1. Assessment of nutritional and micronutrient status Wolfgang Stütz Institute of Biological Chemistry and Nutrition University of Hohenheim Scale-N Kickoff-Meeting, January 2016, Morogoro

2. Assessment of nutritional/micronutrient status by
Anthropometry: weight, height, BMI
‘Stunting’: height for age" value to be less than two standard deviations of
the WHO Child Growth Standards median
Dietary intake (24 hour recall, food frequency)
of macro- and micronutrients (proteins, fat, vitamins)
Questionnaires on clinical symptoms for deficiencies
Analysis of macro- and micronutrients (MNs) in blood
Biological monitoring: detailed assessment to control
an intervention / nutrition program (e.g. Scale-N)

3. Minerals and trace elements
Macronutrients
Micronutrients
Vitamins
Minerals and trace elements
carbohydrates
glucose
fat
fat acids
triglycerides
cholesterol
protein
albumin
amino acids
water soluble
vitamin B1
vitamin B2
vitamin B6
vitamin B12
vitamin C
folate
fat soluble
vitamin A
vitamin D
vitamin E
vitamin K
sodium
potassium
calcium
magnesium
iron
copper
iodine
fluorine
manganese
selenium
zinc

4. Main ‚important‘ micronutrients (MNs)
essential for
manifestation of its deficiency
indicator
cut off value
Iron
hemoglobin,
many enzymes
anemia, reduced growth, impaired development
serum ferritin
< 12 µg/L
< 30 µg/L
Vitamin A
eyes / vision
immune system
xerophthalmia
immune deficiency
serum retinol
< 0.7 µmol/L
< 1.05 µmol/L
Zinc
Growth retardation, immune deficiency
serum zinc
< 10.7 µmol/L
(0.7 mg/L)

5. Specimen and Methods to analyse MNs / MN status in
Food: iron, pro-vitamin A, zinc in fruits, vegetables, corn
Blood: iron, vitamin A, zinc in serum/plasma; hemoglobin in whole blood
Direct measurement of MNs: vitamin A (retinol) and carotenoids (HPLC),
iron, zinc (AAS or ICP-MS)
Indirect measurement: hemoglobin (iron status) and transport proteins in blood
retinol binding protein (RBP)  vitamin A status
ferritin, soluble transferrin receptor (sTfR)  iron status
HPLC: high performance liquid chromatography: vitamin A, carotenoids, vitamin E
AAS: atomic absorption spectrophotometry: zinc, iron,
ICP- MS: inductively coupled plasma – mass spectrometry: zin, iron
ELISA: enzyme-linked immuno (sorbent) assay: antibodies (RBP, ferritin, sTfR)
Spectro-photometry: also in connection with other techniques (HPLC)

6. Assessment of Iron status
Hemoglobin - Hb or hematocrit - Hct (packed cell volume: % x 3.33 ≈ Hb )
Anemia: Hb < 120 g/L (< 110 g/L pregnant women, children)
< 70 g/L severe anemia
Serum Ferritin (SF): transport protein reflecting iron storage
SF < 12 µg/L - depleted iron stores
SF < 30 µg/L depleted iron stores during infections
SF is affected by infections: ↑ if acute phase protein CRP or AGP ↑
CRP: C-reactive protein (acute infections)
AGP: alpha 1-glycoprotein (‚persistant‘ infections)
Soluble Transferrin Receptor (sTfR): reflecting tissue iron storage
sTfR > 8.5 mg/L - iron deficiency
Iron deficiency anemia (IDA): anemia and iron deficiency
e.g. Hb < 120 g/L and SF <12 µg/ L and/or sTfR > 8.5 mg/L
hemoglobin/hct ↓ serum ferritin ↓ soluble transferrin receptor ↑
MNs responsible for anemia: iron, folic acid, vitamin B12, vitamin A

7. Assessment of vitamin A and zinc status
Serum / plasma retinol: normal range µmol/L
vitamin A deficiency (VAD): retinol < 0.7 µmol/L (< 20 µg/dL)
severe VAD: < 0.35 µmol/L (night blindness)
subclinical VAD: µmol/L ( µg/dL)
low vitamin A status : < 1.05 µmol/L (< 30 µg/dL)
RBP - retinol binding protein (ELISA): highly correlated to plasma retinol
Pro-vitamin A- carotenoids: α-/β-carotene, β-cryptoxanthin
Zinc in plasma: normal range >0.7 mg (10.7 µmol/L)

8. Retinol,  -tocopherol, and  -carotene in food or blood by high performance liquid chromatography (HPLC)
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
11.0
min
-1000
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
11000
12000 uV
ß-Cryptoxanthin
Oxim
α-, ß- Carotene
Retinol
Lycopene
Lutein
Zeaxanthin
Retinol
at 325 nm
Carotenoids
at 450 nm
Tocopherols
EX/EM
298/328 nm
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
11.0
min
-2500
2500
5000
7500
10000
12500
15000
17500
20000
22500 uV
γ-,α- Tocopherol

9. Budget for hemoglobin and MN analysis
€ per Unit
N Units
Total €
Carotenoids , retinol and vitamin E
in food (HPLC) 10
750
7500
Vitamin C in food 6
4500
Iron and zinc in food (ICP-MS) 4
3000
15000
Hemoglobin 1
1200 +
2100
Ferritin, soluble transferrin receptor
CRP (C-recative protein)
AGP (α-1 glycoprotein)
RBP - Retinol Binding Protein
2 x 600
1200
(2400)
Transport to Germany 2
Carotenoids, Vitamin A, E in plasma
12000 (24000)

10. Nutritional Surveys: baseline and after ‚intervention‘
June 2016
Measurement
Method
House-holds
Number (n)
Dietary intake
FFQ and 24 h Recall
4 x 150
600
Anthropometry
Weight (kg) and height (cm)
> 600
Blood MNs
Mother infant pairs:
Iron status (ferrritin, sTfR), vitamin A (RBP, vitamin A, carotenoids)
1200
MNs in food
(vegetables, fruits)
Iron, zinc, carotinoids (vitamin A)
???
Nutritional Survey June 2018