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  • Could new approaches to global nutrition lead

    2019-04-26

    Could new approaches to global nutrition lead to interventions that would make children grow tall without putting on excessive fat, as is the case for present-day piglets? Animal science has been addressing this issue for a long time, although with rigorous studies that cannot be conducted in humans. More than 60 years after Leitch\'s paper, Jack Odle and colleagues produced a landscape review to address a crucial question: what can global human nutrition learn from animal science? The review covered four main areas, known in the global health literature as the continuum of care: preconception, gestation and pregnancy, lactation and suckling, and post-weaning and toddler phases. This review resulted in more than a dozen key findings, suggesting some potential interventions that receive scant attention in global nutrition at present. In particular, the review highlighted “the quantitative importance of essential fatty thip and aminoacid nutrition in reproductive health; the suggested application of the ideal protein concept for improving the aminoacid nutrition of mothers and children; the prospect of using dietary phytase to improve the bioavailability of trace minerals in plant and vegetable-based diets; and nutritional interventions to mitigate environmental enteropathy”. The shows the contrast between Odle and colleagues\' potential recommendations and the comprehensive list of effective diet-related interventions published in the 2013 Nutrition Series (). From the end of World War 2, the global community regarded protein deficiency to be the major nutritional problem in poor countries and called for policies and programmes to close the so-called protein gap. In the mid-1970s, prominent nutritionists declared this to be fallacious using terms such as “the great protein fiasco” and world attention shifted from protein quantity and quality, to quantity of food. More recently, the concern with quality returned but with a focus on micronutrients. The first major difference with respect to animal research is the extent to which human programmes today focus on micronutrients. At different stages during the continuum of care, global nutrition relies on promotion of intake of folic acid, iron, calcium, iodine, vitamin K, vitamin A, and multiple micronutrient supplements. By contrast, animal studies give more comprehensive attention to macronutrients, such as specific aminoacids and fatty acids, which are not considered at all in global human nutrition programmes. Even programmes that promote nutrition counselling with use of locally grown foods or provision of protein-energy supplements do not focus on specific macronutrients. Odle and colleagues emphasise that, in the case of protein and fat, it is crucial to consider both the quantity provided by the diet as well as the pattern of essential aminoacids and fatty acids ingested. They further declare that “the basic information needed to formulate diets to meet aminoacid needs in humans represents a serious gap in knowledge”, unlike animal science where aminoacid patterns resulting in ideal proteins are well described and widely used.
    The Xpert MTB/RIF assay (Cepheid; Sunnyvale, CA, USA) on the GeneXpert molecular system, which was endorsed by WHO in 2010, is the biggest advance in tuberculosis diagnosis and the most scaled-up new tuberculosis technology. Between 2010 and 2016, more than 6500 GeneXpert machines and 23 million Xpert assay cartridges were procured in the public sector in 130 of the 145 countries eligible for concessional pricing. India alone has acquired more than 750 GeneXpert systems in the public sector and more than 100 systems in the private sector. However, GeneXpert systems are often underused because of high cost, restrictive algorithms, inadequate decentralisation, exclusion of the private sector from concessional pricing, and weak implementation of policies.
    Elizabeth Speakman and colleagues (April, 2017) propose the development of a European global health strategy. As researchers who have analysed the European Union\'s (EU\'s) role in global health in the past, we appreciate a renewed debate on this topic. However, we would like to contest some of the arguments.