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Response to Comments from Brown et al. (ref: 2021EJCN0980RR)

European Journal of Clinical Nutrition volume 76, pages 1206–1207 (2022)Cite this article

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We thank Brown et al. [1] who are important voices in the field of zinc nutrition, for their generous comments, and for introducing an interesting debate on our recent publications [2, 3]. This debate is more than just about zinc, applying to all contemporary aspects of under- and overnutrition in public health. In addition to the dilemmas that they elucidate, there are additional and perturbing aspects of ethics, economics, and local stake-holding, which we wish to emphasize.

Brown et al. [1] highlight some of the several issues involved in defining a diagnostic biomarker cutoff for nutrient deficiency. Ideally, these should be based on the appearance of clinical or functional signs. However, these might not be specific enough. As they point out, Wessels et al. [4] found a substantial overlap of SZC distribution among subjects with and without clinical signs. The measurement of function is equally variable. The statistical approach in a healthy population is next best. But as Brown et al. [1, 5] have acknowledged, good health can be present with higher than necessary nutrient intakes and body status, which would inevitably lead to higher cut-offs in this statistical paradigm. As we have stated above, this problem applies to many nutrients and conditions [6], with a broader, universal context.

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The Ministry of Health and Family Welfare (MoHFW), Government of India, owns the CNNS data.

References

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Authors and Affiliations

  1. ICMR-National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India

    Raghu Pullakhandam, Bharati Kulkarni, G. Bhanuprakash Reddy & Hemalatha Rajkumar

  2. St John’s Medical College, Bangalore, India

    Santu Ghosh & Anura V. Kurpad

  3. Institute of Liver and Biliary Sciences, New Delhi, India

    Umesh Kapil

  4. Sitaram Bhartia Institute of Science and Research, New Delhi, India

    Harshpal S. Sachdev

Authors
  1. Raghu Pullakhandam
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  2. Santu Ghosh
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  3. Bharati Kulkarni
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  4. G. Bhanuprakash Reddy
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  5. Hemalatha Rajkumar
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  6. Umesh Kapil
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  7. Anura V. Kurpad
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  8. Harshpal S. Sachdev
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Contributions

HSS, AVK, SG, and RP wrote the paper. All authors reviewed and approved the submitted paper. HSS and AVK had final responsibility for the decision to submit for publication.

Corresponding authors

Correspondence to Anura V. Kurpad or Harshpal S. Sachdev.

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Pullakhandam, R., Ghosh, S., Kulkarni, B. et al. Response to Comments from Brown et al. (ref: 2021EJCN0980RR). Eur J Clin Nutr 76, 1206–1207 (2022). https://doi.org/10.1038/s41430-022-01162-x

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