127Abstract
The term “vitamin A (VA) fiasco” refers to the global
programme for universal VA supplementation,
which has been challenged for its validity and wisdom.
The Federated States of Micronesia (FSM) situation
presents an example where VA supplementation
has vied with food-based approaches for resources.
The FSM has experienced many lifestyle changes
since the 1970s, including a shift to imported processed
foods and neglect of traditional foods. This led to
serious health problems, including VA deficiency,
diabetes, heart disease and cancer. In 1998 efforts
were initiated to identify FSM foods that might
alleviate VA deficiency. This led to discovering a
yellow/orange-fleshed banana variety, Karat,
containing 2 230 μg/100 g of the provitamin A
carotenoid beta-carotene, 5 0 times more than in
white-fleshed bananas. Other Micronesian yellow-
and orange-fleshed carotenoid-rich varieties of ba-
nana, giant swamp taro, breadfruit and pandanus
were later identified, also containing rich contents
of vitamins and minerals. In a global health study
led by the Centre for Indigenous Peoples’ Nutrition
and Environment, the Pohnpei, FSM traditional food
system was documented. A two-year community-
based, interagency, intervention was implemented,
focused on increasing local food production and
consumption. Multiple methods were used, includ-
ing awareness, workshops, horticulture, cooking
classes, mass media, posters, print materials,
postal stamps, youth clubs, school activities, farm-
ers’ fairs, competitions, email and slogans: “Go Yel-
low” and “Let’s Go Local”. Results showed an
increase in banana and taro consumption, varieties
consumed, and improved attitudes towards local
food. Carotenoid-rich banana varieties including
Karat, which had not previously been marketed, be-
came regular market items. Local food take-outs
not previously sold became common sale items.
The campaign stimulated great interest as an
awareness success in FSM and throughout the re-
gion, stimulating interest to applying this approach
to other Pacific islands. The campaign could, how-
ever, have a greater impact with greater allocation
of resources to this food-based approach.- Introduction
1.1 Vitamin A fiasco
The term “the vitamin A fiasco” as discussed by
Latham (2010) refers to the large global programme
for universal VA supplementation, which has been
challenged for its validity and wisdom. The rational
of this programme was to decrease overall child
mortality, but the article shows the weak scientific
basis for this. No study has shown the proof of suc-
cess of the vitamin A supplementation programmes.
The programme has utilized huge amounts of funds
in 100 countries. As funds were allocated to the vita-
min A programme, this blocked food-based ap-
proaches for improving vitamin A status. This has
also taken place in Micronesia, where there are lim-
ited resources plus the mentality that once the vita-
min A supplements have been given, the problem has
been dealt with.
This paper presents a success story of food. The
areas covered are:
- How we first carried out food composition studies
on Micronesian foods and identified yellow-
and orange-fleshed varieties of local foods rich in
provitamin A carotenoids and other nutrients that
could be promoted to alleviate the serious
problems of vitamin A deficiency and other health
problems in Micronesia. - How we developed our food-based “Go Local”
programme with the aim to improve nutrition and
health, and showing success in a target community.
1.2 Background to the situation in the Federated
States of Micronesia
The Federated States of Micronesia (FSM), total
population of 102 624, comprises four states: Pohn-
pei, Chuuk, Yap and Kosrae, altogether with 607 is-
lands (FSM, 2010).
Since the 1970s, there have been great lifestyle and
dietary changes in Micronesia. The traditional local
foods include the starchy staples, including bread-