bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of Distribution of Multimicronutrient Supplements in Children and in Women and Adolescent Girls of Childbearing Age in Chiclayo, Peru
Authors: Gross Ursula , Valle Claudia , Diaz Marita Mamani
Published: November 2015

Background

There is a need to better understand the coverage of scaled-up multimicronutrient supplementation programs.

Objective

The coverage of the distribution of multimicronutrient supplements in 26 urban communities among women and adolescent girls 12 through 44 years of age and children under 5 years of age was evaluated for purposes of scaling-up.

Methods

Formative research and descriptive statistics were used to analyze the distribution of supplements.

Results

Despite a delayed memorandum of understanding with the health sector and delayed delivery by the producer of the supplement, a high coverage rate of supplement distribution to the children (88% on average during the 3 months of supplementation) was still achieved as a result of the strong commitment of the community and the Integrated Food Security Program. The lower coverage rate among women and adolescent girls (47% on average) was the result of too short a period of enrollment in the program. There was no decrease of coverage during the 3 months of supplementation in both groups.

Conclusions

Effective, sustainable, large-scale micronutrient supplementation programs require broad partnerships with commitments of governmental and nongovernmental organizations, communities, and the private sector. Availability of the supplements and communication materials must be secured well ahead of the supplementation campaign and distribution of the supplement.
Lessons Learned from the Scaling-Up of a Weekly Multimicronutrient Supplementation Program in the Integrated Food Security Program (Pisa)
Authors: Lechtig Aarón , Gross Rainer , Vivanco Oscar Aquino , Gross Ursula , de Romaña Daniel López
Published: November 2015

Background

Weekly multimicronutrient supplementation was initiated as an appropriate intervention to protect poor urban populations from anemia.

Objective

To identify the lessons learned from the Integrated Food Security Program (Programa Integrado de Seguridad Alimentaria [PISA]) weekly multimicronutrient supplementation program implemented in poor urban populations of Chiclayo, Peru.

Methods

Data were collected from a 12-week program in which multimicronutrient supplements were provided weekly to women and adolescent girls 12 through 44 years of age and children under 5 years of age. A baseline survey was first conducted. Within the weekly multimicronutrient supplementation program, information was collected on supplement distribution, compliance, biological effectiveness, and cost.

Results

Supplementation, fortification, and dietary strategies can be integrated synergistically within a micronutrient intervention program.

Conclusions

To ensure high cost-effectiveness of a weekly multimicronutrient supplementation program, the following conditions need to be met: the program should be implemented twice a year for 4 months; the program should be simultaneously implemented at the household (micro), community (meso), and national (macro) levels; there should be governmental participation from health and other sectors; and there should be community and private sector participation. Weekly multimicronutrient supplementation programs are cost effective options in urban areas with populations at low risk of energy deficiency and high risk of micronutrient deficiencies.
Long-Term Longitudinal Studies and Implications for the Development of an International Growth Reference for Children and Adolescents
Authors: Himes John H.
Published: November 2015

This report reviews 21 long-term, longitudinal studies of physical growth as background for the International Growth Reference for Children and Adolescents (IGRCA) initiative. Longitudinal studies form a large share of the evidence base for much of the knowledge on normal growth of children, and the collective experience from their long history is instructive relative to future studies that may result from the IGRCA. Many of the studies were initiated in the 1920s and 1930s when some current techniques, such as the use of doubly labeled water for the assessment of energy expenditure or dual-energy x-ray absorptiometry (DEXA) for the study of body composition, were not available. Nevertheless, many well-established protocols for anthropometry and for assessment of somatic maturation are as important today as they were in the past. With some important exceptions, few of the studies collected detailed information on dietary intake or child health and illness. Genetic or familial factors were limited as well. Many lessons can be drawn from the past experience with prominent longitudinal growth studies. Nevertheless, the exact design, sampling, and measurement protocols chosen for future growth studies emanating from the IGRCA effort must be carefully linked to specific research questions and the explicit purposes for which the resultant data will be used.
Interpopulation Variation in Height among Children 7 to 18 Years of Age
Authors: Haas Jere D. , Campirano Fabricio
Published: November 2015

The objective of this review is to examine the degree of variation that exists in the achieved height of preadolescent and adolescent children across populations experiencing favorable conditions that support linear growth. Fifty-three population groups were identified that reported mean heights for economically privileged populations from all major continents. Graphic representation of the heights for these populations indicates that the mean height of preadolescent children differs by 3 to 5 cm, whereas population means begin to diverge from the National Center for Health Statistics/World Health Organization (NCHS/WHO) reference at puberty, with most non-European populations falling to approximately 5 cm below the reference and northern European populations exceeding the reference by a similar amount. We conclude that the evidence for limited interpopulation variation in the height of preadolescents supports consideration of a single growth reference for children up to puberty, but the uncertainty of the causes of the divergence in achieved height during puberty requires further research in order to establish an appropriate adolescent growth reference.
Does Provision of Food in School Increase Girls' Enrollment? Evidence from Schools in Sub-Saharan Africa
Authors: Gelli Aulo , Meir Ute , Espejo Francisco
Published: November 2015

Background

The problem of low female literacy rates in Africa starts with low primary school enrollment, particularly in areas of high food insecurity. The provision of food in, and through, schools is considered to be one way of enrolling more girls in school, keeping them enrolled, and enhancing their adult well-being and pro- ductivity as a result.

Objective

To investigate the effects of provision of food and additional take-home rations in schools on girls' enrollment.

Methods

A retrospective cross-sectional study was designed based on school-level surveys in 32 African countries between 2002 and 2005. The study population consisted of girls and boys in primary schools targeted by the World Food Programme (WFP) and located in food-insecure areas that also suffered from lack of access to education.

Results

Provision of food in schools through the Food for Education (FFE) program contributed to increasing absolute enrollment in WFP-assisted schools by 28% for girls and 22% for boys in the first year. Post year-one enrollment patterns varied according to the type of FFE program. Where provision of take-home rations for girls was combined with on-site feeding for all pupils, the increase in girls' absolute enrollment was sustained at 30% after the first year. However, in schools providing on-site feeding alone, the rate of increase in absolute enrollment after the first year reverted to the rates of increase found in the year prior to FFE implementation. The provision of take-home rations also appeared to reduce the dropout rate of female students, particularly in the higher grades.

Conclusions

FFE programs can have a lasting positive influence on school enrollment and, by providing extra take-home rations to girls, in addition to on-site feeding, can make a strong contribution to the Millennium Development Goals.
Dialyzability of Minerals in Corn Masa Gruel (Atole) Fortified with Different Iron Compounds: Effects of Ascorbic Acid, Disodium EDTA, and Phytic Acid
Authors: De-Regil Luz Maria , Casanueva Esther , Killilea David W. , Viteri Fernando E.
Published: November 2015

Background

Lime-treated corn gruel ( atole) is a common weaning food in iron-deficient populations, especially in Mexico and Central America, and is a potential vehicle for fortification with iron.

Objective

The objective of this study was to screen promising iron compounds for use in the fortification of atole, using in vitro enzymatic digestion–dialysis techniques, while also considering their response to known iron absorption enhancers and inhibitors.

Methods

Atole, unaltered or preincubated with phytase, was fortified with iron (10 mg/L) from ferrous sulfate, ferrous bisglycinate, or ferrous fumarate, or with ferric chloride, ferric ammonium citrate, or ferric sodium ethylenediaminetetraacetic acid (NaFeEDTA), and submitted to in vitro digestion. Dialysis of calcium, copper, iron, phosphorus, and zinc (analyzed by inductively coupled plasma atomic emission spectrometry) was measured when atole was fortified with iron compounds alone or together with ascorbic acid or disodium ethyl- enediaminetetraacetic acid (Na2 EDTA).

Results

Iron dialyzability was higher with NaFeEDTA ( p < .05) than with all other iron compounds, which did not differ among themselves in iron dialyzability. Addition of ascorbic acid had no significant effect on iron dialysis, whereas Na2 EDTA enhanced iron dialyzability by 7 to 10 times in unaltered atole and 15 to 20 times in phytase-preincubated atole ( p < .05). Addition of Na2 EDTA always increased intrinsic zinc dialyzability, and most of the time this increase was significant. Phytase pretreatment generally increased mineral dialysis.

Conclusions

Adding EDTA (either as NaFeEDTA or as Na2 EDTA) to atole can increase the dialyzability of ferrous and ferric iron compounds and enhance the dialyzability of intrinsic zinc without any negative effects on calcium, phosphorus, or copper dialysis.
Assessment of the Sustainability of the Iodine-Deficiency Disorders Control Program in Lesotho
Authors: Sebotsa Masekonyela Linono Damane , Dannhauser André , Jooste Pieter L. , Joubert Gina
Published: November 2015

Background

Evaluation of the sustainability of iodine-deficiency disorders control programs guarantees successful and sustained virtual elimination of iodine deficiency. The Lesotho universal salt iodization legislation was enacted in 2000 as an iodine-deficiency disorders control program and has never been evaluated.

Objectives

To assess the sustainability of the salt iodization program in Lesotho, 2 years after promulgation of the universal salt iodization legislation.

Methods

The proportion to population size method of sampling was used in 2002 to select 31 clusters in all ecological zones and districts of Lesotho. In each cluster, 30 women were selected to give urine and salt samples and 30 schoolchildren to give urine samples. The salt samples were analyzed by the iodometric titration method, and the ammonium persulfate method was used to analyze the urine samples. The chairperson of the iodine-deficiency disorders control program was interviewed on programmatic indicators of sustainability. SAS software was used for statistical analysis of the data.

Results

The urinary iodine concentrations of very few children (10.1% and 21.5%) and women (9.8% and 17.9%) were lower than 50 μg/L and 100 μg/L, respectively. At the household level, 86.9% of the households used adequately iodized salt. Only four indicators of sustainability have been attained by the salt iodization program in Lesotho.

Conclusions

Iodine-deficiency disorders have been eliminated as a public health problem in Lesotho, but this elimination is not sustainable. Effective regular monitoring of salt iodine content at all levels, with special attention to iodization of coarse salt, is recommended, together with periodic evaluation of the iodization program.
Undernutrition among Adult Dhimals of Naxalbari, West Bengal: Comparison with other Tribes of Eastern India
Authors: Datta Banik Sudip , Bose Kaushik , Bisai Samiran , Bhattacharya Mithu , Das Subal , Jana Arpita , Purkait Pulakesh
Published: November 2015

Background

The tribes of India comprise approximately 8% of the total population of the country, which probably has the largest number of tribal communities in the world. In general, the tribal populations are among the most underprivileged and undernourished people in India.

Objectives

To determine the anthropometric characteristics and prevalence of undernutrition, based on body mass index (BMI), of adult Dhimals, a tribal population of Naxalbari, West Bengal, India, and to compare these results with those from four other tribes of Eastern India: the Bathudis, Kora Mudis, Santals, and Savars.

Methods

A total of 305 adult (18 years or older) Dhimals (159 men and 146 women) from three villages (Maniram, Hatighisa, and Buraganj) in the Mallabari area of Naxalbari were studied. These villages are located 5 km from Siliguri town, which is approximately 580 km from Kolkata, the provincial capital of West Bengal. Anthropometric measurements included height and weight. BMI was calculated by the standard equation. Undernutrition was evaluated according to World Health Organization (WHO) cutoff points.

Results

The overall prevalence of undernutrition (BMI < 18.5) was very high (36.4%). The prevalence was significantly higher in women than in men (46.4% vs. 27.0%; χ2 = 12.54; p < .001; odds ratio, 2.35). According to the WHO criterion, the prevalence of undernutrition was high and the situation was serious in men. Among women, the prevalence of undernutrition was very high and the situation was critical. However, in general, compared with other tribal people of eastern India except the Santals, adult Dhimals had better anthropometric and nutritional profiles.

Conclusions

This study provides evidence that although the anthropometric and nutritional profiles of adult Dhimals are better than those of some of the other tribal populations of eastern India, immediate appropriate nutritional intervention programs are needed for implementation among this ethnic group.
Reaching the Goal of Universal Salt Iodization (USI): Experience of Uttar Pradesh, India
Authors: Vir Sheila C. , Dwivedi Shraddha , Singh Richa , Mukherjee Ashish
Published: November 2015

Background

In 2002, the percentage of households consuming iodized salt in the state of Uttar Pradesh (UP) in India dropped to as low as 6%. This implied that 3.5 million newborns in this non-salt producing state, with 180 million population, were at risk of brain damage unless universal accessibility and consumption of iodized salt was ensured and sustained.

Objectives

Urgent measures were introduced in 3 phases in the state for accelerating procurement, distribution and consumption of iodized salt.

Methods

In the first phase, a study on mapping of salt wholesalers and understanding the salt trading system—including understanding the knowledge, attitudes, and practices of salt traders was undertaken to accelerate efforts to influence availability, marketing, and accessibility of iodized salt. The study revealed that a total of only 344 primary wholesalers supplied salt to the entire state. Of these, 126 wholesalers marketed 80% of salt and were located in only 15 of the total 70 districts of the state. This finding became a very strong basis for the program in phase II, which focused on the critical group of wholesalers and set up a system to frequently interact with them. The salt wholesalers were equipped with Salt Testing Kits (STKs) to ensure adequate iodine content in the salt procured by them and adherence to the legal ban on the sale of non-iodized salt for human consumption. Simultaneously, a “child-to-community” approach was launched through involvement of middle and high school children to create demand and monitor consumption of iodized salt at the household level. Over 217,000 salt samples (about 26,000 samples per quarter) were brought in by school children and tested for iodine content.

Results

The school activities resulted not only in influencing consumption of iodized salt, but also galvanized the entire chain linking consumers, retailers, and wholesalers. In less than 2 years, salt procured with nil iodine decreased from 38% to 15.3%, and salt marketed with adequate iodine level increased from 28.6% to 64.9%. School data revealed an increase in consumption of iodized salt from 6% to 46.7%. In phase 3, additional standardized activities at the school level were included and the program was taken to scale in the state.

Conclusion

The findings revealed that identification and inclusion of salt wholesalers—not only the salt manufacturers—was important for achieving a rapid positive shift in iodized salt marketing and consumption practices.
Stability of Iodine in Iodized Fresh and Aged Salt Exposed to Simulated Market Conditions
Authors: Maramag Cherry C. , Tengco Lorena W. , Rayco-Solon Pura , Solon Juan Antonio A. , Maglalang Hector C. , Solon Florentino S.
Published: November 2015

Background

The salt iodization law of the Philippines required that iodized salt sold at retail not be exposed to direct sunlight, high temperature and relative humidity, and contamination with moisture and dust from the environment. However, because the majority of local consumers buy salt displayed in open heaps, it was suggested that iodized salt should be sold in the same manner for greater accessibility and availability.

Objective

We aimed to provide evidence on the stability of iodine in local aged and fresh salt iodized at 100 ppm iodine and exposed to various market and storage conditions.

Methods

Samples of salt in open heaps and repacked salt were exposed for 4 weeks, and salt packed in woven polypropylene bags was stored for 6 months. The iodine content of the salt was determined by the iodometric titration method, and the moisture content was determined by the oven-drying method.

Results

For all types of exposed salt, iodine levels were above 60 ppm after the end of the study (4 weeks). Within each salt type, losses were greater for open-heap salt than for repacked salt. The greatest drop in moisture content occurred in the first week for most types of salt and exposure combinations. Moisture content was linearly correlated with iodine content. Iodine levels in stored salt remained above 60 ppm even after 6 months.

Conclusions

Iodized salt is able to retain iodine above the recommended levels despite exposure to an open environment and use of ordinary packaging materials while being sold at retail and kept in storage.
Iron, Folate, and Vitamin B12 Stores Among Pregnant Women in a Rural Area of Haryana State, India
Authors: Pathak Priyali , Kapil Umesh , Yajnik C.S. , Kapoor S.K. , Dwivedi S.N. , Singh Rajvir
Published: November 2015

Background

Iron, folate, and vitamin B12 deficiencies have adverse effects on pregnancy outcome. In India, data on the concomitant prevalence of these deficiencies among pregnant women are meager.

Objective

We conducted a community-based study to assess the prevalence of deficiencies of iron, folate, and vitamin B12 among pregnant women in a rural block of Haryana State.

Methods

The study was approved by the ethics committee of the All India Institute of Medical Sciences, New Delhi. A total of 283 pregnant women were enrolled in the study. After oral informed consent had been obtained from the women, blood was drawn from the antecubital vein for estimation of the levels of serum ferritin by enzyme-linked immunosorbent assay (levels < 12 ng/mL were considered as indicative of poor iron stores); serum folate was determined by radioimmunoassay (levels < 3 ng/mL were considered as indicative of poor folate stores); and serum vitamin B12 was estimated by the microbiologic method (levels < 200 pg/mL were considered as indicative of poor vitamin B12 stores).

Results

The results indicated that 67.7%, 26.3%, and 74.1% of the women had poor iron, folate, and vitamin B12 stores, respectively. Concomitant deficiencies of iron, folate, and vitamin B12 occurred in 16.2% of the women. We found that 59.9% of the women were consuming less than 75% of the recommended daily caloric allowance (2,175 kcal), indicating an overall poor food intake. This could be one of the predominant reasons for poor iron, folate, and vitamin B12 stores among the women.

Conclusions

Our findings suggest that apart from iron and folate, vitamin B12 deficiencies may play an important role in causing anemia.
Food and Nutritional Security of Children of Urban Farmers in Kampala, Uganda
Authors: Yeudall Fiona , Sebastian Renée , Cole Donald C. , Ibrahim Selahadin , Lubowa Abdelrahim , Kikafunda Joyce
Published: November 2015

Background

Urban agriculture is an important livelihood strategy to increase access to and availability of food in urban settings.

Objective

We examined the impact of sociodemographic and farming variables on the household food security and nutritional security of an index child aged 2 to 5 years. Our hypothesis was that dietary quality (percentage of energy from animal-source foods [%ASF] and dietary diversity) would have an impact on infection (as measured by C-reactive protein [CRP]), which in turn would have an impact on biochemical indices (hemoglobin and retinol) and anthropometric indices (weight-for-age z-score [WAZ] and body mass index z-score [ZBMI]). We examined the relationships among urban agricultural activities, household food security, and child nutritional security.

Methods

We conducted a cross-sectional survey of 296 households within each randomly selected study zone in Kampala, Uganda. Correlations were calculated and bivariate and exploratory path analysis was conducted to explore relationships.

Results

Household food security score was significantly positively correlated with the number of tropical livestock units ( r = 0.142, p = .017), dietary diversity ( r = 0.230, p < .001), %ASF ( r = 0.185, p = .002), and WAZ ( r = 0.149, p = .017). Exploratory path analysis demonstrated a significant positive relationship between household food security and %ASF, which in turn was positively associated with retinol. Consumption of animal-source food was significantly negatively associated with C-reactive protein level, which in turn was significantly negatively associated with hemoglobin level, and hemoglobin was significantly positively associated with WAZ.

Conclusions

Our findings are supportive of efforts to enhance access to land for urban farming and engagement in activities aimed at improving the quality of dietary intake of urban residents, in particular by increasing consumption of animal-source foods.
Iron Supplementation of Young Children: Learning from the New Evidence
Authors: Stoltzfus Rebecca J. , Heidkamp Rebecca , Kenkel Donald , Habicht Jean-Pierre
Published: November 2015

High iron needs and low-iron diets combine to make early childhood one of the highest risk periods for iron deficiency. Recommendations for iron supplementation for this age group have been based on positive effects on anemia and child development. In contrast, the evidence regarding growth and morbidity outcomes has been equivocal, with some evidence of risk. The new evidence from Nepal and Zanzibar is reviewed, and possible interpretations are discussed. The Zanzibar trial found significant adverse effects in the overall population with poor malaria services and substantial benefit to iron-deficient children (the majority) in an area where access to treatments was provided. Cost-effectiveness analysis suggests that targeting supplements to iron-deficient children in Zanzibar may not increase costs (relative to universal supplementation) and would increase benefit. Operations research is needed to test this. We conclude with three options for maximizing the benefits and minimizing the risks of iron supplements.
Infant-Feeding Practices and Beliefs about Complementary Feeding among Low-Income Brazilian Mothers: A Qualitative Study
Authors: Lindsay Ana Cristina , Machado Marcia Tavares , Sussner Katarina M. , Hardwick Cary K. , Peterson Karen E.
Published: November 2015

Background

Breastfeeding and weaning practices are important determinants of growth and development not only in infancy but also later in life.

Objective

To describe infant-feeding practices and beliefs about complementary feeding among low-income Brazilian mothers.

Methods

Qualitative methods included focus group discussions with low-income mothers enrolled in a Family Health/Community Health Workers program in Ceará, Northeast Brazil.

Results

Breastfeeding is widely practiced in this area, and overall, mothers are knowledgeable about the benefits of breastfeeding for their infants and themselves. Practices of prolonged breastfeeding and delayed supplementation of infants with semisolid foods emerged as a problem among very poor women. In addition, the results showed common problems related to complementary feeding practices, such as the early introduction of solid foods and the use of expensive commercial cereals and formula for weaning. Cultural factors and taboos appeared to have an important influence on mothers' infant-feeding practices and eating patterns of their children.

Conclusions

The results have implications for the design of breastfeeding promotion and interventions to improve complementary feeding. Improvements of the national Food Grant Program are also suggested, which are needed by low-income mothers to improve their infant-feeding practices.
Impact of Orphanhood on Underweight Prevalence in Sub-Saharan Africa
Authors: Rivers Jonathan , Mason John , Silvestre Eva , Gillespie Stuart , Mahy Mary , Monasch Roeland
Published: November 2015

Background

In Africa, approximately 25 million people live with HIV/AIDS and 12 million children are orphaned. Although evidence indicates that orphans risk losing opportunities for adequate education, health care, and future employment, the immediate effects of orphanhood on child nutritional status remain poorly understood.

Objective

This paper assesses the nutritional impact of orphanhood, with particular emphasis on taking account of various factors potentially confounding or masking these impacts.

Methods

Child anthropometry and orphan status were examined in 23 Multiple Indicator Cluster Surveys and Demographic and Health Surveys throughout sub-Saharan Africa, which were subsequently merged into larger, region-specific datasets (East, West, and Southern Africa). To compare orphans and nonorphans, linear regression and probit models were developed, taking account of orphan status and type, presence of a surviving parent in the household, household structure, child age and sex, urban versus rural residence, and current wealth status.

Results

Few differences emerged between orphans and nonorphans in controlled and uncontrolled comparisons, regardless of orphan type, presence of surviving parent, or household structure. Age differentials did confound nutritional comparisons, although in the counterintuitive direction, with orphans (who were 8 months older on average) becoming less malnourished when age differences were taken into account. Wealth did appear to be associated with orphanhood status, although it did not significantly confound nutritional comparisons.

Conclusions

Orphans were not consistently more malnourished than nonorphans, even when potential confounding variables were examined. Since household wealth status is likely to change after becoming affected by HIV, ruling out wealth as a potential confounder would require more detailed, prospective studies.
Impact of Pilot Project of Rural Maintenance Programme (RMP) on Destitute Women: CARE, Bangladesh
Authors: Roy Swapan Kumar , Bilkes Farzana , Islam Khaleda , Ara Gulshan , Tanner Phillip , Wosk Irena , Rahman Ahmed Shafiqur , Chakraborty Barnali , Jolly Saira Parveen , Khatun Wahjiah
Published: November 2015

Background

The rate of malnutrition among women in Bangladesh is high, but historically there has not been a specific program focusing on the improvement of the nutritional status of Bangladeshi women.

Objective

To observe changes in the nutritional status of destitute women of the Rural Maintenance Programme (RMP) by incorporating a health and nutrition intervention package with RMP ongoing activities.

Methods

An intervention study involving 1,275 poor destitute women was conducted from July 2004 to June 2005 in 17 districts in Bangladesh under two field offices, Mymensingh and Jessore, covering 8 and 9 districts, respectively. The respondents were divided into intervention, comparison, and control groups. All participants in the intervention and comparison groups were paid as part of the RMP and received weekly 30-minute nutrition interventions for 7 weeks in addition to routine training. The comparison group also received RMP training. The control group consisted of women with similar demographic characteristics to the intervention and comparison groups who did not receive pay or any intervention. The intervention was a unique combination of the three components of the UNICEF triangle model (food security, caring practices, and disease contol). Data on socioeconomic and anthropometric characteristics, immunization, and vitamin A capsule intake were also collected with the use of a structured questionnaire.

Results

After the intervention, the mean body weight had significantly increased by 1,333 g in the intervention group and had decreased by 277 g in the control group and 147 g in the comparison group. The body mass index of women in the intervention group had also significantly increased at the end of the study ( p < .001). There was a significant increase in the intake of iodized salt in the intervention group as well as increased immunization coverage in all groups. Intake of the first vitamin A capsule by children increased (from 60% to 97%) in the intervention group only.

Conclusions

The nutrition pilot intervention was highly effective in improving the nutritional status of women in the RMP.
Insulin Resistance and Impaired Glucose Tolerance in Overweight and Obese Costa Rican Schoolchildren
Authors: Holst-Schumacher Ileana , Nuñez-Rivas Hilda , Monge-Rojas Rafael , Barrantes-Santamaría Mauro
Published: November 2015

Background

Worldwide obesity has become an unprecedented public health challenge. In addition, a notable increase in the risk of insulin resistance and type 2 diabetes mellitus has emerged. In Costa Rica, there are no epidemiological data to establish the prevalence of type 2 diabetes in the pediatric population. However, information from the Endocrinology Department of the Children's National Hospital indicates an increased number of cases in the last 2 to 3 years.

Objective

To determine the prevalence of insulin resistance and impaired glucose tolerance in overweight and obese schoolchildren.

Methods

This cross-sectional study was conducted among 214 healthy 8- to 10-year-old children from urban schools of San José, Costa Rica. Anthropometric measurements and blood determinations of glucose, insulin, proinsulin, glycosylated hemoglobin, C-peptide, and leptin were performed. Indexes were calculated to assess insulin resistance. Information on social and lifestyle variables was obtained from questionnaires, and acanthosis nigricans was certified by a physician. Statistical analysis was performed with SPSS software for Windows, version 10.0.

Results

The prevalence of type 2 diabetes mellitus was very low (0.5%) in the studied population. However, hyperinsulinemia and impaired glucose tolerance were present in 20.6% and 6.5% of the subjects, respectively. On the basis of the Fasting Glucose-to-Insulin Resistance Ratio (FGIR), 46.7% of the children showed insulin resistance. Girls and obese children (body mass index ≥ 95th percentile) were more likely to have higher serum insulin levels and insulin resistance than boys and over-weight children (BMI ≥ 85th percentile). Compared with the lowest quintile, children in the highest quintile of body-fat tissue had higher insulin resistance but had similar serum concentrations of glucose, C-peptide, and proinsulin. Positive family histories of type 2 diabetes mellitus and sedentarism (73.7% and 40.7%, respectively) were highly prevalent among overweight and obese children.

Conclusions

The prevalence of impaired glucose tolerance and insulin resistance in obese children indicates a worrisome trend in the incidence of type 2 diabetes in Costa Rica. Strategies for weight reduction, obesity prevention, and promotion of healthy lifestyles are necessary to prevent the onset of type 2 diabetes during childhood and adolescence.
Vitamin B12 Status of Pregnant Indian Women and Cognitive Function in their 9-year-old Children
Authors: Bhate Vidya , Deshpande Swapna , Bhat Dattatray , Joshi Niranjan , Ladkat Rasika , Watve Sujala , Fall Caroline , de Jager Celeste A. , Refsum Helga , Yajnik Chittaranjan
Published: November 2015

Background

Recent research has highlighted the influence of maternal factors on the health of the offspring. Intrauterine experiences may program metabolic, cardiovascular, and psychiatric disorders. We have shown that maternal vitamin B12 status affects adiposity and insulin resistance in the child. Vitamin B12 is important for brain development and function.

Objective

We investigated the relationship between maternal plasma vitamin B12 status during pregnancy and the child's cognitive function at 9 years of age.

Methods

We studied children born in the Pune Maternal Nutrition Study. Two groups of children were selected on the basis of maternal plasma vitamin B12 concentration at 28 weeks of gestation: group 1 ( n = 49) included children of mothers with low plasma vitamin B12 (lowest decile, < 77 pM) and group 2 ( n = 59) children of mothers with high plasma vitamin B12 (highest decile, > 224 pM).

Results

Children from group 1 performed more slowly than those from group 2 on the Color Trail A test (sustained attention, 182 vs. 159 seconds; p < .05) and the Digit Span Backward test (short-term memory, p <.05), after appropriate adjustment for confounders. There were no differences between group 1 and group 2 on other tests of cognitive function (intelligence, visual agnosia).

Conclusions

Maternal vitamin B12 status in pregnancy influences cognitive function in offspring.
Indicators for Assessing Folate and Vitamin B12 Status and for Monitoring the Efficacy of Intervention Strategies
Authors: Green Ralph
Published: November 2015

Deficiencies of folate or of vitamin B12 are widespread and constitute a major global burden of morbidity affecting all age groups. Detecting or confirming the presence of folate or vitamin B12 deficiency and distinguishing one from the other depends, ultimately, on laboratory testing. Tests to determine the presence of folate or vitamin B12 deficiency are used singly or in combination to establish the nutritional status and prevalence of deficiencies of the vitamins in various populations. The efficacy of interventions through the use of fortification or supplements is monitored using the same laboratory tests. Tests currently in use have limitations that can be either technical or have a biological basis. Consequently, each single test cannot attain perfect sensitivity, specificity, or predictive value. Laboratory indicators of vitamin B12 or folate status involve measurement of either the total or a physiologically relevant fraction of the vitamin in a compartment such as the blood. Thus, assays to measure vitamin B12 or folate in plasma or serum as well as folate in red blood cells are in widespread use, and more recently, methods to measure vitamin B12 associated with the plasma binding protein transcobalamin (holotranscobalamin) have been developed. Alternatively, levels of surrogate biochemical markers that reflect the metabolic function of the vitamin can be used. Surrogates most commonly used are plasma homocysteine, for detection of either vitamin B12 or folate deficiency and methylmalonic acid for detection of vitamin B12 deficiency. The general methods as well as their uses, indications, and limitations are presented.
Efficacy and Safety of Fortification and Supplementation with Vitamin B12: Biochemical and Physiological Effects
Authors: Carmel Ralph
Published: November 2015

Long known as an uncommon but serious medical disorder requiring medical management, vitamin B12 deficiency is now seen to be common worldwide, but it is in a quite different form than traditionally envisioned. Most of the newly recognized deficiency is subclinical in nature, its health impact and natural history are uncertain, and its prevalence has been greatly inflated by also including persons with “low-normal” vitamin B12 levels, few of whom are deficient. The spread of folic acid fortification has also introduced concerns about folate's potentially adverse neurologic consequences in persons with undetected vitamin B12 deficiency. Fortification with vitamin B12 may prove more complicated than fortification with folic acid, however, because the bioavailability of vitamin B12 is limited. Bioavailability for those who need the vitamin B12 the most is especially poor, because they often have malabsorption affecting either classical intrinsic factor-mediated absorption or food-vitamin B12 absorption. Moreover, new evidence shows that many elderly persons respond poorly to daily oral doses under 500 μg (1 μg = 0.74 nmol), even if they do not have classical malabsorption, which suggests that proposed fortification with 1 to 10 μg may be ineffective. Those least in need of vitamin B12 usually have normal absorption and are thus at greatest risk for whatever unknown adverse effects of high-dose fortification might emerge, such as the effects of excess accumulation of cyanocobalamin. Studies are needed to define the still unproven health benefits of vitamin B12 fortification, the optimal levels of fortification, the stability of such fortification, interactions with other nutrients, and any possible adverse effects on healthy persons. The answers will permit formulation of appropriately informed decisions about mandatory fortification or (because fortification may prove a poor choice) about targeted supplementation in subpopulations with special needs for additional vitamin B12, such as vegetarians, nursing mothers, and the elderly.
Establishing Safe and Potentially Efficacious Fortification Contents for Folic Acid and Vitamin B12
Authors: Dary Omar
Published: November 2015

Determining the micronutrient contents in fortified foods depends not only on the health goal (additional intake to complement the diet), but also on ensuring that fortification does not raise micronutrient intakes beyond the Tolerable Upper Intake Level (UL), i.e., the safe limit. Technological incompatibility and cost may also restrict the fortification contents. For folic acid, the limiting factor is safety, while for vitamin B12, it is cost. However, adequate fortification contents that are both safe and efficacious can be estimated for both nutrients. In order to obtain the maximum benefit from the fortification programs, three different formulas responding to three categories of consumption, as specified by the median and 95th percentile of consumption, are proposed.

The model presented is based on the estimation of a Feasible Fortification Level (FFL), which then is used to determine the average, minimum, and maximum contents of the nutrients during production, taking into consideration the acceptable variation of the fortification process. Finally, the regulatory parameters, which support standards and enforcement, are calculated by reducing the proportion of the nutrient that is degraded during the usual marketing process of the fortified food. It is expected that this model will establish a common standard for food fortification, and improve the reliability and enforcement procedures of these programs.

The model was applied to flours as vehicles for folic acid in the United States, Guatemala, and Chile. Analysis of the data revealed that, with the exception of Chile, where wheat flour consumption is very high and probably within a narrow range, supplementation with folic acid is still needed to cover individuals at the low end of consumption. This is especially true when the difference in flour consumption is too wide, as in the case of Guatemala, where the proportional difference between consumption at the 95th percentile of the nonpoor group is as high as 100 times the consumption at the 5th percentile of the extremely poor group. Adoption of fortification content for staple foods near the safe limit brings together the need of restricting the voluntary addition of the specific nutrient to other foods and to dietary supplements.
Antioxidant System for the Preservation of Vitamin A in Ultra Rice
Authors: Li Yao Olive , Lam Jane , Diosady Levente L. , Jankowski Shirley
Published: November 2015

Background

Ultra Rice grains are micronutrient-fortified, extruded rice grains designed to address specific nutritional deficiencies in populations where rice is a staple food. Vitamin A and some of the B vitamins, as well as iron and zinc, are target nutrients for fortification through Ultra Rice technology. Vitamin A is sensitive to degradation. Therefore, the original Ultra Rice formulations included stabilizers, some of which were not approved as food additives in all of the receiving markets.

Objective

To develop a new antioxidant system for improving vitamin A storage stability in Ultra Rice grains, while complying with international food regulations.

Methods

Ten formulations were prepared containing various combinations of hydrophilic and hydrophobic antioxidants, as well as moisture stabilizers. Accelerated vitamin A storage stability tests were conducted at 25°, 35°, and 45°C with 70% to 100% relative humidity.

Results

The most stable samples contained one or more phenolic antioxidants, a water-soluble antioxidant, and stabilizing agents. The best results were obtained by using butylated hydroxyanisole (BHA) in combination with butylated hydroxytoluene (BHT) as the hydrophobic antioxidants and ascorbic acid as the hydrophilic anti-oxidant. Citric acid and sodium tripolyphosphate (STPP) were used to chelate metal ions and to stabilize moisture, respectively. The best formulations retained more than 85% and approximately 70% of the added vitamin A at 25° and 45°C, respectively, after 24 weeks storage.

Conclusions

The best antioxidant system, composed of generally accepted food additives, improved vitamin A stability while reducing the price, thus greatly improving the commercial viability of Ultra Rice grains for use as a rice fortificant.
Impact of a Positive Deviance Approach to Improve the Effectiveness of an Iron-Supplementation Program to Control Nutritional Anemia among Rural Senegalese Pregnant Women
Authors: Ndiaye Mamadou , Siekmans Kendra , Haddad Slim , Receveur Olivier
Published: November 2015

Background

Iron supplementation through prenatal care remains the most widespread strategy to control anemia during pregnancy, but its effectiveness is only partial, showing the need to address other approaches.

Objective

This study was conducted to measure the impact of a positive deviance approach to improve an iron-supplementation program among pregnant women in a rural Senegalese area.

Methods

A positive deviance approach (PD Micah) was compared with an ongoing integrated nutrition and health program intervention (Micah) in a rural Senegalese area. A pre-post evaluation was conducted using independent cross-sectional samples with a total of 371 pregnant women. A sociodemographic questionnaire was administered, and biologic and anthropometric measurements were performed.

Results

After 9 months of activities, the mean hemoglobin level rose from 93.9 to 100.7 g/L in the PD Micah group. Distribution of iron supplements through community volunteers and implementation of healthy pregnancy promotion sessions on a monthly basis improved the accessibility to 23.3% in the PD Micah group. No significant change was observed in the Micah group. Logistic regression analysis showed a significantly reduced risk of anemia in the PD Micah area (adjusted odds ratio, 0.25; 95% confidence interval, 0.12 to 0.53).

Conclusions

This intervention shows that a community-based strategy, such as the positive deviance approach, can contribute to improving the effectiveness of iron supplementation during pregnancy.
Use of the new World Health Organization Child Growth Standards to Describe Longitudinal Growth of Breastfed Rural Bangladeshi Infants and Young Children
Authors: Saha Kuntal K. , Frongillo Edward A. , Alam Dewan S. , Arifeen Shams E. , Persson Lars Å. , Rasmussen Kathleen M.
Published: November 2015

Background

Although the National Center for Health Statistics (NCHS) reference has been widely used, in 2006 the World Health Organization (WHO) released new standards for assessing growth of infants and children worldwide.

Objective

To assess and compare the growth of breastfed rural Bangladeshi infants and young children based on the new WHO child growth standards and the NCHS reference.

Methods

We followed 1,343 children in the Maternal and Infant Nutrition Intervention in Matlab (MINIMat) study from birth to 24 months of age. Weights and lengths of the children were measured monthly during infancy and quarterly in the second year of life. Anthropometric indices were calculated using both WHO standards and the NCHS reference. The growth pattern and estimates of undernutrition based on the WHO standards and the NCHS reference were compared.

Results

The mean birthweight was 2,697 ± 401 g, with 30% weighing < 2,500 g. The growth pattern of the MINIMat children more closely tracked the WHO standards than it did the NCHS reference. The rates of stunting based on the WHO standards were higher than the rates based on the NCHS reference throughout the first 24 months. The rates of underweight and wasting based on the WHO standards were significantly different from those based on the NCHS reference.

Conclusions

This comparison confirms that use of the NCHS reference misidentifies undernutrition and the timing of growth faltering in infants and young children, which was a key rationale for constructing the new WHO standards. The new WHO child growth standards provide a benchmark for assessing the growth of breastfed infants and children.