Does zinc deficiency play a role in stunting among primary school children in NE Thailand?

The Role of Nutrients and MCV on Stunting: A Case Study on Indonesian Early Teenagers

BACKGROUND: Many teenagers experience many nutritional problems, including anemia and stunting. The correlation between energy intake, protein, iron, and stunting with MCV levels in stunting adolescents in Jatinangor is not yet known. AIM: This study aims to analyze the correlation of energy intake, protein, iron, and stunting and MCV levels in stunting adolescents in Jatinangor. METHODS: This study was conducted with a cross-sectional design involving early adolescents aged 10-14 years in Jatinangor District as many as 41 people. Analysis of MCV levels was done by taking blood through veins. Stunting data were obtained based on WHO criteria with a value of z-score TB / U<- 2 SD and nutritional intake data including energy, protein, and iron obtained through 24-hour recall. To determine the intake of nutrients is done by interviewing with the method of 24 hours recall and FFQ. The data were analyzed with the Pearson Correlation Test. RESULTS: The correlation between energy intake and MCV levels was p=0.022 (r=0.356). Furthermore, the correlation of protein intake and MCV levels was p=0.257, and iron intake with MCV levels was p=0.301. Eventually, the stunting correlation test to MCV levels was p=0.006 (r=0.419). CONCLUSIONS: This study concludes that there is a correlation between energy intake and the value of the z-score TB / U index with MCV levels. There is no significant correlation between protein intake and iron intake with MCV levels in stunting adolescents in Jatinangor. There is a correlation between MCV and stunting levels, and there is no correlation between nutrient intake and stunting.

Growth performance, biochemical and haematological parameters of BALB/c mice fed on staple grains and bee larvae (Apis Mellifera) blended complementary foods

In Sub-Saharan Africa, inadequate complementary feeding practices and being nutritionally inadequate are primary factors in infant and young child malnutrition, growth failure, and high morbidity and mortality. Therefore, novel complementary foods need to be developed to alleviate malnutrition problems in IYC. Therefore, this experimental study aimed to assess the effects of newly developed grain-bee larvae blended complementary foods on the growth performance, haematological, and biochemical parameters of BALB/c mice. A complete randomized design was used and a total of 75 BALB/c mice were assigned to each of the five treatments. The treatments were: T1 = Casein diet; T2 = 57 % Maize, 29 % Teff, 14 % Soybean; T3 = 58 % Maize, 29 % Teff, 13 % Bee larvae; T4 = Commercial wean mix; and T5 = Basal diet alone. The in vivo experiment trial was done for 28 days along with seven days of adaptation. Dietary intake was not significantly different (P = 0.96) between treatments, but it was noted that T3 had gained the highest final body weight (38.52 g). The examined biochemical parameters showed T4 had the lowest serum protein (6.27 mg/dl) and globulin (3.61 mg/dl). Compared to others, T3 significantly (P < 0.001) increased WBC (4 × 10⁶ mm³), RBC (11.37 × 10³ mm³), Haemoglobin (16.42 g/dl), and Hematocrit (63.04 %). The highest serum levels of zinc (0.55 mg/dl) and iron (2.08 mg/dl) were reported on T2, while the highest serum calcium content (10.64 mg/dl) was reported on T1. The results indicated that T3 can aid body growth, health, and prevent malnutrition in infants and young children.

The effect of zinc-biofortified rice on zinc status of Bangladeshi preschool children: a randomized, double-masked, household-based, controlled trial

BACKGROUND

Zinc biofortification of rice could sustainably improve zinc status in countries where zinc deficiency is common and rice is a staple, but its efficacy has not been tested. Fatty acid desaturases (FADS) are putative new zinc status biomarkers.

OBJECTIVES

Our objective was to test the efficacy of zinc-biofortified rice (BFR) in preschool-aged children with zinc deficiency. Our hypothesis was that consumption of BFR would increase plasma zinc concentration (PZC).

METHODS

We conducted a 9-mo, double-masked intervention trial in 12-36-mo-old rural Bangladeshi children, most of whom were zinc-deficient (PZC <70 µg/dL) and stunted (n = 520). The children were randomly assigned to receive either control rice (CR) or BFR provided in cooked portions to their households daily, with compliance monitoring. The primary outcome was PZC. Secondary outcomes were zinc deficiency, linear growth, infection-related morbidity, FADS activity indices, intestinal fatty acid binding protein (I-FABP) and fecal calprotectin. We applied sparse serial sampling for midpoint measures and analyzed data by intention-to-treat using mixed-effects models.

RESULTS

At baseline, median (IQR) PZC was 60.4 (56.3-64.3) µg/dL, 78.1% of children were zinc deficient, and 59.7% were stunted. Mean ± SD daily zinc intakes from the CR and BFR during the trial were 1.20 ± 0.34 and 2.22 ± 0.47 mg/d, respectively (P < 0.001). There were no significant time-by-treatment effects on PZC, zinc deficiency prevalence, FADS activity, I-FABP, or fecal calprotectin (all P > 0.05). There was a time-treatment interaction for height-for-age z-scores (P < 0.001) favoring the BFR group. The morbidity longitudinal prevalence ratio was 1.08 (95% CI: 1.05, 1.12) comparing the BFR and CR groups, due to more upper respiratory tract illness in the BFR group.

CONCLUSIONS

Consumption of BFR for 9 mo providing ∼1 mg of additional zinc daily to Bangladeshi children did not significantly affect PZC, prevalence of zinc deficiency, or FADS activity.The trial was registered at clinicaltrials.gov as NCT03079583.

Factors Determining Consumer Acceptance of Biofortified Food: Case of Zinc-Fortified Wheat in Pakistan's Punjab Province

Zinc (Zn) is a fundamental micronutrient required by all living organisms. Zn deficiency among children under 5 years, pregnant, and child-bearing women has been identified in developing countries such as Pakistan. Biofortified crops can increase micronutrient levels and decrease deficiencies. Meanwhile, consumer acceptance is essential, given that genetic alterations can occur during biofortification, resulting in changes in sensory traits and the quality of grains. Therefore, the present study focuses on the determining factors for consumer acceptance of Zn-biofortified wheat., an experimental survey was conducted to achieve the study's objectives. Qualitative and quantitative data were collected and analyzed from 203 respondents in the Punjab province. The results regarding sensory perceptions revealed that people attached great importance to the appearance of the chapati prepared with Zn-biofortified wheat. Therefore, they were willing to purchase Zn-biofortified wheat when asked to choose between the conventional wheat and the Zn-biofortified wheat. Moreover, the probit model illustrates that the level of education in the family and having young children aged under 5 years in the household positively impacted the acceptance of Zn-biofortified wheat among the participants. The findings suggest that there is significant scope for promoting Zn-biofortified wheat in the country. It is also imperative to ensure its availability across various regions so that households with weak purchasing power can buy and address their Zn deficiency. Furthermore, policymakers could introduce reforms targeting business communities for food management, keeping Zn-biofortified wheat in the priority stream.

Risk Factors and Nutritional Profiles Associated with Stunting in Children

PURPOSE

To analyze risk factors and various nutrients associated with stunting among children aged 6-60 months.

METHODS

This is a case-control and cross-sectional study between 40 stunting cases and 40 controls. Data on possible risk factors associated with stunting were obtained through direct interviews and using a questionnaire. Examination of vitamin D, zinc, albumin, and ferritin levels was performed on both groups. Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Co., Armonk, NY, USA) to determine risk factors for stunting and to assess the relationship between nutritional levels and stunting.

RESULTS

The incidence of stunting was highest in children aged 12-36 months. Children with low weight and very low weight for age comprised of 55% and 22.5%, respectively, of the study participants. The highest mother's educational level was junior high school (40%). History of low birth weight (LBW) was more commonly observed in the stunting group than that in the control group (25.0% and 7.5%, respectively; p=0.034, odds ratio, 0.310 [95% confidence interval, 0.122-0.789]). Approximately 7.5% of cases had premature birth. Exclusive breast feeding was found to be not correlated with stunting. The mean zinc level in the stunting group was 34.17 ng/mL, which was different from that in the control group (50.83 ng/mL) (p=0.023). Blood ferritin, vitamin D, albumin, and calcium levels were not strongly correlated with stunting.

CONCLUSION

LBW is the main risk factor contributing to stunting and is strongly associated with low zinc level.

Zinc status and its requirement by rural adults consuming wheat from control or zinc-treated fields

Human zinc (Zn) deficiency is prevalent in areas where cereals dominate in the diet. Soil Zn application may enhance the concentration of Zn in wheat grains and dietary Zn intake by target populations. However, its value has never been practically quantified in Zn nutrition of any population group. We, therefore, studied farming families in rural Punjab (Pakistan). The selected adults (n = 156, grouped based on age and gender) were Zn undernourished (as assessed by estimated Zn bioavailability in their diet) and their plasma Zn levels also indicated Zn deficiency. On average, wheat consumption by the adults contributed about 68% in total Zn and 93% in total phytate intakes. Soil Zn application to wheat fields significantly increased Zn and decreased phytate concentration in chapati (flatbread made of whole-wheat flour). From dietary phytate intakes by the adults, we calculated desired chapati Zn concentration and dietary Zn intake that would meet their daily Zn requirement. The physiological Zn requirements of adult women and men were estimated to be achieved by intake of, respectively, 10.4-15.3 mg Zn d^-1 (37-46 mg Zn kg^-1 in chapati) and 14.4-23.3 mg Zn d^-1 (41-52 mg Zn kg^-1 in chapati). It was evident that soil Zn application aiming at optimum grain yield of wheat significantly improved Zn nutrition of the studied adults, but not up to desired levels. High Zn applications (via soil and/or foliage) to wheat and growing cultivars specifically selected for Zn biofortification may be needed to optimise Zn nutrition in rural Pakistan.

Effect of Eel Biscuit Supplementation on Height of Children with Stunting Aged 36-60 Months: A Pilot Study

Background

Stunting is a major health problem in developing countries. Animal-based supplements can increase the height of children with stunting. This study was aimed at determining the effect of eel biscuit supplementation on increase in the height of children with stunting aged 36-60 months.

Methods

A pilot study with pretest-post-test design. The study was conducted in two villages in the Priangan Region, West Java Province, Indonesia. The participants were divided into two groups: intervention group (10 supplemented eel biscuit pieces) and control group (biscuits from the government's biscuit programme). A total of 56 children aged 36-60 months with the height-for-age z-score of <-2 SD were recruited voluntarily for sampling.

Results

The initial height-for-age z-score of the intervention group was -3.45 SD and that of the control group was -3.11 SD. After 3 months of supplemented eel biscuit consumption, the height-for-age z-score of the intervention group changed to -2.52 SD and that of the control group changed to -2.51 SD. The average shift of the height-for-age z-score after 3 months of supplemented eel biscuit consumption was 0.93 SD in the intervention group and 0.6 SD in the control group. There were significant differences in delta and percent increase in the height-for-age z-score between both groups.

Conclusions

Consumption of supplemented eel biscuits for 3 months increased the height-for-age z-score of children with stunting aged 36-60 months by 0.93 SD.

Biofortified Crops for Combating Hidden Hunger in South Africa: Availability, Acceptability, Micronutrient Retention and Bioavailability

In many poorer parts of the world, biofortification is a strategy that increases the concentration of target nutrients in staple food crops, mainly by genetic manipulation, to alleviate prevalent nutrient deficiencies. We reviewed the (i) prevalence of vitamin A, iron (Fe) and zinc (Zn) deficiencies; (ii) availability of vitamin A, iron and Zn biofortified crops, and their acceptability in South Africa. The incidence of vitamin A and iron deficiency among children below five years old is 43.6% and 11%, respectively, while the risk of Zn deficiency is 45.3% among children aged 1 to 9 years. Despite several strategies being implemented to address the problem, including supplementation and commercial fortification, the prevalence of micronutrient deficiencies is still high. Biofortification has resulted in the large-scale availability of βcarotene-rich orange-fleshed sweet potatoes (OFSP), while provitamin A biofortified maize and Zn and/or iron biofortified common beans are at development stages. Agronomic biofortification is being investigated to enhance yields and concentrations of target nutrients in crops grown in agriculturally marginal environments. The consumer acceptability of OFSP and provitamin A biofortified maize were higher among children compared to adults. Accelerating the development of other biofortified staple crops to increase their availability, especially to the target population groups, is essential. Nutrition education should be integrated with community health programmes to improve the consumption of the biofortified crops, coupled with further research to develop suitable recipes/formulations for biofortified foods.

Pesticide Exposure and Stunting among Children in Agricultural Areas

Background:

The prevalence of growth disorders among school-aged children in Indonesia is high (30.7%). Pesticides have been massively used in Indonesian agricultural areas.

Objective:

Objective: To determine if exposure to pesticides is associated with stunting among children in agricultural areas.

Methods:

This case-control study included 160 children (48 cases and 112 controls) aged 8–12 years. Exposure to pesticides was measured based on the history of the exposure since perinatal period, infancy, and childhood of the participants. Stunting was determined as a height for age z-score (HAZ) < -2 SD. Other variables measured were levels of thyroid stimulating hormone (TSH), insulin-like growth factor-1 (IGF-1), hemoglobin, zinc, albumin, nutrient adequacy level (energy and protein), and history of infection, low-birth weight (LBW), and mother's height.

Results:

There were no significant difference between the cases and controls in terms of in the baseline characteristics, except for the median IGF-1 level; it was significantly (p<0.001) lower in the cases (66.73 ng/mL) than the controls (112.57 ng/mL). High level of pesticide exposure (p=0.029) and low IGF-1 levels (p<0.001) were significantly associated with stunting. After adjusting for confounding variables, these variables were found to be independent risk factors for stunting in children (aOR 3.90, 95% CI 1.15 to 13.26; and aOR 8.35, 95% CI 3.65 to 19.14, respectively).

Conclusion:

Pesticide exposure could be a risk factor for the occurrence of growth disorders in children living in agricultural areas. Necessary actions should be taken to protect children living in agricultural areas from exposure to pesticides.

Association of Fecal Markers of Environmental Enteric Dysfunction with Zinc and Iron Status among Children at First Two Years of Life in Bangladesh

Environmental enteric dysfunction (EED) causes gut inflammation and increased intestinal permeability leading to deficiencies in micronutrients such as zinc and iron. Fecal markers such as myeloperoxidase (MPO), neopterin (NEO), and alpha-1-anti-trypsin (AAT) can predict EED. The aim of this study was to examine the association between fecal markers of EED with zinc and iron status among children at first 2 years of life. Malnutrition and Enteric Disease Study Bangladeshi birth cohort data were used to conduct this analysis. Multivariable analyses using generalized estimating equations were performed to test the association between individual fecal markers with zinc or iron status of the children. A total of 265 children were enrolled in the study (male:female = 1:1). Of the 627 stool samples collected (N = 222 children), 535, 511, and 577 were accompanied by zinc, ferritin, and soluble transferrin receptor values, respectively. Median (interquartile range [IQR]) values of AAT, MPO, and NEO were 0.33 (0.18-0.62) mg/g, 3,895.42 (1,563.76-8,432.82) ng/mL, and 890.81 (331.57-2,089.04) nmol/L, respectively. Overall, 60%, 71%, and 97% of samples were above the values considered normal in nontropical settings for AAT, MPO, and NEO, respectively. High AAT levels were significantly associated with low ferritin values after adjusting for age and gender (coefficient = -5.85; 95% confidence interval = -11.23 to -0.47; P value = 0.03). No such association was found between AAT and plasma zinc status. Myeloperoxidase and NEO were not associated with plasma zinc or iron status. The study results imply the importance of enteric protein loss in contributing to reduced ferritin levels at first 2 years of life.

Perbedaan Asupan Energi, Protein, Zink, dan Perkembangan pada Balita Stunting dan non Stunting

 Background: Stunting is a nutritional problem caused by inadequate nutrition intake for  a long time and/or recurrent infectious diseases. The impacts of stunting are increase mortality,  morbidity,  health costs, decrease cognitive development, motor, and language development.There are nutrients that important to linear growth as energy, protein, and zinc. Objectives: The purpose of this study was to analyze the differences of intake of the energy, protein, Zinc, development in stunting and non-stunting toddler. Methods: The research was a cross sectional study with quantitative approach. The sample size was 64 toddler in Manyar Sabrangan Sub-district, Surabaya, 32 toddler each stunting and non-stunting were taken by simple random sampling. The data were collected by measuring height, structure questionnaire, food recall 2x24 hours, questionnaire for screening development (KPSP). The data were analyzed using Chi Square Test. Results: Non-stunting toddlers have an adequate intake of energy, protein, zinc respectively 71,9%, 93,7%, 71,9%, meanwhile appropriate development was 75%. Stunting toddlers have an inadequate intake of energy, zinc respectively 68,7%, 65,6% and adequate intake of protein was 68,7%, meanwhile deviance development was 62,5%. The results of this study showed that the comparison of differences between stunting and non-stunting toddler were significant (≤0,05) in energy, protein, Zinc, and development. Conclusion: Non-stunting toddler have a higher intake of the energy, protein, Zinc, and development rather than stunting toddler. Mother of toddler should to increase intake of energy, protein, Zinc to prevent stunting and achieve appropriate development.ABSTRAK Latar belakang: Stunting adalah permasalahan gizi yang disebabkan oleh asupan zat gizi yang kurang dalam waktu lama dan/atau penyakit infeksi yang berulang. Terdapat beberapa zat gizi yang berperan dalam pertumbuhan linier. Salah satu zat gizi tersebut adalah energi, protein, dan zink. Dampak stunting dapat meningkatkan mortalitas, morbiditas, biaya kesehatan, menurunkan perkembangan kognitif, motorik, dan bahasa.Tujuan: Tujuan dari penelitian ini adalah untuk menganalisis perbedaan asupan energi, protein, Zink, dan perkembangan pada balita stunting dan non stunting.Metode: Penelian ini menggunakan studi cross sectional dengan pendekatan kuantitatif. Sampel terdiri dari 64 balita yang di Kelurahan Manyar Sabrangan Surabaya, balita stunting dan non-stunting masing-masing berjumlah 32. Pengumpulan data menggunakan pengukuran tinggi badan, food recall 2x24 jam, kuesioner pra skrining perkembangan (KPSP) ,dan kuesioner. Data dianalisis menggunakan chi square Tets.Hasil: Balita non-stunting mempunyai asupan energi, protein, zink adekuat yaitu 71,9%, 93,7%, dan 71,9% serta perkembangan sesuai yaitu 75%. Balita stunting mempunyai asupan energi, zink inadekuat yaitu 68,7%, 65,6% dan protein adekuat yaitu 68,7% serta perkembangan menyimpang yaitu 62,5%. Hasil dari penelitian menunjukkan perbandingan balita stunting dan non stunting adalah ada perbedaan signifikan (p≤0,05) pada energi, protein, Zink, dan perkembangan.Kesimpulan: Balita non-stunting mempunyai asupan energi, protein, Fe, Zink yang tinggi dan stimulasi psikososial serta perkembangan yang baik daripada balita stunting. Ibu balita harus meningkatkan asupan energi, protein, Zink agar dapat mencegah terjadinya stunting dan dapat mencapai perkembangan yang sesuai.

Assessment of Zinc Status in School-Age Children from Rural Areas in China Nutrition and Health Survey 2002 and 2012

Zinc is an essential trace element for growth and development in children, but zinc deficiency is a serious nutritional problem worldwide. Our study aimed to assess the zinc status of school-age children living in rural areas of China and to examine the change of zinc status based on the China Nutrition and Health Survey 2002 and 2012. We used the probability proportional to size sampling method for subject selection, and a total of 3407 school-age children were included in this study. Zinc status was assessed by three items of indicators recommended by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the International Atomic Energy Agency (IAEA), and the International Zinc Nutrition Consultative Group (IZiNCG). The concentration of serum zinc was 718.2 μg/L, and 44.4% of children being zinc deficiency in 2002, while 846.8 μg/L and 10.4% in 2012. Zinc intake was 7.8 mg/day with a 7.6% inadequate zinc intake in 2002, together with 6.9 mg/day and 38.2% in 2012. Height-for-age Z score was -1.06 and 19.1% of children being stunting in 2002, as well as -0.15 and 6.8% in 2012. In conclusion, the zinc status of school-age children living in rural areas of China has been significantly improved in addition to zinc intake over the past 10 years. However, the zinc deficiency still observed in poor rural areas of China in 2012. In addition, we suggested that the zinc bioavailability should be taken into account when assessing zinc status in population.

Serum and Hair Mineral Levels in Children with Failure to Thrive According to the Type of Feeding Difficulties

This study evaluated serum and hair mineral and trace element levels as well as levels of other nutritional factors affecting growth and appetite in young children with non-organic failure to thrive (NOFTT) based on the presence or types of feeding difficulty (FD). Between August 2012 and July 2015, 136 children less than 6 years of age with NOFTT were included. FD was diagnosed based on Wolfson criteria and divided into subtypes according to Chatoor's classification. Clinical data were reviewed, and serum and hair mineral levels were measured. Of all assessed serum and hair minerals, only hair sulfur contents differed significantly between subjects with and without infantile anorexia (39,392 ± 2211 vs. 40,332 ± 2551 μg/g, P = 0.034). There were no differences in serum and hair mineral levels between children with and without sensory food aversion. Hair copper contents were significantly lower in children with FD of reciprocity (12.3 ± 6.0 vs. 22.4 ± 25.1 μg/g, P = 0.049). While hair zinc contents were also lower, the difference was not statistically significant (49.2 ± 26.8 vs. 70.6 ± 41.0 μg/g, P = 0.055). Only hair manganese contents were significantly lower in children with posttraumatic FD (0.12 ± 0.04 vs. 0.26 ± 0.73 μg/g, P = 0.037). In conclusion, there were no differences in most serum and hair mineral levels in children with NOFTT, except for relatively lower hair levels of sulfur, copper and possibly zinc, and manganese in infantile anorexia, reciprocity, and posttraumatic types of FD, respectively.

Dietary Zinc Intake and Plasma Zinc Concentrations in Children with Short Stature and Failure to Thrive

Background: The burden of zinc deficiency on children includes an increased incidence of diarrhea, failure to thrive (FTT) and short stature. The aim of this study was to assess whether children with FTT and/or short stature have lower dietary zinc intake and plasma zinc concentrations compared to controls. Methods: A case-control study conducted at the American University of Beirut Medical Center included 161 subjects from 1 to 10 years of age. Results: Cases had a statistically significant lower energy intake (960.9 vs. 1,135.2 kcal for controls, p = 0.010), lower level of fat (30.3 vs. 36.5 g/day, p = 0.0043) and iron intake (7.4 vs. 9.1 mg/day, p = 0.034). There was no difference in zinc, copper, carbohydrate and protein intake between the 2 groups. The plasma zinc concentration did not differ between the cases and controls (97.4 vs. 98.2 μg/dl, p = 0.882). More cases had mild-to-moderate zinc deficiency when compared to controls with 10.3 vs. 3.6%, p = 0.095. Conclusion: Our study did not show statistically significant difference in dietary zinc intake and plasma zinc concentrations between children with FTT and/or short stature compared to healthy controls. A prospective study is planned to assess the effect of zinc supplementation on growth parameters in FTT children.

Rural Beninese Children Are at Risk of Zinc Deficiency According to Stunting Prevalence and Plasma Zinc Concentration but Not Dietary Zinc Intakes

BACKGROUND

Three commonly recommended indicators for risk assessment of population zinc deficiency are stunting rates among children aged <5 y, prevalence of inadequate dietary zinc intake, and prevalence of low plasma zinc (PZn). Data on zinc status in Benin are mainly drawn from stunting rates and data on PZn and dietary zinc intake are lacking.

OBJECTIVES

The aims of this study were 1) to assess the risk of zinc deficiency in preschool and school-age children from rural communities in northern Benin by means of the 3 indicators for population assessment, 2) to evaluate their level of agreement, and 3) to identify predictors of PZn and height-for-age z scores (HAZ).

METHODS

We analyzed preintervention data collected during 2 efficacy trials and cross-sectionally assessed the risk of zinc deficiency in preschool (1-5 y, n = 326) and school-age children (5-10 y, n = 272) by 1) conducting a 3-d weighed food record survey, coupled with direct zinc and phytic acid analysis of consumed foodstuffs, and calculating usual dietary zinc intakes in a subsample of school-age children (n = 36); 2) analyzing PZn in all children (n = 598); and 3) measuring anthropometry indexes for assessment of stunting (HAZ <-2 SD) in all children (n = 594) and in <5-y-old children only (n = 273). We derived predictors of PZn and HAZ by using multivariate regression with mixed-effect models.

RESULTS

Prevalence of inadequate intakes of zinc ranged from 11% to 80% depending on whether the estimated average requirements (EARs) by the International Zinc Nutrition Consultative Group or the EARs derived from the WHO's recommended nutrient intakes were used. Prevalence of low PZn adjusted for acute-phase protein status was 45.7%, with higher rates among preschoolers than school-age children (P = 0.002). The stunting rate in <5-y-old children was 51.3%. PZn was predicted by age, methodologic factors, and socioeconomic status, whereas HAZ was predicted by age, sex, hemoglobin, and socioeconomic status.

CONCLUSIONS

The prevalence of <5-y stunting and the prevalence of low PZn indicate that the risk of zinc deficiency is elevated in this population. Risk estimates based on the prevalence of inadequacy of zinc intakes varied depending on the EARs used, and a consensus would facilitate nutrition survey evaluations. These trials were registered at clinicaltrials.gov as NCT01472211 and NCT01790321.

Dietary intake of schoolchildren and adolescents in developing countries

School age and adolescence is a dynamic period of growth and development forming a strong foundation for good health and productive adult life. Appropriate dietary intake is critical for forming good eating habits and provides the much needed nutrients for growth, long-term health, cognition and educational achievements. A large proportion of the population globally is in the school age or adolescence, with more than three quarters of these groups living in developing countries. An up-to-date review and discussion of the dietary intake of schoolchildren and adolescents in developing countries is suitable to provide recent data on patterns of dietary intake, adequacy of nutrient intake and their implications for public health and nutrition issues of concern. This review is based on literature published from 2000 to 2014 on dietary intake of schoolchildren and adolescents aged 6-19 years. A total of 50 studies from 42 countries reporting on dietary intake of schoolchildren and adolescents were included. The dietary intake of schoolchildren and adolescents in developing countries is limited in diversity, mainly comprising plant-based food sources, but with limited intake of fruits and vegetables. There is a low energy intake and insufficient micronutrient intake. At the same time, the available data indicate an emerging trend of consumption of high-energy snacks and beverages, particularly in urban areas. The existence of a negative and positive energy balance in the same population points to the dual burden of malnutrition and highlights the emerging nutrition transition in developing countries. This observation is important for planning public health nutrition approaches that address the concerns of the two ends of the nutrition divide.

Vitamin D status among Thai school children and the association with 1,25-Dihydroxyvitamin D and parathyroid hormone levels

In several low latitude countries, vitamin D deficiency is emerging as a public health issue. Adequate vitamin D is essential for bone health in rapidly growing children. In the Thai population, little is known about serum 25-hydroxyvitamin D [25(OH)D] status of infants and children. Moreover, the association between 25(OH)D and the biological active form of 1,25-dihydroxyvitamin D [1,25(OH)]₂D is not clear. The specific aims of this study were to characterize circulating serum 25(OH)D, 1,25(OH)₂D and their determinants including parathyroid hormone (PTH), age, sex, height and body mass index (BMI) in 529 school-aged Thai children aged 6–14 y. Adjusted linear regression analysis was performed to examine the impact of age and BMI, and its interaction with sex, on serum 25(OH)D concentrations and 1,25(OH)₂D concentrations. Serum 25(OH)D, 1,25(OH)₂D and PTH concentrations (geometric mean ± geometric SD) were 72.7±1.2 nmol/L, 199.1±1.3 pmol/L and 35.0±1.5 ng/L, respectively. Only 4% (21 of 529) participants had a serum 25(OH)D level below 50 nmol/L. There was statistically significant evidence for an interaction between sex and age with regard to 25(OH)D concentrations. Specifically, 25(OH)D concentrations were 19% higher in males. Moreover, females experienced a statistically significant 4% decline in serum 25(OH)D levels for each increasing year of age (P = 0.001); no decline was seen in male participants with increasing age (P = 0.93). When BMI, age, sex, height and serum 25(OH)D were individually regressed on 1,25(OH)₂D, height and sex were associated with 1,25(OH)₂D with females exhibiting statistically significantly higher serum 1,25(OH)₂D levels compared with males (P<0.001). Serum 1,25(OH)₂D among our sample of children exhibiting fairly sufficient vitamin D status were higher than previous reports suggesting an adaptive mechanism to maximize calcium absorption.

Anthropometric and micronutrient status of school-children in an urban West Africa setting: a cross-sectional study in Dakar (Senegal)

BACKGROUND

Urban areas in West Africa are not immune to undernutrition with recent urbanization and high food prices being important factors. School children often have a poor nutritional status, potentially affecting their health and schooling performance. Yet, generally school children do not benefit from nutrition programs. The objective of the study was to assess the anthropometric and micronutrient status of children from state schools in the Dakar area.

METHODS

School children (n = 604) aged from 5 to 17 y (52.5% girls, 47.5% ≥ 10 y) were selected through a two-stage random cluster sample of children attending urban primary state schools in the Dakar area (30 schools × 20 children). The prevalence of stunting (height-for-age<-2 z-scores) and thinness (BMI-for-age<-2 z-scores, WHO 2006, and three grades of thinness corresponding to BMI of 18.5, 17.0 and 16.0 kg/m2 in adults) were calculated from weight and height. Hemoglobin, plasma concentrations of ferritin (FER), transferrin receptors (TfR), retinol binding protein (RBP), and zinc, and urinary iodine concentrations were measured. Correction factors were used for FER and RBP in subjects with inflammation determined with C-reactive protein and α1-acid-glycoprotein.

RESULTS

4.9% of children were stunted, 18.4% were thin, 5.6% had severe thinness (BMI-for-age<-3 z-scores). Only one child had a BMI-for-age>2 z-scores. Prevalence of anemia, iron deficiency and iron deficiency anemia was 14.4%, 39.1% and 10.6% respectively. 3.0% had vitamin A deficiency, 35.9% a marginal vitamin A status, and 25.9% zinc deficiency. Urinary iodine was <50 µg/L in 7.3% of children and ≥ 200 µg/L in 22.3%. The prevalence of marginal vitamin A, zinc deficiency, high TfR was significantly higher in boys than in girls (P<0.05). Height-for-age and retinol were significantly lower in participants ≥ 10 y and <10 y respectively.

CONCLUSION

Undernutrition, especially thinness, iron and zinc deficiencies in school children in the Dakar area requires special targeted nutrition interventions.

Nutrition and bone growth in pediatrics

Children's growth is a hallmark of their normal development and the association between nutrition and linear growth in children is well accepted. Growth requires an adequate supply of many different nutritional factors, some form the "building materials," whereas others play regulatory roles. In this article we describe the growth of the growth plate and discuss the role of nutritional affected hormones on this process. In addition we describe the effect of local regulators and nutritional factors on the growth process and suggest the involvement of new regulatory factors in the translation of nutrition to growth.

Nutritional status of Makushi Amerindian children and adolescents of Guyana

BACKGROUND

Amazonian Indians are in the midst of a rapid cultural transition. The developments affecting Amazonian Indians present an opportunity to address important public health problems through public and private initiatives, but to do so it is imperative to begin with information on the health status of these peoples and the underlying factors affecting it. However, relatively few such data are available for this vast region.

AIM

This study describes the nutritional status of Makushi Amerindians of Guyana and considers several variables which might help to explain it.

SUBJECTS AND METHODS

Data for 792 Makushi, 0-20 years of age from 11 villages are considered. Outcome variables considered are anthropometric markers of growth and nutritional status; specifically height-for-age, weight-for-height and body-mass index. Predictor variables explored are age, sex, relative isolation, number of siblings, season of birth, diet and morbidity. Fisher's exact test, chi-square, Pearson's correlation and multiple regression were used to assess possible relationships between these variables.

RESULTS

Relative to other Amazonian Indians, the Makushi have a lower rate of linear-growth faltering and a higher rate of linear-growth faltering relative to non-Amerindian Guyanese. Males, older cohorts, those living in isolated villages or born in the wet season showed higher rates of growth faltering.

CONCLUSION

Makushi nutritional status may be explained by sex, age, relative isolation, family size, season of birth, dietary intake and infectious disease.

Higher risk of zinc deficiency in New Zealand Pacific school children compared with their Māori and European counterparts: a New Zealand national survey

Few multi-ethnic national surveys have examined Zn nutriture, despite its importance for optimal growth and development during childhood. We assessed the Zn status of urban and semi-urban children aged 5–15 years from three ethnic groups in New Zealand (NZ) in the 2002 Children's National Nutrition Survey and investigated the factors predisposing them to Zn deficiency. In a 10-month cross-sectional survey, Pacific and Māori children were over-sampled permitting ethnic-specific analyses. Anthropometry, serum Zn and Zn intakes via 24 h recalls were measured. Anthropometriczscores were highest in Pacific children. Overall, mean adjusted serum Zn at 11 years was for males and females, respectively: 11·9 (95 % CI 11·5, 12·3) and 12·5 (95 % CI 12·0, 12·9) μmol/l in NZ European and Other (NZEO) children (n395); 11·9 (95 % CI 11·4, 12·4) and 12·0 (95 % CI 11·4, 12·5) μmol/l in Māori children (n379); and 11·5 (95 % CI 11·1, 11·9) and 11·4 (95 % CI 11·1, 11·8) μmol/l in Pacific children (n589). The predictors of serum Zn were age, serum Se and sex for NZEO children; serum Se and age for Pacific children; and none for Māori children. Pacific children had the highest prevalence of low serum Zn (21 (95 % CI 11, 30) %), followed by Māori children (16 (95 % CI 12, 20) %) and NZEO children (15 (95 % CI 9, 21) %). Prevalence of inadequate Zn intakes, although low, reached 8 % for Pacific children who had the lowest Zn intake/kg body weight. Pacific boys but not girls with low serum Zn had a lower mean height-for-agez-score (P < 0·007) than those with normal serum Zn. We conclude that the biochemical risk of Zn deficiency in Pacific children indicates a public health problem. However, a lack of concordance with the risk of dietary Zn inadequacy suggests the need for better defined cut-offs in children.

Essential role of vitamin C and zinc in child immunity and health

With the progressive elimination of dietary protein-energy deficits, deficiencies of micronutrients are emerging as the limiting factors in ensuring children's optimal health. Data from several countries in Asia and Latin America indicate that deficiencies of vitamin C and zinc continue to be at alarming levels. This article reviews the roles of vitamin C and zinc in supporting children's growth and development, with a particular focus on the complementary roles they play in supporting immune functions and combating infections. The contemporary relevance of vitamin C and zinc deficiency in the Asian and Latin American regions, both undergoing a rapid nutritional transition, are also discussed. Overall, there is increasing evidence that deficiency of vitamin C and zinc adversely affects the physical and mental growth of children and can impair their immune defences. Nutrition should be the main vehicle for providing these essential nutrients; however, supplementation can represent a valid support method, especially in developing regions.

Nutrition and bone growth in pediatrics

Children's growth is a hallmark of their normal development and the association between nutrition and linear growth in children is well accepted. Growth requires an adequate supply of many different nutritional factors, some form the "building materials," whereas others play regulatory roles. In this article we describe the growth of the growth plate and discuss the role of nutritional affected hormones on this process. In addition we describe the effect of local regulators and nutritional factors on the growth process and suggest the involvement of new regulatory factors in the translation of nutrition to growth.

A micronutrient-fortified seasoning powder reduces morbidity and improves short-term cognitive function, but has no effect on anthropometric measures in primary school children in northeast Thailand: a randomized controlled trial

BACKGROUND

Reductions in iodine and zinc deficiencies and improvements in hemoglobin were achieved from a micronutrient-fortified seasoning powder consumed in school lunches by children in northeast Thailand.

OBJECTIVE

The objective was to determine whether fortification with 4 micronutrients in a school lunch results in changes in children's growth, morbidity, and cognitive function compared with no fortification.

DESIGN

In a randomized controlled trial of 569 children aged 5.5-13.4 y from 10 schools, we compared the efficacy of a seasoning powder fortified with or without 5 mg Fe, 5 mg Zn, 50 mug I, and 270 mug vitamin A per serving consumed with a school lunch 5 d/wk. Here we report on results of the secondary functional outcomes.

RESULTS

The groups were comparable concerning compliance and loss to follow-up. The intervention had no statistically significant effect on anthropometric measures over 31 wk, but reduced the incidence of respiratory-related illnesses [rate ratio (RR): 0.83; 95% CI: 0.73, 0.94], symptoms of runny nose (RR: 0.80; 95% CI: 0.70, 0.92), cough (RR: 0.80; 95% CI: 0.66, 0.96), and diarrhea (RR: 0.38; 95% CI: 0.16, 0.90). For the visual recall test, those in the fortified group recalled 0.5 more items (95% CI: 0.1, 0.9) than did the controls. There were no statistically significant differences between groups in the results of the digits forward and backward tests or in school grades at the conclusion of the 2 semesters.

CONCLUSION

The beneficial effects on morbidity and visual recall over a short period, in addition to some biochemical improvements, highlight the potential of this micronutrient-fortified seasoning powder supplied in a school lunch. This trial was registered at clinical trials.gov as ACTRN12605000341628.

Intakes from non-breastmilk foods for stunted toddlers living in poor urban villages of Phnom Penh, Cambodia, are inadequate

In Cambodia, the energy and nutrient densities of the traditional rice-based complementary diets used for infant feeding are very low. Whether the adequacy improves after the first year of life is uncertain. Therefore, we examined the feeding practices and the energy and nutrient intakes from non-breastmilk foods (NBMFs) of two groups: partially breastfed (PBF) (n = 41) and non-breastfed (NBF) (n = 210) stunted toddlers aged 12-42 months from poor villages in Phnom Penh, Cambodia. Intakes of NBMFs were estimated from 24-h recalls and a specially constructed Cambodian food composition table. All the toddlers were breastfed initially, but more than 50% received complementary foods before 6 months of age (mainly rice porridge). Many PBF toddlers received mixed feeding and were often bottle-fed diluted sweetened condensed milk. Unresponsive feeding was widespread. Inappropriate snacks, such as crisps, were the major source of energy, calcium, iron, zinc and vitamin A from NBMFs for the PBF group, and energy and iron for the NBF group. The snacks were often purchased and consumed without any adult supervision. For both groups, intakes of energy, calcium, iron and zinc were consistently below recommendations, as a result of the low micronutrient density of NBMFs and the small amounts fed per feeding. Increasing intakes of animal-source foods and dark-green and yellow fruits and vegetables would enhance micronutrient densities, although this may be neither feasible nor sufficient to overcome the existing deficits. Instead, the feasibility of micronutrient fortification of the rice-based diets of Cambodian toddlers should be explored.