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In This Issue:
Janet Rich-Edwards, ScD Director of Developmental Epidemiology, Connors Center for Women’s Health and Gender Biology
Life is an intricate path that can take us from the familiarities of home to the far stretches of foreign lands. For Janet Rich-Edwards, life led her to Mongolia, a country of nearly three million people nestled between Russia and China.
Since 2004, Rich-Edwards has travelled to the "Land of Eternal Blue Sky" to conduct research that has helped shape the country's public health policies.
What led you to conduct research in Mongolia?
My path to Mongolia was unexpected. Initially, my colleagues and I wanted to study whether cow's milk consumed by children affected their hormone levels and puberty. But recruiting participants in the U.S. proved challenging because children here consume so many dairy products that we couldn't get a "low dairy" control group.
Later, I happened to connect with Ganmaa Davaasambuu, MD, PhD, at a conference, and she encouraged me to go to Mongolia, where there is a large population of children who tolerate milk well but-due to historical and economic forces-lacked access to milk.
In 2004, we were awarded a grant to set up a small study to look at milk consumption and hormone levels among Mongolian children. In our work there, we learned that Mongolia has a high prevalence of rickets, a bone disorder caused by lack of vitamin D. No one had ever measured the vitamin D levels of school-age children.
So my team thought, "What could we give back to this country that has been so generous in hosting us?" We decided to measure the vitamin D levels in children. We could not believe how low their levels were.
What happened next?
We knew that the reason Mongolians had such low levels of vitamin D was the result of their extreme latitude and absence of vitamin D in their diet. We take for granted that our food supply has vitamin D, since we fortify our milk and breakfast cereals in the U.S. But most countries do not.
We needed to prove to health and agricultural officials in Mongolia that the children's vitamin D levels could be lifted out of deficiency by either supplements or by fortifying food. So we obtained funding from various foundations and conducted the "Blue Sky" study.
We gave children several forms of vitamin D-either small amounts of daily vitamin D in a pill or in fortified milk, or one big dose of vitamin D given at the outset of winter, which is the traditional way of giving vitamin D. We found that consistent supplementation with vitamin D by a daily pill or fortified milk was much better at increasing vitamin D levels than a large, one-time dose.
Were you surprised with the results?
Since our team was sure that giving children vitamin D would increase their blood levels of the vitamin, the fact that levels rose may be one of the least exciting scientific findings we've ever had. But I will say that the results were by far the most exciting from a public health perspective.
We went from one public health office to the next showing the officials the results. They were astonished-both at the profound level of deficiency at the start of the study, and how easy it was to raise the levels. The results generated some local excitement about vitamin D.
How have the study results influenced public health policy?
After working on policy with UNICEF and the World Health Organization, Mongolia's Ministry of Health has issued guidelines to the Ministry of Food and Agriculture stating that they should include vitamin D in the national fortification program. It's very exciting. When this project rolls out, we hope to see a drop in rickets.
What other current projects are you involved in?
We are conducting a national survey with the World Health Organization and the Millennium Challenge Corporation to look at the winter and summer vitamin D levels in adults around the country, including indoor office workers and traditional nomads. This is the first national profile of vitamin D levels for Mongolia.
What are some of your perceptions of the country?
Mongolia is beautiful. The country is a dome of blue sky that just goes on forever. With the opening of the economy, there is a new entrepreneurial spirit. Between the geography, the horses and the expanding opportunities, I feel like I'm in the Wild West.
But Mongolia is also a sort of orphan country that has been overlooked by major philanthropists and funders, since it isn't sub-Saharan Africa or Southeast Asia. It is one of those new market economies that is not wealthy enough to fund its own research but would greatly benefit from it.
Do you have any memorable moments?
Mongolians love to sing. And we have a song in common with them: "If You're Happy and You Know It." I remember huddling in a yurt (dwelling), drinking fermented mare's milk with our Mongolian colleagues who were singing in Mongolian while we sang along in English. It was a riot.
Mongolians also love to laugh, which is a very endearing characteristic. It makes me want to go back.