Berger Jacques, Roos Nanna, Greffeuille Valérie, Dijkhuizen Marjoleine, Wieringa Frank
Institute of Research for Development (IRD), UMR 204 Nutripass IRD/UM/SupAgro, Montpellier, France.
Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
Matern Child Health J. 2019 Jan;23(Suppl 1):79-85. doi: 10.1007/s10995-018-02730-z.
Objective The SMILING (Sustainable Micronutrient Interventions to Control Deficiencies and Improve Nutritional Status and General Health in Asia) project aimed at creating awareness and improving policies around micronutrient deficiencies in five Southeast Asian countries (Vietnam, Laos, Thailand, Cambodia and Indonesia). Results The project showed large gaps in recent data on micronutrient status in most of the five countries. By updating existing, or creating national food composition tables, the SMILING project enabled analyses of food consumption in women of reproductive age and young children. Linear programming showed a high risk for multiple micronutrient deficiencies in these groups, and especially in pregnant women. Most programs to improve micronutrient status target iodine, iron and vitamin A deficiency. However, the high prevalence of zinc, vitamin D, thiamine and folate deficiency in the region warrant interventions too. For certain micronutrients (zinc, iron, calcium), dietary changes alone appeared not enough to fulfill requirements. Food fortification was identified to be a sustainable, long-term solution to improve micronutrient intake. Multiple criteria mapping by stakeholders in each country resulted in a list of country-specific priority interventions. Surprisingly, food fortification was ranked low, due to concerns on quality control and organoleptic changes of the fortified food. More advocacy is needed for new, innovative interventions such as delayed cord clamping. Conclusions for practice The SMILING project recommends regular surveys to monitor micronutrient status of population, to measure impact of interventions and to guide nutrition policies.
目标 “微笑”（亚洲可持续微量营养素干预以控制缺乏症并改善营养状况和总体健康）项目旨在提高五个东南亚国家（越南、老挝、泰国、柬埔寨和印度尼西亚）对微量营养素缺乏问题的认识并完善相关政策。结果 该项目显示这五个国家中大多数国家近期微量营养素状况数据存在很大差距。通过更新现有的或编制国家食物成分表，“微笑”项目得以分析育龄妇女和幼儿的食物消费情况。线性规划显示这些群体，尤其是孕妇，存在多种微量营养素缺乏的高风险。大多数改善微量营养素状况的项目针对碘、铁和维生素A缺乏。然而，该地区锌、维生素D、硫胺素和叶酸缺乏的高患病率也需要进行干预。对于某些微量营养素（锌、铁、钙），仅靠饮食改变似乎不足以满足需求。食物强化被认为是提高微量营养素摄入量的可持续长期解决方案。每个国家的利益相关者通过多标准映射得出了一份各国特定的优先干预措施清单。令人惊讶的是，由于对强化食品质量控制和感官变化的担忧，食物强化的排名较低。对于延迟脐带结扎等新的创新干预措施，需要更多宣传。实践结论 “微笑”项目建议定期进行调查，以监测人群的微量营养素状况，衡量干预措施的影响并指导营养政策。
