Public health decisions are seldom straightforward. An example of the
complexities that may surface when a potentially beneficial intervention has
been identified, is the recent experience of attempts to introduce flour
fortification with folic acid in the UK.
From a purely biochemical and mechanistic viewpoint, normal growth and
development of the infant depends upon a program that is orchestrated by
the genome and initiated through transduction mechanisms by signals
originating outside the cell.
Iodine is a micronutrient present in minute amounts (15–20 mg) in the
human body, almost exclusively in the thyroid gland. Iodine is an essential
component of the thyroid hormones, thyroxine (T4) and triiodothyronine (T3),
comprising 65 and 59% of their respective weights.
Iron deficiency in its most severe form results in anemia (iron deficiency
anemia, IDA) and since anemia (Hb concentration or Hct below established
cutoff levels) is relatively easy to diagnose, the prevalence of anemia has often
been used as a proxy for IDA.
Typically nutritional rickets and osteomalacia are problems associated with
the extremes of life. In both groups they are the consequence of an inability
to obtain adequate exposure to ultraviolet radiation as a result of their
dependence on others to get out of doors into sunlight.
Based on a WHO Expert Consultation, the World Health Assembly
recommends that infants should be exclusively breast-fed for about the first
6 months of life . Additional foods or fluids are considered to be
contraindicated, except in rare cases.
Vitamin A is required for normal human growth and development, with
nuclear receptors for this nutritional ligand detectable in embryonic life.
Observational studies over the past 30 years document a strong association
between maternal anemia and birth outcomes such as low birth weight
(LBW), prematurity, infant anemia, and mortality for either mother or infant.
The importance of zinc as a nutrient essential for growth, tissue repair,
neural and cognitive development, development and functionality of the
immune system has been known for a long time .
Infectious diseases (respiratory and diarrheal) are among the leading
causes of death in children around the world. The immune system in children
is not developed and is different from that of adults.
The classical role of vitamin K is as an antihemorrhagic factor which
is needed for the synthesis in the liver of functional forms of prothrombin
(factor II) together with factors VII, IX and X [1, 2].
Strategies to lower the rates of low birth weight and perinatal and neonatal
mortality in the Third World have had limited success. In south Asia alone,
10–15% of infants are stillborn, die within 7 days of birth, or are born alive but
fail to survive beyond the 1st month of life.
There are a number of features specific to the infant born prematurely that
challenge the caregiver to achieve appropriate goals for growth, nutrient
accretion and mental and physiologic development.
Human immunodeficiency virus (HIV) infection is one of the major public
health challenges worldwide. According to most recent estimates,
approximately 40 million persons are HIV-infected, among them 2.7 million
children under 15 years of age .
Birth defects (the World Health Organization prefers the term congenital
anomalies) represent a particular category of pathological conditions. As
figure 1 shows births defects have a wide spectrum of developmental disturbances,
however, we are interested in structural birth defects, i.e. congenital
abnormalities (CAs), in this presentation.
Spectacular progress has been made in the last decades in the global fight
against deficiencies of iodine and vitamin A . As a result, the number of
people suffering from iodine deficiency has been reduced from about 1.5
billion in 1990 to about 0.5 billion now, almost entirely due to the introduction
in many countries of what has been termed ‘universal salt iodization’.
This brings our workshop to a close but we have hardly brought the
challenges facing us to a close: to understand the depths and breadth of
micronutrient nutrition as it effects infant health in the first 6 months of life.