bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Challenging Nutritional Problems among Adolescents in Sri Lanka
Authors: Jayatissa Renuka , Ranbanda R. M.
Published: November 2015

Background

Although 21% of the population of Sri Lanka consists of adolescents, studies of nutritional status among this group are limited.

Objective

To assess nutritional problems and dietary and activity patterns among adolescents in Sri Lanka.

Methods

A nationally representative cross-sectional study was conducted on 6,264 adolescents 10 to 15 years of age. All subjects were clinically examined for Bitot's spots, and their weights and heights were measured. The subjects were interviewed during regular class time. Hemoglobin concentration and dietary and activity patterns were assessed among a subsample ( n = 787) of 1,521 adolescents. The World Health Organization age- and sex-specific references for body-mass index and height-for-age were used to estimate the prevalence of underweight and stunting, respectively. The International Obesity Task Force age- and sex-specific reference for body-mass index was used to estimate the prevalence of overweight. Age-specific WHO-defined cutoff points were used to estimate the prevalence of anemia.

Results

The prevalence rates of underweight, stunting, and overweight were 47.2%, 28.5%, and 2.2%, respectively. The prevalence rates of anemia and vitamin A deficiency were 11.1% and 0.4%, respectively. During the previous 6 months, 10.4% of the subjects had usually not eaten breakfast before going to school. During the week before the interview, 24.4% of the children had not consumed green leafy vegetables, 26.6% had not consumed fruit, 19.0% had not participated in physical activities, and 27.5% had watched television for more than 2 hours per day.

Conclusions

The nutritional problems of adolescents aged 10 to 15 years should be addressed through the schools. Specific policies should be developed in collaboration with the Ministry of Health and Education to control nutritional problems among adolescents.
Good Governance for Nutrition in the Philippines: Elements, Experiences, and Lessons Learned
Authors: Solon Florentino S.
Published: November 2015

Malnutrition is a multifactorial problem that needs a multisectoral solution. This article reviews the role of good governance in nutrition programs, citing the Philippines as an example. In the Philippines, these efforts are reflected in the partnership between the public and private sectors in the establishment of the country's capability in research, policy-making, and program implementation. The establishment of the different public institutions engaged in research and policy-making is discussed, highlighting the role of political will through legislation. The evolving tasks of the nutrition program are discussed by citing the tasks in two eras. In the 1970s, the challenges were limited national nutrition data, manpower, tools, and health infrastructure. The public and private institutions were able to respond by legislating national nutrition surveys and dedicated nutrition workers in each village. The challenges in the current era are improved implementation of health programs, given the devolution of health services, and the gathering of an evidence base to further strengthen and refine the strategies of supplementation, fortification, breastfeeding, and food security. In responding to these challenges, multisectoral solutions and collaboration are critical in providing an evidence base to formulate policy. The role of the private sector, with the Nutrition Center of the Philippines used as an example, is that of a supportive and collaborative partner in good governance. Finally, the lessons learned from the past decades of implementing a national nutrition program, given changes in political and economic circumstances, are summarized.
The Sustainability of Community-Based Therapeutic Care (CTC) in Nonemergency Contexts
Authors: Gatchell Valerie , Forsythe Vivienne , Thomas Paul-Rees
Published: November 2015

Background

Concern Worldwide is an international humanitarian nongovernmental organization that piloted and is now implementing and researching community-based therapeutic care (CTC) approaches to managing acute malnutrition. Experience in several countries suggests that there are key issues to be addressed at the international, national, regional, and community levels for community-based treatment of acute malnutrition to be sustainable.

National level

At the national level there must be demonstrated commitment to a clear health policy and strategy to address outpatient treatment of acute malnutrition. In addition, locally available, affordable ready-to-use therapeutic food (RUTF) must be accessible.

Regional level

At the regional level a functional health system and appropriate capacity for service provision are required. Integration of outpatient services should be viewed as a process with different levels of inputs at different phases depending on the capacity of the Ministry of Health (MOH). There is a need for indicators to facilitate scale-up and scale-back for future emergency response.

Community level

Strong community participation and active screening linked to health service provision at the local level is paramount for sustainable assessment and referral of severe acute malnutrition.

Future challenges to sustain community-based therapeutic care

Key challenges to the sustainable treatment of severe acute malnutrition include the development of locally produced RUTF, development of international standards on local RUTF production, the integration of outpatient treatment protocols into international health and nutrition guidelines, and further operational research into integration of community-based treatment of severe acute malnutrition into health systems in nonemergency contexts.
Baseline Evaluation of Nutritional Status and Government Feeding Programs in Chiclayo, Peru
Authors: Gross Rainer , Lechtig Aarón , de Romaña Daniel López
Published: November 2015

Background

Because of the rapid growth of the urban population in Peru, food and nutrition insecurity will occur increasingly in this population. For appropriate policy setting and programming, the food and nutrition situation of the urban poor requires better understanding.

Objective

To gain information about the nature, magnitude, severity, and causes of the nutritional problems of the population in low-income areas of the city of Chiclayo, Peru.

Methods

A cross-sectional nutrition survey was conducted in 1,604 households, covering children under 5 years of age and their parents.

Results

The prevalence rates of stunting, wasting, overweight. and anemia in children were 15.4%, 1.3%, 4.6%, and 65.7%, respectively; one third of adults were overweight, and one tenth were obese; 2.1% of the mothers were underweight; and 34.3% of mothers and 12.2% of fathers had anemia. Governmental feeding programs did not address these problems adequately.

Conclusions

Interventions must have adequate targeting; address appropriate responses at the household, community, and national levels; and reduce stunting, obesity, and iron-deficiency anemia.
Effectiveness of the Communication Program on Compliance in a Weekly Multimicronutrient Supplementation Program in Chiclayo, Peru
Authors: Gross Ursula , Diaz Marita Mamani , Valle Claudia
Published: November 2015

Background

Compliance with daily micronutrient supplementation is usually poor and the question arises whether compliance with a weekly regimen would be better.

Objectives

The inputs (messages and channels), output (increase of knowledge), and outcome (behavior changes) of a communication campaign in a micronutrient supplementation program for women and adolescent girls 12 through 44 years of age and children under 5 years of age (primary audience) were analyzed.

Methods

The communication program addressed not only the primary, but also the secondary (facilitators) and tertiary audiences. Formative research and descriptive statistics were used to analyze the communication campaign.

Results

Nearly all women and adolescent girls (89%) and children (91%) took at least 75% of the supplements over the 3-month period. The incidence rates of reported negative side effects of supplementation in children and in women and adolescent girls were less than 10%. Knowledge of micronutrient nutrition among facilitators of all ages and education levels increased significantly (p < .001).

Conclusions

A thoroughly planned and implemented nutrition communication program can secure high compliance of the beneficiaries of micronutrient supplementation programs. The necessary supplies should be available at least 3 months before program implementation. With an adequate communication program, supplementation programs can be used to foster food-based approaches for the target audience.
Cross-Sectional Growth References and Implications for the Development of an International Growth Standard for School-Aged Children and Adolescents
Authors: Seidell Jacob C. , Doak Colleen M. , de Munter Jeroen S. L. , Kuijper Lothar D. J. , Zonneveld Cor
Published: November 2015

Normative data are needed to create a reference that indicates optimal development of weight in relation to height and age, particularly in the face of the unfolding obesity epidemic. The body-mass index (BMI) has some serious limitations: it is a relatively poor predictor of current and future fatness. Currently, however, there are few available alternatives, with the possible exception of waist circumference or skinfolds. The use of cross-sectional references to construct a BMI-reference curve is problematic when there are period and cohort effects. Ideally, a reference would be based on longitudinal data in populations with little underweight, overweight, and obesity.

In the meantime cross-sectional data in appropriate populations could be used to construct BMI percentiles linking BMI values at age 5 to those at age 18 (or 21) that would correspond with adult BMI values reflecting optimal health (e.g., that would correspond to adult BMI values between 21 and 23 kg/m2).
Effect of Household Processing on the In Vitro Bioavailability of Iron in Mungbean (Vigna Radiata)
Authors: Barakoti Lotika , Bains Kiran
Published: November 2015

Background

Mungbean (Vigna radiata) is a major source of energy and protein in developing countries, especially for the vegetarian population. Improvement of the bioavailability of iron in mungbean by common household processes could make a significant contribution to the nutrition of people in countries where iron-deficiency anemia is widespread.

Objective

The study was conducted to determine the effect of common household processes on nutritional and antinutritional factors as well as in vitro bioavailability of iron in mungbean.

Methods

Mungbean was subjected to various domestic processes such as dehulling, pressure cooking, germination, and fermentation. The effects of these processes on proximate composition, antinutritional factors (phytin phosphorus, polyphenols, and neutral detergent), and iron, including ionizable iron, were determined.

Results

No significant change in crude protein content was observed. There was a significant (p≤.05) increase in fiber content after germination. Ash content decreased significantly (p≤.05) after all processing methods. The processing methods resulted in a significant (p≤.05) reduction in phytin phosphorus and polyphenols. Pressure cooking significantly (p≤.05) decreased the neutral detergent fiber, whereas fermentation and germination increased it. The phytate:iron molar ratio of processed mungbean revealed that the maximum reduction was in germinated and fermented samples. Ascorbic acid content increased significantly (p ≤ .05) after germination. The in vitro bioavailability of iron in raw mungbean was 7.32%. All of the processing methods resulted in an increase in iron bioavailability in vitro; the maximum bioavailability was in germinated cooked mungbean (12.52%), followed by fermented cooked mungbean and germinated raw mungbean (both 11.04%).

Conclusions

Suitable processing techniques can improve the in vitro bioavailability of iron from mungbean. If mungbean products with enhanced iron bio-availabilty are developed, they could help improve the iron status of the population.
Effect of Iodine Status and other Nutritional Factors on Psychomotor and Cognitive Performance of Filipino Schoolchildren
Authors: Amarra Ma. Sofia V. , Bongga Demetria C. , Peñano-Ho Leticia , Cruz Federico B. , Solis José S. , Barrios Erniel B.
Published: November 2015

Background

Until 1998, iodine deficiency was a public health problem in the Philippines. A law entitled “An Act Promoting Salt Iodization Nationwide” (ASIN) has been passed and implemented by the government to eliminate iodine deficiency. The contribution of salt iodization, as well as dietary, health, and environmental factors, to improving the intellectual performance of Filipino schoolchildren remains to be determined.

Objective

The objectives of the study were to determine the relationship between iodine status and levels of psychomotor and cognitive performance in first-grade children aged 6 to 10 years, and to examine the extent to which dietary, biochemical, health, and environmental factors contribute to children's mental performance.

Methods

Two hundred ninety children in six classroom sections from a public school in Manila were examined by measurement of urinary iodine excretion (UIE) and thyroid palpation. The median UIE level for each section was determined. Sixty-five children classified as iodine deficient (UIE < 90 μg/L with grade 1 goiter, n = 34) and non-iodine deficient (UIE > 100 μg/L without goiter, n = 31) were given psychomotor and cognitive function tests (Bender–Gestalt and Raven's Colored Progressive Matrices). Scores from the two tests were used to determine each child's general ability percentile rank. Other variables examined were dietary intake (% RDA of nutrients ingested based on two nonconsecutive 24-hour recalls); deficiencies in iron, vitamin A, and selenium; parasitic infection; coliform contamination of drinking water; household use of iodized salt; illness in the past 2 weeks; and wasting and stunting.

Results

Children whose general ability scores were at or above the 50th percentile had higher UIE levels, but the relationship was not significant. Children from sections with higher median UIE levels had higher percentile ranks for general ability (p =.002). Backward logistic regression showed that the variance in deficient and adequate mental performance was explained by dietary intakes that met ≥ 80% of the RDA for energy, protein, thiamin, and riboflavin; the use of iodized salt; child's iodine status; and stunting (R2 =.520, p =.0016). Higher class median UIE was associated with better psychomotor and cognitive performance in children who were tested. Factors that contributed to better performance include higher intakes of energy, protein, thiamin, and riboflavin; household use of iodized salt; normal iodine status; and absence of stunting or chronic malnutrition.

Conclusions

Salt iodization, accompanied by adequate intakes of energy, protein, and foods rich in thiamin and riboflavin, can contribute to improved mental performance in Filipino schoolchildren. Longer-term factors that can contribute to improved performance are achievement of normal iodine status and elimination of protein–energy malnutrition.
Outbreak of Beriberi in a Prison in Côte D'Ivoire
Authors: Ahoua Laurence , Etienne William , Fermon Florence , Godain Graziella , Brown Vincent , Kadjo Kassy , Bouaffou Kouamé , Legros Dominique , Guerin Philippe Jean
Published: November 2015

Background

A beriberi outbreak occurred in the Maison d'Arrêt et de Correction d'Abidjan (MACA), a detention center in Abidjan, Côte d'Ivoire, between October 2002 and April 2003.

Objective

A retrospective investigation was conducted to document the outbreak in April 2003.

Methods

A descriptive analysis and a case–control study were performed. A probable case patient was defined as a person detained in the center between October 2002 and April 2003 with at least two of the following symptoms: bilateral leg edema, dyspnea, positive squat test, motor deficiencies, and paresthesia. A definite case patient was defined as a probable case patient who showed clinical improvement under thiamin treatment.

Results

Of 712 cases reported, 115 (16%) were probable and 597 (84%) were definite. The overall attack rate was 14.1%, and the case fatality rate was 1.0% (7/712). The highest attack rate was reported in the building housing prisoners with long-term sentences (16.9%). All patients were male, and the mean age was 28 years. During the period studied, the penal ration provided a fifth of the quantity of thiamin recommended by international standards. After adjustment for potential confounders, a history of cholera infection (adjusted odds ratio [ORa], 12.9; 95% confidence interval [CI], 2.9 to 54.1) and incarceration in the building for severe penalties (ORa, 4.8; 95% CI, 1.3 to 18.5) were associated with the disease.

Conclusions

Beriberi has been underreported among prisoners. Further attention should be given to its risk factors, especially a history of acute diarrhea. Systematic food supplementation with vitamins and micronutrients should be discussed when the penal ration does not provide the necessary nutrient intake recommended according to international standards.
Estimating the Global Costs of Vitamin A Capsule Supplementation: A Review of the Literature
Authors: Neidecker-Gonzales Oscar , Nestel Penelope , Bouis Howarth
Published: November 2015

Background

Vitamin A supplementation reduces child mortality. It is estimated that 500 million vitamin A capsules are distributed annually. Policy recommendations have assumed that the supplementation programs offer a proven technology at a relatively low cost of around US$0.10 per capsule.

Objectives

To review data on costs of vitamin A supplementation to analyze the key factors that determine program costs, and to attempt to model these costs as a function of per capita income figures.

Methods

Using data from detailed cost studies in seven countries, this study generated comparable cost categories for analysis, and then used the correlation between national incomes and wage rates to postulate a simple model where costs of vitamin A supplementation are regressed on per capita incomes.

Results

Costs vary substantially by country and depend principally on the cost of labor, which is highly correlated with per capita income. Two other factors driving costs are whether the program is implemented in conjunction with other health programs, such as National Immunization Days (which lowers costs), and coverage in rural areas (which increases costs). Labor accounts for 70% of total costs, both for paid staff and for volunteers, while the capsules account for less than 5%. Marketing, training, and administration account for the remaining 25%.

Conclusions

Total costs are lowest (roughly US$0.50 per capsule) in Africa, where wages and incomes are lowest, US$1 in developing countries in Asia, and US$1.50 in Latin America. Overall, this study derives a much higher global estimate of costs of around US$1 per capsule.
Anthropometric, Metabolic, and Dietary Fatty Acids Characteristics in Lean and Obese Dyslipidemic Asian Indian Women in Calcutta
Authors: Ghosh Arnab
Published: November 2015

Background

The precise etiology and mechanisms leading to the development of increasing incidence of coronary heart disease (CHD) in Asian Indians remains incompletely understood. There is evidence that women in this population may have comparatively greater risk factors (e.g., dyslipidemia) for CHD than men.

Objective

To determine how dietary fatty acids composition could be used to identify Asian Indian women who are at greater risk of obesity and dyslipidemia.

Methods

The present cross-sectional study comprised of 130 (Group I: lean control, n = 40; Group II: lean dyslipidemic, n = 45; and Group III: obese dyslipidemic, n = 45) Asian Indian women (≥ 30 years) living in Calcutta, India and the surrounding suburbs. Anthropometric measures, lipoproteins, plasma glucose, and intake of dietary fatty acids were obtained from each participant. Obesity measures were subsequently calculated from anthropometric measures. Conversion of foods into nutrients was done according to standard nutritive values of Indian foods.

Results

ANOVA with Duncan's post-hoc test revealed significant group differences for anthropometric measures, lipids profiles, blood glucose, and dietary fatty acids. Pearson's partial correlations (controlling for age) also revealed that central obesity measure had a significant association with dietary fatty acids and their ratios. Discriminant function analysis revealed that overall, 80% of all entries were positively (correctly) classified in three groups using fatty acids and their ratios.

Conclusions

Dietary fatty acids composition is related to indicators of obesity. The recent shift in dietary habits may have caused an increase in the prevalence of obesity and dyslipidemia in this region.
Human Nutrition and Genetic Variation
Authors: Stover Patrick J.
Published: November 2015

Human genetic variation is a determinant of nutrient efficacy and of tolerances and intolerances and has the potential to influence nutrient intake values (NIVs). Knowledge derived from the comprehensive identification of human genetic variation offers the potential to predict the physiological and pathological consequences of individual genetic differences and prevent and/or manage adverse outcomes through diet. Nutrients and genomes interact reciprocally; genomes confer differences in nutrient utilization, whereas nutrients effectively modify genome expression, stability, and viability. Understanding the interactions that occur among human genes, including all genetic variants thereof, and environmental exposures is enabling the development of genotype-specific nutritional regimens that prevent disease and promote wellness for individuals and populations throughout the life cycle. Genomic technologies may provide new criteria for establishing NIVs. The impact of a gene variant on NIVs will be dependent on its penetrance and prevalence within a population. Recent experiences indicate that few gene variants are anticipated to be sufficiently penetrant to affect average requirement (AR) values to a greater degree than environmental factors. If highly penetrant gene variants are identified that affect nutrient requirements, the prevalence of the variant in that country or region will determine the feasibility and necessity of deriving more than one AR or upper limit (UL) for affected genetic subgroups.
Trade, Development, and Regulatory Issues in Food
Authors: Ramaswamy Sunder , Viswanathan Brinda
Published: November 2015

Trade in food and animal products has increased several-fold in the past decade, and simultaneously regulations governing the movement of such products across national boundaries have also increased. The present study reviews harmonization in food trade regulation by focusing on nutritional aspects to understand its role in enhancing world trade on the one hand and consumer interest and welfare on the other. Harmonization to a large extent brings in more regulation from the developed world acting through their governments, consumer organizations, and multinational companies; it does not seem to address, in general, the concerns of the large segments of the poor population for whom agriculture and food trade are the main sources of livelihood. There is a lack of quantifiable estimates of the loss in well-being of the disadvantaged. However, there is substantial research focused on the potential harm to developed nations as a result of nonadherence to the rules. Clearly, lack of adequate infrastructure, resource constraints, and weak institutions not only result in poor food safety regulation within developing countries but also remain barriers to realizing the greater potential benefits from increased trade. Harmonization of standards would have some losers and some winners, but to make it more inclusive, scientific knowledge alone may not be adequate; social and cultural aspects also need to be considered, since food systems differ among regions, with varying preferences, local resource availability, and levels of economic development. Improvement in governance in many countries not only would ensure better participation in international rule-making and the negotiation process for fairer trade but also would result in effective domestic legislation to ensure safer health for citizens, resulting in higher overall well-being.
Promoting Healthy Diets and Tackling Obesity and Diet-Related Chronic Diseases: What are the Agricultural Policy Levers?
Authors: Hawkes Corinna
Published: November 2015

Background

Diet-related chronic diseases are now a serious global public health problem. Public health groups are calling for the agricultural sector to play a greater role in tackling the threat.

Objective

To identify potential points of policy intervention in the agricultural sector that could be leveraged to promote healthy diets and tackle obesity and diet-related chronic diseases.

Methods

A review of the literature on the dietary implications of agriculture, a conceptual analysis of the issues, and the identification of relevant examples.

Results

There are two main potential points of intervention in the agricultural sector that could be leveraged to promote healthy diets: agricultural policies and agricultural production practices. Agricultural policies and practices affect diet through their influence on food availability, price, and nutrient quality, which in turn affects food choices available to consumers. Agricultural policies amenable to intervention include input, production, and trade policies; agricultural production practices amenable to intervention include crop breeding, crop fertilization practices, livestock-feeding practices, and crop systems diversity.

Conclusions

It is well-known that agricultural policies and production practices influence what farmers choose to grow. Agricultural policies and production practices could also play a role in influencing what consumers choose to eat. To identify how agricultural policies and practices can usefully contribute toward promoting healthy diets and tackling obesity and diet-related chronic diseases, health policymakers need to examine whether current agricultural policies and production practices are contributing to—or detracting from—efforts to attain dietary goals; where and how could agricultural intervention help achieve dietary goals; and whether there are trade-offs between these interventions and other important concerns, such as undernutrition and the livelihoods of agricultural producers. Given the potential of agriculture to contribute to large-scale, population-level dietary improvements, these questions warrant closer attention from health policymakers.
Aflatoxin Exposure in Developing Countries: The Critical Interface of Agriculture and Health
Authors: Wild Christopher Paul
Published: November 2015

Background

Aflatoxins are common contaminants of staple foods in sub-Saharan Africa. These toxins are human liver carcinogens, especially in combination with chronic infection with hepatitis B virus. However, in an agricultural setting, the effects on growth, immune status, and susceptibility to infectious disease in farm animals are also well recognized. These latter effects have been far less explored in human populations.

Objectives

To review some of the more recent work on aflatoxins where the health outcomes seen in the agricultural setting, including growth impairment and immune suppression, have been investigated in human populations. The paper draws largely on examples from West Africa. The paper also sets out how knowledge gained about aflatoxins in the agricultural setting can be used to design intervention studies in human populations.

Methods

A review of the relevant literature.

Results

Human exposure to aflatoxins begins early in life, and recent studies in West Africa have demonstrated an association between exposure and growth faltering, particularly stunting, in young children. At present the underlying mechanisms for the latter effects are unknown but may include impairment of immunity and increased susceptibility to infections. Simple postharvest intervention strategies were successful in reducing aflatoxin exposure in a subsistence farm setting, providing a rationale for prevention of aflatoxin-related disease.

Conclusions

There are potential benefits to public health from intervention strategies combining expertise in the agricultural and health settings to address the aflatoxin problem.
Determination of the Leading Central Obesity Index among Cardiovascular Risk Factors in Iranian Women
Authors: Shahraki Touran , Shahraki Mansour , Roudbari Masoud , Gargari Bahram Pourghassem
Published: November 2015

Background

It is unknown whether the waist circumference (WC) or the waist-to-hip ratio (WHR) is a better predictor of cardiovascular risk factors at different ages.

Objective

To compare WC and WHR as predictors of cardiovascular risk factors and to determine the prevalence of some cardiovascular risk factors in overweight and obese adult women at different ages.

Methods

In this clinical cross-sectional study, 714 overweight and obese women aged 20 to 70 years who were referred to two nutrition clinics in Sistan and Baluchestan province, Islamic Republic of Iran, were studied. The subjects were classified into three groups, 20 to < 35, 35 to < 50, and > or = 50 years of age. Anthropometric indices were measured according to the standard protocol. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and TC/HDL-C ratios were enzymatically determined.

Results

Older subjects (> or = 50 years old) had significantly higher values of body mass index (BMI), WC, TC, TG, and LDL-C than those in the two younger age classes. The prevalence rates of obesity, high WC, high WHR, high TC, high TG, high LDL-C, and high TC/HDL-C ratios were higher in the older subjects. After adjustment for age and BMI, multiple linear regression showed that WC was significantly related to TC and TG in the 20- to < 35-year-old group and to TG in the 35- to < 50-year-old group. In the older participants, WHR was significantly related to TG.

Conclusions

The prevalence of cardiovascular risk factors increases with age. In clinical practice, WC is a better index for predicting some cardiovascular risk factors in younger and middle-aged women; however, for older women, WHR is better.
Secular Trends in Food Patterns of Guatemalan Consumers: New Foods for Old
Authors: Bermudez Odilia I. , Hernandez Liza , Mazariegos Manolo , Solomons Noel W.
Published: November 2015

Background

Food patterns of population groups change and adapt under the influence of several factors, including those related to globalization, urbanization, and the nutrition transition.

Objective

To document changes in food consumption and dietary patterns of Guatemalans, based on food surveys from the middle of the 20th century and the beginning of the 21st century.

Methods

We accessed archival dietary data from surveys conducted in nine rural or semirural traditional Guatemalan communities in the 1950s and from two studies of nonindigenous Guatemalans and Guatemalans of Mayan descent conducted after 1998. The total number and types of food items and the nutrient intakes from the two eras were compared.

Results

We identified 210 distinct food items across time, including 108 items consumed in traditional indigenous and nonindigenous Guatemalan communities (“old” foods), of which 72% were still consumed by nonindigenous Guatemalans and 76% were still consumed by Mayan Guatemalans. Processed foods represented only 11% of the items consumed in traditional Guatemalan communities but 30% of those consumed by nonindigenous Guatemalans and 25% of those consumed by Mayan Guatemalans. The proportions of carbohydrates, fats, and proteins as percentages of total energy were 79:9:12 among traditional Guatemalan communities, 67:20:13 among nonindigenous Guatemalans, and 61:27:12 among Mayan Guatemalans.

Conclusions

Changes in Guatemalan food patterns and in nutrient intakes are marked by increased food variety, at the expense of reduction in the consumption of nutrient-dense foods and increase in the consumption of processed foods. Such changes are consistent with those observed in other societies, where a combination of forces associated with demographic, epidemiologic, and nutritional transitions is occurring within the dynamics of urbanization and globalization phenomena that characterize contemporary times.
A High Prevalence of Biochemical Evidence of Vitamin B12 or Folate Deficiency does not Translate into a Comparable Prevalence of Anemia
Authors: Metz Jack
Published: November 2015

Based on biochemical evidence, a high prevalence of biochemical evidence of vitamin B12 or folate deficiency has been reported in a number of areas in the world. The evidence that these biochemical abnormalities lead to a comparable prevalence of anemia is reviewed. The overall contribution of vitamin B12 deficiency to the global burden of anemia is probably not significant, except perhaps in women and their infants and children in vegetarian communities. In developed countries, folate-deficiency anemia is uncommon. In some developing countries, this anemia is still seen, but there are no comprehensive data on the relative prevalence compared with anemia due to malaria, iron-deficiency, hemoglobinopathy, and HIV disease. It seems unlikely that folate deficiency makes a major contribution to the burden of anemia in developing countries. Iron-deficiency anemia may coexist with vitamin B12 and especially folate deficiency, and may confound the hematological features of the vitamin deficiencies whose prevalence would then be underestimated. Supplementation of the diet of pregnant women with folic acid can virtually eliminate folate-deficiency anemia in these women. There are very few data on the hematological effect of vitamin B12 supplementation or fortification at the population level. The addition of vitamin B12 to the supplementation of the diet of pregnant women with iron and folic acid does not produce an increased hematological response, at least in nonvegetarian populations. There are numerous reports of the effect of folic acid fortification of food on tests of folate status, but only a single published report on the hematological response was found.
Monitoring of the Folic Acid Supplementation Program in the Netherlands
Authors: de Jong-van den Berg Lolkje T. W.
Published: November 2015

In November of 1993, the Dutch government recommended daily folic acid supplementation of 0.4 or 0.5 mg for all women planning pregnancy, starting 4 weeks before conception until 8 weeks after. In 1995, a one-time mass media campaign was conducted, and due to this campaign, the use of folic acid in this recommended period increased from 4.8% in 1995 to 21% in 1996. Subsequently, no structural strategies were undertaken until 2003, and at that time, 22% of lower-educated women used folic acid in the recommended period. The prevalence of neural tube defects (NTD) decreased from 11.44/10,000 before the official recommendations to 6.52/10,000 thereafter. Currently, community pharmacies proactively approach women before their first pregnancy on the subject of folic acid supplementation. This is done by means of a sticker placed on packages of oral contraceptives with the text “Child wish?*”. Ask for information about folic acid in your pharmacy,” and a brochure (leaflet) containing detailed information about folic acid. (*“Child wish” refers to women who plan to become pregnant.) Data from an explorative, comparative study strongly suggest that this intervention is effective. Sustainable education programs through which women are informed repeatedly to take folic acid supplements during the periconceptional period are urgently needed.
Efficacy of Canadian Folic Acid Food Fortification
Authors: Ray Joel G.
Published: November 2015

Canada mandated that cereal grains, especially white flour, be fortified with folic acid by mid-1998. Between 0.1 and 0.2 mg of additional synthetic folic acid per day has been provided through this initiative. The current paper describes how this took place, and the epidemiological effects that occurred in the Canadian population, including higher blood folate levels and a decline in the prevalence of neural tube defects.
Can Coca Leaves Contribute to Improving the Nutritional Status of the Andean Population?
Authors: Penny Mary E. , Zavaleta Alfonso , Lemay Melanie , Liria Maria Reyna , Huaylinas Maria Luisa , Alminger Marie , McChesney James , Alcaraz Franklin , Reddy Manju B.
Published: November 2015

Background

Coca leaves ( Erythroxylum coca) have been promoted as a food that could address the dietary deficiencies of the Andean population, but this is based on nutrient analyses of a small sample of leaves.

Objective

We assessed the nutritional potential of eight samples of coca leaves grown in different regions of Peru.

Methods

We used AOAC techniques to measure nutrients, nutrient inhibitors (phytate, polyphenols, oxalic acid, and fiber), and alkaloid concentrations, all expressed per 100 g dry weight (DW) of the ground leaves. Minerals were measured by inductively coupled plasma-mass spectrometry in two independent laboratories.

Results

The leaves contained protein, 20.28 g/100 gDW, with lysine as the limiting amino acid; β-carotene, 3.51 mg/100 gDW; vitamin E, 16.72 mg/100 gDW; trace amounts of vitamin D; calcium, 990.18 and 1033.17 mg/100 gDW at two different laboratories; iron, 29.16 and 29.16 mg/100 gDW; zinc, 2.71 and 2.63 mg/100 gDW; and magnesium, 225.19 and 196.69 mg/100 gDW. Cocaine was the principal alkaloid, with a concentration of 0.56 g/100 gDW; other alkaloids were also identified. The results were compared with those for other edible leaves. The nutrient contributions of coca powder (5 g) and bread made with coca were compared with those of normal portions of alternative foods.

Conclusions

Two spoonfuls of coca leaf flour would satisfy less than 10% of dietary intakes for schoolchildren and adults for critical commonly deficient nutrients in the diet. Coca leaves do not provide nutritional benefits when eaten in the recommended quantities, and the presence of absorbable cocaine and other alkaloids may be potentially harmful; hence coca leaves cannot be recommended as a food.
A Review of Interventions Based on Dietary Diversification or Modification Strategies with the Potential to Enhance Intakes of Total and Absorbable Zinc
Authors: Gibson Rosalind S. , Anderson Victoria P.
Published: November 2015

Dietary diversification or modification has the potential to prevent deficiencies of zinc and other coexisting limiting micronutrients simultaneously, without risk of antagonistic interactions. In this review, we have addressed the following. The first section focuses on strategies with the potential to enhance intake and/or bioavailability of zinc, and includes interventions (with and without nutrition education) based on agriculture, production or promotion of animal-source foods through animal husbandry or aquaculture, and commercial and household processing strategies to enhance zinc absorption. Outcome indicators include intakes of foods or nutrients (although rarely zinc) and, in some cases, zinc status, or zinc-related functional responses. The next two sections address whether dietary diversification or modification can achieve increases in absorbable zinc that are sufficient to enhance zinc status or zinc-related functional responses in breastfed infants and toddlers and in older children and women of reproductive age. Evidence for the impact of dietary diversification or modification on behavior change and on nutritional status in the short and long term, and the possible role of modifying factors (e.g., baseline nutritional status, socioeconomic status, infection, sex, age, and life-stage group) is the emphasis of the next section. The following section highlights the evidence for three potential adverse effects of dietary diversification or modification: aflatoxin contamination from germinated cereals, loss of water-soluble nutrients, and displacement of breastmilk. Finally, an example of a dietary diversification or modification program (Homestead Food Production) developed and implemented by Helen Keller International is given, together with the critical steps needed to scale up dietary diversification or modification for programs and future research needs.
A Comparative Evaluation of Multiple Micronutrient and Iron–Folic Acid Supplementation during Pregnancy in Pakistan: Impact on Pregnancy Outcomes
Authors: Bhutta Zulfiqar A. , Rizvi Arjumand , Raza Farrukh , Hotwani Sunil , Zaidi Shujaat , Hossain S. Moazzam , Soofi Sajid , Bhutta Shereen
Published: November 2015

Background

Maternal micronutrient deficiencies are widespread in Pakistan and are potentially associated with maternal undernutrition and intrauterine growth retardation. Intervention strategies largely consist of administration of iron–folic acid supplements during pregnancy.

Objective

We evaluated the acceptability of multiple micronutrient supplementation and its potential benefits on pregnancy outcomes and maternal micronutrient status in a cohort of pregnant women in rural and urban Sindh through a cluster-randomized design.

Methods

We randomly assigned 2,378 pregnant women to receive either iron–folic acid or multiple micronutrient supplements. The supplements were administered fortnightly by community health workers who performed home visits to assess tolerance and observe the mothers.

Results

The women in both groups consumed about 75% of the supplements provided, and few reported adverse effects such as vomiting, abdominal pain, etc. There was a small (70 g) but significant increase in birthweight among infants of mothers receiving multiple micronutrients as compared with infants of mothers receiving iron–folic acid supplements (2.95 ± 0.6 vs. 2.88 ± 0.5 kg, p = .01). This translated into a 10% reduction (p < 0.17) in the proportion of low-birthweight infants among infants of mothers receiving multiple micronutrients. Although stillbirth rates were comparable in the two groups, the early neonatal mortality rate in the group receiving multiple micronutrients was higher, although not significantly, than that in the group receiving iron– folic acid (43.2 vs. 23.5 deaths per 1,000 live births; RR = 1.64; 95% CI, 0.94 to 2.87). Comparable reductions in anemia (hemoglobin < 11 g/dL) were observed, although the proportion with low iron stores (assessed by serum ferritin) was lower in the iron–folic acid group in the postnatal period. Although the proportion of women with subclinical vitamin A deficiency after supplementation did not differ between the two groups, the iron–folic acid group had a higher proportion with lower serum zinc levels in the immediate postpartum period.

Conclusions

These data suggest that multiple micronutrient supplements are well tolerated during pregnancy, but the effect on birthweight is modest. The observed effect on early neonatal mortality suggests the need for further studies and careful assessment of the intervention in health system settings.
INCAP Studies of Hematologic and Gastrointestinal Function in Healthy Individuals and those with Protein–Energy Malnutrition and Infection
Authors: Viteri Fernando E.
Published: November 2015

Anemia is highly prevalent, especially in poorly nourished populations living in unsanitary conditions. Studies of the Central American population showed that iron was the predominant deficient hematopoyetic micronutrient and that correction of nutrient deficiencies led to hematological normality as defined by WHO. The bioavailability of diverse iron compounds added to the mostly vegetable diets of such populations showed the superior absorption of chelated iron (NaFeEDTA) and its strong effectiveness in correcting iron deficiency when added to sugar. The consequences on development and mental behavioral functions as well as on work capacity of iron deficiency and anemia in infants, children and adults, and the positive effects of their correction was demonstrated. In protein-energy malnourished (PEM) children, the deficit in active tissue mass (basal oxygen consumption) and in total hemoglobin content were closely related. This relationship persisted as the rates of active tissue mass repletion was modified by levels of protein intake. This demonstrated the strong adaptive nature of hemoglobin content in response to oxygen needs in PEM and during recovery.

Gastrointestinal functions in PEM and in populations demonstrated the bacterial invasion of the upper GI tract and how this resulted in secondary bile acids that are toxic to the intestinal mucosal cells impairing their absorptive functions. Environmental hygiene in populations reversed gut bacterial migration and improved GI function.
Daily Use of Sprinkles Micronutrient Powder for 2 Months Reduces Anemia among Children 6 to 36 Months of Age in the Kyrgyz Republic: A Cluster-Randomized Trial
Authors: Lundeen Elizabeth , Schueth Tobias , Toktobaev Nurjan , Zlotkin Stanley , Hyder S.M. Ziauddin , Houser Robert
Published: November 2015

Background

Iron-deficiency anemia is widespread among young children in the Kyrgyz Republic, and there is an urgent need to identify an effective intervention to address this significant public health problem.

Objective

To test the effectiveness of a 2-month intervention with daily home fortification of complementary food using micronutrient powder (Sprinkles) in reducing anemia among children 6 to 36 months of age in the Kyrgyz Republic.

Methods

In this cluster-randomized, community-based effectiveness trial conducted in three regions of the Kyrgyz Republic, 24 clusters of children aged 6 to 36 months were randomly assigned to two groups. The intervention group (12 clusters, n = 1,103) received 60 sachets of micronutrient powder (12.5 mg elemental iron), which were taken as one sachet daily for 2 months. The control group (12 clusters, n = 1,090) did not receive micronutrient powder until after the study period. Blood hemoglobin concentration was assessed at the start and end of the intervention.

Results

From baseline to follow-up, the mean hemoglobin concentration in the intervention group increased by 7 g/L, whereas it decreased by 2 g/L in the control group ( p < .001). The prevalence of anemia (hemoglobin < 110 g/L) in the intervention group decreased from 72% at baseline to 52% at follow-up, whereas it increased from 72% to 75% in the control group ( p < .001). Compliance with the intervention was high, with children consuming on average 45 of the 60 sachets given.

Conclusions

A course of 60 Sprinkles micronutrient powder sachets taken daily for 2 months is effective in improving hemoglobin levels and reducing the prevalence of anemia among young children in the Kyrgyz Republic.