bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnitude of Zinc Deficiency among Nulliparous Nonpregnant Women in a Rural Community of Haryana State, India
Authors: Pathak Priyali , Kapil Umesh , Kapoor Suresh Kumar , Dwivedi Sada Nand , Singh Rajvir
Published: November 2015

Zinc deficiency during pregnancy affects the outcome of pregnancy. A high prevalence of zinc deficiency (55.5%) has been reported among pregnant women. It is not known whether pregnancy leads to zinc deficiency due to the increased fetal needs or whether the women are zinc deficient when they become pregnant. No data are available on the zinc status of nulliparous nonpregnant women from India. To assess the magnitude of zinc deficiency among nulliparous nonpregnant women in a rural community of Haryana State, India. A community-based cross-sectional survey was conducted in six villages of a rural area in a district of Haryana State, India. All nulliparous nonpregnant women aged 18 years or over who were willing to participate in the study were enrolled. Each woman was questioned about her age, socioeconomic status, and dietary pattern with the use of a pretested semistructured questionnaire. Blood from the antecubital vein was drawn to assess the serum zinc levels using an atomic absorption spectrophotometer. Serum zinc levels less than 70.0 μg/dl were considered to indicate zinc deficiency. The dietary intakes of zinc, protein, and calories were assessed by the 24-hour dietary recall method. Two hundred eighty-eight nulliparous nonpregnant women were enrolled. Forty-one percent had zinc deficiency, and 75.7%, 1.4%, and 7.3% of the women consumed less than 50% of the recommended intake of zinc, protein, and calories, respectively. Women who consumed less than 50% of the recommended intake of calories (1,875 kcal) were at a 4.9 times higher risk of zinc deficiency than women who consumed more than 50% of the recommended intake. A high prevalence of zinc deficiency was found among the nulliparous nonpregnant women in the area studied.
Drinking to Their Health: Social Analysis of a Micronutrient-Fortified Beverage Field Trial
Authors: Benjamin Martin , Ash Deborah M.
Published: November 2015

Anthropologic research was conducted among pregnant and lactating women in rural Tanzania in conjunction with clinical trials of a micronutrient-fortified beverage. Use of the beverage was examined through interviews and ethnographic observation in clinics and at home. Women liked the taste of the beverage, considered it beneficial to their health, preferred it to pills or injections, and most were willing and able to use it according to instructions. Most consumed the beverage according to schedule in the hope of improving pregnancy outcomes. However, public health facilities in Tanzania are not currently equipped to ensure regular delivery of micronutrient supplements, and many of the women with the worst nutrition profiles are also those who would be least able to purchase supplements on the open market. Successful distribution of micronutrient supplements in forms that appeal to consumers, such as a fortified beverage, will require programmatic attention to locally appropriate social marketing and to the challenges of reaching those with extremely low incomes.
Lessons from Successful Micronutrient Programs Part III: Program Impact
Authors: Mason John , Deitchler Megan , Mathys Ellen , Winichagoon Pattanee , Tuazon Ma Antonia
Published: November 2015

Micronutrient-deficiency control programs have been greatly extended at the national level in the last 10 to 15 years. However, rigorous evaluations of these are scarce, so that conclusions on impact are tentative and based mainly on indirect evidence. The coverage of vitamin A capsule distribution programs has exceeded 70% in most study countries. In countries implementing national iodized salt programs, the coverage reaches 60% to 90% of households with adequately iodized salt. Of the three micronutrients, coverage of iron tablet supplementation is the least well documented due to inadequate program monitoring systems and population survey data. Supplementation of preschool children 6 to 59 months of age with vitamin A capsules has plausibly contributed to the reduction in clinical vitamin A deficiency and its near-elimination in many countries. The impact of vitamin A capsule supplementation on children's biochemical vitamin A status (serum retinol) in national programs may be less. National data on salt iodization show a consistent relation to reduced prevalence of iodine-deficiency disorder symptoms (goiter); the rates of cretinism and other results of iodine deficiency are almost certainly falling too. The evaluation of the impact of salt iodization programs on biochemical iodine status is limited by a lack of data. Although trials have demonstrated the efficacy of iron supplementation in reducing the prevalence of anemia, the interpretation of national-level data is not so clear. Given the substantial financial and technical commitment required to implement national micronutrient-deficiency control programs, it is vital that investment enable the evaluation of the impact of these programs. It is becoming increasingly important to collect data on subclinical deficiency (e.g., biochemical data) to assess program impact.
Biocultural Diversity in the Sustainability of Developing-Country Food Systems
Authors: Johns Timothy , Sthapit Bhuwon R.
Published: November 2015

The policy implications of a model of contemporary food systems for developing countries that integrates nutrition, reduction of disease risk, culture, income generation, and biodiversity are reviewed within a theoretical and empirical examination of the relevance of nutrition to the priorities put forward at the World Summit on Sustainable Development in Johannesburg, South Africa, 2002. Agricultural, health, economic, and social policies with local reach are necessary responses to the increase in noncommunicable disease associated with the globalization of food systems. Nutrition offers a nexus for the changes in individual behavior and motivation essential for fundamental shifts in production and consumption patterns. Mutual consideration of biocultural diversity and nutrition can guide policy, research, promotion, and applied action in developing countries. Benefits from enhanced use of biodiversity must legitimately flow to the undernourished poor, while potential negative consequences must be minimized and mitigated. Quality and quantity of food need not be mutually exclusive. Functions related to energy density, glycemic control, oxidative stress, and immunostimulation define important research priorities. Tests of the hypothesis that biodiversity equates with dietary diversity and health might combine quantitative indicators of dietary and biological diversity with nutrition and health outcomes. Biodiversity, where it is part of traditional agricultural and food systems, can be best conserved and enhanced through rational use within a broad-based developmental focus on small-scale and low-input production. The fact that traditional systems, once lost, are hard to recreate underlines the imperative for timely documentation, compilation, and dissemination of eroding knowledge of biodiversity and the use of food culture for promoting positive behaviors.
Weight of Foods and Number of Portions Consumed Are Not Proxies for Expressing Nutrient Intakes in Field Studies
Authors: Valdés-Ramos Roxana , Cervantes Inés , Mendoza Ivan , Solomons Noel W. , Anderson Annie S.
Published: November 2015

In order to determine whether simplified indicators for usual consumption of selected food groups, specifically those derived from either the percentage of the number of daily portions, the percentage of total daily weight consumed, or both, could serve as proxies for the conventional expression of daily energy intake, these indicators were computed and compared from food-frequency data in a data set. Food consumption was reported in frequency categories and portion sizes per month, per week, or per day, and the cumulative sum was divided by 365 to provide a daily average. The survey was done in the township of Santa Cruz and three hamlets of a rural county seat in Guatemala. Data from food-frequency questionnaires from 269 individuals (55 men and 214 women aged 16 to 86 years) were analyzed. For foods of plant origin, the percentage of total energy, percentage of total food weight, and percentage of total number of portions consumed showed low correlations (r < .45). When subdivided into specific foods and food groups (fruits and vegetables, red meat, etc.), marked differences were revealed across sites and among different indicators of consumption. Despite the simplicity of calculation, neither the percentage of weight of food in a group nor the percentage of portions consumed could serve reliably as proxies for their contributions to the percentage of total energy in this rural population in Guatemala.
Promoting Physical Activity in the Americas
Authors: Pratt Michael , Jacoby Enrique R. , Neiman Andrea
Published: November 2015

Physical inactivity, obesity, and noncommunicable disease rates are rapidly climbing to epidemic proportions and are becoming the leading causes of death and disability in the Americas and globally. The causes are complex and will require a multifaceted, multisectoral approach. Recognizing this, the World Health Organization adopted a broad-ranging process to develop a Global Strategy for the Promotion of Diet, Physical Activity, and Health, as mandated by the World Health Assembly in May 2002. The results of the yearlong effort are to be presented at the World Health Assembly in May 2004.
Methodologic Considerations in Descriptive Food-Consumption Surveys in Developing Countries
Authors: Harrison Gail G.
Published: November 2015

This paper reviews some methodologic issues relative to food-consumption studies in developing countries, including sampling considerations; capturing temporal variation in food consumption; choice of dietary instruments and protocols; and food-composition databases and needs for adequate software interfaces. Increasingly, issues of cross-country and regional comparability in food-consumption data are now coming into the decision mix. Comparability of data across countries requires comparability of several fundamental systems. Specific countries and cultural contexts must tackle problems of how to estimate individual intakes when one-dish serving is the norm; how to keep up with rapidly changing food supplies; how to capture ingredients added at the table that may be concentrated sources of nutrients or other components of interest; and how to document out-of-home eating. Assumptions about error, bias, and intra-individual variation in food intake need to be thoroughly tested in developing-country contexts. There is an urgent need for improvement in the availability of appropriate food-composition databases and software interfaces for developing-country use.
Promotion of the Feeding Minds and Fighting Hunger Initiative in Selected Rural Schools in Andhra Pradesh, India
Authors: Bamji Mahtab S. , Murthy P. V. V. S.
Published: November 2015

Background

Schoolchildren are good agents of change and need to be educated and sensitized to specific issues of hunger and malnutrition through a question-and-answer process. Feeding Minds and Fighting Hunger (FMFH), a global project initiated by the Food and Agriculture Organization and partner organizations, attempts to help schoolchildren learn about these issues by introducing concepts in the prevention of hunger and malnutrition to teachers, and by facilitating transfer of knowledge to the children through a set of model lessons.

Objective

To test the feasibility of the FMFH approach to improve the nutrition knowledge of rural schoolchildren in three rural schools in Medak District of the South Indian state of Andhra Pradesh.

Methods

Participatory workshops for teachers were conducted to facilitate knowledge transfer to the children through interactive classroom teaching and other activities. The change in knowledge and thinking of children in the seventh and eighth grades was assessed by a questionnaire administered before and after the intervention. The questionnaire also assessed, in part, the status of local food security based on the sources of different food items in the households.

Results

The responses to the questionnaire suggested that the children's knowledge of nutrients and their functions was not good initially but improved after the intervention. However, their understanding of the social factors responsible for hunger and malnutrition was fairly good prior to the intervention. Improvement in responses to the question of what should be done to combat malnutrition also occurred after intervention. The community had village-level food security for rice and maize but depended partially or fully on outside sources for pulses, fruits and vegetables, and animal products.

Conclusions

The FMFH approach can be applied in rural schools where “the poorest of the poor” children can improve their understanding of balanced diets, better nutrition, the causes of malnutrition, and approaches to combat malnutrition.
Effectiveness of Intermittent Iron Treatment of Two- to Six-Year-Old Jordanian Children with Iron-Deficiency Anemia
Authors: Faqih Ahmad M. , Kakish S. B. , Izzat M.
Published: November 2015

Background

Iron deficiency is a common nutritional problem in young children among vulnerable populations in Jordan. Several studies have shown the effectiveness of intermittent iron supplementation in improving iron status. Such a study has not been carried out in 2- to-6-year-old Jordanian children diagnosed with iron deficiency anemia in a clinical setting.

Objective

To study the effectiveness of intermittent versus daily iron treatment in a clinical setting in 2- to 6-year-old Jordanian children with iron-deficiency anemia.

Methods

About 4,400 children aged 2 to 6 years who visited Prince Hashim Military Hospital in Zarqa, Jordan, from August 2000 to June 2001 were screened for age, general health, and birthweight. About 10% of these children were screened for anemia, using complete blood count (defined as a hemoglobin level ≤ 10.5 g/dL, and a mean corpuscular volume ≤ 75 fL). Anemic children underwent further screening for iron deficiency, defined as serum ferritin level ≤ 12 μ g/L. Children with iron-deficiency anemia, as indicated by hemoglobin ≤ 10.5 g/dL, mean corpuscular volume ≤ 75 fL, and serum ferritin ≤ 12 μ g/L, or as indicated by mean corpuscular volume ≤ 75 fL and hemoglobin ≤ 10.5 g/dL, were enrolled in the study after informed oral consent by their parents. Study children (n = 134) were assigned randomly to one of three groups. Subjects in group 1 (n = 45), group 2 (n = 45), and group 3 (n = 44) received iron treatment daily, weekly, and twice weekly, respectively. Out of 134 children recruited for the study, only 63 (39 boys and 24 girls) completed the 3-month treatment period. All of the children received medicinal iron drops at a dosage of 5 mg elemental iron as ferrous sulfate per kilogram of body weight. The parents also received nutritional counseling.

Results

At the end of treatment, hemoglobin, serum ferritin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration increased significantly in all groups with no significant differences between groups. The increases in hemoglobin in groups 1, 2, and 3 were 2.47 ± 0.17, 2.12 ± 0.18, and 2.18 ± 0.18 g/dL, respectively. Measurements of final serum ferritin concentration were available for only 12, 12, and 10 children in groups 1, 2, and 3, respectively. In all children who completed the study, except for one in group 1, hemoglobin, mean corpuscular volume, and serum ferritin reached normal values in response to iron treatment.

Conclusions

Weekly and twice-weekly iron therapy with 5 mg elemental iron as ferrous sulfate per kilogram of body weight accompanied by nutritional counseling was as effective as daily iron therapy in correcting iron-deficiency anemia in 2- to 6-year-old children under the clinical conditions of this study.
Indicators of Biological Maturation and Secular Changes in Biological Maturation
Authors: Beunen Gaston P. , Rogol Alan D. , Malina Robert M.
Published: November 2015

Commonly used indicators of biological maturation are discussed, including sexual, skeletal, morphological, and dental maturity, and the hypothalamus–pituitary–end organ axes that regulate the growth and maturation processes. Interrelationships among indicators and the tempo, timing, and sequence of maturational events are also considered. Environmental factors that influence the level of maturity at a given point in time and the process of maturation are also discussed: undernutrition, obesity, ethnic/racial background, social class, familial characteristics, climate, and altitude. Recommendations for the design of studies of maturational events are made, and an overview of secular changes before and after 1970 is provided. The review concludes with specific recommendations for the inclusion of a maturity indicator or maturity indicators in the construction of an international growth standard for preadolescent and adolescent children
Nutritional Status in Postconflict Afghanistan: Evidence from the National Surveillance System Pilot and National Risk and Vulnerability Assessment
Authors: Johnecheck Wendy A. , Holland Diane E.
Published: November 2015

Background

Two large-scale studies, the National Surveillance System (NSS) Pilot Study (2003–2004) and the National Risk and Vulnerability Assessment (NRVA) 2003, were conducted by government, United Nations, and nongovernmental organizations in Afghanistan, as part of wider efforts characterizing Afghan livelihoods in relation to particular outcomes of interest: vulnerability to poverty, food insecurity, and malnutrition.

Objective

To present the data from these two surveys with nutrition as the key outcome of interest, and to further construct the understanding of the underlying causes of malnutrition, thus providing public health practitioners and other sector specialists with insight into how a variety of sectoral programs can impact nutritional outcomes in Afghanistan.

Methods

The NSS gathered information on livelihoods, food security, and nutrition from 20 to 40 randomly selected households in each of 26 purposively selected sentinel sites (representative of livelihood zones) during November–December 2003 and May–June 2004. The NRVA gathered information nationally from households selected with a two-stage sampling (based on livelihood zone and then socioeconomic group) during July–September 2004.

Results

Acute malnutrition is below emergency levels for children under five. The level of chronic malnutrition in children under five indicates a problem of public health importance. Dietary diversity in Afghanistan is not as low as expected but still shows room for improvement, particularly in remote areas and with respect to food groups associated with adequate micronutrient intake. The findings also suggest that in addition to lack of adequate household food intake, recurrent illness and suboptimal infant and young child feeding and hygiene practices contribute to poor nutritional outcomes in this age group. The survey also found poor access to health care, markets, and water for household use.

Conclusions

Improving nutritional status requires a multipronged approach, directly targeting malnutrition, coupled with economic growth, household livelihood security, social protection, access to public health services, and water and sanitation. Nutrition policy, programming, and monitoring need to reflect the immediate and underlying causes of malnutrition. Future research needs to be designed to quantify the relative contribution of underlying causes of poor nutrition, allowing practitioners to prioritize responses aimed at improving nutritional outcomes.
Effects of Various Iron Fortificants on Sensory Acceptability and Shelf-Life Stability of Instant Noodles
Authors: Kongkachuichai Ratchanee , Kounhawej Arunwadee , Chavasit Visith , Charoensiri Rin
Published: November 2015

Background

Iron-deficiency anemia is the most common nutritional problem in Thailand and many developing countries. One of the most sustainable and cost-effective strategies for combating iron deficiency is fortification of staple foods with iron.

Objective

In this study, the feasibility of fortifying instant noodles with different forms of iron fortificants (ferrous sulfate [FS], ferric sodium ethylenediamine- tetraacetic acid [NaFeEDTA], and encapsulated H- reduced elemental iron [EEI] was evaluated, and the fortified noodles were compared with unfortified noodles for changes in physical, chemical, and sensory qualities.

Methods

Wheat flour used to make instant noodles was fortified to produce a concentration of 5 mg of iron per 50-g serving of instant noodles (one-third of the Thai recommended dietary intake).

Results

Analytical data showed that the iron contents were close to 5 mg per serving of noodles fortified with FS, NaFeEDTA, or EEI (5.27 ± 0.10, 4.27 ± 0.07, and 5.26 ± 0.47 mg, respectively). The color quality (measured by L*, lightness, and b*, yellowness) of the raw dough sheet and of uncooked and cooked instant noodles fortified with FS was lower than that of the unfortified, but color quality was not changed by the addition of NaFeEDTA. The overall sensory acceptability scores of unfortified and fortified noodles were about 6 (“like slightly”). No metallic odor was observed. During 3 months of storage at room temperature, the iron fortificants did not affect the peroxide level, color, or sensory qualities of the product.

Conclusions

Iron fortification of wheat flour used to make instant noodles is feasible. NaFeEDTA is the preferred fortificant because of its nonsignificant effect on the color and sensory quality of the products.
Home Fortification in Emergency Response and Transition Programming: Experiences in Aceh and Nias, Indonesia
Authors: de Pee Saskia , Moench-Pfanner Regina , Martini Elviyanti , Zlotkin Stanley H. , Darnton-Hill Ian , Bloem Martin W.
Published: November 2015

Background

Improving the nutritional status of an emergency-affected population is essential, because undernutrition increases infection risk and is linked to more than 50% of childhood deaths in developing coun- tries. Emergency food aid addresses nutritional needs, including micronutrient deficiencies, but is provided only for a limited time and uses few items, so the needs of specific target groups are often not fully met.

Objective

To describe the post-tsunami experience with distribution of Vitalita Sprinkles in Aceh and Nias and to analyze the monitoring data gathered for the emergency response.

Methods

International agencies such as Helen Keller International and partners provided micronutrients in response to the tsunami emergency in Aceh and Nias and to analyze the monitoring data gathered for the emergency response.

Results

In March and April 2006, the percentage of children aged 6 months to 59 months who had consumed Vitalita in the previous month was more than 70% in 5 of 11 districts evaluated, 40% to 70% in another five districts, and 32% in one district. An independent survey found 25% less anemia among recipients. Almost all mothers interviewed during March to April 2006 (96.3%) had heard about Vitalita and recognized its packaging, 69% said that Vitalita contained vitamins for under-fives, 86% knew the appropriate target group for Vitalita, and 83% said it had to be mixed with solid food. Of the 26% that reported not having given Vitalita to their child in the last month, 90.5% said that their child did not like it.

Conclusions and lessons learned

Because the prod- uct, including its concept, was new, appropriate infor- mation and training was required as well as a thorough introduction to the beneficiaries, particularly on proper use, to ensure acceptance. This experience demonstrates that providing micronutrients as part of emergency relief and transition programming, as recently recommended by the World Health Organization/UNICEF/World Food Program, is feasible.
In Vitro Bioavailability of Iron and Sensory Qualities of Iron-Fortified Wheat Biscuits
Authors: Govindaraj Thara , KrishnaRau Leelavathi , Prakash Jamuna
Published: November 2015

Background

Because biscuits are a popular snack item and are consumed frequently by the younger population, fortification of biscuits with iron can be beneficial in preventing iron-deficiency anemia, which is widely prevalent in developing countries.

Objective

To determine the bioavailability of iron from biscuits fortified with either ferrous sulfate or sodium iron ethylenediaminetetraacetic acid (NaFeEDTA) equivalent to 8.8 mg of iron per 100 g of flour in combination with either citric and tartaric acids at 60, 80, or 100 mg/100 g levels.

Methods

The study involved analysis of physical characteristics, total and ionizable iron of biscuits, and sensory qualities. The ionizable iron value was used to calculate bioavailable iron. The biscuits were evaluated for sensory attributes by 30 panelists with the help of a scorecard specially developed for biscuits.

Results

The amount of bioavailable iron in biscuits increased over that in controls by about 27% after the addition of ferrous sulfate and 83.8% after the addition of NaFeEDTA. The addition of citric acid (80 mg/100 g) along with ferrous sulfate increased bioavailability by about 104% over that in controls. The maximum increase was seen on addition of tartaric acid (100 mg/100 g). The amount of bioavailable iron increased by 117% after the addition of NaFeEDTA with 80 mg/100 g of citric acid and by 338% after the addition of NaFeEDTA with 100 mg/100 g of tartaric acid. Sensory evaluation tests indicated that NaFeEDTA-fortified biscuits were more acceptable than ferrous sulfate–fortified biscuits and that biscuits fortified with NaFeEDTA along with tartaric acid were similar to control biscuits in all sensory attributes.

Conclusions

From both the subjective and the objective evaluation of biscuits, it can be concluded that the addition of NaFeEDTA along with either citric acid (80 mg/100 g) or tartaric acid (100 mg/100 g) results in improved iron bioavailability with an organoleptically acceptable product.
Health, Livelihoods, and Nutrition in Low-Income Rural Systems
Authors: Joffe Michael
Published: November 2015

Background

Absolute poverty remains a major challenge: the proportion of the world population living with hunger, food insecurity, and undernutrition has fallen, but the absolute number remains stubbornly large. An even larger number of people have enough to eat but suffer from severe micronutrient deficiencies.

Objectives

To provide a conceptual framework showing the interdependence of hunger and poverty with ill health among the rural poor.

Methods

Review of the relevant health, nutrition, agriculture, and economics literature and organization of the findings into a systems framework.

Results

Economic growth is not a sufficient answer to rural poverty. The predicament of poor households can be represented in terms of a self-reinforcing cycle involving nutrition, health, and productivity. The degree of poverty limits the quantity and quality of food intake. Macro- and micronutrient deficiencies interfere with child growth and development and impair immune function, resulting in a predisposition to infectious diseases. Health status strongly influences the quantity and quality of labor and achieved educational status. The high risk of child mortality prevents households from going through the demographic transition to smaller families and better-educated children. The death of a working adult may be catastrophic for the household. This self-reinforcing cycle means that the beneficial effects of an intervention are propagated around the cycle, potentiating its impact. Each main element—nutrition, health, and productivity—also has numerous other determinants and can be influenced by interventions. Interventions that increase the carrying capacity of the household's environment are likely to be more sustainable than “technical fixes,” such as lifesaving medical treatment.

Conclusions

The self-reinforcing cycle is likely to be self-perpetuating without outside intervention. For any rural area where poverty reduction is planned, the key bottlenecks need to be identified. This can be done by using a causal diagram, as described in this paper.
Use of Serum Zinc Concentration as an Indicator of Population Zinc Status
Authors: Hess Sonja Y. , Peerson Janet M. , King Janet C. , Brown Kenneth H.
Published: November 2015

Assessing the prevalence and severity of zinc deficiency in populations is critical to determine the need for and appropriate targeting of zinc intervention programs and to assess their effectiveness for improving the health and well-being of high-risk populations. However, there is very little information on the zinc status of populations worldwide due to the lack of consensus on appropriate biochemical indicators of zinc status. The objective of this review was to evaluate the use of serum zinc concentration as an indicator of population zinc status.

We have reviewed the response of serum zinc concentration to dietary zinc restriction and zinc supplementation. In addition, we completed pooled analyses of nine zinc intervention trials in young children to assess the relations between serum zinc concentration of individuals before treatment and their responses to zinc supplementation. Also, in updated combined analyses of previously published data, we investigated the relation between the mean initial serum zinc concentration of a study population and their mean growth responses to zinc supplementation in randomized intervention trials among children.

The results from depletion/repletion studies indicate that serum zinc concentrations respond appreciably to severe dietary zinc restriction, although there is considerable interindividual variation in these responses. There is also clear evidence that both individual and population mean serum zinc concentrations increase consistently during zinc supplementation, regardless of the initial level of serum zinc concentration. By contrast, an individual's serum zinc concentration does not reliably predict that person's response to zinc supplementation.

Serum zinc concentration can be considered a useful biomarker of a population's risk of zinc deficiency and response to zinc interventions, although it may not be a reliable indicator of individual zinc status.
Integrating Nutrition Security with Treatment of People Living with HIV: Lessons from Kenya
Authors: Byron Elizabeth , Gillespie Stuart , Nangami Mabel
Published: November 2015

Background

The increased caloric requirements of HIV-positive individuals, undesirable side effects of treatment that may be worsened by malnutrition (but alleviated by nutritional support), and associated declines in adherence and possible increased drug resistance are all justifications for developing better interventions to strengthen the nutrition security of individuals receiving antiretroviral treatment.

Objective

To highlight key benefits and challenges relating to interventions aimed at strengthening the nutrition security of people living with HIV who are receiving antiretroviral treatment.

Methods

Qualitative research was undertaken on a short-term nutrition intervention linked to the provision of free antiretroviral treatment for people living with HIV in western Kenya in late 2005 and early 2006.

Results

Patients enrolled in the food program while on treatment regimens self-reported greater adherence to their medication, fewer side effects, and a greater ability to satisfy increased appetite. Most clients self-reported weight gain, recovery of physical strength, and the resumption of labor activities while enrolled in dual (food supplementation and treatment) programs. Such improvements were seen to catalyze increased support from family and community.

Conclusions

These findings provide further empirical support to calls for a more holistic and comprehensive response to the coexistence of AIDS epidemics with chronic nutrition insecurity. Future work is needed to clarify ways of bridging the gap between short-term nutritional support to individuals and longer-term livelihood security programming for communities affected by AIDS. Such interdisciplinary research will need to be matched by intersectoral action on the part of the agriculture and health sectors in such environments.
Anemia in Low-Income Countries is Unlikely to be Addressed by Economic Development without Additional Programs
Authors: Alderman Harold , Linnemayr Sebastian
Published: November 2015

Although governments may decline to invest in iron fortification or supplementation influenced by the view that income growth will address the problem, the data do not support this view. Looking at the rates of anemia among children and adult women across 40 Demographic and Health Surveys from 32 countries, this study found that although anemia rates do decrease as income increases, the decrease is modest. Indeed, overall anemia rates decline roughly a quarter as fast as income increases and at only half the speed at which rates of underweight decline.
Assessing Impact and Impact Pathways of a Homestead Food Production Program on Household and Child Nutrition in Cambodia
Authors: Olney Deanna K. , Talukder Aminuzzaman , Iannotti Lora L. , Ruel Marie T. , Quinn Victoria
Published: November 2015

Background

Homestead food production programs have the potential to improve maternal and child health and nutrition through multiple pathways.

Objective

To evaluate the impact of a homestead food production program in Cambodia on household production and consumption of micronutrient-rich foods and on maternal and child health and nutrition (intake of micronutrient-rich foods, anthropometry, hemoglobin, and anemia prevalence); and to assess pathways of impact on maternal and child health and nutrition.

Methods

Two cross-sectional surveys (baseline and endline) were used to assess differences between intervention ( n = 300) and control ( n = 200) households using t-tests and chi-square tests. Using endline data and multivariate analyses, we examined the pathways of impact of the program on maternal and child health and nutrition.

Results

Intervention and control households were similar at baseline in sociodemographic characteristics, but more intervention households owned animals, earned income from homestead food production, and produced and consumed micronutrient-rich foods. At endline, some of these differences had widened; more intervention households produced and consumed more vegetables, had higher dietary diversity, and had a lower prevalence of fever among children under 5 years of age. In the intervention group, more children consumed more eggs and more mothers consumed micronutrient-rich food more frequently than in the control group. There were no other differences between the groups in maternal and child health and nutrition. Greater household production of fruits and vegetables was associated with greater household dietary diversity, which was associated with dietary diversity among mothers and children. Dietary diversity was not associated with other maternal and child health and nutrition outcomes.

Conclusions

Cambodia's homestead food production program increased household production and consumption of micronutrient-rich foods and maternal and child intake (or frequency of intake) of some of these foods. Weaknesses in the evaluation design (e.g., lack of comparability between groups at baseline, failure to control for self-selection of households into the intervention, and collection of baseline and endline data during different seasons) prevent drawing firm conclusions about the program impacts. Analysis of impact pathways also shows that household-level benefits from the program did not translate into significant improvements in maternal and child health and nutrition. A careful redesign and rigorous assessment of the program using a program theory framework would help unleash its true potential to improve maternal and child health and nutrition outcomes.
Preventive Zinc Supplementation among Infants, Preschoolers, and Older Prepubertal Children
Authors: Brown Kenneth H. , Peerson Janet M. , Baker Shawn K. , Hess Sonja Y.
Published: November 2015

Zinc supplementation trials carried out among children have produced variable results, depending on the specific outcomes considered and the initial characteristics of the children who were enrolled. We completed a series of meta-analyses to examine the impact of preventive zinc supplementation on morbidity; mortality; physical growth; biochemical indicators of zinc, iron, and copper status; and indicators of behavioral development, along with possible modifying effects of the intervention results. Zinc supplementation reduced the incidence of diarrhea by ∼20%, but the impact was limited to studies that enrolled children with a mean initial age greater than 12 months. Among the subset of studies that enrolled children with mean initial age greater than 12 months, the relative risk of diarrhea was reduced by 27%. Zinc supplementation reduced the incidence of acute lower respiratory tract infections by ∼15%. Zinc supplementation yielded inconsistent impacts on malaria incidence, and too few trials are currently available to allow definitive conclusions to be drawn. Zinc supplementation had a marginal 6% impact on overall child mortality, but there was an 18% reduction in deaths among zinc-supplemented children older than 12 months of age. Zinc supplementation increased linear growth and weight gain by a small, but highly significant, amount. The interventions yielded a consistent, moderately large increase in mean serum zinc concentrations, and they had no significant adverse effects on indicators of iron and copper status. There were no significant effects on children's behavioral development, although the number of available studies is relatively small. The available evidence supports the need for intervention programs to enhance zinc status to reduce child morbidity and mortality and to enhance child growth. Possible strategies for delivering preventive zinc supplements are discussed.
The Effect of Therapeutic Zinc Supplementation among Young Children with Selected Infections: A Review of the Evidence
Authors: Haider Batool A. , Bhutta Zulfiqar A.
Published: November 2015

Background

Zinc deficiency is now widely recognized as a leading risk factor for morbidity and mortality and is estimated to be responsible for approximately 800,000 excess deaths annually among children under 5 years of age.

Objective

To evaluate the impact of zinc supplementation as an adjunct in the treatment of diarrhea, pneumonia, malaria, and tuberculosis in children under 5 years of age.

Methods

A comprehensive literature search of electronic databases to identify randomized, controlled trials on the topic was undertaken in January 2008. Eligible studies identified on search were reviewed by the authors and data extraction was done. Statistical analyses were performed with the use of Review Manager software.

Results

Current analysis of the adjunctive therapeutic benefit of zinc in acute diarrhea corroborates existing reviews and provides evidence of reduction in the duration of acute diarrhea by 0.5 day (p = .002) in children under 5 years of age. However, zinc supplementation is found to have no beneficial impact in infants under 6 months of age. A beneficial effect of zinc as an adjunctive treatment is also found in persistent diarrhea, the duration of which is reduced by 0.68 day (p < .0001). Evidence of the benefit of zinc supplementation in pneumonia and malaria is insufficient, whereas no studies are available in children with tuberculosis.

Conclusions

The existing literature provides evidence of a beneficial effect of therapeutic zinc supplementation in the reduction of the duration of acute and persistent diarrhea. However, evidence for its impact on pneumonia, malaria. and tuberculosis in children under 5 years of age is insufficient and needs further evaluation.
Proposed Recommended Nutrient Densities for Moderately Malnourished Children
Authors: Golden Michael H.
Published: November 2015

Recommended Nutrient Intakes (RNIs) are set for healthy individuals living in clean environments. There are no generally accepted RNIs for those with moderate malnutrition, wasting, and stunting, who live in poor environments. Two sets of recommendations are made for the dietary intake of 30 essential nutrients in children with moderate malnutrition who require accelerated growth to regain normality: first, for those moderately malnourished children who will receive specially formulated foods and diets; and second, for those who are to take mixtures of locally available foods over a longer term to treat or prevent moderate stunting and wasting. Because of the change in definition of severe malnutrition, much of the older literature is pertinent to the moderately wasted or stunted child. A factorial approach has been used in deriving the recommendations for both functional, protective nutrients (type I) and growth nutrients (type II).
Physical Growth and Development of the Malnourished Child: Contributions from 50 years of Research at INCAP
Authors: Martorell Reynaldo
Published: November 2015

This paper reviews the main findings and policy implications of 50 years (1949–1999) of research conducted by INCAP on growth and development. Topical areas reviewed include a) maternal size and birthweight and the causes of intrauterine growth retardation (IUGR), b) patterns and causes of postnatal growth retardation, c) the relative importance of genetics and the environment in explaining differences in growth among populations, d) the implications of being small, for both children and adults, e) bone growth and maturation and dental development, f) menarche, and g) methodological contributions such as anthropometric reference data, quality control of data collection, development of risk indicators and use of anthropometry in nutrition surveillance systems. Key contributions to knowledge by INCAP include a) characterization of growth failure and maturational delays as mainly occurring during the intrauterine period and the first 3 years of life b) clarification of the role of small maternal size and of inadequate dietary intakes during pregnancy as major causes of intrauterine growth failure, c) evidence that diarrheal diseases and poor dietary intakes are the principal causes of growth failure in early childhood, d) demonstration that environmental factors related to poverty, and not genetic or racial ancestry, account for most of the differences in growth between populations, e) evidence that growth failure predicts functional impairment in the child as well as in the adult and f) demonstration that nutrition interventions are effective in preventing growth failure and its consequences, if targeted to needy women and young children. INCAP's work has contributed knowledge that has informed and improved policies and programs aimed at overcoming maternal and child undernutrition and promoting optimal growth and development.
The Effectiveness of Quality Protein Maize in Improving the Nutritional Status of Young Children in the Ethiopian Highlands
Authors: Akalu Girma , Taffesse Samson , Gunaratna Nilupa S. , De Groote Hugo
Published: November 2015

Background

Undernutrition is a persistent problem in Africa, especially in rural areas where the poor largely depend on staples and have limited access to a diverse diet. Quality protein maize (QPM) consists of maize varieties biofortified with increased lysine and tryptophan levels. Several studies in controlled settings have indicated the positive impact of QPM on the nutritional status of children.

Objective

Two 1-year, randomized, controlled studies were undertaken to measure the effect of QPM on the nutritional status of children consuming typical maize-based diets when QPM was cultivated by their households in the western Ethiopian highlands.

Methods

The first study used a cluster-randomized design with 151 children aged 5 to 29 months; the second study used a completely randomized design with 211 children aged 7 to 56 months. In both studies, half of the households were provided with QPM seed and the other half with seed of an improved conventional maize variety.

Results

Undernutrition was pervasive, and maize was the dominant food in the children's complementary diets. In the first study, a positive effect of QPM was observed for weight but not height, with children in the QPM group recovering from a drop in weight-for-height. In the second study, children consuming conventional maize progressively faltered in their growth, whereas children consuming QPM did not change significantly in height-for-age and had a marginal increase in weight-for-age.

Conclusions

These studies indicate that in major maize-producing and -consuming areas of Africa, home cultivation and use of QPM in children's diets could reduce or prevent growth faltering and may in some cases support catch-up growth in weight.
Health, Nutrition, and Public Policy
Authors: Frenk Julio , Le Coutre Johannes , Van Bladeren Peter , Blum Stephanie
Published: November 2015

The relationship between health and the economy is complex and hardly a matter of unidirectional cause and consequence. With health increasingly being understood as a stimulus for the economy, nutrition directly assumes the status of an economic identifier. This paper discusses the growing complexity of the global health field and tries to develop a new way of understanding the role of health and nutrition in the broader global agenda. The objective is to develop sensitive policies that can generate progress around the world. Such policies must be based on scientifically derived evidence. Initially, and with a nutritional perspective, the economic effects resulting from a healthy population are assessed. Next, the relationship between healthcare systems and economic performance is analyzed. We then describe the health transition in low- and middle-income countries. Finally, we discuss two national social policies (Oportunidades and Seguro Popular) developed in Mexico to confront its health and nutritional challenges as the keystone for economic development. The main conclusion of this paper is that globalization can turn policy knowledge into international public goods that can be used to address local problems. Such application, in turn, feeds back into the global pool of experience, thus generating a process of shared learning.
Miller's Best/Enhanced Practices for Flour Fortification at the Flour Mill
Authors: Johnson Quentin W. , Wesley Annie S.
Published: November 2015

Background

Cereal flour fortification has been identified as an effective mass fortification intervention as part of a national public health strategy to overcome micronutrient deficiencies and improve the health status of populations, especially women and children.

Objective

The effectiveness of cereal flour fortification programs requires the use of micronutrient premixes that provide the desired health benefits.

Method

The Miller's Best/Enhanced Practices for Flour Fortification at the flour mill has been developed to provide specific guidance to millers and government officials to ensure that flour fortification practices are carried out in a way that results in the anticipated public health impact.

Results

The paper provides information specific to the use of micronutrient premixes, feeders, the fortification process, and quality control systems to ensure that both minimum and enhanced practices can be followed by the millers.

Conclusions

Guidelines for basic and best/enhanced practices to be followed for each stage of the flour fortification process at the flour mill are presented. The paper is designed to be a companion to the Recommended Practices for the Production and Procurement of Premix used in Cereal Fortification Programs and supplementary to existing food quality manuals and systems, such as Good Manufacturing Practices, Food Quality Systems, and Hazard Analysis and Critical Control Points. Other stakeholders involved in flour fortification programs have the responsibility to follow best practices of their own to ensure optimum effectiveness.