Perspective: Integration to Implementation (I-to-I) and the Micronutrient Forum-Addressing the Safety and Effectiveness of Vitamin A Supplementation

• Type of Material: Article
• Authors: Daniel J. Raiten, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Ian Darnton-Hill, University of Sydney; Sherry A. Tanumihardjo, University of Wisconsin; Parminder Suchdev, Emory University; Emorn Udomkesmalee, Mahidol University; Carolina Martinez, nstituto de Nutrición de Centro América y Panamá (INCAP); Dora Ines Mazariegos, nstituto de Nutrición de Centro América y Panamá (INCAP); Musonda Mofu, National Food and Nutrition Commission, Lusaka, Zambia; Klaus Kraemer, Sight & Life; Homero Martinez, Nutrition International
• Language: English
• Date: 2020-03-01
• Publisher: Oxford University Press
• Publication Version: Final Published Version
• Copyright Statement: © American Society for Nutrition 2019.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/advances/nmz100
• Title of Journal or Parent Work: Advances in Nutrition
• Volume: 11
• Issue: 2
• Start Page: 185
• End Page: 199
• Grant/Funding Information: Supported by the Bill & Melinda Gates Foundation.
• Keywords: Food fortification; Middle-income countries; Nutritional determinants; safety; integration to effective implementation (I-to-I); Indonesian children; Life Sciences & Biomedicine; effectiveness; vitamin A supplementation; Science & Technology; Intervention programs; Preschool children; Kakuma refugee camp; transition; Biomarkers reflecting inflammation; Zambian children; nutrition-sensitive; policies and programs; nutrition-specific; Hepatic retinol; Nutrition & Dietetics; health promotion and disease prevention
• Research Categories: Health Sciences, Public Health; Health Sciences, Nutrition; Health Sciences, Human Development

Abstract

An ongoing challenge to our ability to address the role of food and nutrition in health promotion and disease prevention is how to design and implement context-specific interventions and guidance that are safe, efficacious, and avoid unintended consequences. The integration to effective implementation (I-to-I) concept is intended to address the complexities of the global health context through engagement of the continuum of stakeholders involved in the generation, translation, and implementation of evidence to public health guidance/programs. The I-to-I approach was developed under the auspices of the Micronutrient Forum and has been previously applied to the question of safety and effectiveness of interventions to prevent and treat nutritional iron deficiency. The present article applies the I-to-I approach to questions regarding the safety and utility of large-dose vitamin A supplementation programs, and presents the authors' perspective on key aspects of the topic, including coverage of the basic and applied biology of vitamin A nutrition and assessment, clinical implications, and an overview of the extant data with regard to both the justification for and utility of available intervention strategies. The article includes some practical considerations based on specific country experiences regarding the challenges of implementing vitamin A-related programs. This is followed by an overview of some challenges associated with engagement of the enabling communities that play a critical role in the implementation of these types of public health interventions. The article concludes with suggestions for potential approaches to move this important agenda forward.