Zinc and Folic Acid Deficiencies: Moving from Research to Action

Knowledge of the occurrence of zinc deficiency and its importance to human health has increased significantly in recent years. Available evidence indicates that zinc deficiency is an important cause of increased morbidity and mortality of children in under-privileged settings and a contributing factor to their impaired growth and development. Twenty percent of the world's population may be at risk of inadequate dietary intakes of zinc; and one third of the world's people live in countries currently classified as having a high risk of zinc deficiency. Despite this knowledge, public health and nutrition programs have been slow to initiate zinc-related interventions. Thus, additional concerted efforts are needed to disseminate information on the significance of zinc deficiency, the available methods to assess population zinc status and possible intervention strategies.

The recent MI -supported review of zinc deficiency and approaches to reducing it, bolstered by the attention that zinc supplementation has received from child survival advocates, provides a new opportunity for MI to advance programming at country level.

MI supported the International Zinc Consultative Group in preparing a global strategic plan outlining how governments with support from development agencies, NGOs and the private sector should begin to tackle the problem of zinc deficiency through supplementation for diarrhea treatment, preventive supplementation with zinc, and targeted as well as universal food fortification. The strategy proposes a five-year plan for incorporating zinc-related activities into ongoing or planned nutrition, health, and other intervention programs.

MI supports the addition of micronutrient premixes to foods served to children less than five years of age under India 's Integrated Child Development Scheme. MI has also been advocating for including zinc in fortification programs (e.g. Indonesia , South Africa ). However zinc is not yet widely accepted for fortification of cereal flours. Over the next five years, MI will mobilize resources, and promote and support specific advocacy and technical assistance interventions that will increase awareness of and commitment to the alleviation of zinc deficiency. Emphasis will be placed on the implementation of zinc supplementation for diarrhea treatment in up to 5 target countries. There is a scope for MI to help ensure that evidence of efficacy and effectiveness of zinc fortification of complementary foods is compiled in order to advance this as a viable approach to deficiency reduction.

Folate deficiency causes an estimated 200,000 severe birth defects each year that can be prevented by supplemental synthetic folic acid, preferably through fortification of staple foods. Folate deficiency is widespread globally. In addition to causing neural tube defects, it is suspected to increase the risk of cardiovascular disease. Fortification of grains—especially wheat and corn with folic acid is a cheap, sustainable means to eliminating folate deficiency. The low cost of the intervention and the severity of the diseases folic acid fortification can prevent are compelling reasons to increase the pace at which wheat and corn flours are fortified.

I encourages the addition of folic acid along with iron as a minimum package for fortification of cereal flours. Folic acid fortification of wheat flour, implemented to date by fewer than 40 countries has prevented only 10% of the estimated 200,000 annual cases of folic-acid preventable neural tube defects (NTD) estimated to occur worldwide. As evidence on the impact of folic acid on cardiovascular morbidity and mortality prevention becomes more available, the case for increased advocacy to build awareness and catalyze action will become stronger.