The emblematic images of famine—emaciated children, skin taut across delicate bones—have habituated Americans to think of malnutrition primarily as brutal starvation. While famine relief is vitally important, too little recognized is the larger problem of “hidden hunger.”
Though their external symptoms aren’t necessarily obvious nor is their prevalence in a population easy to gauge, micronutrient deficiencies affect one-third of the world’s people and are a leading cause of child disability and mortality. Keith P. West, Jr., DrPH ’87, MPH ’79, hopes research on protein biomarkers will bring the problem into the light.
Insufficient intake of a few dozen micronutrients essential to healthy development is implicated in a wide range of preventable illnesses. However, characterizing these deficiencies at the population level has been hampered by the cost and difficulty of measurement. Blood samples drawn in the field must be shipped to distant laboratories for analysis with expensive machinery, and it may take years to assemble the results. Performing the recurrent tests necessary to maintain consistent micronutrient surveillance is thus untenable; in Nepal, for example, the last time such data were collected was 1998, says West, the George G. Graham Professor of Infant and Child Nutrition.
“It dawned on us that we needed a change in paradigm," he recalls.
West and his colleagues in the Bloomberg School and the Johns Hopkins School of Medicine aspire to identify a cheap and quick way to measure a spectrum of micronutrient deficiencies. They have focused on blood plasma, which contains a cross-section of the body’s proteins, and which the new field of proteomics has made more accessible. Since the proteins present in plasma at any moment may reflect what is going on in the tissues, the investigators hypothesized that changes in the concentration of certain proteins might indicate micronutrient deficiencies. For example, measures of the protein transthyretin may parallel the plasma content of retinol (vitamin A).
“The circulation becomes a window for viewing the way that nutrients and proteins interact in the body,” West explains.
What began as “a hobby that kept us up late at night” has grown into a full-scale pilot project funded by the Gates Foundation. West and his colleagues have already identified proteins that co-vary reliably with nutrient levels and, within the next 10 years, they are determined to develop an onsite, real-time test for multiple micronutrient deficiencies. This would allow investigators to quickly and accurately profile an entire population and take effective action.
“It would change the entire information landscape for making more rapid decisions about the nutritional conditions of populations affected today,” says West.
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