bluuebunny/crossref_metadata_2025 huggingface dataset:
Increases in Breastfeeding Duration Observed in Latin America and the Caribbean and The Role of Maternal Demographic and Healthcare Characteristics
Authors: Chaparro Camila M. , Lutter Chessa K.
Published: November 2015

To understand the factors contributing to changes in breastfeeding duration, we analyzed data from seven countries in Latin America and from Haiti to document changes in breastfeeding duration between 1986 and 2005. We used a novel method that permits the overall change to be separated into the portion attributable to changing population characteristics (e.g., greater urban population or increased maternal employment) and the portion resulting from changing breastfeeding behaviors within population subgroups (e.g., more breastfeeding among urban women). Our results indicate that in the low-to-middle-income countries studied, which are experiencing socioeconomic and demographic changes, improvements in breastfeeding duration occurred. These improvements are explained almost entirely by changing breastfeeding behaviors, which were particularly evident in certain subgroups of women, such as those with higher levels of education, and very little by changing population characteristics. The socioeconomic and demographic changes we studied that were previously associated with less breastfeeding no longer appear to have a large negative effect. Our findings show that individual behaviors are amenable to change and that changes in individual behaviors collectively contribute to positive national trends in breastfeeding.
Addressing Tuberculosis in the Context of Malnutrition and HIV Coinfection
Authors: Semba Richard D. , Darnton-Hill Ian , de Pee Saskia
Published: November 2015

Background

Tuberculosis is the second leading cause of infectious disease mortality (1.8 million/year), after HIV/AIDS. There are more than 9 million new cases each year. One-third of the world's population, and 50% of adults in sub-Saharan Africa, South Asia, and South-East Asia, are infected, representing an enormous pool of individuals at risk for developing the disease. The situation is complicated by the HIV/AIDS pandemic, widespread undernutrition, smoking, diabetes, increased mobility, and emergence of multi- and extensively drug-resistant tuberculosis.

Objective

To review the scientific evidence about the interactions among tuberculosis, nutrition, and HIV coinfection.

Results

HIV infection and malnutrition lower immunity, increasing the risk of reactivation tuberculosis and primary progressive disease. Having either tuberculosis or HIV infection causes weight loss. Malnutrition markedly increases mortality among both tuberculosis and HIV/AIDS patients and should be treated concurrently with treatment of the infections. Tuberculosis treatment is a prerequisite for nutritional recovery, in addition to intake of nutrients required for rebuilding tissues, which is constrained in food-insecure households. Additional pharmaceutical treatment to reduce the catabolic impact of inflammation or promote growth may be needed. Specific nutrients can contribute to faster sputum smear clearance, which is important for reducing transmission, as well as faster weight gain when combined with an adequate diet. Adequate nutrition and weight gain in undernourished populations might reduce the incidence of tuberculosis.

Conclusions

The many risk factors for the development of tuberculosis need to be addressed simultaneously, especially HIV/AIDS and food insecurity and undernutrition. For stronger evidence-based guidelines, existing recommendations and clinical applications need to be more widely applied and evaluated.
Diarrhea and Novel Dietary Factors Emerge as Predictors of Serum Vitamin B12 in Panamanian Children
Authors: Scatliff Candice E. , Koski Kristine G. , Scott Marilyn E.
Published: November 2015

Background

The role of gastrointestinal infection as a factor determining vitamin B12 status in populations with low intake of animal-source foods is unclear.

Objective

To determine dietary adequacy and serum concentrations of vitamin B12 in an extremely impoverished indigenous population of Panamanian children aged 12 to 60 months, and to identify predictors of both dietary and serum vitamin B12.

Methods

A previous community-based survey provided the usual dietary intake and personal, household, and infection (Ascaris and diarrheal disease) information for 209 weaned children. Serum vitamin B12 was assayed using electrochemiluminescence for 65 of these children. Children with adequate or inadequate dietary vitamin B12 intake were compared, and predictors of dietary and serum vitamin B12 were identified using step-wise regression analyses of one index child per household.

Results

Dietary vitamin B12 intake was inadequate in 43% of children; these children were poorer, had less frequent diarrhea, and obtained a higher percentage of their energy from carbohydrate than children with adequate intake. Energy intake positively predicted dietary vitamin B12 intake. In contrast, serum vitamin B12 concentrations were normal in all but 3% of the children. Serum vitamin B12 was positively associated with weekly servings of fruit, corn-based food, and ñame (a traditional starchy food), but not with animal-source foods. Finally, serum vitamin B12 was not associated with Ascaris intensity but was lowered with increasing frequency of diarrhea.

Conclusions

Although inadequate dietary intake of vitamin B12 was common, most serum values were normal. Nevertheless, diarrheal disease emerged as a negative predictor of serum vitamin B12 concentration.
Negative Impact on Calorie Intake Associated with the 2006–08 Food Price Crisis in Latin America
Authors: Iannotti Lora , Robles Miguel
Published: November 2015

Background

From 2006 to 2008, there were sharp increases in the prices of major food commodities globally, including maize, rice, and wheat. Few studies have contributed empirical evidence of the nutritional impacts of this food price crisis.

Objective

To assess changes in energy intake in response to food price shocks and in relation to calorie adequacy levels in seven Latin American countries.

Methods

Data were drawn from nationally representative household budget surveys. The quadratic almost ideal demand system (QUAIDS) model characterized change patterns in consumption for six food groups and one nonfood group under two scenarios: actual change in food prices by country, and standardized 10% increase in prices across all countries. Energy intakes before and after the crisis were determined once calories were assigned to food items from the ProPAN and US Department of Agriculture food composition databases.

Results

Energy intakes were reduced by 8.0% (range, 0.95% to 15.1%) from precrisis levels across all countries. Ecuador and Panama were the worst affected, followed by Haiti and Nicaragua. There was a consistent, direct relationship between wealth quintile and change in energy intake. Rural areas were affected to the same extent as or a greater extent than urban areas. High positive increases in calorie consumption were found in the richest wealth quintile, exceeding 10% of previous levels in five countries.

Conclusions

Policies and programs targeting the poorest households in both rural and urban areas may be needed to offset the energy deficits associated with food price increases. More research is needed on the effect of food prices and micronutrient nutrition.
Vitamin E Deficiency in Developing Countries
Authors: Dror Daphna K. , Allen Lindsay H.
Published: November 2015

In addition to its role as a potent antioxidant, vitamin E is involved in a wide range of physiological processes, ranging from immune function and control of inflammation to regulation of gene expression and cognitive performance. Results from multiple studies suggest that poor nutritional status and higher prevalence of other oxidative stressors such as malaria and HIV infection predispose populations in developing countries for vitamin E deficiency. Although direct comparison between study outcomes is complicated by varied definitions of vitamin E deficiency, data trends indicate that children and the elderly are more vulnerable age groups and that men may be at higher risk for deficiency than women. Public health initiatives aimed at improving the vitamin E status of high-risk populations in developing countries would be prudent to counteract oxidative stress, improve immune function, and protect against neurologic and cognitive deficits. Additional research is needed to estabish dose—response relationships of various interventions and to develop cost-effective, culturally-appropriate, and targeted programs.
Why Does Nutrition Deteriorate Rapidly among Children under 2 Years of Age? Using Qualitative Methods to Understand Community Perspectives on Complementary Feeding Practices in Bangladesh
Authors: Rasheed Sabrina , Haider Rukhsana , Hassan Nazmul , Pachón Helena , Islam Sanjeeda , Jalal Chowdhury S. B. , Sanghvi Tina G.
Published: November 2015

Background

Child undernutrition remains high in South Asian and sub-Saharan African countries. Rapid declines in nutritional status occur before the age of 2 years, particularly during the period of complementary feeding. Improving complementary feeding practices is a neglected area in nutrition programs.

Objective

To understand community perspectives on complementary feeding practices in order to inform the design of future interventions for improved complementary feeding.

Methods

From May through August 2009, data were collected in two rural locations and one urban location in Bangladesh through semistructured interviews, food attributes exercises, 24-hour dietary recalls, opportunistic observations, and trials of improved practices (TIPs). Key informant interviews and focus group discussions were also carried out among family members and community opinion leaders.

Results

Lay perceptions about complementary feeding differ substantially from international complementary feeding recommendations. A large proportion of children do not consume sufficient amounts of complementary foods to meet their energy and micronutrient needs. There was a gap in knowledge about appropriate complementary foods in terms of quality and quantity and strategies to convert family foods to make them suitable for children. Complementary feeding advice from family members, peers, and health workers, the importance given to feeding young children, and time spent by caregivers in feeding influenced the timing, frequency, types of food given, and ways in which complementary feeding occurred.

Conclusions

Perceptions and practices related to complementary feeding need to be effectively addressed to improve the levels of child undernutrition. Lack of understanding of children's nutritional needs and insufficient time for feeding children are key barriers to complementary feeding.
Relationship of the Availability of Micronutrient Powder with Iron Status and Hemoglobin among Women and Children in the Kakuma Refugee Camp, Kenya
Authors: Ndemwa Philip , Klotz Christine L. , Mwaniki David , Sun Kai , Muniu Erastus , Andango Pauline , Owigar Joyce , Rah Jee Hyun , Kraemer Klaus , Spiegel Paul B. , Bloem Martin W. , de Pee Saskia , Semba Richard D.
Published: November 2015

Background

Micronutrient powder is a potential strategy to improve iron status and reduce anemia in refugee populations.

Objective

To evaluate the effect of the availability of home fortification with a micronutrient powder containing 2.5 mg of sodium iron ethylenediaminetetraacetate (NaFeEDTA) on iron status and hemoglobin in women and children in the Kakuma Refugee Camp in northwest Kenya.

Methods

Hemoglobin and soluble transferrin receptor were measured in 410 children 6 to 59 months of age and 458 women of childbearing age at baseline (just before micronutrient powder was distributed, along with the regular food ration) and at midline (6 months) and endline (13 months) follow-up visits.

Results

At the baseline, midline, and endline visits, respectively, the mean (± SE) hemoglobin concentration in women was 121.4 ± 0.8, 120.8 ± 0.9, and 120.6 ± 1.0 g/L ( p = .42); the prevalence of anemia (hemoglobin < 120 g/L) was 42.6%, 41.3%, and 41.7% ( p = .92); and the mean soluble transferrin receptor concentration was 24.1 ± 0.5, 20.7 ± 0.7, and 20.8 ± 0.7 nmol/L ( p = .0006). In children, the mean hemoglobin concentration was 105.7 ± 0.6, 109.0 ± 1.5, and 105.5 ± 0.3 g/L ( p = .95), respectively; the prevalence of anemia (hemoglobin < 110 g/L) was 55.5%, 52.3%, and 59.8% ( p = .26); and the mean soluble transferrin receptor concentration was 36.1 ± 0.7, 29.5 ± 1.9, and 28.4 ± 3.2 nmol/L ( p = .02), in models that were adjusted for age using least squares means regression.

Conclusions

In children and in women of childbearing age, the availability of micronutrient powder was associated with a small improvement in iron status but no significant change in hemoglobin in this refugee camp setting.
Consumption of Micronutrient-Fortified Milk and Noodles is Associated with Lower Risk of Stunting in Preschool-Aged Children in Indonesia
Authors: Semba Richard D. , Moench-Pfanner Regina , Sun Kai , de Pee Saskia , Akhter Nasima , Rah Jee Hyun , Campbell Ashley A. , Badham Jane , Bloem Martin W. , Kraemer Klaus
Published: November 2015

Background

Stunting is highly prevalent in developing countries and is associated with greater morbidity and mortality. Micronutrient deficiencies contribute to stunting, and micronutrient-fortified foods are a potential strategy to reduce child stunting.

Objective

To examine the relationship between the use of fortified powdered milk and noodles and child stunting in a large, population-based sample of Indonesian children.

Methods

Consumption of fortified milk and fortified noodles was assessed in children 6 to 59 months of age from 222,250 families living in rural areas and 79,940 families living in urban slum areas in Indonesia.

Results

The proportions of children who consumed fortified milk and fortified noodles were 34.0% and 22.0%, respectively, in rural families, and 42.4% and 48.5%, respectively, in urban families. The prevalence of stunting among children from rural and urban families was 51.8% and 48.8%, respectively. Children from rural and urban families were less likely to be stunted if they consumed fortified milk (in rural areas, OR = 0.87; 95% CI, 0.85 to 0.90; p < .0001; in urban areas, OR = 0.80; 95% CI, 0.76 to 0.85; p < .0001) or fortified noodles (in rural areas, OR = 0.95; 95% CI, 0.91 to 0.99; p = .02; in urban areas, OR = 0.95; 95% CI, 0.91 to 1.01; p = .08) in multiple logistic regression models adjusted for potential confounders. In both rural and urban families, the odds of stunting were lower when a child who consumed fortified milk also consumed fortified noodles, or when a child who consumed fortified noodles also consumed fortified milk.

Conclusions

The consumption of fortified milk and noodles is associated with decreased odds of stunting among Indonesian children. These findings add to a growing body of evidence regarding the potential benefits of multiple micronutrient fortification on child growth.
Policy Interventions to Promote Healthy Eating: A Review of What Works, What Does Not, and What is Promising
Authors: Brambila-Macias Jose , Shankar Bhavani , Capacci Sara , Mazzocchi Mario , Perez-Cueto Federico J. A. , Verbeke Wim , Traill W. Bruce
Published: November 2015

Unhealthy diets can lead to various diseases, which in turn can translate into a bigger burden for the state in the form of health services and lost production. Obesity alone has enormous costs and claims thousands of lives every year. Although diet quality in the European Union has improved across countries, it still falls well short of conformity with the World Health Organization dietary guidelines. In this review, we classify types of policy interventions addressing healthy eating and identify through a literature review what specific policy interventions are better suited to improve diets. Policy interventions are classified into two broad categories: information measures and measures targeting the market environment. Using this classification, we summarize a number of previous systematic reviews, academic papers, and institutional reports and draw some conclusions about their effectiveness. Of the information measures, policy interventions aimed at reducing or banning unhealthy food advertisements generally have had a weak positive effect on improving diets, while public information campaigns have been successful in raising awareness of unhealthy eating but have failed to translate the message into action. Nutritional labeling allows for informed choice. However, informed choice is not necessarily healthier; knowing or being able to read and interpret nutritional labeling on food purchased does not necessarily result in consumption of healthier foods. Interventions targeting the market environment, such as fiscal measures and nutrient, food, and diet standards, are rarer and generally more effective, though more intrusive. Overall, we conclude that measures to support informed choice have a mixed and limited record of success. On the other hand, measures to target the market environment are more intrusive but may be more effective.
REACH: An Effective Catalyst for Scaling up Priority Nutrition Interventions at the Country Level
Authors: Pearson Brenda L. , Ljungqvist Björn
Published: November 2015

Background

Renewed Efforts Against Child Hunger (REACH) is the joint United Nations initiative to address Millennium Development Goal (MDG) 10, Target 3, i.e., to halve the proportion of underweight children under 5 years old by 2015. The United Nations Food and Agriculture Organization (FAO), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the World Food Programme (WFP), and the International Fund for Agricultural Development (IFAD) developed and tested a facilitation mechanism to act as a catalyst for scaling up multisectoral nutrition activities.

Objective

The UN-REACH partners developed pilot projects in Mauritania and Lao PDR from 2008 to 2010 and deployed facilitators to improve nutrition governance and coordination. Review missions were conducted in February 2011 to assess the REACH approach and what it achieved.

Methods

The UN review mission members reviewed documents, assessed policy and management indicators, conducted qualitative interviews, and discussed findings with key stakeholders, including the most senior UN nutrition directors from all agencies.

Results

Among other UN-REACH achievements, the Prime Minister of Mauritania agreed to preside over a new National Nutrition Development Council responsible for high-level decision-making and setting national policy objectives. REACH facilitated the completion of Lao's first national Nutrition Strategy and Plan of Action and formation of the multistakeholder Nutrition Task Force. During the REACH engagement, coordination, joint advocacy, situation analysis, policy development, and joint UN programming for nutrition were strengthened in Lao PDR and Mauritania.

Conclusions

Improvements in the nutrition governance and management mechanisms in Mauritania and Lao PDR were observed during the period of REACH support through increased awareness of nutrition as a key development objective, establishment of governmental multisectoral coordinating mechanisms, improved government capacity, and new joint UN–government nutrition programming.
Development, Acceptability, and Nutritional Characteristics of a Low-Cost, Shelf-Stable Supplementary Food Product for Vulnerable Groups in Kenya
Authors: Kunyanga Catherine , Imungi Jasper , Okoth Michael , Vadivel Vellingiri , Biesalski Hans Konrad
Published: November 2015

Background

Food-based approaches have been advocated as the best strategies to curb hunger and malnutrition in developing countries. The use of low-cost, locally available, nutritious foods in the development of supplementary foods has been recommended.

Objective

To develop low-cost food supplements using different traditionally processed local foods, consisting of cereals, legumes, nuts, fish, and vegetables, to meet the nutrient requirements for vulnerable groups in Kenya.

Methods

Four food supplements were developed and evaluated by taste panel procedures. The product containing amaranth grain, pigeon pea, sweet potato, groundnuts, and brown sugar was found to be the most acceptable supplement. Evaluation of nutritional composition, shelf-life, and cost analysis of the acceptable supplement was carried out to assess if it could satisfactorily provide more than 50% of the Recommended Dietary Allowances (RDAs) of the basic nutrients for vulnerable groups.

Results

The acceptable supplement contained 453.2 kcal energy, 12.7 g crude protein, 54.3 g soluble carbohydrates, 20.8 g crude fat, and 10.1 g crude fiber per 110 g. The micronutrient contents were 93.0 mg calcium, 172.4 mg magnesium, 2.7 mg zinc, 5.7 mg iron, 0.8 mg vitamin B1, 0.2 mg vitamin B2, 7.9 mg niacin, 100 μg folic acid, and 140 μg retinol equivalent per 110 g. The supplement also contained 21% total essential amino acid in addition to appreciable levels of palmitic, stearic, oleic, linoleic, and α-linolenic fatty acids. The shelf-life study showed that it could be stored in different packaging materials (polythene bags, gunny bags, and kraft paper) at 26°C without deleterious effects on its chemical composition for up to 4 months. Cost analysis of the supplement indicated that the product could be competitively sold at US$0.812/kg (KES 65.50/kg).

Conclusions

Locally available indigenous foods can be used in the formulation of acceptable, low-cost, shelf-stable, nutritious supplementary foods for vulnerable groups.
The Adult Male Equivalent Concept and its Application to Household Consumption and Expenditures Surveys (HCES)
Authors: Weisell Robert , Dop Marie Claude
Published: November 2015

Background

Knowledge of the amount and quality of food consumed by a population is essential in determining the adequacy of the food availability and supply. Since its founding, the Food and Agriculture Organization (FAO) has developed methods for determining food availability and consumption that may be useful to other investigators.

Objective

Based on FAO's 60 years of experience in conducting Household Consumption and Expenditures Surveys (HCES), to explain and demonstrate the advantages and use of the Adult Male Equivalent (AME) and Equivalent Nutrition Unit (ENU) concepts.

Methods

The important factors related to the AME and ENU, such as energy requirements, size and composition of the food consumer unit, and attendance at meals, are explained through the examples of two hypothetical families: a family consisting of a father, a mother, a 12-year old daughter, and a 3-year old son plus an adult guest; and a family consisting of a single mother, a 10-year old son, and two daughters, 6 and 4 years of age. The reader is guided through the steps in calculating the AME and ENU.

Results

The various scenarios of the composition, size, and attendance at meals of the consumer unit show that the calculated food energy adequacy can range from +2% to −29%.

Conclusions

Care and attention must be given to correctly attributing the consumers of the food intake measured or estimated. In addition, use of these concepts allows for a valid comparison of food consumption units of various sizes and compositions.
Less than Adequate Vitamin D Status and Intake in Latin America and the Caribbean: A Problem of Unknown Magnitude
Authors: Brito Alex , Cori Héctor , Olivares Manuel , Mujica María Fernanda , Cediel Gustavo , de Romaña Daniel López
Published: November 2015

Background

The prevalence of vitamin D deficiency in Latin America and the Caribbean is unknown.

Objective

To examine the prevalence data available on vitamin D deficiency in Latin America and the Caribbean.

Methods

A systematic review was conducted in 2011. Studies using biochemical biomarkers and dietary intake estimation were included. Studies conducted in apparently healthy individuals, independently of age, latitude, skin pigmentation, and season of the year at the time of blood collection, were included.

Results

A total of 243 studies were identified. The final number of selected studies was 28, including two National Health Surveys (Mexico and Argentina). There are studies that report the vitamin D status of specific subgroups conducted in Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, and Mexico. However, the small sample sizes in these studies and thus the low national representativeness of the reported data do not allow for an accurate assessment of vitamin D status at the regional level. In the majority of the countries with available data, we observed that vitamin D insufficiency was classified as a mild, moderate, or severe public health problem. The only country with a nationally representative sample was Mexico, which found 24%, 10%, 8%, and 10% prevalence rates of vitamin D insufficiency (25-hydroxyvitamin D < 50 nmol/L) in preschoolers, schoolchildren, adolescents, and adults, respectively. The prevalence of vitamin D deficiency (25-hydroxyvitamin D < 20 nmol/L) was less than 1% for all groups.

Conclusions

There is some indication that vitamin D insufficiency may be a public health problem in Latin America and the Caribbean, but the exact magnitude is currently unknown.
The Importance of Using Food and Nutrient Intake Data to Identify Appropriate Vehicles and Estimate Potential Benefits of Food Fortification in Uganda
Authors: Kyamuhangire William , Lubowa Abdelrahman , Kaaya Archileo , Kikafunda Joyce , Harvey Philip W. J. , Rambeloson Zo , Dary Omar , Dror Daphna K. , Allen Lindsay H.
Published: November 2015

Background

Concern over micronutrient inadequacies in Uganda has prompted the introduction of mass fortification.

Objective

To use food intake to determine nutrient inadequacies in children aged 24 to 59 months and nonpregnant women of reproductive age, and to model the adequacy of mass fortification.

Methods

Data were collected by the 24-hour recall method in three regions. Usual nutrient intakes were calculated by adjusting actual intake distribution for the intraindividual variance. The impact of fortification on intake adequacy was simulated.

Results

The nutrients with the highest prevalence of inadequate intake across regions were vitamin A (30% to 99%), vitamin B12 (32% to 100%), iron (55% to 89%), zinc (18% to 82%), and calcium (84% to 100%). According to simulations, fortification of vegetable oil and sugar with vitamin A would reduce the prevalence of vitamin A inadequacy in the Western and Northern regions; in Kampala it would eliminate vitamin A inadequacy but would cause 2% to 48% of children to exceed the Tolerable Upper Intake Level (UL). The proposed fortification of wheat flour would reduce the prevalence of inadequate intakes of thiamine, riboflavin, folate, and niacin in Kampala, but would have little impact in the other two regions due to low flour consumption.

Conclusions

Micronutrient fortification of vegetable oil and sugar in all regions and of wheat flour in Kampala would reduce the prevalence of micronutrient inadequacies. However, the wheat flour formulation should be modified to better meet requirements, and the vitamin A content in sugar should be reduced to minimize the risk of high intakes. Maize flour may be suitable for targeted fortification, but prior consolidation of the industry would be required for maize flour to become a good vehicle for mass fortification.
Low Vitamin B12 Intake during Pregnancy and Lactation and Low Breastmilk Vitamin B12 Content in Rural Kenyan Women Consuming Predominantly Maize Diets
Authors: Neumann Charlotte G. , Oace Susan M. , Chaparro M. Pia , Herman Dena , Drorbaugh Natalie , Bwibo Nimrod O.
Published: November 2015

Background

Vitamin B12 deficiency during pregnancy and lactation may negatively affect fetal growth, brain development, pregnancy outcome, and breastmilk vitamin B12 content.

Objective

To examine associations between pregnant and lactating women's vitamin B12 intake and pregnancy outcomes, breastmilk vitamin B12 concentration, and growth and development of breastfed infants from birth to 6 months.

Methods

One hundred thirty-eight Kenyan women were followed during pregnancy, with 98 followed through 6 months of lactation and providing 294 randomly collected breastmilk samples. Maternal hematologic analyses were performed for erythrocyte morphology, erythrocyte size, and serum vitamin B12 concentration. Women's and infants' food intake was assessed. Breastmilk vitamin B12 was measured by a competitive binding isotope dilution technique. Infant anthropometric data and the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) were assessed within 3 days after birth. The Infant Bayley Motor Scale was assessed at 6 months. Statistical analyses included simple regression and correlation analyses in relation to vitamin B12 status and gestational age.

Results

Intrauterine growth restriction and stillbirths were correlated with maternal macrocytic anemia and hypersegmented polymorphonuclear nuclei. Postpartum maternal vitamin B12 intake influenced breastmilk vitamin B12 levels 1 to 6 months postpartum. No associations were found between vitamin B12 intake during pregnancy or vitamin B12 levels in breastmilk and infant length, weight, or head circumference at birth or 6 months. Vitamin B12 intake during pregnancy was correlated with improved scores on infants' BNBAS reflex subscale ( R = −0.19, p = .05) with adjustment for gestational age. Bayley Motor Scale results at 6 months were not significantly associated with breastmilk or supplemental feeding vitamin B12 content.

Conclusions

Vitamin B12 deficiency may adversely affect pregnancy outcome, infant reflexes at birth, and breastmilk vitamin B12 content.
Assessing Zambia's Industrial Fortification Options: Getting beyond Changes in Prevalence and Cost-Effectiveness
Authors: Fiedler John L. , Lividini Keith , Kabaghe Gladys , Zulu Rodah , Tehinse John , Bermudez Odilia I. , Jallier Vincent , Guyondet Christophe
Published: November 2015

Background

Since fortification of sugar with vitamin A was mandated in 1998, Zambia's fortification program has not changed, while the country remains plagued by high rates of micronutrient deficiencies.

Objective

To provide evidence-based fortification options with the hope of reinvigorating the Zambian fortification program.

Methods

Zambia's 2006 Living Conditions Monitoring Survey is used to estimate the apparent intakes of vitamin A, iron, and zinc, as well as the apparent consumption levels and coverage of four fortification vehicles. Fourteen alternative food fortification portfolios are modeled, and their costs, impacts, average cost-effectiveness, and incremental cost-effectiveness are calculated using three alternative impact measures.

Results

Alternative impact measures result in different rank orderings of the portfolios. The most cost-effective portfolio is vegetable oil, which has a cost per disability-adjusted life-year (DALY) saved ranging from 12% to 25% of that of sugar, depending on the impact measure used. The public health impact of fortified vegetable oil, however, is relatively modest. Additional criteria beyond cost-effectiveness are introduced and used to rank order the portfolios. The size of the public health impact, the total cost, and the incremental cost-effectiveness of phasing in multiple vehicle portfolios over time are analyzed.

Conclusions

Assessing fortification portfolios by measuring changes in the prevalence of inadequate intakes underestimates impact. A more sensitive measure, which also takes into account change in the Estimated Average Requirement (EAR) gap, is provided by a dose—response-based approach to estimating the number of DALYs saved. There exist highly cost-effective fortification intervention portfolios with substantial public health impacts and variable price tags that could help improve Zambians' nutrition status.
The Growing Importance of Staple Foods and Condiments Used as Ingredients in the Food Industry and Implications for Large-Scale Food Fortification Programs in Southeast Asia
Authors: Spohrer Rebecca , Larson Melanie , Maurin Clémence , Laillou Arnaud , Capanzana Mario , Garrett Greg S.
Published: November 2015

Background

Food fortification is a viable strategy to improve the nutritional status of populations. In South-east Asia, recent growth and consolidation of the food industry provides an opportunity to explore whether certain widely consumed processed foods could contribute to micronutrient status if they are made with adequately fortified staples and condiments.

Objective

To estimate the potential contribution certain processed foods can make to micronutrient intake in Southeast Asia if they are made with fortified staples and condiments; e.g., via the inclusion of iodized salt in various processed foods in the Philippines, fortified wheat flour in instant noodles in Indonesia, and fortified vegetable oil in biscuits in Vietnam.

Methods

For Indonesia, the Philippines, and Vietnam, a review of consumption trends, relevant policies, and industry practices was conducted using publicly available sources, food industry market data and research reports, and oral communication. These informed the estimates of the proportion of the Recommended Nutrient Intake (RNI) that could be delivered via select processed foods.

Results

In the Philippines, Indonesia, and Vietnam, the processed food industry is not always required to use fortified staples and condiments. In the Philippines, dried salted fish with iodized salt would provide 64% to 85% of the iodine RNI for women of reproductive age and 107% to 141% of the iodine RNI for children 1 to 6 years of age. In Indonesia, a 75-g pack of instant noodles (a highly consumed product) with fortified wheat flour would provide 45% to 51% of the iron RNI for children 4 to 6 years of age and 10% to 11% of the iron RNI for women of reproductive age. In Vietnam, biscuits containing vegetable oil are increasingly popular. One 35-g biscuit serving with fortified vegetable oil would provide 13% to 18% of the vitamin A RNI for children 4 to 6 years of age and 12% to 17% of the vitamin A RNI for women of reproductive age.

Conclusions

Ensuring that fortified staples and condiments such as flour, salt, and vegetable oil are used in widely consumed processed foods would ensure that these foods contribute to improvement in micronutrient intake among populations in Southeast Asia, particularly as the consumption of these foods is increasing. Policymakers and nutrition program managers should consider the contribution to nutritional intake that fortified staples and condiments can provide through processed foods, in addition to being used for cooking in the home, and ensure that the food industry is required to use these fortified staples and condiments rather than nonfortified foods.
Fish Sauce, Soy Sauce, and Vegetable Oil Fortification in Cambodia: Where do we Stand to Date?
Authors: Theary Chan , Panagides Dora , Laillou Arnaud , Vonthanak Saphoon , Kanarath Chheng , Chhorvann Chhea , Sambath Pol , Sowath Sol , Moench-Pfanner Regina
Published: November 2015

Background

The prevalence of micronutrient deficiencies in Cambodia is among the highest in Southeast Asia. Fortification of staple foods and condiments is considered to be one of the most cost-effective strategies for addressing micronutrient deficiencies at the population level. The Government of Cambodia has recognized the importance of food fortification as one strategy for improving the nutrition security of its population.

Objective

This paper describes efforts under way in Cambodia for the fortification of fish sauce, soy sauce, and vegetable oil.

Methods

Data were compiled from a stability test of Cambodian fish sauces fortified with sodium iron ethylenediaminetetraacetate (NaFeEDTA); analysis of fortified vegetable oils in the Cambodian market; a Knowledge, Attitudes, and Practices (KAP) study of fortified products; and food fortification program monitoring documents.

Results

At different levels of fortification of fish sauce with NaFeEDTA, sedimentation and precipitation were observed. This was taken into consideration in the government-issued standards for the fortification of fish sauce. All major brands of vegetable oil found in markets at the village and provincial levels are imported, and most are nonfortified.

Conclusions

Fish sauce, soy sauce, and vegetable oil are widely consumed throughout Cambodia and are readily available in provincial and village markets. Together with an effective regulatory monitoring system, the government can guarantee that these commodities, whether locally produced or imported, are adequately fortified. A communications campaign would be worth-while, once fortified commodities are available, as the KAP study found that Cambodians had a positive perception of fortified sauces.
Rapid Quantification of Iron Content in Fish Sauce and Soy Sauce: A Promising Tool for Monitoring Fortification Programs
Authors: Laillou Arnaud , Icard-Vernière Christèle , Rochette Isabelle , Picq Christian , Berger Jacques , Sambath Pol , Mouquet-Rivier Claire
Published: November 2015

Background

In a number of Southeast Asian countries and China, fish sauce and soy sauce produced at the industrial level are fortified with iron. Unfortunately, the food producers and regulatory agencies implementing fortification programs do not always have the capacity to monitor the programs on an ongoing basis.

Objective

To assess a new portable device for the quantitative measurement of iron content of fortified sauces that could be used to control fortification levels.

Methods

The linearity, detection limits, and inter- and intraassay variability of this device were assessed on fish sauce and soy sauce fortified with ferrous sulfate, ferrous fumarate, and sodium iron ethylenediaminetetraacetate (NaFeEDTA); the accuracy of the results was determined by comparing them with the results obtained by atomic absorption spectrophotometry.

Results

Measurements required a minimum incubation time of 1 hour for iron sulfate or iron fumarate and 24 hours for NaFeEDTA. Linearity of the results ranged from 2 to 10 mg iron/L for ferrous sulfate or ferrous fumarate and from 1 to 10 mg iron/L for NaFeEDTA, implying the need for proper dilution, as the iron contents of fortified sauce are usually in the range of 150 to 1,000 mg/L. Depending on incubation time, iron compounds, and sauces, the coefficient of variation (CV) of intraassay precision was between 1.5% and 7.6% and the CV of interassay precision was between 2.9% and 7.4%. Comparison with results from atomic absorption spectrophotometry showed high agreement between both methods, with R = 0.926 and R = 0.935 for incubation times of 1 hour and 24 hours, respectively. The Bland—Altman plots showed limits of agreement between the two methods of ± 70 mg/L in the range of fortification levels tested (100 to 500 mg/L).

Conclusions

This device offers a viable method for field monitoring of iron fortification of soy and fish sauces after incubation times of 1 hour for ferrous sulfate or ferrous fumarate and 24 hours for NaFeEDTA.
The SMILING Project: A North—South—South Collaborative Action to Prevent Micronutrient Deficiencies in Women and Young Children in Southeast Asia
Authors: Berger Jacques , Blanchard Gentiane , Ponce Maiza Campos , Chamnan Chhoun , Chea Mary , Dijkhuizen Marjoleine , Doak Coleen , Doets Esmee , Fahmida Umi , Ferguson Elaine , Hulshof Paul , Kameli Yves , Kuong Khov , Akkhavong Kongsap , Sengchanh Kounavong , Le Bach Mai , Tran Thi Lua , Muslimatun Siti , Roos Nanna , Sophonneary Prak , Wieringa Frank , Wasantwisut Emorn , Winichagoon Pattanee ,   SMILING consortium group
Published: November 2015

Background

The “Sustainable Micronutrient Interventions to Control Deficiencies and Improve Nutritional Status and General Health in Asia” project (SMILING), funded by the European Commission, is a transnational collaboration of research institutions and implementation agencies in five Southeast Asian countries—Cambodia, Indonesia, Laos PDR, Thailand, and Vietnam—with European partners, to support the application of state-of-the art knowledge to alleviate micronutrient malnutrition in Southeast Asia.

Objective

The major expected outcomes are to improve micronutrient status on a large scale, to identify priority interventions in each Southeast Asian country, and to develop a road map for decision makers and donors for inclusion of these priority interventions into the national policy.

Methods

SMILING has been built around a strong project consortium that works on a constant and proactive exchange of data and analyses between partners and allows for the differences in contexts and development stages of the countries, as well as a strong North—South—South collaboration and colearning.

Results

The selection of Southeast Asian countries considered the range of social and economic development, the extent of micronutrient malnutrition, and capacity and past success in nutrition improvement efforts. SMILING is applying innovative tools that support nutrition policy-making and programming. The mathematical modeling technique combined with linear programming will provide insight into which food-based strategies have the potential to provide essential (micro) nutrients for women and young children. Multicriteria mapping will offer a flexible decision-aiding tool taking into account the variability and uncertainty of opinions from key stakeholders. The lessons learned throughout the project will be widely disseminated.
Using an Evidence-Based Approach to Design Large-Scale Programs to Improve Infant and Young Child Feeding
Authors: Baker Jean , Sanghvi Tina , Hajeebhoy Nemat , Martin Luann , Lapping Karin
Published: November 2015

Background

Global interest in scaling up nutrition outcomes has focused attention on the need for more effective programs to improve infant and young child feeding (IYCF). However there are few examples in the literature of comprehensive programs that have been systematically designed.

Objective

To describe an evidence-based approach for designing large-scale yet tailored IYCF programs in varied country settings.

Methods

Behavior change principles, epidemiological data, situational analysis, stakeholder consultations, formative research, and feasibility studies informed the design of IYCF programs delivered at scale in Bangladesh, Ethiopia, and Vietnam.

Results

Impact, scale, and sustainability objectives guided the choice of partners, service delivery platforms, and advocacy, systems strengthening, and communication strategies for reaching mothers and decision makers. All programs focused on the critical first 2 years of life, followed global World Health Organization and UNICEF guidelines for IYCF, and applied a common theory of change. Formative research, stakeholder consultations, trials of improved practices, and assessments of media habits were most useful for making program decisions. Opinion leader research, monitoring of the policy environment, and stakeholder analysis were key elements in the design of advocacy strategies. All programs found that setting measurable and explicit targets, strengthening systems to provide support for mothers, multichannel communication, and advocacy for opinion leaders were vital components in the design.

Conclusions

A systematic, evidence-based collaborative approach can facilitate the design of comprehensive IYCF programs. Programs should also embed design flexibility to enable changes as new challenges and opportunities arise.
Bringing Rigor to Evaluations of Large-Scale Programs to Improve Infant and Young Child Feeding and Nutrition: The Evaluation Designs for the Alive & Thrive Initiative
Authors: Menon Purnima , Rawat Rahul , Ruel Marie
Published: November 2015

Background

The evidence base on the impact of large-scale infant and young child feeding (IYCF) and nutrition programs is limited, partly due to the challenges of rigorously evaluating complex programs including multiple interventions.

Objectives

To describe the process used to design Alive & Thrive's impact evaluations in the three target countries and discuss the feasibility of developing contextually relevant designs adapted to the country-specific programmatic context.

Methods

The evaluation designs for Alive & Thrive needed to address several challenges. These included the selection of intervention components to evaluate rigorously; the identification of appropriate comparison groups in the context of rapidly scaling-up programs; the choice of impact indicators; addressing measurement challenges related to evaluating the impact of interventions targeted during the first 2 years of life on stunting; and developing methods and tools to assess implementation, utilization, and program impact pathways within evolving program portfolios.

Results

In Bangladesh and Vietnam, cluster-randomized probability designs are used for the impact evaluations; in Ethiopia, the impact evaluation uses an adequacy design. In all three countries, repeated cross-sectional surveys, 4 years apart, are used to measure impact, and appropriate age groups are sampled separately to capture change in the main impact indicators. In addition, theory-driven process evaluations are used to study factors that facilitate or prevent achievement of impact and scale.

Conclusions

We conclude that robust impact and process evaluations of complex, large-scale nutrition programs are feasible, but that early implementer—evaluator engagement and shared vision and motivation to establishing meaningful evaluations are essential.
Epidemiological Study of Risk Factors for Goiter among Primary Schoolchildren in Southern Ethiopia
Authors: Wolka Eskinder , Shiferaw Solomon , Biadgilign Sibhatu
Published: November 2015

Background

Iodine-deficiency disorders are a major public health problem all over the world. Goiter is the most visible manifestation of iodine-deficiency disorder. Goiter rate is useful to assess the long-term impact of iodine-deficiency disorders.

Objective

To determine the risk factors for goiter in primary schoolchildren in southern Ethiopia.

Methods

A cross-sectional study on a sample population of 270 children 6 to 12 years of age with goiter and 264 without goiter was conducted in a primary school in Sodo Town, southern Ethiopia. All students in each class were examined for the presence of goiter and classified based on World Health Organization criteria. For each child with goiter, the next child without goiter was selected from the same class. Multivariate logistic regression analysis was employed to determine the effect of independent variables on the goiter rate.

Results

A total of 534 participants (270 children with goiter and 264 without goiter) were included. Although the difference was not significant, the prevalence of goiter was higher among girls than among boys (54.8% vs. 45.2%), and the prevalence in both sexes increased with age. In the multivariate logistic regression model, consuming common goitrogenic foods (adjusted OR, 1.9; 95% CI, 1.2 to 2.9) and drinking water from the river (adjusted OR, 2.5; 95% CI, 1.2 to 4.9) were independently associated with goiter.

Conclusions

Goiter rate is significantly associated with consumption of goitrogenic food items in the area and contaminated drinking water. Creating awareness in the community about the consumption of food items and provision of tap water by concerned bodies in the area is recommended to prevent iodine-deficiency disorders.