bluuebunny/crossref_metadata_2025 huggingface dataset:
Neural Mechanisms of the Ultrafast Activities
Authors: Ozaki Isamu , Hashimoto Isao
Published: November 2015

A brief review of previous studies is presented on ultrafast activities > 300 Hz (high frequency oscillations, HFOs) overlying the cortical response in the somatosensory evoked potential (SEP) or magnetic field (SEF). The characteristics of somatosensory HFOs are described in terms of reproducibility and origin (area 3b and 1) of the HFOs, changes during a wake-sleep cycle, effects of higher stimulus rate or tactile interference, etc. Also, several hypotheses on the neural mechanisms of the HFOs are introduced; the early HFO burst is probably generated from action potentials of thalamocortical fibers at the time when they arrive at the area 3b (and 1), since this component is resistant to higher stimulus rate > 10Hz or general anesthesia: by contrast, the late HFO burst is sensitive to higher stimulus rate, reflecting activities of a postsynaptic neural network in the somatosensory cortices, area 3b and 1. As to possible mechanisms of the late HFO burst genesis, an interneuron hypothesis, a fast inhibitory postsynaptic potential (IPSP) hypothesis of the pyramidal cell and a chattering cell hypothesis will be discussed on the basis of physiological and pathological features of the somatosensory HFOs.
Complementary Foods in Colombia
Authors: Rozo Camilo
Published: November 2015

This paper describes the development of processed complementary foods in Colombia and the composition of currently available foods. The main product, Bienestarina, has been produced by the Instituto Colombiano de Bienestar Familiar since 1976. The total annual production of the product exceeds 300,000 tons. In 1999 nearly 27,000 tons were produced and served to over 4.2 million beneficiaries. Both the government and the private sector are involved in the production of these foods. Bienestarina and other complementary foods appear to be widely accepted by the low-income population. Their nutritional impact has not been evaluated, and their composition reflects former concerns about protein rather than micronutrient adequacy and bioavailability.
The Need for Strategic Planning, not a Technological Fix
Authors: Griffiths Marcia
Published: November 2015

We know from past experience that nutritional status can be improved by improving practices without the use of processed food. The question should be: Can food alone, in the absence of improved practices, improve nutritional status outside a rehabilitative, structured feeding situation? Projects discussed in this paper demonstrate that there can be biological impacts from improved practices. Helping families use their own resources better is an important first step, not a last step, in programme development. The lessons that have been learned over the years for improving young child feeding are as follows: science is not enough; knowledge is not enough; the focus should be on improving practices; mothers are not a homogeneous group; and the solution is seldom singular. Processed complementary food is really a small piece of a larger picture that needs to be thought about strategically on the basis of practices and the barriers to improving them. It is important to work with governments to help them formulate and think through the options that present themselves to improve the nutritional intake of young children. Rather than using a zoom lens, which often magnifies the food component, we need to use a panoramic lens to see other options when helping countries.
The Essential Role of Communication in Behavioural Change
Authors: McGuire Judith
Published: November 2015

The use of a processed weaning food in a public health programme should never proceed without an effective programme of communication for behavioural change. There is a long and largely unsuccessful history of public health-oriented weaning foods. Most of the problems have been due to the lack of attention to behaviour, which is not a priority for most nutritionists. Food consumes programmes and consequently uses most of the economic and human resources devoted to the programme. A food programme is not a nutrition programme, and processed weaning foods are not always necessary and are not a priori the best food. The trade-offs between promoting processed foods versus promoting local foods must be considered. It is important not to let the scientifically perfect weaning food stand in the way of practical, sustainable solutions for improving the nutrition of infants and toddlers.
Processed Complementary Foods: Summary of Nutritional Characteristics, Methods of Production and Distribution, and Costs
Authors: Lutter Chessa K.
Published: November 2015

The cost of feeding Latin America's children is high, when viewed in the context of public expenditures on food. The need to increase the cost-effectiveness of such expenditures, coupled with the growing interest in partnerships between the public and private sectors and increases in urbanization, female employment, and household food expenditures, suggests a potential role for processed complementary food in the prevention of malnutrition. The nutritional characteristics of the various foods currently used in nutrition and health programmes are variable, depending on the scientific information available when the food was formulated. A growing interest in the role of the private sector in public health interventions is evidenced by the number of programmes in which such a collaboration exists. The cost of production per 100 g of dry product varies from US$0.04 for World Food Programme blended foods to approximately US$0.20 for recently formulated foods with a significantly higher fat content for national programmes in Mexico and Peru. The constraints and challenges for harnessing the potential of processed complementary foods to improve infant and child nutritional status are numerous. However, the multifactorial causation of child malnutrition points to the importance not only of ensuring access to the appropriate mix of foods, but also of promoting optimal breastfeeding and complementary feeding practices and care.
South African Experience with the Use of Red Palm Oil to Improve the Vitamin A Status of Primary Schoolchildren
Authors: van Stuijvenberg M. E. , Benadé A. J. S.
Published: November 2015

A randomized, controlled, three-month trial compared the effect of biscuits containing red palm oil as a source of β-carotene and biscuits containing synthetic β-carotene on the vitamin A status of primary schoolchildren. Children consuming either type of fortified biscuit had a significant improvement in serum retinol concentrations compared with control children who received an unfortified biscuit. Using a red palm oil shortening in the biscuit has several other advantages. Unlike the commercial fat normally used in the baking industry, red palm oil contains no trans fatty acids. Because of its high carotenoid and vitamin E contents, the need to add synthetic β-carotene and antioxidant to the baking mix is eliminated. Quality control is simplified. Production costs for the red palm oil biscuit are slightly lower than those for the synthetic β-carotene biscuit. Red palm oil is thus ideally suited for use as a source of β-carotene in food fortification in the baking industry.
Prevalence and Potential Determinants of Protein–energy Malnutrition in Upper Egypt
Authors: El-Sayed Nawal A. , Nofal Laila H. , Zeid Hamdy Abou , Gad Ashry M. , Shabayek Magda , Saleh Sanaa , Prince Mona El
Published: November 2015

The present community-based study of 2,700 children in three governorates of Upper Egypt revealed that stunting was present among 35.7% of the total sample. It was more prevalent in Menia (39.4%), followed by Assiut (38%), and Sohag (29.9%) governorates. Underweight was observed in 30.4% of all pre-schoolers (Menia 28.6%, Sohag 27.1%, and Assiut 25.7%). The prevalence of wasting in the whole sample was 9.2% (Assiut 10.8%, Sohag 9.3%, and Menia 7.6%). Protein–energy malnutrition (PEM) was usually higher in rural than in urban sites and higher in girls than in boys, with the second year of life showing the highest prevalence. Low socioeconomic level and high morbidity load were associated with increased risk of all PEM indicators. Integrated programmes are needed to improve socio-economic conditions and infant-feeding practices.
Household Structure and Dietary Patterns in the Afro-Ecuadorian Highlands
Authors: Guerrón-Montero Carla , Moreno-Black Geraldine
Published: November 2015

Dietary patterns in contemporary societies have been a primary focus of nutritional and anthropological research. Class, occupation, income, and gender have been studied when analyzing dietary patterns and the roots of malnutrition and hunger; however, the effects of household structure have received less attention. The main purpose of our study was to obtain information on the diet of a highland Afro-Ecuadorian community and examine the relationship between household structure and dietary patterns. Survey questionnaires, in-depth questionnaires, and participant observation were utilized to examine how women in female-headed households compare with women in male-headed households in meeting the dietary needs of their families. There was no significant difference in food-acquisition patterns. Weekly expenditures for food in the two types of households were similar, despite different income levels. However, female-headed households had higher food-group scores and consumed more meals per day.
Toward Better Compliance with Iron–folic Acid Supplements: Understanding the Behavior of Poor Urban Pregnant Women through Ethnographic Decision Models in Vadodara, India
Authors: Ghanekar Jai , Kanani Shubhada , Patel Sucheta
Published: November 2015

This study made an attempt to develop ethnographic decision models to understand and improve iron–folic acid supplement procurement and compliance-related behaviors of poor urban pregnant women in Vadodara, India, based on data obtained through the use of qualitative research tools. Open-ended, in-depth interviews were conducted with 36 pregnant women (17–32 weeks of gestation) purposively selected from four urban slums. Fortnightly home visits were made to the houses of 20 pregnant women–family member pairs to elicit behaviors related to iron–folic acid supplement procurement and compliance at the household level, from which the ethnographic decision models were developed. the hemoglobin levels of these women were also assessed. Regular counseling until delivery, based on the ethnographic data, helped to improve compliance, which resulted in 95% of the women consuming over 90% of the required dose. the mean hemoglobin level also improved from 9.6 to 11.08 g/dl until the end of the last trimester. This study highlighted the need for qualitative ethnographic data to develop such models that would help in the understanding of specific behaviors that influence program acceptance. Such data would have policy-level implications, for example, developing appropriate information-education-communication material and counseling strategies.
Comparison of a Positive Deviant Inquiry with a Case-Control Study to Identify Factors Associated with Nutritional Status among Afghan Refugee Children in Pakistan
Authors: Lapping Karin , Schroeder Dirk , Marsh David , Albalak Rachel , Jabarkhil Mohammad Zahir
Published: November 2015

We compared the positive deviance (PD) approach in Save the Children's field guide with a case-control study (CCS) to identify behaviors associated with good nutritional status in Afghan refugee children 6 to 24 months of age in the Northwest Frontier Province (NWFP), Pakistan. The positive deviance inquiry (PDI), utilizing observations and interviews with mothers, fathers, and secondary caregivers in eight households, identified 12 feeding, caring, and health-seeking behaviors that were not widely practiced. The CCS, using the same selection criteria and content as the PDI with 50 mother-child pairs not in the PDI, yielded six significant associations with good nutritional status. Both the PDI and CCS detected feeding behaviors. The PDI alone identified complex phenomena (active feeding and maternal affect). The CCS alone confirmed the beneficial use of health services. The PD approach was an affordable, participatory, and valid method to identify feeding behaviors and other factors associated with good nutrition in this context.
Effect of an Integrated Nutrition Program on Child Morbidity Due to Respiratory Infection and Diarrhea in Northern Viet Nam
Authors: Sripaipan Teerada , Schroeder Dirk G. , Marsh David R. , Pachón Helena , Dearden Kirk A. , Ha Tran Thu , Lang Tran Thi
Published: November 2015

Infectious disease and poor diet are the two proximal causes of malnutrition in children. During the 1990s, integrated nutrition programs implemented by Save the Children (SC) in Vietnam reduced severe child malnutrition, but it has not been clear if this impact was due primarily to improved diet or reduced disease. The aim of this study was to determine whether a community-based, integrated nutrition program in Vietnam reduced child morbidity due to diarrhea or acute respiratory infections. Children 5 to 25 months old were randomly selected from randomly assigned intervention and comparison communes. Caregivers of children from the intervention and comparison groups ( n = 119 per group) were interviewed about their child's morbidity at program baseline and at study months 2, 4, 6, and 12. Multiple logistic regression and general estimating equations (GEE) were used to evaluate the effect of the intervention on the occurrence of any diarrhea and respiratory illness in the preceding two weeks. Respiratory illness, mainly upper respiratory illness, was more common than diarrheal disease at baseline (54% vs. 6%, respectively). During follow-up, children in the intervention communes had approximately half the respiratory illness experienced by those in comparison communes (AOR = 0.5; p = .001). Diarrheal disease was also lower in the intervention group, although differences were not statistically significant. We conclude that SC's integrated nutrition program was associated with reduced upper respiratory illness, perhaps due to improved hygiene practices and/or improved micronutrient intakes.
Malnutrition and Dietary Protein: Evidence from China and from International Comparisons
Authors: Jamison Dean T. , Leslie Joanne , Musgrove Philip
Published: November 2015

Malnutrition, as measured by anthropometric status, is a powerful risk factor for illness and elevated death rates throughout life. Understanding the relative importance of disease, dietary quantity, and dietary quality in causing malnutrition is therefore of major importance in the design of public policy. This paper contributes to the understanding of the relative importance of quantity and quality of diet by utilizing aggregate data to complement previously reported individual-level studies. Three compilations of anthropometric data—one involving subjects from 13 provinces in China, another involving subjects from 64 counties in China, and a third involving 41 populations in 40 countries—are used to examine the relative importance for human growth of inadequacies of dietary energy and protein. The analysis involves regressing average adult heights and weights against estimates of average energy and protein availability (by province, county, or country) and per capita incomes. We use protein availability in part as a marker for overall quality of the diet, while recognizing that protein is far from perfectly correlated with dietary fat or micronutrient availability. The paper discusses issues of both data quality and statistical methodology, and points to relevant resulting caveats to our conclusions. Subject to these limitations, all three analyses suggest that, at the levels of dietary intake in these populations, lower protein intake is related to growth failure whereas lower levels of energy availability are not. The protein effect appears stronger for males than for females.
Food-Consumption Patterns in Central West Africa, 1961 to 2000, and Challenges to Combating Malnutrition
Authors: Honfoga B. G. , van den Boom G. J. M.
Published: November 2015

We discuss food-consumption patterns in Central West Africa from 1961 to 2000 and some implications for combating malnutrition. The availability of food in the region improved in the 1960s, declined sharply in the 1970s and the early 1980s, and has shown a modest positive trend since the mid-1980s. Notwithstanding obvious progress over the past decades and in the region as a whole, food availability today remains below the required levels for large parts of the population and appears unstable over time, particularly in the Sahelian zone. On average, diets in this zone contain fewer than 2,200 kcal, compared with almost 2,500 kcal in the coastal zone. Conversely, protein deficiency is more common in the coastal zone, where a typical diet contains only 45 g of protein, compared with 60 g in the Sahelian zone. Furthermore, consumption is showing a dietary shift toward cereals, while yield growth lags far behind population growth. The associated import dependency and pressure on land seem to gain significance regardless of the region's agro-ecological capacity to increase and to substitute cereal imports for locally produced food. Moreover, food consumption appears responsive to income changes (calorie-income elasticity ranges from 0.25 to 0.62), while, in turn, it has a significant impact on nutritional outcomes (stunting-calorie elasticity of −1.42). We conclude that combating malnutrition requires first broad-spectrum income growth, and next specific policies that promote the yield and the contribution to diets of nutritious food produced within the region.
Food Patterns during An Economic Crisis among Pregnant Women in Purworejo District, Central Java, Indonesia
Authors: Hartini Theresia Ninuk Sri , Winkvist Anna , Lindholm Lars , Stenlund Hans , Surjono Achmad
Published: November 2015

A cross-sectional study was conducted between 1996 and 1998. Six 24-hour recalls were performed during the second trimester of pregnancy among 450 women in Purworejo District, Central Java, Indonesia. The objectives of the study were to assess the food intake and food pattern among pregnant women before and during the economic crisis. Before the crisis, rich women had the highest intakes of animal foods, fats and oils, and sugar. Food intake among the urban poor and the rural landless poor subgroups was influenced by the emerging economic crisis. Although the price of rice increased, the intake of rice also increased among all subgroups. Rural poor women with access to rice fields increased their intake of rice and decreased their intake of nonrice staple foods (p < .05). There were significant decreases in the consumption of chicken by rich women and rural poor women with access to rice fields (p < .05). Rice was a strongly inferior good and remained an important supplier of energy, protein, and carbohydrate. Nuts and pulses were important suppliers of calcium and iron, and vegetables were an important supplier of vitamin A. Rich women increased their intake of nuts and pulses, vegetables, fats and oils, and sugar when their intake of rice increased (p < .05). The food patterns were based on rice, nuts and pulses, and vegetables, i.e., plant food. All but the rich women decreased their intake of nutritious foods such as meat, chicken, and fruits. The intake of nuts and pulses and of vegetables increased, whereas the intake of cooking oil and sugar remained constant.
Carotenoid-Rich Bananas: A Potential Food Source for Alleviating Vitamin A Deficiency
Authors: Englberger Lois , Darnton-Hill Ian , Coyne Terry , Fitzgerald Maureen H. , Marks Geoffrey C.
Published: November 2015

This review article points out that bananas are an important food for many people in the world. Thus, banana cultivars rich in provitamin A carotenoids may offer a potential food source for alleviating vitamin A deficiency, particularly in developing countries. Many factors are associated with the presently known food sources of vitamin A that limit their effectiveness in improving vitamin A status. Acceptable carotenoid-rich banana cultivars have been identified in Micronesia, and some carotenoid-rich bananas have been identified elsewhere. Bananas are an ideal food for young children and families for many regions of the world, because of their sweetness, texture, portion size, familiarity, availability, convenience, versatility, and cost. Foods containing high levels of carotenoids have been shown to protect against chronic disease, including certain cancers, cardiovascular disease, and diabetes. Because the coloration of the edible flesh of the banana appears to be a good indicator of likely carotenoid content, it may be possible to develop a simple method for selecting carotenoid-rich banana cultivars in the community. Research is needed on the identification of carotenoid-rich cultivars, targeting those areas of the world where bananas are a major staple food; investigating factors affecting production, consumption, and acceptability; and determining the impact that carotenoid-rich bananas may have on improving vitamin A status. Based on these results, interventions should be undertaken for initiating or increasing homestead and commercial production.
Dietary Assessment of Refugees Living in Camps: A Case Study of Mae La Camp, Thailand
Authors: Banjong Orapin , Menefee Andrea , Sranacharoenpong Kitti , Chittchang Uraiporn , Eg-kantrong Pasamai , Boonpraderm Atitada , Tamachotipong Sopa
Published: November 2015

This study presents data on consumption patterns, methods of food procurement, and adequacy of dietary intake among Burmese refugee camp households living along Thailand's border with Burma. Households established for one or more years and with children under 15 years of age were sampled. A questionnaire was used to determine economic, food-consumption, and dietary intake patterns; foods consumed were weighed and measured using a 24-hour recall for the household unit; and nutritional status was determined by a Microtoise tape and digital standing scales. In total, 182 households containing 1,159 people were surveyed. The average household energy and protein intakes were 96.6% and 111.4%, respectively, of the recommended daily allowance (RDA) for healthy Thais. Twelve percent of protein was derived from animal sources. Carbohydrate, protein, and fat accounted for 84%, 9%, and 7% of total energy, respectively. The intake of vitamins A, B1, B2, and C and of calcium ranged from 24.2% to 53.1% of the RDA. Iron intake was 85.3% of the RDA, derived mainly from rice, fermented fish, mung beans, green leafy vegetables, and eggs. Ration foods supplied 60.5% to 98.18% of all nutrients consumed in the households, with the exception of vitamins A and C. Among children under five years of age, 33.7% were underweight, 36.4% were stunted, and 8.7% were wasted. Although the refugees were able to procure some nonration foods by foraging, planting trees and vegetables, raising animals, and purchasing and exchanging ration foods for other items, the quantity and quality were not sufficient to compensate for the nutrients that were low or lacking in the ration. The overwhelming majority of dietary nutrients were provided by ration foods, and although the ration and the overall diet may be adequate for short-term subsistence, they do not suffice for long-term survival and optimal growth, especially for younger children.
The Foodlet Vehicle Designed for and Used in the Iris I Intervention
Authors: Lock Gabriela
Published: November 2015

At the behest of UNICEF, conceptual specifications from the International Workshop on Micronutrient Supplementation throughout the Life Cycle (held in Rio de Janeiro, Brazil, in November 1999) were developed for a chewable, flavored multiple-micronutrient vehicle that was a hybrid of a food and a tablet (i.e., “foodLET”). Two varieties of foodLET were created: one with a single infant–toddler RDA for selected micronutrients, and the other with two RDAs for the same vitamins and minerals. They were shipped and stored in special, hermetic blister packs to protect the physical form from crumbling and to protect the vitamins from oxidative damage. In the actual experience of delivering more than 40,000 foodLETs in four sites in diverse settings, the ability of the product to live up to the ideal characteristics can be assessed.
Bioavailability of Iron, Zinc, Folate, and Vitamin C in the Iris Multi-Micronutrient Supplement: Effect of Combination with a Milk-Based Cornstarch Porridge
Authors: Kamp Fernanda , Jandel Doris , Hoenicke Imke , Pietrzk Klaus , Gross Rainer , Trugo Nadia M.F. , Donangelo Carmen M.
Published: November 2015

The effect of combining a multi-micronutrient supplement with a milk-based cornstarch porridge on the bioavailability of iron, zinc, folate, and vitamin C was evaluated using the plasma curve response over time (8 hours) in healthy women. Three tests were carried out in a crossover design: S (multi-micronutrient supplement), MS (multi-micronutrient supplement plus test meal), and M (test meal). Relative bioavailability was determined as the percent ratio of the area under the curve (AUC) in MS corrected by M, and AUC in S. Compared to S, AUC in MS was smaller for iron (p < .05), for zinc (p < .01), and for folate (p < .05), but not different for vitamin C. Relative bioavailability was lower (p < .05) than 100% for iron (80%), zinc (70%), and folate (85%). The decrease in bioavailability of these nutrients when the multi-micronutrient supplement is combined with a milk-based cornstarch porridge is small. Therefore, the tested meal is a suitable vehicle for the multi-micronutrient supplement.
Iris I: A Foodlet-Based Multiple-Micronutrient Intervention in 6- to 12-Month-Old Infants at High Risk of Micronutrient Malnutrition in Four Contrasting Populations: Description of a Multicenter Field Trial
Authors:   International Research on Infant Supplementation (IRIS I) Study Group:, Smuts C. Marius , Benadé A.J. Spinnler , Berger Jacques , Hop Le Thi , de Romaña Guillermo López , Untoro Juliawati , Karyadi Elvina , Erhardt Jürgen , Gross Rainer
Published: November 2015

Infants in developing countries are at risk of concurrent micronutrient deficiencies, because the same causative factors may lead to deficiencies of different micronutrients. Inadequate dietary intake is considered one of the major causes of micronutrient deficiencies, especially among poor and underprivileged children in developing countries. Operational strategies and distribution systems are often duplicated when supplementation programs for single micronutrients are implemented at the same time. The International Research on Infant Supplementation (IRIS) trial was conducted in four distinct populations on three continents: Africa, Latin America, and Asia. The participating countries were South Africa, Peru, Vietnam, and Indonesia. The study had a randomized, doubleblind, placebo-controlled design. Each country aimed to enroll at least 70 infants per intervention group (65 + 5 anticipated dropouts). The micronutrient vehicle was in the form of a “foodlet” (food-like tablet) manufactured as chewable tablets, which were easy to break and dissolve, and which had the same taste, color, and flavor for all countries.

Children were randomly assigned to one of four 6-month intervention groups: group 1 received a daily foodlet containing multiple micronutrients; group 2 received a daily placebo foodlet containing no micronutrients; group 3 received a weekly foodlet that contained multiple micronutrients (twice the dose of the daily foodlet) and placebo foodlets on the other days of the week; group 4 received a daily foodlet containing only 10 mg of elemental iron.

The IRIS Trial aimed to examine the prevalence of multi-micronutrient deficiencies in 6- to 12-month-old infants from rural populations, and to examine the efficacy of multi-micronutrient supplementation in infants from the different countries included in the study. This paper describes the general methodology of the IRIS trial and the operational differences among the country sites.
Communicating the Benefits of Micronutrient Fortification
Authors: Griffiths Marcia
Published: November 2015

Food fortification offers an affordable, convenient, and effective mechanism to improve the nutrition status of large segments of a population. However, the success of fortification has been less than public-health professionals and private-sector companies alike have hoped for, though often for different reasons. As new opportunities are available, success will be dictated by the ability of public health professionals to learn from private food companies' marketing efforts and, in turn, for the food companies to learn from the public health sector about how to reach groups who need fortified products the most. Simply having fortified products on the market does not promise that consumers will use the products or that businesses will continue to promote them. Carefully crafted and strategically implemented behavior-change communication can inform and motivate consumers to purchase and use the products appropriately, and, in turn, can motivate food companies, program managers, and policy makers to participate in the marketing of these products. Public health and development professionals can learn from the success of private-sector companies in creating demand for products. Good consumer research and testing can guide effective development and marketing of fortified products, as they do for all products and services. Private-sector companies that know how to market products need assistance to focus on the poorest segments of a population to pursue cost-effective strategies to get the product to those in need, in addition to those with purchasing power for the new product. Audience-specific marketing strategies can ensure that the same fortified product reaches every person who would benefit from it.
Lysine-Fortified Wheat Flour Improves the Nutritional and Immunological Status of Wheat-Eating Families in Northern China
Authors: Zhao Wenhua , Zhai Fengying , Zhang Ding , An Yunqing , Liu Ying , He Yuna , Ge Keyou , Scrimshaw Nevin S.
Published: November 2015

The purpose of this study was to determine the impact of the fortification of wheat flour with lysine on selected health indicators among farm families obtaining 58% to 67% of their dietary protein from wheat. A man, a woman, and a child aged 5 to 12 years were studied from each of 88 families in a village near Huixian City, Henan Province, China. Half of the families received wheat flour fortified with 3 g of lysine per kilogram for three months, and the other half received wheat flour without fortification. The results showed a significantly greater gain in the height and weight of children receiving lysine-fortified wheat flour. Hemoglobin values were not affected. The mean prealbumin values of adult men and women were higher in those receiving lysine. The numbers of CD3 T cells increased significantly in women and children, as did the complement fraction C3 and IgG in men, IgA in women, and IgG, IgA, IgM, and C3 in children. These results indicate that lysine fortification of wheat flour can significantly improve some indicators of the nutritional status and immune function of family members consuming a wheat-based diet.
General Approaches to Estimation of Dietary Exposure to Contaminants
Authors: Pennington Jean
Published: November 2015

The initial steps in estimating dietary exposure to contaminants include gathering the necessary expertise, clarifying the intent and purpose of the work, selecting a dietary exposure model, and gathering available pertinent information. Expertise is generally needed in chemistry, agriculture, toxicology, statistics, nutritional epidemiology, and computer software development. The goal might be to determine the average exposure of a population to contaminants, to identify demographic groups within a population that are especially vulnerable to a contaminant, to evaluate the regulation of agricultural and food-manufacturing practices, or to determine compliance with standards for local and/or imported foods. Examples of dietary exposure models include the core food model, directed core food model, large database model, raw agricultural commodity (RAC) model, regional diet model, duplicate diet model, and total diet composite model. Each model has advantages and disadvantages and different costs and resource requirements. Consideration of the sources and flow of selected contaminants though the food supply may help identify the best exposure model to use. Pertinent information that may already be available includes analytical data on contaminants in foods or commodities, government regulations pertaining to the levels of contaminants in foods, food-consumption data, data on the average body weights of age-gender groups (to express exposure on a body weight basis), and biochemical measures of contaminants or their residues/metabolites. Collecting available information helps to clearly define what critical information is missing so that the planned research can be most effective. Careful documentation of decisions and assumptions allows for recalculating exposure estimates with the same model using different decisions and assumptions; documentation also allows others to understand what was done and how to use the resulting intake estimates properly. Clearly identifying the limitations of the exposure model may provide justification for additional resources to further refine and improve the model.
Rationale for Developing a New International Growth Reference
Authors: Garza Cutberto , de Onis Mercedes
Published: November 2015

The rationale for developing a new international growth reference derived principally from a Working Group on infant growth established by the World Health Organization (WHO) in 1990. It recommended an approach that described how children should grow rather than describing how children grow; that an international sampling frame be used to highlight the similarity in early childhood growth among diverse ethnic groups; that modern analytical methods be exploited; and that links among anthropometric assessments and functional outcomes be included to the fullest possible extent. Upgrading international growth references to resemble standards more closely will assist in monitoring and attaining a wide variety of international goals related to health and other aspects of social equity. In addition to providing scientifically robust tools, a new reference based on a global sample of children whose health needs are met will provide a useful advocacy tool to health-care providers and others with interests in promoting child health.
Implementation of the who Multicentre Growth Reference Study in Oman
Authors: Prakash Nitya S. , Mabry Ruth M. , Mohamed Ali J. , Alasfoor Deena
Published: November 2015

The World Health Organization (WHO) Multicentre Growth Study (MGRS) Middle East site was Muscat, Oman. A survey in Muscat found that children in households with monthly incomes of at least 800 Omani Rials and at least four years of maternal education experienced unconstrained growth. The longitudinal study sample was recruited from two hospitals that account for over 90% of the city's births; the cross-sectional sample was drawn from the national Child Health Register. Residents of all districts in Muscat within the catchment area of the two hospitals were included except Quriyat, a remote district of the governorate. Among the particular challenges of the site were relatively high refusal rates, difficulty in securing adherence to the protocol's feeding recommendations, locating children selected for the cross-sectional component of the study, and securing the cooperation of the children's fathers. These and other challenges were overcome through specific team building and public relations activities that permitted the successful implementation of the MGRS protocol.
Fertility Behavior and Reproductive Outcomes among Young Guatemalan Adults
Authors: Ramakrishnan Usha , Yount Kathryn M. , Behrman Jere R. , Graff Mariaelisa , Grajeda Rubén , Stein Aryeh D.
Published: November 2015

Fertility rates have declined in many developing countries and this has implications for health and development of subsequent generations. Guatemala has the highest fertility rates in Central America. Reproductive histories were obtained by interview in 2002–04, in a cohort of 779 women and 647 men who had participated as young children in a nutrition supplementation trial in Guatemala conducted between 1969 and 1977. Most women (77%) and men (79%) are currently married. Among the 700 women and 524 men reporting at least one birth, mean age at first birth was 20.7 ± 3.8 years and 23.1 ± 3.9 years respectively. Knowledge (> 80%) and use (∼70%) of modern contraceptive methods is fairly high; knowledge increases with parental socioeconomic status (SES) as measured in 1975. Younger respondents have experienced fewer pregnancies and live births compared with older respondents; age-specific fertility rates between 20 and 24 years were 294, 249, 236, and 261 births per 1,000 women, respectively, for women born from 1962–65, 1966–69, 1969–73, and 1974–77. Women in the top tertile of parental SES have had significantly fewer pregnancies (3.3) compared with those in the middle (3.7) and lower (3.8) tertiles. Migrants to Guatemala City reported greater knowledge of contraceptive methods, fewer pregnancies and living children, higher age at first birth, and more pregnancy and newborn complications as compared with cohort members who remained in the original villages (p < .05 for each comparison). Fertility rates, especially between 20 and 24 years, have declined over time. Differences in reproductive behaviors by parental SES and current residence suggest the role of social transitions in determining family formation in Guatemala.
Research Note: A Socioeconomic Index for the INCAP Longitudinal Study 1969–77
Authors: Maluccio John A. , Murphy Alexis , Yount Kathryn M.
Published: November 2015

In this note, we calculate and describe proxy measures that account for variation in standard of living across subjects in the Institute of Nutrition of Central America and Panama (INCAP) Longitudinal Study (1969–77), at the time of the original intervention. Using principal components analysis, we construct two linear indices from an array of household consumer durable goods and housing characteristics, measured at the nuclear family level in the 1975 cross-sectional census. The two indices perform well on three dimensions. First, they are internally coherent in that average ownership and quality of housing characteristics increase with the principal component score. Second, they are robust in that the different approaches yield similar results, for example, in classifying nuclear families into tertiles. And third, they are consistent in that they yield results similar to scores constructed by previous researchers. The indices can be used as background controls in analyses of the INCAP Longitudinal Study (1969–77) data and subsequent follow-up studies, including the Human Capital Study 2002–04. Several articles presented in this supplement to the Food and Nutrition Bulletin used the 1975 index.
Height, Weight, and Education Achievement in Rural Peru
Authors: Cueto Santiago
Published: November 2015

The education system in Peru and many other developing countries faces several challenges, including improving education achievement and increasing education enrollment in high school. It is clear from several indicators that rural students have lower education outcomes than do urban students. In this study we used cross-sectional and longitudinal analysis to determine the relationship between height-for-age z-scores (HAZ), weight-for-age z-scores (WAZ), body-mass index (BMI), and education outcomes. The sample was composed of students from 20 elementary public schools in two rural zones in Peru. The descriptive results show that there was no association between any of the anthropometric variables and achievement (mathematics and reading comprehension) or advancing to high school without repeating a grade. However, BMI was associated with dropping out of school: children with higher BMI in 1998 were more likely to be out of school by 2001. The hierarchical multivariate analysis also showed no relationship between anthropometry and achievement at the individual level, but students with relatively higher HAZ in 1998 were more likely to be drop-outs by 2001. These results contradict prior findings that showed a positive association between anthropometric variables (especially HAZ) and education achievement. The results might be explained by the fact that the study was carried out at very poor sites, at altitudes between 3,000 and 3,500 meters above sea level. The scarce studies about development in high altitudes suggest that the patterns for height and weight for children and adolescents are different than at sea level. Another possible explanation has to do with the fact that in the contexts studied, children who are perceived as relatively heavier (BMI) or taller (HAZ) might be expected to be out of school and start working (in fact, this was the primary reason given by children for dropping out of school).
Micronutrient Status and Intervention Programs in Malaysia
Authors: Khor Geok Lin
Published: November 2015

Approximately 70% of the world's malnourished children live in Asia, giving that region the highest concentration of childhood malnutrition worldwide. Prevalence of stunting and underweight are high especially in south Asia where one in every two preschool children is stunted. Iron-deficiency anemia affects 40%–50% of preschool and primary schoolchildren. Nearly half of all vitamin A deficiency and xerophthalmia in the world occurs in south and southeast Asia. Iodine deficiency disorders have resulted in high goiter rates in India, Pakistan, and parts of Indonesia. Compared with other developing countries in Asia, the nutrition situation in Malaysia is considerably better, owing to rapid economic and socioeconomic development that has occurred since Malaysia gained its independence in 1957. Prevalence of undernutrition and micronutrient deficiency is markedly lower in Malaysian children. Nonetheless, undernutrition in the form of underweight, stunting, and anemia can be found in poor communities throughout the country. A prevalence of 25% underweight and 35% stunting is reported among young children from poor rural households. Anemia and subclinical forms of vitamin A deficiency were reported in children under 5 years old. Typical of a country in nutrition transition, Malaysia faces the dual burden of malnutrition in children, with the persistence of undernutrition problems especially among the poor and the emerging overweight problem especially in urban areas. Since 1996, nutrition programs of the government sector are coordinated under the National Plan of Action for Nutrition. These activities and other nutrition intervention efforts by other agencies are discussed in this paper.
Fortification of Soy Sauce Using Various Iron Sources: Sensory Acceptability and Shelf Stability
Authors: Watanapaisantrakul Ratana , Chavasit Visith , Kongkachuichai Ratchanee
Published: November 2015

Background

Soy sauces are available in different types and grades, which allows them to reach consumers of all socioeconomic groups. Ferric sodium ethylenediaminetetraacetic acid (NaFeEDTA) has been used for iron fortification of soy sauces in some countries, however, its high cost may make it unattractive to policymakers and industry.

Objective

We evaluated the feasibility of using more economical iron sources for iron fortification, with soy sauce of various types and grades used as a vehicle.

Methods

Seven iron sources were tested for their feasibility for fortification of four types of soy sauce: naturally fermented in the traditional style, naturally fermented according to large-scale industrial formulas 1 and 5, and chemically hydrolyzed at 5 mg per serving (15 mL, per Thailand's food labeling regulations). Either citric acid or sodium citrate was added at 0.1% as a chelator.

Results

Five iron sources—ferrous sulfate, NaFeEDTA, ferric ammonium citrate, ferrous lactate, and ferrous gluconate—did not significantly affect the sensory qualities of the product over a period of 3 months ( p > .05). Ferrous fumarate and ferrous bisglycinate caused unacceptable precipitation. Less than 3% of 260 and 306 commonly cooked foods out of 871 and 772 preparations using soy sauces fortified with NaFeEDTA and ferrous sulfate, respectively, were found to be different from normal with regard to sensory qualities. The cost of fortification was US 0.22 cents to US 3.28 cents per bottle (700 mL).

Conclusions

Both naturally fermented and chemically hydrolyzed soy sauces could be fortified with all five iron sources. Ferrous sulfate is the most appropriate source because of its low cost and acceptable sensory characteristics. Soy sauce is a promising vehicle for iron fortification, however, the bioavailability of iron in the products examined here needs to be evaluated under normal use conditions.
Women's Empowerment and Domestic Violence: The Role of Sociocultural Determinants in Maternal and Child Undernutrition in Tribal and Rural Communities in South India
Authors: Sethuraman Kavita , Lansdown Richard , Sullivan Keith
Published: November 2015

Background

Moderate malnutrition continues to affect 46% of children under five years of age and 47% of rural women in India. Women's lack of empowerment is believed to be an important factor in the persistent prevalence of malnutrition. In India, women's empowerment often varies by community, with tribes sometimes being the most progressive.

Objective

To explore the relationship between women's empowerment, maternal nutritional status, and the nutritional status of their children aged 6 to 24 months in rural and tribal communities.

Methods

This study in rural Karnataka, India, included tribal and rural subjects and used both qualitative and quantitative methods of data collection. Structured interviews with mothers were performed and anthropometric measurements were obtained for 820 mother—child pairs. The data were analyzed by multivariate and logistic regression.

Results

Some degree of malnutrition was seen in 83.5% of children and 72.4% of mothers in the sample. Biological variables explained most of the variance in nutritional status, followed by health-care seeking and women's empowerment variables; socioeconomic variables explained the least amount of variance. Women's empowerment variables were significantly associated with child nutrition and explained 5.6% of the variance in the sample. Maternal experience of psychological abuse and sexual coercion increased the risk of malnutrition in mothers and children. Domestic violence was experienced by 34% of mothers in the sample.

Conclusions

In addition to the known investments needed to reduce malnutrition, improving women's nutrition, promoting gender equality, empowering women, and ending violence against women could further reduce the prevalence of malnutrition in this segment of the Indian population.