1. How science and partnerships can improve the
agricultural and nutrition value chain - towards
delivering more nutritious foods for those in need.
Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany

2. Detection of micronutrient inadequacies and
how to compensate?
• Inadequate supply of micronutrients may have a
strong impact on health and development in
particular during pregenancy and childhood
• Early detection of dietary gaps are necessary to
optimize the diet and to avoid „hidden hunger“

3. Supply
Symptoms
No Subclinical/unspecific Clinical
Hidden Hunger describes the inadequate supply with
one or more essential nutrients (Vitamins, Minerals,
Trace elements, Amino acids)
Hidden hunger becomes „visible“ with the occurence of
clinical symptoms

4. Reasons: Missing sources (Liver, Eggs, pro-vitamin A).
Low stores at birth. Frequent diarrhoe (Zinc def.)
200 – 500 million children are vitamin A deficient. 5 million
per year get blind. High mortality in the first 5 years of live
(30-50%). How many children with inadequate intake?

5. S
Decline of vitamin A status without biochemical signs and occurence
of non-specific and specific symptoms
Clinical consequences
SYSTEMIC (unspecific) COMPLICATIONS
Increased mortality
due to infections
Increase of anemia/
growth retardation
OCULAR COMPLIKATIONS
Nightblindness
Ocular infections
Keratomalacia-Blindness
Vitamin-A-Status
Somer A., Nature Med. 1997
Hidden Hunger and consequences?

6. How to improve the nutrition value chain with
respect to miconutrients?
• Biochemical data or clinical signs document a more
or less severe deficiency of one or more
micronutrients.
• Prior deficiency signs an inadequate intake of
micronutrients affects health and development
• The composition of the diet and the micronutrient
gaps should be elucidated before clinical symptoms
of a deficiency occur!

7. Objectives for the developement of CIMI
(calculator for identification of micronutrient inadequacy)
Fast and easy analysis of micronutrient adequacy on basis of population
specific food groups
-> time and cost saving data collection and analysis
Comparison of the results to the reference values including the classification
of iron and zinc bioavailability
Self-explanatory presention of the results
-> visualisation of micronutient sources and deficits for health education
purposes

8. Calculation of macro- and micronutrient intake
classification of zinc and iron bioavailability
is based on dietary pattern
Program structureProgram structure
Total intake and % of FAO/WHO recommendations
of energy, protein, carbohydrates, fat, iron, zinc, vitamin A,
ß-carotene, retinol equivalents (1:6 and 1:12 conversion factor)
Food intake in grams per day
of a limited number of food groups
Electronic assessment of micronutrient
inadequacies on a population level

9. Algorithm for iron
Program structureBioavailability calculation
Classification to
15%, 12%, 10% or
5% of iron bioavailability
Software determines:
% of total energy intake is accounted for all starchy stables
% of total energy intake is accounted for protein from fish, eggs, dairy and meat
% of total energy intake is accounted for protein from fish and meat
…
Electronic assessment of micronutrient
inadequacies on a population level
Algorithm for zinc
Classification to
high, moderate or low zinc
bioavailability

10. Food survey data of target population
Data of the Indonesian Socio Economic Survey taken
among 68,800 public households in 2008
Program structureProgram development
Micronutrient density of extracted food groups
Calculation of
average nutrient
density per food
group based on
the typical food
composition
Electronic assessment of micronutrient
inadequacies on a population level

11. Program structureCIMI data input
Electronic assessment of micronutrient
inadequacies on a population level

12. Program structureCIMI data input
Electronic assessment of micronutrient
inadequacies on a population level

13. Program structureCIMI data input
Electronic assessment of micronutrient
inadequacies on a population level

14. Program structureCIMI data input
Electronic assessment of micronutrient
inadequacies on a population level

15. Program structureIndonesian children 4-6 years: nutrition data
Electronic assessment of micronutrient
inadequacies on a population level

16. Program structureIndonesian children 4-6 years: results in tables
Electronic assessment of micronutrient
inadequacies on a population level

17. Program structureIndonesian children 4-6 years: results in ring diagrams
Electronic assessment of micronutrient
inadequacies on a population level
Iron Zinc

18. Program structureIndonesian children 4-6 years: results in ring diagrams
Electronic assessment of micronutrient
inadequacies on a population level
Vitamin A

19. Females 20 – 52 years

20. 118 Children 1 – 3 years 128 Females 20 – 40 years
The distribution of the ratio of nutrient intake calculated by NS and CIMI
Validation of CIMI using Nutrisurvey programm as a control

21. Average intake of nutrients calculated by NS and CIMI and number and %
of indviduals below the threshold

22. The CIMI program can be used to
for a rough estimation of micronutrient gaps
in different age and sex groups
in different income groups
in different local dietary diversity
in different threshold aproaches
educate people how to compose a diet to reduce gaps
uncover food or food composition related to a specific
micronutrient
The CIMI program will not calculate a risk for deficiency or a level
of adequacy

23. Science and partnership to improve the nutrtion value chain
Electronic assessment of micronutrient
inadequacies on a population level
Micronutrient gaps which, to several reasons, cannot be closed via
optimization of the dietary pattern might be closed with fortified
food or with food with improved bioavailability of one or more
micronutrients.
But
We always must consider that a deficiency of a micronutient does
not mean that only this isolated micronutrient is missing in the diet.
It is the micronutrient containing food which is missing.
Consequently all the other essential micronutrients within that food
might be also missing.
Treatment of the symptom (isolated defciency) might be misleading

24. Thank you
for your attention