Nutritional and Health-Related Environmental Studies (NAHRES)

Co-ordinated Research Projects

CRP Number: E4.30.30 
CRP Title: Optimising nuclear techniques to assess vitamin A status and the risk of excess vitamin A intakes due to multiple vitamin A programmes
Objective: The proposed CRP will contribute to a better understanding of the appropriate use of the stable isotope dilution technique to assess vitamin A status across the continuum from deficiency to toxicity in children under the age of 5 years. The findings will provide guidance for programme managers and public health nutrition policy makers to improve the evaluation of their vitamin A programmes, in particular in countries where multiple vitamin A interventions are in place, and enable them to improve national nutrition strategies and plans. The combination of malnutrition, including micronutrient malnutrition, and infectious diseases is the most prevalent and preventable public health problem in the world; responsible for millions of deaths annually, particularly in infants and children. Infections affect nutritional biomarkers making it difficult to assess the real magnitude of some nutritional problems, for example vitamin A deficiency. Vitamin A is involved in numerous physiological processes essential for normal growth and development, the immune system, the visual system, and other functions in the human body. Vitamin A deficiency is a major nutritional concern in low-resource households in low-income countries. Vitamin A fortified foods such as sugar, margarine, vegetable oil, milk, and wheat flour as well as micronutrient powders and supplements, have been used as a complementary approach. The potential risk of excess vitamin A intake is increased due to a lack of coordination to avoid overlap of intervention coverage. Additionally, assessing vitamin A status, and the effectiveness of government interventions, is challenging in settings where infectious diseases and micronutrient deficiencies are endemic, as in most low-income countries. The isotope dilution technique, which will be used in this CRP, is among the most accurate techniques for assessing total body vitamin A pool size in individuals. However, it is not known whether the method is valid under conditions of hypervitaminosis A, inflammation and selected micronutrient deficiencies. Therefore, this CRP will address methodological issues in the application of the stable isotope dilution technique to accurately determine vitamin A stores in children and thus, provide important new knowledge on optimising the stable isotope dilution technique for the assessment of vitamin A status. The CRP will be complementary to a grant of the Bill & Melinda Gates Foundation that assesses the risk of vitamin A toxicity due to large scale food fortification and other interventions with the University of Newcastle as grantee.
Number of RCMs: 0
Year of Commencement: 2015
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CRP Number: E4.30.29
CRP Title: Using nuclear techniques to assess the role of nutrition-sensitive agri-food systems in improving diet, health and nutritional status of vulnerable populations
Objective: Malnutrition is a significant public health problem in low- and middle-income countries. It includes both undernutrition, especially among women and children, as well as overnutrition, leading to overweight and obesity. Improving health and nutrition of vulnerable populations will require not only direct “nutrition-specific” interventions, but also indirect “nutrition-sensitive” action addressing the underlying determinants of nutrition and inputs from multiple sectors. Nutrition-sensitive, biodiverse, and sustainable agri-food systems improve nutritional status through increased access to and consumption of high quality diets; however there is a need for further research in this area that includes rigorous design and appropriate measurement techniques for assessing health and nutritional impacts. Body composition divides weight into fat mass and fat-free mass and, compared to total body weight, will provide a more sensitive means of assessing changes in nutritional status in response to nutrition-sensitive agricultural interventions and changes in consumption. It can thus help to improve or optimize intervention strategies and understand the impact of dietary transitions. The deuterium dilution stable isotope technique, which will be used in this CRP, is among the most accurate techniques for assessing body composition. It involves the estimation of fat-free mass by measuring total body water (TBW) and provides reliable information on changes in body composition in individuals. This CRP will provide important information on the role of structural outcome measures such as body composition in understanding the link between agriculture and nutrition and in strengthening the evidence in support of nutrition-sensitive agricultural policies and practices. Studies to be included in this CRP may be stand-alone projects, or, perhaps more appropriately, build on existing research agendas (e.g. added on to a larger study). Doctoral students are encouraged to participate. The CRP will contribute to better understanding of the effect of nutrition-sensitive agri-food systems on the diet, health, and nutritional status of vulnerable populations. These findings will inform stakeholders influencing public health and agricultural policies in the design of effective interventions to combat malnutrition in all its forms.
Number of RCMs: 0
Year of Commencement: 2013
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CRP Number: E4.30.28.
CRP Title: Doctoral CRP on Longitudinal measures of body composition of healthy infants and young children up to 2 years of age using stable isotope techniques
Objective: It is now recognised that adequate growth during the period from conception to two years of age is crucial to decreasing the risk of ill-health in later life; the concept of developmental origins of disease. Despite this recognition there is a paucity of data of what constitutes normal growth beyond simple anthropometric measurements of weight and height. These measures do not capture the “quality” of growth in terms of body composition, the relative amounts of fat and lean tissue. Two individuals can have the same weight and height but differ markedly in the proportions of fat and lean and hence risk of non-communicable diseases in later life. Unfortunately information on changes in body composition during the first two years of life is lacking. Although measurement of body composition in the infant can be challenging, it can be accomplished by using isotopic procedures. The IAEA has been a leader in this area, developing and promoting the use of standardised protocols for body composition assessment using such techniques. The overall aim of this CRP is to use this knowledge to assess longitudinal changes in body composition that occur in healthy infants and children up to age two years. This will contribute new information on growth of healthy infants and young children. This CRP has a strong focus on training and education and will contribute to capacity building in nuclear techniques in nutrition by training of PhD students in developing countries.
Number of RCMs: 0
Year of Commencement: 2012
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CRP Number: E4.30.26
CRP Title: Doctoral CRP on stable isotope techniques to assess intake of human milk and body composition of infants and young children up to 2 years of age
Objective: Exclusive breastfeeding for 6 months, followed by the introduction of appropriate complementary foods and continued breastfeeding, as recommended by the World Health Organization and UNICEF (1), are cornerstones in infant nutrition. However, only limited information is available on the quantities of human milk consumed and the time of introduction of other foods into the infants’ diet, in particular in developing countries. The lack of information is, at least partly, due to the difficulties involved in measuring intake of human milk. By conventional technique, infants are weighed before and after each feed, “test weighing”. This technique is obviously time consuming and may disturb the normal feeding pattern. These practical problems can be overcome by using a stable isotope technique, the deuterium-oxide turnover method, as the normal feeding pattern is not influenced and the total volume of human milk, consumed by the baby over a period of 14 days, is measured. In addition, information about whether the infant has consumed water from other sources than human milk (representing intake of complementary foods or fluids) and the lactating mother’s body composition can be assessed based on total body water content. Furthermore, stable isotope technique can be used to evaluate the influence of feeding patterns on body composition of children during the first 2 years of life to contribute new information on the link between infant feeding and later risk of ill health. The overall aim of this CRP is to contribute new information on infant feeding practices and the influence of early feeding on body composition of young children in different settings. This CRP has a strong focus on training and education and will contribute to capacity building in nuclear techniques in nutrition by training of PhD students in developing countries.
Number of RCMs: 0
Next RCM: 2012
Year of Commencement: 2011
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CRP Number: E4.30.27
CRP Title: Using nuclear techniques to develop and evaluate food-based strategies to prevent micronutrient deficiencies in young children
Objective: Maternal and child nutrition during pregnancy and up to two years of age are critical for a child’s future. Appropriate feeding practices are essential for achieving optimal child growth, development and health. The World Health Organization and UNICEF recommend exclusive breastfeeding for the first six months of life and thereafter, infants should be given nutritionally adequate and safe complementary foods while breastfeeding continues up to the age of two years or beyond. In contrast to the high nutritional requirements in the first two years of life, traditional complementary foods in low-income countries are low in nutrient density. These foods are predominantly plant-based and generally monotonous with high contents of phytic acid and phenolic compounds, but negligible quantities of animal source foods or fruits and vegetables rich in ascorbic-acid, vitamin A and provitamin A carotenoids. They provide insufficient bioavailable amounts of key nutrients such as iron, zinc and vitamin A. Besides, the concentration of certain nutrients can be low in human milk due to mothers’ poor status and low intake. The proposed CRP will contribute new knowledge on dietary diversification and modification approaches that optimize trace element bioavailability and increase trace element and vitamin density to enhance the nutrient intake from plant-based local complementary foods and human milk. Stable isotope methods will be used to evaluate trace element bioavailability, zinc and vitamin A status and infants’ human milk intake. The overall goal is to contribute to the design of effective, feasible and sustainable interventions based on locally available foods that help prevent micronutrient deficiencies of infants and young children.
Number of RCMs: 0
Next RCM: 2011
Year of Commencement: 2011
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CRP Number: E4.30.24
CRP Title: Nuclear techniques to assess body composition in children and adolescents as a risk factor in the development of chronic diseases
Objective: The World Health Organisation (WHO) has highlighted childhood obesity as one of the most serious health challenges of the 21st century. Obese children are at greater risk of non-communicable diseases, such as cardiovascular disease, diabetes and stroke in adulthood. Rapid urbanisation, unhealthy diet and increasingly sedentary lifestyle have contributed to the increasing prevalence of childhood and adolescent obesity, which has become a growing public health concern also in low- to middle-income countries. IAEA has recently supported a CRP and Regional TC Projects in Asia and Latin America, which focused on body fat and metabolic risk in children, and evaluation of healthy eating and physical activity interventions. There is now the opportunity to perform follow-on studies to obtain longitudinal data in the same children, in line with the recommendations of the International Diabetes Federation, and to initiate new studies aimed at evaluating lifestyle interventions targeted at obese children and adolescents. Stable isotope techniques are the reference methods of assessing body composition and total daily energy expenditure in the community setting. The overall goal of the proposed CRP is to contribute new information regarding the body composition, metabolic health and energy expenditure of children and adolescents to assist public health policy makers in the design and evaluation of interventions aimed at reducing childhood obesity and hence reducing longer-term health risks.
Number of RCMs: 0
Next RCM: 2010
Year of Commencement: 2010
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CRP Number: E4.30.25.
CRP Title: Stable isotope techniques to design effective food fortification strategies in settings with high Helicobacter pylori infection
Objective: H. pylori infection is the most common bacterial infection in humans with particularly high prevalence in developing countries. Acquisition takes place in early childhood and persists life-long. Most individuals are asymptomatic, however, there is evidence that gastric acid output is reduced which affects the solubility of essential micronutrients and limits their absorption. Limited absorption of non- water-soluble compounds might compromise the effectiveness of food fortification programs, because these programs often use iron and zinc compounds that are soluble in diluted acid, but not in water. Thus, in particular, in the context of high rates of infectious diseases and malnutrition, H. pylori infection presents an additional burden to vulnerable population groups. The proposed CRP will evaluate the effect of H. pylori infection on gastric acid secretion and on iron and zinc absorption from different fortification compounds. The [13C] Urea Breath Test will be used for the diagnosis of H. pylori infection and stable isotope techniques will be used to provide information on absorption of iron and zinc from compounds with different physical and chemical properties. Study participants with diagnosed H. pylori infection will be treated thereafter. Results will be disseminated to different stakeholders, including policy makers. The overall goal of the proposed CRP is to contribute evidence of how H. pylori infection affects iron and zinc absorption from fortification compounds in asymptomatic individuals in developing countries. This will assist public health policy makers in designing effective food fortification strategies using bioavailable compounds to address micronutrient deficiencies. In general, food fortification with iron and zinc is highly cost effective and of particular importance to developing countries, where the degree of micronutrient deficiency is high.
Number of RCMs: 0
Next RCM: 2011
Year of Commencement: 2010
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CRP Number: E4.30.23
CRP Title: Stable isotope techniques in the development and monitoring of nutritional interventions for infants and children with malaria, TB and other infectious diseases
Objective: Malnutrition is a contributing factor in approximately half of the deaths of young children in developing countries that are attributed to infectious diseases such as acute respiratory infections, diarrhoeal diseases, and malaria. A better understanding is needed for developing and evaluating appropriate nutritional care for infants and children in endemically infectious areas. Mortality from tuberculosis (TB) is on the increase, especially in association with HIV infection, and poverty, partly reflecting poor nutrition, is the strongest risk factor for childhood TB infection. Recent unexpected findings suggest that micronutrient supplementation in accordance with previously established guidelines may have adverse effects in regions where malaria is endemic, and more information is needed on the best way to manage nutritional deficiencies in such regions. The overall objective of this CRP is to contribute to development or monitoring of practices for improving the nutrition of infants and young children at high risk of infectious diseases such as malaria and tuberculosis.
Number of RCMs: 1
Next RCM: 2011
Year of Commencement: 2009
Number of Contract Holders: 7
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CRP Number: E4.10.15
CRP Title: Stable isotope technique to assess human milk intake in infants living in contaminated areas
Objective: The World Health Organization (WHO) recommends that infants should be exclusively breastfed for the first six months of life, followed by the introduction of appropriate complementary foods and continued breastfeeding for up to two years to achieve optimal growth, development and health. Paediatricians and policy makers agree that protection, promotion and support of breastfeeding are a public health priority. WHO classifies exclusively breastfed infants as receiving human milk and nothing else. Predominantly breastfed infants receive human milk and small amounts of other fluids (teas, water or juice) on at least three days a week. Many infants are predominantly breastfed until 9 months of age, especially in developing countries. Human milk is used in human biomonitoring as an indicator for accumulation of environmental chemicals. Evidence about toxic and potentially toxic chemicals in human milk can be used to promote environmental protection issues, but this can have an adverse effect on the public health messages issued by WHO. Breastfeeding is safer and cheaper than formula feeding and has significant advantages for the mother and her baby. Breastfed infants score significantly higher than formula-fed infants in studies of mental development. In addition, breastfeeding improves the bonding between mother and baby and has positive effects on the baby’s immune function including fewer incidents of gastrointestinal infections. There is currently no information available on the effect of environmental contamination from mining activities and natural sources on lactation performance of women living in contaminated areas. Young infants are particularly vulnerable since human milk is their primary or sole source of nutrition. Human milk intake and thus lactation performance can be accurately assessed using stable isotope technique. The CRP will use a longitudinal study design to focus on assessing human milk intake and lactation performance of nursing mothers using the deuterium oxide dose-to-mother technique. Repeated measures will be performed in infants aged 3, 6 and 9 months. Depending on the study location, the infants’ intake of lead (Pb), mercury (Hg), arsenic (As), cadmium (Cd), selenium (Se) and manganese (Mn) though human milk will be assessed by combining accurate data on human milk intake with measures of concentration. The infants’ growth will be monitored with reference to the new WHO growth standards and they will be monitored for incidence of infectious diseases. The overall objective of the proposed CRP is to assess lactation performance of women living in contaminated areas and to provide better estimates of transfer of toxic and potentially toxic elements from mother to child via human milk.
Number of RCMs: 1
Next RCM: 2011
Year of Commencement: 2009
Number of Contract Holders: 9
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CRP Number: E4.30.21
CRP Title: Food fortification and biofortification to improve micronutrient status during early life
Objective: The high prevalence of micronutrient deficiencies, in particular deficiencies of iron, zinc and vitamin A, is contributing significantly to the unacceptably high childhood morbidity and mortality observed in developing countries. Food fortification and biofortification are potentially useful strategies to prevent and control these deficiencies, however, limited data are available on the efficacy of these public health interventions in infants and children. Stable isotope techniques can be used in the development and evaluation of nutritional strategies by the assessment of bioavailability of iron, zinc and pro-vitamin A carotenoids as well as by monitoring changes in body pools of vitamin A to evaluate efficacy. This CRP will generate new information on the usefulness of food fortification and biofortification to improve micronutrient status in infants and children.
Number of RCMs: 1
Next RCM: 2010
Year of Commencement: 2008
Number of Contract Holders: 10
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CRP Number: E4.30.22.
CRP Title: Management of severe acute malnutrition during early life; addressing nutritional requirements by stable isotope techniques
Objective: The World Health Organization (WHO) estimates that nearly 20 million children under 5 years of age suffer from severe acute malnutrition (SAM). Children with SAM are at considerably higher risk of dying compared to well nourished children, either as a direct cause of SAM or as an indirect cause as SAM dramatically increases the risk of dying from common illnesses such as diarrhoea and pneumonia. Estimates suggest that SAM contributes to about 1 million child deaths every year - one child death every thirty seconds. The large majority of children with SAM live in south Asia and sub-Saharan Africa and although children with SAM appear in news coverage of humanitarian emergencies, the silent suffering of most of these children remains largely unnoticed. The overall goal of this CRP is to contribute new information to re-examine and improve dietary recommendations for treatment of children with SAM. Stable isotope techniques provide powerful tools to provide much needed information on energy and nutrient kinetics in vulnerable population groups but the application of these techniques has been limited in children with SAM. However, the usefulness of these techniques is clearly highlighted by recent studies, for example in Malawi and Jamaica. The results generated within this CRP will contribute to improved management of severe acute malnutrition in infants and young children.
Number of RCMs: 1
Next RCM: 2010
Year of Commencement: 2008
Number of Contract Holders: 10
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CRP Number: E4.10.14
CRP Title: Exposure to toxic and potentially toxic elements in women of childbearing age in developing countries
Objective: Rapid urbanization and industrialisation increase the risk of exposure to toxic/potentially toxic elements such as lead, mercury and manganese in developing countries. In addition, drinking water and foods contain high levels of arsenic and mercury in many resource poor settings where undernutrition is common. For example, drinking water with high arsenic content is consumed widely in Bangladesh and India. Undernutrition and exposure to toxic/potentially toxic elements have often been treated as separate issues. However, there is now increased concern about whether undernourished people are potentially more vulnerable to exposure to toxic/potentially toxic elements. The overall aim of new CRP “Exposure to toxic and potentially toxic elements in women of childbearing age in developing countries” is to contribute to a better understanding of these issues by evaluating exposure in adult women with different nutritional status.
Number of RCMs: 3
Year of Commencement: 2005
Number of Contract Holders: 8

CRP Number: E4.30.20
CRP Title: Nutrition and HIV/AIDS: The efficacy of food based nutrition interventions evaluated by stable isotope techniques
Objective: The overall aim of this CRP is to evaluate the efficacy of nutrition interventions in people living with HIV/AIDS based on changes in body composition (muscle mass), measured by stable isotope techniques. In particular, the associations between nutrition - HIV/AIDS - antiretroviral treatment will be given special emphasis. The outcome of the project will contribute to a better understanding of the importance of nutrition in the management of HIV/AIDS. The results will be of particular relevance to countries where the prevalence of HIV/AIDS is high and where there is an urgent need to develop effective nutrition interventions based on locally appropriate, sustainable food based strategies to integrate nutrition into a comprehensive response to HIV/AIDS.
Number of RCMs: 3
Year of Commencement: 2005
Number of Contract Holders: 8
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CRP Number: E4.30.19
CRP Title: Body fat and its relationship with metabolic syndrome indicators in overweight pre-adolescents and adolescents
Objective: Overweight and obesity are defined as an excess of body fat. Children and adolescents can be defined as overweight or obese based on reference percentiles of BMI (body weight/hight2) for age. However, although BMI for age standards is a widely accepted approach for classifying overweight and obesity, careful interpretation of weight-height relationships is required in children and adolescents with low stature resulting from chronic undernutrition. Moreover, the assumption that BMI can classify overweight and obesity in all ethnic groups of children and adolescents has not been demonstrated. The overall objectives of this CRP are to establish the relationship between body mass index (body weight/stature2) and body fat and explore the association with indicators of the metabolic syndrome in pre-adolescents of 9 years at first Tanner stage of puberty (T-1) and adolescents of 16 years at 4th and 5th Tanner stages of puberty (T4-5) who are at risk of overweight (above the 85th percentile of BMI for age according to the CDC charts) in different ethnic groups.
Number of RCMs: 2
Next RCM: 2009
Year of Commencement: 2005
Number of Contract Holders: 11
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CRP Number: E4.30.18
CRP Title: Zinc nutrition during early life
Objective: The overall objective of this CRP is to contribute to a better understanding of zinc nutrition during the first year of life. More specifically, the aim is to evaluate human milk intake and the introduction of other fluids during the first year of life in different countries. In countries with high prevalence of small for gestational age (SGA) infants, SGA infants and infants appropriate for gestational age (AGA) will be studied in parallel. In addition, changes in human milk zinc concentration (and zinc intake from human milk) will be evaluated during the first year of life. In some settings, zinc status will be measured by stable isotope techniques in sub-groups of SGA and AGA infants.
Number of RCMs: 2
Next RCM: 2009
Year of Commencement: 2005
Number of Contract Holders: 8
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