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Jing H, Teng Y, Chacha S, Wang Z, Shi G, Mi B, Zhang B, Cai J, Liu Y, Li Q, Shen Y, Yang J, Kang Y, Li S, Liu D, Wang D, Yan H, Dang S. Is Increasing Diet Diversity of Animal-Source Foods Related to Better Health-Related Quality of Life among Chinese Men and Women? Nutrients 2023; 15:4183. [PMID: 37836467 PMCID: PMC10574670 DOI: 10.3390/nu15194183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Diet plays a crucial role in regulating individuals' lifestyles and is closely related to health. The intake of animal-sourced foods (ASF) provides the human body with high-quality protein and various micronutrients. This study aimed to investigate whether the diversity of animal foods has a positive impact on the health-related quality of life (HRQoL) among residents. The data came from the Shaanxi baseline survey of the Northwest Chinese Regional Ethnic Cohort Study, which recruited more than 100 thousand participants aged 35 to 74 from five provinces between June 2018 and May 2019. A total of 39,997 participants in Shaanxi (mean age: 50 years; 64% women) were finally included in this current study. The animal source food diet diversity score (ASFDDS) was established based on the frequency of consuming pork, mutton, beef, poultry, seafood, eggs, pure milk, and yogurt. The physical component score (PCS) and mental component score (MCS), ranging from 0 to 100 on the 12-Item Short Form Survey (SF-12), were used to assess participants' HRQoL. Better PCS/MCS was defined as scores higher than the 90th percentile. The results showed that men had a higher intake of ASF and ASFDDS than women. After adjusting for potential confounders, compared with those who never or rarely consumed animal foods, the likelihood of having better PCS and MCS increased by 16% (OR = 1.16, 95%CI: 1.01-1.34) and 24% (OR = 1.24, 95%CI: 1.03-1.448), respectively, in men with an ASFDDS ≥ 2. In women, a 34% increase (OR = l.34, 95%CI: 116-l.54) likelihood for better PCS was observed for an ASFDDS ≥ 2, but no association was observed for MCS. Increasing each specific animal source's food intake was associated with better PCS after adjusting for all covariates. However, for MCS, positive associations were only observed in seafood consumption among men and eggs among women. Restricted cubic splines showed a substantial dose-response association between intake frequency of animal-source foods and PCS, both in men and women. The study suggests that a diverse intake of animal-sourced foods can potentially improve the HRQoL of Chinese adults.
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Affiliation(s)
- Hui Jing
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
| | - Yuxin Teng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
| | - Samuel Chacha
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
| | - Ziping Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
| | - Guoshuai Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
| | - Baibing Mi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
| | - Binyan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
| | - Jiaxin Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
| | - Yezhou Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
| | - Qiang Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
| | - Yuan Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
| | - Jiaomei Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
| | - Yijun Kang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
| | - Shanshan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
| | - Danmeng Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L7 8XZ, UK;
| | - Hong Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
| | - Shaonong Dang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (H.J.); (Y.T.); (S.C.); (Z.W.); (G.S.); (B.M.); (B.Z.); (J.C.); (Y.L.); (Q.L.); (Y.S.); (J.Y.); (Y.K.); (S.L.); (D.L.)
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Vanderkooy A, Ferguson EL, Sy NY, Kane R, Diagne M, Mbodji A, Pries AM. High unhealthy food and beverage consumption is associated with poor diet quality among 12-35-month-olds in Guédiawaye Department, Senegal. Front Nutr 2023; 10:1125827. [PMID: 37404859 PMCID: PMC10315617 DOI: 10.3389/fnut.2023.1125827] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/19/2023] [Indexed: 07/06/2023] Open
Abstract
Background High consumption of unhealthy foods and beverages (UFB) during early childhood is cause for concern, with growing evidence from low- and middle-income countries finding associations with poor diet quality and malnutrition. Research from sub-Saharan Africa remains limited, with no studies quantifying the contribution of UFB to total energy intakes among young children or exploring the relationship between such intakes and diet quality or anthropometric outcomes. Objectives Assess UFB consumption patterns and their contribution to total energy intake from non-breastmilk foods/beverages (TEI-NBF), assess the association between high UFB consumption and dietary/nutrition outcomes, and explore drivers of unhealthy food choice among young children in Guédiawaye Department, Senegal. Methods We conducted a cross-sectional study of a representative sample of 724 primary caregivers and their 12-35.9-month-old children. The study included a questionnaire, a quantitative four-pass 24-h dietary recall, and anthropometric measurements. The contribution of UFB to TEI-NBF was calculated and terciles generated. Logistic and linear models were used to compare outcomes of high versus low UFB consumption terciles. Results UFB contributed on average 22.2% of TEI-NBF, averaging 5.9% for the lowest tercile and 39.9% for the highest. Diets of high UFB consumers, as compared to low, were significantly less dense in protein, fiber, and seven of the 11 micronutrients assessed and significantly denser in total fat, saturated fat, and total sugar. No associations were found with anthropometric outcomes. High UFB consumers were older and more likely to be living in food insecurity. The most common drivers of commercial UFB consumption were related to child preference, the use of these products as behavior management tools, treats, or gifts, and the sharing of these products by someone else eating them. Conclusion High UFB consumption is associated with poor diet quality among 12-35-month-olds in Guédiawaye Department, Senegal. Addressing high UFB consumption during this critical developmental period should be prioritized in young child nutrition research, programming, and policy development.
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Affiliation(s)
| | - Elaine L. Ferguson
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Maty Diagne
- Direction de la Santé de la Mère et de l’Enfant, Division Alimentaire et Nutrition, Ministère de la Santé et de l’Action Sociale, Dakar, Senegal
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Hinnouho G, Ferguson EL, MacDougall A, Kroeun H, Sophonneary P, Chea M, Pries AM. High consumption of unhealthy commercial foods and beverages tracks across the complementary feeding period in rural/peri-urban Cambodia. MATERNAL & CHILD NUTRITION 2023; 19:e13485. [PMID: 36751966 PMCID: PMC10019055 DOI: 10.1111/mcn.13485] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/02/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023]
Abstract
Consumption of unhealthy commercial foods and beverages (UCFB) is common among infants and young children living in low- and middle-income countries. Such foods can displace other nutritious foods, however, there is limited evidence on how this consumption tracks across time. This study assessed and tracked UCFB consumption of children living in rural/peri-urban Cambodia during the complementary feeding period, identified UCFB consumption patterns of these children, and explored the association between UCFB consumption and growth. A 6-month longitudinal cohort study was implemented among 567 caregivers of children aged 10-14 months at recruitment. UCFB consumption was estimated each month via a telephone-administered 7-day food frequency questionnaire, and UCFB consumption patterns were identified based on changes in this frequency of consumption over time. The majority of children either maintained (45.7%, n = 246) or developed (43.5%, n = 234) an unhealthy consumption pattern and only 10.8% (n = 58) of children maintained/transitioned into a healthy consumption pattern. High consumers of UCFB at 10-14 months had a 4.7 (CI: 4.7 [3.1-7.2]) times odds of being high consumers of UCFB at 15-19 months (p < 0.001). There was a trend of lower length-for-age z-scores (LAZ) among children maintaining or developing an unhealthy consumption pattern (~-0. SD LAZ) compared to children maintaining/transitioning into a healthy consumption pattern, however, this association was not statistically significant. Findings indicate that high UCFB consumption begins during infancy and tracks into early childhood. National policies and programmes centred on early interventions addressing the use of UCFB for infant and young child feeding are needed.
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Affiliation(s)
| | | | | | - Hou Kroeun
- Helen Keller InternationalNew York CityNew YorkUSA
| | | | - Mary Chea
- Ministry of HealthPhnom PenhCambodia
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Windus JL, Duncanson K, Burrows TL, Collins CE, Rollo ME. Review of dietary assessment studies conducted among Khmer populations living in Cambodia. J Hum Nutr Diet 2022; 35:901-918. [PMID: 35377499 PMCID: PMC9545030 DOI: 10.1111/jhn.13011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/14/2022] [Indexed: 11/28/2022]
Abstract
Background Despite economic growth, Cambodia continues to have high rates of malnutrition, anaemia and nutrition‐related deficiencies. Government policies promote nutrition strategies, although dietary intake data is limited. A detailed synthesis of existing intake data is needed to inform nutrition policy and practice change. This review aims to characterise and assess quality of dietary assessment methods and outcomes from individual‐level ‘whole diet’ studies of Khmer people living in Cambodia. Methods Searches were conducted using PRISMA‐ScR guidelines. Included papers reported dietary intake at an individual level for ‘whole diet’. Studies using secondary data or lacking dietary assessment details were excluded. Extracted data included dietary assessment features, nutrient/food group intakes and database. Results Nineteen publications (15 studies) were included, with nine carried out among children under 5 years and six among women. Eleven studies reported intake by food groups and four by nutrients, prominently energy, protein, vitamin A, iron, calcium and zinc. Inconsistent intakes, food groupings and reporting of study characteristics limited data synthesis. All but one study used 24‐h recalls. Trained local fieldworkers used traditional interview‐administered data collection and varied portion estimation tools. Food composition databases for analysis were not tailored to the Cambodian diet. Overall quality was rated as ‘good’. Conclusions We recommend the development of a best‐practice protocol for conducting dietary assessment, a Cambodia‐specific food composition database and a competent trained workforce of nutrition professionals, with global support of expertise and funding for future dietary assessment studies conducted in Cambodia. Fifteen studies with highly variable intake data included in the review. The food composition databases used were not specific to Cambodian diet. Minimum reporting standards and best practice protocols recommended, including in‐country nutrition training. Lack of whole population dietary intake data indicates the need for a national survey.
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Affiliation(s)
- Janelle L Windus
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Kerith Duncanson
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Tracy L Burrows
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Megan E Rollo
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, Australia
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Windus JL, Burrows TL, Duncanson K, Collins CE, Rollo ME. Scoping review of nutrition intervention and dietary assessment studies in Khmer populations living in Cambodia. J Hum Nutr Diet 2021; 34:953-968. [PMID: 34231266 DOI: 10.1111/jhn.12932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This scoping review aims to describe the body of nutrition intervention and dietary assessment research undertaken with Khmer populations in Cambodia, as well as summarise the nutrition knowledge base and highlight priority areas for future research. METHODS Five databases and the grey literature were searched, following PRISMA-ScR guidelines. Studies involving dietary assessment or nutrition interventions published after 1992 were identified using specific search terms and extracted to a customised data extraction table for categorisation and analysis. Study participants were Khmer people of any age and gender, living in rural or urban Cambodia. RESULTS Of the 100 included studies, 58 were dietary assessment only studies, 24 were nutrition interventions only, and 18 studies involved both assessment of intake and an intervention. Sixty-eight percent of study populations were mothers and young children, of which 52 studies focused on children aged under 5 years. Nineteen interventions involved supplementation and six trialled fortification of rice or fish sauce. Anaemia was the most common nutrition condition studied (n = 17), followed by malnutrition (n = 15) and malnutrition risk factors (n = 11). General nutrition status was explored in 25 studies, and individual micronutrients that were studied included iron (n = 27), zinc (n = 6), vitamin A (n = 4) and thiamine (n = 3). CONCLUSIONS Diet-related research in Khmer populations in Cambodia has predominantly focused on dietary assessment or evaluation of interventions aimed at reducing malnutrition and resolving micronutrient deficiencies. Areas identified as emerging needs included non-communicable diseases, the ageing population and non-iron deficiency anaemia.
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Affiliation(s)
- Janelle L Windus
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Tracy L Burrows
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Kerith Duncanson
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Megan E Rollo
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
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Kendall E, Millard A, Beaumont J. The "weanling's dilemma" revisited: Evolving bodies of evidence and the problem of infant paleodietary interpretation. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 175 Suppl 72:57-78. [PMID: 33460467 DOI: 10.1002/ajpa.24207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/23/2020] [Accepted: 12/06/2020] [Indexed: 01/02/2023]
Abstract
Breastfeeding is known to be a powerful mediator of maternal and childhood health, with impacts throughout the life course. Paleodietary studies of the past 30 years have accordingly taken an enduring interest in the health and diet of young children as a potential indicator of population fertility, subsistence, and mortality patterns. While progress has been made in recent decades toward acknowledging the agency of children, many paleodietary reconstructions have failed to incorporate developments in cognate disciplines revealing synergistic dynamics between maternal and offspring biology. Paleodietary interpretation has relied heavily on the "weanling's dilemma," in which infants are thought to face a bleak choice between loss of immunity or malnutrition. Using a review of immunological and epidemiological evidence for the dynamic and supportive role that breastfeeding plays throughout the complementary feeding period, this article offers context and nuance for understanding past feeding transitions. We suggest that future interpretative frameworks for infant paleodietary and bioarchaeological research should include a broad knowledge base that keeps pace with relevant developments outside of those disciplines.
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Affiliation(s)
- Ellen Kendall
- Department of Archaeology, Durham University, Durham, UK
| | - Andrew Millard
- Department of Archaeology, Durham University, Durham, UK
| | - Julia Beaumont
- School of Archaeological and Forensic Sciences, University of Bradford, Bradford, UK
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Som SV, Van Der Hoeven M, Laillou A, Poirot E, Chan T, Polman K, Ponce MC, Wieringa FT. Adherence to Child Feeding Practices and Child Growth: A Retrospective Cohort Analysis in Cambodia. Nutrients 2020; 13:nu13010137. [PMID: 33396559 PMCID: PMC7823716 DOI: 10.3390/nu13010137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 12/13/2022] Open
Abstract
Appropriate feeding in the first 1000 days of a child’s life is critical for their health and growth. We determined associations between adherence to age-appropriate feeding practices and child growth in Cambodia. Children (n = 1079) were included in the first follow-up (FU) data analyses and followed for 30 months (six FUs). Data were analyzed by generalized linear mixed-effect models. Children who adhered to feeding practices on at least three FUs, with an adequate minimal dietary diversity (MDD), a minimal acceptable diet (MAD), and age-appropriate daily feeding (ADF) were less stunted (14.8%, 12.3%, and 6.4%, respectively) than children who never adhered to these indicators (25.2%, 30.1%, and 24.8%, respectively). A higher adherence to MDD and ADF was associated with a higher height-for-age Z-score (HAZ) (β: 0.13, 95% CI: 0.01–0.25 and β: 0.36, 95% CI: 0.22–0.50), while a higher adherence to the MDD and MAD was associated with a higher weight-for-height Z-score (WHZ) (β: 0.19, 95% CI: 0.08–0.30; and β: 0.16, 95% CI: 0.05–0.27). A higher adherence to a minimum meal frequency (MMF) was associated with a lower HAZ (β: −0.99, 95% CI: −1.28–−0.70). Our findings showed that to reduce wasting and stunting in Cambodia, interventions should focus on improving both the quality and quantity of food intake of children under two while targeting the whole complementary feeding period.
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Affiliation(s)
- Somphos Vicheth Som
- Section of Infectious Diseases, Department of Health Sciences, Vrije Universiteit Amsterdam, de Boelelaan 1091, 1081 HV Amsterdam, The Netherlands; (M.V.D.H.); (K.P.); (M.C.P.)
- Correspondence: ; Tel.: +31-20-59-84395
| | - Marinka Van Der Hoeven
- Section of Infectious Diseases, Department of Health Sciences, Vrije Universiteit Amsterdam, de Boelelaan 1091, 1081 HV Amsterdam, The Netherlands; (M.V.D.H.); (K.P.); (M.C.P.)
| | - Arnaud Laillou
- Department of Child Survival and Development, United Nations Children’s Fund Cambodia, Exchange Square Building, Phnom Penh 12101, Cambodia; (A.L.); (E.P.)
| | - Etienne Poirot
- Department of Child Survival and Development, United Nations Children’s Fund Cambodia, Exchange Square Building, Phnom Penh 12101, Cambodia; (A.L.); (E.P.)
| | - Theary Chan
- Reproductive and Child Health Alliance, Phnom Penh 12100, Cambodia;
| | - Katja Polman
- Section of Infectious Diseases, Department of Health Sciences, Vrije Universiteit Amsterdam, de Boelelaan 1091, 1081 HV Amsterdam, The Netherlands; (M.V.D.H.); (K.P.); (M.C.P.)
- Department of Biomedical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Maiza Campos Ponce
- Section of Infectious Diseases, Department of Health Sciences, Vrije Universiteit Amsterdam, de Boelelaan 1091, 1081 HV Amsterdam, The Netherlands; (M.V.D.H.); (K.P.); (M.C.P.)
| | - Frank T. Wieringa
- UMR Qualisud, French National Research Institute for Sustainable Development (IRD), IRD/CIRAD/Université de Montpellier/SupAgro, 911 avenue d’Agropolis, 34394 CEDEX 5 Montpellier, France;
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Karpati J, de Neubourg C, Laillou A, Poirot E. Improving children's nutritional status in Cambodia: Multidimensional poverty and early integrated interventions. MATERNAL AND CHILD NUTRITION 2020; 16 Suppl 2:e12731. [PMID: 32621576 PMCID: PMC7591312 DOI: 10.1111/mcn.12731] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/14/2018] [Accepted: 08/23/2018] [Indexed: 01/16/2023]
Abstract
One in three Cambodian children under 5 years of age are stunted. This study adopted a multidimensional approach to understand the influence of a series of contextual factors on the nutritional status of Cambodian children. In this study, we use a multidimensional poverty framework to identify a combination of interventions likely to achieve reductions in child stunting, in Cambodia. We used the UNICEF Multiple Overlapping Deprivation Analysis tool and data from the Cambodia Demographic and Health Survey 2014 to assess children's multidimensional poverty across nutrition, health, early childhood development, water, sanitation, and housing dimensions. We found that 80% of children under age five were deprived in at least two poverty dimensions. Multivariate logistic regression analysis revealed that reducing the likelihood of being deprived in three or more poverty dimensions was associated with a significant reduction of the probability of being stunted, after controlling for potential confounders. The combined probability of nondeprivation in nutrition, sanitation, and health dimensions had the largest effect on reducing the probability of stunting. The results of this study highlight the multiple, intersecting needs of children and their associated explanatory factors. Targeted and integrated cross-sectoral policies that reinforce comprehensive early childhood interventions are needed for improving nutritional status as part of a wider set of child poverty reduction measures in Cambodia.
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Affiliation(s)
- Julia Karpati
- Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, Netherlands.,Poverty and Social Protection, Social Policy Research Institute, Broechem, Belgium
| | - Chris de Neubourg
- Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, Netherlands.,Poverty and Social Protection, Social Policy Research Institute, Broechem, Belgium
| | - Arnaud Laillou
- Maternal, Newborn and Child Health and Nutrition, United Nations Children's Fund (UNICEF), Phnom Penh, Cambodia
| | - Etienne Poirot
- Maternal, Newborn and Child Health and Nutrition, United Nations Children's Fund (UNICEF), Phnom Penh, Cambodia
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Ratsavong K, van Elsacker T, Doungvichit D, Siengsounthone L, Kounnavong S, Essink D. Are dietary intake and nutritional status influenced by gender? The pattern of dietary intake in Lao PDR: a developing country. Nutr J 2020; 19:31. [PMID: 32278347 PMCID: PMC7151640 DOI: 10.1186/s12937-020-00545-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/20/2020] [Indexed: 11/28/2022] Open
Abstract
Background Recognition of discrepancies between men and women in nutritional intake is important to tackle food and nutrition insecurity and the often-double burden of malnutrition. The purpose of this study was to assess nutritional status and dietary intake of the Lao population, with a focus on possible influences of gender. Methods Dietary intake was assessed in a national cross-sectional study of 1771 randomized participants aged from 1.01 to 89 years, using 24-h dietary recall. Dietary reference intakes were used to assess nutrient insufficiency. Chi-square test was used to evaluate gender differences and multiple univariate logistic regression to examine associations between gender, nutritional status, demographics and nutrient insufficiency. Results Nutrient insufficiencies were higher among pregnant and lactating women than other adult men and women, especially for protein and micronutrients such as vitamin B3, B1, C and other vitamins. Dietary intake and BMI were similar between men and women; all had insufficient intake of all types of nutrients, except sodium. However, women had lower intake than men for almost all nutrients and age groups. The prevalence of overnutrition was higher among those aged 18 years and over for both sexes. Among adult women (15–49.9 years old) and older adult women (50 years old or above), the proportions were: underweight 8.6% (both groups), overweight 18.4 and 20.5%, and obese 34.2 and 39.1%, respectively. Among pregnant and lactating women, the rates of underweight were 7.5 and 1.4%, of overweight were 17.8 and 27.1%, and obese, 21.9 and 40.0%. Among adult and older men, 3.2 and 8.3% were underweight; 21.0 and 18.6% were overweight and 28.2 and 27.6% were obese. Multiple univariate logistic regressions revealed that the factors rural area, dry season and Northern-Lowland region were associated with inadequate micronutrient intake among children, adolescents and adults of both genders. Conclusions Dietary intakes were alarmingly micronutrient-insufficient. Macronutrient imbalance and double burden of malnutrition were confirmed in both sexes. Gender differences were limited; men and women had similarly insufficient intakes, but pregnant and lactating women were disproportionately affected. Nutritional interventions should also take men and older people into account to solve nutrition problems.
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Affiliation(s)
| | | | | | | | | | - Dirk Essink
- Athena Institute, Vrije University, Amsterdam, the Netherlands
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10
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Green M, Hadihardjono DN, Pries AM, Izwardy D, Zehner E, Huffman SL. High proportions of children under 3 years of age consume commercially produced snack foods and sugar-sweetened beverages in Bandung City, Indonesia. MATERNAL AND CHILD NUTRITION 2020; 15 Suppl 4:e12764. [PMID: 31225706 PMCID: PMC6619027 DOI: 10.1111/mcn.12764] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 01/06/2023]
Abstract
Child undernutrition continues to be a national concern in Indonesia, whereas childhood overweight/obesity rises. Economic development has led to wide availability of highly processed foods and beverages, with growing evidence that children are consuming commercial snack products during the critical complementary feeding period. This study assessed the prevalence and patterns of consumption of commercially produced snack foods and sugar‐sweetened beverages among Indonesian children. A cross‐sectional survey was conducted with 495 mothers of children aged 6–35 months living in Bandung City, Indonesia. Among all children, 81.6% consumed a commercial snack food and 40.0% consumed a sugar‐sweetened beverage in the day preceding the interview. At 6–11 months, 46.5% of children consumed a snack food and 2.0% consumed a sugar‐sweetened beverage. Snack foods were consumed 3 or more times a day by 60.0% of children 24–35 months of age. Sweet biscuits and savory snacks were the most commonly consumed snack foods; sweetened milks and sweetened teas were the most common beverages. Maternal education, child age, and consumption of a commercially produced complementary food were associated with snack food consumption. Factors associated with sugar‐sweetened beverage consumption were child age and consumption of a commercially produced complementary food or breastmilk substitute. These findings reflect a high presence of processed, high‐sugar/salt commercial snack products in the diets of children 6–35 months. National attention should focus on interventions to reduce reliance on processed snack products and increase consumption of nutrient‐rich, locally available foods during the complementary feeding period.
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Affiliation(s)
| | | | | | - Doddy Izwardy
- Direktorat Gizi Masyarakat-Kementerian Kesehatan RI, Jakarta, Indonesia
| | | | - Sandra L Huffman
- Consultant to Helen Keller International, New York, New York, USA
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11
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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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12
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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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13
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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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14
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Suboptimal feeding and caring practices among young Indian children ages 12 to 24 mo living in the slums of New Delhi. Nutrition 2019; 69:110553. [PMID: 31539814 DOI: 10.1016/j.nut.2019.110553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 05/08/2019] [Accepted: 07/12/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Inappropriate infant and young child feeding and caring practices affect nutritional status, increases the risk for growth faltering, and ultimately, affect child survival. The aim of this study was to characterize the feeding and caring practices of disadvantaged urban Indian children 12 to 24 mo of age in relation to the World Health Organization (WHO) and Pan American Health Organization (PAHO) recommendations. METHODS This cross-sectional study was conducted in self-selected households in a South Delhi slum. A household survey was administered to the mother/primary caregiver of 120 eligible children. We collected child anthropometry, 2-d weighed food records (n = 69), and compliance to WHO and PAHO recommended feeding, caring, food safety, and hygiene practices. RESULTS Of the children, 39% were stunted, 31% underweight, and 10% wasted; none were overweight. Despite 88% achieving minimum meal frequency (more than three to four meals daily), only 50% consumed at least four food groups (minimum dietary diversity), and 44% a minimum acceptable diet (composite score of minimum meal frequency and minimum dietary diversity). Consumption of iron-rich or iron-fortified foods, vitamin A-rich fruits and vegetables, and eggs was low (<25%) and flesh foods were negligible (1.4%), whereas consumption of both sugary and snack foods was >60%. Reported compliance to responsive feeding indicators was generally ∼50%, but there was a wide range (13-98%) for food safety and hygiene practices, which were not always consistent with home observations. CONCLUSIONS Complementary feeding and caregiving practices were suboptimal among these disadvantaged young Indian children and education interventions focused on infant and young child feeding, responsive feeding, food safety, and hygiene practices are urgently needed.
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15
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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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16
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Blaney S, Menasria L, Main B, Chhorvann C, Vong L, Chiasson L, Hun V, Raminashvili D. Determinants of Undernutrition among Young Children Living in Soth Nikum District, Siem Reap, Cambodia. Nutrients 2019; 11:E685. [PMID: 30909463 PMCID: PMC6471553 DOI: 10.3390/nu11030685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Child undernutrition is of public concern in Cambodia. An understanding of factors influencing child nutritional status is essential to design programs that will reduce undernutrition. Using the UNICEF conceptual framework of causes of malnutrition, our research investigates the relationship between nutritional status of children aged 6⁻23 months and its immediate and underlying determinants. METHODS Baseline data from a cluster-randomized controlled trial aiming to assess the impact of the promotion of optimal feeding practices combined or not with the provision of local foods among 360 children 6⁻23 months of age were used. Anthropometry and biochemical measurements were performed at baseline. Data on each determinant of undernutrition were collected through interviews and direct observations. RESULTS Our results show that the degree of satisfaction of proteins and zinc requirements as well as the access to improved water sources and sanitation were positively associated with length-for-age, while having a better health status and a higher degree of satisfaction of energy, protein, zinc, and iron requirements were associated to an improved weight-for-length. Only child health status was associated to ferritin. CONCLUSION Our results reiterate the importance of improving child diet and health status, but also the access to a healthy environment to ensure an optimal nutritional status.
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Affiliation(s)
- Sonia Blaney
- École des sciences des aliments, de nutrition et d'étude familiale, Université de Moncton, 18 avenue Antonine-Maillet, Moncton, NB E1A 3E9, Canada.
| | - Lylia Menasria
- École des sciences des aliments, de nutrition et d'étude familiale, Université de Moncton, 18 avenue Antonine-Maillet, Moncton, NB E1A 3E9, Canada.
| | - Barbara Main
- Public Health Specialist, Guelph, ON N1E 6Y8, Canada.
| | - Chhea Chhorvann
- National Institute of Public Health, Phnom Penh 12203, Cambodia.
| | - Lenin Vong
- Independent consultant, Phnom Penh 12203, Cambodia.
| | - Lucie Chiasson
- Direction du mieux-être, Ministère du développement social, 1780 rue Water, Miramichi, NB E1N 1B6, Canada.
| | - Vannary Hun
- World Vision Cambodia, #20 Street 71 Tonle Bassac, Chamkar Morn, Phnom Penh 12203, Cambodia.
| | - David Raminashvili
- World Vision Cambodia, #20 Street 71 Tonle Bassac, Chamkar Morn, Phnom Penh 12203, Cambodia.
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17
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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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18
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Pries AM, Huffman SL, Champeny M, Adhikary I, Benjamin M, Coly AN, Diop EHI, Mengkheang K, Sy NY, Dhungel S, Feeley A, Vitta B, Zehner E. Consumption of commercially produced snack foods and sugar-sweetened beverages during the complementary feeding period in four African and Asian urban contexts. MATERNAL AND CHILD NUTRITION 2018; 13 Suppl 2. [PMID: 29032629 DOI: 10.1111/mcn.12412] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/29/2016] [Accepted: 10/14/2016] [Indexed: 12/26/2022]
Abstract
The availability and consumption of commercially produced foods and beverages have increased across low-income and middle-income countries. This cross-sectional survey assessed consumption of commercially produced foods and beverages among children 6-23 months of age, and mothers' exposure to promotions for these products. Health facility-based interviews were conducted among 218 randomly sampled mothers utilizing child health services in Dakar, Senegal; 229 in Dar es Salaam, Tanzania; 228 in Kathmandu Valley, Nepal; and 222 in Phnom Penh, Cambodia. In the day prior to the interview, 58.7% of 6-23-month-olds in Dakar, 23.1% in Dar es Salaam, 74.1% in Kathmandu Valley, and 55.0% in Phnom Penh had consumed a commercially produced snack food. In the previous week, the majority of children in Dakar (79.8%), Kathmandu Valley (91.2%), and Phnom Penh (80.6%) had consumed such products. Consumption of commercially produced sugar-sweetened beverages was noted among 32.0% of Phnom Penh, 29.8% of Dakar, 23.1% of Dar es Salaam, and 16.2% of Kathmandu Valley children. Maternal education was negatively associated with commercial snack food consumption in Dakar and Kathmandu Valley. Children of Phnom Penh mothers in the lowest wealth tercile were 1.5 times more likely to consume commercial snack food products, compared to wealthier mothers. These snack consumption patterns during the critical complementary feeding period demand attention; such products are often high in added sugars and salt, making them inappropriate for infants and young children.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Alison Feeley
- JB Consultancy, Johannesburg, South Africa.,United Nations Children's Fund, South Africa
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19
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Verbowski V, Talukder Z, Hou K, Sok Hoing L, Michaux K, Anderson V, Gibson R, Li KH, Lynd LD, McLean J, Green TJ, Barr SI. Effect of enhanced homestead food production and aquaculture on dietary intakes of women and children in rural Cambodia: A cluster randomized controlled trial. MATERNAL AND CHILD NUTRITION 2018; 14:e12581. [PMID: 29314705 DOI: 10.1111/mcn.12581] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 11/17/2017] [Accepted: 11/27/2017] [Indexed: 01/16/2023]
Abstract
The Cambodian diet is low in nutrient-dense animal-source foods. Enhanced homestead food production (EHFP) and aquaculture, which increase availability of nutrient-dense foods, are promising interventions to improve dietary intake. This study examined the effect of EHFP with or without aquaculture on dietary intake and prevalence of inadequate intake of select nutrients among women and children living in rural Cambodia, compared to controls. In a registered, cluster randomized controlled trial in Prey Veng, Cambodia, 10 households in each of 90 villages (n = 900) were randomized by village to receive EHFP, EHFP plus aquaculture, or control. After 22-month intervention, 24-hr dietary recalls (24HRs) were collected from mothers aged 18-50 years (n = 429) and their children aged 6 months-7 years (n = 421), reported by their mothers. Usual intake distributions (generated using 24HRs and repeat 24HRs on a subsample) were used to estimate prevalence of inadequate intake. Compared to controls, women in the EHFP group had significantly higher zinc (+1.0 mg/d) and Vitamin A (+139 retinol activity equivalents/d) intakes, and women in the EHFP plus aquaculture group had significantly higher iron (+2.7 mg/d), Vitamin A (+191 retinol activity equivalents/d), and riboflavin (+0.17 mg/d) intakes. Women in the EHFP plus aquaculture group also had significantly lower prevalence of inadequate iron (-7%, at 10% bioavailability), Vitamin A (-19%), and riboflavin (-17%) intakes, compared to controls. No significant differences in intakes or nutrient adequacy were observed among children or between EHFP and EHFP plus aquaculture groups. The biological importance of the small differences in nutrient intakes among women remains to be established.
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Affiliation(s)
- Vashti Verbowski
- Faculty of Land and Food Systems, Department of Human Nutrition, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zaman Talukder
- Helen Keller International, Cambodia, Phnom Penh, Cambodia
| | - Kroeun Hou
- Helen Keller International, Cambodia, Phnom Penh, Cambodia
| | - Ly Sok Hoing
- Helen Keller International, Cambodia, Phnom Penh, Cambodia
| | - Kristina Michaux
- Faculty of Land and Food Systems, Department of Human Nutrition, University of British Columbia, Vancouver, British Columbia, Canada
| | - Victoria Anderson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Rosalind Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Kathy H Li
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, BC, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, BC, Canada
| | - Judy McLean
- Faculty of Land and Food Systems, Department of Human Nutrition, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim J Green
- Faculty of Land and Food Systems, Department of Human Nutrition, University of British Columbia, Vancouver, British Columbia, Canada.,Healthy Mothers, Babies, and Children Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia
| | - Susan I Barr
- Faculty of Land and Food Systems, Department of Human Nutrition, University of British Columbia, Vancouver, British Columbia, Canada
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20
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Pries AM, Huffman SL, Adhikary I, Upreti SR, Dhungel S, Champeny M, Zehner E. High consumption of commercial food products among children less than 24 months of age and product promotion in Kathmandu Valley, Nepal. MATERNAL AND CHILD NUTRITION 2017; 12 Suppl 2:22-37. [PMID: 27061954 PMCID: PMC5071716 DOI: 10.1111/mcn.12267] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Commercially produced complementary foods can help improve nutritional status of young children if they are appropriately fortified and of optimal nutrient composition. However, other commercially produced snack food products may be nutritionally detrimental, potentially increasing consumption of foods high in salt or sugar and displacing consumption of other more nutritious options. Helen Keller International, in collaboration with the Nepal government, implemented a study to assess mothers' utilization of commercial food products for child feeding and exposure to commercial promotions for these products. A cross‐sectional survey was conducted among 309 mothers of children less than 24 months of age across 15 health facilities. Utilization of breastmilk substitutes was low, having been consumed by 6.2% of children 0–5 months of age and 7.5% of children 6–23 months of age. Approximately one‐fourth (24.6%) of children 6–23 months age had consumed a commercially produced complementary food in the prior day. Twenty‐eight percent of mothers reported observing a promotion for breastmilk substitutes, and 20.1% reported promotions for commercially produced complementary foods. Consumption of commercially produced snack food products was high at 74.1% of children 6–23 months. Promotions for these same commercially produced snack food products were highly prevalent in Kathmandu Valley, reported by 85.4% of mothers. In order to improve diets during the complementary feeding period, development of national standards for complementary food products is recommended. Nutritious snack options should be promoted for the complementary feeding period; consumption of commercially produced snack food products high in sugar and salt and low in nutrients should be discouraged.
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Affiliation(s)
- Alissa M Pries
- Helen Keller International, Asia Pacific Regional Office, Phnom Penh, Cambodia
| | | | | | | | | | - Mary Champeny
- Helen Keller International, Washington D.C., United States of America
| | - Elizabeth Zehner
- Helen Keller International, Washington D.C., United States of America
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21
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Pries AM, Huffman SL, Mengkheang K, Kroeun H, Champeny M, Roberts M, Zehner E. High use of commercial food products among infants and young children and promotions for these products in Cambodia. MATERNAL AND CHILD NUTRITION 2017; 12 Suppl 2:52-63. [PMID: 27061956 PMCID: PMC5021124 DOI: 10.1111/mcn.12270] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Despite national improvements in child survival, 40% of Cambodian children less than 5 years of age are stunted. Commercially produced complementary foods could be nutritionally beneficial for young children in Cambodia if fortified and of optimal nutrient composition. However, other nutrient‐poor commercially produced snack foods may be detrimental to young child feeding by displacing consumption of other nutritious foods. This study assessed consumption of commercial food products among infants and young children and their mothers' exposure to promotions for these products. A cross‐sectional survey was conducted among 294 mothers of children less than 24 months of age living in Phnom Penh. Of children 6‐23 months of age, 55.0% consumed a commercially produced snack food product on the prior day, and 80.6% had consumed one in the prior week. Only 12 (5.4%) children 6‐23 months of age had consumed a commercially produced complementary food. Almost all mothers (96.9%) had observed a promotion for a commercially produced snack food product, and 29.3% reported observation of a promotion for a commercial complementary food. Only one‐third (32.9%) of children 6‐23 months of age achieved a minimum acceptable diet. Findings indicate that there is a need to improve infant and young child feeding practices among children less than 24 months of age living in Phnom Penh. Nutritious options should be promoted, and consumption of unhealthy commercially produced snack food products should be discouraged.
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Affiliation(s)
- Alissa M Pries
- Helen Keller International, Asia Pacific Regional Office, Phnom Penh, Cambodia
| | | | | | - Hou Kroeun
- Helen Keller International, Phnom Penh, Cambodia
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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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Local food-based complementary feeding recommendations developed by the linear programming approach to improve the intake of problem nutrients among 12-23-month-old Myanmar children. Br J Nutr 2015; 116 Suppl 1:S16-26. [PMID: 26696232 DOI: 10.1017/s000711451500481x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Poor feeding practices result in inadequate nutrient intakes in young children in developing countries. To improve practices, local food-based complementary feeding recommendations (CFR) are needed. This cross-sectional survey aimed to describe current food consumption patterns of 12-23-month-old Myanmar children (n 106) from Ayeyarwady region in order to identify nutrient requirements that are difficult to achieve using local foods and to formulate affordable and realistic CFR to improve dietary adequacy. Weekly food consumption patterns were assessed using a 12-h weighed dietary record, single 24-h recall and a 5-d food record. Food costs were estimated by market surveys. CFR were formulated by linear programming analysis using WHO Optifood software and evaluated among mothers (n 20) using trial of improved practices (TIP). Findings showed that Ca, Zn, niacin, folate and Fe were 'problem nutrients': nutrients that did not achieve 100 % recommended nutrient intake even when the diet was optimised. Chicken liver, anchovy and roselle leaves were locally available nutrient-dense foods that would fill these nutrient gaps. The final set of six CFR would ensure dietary adequacy for five of twelve nutrients at a minimal cost of 271 kyats/d (based on the exchange rate of 900 kyats/USD at the time of data collection: 3rd quarter of 2012), but inadequacies remained for niacin, folate, thiamin, Fe, Zn, Ca and vitamin B6. TIP showed that mothers believed liver and vegetables would cause worms and diarrhoea, but these beliefs could be overcome to successfully promote liver consumption. Therefore, an acceptable set of CFR were developed to improve the dietary practices of 12-23-month-old Myanmar children using locally available foods. Alternative interventions such as fortification, however, are still needed to ensure dietary adequacy of all nutrients.
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Burnham L, Matlak S, Makrigiorgos G, Braun N, Knapp BP, Merewood A. Breastfeeding and coffee consumption in children younger than 2 years in Boston, Massachusetts, USA. J Hum Lact 2015; 31:267-72. [PMID: 25678326 DOI: 10.1177/0890334415570971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 01/13/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although introduction of inappropriate foods and liquids in early childhood and their association with breastfeeding is commonly reported in US children, coffee use in very young US children and its association with breastfeeding is not. OBJECTIVES This study aimed to determine the proportion of 1- and 2-year-olds in an urban population consuming coffee, their rate of consumption, and predictors of consumption, including breastfeeding status. METHODS We used data from a prospective cohort study on infant weight gain and diet, and body mass index at age 2. We used bivariate analyses to examine variables associated with coffee consumption at 1 and 2 years and multivariate logistic regression to control for variables of interest. RESULTS This study included 315 mother-infant dyads. At 1 year, the rate of coffee consumption reported was 2.5%; at 2 years, it was 15.2% and average daily consumption was 1.09 oz (range, 0.01- 4.00 oz). The only characteristic associated with coffee consumption at 1 year was breastfeeding at 1 year (P = .0275), which did not remain significant after controlling for confounding variables. Variables significantly associated with coffee consumption at year 2 were lower maternal education (P = .0016), non-US maternal place of birth (P = .0015), maternal Hispanic ethnicity (P < .0001), infant female sex (P = .0495), and receiving any breast milk at 1 year of age (P = .0189). After multivariate logistic regression, maternal Hispanic ethnicity (P = .0139) and infant female sex (P = .0371) remained significant. CONCLUSION Coffee consumption is not uncommon among toddlers in Boston, Massachusetts, USA. After controlling for possible confounding factors, maternal ethnicity and infant sex were significantly associated with this practice.
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Affiliation(s)
| | | | | | | | | | - Anne Merewood
- Boston University School of Medicine, Boston, MA, USA
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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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Skau JKH, Bunthang T, Chamnan C, Wieringa FT, Dijkhuizen MA, Roos N, Ferguson EL. The use of linear programming to determine whether a formulated complementary food product can ensure adequate nutrients for 6- to 11-month-old Cambodian infants. Am J Clin Nutr 2014; 99:130-8. [PMID: 24153341 DOI: 10.3945/ajcn.113.073700] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A new software tool, Optifood, developed by the WHO and based on linear programming (LP) analysis, has been developed to formulate food-based recommendations. OBJECTIVE This study discusses the use of Optifood for predicting whether formulated complementary food (CF) products can ensure dietary adequacy for target populations in Cambodia. DESIGN Dietary data were collected by 24-h recall in a cross-sectional survey of 6- to 11-mo-old infants (n = 78). LP model parameters were derived from these data, including a list of foods, median serving sizes, and dietary patterns. Five series of LP analyses were carried out to model the target population's baseline diet and 4 formulated CF products [WinFood (WF), WinFood-Lite (WF-L), Corn-Soy-Blend Plus (CSB+), and Corn-Soy-Blend Plus Plus (CSB++)], which were added to the diet in portions of 33 g/d dry weight (DW) for infants aged 6-8 mo and 40 g/d DW for infants aged 9-11 mo. In each series of analyses, the nutritionally optimal diet and theoretical range, in diet nutrient contents, were determined. RESULTS The LP analysis showed that baseline diets could not achieve the Recommended Nutrient Intake (RNI) for thiamin, riboflavin, niacin, folate, vitamin B-12, calcium, iron, and zinc (range: 14-91% of RNI in the optimal diets) and that none of the formulated CF products could cover the nutrient gaps for thiamin, niacin, iron, and folate (range: 22-86% of the RNI). Iron was the key limiting nutrient, for all modeled diets, achieving a maximum of only 48% of the RNI when CSB++ was included in the diet. Only WF and WF-L filled the nutrient gap for calcium. WF-L, CSB+, and CSB++ filled the nutrient gap for zinc (9- to 11-mo-olds). CONCLUSIONS The formulated CF products improved the nutrient adequacy of complementary feeding diets but could not entirely cover the nutrient gaps. These results emphasize the value of using LP to evaluate special CF products during the intervention planning phase. The WF study was registered at controlled-trials.com as ISRCTN19918531.
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Affiliation(s)
- Jutta K H Skau
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark (JKHS, MAD, and NR); the Department of Fisheries Post-harvest Technologies and Quality Control, Fishery Administration, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia (TB and CC); Institut de Recherche pour le Développement, Montpellier, France (FTW); and the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom (ELF)
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Allen LH. Global dietary patterns and diets in childhood: implications for health outcomes. ANNALS OF NUTRITION AND METABOLISM 2013; 61 Suppl 1:29-37. [PMID: 23343945 DOI: 10.1159/000346185] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article provides an overview of child feeding recommendations and how these relate to actual practice and dietary adequacy, primarily in developing countries. From birth to 6 months, recommendations focus on optimal breastfeeding practices, although these are still suboptimal in about one third of infants in developing countries. From 6 months of age, breast milk can no longer meet all the nutrient requirements of the child, so from 6 months through at least 24 months, the recommendation is to continue breastfeeding but gradually introduce complementary foods. In poorer populations, the available foods for complementary feeding are primarily cereals and legumes, to which small amounts of fruits and vegetables are added, and even less animal source foods. Based on intake data from infants and preschoolers, it is evident that usual diets typically fall far short of supplying micronutrient needs. By adding more fruits, vegetables, and animal source foods the diet can be improved. Intervention studies show that increasing animal source food intake improves growth, muscle mass, and cognitive function of school children. Milk and dairy product intakes are correlated with greater child growth in many studies, even in industrialized countries. However, for many families, substantially improving children's diets by providing higher quality foods is often financially unrealistic. Newer approaches to home fortification of children's foods using micronutrient powders or lipid-based nutrient supplements hold great potential to prevent micronutrient deficiencies at reasonable cost, thus preventing the adverse consequences of these deficiencies for child development.
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Affiliation(s)
- Lindsay H Allen
- USDA, ARS Western Human Nutrition Research Center, University of California, Davis, Calif 95616, USA.
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29
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Red meat in global nutrition. Meat Sci 2012; 92:166-73. [DOI: 10.1016/j.meatsci.2012.03.014] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 03/27/2012] [Accepted: 03/28/2012] [Indexed: 02/07/2023]
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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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George J, Yiannakis M, Main B, Devenish R, Anderson C, An US, Williams SM, Gibson RS. Genetic hemoglobin disorders, infection, and deficiencies of iron and vitamin A determine anemia in young Cambodian children. J Nutr 2012; 142:781-7. [PMID: 22378325 PMCID: PMC3301994 DOI: 10.3945/jn.111.148189] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In Cambodia, many factors may complicate the detection of iron deficiency. In a cross-sectional survey, we assessed the role of genetic hemoglobin (Hb) disorders, iron deficiency, vitamin A deficiency, infections, and other factors on Hb in young Cambodian children. Data on sociodemographic status, morbidity, and growth were collected from children (n = 3124) aged 6 to 59 mo selected from 3 rural provinces and Phnom Penh municipality. Blood samples were collected (n = 2695) for complete blood count, Hb type (by DNA analysis), ferritin, soluble transferrin receptor (sTfR), retinol-binding protein (RBP), C-reactive protein, and α(1)-acid glycoprotein (AGP). Genetic Hb disorders, anemia, and vitamin A deficiency were more common in rural than in urban provinces (P < 0.001): 60.0 vs. 40.0%, 58.2 vs. 32.7%, and 7.4 vs. 3.1%, respectively. Major determinants of Hb were age group, Hb type, ferritin, sTfR, RBP, AGP >1.0 g/L (P < 0.001), and rural setting (P < 0.05). Age group, Hb type, RBP, elevated AGP, and rural setting also influenced ferritin and sTfR (P < 0.02). Multiple factors affected anemia status, including the following: age groups 6-11.99 mo (OR: 6.1; 95% CI: 4.3, 8.7) and 12-23.99 mo (OR: 2.7; 95% CI: 2.1, 3.6); Hb type, notably Hb EE (OR: 18.5; 95% CI: 8.5, 40.4); low ferritin (OR: 3.2; 95% CI: 2.2, 4.7); elevated AGP (OR: 1.4; 95% CI: 1.2,1.7); rural setting (OR: 2.3; 95% CI: 1.7, 3.1); low RBP (OR: 3.6; 95% CI: 2.2, 5.9); and elevated sTfR (OR: 2.1; 95% CI: 1.7, 2.7). In Cambodia, where a high prevalence of genetic Hb disorders exists, ferritin and sTfR are of limited use for assessing the prevalence of iron deficiency. New low-cost methods for detecting genetic Hb disorders are urgently required.
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Affiliation(s)
| | - Miriam Yiannakis
- Nutrition Center of Expertise, World Vision International, Mississauga, Ontario
| | - Barbara Main
- World Vision Canada, Mississauga, Ontario, Canada Mississauga, Ontario, Canada
| | | | - Courtney Anderson
- World Vision Canada, Mississauga, Ontario, Canada Mississauga, Ontario, Canada
| | - Ung Sam An
- National Institute of Public Health, Phnom Penh, Cambodia; and Departments of
| | | | - Rosalind S. Gibson
- Human Nutrition, University of Otago, Dunedin, New Zealand,To whom correspondence should be addressed. E-mail: or
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Harris S, Jack S. Home-Based Treatment of Acute Malnutrition in Cambodian Urban Poor Communities. Food Nutr Bull 2011; 32:333-9. [DOI: 10.1177/156482651103200404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The prevalence of malnutrition in Cambodia is among the highest in Southeast Asia. Until recently, there has been a consensus that the treatment and rehabilitation of acutely severely malnourished children should take place in hospitals; however, limited local health resources often place constraints upon the inpatient management of these children. Objective This study reviews the outcomes of a community nutrition program designed to rehabilitate children under the age of 5 years with moderate or severe acute malnutrition living in a poor urban community in Phnom Penh, Cambodia. Methods Clinical records of the program participants during the period from January 1999 to November 2006 were reviewed. Attainment of recovery weight-for-height z-scores, the length of time taken to achieve this recovery, rates of weight gain, mortality rate, and rate of default were determined from the data. Results One hundred fifty-nine children aged 4 years or younger with a mean admission weight-for-height z-score of −3.3 were treated. The mean outcome weight-for-height z-score was −1.5. Eighty-seven children (55%) reached a weight-for-height z-score ≥ −1 over a mean period of 14 weeks of rehabilitation. The average rate of weight gain was 4 g/kg/day. The case fatality rate was 5.6%. Conclusions This program is an example of effective, community-based rehabilitation of children with moderate or severe acute malnutrition in an urban, Southeast Asian, non-humanitarian-relief context, through a combination of nutritional education, regular home visiting, and food support.
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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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Garcia MT, Granado FS, Cardoso MA. Alimentação complementar e estado nutricional de crianças menores de dois anos atendidas no Programa Saúde da Família em Acrelândia, Acre, Amazônia Ocidental Brasileira. CAD SAUDE PUBLICA 2011; 27:305-16. [DOI: 10.1590/s0102-311x2011000200012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 11/29/2010] [Indexed: 11/22/2022] Open
Abstract
Com objetivo de investigar o estado nutricional e alimentação complementar em crianças de 6 a 24 meses, residentes na Amazônia Ocidental Brasileira, um estudo transversal foi realizado na área urbana do Município de Acrelândia, Estado do Acre, com 164 crianças. As prevalências de déficit de estatura/idade e anemia foram de 12% e 40%, respectivamente, e de deficiência de ferro isolada, de 85%. Os níveis séricos das vitaminas A e B12 estavam baixos em 15% e 12% das crianças, respectivamente. Houve baixo consumo alimentar dos seguintes nutrientes (% de crianças abaixo das recomendações): ácido fólico (33%), vitamina C (40%), vitamina A (42%), zinco (46%) e ferro (71%). A biodisponibilidade de ferro da dieta foi de 8%. Observou-se baixo consumo de frutas, hortaliças e carnes, com consumo excessivo de leite de vaca e mingau.
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Enneman A, Campos R, Hernández L, Palma AV, Vossenaar M, Solomons NW. Contribution of complementary foods to the total daily water needs of urban Guatemalan infants. J Hum Nutr Diet 2010; 23:520-8. [DOI: 10.1111/j.1365-277x.2010.01044.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Poor dietary quality of complementary foods is associated with multiple micronutrient deficiencies during early childhood in Mongolia. Public Health Nutr 2009; 13:1304-13. [DOI: 10.1017/s1368980009991856] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo assess whether persistent micronutrient deficiencies in Mongolian children identified in our earlier biochemical study are associated with inadequacies in quantity and/or quality in their complementary diets.DesignA cross-sectional study of breast-fed children aged 6–23 months, randomly selected from four districts in Ulaanbaatar and four provincial capitals.SubjectsWeight and length were measured, and sociodemographic status, feeding practices and nutrient adequacy of complementary foods for children aged 6–8 months (n 26), 9–11 months (n 29) and 12–23 months (n 73) were assessed via questionnaire and in-home interactive 24 h recalls.ResultsNo geographic differences existed so data were combined. Adherence to WHO infant and young child feeding practices was poor: few children were exclusively breast-fed up to 6 months of age or received the recommended number of feedings containing the recommended number of food groups. Nevertheless, energy intakes from complementary diets, primarily from cereals and non-nutritious snacks, were above WHO-estimated needs; <1 % of energy was from meat and eggs or fruits and vegetables. Median intakes and densities of most nutrients (except protein, thiamin and riboflavin) failed to meet WHO recommendations for at least two age groups, assuming average breast milk intake; greatest density deficits were for Fe > vitamin C > vitamin A > Zn > Ca.ConclusionsComplementary feeding in Mongolia is compromised by deficits in several micronutrients but not energy, in part because of frequent consumption of non-nutritious snacks. The latter may interfere with breast-feeding and should be avoided. Instead, wheat-based complementary foods should be enriched with affordable cellular animal foods and fruits rich in vitamin C to combat existing micronutrient deficits.
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Gibson RS, Abebe Y, Hambidge KM, Arbide I, Teshome A, Stoecker BJ. Inadequate feeding practices and impaired growth among children from subsistence farming households in Sidama, Southern Ethiopia. MATERNAL AND CHILD NUTRITION 2009; 5:260-75. [PMID: 20572929 DOI: 10.1111/j.1740-8709.2008.00179.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Whether current child feeding practices and behaviours among rural households in Sidama, Southern Ethiopia conform to the World Health Organization (WHO) guiding principles for complementary feeding is uncertain. We assessed socio-demographic status, anthropometry, breastfeeding, complementary feeding practices and behaviours, and motor development milestones in a convenience sample of 97 breastfed children aged 6-23 months from three rural Sidama communities. Energy and nutrient intakes from complementary foods were also calculated from 1-day in-home weighed records. Prevalence of stunting ranged from 25% for infants aged 6-8 months to 52% for children aged 12-23 months, whereas for wasting, the corresponding prevalence was 10% and 14%, respectively. Very few children were exclusively breastfed up to 6 months of age (n = 2), or received solids/semi-solids for the recommended minimum number of times containing the recommended number of food groups. Responsive feeding was not practised and no cellular animal products were consumed. Median intakes of energy, and intakes and densities of micronutrients from complementary foods (but not protein) were below WHO recommendations, assuming average breast milk intakes; greatest shortfalls were for retinol, vitamin C and calcium densities. Mothers of stunted children were shorter and lighter, and from households of lower socio-economic status than non-stunted children (P < 0.05). Acquisition of some motor development milestones was delayed in stunted infants compared with their non-stunted counter-parts. In conclusion, interventions that address the WHO guiding principles for complementary feeding practices and behaviours, as well as prenatal influences on growth, are urgently required in this setting.
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Fischer PR, Thacher TD, Pettifor JM. Pediatric vitamin D and calcium nutrition in developing countries. Rev Endocr Metab Disord 2008; 9:181-92. [PMID: 18604643 DOI: 10.1007/s11154-008-9085-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 06/10/2008] [Indexed: 01/10/2023]
Abstract
Over one billion humans have insufficient circulating levels of vitamin D, and dietary insufficiency of calcium is common in developing countries. Worldwide, nutritional rickets is considered to be the most common non-communicable disease of children. Rickets can be due either to primary deficiencies of vitamin D or calcium or to combined deficiencies of both elements. Vitamin D deficiency is also increasingly linked to non-skeletal complications. Even without laboratory and radiologic resources, the diagnosis of rickets is considered clinically when a child presents with limb deformities and has beaded ribs and widened wrists and ankles. Prevention is possible through increased sun exposure and dietary enhancement. Treatment of nutritional rickets involves provision of adequate vitamin D and calcium. Further research is needed to elucidate the precise epidemiology of vitamin D and calcium deficiencies in developing countries, to determine the roles of additional pathologic factors contributing to the development and morbidity of rickets, to improve affordable and feasible means of diagnosing rickets in resource-limited areas, to better target at-risk populations for preventive interventions, to identify accurate dosing and delivery of therapeutic interventions, and to evaluate the long-term consequences of vitamin D and calcium deficiencies in childhood.
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Affiliation(s)
- Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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