bluuebunny/crossref_metadata_2025 huggingface dataset:
A Strategic Approach to the Unfinished Fortification Agenda: Feasibility, Costs, and Cost-Effectiveness Analysis of Fortification Programs in 48 Countries
Authors: Fiedler John L. , Macdonald Barbara
Published: November 2015

Background

Food fortification is a promising strategy for combating micronutrient deficiencies, which plague one-third of the world's population. Which foods to fortify, with which micronutrients, and in which countries remain essential questions that to date have not been addressed at the global level.

Objective

To provide a tool for international agencies to identify and organize the next phase of the unfinished global fortification agenda by prioritizing roughly 250 potential interventions in 48 priority countries. By explicitly defining the structure and operations of the fortification interventions in a detailed and transparent manner, and incorporating a substantial amount of country-specific data, the study also provides a potentially useful starting point for policy discussions in each of the 48 countries, which—it is hoped—will help to catalyze the development of public–private partnerships and accelerate the introduction of fortification and reduction of micronutrient deficiencies.

Methods

Forty-eight high-priority countries were identified, and the feasibility of fortifying vegetable oil and sugar with vitamin A and fortifying wheat flour and maize flour with two alternative multiple micronutrient formulations was assessed. One hundred twenty-two country-, food-, and fortification formulation–specific interventions were assessed to be feasible, and the costs of each intervention were estimated. Assuming a 30% reduction in the micronutrient deficiencies of the persons consuming the food, the number of disability-adjusted life years (DALYs) saved by each of the programs was estimated.

Results

The cost per DALY saved was calculated for each of the 122 interventions, and the interventions were rank-ordered by cost-effectiveness. It is estimated that the 60 most cost-effective interventions would carry a 10-year price tag of US$1 billion and have costs per DALY saved ranging from US$1 to US$134. The single “best bet” intervention—i.e., the most cost-effective intervention—in each of the 48 countries was identified.

Conclusions

This study provides a detailed, transparent, evidence-based approach to defining and estimating the costs and cost-effectiveness of the unfinished global fortification agenda in the 48 priority countries. Other considerations in designing a strategic approach to the unfinished global fortification agenda are also discussed.
Scaling up Protection, Promotion, and Support of Breastfeeding at the Community Level
Authors: Casanovas Carmen , Saadeh Randa
Published: November 2015

A World Health Organization (WHO)/UNICEF consultation held in 2008 focused on actions needed to promote infant and young child feeding, including integrating breastfeeding in community and health sector interventions; accelerating progress in breastfeeding protection, promotion, and support among working women; integrating breastfeeding into community development programs; advocacy and communication; situation analysis, monitoring, and evaluation; and planning and capacity building. Recommendations were given on how these could be accelerated based on reviews of country programs.
Early INCAP Longitudinal Nutrition Studies at the Community Level
Authors: Guzmán Miguel A. , Scrimshaw Nevin S.
Published: November 2015

This paper reviews the findings of early field studies of INCAP comparing the effects of vitamin B12 and animal and vegetable protein on the growth of poorly nourished schoolchildren. It also describes a 5-year community-based intervention study showing that a protein-rich supplement given to preschool children improves growth and cognition and decreases morbidity and mortality. Medical care in one village had no detectable benefits. A classical seven-year community-based detailed observational study of the infection status and growth in children from birth is also summarized.
Recommendations for Improving Guatemala's Food Fortification Program Based on Household Income and Expenditure Survey (HIES) Data
Authors: Fiedler John L. , Helleranta Meri
Published: November 2015

Background

Fortification offers great potential for reducing the enormous disease burden of micronutrient deficiencies. The lack of information on food consumption patterns has been a major impediment to the development of fortification programs. In some countries, the absence of this information has been an obstacle to the introduction of fortification. In countries that have fortification, governments are increasingly being challenged to provide evidence that programs are well designed and effective.

Objective

To examine the usefulness of household income and expenditure surveys (HIES) as a means for addressing this information gap and making fortification programs more evidence-based and more accountable.

Methods

Data from Guatemala's 2005/6 Living Standards Measurement Survey are used to develop a measure of “apparent food consumption.” The measure is used to assess Guatemala's fortification program by analyzing the coverage and the additional micronutrient intake attributable to different food vehicles, combinations of food vehicles, and fortification formulations.

Results

There are three key findings. The impact of the wheat flour fortification program is considerably greater than had previously been estimated; the level at which sugar is currently fortified with vitamin A may be excessive and should be reviewed; and fortifying semolina flour (used to make pasta) would extend the benefits of wheat flour fortification to 60,000 households that currently do not benefit from it and would increase the amount of fortified food consumed by 68% of the population. Beneficiaries would include 63% of the extreme poor, and the greatest benefits would go to those wheat flour consumers who currently benefit the least from consuming fortified wheat flour products.

Conclusions

HIES data should be used more routinely as a tool in the designing, monitoring, and assessing of fortification programs.
Revised Recommendations for Iron Fortification of Wheat Flour and an Evaluation of the Expected Impact of Current National Wheat Flour Fortification Programs
Authors: Hurrell Richard , Ranum Peter , de Pee Saskia , Biebinger Ralf , Hulthen Lena , Johnson Quentin , Lynch Sean
Published: November 2015

Background

Iron fortification of wheat flour is widely used as a strategy to combat iron deficiency.

Objective

To review recent efficacy studies and update the guidelines for the iron fortification of wheat flour.

Methods

Efficacy studies with a variety of iron-fortified foods were reviewed to determine the minimum daily amounts of additional iron that have been shown to meaningfully improve iron status in children, adolescents, and women of reproductive age. Recommendations were computed by determining the fortification levels needed to provide these additional quantities of iron each day in three different wheat flour consumption patterns. Current wheat flour iron fortification programs in 78 countries were evaluated.

Results

When average daily consumption of low-extraction (≤ 0.8% ash) wheat flour is 150 to 300 g, it is recommended to add 20 ppm iron as NaFeEDTA, or 30 ppm as dried ferrous sulfate or ferrous fumarate. If sensory changes or cost limits the use of these compounds, electrolytic iron at 60 ppm is the second choice. Corresponding fortification levels were calculated for wheat flour intakes of < 150 g/day and > 300 g/day. Electrolytic iron is not recommended for flour intakes of < 150 g/day. Encapsulated ferrous sulfate or fumarate can be added at the same concentrations as the non-encapsulated compounds. For high-extraction wheat flour (> 0.8% ash), NaFeEDTA is the only iron compound recommended. Only nine national programs (Argentina, Chile, Egypt, Iran, Jordan, Lebanon, Syria, Turkmenistan, and Uruguay) were judged likely to have a significant positive impact on iron status if coverage is optimized. Most countries use non-recommended, low-bioavailability, atomized, reduced or hydrogen-reduced iron powders.

Conclusion

Most current iron fortification programs are likely to be ineffective. Legislation needs updating in many countries so that flour is fortified with adequate levels of the recommended iron compounds.
Considering the Case for Vitamin B12 Fortification of Flour
Authors: Allen Lindsay H. , Rosenberg Irwin H. , Oakley Godfrey P. , Omenn Gilbert S.
Published: November 2015

Reasons to fortify flour with vitamin B12 are considered, including the high prevalence of depletion and deficiency of this vitamin that occurs in persons of all ages in resource-poor countries and in the elderly in wealthier countries, and the adverse functional consequences of poor vitamin B12 status. From a global perspective, the main cause of inadequate intake and status is a low intake of animal-source foods; even lacto-ovo vegetarians have lower serum vitamin B12 concentrations than omnivores, and for various reasons many populations have limited consumption of animal-source foods. Infants are vitamin B12-depleted from early infancy if their mothers' vitamin B12 status and intake are poor during pregnancy and lactation. Even in the United States, more than 20% of the elderly have serum vitamin B12 concentrations that indicate depletion, and an additional 6% have deficiency, primarily due to gastric atrophy, which impairs the absorption of the vitamin from food but usually not from supplements or fortified foods. Although the evidence is limited, it shows that fortified flour, consumed as bread, can improve vitamin B12 status. Where vitamin B12 fortification is implemented, the recommendation is to add 20 μg/kg flour, assuming consumption of 75 to 100 g flour per day, to provide 75% to 100% of the Estimated Average Requirement; the amount of the vitamin that can be added is limited by its cost. The effectiveness of this level of addition for improving vitamin B12 status in programs needs to be determined and monitored. In addition, further research should evaluate the bioavailability of the vitamin from fortified flour by elderly people with food cobalamin malabsorption and gastric atrophy.
Marketing Complementary Foods and Supplements in Burkina Faso, Madagascar, and Vietnam: Lessons Learned from the Nutridev Program
Authors: Bruyeron Olivier , Denizeau Mirrdyn , Berger Jacques , Trèche Serge
Published: November 2015

Background

Sustainable approaches to improving infant and young child feeding are needed. The Nutridev program worked in Vietnam, Madagascar, and Burkina Faso to test different strategies to improve complementary feeding using fortified products sold to families.

Objective

To review the experiences of programs producing and marketing fortified complementary foods and to report on the feasibility of local production and marketing of fortified complementary foods to increase usage of high-quality foods among children of low-income families in a self-sustaining manner.

Methods

Project documents, surveys of mothers, and production and sales reports were reviewed.

Results

Nutridev experience in Vietnam, Madagascar, and Burkina Faso demonstrates that it is possible to produce affordable, high-quality complementary foods and supplements locally in developing countries. Strategies to make products readily available to the targeted population and to convince this population to consume them yielded mixed results, varying greatly based on the strategy utilized and the context in which it was implemented.

Conclusions

In several contexts, the optimal approach appears to be strengthening the existing food distribution network to sell complementary foods and supplements, with the implementation of a temporary promotion and nutrition education network in partnership with local authorities (e.g., health services)to increase awareness among families about the fortified complementary food product and optimal feeding practices. In urban areas, where the density of the population is high, design and implementation of specific networks very close to consumers seems to be a good way to combine economic sustainability and good consumption levels.
Monitoring the Marketing, Distribution, and Use of Sprinkles Micronutrient Powders in Rural Western Kenya
Authors: Suchdev Parminder S. , Ruth Laird , Obure Alfredo , Were Vincent , Ochieng Cliff , Ogange Lorraine , Owuor Mercy , Ngure Frances , Quick Robert , Juliao Patricia , Jung Christina , Teates Kathryn , Cruz Kari , Jefferds Maria Elena D.
Published: November 2015

Background

In 2007, the US Centers for Disease Control and Prevention partnered with local Kenyan institutions to implement the Nyando Integrated Child Health and Education Project, an effectiveness study that used social marketing and a community-based distribution program to promote the sale of Sprinkles and other health products.

Objective

To describe monitoring of wholesale sales, household demand, promotional strategies, and perceived factors influencing Sprinkles sales among vendors.

Methods

Ongoing quantitative and qualitative monitoring of Sprinkles sales began in May 2007 in 30 intervention villages. Data sources included baseline and follow-up cross-sectional surveys; office records of Sprinkles sales to vendors; biweekly household monitoring of Sprinkles use; and qualitative data collection, including vendor focus groups and key informant interviews.

Results

A total of 550 children aged 6 to 35 months were enrolled at baseline, and 451 were available at 12-month follow-up. During this period, nearly 160,000 sachets were sold wholesale to vendors, with variability in sales influenced by the social, political, and economic context. Vendors living closer to the wholesale office purchased more Sprinkles, so a second office was opened closer to remote vendors. On average, 33% of house-holds purchased Sprinkles during household monitoring visits. Training sessions and community launches were important for community support and raising awareness about Sprinkles. Vendor incentives motivated vendors to sell Sprinkles, and consumer incentives promoted purchases.

Conclusions

Sprinkles program monitoring in Kenya was critically important for understanding sales and distribution trends and vendor perceptions. Understanding these trends led to strategic changes to the intervention over time.
Impact of Drought and HIV on Child Nutrition in Eastern and Southern Africa
Authors: Mason John B. , Chotard Sophie , Bailes Adam , Mebrahtu Saba , Hailey Peter
Published: November 2015

Background

Intermittent food insecurity due to drought and the effects of HIV/AIDS affect child nutritional status in sub-Saharan Africa. In Southern Africa in 2001–3 drought and HIV were previously shown to interact to cause substantial deterioration in child nutrition. With additional data available from Southern and Eastern Africa, the size of the effects of drought and HIV on child underweight up to 2006 were estimated.

Objective

To determine short- and long-term trends in child malnutrition in Eastern and Southern Africa and how these are affected by drought and HIV.

Methods

A secondary epidemiologic analysis was conducted of area-level data derived from national surveys, generally from the mid-1990s to the mid-2000s. Data from countries in the Horn of Africa (Ethiopia, Kenya, and Uganda) and Southern Africa (Lesotho, Malawi, Mozambique, Swaziland, Zambia, and Zimbabwe) were compiled from available survey results. Secondary data were obtained on weight-for-age for preschool children, HIV prevalence data were derived from antenatal clinic surveillance, and food security data were obtained from United Nations sources (Food and Agriculture Organization, International Labour Office, and others).

Results

Overall trends in child nutrition are improving as national averages; the improvement is slowed but not stopped by the effects of intermittent droughts. In Southern Africa, the prevalence rates of underweight showed signs of recovery from the 2001–03 crisis. As expected, food production and price indicators were related (although weakly) to changes in malnutrition prevalence; the association was strongest between changes in food production and price indicators and changes in malnutrition prevalence in the following year. Areas of higher HIV prevalence had better nutrition (in both country groups), but this counterintuitive association is removed after controlling for socioeconomic status. In low-HIV areas in Eastern Africa, nutrition deteriorates during drought, with prevalence rates of underweight 5 to 12 percentage points higher than in nondrought periods; less difference was seen in high-HIV areas, in contrast to Southern Africa, where drought and HIV together interact to produce higher prevalence rates of underweight.

Conclusions

Despite severe intermittent droughts and the HIV/AIDS epidemic (now declining but still with very high prevalence rates), underlying trends in child underweight are improving when drought is absent: resilience may be better than feared. Preventing effects of drought and HIV could release potential for improvement and, when supported by national nutrition programs, help to accelerate the rates of improvement, now generally averaging around 0.3 percentage points per year, to those needed to meet Millennium Development Goals (0.4 to 0.9 percentage points per year).
A Review of Global Progress toward the Millennium Development Goal 1 Hunger Target
Authors: Fanzo Jessica C. , Pronyk Paul M.
Published: November 2015

Background

The hunger component of the first Millennium Development Goal (MDG) aims to reduce the proportion of people who suffer from hunger by half between 1990 and 2015. In low- and middle-income countries, progress has been mixed, with approximately 925 million people hungry and 125 million and 195 million children underweight and stunted, respectively.

Objective

To assess global progress on the hunger component of MDG1 and evaluate the success of interventions and country programs in reducing undernutrition.

Methods

We review global progress on the hunger component of MDG1, examining experience from 40 community-based programs as well as national efforts to move interventions to scale drawn from the published and gray literature, alongside personal interviews with representatives of governments and development agencies.

Results

Based on this review, most strategies being implemented and scaled are focusing on treatment of malnutrition and rooted within the health sector. While critical, these programs generally address disease-related effects and emphasize the immediate determinants of undernutrition. Other major strategies to tackle under-nutrition rely on the production of staple grains within the agriculture sector. These programs address hunger, as opposed to improving the quality of diets within communities. Strategies that adopt multisectoral programming as crucial to address longer-term determinants of undernutrition, such as poverty, gender equality, and functioning food and health systems, remain under-developed and under-researched.

Conclusions

This review suggests that accelerating progress toward the MDG1 targets is less about the development of novel innovations and new technologies and more about putting what is already known into practice. Success will hinge on linking clear policies with effective delivery systems in working towards an evidence-based and contextually relevant multisectoral package of interventions that can rapidly be taken to scale.
Dietary Patterns and Nutritional Health of Women: The Nutrition Transition in Rural Tanzania
Authors: Keding Gudrun B. , Msuya John M. , Maass Brigitte L. , Krawinkel Michael B.
Published: November 2015

Background

Many developing countries are experiencing a rapid nutrition transition in urban areas.

Objective

To investigate whether a nutrition transition was occurring in a rural area by examining the dietary patterns of women in rural Tanzania.

Methods

A total of 252 women aged 16 to 45 years from three districts of northeastern and central Tanzania participated. During three different seasons in 2006–2007, the women were interviewed with the use of a structured, interviewer-administered questionnaire, including a 24-hour dietary recall. From these recalls, the mean intakes of 12 main food groups were calculated and used to establish five dietary patterns by principal component analysis. Data were also obtained on attitudes toward obesity, body mass index (BMI), hemoglobin level, and measures of socioeconomic status and analyzed for associations with dietary patterns.

Results

The five dietary patterns were “traditional-coast,” characterized by fruits, nuts, starchy plants, and fish; “traditional-inland,” characterized by cereals, oils and fats, and vegetables; “purchase,” characterized by bread and cakes (usually fried in oil), sugar, and black tea; “pulses,” characterized mainly by pulses, with few or no vegetables; and “animal products,” characterized by a high consumption of meat, eggs, and/or milk. Significant positive associations were found, among others, between the purchase pattern and BMI (ρ = 0.192, p = .005) and between the animal products pattern and wealth (ρ = 0.168, p = .002).

Conclusions

Differences between traditional and modern nutritional food patterns were evident. This study found the “traditional-inland” pattern to be the most healthy, while the “purchase” food pattern was the most prevalent. The purchase pattern, in particular, may provide some evidence for early stages of the nutrition transition in rural Tanzania.
The Importance of Milk and other Animal-Source Foods for Children in Low-Income Countries
Authors: Dror Daphna K. , Allen Lindsay H.
Published: November 2015

Background

Milk and other animal-source foods are concentrated dietary sources of macro- and micronutrients. Despite a global increase in milk production and consumption over the past decades, milk and other animal-source foods are often lacking in the diets of children in developing countries.

Objective

To evaluate the importance of milk and other animal-source food intake in promoting the growth, development, and health of children in low-income countries.

Methods

Original research articles describing observational and intervention studies with unfortified milk, fortified milk, and other animal-source foods in children were identified by searching the PubMed database.

Results

Consumption of milk and other animal-source foods by undernourished children improves anthropometric indices and cognitive function and reduces the prevalence of biochemical and functional nutritional deficiencies, reducing morbidity and mortality. Unfortified and fortified milk used in supplementation trials has been well tolerated and widely accepted by parents and children.

Conclusions

To improve the dietary quality of children in low-income countries and further the effort to eradicate extreme poverty and hunger in accordance with the United Nations Millennium Development Goals, additional research is necessary to identify and implement programs and policy supporting increased intake of milk and other animal-source foods.
Assessing the Impact of Micronutrient Intervention Programs Implemented under Special Circumstances—Meeting Report
Authors: de Pee Saskia , Spiegel Paul , Kraemer Klaus , Wilkinson Caroline , Bilukha Oleg , Seal Andrew , Macias Kathy , Oman Allison , Fall Ahmed Baba , Yip Ray , Peña-Rosas Juan Pablo , West Keith , Zlotkin Stanley , Bloem Martin W.
Published: November 2015

Introduction and Objective

The World Food Programme and the Office of the United Nations High Commissioner for Refugees organized a meeting of experts to discuss evaluation of micronutrient interventions under special circumstances, such as emergency and refugee situations.

Results

Multimicronutrient interventions for groups with higher needs may include home fortification products for young children or supplements for pregnant and lactating women. The choice of preparation should be guided by target group needs, evidence of efficacy of a product or its compounds, acceptability, and cost-effectiveness. Different designs can be used to assess whether an intervention has the desired impact. First, program implementation and adherence must be ascertained. Then, impact on micronutrient status can be assessed, but design options are often limited by logistic challenges, available budget, security issues, and ethical and practical issues regarding nonintervention or placebo groups. Under these conditions, a plausibility design using pre- and postintervention cross-sectional surveys, a prospective cohort study, or a step-wedge design, which enrolls groups as they start receiving the intervention, should be considered. Post hoc comparison of groups with different adherence levels may also be useful. Hemoglobin is often selected as an impact indicator because it is easily measured and tends to respond to change in micronutrient status, especially iron. However, it is not a very specific indicator of micronutrient status, because it is also influenced by inflammation, parasitic infestation, physiological status (age, pregnancy), altitude, and disorders such as thalassemia and sickle cell disease.

Conclusion

Given the constraints described above, replicability of impact in different contexts is key to the validation of micronutrient interventions.
Community-Led Initiative for Control of Anemia among Children 6 to 35 Months of Age and Unmarried Adolescent Girls in Rural Wardha, India
Authors: Dongre Amol R. , Deshmukh Pradeep R. , Garg Bishan S.
Published: November 2015

Background

Studies in India have reported a high prevalence of nutritional anemia among children and adolescent girls. Nutritional anemia is associated with impaired mental, physical, and cognitive performance in children and is a significant risk factor for maternal mortality.

Objective

To evaluate the effect of a community-led initiative for control of nutritional anemia among children 6 to 35 months of age and unmarried rural adolescent girls 12 to 19 years of age.

Methods

This Participatory Action Research was done in 23 villages of the Primary Health Centre, Anji, in Wardha District of Maharashtra. In February and March 2008, needs assessment was undertaken by interviewing the mothers of 261 children and 260 adolescent girls. Hemoglobin levels of adolescent girls and children were measured with the use of the hemoglobin color scale. The girls were given weekly iron—folic acid tablets, and the children were given daily liquid iron prophylaxis for 100 days in a year through community participation. The adolescent girls and the mothers of the children and adolescent girls were also given nutritional education on the benefits and side effects of iron supplementation. In June and July 2008, follow-up assessment was performed by survey and force field analysis.

Results

There was a significant reduction in the prevalence of nutritional anemia from 73.8% to 54.6% among the adolescent girls and from 78.2% to 64.2% among the children. There was improvement in awareness of iron-rich food items among the adolescent girls and the mothers of the children. The benefits to girls, such as increase in appetite and reduction in scanty menses, tiredness, and weakness, acted as positive factors leading to better compliance with weekly iron supplementation. The benefits to children perceived by the mothers, such as increase in appetite, weight gain, reduction in irritability, and reduction in mud-eating behavior, acted as a dominant positive force and generated demand for iron syrup.

Conclusions

The community-led initiative for once-weekly iron supplementation for adolescent girls and iron prophylaxis for children, in addition to nutritional education, improved the hemoglobin status of children 6 to 35 months of age and unmarried rural adolescent girls 12 to 19 years of age.
New Benchmarks for Costs and Cost-Efficiency of School-Based Feeding Programs in Food-Insecure Areas
Authors: Gelli Aulo , Cavallero Andrea , Minervini Licia , Mirabile Mariana , Molinas Luca , de la Mothe Marc Regnault
Published: November 2015

Background

School feeding is a popular intervention that has been used to support the education, health and nutrition of school children. Although the benefits of school feeding are well documented, the evidence on the costs of such programs is remarkably thin.

Objective

Address the need for systematic estimates of the cost of different school feeding modalities, and of the determinants of the considerable cost variation among countries.

Methods

WFP project data, including expenditures and number of schoolchildren covered, were collected for 78 projects in 62 countries through project reports and validated through WFP Country Office records. Yearly project costs per schoolchild were standardized over a set number of feeding days and the amount of energy provided by the average ration. Output metrics, such as tonnage, calories, and micronutrient content, were used to assess the cost-efficiency of the different delivery mechanisms.

Results

The standardized yearly average school feeding cost per child, not including school-level costs, was US$48. The yearly costs per child were lowest at US$23 for biscuit programs reaching school-going children and highest at US$75 for take-home rations programs reaching families of schoolgoing children. The average cost of programs combining on-site meals with extra take-home rations for children from vulnerable households was US$61. Commodity costs were on average 58% of total costs and were highest for biscuit and take-home rations programs (71% and 68%, respectively). Fortified biscuits provided the most cost-efficient option in terms of micronutrient delivery, whereas take-home rations were more cost-efficient in terms of food quantities delivered.

Conclusions

Both costs and effects should be considered carefully when designing school feeding interventions. The average costs of school feeding estimated here are higher than those found in earlier studies but fall within the range of costs previously reported. Because this analysis does not include school-level costs, these findings highlight the higher nontransfer costs for programs delivering cooked meals in schools than for other school feeding modalities. The benchmarks presented here reflect the centralized WFP implementation model, which is not always relevant in terms of government school feeding programs, particularly those procuring within national boundaries using “home-grown” approaches.
Bioavailability of Micronutrients: Stable Isotope Techniques to Develop Effective Food-Based Strategies to Combat Micronutrient Deficiencies
Authors: Davidsson Lena , Haskell Marjorie
Published: November 2015

Background

The prevalence of micronutrient deficiencies, in particular those of iron, vitamin A, iodine, and zinc, is unacceptably high, especially among infants, children, and women of childbearing age in developing countries. Effective food-based strategies to combat these public health problems are therefore urgently needed.

Objective

As only a fraction of dietary iron, zinc, and provitamin A carotenoids is absorbed and utilized, i.e., bioavailable, access to information on micronutrient bioavailability is crucial in the development of food fortification strategies and interventions based on dietary diversification.

Methods

Review of literature

Results and conclusions

This overview highlights the usefulness of stable isotope techniques to assess the bioavailability of nonheme iron and provitamin A carotenoids and the importance of generating data on micro-nutrient bioavailability to move the agenda forward.
Response of Urinary Biomarkers of Systemic Oxidation to Oral Iron Supplementation in Healthy Men
Authors: Orozco Monica N. , Solomons Noel W. , Schümann Klaus , Friel James K.
Published: November 2015

Background

Urinary biomarkers are used in assessment of severe, clinical oxidative stress. Little is known, however, about their diagnostic value within the normative range.

Objective

To evaluate the response of urinary thiobarbituric acid reactive substances (TBARS) and 8-hydroxy-2-deoxyguanosine (8-OHdG) as indicators of systemic oxidation in response to short-term oral iron and antioxidant supplementation.

Methods

Five healthy adult men participated in the pilot study phase and 12 in the definitive intervention trial. For 7 days each, separated by 12-day washouts, the subjects received different treatment regimens, consisting of 120 mg of iron, 120 mg of iron in refined palm oil, and 120 mg of iron in palm oil combined with one of the two doses of Carotino® Tocotrienol Carotene Mixed Concentrate (CTCMC). Creatinine-normalized urinary TBARS and 8-OHdG concentrations were quantified in samples taken from subjects with and without active supplementation. Temporal and correlative associations between TBARS and 8-OHdG were explored.

Results

Daily intake of supplemental iron failed to produce any increment in urinary excretion of TBARS or 8-OHdG. However, a significant within-individual correlation between the urinary biomarkers was observed (Spearman r = 0.697, p < .0001, n = 466). Both doses of CTCMC significantly lowered urinary excretion of both oxidation indicators.

Conclusions

Despite the lack of effect of oral iron on the biomarkers of systemic oxidation, they show a strong and significant mutual association within the nonpathological range of oxidative stress in healthy male adults.
Estimating Micronutrient Intakes from Household Consumption and Expenditures Surveys (HCES): An Example from Bangladesh
Authors: Bermudez Odilia I. , Lividini Keith , Smitz Marc-Francois , Fiedler John L.
Published: November 2015

Background

Globally, there is a scarcity of national food consumption data that could help to assess food patterns and nutrient intakes of population groups. Estimates of food consumption patterns and apparent intakes of energy and nutrients could be obtained from national Household Consumption and Expenditures Surveys (HCES).

Objective

To use the HCES conducted in Bangladesh in 2005 (HIES2005) to estimate apparent intakes of vitamin A, iron, and zinc.

Methods

Food acquisition data from HIES2005, which surveyed 10,080 households, were transformed into standard measurement units. Intrahousehold food and nutrient distribution was estimated with Adult Male Equivalent (AME) units. Adequacy of intake was assessed by comparing individual nutrient intakes with requirements and was then aggregated by households.

Results

The weighted mean energy intake for the population was 2,151 kcal/person/day, with a range among divisions from 1,950 in Barisal to 2,195 in Dhaka division. The apparent intakes of vitamin A and iron were insufficient to satisfy the recommended intakes for more than 80% of the population in Bangladesh, while apparent intakes of zinc, adjusted by bioavailability, satisfied the requirements of approximately 60% of the population.

Conclusions

Using the HIES2005, we were able to produce estimates of apparent food consumption and intakes of some key micronutrients for the Bangladeshi population and observed wide differences among divisions. However, the methodological approaches reported here, although feasible and promising, need to be validated with other dietary intake methods.
Effects of Boiling and Frying on the Bioaccessibility of β-Carotene in Yellow-Fleshed Cassava Roots (Manihot Esculenta Crantz cv. BRS Jari)
Authors: Gomes Suellen , Torres Alexandre Guedes , Godoy Ronoel , Pacheco Sidney , Carvalho José , Nutti Marília
Published: November 2015

Background

The effects of boiling and frying on the bioaccessibility of all- trans-β-carotene in biofortified BRS Jari cassava roots have not been investigated, although these are conventional methods of cassava preparation.

Objective

The aims of the present study were to investigate β-carotene micellarization efficiency of yellow-fleshed BRS Jari cassava roots after boiling and frying, as an indicator of the bioaccessibility of this carotenoid, and to apply fluorescence microscopy to investigate β-carotene in the emulsified fraction.

Methods

Uncooked, boiled, and fried cassava roots were digested in vitro for the evaluation, by reversed-phase high-performance liquid chromatography (HPLC), of the efficiency of micellarization of all- trans-β-carotene in BRS Jari cassava roots. Fluorescence microscopy of the micellar fraction was used to confirm the presence of β-carotene in the emulsified fraction and to observe the structure of the microemulsion from the boiled and fried cassava samples.

Results

Fried cassava roots showed the highest ( p < .05) micellarization efficiency for total carotenoids and all-trans-β-carotene (14.1 ± 2.25% and 14.37 ± 2.44%, respectively), compared with boiled and raw samples. Fluorescence microscopy showed that after in vitro digestion there were no carotenoid crystals in the micellar fraction, but rather that this fraction presented a biphasic system compatible with emulsified carotenoids, which was consistent with the expected high bioavailability of β-carotene in this fraction.

Conclusions

Increased emulsification and bioaccessibility of β-carotene from fried biofortified BRS Jari cassava roots compensates for chemical losses during preparation, indicating that this preparation is suitable for home use of BRS Jari cassava roots and might represent a relatively good food source of bioavailable provitamin A.
Effects of Breastfeeding on Weight Loss and Recovery of Pregestational Weight in Adolescent and Adult Mothers
Authors: Sámano Reyna , Martínez-Rojano Hugo , Martínez Estela Godínez , Jiménez Bernarda Sánchez , Rodríguez Gilda Paulina Villeda , Zamora Julieta Pérez , Casanueva Esther
Published: November 2015

Background

Exclusive breastfeeding (EBF) in adolescent mothers has been associated with greater postpartum maternal weight loss.

Objective

To assess the associations between EBF and weight loss in adolescent and adult mothers and between EBF and weight and length gain of their children.

Methods

A cohort of 68 adolescent mothers (15 to 19 years), 64 adult mothers (20 to 29 years), and their infants were studied. Anthropometric measurements were performed at 15, 90, 180, and 365 days postpartum in the mothers and children. EBF was defined as consumption of human milk without supplementation of any type (water, juice, nonhuman milk, or food) for 4 months.

Results

Sixty-five percent of mothers sustained EBF for 4 months. There were no significant differences in the weight or length of the infants of adolescent and adult mothers at 365 days postpartum. Among infants of adult mothers, there was a significant difference between the weight gain of those were exclusively breastfed and those who were not exclusively breastfed (6,498 ± 1,060 vs 6,096 ± 1,035 g, p < .050) at 365 days postpartum, according to the parameters for weight gain and length established by the World Health Organization (WHO). Among both adult and adolescent mothers, those who practiced EBF lost more weight than those who did not practice EBF (–2.9 kg, 95% interquartile range, −5.7 to 0.8 kg, vs −1.8 kg, 95% interquartile range −2.8 to 2.2 kg; p = .004). Gestational weight gain, duration of EBF, and recovery menstruation explained 21% of the variance ( F = 28.184, p = .001) in change in postpartum maternal weight (in kilograms) from 0 to 365 days postpartum in all mothers. Pregestational weight, duration of EBF, and maternal age were factors that explained 14% ( F = 22.759, p = .001) of the change in the weight and length of the infants from 0 to 365 days of life.

Conclusions

EBF in adolescent and adult mothers influences postpartum weight loss and provides adequate infant growth in accordance with the WHO 2006 standards.
Control of Iodine-Deficiency Disorders following Universal Salt Iodization in Shenzhen, China, 1997–2011
Authors: Huang Wei , Peng Chaoqiong , Huang Haixiong , Zhang Jinzhou , Liu Jianping , Mao Lisha , Luo Ruorong , Xiao Yunjun
Published: November 2015

Background

Since universal salt iodization (USI) was implemented in Shenzhen, China, in 1996, evaluation of the time trend of USI to indicate the control of iodine-deficiency disorders has not been performed.

Objective

To assess the time trend of median urinary iodine and total goiter rates from 1997 to 2011.

Methods

Probability-proportionate-to-size sampling was employed in the surveillance of iodine-deficiency disorders, for which schoolchildren aged 8 to 10 years were randomly selected from five districts of the city during each iodine-deficiency disorders survey. Urinary iodine content and thyroid size were measured by ammonium persulfate oxidation and B ultrasound, respectively.

Results

The coverage of iodized salt increased from 73.2% in 1997 to more than 90% in 2011. The median urinary iodine of children aged 8 to 10 years varied between 207.1 and 278.8 μg/L; these levels were above the urinary iodine level in 1995. The proportion of urine samples with iodine content above 300 μg/L was 45.6% in 1997 and decreased to 20.8% in 2011, indicating excessive consumption of iodine by the children. The goiter rate among children dropped from 10.8% in 1997 to 1.3% in 2011; both values were lower than the goiter rate in 1995, indicating that the spread of endemic goiter was under control.

Conclusions

Preliminary elimination of iodine-deficiency disorders was achieved by USI in Shenzhen. Nevertheless, some problems still existed, such as over-iodization. To clarify the causes of excessive urinary iodine content, the various sources of iodine from the diet need to be investigated in the future.
Agriculture for Improved Nutrition: The Current Research Landscape
Authors: Turner Rachel , Hawkes Corinna , Waage Jeff , Ferguson Elaine , Haseen Farhana , Homans Hilary , Hussein Julia , Johnston Deborah , Marais Debbi , McNeill Geraldine , Shankar Bhavani
Published: November 2015

Background

Concern about food security and its effect on persistent undernutrition has increased interest in how agriculture could be used to improve nutritional outcomes in developing countries. Yet the evidence base for the impact of agricultural interventions targeted at improved nutrition is currently poor.

Objective

To map the extent and nature of current and planned research on agriculture for improved nutrition in order to identify gaps where more research might be useful.

Methods

The research, which was conducted from April to August 2012, involved developing a conceptual framework linking agriculture and nutrition, identifying relevant research projects and programs, devising and populating a “template” with details of the research projects in relation to the conceptual framework, classifying the projects, and conducting a gap analysis.

Results

The study identified a large number of research projects covering a broad range of themes and topics. There was a strong geographic focus on sub-Saharan Africa, and many studies were explicitly concerned with nutritional impacts on women and children. Although the study revealed a diverse and growing body of research, it also identified research gaps. Few projects consider the entire evidence chain linking agricultural input or practice to nutritional outcomes. There is comparatively little current research on indirect effects of agriculture on nutrition, or the effect of policies or governance, rather than technical interventions. Most research is focused on undernutrition and small farmer households, and few studies target consumers generally, urban populations, or nutrition-related non-communicable diseases. There is very little work on the cost-effectiveness of agricultural interventions.

Conclusions

On the basis of these findings, we make suggestions for research investment and for broader engagement of researchers and disciplines in developing approaches to design and evaluate agricultural programs for improved nutrition.
Predictors of Anemia among Haitian Children Aged 6 to 59 Months and Women of Childbearing Age and Their Implications for Programming
Authors: Heidkamp Rebecca A. , Ngnie-Teta Ismael , Ayoya Mohamed Ag , Stoltzfus Rebecca J. , Mamadoultaibou Aissa , Durandisse Emmanuela Blain , Pierre Joseline Marhone
Published: November 2015

Background

The Haitian National Nutrition Policy prioritizes prevention and treatment of anemia among mothers and young children, but there are few available data to support planning for scale-up of anemia interventions.

Objective

To describe the prevalence and predictors of anemia among Haitian women (15 to 49 years) and children (6 to 59 months) and to draw implications for national nutrition programming.

Methods

Descriptive and univariate analyses and multivariate logistic regression models were performed using data from the nationally representative Haitian Demographic Health Survey 2005/06.

Results

The prevalence of mild (hemoglobin 11.0 to 11.9 g/dL), moderate (hemoglobin 8.0 to 10.9 g/dL), and severe (hemoglobin < 8.0 g/dL) anemia was 19.2%, 21.7%, and 4.4%, respectively, among women aged 15 to 49 years and 22.9%, 33.9%. and 2.2% among children aged 6 to 59 months. Unexpectedly, anemia was more prevalent in urban women (54.4 %) and children (65.1%) than in rural women (43.1%, p < .001) and children (55.7%, p = .004). In multivariate regression models, factors associated with anemia among urban women (birth spacing, p = .027; overweight BMI, p < .001; education level, p = .022) were different from those in rural women (wealth quintile, p < .05; employment, p = .003). Anemia in urban and rural children aged 6 to 59 months increased with child age ( p < .05) and maternal anemia status ( p = .004; p < .001). Female sex ( p = .007) and maternal overweight ( p = .009) were associated with reduced risk of anemia in rural children only.

Conclusions

Anemia among Haitian young children and women of childbearing age is a severe public health problem. The findings suggest the need for context-specific rural and urban strategies, reinforcement of anemia prevention in health services reaching women of childbearing age, and targeted interventions for young children.
Cost of the Diet (CoD) Tool: First Results from Indonesia and Applications for Policy Discussion on Food and Nutrition Security
Authors: Baldi Giulia , Martini Elviyanti , Catharina Maria , Muslimatun Siti , Fahmida Umi , Jahari Abas Basuni , Hardinsyah  , Frega Romeo , Geniez Perrine , Grede Nils , Minarto  , Bloem Martin W. , de Pee Saskia
Published: November 2015

Background

The Minimum Cost of a Nutritious Diet (MCNut) is the cost of a theoretical diet satisfying all nutrient requirements of a family at the lowest possible cost, based on availability, price, and nutrient content of local foods. A comparison with household expenditure shows the proportion of households that would be able to afford a nutritious diet.

Objective

To explore using the Cost of Diet (CoD) tool for policy dialogue on food and nutrition security in Indonesia.

Methods

From October 2011 to June 2012, market surveys collected data on food commodity availability and pricing in four provinces. Household composition and expenditure data were obtained from secondary data (SUSENAS 2010). Focus group discussions were conducted to better understand food consumption practices. Different types of fortified foods and distribution mechanisms were also modeled.

Results

Stark differences were found among the four areas: in Timor Tengah Selatan, only 25% of households could afford to meet the nutrient requirements, whereas in urban Surabaya, 80% could. The prevalence rates of underweight and stunting among children under 5 years of age in the four areas were inversely correlated with the proportion of households that could afford a nutritious diet. The highest reduction in the cost of the child's diet was achieved by modeling provision of fortified blended food through Social Safety Nets. Rice fortification, subsidized or at commercial price, can greatly improve nutrient affordability for households.

Conclusions

The CoD analysis is a useful entry point for discussions on constraints on achieving adequate nutrition in different areas and on possible ways to improve nutrition, including the use of special foods and different distribution strategies.