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IFPRI reports

Poverty, food security, and nutrition

Managing food security in a predominantly rural economy such as Pakistan's requires an understanding not only of how agricultural policies affect food supply and incomes but also of how households acquire food and cope with insecurity. Many economists regard income as the main indicator of welfare, but other planners maintain that food consumption, health, and nutrition of household members are also important in defining a household's standard of living. The main concern of this research is to trace the pathways from economic and social policies to food security and, ultimately, to nutrition. In effect, the report considers how income is best converted into nutritional well-being. Snapshot approaches- those that look at one point in time-have various uses in understanding these processes but are limited in that they do not reveal anything about the actual dynamics of poverty and food security and their consequences for nutrition and health. This report addresses these concerns by looking at longitudinal data for a three-year period, 1986 to 1989, and analysing the fluctuations in incomes, consumption, saving, nutrition, and health-seeking behaviour of 800 households in five districts in rural Pakistan.

Although the sample households are all located in rural areas, their sources of livelihood are not strictly agricultural. Diverse sources of income other than crops and livestock are found, including artisan work, village crafts, operation of public conveyances, and different forms of trading activities. Moreover, many households receive substantial remittances from household members working in large Pakistani cities such as Karachi or abroad (the Middle East, for example). Together, non-farm income accounts for nearly 45% of total income, including transfers such as remittances and pensions. Much of the rural non-farm income is from self-employment, unskilled labour, or business activities such as production of inputs or processing of agricultural output and therefore is a natural outgrowth of crop and livestock productivity. Hence, strategies for rural development should involve a much broader array of policies than agricultural development per se, including the broadening of credit to non-farm enterprises, improvement of infrastructure, and expansion of rural education.

Income inequality is quite high in the rural areas. An overall Gini coefficient (a measure of income inequality) of 0.40 is calculated for these populations, compared with 0.75 when land ownership is used as a measure of wealth. Of the five sources of rural income-agriculture, livestock, non-farm, rental, and transfers-agricultural income accounts for the largest share of overall income inequality. On the other hand, income from livestock and non-farm sources helps decrease income inequality. These findings indicate that policies that seek to promote livestock development and to attract non-farm investments in rural areas are likely to promote better distribution of income in Pakistan.

Fluctuations in income, even over the relatively short three-year period, were considerable. Weather, illness, and decline in remittances from abroad were among the reasons. This study finds that a moderate share of income fluctuation is explained by district variables and a far greater share by village-level variables. Consumption risks in these households were only partially mitigated by sharing through family networks. Savings played a major role in smoothing consumption. Income risks were also reduced by diversification of income sources.

On average, 70% of a short-run increase in income is either saved or used to pay off the debt, and even low-income households manage to save half, although net physical savings of only about 10% are attained because the rest is usually channelled to repayment of debt. Surprisingly, in these rural settings, households use formal financial instruments such as bank savings accounts to channel half of the remittances from family members abroad. Remittances are mostly saved, and the rest (about 30%) are channelled into physical property, mostly for housing and physical improvements.

According to this study, fluctuations in income do not translate into fluctuations in calorie intakes in the rural households, however. No evidence of seasonality in consumption is detected in 12 separate observations. Even the shift from eating rice to wheat, which occurs in some areas because their harvest times are different, does not affect total calorie intakes. The households surveyed for this study generally have a higher calorie supply per capita than in most parts of South Asia. They cope with seasonal lows and higher food prices through savings, including storage of grains. Credit-mostly from the informal sector, such as friends, relatives, and local stores helps maintain a fairly constant expenditure level.

Calorie-income elasticities in the sample households ranging from 0.12 to 0.39 imply that it would take, on average, about a 30% rise in income to achieve a 10% rise in calorie consumption. Thus, underconsumption of calories in the poorest households is unlikely to disappear in the normal course of economic development. The study, however, also finds that food expenditure elasticities are 1.5 to 2.0 times higher than calorie elasticities, indicating that as household incomes increase, diets are diversified with higher-quality foods, not necessarily with larger quantities of food.

Other policies to attain higher levels of food security need to be found. One possibility is investment in the education of women, who play a critical role in determining household food acquisition patterns. Education of women is found to be a key factor in achieving better nutrition. Educating women to at least the primary level is likely to be nearly three times more effective than increasing incomes by 10%. Clearly, public investments in education for women will have a very high pay-off.

But this study also finds that increases in calories will not automatically translate into better nutrition and health in children unless the high rates of infection are addressed. The low association between calorie intake and child nutrition found in many past studies was primarily due to the failure to consider the interaction between diet and disease. In an environment such as the rural area in this report, where disease is widespread, the role of infection is often magnified. Diarrhoea and illness strongly determine the nutrition status of the preschoolers.

The nutrition status modelling in this study indicates that critical community services-including health services, sanitation, village water supply, and public drainage systems-are necessary to stem the spread of infectious diseases. Public health programmes that reduce illness, such as immunization, or those that encourage prenatal care are important instruments for influencing nutrition. However, the mere physical presence of the services in a community is not enough: quality of services is equally important. For the most part, households cannot provide these services from their own resources. Support from the government for the provision of such critical community services is essential.


World food trends and future food security

Malthus never fully anticipated the miracles of technological innovation, which, despite population doubling and re-doubling have so far kept at bay the threat of food supplies falling below the level where life can be sustained. Instead, the 1980s saw a near balance in growth of population and per capita food production in many regions; in fact, for the world as a whole, per capita food production increased by 5%. Yields of major cereals have more than doubled in the past few decades.

As a consequence, marvelling at the miracle of the "green revolution" has given way to a complacent assurance that technological innovation will always be able to conjure up adequate supplies to feed a growing population. Many countries and institutions have even begun to cut back their investment in the very agricultural research that made it possible to feed the world in the past.

In World Food Trends and Future Security, IFPRI Director General Per Pinstrup-Andersen looks at recent world food trends and asks if the positive production trends of the past 30 years are likely to continue. Or, as 100 million new people are added to the world's population each year, will Malthus's prediction of increasing food scarcity come true? Will food scarcity, hunger, and disease related to malnutrition become even more widespread in the next 20 to 30 years?

Overall positive trends disguise wide disparities in production and distribution of food among regions. Today more than 700 million people in developing countries do not have access to sufficient food to lead healthy, productive lives. More than 180 million children are underweight. As many as 500,000 preschool children go blind each year as a result of vitamin A deficiency. Lack of micronutrients such as vitamin A and iron not only causes suffering and death but also cuts deeply into productivity. Through research and policy, diets could be changed to eliminate much of this suffering.

Although enough food is now being produced to feed everyone if it were evenly distributed, access to adequate food is largely governed by income. Of the 1.1 billion poor people in developing countries in 1990, 50% were in South Asia, 19% in sub-Saharan Africa, 15% in East Asia, and 10% in Latin America. In South Asia and Africa, 50% of the regions' populations live in poverty. While significant reductions are expected in both South and East Asia, the poor in Africa are expected to increase by 40% by the year 2000.

Although food production increases of 30% in the 1980s seem impressive, they are less so in the light of population growth, On a per capita basis, 75 developing countries produced less food per person at the end of the 1980s than at the beginning. Except in Africa, 80% of the production gains came from increased yields in major cereal crops. The area cultivated has actually begun to decline in some regions. From now on, however, even Africa, which has always relied on cultivation of new land for production increases, will have to count on yield gains or pay high financial and ecological costs for expansion into areas not yet cultivated.

Yield trends have climbed steadily upward in all major cereals since the 1960s, but some experts detect a tapering off. In China, for example, rice yield growth rates have slowed more than 4% a year in the late 1970s to about 1.6% a year during the 1980s. Stagnation between 1980 and 1993 in per capita grain production in developing countries is causing concern because factors in addition to population growth are pushing up demand. Expected growth in world feed-grain demand is more than twice the expected population growth.

For more than 50 years food supplies have been sufficient to assure that international food prices increased less than other prices. Recent projections indicate that real food prices are unlikely to increase significantly during the remainder of the 1990s. Low food prices in the world market do not necessarily mean that more people will be fed, however. Poor people cannot express their demand for food, because they cannot afford to buy it. More than 1 billion people live in households that earn less than a dollar a day per person. Clearly, they are not in a position to convert their food needs to effective market demand. Since price is a product of both food supplies and economic demand, low prices indicate the persistence of poverty and a lack of sufficient purchasing power as well as increasing food production.

If a sustainable balance between world food production and food needs (as opposed to food demand) is to be achieved in the coming years, four conditions must be met: (1) economic growth must resume in the developing world, especially in sub-Saharan Africa; (2) effective policies to reduce population growth and to slow rural-to-urban migration must be adopted; (3) resources must be committed to development of rural infrastructure, to continuation of international and national agricultural research, and to provision of credit and technical assistance to give farmers access to modern inputs; and (4) measures must be developed to manage natural resources and to prevent environmental degradation.

At this point, international real food prices are low, food surpluses exist in developed countries, and there is reason to believe that former Soviet Union countries will increase their food production in the decade to come. Yields of wheat, rice, and maize are still increasing in Asia and parts of Latin America although at a lower rate than before. All of these positive signs have caused developed countries to reduce their support for developing-country agriculture, including investment in research and technology.

Although the overall picture is bright, about 700 million people are food-insecure today, and tomorrow does not look so promising. Population in sub-Saharan Africa is expected to grow at 3% a year and food production at less than 2 %. If current trends in population growth and food production continue, the World Bank estimates that by the year 2020 Africa will have a food shortage of 250 million tons. And poverty and the numbers of underfed children will grow accordingly. Though less severe, shortages are also likely in South Asia. At the same time, large areas of land are being degraded and deforested, largely due to poverty, population growth, and limited access to appropriate technology.

Now is not the time for complacency. Malthus's predictions have failed to materialize so far because science has been used to expand food production. Failure to invest in agricultural research today will show up in production shortfalls 10 to 20 years from now. If environmental degradation continues unchecked, shortfalls could occur much sooner. But even if food supplies continue to be adequate to meet global demand at low prices, complacency is not in order. Unless more food is produced by the poor in the developing countries where large increases in population and poverty are expected,

food insecurity and its toll in human misery will continue to increase. To avoid future food crises, adequate investments in the components of agricultural development such as rural infrastructure, research, and technology must be made today.


News and notes

The international dietary energy consultancy group

The International Dietary Energy Consultancy Group (IDECG) was established for the study of dietary energy intake in relation to the health and welfare of individuals and societies. Its specific objectives, as defined at the foundation meeting in Geneva on 3 Sept. 1986 are:

» the compilation and interpretation of relevant research data on functional and other consequences of deficiency, change, or excess of dietary energy intake;
» the identification of related research needs, determination of priorities, and promotion of needed research;
» the publication of scientific and policy statements and other information on the significance of chronic deficiencies and excesses of dietary energy;
» the identification and promotion of appropriate and practical means of corrective action.

To meet these objectives, IDECG seeks to bring together scientists engaged in relevant research with representatives of international organizations concerned with the problem. It also seeks to involve in its work bilateral agencies, foundations, and governments interested in relevant research and policy actions.

IDECG is sponsored by United Nations University, with the endorsement of the UN ACC Subcommittee on Nutrition (SCN), and by the International Union of Nutrition Sciences (IUNS). UNU responsibility for the policies of IDECG is delegated to a steering committee consisting of a representative of the UNU as chairperson, the Secretary General of IUNS, and the Executive Secretary of IDECG. Responsibility for the administration of IDECG is delegated to the Executive Secretary.


Activities and publications

Chronic energy deficiency: Consequences and related issues

A workshop was held at INCAP in Guatemala in August of 1987 to discuss the effects of chronic energy deficiency on behavioural development, stature, work capacity, and productivity. Papers were also presented on the socioeconomic consequences of and responses to food deprivation, seasonality in energy metabolism, the effect of energy supplementation, research on metabolic adaptation to low energy intake, and maternal energy requirements. The proceedings of the meeting were published as the first volume in the IDECG series in 1987.


Activity, energy expenditure, and energy requirements of infants and children

A workshop re-examining the energy requirements of infants and children from the point of view of physical activity and energy expenditure was held in Cambridge, Mass., USA, in the fall of 1989. The workshop proceedings, entitled Activity, Energy Expenditure and Energy Requirements of Infants and Children, were published as the second volume in the IDECG series in 1990.


Improved protein-energy Intakes in early childhood and human-capital formation

In the summer of 1990 IDECG sponsored a workshop in Bellagio, Italy, bringing together scientists involved in the follow-up of a longitudinal food supplementation study in Guatemala. Data presented at the meeting indicated that nutritional improvements during the critical period of gestation and the first two to three years of life can enhance human-capital formation assessed by a wide range of variables in adolescence. A first series of papers presented and discussed at the meeting, dealing with the background of the INCAP longitudinal study, the supplementation effects in early childhood, the demographic and social changes between the two studies, and the design and main findings of the follow-up, appeared in the Food and Nutrition Bulletin, vol. 14, no. 3 (Sept. 1992).

A second report, entitled Early Supplementary Feeding and Cognition: Effects over Two Decades, dealing with supplementation effects on cognition, appeared as a monograph of the Society for Research in Child Development (vol. 58, no. 7, 1993, serial no. 135) in the fall of 1993.

A third series of papers, focusing on the follow-up study and presenting its results in detail is in print as a supplement to the Journal of Nutrition.


Protein-energy interactions

In October 1993 IDECG convened a workshop in Waterville Valley, New Hampshire, USA, to explore in depth the full range of dietary, physiological, and pathological factors influencing the relative demand of the human body for dietary protein, amino acids, and energy. The workshop proceedings, entitled Protein-Energy Interactions, appeared in 1992 as the third volume in the IDECG series.


Functional significance of low body mass Index

IDECG and the FAO convened a meeting in Rome, 46 Nov. 1992, to review in greater depth the functional correlates of low body mass index (BMI) and to try to derive from this a clearer view of the meaning and functional significance of this indicator.

The information examined at the workshop generally tended to confirm relationships between BMI in the lower range on the one hand and various socioeconomic indicators (such as household income), morbidity, and mortality on the other. Relationships between BMI, work capacity, and time devoted to work are more consistent than those between BMI and work productivity measures, perhaps because of the lack of a satisfactory model of the links between BMI and work productivity.

Human lactation performance appears to be very robust, and BMI does not provide a useful indicator of function at the levels studied so far. Lactation performance must become compromised when undernutrition is sufficiently severe, but it appears that this must be in famine or near famine conditions.

The proceedings of the meeting are in print as Supplement 2, 1994, of the European Journal of Clinical Nutrition.


Causes and mechanisms of linear growth retardation (stunting)

A workshop on this topic was held in London, 15-18 Jan. 1993. The meeting brought together scientists who had made observations on causes, correlates, and patterns of linear growth retardation with experts on the cellular biology and hormonal regulation of bone growth who could speculate on the mechanisms involved.

Workshop participants concluded that the main factors affecting linear growth were nutrition, infection, and mother-infant interaction. Since most stunted children are of normal weight for height, the quality of their diet appears to be generally more limiting than the quantity. Several studies have suggested an effect of animal food on linear growth, but it is not yet clear whether amino acids, micronutrients, or lipids are the most limiting factor. Infections contribute through injury to the gastrointestinal mucosa, leading to malabsorption, particularly of micronutrients, and to increased permeability of antigens and bacteria. The systemic effects of infections, mediated by cytokines, result in anorexia and extra losses of nutrients.

Stunting results from a delay in the growth of long bones, which occurs in three phases. During the infancy phase, which begins in utero, reaches its apex around birth, and then declines until three to four years of age, the growth of long bones depends primarily on insulin and insulin-like growth factors. Growth hormone is in circulation in relatively large amounts, but the receptors for it in the end organs are not expressed yet. Around six months after birth, in a normally growing child, these receptors begin to express themselves and the hormone becomes the most important determinant of bone growth; this is the beginning of the childhood growth phase. Evidence is accumulating that what characterizes and determines stunting is a delay in the onset of the childhood growth phase. We do not, however, know what determines the time of the onset of this phase.

The workshop proceedings appeared as Supplement 1, 1994, of the European Journal of Clinical Nutrition. They contain a useful set of guidelines for scientists interested in further study of mechanisms involved in the prevention or reversal of linear growth retardation in developing countries.


Updating of the 1985 FAO/WHO/UNU report on energy and protein requirements

IDECG has taken the initiative in an effort to update selected parts of the 1985 FAO/WHO/UNU expert consultation report Energy and Protein Requirements. To provide a basis for discussion and decision, experts were asked to write position papers on: (1) energy requirements: general principles; (2) energy requirements of infancy; (3) energy requirements of children; (4) energy requirements of pregnant and lactating women; (5) protein requirements of infants and children; (6) protein requirements of adults; (7) energy and protein requirements of older individuals. These papers were discussed at an IDECG workshop held in London, 31 Oct.-4 Nov. 1994. The revised papers and the recommendations of the workshop participants will be published and will form the scientific basis for an FAD/WHO/ UNU consultation in 1995.

Copies of IDECG publications are available free of charge from the IDECG secretariat. For further information write to: Dr. Beat Schürch, Executive Secretary of IDECG, c/o Nestlé Foundation, PO Box , 581, 1001 Lausanne, Switzerland.


Books received

Nutrition in the nineties: Policy issues. Edited by Margaret R. Biswas and Mamdouh Gabr. Oxford University Press, Delhi, 1994. (ISBN 0-19-563393-8) 218 pages, hardback. US$9 plus postage.

This book, developed by the IUNS Committee on Nutrition and Development as a sequel to Nutrition and Development (Oxford, 1984), explores new issues, including feeding urban populations, dealing with the negative effects of environmental pollution on health and food production, the effect of dietary excesses with increased affluence on chronic degenerative diseases, and communication and nutrition education. Although it is a policy book, it contains considerable original information, as some chapters are the product of major studies: e.g., nutrition and health relationships in the aged, the effect of female-headed households in Africa and the health of mothers and children, the effects of economic adjustment on the nutrition status of African populations, and nutrition status in Egypt. The opening chapter, `'Nutrition, food production, and the environment," written by the senior editor, is particularly comprehensive and topical. Although it will be useful to nutritionists, it should be noted that, despite its title, the book does not attempt comprehensive coverage of all the multiple and complex nutrition issues in the nineties.

Nutrition in the '90s: Current controversies. Vol. 2. Edited by Frank N. Kotsonis and Maureen A. Mackey. Marcel Dekker, New York, 1994. (ISBN 0-8247-9212-2) 170 pages, paperback.

Despite its similar title, this is a totally different kind of book from the one listed above. It is a concise series of critical analyses of a series of current issues and controversies in nutrition and health, including diet and breast cancer, complex carbohydrates and health, the genetics of cardiovascular diseases, the roles of low-fat diets and exercise in weight loss, the benefits of exercise for older adults, and new developments in nutrition research including the role of transgenic animals, and the impact of health claims regulations under the US Nutrition Labeling Education Act on food product development. The book is a convenient way for anyone concerned with nutrition policy to catch up on the topics covered.

Mayo Clinic diet manual: A handbook of nutrition practices. 7th edition. Jennifer K. Nelson, Karen E. Moxness, Michael D. Jensen, and Clifford F. Gastineau. Mosby Year Book, Inc., St. Louis, Mo., USA, 1994. (ISBN 0-8151-6348-7) 883 pages, paperback. US$59.95.

This manual provides guidelines for nutritional care practices at the Mayo Medical Center, but the indications and rationale behind nutrition interventions are documented to enable other health care organizations and their nutritionists to adapt it to their specific needs. It is divided into four parts: normal nutrition and therapeutic diets for adults; nutritional management of disease and disorders for adults; normal nutrition and therapeutic diets for infants, children, and adolescents; and nutritional management of diseases and disorders for infants, children, and adolescents.

Chapters on nutritional assessment precede both the adult and paediatric sections. Other chapters provide summaries of the key aspects of nutritional intervention or dietary modification, a section on nutritional inadequacy identifying diet plans that have the potential for producing nutrient deficiencies if adhered to for a long time, and sections on indications and rationale for dietary modifications. The section on the goals of dietary management is intended as a brief summary of the key objective or purpose of nutritional intervention. The dietary recommendations section includes discussions of aspects of assessment that are unique to a particular disease or disorder and presents specific guidelines for diet modification and for the development of a nutritional care plan. Tables summarizing food composition are provided in many sections, as well as references and other resources.

This manual will be a useful and authoritative reference tool for dietitians and medical and health care staff as well as for students of nutrition and dietetics.


The diet history method. Proceedings of the 2nd Berlin Meeting on Nutritional Epidemiology. Edited by Lenore Kohlmeier. Smith-Gordon and Company, London, 1991. (ISBN 1-85463-066-0) 143 pages, paperback. £20/US$36.

In the introduction to this volume the editor notes that epidemiologically, the goal of dietary assessment is to quantify the exposure level of individuals to certain foods or nutrients over time. It has been argued that "for certain dietary factors, there is currently no reliable, observational approach to the assessment of the diet and disease association of major public health potential." Three paths are outlined and discussed for nutritional epidemiological research: One is to devote time and effort to quantifying the errors and inaccuracies in currently used dietary assessment methods as well as validating results and estimating the effects of the flaws on the results. A second path is to concentrate on new technology, e.g., computer technology, research in the psychology of questioning, and the art of interviewing. The third alternative is to turn to indicators of usual dietary behaviour, the biomarkers of dietary intake that can be quantified objectively through measurements of biological samples of blood, hair, saliva, urine, and nails or through anthropometric measurements. Chapters are included on each of these pathways, each of which has advantages and disadvantages. There is also a section summarizing eight workshops held during the meeting.

The book is intended to provide a forum for airing differences of opinion regarding the best solutions to the problems of dietary assessment, with the hope that the interactions and results will inspire new and innovative approaches to the problem of accurate, affordable, and rapid methods of assessment of usual dietary behaviour. It will be a useful reference tool for nutritionists, dietitians, and other health professionals as well as epidemiologists who obtain and use dietary intake data.

Biochemistry of zinc. Ananda S. Prasad. Plenum Press, New York, 1993. (ISBN 0-306-44399-6) 303 pages, hardback.

There have been extensive advances in zinc research in recent decades, and this comprehensive treatise written by one of the world's authorities is welcome. The improvement in understanding zinc metabolism is impressive-for example, from the recognition of three zinc-dependent enzymes in the 1960s to over 300 today. Knowledge has been advanced by the recognition of a fatal genetically induced zinc deficiency, acrodermatitis enteropathica. The growing number of reports of significant clinical effects of zinc deficiency in humans are reviewed, although the weakness of the link is that "diagnostic criteria for a mild or marginal deficiency of zinc, which appears to be common ... have yet to be established." The chapter on assay techniques lays the groundwork for doing so. Other chapters cover the progress in characterizing the clinical, biochemical, metabolic, and immunological characteristics of zinc deficiency, the need for zinc in parenteral hyperalimentation, and the role of zinc in controlling the compound metalothionein, which is important for ameliorating heavy metal toxicity. This is a successful effort to bring together all of the basic knowledge of zinc function and relate it to the clinical effects of zinc deficiency. As such it will be useful both to students of nutrition and biochemistry and to physicians whose practices involve nutritional and metabolic disorders.

Vitamin E in health and disease. Edited by Lester Packer and Jürgen Fuchs. Marcel Dekker, New York, 1993. (ISBN 0-8247-8692-0) 1,000 pages, hardback. US$195.

Vitamin A in health and disease. Edited by Rune Blomhoff. Marcel Dekker, New York, 1994. (ISBN 08247-9120-7) 667 pages, hardback. US$175.

The contributors to these two new books focusing on antioxidant vitamins are leading vitamin researchers. They exhaustively review recent breakthroughs in research on vitamins E and A, with strong emphasis on their antioxidant properties. Both volumes have good indices. The information they contain will be of interest to biochemists, nutritionists, physiologists, and pharmacologists as well as clinicians and public health workers.

Vitamin E in Health and Disease is a massive (and expensive) volume covering the natural occurrence and tissue levels of vitamin E (5 chapters), chemical reactions, antioxidant action, and biomembranes (14 chapters), cell biology (6 chapters), pharmacology (6 chapters), pathophysiology (4 chapters), cancer (4 chapters), immunity and disease (4 chapters), ischaemic heart disease and atherosclerosis (4 chapters), pulmonary and respiratory diseases (4 chapters), and such medical applications as dermatology (3 chapters), neurology (5 chapters), paediatrics (1 chapter), ophthalmology (1 chapter), internal medicine (3 chapters), and obstetrics and gynecology (1 chapter). The number of chapters on the role of vitamin E as a lipophilic free radical quencher indicates the area of most active research and health interest, but all significant aspects of current interest in vitamin E are well covered.

Vitamin A in Health and Disease covers the metabolism of vitamin A (5 chapters), the mechanisms of action of vitamin A and carotenoids (4 chapters), the role of vitamin A and carotenoids (4 chapters), and the role of vitamin A in embryonic development (3 chapters), skin and epithelial cells (2 chapters), blood cells (2 chapters), vision (1 chapter), reproduction (1 chapter), cancer incidence (1 chapter), deficiency and toxicity (2 chapters), and requirements (1 chapter). Current research and knowledge are also well covered.

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