Mwangi Martin N, Phiri Kamija S, Abkari Abdelhak, Gbané Mory, Bourdet-Sicard Raphaelle, Braesco Véronique Azaïs, Zimmermann Michael B, Prentice Andrew M
Division of Human Nutrition, Wageningen University and Research, Wageningen 6700 AA, The Netherlands.
Nutrition and Health Department, School of Public Health and Community Development, Maseno University, Maseno, Kenya.
Nutrients. 2017 Jun 5;9(6):576. doi: 10.3390/nu9060576.
Scientific experts from nine countries gathered to share their views and experience around iron interventions in Africa. Inappropriate eating habits, infections and parasitism are responsible for significant prevalence of iron deficiency, but reliable and country-comparable prevalence estimates are lacking: improvements in biomarkers and cut-offs values adapted to context of use are needed. Benefits of iron interventions on growth and development are indisputable and outweigh risks, which exist in populations with a high infectious burden. Indeed, pathogen growth may increase with enhanced available iron, calling for caution and preventive measures where malaria or other infections are prevalent. Most African countries programmatically fortify flour and supplement pregnant women, while iron deficiency in young children is rather addressed at individual level. Coverage and efficacy could improve through increased access for target populations, raised awareness and lower cost. More bioavailable iron forms, helping to decrease iron dose, or prebiotics, which both may lower risk of infections are attractive opportunities for Africa. Fortifying specific food products could be a relevant route, adapted to local context and needs of population groups while providing education and training. More globally, partnerships involving various stakeholders are encouraged, that could tackle all aspects of the issue.
来自九个国家的科学专家齐聚一堂,分享他们在非洲铁干预措施方面的观点和经验。不良饮食习惯、感染和寄生虫病是缺铁现象普遍存在的主要原因,但目前缺乏可靠且可在各国间进行比较的患病率估计数据:需要改进生物标志物以及根据使用环境调整临界值。铁干预措施对生长发育的益处是无可争议的,且大于风险,这些风险存在于感染负担较高的人群中。事实上,随着可利用铁的增加,病原体的生长可能会加快,这就需要在疟疾或其他感染流行的地区谨慎行事并采取预防措施。大多数非洲国家通过政策规定对面粉进行强化,并为孕妇提供补充剂,而幼儿缺铁问题则更多地在个体层面上加以解决。通过增加目标人群的可及性、提高认识和降低成本,可以提高覆盖率和效果。更多有助于减少铁剂量的生物可利用铁形式,或益生元,这两者都可能降低感染风险,对非洲来说是很有吸引力的机会。强化特定食品可能是一条合适的途径,既适应本地情况和人群需求,又能提供教育和培训。从更广泛的层面来看,鼓励建立涉及各利益相关方的伙伴关系,以解决该问题的所有方面。