Showing papers in "Food and Nutrition Bulletin in 2016"
TL;DR: Recommendations for reporting nutritional epidemiology and dietary assessment research are proposed by extending the STROBE statement into Strengthening the Reporting of Observational Studies in Epidemiology – Nutritional Epidemiology (STROBE‐nut).
Abstract: Concerns have been raised about the quality of reporting in nutritional epidemiology. Research reporting guidelines such as the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement can improve quality of reporting in observational studies. Herein, we propose recommendations for reporting nutritional epidemiology and dietary assessment research by extending the STROBE statement into Strengthening the Reporting of Observational Studies in Epidemiology – Nutritional Epidemiology (STROBE-nut). Recommendations for the reporting of nutritional epidemiology and dietary assessment research were developed following a systematic and consultative process, co-ordinated by a multidisciplinary group of 21 experts. Consensus on reporting guidelines was reached through a three-round Delphi consultation process with 53 external experts. In total, 24 recommendations for nutritional epidemiology were added to the STROBE checklist. When used appropriately, reporting guidelines for nutritional epidemiology can contribute to improve reporting of observational studies with a focus on diet and health.
134 citations
TL;DR: The basis for the differences in the dietary zinc recommendations set by the World Health Organization, the US Institute of Medicine, the International Zinc Nutrition Consultative Group, and the European Food Safety Agency is described.
Abstract: Background:Large discrepancies exist among the dietary zinc recommendations set by expert groups.Objective:To describe the basis for the differences in the dietary zinc recommendations set by the World Health Organization, the US Institute of Medicine, the International Zinc Nutrition Consultative Group, and the European Food Safety Agency.Methods:We compared the sources of the data, the concepts, and methods used by the 4 expert groups to set the physiological requirements for absorbed zinc, the dietary zinc requirements (termed estimated and/or average requirements), recommended dietary allowances (or recommended nutrient intakes or population reference intakes), and tolerable upper intake levels for selected age, sex, and life-stage groups.Results:All 4 expert groups used the factorial approach to estimate the physiological requirements for zinc. These are based on the estimates of absorbed zinc required to offset all obligatory zinc losses plus any additional requirements for absorbed zinc for growth,...
76 citations
TL;DR: There is high dietary diversity in the study communities of Accra but low consumption of foods rich in micronutrient, such as fruits and milk/dairy products.
Abstract: Background:The world’s population is increasingly becoming urbanized. If the current urban growth rate is to continue, new and unprecedented challenges for food security will be inevitable. Dietary...
57 citations
TL;DR: The findings suggest that optimizing the use of local foods in diets of children aged 6 to 23 months can improve nutrient intakes; however, additional cost-effective strategies are needed to ensure adequate intakes of iron and zinc.
Abstract: Background:The question whether diets composed of local foods can meet recommended nutrient intakes in children aged 6 to 23 months living in low- and middle-income countries is contested.Objective...
56 citations
TL;DR: Three types of intervention appear most feasible: maternal and child health programs to simultaneously address short-term undernutrition problems while at the same time helping to reduce future tendencies toward overweigh and regulatory and fiscal actions to limit access to unhealthy foods.
Abstract: Background:Sub-Saharan Africa is the last region to undergo a nutrition transition and can still avoid its adverse health outcomes.Objective:The article explores emerging responses to “bend the curve” in sub-Saharan Africa’s nutrition transition to steer public health outcomes onto a healthier trajectory.Methods:Early responses in 3 countries at different stages of food system transformation are examined: South Africa—advanced, Ghana—intermediate, and Uganda—early. By comparing these with international experience, actions are proposed to influence nutrition and public health trajectories as Africa’s food systems undergo rapid structural change.Results:Arising from rapid urbanization and diet change, major public health problems associated with overweight are taking place, particularly in South Africa and among adult women. However, public health responses are generally tepid in sub-Saharan Africa. Only in South Africa have policy makers instituted extensive actions to combat overweight and associated nonc...
48 citations
TL;DR: The analysis has shown that diet quality of pregnant women was poor and intake of micronutrient-rich foods was low despite having knowledge about the importance of these foods, underscoring the need for promoting the diet quality in developing countries through behavior change communication programs.
Abstract: Background:Diet diversity of pregnant women is associated with nutrition sufficiency, micronutrient adequacy, and pregnancy outcomes. However, the sociodemographic determinants of diet diversity am...
47 citations
TL;DR: The policy space analysis framework used here can help to identify specific, contextually appropriate policy options and strategies for strengthening public health nutrition policy within sectors responsible for food supply policy.
Abstract: Background:There is global consensus that a strong policy response is essential for addressing the dual burden of malnutrition. However, policy makers in low- and middle-income countries may perceive a conflict between food supply policies to combat persistent undernutrition and more recent recommendations for policies addressing rising rates of diet-related noncommunicable diseases (NCDs).Objective:This article explores the potential to use policy space analysis to identify food supply policy opportunities for addressing both undernutrition and diet-related NCDs and to support improved policy coherence.Methods:We conducted an exploratory policy space analysis to identify opportunities and constraints for integrated nutrition policy with respect to the food supply in India, where a dual burden of malnutrition has been well documented. We conducted a review of food supply policies and 27 key informant interviews (16 with stakeholders active in India’s national nutrition policy space, and 11 with policy mak...
45 citations
TL;DR: Lactose may be an overlooked beneficial nutrient for young and undernourished children and at limited extra costs, lactose or lactose-containing milk ingredients may have beneficial effects if added to food products for undernouredished children.
Abstract: Background:Lactose is an important energy source in young mammals, and in fully breast-fed human infants, it constitutes around 40% of the total daily energy intake. The role of lactose in feeding of undernourished infants and young children is not well described.Objective:A narrative review of the potential positive and negative effects of lactose in the treatment of undernourished children.Methods:Searches were conducted using PUBMED and Web of Science up to July 2015. Relevant references in the retrieved articles were included.Results:Lactose may exhibit several health benefits in young children, including a prebiotic effect on the gut microbiota and a positive effect on mineral absorption. Studies in piglets suggest there might also be a stimulating effect on growth, relative to other carbohydrates. Lactose intolerance is a potential concern for undernourished children. Most undernourished children seem to tolerate the currently recommended (low lactose level) therapeutic foods well. However, a subgro...
44 citations
TL;DR: Health extension workers’ KSE is associated with child stunting and future training of HEWs would benefit from emphasis on not only the content of the IYCF messages but also the process of delivery while increasing their counseling skills.
Abstract: Background:Little is known about how the knowledge and the knowledge-sharing effectiveness (KSE) of health extension workers (HEWs) affect maternal knowledge of optimal infant and young child feedi...
42 citations
TL;DR: Solar Market Gardens have the potential to improve household nutritional status through direct consumption and increased income to make economic decisions and increase the variety of fruits and vegetables consumed by SMG women's groups compared to other groups.
Abstract: Background:Meeting the food needs of Africa's growing population will require innovative and appropriate technologies whose effectiveness needs to be assessed.Objective:To evaluate the impact of So...
41 citations
TL;DR: The article outlines the importance of protein quality in pregnancy and early growth and examines the potential of high-quality protein in prevention of stunting and treatment of severe and moderate acute malnutrition.
Abstract: The aim of this article is to provide an overview of the role of protein quality within the first 1000 days of life. The article outlines the importance of protein quality in pregnancy and early growth and examines the potential of high-quality protein in prevention of stunting and treatment of severe and moderate acute malnutrition. The article also provides a summary of the recent changes in protein quality evaluation and the development of a new index, the Digestibility Corrected Amino Acid Score, examining the opportunities and challenges this new methodology presents in assessing protein quality.
TL;DR: The findings alert program planners and policy makers to the value of increasing the availability, accessibility, and utilization of ASF to simultaneously address multiple nutrient deficiencies, as well as the nutrition challenges that remain when expanding the availability of plant-based staples.
Abstract: There have been successful interventions fortifying staple foods to mobilize micronutrients as well as agricultural efforts to raise yields of staple foods to increase food availability. Zambia serves as an interesting case study because since 1961 there has been a notable decline in the availability of animal source foods (ASFs) and pulses and a significant increase in the supply of cassava and vegetable oils. The shift in food availability was partly attributed to the agricultural success in high-yielding and drought-resistant varieties that made cassava and oil crops more affordable and readily available. In this research, we explore another policy strategy that involves ASF as a mechanism to help remedy micronutrient inadequacies in a population. A scenario modeling analysis compares the changes in the nutrient profile of the Zambian diet through adding either staple plant source foods (PSFs) or ASFs. The scenarios under study involve the addition of (1) 18 fl oz of whole cow's milk; (2) 60 g of beef, 30 g of chicken, and 5 g of beef liver; (3) milk plus meat; or (4) 83 g of maize flour, 123 g of cassava, and other staple PSF, that is, isocaloric to the "milk + meat" group. The findings alert program planners and policy makers to the value of increasing the availability, accessibility, and utilization of ASF to simultaneously address multiple nutrient deficiencies, as well as the nutrition challenges that remain when expanding the availability of plant-based staples.
TL;DR: Isotope dilution methodology can provide useful estimates of total body VA stores in apparently healthy populations under controlled study conditions, however, more research is needed to determine whether the method is suitable for use in settings where there is a high prevalence of infection, iron deficiency, and/or liver disease.
Abstract: Background:Retinol isotope dilution (RID) methodology provides a quantitative estimate of total body vitamin A (VA) stores and is the best method currently available for assessing VA status in adults and children. The methodology has also been used to test the efficacy of VA interventions in a number of low-income countries. Infections, micronutrient deficiencies (eg, iron and zinc), liver disease, physiological age, pregnancy, and lactation are known or hypothesized to influence the accuracy of estimating total body VA stores using the isotope dilution technique.Objective:Our objectives were to review the strengths and limitations of RID methods, to discuss what is known about the impact of various factors on results, and to summarize contributions of model-based compartmental analysis to assessing VA status.Methods:Relevant published literature is reviewed and discussed.Results:Various equations and compartmental modeling have been used to estimate the total body VA stores using stable isotopes, includi...
TL;DR: The high levels of stunting and suboptimal feeding practices as well as low dietary diversity scores, energy, and nutrient intake in both communities, particularly in Halaba, indicate a need to improve/strengthen nutrition strategies for complementary feeding children in these areas.
Abstract: Background:Good nutrition and appropriate child feeding are vital in early stages of child development, particularly in the first 1000 days of life.Objective:To assess the adoption of infant and yo...
TL;DR: Structural factors, especially long hours working in agricultural fields, impeded mothers’ ability to feed their children optimally and interventions to address child nutrition should take into account these factors, in addition to food access, nutrition education, and behavior change.
Abstract: Background:Suboptimal infant and young child feeding (IYCF) practices are determinants of poor child nutritional status. In the Democratic Republic of Congo, few children are fed according to international guidelines; this combined with endemic poverty and food insecurity have contributed to the high prevalence of child undernutrition.Objective:To characterize IYCF practices and barriers and enablers to optimal child feeding in South Kivu.Methods:Focus group discussions, structured and in-depth interviews with women of reproductive age, mothers of children <2 years, and health workers were conducted in 2012 as part of formative research for the US Agency for International Development (USAID)-funded Jenga Jamaa II multiyear assistance program.Results:Although breastfeeding was prevalent, few mothers engaged in optimal feeding practices. Barriers included poverty, high work burden, lack of decision-making power in the household, and perceived milk insufficiency. Health provider guidance and mothers’ motivat...
TL;DR: These studies show that remittances can increase access to (purchased) food and may have a consumption smoothing effect, reducing households’ vulnerability and leading to improved food security and reductions in underweight, butRemittances appear to have little effect on markers of chronic undernourishment.
Abstract: Background:Remittance income is rising rapidly in most low- and middle-income countries. Despite nutrition being a key policy priority for health and development, we know little about the effect of...
TL;DR: The implications of a changing epidemiologic and programmatic landscape for vitamin A (VA) programs are considered, with further effort needed to monitor VA intakes, ensuring that targeted groups are consuming adequate amounts but not exceeding the tolerable upper intake level.
Abstract: Background:Vitamin A deficiency (VAD) remains a widespread public health problem in the developing world, despite changes in under-5 mortality rates, morbidity patterns, and intervention options.Objective:This article considers the implications of a changing epidemiologic and programmatic landscape for vitamin A (VA) programs.Methods:We review progress to prevent VAD and its health consequences, assess gaps in VA status and intervention coverage data, and assess data needed to guide decisions regarding the optimal mix, targeting, and dose of VA interventions to maximize benefit and minimize risk.Results:Vitamin A supplementation programs have contributed to the reduction in under-5 mortality rates, but alone, do not address the underlying problem of inadequate dietary VA intakes and VAD among preschool-aged children in the developing world. A combination of VA interventions (eg, supplementation, fortified foods, multiple micronutrient powders, and lipid-based nutrient supplements) will be required to achi...
TL;DR: Although wealth indices and consumption per capita are related and both are drivers of food security, they cannot be used interchangeably for food security analysis.
Abstract: Background:Poverty and food insecurity are intrinsically linked as poor households often lack the resources required to access sufficient nutritious food to live an active and healthy life. Consump...
TL;DR: Clear gaps emerged in pregnant women’s knowledge and practice regarding diet and IFA tablet use, indicating lack of control over decision-making due to their low status of women was also hindering IFA use and healthy eating.
Abstract: Background:Maternal anemia continues to be a public health problem in India, despite existence of multipronged governmental programs to combat it.Objective:This study explores the determinants of persistent anemia in poor pregnant women in an urban population in Chandigarh, India.Methods:A mixed method approach was used to examine the causes of maternal anemia. Three focus group discussions with pregnant women from different socioeconomic groups and 2 with female health workers were conducted to explore their perceptions and beliefs about maternal anemia and iron folic acid (IFA) tablets in urban settings in 2009. This was followed by interviews of 120 pregnant women about their nutrition knowledge and practices. Food frequency questionnaires were used to estimate daily consumption of nutrients. Finally, a follow-up survey in health clinics explored issues of stock-outs of IFA.Results:Sixty-five percent of respondents had hemoglobin less than 11g/dL and were anemic. Only 35% respondents obtained free IFA ...
TL;DR: The egregious gap in human resources needed for effective nutrition actions in most low-income settings, the value of research on bottlenecks and successes, and the need for routine monitoring of national policies and plans to measure their effectiveness are identified.
Abstract: Based on the data collected in Uganda, Nepal, and Ethiopia, the papers included in this supplement fill a critical gap in evidence regarding multisectoral National Nutrition Action Plans. The studi...
TL;DR: Fortification programs have resulted in adequate VA status in Guatemala, Zambia, and parts of Cameroon, and additional studies are needed to compare biomarkers of tissue damage to RID methods during hypervitaminosis A and to determine what other biomarkers can be used to assess excessive preformed VA intake.
Abstract: Background Vitamin A (VA) deficiency (VAD) is still a concern in many parts of the world, and multiple intervention strategies are being implemented to reduce the prevalence of VAD and associated morbidity and mortality. Because some individuals within a population may be exposed to multiple VA interventions, concerns have been raised about the possible risk of hypervitaminosis A. Objectives A consultative meeting was held in Vienna, Austria, in March 2014 to (1) review current knowledge concerning the safety and effectiveness of large-scale programs to control VAD, (2) develop a related research agenda, and (3) review current available methods to assess VA status and risk of hypervitaminosis A. Methods Multiple countries were represented and shared their experiences using a variety of assessment methods, including retinol isotope dilution (RID) techniques. Discussion included next steps to refine assessment methodology, investigate RID limitations under different conditions, and review programmatic approaches to ensure VA adequacy and avoid excessive intakes. Results Fortification programs have resulted in adequate VA status in Guatemala, Zambia, and parts of Cameroon. Dietary patterns in several countries revealed that some people may consume excessive preformed VA from fortified foods. Conclusion Additional studies are needed to compare biomarkers of tissue damage to RID methods during hypervitaminosis A and to determine what other biomarkers can be used to assess excessive preformed VA intake.
TL;DR: Protein quality scores were highly correlated with the rate of weight gain in recovery from SAM, and the DIAAS scoring system adjusted for the higher expected weight gain had the strongest correlation with the observed weight gain.
Abstract: Background:Protein quality refers to the amounts and ratios of essential amino acids in a food. Two methods most commonly used for determining protein quality are the protein digestibility-correcte...
TL;DR: Mothers in this study were resorting to the expertise of the grandmothers and receiving information and advice about child feeding from them, highlighting the need for successful intervention programs to be implemented for mothers and grandmothers through health care providers.
Abstract: Background:Understanding women’s breastfeeding perceptions and experiences is increasingly recognized as a vital tool to provide effective support that would encourage the extension of the breastfe...
TL;DR: The evidence suggests that focusing on counseling caregivers and other family members on the importance of MNP and on age-appropriate feeding practices will be critical to the success of this intervention program as will regular visits by health workers and improved service delivery.
Abstract: Background:Anemia is a major public health concern in Bangladesh, affecting about 51% of under-5 children. There are a number of strategies to overcome this micronutrient-deficiency burden, and hom...
TL;DR: The ways by which the commitment and capabilities of policy implementers affect collaborative efforts for achieving nutrition goals are explored, and Nepal offers an example of effective efforts to improve nutrition governance across sectors at all levels of administration.
Abstract: Background:Global commitments to nutrition have supported calls for better evidence to support effective investments at national level. However, too little attention has so far been paid to the role of governance in achieving impacts.Objective:This article explores the ways by which the commitment and capabilities of policy implementers affect collaborative efforts for achieving nutrition goals.Methods:Over 1370 structured interviews were held with government and nongovernment officials over 3 years in 21 districts. Coded responses supported quantitative analysis of stakeholders’ knowledge, attitudes, and practices regarding policy implementation.Results:Stakeholder commitment was already high in 2013 when a new national policy was adopted, but capabilities were weak. Only one-third of interviewed respondents had any nutrition training. Rollout of training focusing on districts targeted for early implementation of multisector programming. This raised levels of nutrition training among interviewed responde...
TL;DR: A tablet supplementation program for pregnant women is an appealing approach for the reduction in preeclampsia and preterm birth in young children and women of childbearing age in Bangladesh.
Abstract: Background:Bangladesh incurs among the highest prevalence of stunting and micronutrient deficiencies in the world, despite efforts against diarrheal disease, respiratory infections, and protein-energy malnutrition which have led to substantial and continuous reductions in child mortality over the past 35 years. Although programs have generally paid more attention to other micronutrients, the local importance of calcium to health has been less recognized.Objective:To synthesize available information on calcium deficiency in Bangladesh in order to inform the design of an effective national calcium program.Methods:We searched 3 online databases and a multitude of survey reports to conduct a narrative review of calcium epidemiology in Bangladesh, including population intake, determinants and consequences of deficiency, and tested interventions, with particular reference to young children and women of childbearing age. This was supplemented with secondary analysis of a national household survey in order to map...
TL;DR: The main challenges identified included the need for more specificity in the roles of agencies/individuals in program implementation, more effective mechanisms for linking national to subnational officials, methods for creating awareness of the plans, and a dedicated line item in the budgets of each agency.
Abstract: Effective governance is essential for effective nutrition program implementation. There are additional challenges in launching multisector plans to enhance nutritional status. The present study compares the challenges and opportunities in Ethiopia and Nepal in designing and implementing a multisector plan for nutrition. A semi-quantitative questionnaire with open-ended questions was used to solicit information from senior national-level policy officials and other key stakeholders. The nature of the major nutrition problems in each country was similar; these include malnutrition (particularly stunting), food insecurity, and micronutrient malnutrition. The main challenges identified included the need for more specificity in the roles of agencies/individuals in program implementation, more effective mechanisms for linking national to subnational officials, methods for creating awareness of the plans, and a dedicated line item in the budgets of each agency. The level of enthusiasm was high in both countries. Respondents in both countries highlighted the need to identify a "champion" at the highest level who would keep the momentum for the respective plans alive.
TL;DR: The findings suggest that targeting fathers may be a worthwhile approach and that it seems justifiable to plan interventions involving fathers as well as providing new insight to the literature in describing fathers’ roles and challenges in routine child care and feeding practices.
Abstract: Background:The role of fathers in proper nutrition of young children has not been a frequent topic of studies. Mothers are usually the primary caregivers for young children. However, the father is often responsible for the financial choices of the household, especially in developing countries; we wondered to what extent fathers were involved in child feeding.Objective:This study aimed to investigate the extent of perceptions, practices, and challenges of fathers from low-income settings in routine child care, particularly in relation to child-feeding practices.Methods:A qualitative study was conducted in northern Ethiopia. Ten fathers, who had children between 6 and 23 months, were participated in the study. To validate fathers’ comments, 10 mothers (from different households) also participated. In-depth interviews and focus group discussions were carried out. A thematic analysis was completed to identify emergent themes within the data.Results:In general, traditional fathers, fathers in transition, and m...
TL;DR: The findings indicated that risk factors for diet-related chronic diseases such as unhealthy dietary habits and sedentary behaviors are starting to rise among urban adolescents in Sudan and creates the need for immediate action to prevent and control these risk factors before these diseases become major public health problems.
Abstract: Objective:The aim of this study was to investigate the prevalence of obesity, dietary habits, and sedentary patterns among Sudanese adolescents.Methods:A multistage stratified sampling method was used to select 945 adolescents (507 males and 438 females) aged 14 to 18 years, from Khartoum State, Sudan. A self-reported pretested questionnaire was used to collect the data. Overweight and obesity were determined using the International Obesity Task Force standard, which is based on body mass index for sex and age.Results:Overweight and obesity were growing problems among urban Sudanese adolescents (10.7%). Breakfast was commonly consumed on a daily basis by the majority of adolescents (74.2%), followed by lunch (63.9%) and supper (33.5%). Snacking was not a common practice among these individuals. Vegetables (63.9%) were more frequently consumed (more than 3 days per week) than fruit (30.1%). There were significant differences between genders regarding intake of vegetables (P < .048), chicken (P < .013), dai...
TL;DR: The results show that the important nutritional risks for school-age children in the West Bank would seem to be the simultaneous occurrence of undernutrition and obesity, highlighting the need to balance obesity management and prevention with interventions to tackle undernutrition.
Abstract: Background:The coexistence of underweight and overweight (double burden) remains a major problem in many developing countries. Little is known about the factors associated with the double burden of...