National Nutritional week (1st September to 7th September)
Eminent Author, Medical Biochemist and Scientist, Technical Education consultant.
AGD Biomedicals (Pvt) LTD. Andheri East, Mumbai.
According to the Food Safety and Standards Authority of India (FSSAI), (2012, December), preventable micronutrient deficiency is on the increase in India, since past two decades(1)(Ref. Q1). A significant proportion of deaths in young children worldwide is attributable to low weight-for-age, due to nutritional deficiencies(2,3) (Ref. Q2). Maternal anemia is associated with enhanced risk of stillbirth, neonatal deaths and low birth weight (LBW). Young children are especially vulnerable due to the irreversible effects of Iron Deficiency Anemia (IDA) on cognitive development(4,5). Routine determination of IVD tests could easily diagnose the nutritional deficiencies and indicate, whether advanced IVD tests are required to identify specific nutritional deficiencies(6, 7)(Ref. Q3). It is estimated that nearly one in three persons globally has at least the following one form of malnutrition: Vitamin deficiency, mineral deficiency, diet-related noncommunicable diseases, wasting disease or stunting(5)(Ref. Q3, 4).
Q1. What are the study results of the Food Safety and Standards Authority of India (FSSAI)?
ANS: FSSAI classified the study population groups into infants (0–5 years), adolescents (<18 years), adults (>18 years) and pregnant women. The estimated overall prevalence was 17% for iodine deficiency, 37% for folic acid deficiency, 54 % for iron deficiency, 53% for vitamin B12 deficiency, 19% for vitamin A deficiency and 61% for vitamin D deficiency(1). Despite years of iron supplementation programs, IDA remains a crucial public health issue in India, particularly for female. IDA is an obstacle to the economic advancement of the poor. The micronutrient deficiency risks increase; if anemia and underweight are present simultaneously. The health-damage suffered in the early life leads to permanent impairment, and also might affect future generations. Early diagnosis of nutritional deficiency can prevent an individual from the related long-term specific symptoms such as fatigue, headache, malice, loss of weight, shortness of breath, hair loss, and related immunocompromised conditions. FSSAI emphasized on the immediate need for the active public health interventions to address micronutrient deficiencies.
Q2. What parameters of Complete hemogram indicate micronutrient deficiencies?
ANS: The following Parameters of Complete hemogram indicate micronutrient deficiencies: Blood hemoglobin (Hb), RBC count, HCT (PCV), MCV, MCH, MCHC and RDW
| Parameters | Clinical Significance |
| 1) Low values of Hb, HCT | Anemia |
| 2) Low Values of MCV, MCH, MCHC, and Increased RDW | Iron Deficiency anemia |
| 3) High Values of MCV, MCH, MCHC and Normal RDW | Folic acid or Vitamin B12 Deficiency |
Q3. How fifth-generation advanced IVD tests have impacted fast and accurate diagnosis of micronutrient deficiencies?
ANS: Fifth-generation advanced automated chemistry analyzers have facilities for the determination of serum iron, ferritin, transferrin (for IDA), calcium, inorganic phosphorus and vitamin D (for rickets), magnesium and zinc (deficiency), iodine (hypothyroidism), vitamin A (night blindness, Xerophthalmia), folic acid vitamin B12 (megaloblastic anemia), and vitamin B12 (pernicious anemia). Multispeciality Clinical laboratories have advanced autoanalyzers for the generation of laboratory reports of micronutrients in blood in a day(6, 7) so that effective treatment on a specific micronutrient deficiency could be started early.
Q4. What are the recent innovations in IVD tests that have impacted the monitoring and management of nutritional deficiencies.
ANS: Fourth and fifth-generation advanced clinical laboratory tests are based on Microparticle Enzyme-Immunoassays (MEIA), Florescent Polarization Immunoassays (FPIA), High Performance Liquid Chromatography (HPLC) and some Point of care Tests (POCT) tests based on Immunochromatographic techniques are the recent advances that are used to generate Complete Body Profile tests in one day(6,7). Laboratory tests based on these techniques facilitate determination of micronutrients in terms of micrograms, nanograms, picograms to femtograms.
Q5. What is the impact of timely diagnosis of nutritional deficiencies on patient outcomes and overall healthcare costs?
ANS: The loss due to micronutrient deficiency costs India 1 percent of its GDP, which amounts to a loss of Rs. 27,720 crore every year in terms of illness, deaths, increased health care costs, and productivity(8,9). Every day, average 5,000-6000 children below the age of five die in India. Timely prevention of nutritional deficiencies will bring about important health, educational, and economic benefits(8,9).
AGD’s Semi & Fully Automatic Clinical Chemistry Analyzers and Hematology Analyzers are designed to enhance the accuracy and efficiency of diagnosing micronutrient deficiencies
References
(1) WHO. The double burden of malnutrition. Policy brief. Geneva: World Health Organization; 2017.
(2) “The Double Burden of Malnutrition”. The Lancet Commission. December 16, 2019. Retrieved January 17, 2022.
(3) Murarkar, S., Gothankar, J., Doke, P., Pore, P., Lalwani, S., Dhumale, G., Quraishi, S., Patil, R., Waghachavare, V., Dhobale, R., Rasote, K., Palkar, S. and Malshe, N., 2020. Prevalence and determinants of undernutrition among under-five children residing in urban slums and rural area, Maharashtra, India: a community-based cross-sectional study. BMC Public Health, 20(1).
(4) U. Venkatesh, Akash Sharma, Velmurugan A. Ananthan, Padmavathi Subbiah, R. Durga, and CSIR Summer Research training team, Micronutrient’s deficiency in India: a systematic review and meta-analysis. J Nutr Sci. 2021; 10.
(5) de Onis Mercedes, Blössner Monika, Black Robert E. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. The American Journal of Clinical Nutrition (July 2004), Pages 193-198.
(6) Godkar PB, Godkar DP. Medical Biochemistry, Theory and Practicals (1st edition, 2024), CBS Publishers, New Delhi,India.
(7) Godkar PB, Godkar DP. Text book of Medical laboratory technology (4th edition, 2024), Bhlani Publishers, Mumbai. India.
(8) Rafael Plessow, Narendra Kumar Arora, Beatrice Brunner, Christina Tzogiou, Klaus Eichler, Urs Brügger , Simon Wieser. Social Costs of Iron Deficiency Anemia in 6-59-Month-Old Children in India. PLoS One (2015) Aug 27;10(8).
(9) Alexander J Stein, Matin Qaim. Food and nutrition Bulletin, Vol 28, 202 (2007) USA.
