bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dietary Protein Inadequacy among Women of Reproductive Age from Five Low‐Income Countries
Authors: Arsenault Joanne E. , Brown Kenneth H. 
Published: November 2023

Women in low‐income countries have low micronutrient intake adequacy, but protein adequacy has not been assessed rigorously. A 2015 report from SPRING indicated that protein intake was generally adequate in most cohorts based on the mean protein intakes being above a threshold of % energy rather than high prevalence of usual intakes above estimated average requirements (EAR) per kg body weight. Moreover, protein quality was not considered.We assessed dietary protein intake adequacy of women using existing quantitative dietary data from Bangladesh, Burkina Faso, Mozambique, Uganda, and Zambia. Food intakes were assessed by 24‐h recall, except in Bangladesh where 12‐h direct observation and weighing and 12‐h recall were used. Protein intakes were adjusted for fecal digestibility factors and amino acid scoring patterns using the Protein Digestibility Corrected Amino Acid Score (PDCAAS) method to estimate “available” protein (AP) intake. The distribution of usual intakes of AP per kg of body weight was obtained using 1–2 days of intake from each dataset, and the prevalence of inadequate intakes (PII) < EAR (0.66 g/kg, for non‐pregnant, non‐lactating, NPNL) was estimated using the National Cancer Institute usual intake model. For lactating women, the PII was estimated using 2 different EAR due to uncertainties about the age of the breastfeeding child or the protein requirement beyond 12 mo of lactation: 1) 0.66 g/kg/d and 2) 0.66 g/kg/d plus 10 g/d (additional need for 6–12 mo) divided by the average body weight of the women (0.84 – 0.89 g/kg/d).For NPNL women, the PII was: 35% in Bangladesh, 32% in Burkina Faso during lean season, 16% in Burkina Faso during post‐harvest season, 23% in Zambia, 12% in Uganda, and 1% in Mozambique. For lactating women, the PII (using lower – higher EAR) was: 30–76% in Bangladesh, 26–53% in Burkina lean season, 14–36% in Burkina Faso post‐harvest season, 14–34% in Zambia, 9–29% in Uganda, and 1–15% in Mozambique. The mean PDCAAS of the diets was lower for Burkina Faso in the lean season (62% for NPNL and 59% for lactating) than for Bangladesh (71% for NPNL and 69% for lactating), likely due the lower protein quality of the main staple in Burkina Faso (sorghum 27%) than in Bangladesh (rice 56%) and the very low intake of animal‐source foods in both countries.In summary, dietary protein inadequacy is evident in women residing in countries with diets reliant on main staples that are low in protein quality. This is of particular concern for lactating women (and likely for pregnant women in some of these settings) who have higher protein requirements.Support or Funding InformationPartially funded by the Bill & Melinda Gates Foundation grant # OPP1128015.
Effectiveness of a 10‐wk Lifestyle Modification Program in Reducing Hypertension in Brazilian Free‐Living Adults
Authors: Burini Roberto Carlos , Kano Hugo Tadashi , Nakagaki Mariana Santoro , Figueira Tatiana Cristina , Burini Franz Homero Paganini 
Published: November 2023

RATIONALEHigh blood pressure (BP) is a strong, independent and etiologically relevant risk factor for cardiovascular diseases. Free distribution of more than 15 medications for HyPERtension and DIAbetes (HIPERDIA program) clearly shows the important role of drugs in the Brazilian Government's effort to tackle these two diseases. Each medicated BP subject has an estimated cost of US$ 39.50. However, drug therapy has been largely unsuccessful in halting and reversing the hypertension epidemic and more emphasis must be placed on primary prevention guidelines. BP is often associated with unhealthy lifestyles such as consumption of high fat and/or high‐salt diets and physical inactivity.PURPOSETo verify the effectiveness of a lifestyle modification program in reducing the hypertension in free‐living adultsMETHODSA lifestyle modification program(LSM) involving dietary counseling and regularly supervised physical activity(“Move for Health”) has been used here, since 1991, for NCDs primary care. Cross‐sectional analysis of clinical, anthropometric, dietary and physical activity data from 1317 subjects(2006–2016) was used to characterize the BP subjects at baseline. Next, a sub‐sample(n=453) were submitted to a 10‐wk LSM and repeated assessments. Statistical comparisons were defined by p=0.05.RESULTSThe BP rate(higher than 140/90mmHg) was 51.2% for SBP and 42.7% for DBP. The top quartile of bood pressure(142.2/88.5mmHg) differed from the lower quartile (120.6/69.2mmHg) by being older and lower either, schooling, income, physical activity(IPAQ) and aerobic capacity(VO2max.). The p75 showed a low quality diet (HEI score) with more processed foods(higher CHO/fiber, sodium/potassium and saturated fat). They showed also a higher body fatness and prevalence of metabolic syndrome (MetS) along with MetS co‐morbidities of inflammation, peroxidation and insulin resistance but, without differences in the Framingham score. After 10 weeks of LSM the BP normalization achieved 17.8% for SBP and 9.3% for DBP with a net effectiveness of 8.5% and 2.4%, respectively. The reduction of BP was followed by increased aerobic conditioning and reduced intake of processed foods along with decreased values of BMI, abdominal fatness and co‐morbidities.CONCLUSIONBased on the found effectiveness of this LSM and, if applyied nationwide it would save medications for 3.1 million of Brazilian hypertensives at an estimated saving of US$ 1.47 billion a year!Support or Funding InformationSupported by FAPESP, CAPES and CNPq
Changing Food Environments and Health Outcomes: Quantifying the Nutrition Transition in Global Nutrition Research
Authors: Becker Haley V , Eaton Jacob C , Iannotti Lora L 
Published: November 2023

BackgroundThe last century has born witness to extensive changes in global food and activity environments, resulting in alterations of diet, nutritional status, physical activity behaviors, and related health outcomes, otherwise known as the nutrition transition. Previous efforts to quantify a country's stage in the nutrition transition have maintained only a regional focus, and no study has yet to systematically quantify the nutrition transition on a global scale. This study fills that gap by providing an objective measure of nutrition transition across countries of all income brackets with potential for global application.MethodsUsing data from the World Health Organization (WHO) and Food and Agriculture Organization of the United Nations (FAO), 52 countries were selected for analysis representing high‐, middle‐, and low‐income countries from each of the WHO Region Groupings. A ten‐point score was developed to identify each country's stage in the nutrition transition, resulting in Nutrition Transition Scores (NTSs) for each country. Correlations were calculated between NTSs and Gross Domestic Product (GDP) per capita.ResultsThere was a significant, positive association between NTSs and GDP per capita (r=0.671, n=52, p<0.01). High‐income countries (HICs) had higher NTSs than low‐ and middle‐income countries (LMICs). The lowest NTSs were clustered in the African and Asian WHO‐designated regions; these include: Ethiopia, Madagascar, Zambia, Bangladesh, and Vietnam.ConclusionsThis study adds to the literature by highlighting correlated determinants of the nutrition transition, giving a clearer outlook on how countries develop in terms of the inputs and impacts on their food systems. Roughly half of the countries transitioning between the third and fourth stages scored near the 50th percentile for both stunting and obesity, representing a looming epidemic of the dual‐burden of malnutrition. Identifying a country's position in nutrition transition allows for more meaningful international comparisons of programs, policies, and research. As GDP per capita and NTSs were significantly, positively correlated, this warrants further investigation into the relationship between economic growth, globalization, and the resulting changes in food and activity environments.
Predicting and modeling follow‐up clinic visits (persistence) after bariatric surgery
Authors: Brazell Taler , Paynter Jonathan , Thomas Diana , Watts Krista , Cottam Daniel 
Published: November 2023

BackgroundBariatric surgery is known as one of the most effective interventions to manage weight for individuals with obesity. While mean weight loss is typically strong, there exists high variability in these results; not all patients achieve successful weight loss post‐surgery. Follow‐up clinical visits are a known predictor of patient success however little is known about the factors that influence follow‐up persistence.MethodsWe developed a class of one dimensional 2‐parameter linear discrete dynamical systems to predict the percent of patients that attend each follow up visit. These parameters biologically represent the half‐life in the drop off rate observed in the percent of patients attending follow up visits and their persistence plateau. To test whether the half‐life of persistence differs between surgeries, separate models were developed using data from 7 different types of bariatric surgery performed by the Bariatric Medicine Institute in Utah. Model parameters were determined by regressing between the percent of patients attending follow up visit number n, denoted by the variable, pn,− against the previous follow up visit, (pn−1). We then compared the discrete model simulations against the actual persistence data graphically to evaluate the quality of model calibration to observed data and computed the half‐life.ResultsThere were seven types of surgeries (loop to duodenal switch, duodenal switch, sleeve, bypass, duodenal switch to bypass, bandication, and band) where the recursive relationship was found to modeled well by a linear discrete dynamical system pn=apn‐1+b. Parameter values specifically the half‐life differed based on surgery type (Table 1). The optimal half‐life was found in band and bandication while the highest drop in persistence was found in bypass surgeries.ConclusionsTo date, all models that examine persistence of clinic follow‐up visits post‐surgery and predictions of bariatric surgery success are statistical. Our deterministic system provides new mechanistic insights by characterizing persistence by two parameters. Our findings suggest that while gastric bypass has strong mean weight loss results, persistence for clinical follow up visits drops off early in comparison to gastric band. Furthermore, clinicians can estimate our discrete model parameters based on individual demographics to inform optimal surgery types and predict potential patient drop off pre‐surgery.
Half‐life of persistence derived from each surgery type

Surgery Type
Half‐Life

Loop DS
0.86587

DS
0.88248

Sleeve
0.80547

Bypass
0.79028

DS to Bypass
0.86417

Bandication
0.97439

Band
0.94337
Trunk‐to‐leg ratio in regions of extreme stunting prevalence in the Western Highlands of Guatemala: A comparative perspective and interpretation
Authors: Shiu Kimberly , Beintema Joni , Liem Windy Mulia , García‐Meza Rosario , Doak Collen , Orozco Monica , Solomons Noel W. 
Published: November 2023

BackgroundCeSSIAM has an interest in the origins and biology of acquired linear growth retardation, also referred to as “stunting” or “chronic undernutrition.” Towards overcoming the tactile disadvantage of direct measuring tape assessment and the gluteal‐thickness artifact in sitting height, we developed a photographic approach to estimating differential body segment lengths: trunk vs leg. Current experience suggests photographic imaging to be easily reproducible, less invasive and more objective than the aforementioned techniques. Preliminary studies defined body segment lengths in normal‐height and modestly‐stunted Guatemalan preschoolers.ObjectiveTo document any further effects on the body‐segment ratios that might occur with the even more profound stunting occuring in the far western highlands of Guatemala.MethodsThe height and clothing‐adjusted weight of 212 individuals between 4 – 7 y from zones of established high stunting prevalence (combining La Estancia and Santa María Chiquimula {Com}) were measured. Two, partly‐overlapping samples of 102 children each were pair‐matched by age and sex to a previous series of equal numbers of affluent (Quetzaltenango City {Que}) and of poor urban children (Sololá {Sol}). The former sample was derived from matching by sequential enrollment (Com1) and the latter was enriched for stunting using the shortest children available for matching (Com2). A sagittal photograph was taken with a digital camera with the child in an erect posture with the Frankfort gaze standing on a stadiometer platform. After printing out the photo, the lengths of the trunk and the legs were measured in mm, allowing the generation of trunk‐to‐leg ratios.ResultsThe stunting prevalence for the four respective series increased progressively: 5.9% (Que); 46.1% (Sol); 68.6% (Com1); and 87.3% (Com2). Children in the Com1 sample were 9.2% shorter on average than those in Que and 3.4% shorter than Sol. Those in the Com2 sample were 10.9% and 5.0% shorter, respectively. The median trunk‐to‐leg ratios across the four respective series were 0.76; 0.82; 0.81; and 0.82. This value declined to 0.85 for third degree stunting alone (n=52).ConclusionAs stunting prevalence increases in a population, the median trunk‐to‐leg ratio initially falls to the 0.82 range and stabilizes thereafter, but in isolated third‐degree stunting, the median trunk‐to‐leg ratio reaches 0.85.
A Novel Distribution Method To Provide Micronutrients At A Community Level Improves Linear Growth In Young Guatemalan Children
Authors: Villanueva Lisa Maria , Palacios Ana M 
Published: November 2023

The objective of this study was to test a novel and low‐cost distribution method to provide a 21 micronutrient‐fortified beverage (Chispuditos®) to improve the nutritional status of children with a Length/Height‐for‐age Z‐score (HAZ) ≤−1, in rural southwest Guatemala. Community woman leaders from 9 villages were identified and trained to provide coached guidance on nutrition, caregiving, parenting and early learning opportunities. The distribution mechanism consisted of groups of ~30 mothers organized by the community leader that met on a monthly basis at a point of convenience. The woman leader guided discussion and practice of the topics mentioned above among the peer group. Duration of meetings was approximately 30 minutes, and mother‐child dyads received a 24‐day supply of Chispuditos and instructions on how to prepare. Participants provided 1 Guatamalan Quetzal ($0.13 USD) to cover the complete cost of the community leader service. A total of 290 children from 6–72 months of age completed 21 months of receiving the fortified atole. A cross‐sectional analysis showed a significant improvement in mean HAZ scores: from −2.34 (0.89SD) to −1.95 (1.09SD), (p<0.01) and a significant reduction in the prevalence of stunting (from 58.3% to 46.0%, p<0.001). In conclusion, this community‐based low‐cost distribution model along with the nutrition intervention appears to be effective in improving linear growth in stunted children from rural southwest Guatemala.Support or Funding InformationThe Mathile Institute for the Advancement of Human Nutrition
Iron Status of Reproductive Age Women in Northern Ghana is Improved by Indigenous Hibiscus Sabdariffa Meal
Authors: Kubuga Clement Kubreziga , Song SuJin , Kennedy Gina , Lee Kyung Won , Song Won O. 
Published: November 2023

In northern Ghana, iron deficiency anemia (IDA) is prevalent and severe among reproductive age women. Anemia is detrimental to women's health and pregnancy outcomes. Efficacy of supplementation and fortification have been tested to counter the problem, while little efforts have been reported with improving food systems utilizing native food sources to improve iron status in Ghana. Inhabitants are largely of low socioeconomic status, and consume monotonous diets consisting of staple cereals, legumes and vegetables with little or no animal products. Hibiscus Sabdariffa is a native plant high in iron concentration that is widely consumed in northern Ghana during wet seasons. We aimed to investigate the efficacy of standardized native Hibiscus Sabdariffa leaves meal (HSM) containing dry fish in improving iron status of reproductive age women through a 12‐wk community‐based feeding intervention during lean season. Reproductive age women (15–49 yrs, n=118) with children (6–23 mo) were recruited from five rural communities in two districts of Upper East region between May‐September, 2016. Study participants were assigned by district to either treatment (n=58 dyads) or control group (n=60 dyads). At baseline, sociodemographic characteristics, health information including malaria and ill health status were obtained from the participants using a questionnaire. The treatment group received 3 HSM/wk made from Hibiscus Sabdariffa leaves, groundnut, dawadawa, dried fish, iodied salt and water on feeding days by the women in their respective community health centers, whereas the control group received no interventions. HSM contained 25.7 mg of iron and 98.7 mg of protein/meal and the amount of consumption was determined by each subject. Hemoglobin (Hb) levels were measured on the field at baseline, midpoint (6 wk) and endpoint (12 wk) using Hemocue HB 201 analyzer. Women were mostly peasant farmers. Mean Hb values at baseline did not differ between the groups. Mean Hb values increased from baseline to endpoint in the intervention group (mean Δ=0.19g/dl, p trend=0.029) but not in the control group (mean Δ=0.05g/dl, p trend=0.660). The velocity of changes in Hb values were prominent between the midpoint to the endpoint between the two groups (p=0.046) after adjustment for malaria status, household wealth index, marital status, sex of household head, mother's age, and child's age. The HSM is efficacious in improving Hb levels in the treatment group. Future studies may be planned for longer than 12 weeks feeding trials including bioavailability, and multiple doses to determine the dose responses in a larger scale during a full spectrum of dry season.Support or Funding InformationThis study has been conducted with financial support from Borlaug Higher Education for Agricultural Research and Development (BHEARD) and Borlaug Leadership Enhancement in Agriculture Program (LEAP).
Mobilizing Markets: Community Efforts to Decrease Food Insecurity in Meadville, Pennsylvania
Authors: Martin Kerstin , Hinton Taylor , Anderson Darby , Schafer Elizabeth J , Dawson Rebecca Smullin 
Published: November 2023

The rural town of Meadville, PA is considered a food dessert and issues of food insecurity are a root cause of numerous chronic health problems. In 2014, 26.1% of Meadville residents were living in poverty and nearly 13% have poor nutritional status as a result of food insecurity. Meadville is categorized as a food desert according to U.S. Department of Agriculture's quantitative definition of of a food desert. Seventy percent of adults within the Northwest part of Pennsylvania, which includes Meadville, were overweight or obese in 2014 and it is estimated that the childhood obesity rate is greater than 30%. In an effort to both increase access to fresh produce and reduce the obesity rate in Meadville, a comprehensive community wellness initiation was begun in 2014. To date community gardens have been started, a fresh fruits and vegetables program has been piloted in a local elementary school, and a mobile farmers market has begun. In this presentation, we will specifically discuss the design, implementation, and assessment of a the community garden project, the school programs, and the mobile farmers market that targeted a low‐income neighborhood. We will discuss the development of the survey instruments used to assess each of these initiatives and highlight how bringing fresh produce into a school and low‐income neighborhood increased social capital in addition to access to produce. Ultimately, we will show how the pilot mobile market (conducted during the summer of 2016) was used as a proof of concept idea for a larger scale mobile market that is being created in collaboration with the local bus company. All of the work we are doing is aimed at increasing access to fresh produce in Meadville in order to improve both community and individual health.Support or Funding InformationBy funding through a grant (anonymous) given to support the Allegheny College Community Wellness Initiative.
Impact of Health Workers Infant Feeding Practices Training on the Prevalence of Functional Constipation among Children at Six Years Old. A Cluster Randomized Field Trial
Authors: Sangalli Caroline Nicola , de Morais Mauro Batista , Vitolo Márcia Regina 
Published: November 2023

ObjectiveTo assess the impact of health workers training on infant feeding practices on the prevalence of functional constipation among children at six years old.MethodsCluster‐randomized field trial conducted in Porto Alegre, Brazil. Health care centers were randomized into intervention (n=9) and control (n=11) groups. The health workers in the intervention group received training on Ten Steps for infant health feeding and the outcomes were assessed for mother‐child pairs who received primary care at these centers. The prevalence of functional constipation were evaluated among children at 6 years old according Rome III criteria.ResultsThe prevalence of functional constipation was lower in the intervention group compared to the control group (18.0% versus 28.9%; PR=0.62; 95%CI: 0.43–0.88, p<0.01). Specifically, the children from intervention group showed a 38% higher probability of not being constipated at 6 years old compared to children from control group. Furthermore, the number of children who presented history of retentive posturing and presence of large fecal mass in the rectum differ between the intervention and control groups (6.6% versus 19.0%; PR=0.34; 95%CI: 0.22–0.54 and 14.4% versus 23.2%; PR= 0.61; 95%CI: 0.43–0.88, respectively, p<0.01).ConclusionHealth workers training on feeding practices in the first year of life had a positive impact on reduce the prevalence of functional constipation among low income children at six years old.Support or Funding InformationConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ) Nº 14/2013‐47731/2013‐8.
How Health‐Related Signs Unexpectedly Promote Healthy Choices: Long‐term Conclusion for Nordic Cafeteria
Authors: Wansink Brian , Karevold Knut Ivar , Kallbekken Steffen , Tran Huy 
Published: November 2023

Signs promoting healthy choices are becoming increasingly common in restaurants and buffets. Although some people avoid foods with healthy signs, could these signs guide them to take other healthy foods that do not have such signs? In analyzing the food taken by 4,521 guests at lunch buffets we found that when health‐related signs (“Eat Smart”) were placed on Bean Salad, the percent of guests who selected this salad decreased by 3.1% but the percent of guests who selected the Hot Vegetable side dishes (foods with no signs) increased by 15.5%. While adding health‐related signs may not benefit the healthy options that these signs are associated with, it can increase the selection of healthy foods in other areas of the buffet. Furthermore, placing healthy options with contrasting dishes, such as hot vegetables with hot meat, could stimulate the consumption of these healthy foods.Support or Funding InformationNordic Choice Hotels, Eat Forum, and GreeNudge.