 1
VMNIS | 1
Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations
WHONMHNHDMNM113
Iron stores in the body exist primarily in the form of ferritin The ferritin
molecule is an intracellular hollow protein shell composed of 24 subunits
surrounding an iron core that may contain as many as 4000-4500 iron
atoms In the body small amounts of ferritin are secreted into the plasma
The concentration of this plasma (or serum) ferritin is positively correlated
with the size of the total body iron stores in the absence of inflammation A
low serum ferritin value reflects depleted iron stores but not necessarily
the severity of the depletion as it progresses
Normal ferritin concentrations vary by age and sex Concentrations are
high at birth rise during the first two months of life and then fall
throughout later infancy (1) At about one year of age concentrations
begin to rise again and continue to increase into adulthood (2) Beginning
in adolescence however males have higher values than females a trend
that persists into late adulthood Values among men peak between 30ndash39
years of age and then tend to remain constant until about 70 years of age
Among women serum ferritin values remain relatively low until
menopause and then rise (2)
Body ferritin levels in contrast to haemoglobin are not affected by
residential elevation above sea level or smoking behaviour However
ferritin is a positive acute phase response protein whereby concentrations
increase during inflammation and thereby no longer reflect the size of the
iron store This makes the interpretation of normal or high serum ferritin
values difficult in areas of widespread infection or inflammation (3) In the
absence of inflammation or liver disease high serum ferritin concentrations
indicate iron overload
Inside
Background
Serum ferritin concentrations
for the assessment of iron
status and iron deficiency in
populations
Background
1
Description of
Technical Consultation 2
Recommendations 2
Summary
Development
Acknowledgements 5
Plans for Update 5
VMNIS | Vitamin and Mineral Nutrition Information System
References
5
WHONMHNHDMNM112
5
VMNIS | 1
Scope and Purpose
2
VITAMIN AND MINERAL NUTRITION INFORMATION SYSTEM
Micronutrients 2010-2011Department of Nutrition for Health and Development
9DRAFT
Ideally dissemination and wide-spread use of the WHOCDC indicators eCatalogue will increase the standardization
of indicators and increase consistency and comparability across programmes A Technical Consultation ldquoldquoInventory of
indicators for monitoring and evaluation of micronutrient interventionsrdquo was held in Atlanta United States of America
in 6-7 January 2010 The objectives were to fine tune the details of the logic model for monitoring and evaluation of
micronutrient interventions refine search criteria and to validate the usefulness of the indicators web-tool The team is
currently working in the compilation of these indicators using the logic model as a framework to organizing the different
types of indicators currently used in public health programmes involving micronutrient interventions
Micronutrients 2010-2011Department of Nutrition for Health and Development
10
MAIN
Dr Francesco Branca is the Director of
the Department of Nutrition for Health and
Development in the World Health Organization
Geneva He graduated in Medicine and Surgery
and specialized in Diabetology and Metabolic
Diseases at the Universitarsquo Cattolica del Sacro
Cuore Roma He obtained a PhD in Nutrition at
Aberdeen University He was a Senior Scientist
at the Italian Food and Nutrition research
Institute where he was responsible for the
design and implementation of several studies
on the effects of food and nutrients on human
health at the different stages of the life cycle
and for the design management and evaluation
of public health nutrition programmes He
was been President of the Federation of the
European Nutrition Societies in 2003-2007
Dr JP Pena-Rosas is the Coordinator Evidence
and Programme Guidance Department of
Nutrition for Health and Development at the
World Health Organization (WHO) in Geneva
Switzerland He joined WHO on July 2008 and
now oversees the Evidence and Programme
Guidance workplan in the development of
evidence-informed guidelines for interventions
addressing the double burden of malnutrition
for neonates infants children and women in
stable and emergency settings under the WHO
Research Strategy umbrella He is an Adjunct
Assistant Professor at Emory University Rollins
School of Public Health in Atlanta United States
since 2011 Previously he worked several
years in the Division of Nutrition Physical
Activity and Obesity at the Centers for Disease
Control and Prevention (CDC) in Atlanta United
States He was involved in nutrition surveys
and programme monitoring and evaluation for
nutrition interventions in Uzbekistan Morocco
Egypt Peru Nicaragua Georgia and Dominican
Republic In the private sector Dr Pena-Rosas
worked at Kellogg Company Latin America
and the Caribbean Headquarters where he
served several positions including Manager of
Scientific and Regulatory Affairs for the regional
operations He received his Medical Degree from
Universidad Central de Venezuela in his native
country and a Masterrsquos Degree in Public Health
Nutrition from University of Puerto Rico in San
Juan He holds a PhD in Human Nutrition and
Epidemiology from Cornell University Ithaca NY
United States of America He is a member of the
American Society for Nutrition Latin American
Society of Nutrition the American Evaluation
Association the Cochrane Collaboration and
the WHO Guidelines Review Committee
Dr Lisa Rogers is the technical officer for
the Evidence and Programme Guidance Unit
in the Department of Nutrition for Health and
Development She has been working at the
World Health Organization (WHO) in Geneva
Switzerland since April 2006 She is primarily
responsible for managing a grant for mechanistic
studies on neonatal vitamin A supplementation
and coordinating the completion of evidence
reviews and guideline groups to inform vitamin
and mineral intervention guidelines She holds
a PhD in Nutrition on International Nutrition
from the University of California Davis United
States of America Her work included research
in Guatemala investigating the causes of vitamin
B12 deficiency in school age children and
laboratory research involving the optimization of
an immunological assay for holotranscobalamin
II and the analysis of methylmalonic acid
homocysteine vitamin B12 and folate She
received a Master of Science in Nutritional
Sciences from the University of Florida where
she conducted research involving the analysis of
the stability of folic acid added to cereal-grain
products the bioavailability of stable-isotopically
labeled folic acid added to these products and
conducted several human subject studies She
is a member of the American Society for Nutrition
and the Academy of Nutrition and Dietetics
Dr Luz Maria De-Regil is epidemiologist at the
World Health Organization with the Evidence
and Programme Guidance Unit since September
2009 She is responsible for coordinating the
development of global guidelines on nutrition
interventions for different age groups and
settings updating and expanding the Vitamin and
Mineral Nutrition Information System (VMNIS)
developing tools for monitoring and evaluation
of nutrition interventions leading international
and multidisciplinary review teams to assess the
evidence and translating knowledge into global
public policy With more than 50 publications in
5 OUR TEAM
Micronutrients 2010-2011Department of Nutrition for Health and Development
11DRAFT
English and Spanish for different audiences Luz Maria has been involved in community programmes and designed and implemented
research focused on maternal and infant nutrition and health She has experience in applying in vitro and in vivo laboratory techniques
in combination with food science and epidemiology She is an active member of the WHO Research and Ethics Committee the
GRADE working group four groups within the Cochrane Collaboration the American Society for Nutrition the Latin American
Society of Nutrition the Mexican Pediatric Research Association and a former vice-president of the Mexican Society of Nutrition
Ms Grace Rob is a technical assistant in the Evidence and Programme Guidance Unit department of Nutrition for Health and
Development She has been working at the World Health Organization (WHO) in Geneva Switzerland since 2000 She holds a
Bachelors of Science in Home Economics major in food and nutrition and minor in business administration from University of
Eastern Africa Baraton Eldoret in her native Kenya
Mrs Paule Pillard is the Assistant to Coordinator in the Evidence and Programme Guidance Unit Department of Nutrition for Health
and Development and provides administrative support to the coordinator and the unit staff since 2007
Micronutrients 2010-2011Department of Nutrition for Health and Development
12DRAFT
NEONATAL VITAMIN A SUPPLEMENTATION MECHANISTIC STUDIES
There is considerable interest in vitamin A supplementation during the neonatal period as an intervention for reducing infant
mortality The efficacy of this intervention is still to be determined NHD along with the Department of Maternal Newborn Child
and Adolescent Health (MCA) have received funding to conduct studies for the generation of evidence to inform global policy on
the efficacy of neonatal vitamin A supplementation in improving child survival In support of uncovering biological mechanisms
by which neonatal vitamin A supplementation may be acting NHD is coordinating the conduct of one animal study and two human
studies to understand the biological mechanisms through which neonatal vitamin A supplementation can potentially have an
impact on infant survival when given at birth The animal study is being conducted at the University of Wisconsin-Madison USA
(PI S Tanumihardjo) and is using the sow-piglet dyad model The two human studies are double blind randomized controlled
trials to determine the effect of vitamin A supplementation on immune responses in early infancy One study is being conducted
in Bangladesh (n=300) by the USDA-ARS Western Human Nutrition Research Center University of California Davis CA USA (PI
C Stephensen) and the other in The Gambia (n=200) by the Medical Research Council London UK and Keneba Gambia (PI A
Prentice)
The three proposals were reviewed at a WHO Technical Consultation on Vitamin A in Newborn Health - Mechanistic Studies in
December 2009 Final proposals were approved by the WHO Ethics Review Committee (ERC) and the studies are now in progress
NUTRITION IMPACT MODEL-STUDY (NIMS)
This study is funded by a grant from The Bill amp Melinda Gates Foundation to the Harvard School of Public Health and aims to
develop empirically parameterize apply and make publicly available a policy-relevant analytical tool for estimating the health
impacts of undernutrition exposures and interventions
Representatives of the Department of Nutrition for Health and Development work closely with partners to select appropriate
exposure metrics and develop and apply statistical methods for sparse time-space data in order to estimate current levels and past
trends of anaemia and vitamin A deficiency
6 RESEARCH
Micronutrients 2010-2011Department of Nutrition for Health and Development
13DRAFT
The Department of Nutrition for Health and Development works closely with internal collaborators at WHO and with various external
organizations on topics related to micronutrients
COCHRANE COLLABORATION
Over 28000 contributors worldwide work together to help health care providers policy-makers patients their advocates and
carers make well-informed decisions about health care based on the best available research evidence by preparing updating
and promoting the accessibility of Cochrane Reviews ndash over 4600 so far published online in The Cochrane Library In 2010 the
Cochrane Database of Systematic Reviews achieved a top-10 ISI Impact Factor for an outstanding achievement The work of the
Cochrane Collaboration is internationally recognised as the benchmark for high-quality information about the effectiveness of
health care In January 2011 The Cochrane Collaboration was accepted as a Non-Governmental Organization in Official Relations
with the World Health Organization (WHO) the public health arm of the United Nations establishing formalised communication
between our two organisations
This collaboration supports the development of the WHO Library of Evidence for Nutrition Actions (eLENA) and grants open access
to all Member States For the work in micronutrients we have closely collaborated with the following Cochrane groups
Cochrane Editorial Unit (wwweditorial-unitcochraneorg)
Developmental Psychosocial and Learning Problems Group (wwwdplpgcochraneorg)
Infectious Diseases Group (wwwcidgcochraneorgenindexhtml)
Pregnancy and Childbirth Group (wwwpregnancycochraneorg)
Public Health Group (wwwphcochraneorg)
Our Department has also supported the update or undertake of systematic reviews within the following groups
HIVAIDS Group (hivcochraneorg)
Metabolic and Endocrine Disorders Group (wwwendoccochraneorg)
Neonatal Group (wwwneonatalcochraneorg)
Iberoamerican Cochrane Center (wwwcochranees)
GRADE WORKING GROUP
The Grading of Recommendations Assessment Development and Evaluation (GRADE) Working Group began in the year 2000
as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health
care The working group has developed a common sensible and transparent approach to grading the quality of evidence
and the strength of recommendations Many international organizations have provided input into the development of the
approach and have started using it
A representative of our team joined the working group in 2010 to discuss issues related to the normative work in
micronutrients at WHO
CENTERs fOR DIsEAsE CONTROL AND PREVENTION (CDC)
The International Micronutrient Malnutrition Prevention and Control (IMMPaCt) programme works with global partners to
contribute CDC skills and resources to eliminate vitamin and mineral deficiencies (micronutrient malnutrition) among vulnerable
populations throughout the world Established by the CDC in 2000 IMMPaCt focuses primarily on helping eliminate deficiencies in
iron vitamin A iodine and folate
Through a 2009-2014 agreement IMMPaCt supports WHO in various selected projects including providing technical assistance
and subject matter expertise to help design implement and maintain new and current micronutrient databases as well as assist
with processes promoting new WHO guidelines and recommendations
The CDC Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects provides the scientific and programmatic
expertise to build upon and strengthen global neural tube defect surveillance systems and expand the reach of global folic acid
fortification for neural tube defect prevention Expansion of global folic acid fortification efforts can have a significant impact on
infant mortality and childhood morbidity worldwide
7 OUR PARTNERS
Micronutrients 2010-2011Department of Nutrition for Health and Development
14DRAFT
CDCrsquos National Center on Birth Defects and Developmental Disabilities has developed a global initiative to significantly reduce infant
mortality and childhood morbidity resulting from the more than 300000 neural tube defects worldwide each year and contribute
to the achievement of United Nations Millennium Development Goal 4 help to meet the Global Health Initiative Child Health Goal
and support the 63rd World Health Assembly Resolution on Birth Defects
The initiative aims to expand the number of developing countries with mandatory folic acid fortification of high penetrance staples
and provide sustainable support of long-term interventions to eliminate folic acid-preventable neural tube defects worldwide CDC
works with WHO and others to support and advance country-level fortification efforts and to provide needed technical expertise for
surveillance of neural tube defects monitor fortification efforts and improve laboratory capacity on folate-preventable birth defects
THE MICRONUTRIENT INITIATIVE
The Micronutrient Initiative (MI) is an independent not-for-profit organization committed to promoting simple cost-effective
solutions to hidden hunger combat vitamin and mineral deficiency and developing innovative new solutions where needed based in
Ottawa Canada MI is working to end hidden hunger end vitamin and mineral deficiency by helping governments food producers
and partner organizations like WHO develop implement and monitor and evaluate innovative culturally appropriate and cost-
effective programmes to get essential vitamins and minerals to the people who need them most by providing technical and
financial assistance offering procurement and quality control services for highly specialized supplies and equipment needed to
prevent hidden hunger advocating for micronutrient programmes and educating government bodies around the world on policies
legislation and programs to ensure the sustained delivery of essential vitamins and minerals
THE EUNICE KENNEDy sHRIVER NATIONAL INsTITUTE Of CHILD HEALTH AND HUMAN DEVELOPMENT
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health
(NIH)US Department of Health and Human Services in collaboration with partners representing the breadth of the global food and
nutrition enterprise including WHO created the Biomarkers of Nutrition for Development (BOND) Program to meet the growing
need for discovery development and implementation of reliable and valid biomarkers to assess nutrient exposure status function
and effect Also with co-funding from the Bill amp Melinda Gates Foundation has developed the Iron and Malaria Project to address
the safe and effective use of iron interventions in areas of malaria burden Both projects have been done with involvement of and
in support of WHO work in the area of micronutrients
WHO NUTRITION GUIDANCE ExPERT ADVIsORy GROUP MEMBERs
Micronutrients
Ms Deena AlasfoorProfessor Beverley-Ann BiggsDr Heacutector Bourges RodriacuteguezProfessor Norm CampbellProfessor Susan Fairweather-Tait Dr Rafael Flores-AyalaProfessor Malik GoonewardeneDr Junsheng HuoDr Janet C KingDr Marzia Lazzerini Professor Malcolm E Molyneux Eng Wisam QarqashDr Mahdi Ramsan Mohamed Dr Daniel RaitenDr Meera ShekarDr Rebecca Joyce StoltzfusMs Carol TomDr David Tovey Mrs Vilma Qahoush TylerDr Gunn Elisabeth VistDr Emorn Wasantwisut
Monitoring and Evaluation
Dr Lindsay AllenDr Deborah AshDr France BeginDr Zulfiqar BhuttaDr Christine Clewes Professor Susan Fairweather-TaitDr Jonathan GorsteinDr Junsheng HuoDr Ibrahim MD KhatibDr Roland KupkaDr Christine PfeifferDr Rob JPM ScholtenDr Holger SchuumlnemannDr Ismaeumll Ngnieacute TeacutetaDr Emorn Wasantwisut
Vitamin A supplementation
Professor Hany Abdel-AleemProfessor Michael ClarkeDr Anna CoutsoudisDr M Monir HossainDr Jean HumphreyDr Yustina Anie IndriastutiDr Marzia LazzeriniDr Pavitra MohanDr Rintaro MoriDr A Catherine RossDr Isabella Sagoe-MosesDr Claudia SaundersDr Prak SophonnearyDr Charles StephensenDr Sherry TanumihardjoDr Khalid Yunis
Micronutrients 2010-2011Department of Nutrition for Health and Development
15DRAFT
INTERNsHIPs
WHO is committed to building future leaders in public health and WHOrsquos Internship Programme provides a wide range of
opportunities for graduate and post-graduate students to gain insight into the work of WHO Although WHO receives a large
number of intern applications each year only a limited number of places for internships are available Internships are available for
work in micronutrients at WHO for a minimum of 6 weeks and a maximum of 3 months to allow the internship to be both worthwhile
and effective The following selected interns were hosted by NHD during the biennium 2010-2011 to work on topics related to
micronutrients
Ms Alison Sylvetsky 7 June - 13 August 2010 - EMORY UNIVERSITY ATLANTA USA
Ms Aida Victoria Campos 1 March - 31 May 2010 - UNIVERSIDAD LA SALLE MExICO DF MExICO
Mrs Sarah Pedersen 14 June - 13 August 2010- CORNELL UNIVERSITY ITHACA NEW YORK USA
Mr Joseph Ashong1 March 2011 - 1 July 2011 - CORNELL UNIVERSITY ITHACA NEW YORK USA
Dr Saint-Rayn Pasricha 14 February 2011 - 17 June 2011 - UNIVERSITY OF MELBOURNE VICTORIA AUSTRALIA
Ms Ellie Souganidis 20 June 2011 - 12 August 2011 - JOHNS HOPKINS UNIVERSITY BALTIMORE MARYLAND USA
Mr Raheel Arif 15 August - 4 November 2011- UNIVERSITY OF THE SCIENCES PHILADELPHIA PENNSYLVANIA USA
ADVOCACy AND NETWORKs
Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource
allocation decisions within political economic and social systems and institutions Advocacy in WHO for vitamin and mineral
nutrition includes many activities such as media campaigns public speaking commissioning and publishing research as well as
participation in several groups and networks
Home Fortification Technical Advisory Group (HFTAG) (httpwwwgainhealthorghftag)
The Network For Sustained Elimination of Iodine Deficiency (httpwwwiodinenetworknet)
International Council for the Control of Iodine Deficiency Disorders (wwwicciddorg)
Rice Fortification Technical Group (httpwwwgainhealthorgriforg)
Global Alliance for Vitamin A (GAVA)
Flour Fortification Initiative (httpwwwsphemoryeduwheatflour)
International Zinc Nutrition Consultative Group (wwwizincgorg)
United Nations World Food Programme (httpwwwwfporg)
United Nations Childrenrsquos Fund (httpwwwuniceforg)
United Nations High Commissioner for Refugees (httpwwwunhcrorg)
Food and Agriculture Organization of the United Nations (httpwwwfaoorg)
The World Bank (httpwwwworldbankorg)
United Nations Standing Committee on Nutrition (httpwwwunscnorg)
Micronutrients 2010-2011Department of Nutrition for Health and Development
16DRAFT
WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients
during the biennium 2010-2011
US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms
project name Global prevention of non-communicable disease prevention and promotion of health
The Micronutrient Initiative (MI) wwwmicronutrientorg
project name e-Library of nutrition programme guidance
The Government of Luxembourghttpwwwetatlu
project name Support for the update and dissemination of evidence-based nutrition programme
The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg
project name Efficacy of newborn vitamin A supplementation in improving child survival
WHO also thanks the following organizations for their support through small grants
US Agency for International Development (USAID) httpwwwusaidgov
project name Update WHO evidence based position statements on relevant and priority micronutrient interventions
The Global Alliance for Improved Nutrition (GAIN)
httpwwwgainhealthorg
project name Systematic review of evidence of micronutrient interventions and management of moderate
malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification
project name Systematic review of evidence of rice fortification as a public health intervention and consultation on
rice fortification programs implementation
Harvard University
project name Nutrition impact model study (NIM Study)
Sight amp Life
httpwwwsightandlifeorg
project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System
MEMBERsHIPs
De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013
Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014
Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011
De-Regil LM GRADE working group 2010-present
WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs
Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for
Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2
February 2010 Geneva Switzerland
8 FINANCIAL SUPPORT
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
4DRAFT
1 SCIENTIFIC PUBLICATIONS AND REPORTSPeer review and publication in scientific journals help ensure that
sound methods are appropriately utilized in the development of
guidelines They serve as a means of quality control a term which
also includes the transparency and repeatability of research
for independent verification the validity of the conclusions
and interpretations drawn from the reported data the overall
importance for advancement within the field of nutrition
and public health novelty as well as applicability The WHO
guideline development process calls for a systematic review
of the evidence related to a particular intervention undergoing
evaluation For micronutrient interventions technical staff
from NHD have prepared many of these systematic reviews
while WHO has commissioned the Cochrane Collaboration to
complete other reviews Other publications referred to vitamin
and mineral nutrition surveillance and research area related
to micronutrient interventions in public health As part of the
Cochrane pre-publication editorial process protocols and
reviews are commented on by external peers (an editor and
two referees external to the editorial team) and the grouprsquos
statistical adviser before publication httpwwwcochraneorg
The Cochrane handbook for systematic reviews of interventions
describes in detail the process of preparing and maintaining
Cochrane systematic reviews on the effects of healthcare
interventions
Disclaimer The authors in bold are staff members of the
World Health Organization The authors alone are responsible
for the views expressed in this publication and they do not
necessarily represent the decisions or policies of the World
Health Organization
Andersson M de Benoist B Rogers L Epidemiology of iodine
deficiency Salt iodisation and iodine status Best Practice amp
Research Clinical Endocrinology amp Metabolism 2010 Feb
24(1)1-11 httpwwwncbinlmnihgovpubmed20172466
Palacios C Pentildea-Rosas JP Calcium supplementation during
pregnancy for preventing hypertensive disorders and related
problems RHL commentary (last revised 1 February 2010)
The WHO Reproductive Health Library Geneva World Health
Organization httpappswhointrhlpregnancy_childbirth
antenatal_carenutritioncd001059_penasrosasjp_comen
indexhtml
Serdula M Pentildea-Rosas JP Maberly GF Aburto NJ Perrine
CG Mei Z (eds) Flour fortification with iron folic acid vitamin
B12 vitamin A and zinc Proceedings of the Second Technical
Workshop on Wheat Flour Fortification Food and Nutrition
Bulletin vol 31 no 1 (supplement) United Nations University
Press 2010 httpwwwfoodandnutritionbulletinorg
downloadsFNB_v31n1_suppl_webpdf
Bojorquez-Chapela I Mendoza-Flores ME Morales RM
Tolentino MC De-Regil LM Risky eating behaviours are
not associated with micronutrients deficiencies in women
from Mexico City (Spanish) Archivos Latinoamericanos
de Nutricioacuten 201060(1)64-69 httpwwwncbinlmnih
govpubmedterm=Bojorquez-Chapela20I2C2020
Mendoza-Flores20ME2C20Morales20RM2C20
Tolentino20MC2C20De-Regil20LM
De-Regil LM Jamous O Mendoza-Flores ME Morales RM
Tolentino MC Casanueva E Perception of menstrual bleeding
and its asociacioacuten with iron folate and vitamin B12 deficiencies
in women of reproductive age from Mexico City (Spanish)
Anales Venezolanos de Nutricioacuten 201023 (1) 5-9 http
analesfundacionbengoaorganales-nutricion20101i=art1
Pentildea-Rosas JP Rogers LM De-Regil LM Bopardikar A
Panisset U WHO from Research to Action Developing evidence-
informed guidelines and policies for interventions in vitamin and
mineral nutrition (abstract) Evidence in multiple micronutrient
nutrition from history to science to effective programs Public
Health Nutrition 2010 Sept13(9A)17
De-Regil LM Fernaacutendez-Gaxiola AC Dowswell T Pentildea-
Rosas JP Effects and safety of periconceptional folate
supplementation for preventing birth defects Cochrane
Database of Systematic Reviews 2010 (Issue 10) Art No
CD007950 DOI 10100214651858CD007950pub2
httponlinelibrarywileycomdoi10100214651858
CD007950pub2pdf Available in Spanish at httpwww
bibliotecacochranecomBCPGetDocumentaspSessionID=36
22858ampDocumentID=CD007950
Ansary A Palacios C De-Regil LM Pentildea-Rosas JP Vitamin
D supplementation for women during pregnancy [Protocol]
Cochrane Database of Systematic Reviews 2010 Issue 12 Art
No CD008873 DOI 10100214651858CD008873
httponlinelibrarywileycomdoi10100214651858
CD008873pdf
2
Micronutrients 2010-2011Department of Nutrition for Health and Development
5DRAFT
Vist GE Suchdev PS De-Regil LM Walleser S Pentildea-Rosas JP
Home fortification of foods with multiple micronutrient powders
for health and nutrition in children under 2 years of age [Protocol]
Cochrane Database of Systematic Reviews 2011 Issue 1 Art
No CD008959 DOI 10100214651858CD008959 http
onlinelibrarywileycomdoi10100214651858CD008959pdf
Sylvetsky AC Jefferds MED De-Regil LM Dowswell T Intermittent
iron supplementation for improving nutrition and developmental
outcomes in children [Protocol] Cochrane Database of
Systematic Reviews 2011 Issue 4 Art No CD009085 DOI
10100214651858CD009085 httponlinelibrarywileycom
doi10100214651858CD009085pdf
Fernaacutendez-Gaxiola AC De-Regil LM Nasser M Intermittent
iron supplementation for reducing anaemia and its associated
impairments in menstruating women [Protocol] Cochrane
Database of Systematic Reviews 2011 Issue 7 Art No
CD009218 DOI 10100214651858CD009218 http
onlinelibrarywileycomdoi10100214651858CD009218pdf
De-Regil LM Suchdev PS Vist GE Walleser S Pentildea-Rosas
JP Home fortification of foods with multiple micronutrient
powders for health and nutrition in children under two years
of age Cochrane Database of Systematic Reviews 2011
Sep 79CD008959 httpwwwupdate-softwarecomBCP
WileyPDFENCD008959pdf Available in Spanish here
Summary in Portuguese here
Wong EM Sullivan KM Perrine CG Rogers LM Pentildea-Rosas
JP Comparison of median urinary iodine concentration as an
indicator of iodine status among pregnant women school-age
children and nonpregnant women Food and Nutrition Bulletin
Volume 32 Number 3 September 2011 pp 206-212(7)
httpwwwncbinlmnihgovpubmedterm=wong20pena-rosas20jp20
Suchdev PS De-Regil LM Walleser S Vist GE Pentildea-Rosas
JP Multiple micronutrient powders for home (point of use)
fortification of foods in pregnant women a systematic review
WHO e-Library of Evidence for Nutrition Actions Geneva
World Health Organization 2011 httpwhqlibdocwhoint
publications20119789241502559_engpdf
De-Regil LM Jefferds MED Sylvetsky AC Dowswell T
Intermittent iron supplementation for improving nutrition and
development in children under 12 years of age Cochrane
Database of Systematic Reviews 2011 Issue 12 Art No
CD009085 DOI 10100214651858CD009085pub2
httponlinelibrarywileycomdoi10100214651858
CD009085pub2pdf Available in Spanish here
Fernaacutendez-Gaxiola AC De-Regil LM Intermittent iron
supplementation for reducing anaemia and its associated
impairments in menstruating women Cochrane Database of Systematic Reviews 2011 Issue 12 Art No CD009218 DOI
10100214651858CD009218pub2 httponlinelibrary
wileycomdoi10100214651858CD009218pub2pdf
Available in Spanish at httpwwwbibliotecacochranecom
BCPGetDocumentaspSessionID=3622858ampDocumentID=
CD009218
De-Regil LM Palacios C Ansary A Kulier R Pentildea-Rosas
JP Vitamin D supplementation for women during pregnancy
Cochrane Database of Systematic Reviews 2012 Issue 2
Art No CD008873 DOI 10100214651858CD008873
pub2 httponlinelibrarywileycomdoi10100214651858
CD008873pub2pdf
Home fortification of foods with multiple micronutrient
powders for health and nutrition in children under two years
of age (Review)
De-Regil LM Suchdev PS Vist GE Walleser S Pentildea-Rosas JP
This is a reprint of a Cochrane review prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2011 Issue 9httpwwwthecochranelibrarycom
Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age (Review)
Copyright copy 2011 The Cochrane Collaboration Published by John Wiley amp Sons Ltd
Intermittent iron supplementation for reducing anaemia and
its associated impairments in menstruating women (Review)Fernaacutendez-Gaxiola AC De-Regil LM
This is a reprint of a Cochrane review prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2011 Issue 12
httpwwwthecochranelibrarycom
Intermittent iron supplementation for reducing anaemia and its associated impairments in menstruating women (Review)
Copyright copy 2011 The Cochrane Collaboration Published by John Wiley amp Sons Ltd
Micronutrients 2010-2011Department of Nutrition for Health and Development
6DRAFT
TECHNICAL REPORTS
Disclaimer These technical reports contain discussions and presentation from the meetings and do
not necessarily represent the decisions or policies of the World Health Organization Similarly they may
contain background papers commissioned for these meetings The named authors alone are responsible
for the views expressed in this publication
WHO Technical consultation on neonatal vitamin A supplementation research priorities meeting report
Geneva World Health Organization 2009 (httpwhqlibdocwhointpublications20099789241599597_
engpdf) Published in 2010
WHO Estimating appropriate levels of vitamins and minerals for food fortification programmes The WHO Intake
Monitoring Assessment and Planning Program (IMAPP) meeting report Geneva World Health Organization 2010
(httpwwwwhointnutritionpublicationsmicronutrients9789241599603pdf)
WHO Technical consultation on vitamin A in newborn health mechanistic studies Geneva World Health Organization
2012 (httpwhqlibdocwhointpublications20129789241503167_engpdf)
WHO MICRONUTRIENTS MAILING LIST
The WHO Micronutrients Mailing List was developed in order to allow subscribers to receive periodic information on WHOrsquos work
in the area of vitamins and minerals The list was established in 2009 with 990 subscribers There are currently over 3100
subscribers and the list continues to grow Anyone may subscribe to the list by sending an E-mail to micronutrientswhoint with
the following text in the subject and body of the message ldquoSUBSCRIBE MICRONUTRIENTS LISTrdquo
Who Technical
consulTaTion
on ViTamin a
in neWborn
healTh
mechanisTic
sTudies
REPORT
R E P O R T
WHO Me e t i n g O n es t i M at i n g ap p rO p r i ate Leve L s O f vi t a M i n s a n d Mi n e ra L s fO r fO O d fO r t i f i c at i O n prO gra M M e s tH e WHO int a ke MO n i tO r i n g as s e s s M e nt a n d pL a n n i n g prO gra M (iMapp)Ge n e va Sw i t ze r l a n d 22 Ju l y 2009
Micronutrients 2010-2011Department of Nutrition for Health and Development
7DRAFT
WHOrsquos publications and other resources that are produced in several
languages help to ensure that health information reaches those who need it
in the language they can understand This makes access to health information
both more equitable and effective Communicating in different languages
bridges gaps and fosters understanding between people It allows WHO to more
effectively guide public health practices reach out to audiences worldwide
and achieve better global health outcomes The six official languages of WHO
- Arabic Chinese English French Russian and Spanish - were established by
a 1978 World Health Assembly resolution turning multilingualism into a WHO
policy Since the adoption of a 1998 resolution all Governing bodies documents
and corporate materials have been made available online in all official languages
Many of the WHO publications in micronutrients have been translated into these languages Samples of the work on micronutrients
in the WHO official languages includes the translation of the website of the Vitamin and Mineral Nutrition Information System the
recent WHO evidence-informed guidelines in micronutrient interventions the WHOCDC logic model for micronutrient interventions
and summaries of the indicators used in assessing vitamin and mineral nutritional status Efforts will be made in making more
resources available in the six WHO official languages
1 MULTILINGUALISM3
Micronutrients 2010-2011Department of Nutrition for Health and Development
8DRAFT
The WHO Vitamin and Mineral Nutrition Information System (VMNIS) was initially established in 1991 and has now been expanded
into a more comprehensive vitamin and mineral nutrition information system Evaluations of epidemiological and informatics
capabilities of the system in 2009 guided the upgrade and expansion of VMNIS to include a more comprehensive micronutrients
database and additional resources and tools for vitamin and mineral nutrition surveillance by Member States and their partners as
well as the incorporation and utilization of advances in information technology to disseminate the information A new website is now
online for VMNIS that includes the following sections 1) micronutrients database 2) indicators 3) laboratory capacity 4) monitoring
and evaluation and 5) publications The website is now available in all six WHO official languages
The Micronutrients Database of the VMNIS is now upgraded and expanded This process is occurring in three phases two of which
are already completed During phase I the database was restructured to make it more efficient exploit new innovations in information
technology and include more nutritional indicators In collaboration with the Information Technology and Telecommunications Unit
of WHO and with support from CDC partners from the Office of Informatics and Information Resources Management and other
colleagues from the National Center for Chronic Disease Prevention and Health Promotion the new database platform is functioning
During phase II -data migration- all the survey information available from the previous database and an additional systematic
search for data that included scientific literature and communication with WHO Regional Offices relevant UN agencies and other
partner organizations to solicit information on nutritionmicronutrient surveys was included Additionally all surveys reports have
been digitalized to make an electronic repository instead of paper printed documents Phase III data display is expected to be
completed in 2012 and will allow users to create maps tables and access data directly from the internet
The Indicators section includes information on the biomarkers used in assessing vitamin and
mineral status in populations and used in surveys collected in VMNIS
These documents are a compilation of current WHO recommendations on the topic from different sources They summarize the
currently recognized cut-offs for defining deficiencies and their severity at the individual and population level and the chronology of
their establishment These are not new or updated recommendations but compilations of existing guidelines that were dispersed
in several WHO references and reports These summaries that are available in the six WHO official languages will serve as a
starting point for updating current recommendations on the use of these indicators
Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity
Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations
Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations
The Monitoring and Evaluation section of the VMNIS contains resources that can be useful
for monitoring andor evaluating interventions that have a focus on outcomes related to vitamin
and mineral nutrition Notable are the following
The WHOCDC logic model for micronutrient interventions in public health depicts the programme theory and plausible
relationships between inputs and expected MDGs and can be adapted to different contexts Member States can
adjust this proposed generic logic model and use it as part of the continuous quality improvement cycle for planning
performance measurement or evaluation
The WHOCDC indicators e-Catalogue for micronutrient interventions platform has been completed and it intends to be
an up-to-date interactive user-friendly and comprehensive resource of indicators for those who are actively engaged in
providing technical assistance in evaluation of micronutrient interventions There is considerable variation in indicators
used to define micronutrient deficiency limiting comparability across programs and over time
Anaemia is a condition in which the number of red blood cells (and
consequently their oxygen-carrying capacity) is insufficient to meet the
bodyrsquos physiologic needs Specific physiologic needs vary with a personrsquos
age gender residential elevation above sea level (altitude) smoking
behaviour and different stages of pregnancy Iron deficiency is thought to
be the most common cause of anaemia globally but other nutritional
deficiencies (including folate vitamin B12 and vitamin A) acute and chronic
inflammation parasitic infections and inherited or acquired disorders that
affect haemoglobin synthesis red blood cell production or red blood cell
survival can all cause anaemia Haemoglobin concentration alone cannot
be used to diagnose iron deficiency However the concentration of
haemoglobin should be measured even though not all anaemia is caused
by iron deficiency The prevalence of anaemia is an important health
indicator and when it is used with other measurements of iron status the
haemoglobin concentration can provide information about the severity of
iron deficiency (1)
Inside
Background
Scope and purpose This document aims to provide users of the Vitamin and Mineral Nutrition
Information System (VMNIS) with information about the use of
haemoglobin concentration for diagnosing anaemia It is a compilation of
current World Health Organization (WHO) recommendations on the topic
and summarizes the cut-offs for defining anaemia and its severity at the
population level as well as the chronology of their establishment
The use of the cut-off points derived from the referenced publications
permits the identification of populations at greatest risk of anaemia and
priority areas for action especially when resources are limited They also
facilitate the monitoring and assessment of progress towards international
goals of preventing and controlling iron deficiency and further provide the
basis for advocacy for the prevention of anaemia
Haemoglobin concentrations for the diagnosis of anaemia and
assessment of severity
VMNIS | Vitamin and Mineral Nutrition Information System
WHONMHNHDMNM111 Background 1
Description of technical consultation 2
Recommendations 3
Summary development
Acknowledgements 5
Plans for update 5
References 6
4
Scope and purpose 1
VMNIS | 1
4
Retinol is the predominant circulating form of vitamin A in the blood In
response to tissue demand it is released from the liver in a 11 ratio with its
carrier protein retinol-binding protein (1) In the blood this complex
combines with transthyretin (2) Specific receptors on target cell surfaces or
nuclei bind this complex or its active metabolites thereby regulating many
critical functions in the body including vision epithelial tissue integrity
and the expression of several hundred genes (2) Serum retinol levels reflect
liver vitamin A stores only when they are severely depleted (lt 007 micromolg
liver) or extremely high (gt 105 micromolg liver) (1) Between these extremes
serum retinol is homeostatically controlled and thus not always correlated
with vitamin A intake or clinical signs of deficiency Consequently serum
retinol is not useful for assessing the vitamin A status of individuals and
may not respond to interventions Rather the distribution of serum retinol
values in a population and the prevalence of individuals with serum retinol
values below a given cut-off can provide important information on the
vitamin A status of a population and may reflect the severity of vitamin A
deficiency as a public health problem (3) especially when the degree of
underlying infection or inflammation is taken into account Serum retinol
values are most often measured in young children a group highly
vulnerable to deficiency (3) Deficiency of vitamin A is associated with significant morbidity and
mortality from common childhood infections and is the worldrsquos leading
preventable cause of childhood blindness (3)
Inside
Background
Scope and Purpose This document aims to provide users of the Vitamin and Mineral Nutrition
Information System (VMNIS) with information about the use of serum
retinol for assessing the prevalence of vitamin A deficiency in populations
It is a compilation of the current World Health Organization (WHO)
recommendations on the topic and summarizes from the three documents
VMNIS | Vitamin and Mineral Nutrition Information System Background
1
Description of Technical Consultation 2
Recommendations 2
Summary Development
Acknowledgements 4
Plans for Update 4
References 5
4
Scope and Purpose 1
VMNIS | 1
Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations
WHONMHNHDMNM113
Iron stores in the body exist primarily in the form of ferritin The ferritin
molecule is an intracellular hollow protein shell composed of 24 subunits
surrounding an iron core that may contain as many as 4000-4500 iron
atoms In the body small amounts of ferritin are secreted into the plasma
The concentration of this plasma (or serum) ferritin is positively correlated
with the size of the total body iron stores in the absence of inflammation A
low serum ferritin value reflects depleted iron stores but not necessarily
the severity of the depletion as it progresses
Normal ferritin concentrations vary by age and sex Concentrations are
high at birth rise during the first two months of life and then fall
throughout later infancy (1) At about one year of age concentrations
begin to rise again and continue to increase into adulthood (2) Beginning
in adolescence however males have higher values than females a trend
that persists into late adulthood Values among men peak between 30ndash39
years of age and then tend to remain constant until about 70 years of age
Among women serum ferritin values remain relatively low until
menopause and then rise (2)
Body ferritin levels in contrast to haemoglobin are not affected by
residential elevation above sea level or smoking behaviour However
ferritin is a positive acute phase response protein whereby concentrations
increase during inflammation and thereby no longer reflect the size of the
iron store This makes the interpretation of normal or high serum ferritin
values difficult in areas of widespread infection or inflammation (3) In the
absence of inflammation or liver disease high serum ferritin concentrations
indicate iron overload
Inside
Background
Serum ferritin concentrations
for the assessment of iron
status and iron deficiency in
populations
Background
1
Description of
Technical Consultation 2
Recommendations 2
Summary
Development
Acknowledgements 5
Plans for Update 5
VMNIS | Vitamin and Mineral Nutrition Information System
References
5
WHONMHNHDMNM112
5
VMNIS | 1
Scope and Purpose
2
VITAMIN AND MINERAL NUTRITION INFORMATION SYSTEM
Micronutrients 2010-2011Department of Nutrition for Health and Development
9DRAFT
Ideally dissemination and wide-spread use of the WHOCDC indicators eCatalogue will increase the standardization
of indicators and increase consistency and comparability across programmes A Technical Consultation ldquoldquoInventory of
indicators for monitoring and evaluation of micronutrient interventionsrdquo was held in Atlanta United States of America
in 6-7 January 2010 The objectives were to fine tune the details of the logic model for monitoring and evaluation of
micronutrient interventions refine search criteria and to validate the usefulness of the indicators web-tool The team is
currently working in the compilation of these indicators using the logic model as a framework to organizing the different
types of indicators currently used in public health programmes involving micronutrient interventions
Micronutrients 2010-2011Department of Nutrition for Health and Development
10
MAIN
Dr Francesco Branca is the Director of
the Department of Nutrition for Health and
Development in the World Health Organization
Geneva He graduated in Medicine and Surgery
and specialized in Diabetology and Metabolic
Diseases at the Universitarsquo Cattolica del Sacro
Cuore Roma He obtained a PhD in Nutrition at
Aberdeen University He was a Senior Scientist
at the Italian Food and Nutrition research
Institute where he was responsible for the
design and implementation of several studies
on the effects of food and nutrients on human
health at the different stages of the life cycle
and for the design management and evaluation
of public health nutrition programmes He
was been President of the Federation of the
European Nutrition Societies in 2003-2007
Dr JP Pena-Rosas is the Coordinator Evidence
and Programme Guidance Department of
Nutrition for Health and Development at the
World Health Organization (WHO) in Geneva
Switzerland He joined WHO on July 2008 and
now oversees the Evidence and Programme
Guidance workplan in the development of
evidence-informed guidelines for interventions
addressing the double burden of malnutrition
for neonates infants children and women in
stable and emergency settings under the WHO
Research Strategy umbrella He is an Adjunct
Assistant Professor at Emory University Rollins
School of Public Health in Atlanta United States
since 2011 Previously he worked several
years in the Division of Nutrition Physical
Activity and Obesity at the Centers for Disease
Control and Prevention (CDC) in Atlanta United
States He was involved in nutrition surveys
and programme monitoring and evaluation for
nutrition interventions in Uzbekistan Morocco
Egypt Peru Nicaragua Georgia and Dominican
Republic In the private sector Dr Pena-Rosas
worked at Kellogg Company Latin America
and the Caribbean Headquarters where he
served several positions including Manager of
Scientific and Regulatory Affairs for the regional
operations He received his Medical Degree from
Universidad Central de Venezuela in his native
country and a Masterrsquos Degree in Public Health
Nutrition from University of Puerto Rico in San
Juan He holds a PhD in Human Nutrition and
Epidemiology from Cornell University Ithaca NY
United States of America He is a member of the
American Society for Nutrition Latin American
Society of Nutrition the American Evaluation
Association the Cochrane Collaboration and
the WHO Guidelines Review Committee
Dr Lisa Rogers is the technical officer for
the Evidence and Programme Guidance Unit
in the Department of Nutrition for Health and
Development She has been working at the
World Health Organization (WHO) in Geneva
Switzerland since April 2006 She is primarily
responsible for managing a grant for mechanistic
studies on neonatal vitamin A supplementation
and coordinating the completion of evidence
reviews and guideline groups to inform vitamin
and mineral intervention guidelines She holds
a PhD in Nutrition on International Nutrition
from the University of California Davis United
States of America Her work included research
in Guatemala investigating the causes of vitamin
B12 deficiency in school age children and
laboratory research involving the optimization of
an immunological assay for holotranscobalamin
II and the analysis of methylmalonic acid
homocysteine vitamin B12 and folate She
received a Master of Science in Nutritional
Sciences from the University of Florida where
she conducted research involving the analysis of
the stability of folic acid added to cereal-grain
products the bioavailability of stable-isotopically
labeled folic acid added to these products and
conducted several human subject studies She
is a member of the American Society for Nutrition
and the Academy of Nutrition and Dietetics
Dr Luz Maria De-Regil is epidemiologist at the
World Health Organization with the Evidence
and Programme Guidance Unit since September
2009 She is responsible for coordinating the
development of global guidelines on nutrition
interventions for different age groups and
settings updating and expanding the Vitamin and
Mineral Nutrition Information System (VMNIS)
developing tools for monitoring and evaluation
of nutrition interventions leading international
and multidisciplinary review teams to assess the
evidence and translating knowledge into global
public policy With more than 50 publications in
5 OUR TEAM
Micronutrients 2010-2011Department of Nutrition for Health and Development
11DRAFT
English and Spanish for different audiences Luz Maria has been involved in community programmes and designed and implemented
research focused on maternal and infant nutrition and health She has experience in applying in vitro and in vivo laboratory techniques
in combination with food science and epidemiology She is an active member of the WHO Research and Ethics Committee the
GRADE working group four groups within the Cochrane Collaboration the American Society for Nutrition the Latin American
Society of Nutrition the Mexican Pediatric Research Association and a former vice-president of the Mexican Society of Nutrition
Ms Grace Rob is a technical assistant in the Evidence and Programme Guidance Unit department of Nutrition for Health and
Development She has been working at the World Health Organization (WHO) in Geneva Switzerland since 2000 She holds a
Bachelors of Science in Home Economics major in food and nutrition and minor in business administration from University of
Eastern Africa Baraton Eldoret in her native Kenya
Mrs Paule Pillard is the Assistant to Coordinator in the Evidence and Programme Guidance Unit Department of Nutrition for Health
and Development and provides administrative support to the coordinator and the unit staff since 2007
Micronutrients 2010-2011Department of Nutrition for Health and Development
12DRAFT
NEONATAL VITAMIN A SUPPLEMENTATION MECHANISTIC STUDIES
There is considerable interest in vitamin A supplementation during the neonatal period as an intervention for reducing infant
mortality The efficacy of this intervention is still to be determined NHD along with the Department of Maternal Newborn Child
and Adolescent Health (MCA) have received funding to conduct studies for the generation of evidence to inform global policy on
the efficacy of neonatal vitamin A supplementation in improving child survival In support of uncovering biological mechanisms
by which neonatal vitamin A supplementation may be acting NHD is coordinating the conduct of one animal study and two human
studies to understand the biological mechanisms through which neonatal vitamin A supplementation can potentially have an
impact on infant survival when given at birth The animal study is being conducted at the University of Wisconsin-Madison USA
(PI S Tanumihardjo) and is using the sow-piglet dyad model The two human studies are double blind randomized controlled
trials to determine the effect of vitamin A supplementation on immune responses in early infancy One study is being conducted
in Bangladesh (n=300) by the USDA-ARS Western Human Nutrition Research Center University of California Davis CA USA (PI
C Stephensen) and the other in The Gambia (n=200) by the Medical Research Council London UK and Keneba Gambia (PI A
Prentice)
The three proposals were reviewed at a WHO Technical Consultation on Vitamin A in Newborn Health - Mechanistic Studies in
December 2009 Final proposals were approved by the WHO Ethics Review Committee (ERC) and the studies are now in progress
NUTRITION IMPACT MODEL-STUDY (NIMS)
This study is funded by a grant from The Bill amp Melinda Gates Foundation to the Harvard School of Public Health and aims to
develop empirically parameterize apply and make publicly available a policy-relevant analytical tool for estimating the health
impacts of undernutrition exposures and interventions
Representatives of the Department of Nutrition for Health and Development work closely with partners to select appropriate
exposure metrics and develop and apply statistical methods for sparse time-space data in order to estimate current levels and past
trends of anaemia and vitamin A deficiency
6 RESEARCH
Micronutrients 2010-2011Department of Nutrition for Health and Development
13DRAFT
The Department of Nutrition for Health and Development works closely with internal collaborators at WHO and with various external
organizations on topics related to micronutrients
COCHRANE COLLABORATION
Over 28000 contributors worldwide work together to help health care providers policy-makers patients their advocates and
carers make well-informed decisions about health care based on the best available research evidence by preparing updating
and promoting the accessibility of Cochrane Reviews ndash over 4600 so far published online in The Cochrane Library In 2010 the
Cochrane Database of Systematic Reviews achieved a top-10 ISI Impact Factor for an outstanding achievement The work of the
Cochrane Collaboration is internationally recognised as the benchmark for high-quality information about the effectiveness of
health care In January 2011 The Cochrane Collaboration was accepted as a Non-Governmental Organization in Official Relations
with the World Health Organization (WHO) the public health arm of the United Nations establishing formalised communication
between our two organisations
This collaboration supports the development of the WHO Library of Evidence for Nutrition Actions (eLENA) and grants open access
to all Member States For the work in micronutrients we have closely collaborated with the following Cochrane groups
Cochrane Editorial Unit (wwweditorial-unitcochraneorg)
Developmental Psychosocial and Learning Problems Group (wwwdplpgcochraneorg)
Infectious Diseases Group (wwwcidgcochraneorgenindexhtml)
Pregnancy and Childbirth Group (wwwpregnancycochraneorg)
Public Health Group (wwwphcochraneorg)
Our Department has also supported the update or undertake of systematic reviews within the following groups
HIVAIDS Group (hivcochraneorg)
Metabolic and Endocrine Disorders Group (wwwendoccochraneorg)
Neonatal Group (wwwneonatalcochraneorg)
Iberoamerican Cochrane Center (wwwcochranees)
GRADE WORKING GROUP
The Grading of Recommendations Assessment Development and Evaluation (GRADE) Working Group began in the year 2000
as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health
care The working group has developed a common sensible and transparent approach to grading the quality of evidence
and the strength of recommendations Many international organizations have provided input into the development of the
approach and have started using it
A representative of our team joined the working group in 2010 to discuss issues related to the normative work in
micronutrients at WHO
CENTERs fOR DIsEAsE CONTROL AND PREVENTION (CDC)
The International Micronutrient Malnutrition Prevention and Control (IMMPaCt) programme works with global partners to
contribute CDC skills and resources to eliminate vitamin and mineral deficiencies (micronutrient malnutrition) among vulnerable
populations throughout the world Established by the CDC in 2000 IMMPaCt focuses primarily on helping eliminate deficiencies in
iron vitamin A iodine and folate
Through a 2009-2014 agreement IMMPaCt supports WHO in various selected projects including providing technical assistance
and subject matter expertise to help design implement and maintain new and current micronutrient databases as well as assist
with processes promoting new WHO guidelines and recommendations
The CDC Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects provides the scientific and programmatic
expertise to build upon and strengthen global neural tube defect surveillance systems and expand the reach of global folic acid
fortification for neural tube defect prevention Expansion of global folic acid fortification efforts can have a significant impact on
infant mortality and childhood morbidity worldwide
7 OUR PARTNERS
Micronutrients 2010-2011Department of Nutrition for Health and Development
14DRAFT
CDCrsquos National Center on Birth Defects and Developmental Disabilities has developed a global initiative to significantly reduce infant
mortality and childhood morbidity resulting from the more than 300000 neural tube defects worldwide each year and contribute
to the achievement of United Nations Millennium Development Goal 4 help to meet the Global Health Initiative Child Health Goal
and support the 63rd World Health Assembly Resolution on Birth Defects
The initiative aims to expand the number of developing countries with mandatory folic acid fortification of high penetrance staples
and provide sustainable support of long-term interventions to eliminate folic acid-preventable neural tube defects worldwide CDC
works with WHO and others to support and advance country-level fortification efforts and to provide needed technical expertise for
surveillance of neural tube defects monitor fortification efforts and improve laboratory capacity on folate-preventable birth defects
THE MICRONUTRIENT INITIATIVE
The Micronutrient Initiative (MI) is an independent not-for-profit organization committed to promoting simple cost-effective
solutions to hidden hunger combat vitamin and mineral deficiency and developing innovative new solutions where needed based in
Ottawa Canada MI is working to end hidden hunger end vitamin and mineral deficiency by helping governments food producers
and partner organizations like WHO develop implement and monitor and evaluate innovative culturally appropriate and cost-
effective programmes to get essential vitamins and minerals to the people who need them most by providing technical and
financial assistance offering procurement and quality control services for highly specialized supplies and equipment needed to
prevent hidden hunger advocating for micronutrient programmes and educating government bodies around the world on policies
legislation and programs to ensure the sustained delivery of essential vitamins and minerals
THE EUNICE KENNEDy sHRIVER NATIONAL INsTITUTE Of CHILD HEALTH AND HUMAN DEVELOPMENT
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health
(NIH)US Department of Health and Human Services in collaboration with partners representing the breadth of the global food and
nutrition enterprise including WHO created the Biomarkers of Nutrition for Development (BOND) Program to meet the growing
need for discovery development and implementation of reliable and valid biomarkers to assess nutrient exposure status function
and effect Also with co-funding from the Bill amp Melinda Gates Foundation has developed the Iron and Malaria Project to address
the safe and effective use of iron interventions in areas of malaria burden Both projects have been done with involvement of and
in support of WHO work in the area of micronutrients
WHO NUTRITION GUIDANCE ExPERT ADVIsORy GROUP MEMBERs
Micronutrients
Ms Deena AlasfoorProfessor Beverley-Ann BiggsDr Heacutector Bourges RodriacuteguezProfessor Norm CampbellProfessor Susan Fairweather-Tait Dr Rafael Flores-AyalaProfessor Malik GoonewardeneDr Junsheng HuoDr Janet C KingDr Marzia Lazzerini Professor Malcolm E Molyneux Eng Wisam QarqashDr Mahdi Ramsan Mohamed Dr Daniel RaitenDr Meera ShekarDr Rebecca Joyce StoltzfusMs Carol TomDr David Tovey Mrs Vilma Qahoush TylerDr Gunn Elisabeth VistDr Emorn Wasantwisut
Monitoring and Evaluation
Dr Lindsay AllenDr Deborah AshDr France BeginDr Zulfiqar BhuttaDr Christine Clewes Professor Susan Fairweather-TaitDr Jonathan GorsteinDr Junsheng HuoDr Ibrahim MD KhatibDr Roland KupkaDr Christine PfeifferDr Rob JPM ScholtenDr Holger SchuumlnemannDr Ismaeumll Ngnieacute TeacutetaDr Emorn Wasantwisut
Vitamin A supplementation
Professor Hany Abdel-AleemProfessor Michael ClarkeDr Anna CoutsoudisDr M Monir HossainDr Jean HumphreyDr Yustina Anie IndriastutiDr Marzia LazzeriniDr Pavitra MohanDr Rintaro MoriDr A Catherine RossDr Isabella Sagoe-MosesDr Claudia SaundersDr Prak SophonnearyDr Charles StephensenDr Sherry TanumihardjoDr Khalid Yunis
Micronutrients 2010-2011Department of Nutrition for Health and Development
15DRAFT
INTERNsHIPs
WHO is committed to building future leaders in public health and WHOrsquos Internship Programme provides a wide range of
opportunities for graduate and post-graduate students to gain insight into the work of WHO Although WHO receives a large
number of intern applications each year only a limited number of places for internships are available Internships are available for
work in micronutrients at WHO for a minimum of 6 weeks and a maximum of 3 months to allow the internship to be both worthwhile
and effective The following selected interns were hosted by NHD during the biennium 2010-2011 to work on topics related to
micronutrients
Ms Alison Sylvetsky 7 June - 13 August 2010 - EMORY UNIVERSITY ATLANTA USA
Ms Aida Victoria Campos 1 March - 31 May 2010 - UNIVERSIDAD LA SALLE MExICO DF MExICO
Mrs Sarah Pedersen 14 June - 13 August 2010- CORNELL UNIVERSITY ITHACA NEW YORK USA
Mr Joseph Ashong1 March 2011 - 1 July 2011 - CORNELL UNIVERSITY ITHACA NEW YORK USA
Dr Saint-Rayn Pasricha 14 February 2011 - 17 June 2011 - UNIVERSITY OF MELBOURNE VICTORIA AUSTRALIA
Ms Ellie Souganidis 20 June 2011 - 12 August 2011 - JOHNS HOPKINS UNIVERSITY BALTIMORE MARYLAND USA
Mr Raheel Arif 15 August - 4 November 2011- UNIVERSITY OF THE SCIENCES PHILADELPHIA PENNSYLVANIA USA
ADVOCACy AND NETWORKs
Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource
allocation decisions within political economic and social systems and institutions Advocacy in WHO for vitamin and mineral
nutrition includes many activities such as media campaigns public speaking commissioning and publishing research as well as
participation in several groups and networks
Home Fortification Technical Advisory Group (HFTAG) (httpwwwgainhealthorghftag)
The Network For Sustained Elimination of Iodine Deficiency (httpwwwiodinenetworknet)
International Council for the Control of Iodine Deficiency Disorders (wwwicciddorg)
Rice Fortification Technical Group (httpwwwgainhealthorgriforg)
Global Alliance for Vitamin A (GAVA)
Flour Fortification Initiative (httpwwwsphemoryeduwheatflour)
International Zinc Nutrition Consultative Group (wwwizincgorg)
United Nations World Food Programme (httpwwwwfporg)
United Nations Childrenrsquos Fund (httpwwwuniceforg)
United Nations High Commissioner for Refugees (httpwwwunhcrorg)
Food and Agriculture Organization of the United Nations (httpwwwfaoorg)
The World Bank (httpwwwworldbankorg)
United Nations Standing Committee on Nutrition (httpwwwunscnorg)
Micronutrients 2010-2011Department of Nutrition for Health and Development
16DRAFT
WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients
during the biennium 2010-2011
US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms
project name Global prevention of non-communicable disease prevention and promotion of health
The Micronutrient Initiative (MI) wwwmicronutrientorg
project name e-Library of nutrition programme guidance
The Government of Luxembourghttpwwwetatlu
project name Support for the update and dissemination of evidence-based nutrition programme
The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg
project name Efficacy of newborn vitamin A supplementation in improving child survival
WHO also thanks the following organizations for their support through small grants
US Agency for International Development (USAID) httpwwwusaidgov
project name Update WHO evidence based position statements on relevant and priority micronutrient interventions
The Global Alliance for Improved Nutrition (GAIN)
httpwwwgainhealthorg
project name Systematic review of evidence of micronutrient interventions and management of moderate
malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification
project name Systematic review of evidence of rice fortification as a public health intervention and consultation on
rice fortification programs implementation
Harvard University
project name Nutrition impact model study (NIM Study)
Sight amp Life
httpwwwsightandlifeorg
project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System
MEMBERsHIPs
De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013
Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014
Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011
De-Regil LM GRADE working group 2010-present
WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs
Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for
Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2
February 2010 Geneva Switzerland
8 FINANCIAL SUPPORT
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
5DRAFT
Vist GE Suchdev PS De-Regil LM Walleser S Pentildea-Rosas JP
Home fortification of foods with multiple micronutrient powders
for health and nutrition in children under 2 years of age [Protocol]
Cochrane Database of Systematic Reviews 2011 Issue 1 Art
No CD008959 DOI 10100214651858CD008959 http
onlinelibrarywileycomdoi10100214651858CD008959pdf
Sylvetsky AC Jefferds MED De-Regil LM Dowswell T Intermittent
iron supplementation for improving nutrition and developmental
outcomes in children [Protocol] Cochrane Database of
Systematic Reviews 2011 Issue 4 Art No CD009085 DOI
10100214651858CD009085 httponlinelibrarywileycom
doi10100214651858CD009085pdf
Fernaacutendez-Gaxiola AC De-Regil LM Nasser M Intermittent
iron supplementation for reducing anaemia and its associated
impairments in menstruating women [Protocol] Cochrane
Database of Systematic Reviews 2011 Issue 7 Art No
CD009218 DOI 10100214651858CD009218 http
onlinelibrarywileycomdoi10100214651858CD009218pdf
De-Regil LM Suchdev PS Vist GE Walleser S Pentildea-Rosas
JP Home fortification of foods with multiple micronutrient
powders for health and nutrition in children under two years
of age Cochrane Database of Systematic Reviews 2011
Sep 79CD008959 httpwwwupdate-softwarecomBCP
WileyPDFENCD008959pdf Available in Spanish here
Summary in Portuguese here
Wong EM Sullivan KM Perrine CG Rogers LM Pentildea-Rosas
JP Comparison of median urinary iodine concentration as an
indicator of iodine status among pregnant women school-age
children and nonpregnant women Food and Nutrition Bulletin
Volume 32 Number 3 September 2011 pp 206-212(7)
httpwwwncbinlmnihgovpubmedterm=wong20pena-rosas20jp20
Suchdev PS De-Regil LM Walleser S Vist GE Pentildea-Rosas
JP Multiple micronutrient powders for home (point of use)
fortification of foods in pregnant women a systematic review
WHO e-Library of Evidence for Nutrition Actions Geneva
World Health Organization 2011 httpwhqlibdocwhoint
publications20119789241502559_engpdf
De-Regil LM Jefferds MED Sylvetsky AC Dowswell T
Intermittent iron supplementation for improving nutrition and
development in children under 12 years of age Cochrane
Database of Systematic Reviews 2011 Issue 12 Art No
CD009085 DOI 10100214651858CD009085pub2
httponlinelibrarywileycomdoi10100214651858
CD009085pub2pdf Available in Spanish here
Fernaacutendez-Gaxiola AC De-Regil LM Intermittent iron
supplementation for reducing anaemia and its associated
impairments in menstruating women Cochrane Database of Systematic Reviews 2011 Issue 12 Art No CD009218 DOI
10100214651858CD009218pub2 httponlinelibrary
wileycomdoi10100214651858CD009218pub2pdf
Available in Spanish at httpwwwbibliotecacochranecom
BCPGetDocumentaspSessionID=3622858ampDocumentID=
CD009218
De-Regil LM Palacios C Ansary A Kulier R Pentildea-Rosas
JP Vitamin D supplementation for women during pregnancy
Cochrane Database of Systematic Reviews 2012 Issue 2
Art No CD008873 DOI 10100214651858CD008873
pub2 httponlinelibrarywileycomdoi10100214651858
CD008873pub2pdf
Home fortification of foods with multiple micronutrient
powders for health and nutrition in children under two years
of age (Review)
De-Regil LM Suchdev PS Vist GE Walleser S Pentildea-Rosas JP
This is a reprint of a Cochrane review prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2011 Issue 9httpwwwthecochranelibrarycom
Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age (Review)
Copyright copy 2011 The Cochrane Collaboration Published by John Wiley amp Sons Ltd
Intermittent iron supplementation for reducing anaemia and
its associated impairments in menstruating women (Review)Fernaacutendez-Gaxiola AC De-Regil LM
This is a reprint of a Cochrane review prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2011 Issue 12
httpwwwthecochranelibrarycom
Intermittent iron supplementation for reducing anaemia and its associated impairments in menstruating women (Review)
Copyright copy 2011 The Cochrane Collaboration Published by John Wiley amp Sons Ltd
Micronutrients 2010-2011Department of Nutrition for Health and Development
6DRAFT
TECHNICAL REPORTS
Disclaimer These technical reports contain discussions and presentation from the meetings and do
not necessarily represent the decisions or policies of the World Health Organization Similarly they may
contain background papers commissioned for these meetings The named authors alone are responsible
for the views expressed in this publication
WHO Technical consultation on neonatal vitamin A supplementation research priorities meeting report
Geneva World Health Organization 2009 (httpwhqlibdocwhointpublications20099789241599597_
engpdf) Published in 2010
WHO Estimating appropriate levels of vitamins and minerals for food fortification programmes The WHO Intake
Monitoring Assessment and Planning Program (IMAPP) meeting report Geneva World Health Organization 2010
(httpwwwwhointnutritionpublicationsmicronutrients9789241599603pdf)
WHO Technical consultation on vitamin A in newborn health mechanistic studies Geneva World Health Organization
2012 (httpwhqlibdocwhointpublications20129789241503167_engpdf)
WHO MICRONUTRIENTS MAILING LIST
The WHO Micronutrients Mailing List was developed in order to allow subscribers to receive periodic information on WHOrsquos work
in the area of vitamins and minerals The list was established in 2009 with 990 subscribers There are currently over 3100
subscribers and the list continues to grow Anyone may subscribe to the list by sending an E-mail to micronutrientswhoint with
the following text in the subject and body of the message ldquoSUBSCRIBE MICRONUTRIENTS LISTrdquo
Who Technical
consulTaTion
on ViTamin a
in neWborn
healTh
mechanisTic
sTudies
REPORT
R E P O R T
WHO Me e t i n g O n es t i M at i n g ap p rO p r i ate Leve L s O f vi t a M i n s a n d Mi n e ra L s fO r fO O d fO r t i f i c at i O n prO gra M M e s tH e WHO int a ke MO n i tO r i n g as s e s s M e nt a n d pL a n n i n g prO gra M (iMapp)Ge n e va Sw i t ze r l a n d 22 Ju l y 2009
Micronutrients 2010-2011Department of Nutrition for Health and Development
7DRAFT
WHOrsquos publications and other resources that are produced in several
languages help to ensure that health information reaches those who need it
in the language they can understand This makes access to health information
both more equitable and effective Communicating in different languages
bridges gaps and fosters understanding between people It allows WHO to more
effectively guide public health practices reach out to audiences worldwide
and achieve better global health outcomes The six official languages of WHO
- Arabic Chinese English French Russian and Spanish - were established by
a 1978 World Health Assembly resolution turning multilingualism into a WHO
policy Since the adoption of a 1998 resolution all Governing bodies documents
and corporate materials have been made available online in all official languages
Many of the WHO publications in micronutrients have been translated into these languages Samples of the work on micronutrients
in the WHO official languages includes the translation of the website of the Vitamin and Mineral Nutrition Information System the
recent WHO evidence-informed guidelines in micronutrient interventions the WHOCDC logic model for micronutrient interventions
and summaries of the indicators used in assessing vitamin and mineral nutritional status Efforts will be made in making more
resources available in the six WHO official languages
1 MULTILINGUALISM3
Micronutrients 2010-2011Department of Nutrition for Health and Development
8DRAFT
The WHO Vitamin and Mineral Nutrition Information System (VMNIS) was initially established in 1991 and has now been expanded
into a more comprehensive vitamin and mineral nutrition information system Evaluations of epidemiological and informatics
capabilities of the system in 2009 guided the upgrade and expansion of VMNIS to include a more comprehensive micronutrients
database and additional resources and tools for vitamin and mineral nutrition surveillance by Member States and their partners as
well as the incorporation and utilization of advances in information technology to disseminate the information A new website is now
online for VMNIS that includes the following sections 1) micronutrients database 2) indicators 3) laboratory capacity 4) monitoring
and evaluation and 5) publications The website is now available in all six WHO official languages
The Micronutrients Database of the VMNIS is now upgraded and expanded This process is occurring in three phases two of which
are already completed During phase I the database was restructured to make it more efficient exploit new innovations in information
technology and include more nutritional indicators In collaboration with the Information Technology and Telecommunications Unit
of WHO and with support from CDC partners from the Office of Informatics and Information Resources Management and other
colleagues from the National Center for Chronic Disease Prevention and Health Promotion the new database platform is functioning
During phase II -data migration- all the survey information available from the previous database and an additional systematic
search for data that included scientific literature and communication with WHO Regional Offices relevant UN agencies and other
partner organizations to solicit information on nutritionmicronutrient surveys was included Additionally all surveys reports have
been digitalized to make an electronic repository instead of paper printed documents Phase III data display is expected to be
completed in 2012 and will allow users to create maps tables and access data directly from the internet
The Indicators section includes information on the biomarkers used in assessing vitamin and
mineral status in populations and used in surveys collected in VMNIS
These documents are a compilation of current WHO recommendations on the topic from different sources They summarize the
currently recognized cut-offs for defining deficiencies and their severity at the individual and population level and the chronology of
their establishment These are not new or updated recommendations but compilations of existing guidelines that were dispersed
in several WHO references and reports These summaries that are available in the six WHO official languages will serve as a
starting point for updating current recommendations on the use of these indicators
Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity
Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations
Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations
The Monitoring and Evaluation section of the VMNIS contains resources that can be useful
for monitoring andor evaluating interventions that have a focus on outcomes related to vitamin
and mineral nutrition Notable are the following
The WHOCDC logic model for micronutrient interventions in public health depicts the programme theory and plausible
relationships between inputs and expected MDGs and can be adapted to different contexts Member States can
adjust this proposed generic logic model and use it as part of the continuous quality improvement cycle for planning
performance measurement or evaluation
The WHOCDC indicators e-Catalogue for micronutrient interventions platform has been completed and it intends to be
an up-to-date interactive user-friendly and comprehensive resource of indicators for those who are actively engaged in
providing technical assistance in evaluation of micronutrient interventions There is considerable variation in indicators
used to define micronutrient deficiency limiting comparability across programs and over time
Anaemia is a condition in which the number of red blood cells (and
consequently their oxygen-carrying capacity) is insufficient to meet the
bodyrsquos physiologic needs Specific physiologic needs vary with a personrsquos
age gender residential elevation above sea level (altitude) smoking
behaviour and different stages of pregnancy Iron deficiency is thought to
be the most common cause of anaemia globally but other nutritional
deficiencies (including folate vitamin B12 and vitamin A) acute and chronic
inflammation parasitic infections and inherited or acquired disorders that
affect haemoglobin synthesis red blood cell production or red blood cell
survival can all cause anaemia Haemoglobin concentration alone cannot
be used to diagnose iron deficiency However the concentration of
haemoglobin should be measured even though not all anaemia is caused
by iron deficiency The prevalence of anaemia is an important health
indicator and when it is used with other measurements of iron status the
haemoglobin concentration can provide information about the severity of
iron deficiency (1)
Inside
Background
Scope and purpose This document aims to provide users of the Vitamin and Mineral Nutrition
Information System (VMNIS) with information about the use of
haemoglobin concentration for diagnosing anaemia It is a compilation of
current World Health Organization (WHO) recommendations on the topic
and summarizes the cut-offs for defining anaemia and its severity at the
population level as well as the chronology of their establishment
The use of the cut-off points derived from the referenced publications
permits the identification of populations at greatest risk of anaemia and
priority areas for action especially when resources are limited They also
facilitate the monitoring and assessment of progress towards international
goals of preventing and controlling iron deficiency and further provide the
basis for advocacy for the prevention of anaemia
Haemoglobin concentrations for the diagnosis of anaemia and
assessment of severity
VMNIS | Vitamin and Mineral Nutrition Information System
WHONMHNHDMNM111 Background 1
Description of technical consultation 2
Recommendations 3
Summary development
Acknowledgements 5
Plans for update 5
References 6
4
Scope and purpose 1
VMNIS | 1
4
Retinol is the predominant circulating form of vitamin A in the blood In
response to tissue demand it is released from the liver in a 11 ratio with its
carrier protein retinol-binding protein (1) In the blood this complex
combines with transthyretin (2) Specific receptors on target cell surfaces or
nuclei bind this complex or its active metabolites thereby regulating many
critical functions in the body including vision epithelial tissue integrity
and the expression of several hundred genes (2) Serum retinol levels reflect
liver vitamin A stores only when they are severely depleted (lt 007 micromolg
liver) or extremely high (gt 105 micromolg liver) (1) Between these extremes
serum retinol is homeostatically controlled and thus not always correlated
with vitamin A intake or clinical signs of deficiency Consequently serum
retinol is not useful for assessing the vitamin A status of individuals and
may not respond to interventions Rather the distribution of serum retinol
values in a population and the prevalence of individuals with serum retinol
values below a given cut-off can provide important information on the
vitamin A status of a population and may reflect the severity of vitamin A
deficiency as a public health problem (3) especially when the degree of
underlying infection or inflammation is taken into account Serum retinol
values are most often measured in young children a group highly
vulnerable to deficiency (3) Deficiency of vitamin A is associated with significant morbidity and
mortality from common childhood infections and is the worldrsquos leading
preventable cause of childhood blindness (3)
Inside
Background
Scope and Purpose This document aims to provide users of the Vitamin and Mineral Nutrition
Information System (VMNIS) with information about the use of serum
retinol for assessing the prevalence of vitamin A deficiency in populations
It is a compilation of the current World Health Organization (WHO)
recommendations on the topic and summarizes from the three documents
VMNIS | Vitamin and Mineral Nutrition Information System Background
1
Description of Technical Consultation 2
Recommendations 2
Summary Development
Acknowledgements 4
Plans for Update 4
References 5
4
Scope and Purpose 1
VMNIS | 1
Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations
WHONMHNHDMNM113
Iron stores in the body exist primarily in the form of ferritin The ferritin
molecule is an intracellular hollow protein shell composed of 24 subunits
surrounding an iron core that may contain as many as 4000-4500 iron
atoms In the body small amounts of ferritin are secreted into the plasma
The concentration of this plasma (or serum) ferritin is positively correlated
with the size of the total body iron stores in the absence of inflammation A
low serum ferritin value reflects depleted iron stores but not necessarily
the severity of the depletion as it progresses
Normal ferritin concentrations vary by age and sex Concentrations are
high at birth rise during the first two months of life and then fall
throughout later infancy (1) At about one year of age concentrations
begin to rise again and continue to increase into adulthood (2) Beginning
in adolescence however males have higher values than females a trend
that persists into late adulthood Values among men peak between 30ndash39
years of age and then tend to remain constant until about 70 years of age
Among women serum ferritin values remain relatively low until
menopause and then rise (2)
Body ferritin levels in contrast to haemoglobin are not affected by
residential elevation above sea level or smoking behaviour However
ferritin is a positive acute phase response protein whereby concentrations
increase during inflammation and thereby no longer reflect the size of the
iron store This makes the interpretation of normal or high serum ferritin
values difficult in areas of widespread infection or inflammation (3) In the
absence of inflammation or liver disease high serum ferritin concentrations
indicate iron overload
Inside
Background
Serum ferritin concentrations
for the assessment of iron
status and iron deficiency in
populations
Background
1
Description of
Technical Consultation 2
Recommendations 2
Summary
Development
Acknowledgements 5
Plans for Update 5
VMNIS | Vitamin and Mineral Nutrition Information System
References
5
WHONMHNHDMNM112
5
VMNIS | 1
Scope and Purpose
2
VITAMIN AND MINERAL NUTRITION INFORMATION SYSTEM
Micronutrients 2010-2011Department of Nutrition for Health and Development
9DRAFT
Ideally dissemination and wide-spread use of the WHOCDC indicators eCatalogue will increase the standardization
of indicators and increase consistency and comparability across programmes A Technical Consultation ldquoldquoInventory of
indicators for monitoring and evaluation of micronutrient interventionsrdquo was held in Atlanta United States of America
in 6-7 January 2010 The objectives were to fine tune the details of the logic model for monitoring and evaluation of
micronutrient interventions refine search criteria and to validate the usefulness of the indicators web-tool The team is
currently working in the compilation of these indicators using the logic model as a framework to organizing the different
types of indicators currently used in public health programmes involving micronutrient interventions
Micronutrients 2010-2011Department of Nutrition for Health and Development
10
MAIN
Dr Francesco Branca is the Director of
the Department of Nutrition for Health and
Development in the World Health Organization
Geneva He graduated in Medicine and Surgery
and specialized in Diabetology and Metabolic
Diseases at the Universitarsquo Cattolica del Sacro
Cuore Roma He obtained a PhD in Nutrition at
Aberdeen University He was a Senior Scientist
at the Italian Food and Nutrition research
Institute where he was responsible for the
design and implementation of several studies
on the effects of food and nutrients on human
health at the different stages of the life cycle
and for the design management and evaluation
of public health nutrition programmes He
was been President of the Federation of the
European Nutrition Societies in 2003-2007
Dr JP Pena-Rosas is the Coordinator Evidence
and Programme Guidance Department of
Nutrition for Health and Development at the
World Health Organization (WHO) in Geneva
Switzerland He joined WHO on July 2008 and
now oversees the Evidence and Programme
Guidance workplan in the development of
evidence-informed guidelines for interventions
addressing the double burden of malnutrition
for neonates infants children and women in
stable and emergency settings under the WHO
Research Strategy umbrella He is an Adjunct
Assistant Professor at Emory University Rollins
School of Public Health in Atlanta United States
since 2011 Previously he worked several
years in the Division of Nutrition Physical
Activity and Obesity at the Centers for Disease
Control and Prevention (CDC) in Atlanta United
States He was involved in nutrition surveys
and programme monitoring and evaluation for
nutrition interventions in Uzbekistan Morocco
Egypt Peru Nicaragua Georgia and Dominican
Republic In the private sector Dr Pena-Rosas
worked at Kellogg Company Latin America
and the Caribbean Headquarters where he
served several positions including Manager of
Scientific and Regulatory Affairs for the regional
operations He received his Medical Degree from
Universidad Central de Venezuela in his native
country and a Masterrsquos Degree in Public Health
Nutrition from University of Puerto Rico in San
Juan He holds a PhD in Human Nutrition and
Epidemiology from Cornell University Ithaca NY
United States of America He is a member of the
American Society for Nutrition Latin American
Society of Nutrition the American Evaluation
Association the Cochrane Collaboration and
the WHO Guidelines Review Committee
Dr Lisa Rogers is the technical officer for
the Evidence and Programme Guidance Unit
in the Department of Nutrition for Health and
Development She has been working at the
World Health Organization (WHO) in Geneva
Switzerland since April 2006 She is primarily
responsible for managing a grant for mechanistic
studies on neonatal vitamin A supplementation
and coordinating the completion of evidence
reviews and guideline groups to inform vitamin
and mineral intervention guidelines She holds
a PhD in Nutrition on International Nutrition
from the University of California Davis United
States of America Her work included research
in Guatemala investigating the causes of vitamin
B12 deficiency in school age children and
laboratory research involving the optimization of
an immunological assay for holotranscobalamin
II and the analysis of methylmalonic acid
homocysteine vitamin B12 and folate She
received a Master of Science in Nutritional
Sciences from the University of Florida where
she conducted research involving the analysis of
the stability of folic acid added to cereal-grain
products the bioavailability of stable-isotopically
labeled folic acid added to these products and
conducted several human subject studies She
is a member of the American Society for Nutrition
and the Academy of Nutrition and Dietetics
Dr Luz Maria De-Regil is epidemiologist at the
World Health Organization with the Evidence
and Programme Guidance Unit since September
2009 She is responsible for coordinating the
development of global guidelines on nutrition
interventions for different age groups and
settings updating and expanding the Vitamin and
Mineral Nutrition Information System (VMNIS)
developing tools for monitoring and evaluation
of nutrition interventions leading international
and multidisciplinary review teams to assess the
evidence and translating knowledge into global
public policy With more than 50 publications in
5 OUR TEAM
Micronutrients 2010-2011Department of Nutrition for Health and Development
11DRAFT
English and Spanish for different audiences Luz Maria has been involved in community programmes and designed and implemented
research focused on maternal and infant nutrition and health She has experience in applying in vitro and in vivo laboratory techniques
in combination with food science and epidemiology She is an active member of the WHO Research and Ethics Committee the
GRADE working group four groups within the Cochrane Collaboration the American Society for Nutrition the Latin American
Society of Nutrition the Mexican Pediatric Research Association and a former vice-president of the Mexican Society of Nutrition
Ms Grace Rob is a technical assistant in the Evidence and Programme Guidance Unit department of Nutrition for Health and
Development She has been working at the World Health Organization (WHO) in Geneva Switzerland since 2000 She holds a
Bachelors of Science in Home Economics major in food and nutrition and minor in business administration from University of
Eastern Africa Baraton Eldoret in her native Kenya
Mrs Paule Pillard is the Assistant to Coordinator in the Evidence and Programme Guidance Unit Department of Nutrition for Health
and Development and provides administrative support to the coordinator and the unit staff since 2007
Micronutrients 2010-2011Department of Nutrition for Health and Development
12DRAFT
NEONATAL VITAMIN A SUPPLEMENTATION MECHANISTIC STUDIES
There is considerable interest in vitamin A supplementation during the neonatal period as an intervention for reducing infant
mortality The efficacy of this intervention is still to be determined NHD along with the Department of Maternal Newborn Child
and Adolescent Health (MCA) have received funding to conduct studies for the generation of evidence to inform global policy on
the efficacy of neonatal vitamin A supplementation in improving child survival In support of uncovering biological mechanisms
by which neonatal vitamin A supplementation may be acting NHD is coordinating the conduct of one animal study and two human
studies to understand the biological mechanisms through which neonatal vitamin A supplementation can potentially have an
impact on infant survival when given at birth The animal study is being conducted at the University of Wisconsin-Madison USA
(PI S Tanumihardjo) and is using the sow-piglet dyad model The two human studies are double blind randomized controlled
trials to determine the effect of vitamin A supplementation on immune responses in early infancy One study is being conducted
in Bangladesh (n=300) by the USDA-ARS Western Human Nutrition Research Center University of California Davis CA USA (PI
C Stephensen) and the other in The Gambia (n=200) by the Medical Research Council London UK and Keneba Gambia (PI A
Prentice)
The three proposals were reviewed at a WHO Technical Consultation on Vitamin A in Newborn Health - Mechanistic Studies in
December 2009 Final proposals were approved by the WHO Ethics Review Committee (ERC) and the studies are now in progress
NUTRITION IMPACT MODEL-STUDY (NIMS)
This study is funded by a grant from The Bill amp Melinda Gates Foundation to the Harvard School of Public Health and aims to
develop empirically parameterize apply and make publicly available a policy-relevant analytical tool for estimating the health
impacts of undernutrition exposures and interventions
Representatives of the Department of Nutrition for Health and Development work closely with partners to select appropriate
exposure metrics and develop and apply statistical methods for sparse time-space data in order to estimate current levels and past
trends of anaemia and vitamin A deficiency
6 RESEARCH
Micronutrients 2010-2011Department of Nutrition for Health and Development
13DRAFT
The Department of Nutrition for Health and Development works closely with internal collaborators at WHO and with various external
organizations on topics related to micronutrients
COCHRANE COLLABORATION
Over 28000 contributors worldwide work together to help health care providers policy-makers patients their advocates and
carers make well-informed decisions about health care based on the best available research evidence by preparing updating
and promoting the accessibility of Cochrane Reviews ndash over 4600 so far published online in The Cochrane Library In 2010 the
Cochrane Database of Systematic Reviews achieved a top-10 ISI Impact Factor for an outstanding achievement The work of the
Cochrane Collaboration is internationally recognised as the benchmark for high-quality information about the effectiveness of
health care In January 2011 The Cochrane Collaboration was accepted as a Non-Governmental Organization in Official Relations
with the World Health Organization (WHO) the public health arm of the United Nations establishing formalised communication
between our two organisations
This collaboration supports the development of the WHO Library of Evidence for Nutrition Actions (eLENA) and grants open access
to all Member States For the work in micronutrients we have closely collaborated with the following Cochrane groups
Cochrane Editorial Unit (wwweditorial-unitcochraneorg)
Developmental Psychosocial and Learning Problems Group (wwwdplpgcochraneorg)
Infectious Diseases Group (wwwcidgcochraneorgenindexhtml)
Pregnancy and Childbirth Group (wwwpregnancycochraneorg)
Public Health Group (wwwphcochraneorg)
Our Department has also supported the update or undertake of systematic reviews within the following groups
HIVAIDS Group (hivcochraneorg)
Metabolic and Endocrine Disorders Group (wwwendoccochraneorg)
Neonatal Group (wwwneonatalcochraneorg)
Iberoamerican Cochrane Center (wwwcochranees)
GRADE WORKING GROUP
The Grading of Recommendations Assessment Development and Evaluation (GRADE) Working Group began in the year 2000
as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health
care The working group has developed a common sensible and transparent approach to grading the quality of evidence
and the strength of recommendations Many international organizations have provided input into the development of the
approach and have started using it
A representative of our team joined the working group in 2010 to discuss issues related to the normative work in
micronutrients at WHO
CENTERs fOR DIsEAsE CONTROL AND PREVENTION (CDC)
The International Micronutrient Malnutrition Prevention and Control (IMMPaCt) programme works with global partners to
contribute CDC skills and resources to eliminate vitamin and mineral deficiencies (micronutrient malnutrition) among vulnerable
populations throughout the world Established by the CDC in 2000 IMMPaCt focuses primarily on helping eliminate deficiencies in
iron vitamin A iodine and folate
Through a 2009-2014 agreement IMMPaCt supports WHO in various selected projects including providing technical assistance
and subject matter expertise to help design implement and maintain new and current micronutrient databases as well as assist
with processes promoting new WHO guidelines and recommendations
The CDC Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects provides the scientific and programmatic
expertise to build upon and strengthen global neural tube defect surveillance systems and expand the reach of global folic acid
fortification for neural tube defect prevention Expansion of global folic acid fortification efforts can have a significant impact on
infant mortality and childhood morbidity worldwide
7 OUR PARTNERS
Micronutrients 2010-2011Department of Nutrition for Health and Development
14DRAFT
CDCrsquos National Center on Birth Defects and Developmental Disabilities has developed a global initiative to significantly reduce infant
mortality and childhood morbidity resulting from the more than 300000 neural tube defects worldwide each year and contribute
to the achievement of United Nations Millennium Development Goal 4 help to meet the Global Health Initiative Child Health Goal
and support the 63rd World Health Assembly Resolution on Birth Defects
The initiative aims to expand the number of developing countries with mandatory folic acid fortification of high penetrance staples
and provide sustainable support of long-term interventions to eliminate folic acid-preventable neural tube defects worldwide CDC
works with WHO and others to support and advance country-level fortification efforts and to provide needed technical expertise for
surveillance of neural tube defects monitor fortification efforts and improve laboratory capacity on folate-preventable birth defects
THE MICRONUTRIENT INITIATIVE
The Micronutrient Initiative (MI) is an independent not-for-profit organization committed to promoting simple cost-effective
solutions to hidden hunger combat vitamin and mineral deficiency and developing innovative new solutions where needed based in
Ottawa Canada MI is working to end hidden hunger end vitamin and mineral deficiency by helping governments food producers
and partner organizations like WHO develop implement and monitor and evaluate innovative culturally appropriate and cost-
effective programmes to get essential vitamins and minerals to the people who need them most by providing technical and
financial assistance offering procurement and quality control services for highly specialized supplies and equipment needed to
prevent hidden hunger advocating for micronutrient programmes and educating government bodies around the world on policies
legislation and programs to ensure the sustained delivery of essential vitamins and minerals
THE EUNICE KENNEDy sHRIVER NATIONAL INsTITUTE Of CHILD HEALTH AND HUMAN DEVELOPMENT
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health
(NIH)US Department of Health and Human Services in collaboration with partners representing the breadth of the global food and
nutrition enterprise including WHO created the Biomarkers of Nutrition for Development (BOND) Program to meet the growing
need for discovery development and implementation of reliable and valid biomarkers to assess nutrient exposure status function
and effect Also with co-funding from the Bill amp Melinda Gates Foundation has developed the Iron and Malaria Project to address
the safe and effective use of iron interventions in areas of malaria burden Both projects have been done with involvement of and
in support of WHO work in the area of micronutrients
WHO NUTRITION GUIDANCE ExPERT ADVIsORy GROUP MEMBERs
Micronutrients
Ms Deena AlasfoorProfessor Beverley-Ann BiggsDr Heacutector Bourges RodriacuteguezProfessor Norm CampbellProfessor Susan Fairweather-Tait Dr Rafael Flores-AyalaProfessor Malik GoonewardeneDr Junsheng HuoDr Janet C KingDr Marzia Lazzerini Professor Malcolm E Molyneux Eng Wisam QarqashDr Mahdi Ramsan Mohamed Dr Daniel RaitenDr Meera ShekarDr Rebecca Joyce StoltzfusMs Carol TomDr David Tovey Mrs Vilma Qahoush TylerDr Gunn Elisabeth VistDr Emorn Wasantwisut
Monitoring and Evaluation
Dr Lindsay AllenDr Deborah AshDr France BeginDr Zulfiqar BhuttaDr Christine Clewes Professor Susan Fairweather-TaitDr Jonathan GorsteinDr Junsheng HuoDr Ibrahim MD KhatibDr Roland KupkaDr Christine PfeifferDr Rob JPM ScholtenDr Holger SchuumlnemannDr Ismaeumll Ngnieacute TeacutetaDr Emorn Wasantwisut
Vitamin A supplementation
Professor Hany Abdel-AleemProfessor Michael ClarkeDr Anna CoutsoudisDr M Monir HossainDr Jean HumphreyDr Yustina Anie IndriastutiDr Marzia LazzeriniDr Pavitra MohanDr Rintaro MoriDr A Catherine RossDr Isabella Sagoe-MosesDr Claudia SaundersDr Prak SophonnearyDr Charles StephensenDr Sherry TanumihardjoDr Khalid Yunis
Micronutrients 2010-2011Department of Nutrition for Health and Development
15DRAFT
INTERNsHIPs
WHO is committed to building future leaders in public health and WHOrsquos Internship Programme provides a wide range of
opportunities for graduate and post-graduate students to gain insight into the work of WHO Although WHO receives a large
number of intern applications each year only a limited number of places for internships are available Internships are available for
work in micronutrients at WHO for a minimum of 6 weeks and a maximum of 3 months to allow the internship to be both worthwhile
and effective The following selected interns were hosted by NHD during the biennium 2010-2011 to work on topics related to
micronutrients
Ms Alison Sylvetsky 7 June - 13 August 2010 - EMORY UNIVERSITY ATLANTA USA
Ms Aida Victoria Campos 1 March - 31 May 2010 - UNIVERSIDAD LA SALLE MExICO DF MExICO
Mrs Sarah Pedersen 14 June - 13 August 2010- CORNELL UNIVERSITY ITHACA NEW YORK USA
Mr Joseph Ashong1 March 2011 - 1 July 2011 - CORNELL UNIVERSITY ITHACA NEW YORK USA
Dr Saint-Rayn Pasricha 14 February 2011 - 17 June 2011 - UNIVERSITY OF MELBOURNE VICTORIA AUSTRALIA
Ms Ellie Souganidis 20 June 2011 - 12 August 2011 - JOHNS HOPKINS UNIVERSITY BALTIMORE MARYLAND USA
Mr Raheel Arif 15 August - 4 November 2011- UNIVERSITY OF THE SCIENCES PHILADELPHIA PENNSYLVANIA USA
ADVOCACy AND NETWORKs
Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource
allocation decisions within political economic and social systems and institutions Advocacy in WHO for vitamin and mineral
nutrition includes many activities such as media campaigns public speaking commissioning and publishing research as well as
participation in several groups and networks
Home Fortification Technical Advisory Group (HFTAG) (httpwwwgainhealthorghftag)
The Network For Sustained Elimination of Iodine Deficiency (httpwwwiodinenetworknet)
International Council for the Control of Iodine Deficiency Disorders (wwwicciddorg)
Rice Fortification Technical Group (httpwwwgainhealthorgriforg)
Global Alliance for Vitamin A (GAVA)
Flour Fortification Initiative (httpwwwsphemoryeduwheatflour)
International Zinc Nutrition Consultative Group (wwwizincgorg)
United Nations World Food Programme (httpwwwwfporg)
United Nations Childrenrsquos Fund (httpwwwuniceforg)
United Nations High Commissioner for Refugees (httpwwwunhcrorg)
Food and Agriculture Organization of the United Nations (httpwwwfaoorg)
The World Bank (httpwwwworldbankorg)
United Nations Standing Committee on Nutrition (httpwwwunscnorg)
Micronutrients 2010-2011Department of Nutrition for Health and Development
16DRAFT
WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients
during the biennium 2010-2011
US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms
project name Global prevention of non-communicable disease prevention and promotion of health
The Micronutrient Initiative (MI) wwwmicronutrientorg
project name e-Library of nutrition programme guidance
The Government of Luxembourghttpwwwetatlu
project name Support for the update and dissemination of evidence-based nutrition programme
The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg
project name Efficacy of newborn vitamin A supplementation in improving child survival
WHO also thanks the following organizations for their support through small grants
US Agency for International Development (USAID) httpwwwusaidgov
project name Update WHO evidence based position statements on relevant and priority micronutrient interventions
The Global Alliance for Improved Nutrition (GAIN)
httpwwwgainhealthorg
project name Systematic review of evidence of micronutrient interventions and management of moderate
malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification
project name Systematic review of evidence of rice fortification as a public health intervention and consultation on
rice fortification programs implementation
Harvard University
project name Nutrition impact model study (NIM Study)
Sight amp Life
httpwwwsightandlifeorg
project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System
MEMBERsHIPs
De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013
Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014
Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011
De-Regil LM GRADE working group 2010-present
WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs
Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for
Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2
February 2010 Geneva Switzerland
8 FINANCIAL SUPPORT
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
6DRAFT
TECHNICAL REPORTS
Disclaimer These technical reports contain discussions and presentation from the meetings and do
not necessarily represent the decisions or policies of the World Health Organization Similarly they may
contain background papers commissioned for these meetings The named authors alone are responsible
for the views expressed in this publication
WHO Technical consultation on neonatal vitamin A supplementation research priorities meeting report
Geneva World Health Organization 2009 (httpwhqlibdocwhointpublications20099789241599597_
engpdf) Published in 2010
WHO Estimating appropriate levels of vitamins and minerals for food fortification programmes The WHO Intake
Monitoring Assessment and Planning Program (IMAPP) meeting report Geneva World Health Organization 2010
(httpwwwwhointnutritionpublicationsmicronutrients9789241599603pdf)
WHO Technical consultation on vitamin A in newborn health mechanistic studies Geneva World Health Organization
2012 (httpwhqlibdocwhointpublications20129789241503167_engpdf)
WHO MICRONUTRIENTS MAILING LIST
The WHO Micronutrients Mailing List was developed in order to allow subscribers to receive periodic information on WHOrsquos work
in the area of vitamins and minerals The list was established in 2009 with 990 subscribers There are currently over 3100
subscribers and the list continues to grow Anyone may subscribe to the list by sending an E-mail to micronutrientswhoint with
the following text in the subject and body of the message ldquoSUBSCRIBE MICRONUTRIENTS LISTrdquo
Who Technical
consulTaTion
on ViTamin a
in neWborn
healTh
mechanisTic
sTudies
REPORT
R E P O R T
WHO Me e t i n g O n es t i M at i n g ap p rO p r i ate Leve L s O f vi t a M i n s a n d Mi n e ra L s fO r fO O d fO r t i f i c at i O n prO gra M M e s tH e WHO int a ke MO n i tO r i n g as s e s s M e nt a n d pL a n n i n g prO gra M (iMapp)Ge n e va Sw i t ze r l a n d 22 Ju l y 2009
Micronutrients 2010-2011Department of Nutrition for Health and Development
7DRAFT
WHOrsquos publications and other resources that are produced in several
languages help to ensure that health information reaches those who need it
in the language they can understand This makes access to health information
both more equitable and effective Communicating in different languages
bridges gaps and fosters understanding between people It allows WHO to more
effectively guide public health practices reach out to audiences worldwide
and achieve better global health outcomes The six official languages of WHO
- Arabic Chinese English French Russian and Spanish - were established by
a 1978 World Health Assembly resolution turning multilingualism into a WHO
policy Since the adoption of a 1998 resolution all Governing bodies documents
and corporate materials have been made available online in all official languages
Many of the WHO publications in micronutrients have been translated into these languages Samples of the work on micronutrients
in the WHO official languages includes the translation of the website of the Vitamin and Mineral Nutrition Information System the
recent WHO evidence-informed guidelines in micronutrient interventions the WHOCDC logic model for micronutrient interventions
and summaries of the indicators used in assessing vitamin and mineral nutritional status Efforts will be made in making more
resources available in the six WHO official languages
1 MULTILINGUALISM3
Micronutrients 2010-2011Department of Nutrition for Health and Development
8DRAFT
The WHO Vitamin and Mineral Nutrition Information System (VMNIS) was initially established in 1991 and has now been expanded
into a more comprehensive vitamin and mineral nutrition information system Evaluations of epidemiological and informatics
capabilities of the system in 2009 guided the upgrade and expansion of VMNIS to include a more comprehensive micronutrients
database and additional resources and tools for vitamin and mineral nutrition surveillance by Member States and their partners as
well as the incorporation and utilization of advances in information technology to disseminate the information A new website is now
online for VMNIS that includes the following sections 1) micronutrients database 2) indicators 3) laboratory capacity 4) monitoring
and evaluation and 5) publications The website is now available in all six WHO official languages
The Micronutrients Database of the VMNIS is now upgraded and expanded This process is occurring in three phases two of which
are already completed During phase I the database was restructured to make it more efficient exploit new innovations in information
technology and include more nutritional indicators In collaboration with the Information Technology and Telecommunications Unit
of WHO and with support from CDC partners from the Office of Informatics and Information Resources Management and other
colleagues from the National Center for Chronic Disease Prevention and Health Promotion the new database platform is functioning
During phase II -data migration- all the survey information available from the previous database and an additional systematic
search for data that included scientific literature and communication with WHO Regional Offices relevant UN agencies and other
partner organizations to solicit information on nutritionmicronutrient surveys was included Additionally all surveys reports have
been digitalized to make an electronic repository instead of paper printed documents Phase III data display is expected to be
completed in 2012 and will allow users to create maps tables and access data directly from the internet
The Indicators section includes information on the biomarkers used in assessing vitamin and
mineral status in populations and used in surveys collected in VMNIS
These documents are a compilation of current WHO recommendations on the topic from different sources They summarize the
currently recognized cut-offs for defining deficiencies and their severity at the individual and population level and the chronology of
their establishment These are not new or updated recommendations but compilations of existing guidelines that were dispersed
in several WHO references and reports These summaries that are available in the six WHO official languages will serve as a
starting point for updating current recommendations on the use of these indicators
Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity
Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations
Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations
The Monitoring and Evaluation section of the VMNIS contains resources that can be useful
for monitoring andor evaluating interventions that have a focus on outcomes related to vitamin
and mineral nutrition Notable are the following
The WHOCDC logic model for micronutrient interventions in public health depicts the programme theory and plausible
relationships between inputs and expected MDGs and can be adapted to different contexts Member States can
adjust this proposed generic logic model and use it as part of the continuous quality improvement cycle for planning
performance measurement or evaluation
The WHOCDC indicators e-Catalogue for micronutrient interventions platform has been completed and it intends to be
an up-to-date interactive user-friendly and comprehensive resource of indicators for those who are actively engaged in
providing technical assistance in evaluation of micronutrient interventions There is considerable variation in indicators
used to define micronutrient deficiency limiting comparability across programs and over time
Anaemia is a condition in which the number of red blood cells (and
consequently their oxygen-carrying capacity) is insufficient to meet the
bodyrsquos physiologic needs Specific physiologic needs vary with a personrsquos
age gender residential elevation above sea level (altitude) smoking
behaviour and different stages of pregnancy Iron deficiency is thought to
be the most common cause of anaemia globally but other nutritional
deficiencies (including folate vitamin B12 and vitamin A) acute and chronic
inflammation parasitic infections and inherited or acquired disorders that
affect haemoglobin synthesis red blood cell production or red blood cell
survival can all cause anaemia Haemoglobin concentration alone cannot
be used to diagnose iron deficiency However the concentration of
haemoglobin should be measured even though not all anaemia is caused
by iron deficiency The prevalence of anaemia is an important health
indicator and when it is used with other measurements of iron status the
haemoglobin concentration can provide information about the severity of
iron deficiency (1)
Inside
Background
Scope and purpose This document aims to provide users of the Vitamin and Mineral Nutrition
Information System (VMNIS) with information about the use of
haemoglobin concentration for diagnosing anaemia It is a compilation of
current World Health Organization (WHO) recommendations on the topic
and summarizes the cut-offs for defining anaemia and its severity at the
population level as well as the chronology of their establishment
The use of the cut-off points derived from the referenced publications
permits the identification of populations at greatest risk of anaemia and
priority areas for action especially when resources are limited They also
facilitate the monitoring and assessment of progress towards international
goals of preventing and controlling iron deficiency and further provide the
basis for advocacy for the prevention of anaemia
Haemoglobin concentrations for the diagnosis of anaemia and
assessment of severity
VMNIS | Vitamin and Mineral Nutrition Information System
WHONMHNHDMNM111 Background 1
Description of technical consultation 2
Recommendations 3
Summary development
Acknowledgements 5
Plans for update 5
References 6
4
Scope and purpose 1
VMNIS | 1
4
Retinol is the predominant circulating form of vitamin A in the blood In
response to tissue demand it is released from the liver in a 11 ratio with its
carrier protein retinol-binding protein (1) In the blood this complex
combines with transthyretin (2) Specific receptors on target cell surfaces or
nuclei bind this complex or its active metabolites thereby regulating many
critical functions in the body including vision epithelial tissue integrity
and the expression of several hundred genes (2) Serum retinol levels reflect
liver vitamin A stores only when they are severely depleted (lt 007 micromolg
liver) or extremely high (gt 105 micromolg liver) (1) Between these extremes
serum retinol is homeostatically controlled and thus not always correlated
with vitamin A intake or clinical signs of deficiency Consequently serum
retinol is not useful for assessing the vitamin A status of individuals and
may not respond to interventions Rather the distribution of serum retinol
values in a population and the prevalence of individuals with serum retinol
values below a given cut-off can provide important information on the
vitamin A status of a population and may reflect the severity of vitamin A
deficiency as a public health problem (3) especially when the degree of
underlying infection or inflammation is taken into account Serum retinol
values are most often measured in young children a group highly
vulnerable to deficiency (3) Deficiency of vitamin A is associated with significant morbidity and
mortality from common childhood infections and is the worldrsquos leading
preventable cause of childhood blindness (3)
Inside
Background
Scope and Purpose This document aims to provide users of the Vitamin and Mineral Nutrition
Information System (VMNIS) with information about the use of serum
retinol for assessing the prevalence of vitamin A deficiency in populations
It is a compilation of the current World Health Organization (WHO)
recommendations on the topic and summarizes from the three documents
VMNIS | Vitamin and Mineral Nutrition Information System Background
1
Description of Technical Consultation 2
Recommendations 2
Summary Development
Acknowledgements 4
Plans for Update 4
References 5
4
Scope and Purpose 1
VMNIS | 1
Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations
WHONMHNHDMNM113
Iron stores in the body exist primarily in the form of ferritin The ferritin
molecule is an intracellular hollow protein shell composed of 24 subunits
surrounding an iron core that may contain as many as 4000-4500 iron
atoms In the body small amounts of ferritin are secreted into the plasma
The concentration of this plasma (or serum) ferritin is positively correlated
with the size of the total body iron stores in the absence of inflammation A
low serum ferritin value reflects depleted iron stores but not necessarily
the severity of the depletion as it progresses
Normal ferritin concentrations vary by age and sex Concentrations are
high at birth rise during the first two months of life and then fall
throughout later infancy (1) At about one year of age concentrations
begin to rise again and continue to increase into adulthood (2) Beginning
in adolescence however males have higher values than females a trend
that persists into late adulthood Values among men peak between 30ndash39
years of age and then tend to remain constant until about 70 years of age
Among women serum ferritin values remain relatively low until
menopause and then rise (2)
Body ferritin levels in contrast to haemoglobin are not affected by
residential elevation above sea level or smoking behaviour However
ferritin is a positive acute phase response protein whereby concentrations
increase during inflammation and thereby no longer reflect the size of the
iron store This makes the interpretation of normal or high serum ferritin
values difficult in areas of widespread infection or inflammation (3) In the
absence of inflammation or liver disease high serum ferritin concentrations
indicate iron overload
Inside
Background
Serum ferritin concentrations
for the assessment of iron
status and iron deficiency in
populations
Background
1
Description of
Technical Consultation 2
Recommendations 2
Summary
Development
Acknowledgements 5
Plans for Update 5
VMNIS | Vitamin and Mineral Nutrition Information System
References
5
WHONMHNHDMNM112
5
VMNIS | 1
Scope and Purpose
2
VITAMIN AND MINERAL NUTRITION INFORMATION SYSTEM
Micronutrients 2010-2011Department of Nutrition for Health and Development
9DRAFT
Ideally dissemination and wide-spread use of the WHOCDC indicators eCatalogue will increase the standardization
of indicators and increase consistency and comparability across programmes A Technical Consultation ldquoldquoInventory of
indicators for monitoring and evaluation of micronutrient interventionsrdquo was held in Atlanta United States of America
in 6-7 January 2010 The objectives were to fine tune the details of the logic model for monitoring and evaluation of
micronutrient interventions refine search criteria and to validate the usefulness of the indicators web-tool The team is
currently working in the compilation of these indicators using the logic model as a framework to organizing the different
types of indicators currently used in public health programmes involving micronutrient interventions
Micronutrients 2010-2011Department of Nutrition for Health and Development
10
MAIN
Dr Francesco Branca is the Director of
the Department of Nutrition for Health and
Development in the World Health Organization
Geneva He graduated in Medicine and Surgery
and specialized in Diabetology and Metabolic
Diseases at the Universitarsquo Cattolica del Sacro
Cuore Roma He obtained a PhD in Nutrition at
Aberdeen University He was a Senior Scientist
at the Italian Food and Nutrition research
Institute where he was responsible for the
design and implementation of several studies
on the effects of food and nutrients on human
health at the different stages of the life cycle
and for the design management and evaluation
of public health nutrition programmes He
was been President of the Federation of the
European Nutrition Societies in 2003-2007
Dr JP Pena-Rosas is the Coordinator Evidence
and Programme Guidance Department of
Nutrition for Health and Development at the
World Health Organization (WHO) in Geneva
Switzerland He joined WHO on July 2008 and
now oversees the Evidence and Programme
Guidance workplan in the development of
evidence-informed guidelines for interventions
addressing the double burden of malnutrition
for neonates infants children and women in
stable and emergency settings under the WHO
Research Strategy umbrella He is an Adjunct
Assistant Professor at Emory University Rollins
School of Public Health in Atlanta United States
since 2011 Previously he worked several
years in the Division of Nutrition Physical
Activity and Obesity at the Centers for Disease
Control and Prevention (CDC) in Atlanta United
States He was involved in nutrition surveys
and programme monitoring and evaluation for
nutrition interventions in Uzbekistan Morocco
Egypt Peru Nicaragua Georgia and Dominican
Republic In the private sector Dr Pena-Rosas
worked at Kellogg Company Latin America
and the Caribbean Headquarters where he
served several positions including Manager of
Scientific and Regulatory Affairs for the regional
operations He received his Medical Degree from
Universidad Central de Venezuela in his native
country and a Masterrsquos Degree in Public Health
Nutrition from University of Puerto Rico in San
Juan He holds a PhD in Human Nutrition and
Epidemiology from Cornell University Ithaca NY
United States of America He is a member of the
American Society for Nutrition Latin American
Society of Nutrition the American Evaluation
Association the Cochrane Collaboration and
the WHO Guidelines Review Committee
Dr Lisa Rogers is the technical officer for
the Evidence and Programme Guidance Unit
in the Department of Nutrition for Health and
Development She has been working at the
World Health Organization (WHO) in Geneva
Switzerland since April 2006 She is primarily
responsible for managing a grant for mechanistic
studies on neonatal vitamin A supplementation
and coordinating the completion of evidence
reviews and guideline groups to inform vitamin
and mineral intervention guidelines She holds
a PhD in Nutrition on International Nutrition
from the University of California Davis United
States of America Her work included research
in Guatemala investigating the causes of vitamin
B12 deficiency in school age children and
laboratory research involving the optimization of
an immunological assay for holotranscobalamin
II and the analysis of methylmalonic acid
homocysteine vitamin B12 and folate She
received a Master of Science in Nutritional
Sciences from the University of Florida where
she conducted research involving the analysis of
the stability of folic acid added to cereal-grain
products the bioavailability of stable-isotopically
labeled folic acid added to these products and
conducted several human subject studies She
is a member of the American Society for Nutrition
and the Academy of Nutrition and Dietetics
Dr Luz Maria De-Regil is epidemiologist at the
World Health Organization with the Evidence
and Programme Guidance Unit since September
2009 She is responsible for coordinating the
development of global guidelines on nutrition
interventions for different age groups and
settings updating and expanding the Vitamin and
Mineral Nutrition Information System (VMNIS)
developing tools for monitoring and evaluation
of nutrition interventions leading international
and multidisciplinary review teams to assess the
evidence and translating knowledge into global
public policy With more than 50 publications in
5 OUR TEAM
Micronutrients 2010-2011Department of Nutrition for Health and Development
11DRAFT
English and Spanish for different audiences Luz Maria has been involved in community programmes and designed and implemented
research focused on maternal and infant nutrition and health She has experience in applying in vitro and in vivo laboratory techniques
in combination with food science and epidemiology She is an active member of the WHO Research and Ethics Committee the
GRADE working group four groups within the Cochrane Collaboration the American Society for Nutrition the Latin American
Society of Nutrition the Mexican Pediatric Research Association and a former vice-president of the Mexican Society of Nutrition
Ms Grace Rob is a technical assistant in the Evidence and Programme Guidance Unit department of Nutrition for Health and
Development She has been working at the World Health Organization (WHO) in Geneva Switzerland since 2000 She holds a
Bachelors of Science in Home Economics major in food and nutrition and minor in business administration from University of
Eastern Africa Baraton Eldoret in her native Kenya
Mrs Paule Pillard is the Assistant to Coordinator in the Evidence and Programme Guidance Unit Department of Nutrition for Health
and Development and provides administrative support to the coordinator and the unit staff since 2007
Micronutrients 2010-2011Department of Nutrition for Health and Development
12DRAFT
NEONATAL VITAMIN A SUPPLEMENTATION MECHANISTIC STUDIES
There is considerable interest in vitamin A supplementation during the neonatal period as an intervention for reducing infant
mortality The efficacy of this intervention is still to be determined NHD along with the Department of Maternal Newborn Child
and Adolescent Health (MCA) have received funding to conduct studies for the generation of evidence to inform global policy on
the efficacy of neonatal vitamin A supplementation in improving child survival In support of uncovering biological mechanisms
by which neonatal vitamin A supplementation may be acting NHD is coordinating the conduct of one animal study and two human
studies to understand the biological mechanisms through which neonatal vitamin A supplementation can potentially have an
impact on infant survival when given at birth The animal study is being conducted at the University of Wisconsin-Madison USA
(PI S Tanumihardjo) and is using the sow-piglet dyad model The two human studies are double blind randomized controlled
trials to determine the effect of vitamin A supplementation on immune responses in early infancy One study is being conducted
in Bangladesh (n=300) by the USDA-ARS Western Human Nutrition Research Center University of California Davis CA USA (PI
C Stephensen) and the other in The Gambia (n=200) by the Medical Research Council London UK and Keneba Gambia (PI A
Prentice)
The three proposals were reviewed at a WHO Technical Consultation on Vitamin A in Newborn Health - Mechanistic Studies in
December 2009 Final proposals were approved by the WHO Ethics Review Committee (ERC) and the studies are now in progress
NUTRITION IMPACT MODEL-STUDY (NIMS)
This study is funded by a grant from The Bill amp Melinda Gates Foundation to the Harvard School of Public Health and aims to
develop empirically parameterize apply and make publicly available a policy-relevant analytical tool for estimating the health
impacts of undernutrition exposures and interventions
Representatives of the Department of Nutrition for Health and Development work closely with partners to select appropriate
exposure metrics and develop and apply statistical methods for sparse time-space data in order to estimate current levels and past
trends of anaemia and vitamin A deficiency
6 RESEARCH
Micronutrients 2010-2011Department of Nutrition for Health and Development
13DRAFT
The Department of Nutrition for Health and Development works closely with internal collaborators at WHO and with various external
organizations on topics related to micronutrients
COCHRANE COLLABORATION
Over 28000 contributors worldwide work together to help health care providers policy-makers patients their advocates and
carers make well-informed decisions about health care based on the best available research evidence by preparing updating
and promoting the accessibility of Cochrane Reviews ndash over 4600 so far published online in The Cochrane Library In 2010 the
Cochrane Database of Systematic Reviews achieved a top-10 ISI Impact Factor for an outstanding achievement The work of the
Cochrane Collaboration is internationally recognised as the benchmark for high-quality information about the effectiveness of
health care In January 2011 The Cochrane Collaboration was accepted as a Non-Governmental Organization in Official Relations
with the World Health Organization (WHO) the public health arm of the United Nations establishing formalised communication
between our two organisations
This collaboration supports the development of the WHO Library of Evidence for Nutrition Actions (eLENA) and grants open access
to all Member States For the work in micronutrients we have closely collaborated with the following Cochrane groups
Cochrane Editorial Unit (wwweditorial-unitcochraneorg)
Developmental Psychosocial and Learning Problems Group (wwwdplpgcochraneorg)
Infectious Diseases Group (wwwcidgcochraneorgenindexhtml)
Pregnancy and Childbirth Group (wwwpregnancycochraneorg)
Public Health Group (wwwphcochraneorg)
Our Department has also supported the update or undertake of systematic reviews within the following groups
HIVAIDS Group (hivcochraneorg)
Metabolic and Endocrine Disorders Group (wwwendoccochraneorg)
Neonatal Group (wwwneonatalcochraneorg)
Iberoamerican Cochrane Center (wwwcochranees)
GRADE WORKING GROUP
The Grading of Recommendations Assessment Development and Evaluation (GRADE) Working Group began in the year 2000
as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health
care The working group has developed a common sensible and transparent approach to grading the quality of evidence
and the strength of recommendations Many international organizations have provided input into the development of the
approach and have started using it
A representative of our team joined the working group in 2010 to discuss issues related to the normative work in
micronutrients at WHO
CENTERs fOR DIsEAsE CONTROL AND PREVENTION (CDC)
The International Micronutrient Malnutrition Prevention and Control (IMMPaCt) programme works with global partners to
contribute CDC skills and resources to eliminate vitamin and mineral deficiencies (micronutrient malnutrition) among vulnerable
populations throughout the world Established by the CDC in 2000 IMMPaCt focuses primarily on helping eliminate deficiencies in
iron vitamin A iodine and folate
Through a 2009-2014 agreement IMMPaCt supports WHO in various selected projects including providing technical assistance
and subject matter expertise to help design implement and maintain new and current micronutrient databases as well as assist
with processes promoting new WHO guidelines and recommendations
The CDC Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects provides the scientific and programmatic
expertise to build upon and strengthen global neural tube defect surveillance systems and expand the reach of global folic acid
fortification for neural tube defect prevention Expansion of global folic acid fortification efforts can have a significant impact on
infant mortality and childhood morbidity worldwide
7 OUR PARTNERS
Micronutrients 2010-2011Department of Nutrition for Health and Development
14DRAFT
CDCrsquos National Center on Birth Defects and Developmental Disabilities has developed a global initiative to significantly reduce infant
mortality and childhood morbidity resulting from the more than 300000 neural tube defects worldwide each year and contribute
to the achievement of United Nations Millennium Development Goal 4 help to meet the Global Health Initiative Child Health Goal
and support the 63rd World Health Assembly Resolution on Birth Defects
The initiative aims to expand the number of developing countries with mandatory folic acid fortification of high penetrance staples
and provide sustainable support of long-term interventions to eliminate folic acid-preventable neural tube defects worldwide CDC
works with WHO and others to support and advance country-level fortification efforts and to provide needed technical expertise for
surveillance of neural tube defects monitor fortification efforts and improve laboratory capacity on folate-preventable birth defects
THE MICRONUTRIENT INITIATIVE
The Micronutrient Initiative (MI) is an independent not-for-profit organization committed to promoting simple cost-effective
solutions to hidden hunger combat vitamin and mineral deficiency and developing innovative new solutions where needed based in
Ottawa Canada MI is working to end hidden hunger end vitamin and mineral deficiency by helping governments food producers
and partner organizations like WHO develop implement and monitor and evaluate innovative culturally appropriate and cost-
effective programmes to get essential vitamins and minerals to the people who need them most by providing technical and
financial assistance offering procurement and quality control services for highly specialized supplies and equipment needed to
prevent hidden hunger advocating for micronutrient programmes and educating government bodies around the world on policies
legislation and programs to ensure the sustained delivery of essential vitamins and minerals
THE EUNICE KENNEDy sHRIVER NATIONAL INsTITUTE Of CHILD HEALTH AND HUMAN DEVELOPMENT
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health
(NIH)US Department of Health and Human Services in collaboration with partners representing the breadth of the global food and
nutrition enterprise including WHO created the Biomarkers of Nutrition for Development (BOND) Program to meet the growing
need for discovery development and implementation of reliable and valid biomarkers to assess nutrient exposure status function
and effect Also with co-funding from the Bill amp Melinda Gates Foundation has developed the Iron and Malaria Project to address
the safe and effective use of iron interventions in areas of malaria burden Both projects have been done with involvement of and
in support of WHO work in the area of micronutrients
WHO NUTRITION GUIDANCE ExPERT ADVIsORy GROUP MEMBERs
Micronutrients
Ms Deena AlasfoorProfessor Beverley-Ann BiggsDr Heacutector Bourges RodriacuteguezProfessor Norm CampbellProfessor Susan Fairweather-Tait Dr Rafael Flores-AyalaProfessor Malik GoonewardeneDr Junsheng HuoDr Janet C KingDr Marzia Lazzerini Professor Malcolm E Molyneux Eng Wisam QarqashDr Mahdi Ramsan Mohamed Dr Daniel RaitenDr Meera ShekarDr Rebecca Joyce StoltzfusMs Carol TomDr David Tovey Mrs Vilma Qahoush TylerDr Gunn Elisabeth VistDr Emorn Wasantwisut
Monitoring and Evaluation
Dr Lindsay AllenDr Deborah AshDr France BeginDr Zulfiqar BhuttaDr Christine Clewes Professor Susan Fairweather-TaitDr Jonathan GorsteinDr Junsheng HuoDr Ibrahim MD KhatibDr Roland KupkaDr Christine PfeifferDr Rob JPM ScholtenDr Holger SchuumlnemannDr Ismaeumll Ngnieacute TeacutetaDr Emorn Wasantwisut
Vitamin A supplementation
Professor Hany Abdel-AleemProfessor Michael ClarkeDr Anna CoutsoudisDr M Monir HossainDr Jean HumphreyDr Yustina Anie IndriastutiDr Marzia LazzeriniDr Pavitra MohanDr Rintaro MoriDr A Catherine RossDr Isabella Sagoe-MosesDr Claudia SaundersDr Prak SophonnearyDr Charles StephensenDr Sherry TanumihardjoDr Khalid Yunis
Micronutrients 2010-2011Department of Nutrition for Health and Development
15DRAFT
INTERNsHIPs
WHO is committed to building future leaders in public health and WHOrsquos Internship Programme provides a wide range of
opportunities for graduate and post-graduate students to gain insight into the work of WHO Although WHO receives a large
number of intern applications each year only a limited number of places for internships are available Internships are available for
work in micronutrients at WHO for a minimum of 6 weeks and a maximum of 3 months to allow the internship to be both worthwhile
and effective The following selected interns were hosted by NHD during the biennium 2010-2011 to work on topics related to
micronutrients
Ms Alison Sylvetsky 7 June - 13 August 2010 - EMORY UNIVERSITY ATLANTA USA
Ms Aida Victoria Campos 1 March - 31 May 2010 - UNIVERSIDAD LA SALLE MExICO DF MExICO
Mrs Sarah Pedersen 14 June - 13 August 2010- CORNELL UNIVERSITY ITHACA NEW YORK USA
Mr Joseph Ashong1 March 2011 - 1 July 2011 - CORNELL UNIVERSITY ITHACA NEW YORK USA
Dr Saint-Rayn Pasricha 14 February 2011 - 17 June 2011 - UNIVERSITY OF MELBOURNE VICTORIA AUSTRALIA
Ms Ellie Souganidis 20 June 2011 - 12 August 2011 - JOHNS HOPKINS UNIVERSITY BALTIMORE MARYLAND USA
Mr Raheel Arif 15 August - 4 November 2011- UNIVERSITY OF THE SCIENCES PHILADELPHIA PENNSYLVANIA USA
ADVOCACy AND NETWORKs
Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource
allocation decisions within political economic and social systems and institutions Advocacy in WHO for vitamin and mineral
nutrition includes many activities such as media campaigns public speaking commissioning and publishing research as well as
participation in several groups and networks
Home Fortification Technical Advisory Group (HFTAG) (httpwwwgainhealthorghftag)
The Network For Sustained Elimination of Iodine Deficiency (httpwwwiodinenetworknet)
International Council for the Control of Iodine Deficiency Disorders (wwwicciddorg)
Rice Fortification Technical Group (httpwwwgainhealthorgriforg)
Global Alliance for Vitamin A (GAVA)
Flour Fortification Initiative (httpwwwsphemoryeduwheatflour)
International Zinc Nutrition Consultative Group (wwwizincgorg)
United Nations World Food Programme (httpwwwwfporg)
United Nations Childrenrsquos Fund (httpwwwuniceforg)
United Nations High Commissioner for Refugees (httpwwwunhcrorg)
Food and Agriculture Organization of the United Nations (httpwwwfaoorg)
The World Bank (httpwwwworldbankorg)
United Nations Standing Committee on Nutrition (httpwwwunscnorg)
Micronutrients 2010-2011Department of Nutrition for Health and Development
16DRAFT
WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients
during the biennium 2010-2011
US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms
project name Global prevention of non-communicable disease prevention and promotion of health
The Micronutrient Initiative (MI) wwwmicronutrientorg
project name e-Library of nutrition programme guidance
The Government of Luxembourghttpwwwetatlu
project name Support for the update and dissemination of evidence-based nutrition programme
The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg
project name Efficacy of newborn vitamin A supplementation in improving child survival
WHO also thanks the following organizations for their support through small grants
US Agency for International Development (USAID) httpwwwusaidgov
project name Update WHO evidence based position statements on relevant and priority micronutrient interventions
The Global Alliance for Improved Nutrition (GAIN)
httpwwwgainhealthorg
project name Systematic review of evidence of micronutrient interventions and management of moderate
malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification
project name Systematic review of evidence of rice fortification as a public health intervention and consultation on
rice fortification programs implementation
Harvard University
project name Nutrition impact model study (NIM Study)
Sight amp Life
httpwwwsightandlifeorg
project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System
MEMBERsHIPs
De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013
Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014
Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011
De-Regil LM GRADE working group 2010-present
WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs
Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for
Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2
February 2010 Geneva Switzerland
8 FINANCIAL SUPPORT
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
7DRAFT
WHOrsquos publications and other resources that are produced in several
languages help to ensure that health information reaches those who need it
in the language they can understand This makes access to health information
both more equitable and effective Communicating in different languages
bridges gaps and fosters understanding between people It allows WHO to more
effectively guide public health practices reach out to audiences worldwide
and achieve better global health outcomes The six official languages of WHO
- Arabic Chinese English French Russian and Spanish - were established by
a 1978 World Health Assembly resolution turning multilingualism into a WHO
policy Since the adoption of a 1998 resolution all Governing bodies documents
and corporate materials have been made available online in all official languages
Many of the WHO publications in micronutrients have been translated into these languages Samples of the work on micronutrients
in the WHO official languages includes the translation of the website of the Vitamin and Mineral Nutrition Information System the
recent WHO evidence-informed guidelines in micronutrient interventions the WHOCDC logic model for micronutrient interventions
and summaries of the indicators used in assessing vitamin and mineral nutritional status Efforts will be made in making more
resources available in the six WHO official languages
1 MULTILINGUALISM3
Micronutrients 2010-2011Department of Nutrition for Health and Development
8DRAFT
The WHO Vitamin and Mineral Nutrition Information System (VMNIS) was initially established in 1991 and has now been expanded
into a more comprehensive vitamin and mineral nutrition information system Evaluations of epidemiological and informatics
capabilities of the system in 2009 guided the upgrade and expansion of VMNIS to include a more comprehensive micronutrients
database and additional resources and tools for vitamin and mineral nutrition surveillance by Member States and their partners as
well as the incorporation and utilization of advances in information technology to disseminate the information A new website is now
online for VMNIS that includes the following sections 1) micronutrients database 2) indicators 3) laboratory capacity 4) monitoring
and evaluation and 5) publications The website is now available in all six WHO official languages
The Micronutrients Database of the VMNIS is now upgraded and expanded This process is occurring in three phases two of which
are already completed During phase I the database was restructured to make it more efficient exploit new innovations in information
technology and include more nutritional indicators In collaboration with the Information Technology and Telecommunications Unit
of WHO and with support from CDC partners from the Office of Informatics and Information Resources Management and other
colleagues from the National Center for Chronic Disease Prevention and Health Promotion the new database platform is functioning
During phase II -data migration- all the survey information available from the previous database and an additional systematic
search for data that included scientific literature and communication with WHO Regional Offices relevant UN agencies and other
partner organizations to solicit information on nutritionmicronutrient surveys was included Additionally all surveys reports have
been digitalized to make an electronic repository instead of paper printed documents Phase III data display is expected to be
completed in 2012 and will allow users to create maps tables and access data directly from the internet
The Indicators section includes information on the biomarkers used in assessing vitamin and
mineral status in populations and used in surveys collected in VMNIS
These documents are a compilation of current WHO recommendations on the topic from different sources They summarize the
currently recognized cut-offs for defining deficiencies and their severity at the individual and population level and the chronology of
their establishment These are not new or updated recommendations but compilations of existing guidelines that were dispersed
in several WHO references and reports These summaries that are available in the six WHO official languages will serve as a
starting point for updating current recommendations on the use of these indicators
Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity
Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations
Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations
The Monitoring and Evaluation section of the VMNIS contains resources that can be useful
for monitoring andor evaluating interventions that have a focus on outcomes related to vitamin
and mineral nutrition Notable are the following
The WHOCDC logic model for micronutrient interventions in public health depicts the programme theory and plausible
relationships between inputs and expected MDGs and can be adapted to different contexts Member States can
adjust this proposed generic logic model and use it as part of the continuous quality improvement cycle for planning
performance measurement or evaluation
The WHOCDC indicators e-Catalogue for micronutrient interventions platform has been completed and it intends to be
an up-to-date interactive user-friendly and comprehensive resource of indicators for those who are actively engaged in
providing technical assistance in evaluation of micronutrient interventions There is considerable variation in indicators
used to define micronutrient deficiency limiting comparability across programs and over time
Anaemia is a condition in which the number of red blood cells (and
consequently their oxygen-carrying capacity) is insufficient to meet the
bodyrsquos physiologic needs Specific physiologic needs vary with a personrsquos
age gender residential elevation above sea level (altitude) smoking
behaviour and different stages of pregnancy Iron deficiency is thought to
be the most common cause of anaemia globally but other nutritional
deficiencies (including folate vitamin B12 and vitamin A) acute and chronic
inflammation parasitic infections and inherited or acquired disorders that
affect haemoglobin synthesis red blood cell production or red blood cell
survival can all cause anaemia Haemoglobin concentration alone cannot
be used to diagnose iron deficiency However the concentration of
haemoglobin should be measured even though not all anaemia is caused
by iron deficiency The prevalence of anaemia is an important health
indicator and when it is used with other measurements of iron status the
haemoglobin concentration can provide information about the severity of
iron deficiency (1)
Inside
Background
Scope and purpose This document aims to provide users of the Vitamin and Mineral Nutrition
Information System (VMNIS) with information about the use of
haemoglobin concentration for diagnosing anaemia It is a compilation of
current World Health Organization (WHO) recommendations on the topic
and summarizes the cut-offs for defining anaemia and its severity at the
population level as well as the chronology of their establishment
The use of the cut-off points derived from the referenced publications
permits the identification of populations at greatest risk of anaemia and
priority areas for action especially when resources are limited They also
facilitate the monitoring and assessment of progress towards international
goals of preventing and controlling iron deficiency and further provide the
basis for advocacy for the prevention of anaemia
Haemoglobin concentrations for the diagnosis of anaemia and
assessment of severity
VMNIS | Vitamin and Mineral Nutrition Information System
WHONMHNHDMNM111 Background 1
Description of technical consultation 2
Recommendations 3
Summary development
Acknowledgements 5
Plans for update 5
References 6
4
Scope and purpose 1
VMNIS | 1
4
Retinol is the predominant circulating form of vitamin A in the blood In
response to tissue demand it is released from the liver in a 11 ratio with its
carrier protein retinol-binding protein (1) In the blood this complex
combines with transthyretin (2) Specific receptors on target cell surfaces or
nuclei bind this complex or its active metabolites thereby regulating many
critical functions in the body including vision epithelial tissue integrity
and the expression of several hundred genes (2) Serum retinol levels reflect
liver vitamin A stores only when they are severely depleted (lt 007 micromolg
liver) or extremely high (gt 105 micromolg liver) (1) Between these extremes
serum retinol is homeostatically controlled and thus not always correlated
with vitamin A intake or clinical signs of deficiency Consequently serum
retinol is not useful for assessing the vitamin A status of individuals and
may not respond to interventions Rather the distribution of serum retinol
values in a population and the prevalence of individuals with serum retinol
values below a given cut-off can provide important information on the
vitamin A status of a population and may reflect the severity of vitamin A
deficiency as a public health problem (3) especially when the degree of
underlying infection or inflammation is taken into account Serum retinol
values are most often measured in young children a group highly
vulnerable to deficiency (3) Deficiency of vitamin A is associated with significant morbidity and
mortality from common childhood infections and is the worldrsquos leading
preventable cause of childhood blindness (3)
Inside
Background
Scope and Purpose This document aims to provide users of the Vitamin and Mineral Nutrition
Information System (VMNIS) with information about the use of serum
retinol for assessing the prevalence of vitamin A deficiency in populations
It is a compilation of the current World Health Organization (WHO)
recommendations on the topic and summarizes from the three documents
VMNIS | Vitamin and Mineral Nutrition Information System Background
1
Description of Technical Consultation 2
Recommendations 2
Summary Development
Acknowledgements 4
Plans for Update 4
References 5
4
Scope and Purpose 1
VMNIS | 1
Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations
WHONMHNHDMNM113
Iron stores in the body exist primarily in the form of ferritin The ferritin
molecule is an intracellular hollow protein shell composed of 24 subunits
surrounding an iron core that may contain as many as 4000-4500 iron
atoms In the body small amounts of ferritin are secreted into the plasma
The concentration of this plasma (or serum) ferritin is positively correlated
with the size of the total body iron stores in the absence of inflammation A
low serum ferritin value reflects depleted iron stores but not necessarily
the severity of the depletion as it progresses
Normal ferritin concentrations vary by age and sex Concentrations are
high at birth rise during the first two months of life and then fall
throughout later infancy (1) At about one year of age concentrations
begin to rise again and continue to increase into adulthood (2) Beginning
in adolescence however males have higher values than females a trend
that persists into late adulthood Values among men peak between 30ndash39
years of age and then tend to remain constant until about 70 years of age
Among women serum ferritin values remain relatively low until
menopause and then rise (2)
Body ferritin levels in contrast to haemoglobin are not affected by
residential elevation above sea level or smoking behaviour However
ferritin is a positive acute phase response protein whereby concentrations
increase during inflammation and thereby no longer reflect the size of the
iron store This makes the interpretation of normal or high serum ferritin
values difficult in areas of widespread infection or inflammation (3) In the
absence of inflammation or liver disease high serum ferritin concentrations
indicate iron overload
Inside
Background
Serum ferritin concentrations
for the assessment of iron
status and iron deficiency in
populations
Background
1
Description of
Technical Consultation 2
Recommendations 2
Summary
Development
Acknowledgements 5
Plans for Update 5
VMNIS | Vitamin and Mineral Nutrition Information System
References
5
WHONMHNHDMNM112
5
VMNIS | 1
Scope and Purpose
2
VITAMIN AND MINERAL NUTRITION INFORMATION SYSTEM
Micronutrients 2010-2011Department of Nutrition for Health and Development
9DRAFT
Ideally dissemination and wide-spread use of the WHOCDC indicators eCatalogue will increase the standardization
of indicators and increase consistency and comparability across programmes A Technical Consultation ldquoldquoInventory of
indicators for monitoring and evaluation of micronutrient interventionsrdquo was held in Atlanta United States of America
in 6-7 January 2010 The objectives were to fine tune the details of the logic model for monitoring and evaluation of
micronutrient interventions refine search criteria and to validate the usefulness of the indicators web-tool The team is
currently working in the compilation of these indicators using the logic model as a framework to organizing the different
types of indicators currently used in public health programmes involving micronutrient interventions
Micronutrients 2010-2011Department of Nutrition for Health and Development
10
MAIN
Dr Francesco Branca is the Director of
the Department of Nutrition for Health and
Development in the World Health Organization
Geneva He graduated in Medicine and Surgery
and specialized in Diabetology and Metabolic
Diseases at the Universitarsquo Cattolica del Sacro
Cuore Roma He obtained a PhD in Nutrition at
Aberdeen University He was a Senior Scientist
at the Italian Food and Nutrition research
Institute where he was responsible for the
design and implementation of several studies
on the effects of food and nutrients on human
health at the different stages of the life cycle
and for the design management and evaluation
of public health nutrition programmes He
was been President of the Federation of the
European Nutrition Societies in 2003-2007
Dr JP Pena-Rosas is the Coordinator Evidence
and Programme Guidance Department of
Nutrition for Health and Development at the
World Health Organization (WHO) in Geneva
Switzerland He joined WHO on July 2008 and
now oversees the Evidence and Programme
Guidance workplan in the development of
evidence-informed guidelines for interventions
addressing the double burden of malnutrition
for neonates infants children and women in
stable and emergency settings under the WHO
Research Strategy umbrella He is an Adjunct
Assistant Professor at Emory University Rollins
School of Public Health in Atlanta United States
since 2011 Previously he worked several
years in the Division of Nutrition Physical
Activity and Obesity at the Centers for Disease
Control and Prevention (CDC) in Atlanta United
States He was involved in nutrition surveys
and programme monitoring and evaluation for
nutrition interventions in Uzbekistan Morocco
Egypt Peru Nicaragua Georgia and Dominican
Republic In the private sector Dr Pena-Rosas
worked at Kellogg Company Latin America
and the Caribbean Headquarters where he
served several positions including Manager of
Scientific and Regulatory Affairs for the regional
operations He received his Medical Degree from
Universidad Central de Venezuela in his native
country and a Masterrsquos Degree in Public Health
Nutrition from University of Puerto Rico in San
Juan He holds a PhD in Human Nutrition and
Epidemiology from Cornell University Ithaca NY
United States of America He is a member of the
American Society for Nutrition Latin American
Society of Nutrition the American Evaluation
Association the Cochrane Collaboration and
the WHO Guidelines Review Committee
Dr Lisa Rogers is the technical officer for
the Evidence and Programme Guidance Unit
in the Department of Nutrition for Health and
Development She has been working at the
World Health Organization (WHO) in Geneva
Switzerland since April 2006 She is primarily
responsible for managing a grant for mechanistic
studies on neonatal vitamin A supplementation
and coordinating the completion of evidence
reviews and guideline groups to inform vitamin
and mineral intervention guidelines She holds
a PhD in Nutrition on International Nutrition
from the University of California Davis United
States of America Her work included research
in Guatemala investigating the causes of vitamin
B12 deficiency in school age children and
laboratory research involving the optimization of
an immunological assay for holotranscobalamin
II and the analysis of methylmalonic acid
homocysteine vitamin B12 and folate She
received a Master of Science in Nutritional
Sciences from the University of Florida where
she conducted research involving the analysis of
the stability of folic acid added to cereal-grain
products the bioavailability of stable-isotopically
labeled folic acid added to these products and
conducted several human subject studies She
is a member of the American Society for Nutrition
and the Academy of Nutrition and Dietetics
Dr Luz Maria De-Regil is epidemiologist at the
World Health Organization with the Evidence
and Programme Guidance Unit since September
2009 She is responsible for coordinating the
development of global guidelines on nutrition
interventions for different age groups and
settings updating and expanding the Vitamin and
Mineral Nutrition Information System (VMNIS)
developing tools for monitoring and evaluation
of nutrition interventions leading international
and multidisciplinary review teams to assess the
evidence and translating knowledge into global
public policy With more than 50 publications in
5 OUR TEAM
Micronutrients 2010-2011Department of Nutrition for Health and Development
11DRAFT
English and Spanish for different audiences Luz Maria has been involved in community programmes and designed and implemented
research focused on maternal and infant nutrition and health She has experience in applying in vitro and in vivo laboratory techniques
in combination with food science and epidemiology She is an active member of the WHO Research and Ethics Committee the
GRADE working group four groups within the Cochrane Collaboration the American Society for Nutrition the Latin American
Society of Nutrition the Mexican Pediatric Research Association and a former vice-president of the Mexican Society of Nutrition
Ms Grace Rob is a technical assistant in the Evidence and Programme Guidance Unit department of Nutrition for Health and
Development She has been working at the World Health Organization (WHO) in Geneva Switzerland since 2000 She holds a
Bachelors of Science in Home Economics major in food and nutrition and minor in business administration from University of
Eastern Africa Baraton Eldoret in her native Kenya
Mrs Paule Pillard is the Assistant to Coordinator in the Evidence and Programme Guidance Unit Department of Nutrition for Health
and Development and provides administrative support to the coordinator and the unit staff since 2007
Micronutrients 2010-2011Department of Nutrition for Health and Development
12DRAFT
NEONATAL VITAMIN A SUPPLEMENTATION MECHANISTIC STUDIES
There is considerable interest in vitamin A supplementation during the neonatal period as an intervention for reducing infant
mortality The efficacy of this intervention is still to be determined NHD along with the Department of Maternal Newborn Child
and Adolescent Health (MCA) have received funding to conduct studies for the generation of evidence to inform global policy on
the efficacy of neonatal vitamin A supplementation in improving child survival In support of uncovering biological mechanisms
by which neonatal vitamin A supplementation may be acting NHD is coordinating the conduct of one animal study and two human
studies to understand the biological mechanisms through which neonatal vitamin A supplementation can potentially have an
impact on infant survival when given at birth The animal study is being conducted at the University of Wisconsin-Madison USA
(PI S Tanumihardjo) and is using the sow-piglet dyad model The two human studies are double blind randomized controlled
trials to determine the effect of vitamin A supplementation on immune responses in early infancy One study is being conducted
in Bangladesh (n=300) by the USDA-ARS Western Human Nutrition Research Center University of California Davis CA USA (PI
C Stephensen) and the other in The Gambia (n=200) by the Medical Research Council London UK and Keneba Gambia (PI A
Prentice)
The three proposals were reviewed at a WHO Technical Consultation on Vitamin A in Newborn Health - Mechanistic Studies in
December 2009 Final proposals were approved by the WHO Ethics Review Committee (ERC) and the studies are now in progress
NUTRITION IMPACT MODEL-STUDY (NIMS)
This study is funded by a grant from The Bill amp Melinda Gates Foundation to the Harvard School of Public Health and aims to
develop empirically parameterize apply and make publicly available a policy-relevant analytical tool for estimating the health
impacts of undernutrition exposures and interventions
Representatives of the Department of Nutrition for Health and Development work closely with partners to select appropriate
exposure metrics and develop and apply statistical methods for sparse time-space data in order to estimate current levels and past
trends of anaemia and vitamin A deficiency
6 RESEARCH
Micronutrients 2010-2011Department of Nutrition for Health and Development
13DRAFT
The Department of Nutrition for Health and Development works closely with internal collaborators at WHO and with various external
organizations on topics related to micronutrients
COCHRANE COLLABORATION
Over 28000 contributors worldwide work together to help health care providers policy-makers patients their advocates and
carers make well-informed decisions about health care based on the best available research evidence by preparing updating
and promoting the accessibility of Cochrane Reviews ndash over 4600 so far published online in The Cochrane Library In 2010 the
Cochrane Database of Systematic Reviews achieved a top-10 ISI Impact Factor for an outstanding achievement The work of the
Cochrane Collaboration is internationally recognised as the benchmark for high-quality information about the effectiveness of
health care In January 2011 The Cochrane Collaboration was accepted as a Non-Governmental Organization in Official Relations
with the World Health Organization (WHO) the public health arm of the United Nations establishing formalised communication
between our two organisations
This collaboration supports the development of the WHO Library of Evidence for Nutrition Actions (eLENA) and grants open access
to all Member States For the work in micronutrients we have closely collaborated with the following Cochrane groups
Cochrane Editorial Unit (wwweditorial-unitcochraneorg)
Developmental Psychosocial and Learning Problems Group (wwwdplpgcochraneorg)
Infectious Diseases Group (wwwcidgcochraneorgenindexhtml)
Pregnancy and Childbirth Group (wwwpregnancycochraneorg)
Public Health Group (wwwphcochraneorg)
Our Department has also supported the update or undertake of systematic reviews within the following groups
HIVAIDS Group (hivcochraneorg)
Metabolic and Endocrine Disorders Group (wwwendoccochraneorg)
Neonatal Group (wwwneonatalcochraneorg)
Iberoamerican Cochrane Center (wwwcochranees)
GRADE WORKING GROUP
The Grading of Recommendations Assessment Development and Evaluation (GRADE) Working Group began in the year 2000
as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health
care The working group has developed a common sensible and transparent approach to grading the quality of evidence
and the strength of recommendations Many international organizations have provided input into the development of the
approach and have started using it
A representative of our team joined the working group in 2010 to discuss issues related to the normative work in
micronutrients at WHO
CENTERs fOR DIsEAsE CONTROL AND PREVENTION (CDC)
The International Micronutrient Malnutrition Prevention and Control (IMMPaCt) programme works with global partners to
contribute CDC skills and resources to eliminate vitamin and mineral deficiencies (micronutrient malnutrition) among vulnerable
populations throughout the world Established by the CDC in 2000 IMMPaCt focuses primarily on helping eliminate deficiencies in
iron vitamin A iodine and folate
Through a 2009-2014 agreement IMMPaCt supports WHO in various selected projects including providing technical assistance
and subject matter expertise to help design implement and maintain new and current micronutrient databases as well as assist
with processes promoting new WHO guidelines and recommendations
The CDC Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects provides the scientific and programmatic
expertise to build upon and strengthen global neural tube defect surveillance systems and expand the reach of global folic acid
fortification for neural tube defect prevention Expansion of global folic acid fortification efforts can have a significant impact on
infant mortality and childhood morbidity worldwide
7 OUR PARTNERS
Micronutrients 2010-2011Department of Nutrition for Health and Development
14DRAFT
CDCrsquos National Center on Birth Defects and Developmental Disabilities has developed a global initiative to significantly reduce infant
mortality and childhood morbidity resulting from the more than 300000 neural tube defects worldwide each year and contribute
to the achievement of United Nations Millennium Development Goal 4 help to meet the Global Health Initiative Child Health Goal
and support the 63rd World Health Assembly Resolution on Birth Defects
The initiative aims to expand the number of developing countries with mandatory folic acid fortification of high penetrance staples
and provide sustainable support of long-term interventions to eliminate folic acid-preventable neural tube defects worldwide CDC
works with WHO and others to support and advance country-level fortification efforts and to provide needed technical expertise for
surveillance of neural tube defects monitor fortification efforts and improve laboratory capacity on folate-preventable birth defects
THE MICRONUTRIENT INITIATIVE
The Micronutrient Initiative (MI) is an independent not-for-profit organization committed to promoting simple cost-effective
solutions to hidden hunger combat vitamin and mineral deficiency and developing innovative new solutions where needed based in
Ottawa Canada MI is working to end hidden hunger end vitamin and mineral deficiency by helping governments food producers
and partner organizations like WHO develop implement and monitor and evaluate innovative culturally appropriate and cost-
effective programmes to get essential vitamins and minerals to the people who need them most by providing technical and
financial assistance offering procurement and quality control services for highly specialized supplies and equipment needed to
prevent hidden hunger advocating for micronutrient programmes and educating government bodies around the world on policies
legislation and programs to ensure the sustained delivery of essential vitamins and minerals
THE EUNICE KENNEDy sHRIVER NATIONAL INsTITUTE Of CHILD HEALTH AND HUMAN DEVELOPMENT
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health
(NIH)US Department of Health and Human Services in collaboration with partners representing the breadth of the global food and
nutrition enterprise including WHO created the Biomarkers of Nutrition for Development (BOND) Program to meet the growing
need for discovery development and implementation of reliable and valid biomarkers to assess nutrient exposure status function
and effect Also with co-funding from the Bill amp Melinda Gates Foundation has developed the Iron and Malaria Project to address
the safe and effective use of iron interventions in areas of malaria burden Both projects have been done with involvement of and
in support of WHO work in the area of micronutrients
WHO NUTRITION GUIDANCE ExPERT ADVIsORy GROUP MEMBERs
Micronutrients
Ms Deena AlasfoorProfessor Beverley-Ann BiggsDr Heacutector Bourges RodriacuteguezProfessor Norm CampbellProfessor Susan Fairweather-Tait Dr Rafael Flores-AyalaProfessor Malik GoonewardeneDr Junsheng HuoDr Janet C KingDr Marzia Lazzerini Professor Malcolm E Molyneux Eng Wisam QarqashDr Mahdi Ramsan Mohamed Dr Daniel RaitenDr Meera ShekarDr Rebecca Joyce StoltzfusMs Carol TomDr David Tovey Mrs Vilma Qahoush TylerDr Gunn Elisabeth VistDr Emorn Wasantwisut
Monitoring and Evaluation
Dr Lindsay AllenDr Deborah AshDr France BeginDr Zulfiqar BhuttaDr Christine Clewes Professor Susan Fairweather-TaitDr Jonathan GorsteinDr Junsheng HuoDr Ibrahim MD KhatibDr Roland KupkaDr Christine PfeifferDr Rob JPM ScholtenDr Holger SchuumlnemannDr Ismaeumll Ngnieacute TeacutetaDr Emorn Wasantwisut
Vitamin A supplementation
Professor Hany Abdel-AleemProfessor Michael ClarkeDr Anna CoutsoudisDr M Monir HossainDr Jean HumphreyDr Yustina Anie IndriastutiDr Marzia LazzeriniDr Pavitra MohanDr Rintaro MoriDr A Catherine RossDr Isabella Sagoe-MosesDr Claudia SaundersDr Prak SophonnearyDr Charles StephensenDr Sherry TanumihardjoDr Khalid Yunis
Micronutrients 2010-2011Department of Nutrition for Health and Development
15DRAFT
INTERNsHIPs
WHO is committed to building future leaders in public health and WHOrsquos Internship Programme provides a wide range of
opportunities for graduate and post-graduate students to gain insight into the work of WHO Although WHO receives a large
number of intern applications each year only a limited number of places for internships are available Internships are available for
work in micronutrients at WHO for a minimum of 6 weeks and a maximum of 3 months to allow the internship to be both worthwhile
and effective The following selected interns were hosted by NHD during the biennium 2010-2011 to work on topics related to
micronutrients
Ms Alison Sylvetsky 7 June - 13 August 2010 - EMORY UNIVERSITY ATLANTA USA
Ms Aida Victoria Campos 1 March - 31 May 2010 - UNIVERSIDAD LA SALLE MExICO DF MExICO
Mrs Sarah Pedersen 14 June - 13 August 2010- CORNELL UNIVERSITY ITHACA NEW YORK USA
Mr Joseph Ashong1 March 2011 - 1 July 2011 - CORNELL UNIVERSITY ITHACA NEW YORK USA
Dr Saint-Rayn Pasricha 14 February 2011 - 17 June 2011 - UNIVERSITY OF MELBOURNE VICTORIA AUSTRALIA
Ms Ellie Souganidis 20 June 2011 - 12 August 2011 - JOHNS HOPKINS UNIVERSITY BALTIMORE MARYLAND USA
Mr Raheel Arif 15 August - 4 November 2011- UNIVERSITY OF THE SCIENCES PHILADELPHIA PENNSYLVANIA USA
ADVOCACy AND NETWORKs
Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource
allocation decisions within political economic and social systems and institutions Advocacy in WHO for vitamin and mineral
nutrition includes many activities such as media campaigns public speaking commissioning and publishing research as well as
participation in several groups and networks
Home Fortification Technical Advisory Group (HFTAG) (httpwwwgainhealthorghftag)
The Network For Sustained Elimination of Iodine Deficiency (httpwwwiodinenetworknet)
International Council for the Control of Iodine Deficiency Disorders (wwwicciddorg)
Rice Fortification Technical Group (httpwwwgainhealthorgriforg)
Global Alliance for Vitamin A (GAVA)
Flour Fortification Initiative (httpwwwsphemoryeduwheatflour)
International Zinc Nutrition Consultative Group (wwwizincgorg)
United Nations World Food Programme (httpwwwwfporg)
United Nations Childrenrsquos Fund (httpwwwuniceforg)
United Nations High Commissioner for Refugees (httpwwwunhcrorg)
Food and Agriculture Organization of the United Nations (httpwwwfaoorg)
The World Bank (httpwwwworldbankorg)
United Nations Standing Committee on Nutrition (httpwwwunscnorg)
Micronutrients 2010-2011Department of Nutrition for Health and Development
16DRAFT
WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients
during the biennium 2010-2011
US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms
project name Global prevention of non-communicable disease prevention and promotion of health
The Micronutrient Initiative (MI) wwwmicronutrientorg
project name e-Library of nutrition programme guidance
The Government of Luxembourghttpwwwetatlu
project name Support for the update and dissemination of evidence-based nutrition programme
The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg
project name Efficacy of newborn vitamin A supplementation in improving child survival
WHO also thanks the following organizations for their support through small grants
US Agency for International Development (USAID) httpwwwusaidgov
project name Update WHO evidence based position statements on relevant and priority micronutrient interventions
The Global Alliance for Improved Nutrition (GAIN)
httpwwwgainhealthorg
project name Systematic review of evidence of micronutrient interventions and management of moderate
malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification
project name Systematic review of evidence of rice fortification as a public health intervention and consultation on
rice fortification programs implementation
Harvard University
project name Nutrition impact model study (NIM Study)
Sight amp Life
httpwwwsightandlifeorg
project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System
MEMBERsHIPs
De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013
Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014
Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011
De-Regil LM GRADE working group 2010-present
WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs
Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for
Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2
February 2010 Geneva Switzerland
8 FINANCIAL SUPPORT
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
8DRAFT
The WHO Vitamin and Mineral Nutrition Information System (VMNIS) was initially established in 1991 and has now been expanded
into a more comprehensive vitamin and mineral nutrition information system Evaluations of epidemiological and informatics
capabilities of the system in 2009 guided the upgrade and expansion of VMNIS to include a more comprehensive micronutrients
database and additional resources and tools for vitamin and mineral nutrition surveillance by Member States and their partners as
well as the incorporation and utilization of advances in information technology to disseminate the information A new website is now
online for VMNIS that includes the following sections 1) micronutrients database 2) indicators 3) laboratory capacity 4) monitoring
and evaluation and 5) publications The website is now available in all six WHO official languages
The Micronutrients Database of the VMNIS is now upgraded and expanded This process is occurring in three phases two of which
are already completed During phase I the database was restructured to make it more efficient exploit new innovations in information
technology and include more nutritional indicators In collaboration with the Information Technology and Telecommunications Unit
of WHO and with support from CDC partners from the Office of Informatics and Information Resources Management and other
colleagues from the National Center for Chronic Disease Prevention and Health Promotion the new database platform is functioning
During phase II -data migration- all the survey information available from the previous database and an additional systematic
search for data that included scientific literature and communication with WHO Regional Offices relevant UN agencies and other
partner organizations to solicit information on nutritionmicronutrient surveys was included Additionally all surveys reports have
been digitalized to make an electronic repository instead of paper printed documents Phase III data display is expected to be
completed in 2012 and will allow users to create maps tables and access data directly from the internet
The Indicators section includes information on the biomarkers used in assessing vitamin and
mineral status in populations and used in surveys collected in VMNIS
These documents are a compilation of current WHO recommendations on the topic from different sources They summarize the
currently recognized cut-offs for defining deficiencies and their severity at the individual and population level and the chronology of
their establishment These are not new or updated recommendations but compilations of existing guidelines that were dispersed
in several WHO references and reports These summaries that are available in the six WHO official languages will serve as a
starting point for updating current recommendations on the use of these indicators
Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity
Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations
Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations
The Monitoring and Evaluation section of the VMNIS contains resources that can be useful
for monitoring andor evaluating interventions that have a focus on outcomes related to vitamin
and mineral nutrition Notable are the following
The WHOCDC logic model for micronutrient interventions in public health depicts the programme theory and plausible
relationships between inputs and expected MDGs and can be adapted to different contexts Member States can
adjust this proposed generic logic model and use it as part of the continuous quality improvement cycle for planning
performance measurement or evaluation
The WHOCDC indicators e-Catalogue for micronutrient interventions platform has been completed and it intends to be
an up-to-date interactive user-friendly and comprehensive resource of indicators for those who are actively engaged in
providing technical assistance in evaluation of micronutrient interventions There is considerable variation in indicators
used to define micronutrient deficiency limiting comparability across programs and over time
Anaemia is a condition in which the number of red blood cells (and
consequently their oxygen-carrying capacity) is insufficient to meet the
bodyrsquos physiologic needs Specific physiologic needs vary with a personrsquos
age gender residential elevation above sea level (altitude) smoking
behaviour and different stages of pregnancy Iron deficiency is thought to
be the most common cause of anaemia globally but other nutritional
deficiencies (including folate vitamin B12 and vitamin A) acute and chronic
inflammation parasitic infections and inherited or acquired disorders that
affect haemoglobin synthesis red blood cell production or red blood cell
survival can all cause anaemia Haemoglobin concentration alone cannot
be used to diagnose iron deficiency However the concentration of
haemoglobin should be measured even though not all anaemia is caused
by iron deficiency The prevalence of anaemia is an important health
indicator and when it is used with other measurements of iron status the
haemoglobin concentration can provide information about the severity of
iron deficiency (1)
Inside
Background
Scope and purpose This document aims to provide users of the Vitamin and Mineral Nutrition
Information System (VMNIS) with information about the use of
haemoglobin concentration for diagnosing anaemia It is a compilation of
current World Health Organization (WHO) recommendations on the topic
and summarizes the cut-offs for defining anaemia and its severity at the
population level as well as the chronology of their establishment
The use of the cut-off points derived from the referenced publications
permits the identification of populations at greatest risk of anaemia and
priority areas for action especially when resources are limited They also
facilitate the monitoring and assessment of progress towards international
goals of preventing and controlling iron deficiency and further provide the
basis for advocacy for the prevention of anaemia
Haemoglobin concentrations for the diagnosis of anaemia and
assessment of severity
VMNIS | Vitamin and Mineral Nutrition Information System
WHONMHNHDMNM111 Background 1
Description of technical consultation 2
Recommendations 3
Summary development
Acknowledgements 5
Plans for update 5
References 6
4
Scope and purpose 1
VMNIS | 1
4
Retinol is the predominant circulating form of vitamin A in the blood In
response to tissue demand it is released from the liver in a 11 ratio with its
carrier protein retinol-binding protein (1) In the blood this complex
combines with transthyretin (2) Specific receptors on target cell surfaces or
nuclei bind this complex or its active metabolites thereby regulating many
critical functions in the body including vision epithelial tissue integrity
and the expression of several hundred genes (2) Serum retinol levels reflect
liver vitamin A stores only when they are severely depleted (lt 007 micromolg
liver) or extremely high (gt 105 micromolg liver) (1) Between these extremes
serum retinol is homeostatically controlled and thus not always correlated
with vitamin A intake or clinical signs of deficiency Consequently serum
retinol is not useful for assessing the vitamin A status of individuals and
may not respond to interventions Rather the distribution of serum retinol
values in a population and the prevalence of individuals with serum retinol
values below a given cut-off can provide important information on the
vitamin A status of a population and may reflect the severity of vitamin A
deficiency as a public health problem (3) especially when the degree of
underlying infection or inflammation is taken into account Serum retinol
values are most often measured in young children a group highly
vulnerable to deficiency (3) Deficiency of vitamin A is associated with significant morbidity and
mortality from common childhood infections and is the worldrsquos leading
preventable cause of childhood blindness (3)
Inside
Background
Scope and Purpose This document aims to provide users of the Vitamin and Mineral Nutrition
Information System (VMNIS) with information about the use of serum
retinol for assessing the prevalence of vitamin A deficiency in populations
It is a compilation of the current World Health Organization (WHO)
recommendations on the topic and summarizes from the three documents
VMNIS | Vitamin and Mineral Nutrition Information System Background
1
Description of Technical Consultation 2
Recommendations 2
Summary Development
Acknowledgements 4
Plans for Update 4
References 5
4
Scope and Purpose 1
VMNIS | 1
Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations
WHONMHNHDMNM113
Iron stores in the body exist primarily in the form of ferritin The ferritin
molecule is an intracellular hollow protein shell composed of 24 subunits
surrounding an iron core that may contain as many as 4000-4500 iron
atoms In the body small amounts of ferritin are secreted into the plasma
The concentration of this plasma (or serum) ferritin is positively correlated
with the size of the total body iron stores in the absence of inflammation A
low serum ferritin value reflects depleted iron stores but not necessarily
the severity of the depletion as it progresses
Normal ferritin concentrations vary by age and sex Concentrations are
high at birth rise during the first two months of life and then fall
throughout later infancy (1) At about one year of age concentrations
begin to rise again and continue to increase into adulthood (2) Beginning
in adolescence however males have higher values than females a trend
that persists into late adulthood Values among men peak between 30ndash39
years of age and then tend to remain constant until about 70 years of age
Among women serum ferritin values remain relatively low until
menopause and then rise (2)
Body ferritin levels in contrast to haemoglobin are not affected by
residential elevation above sea level or smoking behaviour However
ferritin is a positive acute phase response protein whereby concentrations
increase during inflammation and thereby no longer reflect the size of the
iron store This makes the interpretation of normal or high serum ferritin
values difficult in areas of widespread infection or inflammation (3) In the
absence of inflammation or liver disease high serum ferritin concentrations
indicate iron overload
Inside
Background
Serum ferritin concentrations
for the assessment of iron
status and iron deficiency in
populations
Background
1
Description of
Technical Consultation 2
Recommendations 2
Summary
Development
Acknowledgements 5
Plans for Update 5
VMNIS | Vitamin and Mineral Nutrition Information System
References
5
WHONMHNHDMNM112
5
VMNIS | 1
Scope and Purpose
2
VITAMIN AND MINERAL NUTRITION INFORMATION SYSTEM
Micronutrients 2010-2011Department of Nutrition for Health and Development
9DRAFT
Ideally dissemination and wide-spread use of the WHOCDC indicators eCatalogue will increase the standardization
of indicators and increase consistency and comparability across programmes A Technical Consultation ldquoldquoInventory of
indicators for monitoring and evaluation of micronutrient interventionsrdquo was held in Atlanta United States of America
in 6-7 January 2010 The objectives were to fine tune the details of the logic model for monitoring and evaluation of
micronutrient interventions refine search criteria and to validate the usefulness of the indicators web-tool The team is
currently working in the compilation of these indicators using the logic model as a framework to organizing the different
types of indicators currently used in public health programmes involving micronutrient interventions
Micronutrients 2010-2011Department of Nutrition for Health and Development
10
MAIN
Dr Francesco Branca is the Director of
the Department of Nutrition for Health and
Development in the World Health Organization
Geneva He graduated in Medicine and Surgery
and specialized in Diabetology and Metabolic
Diseases at the Universitarsquo Cattolica del Sacro
Cuore Roma He obtained a PhD in Nutrition at
Aberdeen University He was a Senior Scientist
at the Italian Food and Nutrition research
Institute where he was responsible for the
design and implementation of several studies
on the effects of food and nutrients on human
health at the different stages of the life cycle
and for the design management and evaluation
of public health nutrition programmes He
was been President of the Federation of the
European Nutrition Societies in 2003-2007
Dr JP Pena-Rosas is the Coordinator Evidence
and Programme Guidance Department of
Nutrition for Health and Development at the
World Health Organization (WHO) in Geneva
Switzerland He joined WHO on July 2008 and
now oversees the Evidence and Programme
Guidance workplan in the development of
evidence-informed guidelines for interventions
addressing the double burden of malnutrition
for neonates infants children and women in
stable and emergency settings under the WHO
Research Strategy umbrella He is an Adjunct
Assistant Professor at Emory University Rollins
School of Public Health in Atlanta United States
since 2011 Previously he worked several
years in the Division of Nutrition Physical
Activity and Obesity at the Centers for Disease
Control and Prevention (CDC) in Atlanta United
States He was involved in nutrition surveys
and programme monitoring and evaluation for
nutrition interventions in Uzbekistan Morocco
Egypt Peru Nicaragua Georgia and Dominican
Republic In the private sector Dr Pena-Rosas
worked at Kellogg Company Latin America
and the Caribbean Headquarters where he
served several positions including Manager of
Scientific and Regulatory Affairs for the regional
operations He received his Medical Degree from
Universidad Central de Venezuela in his native
country and a Masterrsquos Degree in Public Health
Nutrition from University of Puerto Rico in San
Juan He holds a PhD in Human Nutrition and
Epidemiology from Cornell University Ithaca NY
United States of America He is a member of the
American Society for Nutrition Latin American
Society of Nutrition the American Evaluation
Association the Cochrane Collaboration and
the WHO Guidelines Review Committee
Dr Lisa Rogers is the technical officer for
the Evidence and Programme Guidance Unit
in the Department of Nutrition for Health and
Development She has been working at the
World Health Organization (WHO) in Geneva
Switzerland since April 2006 She is primarily
responsible for managing a grant for mechanistic
studies on neonatal vitamin A supplementation
and coordinating the completion of evidence
reviews and guideline groups to inform vitamin
and mineral intervention guidelines She holds
a PhD in Nutrition on International Nutrition
from the University of California Davis United
States of America Her work included research
in Guatemala investigating the causes of vitamin
B12 deficiency in school age children and
laboratory research involving the optimization of
an immunological assay for holotranscobalamin
II and the analysis of methylmalonic acid
homocysteine vitamin B12 and folate She
received a Master of Science in Nutritional
Sciences from the University of Florida where
she conducted research involving the analysis of
the stability of folic acid added to cereal-grain
products the bioavailability of stable-isotopically
labeled folic acid added to these products and
conducted several human subject studies She
is a member of the American Society for Nutrition
and the Academy of Nutrition and Dietetics
Dr Luz Maria De-Regil is epidemiologist at the
World Health Organization with the Evidence
and Programme Guidance Unit since September
2009 She is responsible for coordinating the
development of global guidelines on nutrition
interventions for different age groups and
settings updating and expanding the Vitamin and
Mineral Nutrition Information System (VMNIS)
developing tools for monitoring and evaluation
of nutrition interventions leading international
and multidisciplinary review teams to assess the
evidence and translating knowledge into global
public policy With more than 50 publications in
5 OUR TEAM
Micronutrients 2010-2011Department of Nutrition for Health and Development
11DRAFT
English and Spanish for different audiences Luz Maria has been involved in community programmes and designed and implemented
research focused on maternal and infant nutrition and health She has experience in applying in vitro and in vivo laboratory techniques
in combination with food science and epidemiology She is an active member of the WHO Research and Ethics Committee the
GRADE working group four groups within the Cochrane Collaboration the American Society for Nutrition the Latin American
Society of Nutrition the Mexican Pediatric Research Association and a former vice-president of the Mexican Society of Nutrition
Ms Grace Rob is a technical assistant in the Evidence and Programme Guidance Unit department of Nutrition for Health and
Development She has been working at the World Health Organization (WHO) in Geneva Switzerland since 2000 She holds a
Bachelors of Science in Home Economics major in food and nutrition and minor in business administration from University of
Eastern Africa Baraton Eldoret in her native Kenya
Mrs Paule Pillard is the Assistant to Coordinator in the Evidence and Programme Guidance Unit Department of Nutrition for Health
and Development and provides administrative support to the coordinator and the unit staff since 2007
Micronutrients 2010-2011Department of Nutrition for Health and Development
12DRAFT
NEONATAL VITAMIN A SUPPLEMENTATION MECHANISTIC STUDIES
There is considerable interest in vitamin A supplementation during the neonatal period as an intervention for reducing infant
mortality The efficacy of this intervention is still to be determined NHD along with the Department of Maternal Newborn Child
and Adolescent Health (MCA) have received funding to conduct studies for the generation of evidence to inform global policy on
the efficacy of neonatal vitamin A supplementation in improving child survival In support of uncovering biological mechanisms
by which neonatal vitamin A supplementation may be acting NHD is coordinating the conduct of one animal study and two human
studies to understand the biological mechanisms through which neonatal vitamin A supplementation can potentially have an
impact on infant survival when given at birth The animal study is being conducted at the University of Wisconsin-Madison USA
(PI S Tanumihardjo) and is using the sow-piglet dyad model The two human studies are double blind randomized controlled
trials to determine the effect of vitamin A supplementation on immune responses in early infancy One study is being conducted
in Bangladesh (n=300) by the USDA-ARS Western Human Nutrition Research Center University of California Davis CA USA (PI
C Stephensen) and the other in The Gambia (n=200) by the Medical Research Council London UK and Keneba Gambia (PI A
Prentice)
The three proposals were reviewed at a WHO Technical Consultation on Vitamin A in Newborn Health - Mechanistic Studies in
December 2009 Final proposals were approved by the WHO Ethics Review Committee (ERC) and the studies are now in progress
NUTRITION IMPACT MODEL-STUDY (NIMS)
This study is funded by a grant from The Bill amp Melinda Gates Foundation to the Harvard School of Public Health and aims to
develop empirically parameterize apply and make publicly available a policy-relevant analytical tool for estimating the health
impacts of undernutrition exposures and interventions
Representatives of the Department of Nutrition for Health and Development work closely with partners to select appropriate
exposure metrics and develop and apply statistical methods for sparse time-space data in order to estimate current levels and past
trends of anaemia and vitamin A deficiency
6 RESEARCH
Micronutrients 2010-2011Department of Nutrition for Health and Development
13DRAFT
The Department of Nutrition for Health and Development works closely with internal collaborators at WHO and with various external
organizations on topics related to micronutrients
COCHRANE COLLABORATION
Over 28000 contributors worldwide work together to help health care providers policy-makers patients their advocates and
carers make well-informed decisions about health care based on the best available research evidence by preparing updating
and promoting the accessibility of Cochrane Reviews ndash over 4600 so far published online in The Cochrane Library In 2010 the
Cochrane Database of Systematic Reviews achieved a top-10 ISI Impact Factor for an outstanding achievement The work of the
Cochrane Collaboration is internationally recognised as the benchmark for high-quality information about the effectiveness of
health care In January 2011 The Cochrane Collaboration was accepted as a Non-Governmental Organization in Official Relations
with the World Health Organization (WHO) the public health arm of the United Nations establishing formalised communication
between our two organisations
This collaboration supports the development of the WHO Library of Evidence for Nutrition Actions (eLENA) and grants open access
to all Member States For the work in micronutrients we have closely collaborated with the following Cochrane groups
Cochrane Editorial Unit (wwweditorial-unitcochraneorg)
Developmental Psychosocial and Learning Problems Group (wwwdplpgcochraneorg)
Infectious Diseases Group (wwwcidgcochraneorgenindexhtml)
Pregnancy and Childbirth Group (wwwpregnancycochraneorg)
Public Health Group (wwwphcochraneorg)
Our Department has also supported the update or undertake of systematic reviews within the following groups
HIVAIDS Group (hivcochraneorg)
Metabolic and Endocrine Disorders Group (wwwendoccochraneorg)
Neonatal Group (wwwneonatalcochraneorg)
Iberoamerican Cochrane Center (wwwcochranees)
GRADE WORKING GROUP
The Grading of Recommendations Assessment Development and Evaluation (GRADE) Working Group began in the year 2000
as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health
care The working group has developed a common sensible and transparent approach to grading the quality of evidence
and the strength of recommendations Many international organizations have provided input into the development of the
approach and have started using it
A representative of our team joined the working group in 2010 to discuss issues related to the normative work in
micronutrients at WHO
CENTERs fOR DIsEAsE CONTROL AND PREVENTION (CDC)
The International Micronutrient Malnutrition Prevention and Control (IMMPaCt) programme works with global partners to
contribute CDC skills and resources to eliminate vitamin and mineral deficiencies (micronutrient malnutrition) among vulnerable
populations throughout the world Established by the CDC in 2000 IMMPaCt focuses primarily on helping eliminate deficiencies in
iron vitamin A iodine and folate
Through a 2009-2014 agreement IMMPaCt supports WHO in various selected projects including providing technical assistance
and subject matter expertise to help design implement and maintain new and current micronutrient databases as well as assist
with processes promoting new WHO guidelines and recommendations
The CDC Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects provides the scientific and programmatic
expertise to build upon and strengthen global neural tube defect surveillance systems and expand the reach of global folic acid
fortification for neural tube defect prevention Expansion of global folic acid fortification efforts can have a significant impact on
infant mortality and childhood morbidity worldwide
7 OUR PARTNERS
Micronutrients 2010-2011Department of Nutrition for Health and Development
14DRAFT
CDCrsquos National Center on Birth Defects and Developmental Disabilities has developed a global initiative to significantly reduce infant
mortality and childhood morbidity resulting from the more than 300000 neural tube defects worldwide each year and contribute
to the achievement of United Nations Millennium Development Goal 4 help to meet the Global Health Initiative Child Health Goal
and support the 63rd World Health Assembly Resolution on Birth Defects
The initiative aims to expand the number of developing countries with mandatory folic acid fortification of high penetrance staples
and provide sustainable support of long-term interventions to eliminate folic acid-preventable neural tube defects worldwide CDC
works with WHO and others to support and advance country-level fortification efforts and to provide needed technical expertise for
surveillance of neural tube defects monitor fortification efforts and improve laboratory capacity on folate-preventable birth defects
THE MICRONUTRIENT INITIATIVE
The Micronutrient Initiative (MI) is an independent not-for-profit organization committed to promoting simple cost-effective
solutions to hidden hunger combat vitamin and mineral deficiency and developing innovative new solutions where needed based in
Ottawa Canada MI is working to end hidden hunger end vitamin and mineral deficiency by helping governments food producers
and partner organizations like WHO develop implement and monitor and evaluate innovative culturally appropriate and cost-
effective programmes to get essential vitamins and minerals to the people who need them most by providing technical and
financial assistance offering procurement and quality control services for highly specialized supplies and equipment needed to
prevent hidden hunger advocating for micronutrient programmes and educating government bodies around the world on policies
legislation and programs to ensure the sustained delivery of essential vitamins and minerals
THE EUNICE KENNEDy sHRIVER NATIONAL INsTITUTE Of CHILD HEALTH AND HUMAN DEVELOPMENT
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health
(NIH)US Department of Health and Human Services in collaboration with partners representing the breadth of the global food and
nutrition enterprise including WHO created the Biomarkers of Nutrition for Development (BOND) Program to meet the growing
need for discovery development and implementation of reliable and valid biomarkers to assess nutrient exposure status function
and effect Also with co-funding from the Bill amp Melinda Gates Foundation has developed the Iron and Malaria Project to address
the safe and effective use of iron interventions in areas of malaria burden Both projects have been done with involvement of and
in support of WHO work in the area of micronutrients
WHO NUTRITION GUIDANCE ExPERT ADVIsORy GROUP MEMBERs
Micronutrients
Ms Deena AlasfoorProfessor Beverley-Ann BiggsDr Heacutector Bourges RodriacuteguezProfessor Norm CampbellProfessor Susan Fairweather-Tait Dr Rafael Flores-AyalaProfessor Malik GoonewardeneDr Junsheng HuoDr Janet C KingDr Marzia Lazzerini Professor Malcolm E Molyneux Eng Wisam QarqashDr Mahdi Ramsan Mohamed Dr Daniel RaitenDr Meera ShekarDr Rebecca Joyce StoltzfusMs Carol TomDr David Tovey Mrs Vilma Qahoush TylerDr Gunn Elisabeth VistDr Emorn Wasantwisut
Monitoring and Evaluation
Dr Lindsay AllenDr Deborah AshDr France BeginDr Zulfiqar BhuttaDr Christine Clewes Professor Susan Fairweather-TaitDr Jonathan GorsteinDr Junsheng HuoDr Ibrahim MD KhatibDr Roland KupkaDr Christine PfeifferDr Rob JPM ScholtenDr Holger SchuumlnemannDr Ismaeumll Ngnieacute TeacutetaDr Emorn Wasantwisut
Vitamin A supplementation
Professor Hany Abdel-AleemProfessor Michael ClarkeDr Anna CoutsoudisDr M Monir HossainDr Jean HumphreyDr Yustina Anie IndriastutiDr Marzia LazzeriniDr Pavitra MohanDr Rintaro MoriDr A Catherine RossDr Isabella Sagoe-MosesDr Claudia SaundersDr Prak SophonnearyDr Charles StephensenDr Sherry TanumihardjoDr Khalid Yunis
Micronutrients 2010-2011Department of Nutrition for Health and Development
15DRAFT
INTERNsHIPs
WHO is committed to building future leaders in public health and WHOrsquos Internship Programme provides a wide range of
opportunities for graduate and post-graduate students to gain insight into the work of WHO Although WHO receives a large
number of intern applications each year only a limited number of places for internships are available Internships are available for
work in micronutrients at WHO for a minimum of 6 weeks and a maximum of 3 months to allow the internship to be both worthwhile
and effective The following selected interns were hosted by NHD during the biennium 2010-2011 to work on topics related to
micronutrients
Ms Alison Sylvetsky 7 June - 13 August 2010 - EMORY UNIVERSITY ATLANTA USA
Ms Aida Victoria Campos 1 March - 31 May 2010 - UNIVERSIDAD LA SALLE MExICO DF MExICO
Mrs Sarah Pedersen 14 June - 13 August 2010- CORNELL UNIVERSITY ITHACA NEW YORK USA
Mr Joseph Ashong1 March 2011 - 1 July 2011 - CORNELL UNIVERSITY ITHACA NEW YORK USA
Dr Saint-Rayn Pasricha 14 February 2011 - 17 June 2011 - UNIVERSITY OF MELBOURNE VICTORIA AUSTRALIA
Ms Ellie Souganidis 20 June 2011 - 12 August 2011 - JOHNS HOPKINS UNIVERSITY BALTIMORE MARYLAND USA
Mr Raheel Arif 15 August - 4 November 2011- UNIVERSITY OF THE SCIENCES PHILADELPHIA PENNSYLVANIA USA
ADVOCACy AND NETWORKs
Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource
allocation decisions within political economic and social systems and institutions Advocacy in WHO for vitamin and mineral
nutrition includes many activities such as media campaigns public speaking commissioning and publishing research as well as
participation in several groups and networks
Home Fortification Technical Advisory Group (HFTAG) (httpwwwgainhealthorghftag)
The Network For Sustained Elimination of Iodine Deficiency (httpwwwiodinenetworknet)
International Council for the Control of Iodine Deficiency Disorders (wwwicciddorg)
Rice Fortification Technical Group (httpwwwgainhealthorgriforg)
Global Alliance for Vitamin A (GAVA)
Flour Fortification Initiative (httpwwwsphemoryeduwheatflour)
International Zinc Nutrition Consultative Group (wwwizincgorg)
United Nations World Food Programme (httpwwwwfporg)
United Nations Childrenrsquos Fund (httpwwwuniceforg)
United Nations High Commissioner for Refugees (httpwwwunhcrorg)
Food and Agriculture Organization of the United Nations (httpwwwfaoorg)
The World Bank (httpwwwworldbankorg)
United Nations Standing Committee on Nutrition (httpwwwunscnorg)
Micronutrients 2010-2011Department of Nutrition for Health and Development
16DRAFT
WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients
during the biennium 2010-2011
US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms
project name Global prevention of non-communicable disease prevention and promotion of health
The Micronutrient Initiative (MI) wwwmicronutrientorg
project name e-Library of nutrition programme guidance
The Government of Luxembourghttpwwwetatlu
project name Support for the update and dissemination of evidence-based nutrition programme
The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg
project name Efficacy of newborn vitamin A supplementation in improving child survival
WHO also thanks the following organizations for their support through small grants
US Agency for International Development (USAID) httpwwwusaidgov
project name Update WHO evidence based position statements on relevant and priority micronutrient interventions
The Global Alliance for Improved Nutrition (GAIN)
httpwwwgainhealthorg
project name Systematic review of evidence of micronutrient interventions and management of moderate
malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification
project name Systematic review of evidence of rice fortification as a public health intervention and consultation on
rice fortification programs implementation
Harvard University
project name Nutrition impact model study (NIM Study)
Sight amp Life
httpwwwsightandlifeorg
project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System
MEMBERsHIPs
De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013
Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014
Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011
De-Regil LM GRADE working group 2010-present
WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs
Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for
Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2
February 2010 Geneva Switzerland
8 FINANCIAL SUPPORT
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
9DRAFT
Ideally dissemination and wide-spread use of the WHOCDC indicators eCatalogue will increase the standardization
of indicators and increase consistency and comparability across programmes A Technical Consultation ldquoldquoInventory of
indicators for monitoring and evaluation of micronutrient interventionsrdquo was held in Atlanta United States of America
in 6-7 January 2010 The objectives were to fine tune the details of the logic model for monitoring and evaluation of
micronutrient interventions refine search criteria and to validate the usefulness of the indicators web-tool The team is
currently working in the compilation of these indicators using the logic model as a framework to organizing the different
types of indicators currently used in public health programmes involving micronutrient interventions
Micronutrients 2010-2011Department of Nutrition for Health and Development
10
MAIN
Dr Francesco Branca is the Director of
the Department of Nutrition for Health and
Development in the World Health Organization
Geneva He graduated in Medicine and Surgery
and specialized in Diabetology and Metabolic
Diseases at the Universitarsquo Cattolica del Sacro
Cuore Roma He obtained a PhD in Nutrition at
Aberdeen University He was a Senior Scientist
at the Italian Food and Nutrition research
Institute where he was responsible for the
design and implementation of several studies
on the effects of food and nutrients on human
health at the different stages of the life cycle
and for the design management and evaluation
of public health nutrition programmes He
was been President of the Federation of the
European Nutrition Societies in 2003-2007
Dr JP Pena-Rosas is the Coordinator Evidence
and Programme Guidance Department of
Nutrition for Health and Development at the
World Health Organization (WHO) in Geneva
Switzerland He joined WHO on July 2008 and
now oversees the Evidence and Programme
Guidance workplan in the development of
evidence-informed guidelines for interventions
addressing the double burden of malnutrition
for neonates infants children and women in
stable and emergency settings under the WHO
Research Strategy umbrella He is an Adjunct
Assistant Professor at Emory University Rollins
School of Public Health in Atlanta United States
since 2011 Previously he worked several
years in the Division of Nutrition Physical
Activity and Obesity at the Centers for Disease
Control and Prevention (CDC) in Atlanta United
States He was involved in nutrition surveys
and programme monitoring and evaluation for
nutrition interventions in Uzbekistan Morocco
Egypt Peru Nicaragua Georgia and Dominican
Republic In the private sector Dr Pena-Rosas
worked at Kellogg Company Latin America
and the Caribbean Headquarters where he
served several positions including Manager of
Scientific and Regulatory Affairs for the regional
operations He received his Medical Degree from
Universidad Central de Venezuela in his native
country and a Masterrsquos Degree in Public Health
Nutrition from University of Puerto Rico in San
Juan He holds a PhD in Human Nutrition and
Epidemiology from Cornell University Ithaca NY
United States of America He is a member of the
American Society for Nutrition Latin American
Society of Nutrition the American Evaluation
Association the Cochrane Collaboration and
the WHO Guidelines Review Committee
Dr Lisa Rogers is the technical officer for
the Evidence and Programme Guidance Unit
in the Department of Nutrition for Health and
Development She has been working at the
World Health Organization (WHO) in Geneva
Switzerland since April 2006 She is primarily
responsible for managing a grant for mechanistic
studies on neonatal vitamin A supplementation
and coordinating the completion of evidence
reviews and guideline groups to inform vitamin
and mineral intervention guidelines She holds
a PhD in Nutrition on International Nutrition
from the University of California Davis United
States of America Her work included research
in Guatemala investigating the causes of vitamin
B12 deficiency in school age children and
laboratory research involving the optimization of
an immunological assay for holotranscobalamin
II and the analysis of methylmalonic acid
homocysteine vitamin B12 and folate She
received a Master of Science in Nutritional
Sciences from the University of Florida where
she conducted research involving the analysis of
the stability of folic acid added to cereal-grain
products the bioavailability of stable-isotopically
labeled folic acid added to these products and
conducted several human subject studies She
is a member of the American Society for Nutrition
and the Academy of Nutrition and Dietetics
Dr Luz Maria De-Regil is epidemiologist at the
World Health Organization with the Evidence
and Programme Guidance Unit since September
2009 She is responsible for coordinating the
development of global guidelines on nutrition
interventions for different age groups and
settings updating and expanding the Vitamin and
Mineral Nutrition Information System (VMNIS)
developing tools for monitoring and evaluation
of nutrition interventions leading international
and multidisciplinary review teams to assess the
evidence and translating knowledge into global
public policy With more than 50 publications in
5 OUR TEAM
Micronutrients 2010-2011Department of Nutrition for Health and Development
11DRAFT
English and Spanish for different audiences Luz Maria has been involved in community programmes and designed and implemented
research focused on maternal and infant nutrition and health She has experience in applying in vitro and in vivo laboratory techniques
in combination with food science and epidemiology She is an active member of the WHO Research and Ethics Committee the
GRADE working group four groups within the Cochrane Collaboration the American Society for Nutrition the Latin American
Society of Nutrition the Mexican Pediatric Research Association and a former vice-president of the Mexican Society of Nutrition
Ms Grace Rob is a technical assistant in the Evidence and Programme Guidance Unit department of Nutrition for Health and
Development She has been working at the World Health Organization (WHO) in Geneva Switzerland since 2000 She holds a
Bachelors of Science in Home Economics major in food and nutrition and minor in business administration from University of
Eastern Africa Baraton Eldoret in her native Kenya
Mrs Paule Pillard is the Assistant to Coordinator in the Evidence and Programme Guidance Unit Department of Nutrition for Health
and Development and provides administrative support to the coordinator and the unit staff since 2007
Micronutrients 2010-2011Department of Nutrition for Health and Development
12DRAFT
NEONATAL VITAMIN A SUPPLEMENTATION MECHANISTIC STUDIES
There is considerable interest in vitamin A supplementation during the neonatal period as an intervention for reducing infant
mortality The efficacy of this intervention is still to be determined NHD along with the Department of Maternal Newborn Child
and Adolescent Health (MCA) have received funding to conduct studies for the generation of evidence to inform global policy on
the efficacy of neonatal vitamin A supplementation in improving child survival In support of uncovering biological mechanisms
by which neonatal vitamin A supplementation may be acting NHD is coordinating the conduct of one animal study and two human
studies to understand the biological mechanisms through which neonatal vitamin A supplementation can potentially have an
impact on infant survival when given at birth The animal study is being conducted at the University of Wisconsin-Madison USA
(PI S Tanumihardjo) and is using the sow-piglet dyad model The two human studies are double blind randomized controlled
trials to determine the effect of vitamin A supplementation on immune responses in early infancy One study is being conducted
in Bangladesh (n=300) by the USDA-ARS Western Human Nutrition Research Center University of California Davis CA USA (PI
C Stephensen) and the other in The Gambia (n=200) by the Medical Research Council London UK and Keneba Gambia (PI A
Prentice)
The three proposals were reviewed at a WHO Technical Consultation on Vitamin A in Newborn Health - Mechanistic Studies in
December 2009 Final proposals were approved by the WHO Ethics Review Committee (ERC) and the studies are now in progress
NUTRITION IMPACT MODEL-STUDY (NIMS)
This study is funded by a grant from The Bill amp Melinda Gates Foundation to the Harvard School of Public Health and aims to
develop empirically parameterize apply and make publicly available a policy-relevant analytical tool for estimating the health
impacts of undernutrition exposures and interventions
Representatives of the Department of Nutrition for Health and Development work closely with partners to select appropriate
exposure metrics and develop and apply statistical methods for sparse time-space data in order to estimate current levels and past
trends of anaemia and vitamin A deficiency
6 RESEARCH
Micronutrients 2010-2011Department of Nutrition for Health and Development
13DRAFT
The Department of Nutrition for Health and Development works closely with internal collaborators at WHO and with various external
organizations on topics related to micronutrients
COCHRANE COLLABORATION
Over 28000 contributors worldwide work together to help health care providers policy-makers patients their advocates and
carers make well-informed decisions about health care based on the best available research evidence by preparing updating
and promoting the accessibility of Cochrane Reviews ndash over 4600 so far published online in The Cochrane Library In 2010 the
Cochrane Database of Systematic Reviews achieved a top-10 ISI Impact Factor for an outstanding achievement The work of the
Cochrane Collaboration is internationally recognised as the benchmark for high-quality information about the effectiveness of
health care In January 2011 The Cochrane Collaboration was accepted as a Non-Governmental Organization in Official Relations
with the World Health Organization (WHO) the public health arm of the United Nations establishing formalised communication
between our two organisations
This collaboration supports the development of the WHO Library of Evidence for Nutrition Actions (eLENA) and grants open access
to all Member States For the work in micronutrients we have closely collaborated with the following Cochrane groups
Cochrane Editorial Unit (wwweditorial-unitcochraneorg)
Developmental Psychosocial and Learning Problems Group (wwwdplpgcochraneorg)
Infectious Diseases Group (wwwcidgcochraneorgenindexhtml)
Pregnancy and Childbirth Group (wwwpregnancycochraneorg)
Public Health Group (wwwphcochraneorg)
Our Department has also supported the update or undertake of systematic reviews within the following groups
HIVAIDS Group (hivcochraneorg)
Metabolic and Endocrine Disorders Group (wwwendoccochraneorg)
Neonatal Group (wwwneonatalcochraneorg)
Iberoamerican Cochrane Center (wwwcochranees)
GRADE WORKING GROUP
The Grading of Recommendations Assessment Development and Evaluation (GRADE) Working Group began in the year 2000
as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health
care The working group has developed a common sensible and transparent approach to grading the quality of evidence
and the strength of recommendations Many international organizations have provided input into the development of the
approach and have started using it
A representative of our team joined the working group in 2010 to discuss issues related to the normative work in
micronutrients at WHO
CENTERs fOR DIsEAsE CONTROL AND PREVENTION (CDC)
The International Micronutrient Malnutrition Prevention and Control (IMMPaCt) programme works with global partners to
contribute CDC skills and resources to eliminate vitamin and mineral deficiencies (micronutrient malnutrition) among vulnerable
populations throughout the world Established by the CDC in 2000 IMMPaCt focuses primarily on helping eliminate deficiencies in
iron vitamin A iodine and folate
Through a 2009-2014 agreement IMMPaCt supports WHO in various selected projects including providing technical assistance
and subject matter expertise to help design implement and maintain new and current micronutrient databases as well as assist
with processes promoting new WHO guidelines and recommendations
The CDC Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects provides the scientific and programmatic
expertise to build upon and strengthen global neural tube defect surveillance systems and expand the reach of global folic acid
fortification for neural tube defect prevention Expansion of global folic acid fortification efforts can have a significant impact on
infant mortality and childhood morbidity worldwide
7 OUR PARTNERS
Micronutrients 2010-2011Department of Nutrition for Health and Development
14DRAFT
CDCrsquos National Center on Birth Defects and Developmental Disabilities has developed a global initiative to significantly reduce infant
mortality and childhood morbidity resulting from the more than 300000 neural tube defects worldwide each year and contribute
to the achievement of United Nations Millennium Development Goal 4 help to meet the Global Health Initiative Child Health Goal
and support the 63rd World Health Assembly Resolution on Birth Defects
The initiative aims to expand the number of developing countries with mandatory folic acid fortification of high penetrance staples
and provide sustainable support of long-term interventions to eliminate folic acid-preventable neural tube defects worldwide CDC
works with WHO and others to support and advance country-level fortification efforts and to provide needed technical expertise for
surveillance of neural tube defects monitor fortification efforts and improve laboratory capacity on folate-preventable birth defects
THE MICRONUTRIENT INITIATIVE
The Micronutrient Initiative (MI) is an independent not-for-profit organization committed to promoting simple cost-effective
solutions to hidden hunger combat vitamin and mineral deficiency and developing innovative new solutions where needed based in
Ottawa Canada MI is working to end hidden hunger end vitamin and mineral deficiency by helping governments food producers
and partner organizations like WHO develop implement and monitor and evaluate innovative culturally appropriate and cost-
effective programmes to get essential vitamins and minerals to the people who need them most by providing technical and
financial assistance offering procurement and quality control services for highly specialized supplies and equipment needed to
prevent hidden hunger advocating for micronutrient programmes and educating government bodies around the world on policies
legislation and programs to ensure the sustained delivery of essential vitamins and minerals
THE EUNICE KENNEDy sHRIVER NATIONAL INsTITUTE Of CHILD HEALTH AND HUMAN DEVELOPMENT
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health
(NIH)US Department of Health and Human Services in collaboration with partners representing the breadth of the global food and
nutrition enterprise including WHO created the Biomarkers of Nutrition for Development (BOND) Program to meet the growing
need for discovery development and implementation of reliable and valid biomarkers to assess nutrient exposure status function
and effect Also with co-funding from the Bill amp Melinda Gates Foundation has developed the Iron and Malaria Project to address
the safe and effective use of iron interventions in areas of malaria burden Both projects have been done with involvement of and
in support of WHO work in the area of micronutrients
WHO NUTRITION GUIDANCE ExPERT ADVIsORy GROUP MEMBERs
Micronutrients
Ms Deena AlasfoorProfessor Beverley-Ann BiggsDr Heacutector Bourges RodriacuteguezProfessor Norm CampbellProfessor Susan Fairweather-Tait Dr Rafael Flores-AyalaProfessor Malik GoonewardeneDr Junsheng HuoDr Janet C KingDr Marzia Lazzerini Professor Malcolm E Molyneux Eng Wisam QarqashDr Mahdi Ramsan Mohamed Dr Daniel RaitenDr Meera ShekarDr Rebecca Joyce StoltzfusMs Carol TomDr David Tovey Mrs Vilma Qahoush TylerDr Gunn Elisabeth VistDr Emorn Wasantwisut
Monitoring and Evaluation
Dr Lindsay AllenDr Deborah AshDr France BeginDr Zulfiqar BhuttaDr Christine Clewes Professor Susan Fairweather-TaitDr Jonathan GorsteinDr Junsheng HuoDr Ibrahim MD KhatibDr Roland KupkaDr Christine PfeifferDr Rob JPM ScholtenDr Holger SchuumlnemannDr Ismaeumll Ngnieacute TeacutetaDr Emorn Wasantwisut
Vitamin A supplementation
Professor Hany Abdel-AleemProfessor Michael ClarkeDr Anna CoutsoudisDr M Monir HossainDr Jean HumphreyDr Yustina Anie IndriastutiDr Marzia LazzeriniDr Pavitra MohanDr Rintaro MoriDr A Catherine RossDr Isabella Sagoe-MosesDr Claudia SaundersDr Prak SophonnearyDr Charles StephensenDr Sherry TanumihardjoDr Khalid Yunis
Micronutrients 2010-2011Department of Nutrition for Health and Development
15DRAFT
INTERNsHIPs
WHO is committed to building future leaders in public health and WHOrsquos Internship Programme provides a wide range of
opportunities for graduate and post-graduate students to gain insight into the work of WHO Although WHO receives a large
number of intern applications each year only a limited number of places for internships are available Internships are available for
work in micronutrients at WHO for a minimum of 6 weeks and a maximum of 3 months to allow the internship to be both worthwhile
and effective The following selected interns were hosted by NHD during the biennium 2010-2011 to work on topics related to
micronutrients
Ms Alison Sylvetsky 7 June - 13 August 2010 - EMORY UNIVERSITY ATLANTA USA
Ms Aida Victoria Campos 1 March - 31 May 2010 - UNIVERSIDAD LA SALLE MExICO DF MExICO
Mrs Sarah Pedersen 14 June - 13 August 2010- CORNELL UNIVERSITY ITHACA NEW YORK USA
Mr Joseph Ashong1 March 2011 - 1 July 2011 - CORNELL UNIVERSITY ITHACA NEW YORK USA
Dr Saint-Rayn Pasricha 14 February 2011 - 17 June 2011 - UNIVERSITY OF MELBOURNE VICTORIA AUSTRALIA
Ms Ellie Souganidis 20 June 2011 - 12 August 2011 - JOHNS HOPKINS UNIVERSITY BALTIMORE MARYLAND USA
Mr Raheel Arif 15 August - 4 November 2011- UNIVERSITY OF THE SCIENCES PHILADELPHIA PENNSYLVANIA USA
ADVOCACy AND NETWORKs
Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource
allocation decisions within political economic and social systems and institutions Advocacy in WHO for vitamin and mineral
nutrition includes many activities such as media campaigns public speaking commissioning and publishing research as well as
participation in several groups and networks
Home Fortification Technical Advisory Group (HFTAG) (httpwwwgainhealthorghftag)
The Network For Sustained Elimination of Iodine Deficiency (httpwwwiodinenetworknet)
International Council for the Control of Iodine Deficiency Disorders (wwwicciddorg)
Rice Fortification Technical Group (httpwwwgainhealthorgriforg)
Global Alliance for Vitamin A (GAVA)
Flour Fortification Initiative (httpwwwsphemoryeduwheatflour)
International Zinc Nutrition Consultative Group (wwwizincgorg)
United Nations World Food Programme (httpwwwwfporg)
United Nations Childrenrsquos Fund (httpwwwuniceforg)
United Nations High Commissioner for Refugees (httpwwwunhcrorg)
Food and Agriculture Organization of the United Nations (httpwwwfaoorg)
The World Bank (httpwwwworldbankorg)
United Nations Standing Committee on Nutrition (httpwwwunscnorg)
Micronutrients 2010-2011Department of Nutrition for Health and Development
16DRAFT
WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients
during the biennium 2010-2011
US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms
project name Global prevention of non-communicable disease prevention and promotion of health
The Micronutrient Initiative (MI) wwwmicronutrientorg
project name e-Library of nutrition programme guidance
The Government of Luxembourghttpwwwetatlu
project name Support for the update and dissemination of evidence-based nutrition programme
The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg
project name Efficacy of newborn vitamin A supplementation in improving child survival
WHO also thanks the following organizations for their support through small grants
US Agency for International Development (USAID) httpwwwusaidgov
project name Update WHO evidence based position statements on relevant and priority micronutrient interventions
The Global Alliance for Improved Nutrition (GAIN)
httpwwwgainhealthorg
project name Systematic review of evidence of micronutrient interventions and management of moderate
malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification
project name Systematic review of evidence of rice fortification as a public health intervention and consultation on
rice fortification programs implementation
Harvard University
project name Nutrition impact model study (NIM Study)
Sight amp Life
httpwwwsightandlifeorg
project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System
MEMBERsHIPs
De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013
Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014
Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011
De-Regil LM GRADE working group 2010-present
WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs
Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for
Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2
February 2010 Geneva Switzerland
8 FINANCIAL SUPPORT
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
10
MAIN
Dr Francesco Branca is the Director of
the Department of Nutrition for Health and
Development in the World Health Organization
Geneva He graduated in Medicine and Surgery
and specialized in Diabetology and Metabolic
Diseases at the Universitarsquo Cattolica del Sacro
Cuore Roma He obtained a PhD in Nutrition at
Aberdeen University He was a Senior Scientist
at the Italian Food and Nutrition research
Institute where he was responsible for the
design and implementation of several studies
on the effects of food and nutrients on human
health at the different stages of the life cycle
and for the design management and evaluation
of public health nutrition programmes He
was been President of the Federation of the
European Nutrition Societies in 2003-2007
Dr JP Pena-Rosas is the Coordinator Evidence
and Programme Guidance Department of
Nutrition for Health and Development at the
World Health Organization (WHO) in Geneva
Switzerland He joined WHO on July 2008 and
now oversees the Evidence and Programme
Guidance workplan in the development of
evidence-informed guidelines for interventions
addressing the double burden of malnutrition
for neonates infants children and women in
stable and emergency settings under the WHO
Research Strategy umbrella He is an Adjunct
Assistant Professor at Emory University Rollins
School of Public Health in Atlanta United States
since 2011 Previously he worked several
years in the Division of Nutrition Physical
Activity and Obesity at the Centers for Disease
Control and Prevention (CDC) in Atlanta United
States He was involved in nutrition surveys
and programme monitoring and evaluation for
nutrition interventions in Uzbekistan Morocco
Egypt Peru Nicaragua Georgia and Dominican
Republic In the private sector Dr Pena-Rosas
worked at Kellogg Company Latin America
and the Caribbean Headquarters where he
served several positions including Manager of
Scientific and Regulatory Affairs for the regional
operations He received his Medical Degree from
Universidad Central de Venezuela in his native
country and a Masterrsquos Degree in Public Health
Nutrition from University of Puerto Rico in San
Juan He holds a PhD in Human Nutrition and
Epidemiology from Cornell University Ithaca NY
United States of America He is a member of the
American Society for Nutrition Latin American
Society of Nutrition the American Evaluation
Association the Cochrane Collaboration and
the WHO Guidelines Review Committee
Dr Lisa Rogers is the technical officer for
the Evidence and Programme Guidance Unit
in the Department of Nutrition for Health and
Development She has been working at the
World Health Organization (WHO) in Geneva
Switzerland since April 2006 She is primarily
responsible for managing a grant for mechanistic
studies on neonatal vitamin A supplementation
and coordinating the completion of evidence
reviews and guideline groups to inform vitamin
and mineral intervention guidelines She holds
a PhD in Nutrition on International Nutrition
from the University of California Davis United
States of America Her work included research
in Guatemala investigating the causes of vitamin
B12 deficiency in school age children and
laboratory research involving the optimization of
an immunological assay for holotranscobalamin
II and the analysis of methylmalonic acid
homocysteine vitamin B12 and folate She
received a Master of Science in Nutritional
Sciences from the University of Florida where
she conducted research involving the analysis of
the stability of folic acid added to cereal-grain
products the bioavailability of stable-isotopically
labeled folic acid added to these products and
conducted several human subject studies She
is a member of the American Society for Nutrition
and the Academy of Nutrition and Dietetics
Dr Luz Maria De-Regil is epidemiologist at the
World Health Organization with the Evidence
and Programme Guidance Unit since September
2009 She is responsible for coordinating the
development of global guidelines on nutrition
interventions for different age groups and
settings updating and expanding the Vitamin and
Mineral Nutrition Information System (VMNIS)
developing tools for monitoring and evaluation
of nutrition interventions leading international
and multidisciplinary review teams to assess the
evidence and translating knowledge into global
public policy With more than 50 publications in
5 OUR TEAM
Micronutrients 2010-2011Department of Nutrition for Health and Development
11DRAFT
English and Spanish for different audiences Luz Maria has been involved in community programmes and designed and implemented
research focused on maternal and infant nutrition and health She has experience in applying in vitro and in vivo laboratory techniques
in combination with food science and epidemiology She is an active member of the WHO Research and Ethics Committee the
GRADE working group four groups within the Cochrane Collaboration the American Society for Nutrition the Latin American
Society of Nutrition the Mexican Pediatric Research Association and a former vice-president of the Mexican Society of Nutrition
Ms Grace Rob is a technical assistant in the Evidence and Programme Guidance Unit department of Nutrition for Health and
Development She has been working at the World Health Organization (WHO) in Geneva Switzerland since 2000 She holds a
Bachelors of Science in Home Economics major in food and nutrition and minor in business administration from University of
Eastern Africa Baraton Eldoret in her native Kenya
Mrs Paule Pillard is the Assistant to Coordinator in the Evidence and Programme Guidance Unit Department of Nutrition for Health
and Development and provides administrative support to the coordinator and the unit staff since 2007
Micronutrients 2010-2011Department of Nutrition for Health and Development
12DRAFT
NEONATAL VITAMIN A SUPPLEMENTATION MECHANISTIC STUDIES
There is considerable interest in vitamin A supplementation during the neonatal period as an intervention for reducing infant
mortality The efficacy of this intervention is still to be determined NHD along with the Department of Maternal Newborn Child
and Adolescent Health (MCA) have received funding to conduct studies for the generation of evidence to inform global policy on
the efficacy of neonatal vitamin A supplementation in improving child survival In support of uncovering biological mechanisms
by which neonatal vitamin A supplementation may be acting NHD is coordinating the conduct of one animal study and two human
studies to understand the biological mechanisms through which neonatal vitamin A supplementation can potentially have an
impact on infant survival when given at birth The animal study is being conducted at the University of Wisconsin-Madison USA
(PI S Tanumihardjo) and is using the sow-piglet dyad model The two human studies are double blind randomized controlled
trials to determine the effect of vitamin A supplementation on immune responses in early infancy One study is being conducted
in Bangladesh (n=300) by the USDA-ARS Western Human Nutrition Research Center University of California Davis CA USA (PI
C Stephensen) and the other in The Gambia (n=200) by the Medical Research Council London UK and Keneba Gambia (PI A
Prentice)
The three proposals were reviewed at a WHO Technical Consultation on Vitamin A in Newborn Health - Mechanistic Studies in
December 2009 Final proposals were approved by the WHO Ethics Review Committee (ERC) and the studies are now in progress
NUTRITION IMPACT MODEL-STUDY (NIMS)
This study is funded by a grant from The Bill amp Melinda Gates Foundation to the Harvard School of Public Health and aims to
develop empirically parameterize apply and make publicly available a policy-relevant analytical tool for estimating the health
impacts of undernutrition exposures and interventions
Representatives of the Department of Nutrition for Health and Development work closely with partners to select appropriate
exposure metrics and develop and apply statistical methods for sparse time-space data in order to estimate current levels and past
trends of anaemia and vitamin A deficiency
6 RESEARCH
Micronutrients 2010-2011Department of Nutrition for Health and Development
13DRAFT
The Department of Nutrition for Health and Development works closely with internal collaborators at WHO and with various external
organizations on topics related to micronutrients
COCHRANE COLLABORATION
Over 28000 contributors worldwide work together to help health care providers policy-makers patients their advocates and
carers make well-informed decisions about health care based on the best available research evidence by preparing updating
and promoting the accessibility of Cochrane Reviews ndash over 4600 so far published online in The Cochrane Library In 2010 the
Cochrane Database of Systematic Reviews achieved a top-10 ISI Impact Factor for an outstanding achievement The work of the
Cochrane Collaboration is internationally recognised as the benchmark for high-quality information about the effectiveness of
health care In January 2011 The Cochrane Collaboration was accepted as a Non-Governmental Organization in Official Relations
with the World Health Organization (WHO) the public health arm of the United Nations establishing formalised communication
between our two organisations
This collaboration supports the development of the WHO Library of Evidence for Nutrition Actions (eLENA) and grants open access
to all Member States For the work in micronutrients we have closely collaborated with the following Cochrane groups
Cochrane Editorial Unit (wwweditorial-unitcochraneorg)
Developmental Psychosocial and Learning Problems Group (wwwdplpgcochraneorg)
Infectious Diseases Group (wwwcidgcochraneorgenindexhtml)
Pregnancy and Childbirth Group (wwwpregnancycochraneorg)
Public Health Group (wwwphcochraneorg)
Our Department has also supported the update or undertake of systematic reviews within the following groups
HIVAIDS Group (hivcochraneorg)
Metabolic and Endocrine Disorders Group (wwwendoccochraneorg)
Neonatal Group (wwwneonatalcochraneorg)
Iberoamerican Cochrane Center (wwwcochranees)
GRADE WORKING GROUP
The Grading of Recommendations Assessment Development and Evaluation (GRADE) Working Group began in the year 2000
as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health
care The working group has developed a common sensible and transparent approach to grading the quality of evidence
and the strength of recommendations Many international organizations have provided input into the development of the
approach and have started using it
A representative of our team joined the working group in 2010 to discuss issues related to the normative work in
micronutrients at WHO
CENTERs fOR DIsEAsE CONTROL AND PREVENTION (CDC)
The International Micronutrient Malnutrition Prevention and Control (IMMPaCt) programme works with global partners to
contribute CDC skills and resources to eliminate vitamin and mineral deficiencies (micronutrient malnutrition) among vulnerable
populations throughout the world Established by the CDC in 2000 IMMPaCt focuses primarily on helping eliminate deficiencies in
iron vitamin A iodine and folate
Through a 2009-2014 agreement IMMPaCt supports WHO in various selected projects including providing technical assistance
and subject matter expertise to help design implement and maintain new and current micronutrient databases as well as assist
with processes promoting new WHO guidelines and recommendations
The CDC Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects provides the scientific and programmatic
expertise to build upon and strengthen global neural tube defect surveillance systems and expand the reach of global folic acid
fortification for neural tube defect prevention Expansion of global folic acid fortification efforts can have a significant impact on
infant mortality and childhood morbidity worldwide
7 OUR PARTNERS
Micronutrients 2010-2011Department of Nutrition for Health and Development
14DRAFT
CDCrsquos National Center on Birth Defects and Developmental Disabilities has developed a global initiative to significantly reduce infant
mortality and childhood morbidity resulting from the more than 300000 neural tube defects worldwide each year and contribute
to the achievement of United Nations Millennium Development Goal 4 help to meet the Global Health Initiative Child Health Goal
and support the 63rd World Health Assembly Resolution on Birth Defects
The initiative aims to expand the number of developing countries with mandatory folic acid fortification of high penetrance staples
and provide sustainable support of long-term interventions to eliminate folic acid-preventable neural tube defects worldwide CDC
works with WHO and others to support and advance country-level fortification efforts and to provide needed technical expertise for
surveillance of neural tube defects monitor fortification efforts and improve laboratory capacity on folate-preventable birth defects
THE MICRONUTRIENT INITIATIVE
The Micronutrient Initiative (MI) is an independent not-for-profit organization committed to promoting simple cost-effective
solutions to hidden hunger combat vitamin and mineral deficiency and developing innovative new solutions where needed based in
Ottawa Canada MI is working to end hidden hunger end vitamin and mineral deficiency by helping governments food producers
and partner organizations like WHO develop implement and monitor and evaluate innovative culturally appropriate and cost-
effective programmes to get essential vitamins and minerals to the people who need them most by providing technical and
financial assistance offering procurement and quality control services for highly specialized supplies and equipment needed to
prevent hidden hunger advocating for micronutrient programmes and educating government bodies around the world on policies
legislation and programs to ensure the sustained delivery of essential vitamins and minerals
THE EUNICE KENNEDy sHRIVER NATIONAL INsTITUTE Of CHILD HEALTH AND HUMAN DEVELOPMENT
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health
(NIH)US Department of Health and Human Services in collaboration with partners representing the breadth of the global food and
nutrition enterprise including WHO created the Biomarkers of Nutrition for Development (BOND) Program to meet the growing
need for discovery development and implementation of reliable and valid biomarkers to assess nutrient exposure status function
and effect Also with co-funding from the Bill amp Melinda Gates Foundation has developed the Iron and Malaria Project to address
the safe and effective use of iron interventions in areas of malaria burden Both projects have been done with involvement of and
in support of WHO work in the area of micronutrients
WHO NUTRITION GUIDANCE ExPERT ADVIsORy GROUP MEMBERs
Micronutrients
Ms Deena AlasfoorProfessor Beverley-Ann BiggsDr Heacutector Bourges RodriacuteguezProfessor Norm CampbellProfessor Susan Fairweather-Tait Dr Rafael Flores-AyalaProfessor Malik GoonewardeneDr Junsheng HuoDr Janet C KingDr Marzia Lazzerini Professor Malcolm E Molyneux Eng Wisam QarqashDr Mahdi Ramsan Mohamed Dr Daniel RaitenDr Meera ShekarDr Rebecca Joyce StoltzfusMs Carol TomDr David Tovey Mrs Vilma Qahoush TylerDr Gunn Elisabeth VistDr Emorn Wasantwisut
Monitoring and Evaluation
Dr Lindsay AllenDr Deborah AshDr France BeginDr Zulfiqar BhuttaDr Christine Clewes Professor Susan Fairweather-TaitDr Jonathan GorsteinDr Junsheng HuoDr Ibrahim MD KhatibDr Roland KupkaDr Christine PfeifferDr Rob JPM ScholtenDr Holger SchuumlnemannDr Ismaeumll Ngnieacute TeacutetaDr Emorn Wasantwisut
Vitamin A supplementation
Professor Hany Abdel-AleemProfessor Michael ClarkeDr Anna CoutsoudisDr M Monir HossainDr Jean HumphreyDr Yustina Anie IndriastutiDr Marzia LazzeriniDr Pavitra MohanDr Rintaro MoriDr A Catherine RossDr Isabella Sagoe-MosesDr Claudia SaundersDr Prak SophonnearyDr Charles StephensenDr Sherry TanumihardjoDr Khalid Yunis
Micronutrients 2010-2011Department of Nutrition for Health and Development
15DRAFT
INTERNsHIPs
WHO is committed to building future leaders in public health and WHOrsquos Internship Programme provides a wide range of
opportunities for graduate and post-graduate students to gain insight into the work of WHO Although WHO receives a large
number of intern applications each year only a limited number of places for internships are available Internships are available for
work in micronutrients at WHO for a minimum of 6 weeks and a maximum of 3 months to allow the internship to be both worthwhile
and effective The following selected interns were hosted by NHD during the biennium 2010-2011 to work on topics related to
micronutrients
Ms Alison Sylvetsky 7 June - 13 August 2010 - EMORY UNIVERSITY ATLANTA USA
Ms Aida Victoria Campos 1 March - 31 May 2010 - UNIVERSIDAD LA SALLE MExICO DF MExICO
Mrs Sarah Pedersen 14 June - 13 August 2010- CORNELL UNIVERSITY ITHACA NEW YORK USA
Mr Joseph Ashong1 March 2011 - 1 July 2011 - CORNELL UNIVERSITY ITHACA NEW YORK USA
Dr Saint-Rayn Pasricha 14 February 2011 - 17 June 2011 - UNIVERSITY OF MELBOURNE VICTORIA AUSTRALIA
Ms Ellie Souganidis 20 June 2011 - 12 August 2011 - JOHNS HOPKINS UNIVERSITY BALTIMORE MARYLAND USA
Mr Raheel Arif 15 August - 4 November 2011- UNIVERSITY OF THE SCIENCES PHILADELPHIA PENNSYLVANIA USA
ADVOCACy AND NETWORKs
Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource
allocation decisions within political economic and social systems and institutions Advocacy in WHO for vitamin and mineral
nutrition includes many activities such as media campaigns public speaking commissioning and publishing research as well as
participation in several groups and networks
Home Fortification Technical Advisory Group (HFTAG) (httpwwwgainhealthorghftag)
The Network For Sustained Elimination of Iodine Deficiency (httpwwwiodinenetworknet)
International Council for the Control of Iodine Deficiency Disorders (wwwicciddorg)
Rice Fortification Technical Group (httpwwwgainhealthorgriforg)
Global Alliance for Vitamin A (GAVA)
Flour Fortification Initiative (httpwwwsphemoryeduwheatflour)
International Zinc Nutrition Consultative Group (wwwizincgorg)
United Nations World Food Programme (httpwwwwfporg)
United Nations Childrenrsquos Fund (httpwwwuniceforg)
United Nations High Commissioner for Refugees (httpwwwunhcrorg)
Food and Agriculture Organization of the United Nations (httpwwwfaoorg)
The World Bank (httpwwwworldbankorg)
United Nations Standing Committee on Nutrition (httpwwwunscnorg)
Micronutrients 2010-2011Department of Nutrition for Health and Development
16DRAFT
WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients
during the biennium 2010-2011
US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms
project name Global prevention of non-communicable disease prevention and promotion of health
The Micronutrient Initiative (MI) wwwmicronutrientorg
project name e-Library of nutrition programme guidance
The Government of Luxembourghttpwwwetatlu
project name Support for the update and dissemination of evidence-based nutrition programme
The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg
project name Efficacy of newborn vitamin A supplementation in improving child survival
WHO also thanks the following organizations for their support through small grants
US Agency for International Development (USAID) httpwwwusaidgov
project name Update WHO evidence based position statements on relevant and priority micronutrient interventions
The Global Alliance for Improved Nutrition (GAIN)
httpwwwgainhealthorg
project name Systematic review of evidence of micronutrient interventions and management of moderate
malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification
project name Systematic review of evidence of rice fortification as a public health intervention and consultation on
rice fortification programs implementation
Harvard University
project name Nutrition impact model study (NIM Study)
Sight amp Life
httpwwwsightandlifeorg
project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System
MEMBERsHIPs
De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013
Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014
Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011
De-Regil LM GRADE working group 2010-present
WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs
Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for
Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2
February 2010 Geneva Switzerland
8 FINANCIAL SUPPORT
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
11DRAFT
English and Spanish for different audiences Luz Maria has been involved in community programmes and designed and implemented
research focused on maternal and infant nutrition and health She has experience in applying in vitro and in vivo laboratory techniques
in combination with food science and epidemiology She is an active member of the WHO Research and Ethics Committee the
GRADE working group four groups within the Cochrane Collaboration the American Society for Nutrition the Latin American
Society of Nutrition the Mexican Pediatric Research Association and a former vice-president of the Mexican Society of Nutrition
Ms Grace Rob is a technical assistant in the Evidence and Programme Guidance Unit department of Nutrition for Health and
Development She has been working at the World Health Organization (WHO) in Geneva Switzerland since 2000 She holds a
Bachelors of Science in Home Economics major in food and nutrition and minor in business administration from University of
Eastern Africa Baraton Eldoret in her native Kenya
Mrs Paule Pillard is the Assistant to Coordinator in the Evidence and Programme Guidance Unit Department of Nutrition for Health
and Development and provides administrative support to the coordinator and the unit staff since 2007
Micronutrients 2010-2011Department of Nutrition for Health and Development
12DRAFT
NEONATAL VITAMIN A SUPPLEMENTATION MECHANISTIC STUDIES
There is considerable interest in vitamin A supplementation during the neonatal period as an intervention for reducing infant
mortality The efficacy of this intervention is still to be determined NHD along with the Department of Maternal Newborn Child
and Adolescent Health (MCA) have received funding to conduct studies for the generation of evidence to inform global policy on
the efficacy of neonatal vitamin A supplementation in improving child survival In support of uncovering biological mechanisms
by which neonatal vitamin A supplementation may be acting NHD is coordinating the conduct of one animal study and two human
studies to understand the biological mechanisms through which neonatal vitamin A supplementation can potentially have an
impact on infant survival when given at birth The animal study is being conducted at the University of Wisconsin-Madison USA
(PI S Tanumihardjo) and is using the sow-piglet dyad model The two human studies are double blind randomized controlled
trials to determine the effect of vitamin A supplementation on immune responses in early infancy One study is being conducted
in Bangladesh (n=300) by the USDA-ARS Western Human Nutrition Research Center University of California Davis CA USA (PI
C Stephensen) and the other in The Gambia (n=200) by the Medical Research Council London UK and Keneba Gambia (PI A
Prentice)
The three proposals were reviewed at a WHO Technical Consultation on Vitamin A in Newborn Health - Mechanistic Studies in
December 2009 Final proposals were approved by the WHO Ethics Review Committee (ERC) and the studies are now in progress
NUTRITION IMPACT MODEL-STUDY (NIMS)
This study is funded by a grant from The Bill amp Melinda Gates Foundation to the Harvard School of Public Health and aims to
develop empirically parameterize apply and make publicly available a policy-relevant analytical tool for estimating the health
impacts of undernutrition exposures and interventions
Representatives of the Department of Nutrition for Health and Development work closely with partners to select appropriate
exposure metrics and develop and apply statistical methods for sparse time-space data in order to estimate current levels and past
trends of anaemia and vitamin A deficiency
6 RESEARCH
Micronutrients 2010-2011Department of Nutrition for Health and Development
13DRAFT
The Department of Nutrition for Health and Development works closely with internal collaborators at WHO and with various external
organizations on topics related to micronutrients
COCHRANE COLLABORATION
Over 28000 contributors worldwide work together to help health care providers policy-makers patients their advocates and
carers make well-informed decisions about health care based on the best available research evidence by preparing updating
and promoting the accessibility of Cochrane Reviews ndash over 4600 so far published online in The Cochrane Library In 2010 the
Cochrane Database of Systematic Reviews achieved a top-10 ISI Impact Factor for an outstanding achievement The work of the
Cochrane Collaboration is internationally recognised as the benchmark for high-quality information about the effectiveness of
health care In January 2011 The Cochrane Collaboration was accepted as a Non-Governmental Organization in Official Relations
with the World Health Organization (WHO) the public health arm of the United Nations establishing formalised communication
between our two organisations
This collaboration supports the development of the WHO Library of Evidence for Nutrition Actions (eLENA) and grants open access
to all Member States For the work in micronutrients we have closely collaborated with the following Cochrane groups
Cochrane Editorial Unit (wwweditorial-unitcochraneorg)
Developmental Psychosocial and Learning Problems Group (wwwdplpgcochraneorg)
Infectious Diseases Group (wwwcidgcochraneorgenindexhtml)
Pregnancy and Childbirth Group (wwwpregnancycochraneorg)
Public Health Group (wwwphcochraneorg)
Our Department has also supported the update or undertake of systematic reviews within the following groups
HIVAIDS Group (hivcochraneorg)
Metabolic and Endocrine Disorders Group (wwwendoccochraneorg)
Neonatal Group (wwwneonatalcochraneorg)
Iberoamerican Cochrane Center (wwwcochranees)
GRADE WORKING GROUP
The Grading of Recommendations Assessment Development and Evaluation (GRADE) Working Group began in the year 2000
as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health
care The working group has developed a common sensible and transparent approach to grading the quality of evidence
and the strength of recommendations Many international organizations have provided input into the development of the
approach and have started using it
A representative of our team joined the working group in 2010 to discuss issues related to the normative work in
micronutrients at WHO
CENTERs fOR DIsEAsE CONTROL AND PREVENTION (CDC)
The International Micronutrient Malnutrition Prevention and Control (IMMPaCt) programme works with global partners to
contribute CDC skills and resources to eliminate vitamin and mineral deficiencies (micronutrient malnutrition) among vulnerable
populations throughout the world Established by the CDC in 2000 IMMPaCt focuses primarily on helping eliminate deficiencies in
iron vitamin A iodine and folate
Through a 2009-2014 agreement IMMPaCt supports WHO in various selected projects including providing technical assistance
and subject matter expertise to help design implement and maintain new and current micronutrient databases as well as assist
with processes promoting new WHO guidelines and recommendations
The CDC Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects provides the scientific and programmatic
expertise to build upon and strengthen global neural tube defect surveillance systems and expand the reach of global folic acid
fortification for neural tube defect prevention Expansion of global folic acid fortification efforts can have a significant impact on
infant mortality and childhood morbidity worldwide
7 OUR PARTNERS
Micronutrients 2010-2011Department of Nutrition for Health and Development
14DRAFT
CDCrsquos National Center on Birth Defects and Developmental Disabilities has developed a global initiative to significantly reduce infant
mortality and childhood morbidity resulting from the more than 300000 neural tube defects worldwide each year and contribute
to the achievement of United Nations Millennium Development Goal 4 help to meet the Global Health Initiative Child Health Goal
and support the 63rd World Health Assembly Resolution on Birth Defects
The initiative aims to expand the number of developing countries with mandatory folic acid fortification of high penetrance staples
and provide sustainable support of long-term interventions to eliminate folic acid-preventable neural tube defects worldwide CDC
works with WHO and others to support and advance country-level fortification efforts and to provide needed technical expertise for
surveillance of neural tube defects monitor fortification efforts and improve laboratory capacity on folate-preventable birth defects
THE MICRONUTRIENT INITIATIVE
The Micronutrient Initiative (MI) is an independent not-for-profit organization committed to promoting simple cost-effective
solutions to hidden hunger combat vitamin and mineral deficiency and developing innovative new solutions where needed based in
Ottawa Canada MI is working to end hidden hunger end vitamin and mineral deficiency by helping governments food producers
and partner organizations like WHO develop implement and monitor and evaluate innovative culturally appropriate and cost-
effective programmes to get essential vitamins and minerals to the people who need them most by providing technical and
financial assistance offering procurement and quality control services for highly specialized supplies and equipment needed to
prevent hidden hunger advocating for micronutrient programmes and educating government bodies around the world on policies
legislation and programs to ensure the sustained delivery of essential vitamins and minerals
THE EUNICE KENNEDy sHRIVER NATIONAL INsTITUTE Of CHILD HEALTH AND HUMAN DEVELOPMENT
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health
(NIH)US Department of Health and Human Services in collaboration with partners representing the breadth of the global food and
nutrition enterprise including WHO created the Biomarkers of Nutrition for Development (BOND) Program to meet the growing
need for discovery development and implementation of reliable and valid biomarkers to assess nutrient exposure status function
and effect Also with co-funding from the Bill amp Melinda Gates Foundation has developed the Iron and Malaria Project to address
the safe and effective use of iron interventions in areas of malaria burden Both projects have been done with involvement of and
in support of WHO work in the area of micronutrients
WHO NUTRITION GUIDANCE ExPERT ADVIsORy GROUP MEMBERs
Micronutrients
Ms Deena AlasfoorProfessor Beverley-Ann BiggsDr Heacutector Bourges RodriacuteguezProfessor Norm CampbellProfessor Susan Fairweather-Tait Dr Rafael Flores-AyalaProfessor Malik GoonewardeneDr Junsheng HuoDr Janet C KingDr Marzia Lazzerini Professor Malcolm E Molyneux Eng Wisam QarqashDr Mahdi Ramsan Mohamed Dr Daniel RaitenDr Meera ShekarDr Rebecca Joyce StoltzfusMs Carol TomDr David Tovey Mrs Vilma Qahoush TylerDr Gunn Elisabeth VistDr Emorn Wasantwisut
Monitoring and Evaluation
Dr Lindsay AllenDr Deborah AshDr France BeginDr Zulfiqar BhuttaDr Christine Clewes Professor Susan Fairweather-TaitDr Jonathan GorsteinDr Junsheng HuoDr Ibrahim MD KhatibDr Roland KupkaDr Christine PfeifferDr Rob JPM ScholtenDr Holger SchuumlnemannDr Ismaeumll Ngnieacute TeacutetaDr Emorn Wasantwisut
Vitamin A supplementation
Professor Hany Abdel-AleemProfessor Michael ClarkeDr Anna CoutsoudisDr M Monir HossainDr Jean HumphreyDr Yustina Anie IndriastutiDr Marzia LazzeriniDr Pavitra MohanDr Rintaro MoriDr A Catherine RossDr Isabella Sagoe-MosesDr Claudia SaundersDr Prak SophonnearyDr Charles StephensenDr Sherry TanumihardjoDr Khalid Yunis
Micronutrients 2010-2011Department of Nutrition for Health and Development
15DRAFT
INTERNsHIPs
WHO is committed to building future leaders in public health and WHOrsquos Internship Programme provides a wide range of
opportunities for graduate and post-graduate students to gain insight into the work of WHO Although WHO receives a large
number of intern applications each year only a limited number of places for internships are available Internships are available for
work in micronutrients at WHO for a minimum of 6 weeks and a maximum of 3 months to allow the internship to be both worthwhile
and effective The following selected interns were hosted by NHD during the biennium 2010-2011 to work on topics related to
micronutrients
Ms Alison Sylvetsky 7 June - 13 August 2010 - EMORY UNIVERSITY ATLANTA USA
Ms Aida Victoria Campos 1 March - 31 May 2010 - UNIVERSIDAD LA SALLE MExICO DF MExICO
Mrs Sarah Pedersen 14 June - 13 August 2010- CORNELL UNIVERSITY ITHACA NEW YORK USA
Mr Joseph Ashong1 March 2011 - 1 July 2011 - CORNELL UNIVERSITY ITHACA NEW YORK USA
Dr Saint-Rayn Pasricha 14 February 2011 - 17 June 2011 - UNIVERSITY OF MELBOURNE VICTORIA AUSTRALIA
Ms Ellie Souganidis 20 June 2011 - 12 August 2011 - JOHNS HOPKINS UNIVERSITY BALTIMORE MARYLAND USA
Mr Raheel Arif 15 August - 4 November 2011- UNIVERSITY OF THE SCIENCES PHILADELPHIA PENNSYLVANIA USA
ADVOCACy AND NETWORKs
Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource
allocation decisions within political economic and social systems and institutions Advocacy in WHO for vitamin and mineral
nutrition includes many activities such as media campaigns public speaking commissioning and publishing research as well as
participation in several groups and networks
Home Fortification Technical Advisory Group (HFTAG) (httpwwwgainhealthorghftag)
The Network For Sustained Elimination of Iodine Deficiency (httpwwwiodinenetworknet)
International Council for the Control of Iodine Deficiency Disorders (wwwicciddorg)
Rice Fortification Technical Group (httpwwwgainhealthorgriforg)
Global Alliance for Vitamin A (GAVA)
Flour Fortification Initiative (httpwwwsphemoryeduwheatflour)
International Zinc Nutrition Consultative Group (wwwizincgorg)
United Nations World Food Programme (httpwwwwfporg)
United Nations Childrenrsquos Fund (httpwwwuniceforg)
United Nations High Commissioner for Refugees (httpwwwunhcrorg)
Food and Agriculture Organization of the United Nations (httpwwwfaoorg)
The World Bank (httpwwwworldbankorg)
United Nations Standing Committee on Nutrition (httpwwwunscnorg)
Micronutrients 2010-2011Department of Nutrition for Health and Development
16DRAFT
WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients
during the biennium 2010-2011
US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms
project name Global prevention of non-communicable disease prevention and promotion of health
The Micronutrient Initiative (MI) wwwmicronutrientorg
project name e-Library of nutrition programme guidance
The Government of Luxembourghttpwwwetatlu
project name Support for the update and dissemination of evidence-based nutrition programme
The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg
project name Efficacy of newborn vitamin A supplementation in improving child survival
WHO also thanks the following organizations for their support through small grants
US Agency for International Development (USAID) httpwwwusaidgov
project name Update WHO evidence based position statements on relevant and priority micronutrient interventions
The Global Alliance for Improved Nutrition (GAIN)
httpwwwgainhealthorg
project name Systematic review of evidence of micronutrient interventions and management of moderate
malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification
project name Systematic review of evidence of rice fortification as a public health intervention and consultation on
rice fortification programs implementation
Harvard University
project name Nutrition impact model study (NIM Study)
Sight amp Life
httpwwwsightandlifeorg
project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System
MEMBERsHIPs
De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013
Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014
Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011
De-Regil LM GRADE working group 2010-present
WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs
Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for
Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2
February 2010 Geneva Switzerland
8 FINANCIAL SUPPORT
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
12DRAFT
NEONATAL VITAMIN A SUPPLEMENTATION MECHANISTIC STUDIES
There is considerable interest in vitamin A supplementation during the neonatal period as an intervention for reducing infant
mortality The efficacy of this intervention is still to be determined NHD along with the Department of Maternal Newborn Child
and Adolescent Health (MCA) have received funding to conduct studies for the generation of evidence to inform global policy on
the efficacy of neonatal vitamin A supplementation in improving child survival In support of uncovering biological mechanisms
by which neonatal vitamin A supplementation may be acting NHD is coordinating the conduct of one animal study and two human
studies to understand the biological mechanisms through which neonatal vitamin A supplementation can potentially have an
impact on infant survival when given at birth The animal study is being conducted at the University of Wisconsin-Madison USA
(PI S Tanumihardjo) and is using the sow-piglet dyad model The two human studies are double blind randomized controlled
trials to determine the effect of vitamin A supplementation on immune responses in early infancy One study is being conducted
in Bangladesh (n=300) by the USDA-ARS Western Human Nutrition Research Center University of California Davis CA USA (PI
C Stephensen) and the other in The Gambia (n=200) by the Medical Research Council London UK and Keneba Gambia (PI A
Prentice)
The three proposals were reviewed at a WHO Technical Consultation on Vitamin A in Newborn Health - Mechanistic Studies in
December 2009 Final proposals were approved by the WHO Ethics Review Committee (ERC) and the studies are now in progress
NUTRITION IMPACT MODEL-STUDY (NIMS)
This study is funded by a grant from The Bill amp Melinda Gates Foundation to the Harvard School of Public Health and aims to
develop empirically parameterize apply and make publicly available a policy-relevant analytical tool for estimating the health
impacts of undernutrition exposures and interventions
Representatives of the Department of Nutrition for Health and Development work closely with partners to select appropriate
exposure metrics and develop and apply statistical methods for sparse time-space data in order to estimate current levels and past
trends of anaemia and vitamin A deficiency
6 RESEARCH
Micronutrients 2010-2011Department of Nutrition for Health and Development
13DRAFT
The Department of Nutrition for Health and Development works closely with internal collaborators at WHO and with various external
organizations on topics related to micronutrients
COCHRANE COLLABORATION
Over 28000 contributors worldwide work together to help health care providers policy-makers patients their advocates and
carers make well-informed decisions about health care based on the best available research evidence by preparing updating
and promoting the accessibility of Cochrane Reviews ndash over 4600 so far published online in The Cochrane Library In 2010 the
Cochrane Database of Systematic Reviews achieved a top-10 ISI Impact Factor for an outstanding achievement The work of the
Cochrane Collaboration is internationally recognised as the benchmark for high-quality information about the effectiveness of
health care In January 2011 The Cochrane Collaboration was accepted as a Non-Governmental Organization in Official Relations
with the World Health Organization (WHO) the public health arm of the United Nations establishing formalised communication
between our two organisations
This collaboration supports the development of the WHO Library of Evidence for Nutrition Actions (eLENA) and grants open access
to all Member States For the work in micronutrients we have closely collaborated with the following Cochrane groups
Cochrane Editorial Unit (wwweditorial-unitcochraneorg)
Developmental Psychosocial and Learning Problems Group (wwwdplpgcochraneorg)
Infectious Diseases Group (wwwcidgcochraneorgenindexhtml)
Pregnancy and Childbirth Group (wwwpregnancycochraneorg)
Public Health Group (wwwphcochraneorg)
Our Department has also supported the update or undertake of systematic reviews within the following groups
HIVAIDS Group (hivcochraneorg)
Metabolic and Endocrine Disorders Group (wwwendoccochraneorg)
Neonatal Group (wwwneonatalcochraneorg)
Iberoamerican Cochrane Center (wwwcochranees)
GRADE WORKING GROUP
The Grading of Recommendations Assessment Development and Evaluation (GRADE) Working Group began in the year 2000
as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health
care The working group has developed a common sensible and transparent approach to grading the quality of evidence
and the strength of recommendations Many international organizations have provided input into the development of the
approach and have started using it
A representative of our team joined the working group in 2010 to discuss issues related to the normative work in
micronutrients at WHO
CENTERs fOR DIsEAsE CONTROL AND PREVENTION (CDC)
The International Micronutrient Malnutrition Prevention and Control (IMMPaCt) programme works with global partners to
contribute CDC skills and resources to eliminate vitamin and mineral deficiencies (micronutrient malnutrition) among vulnerable
populations throughout the world Established by the CDC in 2000 IMMPaCt focuses primarily on helping eliminate deficiencies in
iron vitamin A iodine and folate
Through a 2009-2014 agreement IMMPaCt supports WHO in various selected projects including providing technical assistance
and subject matter expertise to help design implement and maintain new and current micronutrient databases as well as assist
with processes promoting new WHO guidelines and recommendations
The CDC Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects provides the scientific and programmatic
expertise to build upon and strengthen global neural tube defect surveillance systems and expand the reach of global folic acid
fortification for neural tube defect prevention Expansion of global folic acid fortification efforts can have a significant impact on
infant mortality and childhood morbidity worldwide
7 OUR PARTNERS
Micronutrients 2010-2011Department of Nutrition for Health and Development
14DRAFT
CDCrsquos National Center on Birth Defects and Developmental Disabilities has developed a global initiative to significantly reduce infant
mortality and childhood morbidity resulting from the more than 300000 neural tube defects worldwide each year and contribute
to the achievement of United Nations Millennium Development Goal 4 help to meet the Global Health Initiative Child Health Goal
and support the 63rd World Health Assembly Resolution on Birth Defects
The initiative aims to expand the number of developing countries with mandatory folic acid fortification of high penetrance staples
and provide sustainable support of long-term interventions to eliminate folic acid-preventable neural tube defects worldwide CDC
works with WHO and others to support and advance country-level fortification efforts and to provide needed technical expertise for
surveillance of neural tube defects monitor fortification efforts and improve laboratory capacity on folate-preventable birth defects
THE MICRONUTRIENT INITIATIVE
The Micronutrient Initiative (MI) is an independent not-for-profit organization committed to promoting simple cost-effective
solutions to hidden hunger combat vitamin and mineral deficiency and developing innovative new solutions where needed based in
Ottawa Canada MI is working to end hidden hunger end vitamin and mineral deficiency by helping governments food producers
and partner organizations like WHO develop implement and monitor and evaluate innovative culturally appropriate and cost-
effective programmes to get essential vitamins and minerals to the people who need them most by providing technical and
financial assistance offering procurement and quality control services for highly specialized supplies and equipment needed to
prevent hidden hunger advocating for micronutrient programmes and educating government bodies around the world on policies
legislation and programs to ensure the sustained delivery of essential vitamins and minerals
THE EUNICE KENNEDy sHRIVER NATIONAL INsTITUTE Of CHILD HEALTH AND HUMAN DEVELOPMENT
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health
(NIH)US Department of Health and Human Services in collaboration with partners representing the breadth of the global food and
nutrition enterprise including WHO created the Biomarkers of Nutrition for Development (BOND) Program to meet the growing
need for discovery development and implementation of reliable and valid biomarkers to assess nutrient exposure status function
and effect Also with co-funding from the Bill amp Melinda Gates Foundation has developed the Iron and Malaria Project to address
the safe and effective use of iron interventions in areas of malaria burden Both projects have been done with involvement of and
in support of WHO work in the area of micronutrients
WHO NUTRITION GUIDANCE ExPERT ADVIsORy GROUP MEMBERs
Micronutrients
Ms Deena AlasfoorProfessor Beverley-Ann BiggsDr Heacutector Bourges RodriacuteguezProfessor Norm CampbellProfessor Susan Fairweather-Tait Dr Rafael Flores-AyalaProfessor Malik GoonewardeneDr Junsheng HuoDr Janet C KingDr Marzia Lazzerini Professor Malcolm E Molyneux Eng Wisam QarqashDr Mahdi Ramsan Mohamed Dr Daniel RaitenDr Meera ShekarDr Rebecca Joyce StoltzfusMs Carol TomDr David Tovey Mrs Vilma Qahoush TylerDr Gunn Elisabeth VistDr Emorn Wasantwisut
Monitoring and Evaluation
Dr Lindsay AllenDr Deborah AshDr France BeginDr Zulfiqar BhuttaDr Christine Clewes Professor Susan Fairweather-TaitDr Jonathan GorsteinDr Junsheng HuoDr Ibrahim MD KhatibDr Roland KupkaDr Christine PfeifferDr Rob JPM ScholtenDr Holger SchuumlnemannDr Ismaeumll Ngnieacute TeacutetaDr Emorn Wasantwisut
Vitamin A supplementation
Professor Hany Abdel-AleemProfessor Michael ClarkeDr Anna CoutsoudisDr M Monir HossainDr Jean HumphreyDr Yustina Anie IndriastutiDr Marzia LazzeriniDr Pavitra MohanDr Rintaro MoriDr A Catherine RossDr Isabella Sagoe-MosesDr Claudia SaundersDr Prak SophonnearyDr Charles StephensenDr Sherry TanumihardjoDr Khalid Yunis
Micronutrients 2010-2011Department of Nutrition for Health and Development
15DRAFT
INTERNsHIPs
WHO is committed to building future leaders in public health and WHOrsquos Internship Programme provides a wide range of
opportunities for graduate and post-graduate students to gain insight into the work of WHO Although WHO receives a large
number of intern applications each year only a limited number of places for internships are available Internships are available for
work in micronutrients at WHO for a minimum of 6 weeks and a maximum of 3 months to allow the internship to be both worthwhile
and effective The following selected interns were hosted by NHD during the biennium 2010-2011 to work on topics related to
micronutrients
Ms Alison Sylvetsky 7 June - 13 August 2010 - EMORY UNIVERSITY ATLANTA USA
Ms Aida Victoria Campos 1 March - 31 May 2010 - UNIVERSIDAD LA SALLE MExICO DF MExICO
Mrs Sarah Pedersen 14 June - 13 August 2010- CORNELL UNIVERSITY ITHACA NEW YORK USA
Mr Joseph Ashong1 March 2011 - 1 July 2011 - CORNELL UNIVERSITY ITHACA NEW YORK USA
Dr Saint-Rayn Pasricha 14 February 2011 - 17 June 2011 - UNIVERSITY OF MELBOURNE VICTORIA AUSTRALIA
Ms Ellie Souganidis 20 June 2011 - 12 August 2011 - JOHNS HOPKINS UNIVERSITY BALTIMORE MARYLAND USA
Mr Raheel Arif 15 August - 4 November 2011- UNIVERSITY OF THE SCIENCES PHILADELPHIA PENNSYLVANIA USA
ADVOCACy AND NETWORKs
Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource
allocation decisions within political economic and social systems and institutions Advocacy in WHO for vitamin and mineral
nutrition includes many activities such as media campaigns public speaking commissioning and publishing research as well as
participation in several groups and networks
Home Fortification Technical Advisory Group (HFTAG) (httpwwwgainhealthorghftag)
The Network For Sustained Elimination of Iodine Deficiency (httpwwwiodinenetworknet)
International Council for the Control of Iodine Deficiency Disorders (wwwicciddorg)
Rice Fortification Technical Group (httpwwwgainhealthorgriforg)
Global Alliance for Vitamin A (GAVA)
Flour Fortification Initiative (httpwwwsphemoryeduwheatflour)
International Zinc Nutrition Consultative Group (wwwizincgorg)
United Nations World Food Programme (httpwwwwfporg)
United Nations Childrenrsquos Fund (httpwwwuniceforg)
United Nations High Commissioner for Refugees (httpwwwunhcrorg)
Food and Agriculture Organization of the United Nations (httpwwwfaoorg)
The World Bank (httpwwwworldbankorg)
United Nations Standing Committee on Nutrition (httpwwwunscnorg)
Micronutrients 2010-2011Department of Nutrition for Health and Development
16DRAFT
WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients
during the biennium 2010-2011
US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms
project name Global prevention of non-communicable disease prevention and promotion of health
The Micronutrient Initiative (MI) wwwmicronutrientorg
project name e-Library of nutrition programme guidance
The Government of Luxembourghttpwwwetatlu
project name Support for the update and dissemination of evidence-based nutrition programme
The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg
project name Efficacy of newborn vitamin A supplementation in improving child survival
WHO also thanks the following organizations for their support through small grants
US Agency for International Development (USAID) httpwwwusaidgov
project name Update WHO evidence based position statements on relevant and priority micronutrient interventions
The Global Alliance for Improved Nutrition (GAIN)
httpwwwgainhealthorg
project name Systematic review of evidence of micronutrient interventions and management of moderate
malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification
project name Systematic review of evidence of rice fortification as a public health intervention and consultation on
rice fortification programs implementation
Harvard University
project name Nutrition impact model study (NIM Study)
Sight amp Life
httpwwwsightandlifeorg
project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System
MEMBERsHIPs
De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013
Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014
Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011
De-Regil LM GRADE working group 2010-present
WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs
Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for
Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2
February 2010 Geneva Switzerland
8 FINANCIAL SUPPORT
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
13DRAFT
The Department of Nutrition for Health and Development works closely with internal collaborators at WHO and with various external
organizations on topics related to micronutrients
COCHRANE COLLABORATION
Over 28000 contributors worldwide work together to help health care providers policy-makers patients their advocates and
carers make well-informed decisions about health care based on the best available research evidence by preparing updating
and promoting the accessibility of Cochrane Reviews ndash over 4600 so far published online in The Cochrane Library In 2010 the
Cochrane Database of Systematic Reviews achieved a top-10 ISI Impact Factor for an outstanding achievement The work of the
Cochrane Collaboration is internationally recognised as the benchmark for high-quality information about the effectiveness of
health care In January 2011 The Cochrane Collaboration was accepted as a Non-Governmental Organization in Official Relations
with the World Health Organization (WHO) the public health arm of the United Nations establishing formalised communication
between our two organisations
This collaboration supports the development of the WHO Library of Evidence for Nutrition Actions (eLENA) and grants open access
to all Member States For the work in micronutrients we have closely collaborated with the following Cochrane groups
Cochrane Editorial Unit (wwweditorial-unitcochraneorg)
Developmental Psychosocial and Learning Problems Group (wwwdplpgcochraneorg)
Infectious Diseases Group (wwwcidgcochraneorgenindexhtml)
Pregnancy and Childbirth Group (wwwpregnancycochraneorg)
Public Health Group (wwwphcochraneorg)
Our Department has also supported the update or undertake of systematic reviews within the following groups
HIVAIDS Group (hivcochraneorg)
Metabolic and Endocrine Disorders Group (wwwendoccochraneorg)
Neonatal Group (wwwneonatalcochraneorg)
Iberoamerican Cochrane Center (wwwcochranees)
GRADE WORKING GROUP
The Grading of Recommendations Assessment Development and Evaluation (GRADE) Working Group began in the year 2000
as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health
care The working group has developed a common sensible and transparent approach to grading the quality of evidence
and the strength of recommendations Many international organizations have provided input into the development of the
approach and have started using it
A representative of our team joined the working group in 2010 to discuss issues related to the normative work in
micronutrients at WHO
CENTERs fOR DIsEAsE CONTROL AND PREVENTION (CDC)
The International Micronutrient Malnutrition Prevention and Control (IMMPaCt) programme works with global partners to
contribute CDC skills and resources to eliminate vitamin and mineral deficiencies (micronutrient malnutrition) among vulnerable
populations throughout the world Established by the CDC in 2000 IMMPaCt focuses primarily on helping eliminate deficiencies in
iron vitamin A iodine and folate
Through a 2009-2014 agreement IMMPaCt supports WHO in various selected projects including providing technical assistance
and subject matter expertise to help design implement and maintain new and current micronutrient databases as well as assist
with processes promoting new WHO guidelines and recommendations
The CDC Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects provides the scientific and programmatic
expertise to build upon and strengthen global neural tube defect surveillance systems and expand the reach of global folic acid
fortification for neural tube defect prevention Expansion of global folic acid fortification efforts can have a significant impact on
infant mortality and childhood morbidity worldwide
7 OUR PARTNERS
Micronutrients 2010-2011Department of Nutrition for Health and Development
14DRAFT
CDCrsquos National Center on Birth Defects and Developmental Disabilities has developed a global initiative to significantly reduce infant
mortality and childhood morbidity resulting from the more than 300000 neural tube defects worldwide each year and contribute
to the achievement of United Nations Millennium Development Goal 4 help to meet the Global Health Initiative Child Health Goal
and support the 63rd World Health Assembly Resolution on Birth Defects
The initiative aims to expand the number of developing countries with mandatory folic acid fortification of high penetrance staples
and provide sustainable support of long-term interventions to eliminate folic acid-preventable neural tube defects worldwide CDC
works with WHO and others to support and advance country-level fortification efforts and to provide needed technical expertise for
surveillance of neural tube defects monitor fortification efforts and improve laboratory capacity on folate-preventable birth defects
THE MICRONUTRIENT INITIATIVE
The Micronutrient Initiative (MI) is an independent not-for-profit organization committed to promoting simple cost-effective
solutions to hidden hunger combat vitamin and mineral deficiency and developing innovative new solutions where needed based in
Ottawa Canada MI is working to end hidden hunger end vitamin and mineral deficiency by helping governments food producers
and partner organizations like WHO develop implement and monitor and evaluate innovative culturally appropriate and cost-
effective programmes to get essential vitamins and minerals to the people who need them most by providing technical and
financial assistance offering procurement and quality control services for highly specialized supplies and equipment needed to
prevent hidden hunger advocating for micronutrient programmes and educating government bodies around the world on policies
legislation and programs to ensure the sustained delivery of essential vitamins and minerals
THE EUNICE KENNEDy sHRIVER NATIONAL INsTITUTE Of CHILD HEALTH AND HUMAN DEVELOPMENT
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health
(NIH)US Department of Health and Human Services in collaboration with partners representing the breadth of the global food and
nutrition enterprise including WHO created the Biomarkers of Nutrition for Development (BOND) Program to meet the growing
need for discovery development and implementation of reliable and valid biomarkers to assess nutrient exposure status function
and effect Also with co-funding from the Bill amp Melinda Gates Foundation has developed the Iron and Malaria Project to address
the safe and effective use of iron interventions in areas of malaria burden Both projects have been done with involvement of and
in support of WHO work in the area of micronutrients
WHO NUTRITION GUIDANCE ExPERT ADVIsORy GROUP MEMBERs
Micronutrients
Ms Deena AlasfoorProfessor Beverley-Ann BiggsDr Heacutector Bourges RodriacuteguezProfessor Norm CampbellProfessor Susan Fairweather-Tait Dr Rafael Flores-AyalaProfessor Malik GoonewardeneDr Junsheng HuoDr Janet C KingDr Marzia Lazzerini Professor Malcolm E Molyneux Eng Wisam QarqashDr Mahdi Ramsan Mohamed Dr Daniel RaitenDr Meera ShekarDr Rebecca Joyce StoltzfusMs Carol TomDr David Tovey Mrs Vilma Qahoush TylerDr Gunn Elisabeth VistDr Emorn Wasantwisut
Monitoring and Evaluation
Dr Lindsay AllenDr Deborah AshDr France BeginDr Zulfiqar BhuttaDr Christine Clewes Professor Susan Fairweather-TaitDr Jonathan GorsteinDr Junsheng HuoDr Ibrahim MD KhatibDr Roland KupkaDr Christine PfeifferDr Rob JPM ScholtenDr Holger SchuumlnemannDr Ismaeumll Ngnieacute TeacutetaDr Emorn Wasantwisut
Vitamin A supplementation
Professor Hany Abdel-AleemProfessor Michael ClarkeDr Anna CoutsoudisDr M Monir HossainDr Jean HumphreyDr Yustina Anie IndriastutiDr Marzia LazzeriniDr Pavitra MohanDr Rintaro MoriDr A Catherine RossDr Isabella Sagoe-MosesDr Claudia SaundersDr Prak SophonnearyDr Charles StephensenDr Sherry TanumihardjoDr Khalid Yunis
Micronutrients 2010-2011Department of Nutrition for Health and Development
15DRAFT
INTERNsHIPs
WHO is committed to building future leaders in public health and WHOrsquos Internship Programme provides a wide range of
opportunities for graduate and post-graduate students to gain insight into the work of WHO Although WHO receives a large
number of intern applications each year only a limited number of places for internships are available Internships are available for
work in micronutrients at WHO for a minimum of 6 weeks and a maximum of 3 months to allow the internship to be both worthwhile
and effective The following selected interns were hosted by NHD during the biennium 2010-2011 to work on topics related to
micronutrients
Ms Alison Sylvetsky 7 June - 13 August 2010 - EMORY UNIVERSITY ATLANTA USA
Ms Aida Victoria Campos 1 March - 31 May 2010 - UNIVERSIDAD LA SALLE MExICO DF MExICO
Mrs Sarah Pedersen 14 June - 13 August 2010- CORNELL UNIVERSITY ITHACA NEW YORK USA
Mr Joseph Ashong1 March 2011 - 1 July 2011 - CORNELL UNIVERSITY ITHACA NEW YORK USA
Dr Saint-Rayn Pasricha 14 February 2011 - 17 June 2011 - UNIVERSITY OF MELBOURNE VICTORIA AUSTRALIA
Ms Ellie Souganidis 20 June 2011 - 12 August 2011 - JOHNS HOPKINS UNIVERSITY BALTIMORE MARYLAND USA
Mr Raheel Arif 15 August - 4 November 2011- UNIVERSITY OF THE SCIENCES PHILADELPHIA PENNSYLVANIA USA
ADVOCACy AND NETWORKs
Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource
allocation decisions within political economic and social systems and institutions Advocacy in WHO for vitamin and mineral
nutrition includes many activities such as media campaigns public speaking commissioning and publishing research as well as
participation in several groups and networks
Home Fortification Technical Advisory Group (HFTAG) (httpwwwgainhealthorghftag)
The Network For Sustained Elimination of Iodine Deficiency (httpwwwiodinenetworknet)
International Council for the Control of Iodine Deficiency Disorders (wwwicciddorg)
Rice Fortification Technical Group (httpwwwgainhealthorgriforg)
Global Alliance for Vitamin A (GAVA)
Flour Fortification Initiative (httpwwwsphemoryeduwheatflour)
International Zinc Nutrition Consultative Group (wwwizincgorg)
United Nations World Food Programme (httpwwwwfporg)
United Nations Childrenrsquos Fund (httpwwwuniceforg)
United Nations High Commissioner for Refugees (httpwwwunhcrorg)
Food and Agriculture Organization of the United Nations (httpwwwfaoorg)
The World Bank (httpwwwworldbankorg)
United Nations Standing Committee on Nutrition (httpwwwunscnorg)
Micronutrients 2010-2011Department of Nutrition for Health and Development
16DRAFT
WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients
during the biennium 2010-2011
US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms
project name Global prevention of non-communicable disease prevention and promotion of health
The Micronutrient Initiative (MI) wwwmicronutrientorg
project name e-Library of nutrition programme guidance
The Government of Luxembourghttpwwwetatlu
project name Support for the update and dissemination of evidence-based nutrition programme
The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg
project name Efficacy of newborn vitamin A supplementation in improving child survival
WHO also thanks the following organizations for their support through small grants
US Agency for International Development (USAID) httpwwwusaidgov
project name Update WHO evidence based position statements on relevant and priority micronutrient interventions
The Global Alliance for Improved Nutrition (GAIN)
httpwwwgainhealthorg
project name Systematic review of evidence of micronutrient interventions and management of moderate
malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification
project name Systematic review of evidence of rice fortification as a public health intervention and consultation on
rice fortification programs implementation
Harvard University
project name Nutrition impact model study (NIM Study)
Sight amp Life
httpwwwsightandlifeorg
project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System
MEMBERsHIPs
De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013
Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014
Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011
De-Regil LM GRADE working group 2010-present
WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs
Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for
Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2
February 2010 Geneva Switzerland
8 FINANCIAL SUPPORT
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
14DRAFT
CDCrsquos National Center on Birth Defects and Developmental Disabilities has developed a global initiative to significantly reduce infant
mortality and childhood morbidity resulting from the more than 300000 neural tube defects worldwide each year and contribute
to the achievement of United Nations Millennium Development Goal 4 help to meet the Global Health Initiative Child Health Goal
and support the 63rd World Health Assembly Resolution on Birth Defects
The initiative aims to expand the number of developing countries with mandatory folic acid fortification of high penetrance staples
and provide sustainable support of long-term interventions to eliminate folic acid-preventable neural tube defects worldwide CDC
works with WHO and others to support and advance country-level fortification efforts and to provide needed technical expertise for
surveillance of neural tube defects monitor fortification efforts and improve laboratory capacity on folate-preventable birth defects
THE MICRONUTRIENT INITIATIVE
The Micronutrient Initiative (MI) is an independent not-for-profit organization committed to promoting simple cost-effective
solutions to hidden hunger combat vitamin and mineral deficiency and developing innovative new solutions where needed based in
Ottawa Canada MI is working to end hidden hunger end vitamin and mineral deficiency by helping governments food producers
and partner organizations like WHO develop implement and monitor and evaluate innovative culturally appropriate and cost-
effective programmes to get essential vitamins and minerals to the people who need them most by providing technical and
financial assistance offering procurement and quality control services for highly specialized supplies and equipment needed to
prevent hidden hunger advocating for micronutrient programmes and educating government bodies around the world on policies
legislation and programs to ensure the sustained delivery of essential vitamins and minerals
THE EUNICE KENNEDy sHRIVER NATIONAL INsTITUTE Of CHILD HEALTH AND HUMAN DEVELOPMENT
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health
(NIH)US Department of Health and Human Services in collaboration with partners representing the breadth of the global food and
nutrition enterprise including WHO created the Biomarkers of Nutrition for Development (BOND) Program to meet the growing
need for discovery development and implementation of reliable and valid biomarkers to assess nutrient exposure status function
and effect Also with co-funding from the Bill amp Melinda Gates Foundation has developed the Iron and Malaria Project to address
the safe and effective use of iron interventions in areas of malaria burden Both projects have been done with involvement of and
in support of WHO work in the area of micronutrients
WHO NUTRITION GUIDANCE ExPERT ADVIsORy GROUP MEMBERs
Micronutrients
Ms Deena AlasfoorProfessor Beverley-Ann BiggsDr Heacutector Bourges RodriacuteguezProfessor Norm CampbellProfessor Susan Fairweather-Tait Dr Rafael Flores-AyalaProfessor Malik GoonewardeneDr Junsheng HuoDr Janet C KingDr Marzia Lazzerini Professor Malcolm E Molyneux Eng Wisam QarqashDr Mahdi Ramsan Mohamed Dr Daniel RaitenDr Meera ShekarDr Rebecca Joyce StoltzfusMs Carol TomDr David Tovey Mrs Vilma Qahoush TylerDr Gunn Elisabeth VistDr Emorn Wasantwisut
Monitoring and Evaluation
Dr Lindsay AllenDr Deborah AshDr France BeginDr Zulfiqar BhuttaDr Christine Clewes Professor Susan Fairweather-TaitDr Jonathan GorsteinDr Junsheng HuoDr Ibrahim MD KhatibDr Roland KupkaDr Christine PfeifferDr Rob JPM ScholtenDr Holger SchuumlnemannDr Ismaeumll Ngnieacute TeacutetaDr Emorn Wasantwisut
Vitamin A supplementation
Professor Hany Abdel-AleemProfessor Michael ClarkeDr Anna CoutsoudisDr M Monir HossainDr Jean HumphreyDr Yustina Anie IndriastutiDr Marzia LazzeriniDr Pavitra MohanDr Rintaro MoriDr A Catherine RossDr Isabella Sagoe-MosesDr Claudia SaundersDr Prak SophonnearyDr Charles StephensenDr Sherry TanumihardjoDr Khalid Yunis
Micronutrients 2010-2011Department of Nutrition for Health and Development
15DRAFT
INTERNsHIPs
WHO is committed to building future leaders in public health and WHOrsquos Internship Programme provides a wide range of
opportunities for graduate and post-graduate students to gain insight into the work of WHO Although WHO receives a large
number of intern applications each year only a limited number of places for internships are available Internships are available for
work in micronutrients at WHO for a minimum of 6 weeks and a maximum of 3 months to allow the internship to be both worthwhile
and effective The following selected interns were hosted by NHD during the biennium 2010-2011 to work on topics related to
micronutrients
Ms Alison Sylvetsky 7 June - 13 August 2010 - EMORY UNIVERSITY ATLANTA USA
Ms Aida Victoria Campos 1 March - 31 May 2010 - UNIVERSIDAD LA SALLE MExICO DF MExICO
Mrs Sarah Pedersen 14 June - 13 August 2010- CORNELL UNIVERSITY ITHACA NEW YORK USA
Mr Joseph Ashong1 March 2011 - 1 July 2011 - CORNELL UNIVERSITY ITHACA NEW YORK USA
Dr Saint-Rayn Pasricha 14 February 2011 - 17 June 2011 - UNIVERSITY OF MELBOURNE VICTORIA AUSTRALIA
Ms Ellie Souganidis 20 June 2011 - 12 August 2011 - JOHNS HOPKINS UNIVERSITY BALTIMORE MARYLAND USA
Mr Raheel Arif 15 August - 4 November 2011- UNIVERSITY OF THE SCIENCES PHILADELPHIA PENNSYLVANIA USA
ADVOCACy AND NETWORKs
Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource
allocation decisions within political economic and social systems and institutions Advocacy in WHO for vitamin and mineral
nutrition includes many activities such as media campaigns public speaking commissioning and publishing research as well as
participation in several groups and networks
Home Fortification Technical Advisory Group (HFTAG) (httpwwwgainhealthorghftag)
The Network For Sustained Elimination of Iodine Deficiency (httpwwwiodinenetworknet)
International Council for the Control of Iodine Deficiency Disorders (wwwicciddorg)
Rice Fortification Technical Group (httpwwwgainhealthorgriforg)
Global Alliance for Vitamin A (GAVA)
Flour Fortification Initiative (httpwwwsphemoryeduwheatflour)
International Zinc Nutrition Consultative Group (wwwizincgorg)
United Nations World Food Programme (httpwwwwfporg)
United Nations Childrenrsquos Fund (httpwwwuniceforg)
United Nations High Commissioner for Refugees (httpwwwunhcrorg)
Food and Agriculture Organization of the United Nations (httpwwwfaoorg)
The World Bank (httpwwwworldbankorg)
United Nations Standing Committee on Nutrition (httpwwwunscnorg)
Micronutrients 2010-2011Department of Nutrition for Health and Development
16DRAFT
WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients
during the biennium 2010-2011
US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms
project name Global prevention of non-communicable disease prevention and promotion of health
The Micronutrient Initiative (MI) wwwmicronutrientorg
project name e-Library of nutrition programme guidance
The Government of Luxembourghttpwwwetatlu
project name Support for the update and dissemination of evidence-based nutrition programme
The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg
project name Efficacy of newborn vitamin A supplementation in improving child survival
WHO also thanks the following organizations for their support through small grants
US Agency for International Development (USAID) httpwwwusaidgov
project name Update WHO evidence based position statements on relevant and priority micronutrient interventions
The Global Alliance for Improved Nutrition (GAIN)
httpwwwgainhealthorg
project name Systematic review of evidence of micronutrient interventions and management of moderate
malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification
project name Systematic review of evidence of rice fortification as a public health intervention and consultation on
rice fortification programs implementation
Harvard University
project name Nutrition impact model study (NIM Study)
Sight amp Life
httpwwwsightandlifeorg
project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System
MEMBERsHIPs
De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013
Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014
Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011
De-Regil LM GRADE working group 2010-present
WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs
Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for
Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2
February 2010 Geneva Switzerland
8 FINANCIAL SUPPORT
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
15DRAFT
INTERNsHIPs
WHO is committed to building future leaders in public health and WHOrsquos Internship Programme provides a wide range of
opportunities for graduate and post-graduate students to gain insight into the work of WHO Although WHO receives a large
number of intern applications each year only a limited number of places for internships are available Internships are available for
work in micronutrients at WHO for a minimum of 6 weeks and a maximum of 3 months to allow the internship to be both worthwhile
and effective The following selected interns were hosted by NHD during the biennium 2010-2011 to work on topics related to
micronutrients
Ms Alison Sylvetsky 7 June - 13 August 2010 - EMORY UNIVERSITY ATLANTA USA
Ms Aida Victoria Campos 1 March - 31 May 2010 - UNIVERSIDAD LA SALLE MExICO DF MExICO
Mrs Sarah Pedersen 14 June - 13 August 2010- CORNELL UNIVERSITY ITHACA NEW YORK USA
Mr Joseph Ashong1 March 2011 - 1 July 2011 - CORNELL UNIVERSITY ITHACA NEW YORK USA
Dr Saint-Rayn Pasricha 14 February 2011 - 17 June 2011 - UNIVERSITY OF MELBOURNE VICTORIA AUSTRALIA
Ms Ellie Souganidis 20 June 2011 - 12 August 2011 - JOHNS HOPKINS UNIVERSITY BALTIMORE MARYLAND USA
Mr Raheel Arif 15 August - 4 November 2011- UNIVERSITY OF THE SCIENCES PHILADELPHIA PENNSYLVANIA USA
ADVOCACy AND NETWORKs
Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource
allocation decisions within political economic and social systems and institutions Advocacy in WHO for vitamin and mineral
nutrition includes many activities such as media campaigns public speaking commissioning and publishing research as well as
participation in several groups and networks
Home Fortification Technical Advisory Group (HFTAG) (httpwwwgainhealthorghftag)
The Network For Sustained Elimination of Iodine Deficiency (httpwwwiodinenetworknet)
International Council for the Control of Iodine Deficiency Disorders (wwwicciddorg)
Rice Fortification Technical Group (httpwwwgainhealthorgriforg)
Global Alliance for Vitamin A (GAVA)
Flour Fortification Initiative (httpwwwsphemoryeduwheatflour)
International Zinc Nutrition Consultative Group (wwwizincgorg)
United Nations World Food Programme (httpwwwwfporg)
United Nations Childrenrsquos Fund (httpwwwuniceforg)
United Nations High Commissioner for Refugees (httpwwwunhcrorg)
Food and Agriculture Organization of the United Nations (httpwwwfaoorg)
The World Bank (httpwwwworldbankorg)
United Nations Standing Committee on Nutrition (httpwwwunscnorg)
Micronutrients 2010-2011Department of Nutrition for Health and Development
16DRAFT
WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients
during the biennium 2010-2011
US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms
project name Global prevention of non-communicable disease prevention and promotion of health
The Micronutrient Initiative (MI) wwwmicronutrientorg
project name e-Library of nutrition programme guidance
The Government of Luxembourghttpwwwetatlu
project name Support for the update and dissemination of evidence-based nutrition programme
The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg
project name Efficacy of newborn vitamin A supplementation in improving child survival
WHO also thanks the following organizations for their support through small grants
US Agency for International Development (USAID) httpwwwusaidgov
project name Update WHO evidence based position statements on relevant and priority micronutrient interventions
The Global Alliance for Improved Nutrition (GAIN)
httpwwwgainhealthorg
project name Systematic review of evidence of micronutrient interventions and management of moderate
malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification
project name Systematic review of evidence of rice fortification as a public health intervention and consultation on
rice fortification programs implementation
Harvard University
project name Nutrition impact model study (NIM Study)
Sight amp Life
httpwwwsightandlifeorg
project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System
MEMBERsHIPs
De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013
Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014
Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011
De-Regil LM GRADE working group 2010-present
WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs
Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for
Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2
February 2010 Geneva Switzerland
8 FINANCIAL SUPPORT
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
16DRAFT
WHO thanks the following organizations for their continued long term financial support for activities in the work plan for micronutrients
during the biennium 2010-2011
US Centers for Disease Control and Prevention (CDC) httpwwwcdcgovglobalhealthprograms
project name Global prevention of non-communicable disease prevention and promotion of health
The Micronutrient Initiative (MI) wwwmicronutrientorg
project name e-Library of nutrition programme guidance
The Government of Luxembourghttpwwwetatlu
project name Support for the update and dissemination of evidence-based nutrition programme
The Bill amp Melinda Gates Foundationhttpwwwgatesfoundationorg
project name Efficacy of newborn vitamin A supplementation in improving child survival
WHO also thanks the following organizations for their support through small grants
US Agency for International Development (USAID) httpwwwusaidgov
project name Update WHO evidence based position statements on relevant and priority micronutrient interventions
The Global Alliance for Improved Nutrition (GAIN)
httpwwwgainhealthorg
project name Systematic review of evidence of micronutrient interventions and management of moderate
malnutrition in vulnerable populations as well as dissemination of some existing WHO guidelines on fortification
project name Systematic review of evidence of rice fortification as a public health intervention and consultation on
rice fortification programs implementation
Harvard University
project name Nutrition impact model study (NIM Study)
Sight amp Life
httpwwwsightandlifeorg
project name Maintenance and dissemination platform of the Vitamin and Mineral Nutrition Information System
MEMBERsHIPs
De-Regil LM WHO Ethics and Review Committee (appointed by the Director General) 2010-2013
Pena-Rosas JP WHO Guidelines Review Committee (appointed by the Director General) 2010-2014
Pena-Rosas JP WHO Bulletin Editorial Board member 2010-2011
De-Regil LM GRADE working group 2010-present
WHO NUTRITION sEMINARs sERIEs ndash MICRONUTRIENTs
Effectiveness of two prenatal vitamin A distribution systems for night blind Nepali women Dr Douglas Taren Associate Dean for
Academic Affairs and Professor of Public Health Mel and Enid Zuckerman College of Public Health University of Arizona USA 2
February 2010 Geneva Switzerland
8 FINANCIAL SUPPORT
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
17DRAFT
Development of Nutrient Reference Values The USCanadian Dietary Reference Intake Process - Merits and Limitations Dr Janet C
King Senior Scientist Childrenrsquos Hospital Oakland Research Institute Oakland CA USA 26 February 2010 Geneva Switzerland
Nutrition and Optimizing Development of Peak Bone Mass Dr Connie Weaver Department Head Foods and Nutrition Purdue
University West Lafayette IN USA 4 June 2010 Geneva Switzerland
Vitamin D in Health and Disease Dr Cristina Palacios Alzuru Coordinator and Assistant Professor Nutrition Program Graduate
School of Public Health Medical Sciences Campus University of Puerto Rico 30 August 2010 Geneva Switzerland
Rice Fortification Dr Glen Maberly Director Global Health Institute Centre for Health Innovation and Partnership Sydney West
Area Health Service (SWAHS) NSW Australia 8 September 2010 Geneva Switzerland
An industry perspective on solving vitamin D deficiency globally Dr Michael McBurney Head of Scientific Affairs DSM Nutritional
Products LLC 13 July 2011 Geneva Switzerland
Health communication social marketing and advocacy whatrsquos the difference Dr Claudia Parvanta Professor of Anthropology
University of the Sciences Philadelphia PA USA 29 July 2011 Geneva Switzerland
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121
Micronutrients 2010-2011Department of Nutrition for Health and Development
18DRAFT
A ATLANTA january amp december 2010
WASHINGTON DC november 2011
AMMAN november 2010 PANAMA september 2010
GENEVA february 2010
1 WHO MEETINGS9
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Monitoring and
Evaluation Subgroup on guidelines for the assessment of vitamin A and iron status in populations Panama City
Panama15-17 September 2010Nutririon Guidance Expert Advisory Group Meet
WHOCDC consultation on the indicator inventory and its webtool Global Health Institute Emory University Atlanta USA 6-7 January 2010WHOCDC technical consultation on WHO estimates of vitamin and mineral deficiencies methodological approaches to calculate global and regional prevalence and address uncertainty of the estimates Centers for Disease Control and Prevention Atlanta USA 7-9 December 2010
WHOCDC global nutrition strategic planning 2010-2011 Global prevention of noncommunicable disease and promotion of health project WHO Geneva Switzerland 15-16 February 2010
Meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 22-25 February 2010
Fourth meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Region of the AmericasPan
American Health Organization (PAHO) Washington DC USA 7-9 November 2011
GENEVA march amp february 2011Third meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Geneva Switzerland 14-16 March 2011 Second WHOUNICEF technical guideline group consultation effects and safety of vitamin A supplementation in populations WHO Geneva Switzerland 16-18 March 2011Data Safety and Monitoring Board meeting Trials on the efficacy of newborn vitamin A supplementation in improving immune function WHO Geneva Switzerland 21 February 2011
Second meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Micronutrients Subgroup WHO Regional Office for the Eastern Mediterranean Amman Jordan 15-18 November 2010
GENEVA october 2011Training workshop on surveillance and prevention of birth defects and preterm births In partnership with WHO Departments of Reproductive Health and Research the International Clearinghouse of Birth Defects Surveillance and Research and Centers for Disease Control and Prevention (CDC) WHO Geneva Switzerland 3-5 October 2011
WHONMHNHDEPG121