Chapter 3: Developing Zinc Intervention Programs

Gillespie S. , Kevany J. , Mason J. Controlling iron deficiency. ACC/SCN State-of-the-Art Series Nutrition Policy Discussion Paper. Geneva: United Nations Administrative Committee on Coordination/Sub-Committee on Nutrition, 1991.

Galloway R. , McGuire J. Determinants of compliance with iron supplementation: supplies, side effects, or psychology? Soc Sci Med 1994; 39: 381–90.

World Bank. Enriching lives: overcoming vitamin and mineral malnutrition in developing countries. Washington, DC: World Bank, 1994.

Brown KH, Wuehler SE, International Development Research Centre (Canada), Micronutrient Initiative (Association). Zinc and human health: results of recent trials and implications for program interventions and research. Ottawa, ON: Micronutrient Initiative, 2000.

Sturniolo G.C. , Montino M.C. , Rossetto L. , Martin A. , D'Inca R. , D'Odorico A. , Naccarato R. Inhibition of gastric acid secretion reduces zinc absorption in man. J Am Coll Nutr 1991; 10: 372–5.

Barrie S.A. , Wright J.V. , Pizzorno J.E. , Kutter E. , Barron P.C. Comparative absorption of zinc picolinate, zinc citrate and zinc gluconate in humans. Agents Actions 1987; 21: 223–8.

Scholmerich J. , Freudemann A. , Kottgen E. , Wietholtz H. , Steiert B. , Lohle E. , Haussinger D. , Gerok W. Bioavailability of zinc from zinc-histidine complexes. I. Comparison with zinc sulfate in healthy men. Am J Clin Nutr 1987; 45: 1480–6.

Prasad A.S. , Beck F.W.J. , Nowak J. Comparison of absorption of five zinc preparations in humans using oral zinc tolerance test. J Trace Elem Exp Med 1993; 6: 109–15.

Henderson L.M. , Brewer G.J. , Dressman J.B. , Swidan S.Z. , DuRoss D.J. , Adair C.H. , Barnett J.L. , Berardi R.R. Effect of intragastric pH on the absorption of oral zinc acetate and zinc oxide in young healthy volunteers. J Parenter Enteral Nutr 1995; 19: 393–7.

Wolfe S.A. , Gibson R.S. , Gadowsky S.L. , O'Connor D.L. Zinc status of a group of pregnant adolescents at 36 weeks gestation living in southern Ontario. J Am Coll Nutr 1994; 13: 154–64.

Rosado J.L. , Lopez P. , Munoz E. , Martinez H. , Allen L.H. Zinc supplementation reduced morbidity, but neither zinc nor iron supplementation affected growth or body composition of Mexican preschoolers. Am J Clin Nutr 1997; 65: 13–9.

Cavan K.R. , Gibson R.S. , Grazioso C.F. , Isalgue A.M. , Ruz M. , Solomons N.W. Growth and body composition of periurban Guatemalan children in relation to zinc status: a longitudinal zinc intervention trial. Am J Clin Nutr 1993; 57: 344–52.

Briend A. , Lacsala R. , Prudhon C. , Mounier B. , Grellety Y. , Golden M.H. Ready-to-use therapeutic food for treatment of marasmus. Lancet 1999; 353: 1767–8.

Oelshlegel F.J. , Brewer G.J. Absorption of pharmacological doses of zinc. In: Brewer G.J. , Prasad A.S. , eds. Zinc metabolism: current aspects in health and disease. New York: Alan R. Liss, 1977.

Wood R.J. , Zheng J.J. High dietary calcium intakes reduce zinc absorption and balance in humans. Am J Clin Nutr 1997; 65: 1803–9.

Solomons N.W. Competitive interaction of iron and zinc in the diet: consequences for human nutrition. J Nutr 1986; 116: 927–35.

Fischer P. , Giroux A. , L'Abbe M. Effect of zinc supplementation on copper status in adult man. Am J Clin Nutr 1984; 40: 743–6.

Yadrick M.K. , Kenney M.A. , Winterfeldt E.A. Iron, copper, and zinc status: response to supplementation with zinc or zinc and iron in adult females. Am J Clin Nutr 1989; 49: 145–50.

Sandstrom B. , Davidsson L. , Cederblad A. , Lonnerdal B. Oral iron, dietary ligands and zinc absorption. J Nutr 1985; 115: 411–4.

Valberg L.S. , Flanagan P.R. , Chamberlain M.J. Effects of iron, tin, and copper on zinc absorption in humans. Am J Clin Nutr 1984; 40: 536–41.

Walsh C.T. , Sandstead H.H. , Prasad A.S. , Newberne P.M. , Fraker P.J. Zinc: health effects and research priorities for the 1990s. Environ Health Perspect 1994; 102(suppl 2): 5–46.

Broun E.R. , Greist A. , Tricot G. , Hoffman R. Excessive zinc ingestion: a reversible cause of sideroblastic anemia and bone marrow depression. JAMA 1990; 264: 1441–3.

Crofton R.W. , Gvozdanovic D. , Gvozdanovic S. , Khin C.C. , Brunt P.W. , Mowat N.A. , Aggett P.J. Inorganic zinc and the intestinal absorption of ferrous iron. Am J Clin Nutr 1989; 50: 141–4.

Aggett P.J. , Comerford J.G. Zinc and human health. Nutr Rev 1995; 53: S16–22.

Bates C.J. , Evans P.H. , Dardenne M. , Prentice A. , Lunn P.G. , Northrop-Clewes C.A. , Hoare S. , Cole T.J. , Horan S.J. , Longman S.C. , Stirling D. , Aggett P.J. A trial of zinc supplementation in young rural Gambian children. Br J Nutr 1993; 69: 243–55.

Thu B.D. , Schultink W. , Dillon D. , Gross R. , Leswara N.D. , Khoi H.H. Effect of daily and weekly micronutrient supplementation on micronutrient deficiencies and growth in young Vietnamese children. Am J Clin Nutr 1999; 69: 80–6.

Momcilovic B. Coupling of zinc dose to frequency in a regularly recurrent pattern shows a limited capacity of excessive dietary zinc to compensate for a previously deficient intake. J Nutr 1995; 125: 2687–99.

Brown K.H. , Peerson J.M. , Rivera J. , Allen L.H. Effect of supplemental zinc on the growth and serum zinc concentrations of prepubertal children: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2002; 75: 1062–71.

Bhutta Z.A. , Black R.E. , Brown K.H. , Gardner J.M. , Gore S. , Hidayat A. , Khatun F. , Martorell R. , Ninh N.X. , Penny M.E. , Rosado J.L. , Roy S.K. , Ruel M. , Sazawal S. , Shankar A. , Zinc Investigators’ Collaborative Group. Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. J Pediatr 1999; 135: 689–97.

Castillo-Duran C. , Vial P. , Uauy R. Trace mineral balance during acute diarrhea in infants. J Pediatr 1988; 113: 452–7.

Bahl R. , Baqui A. , Bhan M.K. , Bhatnagar S. , Black R.E. , Brooks A. , Cuevas L.E. , Dutta P. , Frischer R. , Ghosh S. , Malhotra S. , Penny M. , Roy S.K. , Sachdev H.P.S. , Sack D.A. , Sazawal S. , Strand T. , Fontaine O. , Patwari A.K. , Raina N. , Khanum S. Effect of zinc supplementation on clinical course of acute diarrhea (report of a meeting, New Delhi, 7–8 May, 2001). J Health Popul Nutr 2001; 19: 338–46.

Food and Agriculture Organization/International Life Sciences Institute (FAO/ILSI). Preventing micronutrient malnutrition: a guide for food-based approaches. Washington, DC: ILSI Press, 1997.

Rivera J.A. , Lutter C. The potential role of processed complementary foods. In: Martorell R. , Haschke F eds. Nutrition and growth. 47th Nestle Nutrition Workshop Series. Philadelphia, PA: Lippincott, Williams & Wilkins, 2001.

Herman S. , Griffin I.J. , Suwarti S. , Ernawati F. , Permaesih D. , Pambudi D. , Abrams S.A. Co-fortification of iron-fortified flour with zinc sulfate, but not zinc oxide, decreases iron absorption in Indonesian children. Am J Clin Nutr 2002; 76: 813–7.

Lopez de Romaña D. , Lönnerdal B. , Brown K.H. Absorption of zinc from wheat products fortified with iron and either zinc sulfate or zinc oxide. Am J Clin Nutr 2003; 78: 279–283.

Saldamli I. , Kokshel H. , Ozboy O. , Ozalp I. , Kilic I. Zincsupplemented bread and its utilization in zinc deficiency. Cereal Chem 1996; 73: 424–7.

Lopez de Romaña D. , Brown K.H. , Guinard J.X. Sensory trials to assess the acceptability of zinc fortificants added to iron-fortified wheat products. J Food Sci 2002; 67: 461–5.

Nestel P. , Nalubola R. Manual for wheat flour fortification with iron. Part 1: guidelines for the development, implementation, monitoring, and evaluation of a program for wheat flour fortification with iron. Arlington, VA: MOST/USAID, 2000.

Ruel M.T. , Levin C.E. Assessing the potential for food-based strategies to reduce vitamin A and iron deficiencies: a review of recent evidence. Food Consumption and Nutrition Division Discussion Paper. Washington, DC: International Food Policy Research Institute, 2000.

Cakmuk I. , Erdal I. Phytic acid-zinc molar ratios in wheat grains grown in Turkey. Micronutrients Agriculture 1996; 2: 7–18.

Graham R.D. , Welch R.M. Breeding for staple food crops with high micronutrient density. Working Papers on Agricultural Strategies for Micronutrients. Washington, DC: International Food Policy Research Institute, 1996.

CGIAR Micronutrients Project. Update No. 1, October 1996. Washington, DC: International Food Policy Research Institute, 1996.

Raboy V. , Below F.E. , Dickinson D.B. Alterations of maize kernel phytic acid levels by recurrent selection for protein and oil. J Heredity 1989; 80: 311–5.

Adams C. , Raboy V. , Krebs N. , Westcott J. , Lei S. , Hambidge M. The effect of low-phytic acid corn mutants on zinc absorption. FASEB J 2000; 14: A510.

Mendoza C. , Viteri F.E. , Lönnerdal B. , Young K.A. , Raboy V. , Brown K.H. Effect of genetically modified, low-phytic acid maize on absorption of iron from tortillas. Am J Clin Nutr 1998; 68: 1123–7.

House W.A. , Van Campen D.R. , Welch R.M. Supplemental sulfur-containing amino acids enhance the bioavailability to rats of zinc in corn kernels. Nutr Res 1996; 16: 225–35.

Welch R.M. The optimal breeding strategy is to increase the density of promoter compounds and micronutrient minerals in seeds; caution should be used in reducing anti-nutrients in staple food crops. Micronutrients Agriculture 1996; 1: 20.

Ye X. , Al-Babili S. , Kloti A. , Zhang J. , Lucca P. , Beyer P. , Potrykus I. Engineering the provitamin A (beta-carotene) biosynthetic pathway into (carotenoid-free) rice endosperm. Science 2000; 287: 303–5.

Irving G.C. J. Phytase. In: Cosgrove D.J. , ed. Inositol phosphates: their chemistry, biochemistry and physiology. Amsterdam: Elsevier, 1980.

Lönnerdal B. , Sandberg A.S. , Sandstrom B. , Kunz C. Inhibitory effects of phytic acid and other inositol phosphates on zinc and calcium absorption in suckling rats. J Nutr 1989; 119: 211–4.

Lucca P. , Hurrell R. , Potrykus I. Genetic engineering approaches to improve the bioavailability and the level of iron in rice grain. Theor Appl Genet 2001; 102: 392–7.

Ahmed M.M. , Jabbar M. , Ehui S. Household-level economic and nutritional impacts of market-oriented dairy production in the Ethiopian highlands. Food Nutr Bull 1999; 21: 460–5.

International Food Policy Research Institute (IFPRI), Bangladesh Institute of Development Studies, Institute of Nutrition and Food Science, Data Analysis and Tech Assist & Research Dept of Human Nutrition, & Royal Veterinary and Agricultural University. Commercial vegetable and polyculture fish production in Bangladesh: their impacts on income, household resource allocation, and nutrition. New York: Mimeo, 1998.

Holland B. , Brown J. , Buss D.H. Fish and fish products. The third supplement to McCance & Widdowson's The Composition of Foods, 5th ed. Cambridge: The Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food, 1993.

Maage A. , Julshamn K. Assessment of zinc status in juvenile Atlantic salmon (Salmo salar) by measurement of whole body and tissue levels of zinc. Aquaculture 1993; 117: 179–91.

Brummett R.E. , Haight B. Research-development linkages. Report of the Expert Consultation on Small Scale Rural Aquaculture. FAO Fisheries Report No. 548. Rome: Food and Agriculture Organization of the United Nations, 1996; 145–69.

Shrimpton R. Vitamin A deficiency in Brazil: perspectives for food production orientated interventions. Ecol Food Nutr 1989; 23: 261–71.

Grivetti L.E. , Ogle B.M. Value of traditional foods in meeting macro- and micronutrient needs: the wild plant connection. Nutr Res Rev 2000; 13: 31–46.

Ferguson E.L. , Gibson R.S. , Weaver S.D. , Heywood P. , Heywood A. , Yaman C. The mineral content of commonly consumed Malawian and Papua New Guinean foods. J Food Comp Anal 1989; 2: 260–72.

Chittchang U. , Jittinandana S. , Sungpuag P. , Chavasit V. , Wasantwisut E. Recommending vitamin A–rich foods in Southern Thailand. Food Nutr Bull 1999; 20: 238–42.

Bartnik M. , Szafranska I. Changes in phytate content and phytase activity during the germination of some cereals. J Cereal Sci 1987; 5: 23–8.

Gibson R.S. , Yeudall F. , Drost N. , Mtitimuni B. , Cullinan T. Dietary interventions to prevent zinc deficiency. Am J Clin Nutr 1998; 68: 484S–7S.

Lorenz K. Cereal sprouts: composition, nutritive value, food applications. Crit Rev Food Sci Nutr 1980; 13: 353–85.

Amoa B. , Muller H.G. Studies on kenkey with particular reference to calcium and phytic acid. Cereal Chem 1975; 53: 365–75.

Nout M.J.R. Processed weaning foods for tropical climates. Int J Food Sci Nutr 1993; 43: 213–21.

Chavan J.K. , Kadam S.S. Nutritional improvement of cereals by fermentation. Crit Rev Food Sci Nutr 1989; 28: 349–400.

Hotz C. , Gibson R.S. Assessment of home-based processing methods to reduce the phytate content and phytate/zinc molar ratio of white maize (Zea mays). J Agric Food Chem 2001; 49: 692–8.

Food and Agriculture Organization/World Health Organization (FAO/WHO). Fermentation: assessment and research. Report of a Joint FAO/WHO Workshop on Fermentation as a Household Technology to Improve Food Safety. Geneva: World Health Organization, 1996.

Svanberg U. , Lorri W. , Sandberg A.S. Lactic fermentation of non-tannin and high-tannin cereals: effects on in vitro estimation of iron availability and phytate hydrolysis. J Food Sci 1993; 58: 408–12.

de Boland A.R. , Garner G.B. , O'Dell B.L. Identification and properties of phytate in cereal grains and oilseed products. J Agric Food Chem 1975; 23: 1186–9.

Chang R. , Schwimmer S. , Burr H.K. Phytate: removal from whole dry beans by enzymatic hydrolysis and diffusion. J Food Sci 1977; 42: 1098–101.

Hotz C. , Gibson R.S. , Temple L. A home-based method to reduce phytate content and increase zinc bioavailability in maize-based complementary diets. Int J Food Sci Nutr 2001; 52: 133–42.

Navert B. , Sandström B. , Cederblad Å. Reduction of the phytate content of bran by leavening in bread and its effect on zinc absorption in man. Br J Nutr 1985; 53: 47–53.

Larsson M. , Rossander-Hulthén L. , Sandström B. , Sandberg A.S. Improved zinc and iron absorption from breakfast meals containing malted oats with reduced phytate content. Br J Nutr 1996; 76: 677–88.

Hirabayashi M. , Matsui T. , Yano H. Fermentation of soybean meal with Aspergillus usamii improves zinc availability in rats. Biol Trace Elem Res 1998; 61: 227–34.

Yeudall F. , Gibson R.S. , Kayira C. , Umar E. Efficacy of a multi-micronutrient dietary intervention based on hemoglobin, hair zinc concentrations, and selected functional outcomes in rural Malawian children. Eur J Clin Nutr 2002; 56: 1176–85.

Gibson R.S. , Yeudall F. , Drost N. , Mtitimuni B.M. , Cullinan T.R. Experiences of a community-based dietary intervention to enhance micronutrient adquacy of diets low in animal source foods and high in phytate: a case study in rural Malawian children. J Nutr 2003; 133: 3992S–9S.

Gillespie S. , Mason J. Controlling vitamin A deficiency. ACC/SCN State-of-the-art series. Nutrition Policy Discussion Paper No. 14. Geneva: United Nations/Administrative Committee on Coordination–Subcommittee on Nutrition, 1994.

Soleri D. , Cleveland D.A. , Frankenberger T.R. Gardens and vitamin A: a review of recent literature. VITAL Report No. IN-2. Arlington, VA: Vitamin A Field Support Project (VITAL) 1991.

Bouis H. The role of biotechnology for food consumers in developing countries. In: Qaim M. , Krattiger A. , von Braun J , eds. Agricultural biotechnology in developing countries: towards optimizing the benefits for the poor. Boston, MA: Kluwer Academic, 2000; 189–213.

Gopaldas T. , Mehta P. , Patil A. , Gandhi H. Studies on reduction in viscosity of thick rice gruels with small quantities of an amylase-rich cereal malt. Food Nutr Bull 1986; 8: 42–7.

Pedersen B. , Hansen M. , Munck L. , Eggum B.O. Weaning foods with improved energy and nutrient density prepared from germinated cereals, 2. Nutritional evaluation of gruels based on barley. Food Nutr Bull 1989; 11: 46–52.

Singhavanich C. , Jittinandana S. , Kriengsinyos W. , Dhanamitta S. Improvement of dietary density by the use of germinated cereals and legumes. Food Nutr Bull 1999; 20: 261–6.

Dickin K. , Griffiths M. , Piwoz E. Designing by dialogue. A program planner's guide to consultative research for improving young child feeding. Washington DC: Support for Analysis and Research in Africa (SARA), Academy for Educational Development (AED), Health and Human Resources Analysis for Africa (HHRAA), USAID, Bureau for Africa, Office of Sustainable Development, 1997.

Favin M. , Baume C. A guide to qualitative research for improving breastfeeding practices. Washington, DC: The Manoff Group and Wellstart International's Expanded Promotion of Breastfeeding Program, 1996.

Brown K.H. , Bentley M.E. Improved nutritional therapy of diarrhea: a guide for program planners and decision makers. Washington DC: Pritech, 1988.

Griffiths M. , Piwoz E. , Favin M. , Del Rosso J. Improving young child feeding during diarrhea. Arlington, VA: Pritech/USAID, 1988.

Helen Keller International. Changing behaviors: guidelines on using research to increase consumption of micronutrients. New York: Helen Keller International (undated).

Smitasiri S. , Attig G.A. , Valyasevi A. , Dhanamitta S. , Tontisirin K. Social marketing vitamin A–rich foods in Thailand: a model nutrition communication for behavior change process. Bangkok, Thailand: Institute of Nutrition, Mahidol University, 1993.

Blum L. , Pelto P.J. , Pelto P.G.H. , Kuhnlein H.V. Community assessment of natural food sources of vitamin A. Guidelines for an ethnographic protocol. Ottawa, ON: International Nutrition Foundation for Developing Countries (INFDC) and the International Development Research Center, 1997.

Kuhnlein H.V. , Pelto P.G.H. Culture, environment, and food to prevent vitamin A deficiency. Ottawa, ON: International Nutrition Foundation for Developing Countries (INFDC) and the International Development Research Center, 1997.

Rossi P.H. , Freeman H.E. , Lipsey M.W. Evaluation: a systematic approach. Thousand Oaks, CA: Sage Publications, 1999.

Habicht J.P. Epidemiology for scientific and programmatic decision-making. In: Garza C. , Haas J.D. , Habicht J.P. , Pelletier D.L. , eds. Beyond nutritional recommendations: implementing science for healthier populations. Proceedings from the 14th annual Bristol-Myers Squibb/Mead Johnson Nutrition Research Symposium, June 5–7, 1995, Washington, DC. Ithaca, NY: Division of Nutritional Sciences, Cornell University, 1996.

Levinson F.J. , Rogers B.L. , Hicks K.M. , Schaetzel T. , Troy L. , Young C. Monitoring and evaluation. A guidebook for nutrition project managers in developing countries. Washington, DC: Human Development Network, The World Bank, 1999.

Habicht J.P. , Victora C.G. , Vaughan J.P. Evaluation designs for adequacy, plausibility and probability of public health programme performance and impact. Int J Epidemiol 1999; 28: 10–8.

Arroyave G. , Balatazar J. , Kusin J. , Leprowski J.M. , Milton R.C. , Srikantia S.G. Methodology for monitoring and evaluating vitamin A deficiency intervention programmes. A report of the International Vitamin A Consultative Group (IVACG). Washington, DC: IVACG, 1989.

World Health Organization (WHO). Indicators for assessing vitamin A deficiency and their application in monitoring and evaluating intervention programs. WHO/NUT/96.10 Micronutrient Series. Geneva: World Health Organization, 1996.