bluuebunny/crossref_metadata_2025 huggingface dataset:
Determining Life-Stage Groups and Extrapolating Nutrient Intake Values (NIVs)
Authors: Atkinson Stephanie A. , Koletzko Berthold
Published: November 2015

The derivation of reference values in 11 current dietary reference standards is often based on methods of extrapolation or interpolation, but these are not consistent across reports. Such methods are frequently employed to derive nutrient intake values (NIVs) for infants and children owing to the paucity of relevant research data available. The most common method is to extrapolate values for children down from those of adults, employing a weight or metabolic factor and adjusting for growth. In some instances, values for young children are extrapolated up from infants, values for adults are extrapolated up from children, or values for older adults are extrapolated up from young adults. Extrapolation is employed to estimate not only nutrient requirement or adequate intake but also the upper tolerable levels of intake. Extrapolation methods may also form the basis of estimates of tissue deposition of nutrients during growth in children and for the maternal/fetal dyad in pregnancy with adjustments for metabolic efficiency. Likewise, recommended intakes during lactation are extrapolated from known secretion of the nutrient in milk with adjustments for bioavailability. For future dietary standards, a first priority is to obtain relevant scientific data using current methodology, such as stable isotope tracers, body composition analysis, and appropriate biomarkers, from which NIVs for each age group can be derived. Extrapolation to derive an NIV is only acceptable in the sheer absence of sound scientific data and must be modeled with a consistent approach. For the purpose of harmonization of dietary standards, we recommend the following approaches that should be clearly described in reports: standardization of age groups on a biological basis (growth and pubertal stages) with consideration of relevant developmental milestones throughout childhood; application of internationally accepted standards for growth, body size, body composition, fetal and maternal nutrient accretion in pregnancy, and milk composition; and inclusion of appropriate adjustments (metabolic efficiency, weight change, or physical activity).
Cross-Sectoral Coordination Failure: How Significant a Constraint in National Efforts to Tackle Malnutrition in Africa?
Authors: Benson Todd
Published: November 2015

Background

Malnutrition arises from multifaceted causes and requires action from multiple sectors to address. Consequently, oversight and direction are said to be required to ensure that public goods and services needed to reduce malnutrition are delivered by the sectors responsible in a coordinated fashion. To do so, many countries have established cross-sectoral national nutrition coordination agencies.

Objective

The performance of such agencies established recently in three African countries is evaluated to determine how critical their intersectoral coordination function is to national public efforts to reduce malnutrition.

Methods

This evaluation uses qualitative information on the national institutional frameworks within which nutrition activities are carried out in Mozambique, Nigeria, and Uganda, countries with such agencies, and in Ghana, which has none.

Results

None of the agencies has so far effectively carried out the three functions on which they were evaluated: cross-sectoral coordination, advocacy to sustain political commitment to address malnutrition, and resource mobilization. No cross-sectoral national nutrition initiatives are being implemented. Nutrition does not feature strategically in the master development frameworks in any country. No additional government resources have been mobilized, although international resources have been.

Conclusions

The agencies have proven of limited value to the malnourished in these countries. However, cross-sectoral barriers are not the primary reason for this ineffectiveness. Rather, inability to maintain continued political commitment for efforts to address malnutrition—in short, advocacy—is the principal deficiency in performance. Cross-sectoral coordination only becomes important if malnutrition itself is treated as a politically important problem, thereby stimulating action in various sectors.
Dietary Indicators for Assessing the Adequacy of Population Zinc Intakes
Authors: Hotz Christine
Published: November 2015

The assessment of dietary zinc intakes is an important component of evaluating the risk of zinc deficiency in populations, and for designing appropriate food-based interventions, including fortification, to improve zinc intakes. The prevalence of inadequate zinc intakes can describe the relative magnitude of the risk of zinc deficiency in the population and identify subpopulations at elevated risk. As a cornerstone to evaluating the adequacy of population zinc intakes globally, a set of internationally appropriate dietary reference intakes must be defined. The World Health Organization/Food and Agriculture Organization/International Atomic Energy Agency (WHO/FAO/IAEA) and the Food and Nutrition Board/US Institute of Medicine (FNB/IOM) have presented estimated average requirements (EAR) for dietary zinc intake, and, more recently, the International Zinc Nutrition Consultative Group (IZiNCG) presented a revised set of recommendations for international use. A prevalence of inadequate zinc intakes greater than 25% is considered to represent an elevated risk of population zinc deficiency. As the requirement estimates are derived from smaller, clinical studies and, for children, most components of the estimates are extrapolated from data for adults, it was desirable to evaluate their internal validity. The estimated physiological requirements for adult men and women appear to adequately predict zinc status as determined by biochemical indicators of status and/or zinc balance. With the use of data from available studies, the reported prevalence of low serum zinc concentration and the estimated prevalence of inadequate zinc intakes predict similar levels of risk of zinc deficiency, particularly among pregnant and nonpregnant women. Conformity between these two indicators is less consistent for children, suggesting that further data and/or direct studies of zinc requirements among children are needed.
Comments on Background Papers Related to Iron, Folic Acid, Malaria and Other Infections
Authors: Oppenheimer Stephen
Published: November 2015

This review comments on and summarizes five expert presentations and reports made at a meeting hosted by the World Health Organization (WHO) in Lyon, France, 12–14 June 2006, related to iron and folate supplementation and their interactions with infection. The meeting was called because of the mortality implications of the Pemba iron study and the possible need to change WHO policy as soon as possible. Six tabled presentations were reviewed. A majority of these expert reviews regarded the Pemba study as indicating a specific adverse interaction between iron supplementation and malaria. A majority regarded such an effect as already reviewed, demonstrated, and predicted in existing literature published prior to the Pemba study. A majority concluded that there was a risk of malarial morbidity associated with oral iron supplementation. A majority made recommendations for change, indicating either that the 1998 WHO/UNICEF recommendation for iron supplementation in malarious areas should be suspended pending further research or that it should be stopped. A majority felt that folate supplementation was a less likely cause of the Pemba result; two mentioned the interference of oral folate with antifolate antimalarials; a majority suggested suspension of folic acid supplementation to children in malarious areas. Only one presentation argued for net population benefits of folate and none for iron.
Iron Fortification: Its Efficacy and Safety in Relation to Infections
Authors: Hurrell Richard F.
Published: November 2015

Iron-fortification programs are efficacious and effective provided recent guidelines are followed: the iron compound is carefully chosen and its level in the food is based on target population requirements, the amount lacking in the diet, and the iron bioavailability of the diet and the compound. For monitoring, serum ferritin and transferrin receptor should be included in addition to hemoglobin. Thus, recent studies of provision of iron-fortified salt to children in Morocco, rice to children in India, wheat flour to women in Thailand, and fish sauce in Vietnam have demonstrated efficacy and effectiveness. All were in nonmalarious areas, and intestinal parasites were uncommon except in India, where the children were dewormed. C-reactive protein was used to eliminate high ferritin values due to infection. An efficacy study of iron-fortified salt in dewormed school-aged children in Côte d'Ivoire, where the prevalence of malaria parasitemia was 55%, found no change in hemoglobin after 6 months, but serum ferritin increased and transferrin receptor decreased significantly, and the increase in body iron and estimated iron absorbed compared favorably with the results of a study of similar design in Morocco, where the prevalence of iron-deficiency anemia decreased from 30% to 5% after 10 months. Hence, iron-fortification programs in malarious areas may not decrease anemia prevalence but will improve iron status and, presumably, iron-dependent health outcomes. Eight studies in nonmalarious areas, all but one in infants receiving iron-fortified formula, have found no evidence of increase in infections and some evidence of a decrease in respiratory infection. There have been no studies in malarious areas.
Nutrition Education for Student Community Volunteers: A Comparative Study of two Different Communication Methods
Authors: Vijayapushpam T. , Rao G.M. Subba , Antony Grace Maria , Rao D. Raghunatha
Published: November 2015

Background

Nutrition education for student volunteers can enhance their skills, and they can act as change agents in the community. There is a dearth of data from India on the effectiveness of different communication tools in providing nutrition education to student volunteers.

Objective

This study aims to examine the comparative effectiveness of two different methods of communication—lectures in the classroom aided by print material, and a televised version of a local folk-dance form—for providing nutrition education to student community volunteers in a South Indian state.

Methods

Interventions were conducted during two mega-camps of student volunteers (camps 1 and 2) with 70 and 137 participants, respectively. Their knowledge levels were tested at baseline. Camp 1 received the lecture intervention and camp 2 the televised folk-dance intervention. Knowledge scores were measured before and after the intervention in each camp, and the two camps were compared for significant improvements in knowledge.

Results

At baseline, the knowledge levels of students in both camps were comparable. Significant improvement in knowledge was observed in both camps after intervention ( p < .05). Although there was no significant difference between the camps in improvement in knowledge, a significant difference was observed when only the positive increments (improvement over baseline) were compared.

Conclusions

The televised version of the folk-dance form was better in bringing about positive increment.
Anemia Prevalence and Risk Factors in Pregnant Women in an Urban Area of Pakistan
Authors: Baig-Ansari Naila , Badruddin Salma Halai , Karmaliani Rozina , Harris Hillary , Jehan Imtiaz , Pasha Omrana , Moss Nancy , McClure Elizabeth M. , Goldenberg Robert L.
Published: November 2015

Background

Anemia affects almost two-thirds of pregnant women in developing countries and contributes to maternal morbidity and mortality and to low birthweight.

Objective

To determine the prevalence of anemia and the dietary and socioeconomic factors associated with anemia in pregnant women living in an urban community setting in Hyderabad, Pakistan.

Methods

This was a prospective, observational study of 1,369 pregnant women enrolled at 20 to 26 weeks of gestation and followed to 6 weeks postpartum. A blood sample was obtained at enrollment to determine hemoglobin levels. Information on nutritional knowledge, attitudes, and practice and dietary history regarding usual food intake before and during pregnancy were obtained by trained interviewers within 1 week of enrollment.

Results

The prevalence of anemia (defined by the World Health Organization as hemoglobin < 11.0 g/dL) in these subjects was 90.5%; of these, 75.0% had mild anemia (hemoglobin from 9.0 to 10.9 g/dL) and 14.8% had moderate anemia (hemoglobin from 7.0 to 8.9 g/dL). Only 0.7% were severely anemic (hemoglobin < 7.0 g/dL). Nonanemic women were significantly taller, weighed more, and had a higher body mass index. Multivariate analysis after adjustment for education, pregnancy history, iron supplementation, and height showed that drinking more than three cups of tea per day before pregnancy (adjusted prevalence odds ratio [aPOR], 3.2; 95% confidence interval [CI], 1.3 to 8.0), consumption of clay or dirt during pregnancy (aPOR, 3.7; 95% CI, 1.1 to 12.3), and never consuming eggs or consuming eggs less than twice a week during pregnancy (aPOR, 1.7; 95% CI, 1.1 to 2.5) were significantly associated with anemia. Consumption of red meat less than twice a week prior to pregnancy was marginally associated with anemia (aPOR, 1.2; 95% CI, 0.8 to 1.8) but was significantly associated with lower mean hemoglobin concentrations (9.9 vs. 10.0 g/dL, p = .05) during the study period. A subanalysis excluding women with mild anemia found similar associations to those of the main model, albeit even stronger.

Conclusions

A high percentage of women at 20 to 26 weeks of pregnancy had mild to moderate anemia. Pica, tea consumption, and low intake of eggs and red meat were associated with anemia. Women of childbearing age should be provided nutritional education regarding food sources of iron, especially prior to becoming pregnant, and taught how food choices can either enhance or interfere with iron absorption.
Household Income and Expenditure Surveys: A Tool for Accelerating the Development of Evidence-Based Fortification Programs
Authors: Fiedler John L. , Smitz Marc-Francois , Dupriez Olivier , Friedman Jed
Published: November 2015

Background

One-third of the world's population suffers from micronutrient deficiencies due primarily to inadequate dietary intake. Food fortification is often touted as the most promising short- to medium-term strategy for combating these deficiencies. Despite its appealing characteristics, progress in fortification has been slow.

Objective

To assess the potential of household food-purchase data to fill the food-consumption information gap, which has been an important factor contributing to the slow growth of fortification programs.

Methods

Household income and expenditure survey (HIES) data about: (a) a population's distribution of apparent household consumption, which are essential to setting safe fortification levels, (b) the proportion of households purchasing “fortifiable” food, and (c) the quantity of food being purchased were used to proxy food-consumption data and develop suggested fortification levels.

Results

The usefulness of the approach in addressing several common fortification program design issues is demonstrated. HIES-based suggested fortification levels are juxtaposed with ones developed using the most common current approach, which relies upon Food and Agriculture Organization (FAO) Food Balance Sheets.

Conclusions

Despite its limitations, the use of HIES data constitutes a generally unexploited opportunity to address the food-consumption information gap by using survey data that nearly every country of the world is already routinely collecting. HIES data enable the design of fortification programs to become more based on country-specific data and less on general rules of thumb. The more routine use of HIES data constitutes a first step in improving the precision of fortification feasibility analyses and improving estimates of the coverage, costs, and impact of fortification programs.
The Worldwide Challenge of the Dementias: A Role for B Vitamins and Homocysteine?
Authors: Smith A. David
Published: November 2015

Dementia has reached epidemic proportions, with an estimated 4.6 million new cases worldwide each year. With an aging world population, the prevalence of dementia will increase dramatically in the next few decades. Of the predicted 114 million who will have dementia in 2050, about three-quarters will live in less developed regions. Although strongly age-related, dementia is not an inevitable part of aging but is a true disease, caused by exposure to several genetic and nongenetic risk factors. Prevention will be possible when the nongenetic risk factors have been identified. Apart from age, more than 20 nongenetic risk factors have been postulated, but very few have been established by randomized intervention studies. Elevated blood concentrations of total homocysteine and low-normal concentrations of B vitamins (folate, vitamin B12, and vitamin B6) are candidate risk factors for both Alzheimer's disease and vascular dementia. Seventy-seven cross-sectional studies on more than 34,000 subjects and 33 prospective studies on more than 12,000 subjects have shown associations between cognitive deficit or dementia and homocysteine and/or B vitamins. Biologically plausible mechanisms have been proposed to account for these associations, including atrophy of the cerebral cortex, but a definite causal pathway has yet to be shown. Raised plasma total homocysteine is a strong prognostic marker of future cognitive decline, and is common in world populations. Low-normal concentrations of the B vitamins, the main determinant of homocysteine concentrations, are also common and occur in particularly vulnerable sections of the population, such as infants and elderly. Large-scale randomized trials of homocysteine-lowering vitamins are needed to see if a proportion of dementia in the world can be prevented.
Education and Improved Iron Intakes for Treatment of Mild Iron-Deficiency Anemia in Adolescent Girls in Southern Benin
Authors: Alaofè Halimatou , Zee John , Dossa Romain , O'Brien Huguette Turgeon
Published: November 2015

Background

To our knowledge, the impact of a nutrition education program combined with an increase in bioavailable dietary iron to treat iron-deficiency anemia has never been studied in adolescent girls.

Objective

To evaluate the impact of an intensive dietary program for the treatment of iron-deficiency anemia in 34 intervention and 34 control boarding-school girls aged 12 to 17 years from Benin.

Methods

A quasi-experimental design consisting of 4 weeks of nutrition education combined with an increase in the content and bioavailability of dietary iron for 22 weeks was implemented in the intervention school, but not in the control school. Data were obtained from both groups from a nutrition knowledge questionnaire, 24-hour dietary recalls, anthropometric measurements, measurement of iron status indices, and screening for malarial and intestinal parasitic infections.

Results

Nutrition knowledge scores and mean intakes of nutrients, including dietary iron, absorbable iron, and vitamin C, were significantly higher in the intervention group ( p < .05) than in the control group after 26 weeks. Mean hemoglobin and serum ferritin values were also significantly higher in the intervention group than in the control group (122 vs. 112 g/L [p = .0002] and 32 vs. 19 μg/L [ p = .04], respectively), whereas the prevalence of anemia (32% vs. 85% [ p = .005] and iron-deficiency anemia (26% vs. 56% [ p = .04]) was significantly lower in the intervention group than in the control group. No significant differences between the groups were observed in intestinal parasitic infections or malaria status postintervention.

Conclusions

A multidietary strategy aiming to improve available dietary iron can reduce iron-deficiency anemia in adolescent girls.
The Costs and Cost-Efficiency of Providing Food through Schools in Areas of High Food Insecurity
Authors: Gelli Aulo , Al-Shaiba Najeeb , Espejo Francisco
Published: November 2015

Background

The provision of food in and through schools has been used to support the education, health, and nutrition of school-aged children. The monitoring of financial inputs into school health and nutrition programs is critical for a number of reasons, including accountability, transparency, and equity. Furthermore, there is a gap in the evidence on the costs, cost-efficiency, and cost-effectiveness of providing food through schools, particularly in areas of high food insecurity.

Objective

To estimate the programmatic costs and cost-efficiency associated with providing food through schools in food-insecure, developing-country contexts, by analyzing global project data from the World Food Programme (WFP).

Methods

Project data, including expenditures and number of schoolchildren covered, were collected through project reports and validated through WFP Country Office records. Yearly project costs per schoolchild were standardized over a set number of feeding days and the amount of energy provided by the average ration. Output metrics, such as tonnage, calories, and micronutrient content, were used to assess the cost-efficiency of the different delivery mechanisms.

Results

The average yearly expenditure per child, standardized over a 200-day on-site feeding period and an average ration, excluding school-level costs, was US$21.59. The costs varied substantially according to choice of food modality, with fortified biscuits providing the least costly option of about US$11 per year and take-home rations providing the most expensive option at approximately US$52 per year. Comparisons across the different food modalities suggested that fortified biscuits provide the most cost-efficient option in terms of micronutrient delivery (particularly vitamin A and iodine), whereas on-site meals appear to be more efficient in terms of calories delivered. Transportation and logistics costs were the main drivers for the high costs.

Conclusions

The choice of program objectives will to a large degree dictate the food modality (biscuits, cooked meals, or take-home rations) and associated implementation costs. Fortified biscuits can provide substantial nutritional inputs at a fraction of the cost of school meals, making them an appealing option for service delivery in food-insecure contexts. Both costs and effects should be considered carefully when designing the appropriate school-based intervention. The costs estimates in this analysis do not include all school-level costs and are therefore lower-bound estimates of full implementation costs.
Nutritional Monitoring of Preschool-Age Children by Community Volunteers during Armed Conflict in the Democratic Republic of the Congo
Authors: Bisimwa Ghislain , Mambo Thierry , Mitangala Prudence , Schirvel Carole , Porignon Denis , Dramaix Michèle , Donnen Philippe
Published: November 2015

Background

The coverage of preschool preventive medical visits in developing countries is still low. Consequently, very few children benefit from continuous monitoring during the first 5 years of life.

Objective

To assess community volunteers' effectiveness in monitoring the growth of preschool-age children in a context of endemic malnutrition and armed conflict.

Methods

Community volunteers were selected by village committees and trained to monitor children's growth in their respective villages. Community volunteers monitored 5,479 children under 5 years of age in the Lwiro Health Sector of the Democratic Republic of the Congo from January 2004 to December 2005 under the supervision of the district health office. Children's weight was interpreted according to weight-for-age curves drawn on the growth sheet proposed by the World Health Organization and adopted by the Democratic Republic of the Congo.

Results

During the 2-year program, the volunteers weighed children under 5 years of age monthly. The median percentage of children weighed per village varied between 80% and 90% for children of 12–59 months, and 80% and 100% for children of less than 12 months even during the conflict period. The median percentage of children between 12 and 59 months of age per village ranked as highly susceptible to malnutrition by the volunteers decreased from 4.2% (range, 0% to 35.3%) in 2004 to 2.8% (range, 0.0% to 18.9%) in 2005.

Conclusions

The decentralization of weighing of children to the community level could be an alternative for improving growth monitoring of preschool-age children in situations of armed conflict or political instability. This option also offers an opportunity to involve the community in malnutrition care and can be an entry point for other public health activities.
Effective Nutrition Programming for Children and the Role of UNICEF: Consensus Points from an Expert Consultation
Authors: Schultink Werner , Arabi Mandana
Published: November 2015

Countries of the world have agreed on eradicating extreme poverty and hunger and reducing the mortality rate of children under five by two-thirds by 2015 as part of the Millennium Development Goals, and without mainstreaming maternal, infant, and young child nutrition in the development agenda, these goals cannot be achieved.

Although the recent Lancet Series on Maternal and Child Undernutrition brought attention to the importance of early nutrition interventions to improve child health, nutrition, and future economic productivity, there needs to be a more concerted effort at clarifying the path forward, focusing on moving beyond projects and evidence from randomized, controlled trials towards developing large-scale programs with sound plausibility design to achieve results for children. In an effort to cast a fresh eye on nutrition programming in light of the new evidence, UNICEF Headquarters hosted an Expert Consultation on effective nutrition programming with participants from various academic organizations and United Nations agencies to discuss effective program strategies in nutrition. The consultation resulted in recommendations for UNICEF on eight focus areas for programming and recognition of six overarching themes. It is clear that more action is needed to accelerate progress: more effective global coalitions, better coordination, more coherence, and better targeting of efforts.
Implementing an Integrated Nutrition Package at Large Scale in Madagascar: The Essential Nutrition Actions Framework
Authors: Guyon Agnès B. , Quinn Victoria J. , Hainsworth Michael , Ravonimanantsoa Priscilla , Ravelojoana Voahirana , Rambeloson Zo , Martin Luann
Published: November 2015

Background

Madagascar has some of the highest rates of child stunting, maternal malnutrition, and infant mortality in sub-Saharan Africa.

Objective

To improve infant and young child feeding practices, increase uptake of micronutrient supplements, and improve women's dietary practices through implementation of a nutrition project based on the Essential Nutrition Actions (ENA) framework.

Methods

Interventions included training, interpersonal communication, community mobilization, and mass media. Changes in practices were assessed through a comparison of data for children under 2 years of age from representative cross-sectional household surveys collected at baseline in 2000 ( n = 1,200) and at the end of program implementation in 2005 ( n = 1,760). The surveys were conducted in six districts with a population of 1.4 million.

Results

The rate of initiation of breastfeeding within 1 hour of birth increased from 32% to 68%, the rate of exclusive breastfeeding of infants under 6 months of age increased from 42% to 70%, the rate of continuation of breastfeeding at 20 to 23 months increased from 43% to 73%, the rate of feeding children the minimum recommended number of meals per day at 6 to 23 months increased from 87% to 93%, the rate of iron–folic acid supplementation during pregnancy increased from 32% to 76%, and the rate of postpartum vitamin A supplementation increased from 17% to 54% ( p <.001 for all changes). Modest improvement was achieved in maternal dietary practices during lactation and feeding of the sick child after illness. The results were inconclusive regarding food diversity for complementary feeding. No improvements were reported in increasing food intake during child illness or pregnancy.

Conclusions

The ENA framework allows broad-scale improvement of nutritional practices to be achieved through the maximization of contacts using multiple program opportunities within existing health systems and community structures and through mass media.
Adoption of the WHO Child Growth Standards to Classify Indonesian Children under 2 Years of Age According to Nutrition Status: Stronger Indication for Nutritional Intervention
Authors: Julia Madarina
Published: November 2015

Background

The National Center for Health Statistics/World Health Organization (NCHS/WHO) reference is considered unsuitable for assessing the nutritional status of breastfed children. It is gradually being replaced by the WHO Child Growth Standards in many countries.

Objective

To assess the implications of adopting the WHO Child Growth Standards to classify Indonesian children according to nutrition status.

Methods

Data were obtained from two cross-sectional surveys in two districts in Indonesia in 1998. Children under 2 years of age were randomly selected using a two-stage cluster sampling. Z-scores of weight-for-length (WLZ), length-for-age (LAZ), and weight-for-age (WAZ) were calculated based on both the NCHS/WHO reference and the WHO Child Growth Standards. Wasting, stunting, and underweight were defined as z-scores less than −2.0.

Results

We included 1,374 children, of whom 693 (50.4%) were male and 681 (49.6%) were female. Almost all of the children had initiated breastfeeding and were still being breastfed when the data were collected. According to the WHO Child Growth Standards, the prevalence of wasting did not change with age, but the prevalence rates of stunting and underweight rose steadily with age. Although the contribution of wasting to the classification of underweight was relatively constant, the contribution of stunting increased as the children grew.

Conclusions

The WHO Child Growth Standards are a better tool for assessing the nutritional status of Indonesian children than the NCHS/WHO reference. However, low WAZ is not a suitable indicator for commencing an extra feeding program, because it reflects stunting instead of wasting. The high prevalence of stunting indicates the need to perform preventive nutritional intervention beginning earlier in life, i.e., in utero.
Effects of Lifestyle and Diet on Bone Health in Young Adult Chinese Women Living in Hong Kong and Beijing
Authors: Chan Ruth , Woo Jean , Lau Winny , Leung Jason , Xu Ling , Zhao Xihe , Yu Wei , Lau Edith , Pocock Nicholas
Published: November 2015

Background

Dietary and lifestyle variations may be too small to detect possible associations with bone mineral density (BMD) within a community. Pooled data from communities with different diets and lifestyle but of the same ethnicity may help explore these associations.

Objective

To examine the effects of dietary and lifestyle factors on BMD in young Chinese women.

Methods

Baseline data were analyzed from 441 women aged 20 to 35 years in Hong Kong and Beijing who were participating in a longitudinal study evaluating the effect of milk supplementation on bone health. Data on demographic characteristics, lifestyle, use of oral contraceptives, diet, physical activity, and BMD of total hip, femoral neck, and total spine measured by dual-energy x-ray absorptiometry were pooled for analysis.

Results

Hong Kong subjects had significantly lower BMD and higher body-size-adjusted dietary intakes of protein, fat, fiber, vitamins, potassium, sodium, and selenium than Beijing subjects. Multivariate regression of pooled data showed that body mass index was the most important determinant of BMD at all sites. Age was negatively associated and use of oral contraceptives was positively associated with femoral neck BMD. Carbohydrate intake was positively associated with total hip BMD. Fiber intake was negatively associated with BMD at total hip and total spine. Increased vitamin E intake was associated with greater total spine BMD. None of the nutrients were associated with BMD at the femoral neck.

Conclusions

Diet, lifestyle, and BMD differed greatly between young women from Hong Kong and Beijing. Body mass index was the most important determinant of BMD in young Chinese women, whereas age, use of oral contraceptives, and diet had less pronounced effects.
Dietary Intervention Strategies to Enhance Zinc Nutrition: Promotion and Support of Breastfeeding for Infants and Young Children
Authors: Brown Kenneth H. , Engle-Stone Reina , Krebs Nancy F. , Peerson Janet M.
Published: November 2015

Breastmilk is the only dietary source of zinc for exclusively breastfed young infants, and it remains a potentially important source of zinc for older infants and young children who continue breastfeeding beyond early infancy. Therefore, we examined available information on breastmilk zinc concentration and total milk consumption to develop estimates of the amount of zinc transferred in breastmilk to children of different ages. Breastmilk zinc concentration declines rapidly during the first few months postpartum and more slowly thereafter. Breastmilk supplies all of the theoretical zinc needs for at least the first several months of life, although the period during which breastmilk alone remains sufficient is uncertain. Breastmilk continues to provide more than half of children's estimated zinc requirements after the introduction of complementary foods, even into the second year of life. Public health programs to promote and support breastfeeding should be included among the strategies to ensure adequate zinc status of young children.
Multiple Micronutrient Supplementation during Pregnancy in Low-Income Countries: Review of Methods and Characteristics of Studies Included in the Meta-Analyses
Authors: Margetts Barrie M. , Fall Caroline H. D. , Ronsmans Carine , Allen Lindsay H. , Fisher David J.
Published: November 2015

This paper reports on the methods and characteristics of 12 studies from developing countries included in a meta-analysis of the impact of antenatal supplements of multiple micronutrients compared with iron–folic acid on micronutrient status, maternal nutritional status, birth outcomes, and neonatal survival.
Investigation of the Nutrition Problems of Central America and Panama
Authors: Arroyave Guillermo , Scrimshaw Nevin S.
Published: November 2015

From its earliest years, INCAP gave a high priority to a multidisciplinary effort to learn as much as possible about the dietary habits, nutritional status, and their consequences in the populations of Central America and Panama. Most of the papers in this Special Issue contain some of this information. The first studies were in school-children but were soon extended to preschool children, pregnant and lactating women, and other adults.

This paper describes the principal findings of the initial dietary, biochemical, and clinical community-based studies. From 1965–67, very extensive studies were carried out in all six countries including dietary, biochemical, clinical, and anthological studies were carried out in all six countries, the results of which are summarized.
INCAP Studies of Kwashiorkor and Marasmus
Authors: Scrimshaw Nevin S. , Viteri Fernando E.
Published: November 2015

This article summarizes thirty years of intensive clinical metabolic and therapeutic studies of the consequences of severe protein deficiency relative to calories, which results in kwashiorkor, and of a balanced deficiency of protein and calories that results in marasmus. Evidence is provided that these are two different metabolic diseases, but kwashiorkor is usually superimposed on some degree of chronic marasmus and hence most cases studied were marasmic kwashiorkor. The value of the creatinine/height index to indicate the degree of lean body cell mass with any disease is demonstrated.
INCAP Studies of Malnutrition and Cognitive Behavior
Authors: Engle Patrice L. , Fernández Patricia D.
Published: November 2015

The Institute of Nutrition of Central America and Panama (INCAP) has made major contributions to the study of the effects of malnutrition on learning. This report summarizes work on the relationship of nutrition to children's learning and development from the 1960's through 1998. The Oriente Longitudinal Study examined the effects of two types of supplementation for mothers and young children on their growth and development (an energy-only drink compared with a protein-energy drink) using a quasi-experimental design. Both drinks were supplemented with micronutrients, and were offered daily. As a result of the research on malnutrition and mental development, researchers could conclude by 1993 that supplementary feeding of infants and young children resulted in significant increases cognitive development and school performance through adolescence. The research also suggested that the pathways that link malnutrition with later development are not only through the neurological system but also operate through changes in child behavior which affect the kinds of care children receive. Other research on learning and development showed that families understood the concept of intelligence, demonstrated the link between micronutrients and cognitive development, and documented the amount of wastage or repetition and drop-out that occurs in Guatemalan schools.
Vitamin A Fortification in Uganda: Comparing the Feasibility, Coverage, Costs, and Cost-Effectiveness of Fortifying Vegetable Oil and Sugar
Authors: Fiedler John L. , Afidra Ronald
Published: November 2015

Background

Twenty-eight percent of Ugandan preschool children suffer from vitamin A deficiency. With vitamin A supplementation covering only a third of children under 5 years of age, fortification is essential to reduce their vitamin A deficiency–related disease burden. At present, the only widely consumed food in Uganda that is fortified with vitamin A is vegetable oil.

Objective

To compare the feasibility, coverage, costs, and cost-effectiveness of fortifying vegetable oil and sugar with vitamin A in order to assess, from a public health policy perspective, whether sugar should also be fortified.

Methods

The 2005/6 Uganda Household Budget Survey was used to analyze households' apparent consumption levels of sugar and vegetable oil and to model the additional intake of vitamin A, assuming the sugar and oil fortification levels are those set by the Uganda Bureau of Standards.

Results

The annual incremental private sector cost of vitamin fortification is US$555,668 for oil and US$2,644,765 for sugar. Assuming that oil and sugar fortification are both effective in reducing vitamin A deficiency by 30% among those who consume these foods, the estimated cost per disability-adjusted life year (DALY) averted is US$82 for sugar and US$18 for oil. Vitamin A fortification of vegetable oil is 4.6 times more cost-effective than vitamin A fortification of sugar. If sugar were to be fortified, the 17% of Ugandans who purchase sugar but do not purchase oil would become new beneficiaries of vitamin A fortification. This would increase the coverage of vitamin A–fortified foods by 31% and reduce the percentage of Ugandans without any coverage to 25%. Those most at risk for vitamin A deficiency—members of rural, poor households—would benefit disproportionately from the introduction of sugar fortification.

Conclusions

Although the lack of information on the vitamin A deficiency status of consumers of oil and sugar precludes making definitive conclusions, the increased coverage and cost per DALY averted due to sugar fortification suggests—based on World Health Organization guidelines—that the Government of Uganda should pursue sugar fortification.
Protein and Amino Acid Intakes in a Rural Area of Bangladesh
Authors: Heck Julia E. , Nieves Jeri W. , Chen Yu , Parvez Faruque , Brandt-Rauf Paul W. , Howe Geoffrey R. , Ahsan Habibul
Published: November 2015

Background

Few studies have described protein and amino acid intakes in rural Bangladesh, a country with considerable undernutrition.

Objective

The purpose of this population-based study was to assess and describe protein and amino acid intakes in Araihazar, Bangladesh.

Methods

The study participants were 11,170 adult men and women who participated in the Health Effects of Arsenic Longitudinal Study (HEALS), which had a 98% participation rate. Dietary exposures were assessed by a food-frequency questionnaire that had been designed and validated for the HEALS study population.

Results

The mean body mass index (BMI) was 19.7 among all participants, and 34.9% of women and 44.4% of men had a BMI below 18.5. The average caloric intake was 2,142 and 2,394 kcal/day among women and men, respectively, and the mean protein intake was 67.5 and 78.2 g/day. The largest sources of protein were from rice and fish. Greater protein intake was related to younger age and several socioeconomic measures, including more years of education, land and television ownership, and employment in business, farming, or as a laborer (for men) or as a homemaker (for women).

Conclusions

This study found a high prevalence of underweight among study participants. Nonetheless, most participants had adequate protein intake according to Food and Agriculture Organization standards for body weight.
High-Calcium Milk Prevents Overweight and Obesity among Postmenopausal Women
Authors: Angeles-Agdeppa Imelda , Capanzana Mario V. , Li-Yu Julie , Schollum Linda M. , Kruger Marlena C.
Published: November 2015

Background

The Sixth National Nutrition Survey 2003 revealed that the highest prevalence of overweight and obesity among Filipino female adults (30.8%) was found in the age group from 40 to 59 years. Obesity is associated with a number of chronic diseases, including cardiovascular disease, hypertension, and diabetes. Low calcium intake has been identified as a potential contributing factor to overweight and obesity.

Objective

To assess the effect of a high-calcium, fortified, low-fat milk drink with added vitamin D versus a low-calcium placebo drink on anthropometric measurements of postmenopausal women.

Methods

Women who were at least 5 years postmenopausal were invited to participate in the study. Potential participants underwent three stages of screening: initial interview, dual-energy x-ray absorptiometry, and blood testing for biochemical screening. Anthropometric indices were measured at baseline and the end of the study. Sixty women were qualified to participate in the study. The women were randomly assigned to two groups, one of which received 400 ml of the high-calcium milk daily for 16 weeks while the other received the placebo drink.

Results

No significant increases were observed in the anthropometric indices of the subjects receiving the high-calcium fortified milk at the end of the study. However, there were significant increases in the weight ( p = .008), body mass index ( p = .007), and waist ( p = .018) and hip ( p = .003) circumferences of the subjects receiving the placebo drink.

Conclusions

A change in dietary calcium intake may be a useful measure as part of an overall approach to prevent the occurrence of overweight and obesity among postmenopausal women.
What Knowledge and Expectations are Ethiopian Girls Bringing with Them into Parenthood?
Authors: Hadley Craig , Tessema Fasil , Belachew Tefera , Lindstrom David
Published: November 2015

Background

Because of rapid population growth, many countries now have very large cohorts of young people. Despite the population health importance of early child feeding practices, little work has explored the knowledge and expectations about infant feeding that youth bring with them as they transition into parenthood.

Objective

To examine adolescent girls' perceptions of infant and young child feeding practices in their communities, and to assess their knowledge and expectations regarding infant and young child feeding practices and explore their overlap with current feeding recommendations.

Methods

Cross-sectional data were obtained from a random sample of 1,018 girls 13 to 17 years of age living in rural, semiurban, and urban sites in southwestern Ethiopia. Surveys were used to collect information on respondents' attitudes, expectations, and perceptions within the domain of infant and young child feeding practices. Descriptive and bivariate statistics were used to describe the data.

Results

A total of 1,018 girls aged 13 to 17 years were interviewed. The girls were able to report the age at which infants in their communities were provided liquids, semisolids, and solids as well as the perceived duration of breastfeeding in their communities. The girls were generally able to report when they themselves planned to provide liquids and solids to their infants and their expected duration of breastfeeding. The girls' attitudes and expectations were not consistent with exclusive breastfeeding to 6 months, and planned durations of breastfeeding were shorter than they currently perceived in their communities.

Conclusions

Young nulliparous Ethiopian women have well-formed attitudes and expectations about infant and young child feeding. These are unlikely to promote currently accepted best practices. Our results suggest both the potential that suboptimal feeding practices will be reproduced and novel intervention points.
Effects of Docosahexaenoic Acid Supplementation During Pregnancy on Gestational Age and Size at Birth: Randomized, Double-Blind, Placebo-Controlled Trial in Mexico
Authors: Ramakrishnan Usha , Stein Aryeh D. , Parra-Cabrera Socorro , Wang Meng , Imhoff-Kunsch Beth , Juárez-Márquez Sergio , Rivera Juan , Martorell Reynaldo
Published: November 2015

Background

The need for omega-3 fatty acids, especially docosahexaenoic acid (DHA), during pregnancy has received much attention, but evidence of effects on birth outcomes is limited.

Objective

To evaluate whether prenatal DHA supplementation increases gestational age and birth size.

Methods

We conducted a double-blind, randomized, placebo-controlled trial in Cuernavaca, Mexico. We randomly assigned 1,094 pregnant women (18 to 35 years of age; median DHA dietary intake, 55 mg/day) to 400 mg/day of algal DHA or placebo from 18 to 22 weeks of gestation through delivery. Birth outcomes (968 live births and 5 stillbirths) were ascertained from hospital records within 24 hours of delivery.

Results

Intention-to-treat analysis showed no differences between the control and DHA group (all p > .05) in mean gestational age (39.1 + 1.7 and 39.0 ± 1.9 weeks, respectively), weight (3.20 + 0.47 and 3.21 ± 0.45 kg, respectively), length (50.3 ± 2.7 and 50.3 ± 2.3 cm, respectively) and head circumference (34.3 ± 1.8 and 34.3 ± 1.5 cm, respectively) at birth. Offspring of supplemented primigravidae (n = 370) were heavier (difference, 99.4 g; 95% CI, 5.5 to 193.4) and had larger head circumferences (difference, 0.5 cm; 95% CI, 0.1 to 0.9) than controls; the differences in multigravidae (n = 603) were −53.3 g (95% CI, −126.8 to 20.2) and −0.2 cm (95% CI, −0.4 to 0.1), respectively (p < .05 for heterogeneity).

Conclusions

Prenatal DHA supplementation of primigravid women may result in increased birth size in a population where dietary DHA intakes are very low. Benefits of the intervention on infant health and neurodevelopment are under study.