bluuebunny/crossref_metadata_2025 huggingface dataset:
Zinc as a Potential Coadjuvant in Therapy for Type 2 Diabetes
Authors: Ruz Manuel , Carrasco Fernando , Rojas Pamela , Codoceo Juana , Inostroza Jorge , Basfi-Fer Karen , Valencia Alejandra , Vásquez Karla , Galgani Jose , Pérez Alvaro , López Gloria , Arredondo Miguel , Perez-Bravo Francisco
Published: November 2015

Background

Type 2 diabetes is highly prevalent in populations having high rates of overweight and obesity. It is a chronic condition responsible for long-term severe dysfunction of several organs, including the kidneys, heart, blood vessels, and eyes. Although there are a number of pharmacologic products in the market to treat insulin resistance and impaired insulin secretion—the most prominent features of this disease—interventions directed at preserving the integrity and function of β-cells in the long term are less available. The use of some nutrients with important cellular protective roles that may lead to a preservation of β-cells has not been fully tested; among these, zinc may be an interesting candidate.

Objective

To assess the potential of zinc supplementation as coadjuvant to diabetes therapy.

Methods

This article reviews the available information on the use of zinc as part of diabetes therapy.

Results

Cellular and animal models provide information on the insulin mimetic action of zinc, as well as its role as a regulator of oxidative stress, inflammation, apoptosis, and insulin secretion. Zinc supplementation studies in humans are limited, although some positive effects have been reported; mainly, a modest but significant reduction in fasting glucose and a trend to decreased glycated hemoglobin (HbA1c).

Conclusions

Zinc supplementation may have beneficial effects on glycemic control. Nevertheless, among the studies considered, the vast majority lasted for 6 months or less, suggesting the importance of conducting long-duration studies given the characteristics of type 2 diabetes as a chronic disease.
Situational Analysis and Expert Evaluation of the Nutrition and Health Status of Infants and Young Children in Five Countries in Sub-Saharan Africa
Authors: Alles Martine , Eussen Simone , Ake-Tano Odile , Diouf Saliou , Tanya Agatha , Lakati Alice , Oduwole Abiola , Mauras Celine
Published: November 2015

Background

The poor feeding practices of pregnant women, infants, and young children contribute to the burden of malnutrition and subsequently to childhood morbidity and mortality in sub-Saharan Africa. Gaining insight into the nutritional and health status of infants and young children will help to focus future nutrition programs and actions.

Objective

To assess the nutrition and health status of infants and young children in five sub-Saharan African countries: Ivory Coast, Senegal, Cameroon, Kenya, and Nigeria.

Methods

Published and gray literature was critically reviewed and enriched with the views of local experts from academia, hospitals, and institutions to assess infants' and children's diet and health in the five sub-Saharan African countries. Subsequently, the Africa Nutriday Conference was held in Senegal in November 2011 to further discuss key challenges, action plans, and recommendations for future research.

Results

This review highlighted the need for education of parents and healthcare professionals in order to increase their knowledge of breastfeeding, vaccination programs, and over- and undernutrition. An integrated health and nutrition surveillance is needed both to identify micronutrient deficiencies and to recognize early signs of overweight. These data will help to adapt nutrition education and food fortification programs to the target populations.

Conclusions

Different countries in sub-Saharan Africa face similar nutrition and health issues and are currently not sharing best practices, nutrition programs, and scientific studies optimally. There is a need for closer collaboration among scientists within and between countries.
Nutritional Impact of Highly Pathogenic Avian Influenza in Kenya
Authors: Iannotti Lora , Roy Devesh
Published: November 2015

Background

Outbreaks of highly pathogenic avian influenza (HPAI) (virus type H5N1) have led to extensive bird culling and other control measures throughout the world, with implications especially for the livelihoods of the poor. There is limited empirical evidence for the impact of HPAI on poultry consumption and nutrition of vulnerable populations.

Objective

To test the effect of reduced per capita poultry consumption at the household level due to an HPAI event on anthropometric measurements of children.

Methods

This study used data from the Kenya Integrated Household Budget Survey (KIHBS) 2004/05 to characterize the nutritional status of young children 6 to 36 months of age, household dietary diversity (number of food groups consumed), and determinants of anthropometric outcomes, including z-scores for height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ). Propensity score matching (PSM) was applied to ascertain the nutritional impacts of reduced poultry consumption arising from an HPAI event.

Results

Thirty-four percent of the children were stunted (HAZ < −2 SD), 16% were underweight (WAZ < −2 SD), and 8% were wasted (WHZ < −2 SD), with the highest prevalences in the Coast, Eastern, North Eastern, Nyanza, and Rift Valley provinces. On average, households reported consuming food from 2.5 ± 1.3 food groups per week. Consistently significant determinants of anthropometric outcomes in these children were child's age, child's sex, household level of education, and various income and wealth determinants. PSM demonstrated that a reduction of consumption of poultry meat and eggs due to HPAI infection would increase the prevalence of stunting by 3.9 percentage points (Average Treatment Effect on the Treated (ATT), p = .06), increase the prevalence of underweight by 5 percentage points, and reduce WAZ by 0.16 (ATT, p = .03).

Conclusions

Through the household dietary diversity and consumption pathways, HPAI could have nutrition-related consequences with public health significance. In the event of HPAI, action may be needed to protect the nutrition of young children 6 to 36 months of age.
Can Iron Supplementation be Reconciled with Benefits and Risks in Areas Hyperendemic for Malaria?
Authors: Schümann Klaus , Solomons Noel W.
Published: November 2015

Malaria is associated with about a million fatalities annually, largely among young children in zones of intense malarial transmission. The last thing needed would be measures that might increase the severity of clinical malaria. Thus, the finding in a field trial on Pemba Island, Tanzania, that routine oral iron supplementation produced adverse effects in iron-sufficient subjects had a ripple effect throughout the international public health community; it has effectively paralyzed efforts to redress iron-deficiency anemia in malaria-endemic regions. From a Hippocratic perspective, we consider the de facto moratorium on oral supplementation in such circumstance as a prudent interim measure. Public health programs to combat iron-deficiency anemia cannot be denied indefinitely to malaria-endemic populations, but the universal campaigns of iron provision cannot simply resume in the manner of the past. Contemporary biological and epidemiological understanding of the coevolution of humans and their pathogens should be able to provide guidance within the context of the essential and harmful aspects of iron. From these evolutionary standpoints, we identify a series of unresolved dilemmas. Toward a way forward, we highlight the pros and cons, as well as possible directions toward short-term strengthening, within three domains: tailored oral iron compounds, iron administration targeted only to iron-deficient individuals through screening, and prudent use of antimalarial prophylaxis. Although the tension between the essentiality of iron for humans and its role in pathogen virulence looms through every consideration, this recognition is a starting point toward the weighing of appropriate options balancing benefits and safety.
Identifying Zambia's Industrial Fortification Options: Toward Overcoming the Food and Nutrition Information Gap-Induced Impasse
Authors: Fiedler John L. , Lividini Keith , Zulu Rodah , Kabaghe Gladys , Tehinse John , Bermudez Odilia I.
Published: November 2015

Background

Zambia was a pioneer when it started fortifying sugar with vitamin A in 1998. Micronutrient deficiencies—especially among young children—have changed little over the past decade. In 2008 an initiative to introduce fortified flours was halted when last-hour questions about the program could not be answered.

Objective

To provide information about the need, coverage, and impact of alternative fortification portfolio options to help Zambia overcome its fortification impasse.

Methods

Using household data from the 2006 Living Conditions Monitoring Survey, apparent micronutrient intake levels and apparent consumption levels of sugar, vegetable oil, wheat flour and maize meal were estimated. The household level data were used to estimate individual intakes by assuming that food was distributed among household members in direct proportion to their share of the household's total adult consumption equivalent. Intake adequacy was measured relative to age- and gender-specific Estimated Average Requirements. Combining information on the industrial structure and estimated fortifiable quantities consumed of each food, and assuming the nutrient content is that specified in official regulations, simulations were conducted of the coverage and impact of 14 fortification portfolios.

Results

Maize, the most commonly consumed food, is consumed in a fortifiable form by only 23% of the population. Sugar fortification is estimated to have reduced inadequate intake of vitamin A from 87% to 79%. Introducing oil fortification could reduce the prevalence of inadequate vitamin A intake to 61%, and fortifying roller and breakfast maize meal would further reduce it to 57%, and reduce inadequate iron and zinc intakes by 2.2% and 5.5%, respectively. Implementing WHO flour guidelines would triple the potential iron and zinc impacts.

Conclusion

Analysis of LCMS apparent consumption data have helped address important information gaps and provide better understanding of the coverage and impacts of alternative fortification portfolios.
Key Strategies to Further Reduce Stunting in Southeast Asia: Lessons from the ASEAN Countries Workshop
Authors: Bloem Martin W. , de Pee Saskia , Le Hop Thi , Khan Nguyen Cong , Laillou Arnaud , Minarto  , Moench-Pfanner Regina , Soekarjo Damayanti , Soekirman  , Solon J. Antonio , Theary Chan , Wasantwisut Emorn
Published: November 2015

Background

To further reduce stunting in Southeast Asia, a rapidly changing region, its main causes need to be identified.

Objective

Assess the relationship between different causes of stunting and stunting prevalence over time in Southeast Asia.

Methods

Review trends in mortality, stunting, economic development, and access to nutritious foods over time and among different subgroups in Southeast Asian countries.

Results

Between 1990–2011, mortality among under-five children declined from 69/1,000 to 29/1,000 live births. Although disease reduction, one of two direct causes of stunting, has played an important role which should be maintained, improvement in meeting nutrient requirements, the other direct cause, is necessary to reduce stunting further. This requires dietary diversity, which is affected by rapidly changing factors: economic development; urbanization, giving greater access to larger variety of foods, including processed and fortified foods; parental education; and modernizing food systems, with increased distance between food producers and consumers. Wealthier consumers are increasingly able to access a more nutritious diet, while poorer consumers need support to improve access, and may also still need better hygiene and sanitation.

Conclusions

In order to accelerate stunting reduction in Southeast Asia, availability and access to nutritious foods should be increased by collaboration between private and public sectors, and the Association of Southeast Asian Nations (ASEAN) can play a facilitating role. The private sector can produce and market nutritious foods, while the public sector sets standards, promotes healthy food choices, and ensures access to nutritious foods for the poorest, e.g, through social safety net programs.
Tailoring Communication Strategies to Improve Infant and Young Child Feeding Practices in Different Country Settings
Authors: Sanghvi Tina , Jimerson Ann , Hajeebhoy Nemat , Zewale Medhanit , Nguyen Giang Huong
Published: November 2015

Background

Alive & Thrive aims to increase exclusive breastfeeding and complementary feeding practices in Bangladesh, Ethiopia, and Vietnam.

Objective

To develop and execute comprehensive communication strategies adapted to each context.

Methods

We documented how three countries followed an established iterative planning process, with research steps followed by key decisions, to develop a communication strategy in each country. Secondary analysis and formative research identified the priority practices to focus on, and locally specific constraints to proper infant and young child feeding (IYCF). Communication strategies were then developed based on the social, cultural, economic, epidemiological, media use, and programmatic contexts of each country.

Results

There were widespread gaps between recommended and actual feeding practices, and these varied by country. Gaps were identified in household, community, and institutional levels of awareness and skills. Strategies were designed that would enable mothers in each specific setting to adopt practices. To improve priority behaviors, messaging and media strategies addressed the most salient behavioral determinants through face-to-face communication, social mobilization, and mass media. Trials of improved practices (TIPs), concept testing, and pretesting of materials proved useful to verify the relevance and likely effectiveness of communication messages and materials tailored for different audiences in each setting. Coordination and collaboration with multiple stakeholders from the start was important to harmonize messages and approaches, expand geographic coverage to national scale, and sustain the interventions.

Conclusions

Our experience with designing largescale communication strategies for behavior change confirms that systematic analysis and local planning cannot be omitted from the critical process of strategic design tailored to each context. Multiple communication channels matched to media habits in each setting can reach a substantial proportion of mothers and others who influence their IYCF practices. Preliminary data suggest that exposure to mass media plays a critical role in rapidly reaching mothers, household members, community influentials, and health workers on a large scale. Combining face-to-face interventions for mothers with social mobilization and mass media was effective in improving IYCF practices.
Household Food Insecurity and Nutritional Status of Children and Women in Nepal
Authors: Singh Abhishek , Singh Ashish , Ram Faujdar
Published: November 2015

Background

Information on the association between household food insecurity and nutritional status of children and women based on a nationally representative sample is not available from Nepal.

Objective

To examine the association between food insecurity and nutritional status of children and married women in Nepal using data from the 2011 Nepal Demographic and Health Survey.

Methods

The Household Food Insecurity Access Scale was used to assess food insecurity in the 2011 Nepal Demographic and Health Survey. We used body mass index (BMI) to assess the nutritional status of married women, and stunting, wasting, and underweight to assess the nutritional status of children under 5 years of age. Binary logistic regression and multinomial logistic regression were performed to examine the associations.

Results

In severely food-insecure households, 51% of children were stunted and 40% were underweight; 27% of married women had a BMI below 18.5 kg/m2; children were 1.50 (95% CI, 1.15 to 1.97) and 1.40 (95% CI, 1.05 to 1.85) times as likely as children in food-secure households to be stunted and underweight, respectively; and married women were 1.5 (95% CI, 1.17 to 1.92) times as likely as married women in food-secure households to have a BMI below 18.5 kg/m2. No association was found between household food insecurity and wasting among children.

Conclusions

There is a significant association between food insecurity and malnutrition among children in Nepal. Among women, food insecurity is associated with underweight (BMI < 18.5 kg/m2) but not with overweight (BMI ≥ 25.0 kg/m2).
Macronutrient and Sociodemographic Determinants of Gestational Weight Gain among HIV-Negative Women in Tanzania
Authors: Changamire Freeman T. , Mwiru Ramadhani S. , Msamanga Gernard I. , Spiegelman Donna , Urassa Willy , Hertzmark Ellen , Fawzi Wafaie W. , Peterson Karen E.
Published: November 2015

Background

The effect of dietary macronutrient composition on the rate of gestational weight gain among women in sub-Saharan Africa is unclear.

Objective

To examine the effect of macronutrient intake on the rate of gestational weight gain among HIV-negative women in Tanzania.

Methods

The weights of 8,428 women were measured monthly from 12 weeks of gestation to term. Prenatal dietary intake was estimated as the cumulative average of multiple 24-hour dietary recalls. The association between energy intake and percentage of energy from carbohydrate, protein, and total fat and rate of weight gain (grams per month) was estimated from generalized estimating equation models. Macronutrient effects were adjusted for total energy using the nutrient density model and maternal age, maternal height, maternal mid-upper-arm circumference, parity, marital status, maternal occupation, maternal education, household wealth, season, and treatment regimen assignment. Body mass index (BMI) was considered as a confounder and a potential modifier of the effect of macronutrient intake on gestational weight gain.

Results

A 6 g/month increase in rate of weight gain was associated with every 100-kcal increment in daily total energy intake (95% CI, 1 to 12; p = .03). Analyses substituting 5% of energy from fat by protein showed that weight gain would decrease by 72 g/month (95% CI, 6 to 140; p = .03); substituting 5% of energy from carbohydrate by protein decreased gain by 70 g/month (95% CI, 15 to 124; p = .01). Baseline BMI did not modify these associations.

Conclusions

Further research on the effects of macronutrient composition on gestational weight gain is needed to inform the design of supplementation programs for women in developing countries.
Managing the Vitamin A Program Portfolio: A Case Study of Zambia, 2013–2042
Authors: Fiedler John L. , Lividini Keith
Published: November 2015

Background

Micronutrient deficiencies continue to constitute a major burden of disease, particularly in Africa and South Asia. Programs to address micronutrient deficiencies have been increasing in number, type, and scale in recent years, creating an ever-growing need to understand their combined coverage levels, costs, and impacts so as to more effectively combat deficiencies, avoid putting individuals at risk for excess intakes, and ensure the efficient use of public health resources.

Objective

To analyze combinations of the two current programs—sugar fortification and Child Health Week (CHW)—together with four prospective programs—vegetable oil fortification, wheat flour fortification, maize meal fortification, and biofortified vitamin A maize—to identify Zambia's optimal vitamin A portfolio.

Methods

Combining program cost estimates and 30-year Zambian food demand projections, together with the Zambian 2005 Living Conditions Monitoring Survey, the annual costs, coverage, impact, and cost-effectiveness of 62 Zambian portfolios were modeled for the period from 2013 to 2042.

Results

Optimal portfolios are identified for each of five alternative criteria: average cost-effectiveness, incremental cost-effectiveness, coverage maximization, health impact maximization, and affordability. The most likely scenario is identified to be one that starts with the current portfolio and takes into account all five criteria. Starting with CHW and sugar fortification, it phases in vitamin A maize, oil, wheat flour, and maize meal (in that order) to eventually include all six individual interventions.

Conclusions

Combining cost and Household Consumption and Expenditure Survey (HCES) data provides a powerful evidence-generating tool with which to understand how individual micronutrient programs interact and to quantify the tradeoffs involved in selecting alternative program portfolios.
Integrating Food Poverty and Minimum Cost Diet Methods into a Single Framework: A Case Study Using a Nepalese Household Expenditure Survey
Authors: Geniez Perrine , Mathiassen Astrid , de Pee Saskia , Grede Nils , Rose Donald
Published: November 2015

Background

Current tools assessing affordability of nutritious diets are incomplete. “Food poverty” uses expenditure data to identify households unable to acquire a diet adequate in energy but does not consider other nutrients. The “minimum cost of a nutritious diet” method provides a threshold for purchasing a nutritious diet but must rely on other data to identify “nutrient-poor” households.

Objective

Integrating both methods into a single framework using a common data source, we sought to jointly estimate the proportions of a population that are food and nutrient poor.

Methods

Household expenditure data from the 2010/11 Nepal Living Standards Survey were used, focusing on representative samples of households from the mountain region ( n = 401) and Kathmandu ( n = 857). Food poverty thresholds were set at the cost for a lowincome household to purchase a basket of foods providing adequate energy following the Cost of Basic Need method. Linear optimization was used to calculate a “nutrient poverty” threshold. Household expenditures were used to determine food and nutrient poverty rates.

Results

The food and nutrient poverty thresholds were 13,294 and 18,628 rupees/person/year, respectively, in the mountain region and 14,610 and 22,945 rupees/ person/year, respectively, in Kathmandu. In the mountain region, 34% of households were both food and nutrient poor and 24% were just nutrient poor. In Kathmandu the percentages were 7% and 14%, respectively.

Conclusions

This approach, integrating two commonly used tools, provides a more nuanced interpretation of economic access to a nutritious diet and an opportunity to improve the design and targeting of nutrition and food security interventions.
Determinants of Stunting and Overweight among Young Children and Adolescents in Sub-Saharan Africa
Authors: Keino Susan , Plasqui Guy , Ettyang Grace , van den Borne Bart
Published: November 2015

Background

Stunting and overweight are nutritional problems affecting most of sub-Saharan Africa. The region now has the world's highest rate of stunting among children (43%), while overweight and obesity are becoming a global epidemic, and Africa is not spared. The past two decades have seen a dramatic increase in obesity in sub-Saharan Africa.

Objective

The purpose of this systematic review is to explore the determinants of stunting and overweight in sub-Saharan Africa.

Methods

A literature search was conducted in PubMed using the key words stunting, overweight, obesity, Africa, sub-Saharan Africa, determinants, and prevalence. Limits were set to include articles published between 1990 and 2012. The systematic review resulted in 38 studies, and after selection based on title, content, and country of the study, 18 studies were eligible for this review. Data were analyzed by the chi-square test.

Results

The prevalence rates of stunting and over-weight were dependent on socioeconomic, demographic, and environmental factors. Many studies indicate that male children and those living in a rural setting are more likely to be stunted, whereas overweight among children depends more on age, household composition, occupation of the mother, and the mother's body mass index. Stunting occurred together with overweight among both boys and girls from 1 to 5 years of age. Stunting was more prevalent among boys than among girls. Indicators of socioeconomic status, such as mother's education, mother's occupation, and household income, were some of the determinants directly linked to stunting, whereas environmental factors, such as rural or urban setting and sanitation, influenced both stunting and overweight. Concurrent stunting and overweight is influenced by maternal and household factors, such as maternal height, age, and education, large household size, and lower socioeconomic status.

Conclusions

Although socioeconomic, demographic, and environmental factors were significant in determining stunting and overweight, other factors, such as nutrition and lifestyle, were important risk factors. Stunting in childhood is a risk factor that may result in overweight and obesity later in adolescence and adulthood, indicating the need to screen children below 1 year of age to identify stunting early in life. Promoting exclusive breastfeeding is reported to be important in preventing both stunting and overweight among children. More research is needed to explore the relationship between stunting and overweight and to explore policy guidelines to address the phenomenon.
Breastfeeding Knowledge, Attitude, Perceived Behavior, and Intention among Female Undergraduate University Students in the Middle East: The Case of Lebanon and Syria
Authors: Hamade Haya , Naja Farah , Keyrouz Sarah , Hwalla Nahla , Karam Jeanette , Al-Rustom Lea , Nasreddine Lara
Published: November 2015

Background

The Middle East has one of the lowest rates of exclusive breastfeeding in the world, highlighting the need to promote breastfeeding in this region. Young adults represent a key population of interest, since decisions about infant-feeding appear to be made before children are even conceived.

Objective

To examine breastfeeding knowledge, attitude, and perceived behavior among female undergraduate students in Lebanon and Syria and determine factors associated with intention to breastfeed in this population.

Methods

This cross-sectional study was conducted in 2010/11 in Damascus and Beirut. Four universities were selected in each city. A multicomponent questionnaire was administered to a convenience sample of participants ( n = 194 from Beirut and n = 199 from Damascus). The questionnaire included breastfeeding knowledge (measured by the Infant Feeding Knowledge Test Form), attitude (Iowa Infant Feeding Attitude Scale), perceived behavior (Breastfeeding Behavior Questionnaire), and intention (Infant Feeding Intention Scale). Factors associated with intention to breastfeed were examined by multivariate linear regression analysis.

Results

The participants had an average breastfeeding knowledge level (mean score, 10.39 ± 2.09) and neutral perceived behavior (mean score, 22.00 ± 3.68), while having relatively positive attitudes (mean score, 58.12 ± 6.49). Knowledge gaps and negative perceptions were identified, particularly linked to breastfeeding in public and among working mothers. Breastfeeding intention was found to be significantly associated with knowledge and attitude in Lebanon (β = 0.103 and β = 0.230, respectively), and with perceived behavior in Syria (β = −0.135).

Conclusions

By revealing specific knowledge gaps and misconceptions and identifying country-specific disparities in the predictors of the intention to breastfeed, the findings of this study may provide a basis for devising culture-specific interventions aimed at promoting breastfeeding.
Evaluation of a Residential Nutrition Rehabilitation Center in Rural Bolivia: Short-Term Effectiveness and Follow-Up Results
Authors: Forney Kristen M. , Polansky Lauren S. , Rebolledo Paulina A. , Huamani Katherine Foy , Mues Katherine E. , Ramakrishnan Usha , Leon Juan S.
Published: November 2015

Background

Nutrition rehabilitation centers (NRCs) have shown mixed results in reducing morbidity and mortality among undernourished children in the developing world. Follow-up on children after leaving these programs remains undocumented.

Objective

To assess the nutritional improvement of children attending the Centro de Rehabilitación Infantil Nutricional (CRIN), a residential NRC in rural Bolivia, from entrance to exit and to a household follow-up visit 1 month to 6 years later, and to identify factors associated with nutritional improvement.

Methods

A retrospective analysis was conducted of clinical records collected by CRIN staff from 135 children under 3 years of age attending CRIN in rural Cochabamba, Bolivia, from 2003 to 2009, and of clinical records of household follow-up measurements on a subset of 26 children that were taken between 1 month and 6 years postexit. Nutritional status was evaluated by calculating z-scores for weight-for-height (WHZ), weight-for-age (WAZ), and height-for-age (HAZ). Children with z-scores < −2 were considered to be wasted, underweight, or stunted, respectively.

Results

The prevalence of wasting decreased significantly, while the prevalence of stunting did not change significantly between entrance and exit from the program. From entrance to exit, the mean changes in WHZ (0.79) and WAZ (1.08) were statistically significant, while the mean change in HAZ (–0.02) was not significant. Linear regression analysis suggested that nutritional status and diarrhea at entrance had the greatest effect on WHZ and HAZ changes between entrance and exit. Children maintained their nutritional gains from the program between exit and follow-up and showed statistically significant improvement in WAZ (but not HAZ).

Conclusions

CRIN is effective at rehabilitating nutritional deficits associated with wasting, but not those associated with stunting.
Design and Development of a Combined Calcium—Iron—Folic Acid Prenatal Supplement to Support Implementation of the New World Health Organization Recommendations for Calcium Supplementation during Pregnancy
Authors: Phillips Ashley Aimone M. , Zlotkin Stanley H. , Baxter Jo-Anna B. , Martinuzzi Frank , Kadria Tanush , Roth Daniel E.
Published: November 2015

Background

Hypertensive diseases of pregnancy are important causes of maternal and perinatal mortality. Based on meta-analyses of efficacy trials of prenatal cal- cium supplementation to reduce the risk of hypertensive diseases of pregnancy, the World Health Organization recommends 1.5 to 2.0 g of elemental calcium per day for pregnant women with low dietary calcium intakes (as well as 60 mg of iron and 400 μg of folic acid). However, implementation of this recommendation is challenged by the size and number of calcium tablets required and the need to avoid concurrent ingestion of calcium and iron due to intraintestinal interactions.

Objective

We developed a novel micronutrient powder containing microencapsulated pH-sensitive calcium in addition to iron and folic acid, designed to facilitate early intestinal iron release and delayed calcium release.

Methods

Two pharmaceutical companies were con- tracted to develop a prototype, one of which was chosen for clinical testing. Calcium carbonate granules were coated with a trilayer pH-sensitive enteric coating using a fluid-bed spray coater. Iron and folic acid granules were encapsulated with a time-release coating. Iron and cal- cium dissolution profiles were assessed during exposure to acidic (pH 1.2) and/or basic (pH 5.8) media using a modified USP apparatus 1 (basket) method.

Results

At pH 1.2, calcium and iron release was ≤ 10% and > 90% after 120 minutes, respectively. At pH 5.8, > 80% of total calcium was released after 90 minutes.

Conclusions

Based on in vitro criteria, the sup- plement may be a promising approach for delivering calcium, iron, and folic acid as a single daily dose to preg- nant women in settings of low dietary intake of calcium.
The Indian National Food Security Act, 2013: A Commentary
Authors: Varadharajan Kiruba Sankar , Thomas Tinku , Kurpad Anura
Published: November 2015

The National Food Security Act (NFSA) 2013, passed recently by the Indian Parliament, aims to ensure food security in India, chiefly by providing cereals at subsidized prices through the Targeted Public Distribution System (TPDS) for about two-thirds of households. The predominant line of criticism of the NFSA has been the costs of such an ambitious rights-based approach in the context of decelerating economic growth and growing fiscal deficits. We argue that the food subsidy has been increasing through the last few decades and is set to climb even higher with this act but that the incremental costs, at about 0.2% of gross domestic product, are not as high as claimed. Further, recent evidence of increasing utilization of the TPDS and decreasing corruption add credence to the act's premise that significant income transfers to poor households can be achieved, thereby promoting food security as well as dietary diversity. Several concerns remain to be addressed in the design and implementation of the act, including its proposed coverage, a cereal-centric approach, the identification of beneficiaries, and its adaptability at the state level. If these are resolved effectively, the act can prove to be a significant step forward in India's long-drawn-out battle against undernutrition and food insecurity. Finally, the NFSA also provides a fresh opportunity to reform and strengthen the TPDS, which has been an integral component of India's strategy to achieve food security at the national level.
Food Insecurity and Associated Factors in the Portuguese Population
Authors: Álvares Luísa , Amaral Teresa F.
Published: November 2015

Background

The burden of food insecurity in Portugal, and the socioeconomic and demographic factors that are related to this condition, are unknown.

Objective

To evaluate the frequency of food insecurity and to identify its associated characteristics in the Portuguese population.

Methods

Data from 3,552 heads of family respondents of the 2005/06 Portuguese National Health Survey were analyzed in a cross-sectional study. Food insecurity was evaluated with the use of the US Department of Agriculture Household Food Security Survey Module 6-Item Short Form. Chi-square tests and multivariate logistic regression models were conducted. Significance was indicated at p < .05.

Results

Among the respondents, 16.5% were food insecure and 3.5% had very low food security. The odds of being food insecure were highest for women (OR, 1.51; 95% CI, 1.20 to 1.91), smokers (OR, 1.56; 95% CI, 1.20 to 2.02), younger people (OR, 2.54; 95% CI, 1.69 to 3.80), unemployed people (OR, 3.04; 95% CI, 2.01 to 4.60), those with lower education (OR, 7.98; 95% CI, 4.73 to 13.49), and those with lower income (OR, 6.27; 95% CI, 4.23 to 9.30).

Conclusions

The present study explored for the first time the burden of food insecurity in Portugal, revealing that it was highly prevalent, affecting one in six Portuguese citizens. Low education and low income were the main factors associated with food insecurity.
Severe Acute Malnutrition in Asia
Authors: Ahmed Tahmeed , Hossain Muttaquina , Mahfuz Mustafa , Choudhury Nuzhat , Hossain Mir Mobarak , Bhandari Nita , Lin Maung Maung , Joshi Prakash Chandra , Angdembe Mirak Raj , Wickramasinghe V. Pujitha , Hossain S. M. Moazzem , Shahjahan Mohammad , Irianto Sugeng Eko , Soofi Sajid , Bhutta Zulfiqar
Published: November 2015

Severe acute malnutrition (SAM) is a common condition that kills children and intellectually maims those who survive. Close to 20 million children under the age of 5 years suffer from SAM globally, and about 1 million of them die each year. Much of this burden takes place in Asia. Six countries in Asia together have more than 12 million children suffering from SAM: 0.6 million in Afghanistan, 0.6 million in Bangladesh, 8.0 million in India, 1.2 million in Indonesia, 1.4 million in Pakistan, and 0.6 million in Yemen. This article is based on a review of SAM burden and intervention programs in Asian countries where, despite the huge numbers of children suffering from the condition, the coverage of interventions is either absent on a national scale or poor. Countries in Asia have to recognize SAM as a major problem and mobilize internal resources for its management. Screening of children in the community for SAM and appropriate referral and back referral require good health systems. Improving grassroots services will not only contribute to improving management of SAM, it will also improve infant and young child feeding and nutrition in general. Ready-to-use therapeutic food (RUTF), the key to home management of SAM without complications, is still not endorsed by many countries because of its unavailability in the countries and its cost. It should preferably be produced locally from locally available food ingredients. Countries in Asia that do not have the capacity to produce RUTF from locally available food ingredients can benefit from other countries in the region that can produce it. Health facilities in all high-burden countries should be staffed and equipped to treat children with SAM. A continuous cascade of training of health staff on management of SAM can offset the damage that results from staff attrition or transfers. The basic nutrition interventions, which include breastfeeding, appropriate complementary feeding, micronutrient supplementation, and management of acute malnutrition, should be scaled up in Asian countries that are plagued with the burden of malnutrition.
Information-Sharing to Improve Learning about Community-Based Management of Acute Malnutrition (CMAM) and its Impact
Authors: Dent Nicky , Deconinck Hedwig , Golden Kate , Brown Rebecca , Walsh Anne
Published: November 2015

Background

Severe acute malnutrition (SAM) affects 19 million children worldwide annually. The community-based management of acute malnutrition (CMAM) approach was first piloted in 2000. Endorsed by the United Nations in 2007, the approach has been introduced in over 60 countries. Current coverage and quality of services need further strengthening and key stakeholders have expressed the need for improved information-sharing.

Objective

To report on an information-sharing initiative that was established to support scale-up of quality services for CMAM by collecting existing technical guidance, evidence, and learning.

Methods

Routine website monitoring, country case studies, and surveys were used to assess the profiles of CMAM Forum users and the reach and use of information for improved health outcomes.

Results

The number of information products and services and their use have steadily increased. Country case studies have identified ways to adapt information better to the needs of those involved in managing acute malnutrition, particularly at the country level. An urgent need has been identified for more resources in additional languages, especially French and Arabic, and expanded production and use of audiovisual material and social media.

Conclusions

Improved information-sharing can have an impact on health outcomes, but further innovation and support are needed to improve access to, and use of, the information.
Mondelēz Hope Kitchen Program, China: A Program Impact Pathways (PIP) Analysis
Authors: Li Yanran , Yao Xiaoxun , Gu Lan
Published: November 2015

Background

Mondelēz Hope Kitchen is a community program initiated jointly in 2009 by Mondelēz International and the China Youth Development Foundation (CYDF). In response to the urgent needs of students, parents, and teachers at primary and middle schools in poverty-stricken rural areas of China, the program addresses the complex and intertwined issues of under-nutrition and obesity. By funding both kitchen equipment and teacher training in health and nutrition, the Mondelēz Hope Kitchen Program improves the capacity of schools to supply healthy meals, helping students to access safe and nutritious foods and, ultimately, to improve their nutritional status and health. In 2011, the Mondelēz International Foundation awarded CYDF a grant to formally assess the impact of the original program design. The Mondelēz International Foundation encouraged CYDF and six other healthy lifestyles-focused community partners around the world to participate in this program evaluation workshop.

Objective

The goals of this study were to describe the logic model of the Mondelēz Hope Kitchen Program, summarize a recent evaluation of the Mondelēz Hope Kitchen Program, and conduct a Program Impact Pathways (PIP) analysis to identify Critical Quality Control Points (CCPs) and a suite of impact indicators. The findings were presented at the Healthy Lifestyles Program Evaluation Workshop held in Granada, Spain, 13–14 September 2013, under the auspices of the Mondelēz International Foundation.

Methods

The authors developed the program's PIP diagram based on deliberations involving the program managers and Director and consulting the “Hope Kitchen Management Rules” and “Hope Kitchen Inspection and Acceptance Report”.

Results

The PIP analyses identified three CCPs: buy-in from schools, kitchen infrastructure, and changes in teachers' knowledge of nutrition after training. In addition, changes in children's knowledge of nutrition will be added to the core suite of impact evaluation indicators that also includes children's dietary behaviors.

Conclusions

Participation in this program evaluation workshop provided the Mondelēz Hope Kitchen team with the tools to improve the program using a sound monitoring system.
Ready, Steady, Go! Program, Italy: A Program Impact Pathways (PIP) Analysis
Authors: Veracini Giordana , Leonardi Elisabetta , Girotti Rita , Thrasher Erika Willumsen
Published: November 2015

Background

Ready, Steady, Go! promotes proper nutrition and physical activity among people of all ages in targeted neighborhoods and encourages social integration and children's participation in decisions that affect their lives. It also seeks to involve parents in activities so that they can influence their children's attitudes toward lifestyles and personal development. This partnership has reached 70,000 Italian children and adults with new opportunities for physical activities and social experiences that help them improve nutritional behaviors while having fun with their peers.

Objective

To assess the Ready, Steady, Go! Program logic and to identify Critical Quality Control Points (CCPs) and a core suite of impact indicators based on a Program Impact Pathways (PIP) analysis.

Methods

The PIP analysis team reviewed the key activities and processes that form Ready, Steady, Go! and then identified key CCPs for the project. The findings were presented at the Healthy Lifestyles Program Evaluation Workshop held in Granada, Spain, 13–14 September 2013, under the auspices of the Mondelēz International Foundation.

Results

The PIP analysis confirmed that Ready, Steady, Go! has a structure that is likely to support the primary aims of the program. The CCPs identified are training of teachers in healthy lifestyles, teachers' active participation in the program, access to remodeled and well-equipped sports and recreational centers, participation of parents and grandparents, and involvement of local institutions and networks. A suite of impact indicators for changes in healthy lifestyle knowledge, attitudes, and behavior was identified.

Conclusions

Project staff are now more aware of the importance of carefully monitoring the CCPs and have decided to conduct quarterly PIP-informed quality control evaluations.
Fish-Enhanced and Soybean-Enhanced Supplemental Snacks are Acceptable among Pregnant Women in Rural Kenya
Authors: Gewa Constance A. , Frankenfeld Cara L. , Slavin Margaret , Omondi Milton
Published: November 2015

Background.

Although animal-source foods provide a rich source of complete protein and a variety of micronutrients, a majority of these foods are not accessible to a large proportion of populations in low-income nations. Locally available and affordable nutrient-dense dietary solutions that are accessible all year round can provide the most viable solution to improving food and nutrition security for these vulnerable populations. However, their potential to improve nutritional status among pregnant women has not been documented.

Objective.

The study was conducted to help guide the development of fish-enhanced and soybean-enhanced supplemental snacks and evaluate their acceptability among pregnant women in rural Kenya.

Methods.

We developed fish-enhanced and soybean-enhanced snacks using the small local lake fish omena ( Rastrineobola argentea) and soybean flour. A cross-sectional study design was used to assess snack acceptance levels among HIV-infected and -noninfected pregnant women, two high-risk groups for nutrient deficiencies.

Results.

Overall, 96%, 80%, and 81% of participants, indicated that they liked the taste, odor, texture, and color of wheat, fish-enhanced, or soybean-enhanced snacks, respectively. No significant differences were noted across participants' HIV status. Focus group discussions with the women further supported results from the quantitative ratings.

Conclusions.

Our analysis demonstrates the feasibility of developing acceptable, nutrient-dense food supplements using locally available foods in rural Kenya and contributes culturally acceptable, affordable, and sustainable solutions to the problem of undernutrition among pregnant women in low-income countries in sub-Saharan Africa.
Community Interventions for Dietary Improvement in Ghana
Authors: Marquis Grace S. , Colecraft Esi K.
Published: November 2015

Background.

Low caregiver income and poor nutrition knowledge and skills are important barriers to achieving optimal child feeding in rural Ghana.

Objective.

An integrated microcredit and nutrition education intervention was implemented to address these barriers.

Methods.

Using a quasi-experimental design, 134 caregivers of children 2 to 5 years of age in six intervention communities were enrolled into self-selected savings and loan groups. They received small individual loans over four 16-week cycles to support their income-generating activities. Nutrition and entrepreneurial education was provided during weekly loan repayment meetings. Another 261 caregivers in six comparison communities did not receive the intervention. Data on household sociodemographic and economic characteristics, perception of income-generating activity profits, and children's consumption of animal-source foods in the previous week were collected at baseline and at four additional time points. Differences according to group (intervention vs. control) and time (baseline vs. endline) were analyzed with chi-square and Student's t-tests.

Results.

The intervention and comparison groups did not differ by caregivers' age and formal education; few (35) had previous experience with microcredit loans. At endline, more intervention than comparison caregivers perceived that their business profits had increased (59% vs. 23%, p < .001). In contrast to comparison children, after 16 months of intervention children consumed more livestock meat (p = .001), organ meat (p = .04), eggs (p = .001), and milk and milk products (p < .0001) in the previous week in comparison with baseline.

Conclusions.

Integrated food-centered strategies can improve children's diets, which will enhance their nutritional status, health, and cognitive outcomes.