Transcript Use of Multiple Micronutrients (Minerals and Vitamins) Preparations (Introduction) U.Tserendolgor MD,Ph.D, Sc.D

Use of Multiple Micronutrients (Minerals
and Vitamins) Preparations (Introduction)
U.Tserendolgor MD,Ph.D, Sc.D
NRC, PHI
ÎËÎÍ ÍÀÉÐËÀÃÀÒ ÁÈ×ÈË ÒÝÆÝÝÈÉÍ
ÁÝËÄÌÝËÈÉÍ ÒÓÕÀÉ ÒÀÍÈËÖÓÓËÃÀ,
À× ÕÎËÁÎÃÄÎË
ÖÝÐÝÍÄÎËÃÎÐ, ÀØÓ- íû äîêòîð
ÍÝÌÕ, ÕÑÒ
Magnitude of the Problem
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Vitamin and mineral deficiencies affect
a third of the world’s people and
account for an estimated 7.3% of the
global burden of disease.
ÁÈ×ÈË ÒÝÆÝÝËÈÉÍ ÄÓÒËÛÍ ÁÀÉÄÀË
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Õîð óðøèãòàéä òîîöîãäîæ áàéãàà ºâ÷í¿¿äèéí
7.3%- èéã àìèíäýì, ýðäñèéí äóòàëòàé
õîëáîîòîé ýìãýã ýçëýæ áàéíà.
Äýëõèéí õ¿í àìûí 3 õ¿í òóòìûí íýã íü áè÷èë
òýæýýëèéí äóòàëä ºðòºæ áàéíà.
Òºìºð, öàéð, èîä, À àìèíäýìèéí äóòàë
Magnitude of the Problem
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Recent WHO/UNICEF estimates suggest that the
number of children with iron deficiency and anemia is
approximately 750 million (UNICEF 2003).
In developing countries, it is estimated that more
than 40 to 50% of children less than 5 years of age
are iron deficient, primarily due to a diet inadequate
in bioavailable iron (UNICEF/MI 2004).
Micronutrient deficiencies are a form of malnutrition
caused by deficiencies of vitamins and minerals from
the diet that are essential for human health, growth
and development.
ÁÈ×ÈË ÒÝÆÝÝËÈÉÍ ÄÓÒËÛÍ
ÁÀÉÄÀË
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ÄÝÌÁ, ͯÁ-ÈÉÍ ÕÑ- èéí ñóäàëãààãààð öóñ
áàãàäàëòòàé áîëîí òºìðèéí äóòàëòàé õ¿¿õýä
750 ñàÿ (ͯÁ-èéí ÕÑ, 2003).
ÕªÃÆÈÆ ÁÓÉ ÎÐÍÓÓÄÀÄ 5 – ñ äîîø íàñíû
õ¿¿õäèéí 40-50% íü òºìðèéí äóòàëòàé
(òºìðèéí õýðýãöýýã õàíãàõ õîîë õ¿íñíèé
äóòàëòàé, ͯÁ-èéí ÕÑ, 2004).
Õîîë õ¿íñíýýñ àâàõ àìèíäýì, ýðäñèéí äóòàë íü
õ¿¿õäèéí ýð¿¿ë ìýíä , ºñºëò õºãæèëòºä
ñºð㺺ð íºëººëæ áàéíà.
MICRONUTORIENT DEFICIENCIES FOR
THE TARGET GROUP OF POPULATION
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Among the populations most vulnerable to micronutrient
malnutrition are infants, young children and pregnant
women due to their higher dietary requirements.
Children under two are particularly vulnerable to
micronutrient deficiencies.
This form of malnutrition is often a major public health
problem in populations in the developing world where the
availability of a diverse supply of foods is limited.
Common deficiencies among children include those of iron,
vitamin A, zinc and iodine.
ÁÈ×ÈË ÒÝÆÝÝËÈÉÍ ÄÓÒÀËÄ
ªÐÒªÌÕÈÉ Õ¯Í ÀÌÛÍ Á¯ËÝÃ
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ÍßËÕ, ÁÀÃÀ ÍÀÑÍÛ Õ¯¯ÕÝÄ, èõýâ÷ëýí
2 – ñ äîîø íàñíû õ¿¿õýä
ÆÈÐÝÌÑÝÍ ÝÌÝÃÒÝÉׯ¯Ä
Õºãæèæ áóé îðíóóäûí íèéãìèéí ýð¿¿ë
ìýíäèéí áýðõøýýëòýé àñóóäàë áîëäîã.
NEW PRODUCTS
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Numerous new and innovative products to young
children ranging from multiple micronutrient
powders (Sprinkles,Vitashakti, Anuka, MixMe),
spreads (Nutributter, Plumpynut), and crushable
tablets (Foodlet).
One of those newly developed interventions involves
the use of MNPs to fortify and improve the quality of
complementary foods prepared at home which
contain a mix of microencapsulated iron and other
micronutrients in a tasteless power form.
ØÈÍÝ ÁÝËÄÌÝË: ÁÈ×ÈË ÒÝÆÝÝËÈÉÍ
ÕÎËÈÌÎÃ
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Sprinkles
Vitashakti
Anuka
MixMe
TopNutri
MMPs – èéã ãýðèéí íºõöºëä áýëòãýñýí
õ¿¿õäèéí íýìýãäýë õîîëîíä õîëüæ õýðýãëýíý.
Õ¿¿õäèéí íýìýãäýë õîîëíû ÷àíàðûã
ñàéæðóóëíà.
Composition of Multimicronutrient
Micronutrients
Vitamins
A (µg )
D (µg )
E (mg )
C (mg )
B1 (mg )
B2 (mg )
B3 (mg )
B6 (mg )
B12 (µg )
Folic acid (µg )
Minerals
Iron (mg )
Zinc (mg )
Cu (mg )
Selenium (µg )
Iodine (µg )
Pregnant and Lactating
women
Children under 5
800.0
5.0
5.0
30.0
0.5
0.5
6.0
0.5
0.9
150.0
400
5.0
5.0
30
0.5
0.5
6.0
0.5
0.9
150.0
10.0
4.1
0.56
17.0
90.0
10.0
4.1
0.56
17.0
90.0
Importance
Anemia reduction and decrease the
prevalence of other micronutrient
deficiencies.
 Improve the quality of complementary
food.
 Improved growth and mental
development of children
• Improved immune of tissue.
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À× ÕÎËÁÎÃÄÎË
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Öóñ áàãàäàëò áîëîí áóñàä áè÷èë òýæýýëèéí
äóòëûã áóóðóóëàõ
Õ¿¿õäèéí íýìýãäýë õîîëíû ÷àíàðûã
ñàéæðóóëàõ
Áèåèéí ýñýðã¿¿öëèéã ñàéæðóóëàõ
Õ¿¿õäèéí ºñºëò, õºãæèëòèéã ñàéæðóóëàõ
Õ¿¿õäèéí îþóí óõààíû õºãæëèéã
ñàéæðóóëàõ
Advantages of MNPs
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MNPs can provide the Recommended Nutrient Intake of
micronutrients to each child.
Aside from iron, essential micronutrients such as vitamins A,
C and D, folic acid, iodine and zinc can be added to the
sachets to prevent and treat micronutrient deficiencies and
improve overall nutritional status.
Lipid encapsulation of the iron prevents its interaction with
food and masks its taste, thus there are minimal changes to
taste, colour or texture of the food to which MNPs are
added. Encapsulation may also reduce gastrointestinal
discomport and interaction of iron witn other nutrients.
Äàâóó òàë
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ÁÒÕ – èéí íàéðëàãà äàõü áîäèñóóä íü
õîíîãèéí õîîë õ¿íñíýýñ àâáàë çîõèõ
áîäèñóóäûí çºâëºìæ õýìæýýãýýð õ¿¿õýä
á¿ðèéã õàíãàíà.
Òºìºð, À,Ñ, Ä àìèíäýì, ôîëèéí õ¿÷ëèéí
çýðýãöýýãýýð óóòòàé áýëäìýëä öàéðûã
íýìñýí áºãººä áè÷èë òýæýýëèéí äóòëûã
ýì÷ëýõ, ñýðãèéëýõ íºëººòýé áºãººä õîîë
òýæýýëèéí áàéäëûã åðºíõèéä íü
ñàéæðóóëàõ áîëîìæòîé þì.
Advantages of MNPs
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The sachets are easy to use and convenient. No
special measuring utensils or handling is required
and they can be given at any mealtime during the
day. One does not have to be literate to learn how
to use them.
The use of MNPs does not require any change in
food practices as it can be mixed with home-mad
foods. They do not conflict with breast-feeding and
can help promote the timely transition from
exclusive breast-feeding to complementary foods at
6 months of age as recommended by the WHO.
Äàâóó òàë
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ÁÒÕ äàõü òºìºð íü ëèïèäýí á¿ðõ¿¿ë
òýé òóë òºìºð íü õîîë õ¿íñíèé áîäèñòîé
õàðèëöàí óðâàëä îðîõ, õîîëíû àìò, ºíãº,
¿íýðèéã ººð÷ëºõ íü ìàø áàãà áàéäàã.
Ëèïèäèéí á¿ðõ¿¿ë íü õîäîîä ãýäýñíèé õÿìðàë
áîëîí òºìºð íü õîîë òýæýýëèéí áóñàä áîäèñòîé
õàðèëöàí óðâàëä îðîõûã áóóðóóëíà.
Advantages of MNPs
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MNPs are a food-based rather than a
medical intervention and thus can be easily
incorporated into any feeding schedule.
The potential for overdose is unlikely
because numerous individual packages
would have to be opened and ingested for
this to occur (an infant would need to
consume many packages (approximately
20) to reach toxicity levels).
Äàâóó òàë
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Ǻâõºí íýã óäàà õýðýãëýõ õýìæýýãýýð
ñàâëàãäñàí óóòòàé áýëäìýëèéã õýðýãëýõýä
àìàðõàí áºãººä òîõèîìæòîé þì.Èéìä õîîëíû
öàãààð ò¿¿íèéã õýðýãëýõýä òóñãàéëàí
õýìæèõ áàãàæ õýðýãñýë áîëîí íýìýëò
àæèëëàãàà øààðäàãääàõã¿é þì. ̺í óã
áýëäìýëèéã õýðõýí õýðýãëýõ òàëààð
òóñãàéëàí ñóðàëöàõ øààðäëàãàã¿é þì.
Advantages of MNPs
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The sachets are lightweight and thus are
simple to store, transport and distribute.
MNPs have long shelf-life, even in hot or
humid conditions (2 years).
The cost of MNPs is not excessive (0.0150.035 US$ per sachet depending on volume
produced and site of production).
Äàâóó òàë
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ÁÒÕ- èéã ãýðò áýëòãýñýí õîîëîíä
õîëüæ õýðýãëýõýä õ¿¿õäèéí õîîëëîëòûí
áàéäëûã ººð÷ëºõ øàëòãààí áîëîõã¿é þì.
̺í õºõººð õîîëëîëò áîëîí ÄÝÌÁ- ûí
çºâëºìæèéí äàãóó õ¿¿õäèéã 6
ñàðòàéãààñ íü íýìýãäýë õîîëîíä
îðóóëàõàä ñààä áîëîõã¿é þì.
Äàâóó òàë
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ÁÒÕ- ûí õýðýãëýý íü áàãà íàñíû õ¿¿õäèéã
õîîëîõ äàäàëä ñóóðèëñàí òóë ýìèéí áîëîí
ýì÷èëãýýíèé àðãà õýðýãñýë áîëîõã¿é þì.
ÁÒÕ- ûã íýã óäààä õýðýãëýõ õýìæýýãýýð
òóñãàé óóòàíä ñàâëàñàí òóë õýòð¿¿ëýí
õýðýãëýõ, óëìààð õîðäëëîãî ¿¿ñãýõ ýðñäýë
ìàø áàãà þì. Íÿëõàñ, áàãà íàñíû õ¿¿õýä íýã
äîð 200 óóò áýëäìýë õýðýãëýñýí òîõèîëäîëä ë
õîðäëîãî áîëîõ ýðñäýë ¿¿ñíý.
Äàâóó òàë
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ÁÒÕ- íü ìàø õºíãºí æèíòýé òóë ò¿¿íèéã
òýýâýðëýõ, õàäãàëàõ, ò¿ãýýõýä õÿëáàð þì.
Ò¿¿íèé õàäãàëàëòûí õóãàöàà óðò áºãººä
õàëóóí, õ¿éòýí àëü ÷ íºõöºëä ÷àíàð íü ìóóäàõ
ýðñäýë áàãà þì.
ÁÒÕ – íü õÿìäõàí (¯éëäâýðëýëèéí
õýìæýýíýýñ õàìààðààä íýã óóò íü 0.0150.035$.)
CONSIDERATION
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Under UNICEF’ s current Medium Term
Strategic Plan (2008-2011), UNICEF is
to prioritize programme scale up,
document sucesses and lessons
learned, and measure results in a way
which could further inform and improve
programm scale-up.
Õàíäëàãà
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ͯÁ- èéí ÕÑ- èéí äóíä õóãàöààíû
ïðîãðàììûí õ¿ðýýíä (2008-2011) ÁÒÕ- ð
õàíãàõ ïðîãðàììûã õýðýãæ¿¿ëýõ
çîðèëãîòîé áàéãàà.