Strategy to prevent micronutrient deficiency

Micronutrient deficiency, often termed "Hidden Hunger," compromises growth, development, and immunity even when energy intake is adequate. Preventing these deficiencies requires a multi-pronged strategy involving dietary diversification, supplementation, food fortification, and public health measures. The approach is often summarized as a combination of nutrition-specific and nutrition-sensitive interventions.

1. Dietary Strategies (Long-term Sustainable Solutions)

The most sustainable way to prevent micronutrient deficiency is to ensure the consumption of a balanced, diverse diet.

A. Dietary Diversification and the "Rainbow Revolution"

• Rainbow Revolution: This concept emphasizes the cultivation and consumption of colored vegetables and fruits to ensure adequate intake of micronutrients and antioxidants.
  • It promotes the intake of "GYOR" foods: Green, Yellow, Orange, and Red vegetables and fruits.
  • Colored plant foods are rich in beta-carotene (Vitamin A precursor), Vitamin C, and other antioxidants essential for preventing "hidden hunger".
• Animal Source Foods: Promoting the intake of milk, eggs, fish, and meat is crucial to prevent deficiencies of nutrients like Vitamin B12, Zinc, and high-quality protein, which are often lacking in cereal-based vegetarian diets.
• Kitchen Gardens: Encouraging household production of fruits and vegetables (e.g., papaya, drumstick, curry leaves) ensures a low-cost, continuous supply of protective foods.

B. Food Processing to Enhance Bioavailability

Simple household food processing techniques can significantly improve the bioavailability of micronutrients by reducing anti-nutrients (like phytates and oxalates) that inhibit absorption.

• Soaking: Soaking grains and discarding the water reduces phytates and tannins, improving mineral absorption.
• Germination (Sprouting):
  • Sprouting cereals and pulses increases Vitamin C and B-complex content.
  • It activates enzymes (amylases) that break down starch, reducing bulk and viscosity (Amylase Rich Food - ARF), which allows young children to eat more nutrient-dense food.
  • It reduces phytates, thereby enhancing iron and calcium absorption.
• Fermentation: Processes like making curd or idli batter enhance Vitamin C and B vitamins and improve digestibility.
• Parboiling: Parboiling rice helps retain B-complex vitamins that are otherwise lost during milling/polishing.

C. Infant and Young Child Feeding (IYCF) Practices

• Exclusive Breastfeeding: Breast milk is the complete food for the first 6 months. It provides highly bioavailable iron (due to lactoferrin) and protects against infections that deplete nutrient stores.
• Timely Complementary Feeding: Introducing complementary foods at 6 months is critical. Delayed introduction leads to growth faltering and depletion of iron and calcium stores.
• Dietary Diversity in Weaning: Complementary foods should not be just watery gruels. They must include:
  • Thick cereal pulses (for energy and protein).
  • Mashed vegetables and fruits (for vitamins).
  • Added fat (oil/ghee) to increase energy density and absorption of fat-soluble vitamins (A, D, E, K).

2. Nutrient Supplementation (Short-term/Targeted)

Medical supplementation is necessary for vulnerable groups where dietary intake is insufficient to meet high physiological needs.

A. Vitamin A Prophylaxis

• Schedule: A massive dose is administered to children from 9 months to 5 years of age.
  • 9 months: 100,000 IU (with Measles vaccine).
  • 16-18 months: 200,000 IU (with DPT booster).
  • Subsequent doses: 200,000 IU every 6 months until 5 years of age.
• Therapeutic: Additional doses are given during episodes of measles or severe malnutrition to prevent blindness and mortality.

B. Iron and Folic Acid (IFA) Supplementation

Under the Anemia Mukt Bharat (AMB) strategy, life-cycle-based supplementation is recommended to combat anemia:

• Infants (6–59 months): Biweekly IFA syrup (20 mg elemental iron + 100 mcg folic acid).
• Children (5–9 years): Weekly pink tablet (45 mg iron + 400 mcg folic acid).
• Adolescents (10–19 years): Weekly blue tablet (60 mg iron + 500 mcg folic acid). Weekly supplementation is effective and has better compliance.
• Pregnant/Lactating Women: Daily red tablet (60 mg iron + 500 mcg folic acid) for at least 100 days.
• Preterm/LBW Infants: Daily supplementation starting from 2–6 weeks of age is recommended to replenish low stores.

C. Iodine Supplementation

• While salt iodization is the primary strategy, in areas of severe endemicity where salt iodization is insufficient, iodized oil supplements may be used.
• Iodine is critical for preventing goiter, hypothyroidism, and mental retardation (cretinism).

D. Zinc Supplementation

• Diarrhea Management: Zinc (20 mg/day for 14 days; 10 mg for infants <6 months) is given during diarrheal episodes to reduce severity, duration, and recurrence. This replenishes zinc lost during diarrhea.
• Therapeutic: Used in Severe Acute Malnutrition (SAM) management.

3. Food Fortification (Medium-term)

Fortification involves adding essential nutrients to staple foods to improve the nutritional quality of the food supply without requiring major changes in dietary habits.

A. Universal Salt Iodization (USI)

• The most successful global fortification program.
• Target: Salt should contain 30 ppm (parts per million) iodine at the manufacturing level to ensure 15 ppm at the consumer level.
• This prevents Iodine Deficiency Disorders (IDD) across the population.

B. Double Fortified Salt (DFS)

• Salt fortified with both Iron and Iodine.
• This strategy addresses two major public health problems (anemia and goiter) simultaneously and is being implemented in school feeding programs and public distribution systems.

C. Biofortification

• This involves breeding crops with higher levels of micronutrients.
• Examples include iron-rich pearl millet or Vitamin A-rich sweet potato. This is a sustainable agricultural strategy to improve nutrient intake.

D. Commercial Fortification

• Fortification of milk with Vitamin A and D.
• Fortification of oils with Vitamin A and D.
• Fortification of cereals (wheat flour) with Iron, Folic Acid, and B12.

4. Public Health Measures

Non-nutritional interventions are equally important to prevent the loss of nutrients and ensure their absorption.

A. Parasite Control (Deworming)

• Mechanism: Intestinal helminths (like hookworms) cause chronic blood loss and malabsorption, leading to iron and protein deficiency.
• Intervention: Periodic deworming (e.g., Albendazole) every 6 months for children 1–19 years is a key component of anemia control (National Deworming Day).

B. Delayed Cord Clamping

• Delaying the clamping of the umbilical cord by at least 1–3 minutes (or until pulsation ceases) after birth allows placental blood to transfer to the infant.
• This significantly improves the infant's iron stores for the first 6 months of life.

C. WASH (Water, Sanitation, and Hygiene)

• Poor sanitation leads to environmental enteric dysfunction (EED) and recurrent infections (diarrhea), which impair nutrient absorption and cause nutrient loss.
• Access to safe drinking water and handwashing are critical preventive measures.

D. Immunization

• Measles Vaccination: Measles is a major precipitating factor for severe Vitamin A deficiency and malnutrition. Vaccination protects against this vicious cycle.
• General immunization reduces the burden of infectious diseases that deplete micronutrient stores.

5. Nutrition Education and Awareness

• Behavior Change: Educating mothers and families about the importance of "protective foods" (vitamins and minerals) and correcting faulty cooking practices (e.g., discarding cooking water, overcooking vegetables).
• Food Fads: Dispelling myths and food fads that restrict nutrient-rich foods during illness or pregnancy.
• Counseling: Utilizing contact points like immunization sessions to counsel on complementary feeding and iron supplementation.