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Department of Human Nutrition
PO Box 56
University of Otago
Dunedin 9001
New Zealand
E-mail: rosalind.gibson{at}stonebow.otago.ac.nz
This book, a result of a Nestle Nutrition Workshop on micronutrient deficiencies in the first 6 mo of life, contains 16 chapters written by experts in their fields. The first 3 chapters provide excellent background overviews, including up-to-date summary tables. Chapter 1 summarizes biochemical tests for assessing the micronutrient status of both infants and mothers. Chapter 2 highlights uncertainties surrounding the dietary reference intakes of young infants and future research needs; examples for 3 micronutrients of special public health significance in developing countries—vitamin A, iron, and zinc—are provided. Chapter 3 addresses the micronutrient adequacy of the diets of young infants. The paucity of data on the extent to which undernourished women can supply their exclusively breastfed infants with the recommended amounts of the high risk micronutrients, namely, thiamine, riboflavin, selenium and vitamins A, B-6, B-12, and C is highlighted. This adequacy assessment considers both the micronutrient content of breast milk and the volume consumed and involves a discussion of the possible strategies for increasing the delivery of these micronutrients.
Five chapters deal with the etiology, health consequences, and prevention of individual deficiencies of iodine, vitamin A, zinc, vitamin K, or vitamin D during early infancy. A chapter on selenium and vitamin E focuses on host defense and resistance to infection. A chapter on iron emphasizes the relation between maternal deficiency and infant health outcomes, specifically birth weight, prematurity, anemia, and mortality. The multiple causes of anemia are the focus of a separate chapter. Three other chapters cover the effects of multimicronutrient supplements either during periconception, when the emphasis is on reducing the risk of birth defects, or in later pregnancy, when infant outcomes amenable to prenatal multimicronutrient interventions are highlighted. These interventions can have both positive and negative effects; therefore, a cautionary note is included on the universal use of multimicronutrient supplements under circumstances in which the effects on public health are not well understood. The effects of iron or iodine deficiency during pregnancy and early infancy on mental and psychomotor development are described in another chapter.
Of special interest is a chapter that emphasizes the special micronutrient needs of preterm infants to ensure adequate enteral and parenteral intakes of iron, zinc, copper, selenium, chromium, iodine, and manganese. In addition, there is an important chapter on the role of micronutrient status in modulating fetal and child health in the presence of HIV infection, with emphasis on deficiencies of vitamin A, zinc, and selenium. Inconsistencies in the results of randomized controlled trials of micronutrients in relation to micronutrient supplementation during pregnancy and the risk of vertical transmission are highlighted, as are fetal outcomes such as low birth weight, prematurity, and fetal death; the need for more research is emphasized.
Although the chapters differ in style and approach, this book is a useful integrated resource that provides health professionals with an excellent update of an important and often overlooked area. Micronutrient deficiencies in young infants are difficult to identify because of their often subtle but sometimes irreversible health consequences, a point that is emphasized in the verbatim discussion that follows each chapter.