annual report 2006 - nestl© foundation

REPORT 2006

Place de la Gare 4, PO Box 581, 1001 Lausanne, SwitzerlandPhone: +41 (0)21 320 33 51 Fax: +41 (0)21 320 33 92nf@nest le foundat ion.org www.nestlefoundation.org

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REFERENCES AND CREDITS:

PAGE 2: Spirulina algae: Prof. Dr. H.R. Preisig, BotanicalGarden & Institute of Systematic Botany, UniversityZürich, Switzerland. PAGE 10-11: VAD Map, withpermission: Drs. M.Frigg & K. Kraemer, The Task ForceSIGHT & LIFE, DSM, Basel (Switzerland). PAGE 15: 1.From Gutenberg to the Global Information Infrastructure.Christine L. Borgman. MIT Press 2003, Cambridge MA,USA. 2. Building a World Class Personal Library with FreeWeb Resources. Nicolas G. Tomaiuolo. Information TodayInc., Medford, NJ (USA), 2004. PAGE 38-39: 1.Widdowson EM. Proc Nut Soc 1962;21:121-8. 2. RavussinE et al. N Engl J Med 1988;318:467-472. 3. Sims EAH etal. Recent Progress Hormone Research 1973;29:457-496.4. Minghelli G et al. Am J Clin Nutr 1990;51:563-570. 5. Minghelli G et al. Am J Clin Nutr 1991;53:14-20. 6. Ravussin E et al. Am J Physiol 1985;249: E470-477.PAGE 42-43: 1. McDade TW et al. Am J Clin Nutr2001;74:543-548. 2. Moore SE et. Al. Am J Clin Nutr2004; 80:453-459. 3. Barreto ML et al. J Infect Dis2000;182:1800-1803. 4. Elliott AM et al. Lancet1999;354:1000-1001. 5. Berclaz PY et al. Pediatr Res1996;39:401-409. 6. Shetty PS & Shetty N. Parasitology1993;107 Suppl:S159-S167. 7. Desjeux JF & RamakrishnaBS. Annual Report 1996 Nestlé Foundation 1997;75-100.8. Ramakrishna BS et al. N Engl J Med 2000;342:308-313.9. West KP, Jr. Food Nutr Bull 2003;24(4 Suppl):S78-S90.10. Manary MJ et al. Am J Clin Nutr 2002;75:1057-1061.11. Paknawin-Mock J et al. Eur J Clin Nutr 2000;54 Suppl2:S28-S42. 12. Pollitt E et al. Eur J Clin Nutr 2000;54Suppl.2:S80-S90. 13. Pollitt E et al. Eur J Clin Nutr2000;54 Suppl.2:S16-S20. 14. Pollitt E. Eur J Clin Nutr2000;54 Suppl.2:S2-10. 15. Pollitt E. J Nutr 2000;130(2SSuppl):350S-353S. 16. Pollitt E. J Nutr 2001;131(2S-2):669S-675S. 17. Pollitt E et al. J Nutr 2002;132:2617-2625. 18. Gardner JM et al. Am J Clin Nutr 2005;82:399-405. 19. Walker SP et al. J Nutr 2004;134:1417-1423.PAGE 46-47: 1. Energy and protein requirements. Reportof Joint FAO/WHO/UNU Expert Consultation. TechnicalReport Series 724, WHO, Geneva, 1985. 2. Humanenergy requirements. Report of the JointFAO/WHO/UNU Expert Consultation. Food & NutritionTechnical Report Series 1. Food & AgriculturalOrganization, Rome, 2004. 3. Protein and amino acidrequirements in human nutrition. Report of the JointFAO/WHO/UNU Expert Consultation Technical ReportSeries. WHO, Geneva, 2006. 4. James WPT et al.Definition of chronic energy deficiency in adults. Reportof a working party of the International Dietary EnergyConsultative Group. Eur J Clin Nutr 1988;42: 969-81.PAGE 50-51: 1. Singh J et al. Br J Nutr 1989;62:31-329. 2. Pollitt E et al. Eur J Clin Nutr 2000;54 Suppl 2:S16-S20.3. Shetty PS et al. Eur J Clin Nutr 1994;48:S28-S38. 4. Dietary Reference Intakes. Washington, DC: NAS,2002. 5. Flatt JP. Obesity 2006;14:A65. 6. Flatt JP.Differences in basal energy expenditure, BMI and obesity.Obesity (submitted). 7. Flatt JP. Progr Obes Res2003;9:713-717.

PHOTO: Cover: Girl in front of a petroglyphe near Chilas in theIndus valley in Northern Pakistan - photograph by PaoloM. Suter

Spirulina algae (page 2 middle): Prof. Dr. HR Preisig,Botanical Garden & Institute of Systematic Botany,University of Zürich; Kaufmann Marcel / bmi-bild.ch: page 2 top/bottom, 6 top/bottom, 9 top/bottom, 17,26/27, 29, 32/33, 34/35, 40, 42, 48, 50, 54, 61, 64, 67, 69,73, 74/75; Notter Rolf / bmi-bild.ch: page 31, 59, 65, 68;Grüter Heinz / bmi-bild.ch: page 66; Hübscher-JuckerBruno & Marianne / bmi-bild.ch: page 46; ChristianLattmann: page 30, 53, 57; Eric Jéquier: page 38, 44;Paolo M. Suter: inside front/back cover, page 4, 8, 11-14,18-20, 22/23, 26, 28, 36, 37, 52, 70, 72.

CONCEPT & TEXT: Paolo M. Suter

DESIGN: Diane Constans-Marsens

PRINT: IMPRIMERIE MARSENS LAUSANNE

© 2007 Copyright Nestlé Foundation

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THE FOUNDATION AT A GLANCE

FOCUSED AND GLOBAL – THE FOUNDATION FOR THE STUDY OF THE

PROBLEMS OF NUTRITION IN THE WORLD

HIGH IMPACT – RESEARCH PROJECTS TO REDUCE MALNUTRITION

INNOVATIVE – FOR SUCCESS

CAPACITY BUILDING – AS A BASIS FOR IMPROVEMENT

SUSTAINABILITY – A KEY MISSION

ENDURABLE NUTRITION – THE PRESCRIPTION FOR SUCCESS

PUBLIC HEALTH – ORIENTATED

EVIDENCE-BASED – PROACTIVITY

PARTNERSHIP – FOR LONG-TERM SUCCESS

enLINK-ing FOR A BETTER WORLD

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TABLE OF CONTENTS

enLINK-ing FOR A BETTER WORLD

CAPACITY BUILDING

PRESIDENT’S MESSAGE

PROJECTS INITIATED BY THE FOUNDATION:THE enLINK INITIATIVE

OTHER ACTIVITIES

40 YEARS OF THE NESTLÉ FOUNDATION

VISION 2005

CONGRATULATIONS

ONGOING PROJECTS

PUBLICATIONS

THE FOUNDATION

THE COUNCIL

PUBLIC-HEALTH ORIENTATED


Created in 1966, the Nestlé Foundation celebratedits fortieth anniversary in 2006. This report presentssome key achievements of the Foundation over thelast twenty years. Whereas most researchfoundations deal with the financing of projectsdesigned by scientists from developed countries,the Nestlé Foundation has a different policy, onebased on the initiation and support of research inlow-income countries.

One of the major achievements of the Foundationhas been its contribution to the study of humanenergy requirements, with a particular emphasis onenergy needs during pregnancy and lactation. Themain results of these studies, summarized in thisreport, were published in the best scientific journals

and served as a basis for the recentrecommendations of the experts’ consultation onhuman energy requirements organised by theFAO/WHO/UNU. The purpose of the publisheddocument (2004) was to provide internationalagencies and their member countries with tools toassess the adequacy of food supplies and designadequate nutrition programmes to meet apopulation’s nutritional needs. Since requirementsfor energy and protein are closely interrelated, theFoundation has also been instrumental in evaluatinga considerable amount of new information onhuman protein needs that were published insupplements of the European Journal of ClinicalNutrition. These scientific data were also reviewedby the experts FAO/WHO/UNU experts’

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consultation mentioned above.

Between 1986 and 1996, council members andexperts initiated several research projects designedto assess the magnitude of adaptation ofindividuals who are subjected to seasonalconditions of low energy intake. In rural Gambia, for example, a shortage of food supply occurs eachyear at the beginning of the summer season. Usingmodern technologies, several studies weredesigned to assess the extent of the physiologicalvariability in energy utilization. A summary of theseinvestigations is presented in this report.

During the last ten years, the Foundation receivedmany applications dealing with the problems ofmicronutrient deficiencies and the ways to preventthese disorders. Over half the world’s population,mostly women, infants and children, suffer frommicronutrient malnutrition, with the consequencesof increased mortality and morbidity rates andaltered cognitive ability in children. Largeprogrammes of micronutrient supplementation for women and children aiming at improving theirnutritional status have been implemented in manylow-income countries with inconsistent results. Foodfortification and supplementation programmes haveoften not proven to be effective or sustainable forseveral reasons. For example, these programmesare not linked to local agricultural production, whichexplains the lack of sustainability. In addition, thepoor improvement in the nutritional status of infantsand children often results from a lack of appetitedue to infections and illnesses. As a consequence,the basic energy needs of infants and children areoften not met.

Thirty years ago, protein deficiency was consideredto be a key factor responsible for malnutrition inchildren in low-income countries. It was laterdemonstrated that a deficient energy intake wasoften the cause of this apparent protein deficiencyand the term ‘energy-protein malnutrition’ wascoined. Could this reasoning also apply tomicronutrient deficiencies? To describe iron or zincdeficiencies, should we use the term ‘energy-iron/zinc malnutrition’? One of our councilmembers, Professor Gebre-Medhin, has originatedthis concept and he has recently challenged thecurrent concepts and rationale supportingmicronutrient interventions. Several recent studieshave shown that individuals with signs ofmicronutrient deficiencies, such as children with irondeficiency anemia, often simultaneously suffer froma deficit in energy and protein intake. By contrast,children with adequate energy and protein intakesfrom the same diet had no anemia. The implicationis that a diet containing maize, rice, wheat, pulses,fruits and certain vegetables may cover allmicronutrients needs without any supplementation.These observations have far-reaching consequences

and may be the start at the origin of importantchanges in nutrition interventions in low-incomecountries, by promoting a food-based approachinstead of the present policy of micronutrientsupplementation or food fortification. For thesereasons, the Nestlé Foundation favors a food-basedapproach, whenever it is possible.

An anniversary is an opportunity to assess whetherour activities have been appreciated by thescientific community. We are happy to receivepositive comments from renowned scientists allover the world, but we know that we can increaseour modest contributions for improving nutrition inlow-income countries. Our mandate is not toimplement large programmes of nutritionintervention. As a scientific foundation, we aim atproviding a sound scientific basis for public healthinterventions. An example is the emphasis on firstmeeting energy and protein requirements in anynutrition intervention, even if the goal is to correctmicronutrient deficiencies.

This report describes the progress in the activitiesinitiated by the Foundation. It is a pleasure for meto thank the Director, Professor Paolo Suter, whohas been proactive and has greatly improved thevisibility of the Foundation through these newachievements. I also thank Dr. Elisabeth Müller,Assistant to the Director, for her dedication to themany everyday tasks. My warm thanks go to theCouncil members, who play a crucial role in all our activities. It is a privilege to work with suchcolleagues and friends, and the Foundation benefitsgreatly from their unique expertise. I also expressmy gratitude to Mr. Peter Brabeck, the Presidentand Chief Executive of the founding company, toMr. Richard Laube, Director, and to Dr. Irène Cortésyfor their personal interest and support.

Prof. Dr. E. JéquierPresident Nestlé Foundation


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One of the Foundation's main aims is the transferof scientific and technological knowledge to low-income countries. The Foundation advancesnutritional science both by supporting nutritionresearch projects in established institutes anduniversities and by giving focused support toexisting nutrition schools and educationalprograms. To further fulfil the mandate of theCouncil and also encourage sustainableimprovement in nutrition, a proactive strategic area of activities was introduced in 2003:The enLINK Initiative. This year the enLINKhard copy service has been added.

• Vitamin A value of spirulina carotenoidsin humans

• The enLINK micronutrient powder

• The enLINK digital library

• The enLINK hard copy service

PROJECTS INITIATEDBY THE FOUNDATIONTHE enLINK INITIATIVE

in humans

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"If you think education is expensive,try disease"

THE enLINK INITIATIVESustainability and public health relevance are keyissues for all activities of the Foundation. Researchprojects need to result in a short- and long-termpublic health implementation. Knowledge andknow-how have to be sustainable at all levels of the population.

The vast experience of the Foundation’s Councilmembers as well as the Foundation’s past activitiesled to the creation of the enLINK Initiative, aproject which illustrates the proactivity of theFoundation regarding its core issues.

This initiative focuses on information transfer in the area of nutrition and malnutrition as well as onthe resolution of specific research questions andtheir implementation at the public health level.

The name enLINK comes from the old English verb‘to enlink’, meaning ‘to chain together’ or ‘toconnect, as by links’. The analysis of the semanticrelations of ‘enlink’ reveals related words whichillustrate our central concepts and aims: to connect,to join, to associate, to unite, to tie, to conjoin.

Our mission is to link and join cultures, to associateand conjoin institutions and people locally to studyand diminish the problems of malnutrition globally.

Malnutrition can only be solved by ‘enlinking’ –connecting – different strategies and approaches.Malnutrition has to be addressed universally by jointstrategies which address many levels, looking at thelevel of medical issues (such as infection) andhygiene (such as water quality), proposing changesat the level of agriculture as well as in the society atlarge, and, last but not least, working to improve thelevel of education and information.

The enLINK Initiative has three main levels:

1. exploration in nutrition, which represents the research level

2. education in nutrition, targeting populations such as researchers, medical doctors, or health care workers, or the general population or specific population groups such as women

3. endurable nutrition

The elucidation of the bioavailability of provitamin Arepresents the first project in the exploration sectionof the enLINK Initiative. The enLINK powder is thefirst project of the endurable nutrition aspect of theinitiative.

The enLINK library – the electronic nutrition library –represents the core component of the educationallevel of the initiative. Information access is the keyissue in education and for any advancement.Despite the Internet, printed documents in the formof books and other publications remain thecornerstone for education and information transfer.This is especially true for low-income countrieswhere Internet access is not yet fully developed oreven completely lacking, making books and printedmaterials indispensable.

The solution of the nutritional problems in the worldcan only be achieved by enlinking capacities,uniting know-how and joining efforts – as theFoundation has done in the past and will do in thefuture.


VAD

Degree of publichealth importance of vitamin A deficiency:

clinicalsevere subclinicalmoderate subclinicalmild subclinicalno data, problem likelyproblem under control

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VITAMIN A DEFICIENCY (VAD) - ISPROVITAMIN A FROM ALGAE THESOLUTION?

Vitamin A deficiency (VAD) represents the mostimportant preventable single cause of childhoodblindness, morbidity and mortality. The majorstrategies to combat VAD are an improved diet(including breastfeeding from vitamin-A-sufficientmothers), supplementation, and/or foodfortification. Whenever possible, a food-basedapproach is the strategy favored by the Foundation.

The geographical distribution of vitamin Adeficiency in the world parallels the ecologicalparameters of poverty and overall malnutrition. The key step and public health challenge in thesolution to VAD is increasing the availability ofaffordable vitamin-A-rich or provitamin-A-rich foods.However, the content of vitamin A as well as of ß-carotene varies widely, as does the bioavailability,so that there is an urgent need for a good vitamin Asource that is easy to grow, affordable, and highlybioavailable. Spirulina, an unicellular blue-greenalgae, has been identified and promoted in thepast as a potentially important source of vitamin Aand protein. Spirulina would represent an attractivepartial solution to VAD.

The Foundation approaches the problems ofvitamin A malnutrition with evidence-basedresearch directly relevant to public health.Accordingly, a study to evaluate the vitamin Aequivalency of spirulina using modern technologyhas been initiated by the Foundation (see oppositepage).

A project initiated by the Foundation:

VITAMIN A VALUE OF SPIRULINACAROTENOIDS IN HUMANS

Under the principal investigatorship of GuangwenTang and colleagues (Jean Mayer, USDA HumanNutrition Center on Aging, Tufts University, Boston,USA), the vitamin A value (equivalence) of spirulinausing intrinsically deuterium labelled spirulina andan isotope vitamin A reference dose in males (n = 16) has been determined. Deuterium labeledspirulina have been produced by culturing cells in a nutrient solution with heavy water (deuteriumoxide). Two doses have been studied in Boston (5 g and 10 g). To test the effect of vitamin A statuson the bioavailability of spirulina, Chinese adultswith a borderline vitamin A status (n=8, with 10 g of spirulina) have also been studied.

The results, which will be presented for the firsttime at the Experimental Biology 2007 meeting (J. Wang et al), show that spirulina ß-carotene canbe converted to retinol efficiently in humans. Asexpected, the conversion ratio varied amongindividuals, but nevertheless in a range which showsthat spirulina ß-carotene could contributeconsiderably to the maintenance of an adequatevitamin A nutriture.

The results from this study are important forplanning future studies to test the efficacy ofadding spirulina to the diet, and for planning the use of spirulina in vitamin A deficiency preventionprogrammes. Based on the very promising results, acontrolled intervention trial has been planned andwill be carried out soon.


enLINK MICRONUTRIENT POWDER

The food-based approach of the Foundation topromote nutritional adequacy is well-known andwidely respected. However, sometimes food is notenough. Often one encounters a setting where foodis available but there is nevertheless an insufficientconsumption of protein and energy and thus also ofmicronutrients, which in the long run will lead tomalnutrition.

The enLINK initiative includes the concept ofendurable nutrition, which corresponds to aliveable, supportable and, last but not least,sustainable intake of nutrients.

Following the saying ‘Prevention is better thancure’ the Foundation, in collaboration with theNestlé Company, designed a micronutrient powderwith a small amount of selected micronutrients foruse as an addition to complementary food. Theamount of micronutrients (vitamin A, iron, iodine,zinc, and vitamin C) in this preparation isconsiderably lower than the current RDA. Thepurpose of the preparation is twofold: it shouldboth prevent micronutrient malnutrition andenhance the appetite, and thus increase the usualfood intake by improving the taste of the food towhich it is added.

Delivering some micronutrients and simultaneouslyincreasing food intake by enhancing the appetitebears a high potential of ‘double success’ forimproving energy and micronutrient nutriture.

A preliminary study to test the efficacy of thismicronutrient preparation is being performed by aresearch group at the Aga Khan University inKarachi, Pakistan and will be finished in spring 2007.The results are awaited with interest by the researchcommunity.

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enLINK statistics as of December 31,2006:

• 70 users from 31 countries

• More than 25,000 page views per month

• More than 800 page views per day www.

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“Teachers die, but books live on.”

Dutch proverb

Without access to information there is no education.Three years ago the Foundation created the enLINKdigital library of nutrition research, which isappreciated by users in more than 30 different low-income countries. This library is a concertedaction between OVID Technologies, certain publishers and the Foundation.

For nutrition information the enLINK library isalready an established and valued source ofinformation. The enLINK library targets individualusers and so far 70 registered users have access tothis unique library.

Scientific nutrition journals primarily contain thelatest studies and ongoing developments in thefield of nutrition research, while the knowledge baseof nutrition is summarized in different nutritiontextbooks. Since spring 2006 the classic nutritiontextbook Modern Nutrition in Health and Disease(edited by Maurice E. Shils) is available online forenLINK users.

THE ENLINK LIBRARY:A HYBRID COLLECTION

Access to information in the context of digitallibraries means computer connectivity. Yet in manylow-income countries, computer connectivity is justbeing established or is still non-existent, makingaccess to the enLINK library and other digitalinformation resources often difficult or evenimpossible.

In addition, there are several reasons why theInternet cannot replace the conventional library.There are three major misconceptions about the useof the Internet as an information source: 1) all usefulinformation exists on the Internet, 2) (useful andreliable) information is free of charge on theInternet, and last but not least, 3) the needed high-quality information can be found quickly on theInternet.

As in most academic libraries in the developedworld, integrated access to hybrid collections ofprinted and electronic resources is at present themost powerful tool for education.

Based on the experiences from the first years of theenLINK digital library, the Foundation recognizedthat a well-chosen combination of printed andelectronic media represents the future of nutritionand health information dissemination in low-incomecountries. Thus the enLINK library has become avirtual ‘hybrid collection’.

To improve the performance of the enLINK library inthe future, the Foundation will add paper-basedinformation in the form of selected books andprinted journals which will be offered to the librariesof selected institutes and medical faculties. TheenLINK paper collection will include

nutrition textbooks and medical textbooks and willbe implemented initially in several African countries.This activity will be accompanied by a criticalevaluation of it’s short- and long-term impact. Thiswill allow for the optimal future improvement andexpansion of these educational efforts.

THE enLINK LIBRARY


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PRESENT KNOWLEDGE INNUTRITION

Where can I find and study the present knowledgein nutrition? This is a key question asked byhundreds of doctors, researchers, students andnurses in low-income countries every day.

‘Knowledge is of two kinds. We know a subjectourselves, or we know where we can findinformation on it.’ This saying from Samuel Johnsonillustrates nicely the capacity building activities ofthe Foundation. Present knowledge in nutrition caneither be found in the enLINK digital library or inone of the leading textbooks about humannutrition, ‘Present Knowledge in Nutrition’ (PKN).

As the first step in the enLINK hard copy service aconcerted action between the Foundation and theInternational Life Science Institute (ILSI) inWashington , D.C. (USA) was initiated. ‘PresentKnowledge in Nutrition’ (8th edition, 2002) wasshipped free of charge to interested individuals andinstitutions in low-income countries. ILSI donatedthe 8th edition of the book and the Foundationfinanced the shipment.

So far, a total of 2,461 volumes of ‘PresentKnowledge in Nutrition’ have been shipped forpersonal and institutional use to 36 countries.


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OTHER ACTIVITIESNEW RESEARCH PROJECTS

INSTITUTIONAL SUPPORT


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BREASTFEEDING

MACRONUTRIENTS

MICRONUTRIENTS

CHILD DEVELOPMENT

EDUCATION

COMPLEMENTARY FEEDING

BREASTFEEDING

Promoting breastfeeding: a formativestudy among women and their husbandswith infants aged 0 to 6 months inurban households

Judhiastuty FebruhartantySEAMEO-TROPMED Regional Center forCommunity NutritionUniversity of IndonesiaJakarta, IndonesiaUSD 25,284

Breastfeeding is recognized to be important forboth mother and child. Current recommendationson breastfeeding in Indonesia include 1) earlyinitiation of breastfeeding (within 30 minutes afterbirth), 2) exclusive breastfeeding after birth until theage of 6 months, and 3) continued breastfeedinguntil the age of 2 years. However, practices are notalways in accordance with the recommendations,because mothers are exposed to a range of factorsthat also affect the choices for child feeding. InIndonesia, current recommendations onbreastfeeding are promoted publicly, and behaviourchange communication (BCC) is one of the effectivestrategies for improving breastfeeding practice.BCC operates on the basis that new ideas, services,or products can best be introduced if the intendedbeneficiaries see them as fulfilling their ownaspirations and well-being. As such, understandingthe existing knowledge, perceptions, attitudes, andbehaviour influencing breastfeeding practice isessential for BCC. Understanding that breastfeedingpractice is influenced by many factors and thatsuccessful breastfeeding is enhanced throughtimely breastfeeding initiation, a formative studyinvestigating determinant factors related toinitiation and continuation of breastfeeding amongpotential beneficiaries such as nursing women andtheir husbands is important. Such a study is alsodesigned to assess the existing communicationproblem, looking at knowledge, perceptions,attitudes, and practice as well as available potentialswithin the social network of the intended targetaudiences. With an understanding of the currentpractice and the barriers and potentials, existingcommunication resources as well as psychographicinformation of these target audiences will shape thebreastfeeding promotion to be more evidence-based, which in turn is expected to make it moreeffective. This study aims at investigating thecommunication problem(s) related to initiation andcontinuation of breastfeeding among women andtheir husbands having infants aged 0 to 6 months inurban households.

MACRONUTRIENTS:OBESITY

Diet, physical activity or environmentalchange: what are the key factorsunderlying the emerging child obesityepidemic in Ho Chi Minh City, Vietnam?

Hong K. TangCommunity Health DepartmentUniversity Training Centre for Health CareProfessionalsHo Chi Minh City, VietnamUSD 100,000

Overweight and obese children and adolescentsare becoming more prevalent in urban areas ofVietnam. Results of two recent cross-sectionalstudies showed that Ho Chi Minh City is in an early‘nutrition transition’ where both malnutrition and anemerging problem with obesity can be found inadolescents. From 2002 to 2004 there was anincrease in the prevalence of overweight andobesity from 5.0% and 0.8% in 2002 to 11.7% and2.0% in 2004, respectively. In the context of therapidly changing physical and social environmentsin Vietnam, this study aims to assess how changesin home, neighbourhood and school micro-environments are impacting on diets and physicalactivity behaviours and indicators of adiposity in anongoing cohort of adolescents in urban areas of HoChi Minh City. The cohort will be followed up untilthey reach the end of junior high school. This studywill identify micro-environmental risk factors inhomes, schools, and local neighbourhoods, as wellas the physical activity and diet behaviours of thechildren that are key risk factors for overweight/obesity in adolescents. The results will aid inunderstanding which factors are changing mostrapidly, and which are the most important riskfactors for overweight and obesity, thus providingan evidence base for developing preventiveinterventions in the future.


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MICRONUTRIENTSAssessment of iron status of children inrural communities in Abia State, Nigeria

I.A. Onimawo Department of Human Nutrition and DieteticsMichael Okpara University of AgricultureUmudike, NigeriaUSD 30,834

Anaemia affects all segments of the population butthe incidence is highest among infants, pre-schoolchildren, school age children, pregnant andlactating women. In Nigeria and in fact in manydeveloping countries, iron deficiency and anaemiacan be precipitated by infections and infestationsby malaria parasites, helminthes and otherorganisms. Iron deficiency and anaemia can beprevented, controlled or eradicated by appropriatemeasures. Such measures include food basedapproaches (intake of adequate amount of proteinand energy), control of infections and infestations.This research is targeted at the children of 7 yrs to12 yrs being among the most vulnerable groups toiron deficiency and anaemia. Iron status will bedetermined using the haemoglobin of the bloodand serum ferritin levels which will be collectedfrom subjects. Different anthropometric data will bemonitored. Infection control will be implemented.Food or dietary intake of the subjects will bedetermined to find out if iron deficiency is due topoor dietary intake.

Improving iron status of women ofreproductive age and preschool childrenin rural communities of Sokoto State,Nigeria

L.S. BilbisBiochemistry DepartmentUsmanu Danfodiyo UniversitySokoto, NigeriaUSD 20,000

The principal goal of the project is to reduce theincidence of Iron Deficiency Anaemia (IDA) in therural communities of Sokoto State, Nigeria, througheducational strategies to increase iron intake bydietary diversification and control of infectiousdiseases (mainly hookworm and malaria). For thispurpose multidimensional guidelines for the controlof IDA will be worked out, based on the internationalrecommendations but adapted according to thelocal needs as well as to local food and medicalconditions. These guidelines will be summarized in asmall educational booklet for health care workers. Ina workshop, health care workers will be able to learnthe ideal strategies for their work. In addition, a smalllocal campaign will be organized to raise awarenessand facilitate the efforts of the health care workers.

CHILD DEVELOPMENTEffect of psychosocial stimulation ondevelopment of iron-deficient anaemicinfants: a randomized controlled trial

Jena HamadaniICDDR, BCentre for Health and Population Research (ICDDR, B)Dhaka, BangladeshUSD 130,235

In developing countries, poor nutrition, highmorbidity, poverty and poor parental education andstimulation in the home all detrimentally affectchildren’s development. These conditions frequentlyoccur together, increasing the risk of poordevelopment. Iron deficiency anaemia (IDA) affectslarge numbers of young children and is associatedwith poor child development. There is somequestion as to whether infants with IDA can catchup in mental development to non-IDA infants. This study examines the effect of psychosocialstimulation on IDA children’s growth anddevelopment using a randomized controlled trial,and compares them with non-anaemic children. Thestudy will be located in poor villages accessible toDhaka. Children aged 6 to 9 months with IDA(haemoglobin (Hb) 80.0-109 g/L, ferritin <12micro g/L)will be identified by survey and randomly assignedto 2 groups: stimulation (n=100), and no-stimulation(n=100). A group of 100 non-anaemic infants (Hb>109g/L) matched to each non-stimulated IDA infant willalso be enrolled. Intervention will include weeklyhome visits for 9 months by a play leader, who willdemonstrate playing with homemade toys andteach the mothers about child development. AllIDA children will be given 30 mg ferrous-sulphatedaily for 6 months. At the beginning and end of thestudy, the following measurements will be made:Bayley Scales of Infant Development (mental andmotor indices), Wolke’s behaviour ratings, Hb,serum ferritin, anthropometry, home stimulation,and mothers’ knowledge and practices of childdevelopment. Stool microscopy, urinary iodine,dietary history, perinatal history and socioeconomicconditions will be assessed at the beginning andchildren’s language development at the end. Thetreatment effect will be examined by intention totreat analyses using multiple regression of theoutcome variables controlling for initial measures.The findings of this project will have implications forinternational and national policies on earlychildhood development programs for IDA children.


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LIEDUCATIONMedical & Nutrition Education Program(SMNEP): A contribution to thereduction of malnutrition andimprovement of health. A pilot study. (A project of the enLINK initiative)

Mohamed Ag AyoyaMalian Center for Medical Research Bamako, MaliUSD 26,355

The lack of information access, and hence the lackof education, is one of the root causes of malnutritionin many developing countries. The easiest and mostcost-efficient strategy to reach a large fraction of apopulation is by means of modern communicationtechnology, such as radio and TV technology. Radiobroadcasting remains the cheapest way for information transfer in many areas of the world.

In this pilot study, we propose a project for satelliteradio-based nutrition education for medical doctors(MDs) because training MDs in nutrition changestheir counselling skills and their behaviours. It therefore improves their patients’/audience’s knowledge acquisition and hence likely their nutritional status. The hypothesis to be tested inthis phase is that the nutritional knowledge of MDs(general practitioners and internists) in Mali will beimproved by a satellite radio-based educationalcourse. SMNEP is also expected to be extended todifferent health professionals, teachers, and finallyto the public in the future.

This is an intervention study with a control group.Participants will be conveniently selected in onehealth district. The programmes will be developedusing vitamin A deficiency as the main topic becauseit is relevant to the Malian population.

In addition to its public health relevance, individualand institutional development, and capacity buildingcomponents, this project has a high potential to bea pacemaker in fighting vitamin A deficiencythrough adequate education.

Application of learning technologies tosupport community-based lay healthcare workers and build capacity inchronic disease prevention in Thailand

Rhona M. Hanning & Suttilak SmitasiriUniversity of Waterloo, Department of HealthStudies and Gerontology , Waterloo, Ontario,Canada and Institute of Nutrition, MahidolUniversity, Nakhon Pathom, Thailand USD 100,000

The main objective of this programme is to buildcapacity for chronic disease prevention in Thailandthrough application of learning technologies in thenutrition education, support and accreditation of layhealth care workers (LHCWs). Specifically, acomputer-based programme for type 2 diabetesprevention will be developed and tested. Throughthis project a template for a computer-baseddiabetes prevention education/support programmewill be developed and modified based on extensiveinput from key stakeholders. The process andoutcomes of implementing the 4-month programmewill be tested. The effects of the programme on theknowledge and practices of LHCWs will beassessed and compared between ten randomlyallocated intervention and ten control communitiesat baseline, end of programme (4 months) andfollowing a 6-month community implementationphase. Thirty to fifty local LHCWs will be trained inthe diabetes prevention programme. An inventoryof community interventions will be made as part ofthe process evaluation. The awareness of keymessages regarding diet, physical activity, smokingand diabetes of the at-risk population will beassessed and compared in intervention and controlcommunities, both pre-programme and post-community implementation phase. Prevention ofchronic diseases and associated risk factors shouldbe enhanced.

COMPLEMENTARYFEEDINGComplementary feeding-based approachto alleviate linear growth retardationand nutrient deficiencies in infants aged6 to 12 months in the south of Benin(Step I)

Romain Dossa & Waliou B. A. AmoussaFaculty of Agricultural SciencesUniversity of Abomey-CalaviCotonou, Republic of BeninUSD 10,000

Growth is one of the best indicators of the nutritionalstatus of children. In Benin the prevalence of stuntedgrowth varies from 21% to 36% through departments.In most rural areas of Benin, feeding of infants aged6 to 24 months is associated with low energy, proteinand micronutrient intake. The main traditionalcomplementary food given to infants in the south ofBenin is fermented cereal porridge, based on maizeonly. This study intends to improve the quality ofcomplementary food in rural areas by a food-basedapproach with maize, groundnuts and beans asingredients. These crops are available inexpensivelyin rural areas and, when well combined, canenhance the nutritional value of porridge. However,rural mothers are either not aware of this or do notknow the proper combination of ingredients. Animproved gruel will be developed, which will beabout 70% maize, 25% groundnuts and 5% maltedbeans, and which aims to meet energy, protein andmost other nutritional requirements. This study, thefirst part of a large research program, is concernedwith household food-processing technologies withthe aim of improving the nutritional quality, safetyand acceptability of complementary foods. Maizeand groundnuts will be roasted in order to increaseorganoleptic properties, safety and nutrient stability.Beans will be malted to obtain amylase-rich flour(ARF) to increase the energy density of theporridge. The addition of beans and groundnuts tomaize is also expected to increase the energy,protein and nutritional content of the new porridge.In step I of this project an appropriate maize-groundnut-ARF based complementary foodcapable of improving the growth of infants 6 to 24months old will be developed, and the state of themothers’ feeding knowledge, attitude and practices(KAP) will be evaluated.

Efficacy of multiple-micronutrientsupplementation on anaemia in ruralBurkinabe children aged 6 to 23 months

Hermann OuedraogoInstitut de Recherche en Sciences de la SantéOuagadougou, Burkina FasoUSD 50,498

Micronutrient deficiencies are common in childrenin developing countries, leading to impaireddevelopment. In the rural district of Kongoussi,anaemia affects more than 99% of young children,and coexists with other micronutrient deficiencies.Iron supplementation is efficacious in reducinganaemia. However, supplementation with iron alonemight be insufficient to control anaemia, because oflimiting effects of protein-energy malnutrition andother micronutrient deficiencies. Studies onmultiple-micronutrient supplementation showedpositive results regarding the improvement ofhaemoglobin and micronutrient status. However, full control of anaemia was not achieved. It hasbeen suggested that dosages of micronutrientssuch as iron and zinc should be increased, and thatother causes of anaemia such as malaria should betaken into account. This double-blind randomisedcontrolled study assesses the impact of multiple-micronutrient supplementation on anaemia inyoung children of a malaria-endemic, under-privileged area. One-hundred-twenty-six childrenranging in age from 6 to 23 months will receive amultiple-micronutrient alone or in combination witha locally produced protein-energy-rich gruel. All willreceive treatment for associated infections (mainlyhookworm and malaria). It is hypothesized thatadequate protein and energy will be as importantfor anaemia control and growth as the multi-micronutrient supplement.


27

INSTITUTIONAL SUPPORT

SEN

EGAL

AFRI

CA

AFRICAN JOURNAL OF FOOD,AGRICULTURE, NUTRITION ANDDEVELOPMENT

Local dissemination of nutrition knowledge is ofgreat importance. There are only a few nutritionjournals on the African continent, one of thembeing the African Journal of Food, Agriculture,Nutrition and Development (AJFAND) (see alsohttp://www.ajfand.net). Hon. Prof. Ruth Oniang’o,Editor-in-Chief, thinks that there is hope for Africa.Despite the grim television pictures of starvationand human suffering, there is tremendous hope fora continent whose people are its greatest resource.The AJFAND is meant to create awareness of themultiplicity of challenges facing Africa that lead toabject poverty and destitution. The Foundation issupporting this important effort with a contributionof USD 2,000 for each journal issue. Due to the highprinting cost, the journal is no longer available in aprinted version but only as a web-basedpublication. Yet despite only being available indigital form, the AJFAND is widely appreciatedand is continuously improving.

AFRICAN NUTRITIONLEADERSHIP PROGRAMME

The African Nutrition Leadership Programme (ANLP) is a leadership development and networkingseminar in the field of human nutrition in Africa.The ANLP concept is based on activities initiatedby the Food and Nutrition Programme of theUnited Nations University (UNU-FNP) and theInternational Union of Nutrition Sciences (IUNS).Every year a one-week leadership programme isheld at the University of Potchefstroom, SouthAfrica. The Foundation supports this programmeand yearly event with an annual contribution of USD 9,600.

SENEGAL

Since 1997 a DEA (Diplôme d’Etudes Approfondies)in Nutrition, equivalent to a Master of Science inNutrition, has been offered at the Nutrition Unit ofthe Faculty of Sciences of the University CheikhAnta Diop in Dakar, Senegal. This programme issupported with an institutional grant by theFoundation. This programme in Senegal, thesecond French-language nutrition programme inAfrica, is headed by Prof. Salimata Wade. Duringthe last year very promising projects have beenstarted which may lead to the creation of asustainable centre of excellence in nutritionalsciences in this part of Africa.


MAL

I

28

A STORY OF OPTIMALCAPACITY BUILDING

The problems of malnutrition and health arecomplex and can only be solved by multidisciplinaryapproaches. Similarly, nutrition research isbecoming more complex and time consuming andusually larger research teams or groups work closelytogether. In 2003 the Foundation granted supportfor a doctoral research project entitled ‘Evaluationof valid biomarkers to distinguish between irondeficiency anaemia and anaemia of inflammation inareas of high rates of parasite infestation andnutritional deficiencies’ to Dr. Mohamed Ag Ayoyafrom Mali (Malian Center for Medical Research). Asa ‘side product’ – also supported by the NestléFoundation – of the support to Dr. Ag Ayoya, twoyoung Malian students who assisted in the studywere able to write their doctoral theses in medicineand in pharmacy. Two others are finishing up theirdoctoral work. The work and strategy of the Malianresearchers show that a team approach and mutualassistance will enhance local capacity building.Often aspects of local mutual capacity building isforgotten – the example of Dr. Keita and Dr. Koné(and soon Dr. Touré and Dr. Sangaré) underlines theimportance of local and regional capacity building.Thinking and acting globally is a fashionable goalbut rarely a realistic and effective one. The strategychosen by the Malian researchers and funded bythe Nestlé Foundation is a good example of howlocal capacity building can have a sustainable highimpact.

EFFICACY OF IRONSUPPLEMENTATION AMONG ANAEMICSCHOOL CHILDREN WITHHAEMOGLOBINOPATHIES S AND C IN MALI

Sadio Keita, MD

In Mali the high prevalence and the association ofanaemia and haemoglobinopathies constitute realproblems of public health. The study was alongitudinal randomised single-blinded trial, theobjective of which was to evaluate the efficacy ofiron supplementation among anaemic schoolchildren with haemoglobinopathies S and C. A totalof 246 children were included and treated for 3months. Hemoglobin was assessed at inclusion andat 45 and 90 days of the intervention. The resultsshowed a reduction in anaemia among all children.However, the response to iron treatment was betteramong AA and AC groups than among childrenwith haemoglobinopathy AS. In conclusion,anaemic children with haemoglobinopathies canbenefit from iron supplements. Nonetheless, it isnecessary to understand the reasons for a lowerresponse among subjects with AS.

URINARY SCHISTOSOMIASIS ANDIRON DEFICIENCY ANAEMIA INSCHOOL CHILDREN IN BAMAKO

Kadiatou Mahamady Kone, PharmD

In Mali, the high prevalence of urinaryschistosomiasis and iron deficiency anaemia among school-aged children justifies appropriateinterventions. The objective of this study was toassess the association between Schistosomahaematobium and iron deficiency among schoolchildren in Bamako, and the efficacy of daily ironsupplementation in reducing this anaemia. Children(n=244) aged from 7 to 12 years were randomlyassigned to receive praziquantel with and withoutiron. Haemoglobin and serum ferritinconcentrations were measured at baseline (day 0),and at day 45 and day 90 of the intervention. Atbaseline, the prevalences of anaemia and irondeficiency anaemia were 72 and 17.2%, respectively.Iron supplementation (60 mg of elemental iron)given 5 days a week during 3 months significantlyimproved (P < 0.001) children’s haemoglobin andiron stores at day 90. In countries where irondeficiency anaemia and Schistosoma haematobiumare prevalent and often coexist, daily ironsupplementation for 3 months and control ofparasites should be recommended for school-agedchildren who are anaemic.


40 YEARS OF THENESTLÉ FOUNDATION

Activities on 5 continents

Research in more than 50 countries

An investment of over 50 million USD for research and fellowships

Over 250 research projects

Basis for 450 research publications

Support for over 120 Master of Scienceand Ph.D. degrees in nutrition

31


SMALL FOUNDATION - BIG ACHIEVEMENTS

1966

-200

6A N G O L A

A R G E N T I N I A

B A N G L A D E S H

B E N I N

B R A Z I L

B U R K I N A F A S O

C A M E R O O N

C H I L E

C H I N A

C O L U M B I A

C O N G O

C O S T A R I C A

E L S A L V A D O R

E T H I O P I A

G H A N A

G U A T E M A L A

G U I N E A

H O N D U R A S

I N D I A

I N D O N E S I A

I V O R Y C O A S T

J A M A I C A

J O R D A N

K E N Y A

L E B A N O N

M A L A Y S I A

40 YEARS OF THE NESTLÉFOUNDATION

In 2006 the Nestlé Foundation celebrated its 40thanniversary. As with every anniversary it is a time tomake a strategic review – to have a look into thepast and, more importantly, envision activities forthe future. The 40th anniversary takes place in a very dynamicperiod of history and politics but also of nutritionand science. Genomics, proteonomics,metabolomics and many other new areas ofresearch are worldwide priorities – basic nutritionresearch for the sustainable elimination ofmalnutrition is often no longer regarded as anadequate aim for research in the academic setting.Yet still in the year 2006 nutrient deficiencies can beeliminated by food only if a sustainable agricultureis locally available.

All aspects of life have been globalised andinterdependence has reached an unseen level. Thisinterdependence has created common advantagesand common disadvantages. Also diseases,especially lifestyle-related chronic diseases, areemerging more and more frequently in low-incomecountries, contributing to the significant morbidityand mortality. In a world of affluence and diseasesof affluence, the classic deficiency diseases andclassic malnutrition nonetheless remain widespreadand yet are in danger of being easily forgotten. Asin the past, the Foundation will continue to focus

on the latter central aspects. Over the years, the Foundation has adapted to new needs andobjectives, while not getting lost in academic ivorytower research. Focusing on adequate intakes ofmiconutrients, protein and energy was and willremain a central endeavour of the Foundation,along with the promotion of a food-basedapproach as the ultimate goal to fight malnutritionin a sustainable way. A major concern of theFoundation is the implementation of new scientificnutrition knowledge at the population level in orderto improve the nutritional status of children andwomen of low socio-economic classes.

33


40 Y

EA

RS

40 years of capacity building in nutrition research for the sustainableimprovement of nutrition in low-incomecountries:

At the occasion of the general assembly of theNestlé Company on May 6th 1966, in honour of thecentenary of the Nestlé Company, the decision wasmade to constitute a Foundation. The legalconstitution of the Foundation took place on July17th 1967 and on September 1st the Foundationofficially started its work, in its offices in Lausanne.The Foundation was self-constituting andindependently formed a Council consisting of fiveinternationally well-known scientists as CouncilMembers. The first President of the Foundation wasProf. Alexandre von Muralt of the University of Bern(Switzerland). Other Presidents, Council Membersand Advisors followed, and all assisted in asustainable implementation of the portfolio and themandate of the Foundation. From the very first daythe Foundation was financially and operationallyindependent from the founding company.

34

THINK GLOBALLY – ACT LOCALLY

M A L I

M A R O C C O

M E X I C O

M O Z A M B I Q U E

N E P A L

N I C A R A G U A

N I G E R I A

N O R T H K O R E A

P A K I S T A N

P A N A M A

P E R U

R W A N D A

S E N E G A L

S O U T H A F R I C A

S R I L A N K A

S U D A N

T A N Z A N I A

T H A I L A N D

T H E G A M B I A

T U N E S I A

U G A N D A

U Z B E K I S T A N

V I E T N A M

W E S T I N D I E S

Z A I R E

Z A M B I A

Z I M B A B W E

During the past 40 years the Foundation hasbecome a widely recognized organization and anindispensable and highly respected institution forthe promotion of nutrition research and nutritioneducation in low-income countries. The Foundation has contributed with innumerous studies to theknowledge base for the reduction of malnutrition.The results of many research projects which havebeen supported and in part also initiated by theFoundation provided a basis for implementation atthe local, national and also international levels.Looking at the activities and achievements of theFoundation it can be easily recognized that theFoundation is a key institution for the study of theproblems of nutrition in the world.

35


3736

VISION 2006

1966-200640 YEARS OF

THE NESTLÉ FOUNDATION

Vision 2006 reviews the most important activities of the Foundation during the last 40 years. Theseactivities illustrate the evidence for the need to linkdifferent disciplines to control malnutrition. TheFoundation favoured and stressed during all theyears - and against all fashion trends - a food-basedapproach. There are many fields in which theFoundation supported and initiated research.Nevertheless the major activities can be groupedinto five categories, which are briefly summarized byour Council members: • Energy Metabolism• Child Nutrition and Health• Micronutrients, Infection and Child Development• Energy, Amino Acids and Protein• Pregnancy and Lactation

In addition, two former Council members presenttheir personal views on two different topics: RogerWhitehead (1968-2005) describes his view of thework of the Foundation in a changing world and J.P. Flatt (1990-2005) discusses an obvious butneglected aspect of the overweight and obesitypandemia. Our website (www.nestlefoundation.org) provides an almost complete list of publications resultingfrom the many supported research projects. Looking at this list one quickly realizes that most of the supported research was not 'l'art pour l'art',but that these research endeavours often led to asustainable implementation and reduction ofmalnutrition.

ENERGY METABOLISM

PREGNANCY AND LACTATION

MICRONUTRIENTS, INFECTION ANDCHILD DEVELOPMENT

CHILD NUTRITION AND HEALTH

ENERGY, AMINO ACIDS AND PROTEIN

MATCHING POLICIES TO NEED

ENERGY EXPENDITURE AND OBESITY


38 39

CAN HUMANS ADAPT TO LOWOR TO HIGH ENERGY INTAKE ? Eric JéquierPresident Nestlé Foundation

Undernutrition and overnutrition are two publichealth problems that are responsible for a largeburden of diseases. In developing countries, foodinsecurity, hunger and poor nutrition still affect over800 million people, whereas energy excess, leadingto positive energy balance, overweight and obesity,is a worldwide phenomenon affecting 1.2 billionpeople. Can humans adapt to low or to high energyintake to limit the negative effects on health ofthese environmental influences?

The concept of a variability in energy metabolismwas proposed about 45 years ago to account for the

observation that energy intake can apparently varyas much as twofold without influencing body weightor body composition in adult individuals1. Thequestion was also asked whether an insufficientadaptation to low energy intake could explain whysome individuals are prone to becomemalnourished. A similar reasoning was proposed forthe development of obesity: a low resting metabolicrate and a blunted dietary induced-thermogenesis(the increase in energy expenditure following mealingestion) were described as risk factors foroverweight and obesity2. By contrast, individualssubmitted to a prolonged experimental overfeeding

regimen were shown to exhibit a lower weight gainthan that predicted by the cumulative daily positiveenergy balance, suggesting a mechanism of 'luxusconsumption' by which a substantial fraction of theexcess in energy intake could be dissipated asheat3. These individuals appeared to be 'resistantto the development of obesity' by a metabolicadaptation to the excessive energy intake.

The Nestlé Foundation has been proactive in thisresearch area by initiating and supporting human studies. In several developing countries, seasonalvariations in the habitual energy intakes of thepopulation occur each year due to the decrease inthe amount of food stores before the new cropscan be harvested. During this 'hungry season', thebody weight of adult individuals decreases by 2 to 4kg, demonstrating a chronic negative energybalance. In order to assess the magnitude of apossible adaptation to the low energy intake duringthe 'hungry season', we carried out severalinvestigations in a rural village of The Gambia, WestAfrica, by using a respiration chamber (an airtightroom in which an individual can spend 24 hours).Free physical activity was allowed during the testexcept for periods of imposed exercise on atreadmill. The chamber was used to continuouslycalculate energy expenditure of the subject bymeasuring the individual's oxygen consumptionand CO2 production. The results of these studiesclearly showed that changes in body compositionare the main factors which explain a decrease ofabout 10% of energy expenditure during the'hungry season' compared with the period whenthe subjects had regained the lost body weight4.The saving of energy during the 'hungry season'was mainly explained by the loss of metabolicallyactive tissue (lean body mass which mainly consistsin muscle tissue) as a result of the chronic negativeenergy balance4. This was further demonstrated bythe finding that the saving of energy disappearedwhen body weight (and lean body mass) was fullyrecovered5. Our studies (and many others) do notconfirm the existence of an enhanced metabolicefficiency in subjects living in environments thatimpose a chronic low daily energy intake. There isno evidence of a metabolic adaptation whenenergy intake is chronically restricted. As a practicalresult, the recommendations for energyrequirements of adults in the developing countriesmust not be influenced by the unproven concept ofmetabolic adaptation. By contrast, behaviouraladaptation in physical activity patterns can occurwhen energy intake is chronically restricted, withnegative consequences on work output and sociallydesirable activities. These behavioural adaptationsare undesirable, and energy requirements mustcover the energy cost of these activities.

Similar to the lack of evidence for a metabolicadaptation to low energy intake, we found that theconcept of 'luxus consumption', which wasproposed to explain the variability in weight gainduring experimental overfeeding conditions, wasnot supported by measurements of energyexpenditure6. When all the components of theenergy balance equation are carefully measured,there is no evidence for a change in metabolicefficiency during overfeeding.

In conclusion, the efficiency of metabolic processesis very stable in humans. Energy expenditure is littleinfluenced by the level of energy intake. The smallmodifications in energy expenditure that areobserved during under- or overfeeding are mainlyexplained by the changes in the mass of metabolicallyactive tissues. In addition, changes in the energycost of weight-bearing activities, such as walkinguphill, can contribute to the changes of total energyexpenditure during chronic under- or overfeeding.There are no mysterious energy-saving or energy-dissipating mechanisms in humans. These importantscientific findings based on precise measurementsof energy expenditure allow us to derive adequaterecommendations for energy intake of individualsby taking into consideration their body size (andbody composition) and their physical activity level.These data on energy expenditure contrast with theuncertain measurements of food and energy intakeswhich were at the origin of the erroneous conceptof metabolic adaptation.


4140

ENERGY REQUIREMENTSOF PREGNANT WOMEN

Professor John Durnin, then Foundation Advisor. Up to then the most relevant available data onenergy requirements had been studied andcompiled by Hytten and Leitch. They estimated theenergy cost of pregnancy of Caucasian women tobe 335 MJ, partly based upon the estimate for fatgain during pregnancy of 3.35 kg. What were thefindings of the multi-centre studies initiated by theFoundation in the period 1980-1985?

Longitudinal studies during pregnancy were carriedout in five countries, in women living under differentsocial, environmental and economical circumstances:in Scotland, the Netherlands, the Gambia, Thailandand the Philippines. The research teams used similarmeasurement designs and were very well trained inusing the same or very similar methodologies tostudy the various components of energy balance.The findings in Gambian women were quiteexceptional when compared to the results from the other countries involved, but it was not clearwhether this was caused by remarkablephysiological adjustments or by methodologicalissues. In Scotland and the Netherlands womenwere recruited and studied before pregnancystarted. In Thailand and the Philippines womencould only be recruited from week 10-12 ofpregnancy onwards. Main data collected in allcountries include height, weight, skinfoldthicknesses, energy intake, basal metabolic rate(BMR), daily activity pattern and birth weight andbirth length.

The gain in fat mass during pregnancy brought asignificantly different view compared to the estimateby Hytten and Leitch of 3.35 kg. This gain wassubstantially lower: about 2 kg in Scottish and Dutchwomen and about 1.5 kg in Thai and Philippinewomen. This finding consequently had a considerableimpact on the calculation of the energy cost ofpregnancy. Hytten and Leitch arrived at a figure of335 MJ for the whole of pregnancy, and theFoundation studies, after standardization formaternal body weight, came to an average estimateof about 250 MJ. When expressed on a daily basisthese figures are 1200 kJ and 900 kJ, respectively.The WHO stated that if pregnant mothers mayreduce their physical activity, the average dailyenergy requirements might be lowered to 840 kJand 600 kJ, respectively.

The next question was whether the extra energycosts of pregnancy would be accompanied by extraenergy intake during pregnancy. The findings of themulti-centre studies did not confirm substantialincreases in energy intake. Only a modest increasein energy intake of not more than, on average, 420kJ per day was measured, which is substantiallylower than current recommendations. There is novalid explanation for this discrepancy. It is

conceivable that the reduction in physical activity ishigher than estimated or measured. Supplementarystudies have shown that diet-inducedthermogenesis and metabolic efficiency are notreally adapted in pregnancy and therefore alsocannot explain the observed discrepancy.

This paper started with a citation on the healthconsequences of overweight and obesity inpregnant women. What lesson can be learned fromthe still valid results of the Foundation studiescarried out more than 20 years ago? The mainlesson probably is that for a normal pregnancy theextra daily energy requirement is quite small, andthat a pregnant woman living in an obesogenicenvironment should not be stimulated to eat more.It would be much better for more attention to begiven to the quality of her daily diet rather than toquantity.

Main researchers at the various locations:

Glasgow: John Durnin, Fiona McKillop

Wageningen: Jo Hautvast, Joop van Raaij, MetaPeek, Susan Vermaat

Gambia: Roger Whitehead, Mark Lawrence

Thailand: Arie Valyasevi, Kallaya Kijboonchoo

Philippines: Cora Barba, Peachay Tuazon

Joseph Hautvast, MD, PhD and Joop van Raaij, PhDWageningun University, The Netherlands

A recent paper in The Lancet (30 September 2006)reports that overweight or obese women are atgreater risk of major maternal and perinatalcomplications. The present pandemic of overweightand obesity obviously also affects pregnant women.It is therefore relevant to study the complex issue ofenergy balance in pregnancies of women living intoday’s obesogenic environment. However, relevantlessons might also be learned from a research effortfrom about 20 years ago, supported by the NestléFoundation.

The Foundation organized around 1980 a broadconsultation on the issue of energy requirements inpregnancy. There was much conflicting evidence onmaternal energy balances under various free-livingsituations. One of the main conclusions of thatconsultation was that there was a serious lack ofcomprehensive longitudinal data using uniformresearch methods on the various components ofmaternal energy balance. The Foundationconsequently decided to design the most adequatemulti-centre study possible, of course within acertain budgetary limit, under the leadership of


42 43

PROPER NUTRITIONPROPER NUTRITION IS ESSENTIALTO PREVENT INFECTIOUS DISEASESAND ALLOW FOR PSYCHO-SOCIALDEVELOPMENT

Jehan-François Desjeux, MDConservatoire National des Arts et MétiersConsultant in Paediatrics, Nutrition andGastroenterologyMember C, Académie Nationale de Médecine,Paris, France

In addition to aiding growth, proper nutrition isessential to prevent infectious diseases and allowfor psycho-social development. Specific nutrientsmay also be used for specific functions. Prenatal and postnatal undernutrition may have long-termconsequences on health, including hypertension,coronary heart diseases and type 2 diabetes. The Nestlé Foundation supported studies in thePhilippines and Pakistan which extended theconcept of foetal and early infant programming bynutritional status to the immune system. Earlynutrition has short-term consequences on infantgrowth; it may also have long-term consequencesfor immuno-competence and infectious diseasesrisk, including infectious diarrhoea1,2. Immunisationis an essential way to reduce the risk of bacterial or

viral infection. In addition to tuberculosis, the BCGmay also protect against intestinal parasiticinfection, as indicated by studies in Brazil andUganda3,4. In turn, parasitic infection alters thenutritional status. In Gambian children sufferingfrom an acute episode of malaria, the resting energyexpenditure increased by 40%, and whole proteinturnover by a factor of 2, compared to controlvalues5. Malnutrition and parasitic infection areundoubtedly closely linked in adults as in the caseof children in a community6.

Specific nutrients may also help in the preventionand treatment of infectious diseases. This is thecase for amylase-resistant starch in the treatment ofinfectious diarrhoea. Starch which is resistant toamylase is metabolised by the bacteria in the colonin the form of short chain fatty acids, and essentiallyplays in the colon the same role glucose does in thesmall intestine in stimulating water absorption7. TheNestlé Foundation supported a study showing thatthe addition of a resistant starch to oral rehydrationsolution reduced faecal fluid loss and shortened theduration of diarrhoea in Indian adolescents andadults with cholera8. There is an ongoing study inBangladesh to see if the results could be extendedto malnourished children and understand themechanism of action.

Globally, 4.4 million preschool children havexerophthalmia and 6 million mothers suffer nightblindness during pregnancy. Both conditions areassociated with increased risk of morbidity andmortality. While reductions in child mortality from 19 to 54% following vitamin A treatment have beenwidely reported, more recent work suggests thatdosing newborns with vitamin A may, in somesettings, lower infant mortality9. Zinc is anotherspecific nutrient that is now used to treat infectiousdiseases, including diarrhoea and infectiousrespiratory diseases. However the bioavailability ofzinc from food may be reduced by the presence ofdietary phytate. In a study conducted in Malawi andsupported by the Nestlé Foundation, phytatereduction was found to improve zinc status ingroups with increased zinc requirements whoconsume a cereal-based diet10.

Several studies supported by the Foundationindicate that undernourished children are at highrisk not only of increased mortality and morbiditybut also of poor cognitive development andsubsequent school failure. In such a context a largeintervention study was funded by the NestléFoundation and conducted in six tea plantations inWest Java, Indonesia10-17 .The malnourishedchildren received a daily supplementary feeding for12 to 18 months. In that cohort, the group thatreceived a energy + micronutrient supplement(E+M) had an advantage as measured by the Bayley

Scale of Mental Development over groups thatreceived either skim milk + micronutrients (M) orsolely skim milk (S). The functional advantage wasinterpreted as an indication of the beneficial effectof energy. However, another interpretation would be that isolated micronutrient supplementation isassociated in a modest decline in development.Such a study points to several important issues,including: 1) the need for an energy supply withmicronutrient supplements, 2) the potential adverseeffect of micronutrient supplementation, 3) the needto select appropriate and sensitive tests ofdevelopment, 4) the need to follow the child’sdevelopment by repeated measurements and 5) therealisation that supplements could have long-lastingeffects on a specific domain if associated with theproper stimulation. Some nutritional interventionshave been coupled with psychosocial stimulation.For example, the Foundation supported a studydone with undernourished children in Jamaica. Zincsupplementation was found to benefit developmentin those children, and the benefit was enhanced ifstimulation was also provided18. A similar study isunderway in Bangladesh with undernourished andanaemic children.

Low birth weight (LBW) with intrauterine growthretardation affects 11% of infants born in developingcountries. It is often associated with poverty andinadequate psychosocial stimulation in the home.The effect of regular stimulation at home wasassessed in Jamaica. The intervention benefited theinfants’ development quotient and performancesubscale at 15 and 24 months, and homeenvironment at 12 months. Thus LBW wasassociated with development delays, which werereduced with psychosocial intervention19. Clearlythe mechanism linking undernutrition to poordevelopment needs further understanding beforeinitiating large-scale intervention.


44

CHILD NUTRITION AND HEALTH

45

A BIRD’S-EYE VIEW OF THEFOUNDATION’S RESEARCHPROGRAMMES ON CHILD NUTRITIONAND HEALTH 1994–2005

Mehari Gebre-Medhin, MD, MPH, PhDDepartment of Women’s and Children’s HealthUniversity Hospital Uppsala, Sweden

The 40th anniversary edition of the NestléFoundation Annual Report offers a valuableopportunity for a retrospective look at the scope,orientation and focus of the research and fellowshipsupport given to issues related to the health andnutrition of infants and children throughout theworld. During the ten-year period 1994 to 2005 atotal of approximately 210 scientific publicationssupported by the Foundation on various aspects ofnutrition have seen the light of the day. Roughly halfof these, about 120 articles, pertain to the nutritionand health of infants, children and adolescents. Thisamounts to, on average, the publication ofapproximately one Foundation-supported articleevery month for the last ten years.

Growth in relation to nutrition and health occupies a central and dominating place in the series ofpublications. Quite a number of articles haveattempted to elucidate the exclusive position ofbreastfeeding in this respect as well as thenutritional determinants of size at birth, and growthduring infancy, childhood and adolescence.

Significant space has been given to the study ofstunting in children. This topic is investigated inrelation to body composition, fat distribution, energy and nutrient metabolism, energy intake

regulation, physical activity and response tointerventions using specific nutrients. A few studieshave focused on development, cognition andintellectual performance in stunted children. Insome instances multivitamin preparations along withiron were provided to these children with a view toenhancing their appetite and stimulating catch-upgrowth or improving their physical and intellectualperformance.

Interaction between infection and malnutrition hasalways been a challenging and productive topic inchild nutrition research, so also in this series. Severalarticles have looked closely at the nutritional andhealth status of children suffering from intestinalparasites, pneumonia, malaria, measles,tuberculosis, and in recent years also HIV/AIDS,occasionally with pilot interventions usingmultivitamins and other micronutrients. A recurrentsubject that has attracted several investigationsconsists of the search for the circumstances aroundthe development of Cancrum oris - noma, includingpossible causative or precipitating factors such asmalnutrition, nutrient deficiencies and oral hygiene.

In view of their increased nutritional requirementsand vulnerability, the study of the bioavailability ofvarious nutrients in children has always had a

prominent place in nutrition research. A number ofstudies in the present series have emphasised thebioavailability of iron, zinc and vitamin A in infantsand children under different circumstances.

With the emergence of the hypothesis that prenataland early postnatal malnutrition may be significantpredictors of certain diseases later on in life, interesthas grown in the possible effects of earlymalnutrition on parameters such as plasma insulin inadults and the relationship between size at birth,maternal energy status and lipid profile inadolescence. A few articles dwell on this topic.

The pathogenesis and clinical as well asbiochemical, immunological and metabolicmanifestations of severe malnutrition continue tofascinate researchers more than half a century afterthe pioneering studies from East Africa and theCaribbean Islands. Sustained interest in this topic ismanifested in this series by a few articles dealingwith the kinetics of specific nutrients and substancesmeasured during the progression of severemalnutrition or the treatment of the condition.

Iodine deficiency occupies a special place amongmicronutrient deficiencies in view of its devastatingeffects on infants and children and the fact that itsintake principally can only be guaranteed throughuniversal salt iodization. While the questionregarding implementation of national salt iodizationprogrammes has not attracted much scientificattention in this series, some reports provideinteresting data on indicators of iodine status andon iodine and mental performance. A related andoperationally significant and fairly unusualcontribution relates to the benefit of home-visitinginterventions for the support of low birth weightinfants and those in need of follow-up for improvedcognition and intellectual performance.

The geographic origin of the majority of the reportsin this series shows a wide international spread witha clear domination of developing countries in Africa,South America, the Caribbean Islands, Asia and theEast Indies. West Asia and North East Asia, with theexception of China and Pakistan, are barelyrepresented in this series.

The present bird’s-eye view of research support tochild nutrition and health has clearly shown that thesupport given has been instrumental in creatingawareness about the needs of children. The supporthas helped to produce a solid and massive foundationof theoretical and some practical knowledge andexperience on a wide range of topics, from amultitude of environmental, social, economic andcultural settings throughout the world. The supporthas also contributed significantly to the

development of local capacity and infrastructure forthe improvement of child nutrition and health.

Researchers, field workers, UN agencies and civilsociety have never had as much knowledge aboutchild nutrition and health as we have today.However, whether a rear-view mirror will show thatthe situation of children in the developing countrieshas improved in a sustainable manner as a result ofthe application of this knowledge will need aseparate analysis.


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ENERGY AND PROTEIN: NESTLÉ FOUNDATION’SCONTRIBUTION OVER THE YEARS

Prakash S. Shetty, MD, PhDFormer Professor of Human Nutrition, LondonSchool of Hygiene & Tropical Medicine, London (UK)Currently Chief, Nutrition Planning, Assessment &Evaluation, Food & Nutrition Division, FAO, Rome, Italy

Much progress has been made in ourunderstanding of human energy and proteinrequirements over the two decades since the lastinternational expert consultation report on humanenergy and protein requirements1. In 2001 and 2002,the international agencies FAO and WHO alongwith the UNU convened their Joint ExpertConsultations on ‘Human Energy Requirements’ (17-24 October 2001, Rome, Italy)2 and ‘Protein andAmino Acid Requirements’ (9-16 April 2002, Geneva,Switzerland)3. It is a matter of considerable prideand achievement for the Foundation toacknowledge that much of the new information that informed the deliberations of these recentinternational expert consultations were attributableto its crucial support to furthering scientific researchin these areas. Significant aspects among thesecontributions include the support provided toconduct calorimetric and stable isotopicmeasurements of total energy expenditure amongindividuals in developing countries. Support wasprovided to compile databases of basal metabolicrate (BMR) measurements made worldwide and toupdate their use in generating predictive equationsfor BMR and to validate them in different population groups to establish their better

predictive performance for international use.Compilation and tabulation of the energy cost and expenditures related to individuals’ physicalactivities were also supported to enable betterestimates of total energy expenditures of peoplefrom different parts of the world. A large part of thecurrent revised recommendations on requirements of pregnancy and lactation are largely attributableto the data generated from longitudinal studies in both developed and developing countriessupported by the Nestlé Foundation. New researchthat has since helped deal with a contentious issueof adaptation and accommodation that mayinfluence requirements for energy among differentpopulations and during seasonal variations inintakes, a topic that the 1985 report seriouslywrestled with, was also largely attributable tosupport provided by the Foundation for studies ofhuman energy metabolism in several developingcountries.

The Nestlé Foundation also made a majorinvestment in supporting research related to humanamino acid requirements in developing countries.This resulted in obtaining data on the adultrequirements of several amino acids, such as lysine,

leucine, threonine, valine, and methionine. The data was obtained using the stable isotopic tracermethods and analysis by sophisticated massspectrometry in developing countries. It is a matterof pride that the recommendations for amino acidrequirements of adults, which have been revised inthe 2006 report3, are almost entirely attributable toprojects supported by the Foundation. Not only didthey provide much valuable data and contribute tofill a lacuna in the science; they also contributed tothe transfer of essential albeit sophisticatedresearch techniques to developing country scientistswhile enabling them to procure expensiveequipment and set up sophisticated nutritionlaboratories in their countries. This is indeed justanother example of the yeoman contribution tocrucial research in nutrition in developing countriesthat support from the Foundation has accomplishedover the years.

The International Dietary Energy Consultancy Group(IDECG) was founded jointly by the United NationsUniversity (UNU) and the International Union ofNutritional Sciences (IUNS) in 1986 in Geneva byinterested scientists who were attending a scientificmeeting of the Foundation. The Foundation hashosted the Secretariat of the IDECG since itsinception and its then Director, Dr Schürch, servedas its Executive Secretary. Although IDECG wasestablished principally ‘for the study of dietaryenergy intake in relation to the health and welfare ofindividuals and societies’, over the years it has dealtwith related issues and in particular with energy andprotein. The Foundation has provided unstintingsupport to IDECG since it was founded and hasprovided resources for convening numerousmeetings of interested scientists all over the world.Essential outputs of these meetings have included awhole series of excellent publications – both aspeer-reviewed supplements of journals and as muchvalued individual publications (see a detailed list atwww.nestlefoundation.org) on such varied topics asChronic Energy Deficiency (CED), low body massindex (BMI), protein-energy interactions, limits ofadaptation to energy intake, physical activity inchildren and the impact of human ageing on energyand protein requirements. Singular attention mustof course be drawn to the support the Foundationprovided through IDECG in defining CED4

(published in the European Journal of ClinicalNutrition in 1988 and now featured by the journalamong its four most often cited papers) and themeeting on ‘Energy and Protein Requirements’ heldin 1994, which was an essential forerunner to therecent Joint Expert Consultations on energy andprotein convened by the UN agencies. It is noexaggeration to state that it may be well-nighimpossible to describe fully the crucial role theNestlé Foundation has played in our currentknowledge in this important area of nutrition overthe 40 years since it was founded.

ENERGY AND PROTEIN


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Dr. Roger G. Whitehead, CBEFormer Director, MRC Dunn Nutrition Center,Cambridge, UK and Keneba, The Gambia

For any organisation to make significant scientificcontributions continuously over a period of 40 yearsmeans it has had to respond to changingcircumstances. The work of the Foundation isexclusively devoted to research into the nutritionalhealth problems of the developing world and itsinception occurred in the immediate post-colonialera. Things are very different now. In one capacity oranother I was associated with the Foundation formuch of this time and have thus been in a positionto witness this evolution. Perhaps, therefore, I maybe excused for contributing a rather personal

assessment of the main things I think theFoundation has achieved.

Back in the 1960s the main aim was to ensure thatappropriate high quality research was carried out byencouraging talented scientists, mainly from themore privileged parts of the world, to developinterests in this area. As well as awarding thetraditional type of research grant, a researchinstitute was also established in the Ivory Coast. Astime went on, however, the Council realised thatsuch an approach was not sufficiently focussed on

emerging issues and thus it was decided to identifyspecific topics for priority investigation, oneexample being the highly successful investigationsinto the extra-nutritional needs of pregnant andlactating women. The multi-centre approachenabled young scientists in different parts of theworld to collaborate with more experiencedinvestigators.

It became increasingly obvious to the Council,however, that if they were really to help nutritionalresearch in the developing world to emerge, a moreadventurous approach was going to be necessary. Itwas insufficient just to have collaborators working inassociation with universities and institutes from thewestern world – it was essential to encourageresearch proposals to come directly from thosecountries. A more fundamental approach was goingto be necessary. The developing world is far fromhomogeneous – particularly in tropical Africa and insome Asian countries research capacity is oftenlacking – but merely providing even sorely neededequipment to such universities and researchinstitutes was not the complete answer, by anymeans. The concept of supporting institutionaldevelopment emerged. Although the Council hadfor a number of years provided grants so thattalented individual students could travel abroad towork for higher degrees, their full potential wasoften not achieved on returning home. Successfulpost-doctoral development is dependant on thenewly qualified investigator entering anestablishment where there is a tradition for, andencouragement of, research. All too often it wasfound that the young scientist did not find the localenthusiasm he or she yearned for and notinfrequently this was resulting in his/her desire toreturn to the western world.

Contrary to popular opinion because of the sharedname, the Nestlé Foundation is not a wealthy one. Itwas necessary for the Council to devise a pragmaticplan that would make a significant contributionwithin its limited financial means. To assist in theformulation a meeting was organised with scientistsfrom different parts of the developing world to findout more exactly what they thought was needed. Apolicy emerged which, although now well known,merits restatement as it remains a model worthy ofemulation by others. Specific university departmentsof nutrition, especially in Africa – the continentwhere arguably the need was greatest – wereinvited to produce an institutional developmentplan which they would like to get underway if onlythe appropriate personnel could receive, say, anextra one year’s specialist training. It was theresponsibility of the department to identify thepreferred place for this training. It was envisagedthat up to a total of six persons at post-doctorallevel would eventually form a sufficiently self-

stimulating cohort of investigators, but it was alsoappreciated that they would need continuingsupport and encouragement after the initial periodof training. Consequently it was proposed they begiven preferential research support as long as theirresearch proposals were equally competitive withany others received. Although it was recognisedthat outside collaboration was often going to bedesirable, a critical requirement was that theintellectual input in any research proposal camefrom the local scientist. It is still young days and Iwill be interested to see the eventual outcome! Todivert from the usual policies by which grant-awarding bodies usually decide on which types ofresearch to support was never going to be easy. Onmore than one occasion I realised that well-prepared proposals from eminent investigators werebeing turned down because the developing worldinput was little more than nominal.

One final issue I have often been called upon toaddress over the years is the degree of academicfreedom the Nestlé Foundation enjoys. I am takingthis opportunity to say once again that this hasbeen total. A series of eminent Presidents andDirectors of the Council have always ensured thatthis was so.

MATCHING POLICIES TO NEED


published in the 'Dietary Reference Intake' report4

reveals that there is no correlation between % BodyFat content (calculated using the equation linking %Body Fat to BMI in the NHANES3 data4) anddeviations from predicted ('normal') basal energyexpenditure in women or in men (Figure)5,6. Inanother examination of the NHANES3 data, nonegative correlation between height and adipositycould be detected7, even though height has areadily recognizable impact on basal as well as totalenergy expenditure4. Such evidence contradicts thewidely held notion, that low rates of resting energyexpenditure promote fat accumulation and thedevelopment of obesity.

At a time of great concern about the rapidlyincreasing preponderance of obesity even in lessaffluent countries, this insight helps to recognizethat weight maintenance as well as excessive weightgain should be attributed to the factors influencingfood intake and physical activity, but not todifferences in resting energy expenditure.

F I G U R E 1

Percent (%) body fat in 433 women (upper panel)and in 335 men (lower panel) whose ages,anthropometric data and basal energy expenditureare listed in the DRI database (4), plotted againstthe deviation from their 'normal' daily basal energyexpenditure (fBEE for women, mBEE for men), aspredicted using the basal energy expenditureequation given in (4,5)J P Flatt, PhD

Department of Biochemistry and MolecularPharmacologyUniversity of Massachusetts Medical SchoolWorcester, MA, USA

The Nestlé Foundation has supported a number of studies on human energy expenditure. Theyprovided important data for the assessment of theadditional energy needs during pregnancy andlactation1. The Foundation also supported extensivestudies of nutritional supplementation inundernourished children, which showed that thegreatest benefits occur when additional food energyis provided to infants in the 6 to 18 months age-

range2. Other studies conducted with support from the Foundation have shown that in poorlynourished population groups, resting energyexpenditure is relatively low due to small body size,with little evidence of adaptive decreases inthermogenesis3.

A statistical analysis of anthropometric and energyexpenditure data for 433 women and 335 men

RESTING ENERGY EXPENDITUREAND THE OBESITY PROBLEM

50 51


AT THE OCCASION OF THE 40TH ANNIVERSARY OF THE NESTLÉ FOUNDATION

MANY BIRTHDAY WISHES HAVE BEEN SENT TO THE FOUNDATION. A SMALL

SELECTION IS PRESENTED HERE. THE FOUNDATION APPRECIATES THE GREAT

RESPECT AND LOYALTY IT RECEIVES FROM THE WORLDWIDE NUTRITION

RESEARCH COMMUNITY.

53

CONGRATULATIONSFrom an old-timerI am proud to have been associated with the Nestlé Foundation, in one capacity or another, almost from its beginning. There are many aspects I could highlight but I will stick with two. The first is the scientificindependence it has resolutely safeguarded. The second is the flexibility shown in the prioritisation ofprogramme policies. Success in one type of initiative has not been allowed to fossilise future initiatives. Asthe nutritional research needs of the developing countries have changed so has the nature of thenutritional research supported by the Foundation. This adaptability of approach has been accomplishedthrough the wise guidance of a succession of excellent Presidents and Directors.

Roger G. WhiteheadMRC Dunn Nutrition Unit,Cambridge, UK & Keneba, The Gambia


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The contribution of the Nestlé Foundation toscience has been admirable and I hope they cancontribute more and more to improving ourknowledge.

Jena Derakhshani HamadaniICDDR B, Dhaka, Bangladesh

Splendid 40 yearsDuring the past 40 years, the Foundation has givena great deal of love to the world. The NestléFoundation has educated and trained students andexperts of all colours around the world; moreover,the Foundation has supported hundreds of projectsand greatly improved the nutritional status andhealth condition of millions of people.

Ma AiguoMedical College of Qingdao, Qingdao, PRC

Your endeavour makes the world a better placeIn the last 40 year the Nestlé Foundation is workingwith health staff around the world to fight againstmalnutrition and poverty in developing countries.The achievement is wonderful and the mostimportant is that weak and fragile populations getreal and sustainable benefits from the supportedprograms.

Jian ZhangInstitute of Nutrition and Food Safety, CDC Beijing, PRC

Nestle Foundation: A golden research grantor!Beyond financial support, the Foundation also provides us with valuable technical support and professionaladvice, particularly in the person of Professor Paolo Suter, who has always provided me immediate adviceand encouragement. In addition, the Enlink library and global networking establishment are valuable toresearchers at all levels. For researchers in developing countries such as Vietnam, the Foundation helpsscientists achieve far more than they would otherwise be able to in academic research on crucial issues.Once again, my sincere thanks to the Nestlé Foundation – a great research opportunity provider andpartner for researchers around the world.

Dien N. LeNutrition Center, Ho Chi Minh City, Vietnam

Hearty Congratulations ! You have been a friend in need and hence a friendindeed, through your unconditional institutionalsupport to our young MSc Programme in AppliedHuman Nutrition, which is producing the muchneeded human capacity in nutrition, both forUganda and the African region at large.

Joyce KikafundaMakerere University, Kampala, Uganda

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Congratulations on a job well done. We spent avery formative and productive period with Dr. BeatSchürch and the Foundation. Our best wishes for the future.

Anura KurpadSt. John’s National Academy of Health Sciences,Bangalore, India

Many years ago I was invited to become a memberof the Nestlé Foundation’s Council, but I could notaccept because shortly before I had joined anadvisory body of the Nestlé Company, in the hopeof influencing their policy on infant foods. I havealways regretted this, since the Foundation’sactivities were much more important. These havefocussed on the Third World. For me the mostoutstanding were the conferences that theFoundation organized jointly with the InternationalDietary Energy Consultative Group on Protein andEnergy Requirements, Linear Growth Retardation inChildren, and many others. I pay a special tribute toDr. Beat Schürch, for his activity and vision asDirector of the Foundation.

John C. WaterlowEmeritus Professor in the University of London

Wishes for a happy birthday and a long life The Senegalese Nutrition Staff wishes a long life tothe Nestlé Foundation and thanks all the persons incharge of your institution. Your support for capacitybuilding and training African nutritionists is anunquestionable contribution to the fight againstmalnutrition.

Salimata WadeUniversité Cheikh Anta Diop de Dakar, Sénégal

Making a difference for child nutritionThe Nestlé Foundation is one of the feworganizations in the world that funds research onkey nutrition issues relevant to developingcountries. We are very grateful for the opportunityto carry out research, which has great potential toinfluence policies and programs to improve infantand young child nutrition. Congratulations to theFoundation for 40 years of sustained support forresearch on ways to improve child nutrition.

Kathryn G. Dewey University of California, Davis, CA, USA

Lausanne meets Guatemala City

Happy 40th anniversary, Nestlé Foundation. You were born the year I graduated from college. CeSSIAMcelebrated 20 years in Guatemala in1985. The Nestlé Foundation was instrumental in our premier decade,in providing us with the funds for a project on the interaction of nutrition and inflammation. This hasbecome an important research theme of our group through the years. I have also had the opportunity fromtime to time to serve as a reviewer of submitted proposals; this has been a learning experience. Eric is along-term friend; Paolo is a buddy from scientific meetings; Beat was a dear friend and colleague who issorely missed.

Noel W. SolomonsCenter for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala

Your role in promoting and supporting nutritionresearch in developing countries is commendable.As you celebrate your 40th anniversary, Icongratulate you and wish you many moreproductive years ahead.

Anna Lartey, University of Ghana, Legon, Ghana

The Nestlé Foundation has been very instrumental to human development programmes in Africa and theworld over. Their level of commitment to the course of nutrition globally has been unparalleled in recenttimes. The specific role they play in the fight against malnutrition is highly commendable, especially in thecreation of the enLINK library and the initiation and support of research in human nutrition and the insightfulVISION 2005 project, focusing on disease burden in developing countries. Without mincing words, NestléFoundation has made an indelible mark in achieving optimal nutrition for many generations and wishing themmore fruitful years ahead may be an understatement.

Tola AtinmoUniversity of Ibadan, Nigeria and President of the Federation of African Nutrition Societies (FANUS)

I hope the Nestlé Foundation will continue itscontribution to nutrition research by strengtheningresearch abilities and facilities in the developingcountries.

Drupadi H.S. DillonSEAMEO-TROPMED, University of Indonesia,Jakarta, Indonesia

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Congratulations on your 40th anniversary. The Nestlé Foundation played a significant role in supporting the development of a new research group to investigate the effects of nutrition and health on childdevelopment. The Foundation is one of the few funders who have fostered research in developingcountries and have had an explicit policy of encouraging the training of young researchers. They have leadthe way in discouraging the exploitation of developing country researchers by academics in developedcountries. Several young scientists you supported in Jamaica are now making a great contribution tomedical/nutrition research in the Caribbean. I hope you will be able to continue your work for many years.

Sally Grantham-McGregorCentre for International Child Health, Institute of Child Health, University College London, UK

Science has contributed greatly to nutritionaldevelopment in the past 50 years. NestléFoundation, in my view, has been a significantpartner in this development. I hope theFoundation will remain a proactive contributor inthe future. Congratulations for 40 years ofcontinuous work to reduce nutrition problems inthe world.

Suttilak SmitasiriMahidol University, Thailand

We wish Nestlé Foundation many more years ofunselfish and scientifically rigorous support tosound research aimed at ameliorating thenutritional problems of the infants in the world.

Nathalie Charpak, Zita Figueroa & Juan Gabriel RuizKangaroo Foundation and Kangaroo Mother CareProgram, Bogota, Colombia

A happy anniversary is the least I can wish to agood friend of mine: the Nestlé Foundation.For the occasion of the 40th anniversary of theFoundation, it is a pleasure for me to sincerelyacknowledge the very key role this institution hasbeen playing in the less developed countries in thefield of human nutrition for so many decades. I wishlong life to the Nestlé Foundation and a happyanniversary.

Romain Anselme Marc DossaAbomey-Calavi University, Cotonou, Benin

As Director of the Nestlé Foundation for the Study of the Problems of Nutrition in the World in Lausanne,Switzerland from 1979-2002, Beat Schürch quietly and effectively made major contributions to internationalnutrition, for which he was greatly admired by those who knew him well. He initiated an importantinternational fellowship program to strengthen nutrition institutions in low-income countries, particularly inAfrica. His determined support of excellence in the research of selected nutrition groups in developingcountry institutions reinforced the benefits of the fellowship program. His judgment of what constitutedgood research and his ability to select high-quality grant recipients were outstanding. Jointly we proposedthe International Dietary Energy Consultative Group (IDECG) whose working group meetings produced aseries of valuable reports on key issues. The quality of the participants and subsequent reports owed muchto his uncanny ability to identify and critically evaluate nutrition leaders throughout the world. Thisextended to his ability to know the most important nutrition issues at a given time. As Technical Secretaryof IDECG, he meticulously and skilfully edited these reports and ensured their wide distribution indeveloping countries free of charge by the Nestlé Foundation. As its Director, this modest, dedicated,unselfish, hardworking man maintained the value of the nutrition contributions of the Nestlé Foundation tothe world. His loss is keenly felt by his many friends and colleagues throughout the world and especially bythe developing country nutrition scientists and their institutions that he did so much to help.

Nevin S. ScrimshawInternational Nutrition Foundation and United Nations University

The developing countries benefit much fromnutrition research because all research issues canaid in developing feasible interventions forimproving people’s health and nutrition status,especially that of vulnerable groups. The NestléFoundation is an organization with such a purpose.

Nguyen Cong KhanNational Institute of Nutrition Hanoi, Vietnam

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The Foundation gave me a lifeline!I had earlier tried rather unsuccessfully to securefunds from other sources and the NestléFoundation supported me to give me the skillswhich I am now employing in solving the nutritionproblems which we face in developing countries.

Sam NewtonKintampo Health Research Centre, Kintampo,Ghana

Capacity building in a country with urgent needI was involved in providing a short-term training program for two fellows from the Institute of ChildNutrition (Pyongyang, North Korea) with the support of the Foundation. I was pleased with the opportunity,as capacity building in nutrition research is badly needed for them. Both fellows were able to formulate aresearch proposal, which later was also funded by the Foundation. This is very important for a country inneed. As a trainer, I am proud to see that the efforts have been fruitful.

Pattanee WinichagoonMahidol University, Thailand

It gives me great pleasure to extend my heartiest congratulations to the board and staff at the occasion ofthe 40th anniversary of the Nestlé Foundation. The Nestlé Foundation has maintained an independentprofile and proven their commitment to addressing the problem of undernutrition in developing countries.In particular the training and research grants have greatly helped foster capacity development in nutrition indeveloping countries. One hopes that the Nestlé Foundation will continue to thrive and expand itsfraternity of collaborators and partners in the years to come.

Zulfiqar A. BhuttaThe Aga Khan University and Medical Center, Karachi, Pakistan

For the past 40 years, the Nestle Foundation hassponsored many health and nutrition studies thathave contributed to improving the health andnutrition status of people, especially the vulnerablegroups living in developing countries. Vietnam hasbenefited greatly from the Foundation’s meaningfulactivities.

Phan Van HuanThe National Institute of Nutrition, Hanoi, Vietnam

Well done Nestlé Foundation for 40 years ofempowering developing nations in finding solutionsto making a difference to nutrition of theunderprivileged. We look forward to moreconcerted efforts and capacity development intackling past, present and emerging health issues.

Lucie C. MalabaUniversity of Zimbabwe, Harare, Zimbabwe

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11 2004 / Investigation of blood, hair lead andmanganese levels in children with different degreesof iron deficiency in Karachi

12 2004 / Vitamin A value of spirulinacarotenoids in humans

13 2004 / Study on the causes of anemia in theelderly women in China

14 2005 / Environmental supplementation of iodine by iodination of irrigation water in theFerghana Valley

15 2005 / Stability and efficacy of vitamin Afortified cooking oil on nutritional status ofVietnamese children 36-60 months

16 2006 / Improvement of iron status ofpreschool children in rural communities of SokotoState Nigeria by the use of iron rich food sources :a social mobilization approach

17 2006 / Vitamin A status of householdsaccording to the seasonal availability of vitamin Aand beta-carotene rich foods

18 2006 / Effect of psychosocial stimulation ondevelopment of iron-deficient anemic infants: arandomized controlled trial

19 2006 / Assessment of iron status of childrenin rural communities in Abia State, Nigeria

20 2006 / Efficacy of multiple micronutrientssupplementation on anaemia in 6-23-months-oldrural Burkinabe children

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Mohammad Ataur RahmanUniversity of Karachi, Centre for MolecularMedicine & Drug Research, Karachi, Pakistan

Guangwen TangTufts University, Human Nutrition Research Centeron Aging, Boston, USA

Jian ZhangNational Institute of Nutrition and Food Safety,Department of Elderly Nutrition, Beijing, China

Maksuda AbidjanovaAssociation of Endocrinologists, Kokand City,Uzbekistan

Cao Thi Thu HuongNational Institute of Nutrition, Department ofMicronutrient Research & Application, Hanoi, Vietnam

LS BilbisUsmanu Danfodiyo University, BiochemistryDepartment, Sokoto, Nigeria

Romain DossaUniversity of Abomey-Calavi, Department of FoodSciences and Nutrition, Cotonou, Benin

Jena D. HamadaniICDDR,B, C. for Health and Population Research,Dhaka, Bangladesh

Ignatius OnimawoMichael Okpara University of Agriculture, Dpt. ofHuman Nutrition and Dietetics, Umudike, Nigeria

Hermann OuedraogoInst. de Recherche en Sciences de la Santé,Ouagadougou, Burkina-Faso

1 2001 / Effect of vitamin A and B2supplementation added to iron on anemia ofpregnant women in China

2 2002 / Efficacy of multiple micronutrientssupplementation in improving micronutrient statusamong anaemic adolescent girls in Bangladesh

3 2002 / Effect of calcium supplementationto low calcium intake pregnant women onplacental hemodynamic and fetal growth: Arandomized clinical trial

4 2002 / Effects of an additional mealfortified with multiple micronutrients on thenutritional and micronutritional status ofVietnamese children

5 2003 / Evaluation of valid biomarkers todistinguish between iron deficiency anemia andanemia of inflammation in areas of high rates ofparasite infestation and nutritional deficiencies

6 2003 / Effect of zinc supplementation and its interaction with vitamin A on child immuneresponses and morbidity rate

7 2003 / Usefulness of ferrous fumarate andferric pyrophosphate as food fortificants for infantsand young children in developing countries

8 2003 / Zinc homeostasis in and zincrequirements of young Chinese children

9 2004 / Effect of iron fortification of nurserycomplementary food on iron status of infant

10 2004 / Effects of multi-vitamin and multi-mineral supplementation on pregnant women andtheir infants in Chongqing, China

Aiguo MaQingdao University Medical College, Institute ofHuman Nutrition, Qingdao, China

Faruk AhmedUniversity of Queensland, School of PopulationHealth, Brisbane, Australia

Guillermo CarroliCentro Rosarino de Estudios Perinatales, Rosario,Argentina

Nguyen Quang DungNational Institute of Nutrition, Basic NutritionDepartment, Hanoi, Vietnam

Mohamed Ag AyoyaCornell University, Division of Nutritional Sciences,Ithaca, USA

Martha I KartasuryaUniversity of Queensland, School of PopulationHealth, Brisbane, Australia

Shafiqul SarkerICDDR,B, C. for Health and Population Research,Dhaka, Bangladesh

Xiaoyang ShengShanghai Jiao Tong University, Department of Childand Adolescence Healthcare, Shanghai, China

Kim Su HuanInstitute of Child Nutrition, Pyongyang, Korea, Dem.Rep.

Ting-Yu LiChongqing University of Medical Sciences,Children's Hospital, Chongqing, China


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21 2001 / Validation of a model to predict the need for supplementing breastfeeding inpremature infants

22 2003 / Evaluation of two counselingstrategies to improve exclusive breastfeeding ratesamong HIV-negative mothers in Kibera slum ofNairobi, Kenya: a randomized clinical trial

23 2001 / Oral rehydration solution containingamylase resistant starch in severely malnourishedchildren with watery diarrhea due to Vibrio cholerae

24 2004 / Rehabilitation of severelymalnourished children in Senegal (West Africa): useof a local solid food equivalent to WHO F100 withhigh energetic value. Part II

Nathalie CharpakFundacion Canguro, Bogota, Colombia

Sophie OcholaKenyatta University, Department of Nutrition,Nairobi, Kenya

Nur Haque AlamICDDR,B, C. for Health and Population Research,Dhaka, Bangladesh

Salimata WadeUniversité Cheikh Anta Diop, Equipe de Nutrition,Dakar, Senegal

25 2003 / Comparison of the efficacy andacceptability of three types of micronutrientsupplements added to complementary foods forinfants in Ghana

26 2005 / Food-based approach for the controlof stunting among preschool children

27 2006 / Step I : Complementary feeding-based approach to alleviate linear growthretardation and nutrient deficiencies in infants aged6 to 12 months in the south of Benin

28 2006 / Promoting breastfeeding: a formative research among women and theirhusbands having infant aged 0-6 months in urbanhouseholds

29 2001 / Cognitive performance of irondeficient, non-anemic Peruvian infants

30 2005 / Development of term low birthweight infants at 6 years, and the benefits of earlystimulation

Anna LarteyUniversity of Ghana, Department of Nutrition andFood Science, Legon, Ghana

Chineze AgbonUniversity of Agriculture, Department of HomeScience & Management, Abeokuta, Nigeria

Romain DossaUniversity of Abomey-Calavi, Department of FoodSciences and Nutrition, Cotonou, Benin

Judhiastuty FebruhartantyUniversity of Indonesia, SEAMEO-TROPMEDRCCN, Jakarta, Indonesia

Theodore WachsPurdue University, Department of PsychologicalSciences, West Lafayette, USA

Susan WalkerUniversity of the West Indies, Tropical MedicineResearch Institute, Kingston, Jamaica


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31 2002 / Nutrition assessment of childrenorphaned from HIV/AIDS

32 2002 / Examination of the relationshipsbetween low body mass index and micronutrientmalnutrition and the risk of morbidity in adultsaged 18 to 60 years in rural Vietnam

33 2004 / Molecular and biochemical analysisof intestinal microflora in malnourished childrenwith cholera treated with oral rehydration solutionwith and without amylase resistant starch

34 2003 / Assessing physical activity of obesechildren by a clinical score

35 2004 / Changing diets, levels of physicalactivity and environments and their relationship tothe emergence of adolescent overweight andobesity in Ho Chi Minh City, Vietnam

Judith A ErnstIndiana University, Indiana University School ofHealth & Rehabilitation Sciences, Indianapolis, USA

Tran Thanh DoNational Institute of Nutrition, Hanoi, Vietnam

Motiur RahmanICDDR,B, C. for Health and Population Research,Dhaka, Bangladesh

Claude GodardINTA, Unidad de Endocrinologia Infantil, Santiago,Chile

Hong K TangCommunity Health Department, Training Centre forHealth Care Professionals, Ho-Chi-Minh City,Vietnam

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36 2002 / Genetic, pubertal and nutritionaldeterminants of peak bone mass accretion inadolescence

37 2002 / Determinants of nutrition-relatedrickets in Chinese children and associated healthoutcomes

38 2003 / Heritability, nutrition and adolescent bone health

39 2004 / Effects of parathyroid hormone onbone metabolism in older people in China

40 2002 / Impact of vegetable gardening,fishpond and animal husbandry on household foodsecurity and nutritional status in some communes inMidland Vietnam

41 2003 / School-based nutrition interventionpilot program

42 2005 / A community-based randomizedcontrolled trial of complementary feeding strategiesin a squatter settlement of Karachi

Heather GreenfieldUniversity of Sydney, Department of AnimalScience, Sydney, Australia

Mark A StrandUniversity of Colorado, Health and BehavioralSciences, Denver, USA

Ghada El-Hajj FuleihanAmerican University of Beirut, Calcium Metabolism& Osteoporosis Program, Beirut, Lebanon

Bo ZhouShenyang Medical College, Department ofPreventive Medicine, Shenyang, China

Phan Van HuanNational Institute of Nutrition, PlanningDepartment, Hanoi, Vietnam

Dien N LeNutrition Institute, Ho-Chi-Minh City, Vietnam

Zulfiqar Ahmed BhuttaAga Khan University Medical Center, Department ofPaediatrics and Child Health, Karachi, Pakistan

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43 2006 / Satellite Medical & NutritionEducation Program (SMNEP): A contribution toreduction of malnutrition and improvement ofhealth. A pilot study

44 2006 / Application of learning technologiesto support community-based lay health careworkers and build capacity in chronic diseaseprevention in Thailand

45 2004 / Genetic diversity and selection ofcassava (Manihot esculenta Crantz) with high beta-carotene content using molecular markers

Mohamed Ag AyoyaCornell University, Division of Nutritional Sciences,Ithaca, USA

Rhona M. HanningUniversity of Waterloo (UW), Department of HealthStudies and Gerontology, Waterloo, Ontario,Canada

Claudia Fortes FerreiraEmbrapa Mandioca e Fruticultura, Cruz das Almas -BA, Brazil

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PUBLICATIONS

Chu K, Jiamton S, Pepin J, Cowan F,Mahakkanukrauh B, Suttent R, Robinson NJ,Deslandes S, Frost E, Chaisilwattana P,Suthipinittharm P, Grosskurth H, Brown D, Jaffar S.Association between HSV-2 and HIV-1 viral load insemen, cervico-vaginal secretions and genital ulcersof Thai men and women. Int J STD AIDS2006;17:681-6.

Coly AN, Milet J, Diallo A, Ndiaye T, Benefice E,Simondon F, Wade S, Simondon KB. Preschoolstunting, adolescent migration, catch-up growth,and adult height in young Senegalese men andwomen of rural origin. J Nutr 2006;136:2412-20.

El-Hajj Fuleihan G, Nabulsi M, Tamim H, Maalouf J,Salamoun M, Khalife H, Choucair M, Arabi A, ViethR. Effect of vitamin D replacement onmusculoskeletal parameters in school children: arandomized controlled trial. J Clin EndocrinolMetab 2006;91:405-12.

Enwonwu CO. Noma -- the ulcer of extremepoverty. N Engl J Med 2006;354:221-4.

Enwonwu CO, Falkler WA Jr., Phillips RS. Noma(cancrum oris). Lancet 2006;368:147-56.

Kurpad AV, Regan MM, Raj T, Gnanou JV. Branched-chain amino acid requirements in healthy adulthuman subjects. J Nutr 2006;136:256S-63S.

Mahalanabis D, Basak M, Paul D, Gupta S, Shaikh S,Wahed MA, Khaled MA. Antioxidant vitamins E andC as adjunct therapy of severe acute lower-respiratory infection in infants and young children: arandomized controlled trial. Eur J Clin Nutr2006;60:673-80.

Miller MF, Humphrey JH, Iliff PJ, Malaba LC, MbuyaNV, Stoltzfus RJ. Neonatal erythropoiesis andsubsequent anemia in HIV-positive and HIV-negative Zimbabwean babies during the first yearof life: a longitudinal study. BMC Infect Dis 2006;6:1.

Miller MF, Stoltzfus RJ, Iliff PJ, Malaba LC, MbuyaNV, Zimbabwe Vitamin A for Mothers and BabiesProject (ZVITAMBO) Study Group; Humphrey JH.Effect of maternal and neonatal vitamin Asupplementation and other postnatal factors onanemia in Zimbabwean infants: a prospective,randomized study. Am J Clin Nutr 2006;84:212-22.

Moore SE, Collinson AC, Fulford AJ, Jalil F, SiegristCA, Goldblatt D, Hanson LA, Prentice AM. Effect ofmonth of vaccine administration on antibodyresponses in The Gambia and Pakistan. Trop MedInt Health 2006;11:1529-41.

Sacco LM, Caulfield LE, Gittelsohn J, Martinez H.The conceptualization of perceived insufficient milkamong Mexican mothers. J Hum Lact 2006;22:277-86.

Zhu K, Zhang Q, Foo LH, Trube A, Ma G, Hu X, DuX, Cowell CT, Fraser DR, Greenfield H. Growth,bone mass, and vitamin D status of Chineseadolescent girls 3 y after withdrawal of milksupplementation. Am J Clin Nutr 2006;83:714-21.

The publications are available free of charge uponrequest.


3

ORIGIN AND NATURE

The Nestlé Foundation for the Study of Problems ofNutrition in the World was established in 1966 by adonation of the Nestlé Company on the occasion ofits centenary. The Foundation was self-constitutingand formed a council consisting of five internationallywell-known Council Members. The Foundation isfinancially and operationally independent of theNestlé Company. The offices of the NestléFoundation are in Lausanne, Switzerland.

PURPOSE

The Nestlé Foundation initiates and supportsresearch in human nutrition with public healthrelevance in low-income countries (see alsohttp://www.worldbank.org). The results of theresearch projects should provide a basis forimplementation which will lead to sustainableeffects in the studied populations as well as in thepopulation at large.The Foundation expects research proposals to beprimarily the initiative of local researchers from thedeveloping countries.

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THE FOUNDATION


www.n

estlefo

undatio

n.orgHOW TO APPLY

Interested scientists should first submit a letter ofintent in which they describe very briefly the kind ofproject they would like to undertake, including anestimated budget. Instructions for the letter ofintent are available on the Foundation website atwww.nestlefoundation.org. For a submissionof a letter of intent only the downloadable formshould be used. If the suggested project iscompatible with the Foundation's current fundingpolicy, applicants will receive an invitation to submita full grant proposal. The guidelines as well as adownloadable form for the submission of a fullgrant proposal are also available on our website.Other formats will not be accepted, neither for theletter of intent nor for the full grant application.

In the letter of intent and in the grant application,detailed, evidence-based information about thepublic health relevance of the project as well as itsimmediate impact and sustainability have to bereported. This part of the application is as importantas the scientific section of the application.

Research grant applications are evaluated twice a year by the Foundation's Council, a group ofindependent international scientists. The funding ofprojects is primarily based on the scientific quality,public health relevance in the short and long term,sustainability, capacity-building component and, lastbut not least, budget considerations.

Applications are accepted all year, and theFoundation encourages applicants to submit theirproposals early to allow sufficient time for internalas well as external reviews. All submissions shouldbe made electronically by e-mail. Final deadlines for submission are January 10 and May 10 for theSpring and Fall meeting respectively.

CURRENT POLICY

Sustainable improvement in human nutrition is oneof the major issues in the portfolio of the Foundation.During more than 30 years basic and appliedresearch in nutrition has been supported by theFoundation in more than 40 developing countries.In view of the past activities of the Foundation aswell as the world’s situation at the turn of the millennium, it was recognized that the public healthrelevance of the supported research as well asaspects of sustainability and educational issuesshould have a higher priority. Thus, priority is givento projects which lead to sustainable developments,and the implementation of the results of a researchproject should be immediate as well as sustainable.Highly sophisticated nutrition research of mainlyacademic interest without public health relevancehas lower priority for support.

At present the Foundation's work is primarilyconcerned with human nutrition researchdealing with:

(1) nutrition education and health promotion

(2) maternal and child nutrition, including breastfeeding and complementary feeding

(3) macro- and micronutrient deficiencies and imbalances

(4) interactions between infection and nutrition.

Studies in other areas of human nutrition researchmight also be considered, as long as they aredealing with problems of malnutrition in eligiblecountries.

The precise priorities and goals of the Foundationare modified from time to time to meet emergingpublic health and nutritional needs in the developingworld.

Funded projects are usually of one- to three-yearduration. Projects with a high potential for effectiveand sustainable improvement of the nutritionalstatus will be funded preferentially. The budget ofthe projects must be appropriate and has to bejustified in detail.

One of the Foundation's main aims is the transfer of scientific and technological knowledge to eligiblecountries. In cases where Foundation-sponsoredresearch projects are realized in collaboration withscientists at universities and research institutes in

high-income countries, at least 80% of the budgethas to be allocated in the low-income country.

Research grant applications from high-incomecountries can normally not be considered exceptunder exceptional conditions.

The Foundation does not normally fund:

(1) projects with low public health relevance

(2) projects with doubtful sustainability

(3) projects lacking transfer of scientific, technical and educational knowledge, i.e. lacking a capacity-building component

(4) very expensive projects

(5) nutrition surveys

(6) research on food policy, food productionand food technology except when linked to an intervention with high potential for sustainable improvement of the nutritional status

(7) in vitro and/or animal experiments.

Although obesity and related diseases are ofemerging importance in several low-incomecountries, the Foundation does not generallysupport projects in this specific area unless theprotocol is innovative and exceptionally welljustified.


COUN

CILThe Council of the Foundation consists of Council

Members and Advisors. All are internationally well-known scientists with a specific expertise indifferent fields of nutrition. The Council is self-constituting and operates independently. The Foundation is directed by the Director and thePresident of the Foundation.

COUNCIL

Eric Jéquier, MD, PRESIDENTProfessor of Physiology Emeritus University of Lausanne, Lausanne, Switzerland

Jehan-François Desjeux, MDProfessor at the Conservatoire National des Arts et MétiersConsultant in Paediatrics, Nutrition andGastroenterologyMember C, Académie Nationale de Médecine,Paris, France

Mehari Gebre-Medhin, MD, MPH, PhDProfessorDepartment of Women´s and Children´s HealthUniversity Hospital, Uppsala, Sweden

Joseph Hautvast, MD, PhDProfessor EmeritusWageningen University, The Netherlands

Prakash S. Shetty, MD, PhDFormer Professor of Human Nutrition, LondonSchool of Hygiene & Tropical Medicine, London (UK)Currently Chief, Nutrition Planning, Assessment &Evaluation, Food & Nutrition Division, FAO, Rome, Italy

DIRECTOR

Paolo M. Suter, MD, MSProfessorMedical Policlinic, University HospitalZürich, Switzerland

SECRETARIAL OFFICES

Elisabeth Müller, PhDCatherine LiebAssistants to the Director

AUDITOR

Ernst & Young AG, Bern, Switzerland


annual report 2006 - nestl© foundation

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