Pregnant women and children in Asia are vulnerable to multiple micronutrient deficiencies. This presentation is to educate all women the importance of Iron+Folate and other micronutrients supplementation.

1. The Importance of Women and Child Nutrition
・Nutrition and Health Issues
・Why Hime Tomo?
March 2017

2. Introduction:
<Reference>
1.) Blössner, Monika, de Onis, Mercedes. Malnutrition: quantifying the health impact at national and local levels. Geneva, World Health Organization, 2005. (WHO
Environmental Burden of Disease Series, No. 12).
Iron and folic acid are essential nutrients to ensure both
mother and baby`s health.
Iron and folic acid are highly recommended for all
women who are planning to get pregnant and expecting
mothers to prevent anemia that cause preterm and low-
birth weight and folate deficiency that may cause
neural-tube defects in offspring.
Women`s reproductive biology (menstrual cycle,
pregnancy and birth) is one of the factors making all
women more vulnerable in iron and folate deficiency
than men. In women with high risk of anemia
intermittent supplementation is also recommended in
non-pregnant women.
The nutritional status of women and children is
particularly important, because it is through women and
their off-spring that the pernicious effects of malnutrition
are propagated to future generations.[1]
Percent of women
of reproductive
age with anemia
29.4％
Percent of women
of Pregnant women
with anemia
38.2％

3. Anemia
The Southeast Asian Region has the highest
prevalence of Anemia in the world next to
Africa.
Accounting 65% in children, 48.2% in pregnant
women and 35.7% in non-pregnant women of
Asia.
Importance of Iron+Folate Supplementation:
Southeast Asia
<Reference>
1.) WHO. Worldwide prevalence on anaemia 1993-2005. http://www.who.int/vmnis/anaemia/prevalence/summary/anaemia_status_summary/en/.Accessed
on March 17, 2017.
2.) WHO. World Malaria Report 2012. http://www.searo.who.int/entity/malaria/data/sear12.pdf?ua=1.Accessed on March 17 2017.
Malaria
In Southeast Asian Region it is reportedly that approximately 70% of the population is at
risk for malaria.[2]
Pregnancy reduces woman`s immunity making them more vulnerable to illness, anemia,
malaria infection, severe disease and even death.
Malaria Area Map

4. Congenital Disorders
Evidence suggests that congenital and genetic disorders are major proportion of
perinatal and neonatal morbidity and mortality in Arab Countries.
Genetic disorders and congenital disorders occur in about 2%-5% live birth, 30%
paediatric hospitalization and 50% of childhood death.[1]
What are common birth defects in the Arab World?
1. Down Syndrome
2. Thalassamias
3. Sickle-cell anemia
4. Glucose-6-phosphate dehydrogenase(G6PD)
5. Autosomal recessive disorders (congenital malformations, mental and physical
handicap)
Importance of Iron+Folate Supplementation:
Arab World
<Reference>
1.) Lihadh Al-Gazali, Hanan Hamamy, Shaikha Al-Arrayad, Genetic disorders in the Arab world, BMJ. 2006 Oct 21; 333(7573): 831–834.
2.) Akl C. Fahed, 1 Abdul-Karim M. El-Hage-Sleiman, Theresa I. Farhat, 2Georges M. Nemer. Diet, Genetics, and Disease: A Focus on the Middle East and North
Africa Region, Journal of Nutrition and Metabolism Volume 2012 (2012)
3.) WHO EMRO, Genetic disorders and congenital abnormalities: strategies for reducing the burden in the Region, EMHJ 1997:3(1)

5. ・Anemia
Iron and Folic acid plays an important role in production and maintenance of red blood
cell.Lack of iron and folic acid in the body causes anemia
Women of reproductive age lose iron by blood loss during menstruation, pregnancy and
child birth. Folic acid in the other hand being a water soluble vitamin cannot be stored
by our body and easily destroyed by cooking. In addition, it is naturally excreted by
leaving the body through urine.
Therefore, we need to consume folic acid every day to ensure that we have enough in
our system.
According to WHO anemia is accounted for 29.4% in women of reproductive age and
38.2% in pregnant women.[1]
Folic acid and iron supplementation is recommended not only to expecting mothers but
also to menstruating women as well .
Common Micronutrient Deficiencies in Asia
<Reference>
1.) WHO. The global prevalence of anemia in 2011. http://www.who.int/nutrition/publications/micronutrients/global_prevalence_anaemia_2011/en/.
Accessed February 3,2017.

6. ・Vitamin D (VDD)
Vitamin D is produced by human body from exposure to sunlight, consumption of foods
rich in Vitamin D and Vitamin D supplements.
Vitamin D requirements are probably greater in pregnancy.
Vitamin D plays an important role in immune function, healthy cell division and bone
health.
Vitamin D deficiency is associated with several chronic diseases including
cardiovascular, autoimmune disease and cancer.[1]
During pregnancy vitamin D insufficiency may develop and adverse health outcomes
such as preeclampsia, gestational diabetes mellitus and Caesarean section.
There are also health consequences in new-borns such as low birth weight, neonatal
rickets neonatal hypocalcaemia, asthma and type 1 diabetes.
In South Asia, Vitamin D deficiency (VDD) seemed to affect 84% of pregnant women
in India, 70% of healthy volunteers in Pakistan, 26% of male children in Sri Lanka and
8% of children in Bangladesh[1]
<Reference>
1.) Saeed Akhtar et al.Micronutrient deficiencies in South Asia – Current status and strategies.Trends Food Sci Technol;31(1):55–62.

7. ・Vitamin A Deficiency (VAD)
Vitamin A are essential for eye health, immunity and cell growth.
Vitamin A deficiency is the leading cause of preventable blindness, disease and death from severe
infections in children and cause night blindness and increases risk of death in pregnant women.
Vitamin A deficiency is a public health problem in half of all countries especially in low-income
and middle income countries.
・Zinc Deficiency
Zinc is also an essential nutrient. Zinc Deficiency cause severe infections.
Worldwide, zinc deficiency is responsible for approximately 16% of lower respiratory tract
infections, 18% of malaria and 10% of diarrhoeal disease.
・Iodine Deficiency
Iodine deficiency may result mental retardation and goiter.
Iodine deficiency has also been associated with lower mean birth weight and increased infant
mortality, hearing impairment, impaired motor skills, and neurological dysfunction.
<Reference>
1.) WHO. The world health report. http://www.who.int/whr/2002/chapter4/en/index3.html.Accessed on March 16, 2017

8. More than 30% of women of reproductive age are anemic. This is because women of
reproductive age lose blood through menstruation and are particularly vulnerable to iron
deficiency. Intermittent supplementation is recommended.
Additionally, intermittent supplementation also reduce oxidative stress. [1]
Intermittent supplementation of folic acid and iron in menstruating women are
recommended by WHO as public intervention.
Intermittent Supplementation in
Menstruating Women:
<Reference>
1.) WHO. Guideline: Intermittent iron and folic acid supplementation in menstruating women. Geneva, World Health Organization, 2011.
Supplement composition
Iron: 60 mg of elemental iron
Folic acid: 2800 μg (2.8mg)
Frequency One supplement per week
Duration and time interval
between periods of
supplementation
3 months of supplementation
followed by 3 months of no
supplementation after which
the provision of supplements
should restart.
Target
group
All menstruating adolescent
girls and adult women
Settings
Populations where the
prevalence of anemia
among non-pregnant
women of reproductive age
is 20% or higher

9. Folic acid and iron requirements increase during pregnancy.
Folate is required for the growth and development of the fetus. Folate deficiency has been associated with
abnormalities in both mothers (anemia, peripheral neuropathy) and fetuses (congenital abnormalities).[1]
While Iron is required because when maternal anemia is diagnosed before midpregnancy,
it has been associated with an increased risk of preterm delivery and infant low birth weight. [2]
In addition to Folic acid and Iron, supplements may be formulated to include other vitamin and minerals
according to United Nation Multiple Micronutrient Preparation to defeat malnutrition during
pregnancy.[3]
Daily Supplementation in Pregnant Women:
<Reference>
1.) James A Greenberg, MD, Stacey J Bell, DSc, RD, Yong Guan, MD, and Yan-hong Yu, MD, PhD. Folic Acid Supplementation and Pregnancy: More Than Just Neural Tube
Defect Prevention. Rev Obstet Gynecol. 2011 Summer; 4(2): 52–59.
2.) Scholl TO1, Reilly T. Anemia, iron and pregnancy outcome. J Nutr. 2000 Feb;130(2S Suppl):443S-447S.
3.) UNICEF, WHO, UNU. Composition of a multi-micronutrient supplement to be used in pilot programs among pregnant women in developing countries: report of a
United Nations Children’s Fund (UNICEF), World Health Organization (WHO), United Nations University (UNU) workshop held at UNICEF Headquarters, New York, July 9,
1999, New York, United Nations Children’s Fund, 2000 (http://apps.who.int/iris/handle/10665/75358,accessed 1 December 2012).
Supplement
composition
Iron: 30-60 mg of elemental
iron
Folic acid: 400 μg(0.4mg)
Frequency One supplement daily
Duration
Throughout pregnancy. Iron and folic acid
supplementation should begin as early as
possible
Target group
All pregnant adolescents and adult
women
Settings All settings

10. What is Hime Tomo?
“Hime” is the Japanese word for "princess",
or more literally "demoiselle", i.e. a (usually
young) lady of higher birth.
Since the dietary supplement contains
important nutrition such as folic acid and
iron etc., we wish Hime Tomo become
Women’s good “Tomo”.

11. Ingredients That Makes Hime Tomo Unique
Folic acid is widely used as a pre-natal supplement to prevent neural tube defects
(NTD), congenital malformations and folate deficiency. Folate is required for the
growth and development of the fetus. Daily intake of Folic acid 1 month before
and during pregnancy is recommended by WHO.
Iron is an essential mineral that helps make red blood cells that
carry oxygen throughout the body. Iron supplementation
reduced risk of low birth weight, preterm birth, maternal severe
anaemia, and infections during pregnancy.
Iron daily supplementation for pre-natal care is also
recommended by WHO.
*Nutrition Facts, raw materials and their health benefits.
Other Benefits:
• Folic acid also concluded to be cure hot flashes
in menopause women.
• In malaria endemic areas folic acid and iron
supplementation is highly recommended to
prevent and treat malaria infections.

12. *Nutrition Facts, raw materials and their health benefits.
Ingredients That Makes Hime Tomo Unique
Vitamin D also known as “Sunshine Vitamin”
has many functions in the body including bone
integrity and calcium metabolism. Vitamin D
reduce the risk of pre-eclampsia, low birth
weight pre-term birth and Vitamin D deficiency.
Vitamin D deficiency is associated with other
chronic diseases such as insulin resistance,
gestational diabetes mellitus, bacterial vaginosis
and increase of Caesarean section delivery.
Young Green Barely Leaves
Loaded with essential nutrients and active
enzymes that supply nutrition. Also offers
antioxidant, protection against free radical
damage, antidepressant-like effect, overall
detoxification and supports cellular metabolism
reducing premature aging.

13. What Makes Hime Tomo Different?
“Barley young leaves" makes HimeTomo stands out
among many of the folic acid supplement in the market.
In Japan, young barely leaf green juice “Aojiru” is
known as “Super Food” and is widely used as health
supplement.
Young barely leaves has many health benefits and
famous for its loads of nutritional components such as
Vit A, Zinc, Iodine, Amino acids and Fatty acids
etc.[1], micronutrients that is lacking asian diet.
In addition, barley young leaves are reported to help
for stress relief in anxiety, depression, pregnancy. [2]
[3] [4]
<Reference>
1.) National Nutrient Database for Standard Reference Release 28 slightly revised May, 2016
2.) Pharmacogn Mag. 2015 May; 11(Suppl 1): S86–S92.
3.) Curr Opin Psychiatry. 2012 Mar; 25(2): 141–148.
4.) National Academies Press (US); 1990.

14. Folic acid 400 mcg
Barley Young
leaf
50.00 mg
Ferric
Pyrophosphate
25.40 mg
Vitamin D3 4.00 mg
Total 500 mg
Supplement fact of HimeTomo
2 tablets of a day
Other ingredients: Maltitol
Per 2 tablets

15. Healthy Women and Children
Towards the Better Future