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LATEST NEWS UPDATES | Ignore Lancet series, experts tell Centre -Rema Nagarajan

Ignore Lancet series, experts tell Centre -Rema Nagarajan

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published Published on Jun 28, 2013   modified Modified on Jun 28, 2013
-The Times of India


NEW DELHI: Several nutrition experts and members of the Indian Academy of Paediatrics, the largest association of paediatricians in India, have warned that the new set of papers on malnutrition published in the medical journal, Lancet, "should not be allowed to become an opportunity for commercial exploitation of malnutrition".

"The call for engaging with the "private sector" and unregulated marketing of commercial foods for preventing malnutrition in children raises serious concerns. The inherent conflict of interest will ensure that commercial considerations override sustainable nutritional goals," said a joint statement issued by leading nutrition experts and paediatricians.

It was sent to rural development minister Jairam Ramesh, member-health of the Planning Commission Dr Sayeda Hameed, secretary of the women and child development ministry and Health secretary, Keshav Desiraju. While interpreting the recommendation of the papers published in Lancet, the conflict of interest of the leader of the series and some other authors, particularly their links with the big food multinationals and the micronutrient industry, needed to be considered seriously, said the statement.

For instance, the lead author of the series Robert E Black of the Johns Hopkins Bloomberg School of Public Health in the US has stated in his conflict of interest declaration that he serves on the Boards of the Micronutrient Initiative, Vitamin Angels, the Child Health and Nutrition Research Initiative, and the Nestle Creating Shared Value Advisory Committee. Another member of the Maternal and Child Nutrition Study Group of Lancet, Venkatesh Mannar is the president of the Micronutrient Initiative and also serves on the Nestle Creating Shared Value Advisory Committee.

The experts pointed out how there was a bias towards "the selection of product based solutions (particularly Ready to Use Therapeutic Food (RUTF) or Supplementary Foods (RUSF) and single or multiple micronutrients) while prioritising important interventions in the Lancet series. "Majority of the interventions recommended by the Lancet series involve supplementation with food or micronutrients. Most of them are not non-product interventions such as safe water supply sanitation, hygiene, literacy and other developmental aspects," explained Dr H P S Sachdev, one of the signatories of the statement and former national president of the Indian Academy of Paediatrics who was also part of the earlier Lancet series on nutrition.

The joint statement also pointed out the cherry-picking of evidence in the Lancet series which in effect "excluded or ignored relevant, contemporary, and high quality evidence". For instance, the magnitude of expected benefit from vitamin A is inflated because they have not aptly factored in the negative results of the trial on one million children from Lucknow. Again, Indian trials on zinc supplementation have not shown much effect on stunting which it was supposed to impact, something which has not been included in the evidence.

The experts also felt that safety concerns with some of the recommended interventions were not emphasised enough. For example, the recently reported increased risk of diarrhea and bloody diarrhea seen in children given multiple micronutrient supplementation and the potential risk in some situations of increased perinatal and neonatal mortality and babies being too large for gestational age babies with multiple micronutrient supplementation in pregnant women.

According to the experts, the section on Acute Malnutrition in the Lancet series would create intense pressure for introducing specific products marketed by multinational corporations (RUTF and RUSF) without supporting high quality evidence. A recently published study (Cochrane Review) concluded that current evidence is limited; either RUTF or standard diet such as flour porridge can be used to treat severely malnourished children at home. Decisions should be based on availability, cost and practicality. "It would therefore be prudent to adhere to the Government's stated position in the Parliament of India of not utilising commercial RUTF for community treatment of severe malnutrition," said the statement.

The experts who have signed the statement include Prof Umesh Kapil of the Department of Human Nutrition in AIIMS, Dr Panna Choudhury, IAP executive director, Prof A P Dubey, IAP chairperson of IAP, Dr C P Bansal, IAP national president, Dr Arun Gupta of International Breastfeeding Action Network (IBFAN) Asia and Dr Mira Shiva of the Initiative for Health and Equity in Society.

They have appealed to the government to consider the concerns they raise before taking any policy decision based on the Lancet Series on Nutrition 2013.


The Times of India, 28 June, 2013, http://timesofindia.indiatimes.com/india/Ignore-Lancet-series-experts-tell-Centre/articleshow/20808154.cms


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