Background

According to the Food and Agriculture Organization (FAO), more than 17% of the world’s population is underfed, with around 25,000 people dying of malnutrition every day and a large concentration of malnourishment present in Southeast Asia. These figures seem hard to change and hide many causes and consequences. A sufficiently nutritious diet should provide, among other things, ions, vitamins or essential amino acids. A deficiency in one of these elements can trigger pathologies: an iron deficiency disturbs oxygen transport, or a vitamin A deficiency can lead to blindness. [to re-write]

[give some numbers about malnutrition in India]

A Tour of the Deficiencies and Deficiencies Related Disorders around the world

Vitamin A deficiency (VAD)
is, along with iron, iodine and zinc deficiencies, one of the most prevalent and severe micronutrient deficiencies in the world.
People whose diets are mostly based on starchy foods like rice are especially at risk of VAD, as these foods do not contain retinol (vitamin A) or provitamin A (carotenoids).
Symptoms of VAD include xerophthalmia (extreme dryness of the eyes), night blindness, retinal degeneration, cancer, impaired immune response, birth defects and death.
13.8 million children have some degree of vision loss related to VAD. It is estimated that 250,000,000 preschool children have a VAD. Of those 250 million, 500,000 become blind every year. Half of the children who become blind die within 12 months.

(Highest prevalence of vitamin A deficiency are reported in regions of Africa and South-East Asia.)
In India an estimated 2 million people die every year because of VAD related diseases. The most affected states are those in the south.
bibliography:
Potential impact and cost-effectiveness of Golden Rice Alexander J. Stein1 , H.P.S. Sachdev2 & Matin Qaim October 2006


Iron Deficiency Iron deficiency is the most common deficiency in the world. Disability adjusted life year (DALY) IMAGEEEEEE fewer than 9,250 9,250–16,000 16,000–22,750 22,750–29,500 29,500–36,250 36,250–43,000 43,000–49,750 49,750–56,500 56,500–63,250 63,250–70,000 70,000–80,000 more than 80,000

The main cause of iron deficiency is inadequate intake. Symptoms of iron deficiency include fatigue, dizziness, hair loss, weakness, pica, anemia and thrombocytosis.
A simple way to avoid iron deficiency-related disorders is to eat iron containing food like red meat, poultry and insects.There are also non-heme sources of iron like lentils, beans and tofu, but iron from these sources have reduced bioavailabilities.
Phytic acid is a saturated cyclic acid which has a strong affinity for important minerals such as calcium, iron and zinc. Bound minerals form an insoluble precipitate that is far less absorbed in the intestines. It is a major issue for people whose diet is mainly based on foods that contains phytic acid. Rice contains phytic acid and is consumed as a staple food in India and in east Asia, worsening the deficiencies status in those countries.
B12 deficiency Cobalamin

B12 deficiency can cause severe and irreversible damage to the brain and nervous system. Symptoms include fatigue, depression and poor memory. Deficiency can also cause psychosis.
The deficiency is most commonly due to the lack of b12 sources in the alimentation. B12 is only produced by bacteria and is absorbed by animal by a variety of strategies. Fish, meat, eggs, milk and milk product all contains b12 in quite high levels. Very few non animal sources of b12 exist and this puts populations like vegetarians and vegans at risk of deficiency.
In India, cultural and socio-economic conditions are allowing the deficiency to spread (80% of the 51.1% of pregnant Indian women (from an urban south Indian location) had low plasma B12 levels. Low levels of B12 during pregnancy can also lead to birth defects.
Vitamin B12 Intake and Status in Early Pregnancy among Urban South Indian Women



bibliography Samuel T.M.a, f · Duggan C.b, d · Thomas T.a · Bosch R.c · Rajendran R.a · Virtanen S.M.e, f · Srinivasan K.a · Kurpad A.V.a

The FAO reports that more than half the adults have a BMI under 18.5 kg/m2 in the states of Karnataka, Gujarat, Madhya Pradesh and Orissa, due to malnutrition. The states of Arunachal Pradesh, Maharashtra Andhra Pradesh are also shown to have extremely poor nutritional status.
However, several studies reveal an improvement in the nutritional status of the Indian population in the last two decades. They are attributed by the FAO to socio-economic factors, increased availability of drinking water and improvement of health facility. The Global nutrition report 2014 also mentions nutrition-specific interventions, improved access to food and education, and diminution of poverty and fertility as key factors that have allowed child stunting to be reduced by 1/3 since 2006. But the situation is still dire.
In order to evaluate whether and how synthetic biology could help fighting malnutrition in this country, we researched the other solutions that have been proposed so far to reduce vitamin and iron deficiency, and examined their respective benefits and what obstacles and drawbacks they faced.

1. The Integrated Child Development Services (ICDS) programme

The ICDS is a indian governmental programme established in 1975 which monitors growth and provides supplementary foods, as well as education and primary healthcare for children under six and pregnant and lactating mothers. The programme is implemented through a network of community-level anganwadi centres (AWC), which gives supplementary food daily in the center, as well as take-home rations. Those supplements include doses of vitamin A and tablets of iron and folic acid, in order to prevent xerophtalmia - which can lead to blindness - and anaemia.

However, the National Family Health Survey (NFHS-3) held in 2005-2006 in India reports that only 28% of children received those supplements and healthcare even though 4/5 of children under six lived in a region covered by an anganwadi center. In the 6 months preceding the survey, only 1/4 of the children between 12-35 months were given vitamin A supplements - and in 9 states of India, this number falls to less than 20%. The access to ICDS was improved in the recent years though (2). A national survey held in 2013-14 says that 46% of children aged 6-59 months had received vitamin A doses.

Doses of other vitamins do not seem to be included in the programme.

It is also to be noted that India is one of the country with the less coverage rate of nutrition-specific interventions for iron and folic acid supplementation according to the 2014 Global nutrition report - which could suggest that there is a lack of such interventions. The 2013-14 survey reports only 14% of children aged 6-59 months having received iron and folic acid supplements.

In conclusion, the ICDS programme holds great promises, especially for vitamin A supplements, and seems to be helping more and more children and women in the recent years. But it is limited by the important cost of the numerous centers in every state, the access people have to such centers, and its lack of intervention for other vitamins and iron and folic acid.

2. Vitamin pills

(to be updated)
summary: they are more and more popular, but people take them on a daily basis without consulting their doctors, and that's dangerous for their health. They could have an overdose of vitamins, and the pills could have dangerous cocktail effects with other chemicals.

3. Golden Rice

(to be updated)
summary: Cool but not legal in india. Worries = public health, environment, dependence to western companies.

3. Amma Unavagam

(to be updated)
summary: Cheep canteens with fermented foods. For now only in Chennai. They're very popular and they're cool because of fermented food.

Our solution: engineering the microbiome of traditional fermented foods

(to be updated)
summary: decided to work with fermented foods because they're traditional and healthy. Everyone could use our yeast in their batter and cook it at home (and maybe backslop a few times), so it's more accessible than anganwadi. More healthy and less expensive (?) than vitamin pills. No dependance to western companies since you can either backslop, or even if backslop doesn't work you can stop buying it at any time, which is not so easy with Golden Rice.
Hopefully it would be supported and distributed by the government for free, like they already distribute vitamin A supplements (in Amma Unavagam and anganwadi) + villages could start they own culture in a community lab.