Use of Multiple Micronutrients (Minerals and Vitamins) Preparations (Introduction)

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Use of Multiple Micronutrients (Minerals and
Vitamins) Preparations (Introduction)

• U.Tserendolgor MD,Ph.D, Sc.D
• NRC, PHI

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ÎËÎÍ ÍÀÉÐËÀÃÀÒ ÁÈÈË ÒÝÆÝÝÈÉÍ ÁÝËÄÌÝËÈÉÍ ÒÓÕÀÉ
ÒÀÍÈËÖÓÓËÃÀ, À ÕÎËÁÎÃÄÎË

• ÖÝÐÝÍÄÎËÃÎÐ, ÀØÓ- íû äîêòîð
• ÍÝÌÕ, ÕÑÒ

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Magnitude of the Problem

• Vitamin and mineral deficiencies affect a third
  of the worlds people and account for an
  estimated 7.3 of the global burden of disease.

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ÁÈÈË ÒÝÆÝÝËÈÉÍ ÄÓÒËÛÍ ÁÀÉÄÀË

• Õîð óðøèãòàéä òîîöîãäîæ áàéãàà ºâíäèéí 7.3-
  èéã àìèíäýì, ýðäñèéí äóòàëòàé õîëáîîòîé ýìãýã
  ýçëýæ áàéíà.
• Äýëõèéí õí àìûí 3 õí òóòìûí íýã íü áèèë
  òýæýýëèéí äóòàëä ºðòºæ áàéíà.
• Òºìºð, öàéð, èîä, À àìèíäýìèéí äóòàë

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Magnitude of the Problem

• 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.

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ÁÈÈË ÒÝÆÝÝËÈÉÍ ÄÓÒËÛÍ ÁÀÉÄÀË

• ÄÝÌÁ, ÍÁ-ÈÉÍ ÕÑ- èéí ñóäàëãààãààð öóñ
  áàãàäàëòòàé áîëîí òºìðèéí äóòàëòàé õõýä 750 ñàÿ
  (ÍÁ-èéí ÕÑ, 2003).
• ÕªÃÆÈÆ ÁÓÉ ÎÐÍÓÓÄÀÄ 5 ñ äîîø íàñíû õõäèéí
  40-50 íü òºìðèéí äóòàëòàé (òºìðèéí õýðýãöýýã
  õàíãàõ õîîë õíñíèé äóòàëòàé, ÍÁ-èéí ÕÑ, 2004).
• Õîîë õíñíýýñ àâàõ àìèíäýì, ýðäñèéí äóòàë íü
  õõäèéí ýðë ìýíä , ºñºëò õºãæèëòºä ñºð㺺ð
  íºëººëæ áàéíà.

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MICRONUTORIENT DEFICIENCIES FOR THE TARGET GROUP
OF POPULATION

• 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.

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ÁÈÈË ÒÝÆÝÝËÈÉÍ ÄÓÒÀËÄ ªÐÒªÌÕÈÉ ÕÍ ÀÌÛÍ ÁËÝÃ

• ÍßËÕ, ÁÀÃÀ ÍÀÑÍÛ ÕÕÝÄ, èõýâëýí 2 ñ äîîø
  íàñíû õõýä
• ÆÈÐÝÌÑÝÍ ÝÌÝÃÒÝÉÄ
• Õºãæèæ áóé îðíóóäûí íèéãìèéí ýðë ìýíäèéí
  áýðõøýýëòýé àñóóäàë áîëäîã.

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NEW PRODUCTS

• 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.

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ØÈÍÝ ÁÝËÄÌÝË ÁÈÈË ÒÝÆÝÝËÈÉÍ ÕÎËÈÌÎÃ

• Sprinkles
• Vitashakti
• Anuka
• MixMe
• TopNutri
• MMPs èéã ãýðèéí íºõöºëä áýëòãýñýí õõäèéí
  íýìýãäýë õîîëîíä õîëüæ õýðýãëýíý. Õõäèéí
  íýìýãäýë õîîëíû àíàðûã ñàéæðóóëíà.

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Composition of Multimicronutrient
Micronutrients Pregnant and Lactating women Children under 5
Vitamins A (µg ) D (µg ) E (mg ) C (mg ) B1 (mg ) B2 (mg ) B3 (mg ) B6 (mg ) B12 (µg ) Folic acid (µg ) 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
Minerals Iron (mg ) Zinc (mg ) Cu (mg ) Selenium (µg ) Iodine (µg ) 10.0 4.1 0.56 17.0 90.0 10.0 4.1 0.56 17.0 90.0
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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

• Öóñ áàãàäàëò áîëîí áóñàä áèèë òýæýýëèéí äóòëûã
  áóóðóóëàõ
• Õõäèéí íýìýãäýë õîîëíû àíàðûã ñàéæðóóëàõ
• Áèåèéí ýñýðãöëèéã ñàéæðóóëàõ
• Õõäèéí ºñºëò, õºãæèëòèéã ñàéæðóóëàõ
• Õõäèéí îþóí óõààíû õºãæëèéã ñàéæðóóëàõ

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Advantages of MNPs

• 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.

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Äàâóó òàë

• ÁÒÕ èéí íàéðëàãà äàõü áîäèñóóä íü õîíîãèéí õîîë
  õíñíýýñ àâáàë çîõèõ áîäèñóóäûí çºâëºìæ
  õýìæýýãýýð õõýä áðèéã õàíãàíà.
• Òºìºð, À,Ñ, Ä àìèíäýì, ôîëèéí õëèéí
  çýðýãöýýãýýð óóòòàé áýëäìýëä öàéðûã íýìñýí áºãººä
  áèèë òýæýýëèéí äóòëûã ýìëýõ, ñýðãèéëýõ íºëººòýé
  áºãººä õîîë òýæýýëèéí áàéäëûã åðºíõèéä íü
  ñàéæðóóëàõ áîëîìæòîé þì.

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Advantages of MNPs

• 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.

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Äàâóó òàë

• ÁÒÕ äàõü òºìºð íü ëèïèäýí áðõë
• òýé òóë òºìºð íü õîîë õíñíèé áîäèñòîé
  õàðèëöàí óðâàëä îðîõ, õîîëíû àìò, ºíãº, íýðèéã
  ººðëºõ íü ìàø áàãà áàéäàã. Ëèïèäèéí áðõë íü
  õîäîîä ãýäýñíèé õÿìðàë áîëîí òºìºð íü õîîë
  òýæýýëèéí áóñàä áîäèñòîé õàðèëöàí óðâàëä îðîõûã
  áóóðóóëíà.

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Advantages of MNPs

• 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).

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Äàâóó òàë

• Ǻâõºí íýã óäàà õýðýãëýõ õýìæýýãýýð ñàâëàãäñàí
  óóòòàé áýëäìýëèéã õýðýãëýõýä àìàðõàí áºãººä
  òîõèîìæòîé þì.Èéìä õîîëíû öàãààð òíèéã
  õýðýãëýõýä òóñãàéëàí õýìæèõ áàãàæ õýðýãñýë áîëîí
  íýìýëò àæèëëàãàà øààðäàãääàõãé þì. ̺í óã
  áýëäìýëèéã õýðõýí õýðýãëýõ òàëààð òóñãàéëàí
  ñóðàëöàõ øààðäëàãàãé þì.

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Advantages of MNPs

• 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 (0.015-0.035
  US per sachet depending on volume produced and
  site of production).

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Äàâóó òàë

• ÁÒÕ- èéã ãýðò áýëòãýñýí õîîëîíä õîëüæ õýðýãëýõýä
  õõäèéí õîîëëîëòûí áàéäëûã ººðëºõ øàëòãààí
  áîëîõãé þì. ̺í õºõººð õîîëëîëò áîëîí ÄÝÌÁ- ûí
  çºâëºìæèéí äàãóó õõäèéã 6 ñàðòàéãààñ íü
  íýìýãäýë õîîëîíä îðóóëàõàä ñààä áîëîõãé þì.

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Äàâóó òàë

• ÁÒÕ- ûí õýðýãëýý íü áàãà íàñíû õõäèéã õîîëîõ
  äàäàëä ñóóðèëñàí òóë ýìèéí áîëîí ýìèëãýýíèé àðãà
  õýðýãñýë áîëîõãé þì.
• ÁÒÕ- ûã íýã óäààä õýðýãëýõ õýìæýýãýýð òóñãàé
  óóòàíä ñàâëàñàí òóë õýòðëýí õýðýãëýõ, óëìààð
  õîðäëëîãî ñãýõ ýðñäýë ìàø áàãà þì. Íÿëõàñ, áàãà
  íàñíû õõýä íýã äîð 200 óóò áýëäìýë õýðýãëýñýí
  òîõèîëäîëä ë õîðäëîãî áîëîõ ýðñäýë ñíý.

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Äàâóó òàë

• ÁÒÕ- íü ìàø õºíãºí æèíòýé òóë òíèéã òýýâýðëýõ,
  õàäãàëàõ, òãýýõýä õÿëáàð þì. Òíèé õàäãàëàëòûí
  õóãàöàà óðò áºãººä õàëóóí, õéòýí àëü íºõöºëä
  àíàð íü ìóóäàõ ýðñäýë áàãà þì.
• ÁÒÕ íü õÿìäõàí (éëäâýðëýëèéí õýìæýýíýýñ
  õàìààðààä íýã óóò íü 0.015-0.035.)

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CONSIDERATION

• 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.

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Õàíäëàãà

• ÍÁ- èéí ÕÑ- èéí äóíä õóãàöààíû ïðîãðàììûí
  õðýýíä (2008-2011) ÁÒÕ- ð õàíãàõ ïðîãðàììûã
  õýðýãæëýõ çîðèëãîòîé áàéãàà.