A Review of Interventions Based on Dietary Diversification or Modification Strategies with the Potential to Enhance Intakes of Total and Absorbable Zinc
Free accessResearch articleFirst published online March, 2009
A Review of Interventions Based on Dietary Diversification or Modification Strategies with the Potential to Enhance Intakes of Total and Absorbable Zinc
Dietary diversification or modification has the potential to prevent deficiencies of zinc and other coexisting limiting micronutrients simultaneously, without risk of antagonistic interactions. In this review, we have addressed the following. The first section focuses on strategies with the potential to enhance intake and/or bioavailability of zinc, and includes interventions (with and without nutrition education) based on agriculture, production or promotion of animal-source foods through animal husbandry or aquaculture, and commercial and household processing strategies to enhance zinc absorption. Outcome indicators include intakes of foods or nutrients (although rarely zinc) and, in some cases, zinc status, or zinc-related functional responses. The next two sections address whether dietary diversification or modification can achieve increases in absorbable zinc that are sufficient to enhance zinc status or zinc-related functional responses in breastfed infants and toddlers and in older children and women of reproductive age. Evidence for the impact of dietary diversification or modification on behavior change and on nutritional status in the short and long term, and the possible role of modifying factors (e.g., baseline nutritional status, socioeconomic status, infection, sex, age, and life-stage group) is the emphasis of the next section. The following section highlights the evidence for three potential adverse effects of dietary diversification or modification: aflatoxin contamination from germinated cereals, loss of water-soluble nutrients, and displacement of breastmilk. Finally, an example of a dietary diversification or modification program (Homestead Food Production) developed and implemented by Helen Keller International is given, together with the critical steps needed to scale up dietary diversification or modification for programs and future research needs.
RuelMT. Can food-based strategies help reduce vitamin A and iron deficiencies? A review of recent evidence. Washington, DC: International Food Policy Research Institute, 2001.
2.
BiertiPRKrasevecJFitzgeraldS. A review of the effectiveness of agriculture interventions in improving nutrition outcomes. Public Health Nutr2004;7:599–609.
3.
BiertiPRKrasevecJFitzgeraldS. Effectiveness of small-scale rural agriculture interventions. Part 1. Nutrition outcomes—literature review and critical analysis. Ottawa: Programme for Appropriate Technology in Health, 2002.
4.
MarshR. Building on traditional gardening to improve household food security. Food Nutr Agric1998;22:4–14.
5.
KidalaDGreinerTGebre-MedhinM. Five-year follow-up of a food-based vitamin A intervention in Tanzania. Public Health Nutr2000;3:425–431.
6.
ChakravartyI. Food based strategies to control vitamin A deficiency. Food Nutr Bull2000;21:135–143.
7.
NguTQuangNDHaPHGiayTBadcockJCFitzGeraldS. A food based approach to nutrition improvement through household food security in Vietnam, with special reference to vitamin A deficiency. In: Proceedings of 6th IVACG Meeting, Chiang Rai, Thailand, 1994. Washington, DC: International Life Sciences Institute, 1995:7.
8.
SolonFBrionesHFernandezJRShafritzLB. Moving to a long-term strategy: Increasing vegetable gardening and consumption in the Philippines. In: SeidalRE ed. Strategies for promoting vitamin A production, consumption and supplementation. Four case studies. Washington, DC: Academy for Educational Development, 1996.
9.
PhillipsMSanghviTSuarezRMcKigneyJFiedlerJ. The costs and effectiveness of three vitamin A interventions in Guatemala. Soc Sci Med1996;42:1661–8.
10.
SolonFFernandezTLLathamMCPopkinBM. An evaluation of strategies to control vitamin A deficiencies in the Philippines. Am J Clin Nutr1979; 32:1445–53.
11.
PopkinBMSolonFSFernandezTLathamMC. Benefit-cost analysis in the nutrition area: A project in the Philippines. Soc Sci Med1980;14C:207–16.
12.
GalalOMHarrisonGGAbdouAIZein el AbedinA. The impact of a small-scale agricultural intervention on socio-economic and health status. Food Nutr (Roma)1987;13:35–43.
13.
CARE Nepal. A study of the evaluation of home gardening program in Bajura and Mahottari districts. Project Report. Kathmandu, Nepal: CARE, 1995.
14.
HagenimanaVOyungaMALowJNjogeSMGichukiSTKabiraJ. The effects of women farmer's adoption of orange-fleshed sweet potatoes: Raising vitamin A intake in Kenya. Research Reports Series No. 3. Washington, DC: International Center for Research on Women, 1999.
15.
BerzinNIBaumanVK. Vitamin-A-dependent zinc-binding protein and intestinal absorption of zinc in chicks. Br J Nutr1987;57:255–68.
16.
SkalanDHalevyODonoghueS. The effect of different dietary levels of vitamin A on metabolism of copper, iron, and zinc in the chick. Int J Vitam Nutr Res1987;57:11–8.
17.
HollandBWelchAAUnwinIDBussDHPaulAASouthgateDAT. McCance and Widdowson's the composition of foods. 5th revised and extended edition. Cambridge, UK: Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food, 1991.
18.
EnglishRMBadcockJCGiayTNguTWatersAMBennettSA. Effect of nutrition improvement project on morbidity from infectious diseases in preschool children in Vietnam: Comparison with control commune. Br Med J1997;315:1122–5.
19.
EnglishRBadcockJ. A community nutrition project in Viet Nam: Effects on child morbidity. Food Nutr Agric1998;22:15–21.
20.
International Food Policy Research Institute (IFPRI)/Bangladesh Institute of Development Studies, Institute of Nutrition and Food Science, Data Analysis and Technical Assistance and Research Department of Human Nutrition, Royal Veterinary and Agricultural University. Commercial vegetable and poly-culture fish production in Bangladesh: Their impacts on income, household resource allocation, and nutrition. Vol 1. Washington, DC: IFPRI, 1998.
21.
SmitasiriSDhanamittaS. Sustaining behaviour change to enhance micronutrient status: Community and women-based interventions in Thailand. Research Report no. 2. Washington, DC: International Center for Research on Women/Opportunities for Micronutrient interventions, 1999.
22.
SmitasiriSSangobwarcharKKongpunyaPSubsuwanCBanjongOChitchumroonechokchaiCRusami-SopapornWVeeravongSDhanamittaS. Sustaining behavioural change to enhance micronutrient status through community and women-based interventions in northeast Thailand: Vitamin A. Food Nutr Bull1999;20:243–51.
23.
SchipaniSvan der HaarFSinawatSMaleevongK. Dietary intake and nutritional status of young children in families practicing mixed home gardening in northeast Thailand. Food Nutr Bull2002;23:175–80.
24.
StallkampGKarimRJinnatunnessaHabibABatenAUddinATalukderAPanagidesDde PeeS. Homestead food production reduces the prevalence of anemia among non-pregnant women. In: KalambahetiYCharoenkiatklS, eds. Optimizing dietary strategies for better health in developing countries. Bioavailability 2006. Abstract O3.3. Chiang Mai, Thailand: Institute of Nutrition, Mahidol University, 2006:67.
25.
YingCFengyingZWenjunLKeyouGDaxunJde OnisM. Nutritional status of preschool children in poor rural areas of China. Bull World Health Organ1994;72:105–12.
26.
SheikholeslamRKimiagarMSiasiFAbdollahiZJazayeriAKeyghobadiKGhaffarpoorMNorooziFKalantariMMinaeiNEslamiFHormozdyariH. Multidisciplinary intervention for reducing malnutrition among children in the Islamic Republic of Iran. East Mediterr Health J2004;10:844–52.
27.
AyeleZPeacockC. Improving access to and consumption of animal source foods in rural households: The experience of a women-focused goat development program in the highlands of Ethiopia. J Nutr2003;133:3981S–6S.
28.
NielsenHRoosNThilstedSH. The impact of semi-scavenging poultry production on the consumption of animal source foods by women and girls in Bangladesh. J Nutr2003;133:4027S–30S.
29.
RoosNIslamMMThilstedSH. Small fish is an important dietary source of vitamin A and calcium in rural Bangladesh. Int J Food Sci Nutr2003;54:329–39.
30.
RoosNIslamMMThilstedSH. Indigenous fish species in Bangladesh: Contribution to vitamin A and iron intakes. J Nutr2003;133:4021S–6S.
31.
RadfordKB. World Vision Malawi's Micronutrient and Health (MICAH) Progam. Small animal revolving fund. Mississauga, Ontario, Canada: World Vision Canada, 2005.
32.
Carrasco SanezNCde UbillasRMDGuillenISFerreiraSM. Increasing women's involvement in community decision-making: A means to improve iron status. Research Report No. 1. Washington, DC: International Center for Research on Women/Opportunities for Micronutrient interventions, 1998.
33.
Creed-KanashiroHMUribeTGBartoliniRMFukumotoMNLopezTTZavaletaNMBentleyME. Improving dietary intake to prevent anemia in adolescent girls through community kitchens in a periurban population of Lima, Peru. J Nutr2000;130:459S–61S.
34.
GuldanGSFanHMaXNiZXiangXTangM. Culturally appropriate nutrition education improves infant feeding and growth in rural Sichuan China. J Nutr2000;130:1204–11.
35.
PennyMECreed-KanashiroHMRobertRCNarrowMRCaulfieldLEBlackRE. Effectiveness of an educational intervention delivered through health services to improve nutrition in young children: A cluster-randomised controlled trial. Lancet2005;365:1863–72.
36.
HeathALMSkeaffMO'BrienSWilliamsSMWilliamsBSGibsonRS. Can dietary treatment of non-anemic iron deficiency improve iron status?J Am Coll Nutr2001;20:477–84.
37.
LarteyAMauABrownKHPeersonKMDeweyKG. A randomized, community-based trial of the effects of improved, centrally processed complementary foods on growth and micronutrient status of Ghanaian infants from 6 to 12 mo of age. Am J Clin Nutr1999;70:391–404.
38.
KrebsNFWestcottJEButlerNRobinsonCBellMHambidgeKM. Meat as a first complementary food for breastfed infants: Feasibility and impact on zinc intake and status. J Pediatr Gastroenterol Nutr2006;42:207–14.
39.
EngelmannMDMSandströmBMichaelsenKF. Meat intake and iron status in late infancy: An intervention study. J Pediatr Gastroenterol Nutr1998;26:26–33.
40.
GrillenbergerMNeumannCGMurphySPBwiboNOvan't VeerPHautvastJGWestCE. Food supplements have a positive impact on weight gain and the addition of animal source foods increases lean body mass of Kenyan school children. J Nutr2003;133:3957S–64S.
41.
GrillenbergerMNeumannCGMurphySPBwiboNOWeissREJiangLHauvastJGWestCE. Intake of micronutrients high in animal-source foods is associated with better growth in rural Kenyan school children. Br J Nutr2006;95:379–90.
42.
MurphySPGewaCLiangLLGrillenbergerMBwiboNONeumannC. School snacks containing animal source foods improve dietary quality for children in rural Kenya. J Nutr2003;133:3950S–7S.
43.
NeumannCGBwiboNOMurphySPSigmanMWhaleySAllenLHGuthrieDWeissREDemmentMW. Animal source foods improve dietary quality, micronutrient status, growth and cognitive function in Kenyan school children: Background, study design and baseline findings. J Nutr2003;133:3941S–9S.
44.
SiekmannJHAllenLHBwidoNODemmentWMurphySPNeumannCG. Kenyan school children have multiple micronutrient deficiencies, but increased plasma vitamin B-12 is the only detectable micronutrient response to meat or milk supplementation. J Nutr2003;133:3972S–80S.
45.
WhaleySESigmanMNeumannCBwiboNGuthrieDWeissREAlberSMurphySP. The impact of dietary intervention on the cognitive development of Kenyan school children. J Nutr2003;133:3965S–71S.
46.
World Health Organization/UNICEF. Complementary feeding of young children in developing countries: A review of current scientific knowledge. Geneva: WHO, 1998.
47.
GibsonRSHotzC. Dietary diversification/modification strategies to enhance micronutrient content and bioavailability of diets in developing countries. Br J Nutr2001;85:S159–66.
48.
LönnerdalBCederbladÅDavidssonLSandströmB. The effect of individual components of soy formula and cows' milk formula on zinc bioavailability. Am J Clin Nutr1984;40:1064–70.
49.
TurnlundJRKingJCKeyesWRGongBMichelMC. A stable isotope study of zinc absorption in young men: Effects of phytate and α-cellulose. Am J Clin Nutr1984;40:1071–7.
50.
NävertBSandströmB. Reduction of the phytate content of bran by leavening in bread and its effect on zinc absorption in man. Br J Nutr1985;53:47–53.
51.
LönnerdalBBellJGHendrickxAGBurnsRAKeenCL. Effect of phytate removal on zinc absorption from soy formula. Am J Clin Nutr1988;48:1301–6.
52.
KivistöBCederbladÅDavidssonLSandbergA-SSandströmB. Effect of meal composition and phytate content on zinc absorption in humans from an extruded bran product. J Cereal Sci1989;10:189–97.
53.
EtcheverryPHawthorneKMLiangLKAbramsSAGriffinIJ. Effect of beef and soy proteins on the absorption of non-heme iron and inorganic zinc in children. J Am Coll Nutr2006;25:34–40.
54.
DavidssonLZieglerEEKastenmayerPvan DaelPBarclayD. Dephytinisation of soybean protein isolate with low native phytic acid content has limited impact on mineral and trace element absorption in healthy infants. Br J Nutr2004;91:287–93.
55.
ManaryMJHotzCKrebsNFGibsonRSWestcottJEArnoldTBroadheadRLHambidgeKM. Dietary phytate reduction improves zinc absorption in Malawian children recovering from tuberculosis but not in well children. J Nutr2000;130:2959–64.
56.
EgliIDavidssonLZederCWalczykTHurrellR. Dephytinization of a complementary food based on wheat and soy increases zinc, but not copper, apparent absorption in adults. J Nutr2004;134:1077–80.
57.
HambidgeKMMillerLVTranCDKrebsNF. Measurements of zinc absorption: Application and interpretation in research designed to improve human zinc nutriture. Int J Vitam Nutr Res2005;75:385–93.
58.
LiuzziJPCousinsRJ. Mammalian zinc transporter. Annu Rev Nutr2004;24:151–72.
59.
HotzCGibsonRS. Assessment of home-based processing methods to reduce phytate content and phytate/zinc molar ratios of white maize (Zea mays). J Agric Food Chem2001;49:692–8.
60.
AdamsCLHambidgeMRaboyVDorschJASianLWestcottJLKrebsNF. Zinc absorption from a low phytic-acid maize. Am J Clin Nutr2002;76:556–9.
61.
HambidgeKMHufferJWRaboyVGrunwaldGKWestcottJLSianLMillerLVDorschJAKrebsNF. Zinc absorption from low-phytate hybrid of maize and their wild-type isohybrids. Am J Clin Nutr2004;79:1053–9.
62.
MazariegosMHambdigeKMKrebsNFWestcottJELeiSGrunwaldGWCamposRBarahonaBRaboyVSolomonsNW. Zinc absorption in Guatemalan schoolchildren fed normal or low-phytate maize. Am J Clin Nutr2006;83:59–64.
63.
MendozaCViteriFELönnerdalBYoungKARaboyVBrownKH. Effect of genetically modified, low-phytic acid maize on absorption of iron from tortillas. Am J Clin Nutr1998;68:1123–7. Erratum in: Am J Clin Nutr69:743.
64.
HurrellRFReddyMBJuilleratM-ACookJD. Degradation of phytic acid in cereal porridges improves iron absorption by human subjects. Am J Clin Nutr2003;77:1213–9.
65.
HambidgeKMKrebsNFWestcottJLSianLMillerLVPetersonKLRaboyV. Absorption of calcium from tortilla meals prepared from low-phytate maize. Am J Clin Nutr2005;82:84–7.
66.
LachatCKVan CampJHMamiroPSWayua ObuoroFOpsomerASRoberfroidDAKolsterenPW. Processing of complementary foods does not increase hair zinc levels and growth of infants in Kilosa district, rural Tanzania. Br J Nutr2006;95:174–80.
67.
MamiroPSKolsterenPWvan CampJHRoberfroidDATatalaSOpsomerAS. Processed complementary food does not improve growth or hemoglobin status of rural Tanzanian infants from 6–12 months of age in Kilosa District, Tanzania. J Nutr2004;134:1084–90.
68.
LindTLönnerdalBPerssonL-ÅStenlundHTenneforsCHernellO. Effects of weaning cereals with different phytate content on hemoglobin, iron stores, and serum zinc: A randomized intervention in infants from 6 to 12 mo of age. Am J Clin Nutr2003;78:168–75.
69.
LindTPerssonL-ÅLönnerdalBStenlundHHernellO. Effects of weaning cereals with different phytate content on growth, development and morbidity: Randomized intervention trial in infants from 6 to 12 months of age. Acta Paediatr2004;93:1575–82.
70.
GibsonRSYeudallFDrostNMtitimuniBMCullinanTR. Experiences of a community-based dietary intervention to enhance micronutrient adequacy of diets low in animal source foods and high in phytate: A case study in rural Malawian children. J Nutr2003;133:3992S–9S.
71.
YeudallFGibsonRSCullinanTRMtimuniB. Efficacy of a community-based dietary intervention to enhance micronutrient adequacy of high-phytate maize-based diets of rural Malawian children. Public Health Nutr2005;8:826–36.
72.
YeudallFKayiraCUmarEGibsonRS. Impact of a community-based dietary intervention on selected biochemical and functional outcomes in rural Malawian children. Eur J Clin Nutr2002;56:1176–85.
73.
HotzCGibsonRS. A participatory nutrition education intervention improves the adequacy of complementary diets of rural Malawian children: A pilot study. Eur J Clin Nutr2005;59:226–37.
74.
PorresJMEtcheverryPMillerDD. Phytate and citric acid supplementation in whole-wheat bread improves phytate-phosphorus release and iron dialyzability. J Food Sci2001;66:614–9.
75.
LiljebergHBjörckI. Delayed gastric emptying rate may explain improved glycaemia in healthy subjects to a starchy meal with added vinegar. Eur J Clin Nutr1998;52:368–71.
76.
RimbachWAMostEPallaufJ. Effect of citric acid supplements to a maize-soya diet on the in vitro availability of minerals, trace elements, and heavy metals. Zentralbl Veterinarmed A1998;45:517–24.
77.
HuntJRGallagherSKJohnsonLKLykkenGI. High-versus low-meat diets: Effects on zinc absorption, iron status, and calcium, copper, iron, magnesium, manganese, nitrogen, phosphorus, and zinc balance in postmenopausal women. Am J Clin Nutr1995;62:621–32.
78.
JallaSWestcottJSteirnMMillerLVBellMKrebsNF. Zinc absorption and exchangeable zinc pool size in breast-fed infants fed meat or cereal as first complementary food. J Pediatr Gastroenterol Nutr2002;34:35–41.
79.
RosadoJLDiazMGonzalezKGriffinIAbramsSAPreciadoR. The addition of milk or yoghurt to a plant-based diet increases zinc bioavailability but does not affect iron bioavailability in women. J Nutr2005;135:465–8.
80.
SandströmB. Dose dependence of zinc and manganese absorption in man. Proc Nutr Soc1992;51:211–8.
81.
HabichtJPVictoraCGVaughanJP. Evaluation designs for adequacy, plausibility and probability of public health programme performance and impact. Int J Epidemiol1999;28:10–8.
82.
Creed-KanashiroHMBartoliniRMFukumotoMNUribeTGRobertRCBentleyME. Formative research to develop a nutrition education intervention to improve dietary iron intake among women and adolescent girls through community kitchens in Lima, Peru. J Nutr2003;133:3987S–91S.
83.
BjarnsonIMacphersonAHollanderD. Intestinal permeability: An overview. Gastroenterology1995;108:1566–81.
84.
ThurnhamDIMburuASWMwanikiDLDe WagtA. Micronutrients in childhood and the influence of subclinical inflammation. Proc Nutr Soc2005;64:502–9.
85.
QuistCFHowerthEWFischerJRWyattRDMillerDMNettlesVF. Evaluation of low-level aflatoxin in the diet of white-tailed deer. J Wildlife Dis1997;33:112–21.
86.
HellKCradwellKFSetamouMPoehlingHM. The influence of storage practices on aflatoxin contamination in maize in four agroecological zones of Benin, West Africa. J Stored Prod Res2000;36:365–82.
87.
MossMO. Recent studies of mycotoxins. J Appl Microbiol Suppl1998;84:62S–76S.
88.
TempleL. Household processing methods for improving the nutrient adequacy of complementary foods in rural Malawi: Their impact on content and relative bioavailability of calcium, iron, and zinc. MSc thesis, University of Otago, New Zealand, 2001.
89.
TempleLGibsonRSHotzC. Use of soaking and enrichment for improving the content and bioavailability of calcium, iron, and zinc in complementary foods and diets of rural Malawian weanlings. J Food Sci2002;67:1926–32.
90.
MensahPTomkinsA. Household-level technologies to improve the availability and preparation of adequate and safe complementary foods. Food Nutr Bull2003;24:104–25.
91.
DrewettRAmatayakulKWongsawasdiiLMangklabruksARuckpaopuntSRuangyuttikarnCBaumDImongSJacksonDWoolridgeM. Nursing frequency and the energy intake from breast milk and supplementary food in a rural Thai population: A longitudinal study. Eur J Clin Nutr1993;47:880–91.
92.
KimmonsJEDeweyKGHaqueEChakrabortyJOsendarpSJBrownKH. Low nutrient intakes among infants in rural Bangladesh are attributable to low intake and low micronutrient density of complementary foods. J Nutr2005;135:444–51.
93.
PaulAABatesCJPrenticeADayKCTsuchiyaH. Zinc and phytate intake of rural Gambian infants: Contributions from breastmilk and weaning foods. Int Food Sci Nutr1998;49:41–154.
94.
TalukderAStallkampGSapkotaGKroeunHKarimRWittenCHaselowNde PeeSMoench-PfannerRBloemMW. Homestead food production and its impact on the prevalence of anemia among non-pregnant women and children in Asia (Bangladesh, Nepal and Cambodia). In: Consequences and control of micronutrient deficiencies: Science, policy, and programs—defining the issues. Micronutrient Forum. Istanbul, Turkey, 2007. Abstract W18, p 102. http://www.micronutrientforum.org/Meeting2007/posterPresentations.cfm.
95.
StallkampGAkhterNKarimRHabibABatenAUddinATalukderAde PeeS. Homestead food production improves micronutrient status in mothers and young children in Bangladesh. In: Consequences and control of micronutrient deficiencies: science, policy, and programs—defining the issues. Micronutrient Forum. Istanbul, Turkey, 2007. Abstract W15, p 102. http://www.micronutrientforum.org/Meeting2007/posterPresentations.cfm.
96.
Helen Keller International. Homestead food production—an effective integrated approach to improve food security among the vulnerable char dwellers in northern Bangladesh. Homestead Food Prod Prog Bull2006;4:1–4.
97.
Food and Agriculture Organization/International Life Sciences Institute. Preventing micronutrient malnutrition: A guide to food-based approaches. Washington, DC: International Life Sciences Institute, 1997.
98.
KuhnleinHVPeltoGH, eds. Culture, environment, and food to prevent vitamin A deficiency. Boston: International Nutrition Foundation for Developing Countries, 1997.
99.
GibsonRSHotzCTempleLYeudallFMtitimuniBFergusonEL. Dietary strategies to combat deficiencies of iron, zinc and vitamin A in developing countries: Development, implementation, monitoring and evaluation. Food Nutr Bull2000;21:219–31.
100.
FaberMLaurieSVenterS. Home-gardens to address vitamin A deficiency in South Africa: A food-based approach. Pretoria, South Africa: ARC-Roodeplaat Vegetable and Ornamental Plant Institute, 2007.
101.
International Zinc Nutrition Consultative Group. Preventing zinc deficiency through diet diversification and modification. IZiNCG Technical Brief No. 5. Davis, University of California, 2007.
102.
DickinKGriffithsMPiwozE. 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/Academy for Educational Development/Health and Human Resources Analysis for Africa/Bureau for Africa, Office of Sustainable Development, 1997.
103.
PrettyJNGuijtIThompsonJScoonesI. Training in participant methods in the workshop. In: Participatory learning and action: a trainer's guide. London: Sustainable Agriculture Programme, International Institute for Enviroment and Development, 1995:72–89.
104.
PelletierDLKraakVFerri-MorrisM. The CBNM problem solving model: An approach for improving nutrition research decision-making in the community. A manual prepared for the Community-Based Nutrition Monitoring (CBNM) strategy workshop. Ithaca, NY, USA: Division of Nutrition Science, Cornell University, 1994.
105.
SmithWELandaisFL. A new approach to organizing and planning. Dev Southern Afr1991;8:223–38.
106.
LevinsonFJRogersBLHicksKMSchaetzelTTroyLYoungC. Monitoring and evaluation. A guidebook for nutrition project managers in developing countries. Washington, DC: Human Development Network/World Bank, 1999.
107.
de BenoistBDarnton-HillIDavidssonLFontaineO, eds. Report of a WHO/UNICEF/IAEA/IZiNCG Interagency meeting on zinc status indicators. Food Nutr Bull2007;28:S399–S486.
108.
International Zinc Nutrition Consultative Group (IZiNCG), BrownKHRiveraJABhuttaZGibsonRSKingJCLönnerdalBRuelMTSandtrömBWasantwisutEHotzC. Assessment of the risk of zinc deficiency in populations and options for its control. Food Nutr Bull2004;25(1suppl 2):S99–203.
109.
International Zinc Nutrition Consultative Group. Quantifying the risk of zinc deficiency: Recommended indicators. IZiNCG Technical Brief No. 01. Davis, University of California, 2007.
110.
International Zinc Nutrition Consultative Group. Assessing population zinc status with serum zinc concentration. IZiNCG Technical Brief No. 02. Davis, University of California, 2007.
111.
International Zinc Nutrition Consultative Group. Determining the risk of zinc deficiency: Assessment of dietary zinc intake. IZiNCG Technical Brief No. 03. Davis, University of California, 2007.
