IMMPaCt Laboratory Activities

Objective

Provide technical assistance and guidance for laboratory activities to accurately assess micronutrient (vitamin and mineral) status through biochemical measurements

Background

The accurate detection and diagnosis of micronutrient deficiencies depends on the accuracy and validity of lab measurements. However, laboratories in developing countries often lack the resources and experience to decide which biomarkers are best suited for their situation. They may also not have the capacity to properly conduct all aspects of planning, training, specimen collection, quality assurance, and data interpretation for surveys that include micronutrient status biomarkers.

CDC’s International Micronutrient Malnutrition Prevention and Control (IMMPaCt) program works with two branches of CDC’s Division of Laboratory Sciences. Related activities of each branch are below.

Activities

The Nutritional Biomarkers Branch:

• Provides laboratory related support, including in-country planning and training visits, for national nutrition surveys.
• Provides a free external quality assessment program (VITAL-EQA) for serum-based nutritional indicators to laboratories in developing countries. Currently 49 labs participate in the program.
• Provides hands-on trainings to country representatives in how to reliably measure serum and red blood cell folate in low-resource laboratories. Five labs were trained between 2018 and 2019.
• Develops ready-to-use test kits to facilitate in-country analysis of folate results.
• Conducts research on using retinol binding protein as an inexpensive alternative to serum retinol measurements to assess vitamin A status.
• Conducts and publishes research on the effects of pre-analysis procedures on the measurement reliability of nutritional and hematologic indicators.
• Develops nutrition survey tools for laboratory related activities.
• Established a serum micronutrients verification program in 2019. The program provides an independent assessment and documentation of analytical performance to laboratories working to determine population micronutrient status. The program uses 40 serum samples analyzed quarterly over one year.

The Inorganic and Radiation Analytical Toxicology Branch:

• Provides a free external quality assessment program (EQUIP) for urine iodine measurements for laboratories worldwide. Currently 235 labs participate.
• Trains country representatives to reliably measure urine iodine in low-resource laboratories.
• Conducts research and assesses quality control and quality assurance procedures for iodine levels in urine and salt in low-resource laboratories.
• Provides laboratory support, including analysis of quality assurance samples, for various countries.
• Provides quality control material and general analytical guidance for zinc analysis to laboratories.
• Developed a comprehensive guide for salt iodization program managers and an operational guide for the iodine laboratories.

Potential Impact

Guidance and tools on how to correctly collect, process, transport, and analyze biological specimens and how to ensure the quality of the process helps both the public health and scientific communities. Improvements in laboratory measurements allow more efficient and reliable assessment of nutritional status, which supports programs and policies to ultimately improve the health of the population. Technology transfer for resource-appropriate methodologies helps strengthen the infrastructure of developing countries and makes them more independent.

Next Steps

CDC will continue to:

• Support a global network of regional resource laboratory staff who were trained at CDC and are proficient at conducting the folate test. This will lead to reliable folate data that can be compared across labs and overtime.
• Train additional folate resource laboratories across six World Health Organization regions.
• Expand scope of the resource labs to other micronutrients, such as vitamin B12.
• Continue biological preparation of various ready-to-use serum, whole blood or reagent kits, including the folate start-up and survey test kits, for the harmonization of folate results.
• Continue providing additional micronutrient quality control material to allow laboratories worldwide to monitor in-house long-term performance.
• Harmonize serum transferrin receptor tests, which specifically indicate iron deficiency, to allow comparability of data across countries.