bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Household Consumption and Expenditures Survey (HCES) Data to Assess Dietary Intake in Relation to the Nutrition Transition: A Case Study from Cape Verde
Authors: Dop Marie Claude , Pereira Clodomir , Mistura Lorenza , Martinez Claudio , Cardoso Edith 
Published: November 2015

Background Few surveys of food and nutrient intakes are conducted at the individual level in low- and middle- income countries, whereas Household Consumption and Expenditures Surveys (HCES) are regularly carried out to monitor economic conditions. Because of the paucity of individual-level data, there is interest in using HCES to aid in the design of food and nutrition policies. Objective Data from the 2001/02 HCES from Cape Verde were used to assess household dietary intakes in the context of the country's nutrition transition. Methods The survey included weighed measure- ments of household food intake and measurements of the weight and height of all household members. Households were classified as “underweight” if they had at least one underweight member, “overweight” if they had at least one overweight member, and “dual burden” if they had at least one underweight and one overweight member. Results The proportion of households classified as underweight, overweight, and dual burden was 18%, 41%, and 14%, respectively. Household food and nutri- ent intakes were higher in the overweight households (particularly protein, vitamin A, and calcium) and lower in the underweight households, while there was no clear pattern of intakes in the dual burden group. Overweight households consumed more animal food groups than other households. Intakes of fruits and vegetables were low in all groups. Conclusions The HCES data for Cape Verde were useful for assessing the extent of the nutrition transition and characterizing dietary intakes by anthropometric classification. Analysis of nutrient and food intakes showed that ensuring sufficient energy availability is no longer the most important issue for Cape Verde, but that ensuring dietary quality is equally crucial, in particular increasing access to fruits and vegetables.
What Linear Programming Contributes: World Food Programme Experience with the “Cost of the Diet” Tool
Authors: Frega Romeo , Lanfranco Jose Guerra , De Greve Sam , Bernardini Sara , Geniez Perrine , Grede Nils , Bloem Martin , de Pee Saskia 
Published: November 2015

Background Linear programming has been used for analyzing children's complementary feeding diets, for optimizing nutrient adequacy of dietary recommenda- tions for a population, and for estimating the economic value of fortified foods. Objective To describe and apply a linear pro- gramming tool (“Cost of the Diet”) with data from Mozambique to determine what could be cost-effective fortification strategies. Methods Based on locally assessed average household dietary needs, seasonal market prices of available food products, and food composition data, the tool estimates the lowest-cost diet that meets almost all nutrient needs. The results were compared with expenditure data from Mozambique to establish the affordability of this diet by quintiles of the population. Results Three different applications were illustrated: identifying likely “limiting nutrients,” comparing cost effectiveness of different fortification interventions at the household level, and assessing economic access to nutritious foods. The analysis identified iron, vitamin B2, and pantothenic acid as “limiting nutrients.” Under the Mozambique conditions, vegetable oil was estimated as a more cost-efficient vehicle for vitamin A fortification than sugar; maize flour may also be an effective vehicle to provide other constraining micronutrients. Multiple micronutrient fortification of maize flour could reduce the cost of the “lowest-cost nutritious diet” by 18%, but even this diet can be afforded by only 20% of the Mozam- bican population. Conclusions Within the context of fortification, linear programming can be a useful tool for identifying likely nutrient inadequacies, for comparing fortification options in terms of cost effectiveness, and for illustrating the potential benefit of fortification for improving household access to a nutritious diet.
Processed Foods as an Integral Part of Universal Salt Iodization Programs: A Review of Global Experience and Analyses of Bangladesh and Pakistan
Authors: Spohrer Rebecca , Garrett Greg S. , Timmer Arnold , Sankar Rajan , Kar Basanta , Rasool Faiz , Locatelli-Rossi Lorenzo 
Published: November 2015

Background Despite the reference to salt for food processing in the original definition of universal salt iodization (USI), national USI programs often do not explicitly address food industry salt. This may affect program impact and sustainability, given the increasing consumption of processed foods in developing countries. Objective To review experience of the use of iodized salt in the food industry globally, and analyze the market context in Bangladesh and Pakistan to test whether this experience may be applicable to inform improved national USI programming in developing countries. Methods A review of relevant international experience was undertaken. In Bangladesh and Pakistan, local rural market surveys were carried out. In Bangladesh, structured face-to-face interviews with bakers and indepth interviews with processed food wholesalers and retailers were conducted. In Pakistan, face-to-face structured interviews were conducted with food retailers and food labels were checked. Results Experience from industrialized countries reveals impact resulting from the use of iodized salt in the food industry. In Bangladesh and Pakistan, bread, biscuits, and snacks containing salt are increasingly available in rural areas. In Bangladesh, the majority of bakers surveyed claimed to use iodized salt. In Pakistan, 6 of 362 unique product labels listed iodized salt. Conclusions Successful experience from developed countries needs to be adapted to the developing country context. The increasing availability of processed foods in rural Bangladesh and Pakistan provides an opportunity to increase iodine intake. However, the impact of this intervention remains to be quantified. To develop better national USI programs, further data are required on processed food consumption across population groups, iodine contents of food products, and the contribution of processed foods to iodine nutrition.
Fortification of Staple Cereal Flours with Iron and other Micronutrients: Cost Implications of following World Health Organization—Endorsed Recommendations
Authors: Grant J. Aaron , Laillou Arnaud , Wolfson Julian , Moench-Pfanner Regina 
Published: November 2015

Background Wheat and maize flours are widely used delivery vehicles for mass fortification. In lower-income countries, most, if not all, national-level cereal flour fortification programs routinely fortify with iron; however, cofortification with other micronutrients is common. Little information is available on the cost implications programs face when considering current fortification practices versus what the World Health Organization (WHO) interim consensus statement recommends. Objective The objectives of the present paper are to provide information on the costs of adding different chemical forms of iron and/or other micronutrients to premix formulations, and to discuss some of the issues that should be considered regarding which micronutrients to include in the premix. Methods Nine countries in Latin America, Africa, and Asia (three countries per region) that currently cofortify with multiple micronutrients including iron were selected based on low (< 75 g/day), medium (75 to 149 g/day), and high (≥ 150 g/day) mean population flour consumption levels. Premix costs per metric ton of flour produced were estimated for improving iron formulations and for following WHO recommendations for other micronutrients. Results For the selected programs to maintain current premix formulations and improve iron compounds, premix costs would increase by between 155% and 343% when the iron compound was switched from electrolytic iron to sodium iron ethylenediaminetetraacetate (NaFeEDTA), by 6% to 50% when it was switched from electrolytic iron to ferrous sulfate, and by 4% to 13 when iron addition rates were adjusted without switching the compound. To meet WHO recommendations for other micronutrients, premix costs would increase the most when the amounts of vitamins B12 and A were increased. Conclusions For programs that currently cofortify with iron and additional micronutrients, the quality of the iron fortificant should not be overlooked simply to be able to afford to add more micronutrients to the premix. Micronutrients should be selected according to population needs, costs, and potential beneficial synergistic reactions the added micronutrients may have.
Rice Fortification: Its Potential for Improving Micronutrient Intake and Steps Required for Implementation at Scale
Authors: Piccoli Nina Beretta , Grede Nils , de Pee Saskia , Singhkumarwong Anusara , Roks Eveline , Moench-Pfanner Regina , Martin W. Bloem 
Published: November 2015

Background Micronutrient deficiencies affect over 2 billion people worldwide, with profound implications for health, cognitive development, education, economic development, and productivity. Fortification of staple foods is a cost-effective strategy to increase vitamin and mineral intake among the general population. Rice is consumed by billions of people (> 440 million MT/year) but is as yet rarely fortified. Objective To discuss the untapped opportunity of rice fortification. Methods Review literature and experience with rice fortification and compare to fortification of other staple foods. Results Most technologies used to fortify rice first produce the fortified kernels and then blend them with regular, polished rice. Technologies differ with regard to how nutrients are added to the rice kernels, required investment, production cost, and degree of resemblance to unfortified rice. There are, so far, limited success stories for rice fortification. Some of the main roadblocks appear to be high initial investment and associated cost; lack of government leadership; and consumer hesitation to accept variations in the characteristics of rice, or a higher price, without good understanding of the benefits. Conclusions In countries with a large centralized rice milling industry, starting rice fortification is easier than in countries with many small mills. Countries with large safety nets that supply rice to the poorest, for free or subsidized, have a good channel to reach those most in need. Furthermore, key players from the public and private sectors should establish a coalition to support the use of fortified rice and address some of the barriers to its implementation.
GAIN Premix Facility: An Innovative Approach for Improving Access to Quality Vitamin and Mineral Premix in Fortification Initiatives
Authors: Guinot Philippe , Jallier Vincent , Blasi Alessandro , Guyondet Christophe , Van Ameringen Marc 
Published: November 2015

Background Vitamin and mineral premix is one of the most significant recurring input costs for large-scale food fortification programs. A number of barriers exist to procuring adequate quality premix, including accessing suppliers, volatile prices for premix, lack of quality assurance and monitoring of delivered products, and lack of funds to purchase premix. Objective To develop and test a model to procure premix through a transparent and efficient process in which an adequate level of quality is guaranteed and a financial mechanism is in place to support countries or specific target groups when there are insufficient resources to cover the cost of premix. Methods Efforts focused on premixes used to fortify flour, such as wheat or maize (iron, zinc, B vitamins, and vitamin A), edible oils (vitamins A and D), and other food vehicles, such as fortified complementary foods, complementary food supplements, and condiments. A premix procurement model was set up with three distinct components: a certification process that establishes industry-wide standards and guidelines for premix, a procurement facility that makes premix more accessible to countries and private industry engaged in fortification, and a credit facility mechanism that helps projects finance premix purchases. Results After three years of operation, 15 premix suppliers and 29 micronutrient manufacturers have been certified, and more than US$23 million worth of premix that met quality standards has been supplied in 34 countries in Africa, Central and Southern Asia, and Eastern Europe, reaching an estimated 242 million consumers. Conclusions The Premix Facility demonstrated its effectiveness in ensuring access to high-quality premixes, therefore enabling the success of various fortification programs.
Household Economic and Food Security after the 2010 Pakistan Floods
Authors: Doocy Shannon , Leidman Eva , Aung Tricia , Kirsch Thomas 
Published: November 2015

Background The 2010 floods inundated one-fifth of Pakistan and affected more than 20 million people. Objective To characterize the impact of the floods and subsequent humanitarian response on household economy and food security. Methods A cross-sectional 80 × 20 cluster survey ( n = 1,569 households) was conducted using probability proportional to size sampling in the four most flood-affected provinces 6 months after the floods. Analysis included both descriptive statistics and regression models, with receipt of food aid (in the first month), dietary quality, and household income at 6 months postflood as outcomes. Results Need for food aid was nearly ubiquitous (98.9%); however, only half of the study population ever received food aid. Displacement was not a significant predictor of food aid receipt (OR, 1.28; 95% CI, 0.83 to 1.98); however urban location (OR, 2.78; 95% CI, 2.00 to 3.86) and damage to the home (OR, 2.73; 95% CI, 1.34 to 5.60) were significantly associated. Some of the hardest-hit groups, including both farmers and day laborers, were significantly less likely to receive food aid ( p < .05). Additionally, receipt of food aid was not necessarily associated with improved household economy or food security; although households in internally displaced people (IDP) camps were more likely to receive food aid (OR, 2.78; 95% CI, 2.00 to 3.86), they were less likely to report same or improved dietary quality (OR, 0.63; 95% CI, 0.46 to 0.88) or income status (OR, 0.55; 95% CI, 0.35 to 0.86). Conclusions Food aid coverage following the 2010 floods was relatively low, and many of the most affected populations were less likely to receive aid, suggesting that targeting should be improved in future responses.
Differences in Circulating Non-Transferrin-Bound Iron after Oral Administration of Ferrous Sulfate, Sodium Iron EDTA, or Iron Polymaltose in Women with Marginal Iron Stores
Authors: Schümann Klaus , Solomons Noel W. , Orozco Monica , Romero-Abal Maria Eugenia , Weiss Guenter 
Published: November 2015

Background The adverse interactions between iron supplements and malaria have driven the assessment of new therapeutic options for anemia prophylaxis in areas holoendemic for falciparum malaria. Objective To determine the responses of circulating non-transferrin-bound iron (NTBI) and plasma iron to three different oral iron compounds—ferrous sulfate, sodium iron ethylenediaminetetraacetate (NaFeEDTA), and iron polymaltose (IPM)—in women with marginal iron stores. Methods Serum samples from 10 Guatemalan women with marginal iron stores were collected every 90 minutes over a period of 270 minutes, after the individually randomized administration of 100 mg of iron from each of the three studied iron compounds or water alone. Serum iron concentration was quantified by the ferrozine method, and circulating NTBI concentration was determined with a fluorometric competitive binding assay. Kinetic responses and maximal cumulative changes in serum concentrations of iron and NTBI were compared between the four treatments. Comparison was made with data from the same protocol in iron-adequate men. Results The serum iron and NTBI responses to ferrous sulfate were significantly greater than those to water and the other two iron compounds. Serum iron responses to IPM did not differ from those to water alone. Conclusions The administration of the two “slow-release” iron compounds, NaFeEDTA and IPM, resulted in a highly significant suppression of the appearance of NTBI in the circulation in the postsupplement period. These two bioavailable forms of iron supplement could represent a safe option for supplementation in malarial areas. The slope of the iron—NTBI relationship is steeper in men than in women.
Zinc as a Potential Coadjuvant in Therapy for Type 2 Diabetes
Authors: Ruz Manuel , Carrasco Fernando , Rojas Pamela , Codoceo Juana , Inostroza Jorge , Basfi-Fer Karen , Valencia Alejandra , Vásquez Karla , Galgani Jose , Pérez Alvaro , López Gloria , Arredondo Miguel , Perez-Bravo Francisco 
Published: November 2015

Background Type 2 diabetes is highly prevalent in populations having high rates of overweight and obesity. It is a chronic condition responsible for long-term severe dysfunction of several organs, including the kidneys, heart, blood vessels, and eyes. Although there are a number of pharmacologic products in the market to treat insulin resistance and impaired insulin secretion—the most prominent features of this disease—interventions directed at preserving the integrity and function of β-cells in the long term are less available. The use of some nutrients with important cellular protective roles that may lead to a preservation of β-cells has not been fully tested; among these, zinc may be an interesting candidate. Objective To assess the potential of zinc supplementation as coadjuvant to diabetes therapy. Methods This article reviews the available information on the use of zinc as part of diabetes therapy. Results Cellular and animal models provide information on the insulin mimetic action of zinc, as well as its role as a regulator of oxidative stress, inflammation, apoptosis, and insulin secretion. Zinc supplementation studies in humans are limited, although some positive effects have been reported; mainly, a modest but significant reduction in fasting glucose and a trend to decreased glycated hemoglobin (HbA1c). Conclusions Zinc supplementation may have beneficial effects on glycemic control. Nevertheless, among the studies considered, the vast majority lasted for 6 months or less, suggesting the importance of conducting long-duration studies given the characteristics of type 2 diabetes as a chronic disease.
Situational Analysis and Expert Evaluation of the Nutrition and Health Status of Infants and Young Children in Five Countries in Sub-Saharan Africa
Authors: Alles Martine , Eussen Simone , Ake-Tano Odile , Diouf Saliou , Tanya Agatha , Lakati Alice , Oduwole Abiola , Mauras Celine 
Published: November 2015

Background The poor feeding practices of pregnant women, infants, and young children contribute to the burden of malnutrition and subsequently to childhood morbidity and mortality in sub-Saharan Africa. Gaining insight into the nutritional and health status of infants and young children will help to focus future nutrition programs and actions. Objective To assess the nutrition and health status of infants and young children in five sub-Saharan African countries: Ivory Coast, Senegal, Cameroon, Kenya, and Nigeria. Methods Published and gray literature was critically reviewed and enriched with the views of local experts from academia, hospitals, and institutions to assess infants' and children's diet and health in the five sub-Saharan African countries. Subsequently, the Africa Nutriday Conference was held in Senegal in November 2011 to further discuss key challenges, action plans, and recommendations for future research. Results This review highlighted the need for education of parents and healthcare professionals in order to increase their knowledge of breastfeeding, vaccination programs, and over- and undernutrition. An integrated health and nutrition surveillance is needed both to identify micronutrient deficiencies and to recognize early signs of overweight. These data will help to adapt nutrition education and food fortification programs to the target populations. Conclusions Different countries in sub-Saharan Africa face similar nutrition and health issues and are currently not sharing best practices, nutrition programs, and scientific studies optimally. There is a need for closer collaboration among scientists within and between countries.
Nutritional Impact of Highly Pathogenic Avian Influenza in Kenya
Authors: Iannotti Lora , Roy Devesh 
Published: November 2015

Background Outbreaks of highly pathogenic avian influenza (HPAI) (virus type H5N1) have led to extensive bird culling and other control measures throughout the world, with implications especially for the livelihoods of the poor. There is limited empirical evidence for the impact of HPAI on poultry consumption and nutrition of vulnerable populations. Objective To test the effect of reduced per capita poultry consumption at the household level due to an HPAI event on anthropometric measurements of children. Methods This study used data from the Kenya Integrated Household Budget Survey (KIHBS) 2004/05 to characterize the nutritional status of young children 6 to 36 months of age, household dietary diversity (number of food groups consumed), and determinants of anthropometric outcomes, including z-scores for height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ). Propensity score matching (PSM) was applied to ascertain the nutritional impacts of reduced poultry consumption arising from an HPAI event. Results Thirty-four percent of the children were stunted (HAZ < −2 SD), 16% were underweight (WAZ < −2 SD), and 8% were wasted (WHZ < −2 SD), with the highest prevalences in the Coast, Eastern, North Eastern, Nyanza, and Rift Valley provinces. On average, households reported consuming food from 2.5 ± 1.3 food groups per week. Consistently significant determinants of anthropometric outcomes in these children were child's age, child's sex, household level of education, and various income and wealth determinants. PSM demonstrated that a reduction of consumption of poultry meat and eggs due to HPAI infection would increase the prevalence of stunting by 3.9 percentage points (Average Treatment Effect on the Treated (ATT), p = .06), increase the prevalence of underweight by 5 percentage points, and reduce WAZ by 0.16 (ATT, p = .03). Conclusions Through the household dietary diversity and consumption pathways, HPAI could have nutrition-related consequences with public health significance. In the event of HPAI, action may be needed to protect the nutrition of young children 6 to 36 months of age.