Examining the effectiveness and acceptability of the use of bio-fortified crops in alleviating micronutrient deficiencies in Pakistan

根据世界卫生组织的数据，膳食缺锌是一个全球性问题，影响着世界17%的人口，发展中国家的负担最重。巴基斯坦最新的全国调查表明，超过40%的妇女缺锌，而欧洲和北美的这一比例不到15%。缺锌的后果是深远的，包括儿童生长发育迟缓，儿童和成人更容易受到感染，以及怀孕和分娩期间的并发症。这对家庭、社区和区域造成了负面的经济影响。已经尝试了各种克服缺锌的战略，但当涉及到大量人口时，这些战略很难实现。膳食锌补充剂价格昂贵，并不总是能接触到最脆弱的群体，这些群体可能生活在偏远或由于基础设施差或安全问题而难以到达的地方。相比之下，主食的生物强化有潜力成为增加人群膳食锌摄入量的可持续手段。然而，到目前为止，很少有研究评估这一战略的有效性和文化可接受性。衡量这些策略有效性的关键挑战之一是缺乏适用于偏远地区的锌状况的敏感生物标志物。我们有机会评估由HarvestPlus生产的一种新开发的生物强化小麦作为增加巴基斯坦膳食锌摄入量的手段的潜力。通过与巴基斯坦一家化肥公司的合作，我们将研究施肥策略和土壤条件对小麦锌含量的影响，方法是在巴基斯坦土壤锌状况不同的地区的生长季节向土壤和叶片中添加富锌肥料。以前的研究表明，这种新品种的小麦有可能达到比标准品种高出约45%的锌含量。我们将对种植的谷物进行分析，以测量锌含量以及锌在单个谷物中的位置。将进行双盲试验，以检查食用高锌谷物制成的面粉是否对生活在巴基斯坦西北部农村社区的缺锌妇女的锌状况有好处。将高锌粮与标准粮进行比较，均供40户家庭食用8周，A组(20户)食用高锌粮，B组(20户)食用对照粮。这些家庭将在八周后互换。为了监测食用面粉对锌状况的影响，我们将使用既定的方法(血浆和头发锌浓度)，我们还将评估新的锌状况指标，这些指标可能用于基于人群的调查，包括DNA损伤标志物和一种新的便携式激光技术来测量指甲锌浓度。生物强化战略的成功要求干预措施在生产和消费阶段实现广泛和持续的吸收。因此，通过我们与社区领导人和农民建立的广泛和成熟的网络，我们将通过重点小组和访谈，评估这种环境下的文化背景、传统、知识和对生物强化的态度。这项研究的一个关键组成部分是培训和能力建设。这是一个双向的过程，通过这个过程，项目合作伙伴之间分享专业知识，以便巴基斯坦和英国的年轻研究人员更好地准备将这一重要的研究议程推向未来，并在该项目期间产生的合作联系的基础上再接再厉。这项研究的结果将在全球范围内传播给研究人员和政策制定者。

According to the World Health Organisation, dietary zinc deficiency is a global problem affecting 17% of the world's population, with the greatest burden in developing countries. The most recent national survey in Pakistan indicates that over 40% of women are zinc deficient, compared with less than 15% in Europe and North America. The consequences of zinc deficiency are profound and far reaching, ranging from stunted growth and development in children, increased susceptibility to infections in children and adults, and complications during pregnancy and childbirth. This has a negative economic impact on the family, the community and the region.Various strategies to overcome zinc deficiency have been attempted but it is difficult to achieve when large populations are concerned. Dietary zinc supplements are expensive and do not always reach the most vulnerable groups who may live in remote or difficult to reach locations due to poor infrastructure or security problems. In contrast, biofortification of staple foods has potential as a sustainable means of increasing population dietary zinc intake. However to date, few studies have been undertaken to evaluate the efficacy and cultural acceptability of this strategy. One of the key challenges in measuring the effectiveness of such strategies is the lack of a sensitive biomarker of zinc status that is suitable for use in remote settingsWe have an opportunity to evaluate the potential of a newly developed strain of biofortified wheat, produced by HarvestPlus, as a means of increasing dietary zinc intake in Pakistan. Through a collaboration with a Pakistan based fertilizer company, we will examine the impact of fertilization strategies and soil conditions on the wheat zinc content by of the addition of zinc rich fertilizer to the soil and foliage during the growing season in regions of Pakistan with contrasting soil zinc status. Previous studies have indicated that this new strain of wheat has potential to reach a zinc content that is around 45% higher than the standard varieties. The grain grown in our study will be analysed to measure the zinc content, and also the location of the zinc within the individual grains.A double blind trial will be conducted to examine whether or not consuming the flour made from the high zinc grain has a beneficial impact on the zinc status of zinc deficient women living in a rural community in North West Pakistan. The high zinc grain will be compared with standard grain, both of which will be provided to forty families to consume for eight weeks, with group A (20 families) consuming the high zinc grain, and group B (20 families) consuming the control grain. The families will switch over after eight weeks. To monitor the impact of consuming the flour on zinc status we will use established methods (plasma and hair zinc concentration), and we will also evaluate new indicators of zinc status that have potential for use in population based surveys, including markers of DNA damage and a novel portable laser technique for measuring nail Zn concentration. The success of a biofortification strategy requires that the intervention achieves wide and sustained uptake at production and consumption stages. Therefore, through our extensive and established networks with community leaders and farmers, we will assess the cultural context, traditions, knowledge and attitudes to biofortification in this setting, through focus groups and interviews. A key component of this research is training and capacity building. This is a two-way process by which expertise is shared among the project partners, so that young researchers in Pakistan and in the UK are better equipped to take this important research agenda forward into the future, and to build on the collaborative links generated during this project. The findings of this research will be disseminated to researchers and policy makers word wide.