Use of Multiple Micronutrients (Minerals and Vitamins) Preparations (Introduction) U.Tserendolgor MD,Ph.D, Sc.D NRC, PHI

ÖÝÐÝÍÄÎËÃÎÐ, ÀØÓ- íû äîêòîð ÍÝÌÕ, ÕÑÒ ÎËÎÍ ÍÀÉÐËÀÃÀÒ ÁÈ×ÈË ÒÝÆÝÝÈÉÍ ÁÝËÄÌÝËÈÉÍ ÒÓÕÀÉ ÒÀÍÈËÖÓÓËÃÀ, À× ÕÎËÁÎÃÄÎË ÖÝÐÝÍÄÎËÃÎÐ, ÀØÓ- íû äîêòîð ÍÝÌÕ, ÕÑÒ

Magnitude of the Problem Vitamin and mineral deficiencies affect a third of the world’s people and account for an estimated 7.3% of the global burden of disease.

ÁÈ×ÈË ÒÝÆÝÝËÈÉÍ ÄÓÒËÛÍ ÁÀÉÄÀË Õîð óðøèãòàéä òîîöîãäîæ áàéãàà ºâ÷í¿¿äèéí 7.3%- èéã àìèíäýì, ýðäñèéí äóòàëòàé õîëáîîòîé ýìãýã ýçëýæ áàéíà. Äýëõèéí õ¿í àìûí 3 õ¿í òóòìûí íýã íü áè÷èë òýæýýëèéí äóòàëä ºðòºæ áàéíà. Òºìºð, öàéð, èîä, À àìèíäýìèéí äóòàë

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.

ÁÈ×ÈË ÒÝÆÝÝËÈÉÍ ÄÓÒËÛÍ ÁÀÉÄÀË ÄÝÌÁ, ͯÁ-ÈÉÍ ÕÑ- èéí ñóäàëãààãààð öóñ áàãàäàëòòàé áîëîí òºìðèéí äóòàëòàé õ¿¿õýä 750 ñàÿ (ͯÁ-èéí ÕÑ, 2003). ÕªÃÆÈÆ ÁÓÉ ÎÐÍÓÓÄÀÄ 5 – ñ äîîø íàñíû õ¿¿õäèéí 40-50% íü òºìðèéí äóòàëòàé (òºìðèéí õýðýãöýýã õàíãàõ õîîë õ¿íñíèé äóòàëòàé, ͯÁ-èéí ÕÑ, 2004). Õîîë õ¿íñíýýñ àâàõ àìèíäýì, ýðäñèéí äóòàë íü õ¿¿õäèéí ýð¿¿ë ìýíä , ºñºëò õºãæèëòºä ñºð㺺ð íºëººëæ áàéíà.

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.

ÁÈ×ÈË ÒÝÆÝÝËÈÉÍ ÄÓÒÀËÄ ªÐÒªÌÕÈÉ Õ¯Í ÀÌÛÍ Á¯ËÝà ÍßËÕ, ÁÀÃÀ ÍÀÑÍÛ Õ¯¯ÕÝÄ, èõýâ÷ëýí 2 – ñ äîîø íàñíû õ¿¿õýä ÆÈÐÝÌÑÝÍ ÝÌÝÃÒÝÉׯ¯Ä Õºãæèæ áóé îðíóóäûí íèéãìèéí ýð¿¿ë ìýíäèéí áýðõøýýëòýé àñóóäàë áîëäîã.

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.

ØÈÍÝ ÁÝËÄÌÝË: ÁÈ×ÈË ÒÝÆÝÝËÈÉÍ ÕÎËÈÌÎà Sprinkles Vitashakti Anuka MixMe TopNutri MMPs – èéã ãýðèéí íºõöºëä áýëòãýñýí õ¿¿õäèéí íýìýãäýë õîîëîíä õîëüæ õýðýãëýíý. Õ¿¿õäèéí íýìýãäýë õîîëíû ÷àíàðûã ñàéæðóóëíà.

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 30.0 0.5 6.0 0.9 150.0 400 30 Minerals Iron (mg ) Zinc (mg ) Cu (mg ) Selenium (µg ) Iodine (µg ) 10.0 4.1 0.56 17.0 90.0

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.

À× ÕÎËÁÎÃÄÎË Öóñ áàãàäàëò áîëîí áóñàä áè÷èë òýæýýëèéí äóòëûã áóóðóóëàõ Õ¿¿õäèéí íýìýãäýë õîîëíû ÷àíàðûã ñàéæðóóëàõ Áèåèéí ýñýðã¿¿öëèéã ñàéæðóóëàõ Õ¿¿õäèéí ºñºëò, õºãæèëòèéã ñàéæðóóëàõ Õ¿¿õäèéí îþóí óõààíû õºãæëèéã ñàéæðóóëàõ

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.

Äàâóó òàë ÁÒÕ – èéí íàéðëàãà äàõü áîäèñóóä íü õîíîãèéí õîîë õ¿íñíýýñ àâáàë çîõèõ áîäèñóóäûí çºâëºìæ õýìæýýãýýð õ¿¿õýä á¿ðèéã õàíãàíà. Òºìºð, À,Ñ, Ä àìèíäýì, ôîëèéí õ¿÷ëèéí çýðýãöýýãýýð óóòòàé áýëäìýëä öàéðûã íýìñýí áºãººä áè÷èë òýæýýëèéí äóòëûã ýì÷ëýõ, ñýðãèéëýõ íºëººòýé áºãººä õîîë òýæýýëèéí áàéäëûã åðºíõèéä íü ñàéæðóóëàõ áîëîìæòîé þì.

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.

Äàâóó òàë ÁÒÕ äàõü òºìºð íü ëèïèäýí á¿ðõ¿¿ë òýé òóë òºìºð íü õîîë õ¿íñíèé áîäèñòîé õàðèëöàí óðâàëä îðîõ, õîîëíû àìò, ºíãº, ¿íýðèéã ººð÷ëºõ íü ìàø áàãà áàéäàã. Ëèïèäèéí á¿ðõ¿¿ë íü õîäîîä ãýäýñíèé õÿìðàë áîëîí òºìºð íü õîîë òýæýýëèéí áóñàä áîäèñòîé õàðèëöàí óðâàëä îðîõûã áóóðóóëíà.

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).

Äàâóó òàë Ǻâõºí íýã óäàà õýðýãëýõ õýìæýýãýýð ñàâëàãäñàí óóòòàé áýëäìýëèéã õýðýãëýõýä àìàðõàí áºãººä òîõèîìæòîé þì.Èéìä õîîëíû öàãààð ò¿¿íèéã õýðýãëýõýä òóñãàéëàí õýìæèõ áàãàæ õýðýãñýë áîëîí íýìýëò àæèëëàãàà øààðäàãääàõã¿é þì. ̺í óã áýëäìýëèéã õýðõýí õýðýãëýõ òàëààð òóñãàéëàí ñóðàëöàõ øààðäëàãàã¿é þì.

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).

Äàâóó òàë ÁÒÕ- èéã ãýðò áýëòãýñýí õîîëîíä õîëüæ õýðýãëýõýä õ¿¿õäèéí õîîëëîëòûí áàéäëûã ººð÷ëºõ øàëòãààí áîëîõã¿é þì. ̺í õºõººð õîîëëîëò áîëîí ÄÝÌÁ- ûí çºâëºìæèéí äàãóó õ¿¿õäèéã 6 ñàðòàéãààñ íü íýìýãäýë õîîëîíä îðóóëàõàä ñààä áîëîõã¿é þì.

Äàâóó òàë ÁÒÕ- ûí õýðýãëýý íü áàãà íàñíû õ¿¿õäèéã õîîëîõ äàäàëä ñóóðèëñàí òóë ýìèéí áîëîí ýì÷èëãýýíèé àðãà õýðýãñýë áîëîõã¿é þì. ÁÒÕ- ûã íýã óäààä õýðýãëýõ õýìæýýãýýð òóñãàé óóòàíä ñàâëàñàí òóë õýòð¿¿ëýí õýðýãëýõ, óëìààð õîðäëëîãî ¿¿ñãýõ ýðñäýë ìàø áàãà þì. Íÿëõàñ, áàãà íàñíû õ¿¿õýä íýã äîð 200 óóò áýëäìýë õýðýãëýñýí òîõèîëäîëä ë õîðäëîãî áîëîõ ýðñäýë ¿¿ñíý.

Äàâóó òàë ÁÒÕ- íü ìàø õºíãºí æèíòýé òóë ò¿¿íèéã òýýâýðëýõ, õàäãàëàõ, ò¿ãýýõýä õÿëáàð þì. Ò¿¿íèé õàäãàëàëòûí õóãàöàà óðò áºãººä õàëóóí, õ¿éòýí àëü ÷ íºõöºëä ÷àíàð íü ìóóäàõ ýðñäýë áàãà þì. ÁÒÕ – íü õÿìäõàí (¯éëäâýðëýëèéí õýìæýýíýýñ õàìààðààä íýã óóò íü 0.015-0.035$.)

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.

Õàíäëàãà ͯÁ- èéí ÕÑ- èéí äóíä õóãàöààíû ïðîãðàììûí õ¿ðýýíä (2008-2011) ÁÒÕ- ð õàíãàõ ïðîãðàììûã õýðýãæ¿¿ëýõ çîðèëãîòîé áàéãàà.