FFI Newsletter: September 2016
Ravi Patel, Assistant Professor of Pediatrics, Division of Neonatology, Emory University’s School of Medicine in Atlanta, Georgia, USA. Photo: Jack Hearse/Emory University
Adding Infants to the Faces of Anemia
Fortification recommended among interventions to prevent anemia and low-birth-weight infants
In 2015 we conducted a “Faces of Anemia” campaign to call attention to an often hidden and forgotten health problem – iron deficiency anemia. Women shared experiences of debilitating fatigue and fearful episodes during pregnancy related to anemia. This story adds the voice of infants with anemia to that collection. What are the signs of anemia in a newborn? Mild stages of newborn anemia rarely show any signs. As anemia becomes more severe, the infant becomes pale, has difficulty breathing, and has an increased heart rate, said Ravi Patel, Assistant Professor of Pediatrics, Division of Neonatology, at Emory University’s School of Medicine. In extreme cases, anemia can lead to dangerously low amounts of oxygen delivered to vital organs that can lead to cardiovascular collapse and potentially even death. Some of the common causes of infant anemia, Patel said, are “being born prematurely, blood loss from laboratory testing or surgery, iron deficiency, a decreased ability to make new red blood cells or a breakdown of red blood cells due to a blood type incompatibility between newborn and mother.”
The usual treatment for an infant with a low red blood cell count is a liquid iron supplement, Patel said. If the anemia is severe, a blood transfusion may be required to boost red blood cell counts.“The first time I walked into a neonatal intensive care unit during medical school, I was intrigued and a bit amazed by how small and fragile many of the newborns in the unit were,” Patel recalled. “I also saw an infant connected to a life-support machine, similar to a bypass machine, that was taking blood from the infant and adding oxygen and replacing it. I thought that was incredible. I pretty much decided to work in this field during my first month in the unit.”Although anemia in the mother is not necessarily correlated to an anemic newborn, some studies suggest that a woman’s iron status during pregnancy may be related to the infant’s iron status in the first year of life. Also, anemic women in low and middle-income countries have a significantly higher risk of having a low-birth-weight infant than non-anemic women.Low birth weight is considered less than 2500 grams or 5.5 pounds, according to the World Health Organization (WHO). Newborns that small are prone to death and diseases while they are young. If they survive, they are more at risk for poor mental development in childhood and chronic health problems such as diabetes and heart disease later in life.The consequences are so severe that WHO made a 30% reduction in low-birth-weight infants a nutrition target for 2025. WHO currently estimates that 15% to 20% of all births worldwide, representing 20 million infants a year, are low birth weight. In many countries however, infants are not weighed at birth so this figure is impossible to calculate precisely.
During pregnancy women need approximately twice as much iron as they needed before pregnancy, Patel said. This is largely due to the increase in red blood cells and blood volume needed to help support blood circulation through the placenta and growth and development of the fetus.While fortifying grain products will not provide all the increased nutrition that pregnant women need, it can help ensure that women are healthy before pregnancy. This equips them to better handle the additional physical demands of pregnancy.Two of the stories contributed to the Faces of Anemia campaign last year were from women who were iron deficient during pregnancy. “On a few occasions I found myself dizzy and on the verge of fainting. The scariest part was that each time I was alone, twice when I was behind the wheel of a car and another time in my backyard gardening when no one else was home,” remembers Danielle Suchdev. Judie McCliggott recalled being so exhausted that she fell asleep at her desk and missed teaching two classes on the first day of school at a community college. Both women were treated with iron supplements and delivered healthy children.“Increasing iron intake, either through iron-fortified foods or supplemental intake of iron, is the best preventative treatment for mothers to prevent anemia in themselves. For infants, delaying the clamping of the umbilical cord after birth for a minute or longer can provide the infant with additional blood from the placenta, and this has been shown to prevent anemia,” Patel said.
Save the Date for These Micronutrient Forum Events
The bi-annual Micronutrient Forum will be 24-28 October in Cancun, Mexico. The theme is “Positioning Women’s Nutrition at the Centre of Sustainable Development.” Several events are specifically related to food fortification. Mark these on your calendar, and we’ll see you there!
A New Repository for Food Fortification: Helping to Map and Track Global Efforts
Sunday, 23 October, 4 – 5:30 pm – Cancun Convention Center Room Cozumel 4
If you like the country profiles on our website, you’ll love the plans for a global repository of fortification data for multiple food vehicles. The symposium will summarize the progress being made and seek feedback on the repository design.Developing a global system to track progress of food fortification was a recommendation from the #FutureFortified Global Summit on Food Fortification in 2015. We have joined the Global Alliance for Improved Nutrition (GAIN), the Iodine Global Network (IGN), and the Micronutrient Forum to develop plans for a global reporting system. If you plan to attend this symposium, please e-mail Greg S. Garrett, Director of Food Fortification at GAIN at ggarrett@gainhealth.org.
Effectiveness of Large-Scale Fortification
Wednesday, 26 October, 10:30 am-12:00 pm
Topics in this session include:Systematic evidence review and program analysis of large-scale fortification efforts for improving health outcomes in low and middle income countriesEffectiveness of edible oil fortification in IndonesiaFolic acid fortification of wheat flour increases folate levels among women of reproductive age in TanzaniaLow anemia and iron deficiency among women and young children in GuatemalaChallenges of measuring biological impact in food fortification
What’s Stopping You? Addressing Barriers to Food Fortification Implementation Success
Friday, 28 October, 10:30 am – 12:00 pm – Cancun Convention Center
Speakers in this session will address these questions:What are the barriers to fortification implementation?Does providing free or subsidized fortificant facilitate sustainable fortification?How can you improve programmatic monitoring?How do you effectively collate, analyze, interpret and use monitoring data?How do you scale up food fortification?How do public and private sectors work together in food fortification?
Posters
Two posters are specific to grain fortification:
Tuesday and Wednesday, 25-26 October, 1-2 pm
Review of grain fortification legislation, standards, and monitoring documents from more than 50 countries.
Thursday and Friday, 27-28 October, 1-2 pm
Evaluation of the impact of the wheat flour fortification program in Colombia. It was done by examining the relationship between consumption of fortified wheat flour and two outcomes: iron deficiency and anemia prevalence.
FFI Booth
Tuesday - Friday, 25-28 October, 8:30 am - 7:00 pm
Want a fun photo for Facebook or Instagram or your screen saver? Come to the FFI booth, and we’ll take your photo as the face of “Más inteligente. Más fuerte. Más saludable.” (Smarter. Stronger. Healthier.) There is no charge for the photo; just come by our booth with your camera.
The example of the photos we will take at the FFI booth during the Micronutrient Forum includes, from left, Sarah Zimmerman, FFI Communications Coordinator, and Daisy Wang and Iju Shakya, Emory University graduate students and FFI Graduate Research Assistants.
Folic Acid in the News
Research continues to support adding folic acid to flour to prevent neural tube birth defects (NTDs) such as spina bifida and anencephaly. Here are a few highlights in case you missed the news.Last year an estimated 35,500 babies – an average of 97 a day – were born without NTDs in 58 countries which implement mandatory programs to fortify flour with folic acid, according to research published in Birth Defects Research Part A: Clinical and Molecular Teratology. The research also notes that this figure only represents 13.2% of all NTDs that could be prevented globally. See our press release.Australia saw an overall 14.4% decrease in NTDs following mandatory fortification of wheat flour with folic acid, according to a report from the Australian Institute of Health and Welfare. The NTD rate decreased by almost 55% among teenagers and by 74% among Aboriginal and Torres Strait Islander women.Canadian research found an 11% reduction in rates of congenital heart defects after flour there was fortified with folic acid. The beneficial effects were evident in some, but not all, types of congenital heart defects. The authors noted that the study is “modest evidence” for an additional benefit from fortifying with folic acid. The study was published in the American Heart Association’s journal Circulation.