Food Science and the Elimination of Nutrient Deficiencies

A 1999 Centers for Disease Control report indicates that the top 10 public health achievements during the 20th century include the virtual elimination of goiter, rickets, and pellagra, all of which are related to nutrient deficiencies (MMWR, 1999). Iodinization of table salt and vitamin D fortification of milk and orange juice via food science and technology played a major role in these public health achievements.

Currently 46.2 million people in the United States live below the poverty line (Census Bureau, 2012). Thus, many people in the U.S. are at risk of nutritional inadequacies and subject to multiple micronutrient insufficiencies, if not frank deficiencies. The cumulative nutritional impact of these conditions is apparent in developing countries. However, the confounding variables at the intersection of health and disease in the U.S. are less self-evident.

Nutritional deficiencies are responsible for at least 3 million childhood deaths annually in developing countries. It is now abundantly clear that nutritional status in maternal, fetal, and newborn periods is a critical factor in formation of organ systems and especially in immunologic, neurologic, and cognitive development (Piwoz et al., 2012). It is further recognized that early intervention represents the only definitive approach to averting the morbidity and mortality due to undernutrition, and to assuring a lower risk of developing classic noncommunicable diseases, as noted by physicians Mehmood Khan and José Saavedra in the course of 2012 Beacon Lectures at the IFT Annual Meeting in Las Vegas, Nev. More than ever, these harsh realities appear to have catalyzed investigators and clinicians to call for improved research methodologies and more effective nutrition interventions in both developed and developing nations.

In modern post-industrial societies, the fastest-growing segment of the population has been older adults. Vitamin B-12 deficiency has long been associated with general cognitive problems among the elderly. While this thesis has been historically controversial due to observational and experimental threats to validity, several studies, such as the Framingham Heart Study and NHANES analyses, have demonstrated that older adults with low vitamin B-12 status suffered with anemia and cognitive impairment compared with subjects who had normal serum levels of B-12 and folate (Morris et al., 2012; Selhub et al., 2009). High serum folate was not protective when associated with low serum B-12. It has long been appreciated that up to 85% of adults who are hospitalized for extended periods or who reside in long-term care facilities suffer from other forms of malnutrition (Gallagher-Allred, 1996).

A dramatic example of studies conducted earlier in this decade in Kenya (Gewa et al., 2009; Whaley et al., 2003) demonstrated that children (equivalent to U.S. grade one) supplemented with micronutrients (Fe, Zn, and B vitamins [B-12, B-6, folate, and riboflavin]) or meat (a proxy for the high-protein intervention) significantly outperformed all other children based on clinically valid neuropsychological tests.

One of the critical functions of iodine is in neurodevelopment among children and maintenance of cognitive function (Swanson et al., 2012). NHANES data suggest the general population in the U.S. consumes an adequate amount of iodine. However, slightly less than 10% of this population and about 5% of children do not achieve a sufficient iodine intake (Caldwell et al., 2011). Another at-risk population of compromised iodine status are vegans, particularly women of reproductive capacity (Leung et al., 2011).

Interestingly, a recent study among infants and toddlers in New Zealand indicated a mild iodine insufficiency within this population (Skeaff et al., 2005). Related studies in New Zealand, Australia, and the United Kingdom demonstrated similar findings among pre-school and school-age children (Gordon et al., 2009; Skeaff et al., 2012a; Skeaff et al., 2012b; Vanderpump et al., 2011). Fortunately, there is a global micronutrient initiative to decrease these statistics via mandatory programs of iodine fortification of salt. In addition, USAID and UNICEF continue to distribute iodized salt to meet the iodine needs of Eastern Europe, the Middle East, and Africa (Ohlhorst et al., 2012; www.usaid.gov).

The good news is that malnutrition and nutrient inadequacies represent the “greatest modifiable threat to global health and survival” (Prentice et al., 2008). In the face of a frustrating absence of progress in the treatment of some of our most dreaded disease  processes, the fact is that through food science and nutrition, there is a genuine light at the end of the tunnel.

References cited in this article are available from the authors.

Roger Clemens, Dr.P.H.,
Contributing Editor
Chief Scientific Officer, Horn Company, La Mirada, Calif.
[email protected]

Peter Pressman, M.D.,
Contributing Editor
Medicine & Public Health Advisor, Daedalus Humanitarian Inc.
[email protected]