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      Vitamin A-Related Policies in Iran: Document Analysis

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          Abstract

          Background:

          There are one-third of children in the world with Vitamin A deficiency. The prevalence of vitamin deficiency in children aged 15–23 months in Iran has increased 18 times and in rural areas. The present article aims to an analysis of related documents to the existing policies on this vitamin in our country.

          Materials and Methods:

          This study is a descriptive study using a quantitative content analysis approach to analyze nutritional policy documents.

          Results:

          We extracted six themes at the first stage of analysis (based on common policies in the world), which were reduced to two final themes: “Direct interventions” and “Indirect interventions.” There were also six subthemes and eight issues.

          Conclusions:

          It seems that policymaking must revise these documents and also making new policy decision with more emphasis on micronutrient.

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          Most cited references17

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          The Epidemiology of Global Micronutrient Deficiencies

          Regan L. Bailey, Keith P. West Jr, Robert E Black (2015)
          Micronutrients are essential to sustain life and for optimal physiological function. Widespread global micronutrient deficiencies (MNDs) exist, with pregnant women and their children under 5 years at the highest risk. Iron, iodine, folate, vitamin A, and zinc deficiencies are the most widespread MNDs, and all these MNDs are common contributors to poor growth, intellectual impairments, perinatal complications, and increased risk of morbidity and mortality. Iron deficiency is the most common MND worldwide and leads to microcytic anemia, decreased capacity for work, as well as impaired immune and endocrine function. Iodine deficiency disorder is also widespread and results in goiter, mental retardation, or reduced cognitive function. Adequate zinc is necessary for optimal immune function, and deficiency is associated with an increased incidence of diarrhea and acute respiratory infections, major causes of death in those <5 years of age. Folic acid taken in early pregnancy can prevent neural tube defects. Folate is essential for DNA synthesis and repair, and deficiency results in macrocytic anemia. Vitamin A deficiency is the leading cause of blindness worldwide and also impairs immune function and cell differentiation. Single MNDs rarely occur alone; often, multiple MNDs coexist. The long-term consequences of MNDs are not only seen at the individual level but also have deleterious impacts on the economic development and human capital at the country level. Perhaps of greatest concern is the cycle of MNDs that persists over generations and the intergenerational consequences of MNDs that we are only beginning to understand. Prevention of MNDs is critical and traditionally has been accomplished through supplementation, fortification, and food-based approaches including diversification. It is widely accepted that intervention in the first 1,000 days is critical to break the cycle of malnutrition; however, a coordinated, sustainable commitment to scaling up nutrition at the global level is still needed. Understanding the epidemiology of MNDs is critical to understand what intervention strategies will work best under different conditions.
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            Biomarkers of Nutrition for Development (BOND)—Vitamin A Review1234

            Sherry A Tanumihardjo, Robert RUSSELL, Charles Stephensen … (2016)
            The Biomarkers of Nutrition for Development (BOND) project is designed to provide evidence-informed advice to anyone with an interest in the role of nutrition in health. The BOND program provides information with regard to selection, use, and interpretation of biomarkers of nutrient exposure, status, function, and effect, which will be especially useful for readers who want to assess nutrient status. To accomplish this objective, expert panels are recruited to evaluate the literature and to draft comprehensive reports on the current state of the art with regard to specific nutrient biology and available biomarkers for assessing nutritional status at the individual and population levels. Phase I of the BOND project includes the evaluation of biomarkers for 6 nutrients: iodine, folate, zinc, iron, vitamin A, and vitamin B-12. This review of vitamin A is the current article in this series. Although the vitamin was discovered >100 y ago, vitamin A status assessment is not trivial. Serum retinol concentrations are under homeostatic control due in part to vitamin A’s use in the body for growth and cellular differentiation and because of its toxic properties at high concentrations. Furthermore, serum retinol concentrations are depressed during infection and inflammation because retinol-binding protein (RBP) is a negative acute-phase reactant, which makes status assessment challenging. Thus, this review describes the clinical and functional indicators related to eye health and biochemical biomarkers of vitamin A status (i.e., serum retinol, RBP, breast-milk retinol, dose-response tests, isotope dilution methodology, and serum retinyl esters). These biomarkers are then related to liver vitamin A concentrations, which are usually considered the gold standard for vitamin A status. With regard to biomarkers, future research questions and gaps in our current understanding as well as limitations of the methods are described.
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              Evidence-based health policy: context and utilisation.

              Mark Dobrow, Vivek Goel, R E G Upshur (2004)
              Evidence-based decision-making is centred on the justification of decisions. In the shift from an individual-clinical to a population-policy level, the decision-making context becomes more uncertain, variable and complex. To address this we have developed a conceptual framework for evidence-based decision-making, focusing on how context impacts on what constitutes evidence and how that evidence is utilised. We present two distinct orientations towards what constitutes evidence, representing different relationships between evidence and context. We also categorise the decision-making context based on the ways in which context impacts on evidence-based decision-making. Furthermore, we invoke the concept of axes of evidence-based decision-making to describe the relationship between evidence and context as we move from evidence-based medicine to evidence-based health policy. From this, we suggest that it may be more important how evidence is utilised than how it is defined. Based on the research and knowledge utilisation literature, we present a process model of evidence utilisation, which forms the basis for the conceptual framework for context-based evidence-based decision-making. The conceptual framework attempts to capture the role that context plays in the introduction, interpretation and application of evidence. We illustrate this framework with examples from policy development for colorectal cancer screening.
              Article 0 comments Cited 74 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Adv Biomed Res
                Journal ID (iso-abbrev): Adv Biomed Res
                Journal ID (publisher-id): ABR
                Title: Advanced Biomedical Research
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Electronic): 2277-9175
                Publication date Collection: 2020
                Publication date (Electronic): 30 October 2020
                Volume: 9
                Electronic Location Identifier: 62
                Affiliations
                [1 ] Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                [2 ] Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                [3 ] Departments of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran
                [4 ] Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
                [5 ] Health Equity Research Centre, Tehran University of Medical Sciences, Tehran, Iran
                Author notes
                Address for correspondence: Dr. Naser Kalantari, Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail: nkalantari1334@ 123456gmail.com
                Article
                Publisher ID: ABR-9-62
                DOI: 10.4103/abr.abr_159_20
                PMC ID: 7792883
                SO-VID: 3a5a4cea-8823-4a7d-b570-4b23c3a9920a
                Copyright © Copyright: © 2020 Advanced Biomedical Research
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 06 July 2020
                Date revision received : 20 July 2020
                Date accepted : 10 August 2020
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Molecular medicine
                Keywords: analysis,policy,vitamin a,nutrition policy
                Data availability:
                ScienceOpen disciplines: Molecular medicine
                Keywords: analysis, policy, vitamin a, nutrition policy

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