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Improving Health Across the Globe
WHO Publishes New Iron Supplementation Recommendations Based on CHORI Research

"You have to accumulate data from different parts of the world and with different populations under different circumstances for WHO to propose a global utilization measure. Given that, ten or twelve years is actually relatively quick."

CHORI scientist Fernando Viteri, MD, has started 2009 with a variety of successes, including the naming of an Argentinean research institute after Dr. Viteri in honor of his research contributions to their institute, as well as the adoption this spring by the World Health Organization (WHO) of recommendations for weekly preventive iron and folic acid supplementation for women of reproductive age based on Dr. Viteri’s research.

Iron deficiency affects 2 billion people, about a third of the total worldwide population. In addition, the WHO estimates that in the developing world, 43 percent of all non-pregnant women of reproductive age and 56 percent of pregnant women are iron deficient, as are close to 80 percent of infants between 6 and 36 months. The new WHO recommendations, which are based on Dr. Viteri's proposal that preventive iron supplementation should be given on a weekly basis, rather than on the more traditional daily basis, will go a long way toward improving such dire statistics.

"There are several reasons why weekly supplementation is better," says Dr. Viteri. "One is that it is more efficiently utilized compared to current recommended daily doses. When you have iron deficiency and you take a supplement, the first dose of that supplement is very well absorbed - about twenty percent of it. But in about three or four days, the absorption of the same dose decreases significantly, so in the long run you only absorb about six percent."

Dr. Viteri discovered, however, that if you only give an iron supplement in correspondence with the turn over of the intestinal lining of the gut - about every 6 days, or once a week, iron absorption is more efficiently utilized so that increments in body iron increase the same but with one-seventh the dose of iron supplement because the absorption of iron is maintained at a higher level for a longer period of time.

"When you administer iron in a daily dose, the dose from the day before actually decreases iron absorption of the next dose. If we wait for new cells to be generated that are not loaded with previously ingested iron, however, more iron is absorbed," explains Dr. Viteri.

In fact, in one of Dr. Viteri's most recent studies, he and his colleagues demonstrated that weekly iron supplementation resulted in two and a half times the efficiency of daily supplementation. In addition, weekly supplementation also reduces the complications side-effects associated with traditional iron supplementation.

"Because absorption goes down with each dose, this means that if the daily dose, for example, is 100 mg a day, the first day, 80 mg remain in the gut, but the second day, if you take the same amount and only absorb 10 percent, you have 90 mg in your gut, adding to the 80 from the day before and so on," explains Dr. Viteri.
"The result of all that iron in your gut is diarrhea, constipation, heart burn and general discomfort, which in turn decreases compliance with any program of iron support."
With weekly supplementation, however, each dose is given when the intestinal lining is newly turned over, so the excess iron from only one dose remains in the gut, rather than the excess from 6 doses combined. As a result, the weekly approach also limits the production of free radicals, which occurs when the intestinal system is overloaded with iron, allowing unsafe iron to be absorbed.

"Weekly administration is not only more efficient with fewer side effects, but it's also safer, and that is the key issue," says Dr. Viteri, along with the fact that weekly dosing provides greater operational convenience as well as better long-term compliance.

The WHO now agrees, due in great part to both the veracity of Dr. Viteri's research as well as his unflagging commitment to seeing the changes come to fruition on a global scale. This is particularly gratifying for Dr. Viteri, who has dedicated his research to improving the lives of the poor across the world.
Originally from Guatemala, Dr. Viteri trained in the United States and conducted research in his home country for nearly 18 years, reducing the mortality rate there of severely malnourished children from 40 to 4 percent, primarily through a series of nutritional recommendations and other measures based on Dr. Viteri's research that served as a basis for WHO to develop a worldwide guide for the treatment of severely malnourished children.

"I continue to be very concerned about the disparity between the poor and the rich in terms of nutrition. This has been the driving force in my research," says Dr. Viteri. "My heart has been in the developing world for all of my life."

As a result, Dr. Viteri doesn't view the latest WHO recommendations as any sort of culminating event, but a milestone in what he hopes will be a much longer trajectory. As Dr. Viteri says,"There is always more work to be done. I have probably twenty more years of life if I live to be ninety-nine, and I plan to still be working then, too."

Current research areas Dr. Viteri is continuing to pursue include pushing for changing WHO folate and B12 supplementation recommendations to a targeted weekly rather than daily dose, fully elucidating potential risks of too much iron during pregnancy, and improving the nutritional status of folate in populations with some enzymatic mutations by the use of different forms of this vitamin instead of folic acid.

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Tuesday, May 17, 2011 8:19 AM

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