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.

FIGURE 1

The class of nutritional biomarkers and their overlap. Exposure—definition would be contingent on the goal of the evaluation: clinical (what is the baseline information to distinguish between dietary insufficiency compared with a physiologic response to a clinical condition or intervention?); program (at a program level what is the amount of intake of the target population and does it indicate a need, risk, or favorable response to an intervention?). Status—where does the individual or group stand relative to an accepted standard: clinical (a condition that is subject to change); clinical/population (the relative position or standing of somebody or something in a society or other group). Function/effect—direct: did it get from mouth to cell and is it being used (eg, enzyme stimulation assays to evaluate incorporation of cofactors into dependent enzymes, such as vitamin B-6/pyridoxine into erythrocyte glutamic pyruvic transaminase or thiamine into transketolase)? Does the function matter beyond a reflection of nutrient status? Indirect: is the nutrient-dependent system functioning better or worse? Systemic effect of nutrient problem (eg, growth and zinc, vision and vitamin A).