Executive summary—Biomarkers of Nutrition for Development: Building a Consensus

Abstract

The ability to develop evidence-based clinical guidance and effective programs and policies to achieve global health promotion and disease prevention goals depends on the availability of valid and reliable data. With specific regard to the role of food and nutrition in achieving those goals, relevant data are developed with the use of biomarkers that reflect nutrient exposure, status, and functional effect. A need exists to promote the discovery, development, and use of biomarkers across a range of applications. In addition, a process is needed to harmonize the global health community's decision making about what biomarkers are best suited for a given use under specific conditions and settings. To address these needs, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, organized a conference entitled "Biomarkers of Nutrition for Development: Building a Consensus," which was hosted by the International Atomic Energy Agency. Partners included key multilateral, US agencies and public and private organizations. The assembly endorsed the utility of this initiative and the need for the BOND (Biomarkers of Nutrition for Development) project to continue. A consensus was reached on the requirement to develop a process to inform the community about the relative strengths or weaknesses and specific applications of various biomarkers under defined conditions. The articles in this supplement summarize the deliberations of the 4 working groups: research, clinical, policy, and programmatic. Also described are content presentations on the harmonization processes, the evidence base for biomarkers for 5 case-study micronutrients, and new frontiers in science and technology.

Biomarkers of Nutrient Bioactivity and Efficacy

“…For this, it is important to consider that what might be a useful index of nutrient exposure may not necessarily reflect the nutrient status, which in turn may not necessarily reflect its effect or function. 10 The characterization of nutritional status currently relies on the evaluation of biomarkers of dietary intake, which can be classified into 2 types: (a) recovery biomarkers: compounds that have a known quantitative time-associated relation between intake and excretion in waste (eg, total energy expenditure measured by doubly labeled water protocol 13 or protein intake by urinary nitrogen 14 ; and (b) concentration biomarkers: those directly measured in biological samples, such as serum, plasma, saliva, and urine, among others. 15 Currently, it is clear that for most cases, appropriate and reliable biomarkers to assess the nutrient bioefficacy are not yet available.…”

“…[7][8][9] In addition, the importance of genetics (in particular gene polymorphisms) to establish clinical usefulness of nutritional biomarkers, and the fact that there is limited knowledge of how genetic variability affects the interpretation of these biomarkers, has been acknowledged. 5,10 …”

Assessment of Neurodevelopment, Nutrition, and Inflammation From Fetal Life to Adolescence in Low-Resource Settings

“…This article is not intended to be a systematic review of the literature, but instead will: (1) provide an overview of key definitions, tools, and applications relevant to the assessment of child neurodevelopment, nutrition, and inflammation; and (2) identify critical research gaps and priorities. This article will also build on recently conducted work by the authors, including: the NICHD Biomarkers of Nutrition for Development (BOND) 6 and Inflammation and Nutrition Science for Programs and Interpretation of Research Evidence (INSPIRE) 7 projects, which have been charged with developing guidance on biomarkers of exposure, status, and function for micronutrients and inflammation 6 -8 ; and the Interactions of Malnutrition and Enteric Infections: Consequences for Child Health and Development (MAL-ED) study, which is evaluating the relationships between enteric pathogens, malnutrition, gut physiology, and cognitive development. 9 Furthermore, this review will focus on assessment in culturally diverse, resource-limited settings around the globe, where the burden of malnutrition and inflammation is the highest.…”

Reconciling the Irreconcilable: Micronutrients in Clinical Nutrition and Public Health

“…The Nutrigenomics Organization initiative (NuGO; http://www.nugo.org) has started development of a "collaborative, open data sharing, systems nutrition research program named ENOUGH (essential nutrients for optimal underpinning of growth and health) focused on individuals in undernourished populations". This also builds on the biomarkers project under the US NIH BOND (Biomarkers of Nutrition and Development [31], and EURRECA project to review micronutrient intake recommendations (http://www.eurreca.org/) [32], and the NuGO-led Micronutrient Genomics Project (MGP) [33].…”