bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Iron-Fortified Ultra Rice in Improving the Iron Status of Women in Mexico
Authors: Hotz Christine , Porcayo Maribel , Onofre Germán , García-Guerra Armando , Elliott Terry , Jankowski Shirley , Greiner Ted
Published: November 2015

Background

Universal fortification of staple foods with iron has been widely promoted as a cost-effective strategy to reduce iron deficiency in developing-country populations. Nonetheless, relatively few efficacy trials have been reported to date to demonstrate impact on iron status. The Ultra Rice technology provides a means of delivering fortificant iron via rice.

Objective

The objective of this study was to test the efficacy of rice fortified with microencapsulated, micronized iron pyrophosphate to improve the iron status of women in Mexico in a randomized, controlled intervention trial.

Methods

Nonpregnant, nonlactating women 18 to 49 years of age were recruited from six factories. The women received a daily portion of cooked rice 5 days per week for a period of 6 months, before and after which iron status indicators were determined in venous blood samples.

Results

The average intake of iron from the fortificant was 13 mg/day. Mean plasma ferritin concentration and estimated body iron stores were significantly higher, and transferrin receptors were lower, in the iron-fortified rice group following the intervention. Mean hemoglobin concentration also increased in the treatment group, but the increase was significant only when the analysis was restricted to those with baseline hemoglobin < 12.8 g/dL. The absolute reduction in anemia and iron deficiency was 10.3 and 15.1 percentage points, respectively. Total iron intake from fortificant was a significant covariate of change in body iron stores. The overall prevalence of anemia was reduced by 80%.

Conclusions

Fortification of rice with iron using this technology is an efficacious strategy for preventing iron deficiency.
Discussion: Effects of Folate and Vitamin B12 Deficiencies During Pregnancy on Fetal, Infant, and Child Development
Authors: Villalpando Salvador
Published: November 2015

The essentiality of folate and vitamin B12 for the synthesis of DNA may interfere with a successful pregnancy outcome when the mother is deficient in these micronutrients. The objective of this paper is to assess the effects of folate and vitamin B12 deficiencies on pregnancy outcomes, other than neural tube defects (NTD), and the effects of these deficiencies on infant and child development.

Supplementation studies identified by two Cochran Reviews were selected to assess the impact of folate deficiency on pregnancy outcomes, and a systematic review of the literature was used to assess their effects on infant and child developments.

Folate supplementation consistently resulted in improvement of hematological and folate status indicators. Seven supplemental studies consistently found no differences in the risk of total fetal loss, early or late miscarriage, stillbirth, preeclampsia, perinatal death, neonatal death, preterm birth, small-for-gestational age, or infant death in supplemented women compared with their controls. Two of those studies found greater placental weights (difference 96 g; 95% CI, 30.7 to 161.2 g), birthweights (difference 312 g; 95% CI, 108.5 to 515.4 g), and a lower risk for newborns weighing < 2,500 g in supplemented women (RR = 0.94; 95% CI, 0.90 to 0.99). Abnormal vitamin B12 and homocysteine serum concentrations were more readily associated with poor pregnancy outcomes. The very few studies addressing the effects of folate and vitamin B12 deficiencies on infant and child development were inconclusive.

Early supplementation with folate to pregnant women improves hematological and folate status indicators, but has little or no effect on pregnancy outcomes, other than on NTD. Vitamin B12 deficiencies and low homocysteine are more readily associated with poor pregnancy outcomes.
Effects of Vitamin B12 and Folate Deficiency on Brain Development in Children
Authors: Black Maureen M.
Published: November 2015

Folate deficiency in the periconceptional period contributes to neural tube defects; deficits in vitamin B12 (cobalamin) have negative consequences on the developing brain during infancy; and deficits of both vitamins are associated with a greater risk of depression during adulthood. This review examines two mechanisms linking folate and vitamin B12 deficiency to abnormal behavior and development in infants: disruptions to myelination and inflammatory processes. Future investigations should focus on the relationship between the timing of deficient and marginal vitamin B12 status and outcomes such as infant growth, cognition, social development, and depressive symptoms, along with prevention of folate and vitamin B12 deficiency.
Decreasing Stunting, Anemia, and Vitamin A Deficiency in Peru: Results of the Good Start in Life Program
Authors: Lechtig Aarón , Cornale Guido , Ugaz María Elena , Arias Lena
Published: November 2015

Background

The rates of stunting, iron-deficiency anemia, and vitamin A deficiency in Peru are among the highest in South America. There is little scaled-up experience on how to solve these problems countrywide.

Objective

To evaluate the Good Start in Life Program during the period from 2000 to 2004.

Methods

Data on weight, height, hemoglobin, serum retinol, urinary iodine, and age were obtained from children under 3 years of age during two transverse surveys in 2000 and 2004.

Results

In 2004, the program covered 75,000 children, 35,000 mothers, and 1 million inhabitants from 223 poor communities. The rate of stunting decreased from 54.1% to 36.9%, the rate of iron-deficiency anemia decreased from 76.0% to 52.3%, and the rate of vitamin A deficiency decreased from 30.4% to 5.3% ( p < .01). The annual cost per child was US$116.50.

Conclusions

Adaptations of this participative program could contribute to decreased stunting, iron-deficiency anemia, and vitamin A deficiency at the national scale in Peru and many other countries.
Undernutrition in the Kora Mudi Tribal Population, West Bengal, India: A Comparison of Body Mass Index and Mid-Upper-Arm Circumference
Authors: Bisai Samiran , Bose Kaushik
Published: November 2015

Background

Undernutrition among adult tribal women is a major health problem in India.

Objectives

To compare the utility of two different anthropometric indicators of chronic energy deficiency (CED) among tribal Kora Mudi women and to determine which of these two is a better indicator of undernutrition.

Methods

A cross-sectional study of 123 individuals was conducted. The body mass index (BMI) and mid-upper-arm circumference (MUAC) were used to evaluate CED.

Results

The prevalence of CED based on BMI less than 18.5 was 55.3%, and the prevalence of CED based on MUAC less than 22.0 cm was 51.2%. Both of these prevalence rates are classified in the very high-prevalence category (≥ 40%) and indicate a critical situation according to World Health Organization recommendations. Mean BMI increased significantly with higher quartile of MUAC. There was a significant difference in the prevalence of CED between the MUAC quartiles. The risk ratio for CED for women in the lowest quartile of MUAC was 9.33 compared with those in the highest quartile. There was a significant positive association between MUAC and BMI. Regression analysis demonstrated that MUAC had a significant positive impact on BMI; the percentage of the variation in BMI explained by MUAC was 52%. Logistic regression analysis demonstrated that overall, 82.11% of cases of CED were correctly classified with the use of MUAC. The use of MUAC correctly diagnosed 82.35% of cases of CED and 81.82% of women with normal nutritional status.

Conclusions

This population was facing severe nutritional stress. With limited resources and in the absence of skilled manpower, it may be more appropriate to use MUAC for human population surveys, particularly among tribal populations of developing countries.
Are Vitamin A and Iron Deficiencies Re-Emerging in Urban Latin America? A Survey of Schoolchildren in Bogota, Colombia
Authors: Maslova Ekaterina , Mora-Plazas Mercedes , Forero Yibby , López-Arana Sandra , Baylin Ana , Villamor Eduardo
Published: November 2015

Background

In Latin America, the burden of vitamin A and iron deficiencies has been documented primarily in preschool-age children. There are few recent reports on the vitamin A and iron status of school-age children.

Objective

We aimed to determine the prevalence and predictors of vitamin A and iron deficiencies in Colombian schoolchildren.

Methods

We examined plasma retinol and ferritin concentrations in relation to socioeconomic and anthropometric factors in a representative sample of 2,811 low- and middle-income children 5 to 12 years of age in Bogotá, Colombia.

Results

The prevalence rates of deficiencies of vitamin A (plasma retinol < 0.70 μmol/L) and iron (plasma ferritin < 15 μg/L) were 14% and 3%, respectively. In multivariate analysis, plasma retinol concentrations were positively associated with child's age and household's socioeconomic stratum, whereas ferritin concentrations were positively related to child's age, number of home assets, and having a nonsingle mother. Ferritin concentrations were much lower among girls than boys in the 11- and 12-year-old age group, whereas there were only small positive differences between girls and boys in younger children (p for interaction < .0001) . Both vitamin A and iron deficiencies were independently associated with lower z-scores for body-mass-index-for-age, after adjustment for sociodemographic factors and C-reactive protein concentrations. Neither vitamin A nor iron status was related to height-for-age.

Conclusions

The prevalence rates of vitamin A and iron deficiencies among schoolchildren from Bogotá, Colombia, are not negligible. Both vitamin A and iron status are positively associated with socioeconomic status and anthropometric indices. The effect of improving vitamin A and iron status on physical growth and other functional outcomes needs to be further examined in this age group.
Relationship of Household Food Insecurity to Neonatal, Infant, and Under-Five Child Mortality among Families in Rural Indonesia
Authors: Campbell Ashley A. , de Pee Saskia , Sun Kai , Kraemer Klaus , Thorne-Lyman Andrew , Moench-Pfanner Regina , Sari Mayang , Akhter Nasima , Bloem Martin W. , Semba Richard D.
Published: November 2015

Background

Food insecurity is common in developing countries and is related to the physical well-being of families. Household food insecurity is intended to reflect a household's access, availability, and utilization of food, but its relationship with child mortality has not been well characterized.

Objective

To examine the relationship of a modified household food insecurity score with a history of neonatal, infant, and under-five child mortality.

Methods

In a cross-sectional study of 26,339 rural households in the Indonesian Nutrition Surveillance System, 2000–03, household food insecurity was measured with the use of a modified nine-item food security questionnaire. A simple food insecurity score of 0 to 9 was calculated based on responses and related to mortality history in the family.

Results

The proportion of households with neonatal, infant, and under-five child mortality was 4.6%, 8.8%, and 10.6%, respectively. In households with and without neonatal, infant, and under-five child mortality, the mean (± SD) food insecurity scores were 2.19 ± 1.89 vs. 1.72 ± 1.65, 2.29 ± 1.94 vs. 1.69 ± 1.63, and 2.29 ± 1.93 vs. 1.68 ± 1.62 (all p < .0001), respectively. The food insecurity score was related to mortality among neonates (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02 to 1.09; p = .003), infants (OR, 1.06; 95% CI, 1.03 to 1.09; p < .0001), and children under five (OR, 1.07; 95% CI, 1.04 to 1.10; p < .0001) after adjustment for potential confounders.

Conclusions

Higher household food insecurity score is associated with greater neonatal, infant, and under-five child mortality among rural families in Indonesia. Greater household food insecurity may signify a higher risk of infant and young child mortality.
Iodine Stability and Sensory Quality of Fermented Fish and Fish Sauce Produced with the Use of Iodated Salt
Authors: Chanthilath Boualapha , Chavasit Visith , Chareonkiatkul Somsri , Judprasong Kunchit
Published: November 2015

Background

Universal salt iodization promotes the use of iodated salt for producing industrial food products, although it might affect product quality and iodine stability.

Objective

To assess iodine loss during fermentation of fermented fish and fish sauces produced by using iodated salt and the effect on product sensory quality.

Methods

Fermented fish and fish sauces were produced with iodated rock and grain sea salts (approximately 30 ppm iodine). Fermented fish was prepared from freshwater fish mixed with salt and rice bran and fermented for 6 months at room temperature. Fish sauces were prepared by mixing anchovy with salt and fermenting either exposed to sunlight or in the shade for 12 months. Residual iodine was determined with a spectrophotometer at day 0 and months 1, 3, and 6 for fermented fish and day 0 and months 3, 6, and 12 for fish sauces. After fermentation, the products were tested for sensory acceptability by Laotian and Thai panelists (approximately 50 in each panel) after they were cooked and served in the traditional manner.

Results

After fermentation, the level of residual iodine was 7.61 ppm (16% loss) in fermented fish, 5.57 ppm (55% loss) in fish sauce prepared with exposure to sunlight, and 9.52 ppm (13% loss) in fish sauce prepared in the shade. Sensory qualities of the products that were produced from fortified and unfortified salts as well as dishes prepared from these products were not significantly different (p > 0.05).

Conclusions

It is feasible to produce fermented fish and fish sauces with iodated salt and maintain acceptable iodine levels.
Efficacy of Fortification of School Meals with Ferrous Glycine Phosphate and Riboflavin against Anemia and Angular Stomatitis in Schoolchildren
Authors: Vinodkumar Malavika , Rajagopalan Srinivasa
Published: November 2015

Objective

Multiple micronutrient deficiencies exist in many developing countries. We conducted a study to test the efficacy of ferrous glycine phosphate in reducing anemia and of riboflavin in reducing angular stomatitis when these micronutrients were added to the noon meal for schoolchildren.

Methods

A pre- and post-test design was used to study children 5 to 9 years of age, with an experimental and a control group. Two schools in the same locality in Chennai were chosen for the study. The experimental school had 65 children and the control school had 71 children, all of whom consumed a noon meal at the school daily. The children in the experimental school received a powder containing ferrous glycine phosphate and riboflavin, which was added to the meal during cooking every day for 6 months. The dosage was 28 mg of elemental iron and 1 mg of riboflavin per child per day. The children attended school for 5 days each week from Monday to Friday, except for holidays; they received the fortificants on 100 days during the 6-month period. There was no intervention in the control school. Children in the experimental and control groups were matched by socioeconomic status, age, and eating habits at baseline. All the children in the experimental and control schools were dewormed at baseline and at endline after 6 months. Hemoglobin was measured by the cynamethemoglobin method at baseline and endline.

Results

Binary logistic regression showed a significant (p < .001) time x group interaction for anemia. The prevalence of anemia in the experimental school was 69.0% at baseline and 32.8% after 100 days of intervention over 6 months, a statistically significant change ( p < .001). The prevalence of anemia in the control school was 91.5% at baseline and increased to 97.2% at endline; the increase was not statistically significant. The prevalence of angular stomatitis was reduced from 21% at baseline to 0% at endline in the experimental school, whereas it was 23% at baseline and 20% at endline in the control school.

Conclusions

The added fortificants reduced the prevalence of the micronutrient deficiencies.
Nutritional Quality of Diets fed to Young Children in Urban Slums can be Improved by Intensive Nutrition Education
Authors: Palwala Misba , Sharma Shweta , Udipi Shobha A. , Ghugre Padmini S. , Kothari Gopa , Sawardekar Pradeep
Published: November 2015

Background

Almost half of India's children under 3 years of age are undernourished and at risk for illness and death. Poor complementary feeding practices contribute substantially to the problem. Promoting appropriate feeding practices is critical for ensuring child survival, health, and nutrition. Nutrition education is a feasible intervention and has the potential to help achieve the Millennium Goals, provided it is implemented appropriately. However, in existing programs, education is too generalized and based on information transfer.

Objective

To develop and implement a need-based, situation-specific education program for mothers to bring about changes in complementary feeding practices, with emphasis on the quantity and nutritional quality of complementary feeds.

Methods

Four hundred fourteen mothers or caregivers from five slums in Mumbai participated in a 3-month intervention study. Gaps in complementary feeding practices were identified at baseline. Education was given by trained fieldworkers, first to groups of 8 to 10 mothers or caregivers using innovative modules and demonstrations, followed by weekly monitoring and reinforcement. A simple checklist was used at each follow-up to assess impact, identify practices not adopted, and provide further inputs. Data collected at three follow-ups were compared with baseline and analyzed by SPSS using the chi-square test, the t-test, and ANOVA to assess whether feeding practices of the mothers or caregivers were altered favorably.

Conclusions

The intervention process used in this study, the modules used, and the use of the checklist as complementary feeding practices. Incorporation of these in existing Growth Monitoring and Promotion programs would help to improve child nutrient intakes and thus reduce the prevalence of undernutrition.
Effects of Maternal Zinc Supplementation on Pregnancy and Lactation Outcomes
Authors: Hess Sonja Y. , King Janet C.
Published: November 2015

Observational studies in human populations suggest that maternal zinc deficiency during pregnancy may cause adverse pregnancy outcomes for the mother and fetus. Therefore, we reviewed the current evidence from studies of zinc supplementation, with or without other micronutrients, during pregnancy and lactation to assess its impact on maternal, fetal, and infant health.

A meta-analysis of supplementation trials indicates a 14% reduction in premature delivery among zinc-supplemented women. Most studies found no significant impact of maternal zinc supplementation on infant birthweight, but a subset of studies conducted in underweight or zinc-deficient women suggests that there may be a positive effect of zinc supplementation in such women. However, the number of relevant studies is limited, and more information is needed to confirm these observations. The results for other pregnancy outcomes are inconsistent, and the number of available studies is small. Likewise, the impact of maternal zinc supplementation during pregnancy on infant postnatal growth and risk of infection is variable, and few studies are available. Thus, more research will be needed to allow definitive conclusions to be drawn, especially for the second half of infancy and later childhood.

Studies found no adverse effects of maternal zinc supplementation on iron status during pregnancy. More information is required on other potential adverse effects, particularly with regard to a possible modifying effect of preexisting maternal zinc status.

In view of the possible benefits of zinc supplementation for reducing the risk of premature delivery, the possible positive impact of zinc supplementation on infant birthweight among undernourished women, and the lack of reported adverse effects, zinc should be included in maternal supplements given during pregnancy in populations at risk for zinc deficiency.
Integrating Maternal, Infant, and Young Child Nutrition: Report on the Ten Year Strategy Infant and Young Child Nutrition (IYCN) Working Group October 2008 Workshop
Authors: Zehner Elizabeth R.
Published: November 2015

Members of the Infant and Young Child Nutrition (IYCN) Working Group of the Ten Year Strategy for the Reduction of Vitamin and Mineral Deficiencies and several guests and speakers participated in a workshop in Geneva on 10 October 2008. The workshop had two broad objectives. The first objective was to review the evidence base for maternal and IYCN actions and explore how to integrate action throughout the window of opportunity from the prenatal period through the first 2 years of life. The second objective was to discuss the development of the Maternal, Infant, and Young Child Nutrition (MIYCN) Network in relation to the IYCN Working Group's role and structure. The speakers identified a spectrum of efforts needed to improve maternal, infant, and young child nutrition. The group decided to continue discussion on initiating a structure for an MIYCN Network to enhance collaboration.
Implementing and Revitalizing the Baby-Friendly Hospital Initiative
Authors: Saadeh Randa , Casanovas Carmen
Published: November 2015

The Baby-Friendly Hospital Initiative (BFHI) was launched in the 1990s by the World Health Organization (WHO) and UNICEF as a global effort with hospitals, health services, and parents to ensure babies are breastfed for the best start in life. It is one of the Operational Targets of the Global Strategy for Infant and Young Child Feeding endorsed in 2002 by the Fifty-Fifth World Health Assembly and the UNICEF Executive Board. After about 18 years, great progress has been made, and most countries have breastfeeding authorities or BFHI coordinating groups. The BFHI has led to increased rates of exclusive breastfeeding, which are reflected in improved health and survival. Based on this progress, the Initiative was streamlined according to the experience of the countries and materials were revised. The new package consolidated all WHO and UNICEF materials into one package, reflected new research and experience, revisited the criteria used for the BFHI in light of HIV/ AIDS, reinforced the International Code of Marketing of Breast-Milk Substitutes, provided modules for mother-friendly care, and gave more guidance for monitoring and reassessment. WHO and partners will continue to give support to BFHI implementation as one essential effort contributing to achievement of the Millennium Development Goals.
Adherence and Costs of Micronutrient Supplementation in Pregnancy in a Double-Blind, Randomized, Controlled Trial in Rural Western China
Authors: Zeng Lingxia , Yan Hong , Cheng Yue , Dang Shaonong , Dibley Michael J.
Published: November 2015

Background

Efforts to determine the impact of prenatal multivitamin supplementation on birth outcome have been carried out in several developing countries. A review of factors that would impact the effectiveness of prenatal supplementation under normal field conditions is currently lacking and will be required for expanded supplementation programs. An efficacy trial of a multiple micronutrient supplement for pregnant women was conducted in rural western China, and additional information on side effects, rates of adherence, program inputs, and cost was also gathered.

Objectives

To examine reports of side effects and rates of adherence to prenatal multiple micronutrient supplementation in comparison with supplementation with folic acid and with iron–folic acid, and to describe inputs and costs associated with prenatal supplementation in China.

Methods

A cluster-randomized, double-blind, controlled trial was conducted in two rural counties in northwest China. All pregnant women in villages were randomly assigned to take daily supplements of folic acid, iron–folic acid, or a recommended daily allowance of 15 vitamins and minerals from enrollment until delivery. Information was collected from the women on side effects and adherence. Program inputs and costs of supplementation were tracked. Descriptive statistics were used for the analysis. The biological effectiveness of prenatal multiple micronutrient supplements is reported elsewhere.

Results

Less than 4% of women withdrew from the study because of side effects. Adherence to supplementation was high: the supplements were consumed on more than 90% of the days on which they were available for consumption. The mean number of supplements consumed was high at 165 capsules, and about 40% consumed the recommended 180 supplements during pregnancy.

Conclusions

High adherence to a prenatal supplement schedule can be achieved when mothers have frequent contact with trained health workers and a reliable supply of supplements.
Impact of Multiple Micronutrient versus Iron–Folic Acid Supplements on Maternal Anemia and Micronutrient Status in Pregnancy
Authors: Allen Lindsay H. , Peerson Janet M.
Published: November 2015

Background

Multiple micronutrient supplements could increase hemoglobin and improve micronutrient status of pregnant women more than iron supplements alone or iron with folic acid.

Objective

To compare the effects of multiple micronutrients with those of iron supplements alone or iron with folic acid, on hemoglobin and micronutrient status of pregnant women.

Methods

Studies were identified in which pregnant women were randomized to treatment with multiple micronutrients, or with iron with or without folic acid. A pooled analysis was conducted to compare the effects of these supplements on maternal hemoglobin, anemia, and micronutrient status. Effect size was calculated for individual and combined studies, based on mean change from baseline to final measure in the group receiving iron, with or without folic acid, minus the mean change in the group, divided by the pooled standard deviation of the two groups. The effect on the relative risk of anemia or iron deficiency was calculated as the probability of anemia or iron deficiency in the group receiving multiple micronutrients divided by the probability in the group receiving iron, with or without folic acid.

Results

Multiple micronutrient supplements had the same impact on hemoglobin and iron status indicators as iron with or without folic acid. There was no overall effect on serum retinol or zinc. In the only study in which status of other micronutrients was analyzed, a high prevalence of multiple deficiencies persisted in the group receiving multiple micronutrients provided with daily recommended intakes of each nutrient.

Conclusions

Multiple micronutrient supplements increased hemoglobin synthesis to the same extent as supplementation with iron with or without folic acid, although often they contained lower amounts of iron. The amount of supplemental iron and other nutrients that can enable pregnant women with micronutrient deficiencies to achieve adequate status remains to be determined.
Multiple Micronutrient Supplementation during Pregnancy in Low-Income Countries: A Meta-Analysis of Effects on Stillbirths and on Early and Late Neonatal Mortality
Authors: Ronsmans Carine , Fisher David J. , Osmond Clive , Margetts Barrie M. , Fall Caroline H. D.
Published: November 2015

Background

Multiple micronutrient deficiencies are common among women in low-income countries and may adversely affect pregnancy outcomes

Objective

To conduct a meta-analysis of the effects on stillbirths and on early and late neonatal mortality of supplementation during pregnancy with multiple micronutrients compared with iron–folic acid in recent randomized, controlled trials.

Methods

Twelve randomized, controlled trials were included in the analysis (Bangladesh; Burkina Faso; China; Guinea-Bissau; Indramayu and Lombok, Indonesia; Mexico; Sarlahi and Janakur, Nepal; Niger; Pakistan; and Zimbabwe), all providing approximately 1 recommended dietary allowance (RDA) of multiple micronutrients or iron–folic acid to presumed HIV-negative women.

Results

Supplementation providing approximately 1 RDA of multiple micronutrients did not decrease the risk of stillbirth (OR = 1.01; 95% CI, 0.88 to 1.16), early neonatal mortality (OR = 1.23; 95% CI, 0.95 to 1.59), late neonatal mortality (OR = 0.94; 95% CI, 0.73 to 1.23), or perinatal mortality (OR = 1.11; 95% CI, 0.93 to 1.33).

Conclusions

Our meta-analysis provides consistent evidence that supplementation providing approximately 1 RDA of multiple micronutrients during pregnancy does not result in any reduction in stillbirths or in early or late neonatal deaths compared with iron–folic acid alone.
Multiple Micronutrient Supplementation during Pregnancy in Developing-Country Settings: Policy and Program Implications of the Results of a Meta-Analysis
Authors: Shrimpton Roger , Huffman Sandra L. , Zehner Elizabeth R. , Darnton-Hill Ian , Dalmiya Nita
Published: November 2015

Background

An independent Systematic Review Team performed a meta-analysis of 12 randomized, controlled trials comparing multiple micronutrients with daily iron–folic acid supplementation during pregnancy.

Objective

To provide an independent interpretation of the policy and program implications of the results of the meta-analysis.

Methods

A group of policy and program experts performed an independent review of the meta-analysis results, analyzing internal and external validity and drawing conclusions on the program implications.

Results

Although iron content was often lower in the multiple micronutrient supplement than in the iron–folic acid supplement, both supplements were equally effective in tackling anemia. Community-based supplementation ensured high adherence, but some mothers still remained anemic, indicating the need to concomitantly treat infections. The small, significant increase in mean birthweight among infants of mothers receiving multiple micronutrients compared with infants of mothers receiving iron-folic acid is of similar magnitude to that produced by food supplementation during pregnancy. Larger micronutrient doses seem to produce greater impact. Meaningful improvements have also been observed in height and cognitive development of the children by 2 years of age. There were no significant differences in the rates of stillbirth, early neonatal death, or neonatal death between the supplemented groups. The nonsignificant trend toward increased early neonatal mortality observed in the groups receiving multiple micronutrients may be related to differences across trials in the rate of adolescent pregnancies, continuing iron deficiency, and/or adequacy of postpartum health care and merits further investigation.

Conclusions

Replacing iron–folic acid supplements with multiple micronutrient supplements in the package of health and nutrition interventions delivered to mothers during pregnancy will improve the impact of supplementation on birthweight and on child growth and development.
INCAP Studies of Nutrition and Infection
Authors: Scrimshaw Nevin S.
Published: November 2015

As soon as the Institute of Nutrition of Central America and Panama (INCAP) began to study the poor nutritional status and stunting of children in the rural villages of Central America, it was apparent that infections, particularly diarrheas, were also a serious problem. Studies of kwashiorkor indicated that infections precipitated kwashiorkor and anemia in children who were already malnourished. In the 1940s there was almost no suggestion in the literature of a relation between nutrition and infection. INCAP gradually identified the mechanisms by which any infection worsens nutritional status and demonstrated that infections were more severe and more often fatal in malnourished children and adults. These studies ultimately led to the 1968 World Health Organization (WHO) monograph “Interactions of nutrition and infection” and widespread recognition by public health workers of the importance of this relationship for morbidity and mortality in poorly nourished populations.
INCAP Studies of Vegetable Proteins for Human Consumption
Authors: Bressani Ricardo
Published: November 2015

This article describes the efforts of the Institute of Nutrition of Central America and Panama (INCAP) to develop a relatively low-cost vegetable protein mixture suitable as a complementary food for infants and young children. As it turned out, the resulting product became popular with older children and adults, and its superior nutritional benefits were widely recognized by the population. This effort led to broader studies by INCAP of the nutritional quality of vegetable protein mixtures, including raw materials, processing to convert them into human-grade products, product formulation, and commercialization.
Infant and Young Child Feeding Indicators and Determinants of Poor Feeding Practices in India: Secondary Data Analysis of National Family Health Survey 2005–06
Authors: Patel Archana , Badhoniya Neetu , Khadse Sandhya , Senarath Upul , Agho Kingsley E. , Dibley Michael J. ,   for the South Asia Infant Feeding Research Network (SAIFRN)*
Published: November 2015

Background

In India, poor feeding practices in early childhood contribute to the burden of malnutrition and infant and child mortality.

Objective

To estimate infant and young child feeding indicators and determinants of selected feeding practices in India.

Methods

The sample consisted of 20,108 children aged 0 to 23 months from the National Family Health Survey India 2005–06. Selected indicators were examined against a set of variables using univariate and multivariate analyses.

Results

Only 23.5% of mothers initiated breastfeeding within the first hour after birth, 99.2% had ever breastfed their infant, 89.8% were currently breastfeeding, and 14.8% were currently bottle-feeding. Among infants under 6 months of age, 46.4% were exclusively breastfed, and 56.7% of those aged 6 to 9 months received complementary foods. The risk factors for not exclusively breastfeeding were higher household wealth index quintiles (OR for richest = 2.03), delivery in a health facility (OR = 1.35), and living in the Northern region. Higher numbers of antenatal care visits were associated with increased rates of exclusive breastfeeding (OR for ≥ 7 antenatal visits = 0.58). The rates of timely initiation of breastfeeding were higher among women who were better educated (OR for secondary education or above = 0.79), were working (OR = 0.79), made more antenatal clinic visits (OR for ≥ 7 antenatal visits = 0.48), and were exposed to the radio (OR = 0.76). The rates were lower in women who were delivered by cesarean section (OR = 2.52). The risk factors for bottle-feeding included cesarean delivery (OR = 1.44), higher household wealth index quintiles (OR = 3.06), working by the mother (OR=1.29), higher maternal education level (OR=1.32), urban residence (OR=1.46), and absence of postnatal examination (OR=1.24). The rates of timely complementary feeding were higher for mothers who had more antenatal visits (OR=0.57), and for those who watched television (OR=0.75).

Conclusions

Revitalization of the Baby Friendly Hospital Initiative in health facilities is recommended. Targeted interventions may be necessary to improve infant feeding practices in mothers who reside in urban areas, are more educated, and are from wealthier households.
The Nutritional Status of School-Aged Children: Why Should We Care?
Authors: Best Cora , Neufingerl Nicole , van Geel Laura , van den Briel Tina , Osendarp Saskia
Published: November 2015

Background

The nutritional status of school-aged children impacts their health, cognition, and subsequently their educational achievement. The school is an opportune setting to provide health and nutrition services to disadvantaged children. Yet, school-aged children are not commonly included in health and nutrition surveys. An up-to-date overview of their nutritional status across the world is not available.

Objective

To provide a summary of the recent data on the nutritional status of school-aged children in developing countries and countries in transition and identify issues of public health concern.

Methods

A review of literature published from 2002 to 2009 on the nutritional status of children aged 6 to 12 years from Latin America, Africa, Asia, and the Eastern Mediterranean region was performed. Eligible studies determined the prevalence of micronutrient deficiencies or child under- and overnutrition using bio-chemical markers and internationally accepted growth references.

Results

A total of 369 studies from 76 different countries were included. The available data indicate that the nutritional status of school-aged children in the reviewed regions is considerably inadequate. Underweight and thinness were most prominent in populations from South-East Asia and Africa, whereas in Latin America the prevalence of underweight or thinness was generally below 10%. More than half of the studies on anemia reported moderate (> 20%) or severe (> 40%) prevalence of anemia. Prevalences of 20% to 30% were commonly reported for deficiencies of iron, iodine, zinc, and vitamin A. The prevalence of overweight was highest in Latin American countries (20% to 35%). In Africa, Asia, and the Eastern Mediterranean, the prevalence of overweight was generally below 15%.

Conclusions

The available data indicate that malnutrition is a public health issue in school-aged children in developing countries and countries in transition. However, the available data, especially data on micronutrient status, are limited. These findings emphasize the need for nutrition interventions in school-aged children and more high-quality research to assess nutritional status in this age group.
Food Security Indicators after Humanitarian Interventions Including Food Aid in Zimbabwe
Authors: Gandure Sithabiso , Drimie Scott , Faber Mieke
Published: November 2015

Background

Rural households in contemporary Zimbabwe experience various levels of food insecurity and vulnerability. Worsening macroeconomic conditions, a fragile political environment, poor rainfall, low incomes, deteriorating environmental conditions, and the impact of HIV and AIDS characterize their livelihoods. Non-governmental organizations have responded to the situation through a number of food interventions to alleviate food insecurity and poverty.

Objective

To provide an analysis of food security indicators used to assess households benefiting from food interventions in 2006 in Zimbabwe.

Methods

A total of 60 households were chosen for each of three districts (Uzumba-Maramba-Pfungwe [UMP], Chivi, and Tsholotsho), targeting beneficiaries of the Agricultural Protracted Relief Programme. Household food security indicators calculated on the basis of data collected by questionnaire included the Household Dietary Diversity Score (HDDS), months of food shortages, and the Household Food Insecurity Access Scale (HFIAS). Districts were compared by analysis of variance and Tukey post hoc analysis.

Results

The mean HDDS differed between the districts; households in Chivi consumed foods from a greater variety of groups than households in Tsholotsho and UMP (4.7 vs. 2.7 and 3.0, respectively; p < .001). Food shortages during the previous year were experienced by 76.4% of the households, with UMP having the lowest occurrence of food shortages (56.7%) and Tsholotsho the highest (95%). Households in Tsholotsho experienced hunger throughout the year; for households in UMP and Chivi, October to January were the critical months when households experienced the most hunger. Spearman correlation analysis showed an inverse correlation between HFIAS and HDDS ( r = −0.425, p < .01). Households that experienced food shortages the previous year had a lower mean HDDS (3.2 vs.3.9, p = .013) and a higher mean HFIAS (17.1 vs. 12.0, p < .001) than households that did not experience food shortages.

Conclusions

The study demonstrated the value of using a variety and combination of indicators in the design of food security interventions. The HDDS showed that beyond availability, food security also involves access to a variety of nutritious foods. The indicator pertaining to months of food shortages allows a deeper understanding of the nature of food insecurity; hunger in Tsholotsho is experienced throughout the year, implying that the causes are chronic rather than seasonal, whereas Chivi and UMP experience seasonal hunger. The HFIAS usefully revealed the condition of food security in each site in terms of the availability, stability, and intake of food.
Vitamin A Fortification of Wheat Flour: Considerations and Current Recommendations
Authors: Klemm Rolf D. W. , West Keith P. , Palmer Amanda C. , Johnson Quentin , Randall Philip , Ranum Peter , Northrop-Clewes Christine
Published: November 2015

Background

Vitamin A deficiency is a major public health nutrition problem, affecting an estimated 190 million preschool-aged children and 19 million pregnant and lactating women globally, and 83 million adolescents in Southeast Asia alone. Its consequences (disorders) include xerophthalmia (the leading cause of early childhood blindness), increased severity of infection, anemia, and death. Because vitamin A deficiency is largely due to chronic dietary insufficiency of preformed vitamin A and proactive carotenoids, food fortification can offer an effective approach to prevention.

Objective

To provide guidance on fortifying wheat and maize flour milled in industrial rollers for national fortification programs in countries where vitamin A deficiency is considered a public health problem.

Methods

Critical review of the literature on the dietary gap in vitamin A intake and levels of wheat flour intake among risk groups as a basis for determining vitamin A fortificant levels. Additional review of efficacy evidence, safety and cost considerations, and country experiences related to wheat-flour fortification with vitamin A.

Results

Mill-rolled wheat flour is a technically fortifiable, centrally processed food vehicle that, where routinely and adequately consumed by target groups, should be considered a candidate for fortification. Vitamin A can be stable in flour under typical, ambient conditions, with processing losses estimated at approximately 30%, depending on source and premix conditions.

Conclusions

Factors to guide a decision to fortify flour with vitamin A include the extent of deficiency, availability of other food vehicle options, the centrality of milling, market reach and population intake distributions of the flour products, the dietary vitamin A intake required, and associated costs. Large gaps persist in knowledge of these factors, which are needed to enable evidence-based fortification in most countries, leaving most decisions to fortify guided by assumptions. Where flour can and should be fortified, guidelines are given for providing nearly 25% of the Recommended Dietary Allowance for vitamin A to vulnerable groups consuming varying ranges of flour products. The costs will vary according to the level of fortification.
Identifying Priorities for Emergency Intervention from Child Wasting and Mortality Estimates in Vulnerable Areas of the Horn of Africa
Authors: Mason John B. , Chotard Sophie , Cercone Emily , Dieterich Megan , Oliphant Nicholas P. , Mebrahtu Saba , Hailey Peter
Published: November 2015

Background

The relation between anthropometric measures and mortality risk in different populations can provide a basis for deciding how malnutrition prevalences should be interpreted.

Objective

To assess criteria for deciding on needs for emergency interventions in the Horn of Africa based on associations between child wasting and mortality from 2000 to 2005.

Methods

Data were analyzed on child global acute malnutrition (GAM) prevalences and mortality estimates from about 900 area-level nutrition surveys from Ethiopia, Kenya, Somalia, Sudan, and Uganda; data on drought, floods, and food insecurity were added for Kenya (Rift Valley) and Ethiopia, from Food and Agriculture Organization (FAO) reports at the time.

Results

Higher rates of GAM were associated with increased mortality of children under 5 years of age (U5MR), more strongly among populations with pastoral livelihoods than with agricultural livelihoods. In all groups spikes of GAM and U5MR corresponded with drought (and floods). Different GAM cutoff points are needed for different populations. For example, to identify 75% of U5MRs above 2/10,000/day, the GAM cutoff point ranged from 20% GAM in the Rift Valley (Kenya) to 8% in Oromia or SNNPR (Ethiopia).

Conclusions

Survey results should be displayed as time series within geographic areas. Variable GAM cutoff points should be used, depending on livelihood or location. For example, a GAM cutoff point of 15% may be appropriate for pastoral groups and 10% for agricultural livelihood groups. This gives a basis for reexamining the guidelines currently used for interpreting wasting (or GAM) prevalences in terms of implications for intervention.
Role of Nutrition in HIV Infection: Review of Evidence for more Effective Programming in Resource-Limited Settings
Authors: de Pee Saskia , Semba Richard D.
Published: November 2015

Background

HIV infection and malnutrition negatively reinforce each other.

Objective

For program guidance, to review evidence on the relationship of HIV infection and malnutrition in adults in resource-limited settings.

Results and conclusions

Adequate nutritional status supports immunity and physical performance. Weight loss, caused by low dietary intake (loss of appetite, mouth ulcers, food insecurity), malabsorption, and altered metabolism, is common in HIV infection. Regaining weight, particularly muscle mass, requires antiretroviral therapy (ART), treatment of opportunistic infections, consumption of a balanced diet, physical activity, mitigation of side effects, and perhaps appetite stimulants and growth hormone. Correcting nutritional status becomes more difficult as infection progresses. Studies document widespread micronutrient deficiencies among HIV-infected people. However, supplement composition, patient characteristics, and treatments vary widely across intervention studies. Therefore, the World Health Organization (WHO) recommends ensuring intake of 1 Recommended Nutrient Intake (RNI) of each required micronutrient, which may require taking micronutrient supplements. Few studies have assessed the impact of food supplements. Because the mortality risk in patients receiving ART increases with lower body mass index (BMI), improving the BMI seems important. Whether this requires provision of food supplements depends on the patient's diet and food security. It appears that starting ART improves BMI and that ready-to-use fortified spreads and fortified-blended foods further increase BMI (the effect is somewhat less with fortified-blended foods). The studies are too small to assess effects on mortality. Once ART has been established and malnutrition treated, the nutritional quality of the diet remains important, also because of ART's long-term metabolic effects (dyslipidemia, insulin resistance, obesity). Food insecurity should also be addressed if it prevents adequate energy intake and reduces treatment initiation and adherence (due to the opportunity costs of obtaining treatment and mitigating side effects).