bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Period: Linking best Nutrition Practices at Birth to Optimize Maternal and Infant Health and Survival
Authors: Lutter Chessa K. , Chaparro Camila M.
Published: November 2015

Delayed umbilical cord clamping, immediate skin-to-skin contact, and early initiation of breastfeeding have been shown to be simple, safe, and effective and should be implemented in all deliveries, with very few exceptions. Although these practices can also prevent death, their importance extends beyond survival and optimizes both short-and long-term neonatal and maternal health and nutrition. Their implementation requires that they be integrated with one another and included with other standard lifesaving care practices. Leveraging knowledge of efficacious interventions into high-quality programs with broad coverage is often the main obstacle to improving neonatal and maternal health in low-income countries. To achieve results at-scale, attention must be given to increasing access to scientific information supporting evidence-based practices and addressing the skills needed to implement the recommended practices; establishing and communicating global, national, and local policies and guidelines for implementation in conjunction with advocacy and synchronization with other maternal and neonatal care efforts; reorganizing delivery care services; and monitoring and evaluation. This will require international investments similar to those being made for other lifesaving neonatal interventions. Neonatal vitamin A supplementation, recommended for implementation in Asia, is controversial, and the evidence for and against this recommendation is reviewed.
Choice of Foods and Ingredients for Moderately Malnourished Children 6 Months to 5 Years of Age
Authors: Michaelsen Kim F. , Hoppe Camilla , Roos Nanna , Kaestel Pernille , Stougaard Maria , Lauritzen Lotte , Mølgaard Christian , Girma Tsinuel , Friis Henrik
Published: November 2015

There is consensus on how to treat severe malnutrition, but there is no agreement on the most cost-effective way to treat infants and young children with moderate malnutrition who consume cereal-dominated diets. The aim of this review is to give an overview of the nutritional qualities of relevant foods and ingredients in relation to the nutritional needs of children with moderate malnutrition and to identify research needs. The following general aspects are covered: energy density, macronutrient content and quality, minerals and vitamins, bioactive substances, antinutritional factors, and food processing. The nutritional values of the main food groups—cereals, legumes, pulses, roots, vegetables, fruits, and animal foods—are discussed. The special beneficial qualities of animal-source foods, which contain high levels of minerals important for growth, high-quality protein, and no antinutrients or fibers, are emphasized. In cereal-dominated diets, the plant foods should be processed to reduce the contents of antinutrients and fibers. Provision of a high fat content to increase energy density is emphasized; however, the content of micronutrients should also be increased to maintain nutrient density. The source of fat should be selected to supply optimal amounts of polyunsaturated fatty acids (PUFAs), especially n-3 fatty acids. Among multiple research needs, the following are highlighted: to identify the minimum quantity of animal foods needed to support acceptable child growth and development, to examine the nutritional gains of reducing contents of antinutrients and fibers in cereal- and legume-based diets, and to examine the role of fat quality, especially PUFA content and ratios, in children with moderate malnutrition.
Stunting Associated with Poor Socioeconomic and Maternal Nutrition Status and Respiratory Morbidity in Colombian Schoolchildren
Authors: Dekker Louise H. , Mora-Plazas Mercedes , Marín Constanza , Baylin Ana , Villamor Eduardo
Published: November 2015

Background

There are few recent reports on the prevalence and risk factors of stunting and thinness among schoolchildren in Latin America.

Objective

To determine the prevalence and sociodemographic correlates of stunting and thinness among school-age children in Bogotá, Colombia, and to examine whether these nutritional indices are associated with the risk of respiratory and diarrheal morbidity symptoms, visits to the doctor, and school absenteeism during the school year in a prospective study.

Methods

We obtained information on anthropometric and maternal sociodemographic characteristics of 3,100 children 5 to 12 years of age who attended public primary schools in 2006 and who came from low- and middle-income households. Data on the incidence of common gastrointestinal and respiratory symptoms were collected prospectively on morbidity diaries throughout the year.

Results

The prevalence rates of stunting and thinness were 9.9% and 8.7%, respectively. There were inverse, statistically significant trends in the prevalence of stunting by categories of child's birth and current weight; maternal education level, height, and body mass index (BMI); and household socioeconomic stratum. A strong positive association was found with maternal parity ( p for trend < .0001). Thinness was positively associated with the child's and the mother's age and inversely associated with birthweight and maternal BMI. Stunting was associated with a 44% increase in the incidence of cough with fever during the school year ( p = .04).

Conclusions

Child stunting in Bogotá is associated with poor socioeconomic and maternal nutritional status and predicts symptoms of respiratory infection.
Determinants of Infant and Young Child Feeding Practices in Sri Lanka: Secondary Data Analysis of Demographic and Health Survey 2000
Authors: Senarath Upul , Dibley Michael J. , Godakandage S. S. P. , Jayawickrama Hiranya , Wickramasinghe Aravinda , Agho Kingsley E. ,   for the South Asia Infant Feeding Research Network (SAIFRN)*
Published: November 2015

Background

Poor feeding practices in early childhood contribute to the burden of childhood malnutrition and morbidity.

Objective

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

Methods

The sample consisted of 1,127 children aged 0 to 23 months from the Sri Lanka Demographic and Health Survey 2000. The key infant feeding indicators were estimated and selected indicators were examined against a set of individual-, household-, and community-level variables using univariate and multivariate analyses.

Results

Breastfeeding was initiated within the first hour after birth in 56.3% of infants, 99.7% had ever been breastfed, 85.0% were currently being breastfed, and 27.2% were being bottle-fed. Of infants under 6 months of age, 60.6% were fully breastfed, and of those aged 6 to 9 months, 93.4% received complementary foods. The likelihood of not initiating breastfeeding within the first hour after birth was higher for mothers who underwent cesarean delivery (OR = 3.23) and those who were not visited by a Public Health Midwife at home during pregnancy (OR = 1.81). The rate of full breastfeeding was significantly lower among mothers who did not receive postnatal home visits by a Public Health Midwife. Bottle-feeding rates were higher among infants whose mothers had ever been employed (OR = 1.86), lived in a metropolitan area (OR = 3.99), or lived in the South-Central Hill country (OR = 3.11) and were lower among infants of mothers with secondary education (OR = 0.27). Infants from the urban (OR = 8.06) and tea estate (OR = 12.63) sectors were less likely to receive timely complementary feeding than rural infants.

Conclusions

Antenatal and postnatal contacts with Public Health Midwives were associated with improved breastfeeding practices. Breastfeeding promotion strategies should specifically focus on the estate and urban or metropolitan communities.
Growing Children's Bodies and Minds: Maximizing Child Nutrition and Development
Authors: Engle Patrice , Huffman Sandra L.
Published: November 2015

For their optimal growth, and for greater long-term human capital development, children profit not only from improved nutrition but also from improved learning opportunities in the earliest years of life. This paper describes how actions to enhance optimal infant and young child nutrition can be linked with child development interventions for children under 3 years of age. In countries with high rates of malnutrition, linking these two components will result in synergies of program activities, and will bring about a greater impact at reduced cost than either activity conducted separately. New understanding of social marketing and communication strategies can increase effectiveness of linked interventions. Public–private partnerships to improve both child development and nutrition offer promise for sustainable interventions.
The Contribution of Child Health Days to Improving Coverage of Periodic Interventions in Six African Countries
Authors: Oliphant Nicholas P. , Mason John B. , Doherty Tanya , Chopra Mickey , Mann Pamela , Tomlinson Mark , Nsibande Duduzile , Mebrahtu Saba
Published: November 2015

Background

Child Health Days have been implemented since the early 2000s in a number of sub-Saharan African countries with support from UNICEF and other development partners with the aim to reduce child morbidity and mortality.

Objective

To estimate the effect of Child Health Days on preventive public health intervention coverage, and possible trade-offs of Child Health Days with facility-based health systems coverage, in sub-Saharan Africa.

Methods

Data were assembled and analyzed from population-based sample surveys and administrative records and from local government sources, from six countries. Field observations (published elsewhere) provided context.

Results

Child Health Days contributed to improving measles immunization coverage by about 10 percentage points and, importantly, provided an opportunity for a second dose. Child Health Days achieved high coverage of vitamin A supplementation and deworming, and improved access to insecticide-treated nets. Reported measles cases declined to near zero by 2003–5—a result of the combined efforts of routine immunizations and supplementary immunization activities, often integrated with Child Health Days. Collectively these activities were successful in reaching and sustaining a high enough proportion of the child population to achieve herd immunity and prevent measles transmission.

Conclusions

Additional efforts and resources are needed to continue pushing coverage up, particularly for measles immunization, in rural/hard-to-reach areas, amongst younger children, and less educated/poorer groups. In countries with low routine immunization coverage, Child Health Days are still needed.
A Community Perspective on Changes in Health Related to Diarrhea in Northeastern Brazil
Authors: Machado Márcia Maria Tavares , Lindsay Ana Cristina , Mota Gabriela Maia , Arruda Carlos André Moura , do Amaral João Joaquim Freitas , Forsberg Birger Carl
Published: November 2015

Background

Diarrhea is a major cause of death in children in developing countries. However, in Brazil, diarrhea-related morbidity and mortality have declined over the past decades.

Objective

To explore community perspectives in Brazil on changes in health related to diarrhea and factors that may have contributed to these changes.

Methods

This qualitative study included 12 focus group sessions held with 50 mothers and 42 grandmothers in the state of Ceará.

Results

Most grandmothers reported having lost at least one child to diarrhea, and all participants had witnessed children dying from diarrhea in the past. The participants saw a clear decline in diarrhea over the past 20 years. They felt that this was due to social, economic, and cultural progress. The participants also considered government-supported outreach programs very important for health improvement.

Conclusions

Knowledge of diarrhea and its causes in the community is broad, but many traditional beliefs about the illness still prevail. The Brazilian experience is an example of the critical effect that policies to promote income redistribution and universal access to education, health, water supply, and sanitation services may have on the reduction of undernutrition and diarrhea among children.
Home-Based Treatment of Acute Malnutrition in Cambodian Urban Poor Communities
Authors: Harris Stephen , Jack Susan
Published: November 2015

Background

The prevalence of malnutrition in Cambodia is among the highest in Southeast Asia. Until recently, there has been a consensus that the treatment and rehabilitation of acutely severely malnourished children should take place in hospitals; however, limited local health resources often place constraints upon the inpatient management of these children.

Objective

This study reviews the outcomes of a community nutrition program designed to rehabilitate children under the age of 5 years with moderate or severe acute malnutrition living in a poor urban community in Phnom Penh, Cambodia.

Methods

Clinical records of the program participants during the period from January 1999 to November 2006 were reviewed. Attainment of recovery weight-for-height z-scores, the length of time taken to achieve this recovery, rates of weight gain, mortality rate, and rate of default were determined from the data.

Results

One hundred fifty-nine children aged 4 years or younger with a mean admission weight-for-height z-score of −3.3 were treated. The mean outcome weight-for-height z-score was −1.5. Eighty-seven children (55%) reached a weight-for-height z-score ≥ −1 over a mean period of 14 weeks of rehabilitation. The average rate of weight gain was 4 g/kg/day. The case fatality rate was 5.6%.

Conclusions

This program is an example of effective, community-based rehabilitation of children with moderate or severe acute malnutrition in an urban, Southeast Asian, non-humanitarian-relief context, through a combination of nutritional education, regular home visiting, and food support.
USAID's Review of Food Aid Quality
Authors: Webb Patrick
Published: November 2015

As part of US Agency for International Development (USAID) efforts to improve the quality of food aid products and programs, a two year study was commissioned to produce recommendations on ways to improve the quality of food aid products, programming, and institutional processes. The review determined that while much valuable work is done in both emergencies and non-emergency contexts, there is scope for improvement. Smarter programming, more careful targeting, greater attention to cost-effectiveness (in relation to planned human outcomes, not just numbers of people “fed”), enhanced coordination of interagency processes, enhanced policy harmonization among international players, and application of best practices in product formulation can help increase the impact of U.S. food aid resources.
Indian Social Safety Net Programs as Platforms for Introducing Wheat Flour Fortification: A Case Study of Gujarat, India
Authors: Fiedler John L. , Babu Sunil , Smitz Marc-Francois , Lividini Keith , Bermudez Odilia
Published: November 2015

Background

Micronutrient deficiencies exact an enormous health burden on India. The release of the National Family Health Survey results—showing the relatively wealthy state of Gujarat having deficiency levels exceeding national averages—prompted Gujarat officials to introduce fortified wheat flour in their social safety net programs (SSNPs).

Objective

To provide a case study of the introduction of fortified wheat flour in Gujarat's Public Distribution System (PDS), Integrated Child Development Scheme (ICDS), and Mid-Day Meal (MDM) Programme to assess the coverage, costs, impact, and cost-effectiveness of the initiative.

Methods

India's 2004/05 National Sample Survey data were used to identify beneficiaries of each of Gujarat's three SSNPs and to estimate usual intake levels of vitamin A, iron, and zinc. Comparing age- and sex-specific usual intakes to Estimated Average Requirements, the proportion of the population with inadequate intakes was estimated. Postfortification intake levels and reductions in inadequate intake were estimated. The incremental cost of fortifying wheat flour and the cost-effectiveness of each program were estimated.

Results

When each program was assessed independently, the proportion of the population with inadequate vitamin A intakes was reduced by 34% and 74% among MDM and ICDS beneficiaries, respectively. Both programs effectively eliminated inadequate intakes of both iron and zinc. Among PDS beneficiaries, the proportion with inadequate iron intakes was reduced by 94%.

Conclusions

Gujarat's substitution of fortified wheat flour for wheat grain is dramatically increasing the intake of micronutrients among its SSNP beneficiaries. The incremental cost of introducing fortification in each of the programs is low, and, according to World Health Organization criteria, each program is “highly cost-effective.” The introduction of similar reforms throughout India would largely eliminate the inadequate iron intake among persons participating in any of the three SSNPs and would have a significant impact on the global prevalence rate of inadequate iron intake.
Building Global Advocacy for Nutrition: A Review of the European and US Landscapes
Authors: Dangour Alan D. , Diaz Zoey , Sullivan Lucy Martinez
Published: November 2015

Background

An estimated two billion people globally suffer from undernutrition, and yet, despite consensus that improving nutrition is one of the best investments for promoting health and alleviating poverty, nutrition remains chronically underfunded and under-prioritized. Successfully scaling global efforts to address undernutrition requires an understanding of the landscape of potential donors and partners that can be mobilized toward improving nutrition globally.

Objective

To conduct independent reviews of the European and US landscapes of donors and partners focused on undernutrition, and identify opportunities to leverage outreach and advocacy efforts toward increased engagement and funding for nutrition.

Methods

We present the primary findings from two independent landscaping studies conducted between September 2010 and March 2011. Research methods included desk-based research and interviews with stakeholders in bilateral and multilateral organizations ( n = 19), private industries ( n = 46), private funders ( n = 16), and civil society organizations ( n = 29). We report the key thematic findings by sector and the challenges and opportunities for increased engagement and funding for nutrition.

Results

Nutrition is a growing priority for a number of stakeholders across sectors. Strategic commitment to nutrition is emerging across multilateral and bilateral donor agencies; the private sector is increasingly interested in engaging in addressing undernutrition; and nongovernmental and civil society groups are engaged in nutrition advocacy. Key opportunities to increase funding and partnership across sectors include leveraging bilateral and multilateral investments for nutrition across development priorities while ensuring sound commitments within donor policies, focusing on engaging the private sector across the food value chain, mobilizing new resources from private funders through effective communication and outreach, and continuing to prioritize ongoing impact assessment across a range of interventions.

Conclusions

Understanding the current European and US landscape of nutrition stakeholders helps to inform efforts to scale the type of investments and partnership needed to make effective impacts on undernutrition globally. Turning the existing opportunities into results will require effective coordination, strong communication, and active participation across sectors.
Consumer Preferences for Maize Products in Urban Kenya
Authors: De Groote Hugo , Kimenju Simon Chege
Published: November 2015

Background

New maize varieties have been biofortified with provitamin A, mainly β-carotene, which renders the grain yellow or orange. Unfortunately, many African consumers prefer white maize. The maize consumption patterns in Africa are, however, not known.

Objective

To determine which maize products African consumers prefer to purchase and which maize preparations they prefer to eat.

Methods

A survey of 600 consumers was conducted in Nairobi, Kenya, at three types of maize outlets: posho mills (small hammer mills), kiosks, and supermarkets.

Results

Clients of posho mills had lower incomes and less education than those of kiosks and supermarkets. The preferred maize product of the posho-mill clients was artisanal maize meal; the preferred product of the others was industrial maize meal. Maize is the preferred staple for lunch and dinner, eaten as a stiff porridge ( ugali), followed by boiled maize and beans ( githeri), regardless of socioeconomic background. For breakfast, only half the consumers prefer maize, mostly as a soft porridge ( uji). This proportion is higher in low-income groups. Consumers show a strong preference for white maize over yellow, mostly for its organoleptic characteristics, and show less interest in biofortified maize.

Conclusions

Maize is the major food staple in Nairobi, mostly eaten in a few distinct preparations. For biofortified yellow maize to be accepted, a strong public awareness campaign to inform consumers is needed, based on a sensory evaluation and the mass media, in particular on radio in the local language.
Association of Elevated α1-Acid Glycoprotein (AGP) and the Prevalence of Anemia in Nicaraguan Preschool Children
Authors: Sullivan Kevin M. , Venugopalan Balalakshmi , Jefferds Maria E. , Boy Eric , Bonilla Josefina , Sandino Ivette , Halleslevens Patricia
Published: November 2015

Background

Anemia status is frequently assessed in cross-sectional surveys. Recently, the assessment of acute phase proteins (APPs) has become more common, primarily for iron and vitamin A biomarkers. Although the so-called “anemia of infection” has been known for years, the relationship between APPs and anemia has been infrequently presented.

Objective

To assess the relationship between elevated α1-acid glycoprotein (AGP) and the prevalence of anemia among preschool children.

Methods

A nationally representative household-based cross-sectional survey was conducted in 2003–05 in Nicaragua. Blood samples were collected from preschool children 6 to 59.9 months of age and tested for hemo- globin and AGP. Data were also obtained on sex, weight, height, use of iron supplements, maternal education, and urban or rural status.

Results

Among the 1,420 children assessed, the overall prevalence of anemia was 20.2% and the prevalence of elevated AGP was 24.0%. Children with elevated AGP had an anemia prevalence of 27.9%, compared with 17.8% among those with a normal AGP, for a crude prev- alence odds ratio (POR) of 1.8 ( p = .010). Accounting for age, maternal educational level, and year of survey using logistic regression, the adjusted POR for the association between elevated AGP and anemia was 1.5 ( p = .053).

Conclusions

Children in this survey with an elevated AGP had a higher prevalence of anemia, although after controlling for covariates the p-value did not indicate a statistically significant difference ( p = .053). It may be helpful to account for APPs, when this information is available, for purposes of comparing anemia prevalence across populations or within a population over time.
Effect of Wheat Flour Fortified with Sodium Iron EDTA on Urinary Zinc Excretion in School-Aged Children
Authors: Amalrajan Vani , Thankachan Prashanth , Selvam Sumithra , Kurpad Anura
Published: November 2015

Background

Foods fortified with sodium iron ethylenediaminetetraacetate (NaFeEDTA) have been shown to improve iron status in children, but little is known about the effect of this salt on urinary zinc excretion, particularly in children. This is particularly relevant, since zinc deficiency is known to limit growth and development in young children.

Objective

To determine the effect of NaFeEDTA-fortified wheat flour on urinary zinc excretion.

Methods

This study was a part of a randomized, controlled trial that was carried out among 6- to 13-year-old iron-depleted schoolchildren ( n = 179) who had received either a NaFeEDTA-fortified wheat meal (iron group) or an identical control meal without added iron (control group) for a period of 7 months. Urinary zinc concentration was assessed at the end of the intervention period by spot urine samples.

Results

Iron status in the iron group was significantly improved according to measurements of hemoglobin and serum ferritin ( p < .001). However, there was no significant difference in urinary zinc excretion between the iron group (median, 38.4 μg/dL; 25th–75th percentiles, 18.2–67.1 μg/dL) and the control group (median, 33.1 μg/dL; 25th–75th percentiles, 12.4–54.2 μg/dL).

Conclusions

Iron fortification of foods with NaFeEDTA does not affect urinary zinc excretion in children.
Iron-Fortified Wheat Flour and Iron Deficiency among Women
Authors: Grimm Kirsten A. , Sullivan Kevin M. , Alasfoor Deena , Parvanta Ibrahim , Suleiman Ali Jaffer Mohammed , Kaur Meenu , Al-Hatmi Fatima Obaid , Ruth Laird J.
Published: November 2015

Background

Iron deficiency is estimated to impact more than 1.6 billion individuals worldwide, affecting child, maternal, and perinatal mortality. Iron supplementation, fortification, and dietary diversification are strategies to reduce the prevalence of iron deficiency. However, there are relatively few studies demonstrating the effectiveness of iron-fortified wheat flour as an intervention.

Objective

To assess the relationship between average monthly per capita household consumption of iron-fortified wheat flour and iron deficiency among women of childbearing age in Oman.

Methods

Data were obtained from the National Micronutrient Status and Fortified Food Coverage Survey, 2004. Iron deficiency status was compared between women living in households with a monthly per capita consumption of iron-fortified wheat flour of 1 kg or more and women living in households with a monthly per capita consumption of iron-fortified wheat flour of less than 1 kg. The analyses excluded women with elevated or unknown levels of C-reactive protein and controlled for characteristics of the women and household demographics.

Results

Consumption of iron-fortified wheat flour was associated with a lower prevalence of iron deficiency among women in our sample (adjusted odds ratio, 0.60), after controlling for age, employment status, marital status, intake of iron or multivitamin supplements, self-reported presence of a blood disorder, household income, educational level of head of household, and family size.

Conclusions

These results suggest that women in our study living in households with a greater consumption of iron-fortified wheat flour have a lower prevalence of iron deficiency; however, additional study is needed.
Opportunities for Improving Maternal Nutrition and Birth Outcomes: Synthesis of Country Experiences
Authors: Mason John B. , Saldanha Lisa S. , Ramakrishnan Usha , Lowe Alyssa , Noznesky Elizabeth A. , Girard Amy Webb , McFarland Deborah A. , Martorell Reynaldo
Published: November 2015

Background

Undernutrition in women in poor countries remains prevalent and affects maternal, neonatal and child health (MNCH) outcomes. Improving MNCH outcomes requires better policies and programs that enhance women's nutrition.

Objective

The studies aimed to better understand awareness, perceptions, barriers to intervention, and policy and program priorities and approaches, through different platforms, addressing three related priority problems: anemia, intra-uterine growth retardation (IUGR), and maternal thinness and stunting (including incomplete growth with early pregnancy).

Methods

Results of a global literature review on program effectiveness, and from case studies in Ethiopia, India, and Nigeria, were synthesized.

Results and conclusions

Anemia can be reduced by iron-folate supplementation, but all aspects for successful implementation, from priority to resources to local capacity, require strengthening. For IUGR, additional interventions, of food supplementation or cash transfers, may be required for impact, plus measures to combat early pregnancy. Breaking the intergenerational cycle of women's undernutrition may also be helped by child nutrition programs. Potential interventions exist and need to be built on: iron-folate and multiple micronutrient supplementation, food fortification (including iodized salt), food supplementation and/or cash transfer programs, combatting early pregnancy, infant and young child nutrition. Potential platforms are: the health system especially antenatal care, community-based nutrition programs (presently usually child-oriented but can be extended to women), child health days, safety net programs, especially cash transfer and conditional cash transfer programs. Making these more effective requires system development and organization, capacity and training, technical guidelines and operational research, and advocacy (who takes the lead?), information, monitoring and evaluation.
Intrahousehold Distribution of Food: A Review of the Literature and Discussion of the Implications for Food Fortification Programs
Authors: Berti Peter R.
Published: November 2015

Background

The selection of food vehicles and fortification levels in food fortification programs may be made on the assumption of equitable intrahousehold distribution of food. There are concerns that biased intrahousehold distribution of food will make food-based interventions ineffective or unsafe.

Objective

To review available data documenting intrahousehold energy intake (as a proxy for food distribution) in low- and middle-income countries, and discuss the relevance for food fortification programs.

Methods

A literature search was done, selecting reports from low- and middle-income countries that included dietary data from adults and children. The references of relevant reports and all citations of relevant reports were scanned. Intrahousehold distribution of dietary energy was compared with individual energy requirements.

Results

Twenty-eight studies were identified covering 18 countries with as few as 20 and as many as 3,000 households per study. Intrahousehold distribution of food in most countries is relatively equitable, within a 20% margin.

Conclusions

Within the limits of the available data, and in the absence of contrary data, it is reasonable to assume equitable intrahousehold distribution of food when designing food fortification programs; however, for program evaluation, individual assessment of intake is still needed.
Lessons Learned from National Food Fortification Projects: Experiences from Morocco, Uzbekistan, and Vietnam
Authors: Wirth James P. , Laillou Arnaud , Rohner Fabian , Northrop-Clewes Christine A. , Macdonald Barbara , Moench-Pfanner Regina
Published: November 2015

Background

Fortification of staple foods has been repeatedly recommended as an effective approach to reduce micronutrient deficiencies. With the increased number of fortification projects globally, there is a need to share practical lessons learned relating to their implementation and responses to project-related and external challenges.

Objective

To document the achievements, challenges, lessons learned, and management responses associated with national fortification projects in Morocco, Uzbekistan, and Vietnam.

Methods

Independent end-of-project evaluations conducted for each project served as the primary data source and contain the history of, and project activities undertaken for, each fortification project. Other sources, including national policy documents, project reports from the Global Alliance for Improved Nutrition (GAIN) and other stakeholders, industry assessments, and peer-reviewed articles, were used to document the current responses to challenges and future project plans.

Results

All projects had key achievements related to the development of fortification standards and the procurement of equipment for participating industry partners. Mandatory fortification of wheat flour was a key success in Morocco and Uzbekistan. Ensuring the quality of fortified foods was a common challenge experienced across the projects, as were shifts in consumption patterns and market structures. Adjustments were made to the projects' design to address the challenges faced.

Conclusions

National fortification projects are dynamic and must be continually modified in response to specific performance issues and broader shifts in market structure and consumption patterns.
The Global Alliance for Improved Nutrition (GAIN): A Decade of Partnerships to Increase Access to and Affordability of Nutritious Foods for the Poor
Authors: Moench-Pfanner Regina , Van Ameringen Marc
Published: November 2015

The Global Alliance for Improved Nutrition (GAIN) was established in 2002 with a mandate to galvanize efforts by the public and private sectors to end malnutrition. GAIN launched its first large-scale fortification program in 2003, and in less than a decade has scaled its operations to reach more than 600 million people with nutritionally enhanced food. GAIN has evolved considerably as an organization, expanding beyond large-scale food fortification into new program areas, focusing on maternal, infant, and young child nutrition and improvements in agricultural practices to enhance nutrition. This paper describes GAIN's evolution from a large-scale food fortification program focus to a broader nutrition program portfolio directed toward improving access and affordability of nutritious foods for the poor. As GAIN enters its second decade, it continues to respond to the challenges of a changing nutrition landscape by introducing new programs and novel partnerships and by refining its innovative program delivery models.
Comparison of the Estimated Cost-Effectiveness of Preventive and Therapeutic Zinc Supplementation Strategies for Reducing Child Morbidity and Mortality in Sub-Saharan Africa
Authors: Brown Kenneth H. , Hess Sonja Y. , Vosti Stephen A. , Baker Shawn K.
Published: November 2015

Background

Zinc supplementation of young children in lower-income countries reduces morbidity from diarrhea and pneumonia and all-cause mortality, but the most cost-effective approach for distributing zinc supplements is unknown.

Objective

To examine the potential impact of four possible strategies for delivering zinc supplements on disease prevention and deaths averted among children 6 to 59 months of age in sub-Saharan Africa.

Methods

We analyzed different zinc supplementation strategies to assess their likely impact on morbidity and mortality of preschool children in sub-Saharan Africa and to estimate their possible costs.

Results

Preventive zinc supplementation reduces diarrhea incidence by 27% among children 12 to 59 months of age, pneumonia incidence by 21% among children 6 to 59 months of age, and all-cause mortality by 18% among children 12 to 59 months of age. The likely average total program costs of zinc supplementation programs were estimated from the outlays of existing service delivery platforms, such as child health days, community-based nutrition programs, and clinic-based treatment of diarrhea, assuming different levels of coverage and target age ranges of children.

Conclusions

We found that the average total costs per life saved ranged from approximately US$462 to US$3,111, and the most cost-effective interventions were weekly or intermittent preventive zinc supplementation, because of the possibility of high coverage and fewer supplements required. Empirical data from zinc supplementation programs will be needed to confirm these estimates.
Chilean Complementary Feeding Program Reduces Anemia and Improves Iron Status in Children Aged 11 to 18 Months
Authors: Brito Alex , Olivares Manuel , Pizarro Tito , Rodríguez Lorena , Hertrampf Eva
Published: November 2015

Background

Iron deficiency is the most prevalent nutritional deficiency in the world, primarily affecting infants, young children, and women of childbearing age.

Objective

To evaluate the impact of the National Complementary Feeding Program (NCFP) on anemia and iron status in Chilean children aged 11 to 18 months.

Methods

Two studies were performed. The first study was performed at one public outpatient health center in Santiago, using data collected in 1999 ( n = 128) and 2000 ( n = 125), before and after the national introduction of iron-fortified milk. Subsequently, a study of a representative sample ( n = 320) from the two most populated areas of the country was performed in 2009.

Results

One year after fortification, the prevalence of anemia was 9%; significantly lower ( p < .001) than the 27% prevalence observed 1 year before. Ten years after fortification, 14% of children were anemic and 77% of children with anemia (12% of all children) suffered from iron-deficiency anemia. In 2009, 11% of children consuming iron-fortified milk delivered by the NCFP (73%) were anemic, significantly lower ( p = .028) than the 21% prevalence of anemia observed in children without consumption. Consumption of iron-fortified milk was positively associated with hemoglobin concentration ( r = 0.28, p = .022) and was associated with a lower prevalence of anemia after adjusting for confounding factors (odds ratio, 0.50; 95% CI, 0.26 to 0.96).

Conclusions

In Chile, the NCFP has had an impact on the reduction of anemia and improved the iron status of children aged 11 to 18 months. Increasing the consumption of this iron-fortified milk could enhance the impact of the NCFP.
Vitamin A—Fortified Vegetable Oil Exported from Malaysia and Indonesia Can Significantly Contribute to Vitamin A Intake Worldwide
Authors: Laillou Arnaud , Panagides Dora , Garrett Greg S. , Moench-Pfanner Regina
Published: November 2015

Background

Vitamin A deficiency is a public health problem worldwide, affecting approximately 190 million preschool-aged children and 19.1 million pregnant women. Fortification of vegetable oils with vitamin A is an effective, low-cost technology to improve vitamin A intake.

Objective

To examine the potential contribution of fortification of vegetable oils with vitamin A in Indonesia and Malaysia to increasing vitamin A consumption in these two countries and in countries to which oil is exported .

Methods

Detailed interviews were administered and a desk review was conducted. We also estimated potential vitamin A intakes from fortified vegetable oil.

Results

Malaysia and Indonesia are two of the largest producers and exporters of vegetable oil. Fortification of vegetable oil in both countries has the potential to be used as a tool for control of vitamin A deficiency. Both countries have the capacity to export fortified vegetable oil. Vegetable oil fortified at a level of 45 IU/g could provide 18.8% of the Estimated Average Requirement (EAR) for an Ethiopian woman, 30.9% and 46.9% of the EAR for a Bangladeshi child and woman, respectively, and 17.5% of the EAR for a Cambodian woman. Although concerns about obesity are valid, fortification of existing vegetable oil supplies does not promote overconsumption of oil but rather promotes consumption of vegetable oil of higher nutrient quality.

Conclusions

Fortifying vegetable oil on a large scale in Malaysia and Indonesia can reach millions of people globally, including children less than 5 years old. The levels of fortification used are far from reaching the Tolerable Upper Intake Level (UL). Vegetable oil fortification has the potential to become a global public health intervention strategy.
Absorption Studies Show that Phytase from Aspergillus niger Significantly Increases Iron and Zinc Bioavailability from Phytate-Rich Foods
Authors: Troesch Barbara , Jing Hua , Laillou Arnaud , Fowler Ann
Published: November 2015

Background

Iron and zinc deficiency are major public health problems affecting many parts of the world, including Southeast Asia. Infants, young children, and women of reproductive age are particularly vulnerable due to their high requirements. Even though iron and zinc are present in significant amounts in the plant-based diets typically consumed in developing countries, their bioavailability is low due to high levels of absorption inhibitors such as phytate. Phytase has been used in animal nutrition for decades to improve the bioavailability of certain minerals in feed.

Objective

To show the effect of phytase in human nutrition based on evidence from human studies. Phytase can be used either during processing or as an active food ingredient degrading dietary phytate during stomach transit time.

Methods

Evidence from human studies testing the effect of phytase on iron and zinc bioavailability using stable isotopes was reviewed.

Results

Twelve studies tested the effect of phytase on iron and five tested its effect on zinc bioavailability. Most of these studies used a phytase derived from Aspergillus niger. They found a beneficial effect unless phytate concentrations were too low or levels of inhibitors or enhancers of iron absorption were too high. Twenty to 320 phytase units per 100 g of flour significantly improved iron absorption, even though higher levels might further increase iron bioavailability. For zinc, not enough information is available to determine optimal activities.

Conclusions

Phytase clearly has a beneficial effect on iron and zinc absorption from phytate-rich foods. It also has the potential to increase the absorption of magnesium, calcium, and phosphorus in areas such as Southeast Asia where mineral deficiencies are widespread.
Riboflavin Intake and 5-Year Blood Pressure Change in Chinese Adults: Interaction with Hypertensive Medication
Authors: Shi Zumin , Yuan Baojun , Taylor Anne W. , Zhen Shiqi , Zuo Hui , Dai Yue , Wittert Gary A.
Published: November 2015

Background

One previous large cross-sectional study across four countries suggests that riboflavin intake may be inversely associated with blood pressure.

Objective

The aim of this analysis was to investigate a possible association between riboflavin intake and change in blood pressure over 5 years.

Methods

The study population comprised Chinese men and women who participated in the Jiangsu Nutrition Study. Quantitative data relating to riboflavin intake at baseline in 2002 and measurements of blood pressure at baseline and follow-up in 2007 were available for 1,227 individuals.

Results

Overall, 97.2% of the participants had inadequate riboflavin intake (below the Estimated Average Requirement). In multivariable analysis adjusted for sociodemographic and lifestyle factors and dietary patterns, a higher riboflavin intake was inversely associated with change in systolic blood pressure ( p = .036). In participants taking antihypertensive medication at baseline, the relationship between riboflavin intake and systolic blood pressure persisted; whereas, in those not taking antihypertensive medication, the diastolic blood pressure was less likely to increase with the increasing intake of riboflavin ( p = .031). There was a three-way interaction between antihypertensive medications, body mass index, and riboflavin intake. Among those who were obese and taking antihypertensive medication, a higher riboflavin intake was associated with a smaller increment in systolic blood pressure and pulse pressure.

Conclusions

There are complex interactions between riboflavin intake and blood pressure change that depend on prior antihypertensive use and the presence or absence of obesity.
Hepcidin Profile of Anemic Adolescent Schoolgirls in Indonesia at the End of 12 Weeks of Iron Supplementation
Authors: Htet Min Kyaw , Dillon Drupadi , Rosida Azma , Timan Ina , Fahmida Umi , Thurnham David I.
Published: November 2015

Background

Iron deficiency is still the major nutritional problem in the developing world, and iron supplementation remains one of the most effective intervention strategies. Hepcidin, a newly discovered iron regulatory hormone, is an acute phase protein, and its role in iron supplementation has not been well explored.

Objective

To investigate the hepcidin profiles of anemic adolescent girls who had received weekly iron supplementation.

Methods

A cross-sectional study was conducted at the end of iron supplementation among adolescent schoolgirls ( n = 83) in Pramuka Island, Indonesia. All the girls were anemic at the beginning and received 60 mg of elemental iron twice weekly for 12 weeks. Hemoglobin, hepcidin, serum ferritin, and red cell parameters were measured, together with inflammation markers.

Results

At the end of the 12-week supplementation, 65.1% (n=64) of the girls were no longer anemic, but 43.4% ( n = 36) were still iron deficient. The rate of sub-clinical inflammation, measured by C-reactive protein (CRP) and α-1-acid glycoprotein (AGP), was 38.6% ( n = 32). Hepcidin was not correlated with either ferritin or red cell parameters. There was no association between hepcidin and the inflammatory markers CRP and AGP. The mean hepcidin concentration was 42.9 ± 17.9 ng/mL and was not significantly different between anemic and nonanemic girls (44.2 ± 14.9 and 42.3 ± 19.2 ng/mL, respectively; p = .708). However, hepcidin concentration was slightly higher in the iron replete-group than in the iron-deficient group (45.2 ± 20.0 and 39.3 ± 13.5 ng/mL, respectively), a suggestive trend that did not reach statistical significance ( p = .218).

Conclusions

Hepcidin concentrations tended to be higher among the subset of girls who responded poorly to iron supplementation as a consequence of increased subclinical inflammation. A longitudinal study should be conducted to explore the role of hepcidin in iron supplementation.
Toward the Prevention of Childhood Undernutrition: Diet Diversity Strategies Using Locally Produced Food Can Overcome Gaps in Nutrient Supply
Authors: Parlesak Alexandr , Geelhoed Diederike , Robertson Aileen
Published: November 2015

Background

Chronic undernutrition is prevalent in Mozambique, where children suffer from stunting, vitamin A deficiency, anemia, and other nutrition-related disorders. Complete diet formulation products (CDFPs) are increasingly promoted to prevent chronic undernutrition.

Objective

Using linear programming, to investigate whether diet diversification using local foods should be prioritized in order to reduce the prevalence of chronic undernutrition.

Methods

Market prices of local foods were collected in Tete City, Mozambique. Linear programming was applied to calculate the cheapest possible fully nutritious food baskets (FNFB) by stepwise addition of micronutrient-dense local foods.

Results

Only the top quintile of Mozambican households, using average expenditure data, could afford the FNFB that was designed using linear programming from a spectrum of local standard foods. The addition of beef heart or liver, dried fish and fresh moringa leaves, before applying linear programming decreased the price by a factor of up to 2.6. As a result, the top three quintiles could afford the FNFB optimized using both diversification strategy and linear programming. CDFPs, when added to the baskets, were unable to overcome the micronutrient gaps without greatly exceeding recommended energy intakes, due to their high ratio of energy to micronutrient density.

Conclusions

Dietary diversification strategies using local, low-cost, nutrient-dense foods can meet all micronutrient recommendations and overcome all micronutrient gaps. The success of linear programming to identify a low-cost FNFB depends entirely on the investigators' ability to select appropriate micronutrient-dense foods. CDFPs added to food baskets are unable to overcome micronutrient gaps without greatly exceeding recommended energy intake.