bluuebunny/crossref_metadata_2025 huggingface dataset:
Food Insecurity in the Context of HIV/AIDS: A Framework for a New Era of Programming
Authors: Frega Romeo , Duffy Francesca , Rawat Rahul , Grede Nils
Published: November 2015

Background

Food insecurity can be both a consequence and a driver of HIV/AIDS. It is often difficult to disentangle these two roles of food insecurity, since the HIV epidemic has different drivers in different settings. The advent of antiretroviral treatment in resource-limited settings adds an additional layer of complexity. This paper seeks to organize current thinking by reviewing the existing literature on food insecurity and HIV/AIDS and describing the complex interactions between them.

Objective

Based on literature review, the paper proposes a framework to understand the linkages, distinguishing four types of interventions to address them. It is hoped that the model, albeit simplified as is any framework, will help to structure research, policy, and programming in the field of HIV/AIDS and food insecurity. Finally, the paper intends to widen the lens to regard food not just as a means to provide calories or an income transfer but also as a carrier of adequate nutrition in the context of HIV.

Results and conclusions

An adequate response to HIV/AIDS and food insecurity must be tailored to specific settings. Interventions distinguished in this paper are aimed at both promoting food security and providing antiretroviral treatment and nutrition support. The four types of interventions are containing HIV and preventing AIDS through comprehensive treatment regimes that include nutritional support; mitigating the effects of AIDS through support; providing HIV-sensitive, but not HIV-exclusive, safety nets at the individual, household, and community levels; and limiting the exposure to risk through HIV prevention activities.
Pilot-Scale Commercialization of Iron-Fortified Rice: Effects on Anemia Status
Authors: Angeles-Agdeppa Imelda , Saises Marcela , Capanzana Mario , Juneja Lekh R. , Sakaguchi Noboru
Published: November 2015

Background

Rice, the staple food of the Philippines, is an appropriate vehicle for iron fortification to combat the high prevalence of iron-deficiency anemia. A previous study among schoolchildren supplemented with iron-fortified rice showed a significant reduction in the rate of iron-deficiency anemia from 100% to 33%.

Objective

To document the processes involved in commercializing iron-fortified rice and to determine its effects on anemia prevalence.

Subjects and methods

This study was conducted on 766 mothers and their children aged 6 to 9 years in Orion, Bataan. Soliciting political support, networking with local organizations, market surveys, and social marketing activities were conducted. The iron content of iron-fortified rice was tested for each production run. Hemoglobin measurements were performed on the mothers and children at baseline and endline.

Results

A municipal ordinance to sell iron-fortified rice was issued, while the local federation provided funds to kick off the sale of iron-fortified rice. Sales of iron-fortified rice were highest when the rice was sold at Php 27 (Php 1 = US$0.025) per kilogram and lowest when the price was Php 37 per kilogram or greater. The municipal ordinance was not strictly enforced because of the global rice crisis. Social marketing activities encouraged families to buy iron-fortified rice. The iron content of the iron-rice premix was within the set specification limits of 600 to 760 mg of iron per 100 g of premix, while the iron-fortified rice was within 3 to 3.8 mg of iron and 1 to 2 mg (BC No. 2009-010) per 100 g of raw and cooked fortified rice, respectively. The decrease in the rate of anemia was significant among children (from 17.5% to 12.8%) but not among mothers (from 13.0% to 12.5%) after 9 months of study implementation.

Conclusions

Strong political support and intensive social marketing activities are crucial inputs in commercializing iron-fortified rice. Keeping the cost affordable and maintaining the commitment of identified partners were the key factors for providing a continuous supply of iron-fortified rice. Commercializing iron-fortified rice can be considered as one of the strategies for decreasing anemia prevalence.
Secular Trends in Height in Different States of India in Relation to Socioeconomic Characteristics and Dietary Intakes
Authors: Mamidi Raja Sriswan , Kulkarni Bharati , Singh Abhishek
Published: November 2015

Background

Information on adult height and associated secular trends in relation to socioeconomic characteristics based on a nationally representative sample is not available from India.

Objective

To assess the average adult height and secular trends in height in different states of India in relation to socioeconomic characteristics and dietary intakes according to data from the Third National Family Health Survey (NFHS 3).

Methods

Average heights and associated secular trends were analyzed for each state and in relation to socioeconomic variables. Bivariate and multiple regression analyses were performed to examine the association of socioeconomic factors and consumption of animal-source foods with height.

Results

Data from anthropometric measurements were available for 69,245 men and 118,796 women in the age group from 20 to 49 years. The average heights of adult men and women were 165 and 152 cm, respectively, with wide variation among states. Overall, there was a modest secular increase in height (0.50 cm per decade in men and 0.22 cm per decade in women), with a negative secular trend in some of the states. There were striking regional differences in the average heights and the secular trends in height. Similarly, higher socio-economic status was associated with greater height and a greater secular increase in height. Milk consumption had a positive association with height in men ( r = 0.69, p < .001) and women ( r = 0.63, p < .001) in various/different states.

Conclusions

The secular increase in height has been modest in India in spite of impressive economic growth. Consumption patterns of milk in different states may be related to the regional differences in height.
Dietary Intake and Nutrition-Related Knowledge in a Sample of Lebanese Adolescents of Contrasting Socioeconomic Status
Authors: Nabhani-Zeidan Maya , Naja Farah , Nasreddine Lara
Published: November 2015

Background

Socioeconomic status (SES) is postulated to be a major predictor of dietary intake and nutrition-related knowledge in adults. To date, very few studies have addressed this effect among adolescents.

Objective

To explore differences in nutrient intake and nutrition-related knowledge among adolescents of contrasting SES in Lebanon.

Methods

In a cross-sectional survey, 209 males and females, aged 17 to 19 years, were recruited from a private university with high tuition and a free public university in Beirut. The participants completed a multicomponent, self-administered questionnaire that inquired about demographic characteristics and nutrition-related knowledge. Three nonconsecutive 24-hour dietary recalls were obtained through interviews. Energy-adjusted means of dietary intake and age-adjusted nutrition-related knowledge were compared between groups using a general linear model.

Results

Adolescents in the high-SES group consumed more vegetables, meats, and fats and oils ( p < .05). Energy and nutrient intake analysis showed that adolescents in the high-SES group consumed significantly higher amounts of calories, protein, fat, vitamin A, vitamin C, and iron ( p <.001) and significantly lower amounts of carbohydrates (p < .05). Nutritional knowledge, although high among all participants, was higher in the high-SES group ( p < .05).

Conclusions

Although both groups showed good nutrition-related knowledge, SES significantly affected dietary intake in a sample of Lebanese adolescents. This warrants consideration of other factors, such as cost and environment, that may modulate eating behavior among adolescents from different socioeconomic strata.
Determinants of Delayed Initiation of Breastfeeding in Rural Ethiopia: Programmatic Implications
Authors: Horii Naoko , Guyon Agnès B. , Quinn Victoria J.
Published: November 2015

Background

A number of studies have examined the possible adverse impact of services offered by health workers and community members on postpartum infant feeding practices. The present analysis utilized extant data collected previously through the baseline surveys of two related child health and nutrition projects implemented in rural Ethiopia and explored key risk factors associated with delayed initiation of breastfeeding for more than 1 hour after birth.

Objective

To investigate the most important determinants of delayed initiation of breastfeeding.

Methods

Multivariate logistic regression was performed to analyze data from baseline cross-sectional surveys carried out in 2003 and 2004 in selected districts across three regions in Ethiopia.

Results

Attendance at delivery by a health worker was found to be an important risk factor for the delayed initiation of breastfeeding, whereas attendance by traditional birth attendants or family and/or friends represented a protective factor for early initiation of breastfeeding. Additional analysis suggests that targeting of behavior change interventions on optimal infant feeding to these health workers could reverse the risk relationship and lead to improvements in the rate of early initiation of breastfeeding.

Conclusions

Provision of inadequate breastfeeding information in the health system and attendance at delivery by health workers are associated with a delay in the initiation of breastfeeding. Births attended by trained traditional birth attendants and family members are associated with better practices. Targeting health workers, community members, families, and women to promote optimal infant feeding practices is likely to hold much potential to increase the adoption of early initiation of breastfeeding.
Impact of Prophylactic Iron Supplementation in Healthy Pregnant Women on Maternal Iron Status and Birth Outcome
Authors: Falahi Ebrahim , Akbari Soheila , Ebrahimzade Farzad , Gargari Bahram Pourghasem
Published: November 2015

Background

In spite of the beneficial effect of iron supplementation in iron-deficient pregnant women, iron supplementation may not be needed for women who are iron replete or not anemic. Moreover, the theoretical possibility of adverse effects, such as oxidative damage, from administration of iron supplements during pregnancy has been raised.

Objective

To determine the effect of prophylactic iron supplementation on iron status and birth outcomes among nonanemic pregnant women.

Methods

A randomized, triple-blind clinical trial was conducted. One hundred forty-eight nonanemic pregnant women with hemoglobin > 110 g/L, serum ferritin > 12 μg/L, and gestational age < 20 weeks were randomly assigned to receive either ferrous sulfate (60 mg elemental iron) (n = 70) or placebo (n = 78) until delivery. Hemoglobin concentration and serum ferritin were measured by electronic counter and radioimmunoassay, respectively. Data were analyzed by independent t-tests, ANCOVA, and repeated measures.

Results

At delivery, the incidence of iron deficiency was significantly lower in the iron than in the placebo group. There were no significant differences between the two groups in maternal hemoglobin and ferritin concentrations at delivery or in the infant's birthweight, birth length, or length of gestation.

Conclusions

Iron supplementation during pregnancy in nonanemic women with low serum ferritin may have benefits beyond the prevention of iron-deficiency anemia.
Provision of Micronutrient Powder in Response to the Cyclone Sidr Emergency in Bangladesh: Cross-Sectional Assessment at the end of the Intervention
Authors: Rah Jee Hyun , de Pee Saskia , Halati Siti , Parveen Monira , Mehjabeen Syeda Sajia , Steiger Georg , Bloem Martin W. , Kraemer Klaus
Published: November 2015

Background

Micronutrient powder has been endorsed as an effective means to improve the micronutrient status of emergency-affected populations.

Objective

To document the experience and findings of a cross-sectional assessment of the micronutrient powder program implemented as part of the emergency response to Cyclone Sidr.

Methods

Micronutrient powder was distributed to 100,714 children under 5 years of age and 59,439 pregnant or lactating women severely affected by Cyclone Sidr in Bangladesh. A cross-sectional assessment, including hemoglobin and anthropometric measurements, was conducted after the completion of the micronutrient powder program among children under 5 years of age, lactating mothers, and postmenarcheal adolescent girls in the intervention area. Comparison groups for each, drawn from the control area, which had not received micronutrient powder, were assessed at the same time.

Results

The prevalence of anemia among children under 5 years of age was approximately 80% in both areas. Among children in the intervention area, those who consumed at least 75% of the micronutrient powder sachets had a lower prevalence of stunting than those who consumed less than 75% of the sachets (40% vs. 52%, p < .05). Among lactating mothers in the intervention area, the prevalence rates of thinness and anemia were lower among those who consumed at least 75% of the sachets than among those who consumed less than 75% of the sachets (thinness, 31% vs. 46%, p < .05; anemia, 50% vs. 61%, p = .07). For adolescent girls in the intervention and control areas, none of whom had received micronutrient powder, the prevalence rates of anemia were 52% and 45%, respectively ( p = .05).

Conclusions

Micronutrient powder may reduce anemia among lactating mothers, when the compliance rate is high. Anemia prevalence prior to micronutrient powder distribution had not been investigated and could have been higher among children and lactating mothers in the intervention than in the control area, resulting in the negation of the potential positive impact of micronutrient powder on anemia.
Feeding Patterns and Growth of Term Infants in Eldoret, Kenya
Authors: Arusei Roselyne Jelimo , Ettyang Grace Adisa , Esamai Fabian
Published: November 2015

Background

There are limited longitudinal data from developing countries on early infant feeding and growth patterns. In Kenya only 34.8% of infants are exclusively breastfed at 2 months. This finding is of concern, and further understanding of infant feeding and growth patterns is important.

Objective

To determine the feeding and growth patterns of Kenyan term infants during early infancy.

Methods

A longitudinal study was conducted. One hundred and fifty-one resource-constrained mother—infant pairs were recruited from the West Municipal Health Centre (WMHC) within 24 hours after birth, and subsequent follow-up was performed at the WMHC Maternal and Child Health Clinic. Data on baseline characteristics were collected with the use of a structured questionnaire. Data on nonbreastmilk liquids given to the infants and feeding patterns were gathered with the use of a 24-hour recall. Standard procedures were used to measure infant weight, recumbent length, and head circumference. World Health Organization (WHO) growth standards were used, and tests for variation between and within group means were performed, with α < .05 regarded as indicating significance.

Results

At 6 and 10 weeks, the prevalence of exclusive breastfeeding was 40.4% and 9.9%, respectively. The mothers cited “aids infant's digestion” (38%) as the main reason for partial breastfeeding and “breastmilk was not enough” (48%) as the main reason for predominant breastfeeding. Growth velocity based on weight was similar to that in the WHO reference group. All of the children had normal growth (z-score > −2). Mothers without knowledge about WHO/UNICEF early infant feeding recommendations and those who initiated breast-feeding more than 1 hour post partum were ninefold and eightfold more likely to start mixed feeding by 10 weeks of age, respectively.

Conclusions

There is a need to accelerate awareness of optimum infant feeding recommendations and augment the rigorous practice of the WHO Ten Steps to Successful Breastfeeding.
Ecological Approaches to Human Nutrition
Authors: Declerck Fabrice A. J. , Fanzo Jessica , Palm Cheryl , Remans Roseline
Published: November 2015

Background

Malnutrition affects a large number of people throughout the developing world. Approaches to reducing malnutrition rarely focus on ecology and agriculture to simultaneously improve human nutrition and environmental sustainability. However, evidence suggests that interdisciplinary approaches that combine the knowledge bases of these disciplines can serve as a central strategy in alleviating hidden hunger for the world's poorest.

Objective

To describe the role that ecological knowledge plays in alleviating hidden hunger, considering human nutrition as an overlooked ecosystem service.

Methods

We review existing literature and propose a framework that expands on earlier work on econutrition. We provide novel evidence from case studies conducted by the authors in western Kenya and propose a framework for interdisciplinary collaboration to alleviate hidden hunger, increase agricultural productivity, and improve environmental sustainability.

Results

Our review supports the concept that an integrated approach will impact human nutrition. We provide evidence that increased functional agrobiodiversity can alleviate anemia, and interventions that contribute to environmental sustainability can have both direct and indirect effects on human health and nutritional well-being.

Conclusions

Integrated and interdisciplinary approaches are critical to reaching development goals. Ecologists must begin to consider not only how their field can contribute to biodiversity conservation, but also, the relationship between biodiversity and provisioning of nontraditional ecosystem services such as human health. Likewise, nutritionists and agronomists must recognize that many of the solutions to increasing human well-being and health can best be achieved by focusing on a healthy environment and the conservation of ecosystem services.
The Nutrition Policy Process: The Role of Strategic Capacity in Advancing National Nutrition Agendas
Authors: Pelletier David L. , Menon Purnima , Ngo Tien , Frongillo Edward A. , Frongillo Dominic
Published: November 2015

Undernutrition is the single largest contributor to the burden of disease in developing countries and has documented effects on social and economic development, yet progress in reducing undernutrition remains slow. This paper identifies the range of factors that have influenced the nutrition agenda in developing countries, in order to inform the implementation of three major global initiatives related to undernutrition. Data sources include interviews with nutrition practitioners at the national and international level, written accounts from six African countries, and observations of the policy process in five countries. Data were thematically coded to identify recurrent factors that facilitated or inhibited progress in addressing undernutrition. The data reveal the following: First, societal conditions and catalytic events pose a variety of challenges and opportunities to enlarge and shape the nutrition agenda. Some countries have been successful in using such opportunities, while others have been less successful and there have been some unintended consequences. Second, disagreements over interventions and strategies are an almost universal feature of the nutrition policy process, occur primarily among mid-level actors rather than among politicians or senior administrators, and are primarily the product of structural factors such as organizational mandates, interests, and differences in professional perspectives. Third, many of these structural factors can be molded, aligned, and/or circumvented through strategic action on the part of the mid-level actors to strengthen movement on the nutrition agenda. This evidence that strategic action can redirect and/or overcome the effects of structural factors has important implications for future efforts to advance the nutrition agenda.
Selection and Use of US Title II Food Aid Products in Programming Contexts
Authors: Rogers Beatrice , Webb Patrick , Wanke Christine , Sadler Kate , Masterson Amelia Reese , Bagriansky Jack , Schlossman Nina , Narayan Anuradha , Tilahun Jessica
Published: November 2015

Background

Food aid provided by the United States has saved lives for almost two centuries. Delivering the right products is important, but of equal concern are the ways in which products are delivered and to whom.

Objective

The study addresses how food products are currently used, whether interventions are appropriate to achieve nutrition objectives, and whether nutrition targets could be met more cost-effectively with a different mix of products or programs.

Methods

The team conducted consultations with a broad range of stakeholders. A survey of Title II implementing partners was conducted, focusing on procurement and logistics, and uses of FBFs and other foods. Input of implementing partners, civil society, and donor organizations was obtained through individual consultations, international and small group meetings. More than 400 individuals accessed the project's website. The project convened a panel of experts in food technology and science, food policy, law, industry, medicine, development and humanitarian work, and the maritime industry, and held regular joint meetings with USDA and USAID. The draft report was widely disseminated and posted on the website.

Results and conclusions

There is wide variation in the quantities of fortified blended foods provided to target populations. Most of these foods are used in health/nutrition programs, but they are also used in general family rations or as an incentive or pay. Clearer programming guidance and improved decision tools are needed to match products to nutrition goals, and programs should consider delivering nutrients across a basket of commodities, not single products. The evidence base for the effectiveness and cost-effectiveness of specific foods and programs needs to be strengthened and should be supported by FFP. Research is needed to provide guidance on nutrition support for HIV/AIDS. Additional investments are needed in effective behavior change communication.
Prevalence and Sociodemographic Factors of Malnutrition among Children in Malaysia
Authors: Khambalia Amina Z. , Lim Siew S. , Gill Tim , Bulgiba Awang M.
Published: November 2015

Background

For many developing countries undergoing rapid economic growth and urbanization, trends in nutritional status indicate a decrease in malnutrition with an associated rise in the prevalence of obesity. An understanding of the situation among children in Malaysia is lacking.

Objective

To examine the prevalence, trends and sociodemographic factors described for underweight and overweight children in Malaysia.

Methods

The literature from January 1996 to November 2010 on the prevalence of underweight and over-weight among children in Malaysia was reviewed.

Results

Twelve studies were identified that reported on both underweight and overweight among children in Malaysia, of which only one was a nationally representative survey. Based on the National Health and Morbidity Survey in 2006, 13.2% (95% CI, 12.6 to 13.9) of children aged 0 to 18 years were underweight (weight-for-age < −2SD), and 8.0% (95% CI, 7.5 to 8.6) of those aged 0 to 13 years were overweight (weight-for-height > +2SD). Both underweight and overweight were more prevalent in males than females. Children in rural areas were more likely to be underweight and less likely to be overweight than urban children. Ethnic differences between Malays, Chinese, and Indians were inconsistent across studies and less clear. Aborigines were more likely to be underweight and less likely to be overweight than the general population. The available evidence, although limited and sparse, suggests that over the past decade the prevalence of both underweight and overweight among children in Malaysia has been stable or has shown an increasing trend.

Conclusions

Long-term national monitoring and longitudinal cohort studies will be critical for understanding, preventing, and managing the double burden of malnutrition among children in Malaysia.
Comparative Intake of White- versus Orange-Colored Maize by Zambian Children in the Context of Promotion of Biofortified Maize
Authors: Nuss Emily T. , Arscott Sara A. , Bresnahan Kara , Pixley Kevin V. , Rocheford Torbert , Hotz Christine , Siamusantu Ward , Chileshe Justin , Tanumihardjo Sherry A.
Published: November 2015

Background

Vitamin A deficiency is associated with poor health outcomes related to reproduction, growth, vision, and immunity. Biofortification of staple crops is a novel strategy for combating vitamin A deficiency in high-risk populations where staple food intakes are high. African populations are proposed beneficiaries of maize ( Zea mays) biofortified with provitamin A carotenoids, often called “orange maize” because of its distinctive deep yellow-orange kernels. The color facilitates ready recognition but presents a cultural challenge to maize-consuming populations, including those in much of Africa, who traditionally eat white varieties.

Objective

This study explores the intake patterns of, as well as adaptation to, traditional foods made with provitamin A–biofortified maize compared with white maize in rural Zambian children 3 to 5 years of age ( n = 189) during a 3-month feeding trial.

Methods

The subjects were fed a breakfast of maize porridge (sweet mush), a lunch of maize nshima (stiff mush) with various side dishes, and an afternoon snack based on a 6-day rotating menu. The trial was conducted in 2010. The orange maize used in the trial came from three different sources. O1 maize was from the 2009 harvest and was stored in a freezer until use in 2010. O2 maize was also from the 2009 harvest and was stored in a cold room until 2010. O3 (“fresh”) maize was from the 2010 harvest and was fed immediately after harvest in week 9 of the study and then stored in a freezer until milling for the final four weeks.

Results

Consumption of menu items, except snacks, was influenced by week ( p < .0084). The intakes of porridge and nshima made with orange maize equaled those of porridge and nshima made with white maize from week 2 onward. The intakes of porridge and nshima prepared from O1 and O2 did not differ, but intakes became significantly higher when meals made from O3 were introduced ( p < .014 for porridge and p ≤ .013 for nshima).

Conclusions

These results demonstrate quick adaptation to orange maize, a preference for recently harvested maize, and an optimistic outlook for similar adaptation patterns in other biofortified-maize target countries.
Oral Administration of Ferrous Sulfate, but not of Iron Polymaltose or Sodium Iron Ethylenediaminetetraacetic Acid (NaFeEDTA), Results in a Substantial Increase of Non-Transferrin-Bound Iron in Healthy Iron-Adequate Men
Authors: Schümann Klaus , Solomons Noel W. , Romero-Abal Maria-Eugenia , Orozco Monica , Weiss Guenter , Marx Jo
Published: November 2015

Background

Oral iron supplementation with ferrous sulfate (FeSO4) at dosage levels suggested by the international guidelines poses a safety hazard to young children with malaria. Exposure to loosely bound iron in the circulation has been advanced as a potential factor.

Objective

To evaluate the kinetics of circulating concentrations of plasma iron and non-transferrin-bound iron (NTBI) in response to oral iron administration in healthy adults.

Methods

Plasma samples were collected at 90-minute intervals over a period of 270 minutes from 10 healthy Guatemalan men after oral administration of water or 100 mg of iron from each of three iron compounds: FeSO4, sodium iron ethylenediaminetetraacetic acid (NaFeEDTA), and iron polymaltose. The four tests were administered in an individually randomized sequence. Serum iron concentration was measured spectrophotometrically by the ferrozine method, and NTBI concentration was measured by a fluorometric competitive binding assay. The kinetic response and the maximal and cumulative changes in circulating concentrations of the biomarkers of interest were compared.

Results

Serum iron and NTBI responses to oral administration of FeSO4 were significantly greater than responses to plain water or the other two iron compounds. NTBI concentrations after NaFeEDTA or iron polymaltose ingestion were not different from those determined after water intake.

Conclusions

Administration of two iron compounds of proven bioavailability, but with complex absorption characteristics, is associated with a negligible NTBI response, potentially mitigating the safety concerns associated with iron supplementation in malarial areas.
Effects of Third Trimester Counseling on Pregnancy Weight Gain, Birthweight, and Breastfeeding among Urban Poor Women in Bangladesh
Authors: Akter S. M. , Roy S. K. , Thakur S. K. , Sultana M. , Khatun W. , Rahman R. , Saliheen S. S. , Alam N.
Published: November 2015

Background

Maternal malnutrition and poor gestational weight gain are the most important causes of low birth weight and high rates of newborn mortality.

Objective

To assess the effects of nutrition counseling in the third trimester of pregnancy on maternal weight gain, birth weight of newborn, and breastfeeding practices.

Methods

This was a longitudinal experimental study with nutrition intervention for a period of 3 months. One hundred fifteen women (57 in the intervention group and 58 in the comparison group) who were visiting the Maternal and Child Health Training Institute at 6 months of pregnancy were randomly selected. The intervention group was given nutrition education twice in the first month and once a month for the next 2 months before delivery; the comparison group received routine hospital advice on food intake, immunization, personal hygiene, and breastfeeding. The women were weighed monthly up to delivery, the newborn infants' birth weights were measured within 24 hours after delivery, and breastfeeding practices were observed 1 month after delivery.

Results

Women in the intervention group gained 1.73 kg more weight during the third trimester than women in the comparison group (5.61 vs. 3.88 kg, p < 0.001). The mean birthweight of babies of women in the intervention group was 0.44 kg greater than that of babies of women in the comparison group (2.86 vs. 2.42 kg, p <0.001). In the intervention group, 10.5% of babies were born with low birthweight, compared with 48.3% of the babies of women in the comparison group ( p < 0.001). In the intervention group, 75.4% of mothers initiated breastfeeding within 1 hour after birth, compared with 34.5% of mothers in the comparison group ( p < 0.001).

Conclusions

Nutrition education only during the third trimester improved weight gain during pregnancy, reduced 78% of low birth weight, and improved breast-feeding practices.
Bioavailability of Zinc Oxide Added to Corn Tortilla is Similar to that of Zinc Sulfate and is not Affected by Simultaneous Addition of Iron
Authors: Rosado Jorge L. , Díaz Margarita , Muñoz Elsa , Westcott Jamie L. , González Karla E. , Krebs Nancy F. , Caamaño María C. , Hambidge Michael
Published: November 2015

Background

Corn tortilla is the staple food of Mexico and its fortification with zinc, iron, and other micronutrients is intended to reduce micronutrient deficiencies. However, no studies have been performed to determine the relative amount of zinc absorbed from the fortified product and whether zinc absorption is affected by the simultaneous addition of iron.

Objective

To compare zinc absorption from corn tortilla fortified with zinc oxide versus zinc sulfate and to determine the effect of simultaneous addition of two doses of iron on zinc bioavailability.

Methods

A randomized, double-blind, crossover design was carried out in two phases. In the first phase, 10 adult women received corn tortillas with either 20 mg/kg of zinc oxide added, 20 mg/kg of zinc sulfate added, or no zinc added. In the second phase, 10 adult women received corn tortilla with 20 mg/kg of zinc oxide added and either with no iron added or with iron added at one of two different levels. Zinc absorption was measured by the stable isotope method.

Results

The mean (± SEM) fractional zinc absorption from unfortified tortilla, tortilla fortified with zinc oxide, and tortilla fortified with zinc sulfate did not differ among treatments: 0.35 ± 0.07, 0.36 ± 0.05, and 0.37 ± 0.07, respectively. The three treatment groups with 0, 30, and 60 mg/kg of added iron had similar fractional zinc absorption (0.32 ± 0.04, 0.33 ± 0.02, and 0.32 ± 0.05, respectively) and similar amounts of zinc absorbed (4.8 ± 0.7, 4.5 ± 0.3, and 4.8 ± 0.7 mg/day, respectively).

Conclusions

Since zinc oxide is more stable and less expensive and was absorbed equally as well as zinc sulfate, we suggest its use for corn tortilla fortification. Simultaneous addition of zinc and iron to corn tortilla does not modify zinc bioavailability at iron doses of 30 and 60 mg/kg of corn flour.
Scaling up Maternal Nutrition Programs to Improve Birth Outcomes: A Review of Implementation Issues
Authors: Victora Cesar G. , Barros Fernando C. , Assunção Maria Cecilia , Restrepo-Méndez Maria Clara , Matijasevich Alicia , Martorell Reynaldo
Published: November 2015

Background

Maternal nutrition interventions are efficacious in improving birth outcomes. It is important to demonstrate that if delivered in field conditions they produce improvements in health and nutrition.

Objective

Analyses of scaling-up of five program implemented in several countries. These include micronutrient supplementation, food fortification, food supplements, nutrition education and counseling, and conditional cash transfers (as a platform for delivering interventions). Evidence on impact and cost-effectiveness is assessed, especially on achieving high, equitable, and sustained coverage, and reasons for success or failure

Methods

Systematic review of articles on large-scale programs in several databases. Two separate reviewers carried out independent searches. A separate review of the gray literature was carried out including websites of the most important organizations leading with these programs. With Google Scholar a detailed review of the 100 most frequently cited references on each of the five above topics was conducted.

Results

Food fortification programs: iron and folic acid fortification were less successful than salt iodization initiatives, as the latter attracted more advocacy. Micronutrient supplementation programs: Nicaragua and Nepal achieved good coverage. Key elements of success are antenatal care coverage, ensuring availability of tablets, and improving compliance. Integrated nutrition programs in India, Bangladesh, and Madagascar with food supplementation and/or behavioral change interventions report improved coverage and behaviors, but achievements are below targets. The Mexican conditional cash transfer program provides a good example of use of this platform to deliver maternal nutritional interventions.

Conclusions

Programs differ in complexity, and key elements for success vary with the type of program and the context in which they operate. Special attention must be given to equity, as even with improved overall coverage and impact inequalities may even be increased. Finally, much greater investments are needed in independent monitoring and evaluation.
Public Health Interventions, Barriers, and Opportunities for Improving Maternal Nutrition in Northeast Nigeria
Authors: Girard Amy Webb , Dzingina Cynthia , Akogun Oladele , Mason John B. , McFarland Deborah A.
Published: November 2015

Background

Efficacious strategies to improve maternal nutrition and subsequent maternal, neonatal, and child health exist, but their utilization and application at scale is limited.

Objective

This study explored the gaps, barriers, and opportunities for maternal nutrition policy and programming in Nigeria, a country with a disproportionate share of the global burden of maternal and child mortality

Methods

Research was conducted in three phases in four Local Government Authorities in Taraba State. Phase 1 consisted of a desk review of policies, programs, and sociodemographic and health indicators pertinent to maternal nutrition. In-depth interviews were conducted with key informants in state and local ministries of health as well as international nongovernmental organizations and community- and faith-based organizations. Phase 2 utilized in-depth interviews and focus group discussions with community leaders, health promoters, and mothers. Phase 3 consisted of key informant interviews with federal policy and program leaders in government ministries and nongovernmental organizations.

Results

Nutrition, especially maternal nutrition, is not prioritized and is poorly funded in both the governmental and the nongovernmental systems. Perceived weak advocacy for nutrition and its role in economic development and the lack of coordination among governmental and nongovernmental actors were said to contribute to low prioritization. Dependence on health facilities as the primary platform for delivering maternal nutrition is problematic, given severe resource constraints and perceived community barriers, including cost, distance, and poor quality of care.

Conclusions

Advocacy for maternal nutrition that improves understanding of its consequences for health and economic development could hasten prioritization, coordination, and investment in maternal nutrition at the national, state, and local levels. Innovative, multisectoral strategies that move beyond facility-based platforms are needed to reduce the burden of maternal undernutrition in Northeast Nigeria.
Measurement of Food Consumption to Inform Food Fortification and Other Nutrition Programs: An Introduction to Methods and Their Application
Authors: Dary Omar , Imhoff-Kunsch Beth
Published: November 2015

Background

Information on dietary intake is essential for the assessment, planning, monitoring, and evaluation of nutritional interventions. A number of methods are available, each with unique strengths and weaknesses. Dietary intake records, 24-hour recalls, and Food Frequency Questionnaires (FFQs) determine food consumption and nutrient intakes of populations based on individual assessment; few countries have such data at national or regional levels. Food and Agriculture Organization (FAO) Food Balance Sheets (FBS) and food industry data, available in most countries, permit calculations of per capita food consumption but do not provide data on individual consumption. Household Consumption and Expenditures Surveys (HCES) are available for most countries and provide data that can be used to calculate consumption of fortification vehicles and to estimate additional intakes of micronutrients delivered through them to specific population groups.

Objective

To introduce the reader to the set of papers included in this Supplement reviewing methods and experience with HCES to inform nutrition, and specifically food fortification programs.

Methods

The Monitoring, Assessment, and Data (MAD) working group and colleagues critically reviewed experiences in estimating dietary intakes, focusing on the use of secondary analysis of HCES.

Results

HCES predict coverage of the population that consumes a fortification vehicle and consumed amounts of fortification vehicles. HCES allow comparisons of different population strata and may also approximate micronutrient adequacy, based on nutrient density, at the household level.

Conclusions

HCES are useful to inform food fortification and other nutrition programs for planning interventions, but further work is necessary. Currently, combined use of traditional dietary surveys is needed for assessment and for program monitoring and evaluation.
Using Reference Nutrient Density Goals with Food Balance Sheet Data to Identify Likely Micronutrient Deficits for Fortification Planning in Countries in the Western Pacific Region
Authors: Rosalind S. Gibson , Cavalli-Sforza Tommaso
Published: November 2015

Background

Collection of nationwide food consumption data at the individual level is the preferred option for planning fortification programs. However, such data are seldom collected in low-income countries. In con- trast, Food Balance Sheets (FBS), published annually for approximately 180 countries, may provide a source of national data for program planning.

Objective

To explore the use of micronutrient densi- ties from FBS data to identify likely deficits for eight micronutrients in national diets.

Methods

Micronutrient densities in the daily avail- able food supply per capita were calculated from the micronutrient contents of 95 food commodities in 17 Western Pacific Region countries. Densities were com- pared with reference nutrient density goals developed to ensure that at least 95% of individuals, irrespective of life-stage group, are likely to have adequate intakes.

Results

Of the eight micronutrients, Cambodia and Korea D.P.R. had likely deficits for six; China, Fiji, Kiri- bati, Korea Republic, Lao P.D.R., Philippines, Solomon Islands, Vanuatu, and Viet Nam had likely deficits for five; Brunei Darussalam, Malaysia, Mongolia, New Zealand, and Papua New Guinea had likely deficits for four; and New Caledonia had likely deficits for three. The most frequent deficits were for iron, zinc, and calcium (all countries), followed by vitamin B2 and vitamin A ( n = 13), vitamin B1 ( n = 2), and vitamin B12 ( n = 1).

Conclusions

The nutrient density approach could be applied to FBS data for ranking countries according to likely micronutrient deficits, but it provides no information on distribution of nutrient supply for fortification program planning. The approach described here could be applied to data from Household Consumption and Expenditures Surveys (HCES) to characterize households at greatest risk.
Thriving Public—Private Partnership to Fortify Cooking Oil in the West African Economic and Monetary Union (UEMOA) to Control Vitamin A Deficiency: Faire Tache d'Huile en Afrique de l'Ouest
Authors: Sablah Mawuli , Klopp Jennifer , Steinberg Douglas , Touaoro Zaoro , Laillou Arnaud , Baker Shawn
Published: November 2015

Background

In sub-Saharan Africa, more than 42% of children are at risk for vitamin A deficiency, and control of vitamin A deficiency will prevent more than 600,000 child deaths annually. In the West African Economic and Monetary Union (UEMOA), an estimated 54.3% of preschool-age children are vitamin A deficient and 13% of pregnant women have night blindness.

Objective

To project the achievements of this West African coalition.

Methods

This article documents the achievements, challenges, and lessons learned associated with the development of a public—private partnership to fortify vegetable oil in West Africa through project reports and industry assessments.

Results

National-level food consumption surveys identified cooking oil as a key vehicle for vitamin A. Stakeholders therefore advocated for the production of fortified vegetable oil at large scale, supported industrial assessments, and reinforced the capacity of cooking oil industries to implement vitamin A fortification through effective coordination of public and private partnerships tied with standards, regulations, and social marketing. Strong alliances for food fortification were established at the regional and national levels. Stakeholders also developed policies, adopted directives, built capacity, implemented social marketing, and monitored quality enforcement systems to sustain fortification for maximum public health impact. The synergy created resulted from the unique and complementary core competencies of all the partners under effective coordination. The initiative began with the 8 UEMOA member countries and now includes all 15 countries of the Economic Community of West African States (ECOWAS), plus Cameroon, Tanzania, and Mozambique, forming a sub-Saharan Africa-wide initiative on food fortification. All members of the Professional Association of Cooking Oil Industries of the West African Economic and Monetary Union (AIFO-UEMOA) now fortify edible oil with vitamin A. Through multisector cooperation, an estimated 70% of the population has access to vitamin A–fortified edible oil in participating countries.

Conclusions

Sustainable fortification of cooking oil is now a reality in all UEMOA countries.
Iron Status Biomarkers and C-Reactive Protein in Children Aged 19 to 72 Months in Chile
Authors: Brito Alex , Hertrampf Eva , Olivares Manuel
Published: November 2015

Background

The Chilean Ministry of Health has combated iron deficiency through the delivery of fortified milk by the National Complementary Feeding Program (NCFP).

Objective

To assess iron status and associations between biomarkers of iron status and serum C-reactive protein (CRP) in 218 beneficiaries of the NCFP aged 19 to 72 months in Santiago and Valparaiso, Chile.

Methods

Blood was collected from a cross-sectional representative sample. Iron status (measured by hemoglobin, zinc protoporphyrin, and serum ferritin levels) and inflammation (according to CRP level) were determined.

Results

Serum CRP level was positively associated with serum ferritin and zinc protoporphyrin levels ( r = 0.16 and r = 0.15; p = .0168 and p = .0290, respectively). Serum ferritin was higher among children with high CRP (> 10 mg/dL) than among those with low CRP (≤ 10 mg/dL) ( p = .003). After adjustment for 10, 6, and 5 mg/L CRP, the prevalence of low serum ferritin changed from 56.4% without adjustment to 60.6%, 61.5%, and 42.7%, respectively, and the prevalence of high zinc protoporphyrin changed from 22.9% to 21.6%, 17.4%, and 17.9%, respectively. There were no differences between regions in biomarkers of iron status. There was no association between consumption of fortified milk and the prevalence of abnormal serum ferritin (< 15 μg/L) after adjustment for sex, age, and breastfeeding (OR, 1.00; 95% CI, 0.99 to 1.01; p = .288). After adjustment for 10 mg/L CRP, 5.5% were classified as having iron-deficiency anemia, 42.7% as having iron-deficiency erythropoiesis, 17.9% as having depleted iron stores, and 35.8% as having normal iron status.

Conclusions

CRP level was positively associated with serum ferritin and zinc protoporphyrin levels. Chilean children aged 19 to 72 months from Santiago and Valparaiso who were beneficiaries of the NCFP had a low prevalence of iron-deficiency anemia, a high prevalence of iron-deficiency erythropoiesis, and a moderate prevalence of depleted iron stores.