bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low Vitamin B12 Intake during Pregnancy and Lactation and Low Breastmilk Vitamin B12 Content in Rural Kenyan Women Consuming Predominantly Maize Diets
Authors: Neumann Charlotte G. , Oace Susan M. , Chaparro M. Pia , Herman Dena , Drorbaugh Natalie , Bwibo Nimrod O. 
Published: November 2015

Background Vitamin B12 deficiency during pregnancy and lactation may negatively affect fetal growth, brain development, pregnancy outcome, and breastmilk vitamin B12 content. Objective To examine associations between pregnant and lactating women's vitamin B12 intake and pregnancy outcomes, breastmilk vitamin B12 concentration, and growth and development of breastfed infants from birth to 6 months. Methods One hundred thirty-eight Kenyan women were followed during pregnancy, with 98 followed through 6 months of lactation and providing 294 randomly collected breastmilk samples. Maternal hematologic analyses were performed for erythrocyte morphology, erythrocyte size, and serum vitamin B12 concentration. Women's and infants' food intake was assessed. Breastmilk vitamin B12 was measured by a competitive binding isotope dilution technique. Infant anthropometric data and the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) were assessed within 3 days after birth. The Infant Bayley Motor Scale was assessed at 6 months. Statistical analyses included simple regression and correlation analyses in relation to vitamin B12 status and gestational age. Results Intrauterine growth restriction and stillbirths were correlated with maternal macrocytic anemia and hypersegmented polymorphonuclear nuclei. Postpartum maternal vitamin B12 intake influenced breastmilk vitamin B12 levels 1 to 6 months postpartum. No associations were found between vitamin B12 intake during pregnancy or vitamin B12 levels in breastmilk and infant length, weight, or head circumference at birth or 6 months. Vitamin B12 intake during pregnancy was correlated with improved scores on infants' BNBAS reflex subscale ( R = −0.19, p = .05) with adjustment for gestational age. Bayley Motor Scale results at 6 months were not significantly associated with breastmilk or supplemental feeding vitamin B12 content. Conclusions Vitamin B12 deficiency may adversely affect pregnancy outcome, infant reflexes at birth, and breastmilk vitamin B12 content.
Assessing Zambia's Industrial Fortification Options: Getting beyond Changes in Prevalence and Cost-Effectiveness
Authors: Fiedler John L. , Lividini Keith , Kabaghe Gladys , Zulu Rodah , Tehinse John , Bermudez Odilia I. , Jallier Vincent , Guyondet Christophe 
Published: November 2015

Background Since fortification of sugar with vitamin A was mandated in 1998, Zambia's fortification program has not changed, while the country remains plagued by high rates of micronutrient deficiencies. Objective To provide evidence-based fortification options with the hope of reinvigorating the Zambian fortification program. Methods Zambia's 2006 Living Conditions Monitoring Survey is used to estimate the apparent intakes of vitamin A, iron, and zinc, as well as the apparent consumption levels and coverage of four fortification vehicles. Fourteen alternative food fortification portfolios are modeled, and their costs, impacts, average cost-effectiveness, and incremental cost-effectiveness are calculated using three alternative impact measures. Results Alternative impact measures result in different rank orderings of the portfolios. The most cost-effective portfolio is vegetable oil, which has a cost per disability-adjusted life-year (DALY) saved ranging from 12% to 25% of that of sugar, depending on the impact measure used. The public health impact of fortified vegetable oil, however, is relatively modest. Additional criteria beyond cost-effectiveness are introduced and used to rank order the portfolios. The size of the public health impact, the total cost, and the incremental cost-effectiveness of phasing in multiple vehicle portfolios over time are analyzed. Conclusions Assessing fortification portfolios by measuring changes in the prevalence of inadequate intakes underestimates impact. A more sensitive measure, which also takes into account change in the Estimated Average Requirement (EAR) gap, is provided by a dose—response-based approach to estimating the number of DALYs saved. There exist highly cost-effective fortification intervention portfolios with substantial public health impacts and variable price tags that could help improve Zambians' nutrition status.
The Growing Importance of Staple Foods and Condiments Used as Ingredients in the Food Industry and Implications for Large-Scale Food Fortification Programs in Southeast Asia
Authors: Spohrer Rebecca , Larson Melanie , Maurin Clémence , Laillou Arnaud , Capanzana Mario , Garrett Greg S. 
Published: November 2015

Background Food fortification is a viable strategy to improve the nutritional status of populations. In South-east Asia, recent growth and consolidation of the food industry provides an opportunity to explore whether certain widely consumed processed foods could contribute to micronutrient status if they are made with adequately fortified staples and condiments. Objective To estimate the potential contribution certain processed foods can make to micronutrient intake in Southeast Asia if they are made with fortified staples and condiments; e.g., via the inclusion of iodized salt in various processed foods in the Philippines, fortified wheat flour in instant noodles in Indonesia, and fortified vegetable oil in biscuits in Vietnam. Methods For Indonesia, the Philippines, and Vietnam, a review of consumption trends, relevant policies, and industry practices was conducted using publicly available sources, food industry market data and research reports, and oral communication. These informed the estimates of the proportion of the Recommended Nutrient Intake (RNI) that could be delivered via select processed foods. Results In the Philippines, Indonesia, and Vietnam, the processed food industry is not always required to use fortified staples and condiments. In the Philippines, dried salted fish with iodized salt would provide 64% to 85% of the iodine RNI for women of reproductive age and 107% to 141% of the iodine RNI for children 1 to 6 years of age. In Indonesia, a 75-g pack of instant noodles (a highly consumed product) with fortified wheat flour would provide 45% to 51% of the iron RNI for children 4 to 6 years of age and 10% to 11% of the iron RNI for women of reproductive age. In Vietnam, biscuits containing vegetable oil are increasingly popular. One 35-g biscuit serving with fortified vegetable oil would provide 13% to 18% of the vitamin A RNI for children 4 to 6 years of age and 12% to 17% of the vitamin A RNI for women of reproductive age. Conclusions Ensuring that fortified staples and condiments such as flour, salt, and vegetable oil are used in widely consumed processed foods would ensure that these foods contribute to improvement in micronutrient intake among populations in Southeast Asia, particularly as the consumption of these foods is increasing. Policymakers and nutrition program managers should consider the contribution to nutritional intake that fortified staples and condiments can provide through processed foods, in addition to being used for cooking in the home, and ensure that the food industry is required to use these fortified staples and condiments rather than nonfortified foods.
Fish Sauce, Soy Sauce, and Vegetable Oil Fortification in Cambodia: Where do we Stand to Date?
Authors: Theary Chan , Panagides Dora , Laillou Arnaud , Vonthanak Saphoon , Kanarath Chheng , Chhorvann Chhea , Sambath Pol , Sowath Sol , Moench-Pfanner Regina 
Published: November 2015

Background The prevalence of micronutrient deficiencies in Cambodia is among the highest in Southeast Asia. Fortification of staple foods and condiments is considered to be one of the most cost-effective strategies for addressing micronutrient deficiencies at the population level. The Government of Cambodia has recognized the importance of food fortification as one strategy for improving the nutrition security of its population. Objective This paper describes efforts under way in Cambodia for the fortification of fish sauce, soy sauce, and vegetable oil. Methods Data were compiled from a stability test of Cambodian fish sauces fortified with sodium iron ethylenediaminetetraacetate (NaFeEDTA); analysis of fortified vegetable oils in the Cambodian market; a Knowledge, Attitudes, and Practices (KAP) study of fortified products; and food fortification program monitoring documents. Results At different levels of fortification of fish sauce with NaFeEDTA, sedimentation and precipitation were observed. This was taken into consideration in the government-issued standards for the fortification of fish sauce. All major brands of vegetable oil found in markets at the village and provincial levels are imported, and most are nonfortified. Conclusions Fish sauce, soy sauce, and vegetable oil are widely consumed throughout Cambodia and are readily available in provincial and village markets. Together with an effective regulatory monitoring system, the government can guarantee that these commodities, whether locally produced or imported, are adequately fortified. A communications campaign would be worth-while, once fortified commodities are available, as the KAP study found that Cambodians had a positive perception of fortified sauces.
Rapid Quantification of Iron Content in Fish Sauce and Soy Sauce: A Promising Tool for Monitoring Fortification Programs
Authors: Laillou Arnaud , Icard-Vernière Christèle , Rochette Isabelle , Picq Christian , Berger Jacques , Sambath Pol , Mouquet-Rivier Claire 
Published: November 2015

Background In a number of Southeast Asian countries and China, fish sauce and soy sauce produced at the industrial level are fortified with iron. Unfortunately, the food producers and regulatory agencies implementing fortification programs do not always have the capacity to monitor the programs on an ongoing basis. Objective To assess a new portable device for the quantitative measurement of iron content of fortified sauces that could be used to control fortification levels. Methods The linearity, detection limits, and inter- and intraassay variability of this device were assessed on fish sauce and soy sauce fortified with ferrous sulfate, ferrous fumarate, and sodium iron ethylenediaminetetraacetate (NaFeEDTA); the accuracy of the results was determined by comparing them with the results obtained by atomic absorption spectrophotometry. Results Measurements required a minimum incubation time of 1 hour for iron sulfate or iron fumarate and 24 hours for NaFeEDTA. Linearity of the results ranged from 2 to 10 mg iron/L for ferrous sulfate or ferrous fumarate and from 1 to 10 mg iron/L for NaFeEDTA, implying the need for proper dilution, as the iron contents of fortified sauce are usually in the range of 150 to 1,000 mg/L. Depending on incubation time, iron compounds, and sauces, the coefficient of variation (CV) of intraassay precision was between 1.5% and 7.6% and the CV of interassay precision was between 2.9% and 7.4%. Comparison with results from atomic absorption spectrophotometry showed high agreement between both methods, with R = 0.926 and R = 0.935 for incubation times of 1 hour and 24 hours, respectively. The Bland—Altman plots showed limits of agreement between the two methods of ± 70 mg/L in the range of fortification levels tested (100 to 500 mg/L). Conclusions This device offers a viable method for field monitoring of iron fortification of soy and fish sauces after incubation times of 1 hour for ferrous sulfate or ferrous fumarate and 24 hours for NaFeEDTA.
The SMILING Project: A North—South—South Collaborative Action to Prevent Micronutrient Deficiencies in Women and Young Children in Southeast Asia
Authors: Berger Jacques , Blanchard Gentiane , Ponce Maiza Campos , Chamnan Chhoun , Chea Mary , Dijkhuizen Marjoleine , Doak Coleen , Doets Esmee , Fahmida Umi , Ferguson Elaine , Hulshof Paul , Kameli Yves , Kuong Khov , Akkhavong Kongsap , Sengchanh Kounavong , Le Bach Mai , Tran Thi Lua , Muslimatun Siti , Roos Nanna , Sophonneary Prak , Wieringa Frank , Wasantwisut Emorn , Winichagoon Pattanee ,   SMILING consortium group
Published: November 2015

Background The “Sustainable Micronutrient Interventions to Control Deficiencies and Improve Nutritional Status and General Health in Asia” project (SMILING), funded by the European Commission, is a transnational collaboration of research institutions and implementation agencies in five Southeast Asian countries—Cambodia, Indonesia, Laos PDR, Thailand, and Vietnam—with European partners, to support the application of state-of-the art knowledge to alleviate micronutrient malnutrition in Southeast Asia. Objective The major expected outcomes are to improve micronutrient status on a large scale, to identify priority interventions in each Southeast Asian country, and to develop a road map for decision makers and donors for inclusion of these priority interventions into the national policy. Methods SMILING has been built around a strong project consortium that works on a constant and proactive exchange of data and analyses between partners and allows for the differences in contexts and development stages of the countries, as well as a strong North—South—South collaboration and colearning. Results The selection of Southeast Asian countries considered the range of social and economic development, the extent of micronutrient malnutrition, and capacity and past success in nutrition improvement efforts. SMILING is applying innovative tools that support nutrition policy-making and programming. The mathematical modeling technique combined with linear programming will provide insight into which food-based strategies have the potential to provide essential (micro) nutrients for women and young children. Multicriteria mapping will offer a flexible decision-aiding tool taking into account the variability and uncertainty of opinions from key stakeholders. The lessons learned throughout the project will be widely disseminated.
Using an Evidence-Based Approach to Design Large-Scale Programs to Improve Infant and Young Child Feeding
Authors: Baker Jean , Sanghvi Tina , Hajeebhoy Nemat , Martin Luann , Lapping Karin 
Published: November 2015

Background Global interest in scaling up nutrition outcomes has focused attention on the need for more effective programs to improve infant and young child feeding (IYCF). However there are few examples in the literature of comprehensive programs that have been systematically designed. Objective To describe an evidence-based approach for designing large-scale yet tailored IYCF programs in varied country settings. Methods Behavior change principles, epidemiological data, situational analysis, stakeholder consultations, formative research, and feasibility studies informed the design of IYCF programs delivered at scale in Bangladesh, Ethiopia, and Vietnam. Results Impact, scale, and sustainability objectives guided the choice of partners, service delivery platforms, and advocacy, systems strengthening, and communication strategies for reaching mothers and decision makers. All programs focused on the critical first 2 years of life, followed global World Health Organization and UNICEF guidelines for IYCF, and applied a common theory of change. Formative research, stakeholder consultations, trials of improved practices, and assessments of media habits were most useful for making program decisions. Opinion leader research, monitoring of the policy environment, and stakeholder analysis were key elements in the design of advocacy strategies. All programs found that setting measurable and explicit targets, strengthening systems to provide support for mothers, multichannel communication, and advocacy for opinion leaders were vital components in the design. Conclusions A systematic, evidence-based collaborative approach can facilitate the design of comprehensive IYCF programs. Programs should also embed design flexibility to enable changes as new challenges and opportunities arise.
Bringing Rigor to Evaluations of Large-Scale Programs to Improve Infant and Young Child Feeding and Nutrition: The Evaluation Designs for the Alive & Thrive Initiative
Authors: Menon Purnima , Rawat Rahul , Ruel Marie 
Published: November 2015

Background The evidence base on the impact of large-scale infant and young child feeding (IYCF) and nutrition programs is limited, partly due to the challenges of rigorously evaluating complex programs including multiple interventions. Objectives To describe the process used to design Alive & Thrive's impact evaluations in the three target countries and discuss the feasibility of developing contextually relevant designs adapted to the country-specific programmatic context. Methods The evaluation designs for Alive & Thrive needed to address several challenges. These included the selection of intervention components to evaluate rigorously; the identification of appropriate comparison groups in the context of rapidly scaling-up programs; the choice of impact indicators; addressing measurement challenges related to evaluating the impact of interventions targeted during the first 2 years of life on stunting; and developing methods and tools to assess implementation, utilization, and program impact pathways within evolving program portfolios. Results In Bangladesh and Vietnam, cluster-randomized probability designs are used for the impact evaluations; in Ethiopia, the impact evaluation uses an adequacy design. In all three countries, repeated cross-sectional surveys, 4 years apart, are used to measure impact, and appropriate age groups are sampled separately to capture change in the main impact indicators. In addition, theory-driven process evaluations are used to study factors that facilitate or prevent achievement of impact and scale. Conclusions We conclude that robust impact and process evaluations of complex, large-scale nutrition programs are feasible, but that early implementer—evaluator engagement and shared vision and motivation to establishing meaningful evaluations are essential.
Epidemiological Study of Risk Factors for Goiter among Primary Schoolchildren in Southern Ethiopia
Authors: Wolka Eskinder , Shiferaw Solomon , Biadgilign Sibhatu 
Published: November 2015

Background Iodine-deficiency disorders are a major public health problem all over the world. Goiter is the most visible manifestation of iodine-deficiency disorder. Goiter rate is useful to assess the long-term impact of iodine-deficiency disorders. Objective To determine the risk factors for goiter in primary schoolchildren in southern Ethiopia. Methods A cross-sectional study on a sample population of 270 children 6 to 12 years of age with goiter and 264 without goiter was conducted in a primary school in Sodo Town, southern Ethiopia. All students in each class were examined for the presence of goiter and classified based on World Health Organization criteria. For each child with goiter, the next child without goiter was selected from the same class. Multivariate logistic regression analysis was employed to determine the effect of independent variables on the goiter rate. Results A total of 534 participants (270 children with goiter and 264 without goiter) were included. Although the difference was not significant, the prevalence of goiter was higher among girls than among boys (54.8% vs. 45.2%), and the prevalence in both sexes increased with age. In the multivariate logistic regression model, consuming common goitrogenic foods (adjusted OR, 1.9; 95% CI, 1.2 to 2.9) and drinking water from the river (adjusted OR, 2.5; 95% CI, 1.2 to 4.9) were independently associated with goiter. Conclusions Goiter rate is significantly associated with consumption of goitrogenic food items in the area and contaminated drinking water. Creating awareness in the community about the consumption of food items and provision of tap water by concerned bodies in the area is recommended to prevent iodine-deficiency disorders.
Orange-Fleshed Sweet Potato-Based Infant Food is a Better Source of Dietary Vitamin A than a Maize—Legume Blend as Complementary Food
Authors: Amagloh Francis Kweku , Coad Jane 
Published: November 2015

Background White maize, which is widely used for complementary feeding and is seldom fortified at the household level, may be associated with the high prevalence of vitamin A deficiency among infants in low-income countries. Objective The nutrient composition of complementary foods based on orange-fleshed sweet potato (OFSP) and cream-fleshed sweet potato (CFSP), maize—soybean— groundnut (Weanimix), and a proprietary wheat-based infant cereal (Nestlé Cerelac) were assessed using the Codex Standard (CODEX STAN 074-1981, Rev. 1–2006) specification as a reference. Additionally, the costs of OFSP complementary food, CFSP complementary food, and Weanimix production at the household level were estimated. Phytate and polyphenols, which limit the bioavailability of micronutrients, were assessed. Methods Energy, macronutrients, and micronutrients listed as essential composition in the Codex Standard were determined and expressed as energy or nutrient density. Results All the formulations met the stipulated energy and nutrient densities as specified in the Codex Standard. The β-carotene content of OFSP complementary food exceeded the vitamin A specification (60 to 180 μg retinol activity equivalents/100 kcal). All the formulations except Weanimix contained measurable amounts of ascorbic acid (≥ 32.0 mg/100 g). The level of phytate in Weanimix was highest, about twice that of OFSP complementary food. The sweet potato-based foods contained about twice as much total polyphenols as the cereal-based products. The estimated production cost of OFSP complementary food was slightly higher (1.5 times) than that of Weanimix. Conclusions OFSP complementary food is a good source of β-carotene and would therefore contribute to the vitamin A requirements of infants. Both OFSP complementary food and Weanimix may inhibit iron absorption because of their high levels of polyphenols and phytate, respectively, compared with those of Nestlé Cerelac.