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Shenton LM, Jones AD, Wilson ML. Factors Associated with Anemia Status Among Children Aged 6-59 months in Ghana, 2003-2014. Matern Child Health J 2020; 24:483-502. [PMID: 32030533 PMCID: PMC7078144 DOI: 10.1007/s10995-019-02865-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background In 2008, 78% of Ghanaian children under 5 years old were anemic versus 48% of children globally. In this study, we identified proximal and distal determinants of severe–moderate anemia and mild anemia related to socioeconomic status, nutrition, and health access. Methods Using data from the 2003, 2008, and 2014 Ghana Demographic and Health Surveys (GDHS), the odds of severe–moderate anemia and mild anemia compared to no anemia, in relation to various hypothesized risk factors, were assessed using a multivariable, multinomial logistic regression, which accounted for survey design. Results From among 7739 households sampled, severe–moderate anemia was found in approximately 52%, 56%, and 40% of children during 2003, 2008, and 2014, respectively. The proportion of children diagnosed as not anemic was 26% in 2003, 22% in 2008, and 33% in 2014. There are large disparities in anemia prevalence among regions and between urban and rural areas. In 2014, children who were younger (aged 6–24 months), had a recent fever, were from poorer families, and whose mothers were less educated had greater odds of being severely–moderately anemic. These results remained significant when controlling for other risk factors. Predictors of anemia in Ghana remained relatively consistent among the three time periods when the GDHS was administered. Conclusions The prevalence of anemia in Ghana among children aged 6–59 months has remained unacceptably high. To reduce anemia in these children, the Ghanaian government should concentrate on educating women through both the traditional school system and antenatal care visits.
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Affiliation(s)
- Luke M. Shenton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - Andrew D. Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - Mark L. Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
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2
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Bromage S, Daria T, Lander RL, Tsolmon S, Houghton LA, Tserennadmid E, Gombo N, Gibson RS, Ganmaa D. Diet and Nutrition Status of Mongolian Adults. Nutrients 2020; 12:E1514. [PMID: 32456038 PMCID: PMC7284332 DOI: 10.3390/nu12051514] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/30/2023] Open
Abstract
(1) Background: Aspects of the Mongolian food supply, including high availability of animal-source foods and few plant foods, are plausibly associated with disease in the population. Data on Mongolian diets are lacking, and these risks are poorly quantified. The purpose of this study was to provide a multifaceted nutritional analysis of the modern Mongolian diet. (2) Methods: The study population consisted of 167 male and 167 female healthy non-pregnant urban and nomadic adults (22-55 years) randomly selected from lists of residents in 8 regions. From 2011-2016, 3-day weighed diet records and serum were collected twice from each participant in summer and winter; anthropometry was collected once from each participant. Serum was analyzed for biomarkers, and nutrient intake computed using purpose-built food composition data and adjusted for within-person variation. Exploratory dietary patterns were derived and analyzed for associations with diet and nutrition measurements. (3) Results: We collected 1838 of an expected 1986 diet records (92.5%), 610/658 serum samples (92.7%), and 315/334 height and weight measurements (94.3%). Sixty-one percent of men and 51% of women were overweight or obese. Consumption of red meat, refined grains, and whole-fat dairy was high, while that of fruits, non-tuberous vegetables, eggs, nuts and seeds, fish and poultry, and whole grains was low. Dairy and red meat were more consumed in summer and winter, respectively. Dietary inadequacy of 10 of 21 assessed nutrients, including fiber, folate, and vitamin D were >50% prevalent, while protein, zinc, and vitamin B12 inadequacy were low. Biochemical evidence of iron and vitamin A deficiency was also low. Three dietary patterns (Urban, Transitional, Nomadic) explained 41% of variation in food consumption. The Urban pattern was positively associated with BMI in multivariate analysis. (4) Conclusions: Results indicate a high prevalence of key dietary inadequacies and overweight among Mongolian adults. Prior studies by our group have suggested that expanded supplementation and food fortification would be effective in addressing micronutrient inadequacies; these strategies should be coupled with measures to mitigate the growing burden of chronic disease.
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Affiliation(s)
- Sabri Bromage
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Tselmen Daria
- Department of Neurology, Ulm University, Ulm 89081, Germany, and Central Scientific Laboratory, Institute of Medical Sciences, Ulaanbaatar 16081, Mongolia;
| | - Rebecca L. Lander
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Soninkhishig Tsolmon
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar 14210, Mongolia;
| | - Lisa A. Houghton
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand; (L.A.H.); (R.S.G.)
| | | | - Nyamjargal Gombo
- Food and Agriculture Organization of the United Nations Country Office, Ulaanbaatar 14201, Mongolia;
| | - Rosalind S. Gibson
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand; (L.A.H.); (R.S.G.)
| | - Davaasambuu Ganmaa
- Department of Nutrition, Harvard T.H. Chan School of Public Health and Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
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3
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Pries AM, Filteau S, Ferguson EL. Snack food and beverage consumption and young child nutrition in low- and middle-income countries: A systematic review. MATERNAL AND CHILD NUTRITION 2020; 15 Suppl 4:e12729. [PMID: 31225715 PMCID: PMC6618154 DOI: 10.1111/mcn.12729] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/13/2018] [Accepted: 08/23/2018] [Indexed: 12/30/2022]
Abstract
Although snacks can provide important nutrients for young children during the complementary feeding period, the increasing availability of snack foods and sugar‐sweetened beverages (SSB), often energy‐dense and nutrient‐poor, in low‐ and middle‐income countries (LMIC) is a concern. Such foods may displace consumption of nutritious foods in contexts where diets are often nutritionally inadequate and the burden of childhood malnutrition is high. This systematic review summarizes literature on the contribution of snack food/SSB consumption to total energy intakes (TEI) of children below 23 months of age in LMIC and associations between this consumption and nutritional outcomes. It also identifies areas where further research is needed. A systematic search of Embase, Global Health, and MEDLINE for literature published in January 1990–July 2018 was conducted. This search yielded 8,299 studies, 13 of which met inclusion criteria: Nine studies assessed % TEI from snack foods/SSB, and four studies assessed associations between snack food/SSB consumption and nutritional outcomes. Average % TEI from snack foods/SSB ranged from 13% to 38%. Findings regarding associations with growth were inconclusive, and no studies assessed associations with nutrient intakes. Variation in measurement of consumption and definitions of snack foods and SSB limited study comparisons. Further research is needed to understand how consumption of energy‐dense, nutrient‐poor snack foods and SSB influences undernutrition and overnutrition among young children during the complementary feeding period in settings that are experiencing dietary transitions and the double burden of malnutrition.
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Affiliation(s)
- Alissa M Pries
- Helen Keller International, New York, New York.,Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzanne Filteau
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Elaine L Ferguson
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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4
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Hawkes C, Ruel MT, Salm L, Sinclair B, Branca F. Double-duty actions: seizing programme and policy opportunities to address malnutrition in all its forms. Lancet 2020; 395:142-155. [PMID: 31852603 DOI: 10.1016/s0140-6736(19)32506-1] [Citation(s) in RCA: 193] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 12/14/2022]
Abstract
Actions to address different forms of malnutrition are typically managed by separate communities, policies, programmes, governance structures, and funding streams. By contrast, double-duty actions, which aim to simultaneously tackle both undernutrition and problems of overweight, obesity, and diet-related non-communicable diseases (DR-NCDs) have been proposed as a way to effectively address malnutrition in all its forms in a more holisitic way. This Series paper identifies ten double-duty actions that have strong potential to reduce the risk of both undernutrition, obesity, and DR-NCDs. It does so by summarising evidence on common drivers of different forms of malnutrition; documenting examples of unintended harm caused by some undernutrition-focused programmes on obesity and DR-NCDs; and highlighting examples of double-duty actions to tackle multiple forms of malnutrition. We find that undernutrition, obesity, and DR-NCDs are intrinsically linked through early-life nutrition, diet diversity, food environments, and socioeconomic factors. Some evidence shows that programmes focused on undernutrition have raised risks of poor quality diets, obesity, and DR-NCDs, especially in countries undergoing a rapid nutrition transition. This Series paper builds on this evidence to develop a framework to guide the design of double-duty approaches and strategies, and defines the first steps needed to deliver them. With a clear package of double-duty actions now identified, there is an urgent need to move forward with double-duty actions to address malnutrition in all its forms.
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Affiliation(s)
- Corinna Hawkes
- Centre for Food Policy, City, University of London, London, UK.
| | - Marie T Ruel
- International Food Policy Research Institute, Washington, DC, USA
| | - Leah Salm
- International Food Policy Research Institute, Washington, DC, USA
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5
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Exploratory Analysis of Nutritional Quality and Metrics of Snack Consumption among Nepali Children during the Complementary Feeding Period. Nutrients 2019; 11:nu11122962. [PMID: 31817203 PMCID: PMC6950298 DOI: 10.3390/nu11122962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 11/17/2022] Open
Abstract
The World Health Organization recommends feeding snacks between meals to young children. This study explored nutritional quality of snacks consumed between meals and consumption metrics (% total energy intakes (%TEI) and amount of kcal from snacks) to understand correlations with dietary outcomes (total energy intakes and dietary adequacy) and body-mass-index-for-age z-scores (BMIZ). Data used were 24-h dietary recalls and anthropometric measurements among a representative sample (n = 679) of one-year-olds in Nepal. Nepali meal patterns for young children were identified through formative research and all foods/beverages consumed outside of meals were categorized as snacks. A nutrient profiling model was used to categorize snacks as healthy or unhealthy, based on positive and negative nutrient content. Snacks consumed between meals provided half of all energy consumed, and were associated with increased energy and nutrient intakes. The positive effect of snacks between meals on dietary adequacy was greater when these snacks were healthy, while increasing %TEI from unhealthy snacks consumed between meals was negatively associated with dietary adequacy. Consumption of snacks between meals was not associated with mean BMIZ among the children. These findings indicate that the provision of and nutritional quality of snacks are important considerations to communicate to caregivers. Discouragement of unhealthy, nutrient-poor snacks is critical for complementary feeding dietary guidelines in contexts experiencing nutrition transition.
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6
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Pries AM, Sharma N, Upadhyay A, Rehman AM, Filteau S, Ferguson EL. Energy intake from unhealthy snack food/beverage among 12-23-month-old children in urban Nepal. MATERNAL AND CHILD NUTRITION 2019; 15 Suppl 4:e12775. [PMID: 31225707 PMCID: PMC6617731 DOI: 10.1111/mcn.12775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 01/06/2023]
Abstract
Unhealthy snack food and beverage (USFB) consumption among young children has been noted in many low‐income and middle‐income countries (LMIC), however, there is a lack of information on the contribution of these foods to children's diets in these contexts. This study describes the nutrient profiles and costs of snacks consumed by young children in Kathmandu Valley, Nepal, and assesses the proportion of total energy intake from nonbreastmilk foods (%TEI‐NBF) contributed by USFB and factors associated with high USFB consumption. A cross‐sectional survey was conducted among 745 randomly sampled primary caregivers of children aged 12–23 months. Of 239 unique snack foods and beverages consumed, 180 (75.3%) were classified as unhealthy based on nutrient profiling, with 158 of these being commercially branded. Median cost/100 kcal of USFB was lower as compared with healthy snacks. Ninety‐one percent of children had consumed a USFB in the previous 24 hr, with these foods contributing a mean %TEI‐NBF of 24.5 ± 0.7 among all children. Biscuits (10.8%), candy/chocolate (3.5%), and savoury snacks (3.4%) provided the largest %TEI‐NBF. Children who were older, female, or from the poorest households had significantly higher odds of high USFB consumption, whereas children whose caregivers were of upper caste/ethnicity or had achieved tertiary education had lower odds of consumption than other children. To reduce USFB consumption, interventions should seek to further understand social/cultural drivers of feeding practices, target disadvantaged populations, and ensure caregivers are fully aware of the nutritional quality of food products they choose for their children.
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Affiliation(s)
- Alissa M Pries
- Helen Keller International, New York, New York.,Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Andrea M Rehman
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanne Filteau
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elaine L Ferguson
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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7
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Awareness and Attitudes Regarding Industrial Food Fortification in Mongolia and Harbin. Nutrients 2019; 11:nu11010201. [PMID: 30669465 PMCID: PMC6356891 DOI: 10.3390/nu11010201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 02/08/2023] Open
Abstract
This study assessed awareness and attitudes regarding industrial food fortification among adults in urban and rural Mongolia, and the city of Harbin, China. Between 2014 and 2017, surveys were collected from healthy men and women aged ≥18 years (182 Harbin residents and 129 urban and rural Mongolians participating in a nationwide nutrition survey in Mongolia). Survey reproducibility was assessed among 69 Mongolian participants to whom it was administered twice (summer and winter). Findings revealed that only 19% of rural and 30% of urban Mongolians, and 48% of Harbin residents were aware that industrial fortification is practiced in their countries. For most food groups evaluated, at least half of Mongolians and less than half of Harbin residents thought fortification was government-mandated (only the addition of iodine with salt is actually mandated in both countries). Fifty-five percent of rural and urban Mongolians favored mandatory fortification of foods, 14% disapproved of it, and 31% were uncertain (compared with 25%, 38%, and 37% respectively in Harbin). Upon learning that the primary purpose of adding vitamin D to milk is to prevent rickets, 75% of Mongolians but only 18% of Harbin residents favored mandatory fortification, while 42% of Harbin residents favored voluntary fortification (compared with <10% of Mongolians). In conclusion, in Mongolia and Harbin, awareness and understanding of food fortification is low, as is receptivity toward mandatory fortification. Health promotion and social marketing should be designed to create an enabling environment for increasing supply and demand of fortified foods, in support of upcoming program implementation in Mongolia and potential future legislation in northeern China.
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8
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Feeding Practices and Undernutrition in 6⁻23-Month-Old Children of Orthodox Christian Mothers in Rural Tigray, Ethiopia: Longitudinal Study. Nutrients 2019; 11:nu11010138. [PMID: 30634659 PMCID: PMC6356195 DOI: 10.3390/nu11010138] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/31/2018] [Accepted: 01/02/2019] [Indexed: 11/17/2022] Open
Abstract
Fasting period and fasting status affect the feeding practices and nutritional status of Ethiopian Orthodox mothers. Even if children are exempted from fasting, some mothers do not prepare their food from animal sources as it could contaminate utensils for cooking family foods. Therefore, the objective of this study was to assess feeding practices and undernutrition in 6⁻23-months old children whose mothers are Ethiopian Orthodox religion followers during lent fasting and non-fasting periods in rural Tigray, Northern Ethiopia, and to identify associated factors. A community-based longitudinal study was carried out in Ethiopian Orthodox lent fasting and non-fasting periods. Using a multi-stage systematic random sampling technique, 567 and 522 children aged 6⁻23 months old participated in the fasting and non-fasting assessments, respectively. Statistical analyses were done using logistic regression, an independent sample t-test, Wilcoxon signed-rank (WSRT) and McNemar's tests. The prevalences of stunting, underweight and wasting were 31.6⁻33.7%, 11.7⁻15.7% and 4.4⁻4.8%, respectively. The weight-for-height (WHZ) and height-for-age (HAZ) values for children of fasting mothers were significantly lower (p < 0.05) compared to those of non-fasting mothers. Likewise, the median weight-for-age (WAZ) and diet diversity score (DDS) of children of fasting mothers were also significantly higher in non-fasting than in fasting periods. A small proportion of children (2.3⁻6.7%) met the minimum acceptable diet (MAD) in the study population, but these measures were significantly increased (p < 0.001) in the children of non-fasting mothers. Mother's fasting during lactation period of the indexed child was amongst the independent factors common in child stunting, underweight and wasting. Nutritional status and feeding practices of 6⁻23-month-old children are affected by maternal fasting during the fasting period. Therefore, without involvement of religious institutions in the existing nutritional activities, reduction of undernutrition would not be successful and sustainable.
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9
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Bronze Age population dynamics and the rise of dairy pastoralism on the eastern Eurasian steppe. Proc Natl Acad Sci U S A 2018; 115:E11248-E11255. [PMID: 30397125 PMCID: PMC6275519 DOI: 10.1073/pnas.1813608115] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Since the Bronze Age, pastoralism has been a dominant subsistence mode on the Western steppe, but the origins of this tradition on the Eastern steppe are poorly understood. Here we investigate a putative early pastoralist population in northern Mongolia and find that dairy production was established on the Eastern steppe by 1300 BCE. Milk proteins preserved in dental calculus indicate an early focus on Western domesticated ruminants rather than local species, but genetic ancestry analysis indicates minimal admixture with Western steppe herders, suggesting that dairy pastoralism was introduced through adoption by local hunter-gatherers rather than population replacement. Recent paleogenomic studies have shown that migrations of Western steppe herders (WSH) beginning in the Eneolithic (ca. 3300–2700 BCE) profoundly transformed the genes and cultures of Europe and central Asia. Compared with Europe, however, the eastern extent of this WSH expansion is not well defined. Here we present genomic and proteomic data from 22 directly dated Late Bronze Age burials putatively associated with early pastoralism in northern Mongolia (ca. 1380–975 BCE). Genome-wide analysis reveals that they are largely descended from a population represented by Early Bronze Age hunter-gatherers in the Baikal region, with only a limited contribution (∼7%) of WSH ancestry. At the same time, however, mass spectrometry analysis of dental calculus provides direct protein evidence of bovine, sheep, and goat milk consumption in seven of nine individuals. No individuals showed molecular evidence of lactase persistence, and only one individual exhibited evidence of >10% WSH ancestry, despite the presence of WSH populations in the nearby Altai-Sayan region for more than a millennium. Unlike the spread of Neolithic farming in Europe and the expansion of Bronze Age pastoralism on the Western steppe, our results indicate that ruminant dairy pastoralism was adopted on the Eastern steppe by local hunter-gatherers through a process of cultural transmission and minimal genetic exchange with outside groups.
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10
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Low breastmilk vitamin A concentration is prevalent in rural Ethiopia. Eur J Clin Nutr 2018; 73:1110-1116. [DOI: 10.1038/s41430-018-0334-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 09/03/2018] [Accepted: 09/21/2018] [Indexed: 02/06/2023]
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11
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Bromage S, Ganmaa D, Rich-Edwards JW, Rosner B, Bater J, Fawzi WW. Projected effectiveness of mandatory industrial fortification of wheat flour, milk, and edible oil with multiple micronutrients among Mongolian adults. PLoS One 2018; 13:e0201230. [PMID: 30070992 PMCID: PMC6071971 DOI: 10.1371/journal.pone.0201230] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/11/2018] [Indexed: 11/26/2022] Open
Abstract
Industrial fortification of wheat flour is a potentially effective strategy for addressing micronutrient deficiencies in Mongolia, given its ubiquitous consumption and centralized production. However, Mongolia has not mandated fortification of any foods except for salt with iodine. This study modeled the effectiveness and safety of mandatory industrial fortification of wheat flour alone and in combination with edible oil and milk in reducing the prevalence of multiple micronutrient intake deficiencies among healthy non-pregnant adults in Mongolia. Six days of diet records (3 summer, 3 winter) were collected from 320 urban and rural adults across the country and analyzed for food and nutrient consumption using a purpose-built food composition table, and the Intake Monitoring and Planning Program (IMAPP) was used to project the effects of fortification on summer and winter bioavailable micronutrient intake and intake deficiency under different fortification guidelines within population subgroups defined by urban or rural locality and sex. Projections showed that flour fortification would be effective in reducing intake deficiencies of thiamin and folate, while marginal benefits of fortification with iron and riboflavin would be smaller given these nutrients’ higher baseline consumption, and fortification with zinc, niacin, and vitamin B12 may be unnecessary. Fortification of flour, oil, and milk with vitamins A, D, and E at levels suggested by international guidelines would substantially reduce vitamin A intake deficiency and would increase vitamin D intake considerably, with the greatest benefits elicited by flour fortification and smaller benefits by additionally fortifying oil and milk. These results support mandatory industrial fortification of wheat flour, edible oil, and milk with iron, thiamin, riboflavin, folate, and vitamins A, D, and E in Mongolia. Considerations will be necessary to ensure the fortification of these nutrients is also effective for children, for whom the potential benefit of zinc, niacin, and vitamin B12 fortification should be assessed.
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Affiliation(s)
- Sabri Bromage
- Department of Nutrition, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Davaasambuu Ganmaa
- Department of Nutrition, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Janet Wilson Rich-Edwards
- Department of Epidemiology, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bernard Rosner
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jorick Bater
- Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Wafaie Wahib Fawzi
- Department of Nutrition, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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12
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Bromage S, Rosner B, Rich-Edwards JW, Ganmaa D, Tsolmon S, Tserendejid Z, Odbayar TO, Traeger M, Fawzi WW. Comparison of Methods for Estimating Dietary Food and Nutrient Intakes and Intake Densities from Household Consumption and Expenditure Data in Mongolia. Nutrients 2018; 10:E703. [PMID: 29857536 PMCID: PMC6024672 DOI: 10.3390/nu10060703] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 11/17/2022] Open
Abstract
Household consumption and expenditure surveys are frequently conducted around the world and they usually include data on household food consumption, but their applicability to nutrition research is limited by their collection at the household level. Using data from Mongolia, this study evaluated four approaches for estimating diet from household surveys: direct inference from per-capita household consumption; disaggregation of household consumption using a statistical method and the "adult male equivalent" method, and direct prediction of dietary intake. Per-capita household consumption overestimated dietary energy in single- and multi-person households by factors of 2.63 and 1.89, respectively. Performance of disaggregation methods was variable across two household surveys analyzed, while the statistical method exhibited less bias in estimating intake densities (per 100 kcal) of most dietary components in both of the surveys. Increasingly complex prediction models explained 54% to 72% of in-sample variation in dietary energy, with consistent benefits incurred by inclusion of basic dietary measurements. In conclusion, in Mongolia and elsewhere, differences in how household and dietary measurements are recorded make their comparison challenging. Validity of disaggregation methods depends on household survey characteristics and the dietary components that are considered. Relatively precise prediction models of dietary intake can be achieved by integrating basic dietary assessment into household surveys.
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Affiliation(s)
- Sabri Bromage
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
| | - Bernard Rosner
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
| | - Janet W Rich-Edwards
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Davaasambuu Ganmaa
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
| | - Soninkhishig Tsolmon
- Department of Nutrition, Mongolian University of Science and Technology, Ulaanbaatar 14191, Mongolia.
| | - Zuunnast Tserendejid
- Department of Nutrition, Mongolian University of Science and Technology, Ulaanbaatar 14191, Mongolia.
| | - Tseye-Oidov Odbayar
- Department of Food Engineering, Mongolian University of Science and Technology, Ulaanbaatar 14191, Mongolia.
| | - Margaret Traeger
- Department of Sociology, Yale University, New Haven, CT 06511, USA.
| | - Wafaie W Fawzi
- Department of Global Health and Populations, Harvard University T.H. Chan School of Public Health, Boston, MA 02115, USA.
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13
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Joshi N, Bolorhon B, Narula I, Zhu S, Manaseki-Hollan S. Social and environmental determinants of child health in Mongolia across years of rapid economic growth: 2000-2010. Int J Equity Health 2017; 16:189. [PMID: 29084537 PMCID: PMC5663099 DOI: 10.1186/s12939-017-0684-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To understand the effect of economic growth on health, we investigated the trend in socio-economic and regional determinants of child health in Mongolia. This Central Asian country had the fastest economic growth amongst low and middle-income countries (LMICs) from 2000 to 2010 and a healthcare system in transition. METHODS Data was from Mongolian multiple indicator cluster surveys (MICS) in 2000, 2005 and 2010. Child nutrition/growth was measured by height-for-age z-score (HAZ), weight-for-age z-score (WAZ), prevalence of stunted (HAZ < -2) and underweight (WAZ < -2) children. Access to health care was measured by prevalence of fully immunised children <5 years. Multivariate multi-level logistic mixed modelling was used to estimate the effect of socio-economic and environmental health determinants on each outcome in each year; 2000, 2005 and 2010. T-tests were used to measure significant change in HAZ and WAZ over the decade. RESULTS Overall, from 2000 to 2010, there was a significant improvement (p < 0.001) in all three outcomes, but the effect of socio-economic factors increased on both stunting and weight. In 2000, region was a significant determinant: children living in three provinces were significantly more likely to be stunted and less likely to be immunised than Ulaanbaatar, but this was not significant by 2010. By 2010, none of the factors were significant determinants of immunisation in children. In 2000, economic status had no effect on stunting (OR = 0.91; 95%CI:0.49,1.66), however by 2010, children in the poorest economic quintile were 4 times more likely to be stunted than the richest (OR = 0.24; 95% CI:0.13,0.45; p < 0.001). The effect of maternal education on stunting prevalence continued over the 10 years, in both 2000 and 2010 children were twice as likely to be stunted if their mother had no education compared to university education (2000 OR = 0.45; 95% CI:0.28,0.73, p < 0.01,2010 OR =0.55; 95% CI:0.35,0.87, p < 0.05). CONCLUSION Economic growth in Mongolia from 2000 to 2010 resulted in an increase in the effect of social determinants of child health; whilst focused policy improved access to immunisation. Children with less educated mothers and lower household incomes should be targeted in interventions to reduce health inequity.
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Affiliation(s)
- Nehal Joshi
- Medicine, University of Birmingham, Birmingham, UK
| | - Bolormaa Bolorhon
- Medical Student, Health Sciences University of Mongolia, Ulaanbaatar, Mongolia
| | | | - Shihua Zhu
- Research Fellow in Health Economics and Mathematical Modelling, Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Semira Manaseki-Hollan
- Clinical Senior Lecturer, Department of Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Mengistu G, Moges T, Samuel A, Baye K. Energy and nutrient intake of infants and young children in pastoralist communities of Ethiopia. Nutrition 2017; 41:1-6. [PMID: 28760418 DOI: 10.1016/j.nut.2017.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/04/2017] [Accepted: 02/27/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Nutrient intake from complementary foods often is suboptimal in subsistent farming households of developing countries, but little is known about this in pastoralist communities. The aim of this study was to estimate the energy and nutrient intake of children ages 6 to 23 mo living in pastoralist communities of Ethiopia. METHOD As part of the Ethiopian National Food Consumption Survey, 24-h dietary recall data were collected through in-home interviews from a nationally representative sample. In the present study, we report on the feeding characteristics, energy and nutrient intake of infants and young children (ages 6-23 mo) living in pastoralist communities (N = 896) of Ethiopia. Energy and nutrient intakes were estimated and compared with estimated needs from complementary foods. The nutrient density of the complementary diets was compared with desired densities. RESULTS About one-third of the children were stunted. Diets were predominantly dairy and cereal-based. The dietary diversity score was low (2 ± 1.2). Consumption of nutrient-dense foods such as animal source foods (other than milk), vitamin A-rich fruits and vegetables was very low. Energy intake from complementary foods were inadequate. Multiple micronutrient deficiencies including thiamin, niacin, iron, zinc, and calcium and in some instances vitamins A and C were observed in young children. The number of micronutrients for which intake was found deficient increased with child's age. CONCLUSION Energy and nutrient intakes from complementary foods are inadequate in pastoralist communities of Ethiopia. Interventions that improve knowledge and practice of complementary feeding are needed in this setting.
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Affiliation(s)
- Girma Mengistu
- Center for Food Science and Nutrition, Addis Ababa University, Ethiopia; Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Tibebu Moges
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Aregash Samuel
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Kaleab Baye
- Center for Food Science and Nutrition, Addis Ababa University, Ethiopia.
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Roba KT, O’Connor TP, Belachew T, O’Brien NM. Anemia and undernutrition among children aged 6-23 months in two agroecological zones of rural Ethiopia. Pediatric Health Med Ther 2016; 7:131-140. [PMID: 29388596 PMCID: PMC5683282 DOI: 10.2147/phmt.s109574] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Child malnutrition during the first 1,000 days, commencing at conception, can have lifetime consequences. This study assesses the prevalence of anemia and undernutrition among children aged 6-23 months in midland and lowland agroecological zones of rural Ethiopia. METHODS Cross-sectional data examining sociodemographic, anthropometry, hemoglobin levels, and meal frequency indicators were collected from 216 children aged 6-23 months and their mothers randomly selected from eight rural kebele (villages). RESULTS Of 216 children, 53.7% were anemic, and 39.8%, 26.9%, and 11.6% were stunted, underweight, and wasted, respectively. The prevalence of anemia was higher in the lowland agroecological zone (59.5%) than the midland (47.6%). Among those children who were stunted, underweight, and wasted, 63.5%, 66.7%, and 68.0% were anemic, respectively. Child anemia was significantly associated with the child not achieving minimum meal frequency, sickness during the last 2 weeks before the survey, stunting and low body mass index, and with maternal hemoglobin and handwashing behavior. The prevalence of stunting was higher in the lowland agroecological zone (42.3%) than the midland (36.2%). The predictors of stunting were age and sex of the child, not achieving MMF, maternal body mass index, and age. As maternal height increases, the length for age of the children increases (P=0.003). CONCLUSION The overall prevalence of anemia and undernutrition among children aged 6-23 months in these study areas is very high. The prevalence was higher in the lowland agro-ecological zone. Health information strategies focusing on both maternal and children nutrition could be sensible approaches to minimize stunting and anemia.
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Affiliation(s)
- Kedir Teji Roba
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Thomas P O’Connor
- School of Food and Nutritional Science, University College Cork, Cork, Ireland
| | - Tefera Belachew
- Department of Population and Family Health, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Nora M O’Brien
- School of Food and Nutritional Science, University College Cork, Cork, Ireland
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Osendarp SJM, Broersen B, van Liere MJ, De-Regil LM, Bahirathan L, Klassen E, Neufeld LM. Complementary Feeding Diets Made of Local Foods Can Be Optimized, but Additional Interventions Will Be Needed to Meet Iron and Zinc Requirements in 6- to 23-Month-Old Children in Low- and Middle-Income Countries. Food Nutr Bull 2016; 37:544-570. [DOI: 10.1177/0379572116655239] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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: To review evidence of studies evaluating whether (1) macro- and micronutrient requirements of children aged 6 to 23 months from low- and middle-income countries are met by the consumption of locally available foods (“observed intake”) and (2) nutrient requirements can be met when the use of local foods is optimized, using modeling techniques (“modeled intake”). Methods: Twenty-three articles were included after conducting a systematic literature search. To allow for comparisons between studies, findings of 15 observed intake studies were compared against their contribution to a standardized recommended nutrient intake from complementary foods. For studies with data on intake distribution, %< estimated average requirements were calculated. Results: Data from the observed intake studies indicate that children aged 6 to 23 months meet requirements of protein, while diets are inadequate in calcium, iron, and zinc. Also for energy, vitamin A, thiamin, riboflavin, niacin, folate, and vitamin C, children did not always fulfill their requirements. Very few studies reported on vitamin B6, B12, and magnesium, and no conclusions can be drawn for these nutrients. When diets are optimized using modeling techniques, most of these nutrient requirements can be met, with the exception of iron and zinc and in some settings calcium, folate, and B vitamins. Conclusion: Our 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.
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Affiliation(s)
- Saskia J. M. Osendarp
- The Micronutrient Initiative, Ottawa, Ontario, Canada
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Britt Broersen
- The Micronutrient Initiative, Ottawa, Ontario, Canada
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | | | | | | | - Eva Klassen
- The Micronutrient Initiative, Ottawa, Ontario, Canada
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Hemsworth J, Kumwenda C, Arimond M, Maleta K, Phuka J, Rehman AM, Vosti SA, Ashorn U, Filteau S, Dewey KG, Ashorn P, Ferguson EL. Lipid-Based Nutrient Supplements Increase Energy and Macronutrient Intakes from Complementary Food among Malawian Infants. J Nutr 2016; 146:326-34. [PMID: 26740684 DOI: 10.3945/jn.115.215327] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 11/30/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Low intakes of good-quality complementary foods (CFs) contribute to undernutrition and consequently negatively affect health, growth, and development. Lipid-based nutrient supplements (LNSs) are designed to ensure dietary adequacy in micronutrients and essential fatty acids and to provide some energy and high-quality protein. In populations in which acute energy deficiency is rare, the dose-dependent effect of LNSs on CF intakes is unknown. OBJECTIVE The objective of this study was to evaluate the difference in energy and macronutrient intakes from CF between a control (no supplement) group and 3 groups that received 10, 20, or 40 g LNS/d. METHODS We collected repeated interactive 24-h dietary recalls from caregivers of rural Malawian 9- to 10-mo-old infants (n = 748) to estimate dietary intakes (LNS and all non-breast-milk foods) of energy and macronutrients and their dietary patterns. All infants were participating in a 12-mo randomized controlled trial to investigate the efficacy of various doses of LNS for preventing undernutrition. RESULTS Dietary energy intakes were significantly higher among infants in the LNS intervention groups than in the control group (396, 406, and 388 kcal/d in the 10-, 20-, and 40-g LNS/d groups, respectively, compared with 345 kcal/d; each pairwise P < 0.05), but no significant differences were found in energy intakes between groups who were administered the different LNS doses (10 g LNS/d compared with 20 g LNS/d: P = 0.72; 10 g LNS/d compared with 40 g LNS/d: P ≥ 0.67; 20 g LNS/d compared with 40 g LNS/d: P = 0.94). Intakes of protein and fat were significantly higher in the LNS intervention groups than in the control group. No significant intergroup differences were found in median intakes of energy from non-LNS CFs (357, 347, and 296 kcal/d in the 10-, 20-, and 40-g LNS/d groups, respectively, compared with 345 kcal/d in the control group; P = 0.11). CONCLUSION LNSs in doses of 10-40 g/d increase intakes of energy and macronutrients among 9- to 10-mo-old Malawian infants, without displacing locally available CFs. This trial was registered at clinicaltrials.gov as NCT00945698.
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Affiliation(s)
| | - Chiza Kumwenda
- Department for International Health, School of Medicine, and
| | - Mary Arimond
- Program in International and Community Nutrition, and
| | - Kenneth Maleta
- College of Medicine, University of Blantyre, Blantyre, Malawi
| | - John Phuka
- College of Medicine, University of Blantyre, Blantyre, Malawi
| | - Andrea M Rehman
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, CA; and
| | - Ulla Ashorn
- Department for International Health, School of Medicine, and
| | | | | | - Per Ashorn
- Department for International Health, School of Medicine, and Department of Pediatrics, Tampere University Hospital, Tampere, Finland
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Kavle JA, Mehanna S, Saleh G, Fouad MA, Ramzy M, Hamed D, Hassan M, Khan G, Galloway R. Exploring why junk foods are 'essential' foods and how culturally tailored recommendations improved feeding in Egyptian children. MATERNAL AND CHILD NUTRITION 2014; 11:346-70. [PMID: 25536155 PMCID: PMC6860321 DOI: 10.1111/mcn.12165] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In Egypt, the double burden of malnutrition and rising overweight and obesity in adults mirrors the transition to westernized diets and a growing reliance on energy‐dense, low‐nutrient foods. This study utilized the trials of improved practices (TIPs) methodology to gain an understanding of the cultural beliefs and perceptions related to feeding practices of infants and young children 0–23 months of age and used this information to work in tandem with 150 mothers to implement feasible solutions to feeding problems in Lower and Upper Egypt. The study triangulated in‐depth interviews (IDIs) with mothers participating in TIPs, with IDIs with 40 health providers, 40 fathers and 40 grandmothers to gain an understanding of the influence and importance of the role of other caretakers and health providers in supporting these feeding practices. Study findings reveal high consumption of junk foods among toddlers, increasing in age and peaking at 12–23 months of age. Sponge cakes and sugary biscuits are not perceived as harmful and considered ‘ideal’ common complementary foods. Junk foods and beverages often compensate for trivial amounts of food given. Mothers are cautious about introducing nutritious foods to young children because of fears of illness and inability to digest food. Although challenges in feeding nutritious foods exist, mothers were able to substitute junk foods with locally available and affordable foods. Future programming should build upon cultural considerations learned in TIPs to address sustainable, meaningful changes in infant and young child feeding to reduce junk foods and increase dietary quality, quantity and frequency.
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Affiliation(s)
- Justine A Kavle
- PATH, Maternal and Child Health and Nutrition, Washington, District of Columbia, USA.,Maternal and Child Health Integrated Program (MCHIP), Washington, District of Columbia, USA
| | - Sohair Mehanna
- Social Research Center, American University in Cairo, Cairo, Egypt
| | - Gulsen Saleh
- SMART Project, Maternal and Child Health Integrated Program (MCHIP), Cairo, Egypt.,National Nutrition Institute of Egypt, Cairo, Egypt
| | | | - Magda Ramzy
- National Nutrition Institute of Egypt, Cairo, Egypt
| | - Doaa Hamed
- National Nutrition Institute of Egypt, Cairo, Egypt
| | - Mohamed Hassan
- Social Research Center, American University in Cairo, Cairo, Egypt
| | - Ghada Khan
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Rae Galloway
- PATH, Maternal and Child Health and Nutrition, Washington, District of Columbia, USA.,Maternal and Child Health Integrated Program (MCHIP), Washington, District of Columbia, USA
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Huffman SL, Piwoz EG, Vosti SA, Dewey KG. Babies, soft drinks and snacks: a concern in low- and middle-income countries? MATERNAL & CHILD NUTRITION 2014; 10:562-74. [PMID: 24847768 PMCID: PMC4299489 DOI: 10.1111/mcn.12126] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Undernutrition in infants and young children is a global health priority while overweight is an emerging issue. Small-scale studies in low- and middle-income countries have demonstrated consumption of sugary and savoury snack foods and soft drinks by young children. We assessed the proportion of children 6-23 months of age consuming sugary snack foods in 18 countries in Asia and Africa using data from selected Demographic and Health Surveys and household expenditures on soft drinks and biscuits using data from four Living Standards Measurement Studies (LSMS). Consumption of sugary snack foods increased with the child's age and household wealth, and was generally higher in urban vs. rural areas. In one-third of countries, >20% of infants 6-8 months consumed sugary snacks. Up to 75% of Asian children and 46% of African children consumed these foods in the second year of life. The proportion of children consuming sugary snack foods was generally higher than the proportion consuming fortified infant cereals, eggs or fruit. Household per capita daily expenditures on soft drinks ranged from $0.03 to $0.11 in three countries for which LSMS data were available, and from $0.01 to $0.04 on biscuits in two LSMS. Future surveys should include quantitative data on the purchase and consumption of snack foods by infants and young children, using consistent definitions and methods for identifying and categorising snack foods across surveys. Researchers should assess associations between snack food consumption and stunting and overweight, and characterise household, maternal and child characteristics associated with snack food consumption.
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Affiliation(s)
- Sandra L. Huffman
- Department of Nutrition and Program in International and Community NutritionUniversity of CaliforniaDavisCaliforniaUSA
| | | | - Stephen A. Vosti
- Department of Agricultural and Resource EconomicsUniversity of CaliforniaDavisCaliforniaUSA
| | - Kathryn G. Dewey
- Department of Nutrition and Program in International and Community NutritionUniversity of CaliforniaDavisCaliforniaUSA
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Gibson RS, Heath ALM, Szymlek-Gay EA. Is iron and zinc nutrition a concern for vegetarian infants and young children in industrialized countries? Am J Clin Nutr 2014; 100 Suppl 1:459S-68S. [PMID: 24871479 DOI: 10.3945/ajcn.113.071241] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Well-planned vegetarian diets are considered adequate for all stages of the life cycle, despite limited data on the zinc status of vegetarians during early childhood. The bioavailability of iron and zinc in vegetarian diets is poor because of their higher content of absorption inhibitors such as phytate and polyphenols and the absence of flesh foods. Consequently, children as well as adult vegetarians often have lower serum ferritin concentrations than omnivores, which is indicative of reduced iron stores, despite comparable intakes of total iron; hemoglobin differences are small and rarely associated with anemia. However, data on serum zinc concentrations, the recommended biomarker for identifying population groups at elevated risk of zinc deficiency, are sparse and difficult to interpret because recommended collection and analytic procedures have not always been followed. Existing data indicate no differences in serum zinc or growth between young vegetarian and omnivorous children, although there is some evidence of low serum zinc concentrations in vegetarian adolescents. Some vegetarian immigrants from underprivileged households may be predisposed to iron and zinc deficiency because of nondietary factors such as chronic inflammation, parasitic infections, overweight, and genetic hemoglobin disorders. To reduce the risk of deficiency, the content and bioavailability of iron and zinc should be enhanced in vegetarian diets by consumption of fortified cereals and milk, by consumption of leavened whole grains, by soaking dried legumes before cooking and discarding the soaking water, and by replacing tea and coffee at meals with vitamin C-rich drinks, fruit, or vegetables. Additional recommended practices include using fermented soy foods and sprouting at least some of the legumes consumed. Fortified foods can reduce iron deficiency, but whether they can also reduce zinc deficiency is less certain. Supplements may be necessary for vegetarian children following very restricted vegan diets.
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Affiliation(s)
- Rosalind S Gibson
- From the Department of Human Nutrition, University of Otago, Dunedin, New Zealand (RSG and A-LMH); and the Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia (EAS-G)
| | - Anne-Louise M Heath
- From the Department of Human Nutrition, University of Otago, Dunedin, New Zealand (RSG and A-LMH); and the Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia (EAS-G)
| | - Ewa A Szymlek-Gay
- From the Department of Human Nutrition, University of Otago, Dunedin, New Zealand (RSG and A-LMH); and the Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia (EAS-G)
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Poor complementary feeding practices and high anaemia prevalence among infants and young children in rural central and western China. Eur J Clin Nutr 2014; 68:916-24. [PMID: 24896010 DOI: 10.1038/ejcn.2014.98] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 03/13/2014] [Accepted: 03/28/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND/OBJECTIVES Infant and young child feeding (IYCF) has not been documented in central and western China, where anaemia is prevalent. To support policy advocacy, we assessed IYCF and anaemia there using standardized methods. SUBJECTS/METHODS A community-based, cross-sectional survey of 2244 children aged 6-23 months in 26 counties of 12 provinces. Analysis of associations between haemoglobin concentration (HC), IYCF indicators and other variables using crude and multivariate techniques. RESULTS Only 41.6% of those surveyed consumed a minimum acceptable diet. Fewer still-breastfeeding than non-breastfeeding children consumed the recommended minimum dietary diversity (51.7 versus 71.9%; P<0.001), meal frequency (57.7% v. 81.5%; P<0.001) or iron-rich food (63.3% v. 78.9%; P<0.001). Anaemia (51.3% overall) fell with age but was significantly associated with male sex, extreme poverty, minority ethnicity, breastfeeding and higher altitude. Dietary diversity, iron intake, growth monitoring and being left behind by out-migrating parents were protective against anaemia. A structural equation model demonstrated associations between IYCF, HC and other variables. Meal frequency, iron intake and altitude were directly and positively associated with HC; dietary diversity was indirectly associated. Health service uptake was not associated. Continued breastfeeding was directly associated with poor IYCF and indirectly with reduced HC, as were having a sibling and poor maternal education. CONCLUSION Infant and young child anaemia is highly prevalent and IYCF is poor in rural central and western China. Continued breastfeeding and certain other variables indicate risk of poor IYCF and anaemia. Major policy commitment to reducing iron deficiency and improving IYCF is needed for China's rural poor.
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Nutrient intakes from complementary foods consumed by young children (aged 12–23 months) from North Wollo, northern Ethiopia: the need for agro-ecologically adapted interventions. Public Health Nutr 2012; 16:1741-50. [DOI: 10.1017/s1368980012005277] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AbstractObjectiveTo characterize current feeding practices and to evaluate the adequacy of energy and nutrient intakes of young children in subsistence farming rural households in North Wollo, Ethiopia.DesignA cross-sectional study examining sociodemographic status, anthropometry, breast-feeding and complementary feeding practices using two in-home non-consecutive 24 h recalls.SettingsTwo rural villages in the highlands and lowlands of Gobalafto district, North Wollo.SubjectsSeventy-six young children aged 12–23 months, thirty-nine from the lowlands and thirty-seven from the highlands.ResultsAbout 33 % of the children, ∼46 % in the highlands and 24 % in the lowlands (P = 0·05), were stunted. Complementary diets were low in animal products, fruits and vegetables. Cereals and legumes were the major sources of energy, protein, Ca, Fe, Zn and vitamin A. Legumes with potentially toxic components (grass pea, broad beans) and low nutrient-dense beverages such as tea were frequently consumed. Intakes of energy, Ca, Zn, vitamin A and vitamin C from complementary foods were below WHO recommendations assuming average breast-milk intakes. In contrast, Fe and protein intakes and densities met WHO recommendations. Although vitamin C intakes and densities were higher (P < 0·05) for the lowlands, they remained far below WHO recommendations.ConclusionsInterventions promoting the WHO guiding principles for complementary feeding practices and behaviours that take the agro-ecological contexts into account are needed here. Furthermore, specific recommendations should be formulated to discourage the consumption of grass pea, broad beans and low nutrient-dense beverages such as tea.
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Gibbs MM, Carriquiry AL, Capanzana MV, Gibson RS. Establishing desirable fortificant levels for calcium, iron and zinc in foods for infant and young child feeding: examples from three Asian countries. MATERNAL AND CHILD NUTRITION 2012; 10:112-25. [PMID: 22515230 DOI: 10.1111/j.1740-8709.2012.00405.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We used the World Health Organization's recommended procedures to establish desirable fortificant levels for three problem micronutrients in children's diets, based on dietary data collected earlier from Filipino (n = 1374; 6-36 months), Mongolian (n = 179; 12-36 months) and Cambodian (n = 177; 12-36 months) children. Prevalence of inadequate and excessive intakes of calcium and zinc (via cut-point method) and iron (via full-probability approach) was assessed after adjusting usual intake distributions with pc-side using internal or external within-person variances from Filipino (calcium and iron) and US National Health And Nutrition Examination Survey III (zinc) national surveys. Fortificant levels were determined by repositioning usual intake distributions so that the 2.5th percentile of the targeted populations equalled the estimated average requirement (calcium, zinc) or so that full-probability prevalence was no larger than 2.5% (iron). Prevalence of inadequate intakes was ≥70% for calcium and iron, except Filipino infants (30% for Ca) and Cambodian toddlers (41% for Fe); but <1% for zinc for toddlers in Mongolia and 20% in Cambodia. Prevalence of excessive intakes was <1% for zinc, calcium and iron, except for Mongolian toddlers (11% for Zn). Desirable fortificant levels, although apparently negligible for zinc, were 530-783 mg for calcium and 10.8-22.8 mg for iron (per 100 g). Fortificant levels can be estimated from 24-h recalls, preferably by applying internal within-person variances. Fortification with calcium and iron was necessary, but seemingly not for zinc, despite a high prevalence of low serum zinc, suggesting the need for better defined cut-offs for population risk of zinc deficiency based on dietary zinc intake and/or serum zinc.
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Affiliation(s)
- Michelle M Gibbs
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand Department of Statistics, Iowa State University, Ames, Iowa, USA Food and Nutrition Research Institute, Department of Science and Technology, Bicutan, Taguig, Metro Manila, Philippines
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Gibbs M, Bailey KB, Lander RD, Fahmida U, Perlas L, Hess SY, Loechl CU, Winichagoon P, Gibson RS. The adequacy of micronutrient concentrations in manufactured complementary foods from low-income countries. J Food Compost Anal 2011. [DOI: 10.1016/j.jfca.2010.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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