bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical Activity and Fitness in an International Growth Standard for Preadolescent and Adolescent Children
Authors: Malina Robert M. , Katzmarzyk Peter T.
Published: November 2015

Concepts related to energy expenditure, physical activity and physical fitness, and methods of assessment are briefly considered. Variation in energy expenditure, physical activity, and physical fitness associated with age and sex during childhood and adolescence and relationships between physical activity and physical fitness in children and adolescents are reviewed. Implications of undernutrition and obesity for physical activity and physical fitness, and secular changes in physical activity and physical fitness, are briefly highlighted. The review concludes with specific recommendations for and limitations of inclusion of indicators of physical activity and fitness in the construction of an International Growth Standard for Preadolescent and Adolescent Children.
Intensifying Efforts to Reduce Child Malnutrition in India: An Evaluation of the Dular Program in Jharkhand, India
Authors: Dubowitz Tamara , Levinson Dorothy , Peterman Jerusha Nelson , Verma Geeta , Jacob Sangita , Schultink Werner
Published: November 2015

Background

The Dular strategy is a unique nutrition initiative initiated by UNICEF India in collaboration with the states of Bihar and Jharkhand. Designed to complement the government's Integrated Child Development Services (ICDS) and build upon its infrastructure, one of the major goals of the Dular program is to capitalize and develop community resources at the grassroots level. The emphasis of the Dular program is on establishing a community-based tracking system of the health status of women and of children 0 to 36 months of age by neighborhood-based local resource persons (LRPs). The main objectives of the Dular program include increased prenatal attendance, improvement in breastfeeding and colostrum delivery, improved nutritional practices, and decreased malnutrition.

Objectives and methods

An impact evaluation of 744 women and children in Jharkhand examined antenatal and birthing practices, colostrum delivery, delivery of breastmilk as first food, reported use of iodized salt, measured iodized salt status, immunization and weight-for-age z-scores (WAZ) of children 0 to 36 months of age, controlling for various measures of socioeconomic status.

Results

Differences were found between Dular and non-Dular villages in all major outcomes. Particularly noteworthy is that young children in Dular areas had a 45% lower prevalence of severe malnutrition and were four times more likely to receive colostrum than those in non-Dular villages.

Conclusions

Our evaluation results indicate that programmatic overlays to the ICDS program, which focus primary attention on children 0 to 36 months of age and on women, have the potential to transform into a cost-effective instrument for reducing child malnutrition in India, with implications for women and children in India.
Prenatal Multiple Micronutrient Supplementation has Greater Impact on Birthweight than Supplementation with Iron and Folic Acid: A Cluster-Randomized, Double-Blind, Controlled Programmatic Study in Rural Niger
Authors: Zagré Noël M. , Desplats Gwénola , Adou Pierre , Mamadoultaibou Aïssa , Aguayo Victor M.
Published: November 2015

Background

Micronutrient deficiencies during pregnancy are associated with adverse pregnancy outcomes, including reduced birthweight. Low birthweight is associated with increased risk of infant mortality and growth failure.

Objectives

To assess the effects of prenatal supplementation with UNIMMAP (United Nations International Multiple Micronutrient Preparation) compared with iron/folic acid on average birthweight and incidence of low birthweight.

Methods

Pregnant women from 78 villages in Niger were included in a cluster-randomized, double-blinded, controlled supplementation trial. Baseline, monthly follow-up, and birth data were collected. Cluster analysis was conducted to assess differences in mean birthweight and incidence of low birthweight between groups using multiple linear regression models. Analyses were stratified by nutrition status and duration of supplementation.

Results

Of the 3,670 women recruited, 2,550 completed the study and provided complete birthweight data (1,328 received multiple micronutrients and 1,222 received iron/folic acid). Mean birthweight was significantly higher (67 g, p < .001) with multiple micronutrients (3,092 ± 190 g) than with iron/folic acid (3,025 ± 205 g); this corresponded to a 14% fall in the incidence of low birthweight (from 8.4% with multiple micronutrients to 7.2% with folic acid fortification). The impact of multiple micronutrients was greater when the supplements were taken for more than 150 days. The incidence of low birthweight was further reduced in women who entered pregnancy with a poorer nutrition status.

Conclusions

Prenatal supplementation with multiple micronutrients had a greater positive impact on birthweight than supplementation with iron/folic acid. Our data suggest that prenatal supplementation with multiple micronutrients as part of a prenatal care package in addition to interventions to promote improved maternal prepregnancy nutrition status is an important strategy to increase birthweight and reduce the incidence of low birthweight.
An Analysis of the Etiology of Anemia and Iron Deficiency in Young Women of Low Socioeconomic Status in Bangalore, India
Authors: Thankachan Prashanth , Muthayya Sumithra , Walczyk Thomas , Kurpad Anura V. , Hurrell Richard F.
Published: November 2015

Background

Anemia and iron deficiency are significant public health problems in India, particularly among women and children. Recent figures suggest that nearly 50% of young Indian women are anemic.

Objectives

Few studies have comprehensively assessed etiologic factors contributing to anemia and iron deficiency in India. Hence, this study assessed the relative importance of various factors contributing to these problems in young women of low socioeconomic status in Bangalore, India.

Methods

A random sample of 100 nonpregnant, nonlactating women 18 to 35 years of age, selected from among 511 women living in a poor urban settlement, participated in this study. Data were obtained on demography, socioeconomic status, anthropometry, three-day dietary intake, blood hemoglobin, hemoglobinopathies, serum ferritin, serum C-reactive protein, and stool parasites.

Results

The prevalence rates of anemia and iron deficiency were 39% and 62%, respectively; 95% of the anemic women were iron deficient. The mean dietary iron intake was 9.5 mg per day, predominantly from the consumption of cereals, pulses, and vegetables (77%). The estimated bioavailability of nonheme iron in this diet was 2.8%. Dietary intakes were suboptimal for several nutrients. Blood hemoglobin was significantly correlated with dietary intake of fat, riboflavin, milk and yogurt, and coffee. Serum ferritin was significantly correlated with intake of niacin, vitamin B12, and selenium. Parasitic infestation was low.

Conclusions

An inadequate intake of dietary iron, its poor bioavailability, and concurrent inadequate intake of dietary micronutrients appear to be the primary factors responsible for the high prevalence of anemia and iron deficiency in this population.
Nutrient Intake Values (NIVs): A Recommended Terminology and Framework for the Derivation of Values
Authors: King Janet C. , Vorster Hester H. , Tome Daniel G.
Published: November 2015

Although most countries and regions around the world set recommended nutrient intake values for their populations, there is no standardized terminology or framework for establishing these standards. Different terms used for various components of a set of dietary standards are described in this paper and a common set of terminology is proposed. The recommended terminology suggests that the set of values be called nutrient intake values (NIVs) and that the set be composed of three different values. The average nutrient requirement (ANR) reflects the median requirement for a nutrient in a specific population. The individual nutrient level (INLx) is the recommended level of nutrient intake for all healthy people in the population, which is set at a certain level x above the mean requirement. For example, a value set at 2 standard deviations above the mean requirement would cover the needs of 98% of the population and would be INL98. The third component of the NIVs is an upper nutrient level (UNL), which is the highest level of daily nutrient intake that is likely to pose no risk of adverse health effects for almost all individuals in a specified life-stage group. The proposed framework for deriving a set of NIVs is based on a statistical approach for determining the midpoint of a distribution of requirements for a set of nutrients in a population (the ANR), the standard deviation of the requirements, and an individual nutrient level that assures health at some point above the mean, e.g., 2 standard deviations. Ideally, a second set of distributions of risk of excessive intakes is used as the basis for a UNL.
The Role of Diet- and Host-Related Factors in Nutrient Bioavailability and Thus in Nutrient-Based Dietary Requirement Estimates
Authors: Gibson Rosalind S.
Published: November 2015

To convert physiological requirements into dietary requirements, adjustments are needed for some nutrients that take into account certain diet- and host-related factors specific to a country or region. Nutrients whose requirements should be adjusted in this way include calcium, magnesium, iron, zinc, protein, folate, vitamin A, and carotenoids. The diet-related factors that must be considered depend on the nature of the habitual diet and may include the chemical form of the nutrient and the nature of the dietary matrix, interactions between nutrients and/or organic components, and food preparation and processing practices within the country or region. The host-related factors can be further subdivided into intestinal and systemic factors. Reductions in the secretion of hydrochloric acid, gastric acid, and/or intrinsic factor, together with alterations in the permeability of the intestinal mucosa, are all examples of intestinal factors that can markedly influence the absorption of certain nutrients, but that are often ignored when setting dietary requirements. Systemic factors that should also be considered include nutrient status of the host, age, sex, ethnicity, genotype, and physiological state (e.g., pregnancy or lactation), and chronic and acute infectious disease states. Algorithms can estimate the bioavailability of iron, zinc, protein, folate, vitamin A, and carotenoids, although their accuracy is limited by the complex interactions among the absorption modifiers in the whole diet. For calcium and magnesium, the amount available for absorption is still estimated from their major food sources in the habitual diet. Currently, there are often large differences in the adjustments employed to convert physiological requirements to dietary requirements, even among countries consuming diets of similar patterns.
Application of Nutrient Intake Values (NIVs)
Authors: Vorster Hester H. , Murphy Suzanne P. , Allen Lindsay H. , King Janet C.
Published: November 2015

The process of applying nutrient intake values (NIVs) for dietary assessment, planning, and implementing programs is discussed in this paper. In addition to assessing, monitoring, and evaluating nutritional situations, applications include planning food policies, strategies, and programs for promotion of optimal nutrition and preventing and treating malnutrition (both over- and undernutrition). Other applications include nutrition education, food and nutrient legislation, marketing and labeling, research, product development, food procurement and trade (import and export), food aid, and therapeutic (clinical) nutrition. Specific examples of how NIVs are used to develop food labels, fortification policies, and food-based dietary guidelines are described. Applications in both developed and developing countries are also described. In summary, NIVs are the scientific backbone of all aspects of nutrition policy in countries and regions worldwide.
Ensuring the Supply of and Creating Demand for a Biofortified Crop with a Visible Trait: Lessons Learned from the Introduction of Orange-Fleshed Sweet Potato in Drought-Prone Areas of Mozambique
Authors: Low Jan W. , Arimond Mary , Osman Nadia , Cunguara Benedito , Zano Filipe , Tschirley David
Published: November 2015

Background

Orange-fleshed sweet potato (OFSP) is a promising biofortified crop for sub-Saharan Africa because it has high levels of provitamin A carotenoids, the formed vitamin A is bioavailable, and white-fleshed sweet potato is already widely grown.

Objectives

To examine whether farmers will adopt varieties with a distinct visible trait, young children will eat OFSP in sufficient quantities to improve vitamin A intake, OFSP can serve as an entry point for promoting a more diversified diet, and lessons can be drawn to assure sustained adoption.

Methods

The 2-year quasi-experimental intervention study followed households and children ( n = 741; mean age, 13 months at baseline) through two agricultural cycles in drought prone-areas of Mozambique.

Results

OFSP is acceptable to farmers when introduced by using an integrated approach. In the second year, intervention children ( n = 498) were more likely than control children ( n = 243) to have consumed OFSP (54% vs. 4%), dark-green leaves (60% vs. 46%), or ripe papaya (65% vs. 42%) on 3 or more days in the previous week ( p < .001 for all comparisons). Their vitamin A intakes were nearly eight times higher than those of control children (median, 426 vs. 56 μg RAE [retinol activity equivalents], p < .001). Diet diversification was limited by difficult agroecological conditions and low purchasing power. However, dietary diversity was higher among intervention than control children (32% vs. 9% consuming food from more than four groups; p < .001).

Conclusions

An integrated OFSP-based approach had a positive impact on the vitamin A intake of young children. A market development component and improved vine multiplication systems are recommended to assure sustained adoption.
Traditional Lebanese Recipes Based on Wild Plants: An Answer to Diet Simplification?
Authors: Batal Malek , Hunter Elizabeth
Published: November 2015

Background

The challenge posed by the nutrition transition occurring throughout the world is enormous: rates of chronic disease, particularly overweight and obesity and cardiovascular disease, have reached alarming levels—often occurring in parallel with high levels of micronutrient deficiencies. Lebanon is no exception. And yet this Mediterranean country enjoys a rich biodiversity, with thousands of endemic species and an equally rich culinary history, largely based on its local biodiversity, including wild edible plants.

Objectives

To record traditional Lebanese recipes based on wild edible plants and to investigate their potential to contribute to a more diversified diet.

Methods

A series of nine focus group meetings was conducted with key informants knowledgeable in wild edible plant identification, harvesting, and use.

Results

Common recipes based on wild edible plants were collected and standardized from rural communities where collection of wild edible plants is common. Nutrient analysis and food-composition analysis were performed, including comparisons with processed dishes that are increasingly common in the Lebanese diet, revealing that the wild edible plant-based dishes offered a healthier alternative.

Conclusions

Since traditional recipes often use items from several food groups in one dish, they can be a good model for diet diversification. The promotion of the collection and use of wild edible plants and their derived products can lead to improved nutrition.
Avian Influenza H5N1: Risks at the Human–Animal Interface
Authors: Mumford Elizabeth , Bishop Jennifer , Hendrickx Saskia , Embarek Peter Ben , Perdue Michael
Published: November 2015

Background

Great concern has arisen over the continued infection of humans with highly pathogenic avian influenza (HPAI) of the H5N1 subtype. Ongoing human exposure potentially increases the risk that a pandemic virus strain will emerge that is easily transmissible among humans. Although the pathogenicity of a pandemic strain cannot be predicted, the high mortality seen in documented H5N1 human infections thus far has raised the level of concern.

Objectives

To define the three types of influenza that can affect humans, discuss potential exposure risks at the human–animal interface, and suggest ways to reduce exposure and help prevent development of a pandemic virus.

Methods

This review is based on data and guidelines available from the World Health Organization, the scientific literature, and official governmental reports.

Results

Epidemiological data on human exposure risk are generally incomplete. Transmission of HPAI to humans is thought to occur through contact with respiratory secretions, feces, contaminated feathers, organs, and blood from live or dead infected birds and possibly from contaminated surfaces. Consumption of properly cooked poultry and eggs is not thought to pose a risk. Use of antiviral containment and vaccination may protect against development of a pandemic.

Conclusions

To most effectively decrease the risk of a pandemic, the public health and animal health sectors—those which are responsible for protecting and improving the health of humans and animals, respectively—must collaborate to decrease human exposure to HPAI virus, both by controlling virus circulation among poultry and by assessing the risks of human exposure to avian influenza virus at the human—animal interface from primary production through consumption of poultry and poultry products, and implementing risk-based mitigation measures.
Iron Metabolism in Children: Confounding Factors
Authors: Brittenham Gary M.
Published: November 2015

Characterization of iron metabolism in infants and children may be confounded by the diverse effects of developmental, genetic, and acquired influences on iron metabolism and laboratory measurements of iron status, especially in areas with intense perennial transmission of Plasmodium falciparum malaria. In the Pemba iron and folic acid supplementation trial, the coadministration of folic acid with iron is a further confounding factor. Because the design of the Pemba iron and folic acid supplementation study did not include a group that received iron supplementation without folic acid, the observed increase in serious adverse events cannot be ascribed unequivocally to iron alone, to folic acid alone, or to the combination of the two. In interpreting the results from the Pemba iron and folic acid supplementation trial, additional analyses of existing data from the trial and from earlier studies in the area could help clarify the roles of iron and folic acid.
Increasing Iron Intake of Children through Complementary Foods
Authors: Dewey Kathryn G.
Published: November 2015

Low intake of bioavailable iron from complementary foods is the major cause of the high prevalence of iron-deficiency anemia among children 6 to 24 months of age in developing countries. Increased dietary diversity and traditional food-processing techniques are generally unsuccessful at completely closing the gap between iron intake and needs. Thus, iron-fortified processed complementary foods or home fortification (using powders, crushable tablets, or fat-based products) will be needed in most populations. Several studies have demonstrated that both approaches are efficacious, though there are limited data on effectiveness on a wide scale. The choice of which product to promote may depend on the context, as well as cost constraints. No adverse effects of increasing iron intake through fortification or home fortification of complementary foods have been reported, but large-scale studies that include sufficient numbers of iron-replete children are lacking. Further research is needed to verify the safety of iron-fortification strategies, particularly in malarial areas.
Dietary Intake and Clinical Response of Hospitalized Patients with Acute Diarrhea
Authors: Islam Mahfuza , Roy S.K. , Begum Muktara , Chisti M. Jobayer
Published: November 2015

Background

Diarrhea and malnutrition remain major health problems among children of developing countries. During diarrhea, the patient's dietary intake and absorption of nutrients are reduced while nutritional requirements are increased.

Objective

To determine the relationship between food intake and clinical response during the hospital stay of patients with acute diarrhea.

Methods

A hospital-based longitudinal study was conducted in 118 patients with acute diarrhea aged 6 to 59 months who required treatment for at least 3 days in the in-patient ward in Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B). Daily food intake was measured and anthropometric measurements were taken to assess nutritional status. Daily stool weight and clinical records were collected. The data were analyzed with SPSS/PC+, version 10, and EPI STAT, version 3.2.2.

Results

The duration of diarrhea was 50% greater in patients with lower energy intake (less than 50% of the recommended dietary allowance [RDA]) than in those with higher energy intake (6 vs. 4 days, p = <.001). Patients with lower energy intake had 22% greater stool output than those with higher energy intake (122.65 vs. 100.37 mL/kg body weight/day, p = .04). Among patients with lower energy intake, the weight-for-age and weight-for-height z-scores (WAZ and WHZ) at discharge from the hospital were higher than those at admission (−3.53±1.25 vs. −3.67±1.31 and 1.95±1.23 vs. −2.14±1.22, respectively; p = .001 for both comparisons), but these scores did not differ at admission and discharge among patients with higher energy intake. The Kaplan–Meier survival function showed that 80% of well-nourished children (WAZ ≥ −2), as compared with 58% of malnourished children (WAZ < −2), recovered by the 4th day of treatment ( p < .01). The length of the recovery period was related negatively with total energy intake ( p = <.001) and mid-upper-arm circumference ( p = .004) and positively with stool weight.

Conclusions

Food intake was reduced in the hospitalized children because of severe illness. Patients with lower energy intake as a percentaqe of RDA had delayed clinical recovery and higher stool output.
A Comparative Evaluation of Dietary Indicators Used in Food Consumption Assessments of at-Risk Populations
Authors: Rose Donald , Chotard Sophie , Oliveira Leila , Mock Nancy , Libombo Marcella
Published: November 2015

Background

Easy-to-collect dietary indicators have been used increasingly for planning and evaluation of food security interventions. Various indicators have been employed, but rarely has a full set of indicators been compared using a common framework.

Objective

This paper evaluates the performance of five dietary indicators for the assessment of household energy consumption using a common framework and recent data from Mozambique.

Methods

Data were analyzed from a 2004 household survey, Current Vulnerability Analysis in Seven Provinces of Mozambique. Households ( n = 4,358) were sampled from 42 rural districts using a two-stage design, and a quantitative 24-hour dietary recall was employed. Household energy intake ratios were calculated as the food energy consumed by household members divided by the sum of the members' recommended intakes. Five proxy indicators of household consumption in the previous day were developed: the number of meals, the number of food groups, the number of food items, a score based on a simple weighting of food groups consumed, and a predicted energy intake ratio based on weighting of food groups consumed with previously estimated regression coefficients. The performance of these indicators was assessed using correlations with energy intake, receiver operator characteristic analysis, efficiency of predictions, and prevalence estimate comparisons.

Results

Although the predicted energy intake ratio performed best on all these performance criteria, and the simple food-group-weighted score performed second best, differences among the indicators on many of the criteria were relatively small.

Conclusions

New assessment systems could take full advantage of easy-to-collect information by using one of these best-scoring indicators, although established systems could continue to use some of the other indicators explored here, such as the food item count, without much loss in accuracy.
What Difference do the new WHO Child Growth Standards make for the Prevalence and Socioeconomic Distribution of Undernutrition?
Authors: Ergo Alex , Gwatkin Davidson R. , Shekar Meera
Published: November 2015

Background

The World Health Organization has recently established revised child growth standards.

Objective

To assess how the use of these new standards affects the estimated prevalence and socioeconomic distribution of stunting and underweight among children in a large number of low- and middle-income countries.

Methods

We analyzed Demographic and Health Survey data for stunting and underweight in 41 low- and middle-income countries employing these new standards and compared the results with those produced by analyses of the same data using the old growth references.

Results

For all 41 countries, the prevalence of stunting increases with the adoption of the new standards, by 5.4 percentage points on average (95% CI: 5.1, 5.7). The prevalence of underweight decreases in all but two of the countries, by an average of 2.9 percentage points (95% CI: 2.7, 3.2). The impact of using the new standards on socioeconomic inequalities is mixed. For stunting, inequalities tend to rise in absolute terms but tend to decline in relative terms. The impact on underweight is inconsistent across countries. Poor children suffer most from undernutrition, but even among the better-off children in developing countries, undernutrition rates are high enough to deserve attention.

Conclusions

These results suggest that the adoption of the new WHO standards in itself is unlikely to affect policies dramatically. They do confirm, however, that different strategies are likely to be required in these countries to effectively address undernutrition among children at different socioeconomic levels.
Prevalence of Undernutrition among Children in the Garhwal Himalayas
Authors: Dutta Anuradha , Pant Kiran , Puthia Rekha , Sah Archana
Published: November 2015

Background

Nutritional status is the best indicator of the global well-being of children. In India every third child is underweight, whereas in the Garhwal Himalayas only one-fifth of the children are nutritionally normal. Information regarding the causes of such low nutritional status in children of Garhwal is lacking.

Objective

The present study was designed to identify factors that may influence the nutritional status of the children of the Garhwal Himalayas. Stunting, signifying long-term irreversible chronic undernutrition, was studied, along with wasting, which signifies acute undernutrition among children.

Methods

Forty families from one town and one village in each of the three major agroclimatic situations (high, middle, and low hills) were selected at random (total 240 families). The nutritional status of 353 children (0 to 12 years of age) was assessed by nutritional anthropometry and compared with tables of weight-for-age and height-for-age z-scores (WAZ and HAZ) identifying wasting and stunting, respectively, and compared with the World Health Organization (WHO) Growth Reference charts 2007. Chi-square test was applied to analyze the effects of age, sex, altitude, and area on the nutritional status of children.

Results

Of the 353 children studied, 38.2% belonged to the school-aged group, with 7% more girls than boys. Only 11.3% of the children had normal HAZ while 10.3% had normal WAZ. The largest percentages of children (31.8% HAZ and 29.1% WAZ) were clustered in the SD1 group, that is the severely stunted or wasted group. In every age group except the 9- to 12-year group, most of the children were found in the WAZ SD1 category. Gender appeared to influence the SD1 category significantly. There were 17.0% severely stunted girls (SD1), as compared to 14.8% boys; while the percentages of WAZ girls was 16.1% and boys was 13%. The situation in the urban areas was slightly better: 6.4% of the sample had normal HAZ and 7.1% had normal WAZ, compared with 4.4% and 4.6% of the rural children. In all three agroclimatic situations, the largest percentage of children fell in the HAZ SD1 (stunted) category (15.3% in the high hills, 7.3% in the middle hills, and 9.5% in the low hills). There is a significant effect of area (rural vs. urban) on stunting and wasting among children. The child's sex affects stunting only. The other two variables, altitude and age, do not show a significant relationship with stunting or wasting.

Conclusions

The rate of malnutrition among children in the Garhwal is very high. The majority are severely stunted and wasted, indicating a high prevalence of both chronic and acute malnutrition. Only the area of residence (rural or urban) had an influence on a child's nutritional status.
In Vitro Estimates of Iron Bioavailability in Some Kenyan Complementary Foods
Authors: Lung'aho Mercy G. , Glahn Raymond P.
Published: November 2015

Background

Iron-deficiency anemia is by far the most widespread micronutrient deficiency disease in the world, affecting more than 2 billion people. Although there are multiple causes of anemia, its high prevalence among children—especially in developing countries such as Kenya—is attributed to an inadequate intake of dietary iron.

Objective

The main objective of this study was to assess the amount of bioavailable iron in Kenyan complementary foods and to determine whether strategies such as food diversification using locally available foods would improve the bioavailability of iron from these foods.

Methods

The in vitro iron bioavailability system/ Caco-2 cell model that mirrors the gastric and intestinal digestion of humans was used in this study to estimate the amount of bioavailable iron in the porridges.

Results

The addition of cassava significantly increased the amount of ferritin formation in a cereal-based home recipe from 36.74 to 67.58 ng/mg. The in vitro data suggests that home recipes can provide an equal or greater amount of bioavailable iron as the commercially available nonfortified porridge products. However, in vitro assessment showed that the nonfortified recipes had less bioavailable iron than Cerelac, a commercially available fortified complementary food that provides about 26% of the RDA of iron for infants 6 and 7 months of age per serving ( p < .0001).

Conclusions

In addition to diet diversity, more approaches to address iron inadequacy of complementary foods are required to improve the bioavailability of iron from the Kenyan complementary foods analyzed.
School Feeding: Outcomes and Costs
Authors: Galloway Rae , Kristjansson Elizabeth , Gelli Aulo , Meir Ute , Espejo Francisco , Bundy Donald
Published: November 2015

Background

School-feeding programs are popular development assistance programs in developing countries but have previously had few sound, empirical analyses of their effectiveness and costs.

Objective

The goals of this study were to provide a realistic estimate of the costs of school feeding and combine these estimates with outcome information to obtain the cost per outcome.

Methods

Cost studies were conducted in three African countries by reviewing school-feeding costs provided by the World Food Programme and interviewing stakeholders in ministries of education and in the community. In another African country, existing costing information was used. To compare across the countries, costs were standardized for a 200-day school year, a 700-kcal per day ration, and when children were not fed. To obtain cost per outcome data, outcomes were obtained from a review of school-feeding studies.

Results

The cost of school feeding ranged from US$28 to US$63 per child per year (weighted mean cost of US$40 per child per year). The cost for an extra day of attendance was less than US$10 per student, while the cost per extra kilogram of weight ranged from US$38 to US$252. Costs for cognitive outcomes were similarly variable.

Conclusions

This analysis estimates a higher average cost but a narrower range of costs when compared with previous estimates, reflecting the greater precision of the current analyses. The cost per outcome was high, but this analysis does not capture the full range of outcomes (e. g., social protection, educational achievement) potentially derived from school feeding.
Growth and Body Composition of Peruvian Infants in a Periurban Setting
Authors: Iannotti Lora L. , Zavaleta Nelly , León Zulema , Caulfield Laura E.
Published: November 2015

Background

Previous growth studies of Peruvian children have featured high stunting rates and limited information about body composition.

Objective

We aimed to characterize anthropometric measures of Peruvian infants 0 to 12 months of age in relation to the international growth references and biological, environmental, and socioeconomic factors.

Methods

Infants ( n = 232) were followed longitudinally from birth through 12 months of age from a prenatal zinc supplementation trial conducted in Lima, Peru, between 1995 and 1997. Anthropometric measures of growth and body composition were obtained at enrollment from mothers and monthly through 1 year of age from infants. Weekly morbidity and dietary intake surveillance was carried out during the second half of infancy.

Results

The prevalence rates of stunting, underweight, and wasting did not exceed 4% based on the World Health Organization growth references. Infants of mothers from high-altitude regions had larger chest circumference ( p = .006) and greater length ( p = .06) by 12 months. Significant predictors of growth and body composition throughout infancy were age, sex, anthropometric measurements at birth, breastfeeding, maternal anthropometric measurements, primiparity, prevalence of diarrhea among children, and the altitude of the region of maternal origin. No associations were found for maternal education, asset ownership, or sanitation and hygiene factors.

Conclusions

Peruvian infants in this urban setting had lower rates of stunting than expected. Proximal and familial conditions influenced growth throughout infancy.
Galvanizing Action: Conclusions and Next Steps for Mainstreaming Zinc Interventions in Public Health Programs
Authors: Brown Kenneth H. , Baker Shawn K.
Published: November 2015

This paper summarizes the results of the foregoing reviews of the impact of different intervention strategies designed to enhance zinc nutrition, including supplementation, fortification, and dietary diversification or modification. Current evidence indicates a beneficial impact of such interventions on zinc status and zinc-related functional outcomes. Preventive zinc supplementation reduces the incidence of diarrhea and acute lower respiratory tract infection among young children, decreases mortality of children over 12 months of age, and increases growth velocity. Therapeutic zinc supplementation during episodes of diarrhea reduces the duration and severity of illness. Zinc fortification increases zinc intake and total absorbed zinc, and recent studies are beginning to confirm a positive impact of zinc fortification on indicators of population zinc status. To assist with the development of zinc intervention programs, more information is needed on the prevalence of zinc deficiency in different countries, and rigorous evaluations of the effectiveness of large-scale zinc intervention programs should be planned. Recommended steps for scaling up zinc intervention programs, with or without other micronutrients, are described. In summary, there is now clear evidence of the benefit of selected interventions to reduce the risk of zinc deficiency, and a global commitment is urgently needed to conduct systematic assessments of population zinc status and to develop interventions to control zinc deficiency in the context of existing public health and nutrition programs.
INCAP Studies of Energy, Amino Acids, and Protein
Authors: Viteri Fernando E.
Published: November 2015

This Special Issue summarizes the results of several studies aimed at providing information on a series of questions related to the adequate protein and energy intakes that allow adequate growth and function in children and work performance and productivity in adults. The effect of different sources of protein on nitrogen balance and the requirements of essential amino acids in young children were also explored in fully recovered, previously malnourished children housed in the Metabolic Ward of the Biomedical Division of INCAP.

The following are the main results of these investigations: » Animal experiments and studies in children recovering from protein–energy malnutrition (PEM) strongly suggest that even when requirements of all nutrients are satisfied, inactivity reduces the rate of linear growth and physical activity improves it as well as lean body mass repletion. » The effects of different energy intakes on nitrogen balance demonstrated how energy intake modifies the need to ingest different amounts of protein to satisfy protein requirements. » Insensible nitrogen losses in preschool children and their relation to protein intake was demonstrated. » The quality of even “good protein sources” modifies the amount needed to satisfy nitrogen requirements, and corn and bean-based diets can satisfy protein needs for health and even growth of young children. » Essential amino acid requirements of 2-year-old children was assessed by diverse measurements of nitrogen metabolism and amino acid levels in blood, and were found lower than those recommended by FAO-WHO. » In rural adult populations the relationship between energy and protein intake, productivity and body composition, and the impact of environmental hygiene on nitrogen balance was demonstrated and measured.
Social Anthropology in INCAP
Authors: Adams Richard N.
Published: November 2015

Social anthropology at INCAP evolved through a series of stages. The initial work in the 1950s was concerned with finding ways to make INCAP nutritional research more effective. In a second phase, emerging in the 1960s, anthropology examined the nutrition process in the population, especially as it was manifested in child care and feeding, lactation, and population growth and in the relation of economic process to nutritional progress. In the 1970s, anthropology once more became an adjunct of nutritional research. Anthropological awareness was introduced into project planning, and field studies were undertaken by way of shaping the research process to work in accord with local realities. In the 1980s and 1990s, there was a shift away from more descriptive research to research directed to supporting and facilitating specific nutrition and health behavior change.
Across-Country Comparisons of Selected Infant and Young Child Feeding Indicators and Associated Factors in Four South Asian Countries
Authors: Dibley Michael J. , Roy S. K. , Senarath Upul , Patel Archana , Tiwari Kalpana , Agho Kingsley E. , Mihrshahi Seema ,   for the South Asia Infant Feeding Research Network (SAIFRN)*
Published: November 2015

Background

Information on infant and young child feeding is widely available in Demographic and Health Surveys and National Family Health Surveys for countries in South Asia; however, infant and young child feeding indicators from these surveys have not been compared between countries in the region.

Objective

To compare the key indicators of breastfeeding and complementary feeding and their determinants in children under 24 months of age between four South Asian countries.

Methods

We selected data sets from the Bangladesh Demographic and Health Survey 2004, the India National Family Health Survey (NFHS-03) 2005–06, the Nepal Demographic and Health Survey 2006, and the Sri Lanka 2000 Demographic and Health Survey. Infant feeding indicators were estimated according to the key World Health Organization indicators.

Results

Exclusive breastfeeding rates were 42.5% in Bangladesh, 46.4% in India, and 53.1% in Nepal. The rate of full breastfeeding ranged between 60.6% and 73.9%. There were no factors consistently associated with the rate of no exclusive breastfeeding across countries. Utilization of health services (more antenatal clinic visits) was associated with higher rates of exclusive breastfeeding in India but lower rates in Nepal. Delivery at a health facility was a negative determinant of exclusive breastfeeding in India. Postnatal contacts by Public Health Midwives were a positive factor in Sri Lanka. A considerable proportion of infants under 6 months of age had been given plain water, juices, or other nonmilk liquids. The rate of timely first suckling ranged from 23.5% in India to 56.3% in Sri Lanka. Delivery by cesarean section was found to be a consistent negative factor that delayed initiation of breastfeeding. Nepal reported the lowest bottle-feeding rate of 3.5%. Socioeconomically privileged mothers were found to have higher bottle-feeding rates in most countries.

Conclusions

Infant and young child feeding practices in the South Asia region have not reached the expected levels that are required to achieve a substantial reduction in child mortality. The countries with lower rates of exclusive breastfeeding have a great potential to improve the rates by preventing infants from receiving water and water-based or other nonmilk liquids during the first 6 months of life.
Risk Factors Associated with High Prevalence of Anemia among Children under 5 Years of Age in Paddy-Farming Households in Sri Lanka
Authors: Malkanthi R. L. D. K. , Silva K. D. R. R. , Jayasinghe-Mudalige Udith K.
Published: November 2015

Background

The prevalence of anemia among pre- school-aged children remains relatively high in developing countries. Determination of the risk factors associated with anemia is important to develop appropriate interventions.

Objective

To determine the prevalence of anemia among children under 5 years of age and to evaluate the risk factors associated with anemia.

Methods

The subjects were 300 children 0 to 60 months of age from 300 subsistence paddy-farming households from nine divisional secretariats across five districts of Sri Lanka (Anuradhapura, Polonnaruwa, Hambantota, Ratnapura, and Kurunegala). The HaemoCue method was used to measure hemoglobin concentration, and anemia was defined as hemoglobin < 11 g/dl. A 24-hour dietary recall was used to determine nutrient intakes.

Results

Overall, 52% of the children were anemic and 18% were severely anemic. Hemoglobin measurements were strongly positively correlated with age ( r = 0.41, p < .0001) and modestly negatively correlated with duration of exclusive breastfeeding ( r = −0.18, p < .0001). Factors that were significantly associated with anemia were age, duration of exclusive breastfeeding, father's and mother's education, monthly household income, iron intake, and consumption of fruits on the previous day. In multivariate logistic regression, only duration of exclusive breastfeeding, iron intake, and father's education remained significantly associated with anemia ( r2 = 0.060, p = .002). Children with a long duration of exclusive breastfeeding, less educated fathers, and low iron intake were more likely to be anemic.

Conclusions

Anemia is associated with factors reflecting poor socioeconomic and educational status and a less diverse, poor-quality diet among children in paddy-farming households.
Fortification of Flour with Folic Acid
Authors: Berry Robert J. , Bailey Lynn , Mulinare Joe , Bower Carol , Dary Omar
Published: November 2015

Background

After randomized, controlled trials established that consumption of folic acid before pregnancy and during the early weeks of gestation reduces the risk of a neural tube defect (NTD)-affected pregnancy, the United States Public Health Service recommended in 1992 that all women capable of becoming pregnant consume 400 μg folic acid daily. In 1998, folic acid fortification of all enriched cereal grain product flour was fully implemented in the United States and Canada.

Objective

To provide guidance on national fortification of wheat and maize flours to prevent 50 to 70% of the estimated 300,000 NTD-affected pregnancies worldwide.

Methods

An expert workgroup reviewed the latest evidence of effectiveness of folic acid flour fortification and the safety of folic acid.

Results

Recent estimates show that in the United States and Canada, the additional intake of about 100 to 150 μg/day of folic acid through food fortification has been effective in reducing the prevalence of NTDs at birth and increasing blood folate concentrations in both countries. Most potential adverse effects associated with folic acid are associated with extra supplement use not mandatory fortification. Fortification of wheat flour has a proven record of prevention in other developed countries. In 2009, 51 countries had regulations written for mandatory wheat flour fortification programs that included folic acid.

Conclusions

NTDs remain an important cause of perinatal mortality and infantile paralysis worldwide. Mandatory fortification of flour with folic acid has proved to be one of the most successful public health interventions in reducing the prevalence of NTD-affected pregnancies. Most developing countries have few, if any, common sources of folic acid, unlike many developed countries, which have folic acid available from ready-to-eat cereals and supplements. Expanding the number of developed and developing countries with folic acid flour fortification has tremendous potential to safely eliminate most folic acid-preventable NTDs.
Formative Research Exploring Acceptability, Utilization, and Promotion in Order to Develop a Micronutrient Powder (Sprinkles) Intervention among Luo Families in Western Kenya
Authors: Jefferds Maria Elena D. , Ogange Lorraine , Owuor Mercy , Cruz Kari , Person Bobbie , Obure Alfredo , Suchdev Parminder S. , Ruth Laird J.
Published: November 2015

Background

There is a lack of peer-reviewed literature describing in detail the formative research to develop Sprinkles interventions.

Objective

To describe community members' reactions to and experiences using Sprinkles, with an emphasis on acceptability, utilization, and promotion.

Methods

Fourteen initial focus group discussions on Sprinkles and a 25-family home study were conducted. For the home study, each child 6 to 59 months of age in the household received 30 sachets (1 per day). The initial 14 focus group discussions included mothers, grandmothers, vendors, women who purchased from vendors, and adults in the general population. Home study families were recruited from participants in the initial 14 focus group discussions who had at least one child 6 to 59 months of age.

Results

Sprinkles were highly acceptable to adults and most children; some children thought Sprinkles were sugar. Most home study families prepared and used Sprinkles correctly. All families reported positive effects, particularly increased appetite, and recommended Sprinkles; none experienced major problems. Potential barriers identified were lack of knowledge of and experience with Sprinkles, availability of Sprinkles, and cost. Promotional messages targeted to mothers, fathers, all child-care providers, and doctors focused on the positive health effects of Sprinkles.

Conclusions

Issues related to Sprinkles preparation, use, and barriers required attention before implementation. Locally appropriate visual and written instructions were developed for dissemination. Intervention training sessions and promotions were tailored to answer frequently asked questions, increase knowledge of Sprinkles, and provide tangible evidence of health benefits. Information needs and perceptions changed quickly after use of Sprinkles. Existing levels of Sprinkles awareness and knowledge should be considered when designing interventions.