As part of the ongoing work on revising the 2004 Sphere project hand book, I have been asked to initiate an informal consultation and discussion. This has the aim of identifying any existing gaps in indicators or guidance notes relating to micronutrients. In particular, we are keen to obtain views on:
. the micronutrients currently included in the Appendix on Nutritional Requirement (Appendix 7, p189) and recommendations for which should be included in the 2010 edition
. the cut off points for classifying the public health significance of micronutrient malnutrition contained in Appendix 6 (p187), and the possible need for additional indicators
As a starting point for the discussion/consultation I would like to offer a draft proposal for amendment of the micronutrients contained in Appendix 7.
Appendix 7 currently includes 17 micronutrients and minerals:
Vitamin A
Vitamin D
Vitamin E
Vitamin K
Thiamine (B1)
Riboflavin (B2)
Niacin (B3)
Vitamin B12
Folic acid
Vitamin C
Iron
Iodine
Magnesium
Zinc
Selenium
Biotin
Pantothenate
An amended list is proposed (shown below) that also contains 17 micronutrients but is adjusted to take into account the contents of the UN Joint Statement on 'Preventing and controlling micronutrient deficiencies in populations affected by an emergency' (2007). In addition to the micronutrients included in the joint statement, Pantothenate and Calcium have been retained from the Sphere 2004 list due to evidence of their importance in calcium dependent rickets and a B vitamin deficiency syndrome reported in prisoners of war.
Please bear I mind that the objective here is not to compile a list of all the micronutrients required for human health, but rather to focus attention on those that the emergency nutrition community should currently be prioritising, based on the available evidence.
Vitamin A
Vitamin D
Vitamin E
Vitamin B1
Vitamin B2
Vitamin B3
Vitamin B6
Vitamin B12
Folate
Panthothenic Acid
Vitamin C
Iron
Iodine
Zinc
Calcium
Copper
Selenium
We invite comments and discussion on the above proposal as well as the indicators contained in Appendix 6 of the Sphere manual. Please post comments below.
I think that the list should not exclude Vitamin K - haemorrhagic disease of the newborn is very common and leads to cerebral palsy - this devastating condition is very common in my experience although do not know of any quantitative data. There are other causes - but in none of the countries using TBAs etc is Vitamin K routinely given to newborns or mums - breast milk vit K is likely to be low in many of these mothers and contribute to death and disability.
There are "forgotten" nutrients that are of primary imporance, particularly where there is stunting (type II nutrient deficiency) - these include K, Na, P, Mg - in particular Mg is likely to be critical in many situations. I can see no justification for removing it from the list. If you are including Ca (not a "micronutient" and more is needed than Mg for example) then you must also include Phosphorus! I do not think that pantothenate is as imporant as any of these nutrients and could be omitted. There are major gaps in food composition tables so that biotin and pantothenate are probably never going to be evaluated in rations or in children. The asseys for the other nutrients listed are very much easier.
Is there something Magic about keeping the number to 17? Why not include all those whose deficiency occurs and have major health effects - that would be much more rational.
Cheers Mike
Michael Golden
Answered:
14 years agoThanks to Mike and others who have responded to the consultation either here or directly by email. The first draft of the table of nutrients for Sphere 2010 has now been compiled and it will be going out for wider consultation as part of the Sphere process.
Andy Seal
Technical Expert
Answered:
14 years ago