bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opportunities for Improving Maternal Nutrition and Birth Outcomes: Synthesis of Country Experiences
Authors: Mason John B. , Saldanha Lisa S. , Ramakrishnan Usha , Lowe Alyssa , Noznesky Elizabeth A. , Girard Amy Webb , McFarland Deborah A. , Martorell Reynaldo 
Published: November 2015

Background Undernutrition in women in poor countries remains prevalent and affects maternal, neonatal and child health (MNCH) outcomes. Improving MNCH outcomes requires better policies and programs that enhance women's nutrition. Objective The studies aimed to better understand awareness, perceptions, barriers to intervention, and policy and program priorities and approaches, through different platforms, addressing three related priority problems: anemia, intra-uterine growth retardation (IUGR), and maternal thinness and stunting (including incomplete growth with early pregnancy). Methods Results of a global literature review on program effectiveness, and from case studies in Ethiopia, India, and Nigeria, were synthesized. Results and conclusions Anemia can be reduced by iron-folate supplementation, but all aspects for successful implementation, from priority to resources to local capacity, require strengthening. For IUGR, additional interventions, of food supplementation or cash transfers, may be required for impact, plus measures to combat early pregnancy. Breaking the intergenerational cycle of women's undernutrition may also be helped by child nutrition programs. Potential interventions exist and need to be built on: iron-folate and multiple micronutrient supplementation, food fortification (including iodized salt), food supplementation and/or cash transfer programs, combatting early pregnancy, infant and young child nutrition. Potential platforms are: the health system especially antenatal care, community-based nutrition programs (presently usually child-oriented but can be extended to women), child health days, safety net programs, especially cash transfer and conditional cash transfer programs. Making these more effective requires system development and organization, capacity and training, technical guidelines and operational research, and advocacy (who takes the lead?), information, monitoring and evaluation.
Intrahousehold Distribution of Food: A Review of the Literature and Discussion of the Implications for Food Fortification Programs
Authors: Berti Peter R. 
Published: November 2015

Background The selection of food vehicles and fortification levels in food fortification programs may be made on the assumption of equitable intrahousehold distribution of food. There are concerns that biased intrahousehold distribution of food will make food-based interventions ineffective or unsafe. Objective To review available data documenting intrahousehold energy intake (as a proxy for food distribution) in low- and middle-income countries, and discuss the relevance for food fortification programs. Methods A literature search was done, selecting reports from low- and middle-income countries that included dietary data from adults and children. The references of relevant reports and all citations of relevant reports were scanned. Intrahousehold distribution of dietary energy was compared with individual energy requirements. Results Twenty-eight studies were identified covering 18 countries with as few as 20 and as many as 3,000 households per study. Intrahousehold distribution of food in most countries is relatively equitable, within a 20% margin. Conclusions Within the limits of the available data, and in the absence of contrary data, it is reasonable to assume equitable intrahousehold distribution of food when designing food fortification programs; however, for program evaluation, individual assessment of intake is still needed.
Lessons Learned from National Food Fortification Projects: Experiences from Morocco, Uzbekistan, and Vietnam
Authors: Wirth James P. , Laillou Arnaud , Rohner Fabian , Northrop-Clewes Christine A. , Macdonald Barbara , Moench-Pfanner Regina 
Published: November 2015

Background Fortification of staple foods has been repeatedly recommended as an effective approach to reduce micronutrient deficiencies. With the increased number of fortification projects globally, there is a need to share practical lessons learned relating to their implementation and responses to project-related and external challenges. Objective To document the achievements, challenges, lessons learned, and management responses associated with national fortification projects in Morocco, Uzbekistan, and Vietnam. Methods Independent end-of-project evaluations conducted for each project served as the primary data source and contain the history of, and project activities undertaken for, each fortification project. Other sources, including national policy documents, project reports from the Global Alliance for Improved Nutrition (GAIN) and other stakeholders, industry assessments, and peer-reviewed articles, were used to document the current responses to challenges and future project plans. Results All projects had key achievements related to the development of fortification standards and the procurement of equipment for participating industry partners. Mandatory fortification of wheat flour was a key success in Morocco and Uzbekistan. Ensuring the quality of fortified foods was a common challenge experienced across the projects, as were shifts in consumption patterns and market structures. Adjustments were made to the projects' design to address the challenges faced. Conclusions National fortification projects are dynamic and must be continually modified in response to specific performance issues and broader shifts in market structure and consumption patterns.
Comparison of the Estimated Cost-Effectiveness of Preventive and Therapeutic Zinc Supplementation Strategies for Reducing Child Morbidity and Mortality in Sub-Saharan Africa
Authors: Brown Kenneth H. , Hess Sonja Y. , Vosti Stephen A. , Baker Shawn K. 
Published: November 2015

Background Zinc supplementation of young children in lower-income countries reduces morbidity from diarrhea and pneumonia and all-cause mortality, but the most cost-effective approach for distributing zinc supplements is unknown. Objective To examine the potential impact of four possible strategies for delivering zinc supplements on disease prevention and deaths averted among children 6 to 59 months of age in sub-Saharan Africa. Methods We analyzed different zinc supplementation strategies to assess their likely impact on morbidity and mortality of preschool children in sub-Saharan Africa and to estimate their possible costs. Results Preventive zinc supplementation reduces diarrhea incidence by 27% among children 12 to 59 months of age, pneumonia incidence by 21% among children 6 to 59 months of age, and all-cause mortality by 18% among children 12 to 59 months of age. The likely average total program costs of zinc supplementation programs were estimated from the outlays of existing service delivery platforms, such as child health days, community-based nutrition programs, and clinic-based treatment of diarrhea, assuming different levels of coverage and target age ranges of children. Conclusions We found that the average total costs per life saved ranged from approximately US$462 to US$3,111, and the most cost-effective interventions were weekly or intermittent preventive zinc supplementation, because of the possibility of high coverage and fewer supplements required. Empirical data from zinc supplementation programs will be needed to confirm these estimates.
Chilean Complementary Feeding Program Reduces Anemia and Improves Iron Status in Children Aged 11 to 18 Months
Authors: Brito Alex , Olivares Manuel , Pizarro Tito , Rodríguez Lorena , Hertrampf Eva 
Published: November 2015

Background Iron deficiency is the most prevalent nutritional deficiency in the world, primarily affecting infants, young children, and women of childbearing age. Objective To evaluate the impact of the National Complementary Feeding Program (NCFP) on anemia and iron status in Chilean children aged 11 to 18 months. Methods Two studies were performed. The first study was performed at one public outpatient health center in Santiago, using data collected in 1999 ( n = 128) and 2000 ( n = 125), before and after the national introduction of iron-fortified milk. Subsequently, a study of a representative sample ( n = 320) from the two most populated areas of the country was performed in 2009. Results One year after fortification, the prevalence of anemia was 9%; significantly lower ( p < .001) than the 27% prevalence observed 1 year before. Ten years after fortification, 14% of children were anemic and 77% of children with anemia (12% of all children) suffered from iron-deficiency anemia. In 2009, 11% of children consuming iron-fortified milk delivered by the NCFP (73%) were anemic, significantly lower ( p = .028) than the 21% prevalence of anemia observed in children without consumption. Consumption of iron-fortified milk was positively associated with hemoglobin concentration ( r = 0.28, p = .022) and was associated with a lower prevalence of anemia after adjusting for confounding factors (odds ratio, 0.50; 95% CI, 0.26 to 0.96). Conclusions In Chile, the NCFP has had an impact on the reduction of anemia and improved the iron status of children aged 11 to 18 months. Increasing the consumption of this iron-fortified milk could enhance the impact of the NCFP.
Vitamin A—Fortified Vegetable Oil Exported from Malaysia and Indonesia Can Significantly Contribute to Vitamin A Intake Worldwide
Authors: Laillou Arnaud , Panagides Dora , Garrett Greg S. , Moench-Pfanner Regina 
Published: November 2015

Background Vitamin A deficiency is a public health problem worldwide, affecting approximately 190 million preschool-aged children and 19.1 million pregnant women. Fortification of vegetable oils with vitamin A is an effective, low-cost technology to improve vitamin A intake. Objective To examine the potential contribution of fortification of vegetable oils with vitamin A in Indonesia and Malaysia to increasing vitamin A consumption in these two countries and in countries to which oil is exported . Methods Detailed interviews were administered and a desk review was conducted. We also estimated potential vitamin A intakes from fortified vegetable oil. Results Malaysia and Indonesia are two of the largest producers and exporters of vegetable oil. Fortification of vegetable oil in both countries has the potential to be used as a tool for control of vitamin A deficiency. Both countries have the capacity to export fortified vegetable oil. Vegetable oil fortified at a level of 45 IU/g could provide 18.8% of the Estimated Average Requirement (EAR) for an Ethiopian woman, 30.9% and 46.9% of the EAR for a Bangladeshi child and woman, respectively, and 17.5% of the EAR for a Cambodian woman. Although concerns about obesity are valid, fortification of existing vegetable oil supplies does not promote overconsumption of oil but rather promotes consumption of vegetable oil of higher nutrient quality. Conclusions Fortifying vegetable oil on a large scale in Malaysia and Indonesia can reach millions of people globally, including children less than 5 years old. The levels of fortification used are far from reaching the Tolerable Upper Intake Level (UL). Vegetable oil fortification has the potential to become a global public health intervention strategy.
Absorption Studies Show that Phytase from Aspergillus niger Significantly Increases Iron and Zinc Bioavailability from Phytate-Rich Foods
Authors: Troesch Barbara , Jing Hua , Laillou Arnaud , Fowler Ann 
Published: November 2015

Background Iron and zinc deficiency are major public health problems affecting many parts of the world, including Southeast Asia. Infants, young children, and women of reproductive age are particularly vulnerable due to their high requirements. Even though iron and zinc are present in significant amounts in the plant-based diets typically consumed in developing countries, their bioavailability is low due to high levels of absorption inhibitors such as phytate. Phytase has been used in animal nutrition for decades to improve the bioavailability of certain minerals in feed. Objective To show the effect of phytase in human nutrition based on evidence from human studies. Phytase can be used either during processing or as an active food ingredient degrading dietary phytate during stomach transit time. Methods Evidence from human studies testing the effect of phytase on iron and zinc bioavailability using stable isotopes was reviewed. Results Twelve studies tested the effect of phytase on iron and five tested its effect on zinc bioavailability. Most of these studies used a phytase derived from Aspergillus niger. They found a beneficial effect unless phytate concentrations were too low or levels of inhibitors or enhancers of iron absorption were too high. Twenty to 320 phytase units per 100 g of flour significantly improved iron absorption, even though higher levels might further increase iron bioavailability. For zinc, not enough information is available to determine optimal activities. Conclusions Phytase clearly has a beneficial effect on iron and zinc absorption from phytate-rich foods. It also has the potential to increase the absorption of magnesium, calcium, and phosphorus in areas such as Southeast Asia where mineral deficiencies are widespread.
Riboflavin Intake and 5-Year Blood Pressure Change in Chinese Adults: Interaction with Hypertensive Medication
Authors: Shi Zumin , Yuan Baojun , Taylor Anne W. , Zhen Shiqi , Zuo Hui , Dai Yue , Wittert Gary A. 
Published: November 2015

Background One previous large cross-sectional study across four countries suggests that riboflavin intake may be inversely associated with blood pressure. Objective The aim of this analysis was to investigate a possible association between riboflavin intake and change in blood pressure over 5 years. Methods The study population comprised Chinese men and women who participated in the Jiangsu Nutrition Study. Quantitative data relating to riboflavin intake at baseline in 2002 and measurements of blood pressure at baseline and follow-up in 2007 were available for 1,227 individuals. Results Overall, 97.2% of the participants had inadequate riboflavin intake (below the Estimated Average Requirement). In multivariable analysis adjusted for sociodemographic and lifestyle factors and dietary patterns, a higher riboflavin intake was inversely associated with change in systolic blood pressure ( p = .036). In participants taking antihypertensive medication at baseline, the relationship between riboflavin intake and systolic blood pressure persisted; whereas, in those not taking antihypertensive medication, the diastolic blood pressure was less likely to increase with the increasing intake of riboflavin ( p = .031). There was a three-way interaction between antihypertensive medications, body mass index, and riboflavin intake. Among those who were obese and taking antihypertensive medication, a higher riboflavin intake was associated with a smaller increment in systolic blood pressure and pulse pressure. Conclusions There are complex interactions between riboflavin intake and blood pressure change that depend on prior antihypertensive use and the presence or absence of obesity.
Hepcidin Profile of Anemic Adolescent Schoolgirls in Indonesia at the End of 12 Weeks of Iron Supplementation
Authors: Htet Min Kyaw , Dillon Drupadi , Rosida Azma , Timan Ina , Fahmida Umi , Thurnham David I. 
Published: November 2015

Background Iron deficiency is still the major nutritional problem in the developing world, and iron supplementation remains one of the most effective intervention strategies. Hepcidin, a newly discovered iron regulatory hormone, is an acute phase protein, and its role in iron supplementation has not been well explored. Objective To investigate the hepcidin profiles of anemic adolescent girls who had received weekly iron supplementation. Methods A cross-sectional study was conducted at the end of iron supplementation among adolescent schoolgirls ( n = 83) in Pramuka Island, Indonesia. All the girls were anemic at the beginning and received 60 mg of elemental iron twice weekly for 12 weeks. Hemoglobin, hepcidin, serum ferritin, and red cell parameters were measured, together with inflammation markers. Results At the end of the 12-week supplementation, 65.1% (n=64) of the girls were no longer anemic, but 43.4% ( n = 36) were still iron deficient. The rate of sub-clinical inflammation, measured by C-reactive protein (CRP) and α-1-acid glycoprotein (AGP), was 38.6% ( n = 32). Hepcidin was not correlated with either ferritin or red cell parameters. There was no association between hepcidin and the inflammatory markers CRP and AGP. The mean hepcidin concentration was 42.9 ± 17.9 ng/mL and was not significantly different between anemic and nonanemic girls (44.2 ± 14.9 and 42.3 ± 19.2 ng/mL, respectively; p = .708). However, hepcidin concentration was slightly higher in the iron replete-group than in the iron-deficient group (45.2 ± 20.0 and 39.3 ± 13.5 ng/mL, respectively), a suggestive trend that did not reach statistical significance ( p = .218). Conclusions Hepcidin concentrations tended to be higher among the subset of girls who responded poorly to iron supplementation as a consequence of increased subclinical inflammation. A longitudinal study should be conducted to explore the role of hepcidin in iron supplementation.
Toward the Prevention of Childhood Undernutrition: Diet Diversity Strategies Using Locally Produced Food Can Overcome Gaps in Nutrient Supply
Authors: Parlesak Alexandr , Geelhoed Diederike , Robertson Aileen 
Published: November 2015

Background Chronic undernutrition is prevalent in Mozambique, where children suffer from stunting, vitamin A deficiency, anemia, and other nutrition-related disorders. Complete diet formulation products (CDFPs) are increasingly promoted to prevent chronic undernutrition. Objective Using linear programming, to investigate whether diet diversification using local foods should be prioritized in order to reduce the prevalence of chronic undernutrition. Methods Market prices of local foods were collected in Tete City, Mozambique. Linear programming was applied to calculate the cheapest possible fully nutritious food baskets (FNFB) by stepwise addition of micronutrient-dense local foods. Results Only the top quintile of Mozambican households, using average expenditure data, could afford the FNFB that was designed using linear programming from a spectrum of local standard foods. The addition of beef heart or liver, dried fish and fresh moringa leaves, before applying linear programming decreased the price by a factor of up to 2.6. As a result, the top three quintiles could afford the FNFB optimized using both diversification strategy and linear programming. CDFPs, when added to the baskets, were unable to overcome the micronutrient gaps without greatly exceeding recommended energy intakes, due to their high ratio of energy to micronutrient density. Conclusions Dietary diversification strategies using local, low-cost, nutrient-dense foods can meet all micronutrient recommendations and overcome all micronutrient gaps. The success of linear programming to identify a low-cost FNFB depends entirely on the investigators' ability to select appropriate micronutrient-dense foods. CDFPs added to food baskets are unable to overcome micronutrient gaps without greatly exceeding recommended energy intake.
Relationship between Household Expenditures on Strategic Foods and Prevalence of Undernutrition among Children 0 to 23 Months of Age in Indonesia
Authors: Mauludyani Anna Vipta Resti , Fahmida Umi , Santika Otte 
Published: November 2015

Background The global economic crisis in 2007/08 resulted in higher food prices, which increased household food expenditures while worsening the quantity and quality of food consumed, potentially leading to child undernutrition. Objective To characterize the relationship of the mean proportions of household expenditures on strategic foods with the prevalence of undernutrition (high stunting, wasting, and underweight) among children under 2 years of age in Indonesia. Methods The study used data from 437 districts from two nationally representative surveys conducted in 2007, the National Socioeconomic Survey (Susenas) and the Basic Health Research (Riskesdas). Results A higher mean proportion of household expenditure on soybeans was significantly associated with lower odds (3rd vs. 1st tertile) of prevalence of high wasting (OR, 0.51; 95% CI, 0.28 to 0.94; p = .031) and high underweight (OR, 0.09; 95% CI, 0.03 to 0.28; p < .0001). A lower mean proportion of household expenditure on sugar and cooking oil was significantly associated with lower odds of prevalence of high wasting (OR, 2.41; 95% CI, 1.37 to 4.23; p = .002) and high underweight (2nd vs. 1st tertile) (OR, 2.38; 95% CI, 1.05 to 5.41; p = .039). Conclusions Among all strategic foods, a higher proportion of household expenditure on soybeans and a lower proportion of household expenditure on sugar and cooking oil are associated with lower odds of high wasting and underweight prevalence among children 0 to 23 months of age. The results indicate the need for promotion of consumption of fermented soybeans and education aiming at decreasing expenditure on sugar and cooking oil to increase consumption of more nutritious foods.