bluuebunny/crossref_metadata_2025 huggingface dataset:
A Multicenter Community Study on the Efficacy of Double-Fortified Salt
Authors: Vinodkumar Malavika , Rajagopalan S. , Bhagwat I. P. , Singh Sanjay , Parmar Bipinkumar S. , Mishra Om Prakash , Upadhyay Shyam Sundar , Bhalia N. B. , Deshpande Shailesh R.
Published: November 2015

Background

Iron and iodine deficiencies affect more than 30% of the world's population. Typical Indian diets contain adequate amounts of iron, but the bioavailability is poor. This serious limiting factor is caused by low intake of meat products rich in heme iron and intake of phytates in staple foods in the Indian diet, which inhibits iron absorption.

Objective

To test the stability of double-fortified salt (DFS) during storage and to assess its efficacy in improving the iron and iodine status of the communities.

Methods

The stability of both iodized salt and DFS during storage for a 2-year period was determined. The bioefficacy of DFS was assessed in communities covering three states of the country for a period of 1 year. This was a multicenter, single-blind trial covering seven clusters. The experimental group used DFS and the control group used iodized salt. The salts were used in all meals prepared for family members, but determination of hemoglobin by the cyanmethemoglobin method was performed in only two or three members per family, and not in children under 10 years of age (n = 393 and 436 in the experimental and control groups, respectively). The family size was usually four or five, with a male: female ratio of 1:1, consisting of two parents with two or three children. Hemoglobin was measured at baseline, 6 months (midpoint), and 12 months (endpoint). Urinary iodine was measured in only one cluster at baseline and endpoint. All the participants were dewormed at baseline, 6 months, and 12 months.

Results

The iron and iodine in the DFS were stable during storage for 2 years. Over a period of 1 year, there was an increase of 1.98 g/dL of hemoglobin in the experimental group and 0.77 g/dL of hemoglobin in the control group; the latter increase may have been due to deworming. The median urinary iodine changed from 200 μg/dL at baseline to 205 μg/dL at the end of the study in the experimental group and from 225 μg/dL to 220 μg/dL in the control group. There was a statistically significant (p < .05) improvement in the median urinary iodine status of subjects who were iodine deficient (urinary iodine < 100 μg/L) in both the experimental and the control groups, a result showing that DFS was as efficient as iodized salt in increasing urinary iodine from a deficient to sufficient status. There was a statistically significant increase (p < .05) in hemoglobin in all seven clusters in the experimental group compared with the control.

Conclusions

The iron and iodine in the DFS are stable in storage for 2 years. The DFS has proved beneficial in the delivery of bioavailable iron and iodine.
Stability of Iodine in Salt Fortified with Iodine and Iron
Authors: Ranganathan Srinivasaiyengar , Karmarkar Madhu G. , Krupadanam Muddepaka , Brahmam Ginnela N.V. , Rao Mendhu Vishnuvardhana , Vijayaraghavan Kamasamudram , Sivakumar Bhattriprolu
Published: November 2015

Background

Determining the stability of iodine in fortified salt can be difficult under certain conditions. Current methods are sometimes unreliable in the presence of iron.

Objective

To test the new method to more accurately estimate iodine content in double-fortified salt (DFS) fortified with iodine and iron by using orthophosphoric acid instead of sulfuric acid in the titration procedure.

Methods

A double-blind, placebo-controlled study was carried out on DFS and iodized salt produced by the dry-mixing method. DFS and iodized salt were packed and sealed in color-coded, 0.5-kg, low-density polyethylene pouches, and 25 of these pouches were further packed and sealed in color-coded, double-lined, high-density polyethylene bags and transported by road in closed, light-protected containers to the International Council for the Control of Iodine Deficiency Disorders (ICCIDD), Delhi; the National Institute of Nutrition (NIN), Hyderabad; and the Orissa Unit of the National Nutrition Monitoring Bureau (NNMB), Bhubaneswar. The iodine content of DFS and iodized salt stored under normal room conditions in these places was measured by the modified method every month on the same prescribed dates during the first 6 months and also after 15 months. The iodine content of DFS and iodized salt stored under simulated household conditions was also measured in the first 3 months.

Results

After the color code was broken at the end of the study, it was found that the DFS and iodized salt stored at Bhubaneswar, Delhi, and Hyderabad retained more or less the same initial iodine content (30–40 ppm) during the first 6 months, and the stability was not affected after 15 months. The proportion of salt samples having more than 30 ppm iodine was 100% in DFS and iodized salt throughout the study period. Daily opening and closing of salt pouches under simulated household conditions did not result in any iodine loss.

Conclusions

The DFS and iodized salt prepared by the dry-mixing method and stored at normal room conditions had excellent iodine stability for more than 1 year.
Feasibility and Use of Vitamin A–Fortified Vegetable Oils among Consumers of Different Socioeconomic Status in Thailand
Authors: Puysuwan Laddawan , Chavasit Visith , Sungpuag Pongtorn , Hediger Daniela , Punvichai Teerasak
Published: November 2015

Background

Vitamin A losses in fortified vegetable oils can differ, depending upon the cooking and distribution conditions of a country.

Objective

To determine vitamin A losses in different vegetable oils during transportation, cooking, and storage among consumers of different socioeconomic status.

Methods

Soybean, rice bran, and palm oils were fortified with vitamin A palmitate at 267 μg/15 mL. The oils were packaged in 5-L metal cans and 250-mL polyethylene terephthalate (PET) bottles and then stored under light and dark conditions. Unopened and opened bottles were stored for 13 and 4 weeks, respectively. For- tified palm oil also was bulk transported in trucks and packaged in 1-kg polypropylene bags that were closed with rubber bands. Vitamin losses were measured after cooking at 120° and 170°C for 5 and 10 minutes in iron, aluminum, Teflon, and glass pans.

Results

Vitamin A losses of oils in PET bottles stored under light conditions were 20% to 25% at the 5th week and became greater than 80% after 13 weeks, whereas losses under dark conditions and in metal containers were less than 15%. Loss during bulk transportation was 25%, with no change in peroxide value. Losses in opened bottles after 4 weeks under light conditions were 50% to 90% based on the degree of oil unsaturation; however, losses under dark conditions were less than 5%. Losses after cooking at 120° and 170°C for 10 minutes were less than 5% and 15%, respectively. The type of pan did not affect the amount of loss. The peroxide values of oils in bottles increased during storage under light conditions.

Conclusions

Fortification of vegetable oils with vitamin A for consumers of different socioeconomic status is feasible; however, light protection is needed for better stability.
AIDS and Agriculture in Zambia
Authors: Byron Elizabeth , Chapoto Antony , Drinkwater Michael , Gillespie Stuart , Hamazakaza Petan , Jayne Thomas , Kadiyala Suneetha , McEwan Margaret , Samuels Fiona
Published: November 2015

Background

Because agriculture is the livelihood base for the majority of people affected by AIDS in sub-Saharan Africa, the interactions between AIDS and agriculture, and their implications for policy and programming, are of fundamental importance.

Objective

This paper summarizes evidence from three RENEWAL (Regional Network on AIDS, Livelihoods, and Food Security) research studies and one policy review on the interactions between AIDS and agriculture in Zambia and their implications for future policy and programming.

Methods

The unit of analysis adopted for each study varies, spanning the individual, household, cluster, and community levels, drawing attention to the wider socioeconomic landscape within which households operate.

Results

This paper identifies the ways in which livelihood activities, within the prevailing norms of gender, sexuality, and perceptions of risk in rural Zambia, can influence susceptibility to HIV, and how the nature and severity of the subsequent impacts of AIDS are modified by the specific characteristics and initial conditions of households, clusters, and communities.

Conclusions

The findings demonstrate the importance of studying the risks, vulnerabilities, and impacts of the AIDS epidemic in the context of multiple resource flows and relationships between and within households—and in the context of other drivers of vulnerability, some of which interact with HIV and AIDS. The paper addresses several factors that enable or hinder access to formal support programs, and concludes by highlighting the particular importance of engaging communities proactively in the response to HIV and AIDS, to ensure relevance, sustainability, and scale.
Serum Selenium Levels in Healthy Women in Tabriz, Iran
Authors: Rafraf Maryam , Mahdavi Reza , Rashidi Mohamad Reza
Published: November 2015

Background

Selenium is of fundamental importance to human health, and selenium deficiency is associated with disease conditions.

Objective

The objective of this study was to investigate the serum level of selenium in women of childbearing age and postmenopausal women living in Tabriz, Iran.

Methods

In this cross-sectional study, 60 healthy women of childbearing age and 60 healthy postmenopausal women were studied with the use of biochemical methods (measurement of serum selenium by graphite furnace atomic absorption spectrometry), anthropometric measurements (weight and height), and interviews.

Results

The average serum selenium was 76.67 ± 17.98 μg/L (range, 42.00 to 166.61μg/L). This level was lower than those reported in other provinces of Iran and some other countries. Sixty-nine women (57.5%) had serum selenium concentrations under 80 μg/L. There was no significant difference in selenium level between the two groups of women. Serum selenium level did not vary with age and body mass index.

Conclusions

Some Iranian women are of borderline selenium status and as a consequence are more susceptible to selenium-deficiency diseases. There is a need for community-based programs to encourage people to increase consumption of selenium-rich sources, such as marine foods.
Public Health Significance of Elevated Homocysteine
Authors: Selhub Jacob
Published: November 2015

Homocysteine is a sulfur amino acid whose metabolism stands at the intersection of two pathways: remethylation, which requires folic acid and vitamin B12 coenzymes; and transsulfuration, which requires pyridoxal-5′-phosphate, the vitamin B6 coenzyme. Data from a number of laboratories suggest that mild elevations of homocysteine in plasma are a risk factor for occlusive vascular disease. In the Framingham studies, we have shown that plasma homocysteine concentration is inversely related to the intake and plasma levels of folate and vitamin B6 as well as vitamin B12 plasma levels. Almost two-thirds of the prevalence of high homocysteine is attributable to low vitamin status or intake. Elevated homocysteine concentrations in plasma are a risk factor for prevalence of extracranial carotid-artery stenosis ≥ 25% in both men and women. Prospectively elevated plasma homocysteine is associated with increased total and cardiovascular mortality, increased incidence of stroke, increased incidence of dementia and Alzheimer's disease, increased incidence of bone fracture, and higher prevalence of chronic heart failure. It was also shown that elevated plasma homocysteine is a risk factor for preeclampsia and maybe neural tube defects (NTD). This multitude of relationships between elevated plasma homocysteine and diseases that afflict the elderly, pregnant women, and the embryo points to the existence of a common denominator which may be responsible for these diseases. Whether this denominator is homocysteine itself, or homocysteine is merely a marker, remains to be determined.
Burden of Anemia and its Socioeconomic Determinants among Adolescent Girls in India
Authors: Bharati Premananda , Shome Suparna , Chakrabarty Suman , Bharati Susmita , Pal Manoranjan
Published: November 2015

Background

Anemia is still one of India's major public health problems, especially among adolescent girls.

Objective

To investigate the severity and distribution of anemia among Indian adolescent girls aged 10 to 19 years and its association with socioeconomic and sociodemographic factors.

Methods

The study used data from the District Level Household Survey, round II, 2002–04, conducted under the Reproductive and Child Health Project. Data were collected on hemoglobin along with socioeconomic and sociodemographic factors of the households. The survey covered rural and urban areas of 35 states or union territories. Data from 177,670 adolescent girls were analyzed.

Results

The highest prevalence of anemia (99.9%) was observed in Jharkhand in eastern India. The prevalence in the northeastern states was relatively low. The highest prevalence rates were observed among older girls (15 to 19 years), illiterate girls living in rural areas, girls in illiterate households, girls from households with a low standard of living, non-Christian girls, girls from Scheduled Tribes, girls living in west India, and married girls. The highest percentages of girls with normal hemoglobin were reported among Christian Scheduled Tribes (39.4%) and among girls in northeastern India (40.1%). Analysis by binary ordered logistic regression showed that anemia status did not depend on urban or rural residence or on age.

Conclusions

Enhancement of the economic status of families, especially poor families, is a prerequisite to the amelioration of anemia among adolescent girls. The level of education of the girls is also a major factor.
Malnutrition in Emergencies: The Framing of Nutrition Concerns in the Humanitarian Appeals Process, 1992 to 2009
Authors: Webb Patrick
Published: November 2015

This paper examines how nutrition has been used to raise humanitarian relief resources through the United Nations appeals process, from 1992 to early 2009. Recent calls for “nutrition safety nets” as a response to the world food price crisis reflect a growing recognition of nutrition as a key element in crisis management, not simply as a metric of how bad things have become. The evolution in thinking about the role of nutrition in emergency programming is reflected in changes in how nutrition has been conceptualized and presented in the consolidated appeals process. Based on a desk review, supported by key informant interviews, the paper highlights important changes that include an increasing distinction that separates nutrition from food, water, and health; the importance of synergies across sectors; increased emphasis on “essential packages” of inputs and services versus stand-alone activities; the importance of technical rigor in food and nutrition assessment and surveys; the need for technical competency and capacity in the design and management of nutrition interventions; and the importance of planning for long-term change even in delivering a short-term response. There has also been growing emphasis on specificity in objectives — a trend linked to demand for more accountability across the humanitarian system. Enhanced emergency preparedness will require further capacity building and improved systems for surveillance and data management. Without more systematic, targeted attention to pre-crisis malnutrition, the resources needed to tackle nutrition problems during emergencies will continue to grow.
Current and Potential Role of Specially Formulated Foods and Food Supplements for Preventing Malnutrition among 6- to 23-Month-Old Children and for Treating Moderate Malnutrition among 6- to 59-Month-Old Children
Authors: de Pee Saskia , Bloem Martin W.
Published: November 2015

Reducing child malnutrition requires nutritious food, breastfeeding, improved hygiene, health services, and (prenatal) care. Poverty and food insecurity seriously constrain the accessibility of nutritious diets that have high protein quality, adequate micronutrient content and bioavailability, macrominerals and essential fatty acids, low antinutrient content, and high nutrient density. Diets based largely on plant sources with few animal-source and fortified foods do not meet these requirements and need to be improved by processing (dehulling, germinating, fermenting), fortification, and adding animal-source foods, e.g., milk, or other specific nutrients. Options include using specially formulated foods (fortified blended foods, commercial infant cereals, or ready-to-use foods [RUFs; pastes, compressed bars, or biscuits]) or complementary food supplements (micronutrient powders or powdered complementary food supplements containing micronutrients, protein, amino acids, and/or enzymes or lipid-based nutrient supplements (120 to 250 kcal/day), typically containing milk powder, high-quality vegetable oil, peanut paste, sugar, and micronutrients. Most supplementary feeding programs for moderately malnourished children supply fortified blended foods, such as corn–soy blend, with oil and sugar, which have shortcomings, including too many antinutrients, no milk (important for growth), suboptimal micronutrient content, high bulk, and high viscosity. Thus, for feeding young or malnourished children, fortified blended foods need to be improved or replaced. Based on success with ready-to-use therapeutic foods (RUTFs) for treating severe acute malnutrition, modifying these recipes is also considered. Commodities for reducing child malnutrition should be chosen on the basis of nutritional needs, program circumstances, availability of commodities, and likelihood of impact. Data are urgently required to compare the impact of new or modified commodities with that of current fortified blended foods and of RUTF developed for treating severe acute malnutrition.
Concordance with Selected Population Recommendations for Cancer Prevention among Third- and Fourth-Grade Schoolchildren in Quetzaltenango, Guatemala
Authors: Vossenaar Marieke , Sinak Christine , Montenegro-Bethancourt Gabriela , Bermudez Odilia I. , Groeneveld Iris , Doak Colleen M. , Solomons Noel W.
Published: November 2015

Background

The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) 1997 recommendations for cancer prevention were meant to apply to children as well as adults.

Objective

To assess the concordance of behaviors and body composition of urban Guatemalan schoolchildren with the tenets of the WCRF/AICR 1997 recommendations.

Methods

A survey was conducted involving determination of 24-hour consumption of foods and beverages by a pictorial registry and height and weight measurements in 355 third- and fourth-grade schoolchildren in the western highland city of Quetzaltenango, Guatemala. Based on a previous, exhaustive parsing of the population goal recommendations of the WCRF/AICR 1997 report, 25 subcomponents were identified. Eleven could be evaluated with the survey data collected. Adult population criteria could be applied in seven, whereas four components had unique criteria adapted to this juvenile survey setting.

Results

The study sample was concordant on seven components—nutrient adequacy, total variety of foods consumed, plant-based diets, body mass index, vegetable and fruit intake, limitation of red meat consumption, and limitation of total fat consumption, and nonconcordant on four—variety of fruits and vegetables consumed, variety of starchy foods consumed, total intake of starchy foods, and limitation of sugar consumption.

Conclusions

Educational and public health actions need to be conceived and implemented to further improve the rate of concordance of these 11 components with the WCRF/AICR 1997 recommendations for cancer prevention.
Introduction: The South Asia Infant Feeding Research Network (SAIFRN)
Authors: Senarath Upul , Dibley Michael J. ,   for the South Asia Infant Feeding Research Network (SAIFRN)*
Published: November 2015

The South Asia Infant Feeding Research Network (SAIFRN) was established in 2007 to foster and coordinate a research partnership among South Asian and international research groups interested in infant and young child feeding. SAIFRN has brought together a mix of researchers and program managers from Bangladesh, India, Nepal, Pakistan, and Sri Lanka together with international partners from Australia. As the first activity, SAIFRN conducted a series of analyses using Demographic and Health Surveys of Bangladesh, Nepal, and Sri Lanka and the National Family Health Survey of India. The results highlight that most indicators of infant and young child feeding in these four countries have not reached the targeted levels. The rates vary considerably by country, and the factors associated with poor feeding practices were not always consistent across countries. Driven by the ultimate goal of improved child survival in the region, SAIFRN wishes to expand its partnerships with governmental and nongovernmental organizations that share common interests both within and outside the South Asia region. In the future, SAIFRN hopes to provide more opportunities to researchers in the region to improve their skills by participating in capacity-building programs in collaboration with international partner institutions, and looks forward to liaising with potential donors to support such activities.
Determinants of Infant and Young Child Feeding Practices in Bangladesh: Secondary Data Analysis of Demographic and Health Survey 2004
Authors: Mihrshahi Seema , Kabir Iqbal , Roy S. K. , Agho Kingsley E. , Senarath Upul , Dibley Michael J. ,   for the South Asia Infant Feeding Research Network (SAIFRN)*
Published: November 2015

Background

In Bangladesh, poor infant and young child feeding practices are contributing to the burden of infectious diseases and malnutrition.

Objective

To estimate the determinants of selected feeding practices and key indicators of breastfeeding and complementary feeding in Bangladesh.

Methods

The sample included 2,482 children aged 0 to 23 months from the Bangladesh Demographic and Health Survey of 2004. The World Health Organization (WHO)-recommended infant and young child feeding indicators were estimated, and selected feeding indicators were examined against a set of individual-, household-, and community-level variables using univariate and multivariate analyses.

Results

Only 27.5% of mothers initiated breastfeeding within the first hour after birth, 99.9% had ever breastfed their infants, 97.3% were currently breastfeeding, and 22.4% were currently bottle-feeding. Among infants under 6 months of age, 42.5% were exclusively breastfed, and among those aged 6 to 9 months, 62.3% received complementary foods in addition to breastmilk. Among the risk factors for an infant not being exclusively breastfed were higher socioeconomic status, higher maternal education, and living in the Dhaka region. Higher birth order and female sex were associated with increased rates of exclusive breastfeeding of infants under 6 months of age. The risk factors for bottle-feeding were similar and included having a partner with a higher educational level (OR = 2.17), older maternal age (OR for age ≥ 35 years = 2.32), and being in the upper wealth quintiles (OR for the richest = 3.43). Urban mothers were at higher risk for not initiating breastfeeding within the first hour after birth (OR = 1.61). Those who made three to six visits to the antenatal clinic were at lower risk for not initiating breastfeeding within the first hour (OR = 0.61). The rate of initiating breastfeeding within the first hour was higher in mothers from richer households (OR = 0.37).

Conclusions

Most breastfeeding indicators in Bangladesh were below acceptable levels. Breastfeeding promotion programs in Bangladesh need nationwide application because of the low rates of appropriate infant feeding indicators, but they should also target women who have the main risk factors, i.e., working mothers living in urban areas (particularly in Dhaka).
Nutritional Status of Under-Five Children in HIV-Affected Households in Western Kenya
Authors: Ndirangu Murugi , Wariero James O. , Sachs Sonia Ehrlich , Masibo Peninah , Deckelbaum Richard J.
Published: November 2015

Background

Households affected by HIV/AIDS are at an increased risk for food insecurity and malnutrition. Poor nutrition contributes to more than a third of all deaths associated with infectious diseases among children under 5 years of age in developing countries. With increased household food insecurity, and a greater disease burden associated with HIV/AIDS, the growth of children under five could be impacted, resulting in increased malnutrition for this vulnerable group.

Objective

To determine whether there is an association between the type of household (HIV-affected compared with HIV-unaffected) and the nutritional status of children under 5 years of age residing in these households.

Methods

The study was set in a Millennium Village Project site in western Kenya and used a cross-sectional design to compare the stunting, wasting, and under-weight status among 102 and 99 under-five children living in HIV-affected and -unaffected households, respectively. Height-for-age, weight-for-age, and weight-for-age z-scores were calculated based on the World Health Organization growth standards and compared. Proportions, means, and standard deviations were used to describe the data. The data were analyzed with the use of the chi-square test for comparison of proportions and the independent t-test for comparison of means.

Results

Children in HIV-affected households had a significantly higher degree of stunting (height-for-age < −2 SD) than children in unaffected households (25.5% vs. 9.1%, p = .002). The degree of wasting and under-weight did not differ significantly between HIV-affected and -unaffected households.

Conclusions

Residing in HIV-affected households is associated with stunting in children under 5 years of age.
Hazard Identification and Exposure Assessment for Bacterial Risk Assessment of Informally Marketed Milk in Abidjan, Côte d'Ivoire
Authors: Kouamé-Sina Sylvie Mireille , Makita Kohei , Costard Solenne , Grace Delia , Dadié Adjehi , Dje Marcellin , Bonfoh Bassirou
Published: November 2015

Background

Animal-source foods are important causes of food-borne illness, and milk and dairy products can contain pathogenic microorganisms.

Objective

We conducted a stochastic assessment of the risk of ingesting milk contaminated with specific microbial pathogens ( Escherichia coli, Staphylococcus aureus, and Enterococcus spp.) in Abidjan, Côte d'Ivoire.

Methods

We carried out structured interviews and focus group discussions with farmers ( n = 15), vendors ( n = 17), and consumers ( n = 188) to characterize dairy production systems and milk consumption behavior. Microbiological sampling was conducted at different points between milking and sale. A risk model was developed, and the risk of consuming contaminated raw milk was estimated by Monte Carlo simulation.

Results

The investigation into local raw milk consumption patterns showed that the proportion of raw milk consumption was 51.6% in people who consume milk. The probability of ingestion of marketed raw milk that failed to meet standards for this group of bacteria was 29.9% and about 652 consumers per day were estimated to ingest contaminated milk. Microbiological tests from the farm showed that 7.2% of samples taken from milkers' hands, 4.4% of water samples (water used to rinse milk containers or milking utensils (calabash, plastic bottle, filters, buckets), 4.4% of environmental samples (air pollution), 13.2% of samples from milking utensils, and 4.9% of samples from cows' udders were contaminated with one or more of these pathogens. About 624.6 L of marketed raw milk would need to be discarded per day if discarding milk was chosen as the option of risk reduction. The destruction of this milk would result in a potential loss of €623.9 per day for all producers.

Conclusions

The risk of human illness from consumption of raw milk could be mitigated by raising awareness about heat treatment of milk and good hygiene practices in the dairy chain.
Should Household Consumption and Expenditures Surveys (HCES) be Used for Nutritional Assessment and Planning?
Authors: Murphy Suzanne , Ruel Marie , Carriquiry Alicia
Published: November 2015

Background

Household Consumption and Expenditures Surveys (HCES) are routinely conducted in several countries on nationally representative samples, often on a regular basis. The HCES have been considered as a potential alternative to more expensive surveys of individuals' food intakes for use in nutritional assessment and in planning programs such as food fortification. HCES gather information on household food availability (purchased, produced, or received as gifts) and use over a given period of time, often the past week or month.

Objective

To discuss the potential usefulness of HCES consumption data for nutritional assessment and planning for populations of households and individuals within the households.

Conclusions

There are several limitations to the HCES, most notably the difficulty of estimating the intrahousehold allocation of foods and therefore of quantifying the actual food intake of individual household members. Another concern is the lack of information on the variability of consumption over time, making it difficult to estimate the distribution of usual consumption, and thus the prevalence of nutrient inadequacies or excesses. Other potential limitations might be addressed by improvements to the HCES questionnaires, such as including information on foods that are available but not consumed and those that are consumed outside the home. Research is needed to better understand both the strengths and the weaknesses of the HCES data when used to assess and plan intakes at the household and individual levels
Fortification of Indonesian Unbranded Vegetable Oil: Public—Private Initiative, from Pilot to Large Scale
Authors: Soekirman  , Soekarjo Damayanti , Martianto Drajat , Laillou Arnaud , Moench-Pfanner Regina
Published: November 2015

Background

Despite improved economic conditions, vitamin A deficiency remains a public health problem in Indonesia.

Objective

This paper aims to describe the development of the Indonesian unbranded cooking oil fortification program and to discuss lessons learned to date and future steps necessary for implementation of mandatory, large-scale oil fortification with vitamin A.

Methods

An historic overview of the steps involved in developing the Indonesian unbranded cooking oil fortification program is given, followed by a discussion of lessons learned and next steps needed.

Results

Indonesia's low-income groups generally consume unbranded vegetable oil, with an average consumption of approximately 25 g/day. Unbranded oil constitutes approximately 70% of the total oil traded in the country. In 2007–10, a pilot project to fortify unbranded vegetable oil was carried out in Makassar, and an effectiveness study found that the project significantly improved the serum retinol concentrations of schoolchildren. In 2010, the pilot was expanded to two provinces (West Java and North Sumatra) involving the biggest two national refineries. In 2011, a draft national standard for fortified oil was developed, which is currently under review by the National Standard Body and is expected to be mandated nationally in 2013 as announced officially by the Government of Indonesia in national and international meetings.

Conclusions

Indonesia is a leading world supplier of cooking oil. With stakeholder support, the groundwork has been laid and efforts are moving forward to implement mandatory fortification. This project could encourage Indonesian industry to fortify more edible oils for export, thus expanding their market potential and potentially reducing vitamin A deficiency in the region.
Relative Contribution of Physical Activity, Sedentary Behaviors, and Dietary Habits to the Prevalence of Obesity among Kuwaiti Adolescents
Authors: Al-Haifi Ahmad R. , Al-Fayez Mohammad A. , Al-Athari Buthaina I. , Al-Ajmi Fahhad A. , Allafi Ahmad R. , Al-Hazzaa Hazzaa M. , Musaiger Abdulrahman O.
Published: November 2015

Background

The increasing rate of obesity among Kuwaiti adolescents is associated with immediate and long term-risks to their health and well-being.

Objective

To update data on the prevalence of overweight and obesity among Kuwaiti adolescents and to examine the relative contribution of selected lifestyle factors to overweight and obesity in this population.

Methods

The present study is part of the Arab Teens Lifestyle Study (ATLS). A total of 906 adolescents (463 boys and 443 girls) aged between 14 and 19 years were selected from Kuwaiti schools by a multistage stratified randomization process. A validated questionnaire was used to collect data on physical activity, sedentary lifestyle, and eating habits. The International Obesity Task Force (IOTF) cutoff values for adolescents under 18 years of age were used to define overweight and obesity. Total energy expenditure was calculated using metabolic equivalent-minutes per week. A general linear model was used to establish the proportion of the variance (expressed in partial eta squared) in excess weight attributable to differences in eating habits and physical activity.

Results

The prevalence of overweight and obesity was 50.5% in boys and 46.5% in girls. Among boys, moderate and vigorous activities were found to be significantly negatively associated with overweight and obesity ( p < .05), whereas in girls, only those with not less than moderate activities were negatively associated with overweight and obesity ( p < .05). Sedentary behaviors, time spent watching television, and time spent working on the computer were not significantly associated with obesity in either sex. Consumption of breakfast, vegetables, and fast foods (boys and girls) and potatoes, cakes and doughnuts, and sweets (girls only) was significantly associated with overweight and obesity ( p < .05). In general, the partial eta square explained by physical activity was less than 3.6% in boys compared with less than 1.0% in girls, and eating habits explained less than 1.8% in boys compared with 2.5% in girls.

Conclusions

Physical activity explains a greater proportion of variation in body mass index than do eating habits, particularly in boys. Eating habits explain a greater proportion of variation in body mass index than does physical activity in girls. Prospective studies are needed to clarify the relative effects of sedentary behaviors on overweight in adolescents.
Derivation of Nutrient Requirements for Disaster-Affected Populations: Sphere Project 2011
Authors: Seal Andrew , Thurstans Susan
Published: November 2015

Background

Nutritional requirements have been previously calculated for emergency-affected populations and are widely used for planning and assessing the nutritional adequacy of humanitarian food assistance. The Sphere Project is an interagency collaboration that defines minimum standards and indicators for humanitarian responses, including food and nutrition. It last published population nutritional requirements in 2004, but a revision was required due to the release of new Reference Nutrient Intakes (RNIs) by the World Health Organization and Food and Agriculture Organization (WHO/FAO).

Objective

To review and revise the list of specified nutrients and recalculate population requirements using RNIs published by WHO/FAO.

Methods

Review of published normative documents, consultation with experts and participants in the Sphere revision process, construction of a reference demographic profile, and calculation of population nutrient requirements for use in designing emergency general rations.

Results

Twenty-one nutrients and energy were selected for inclusion, and a demographic profile was constructed to represent a typical beneficiary population. Compared with the previous version of the Sphere Handbook, population requirements for nine vitamins and minerals were found to have increased as a result of the new WHO/FAO RNIs.

Conclusions

The calculated requirements were adopted and published as part of the Sphere 2011 Handbook. The incorporation of these requirements into planning, monitoring, and evaluation practices for food assistance will help to ensure that populations receive appropriate nutritional support during crises.
Estimates of Exclusive Breastfeeding Rates among Mother—Infant Dyads in Quetzaltenango, Guatemala, Vary According to Interview Method and Time Frame
Authors: Van Beusekom Ilse , Vossenaar Marieke , Montenegro-Bethancourt Gabriela , Doak Colleen M. , Solomons Noel W.
Published: November 2015

Background

The World Health Organization (WHO) recommends exclusive breastfeeding, defined as receiving only breastmilk, through the first 6 months of life to optimize survival, health, and development.

Objective

To assess exclusive and predominant breastfeeding rates, as defined by WHO, in a sample of Guatemalan infants using three dietary assessment methods.

Methods

Mothers of 156 infants (78 boys and 78 girls) in the 6th month of life, attending a public health center in Quetzaltenango, an urban area located in the Highlands of Guatemala, were recruited. A single face-to-face interview was performed to assess infant dietary intake using three methods: previous day dietary recall (as suggested by WHO), current feeding practices, and recall of feeding practices since birth.

Results

Based on the previous day dietary recall method, exclusive breastfeeding was reported by 87 (56%) of the mothers. Exclusive breastfeeding rates were much lower when estimated by current feeding practices questions (20%) and even lower when based on recall of feeding practices since birth (9%). The sum of exclusive and predominant breastfeeding (full breastfeeding) rates was 58%, 49%, and 31% based on previous day dietary recall, current feeding practices, and recall of feeding practices since birth, respectively.

Conclusions

The WHO method of dietary assessment, based solely on the previous day dietary recall, overestimates the exclusive breastfeeding rate compared with recall of feeding practices since birth. In our population sample, adherence to the WHO guidelines for feeding in the first semester of infancy was less than ideal and in need of strengthening.
Implications of Acquired Environmental Enteric Dysfunction for Growth and Stunting in Infants and Children Living in Low- and Middle-Income Countries
Authors: Keusch Gerald T. , Rosenberg Irwin H. , Denno Donna M. , Duggan Christopher , Guerrant Richard L. , Lavery James V. , Tarr Philip I. , Ward Honorine D. , Black Robert E. , Nataro James P. , Ryan Edward T. , Bhutta Zulfiqar A. , Coovadia Hoosen , Lima Aldo , Ramakrishna Balakrishnan , Zaidi Anita K. M. , Burgess Deborah Hay C. , Brewer Thomas
Published: November 2015

Changes in small bowel function early in infancy in developing countries are increasingly being demonstrated, probably accompanied by altered mucosal architecture in most individuals, including reduced enterocyte mass and evidence of immune activation and inflammation in the mucosa. These alterations appear to be the result of factors of uncertain nature in the environment, and may be a cause of growth faltering and stunting in young children. For these reasons, this constellation of findings is being referred to as environmental enteropathy, or as we propose herein, environmental enteric dysfunction. If the causes were known and effective interventions were available, strategies and policies to intervene at—or possibly before—birth could be developed and promoted in order to prevent subsequent malnutrition and recurrent infection, which are known to interact in a cyclical and synergistic manner in a downward clinical course often ending in death. Resources would be mobilized and applied differently, and the emphasis would change from treatment to prevention.

In order to move in this highly desired direction, investments in research will be required to establish the criteria to assess environmental enteric dysfunction, determine its predictive value for growth faltering and stunting, identify the causes, and propose and test potential interventions. The concepts and tools are available. What is required is the decision to move forward along this pathway to better health for infants and children in low-income countries.
Effect of Poverty Reduction Program on Nutritional Status of the Extreme Poor in Bangladesh
Authors: Jalal Chowdhury S. B. , Frongillo Edward A.
Published: November 2015

Background

Poverty alleviation programs for the extreme poor improve participants' economic status and may impact other important outcomes that are seldom evaluated. A program targeted to the extreme poor by BRAC, a development organization in Bangladesh, has been successful in significantly alleviating extreme poverty.

Objective

We hypothesized that the program also improved the nutritional status of women and preschool children.

Methods

A nonequivalent control, pre- and posttest quasi-experimental design that was longitudinal at the village level was used to test the hypotheses. Data were collected from a random sample of 4,131 children and 3,551 women from 3,409 households in 159 villages of 3 northern districts of Bangladesh in 2002 and 2006. Linear mixed random-intercept models accounted for clustering effects and potential confounders.

Results

The weight-for-height of children between 24 and 35 months of age from program households was significantly higher ( p < .05) than that of children from control households. We found no significant differences between control and program households in three other growth and body-composition indicators in three other age categories of preschool children or in women.

Conclusions

These results are important, as this is a large-scale program that has already been extended to more than half the country. The findings will contribute to judging the cost-benefit and cost-effectiveness of the program and in garnering support for the expansion of such programs.
UNICEF—CDC Global Assessment of Home Fortification Interventions 2011: Current Status, New Directions, and Implications for Policy and Programmatic Guidance
Authors: Jefferds Maria Elena , Irizarry Laura , Timmer Arnold , Tripp Katie
Published: November 2015

Background

Micronutrient powders (MNP) reduce anemia and improve iron status in children aged 6 to 23 months. Little is known about home fortification interventions in low-income and middle-income countries.

Objective

To describe highlights of the Global Assessment of Home Fortification Interventions 2011, new directions, and needed policy and programmatic guidance.

Methods

A cross-sectional survey of home fortification interventions was conducted. Staff at UNICEF and regional focal points at Home Fortification Technical Advisory Group partner agencies sent questionnaires to representatives in 152 low-income and middle-income countries. Included interventions met the following criteria: they were for prevention and used MNP, lipid-based nutrient supplements (LNS), or complementary food supplements (CFS); one recommended mode of use was mixing into food; they were implemented or planning to start within 12 months; and research interventions were directly linked to programs.

Results

This study identified 63 implemented interventions (36 countries) and 28 planned interventions (21 countries), including 34 implemented interventions (22 countries) and 25 planned interventions (20 countries) that used MNP. These interventions were expected to reach 17.2 million people in 2011, including 14.1 million participants in MNP interventions. Among implemented interventions, 16% distributed nationally. Most interventions used integrated approaches targeting young children. Recently, there was increasing expansion of interventions in Africa. The main challenges identified were monitoring and evaluation, adherence, product funding, and procurement.

Conclusions

Home fortification interventions, especially those that use MNP, are increasing and scaling up rapidly in regions with widespread problems of micronutrient deficiencies and stunting. Home fortification interventions contribute to global initiatives to reduce undernutrition.
Using Formative Research to Inform the Design of a Home Fortification with Micronutrient Powders (MNP) Program in Aileu District, Timor-Leste
Authors: Osei Akoto , Septiari Andi , Suryantan Julia , Hossain Md. Monjur , Chiwile Faraja , Sari Mayang , Pinto Paulino , Soares Dirce , Faillace Silvana
Published: November 2015

Background

Using formative research to guide the planning and implementation of home fortification programs is critical if they are to achieve the desired level of acceptance and coverage by the target beneficiaries.

Objective

To explore contextual factors that could influence acceptance, delivery, and use of micronutrient powders (MNP) in Aileu District, Timor-Leste.

Methods

Two focus group discussions were conducted with mothers of children 6 to 23 months of age, and 56 in-depth interviews were conducted with mothers ( n = 18), fathers ( n = 14), grandmothers ( n = 14), health workers ( n = 8), and Catholic catechists ( n = 2). These were followed by a 14-day usability trial during which 45 mothers fed their children MNP daily and were interviewed about their experience. Participants were selected from three villages.

Results

The findings revealed limited exclusive breastfeeding and early introduction of complementary foods due to traditional beliefs and poor knowledge. MNP was generally liked by the respondents. Thirty of the 45 children in the trial consumed all of the 14 MNP sachets provided to them. The majority of mothers (n ≥ 30) split and fed the daily dose of MNP at different times of the day. They gave several reasons for this practice, including changes in the color of food when a whole sachet of MNP was added. Only six mothers shared MNP-fortified food among siblings. The participants suggested contextual attributes that could influence their adoption of MNP, including preferred name, packaging design, and delivery channel. They preferred orange-colored sachets with a picture of a “healthy” Timorese baby, the logo of the Ministry of Health, and instructions on how to use the product.

Conclusions

The findings offer context-specific knowledge that could guide the success of the MNP program in this district and similar settings.