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Mendes GDRL, Souza HFD, Lopes JPA, Rocha ACS, Faria RB, Santos FRD, Mesquita BMADCD, Santos SHS, Durães CAF, Ferreira SR, Boitrago SCODS, Leal JS, Kamimura ES, Brandi IV. A fermented milk drink with Umbu (Spondias tuberosa) pulp and whey is effective for weight gain and re-nutrition in malnourished: An in vivo study in mice and children. Food Res Int 2024; 181:114083. [PMID: 38448094 DOI: 10.1016/j.foodres.2024.114083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 03/08/2024]
Abstract
Malnutrition is considered one of the major public health problems worldwide and negatively affects the growth, development and learning of schoolchildren. This study developed and evaluated a fermented milk drink with added Umbu (Spondias tuberosa) pulp in the weight gain and renutrition of mice submitted to malnutrition by calorie restriction, and in malnourished children. The supplementation with this fermented milk drink contributed to an increase of 7.2 % in body weight, and 64.3 % in albumin, and a reduction of 35 % in cholesterol in malnourished mice. In humans, a group of nine malnourished children consumed a daily 200 mL serving of the milk drink (for 60 days). For humans, the fermented milk drink allowed an increase of 16.5 % in body weight, and 20.9 % in body mass index in malnourished children. In conclusion, fermented milk drink has a positive effect on the re-nutrition of malnourished mice and helps to improve the nutritional status of malnourished children.
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Affiliation(s)
- Gabriela da Rocha Lemos Mendes
- Postgraduate Program in Food and Health; Food Engineering School, Agricultural Sciences Institute (ICA), Federal University of Minas Gerais (UFMG), A. Universitária, 1000, 39404-547 Montes Claros, Brazil
| | - Handray Fernandes de Souza
- Postgraduate Program in Food and Health; Food Engineering School, Agricultural Sciences Institute (ICA), Federal University of Minas Gerais (UFMG), A. Universitária, 1000, 39404-547 Montes Claros, Brazil; Department of Food Engineering, School of Animal Science and Food Engineering, Universidade de São Paulo, Av. Duque de Caxias Norte, 225, 13635-900 Pirassununga, São Paulo, Brazil
| | - João Pedro Antunes Lopes
- Postgraduate Program in Food and Health; Food Engineering School, Agricultural Sciences Institute (ICA), Federal University of Minas Gerais (UFMG), A. Universitária, 1000, 39404-547 Montes Claros, Brazil
| | - Ana Carolina Santos Rocha
- Postgraduate Program in Food and Health; Food Engineering School, Agricultural Sciences Institute (ICA), Federal University of Minas Gerais (UFMG), A. Universitária, 1000, 39404-547 Montes Claros, Brazil
| | - Raquel Borges Faria
- Postgraduate Program in Food and Health; Food Engineering School, Agricultural Sciences Institute (ICA), Federal University of Minas Gerais (UFMG), A. Universitária, 1000, 39404-547 Montes Claros, Brazil
| | - Fábio Ribeiro Dos Santos
- Postgraduate Program in Food and Health; Food Engineering School, Agricultural Sciences Institute (ICA), Federal University of Minas Gerais (UFMG), A. Universitária, 1000, 39404-547 Montes Claros, Brazil; Department of Food Technology, Postgraduate Program in Food Science and Technology, Universidade Federal de Viçosa (UFV), Viçosa, MG, Brazil
| | - Bruna Mara Aparecida de Carvalho de Mesquita
- Postgraduate Program in Food and Health; Food Engineering School, Agricultural Sciences Institute (ICA), Federal University of Minas Gerais (UFMG), A. Universitária, 1000, 39404-547 Montes Claros, Brazil; Universidade Estadual de Montes Claros, Av. Prof. Rui Braga, s/n, 39401-089 Montes Claros, Minas Gerais, Brazil
| | - Sérgio Henrique Sousa Santos
- Postgraduate Program in Food and Health; Food Engineering School, Agricultural Sciences Institute (ICA), Federal University of Minas Gerais (UFMG), A. Universitária, 1000, 39404-547 Montes Claros, Brazil; Universidade Estadual de Montes Claros, Av. Prof. Rui Braga, s/n, 39401-089 Montes Claros, Minas Gerais, Brazil
| | - Carla Adriana Ferreira Durães
- Postgraduate Program in Food and Health; Food Engineering School, Agricultural Sciences Institute (ICA), Federal University of Minas Gerais (UFMG), A. Universitária, 1000, 39404-547 Montes Claros, Brazil; Universidade Estadual de Montes Claros, Av. Prof. Rui Braga, s/n, 39401-089 Montes Claros, Minas Gerais, Brazil
| | - Sildimar Rodrigues Ferreira
- Postgraduate Program in Food and Health; Food Engineering School, Agricultural Sciences Institute (ICA), Federal University of Minas Gerais (UFMG), A. Universitária, 1000, 39404-547 Montes Claros, Brazil
| | | | - Jéssica Santos Leal
- Postgraduate Program in Food and Health; Food Engineering School, Agricultural Sciences Institute (ICA), Federal University of Minas Gerais (UFMG), A. Universitária, 1000, 39404-547 Montes Claros, Brazil
| | - Eliana Setsuko Kamimura
- Department of Food Engineering, School of Animal Science and Food Engineering, Universidade de São Paulo, Av. Duque de Caxias Norte, 225, 13635-900 Pirassununga, São Paulo, Brazil
| | - Igor Viana Brandi
- Postgraduate Program in Food and Health; Food Engineering School, Agricultural Sciences Institute (ICA), Federal University of Minas Gerais (UFMG), A. Universitária, 1000, 39404-547 Montes Claros, Brazil; Universidade Estadual de Montes Claros, Av. Prof. Rui Braga, s/n, 39401-089 Montes Claros, Minas Gerais, Brazil.
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Brown CR, Rocke K, Murphy MM, Hambleton IR. Interventions and policies aimed at improving nutrition in Small Island Developing States: a rapid review. Rev Panam Salud Publica 2022; 46:e33. [PMID: 36042710 PMCID: PMC9409607 DOI: 10.26633/rpsp.2022.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/22/2022] [Indexed: 01/04/2023] Open
Abstract
Objective. To describe features of nutritional interventions implemented in Small Island Developing States (SIDS) in the past 20 years. Methods. A rapid scoping review was conducted by searching PubMed and Web of Science databases for interventions conducted in SIDS that sought to improve the nutrition of their populations between 2000 and 2019 inclusive. The Noncommunicable diseases progress monitor 2020 was also examined to assess nutritional policies in SIDS. Results. A total of 174 interventions were implemented in 49 of the 58 SIDS. The greatest proportion were conducted in the Caribbean (75 interventions; 43%), with the Pacific region, and the Atlantic, Indian Ocean, Mediterranean and South China Sea region each implementing about 30% of interventions. Using the NOURISHING framework, most interventions (67%) were implemented at the community and national or policy level, using multiple components of the framework. The greatest proportion of interventions (35%) were educational and awareness raising. Restrictions on physical availability of and increased taxation on alcohol were the most commonly reported policies that were partially or fully achieved; restrictions on fats were the least commonly reported. These findings were generally consistent across the SIDS regions. Conclusions. There is a paucity of nutritional policies in SIDS; the reasons may be linked to their social, economic, and environmental vulnerabilities. Interventions should be expanded beyond education to encompass multiple components of the NOURISHING framework, with multisectoral inclusion to ensure stronger stakeholder collaboration and buy-in. A systematic review is warranted using a fuller range of sources to assess the effectiveness of interventions.
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Affiliation(s)
- Catherine R. Brown
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Kern Rocke
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Madhuvanti M. Murphy
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Ian R. Hambleton
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
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Ickes SB, Craig C, Heidkamp R. Design Factors for Food Supplementation and Nutrition Education Interventions That Limit Conclusions about Effectiveness for Wasting Prevention: A Scoping Review of Peer-Reviewed Literature. Adv Nutr 2021; 13:328-341. [PMID: 34666351 PMCID: PMC8803494 DOI: 10.1093/advances/nmab107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 05/04/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
We conducted a scoping review to characterize the evidence base for the effectiveness of food supplementation (FS), nutrition education (NE), or FS/NE interventions to prevent wasting among children aged 6 to 59 mo. We aimed to identify gaps in peer-reviewed literature and to develop recommendations for strengthening study designs. We identified 56 unique studies (FS = 21, NE = 19, FS/NE = 16) for which we assessed intervention design factors, implementation context, evaluation methods, and wasting impact. Compared with studies focused on stunting, fewer wasting-focused studies reported weight-for-height z score (WHZ). Midupper arm circumference (MUAC) was more commonly reported in wasting-focused studies (71.4%) than those focused on stunting (36.8%) or wasting and stunting (30.4%). FS studies measured anthropometry (mean, 95% CI) more frequently at every 11.3 (7.8, 14.8) wk than NE interventions at 36.3 (8.8, 62.1) wk (P = 0.036), but not FS/NE interventions at 25.8 (5.6, 49.1) wk (P = 0.138). NE interventions tended to be of longer duration than FS or FS/NE interventions. Only 6 studies followed and measured children after the intervention period ended. Across all studies, 45% reported a significant effect on wasting; these included FS, NE, and FS/NE interventions. The lack of comparability across studies limits conclusions about the effectiveness of specific types of interventions. To build a more unified evidence base for wasting prevention we recommend that future studies 1) report on a consistent set of metrics, including MUAC; 2) attempt to measure change in wasting incidence using more frequent measures; 3) measure wasting prevalence among the general population; 4) follow children postintervention to assess relapse; 5) measure food insecurity and diet quality; and 6) use harmonized protocols across multiple settings. Such efforts to improve study comparability will strengthen the evidence base, may help unite divergent professional communities, and ultimately accelerate progress toward eliminating child undernutrition.
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Affiliation(s)
| | | | - Rebecca Heidkamp
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Roberts SB, Franceschini MA, Silver RE, Taylor SF, de Sa AB, Có R, Sonco A, Krauss A, Taetzsch A, Webb P, Das SK, Chen CY, Rogers BL, Saltzman E, Lin PY, Schlossman N, Pruzensky W, Balé C, Chui KKH, Muentener P. Effects of food supplementation on cognitive function, cerebral blood flow, and nutritional status in young children at risk of undernutrition: randomized controlled trial. BMJ 2020; 370:m2397. [PMID: 32699176 PMCID: PMC7374799 DOI: 10.1136/bmj.m2397] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess the effects of food supplementation on improving working memory and additional measures including cerebral blood flow in children at risk of undernutrition. DESIGN Randomized controlled trial. SETTING 10 villages in Guinea-Bissau. PARTICIPANTS 1059 children aged 15 months to 7 years; children younger than 4 were the primary population. INTERVENTIONS Supervised isocaloric servings (≈1300 kJ, five mornings each week, 23 weeks) of a new food supplement (NEWSUP, high in plant polyphenols and omega 3 fatty acids, within a wide variety and high fortification of micronutrients, and a high protein content), or a fortified blended food (FBF) used in nutrition programs, or a control meal (traditional rice breakfast). MAIN OUTCOME MEASUREMENTS The primary outcome was working memory, a core executive function predicting long term academic achievement. Additional outcomes were hemoglobin concentration, growth, body composition, and index of cerebral blood flow (CBFi). In addition to an intention-to-treat analysis, a predefined per protocol analysis was conducted in children who consumed at least 75% of the supplement (820/925, 89%). The primary outcome was assessed by a multivariable Poisson model; other outcomes were assessed by multivariable linear mixed models. RESULTS Among children younger than 4, randomization to NEWSUP increased working memory compared with the control meal (rate ratio 1.20, 95% confidence interval 1.02 to 1.41, P=0.03), with a larger effect in the per protocol population (1.25, 1.06 to 1.47, P=0.009). NEWSUP also increased hemoglobin concentration among children with anemia (adjusted mean difference 0.65 g/dL, 95% confidence interval 0.23 to 1.07, P=0.003) compared with the control meal, decreased body mass index z score gain (-0.23, -0.43 to -0.02, P=0.03), and increased lean tissue accretion (2.98 cm2, 0.04 to 5.92, P=0.046) with less fat (-5.82 cm2, -11.28 to -0.36, P=0.04) compared with FBF. Additionally, NEWSUP increased CBFi compared with the control meal and FBF in both age groups combined (1.14 mm2/s×10-8, 0.10 to 2.23, P=0.04 for both comparisons). Among children aged 4 and older, NEWSUP had no significant effect on working memory or anemia, but increased lean tissue compared with FBF (4.31 cm2, 0.34 to 8.28, P=0.03). CONCLUSIONS Childhood undernutrition is associated with long term impairment in cognition. Contrary to current understanding, supplementary feeding for 23 weeks could improve executive function, brain health, and nutritional status in vulnerable young children living in low income countries. Further research is needed to optimize nutritional prescriptions for regenerative improvements in cognitive function, and to test effectiveness in other vulnerable groups. TRIAL REGISTRATION ClinicalTrials.gov NCT03017209.
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Affiliation(s)
- Susan B Roberts
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Maria A Franceschini
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Rachel E Silver
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Salima F Taylor
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Augusto Braima de Sa
- International Partnership for Human Development, Leesburg, VA, USA and Bissau, Guinea Bissau
| | - Raimundo Có
- International Partnership for Human Development, Leesburg, VA, USA and Bissau, Guinea Bissau
| | - Aliu Sonco
- International Partnership for Human Development, Leesburg, VA, USA and Bissau, Guinea Bissau
| | | | - Amy Taetzsch
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Patrick Webb
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sai Krupa Das
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - C-Y Chen
- Biofortis, Mérieux NutriSciences, Addison, IL, USA
| | - Beatrice L Rogers
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Edward Saltzman
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Pei-Yi Lin
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Nina Schlossman
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Global Food and Nutrition, Washington, DC, USA
| | - William Pruzensky
- International Partnership for Human Development, Leesburg, VA, USA and Bissau, Guinea Bissau
| | - Carlito Balé
- International Partnership for Human Development, Leesburg, VA, USA and Bissau, Guinea Bissau
| | - Kenneth Kwan Ho Chui
- Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA, USA
| | - Paul Muentener
- Department of Psychology, Tufts University, Medford, MA, USA
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Effectiveness of school-based nutrition interventions in sub-Saharan Africa: a systematic review. Public Health Nutr 2020; 23:2626-2636. [PMID: 32646534 DOI: 10.1017/s1368980020000506] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the effect of school-based nutrition interventions (SBNI) involving schoolchildren and adolescents in sub-Saharan Africa (SSA) on child nutrition status and nutrition-related knowledge, attitudes and behaviour. DESIGN A systematic review on published school nutrition intervention studies of randomised controlled trials, controlled clinical trials, controlled before-and-after studies or quasi-experimental designs with control. Nine electronic bibliographic databases were searched. To be included, interventions had to involve changes to the school's physical and social environments, to the school's nutrition policies, to teaching curriculum to incorporate nutrition education and/or to partnership with parents/community. SETTING Schools in SSA. PARTICIPANTS School-aged children and adolescents, aged 5-19 years. RESULTS Fourteen studies met our inclusion criteria. While there are few existing studies of SBNI in SSA, the evidence shows that food supplementation/fortification is very effective in reducing micronutrient deficiencies and can improve nutrition status. Secondly, school nutrition education can improve nutrition knowledge, but this may not necessarily translate into healthy nutrition behaviour, indicating that nutrition knowledge may have little impact without a facilitating environment. Results regarding anthropometry were inconclusive; however, there is evidence for the effectiveness of SBNI in improving cognitive abilities. CONCLUSIONS There is enough evidence to warrant further trials of SBNI in SSA. Future research should consider investigating the impact of SBNI on anthropometry and nutrition behaviour, focusing on the role of programme intensity and/or duration. To address the high incidence of micronutrient deficiencies in low- and middle-income countries, food supplementation strategies currently available to schoolchildren should be expanded.
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Tam E, Keats EC, Rind F, Das JK, Bhutta ZA. Micronutrient Supplementation and Fortification Interventions on Health and Development Outcomes among Children Under-Five in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Nutrients 2020; 12:E289. [PMID: 31973225 PMCID: PMC7071447 DOI: 10.3390/nu12020289] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/10/2020] [Accepted: 01/19/2020] [Indexed: 12/20/2022] Open
Abstract
Micronutrient deficiencies continue to be widespread among children under-five in low- and middle-income countries (LMICs), despite the fact that several effective strategies now exist to prevent them. This kind of malnutrition can have several immediate and long-term consequences, including stunted growth, a higher risk of acquiring infections, and poor development outcomes, all of which may lead to a child not achieving his or her full potential. This review systematically synthesizes the available evidence on the strategies used to prevent micronutrient malnutrition among children under-five in LMICs, including single and multiple micronutrient (MMN) supplementation, lipid-based nutrient supplementation (LNS), targeted and large-scale fortification, and point-of-use-fortification with micronutrient powders (MNPs). We searched relevant databases and grey literature, retrieving 35,924 papers. After application of eligibility criteria, we included 197 unique studies. Of note, we examined the efficacy and effectiveness of interventions. We found that certain outcomes, such as anemia, responded to several intervention types. The risk of anemia was reduced with iron alone, iron-folic acid, MMN supplementation, MNPs, targeted fortification, and large-scale fortification. Stunting and underweight, however, were improved only among children who were provided with LNS, though MMN supplementation also slightly increased length-for-age z-scores. Vitamin A supplementation likely reduced all-cause mortality, while zinc supplementation decreased the incidence of diarrhea. Importantly, many effects of LNS and MNPs held when pooling data from effectiveness studies. Taken together, this evidence further supports the importance of these strategies for reducing the burden of micronutrient malnutrition in children. Population and context should be considered when selecting one or more appropriate interventions for programming.
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Affiliation(s)
- Emily Tam
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (E.T.); (E.C.K.)
| | - Emily C. Keats
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (E.T.); (E.C.K.)
| | - Fahad Rind
- Centre of Excellence in Women and Child’s Health, Aga Khan University, Karachi 74800, Pakistan;
| | - Jai K. Das
- Division of Women and Child Health, Aga Khan University, Karachi 74800, Pakistan;
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (E.T.); (E.C.K.)
- Centre of Excellence in Women and Child’s Health, Aga Khan University, Karachi 74800, Pakistan;
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A macro- and micronutrient-fortified complementary food supplement reduced acute infection, improved haemoglobin and showed a dose-response effect in improving linear growth: a 12-month cluster randomised trial. J Nutr Sci 2019; 8:e22. [PMID: 31275576 PMCID: PMC6598226 DOI: 10.1017/jns.2019.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 02/05/2023] Open
Abstract
Inadequate protein quality may be a risk factor for poor growth. To examine the effect of a macronutrient-micronutrient supplement KOKO Plus (KP), provided to infants from 6 to 18 months of age, on linear growth, a single-blind cluster-randomised study was implemented in Ghana. A total of thirty-eight communities were randomly allocated to receive KP (fourteen communities, n 322), a micronutrient powder (MN, thirteen communities, n 329) and nutrition education (NE, eleven communities, n 319). A comparison group was followed cross-sectionally (n 303). Supplement delivery and morbidity were measured weekly and anthropometry monthly. NE education was provided monthly. Baseline, midline and endline measurements at 6, 12 and 18 months included venous blood draws, diet, anthropometry, morbidity, food security and socio-economics. Length-for-age Z-score (LAZ) was the primary outcome. Analyses were intent-to-treat using mixed-effects regressions adjusted for clustering, sex, age and baseline. No differences existed in mean LAZ scores at endline (-1·219 (sd 0·06) KP, -1·211 (sd 0·03) MN, -1·266 (sd 0·03) NE). Acute infection prevalence was lower in the KP than NE group (P = 0·043). Mean serum Hb was higher in KP infants free from acute infection (114·02 (sd 1·87) g/l) than MN (107·8 (sd 2·5) g/l; P = 0·047) and NE (108·8 (sd 0·99) g/l; P = 0·051). Compliance was 84·9 % (KP) and 87·2 % (MN) but delivery 60 %. Adjusting for delivery and compliance, LAZ score at endline was significantly higher in the KP v. MN group (+0·2 LAZ; P = 0·026). A macro- and micronutrient-fortified supplement KP reduced acute infection, improved Hb and demonstrated a dose-response effect on LAZ adjusting consumption for delivery.
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Key Words
- AGP, α-1-acid-glycoprotein
- B, baseline
- CRP, C-reactive protein
- Complementary feeding
- E, endline
- GHS, Ghana Health Service
- Hb
- IGF-1, insulin-like growth factor-1
- KOKO Plus
- KP, KOKO Plus
- LAZ, length-for-age Z-score
- Linear growth
- M, midline
- MN, micronutrient powder
- MUAC, mid upper arm circumference
- NE, nutrition education
- RNI, recommended nutrient intakes
- WAZ, weight-for-age Z-score
- WHZ, weight-for-height Z-score
- WLZ, weight-for-length Z-score
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Larson LM, Kubes JN, Ramírez‐Luzuriaga MJ, Khishen S, H. Shankar A, Prado EL. Effects of increased hemoglobin on child growth, development, and disease: a systematic review and meta‐analysis. Ann N Y Acad Sci 2019; 1450:83-104. [DOI: 10.1111/nyas.14105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/24/2019] [Accepted: 04/03/2019] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Maria J. Ramírez‐Luzuriaga
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate SchoolEmory University Atlanta Georgia
| | - Sarah Khishen
- Department of Public Health SciencesUniversity of California – Davis Davis California
| | - Anuraj H. Shankar
- Eijkman‐Oxford Clinical Research UnitEijkman Institute for Molecular Biology Jakarta Indonesia
- The Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of Oxford Oxford United Kingdom
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Eaton JC, Rothpletz‐Puglia P, Dreker MR, Iannotti L, Lutter C, Kaganda J, Rayco‐Solon P. Effectiveness of provision of animal-source foods for supporting optimal growth and development in children 6 to 59 months of age. Cochrane Database Syst Rev 2019; 2:CD012818. [PMID: 30779870 PMCID: PMC6380771 DOI: 10.1002/14651858.cd012818.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Adequate nutrients early in life promote cognitive development and are critical for proper growth and functioning. The effect of individual nutrients consumed through food is often not the same as consuming the same nutrients in supplementary form due to 'food synergy', the biological and chemical interrelations that occur between nutrients. Animal-source foods, such as eggs, meat, fish, and dairy, are energy dense and contain multiple micronutrients and essential fatty acids with high bioavailability. The benefits of animal-source foods may include higher food synergy relative to fortified foods as well as decreasing dependence on external suppliers of fortified foods. OBJECTIVES To assess the effectiveness of animal-source foods compared to any other feeding interventions or no intervention in improving growth and developmental outcomes in children aged 6 to 59 months. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, 18 other databases, and three trials registers up to August 2018. We also contacted authors and known experts in the field for assistance in identifying ongoing or unpublished data, and searched the reference lists of included studies and reviews, and websites of relevant organizations, for other studies that may not have been captured by our electronic searches. SELECTION CRITERIA We included randomized controlled trials and quasi-randomized controlled trials of any duration, where children between 5 months and 59 months (6 years) of age were provided with an animal-source food (e.g. consumption of milk, meat, or eggs), prepared with any cooking method, compared with any intervention or no intervention. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility using prespecified criteria, extracted data, assessed risk of bias, and graded the quality of the evidence using the GRADE approach. MAIN RESULTS Study characteristicsWe included 6 studies that analyzed data from 3036 children aged 5 to 50 months. The studies were conducted in China, the Democratic Republic of Congo, Ecuador, Guatemala, Pakistan, the USA, and Zambia, and lasted between 5 and 12 months. Three studies were funded, in part, by government entities; one study was supported by a nonprofit organization. Two studies did not report a funding source.Three studies compared the effects of feeding an animal-source food with a fortified (iron or iron and zinc), or unfortified cereal; two used a control group with no intervention; one compared a meat-based diet to a dairy-based diet. The types of animal-source foods tested included yogurt, eggs, cheese, lyophilized (freeze-dried) beef product, ground and frozen pork, puréed and jarred beef with gravy or pork, and powdered whey protein.We judged four studies to be at unclear risk of bias overall; three studies because they were funded by an industry with a plausible interest in the outcome of the intervention; and one study because there was insufficient information to assess five of the seven bias 'Risk of bias' domains. We judged two of the six studies to be at high risk of bias overall; one study because there was significant baseline imbalance in length-for-age z scores (LAZ) between groups and evidence of selective reporting; the other study because there there was both a significant baseline imbalance in LAZ and weight-for-age z scores (WAZ) between groups, and a large-scale social media campaign that may have influenced care received at home in the control group.Key resultsAnimal-source foods versus cereal-based foods or no interventionFive studies (2972 children) measured change in linear growth with either height-for-age z scores (HAZ) or LAZ. Three studies (592 children) reported a significant increase in HAZ and LAZ in the intervention group compared to the control group. Two studies (2380 children) reported a decline in LAZ in both groups. In one study (1062 children) there was no difference between the groups in the rate of decline; in the other (1318 children) the decrease in LAZ was significantly smaller in the intervention group.Five studies (2972 children) measured weight gain using WAZ. Three studies (592 children) reported a significant increase in WAZ in the intervention group compared to the control group. In two studies (2380 children), WAZ decreased in both groups. In one of these studies (1318 children), the decrease in the intervention group was significantly smaller than in the control group. In the other study (1062 children), there was no difference between the groups.Three studies (1612 children) reported impacts on all-cause morbidity, but metrics were inconsistent between studies. One study with yogurt (402 children) reported a significant reduction in duration and incidence of diarrhea and upper respiratory infections in the intervention group. One study with eggs (148 children) reported a significant increase in the incidence of diarrhea in the intervention group, but this may have been due to cultural associations with eggs and gastrointestional problems. There were no other significant differences in fever, respiratory infections, or skin conditions between groups. The third study (1062 children) found no differences between intervention and control groups across morbidity measures.No studies reported data on anemia.Meat-based diet versus dairy-based dietOne study (64 children) measured change in LAZ and WAZ in infants fed either a meat-based diet or dairy-based diet. There was a significant increase in LAZ among infants consuming the meat-based diet and a significant decrease in LAZ among infants consuming a dairy-based diet. WAZ increased in both groups, with no significant difference between groups.The study did not assess all-cause morbidity or anemia.Quality of the evidenceWe rated the quality of the evidence as very low overall due to baseline imbalances between intervention and control groups, high heterogeneity in meta-analysis, and imprecision due to wide confidence intervals and inconsistent direction of effects. We have little confidence in the results; further research is likely to change the estimate of magnitude and direction of treatment effect. AUTHORS' CONCLUSIONS Given the limited quality of the evidence, we are uncertain of the effects of the provision of animal-source food versus cereal products or no intervention on the growth or development of children. More adequately powered trials with deliberately selected animal-source foods are needed.
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Affiliation(s)
- Jacob C Eaton
- Washington University in St. LouisBrown School/Institute for Public Health1 Brookings DriveSt. LouisMissouriUSA63130
| | - Pamela Rothpletz‐Puglia
- Rutgers, The State University of New Jersey, School of Health ProfessionsNutritional Sciences65 Bergen Street, SSB 157NewarkNew JerseyUSA07107
| | - Margaret R Dreker
- Rutgers, The State University of New Jersey, School of Health ProfessionsRutgers University Libraries, George F. Smith Library of the Health Sciences30 12th AveNewarkNew JerseyUSA07101
| | - Lora Iannotti
- Washington University in St. LouisBrown School/Institute for Public Health1 Brookings DriveSt. LouisMissouriUSA63130
| | - Chessa Lutter
- RTI InternationalFood Security and Agriculture, International Development Group701 13th Street #750WashingtonDistrict of ColumbiaUSA20005
- University of MarylandSchool of Public HealthRoom 11424200 Valley Drive, Suite 2242College ParkMarylandUSA20742‐2611
| | - Joyceline Kaganda
- Tanzania Food and Nutrition Centre22 Barack Obama AvenuePO Box 977Dar es SalaamTanzania
| | - Pura Rayco‐Solon
- World Health OrganizationEvidence and Programme Guidance, Department of Nutrition for Health and Development20 Avenue AppiaGenevaSwitzerland1211
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10
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Schlossman N. Higher Levels of Dairy Result in Improved Physical Outcomes: A Synthesis of 3 Randomized Controlled Trials in Guinea-Bissau Comparing Supplements with Different Levels of Dairy Ingredients Among Children 6 to 59 Months, 5 to 19 Year Olds, and Mothers in Preschools, Primary Schools, and Villages, and the Implications for Programs. Food Nutr Bull 2018; 39:S35-S44. [PMID: 30238801 DOI: 10.1177/0379572118795729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This article synthesizes the results of 3 cluster randomized controlled trials of dairy-containing ready-to-use supplementary foods (RUSFs) to address malnutrition in primary schools, preschools and villages in Guinea-Bissau, one of the world's poorest countries. Together, these studies document widespread malnutrition across infants, young children, adolescents, and pregnant and lactating women and point to intervention options that were not previously presented. OBJECTIVE To combine the evidence from the United States Department of Agriculture-funded pilot studies in Guinea-Bissau on the effects of dairy protein supplementation to gain a broader perspective on the role of dairy containing RUSFs in various age-groups, the importance of the mother-child dyad and family food dynamics for infant and child growth. Translate the results into action and the next generation of effective products. METHODS A comparative analysis of data and synthesis of evidence from 3 published studies and ongoing research conducted by our team in Guinea-Bissau. RESULTS AND CONCLUSIONS Higher dairy supplements have the potential to achieve broad benefits for malnutrition, especially in mothers and early childhood (first 1000 days and 36-59 months). Higher levels of dairy protein also can prevent moderate acute malnutrition in children younger than 2 years, independent of the family food dynamic. Community-level nutrition behavior change education should target older children and adolescents at the community level and through the preschool/school platform.
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Affiliation(s)
- Nina Schlossman
- 1 Global Food & Nutrition Inc, Washington, DC, USA.,2 Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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11
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Yackobovitch-Gavan M, Phillip M, Gat-Yablonski G. How Milk and Its Proteins Affect Growth, Bone Health, and Weight
. Horm Res Paediatr 2018; 88:63-69. [PMID: 28253494 DOI: 10.1159/000456662] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/18/2017] [Indexed: 12/28/2022] Open
Abstract
Milk has long been recognized to constitute a complete, well-balanced source of the nutrients and energy required to ensure the proper postnatal growth and development of infants. A growing body of evidence suggests the positive effects of dairy products and particularly of milk proteins on linear growth also in older children, both healthy or during recovery from malnutrition. This evidence led the way to the performance of extensive research aimed to delineate the components of milk and the mechanisms acting to make milk so effective. The present review summarizes the current knowledge regarding the influence of milk and its proteins on linear growth in healthy and malnourished children, focusing also on other important aspects of healthy growth, including bone health, weight status, and body composition.
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Affiliation(s)
- Michal Yackobovitch-Gavan
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Galia Gat-Yablonski
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Felsenstein Medical Research Center, Petach Tikva, Israel
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12
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Abstract
The present narrative review outlines the use of milk products in infant and young child feeding from early history until today and illustrates how research findings and technical innovations contributed to the evolution of milk-based strategies to combat undernutrition in children below the age of 5 years. From the onset of social welfare initiatives, dairy products were provided by maternal and child health services to improve nutrition. During the last century, a number of aetiological theories on oedematous forms of undernutrition were developed and until the 1970s the dogma of protein deficiency was dominant. Thereafter, a multifactorial concept gained acceptance and protein quality was emphasised. During the last decades, research findings demonstrated that the inclusion of dairy products in the management of severe acute malnutrition is most effective. For children suffering from moderate acute malnutrition the evidence for the superiority of milk-based diets is less clear. There is an unmet need for evaluating locally produced milk-free alternatives at lower cost, especially in countries that rely on imported dairy products. New strategies for the dietary management of childhood undernutrition need to be developed on the basis of research findings, current child feeding practices, socio-cultural conditions and local resources. Exclusive and continued breast-feeding supported by community-based nutrition programmes using optimal combinations of locally available complementary foods should be compared with milk product-based interventions.
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13
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Roberts SB, Franceschini MA, Krauss A, Lin PY, Braima de Sa A, Có R, Taylor S, Brown C, Chen O, Johnson EJ, Pruzensky W, Schlossman N, Balé C, Wu KC(T, Hagan K, Saltzman E, Muentener P. A Pilot Randomized Controlled Trial of a New Supplementary Food Designed to Enhance Cognitive Performance during Prevention and Treatment of Malnutrition in Childhood. Curr Dev Nutr 2017; 1:e000885. [PMID: 29658962 PMCID: PMC5898396 DOI: 10.3945/cdn.117.000885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/11/2017] [Accepted: 10/12/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cognitive impairment associated with childhood malnutrition and stunting is generally considered irreversible. OBJECTIVE The aim was to test a new nutritional supplement for the prevention and treatment of moderate-acute malnutrition (MAM) focused on enhancing cognitive performance. METHODS An 11-wk, village-randomized, controlled pilot trial was conducted in 78 children aged 1-3 or 5-7 y living in villages in Guinea-Bissau. The supplement contained 291 kcal/d for young children and 350 kcal/d for older children and included 5 nutrients and 2 flavan-3-ol-rich ingredients not present in current food-based recommendations for MAM. Local bakers prepared the supplement from a combination of locally sourced items and an imported mix of ingredients, and it was administered by community health workers 5 d/wk. The primary outcome was executive function abilities at 11 wk. Secondary outcomes included additional cognitive measures and changes in z scores for weight (weight-for-age) and height (height-for-age) and hemoglobin concentrations at 11 wk. An index of cerebral blood flow (CBF) was also measured at 11 wk to explore the use of this measurement as a biological index of cognitive impairment. RESULTS There were no significant differences in any outcome between groups at baseline. There was a beneficial effect of random assignment to the supplement group on working memory at 11 wk in children aged 1-3 y (P < 0.05). This difference contrasted with no effect in older children and was not associated with faster growth rate. In addition, CBF correlated with task-switching performance (P < 0.05). CONCLUSIONS These preliminary data suggest that cognitive impairment can be monitored with measurement of CBF. In addition, the findings provide preliminary data that suggest that it may be possible to improve poor cognitive performance in young children through changes in the nutritional formulation of supplementary foods used to prevent and treat MAM. Powered studies of the new supplement formulation are needed. This trial was registered at clinicaltrials.gov as NCT03017209.
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Affiliation(s)
- Susan B Roberts
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | | | - Amy Krauss
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Pei-Yi Lin
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA
| | - Augusto Braima de Sa
- International Partnership for Human Development, Leesburg, VA
- International Partnership for Human Development, Bissau, Guinea-Bissau
| | - Raimundo Có
- International Partnership for Human Development, Leesburg, VA
- International Partnership for Human Development, Bissau, Guinea-Bissau
| | - Salima Taylor
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Carrie Brown
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Oliver Chen
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Elizabeth J Johnson
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - William Pruzensky
- International Partnership for Human Development, Leesburg, VA
- International Partnership for Human Development, Bissau, Guinea-Bissau
| | | | - Carlito Balé
- International Partnership for Human Development, Leesburg, VA
- International Partnership for Human Development, Bissau, Guinea-Bissau
| | - Kuan-Cheng (Tony) Wu
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA
| | - Katherine Hagan
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA
| | - Edward Saltzman
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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14
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Baum JI, Miller JD, Gaines BL. The effect of egg supplementation on growth parameters in children participating in a school feeding program in rural Uganda: a pilot study. Food Nutr Res 2017; 61:1330097. [PMID: 28659739 PMCID: PMC5475308 DOI: 10.1080/16546628.2017.1330097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/07/2017] [Indexed: 11/07/2022] Open
Abstract
Background: School feeding programs have gained popularity in developing countries . Eggs are an inexpensive source of micronutrients and high-quality protein. Therefore, the objective of this study was to gain preliminary data regarding the impact of egg supplementation on growth in primary school students participating in a school feeding program in rural Uganda. Methods: Children (ages 6–9; n = 241) were recruited from three different schools located throughout the Kitgum District of Uganda. All participants in the same school received the same dietary intervention: control (no eggs (0 eggs); n = 56), one egg five days per week (1 egg; n = 89), or two eggs five days per week (2 eggs; n = 96). Height, weight, tricep skinfold thickness (TSF), and mid-upper arm circumference (MUAC) were measured monthly over 6 months. Results: Following six months of egg supplementation, participants receiving 2 eggs had a greater increase in height and weight compared to the 0 eggs and 1 egg groups (P < 0.05). In addition, participants receiving 1 egg and 2 eggs had a significantly higher (P < 0.05) increase in MUAC at six months compared to 0 eggs. Conclusion: These results suggest that supplementation with eggs can improve parameters of growth in school-aged children participating in school feeding programs in rural Uganda. Abbreviations: MUAC: Mid-Upper Arm Circumference; TSF: Tricep Skinfold Thickness
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Affiliation(s)
- Jamie I Baum
- Department of Food Science, University of Arkansas, Fayetteville, AR, USA
| | - Jefferson D Miller
- Department of Agricultural Education, Communications and Technology, University of Arkansas, Fayetteville, AR, USA
| | - Brianna L Gaines
- Department of Food Science, University of Arkansas, Fayetteville, AR, USA
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15
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Gafos M, Brodnicki E, Desai M, McCormack S, Nutland W, Wayal S, White E, Wood G, Barber T, Bell G, Clarke A, Dolling D, Dunn D, Fox J, Haddow L, Lacey C, Nardone A, Quinn K, Rae C, Reeves I, Rayment M, White D, Apea V, Ayap W, Dewsnap C, Collaco-Moraes Y, Schembri G, Sowunmi Y, Horne R. Acceptability of an open-label wait-listed trial design: Experiences from the PROUD PrEP study. PLoS One 2017; 12:e0175596. [PMID: 28426834 PMCID: PMC5398545 DOI: 10.1371/journal.pone.0175596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/28/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND PROUD participants were randomly assigned to receive pre-exposure prophylaxis (PrEP) immediately or after a deferred period of one-year. We report on the acceptability of this open-label wait-listed trial design. METHODS Participants completed an acceptability questionnaire, which included categorical study acceptability data and free-text data on most and least liked aspects of the study. We also conducted in-depth interviews (IDI) with a purposely selected sub-sample of participants. RESULTS Acceptability questionnaires were completed by 76% (415/544) of participants. After controlling for age, immediate-group participants were almost twice as likely as deferred-group participants to complete the questionnaire (AOR:1.86;95%CI:1.24,2.81). In quantitative data, the majority of participants in both groups found the wait-listed design acceptable when measured by satisfaction of joining the study, intention to remain in the study, and interest in joining a subsequent study. However, three-quarters thought that the chance of being in the deferred-group might put other volunteers off joining the study. In free-text responses, data collection tools were the most frequently reported least liked aspect of the study. A fifth of deferred participants reported 'being deferred' as the thing they least liked about the study. However, more deferred participants disliked the data collection tools than the fact that they had to wait a year to access PrEP. Participants in the IDIs had a good understanding of the rationale for the open-label wait-listed study design. Most accepted the design but acknowledged they were, or would have been, disappointed to be randomised to the deferred group. Five of the 25 participants interviewed reported some objection to the wait-listed design. CONCLUSION The quantitative and qualitative findings suggest that in an environment where PrEP was not available, the rationale for the wait-listed trial design was well understood and generally acceptable to most participants in this study.
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Affiliation(s)
- Mitzy Gafos
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Elizabeth Brodnicki
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Monica Desai
- HIV/STI Department, Public Health England, London, United Kingdom
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Will Nutland
- Sigma research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sonali Wayal
- Centre for Sexual Health and HIV Research, Mortimer Market Centre, London, United Kingdom
| | - Ellen White
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Gemma Wood
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Tristan Barber
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Gill Bell
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Amanda Clarke
- Claude Nichol Centre, Royal Sussex County Hospital, Brighton, United Kingdom
| | - David Dolling
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - David Dunn
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Julie Fox
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lewis Haddow
- Centre for Sexual Health and HIV Research, Mortimer Market Centre, London, United Kingdom
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Charles Lacey
- York Hospitals NHS Foundation Trust, York, United Kingdom
| | - Anthony Nardone
- HIV/STI Department, Public Health England, London, United Kingdom
| | - Killian Quinn
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Caroline Rae
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Iain Reeves
- Department of Sexual Health, Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | - Michael Rayment
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - David White
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Vanessa Apea
- Ambrose King Centre, Barts Health NHS Trust, London, United Kingdom
| | - Wilbert Ayap
- St Mary’s Hospital, Imperial College NHS Foundation Trust, London, United Kingdom
| | - Claire Dewsnap
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Yolanda Collaco-Moraes
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Yinka Sowunmi
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Rob Horne
- School of Pharmacy, University College London, London, United Kingdom
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16
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Schlossman N, Brown C, Batra P, de Sa AB, Balan I, Balan A, Gamache MG, Wood L, Pruzensky W, Saltzman E, Roberts SB, Balé C. A Randomized Controlled Trial of Two Ready-to-Use Supplementary Foods Demonstrates Benefit of the Higher Dairy Supplement for Reduced Wasting in Mothers, and Differential Impact in Infants and Children Associated With Maternal Supplement Response. Food Nutr Bull 2017; 38:275-290. [PMID: 28374648 DOI: 10.1177/0379572117700754] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is no consensus over best approaches to reliably prevent malnutrition in rural communities in low-income countries. OBJECTIVE We compared the effectiveness of 2 lipid-based ready-to-use supplementary foods (RUSFs) differing in dairy protein content to improve the nutritional status of mothers and at-risk infants and young children in rural Guinea-Bissau. METHODS A 3-month cluster-randomized controlled pilot trial of 2 RUSFs was conducted with 692 mothers and 580 mildly or moderately malnourished infants (6-23 months) and children (24-59 months) from 13 villages. The RUSFs contained either 478 (mothers, children) or 239 kcal/d (infants) with 15% or 33% of protein from dairy and were distributed at community health centers 5 d/wk. Controls were wait-listed to receive RUSF. Primary outcomes were mid-upper arm circumference (MUAC) in mothers, and weight-for-age and height-for-age z-scores (WAZ and HAZ) in infants and children. RESULTS There was a significant effect of the RUSF-33% on MUAC in mothers ( P = .03). The WAZ and HAZ increased substantially, by ≈1 z-score, in infants and children ( P < .01) independent of group randomization. In children, but not infants, baseline WAZ and change in maternal MUAC were associated with change in WAZ (β = .07, P = .02). CONCLUSION Ready-to-use supplementary foods with higher dairy protein content had a significant benefit in village mothers, supporting a comparable recent finding in preschool children. In addition, supplementation of children <2 years resulted in improved growth independent of family nutritional status, whereas success in older children was associated with change in maternal nutrition, suggesting the need for community-level education about preventing malnutrition in older, as well as younger, children.
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Affiliation(s)
- Nina Schlossman
- 1 Global Food & Nutrition Inc, Washington, DC, USA.,2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Carrie Brown
- 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Payal Batra
- 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Augusto Braima de Sa
- 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau
| | - Ionela Balan
- 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau
| | - Adrian Balan
- 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau
| | - Madeleine G Gamache
- 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Lauren Wood
- 1 Global Food & Nutrition Inc, Washington, DC, USA
| | - William Pruzensky
- 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau
| | - Edward Saltzman
- 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Susan B Roberts
- 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Carlito Balé
- 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau
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17
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Schlossman N. Delivering Improved Nutrition: Dairy Ingredients in Food Aid Products. Food Nutr Bull 2016; 37 Suppl 1:S6-S13. [PMID: 27005492 DOI: 10.1177/0379572116629780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The United States has a long history of food assistance for humanitarian need. The Food for Peace Act of 1954 established the United States' permanent food assistance program which has fed over 3 billion people in 150 countries worldwide through thousands of partner organizations. In 60 years, the program has evolved and will continue to do so. Recently, the program has gone from a focus on quantity of food shipped to quality food assistance from improved products, programs, and processes to effectively meet the needs of different vulnerable groups. The current debate focuses on the appropriateness of using fortified blended foods to prevent and treat malnutrition during the first 1000 days of life. Dairy ingredients have been at the center of this debate; they were included initially in fortified blended, removed in the 1980s, and now reincorporated into fortified therapeutic and supplemental foods. Improved quality food baskets and effective nutrition programming to prevent and treat malnutrition were developed through multisectoral collaboration between government and nongovernment organizations. The US Agency for International Development has focused on improving nutrition through development programs often tied to health, education, and agriculture. The years since 2008 have been a particularly intense period for improvement. The Food Aid Quality Review was established to update current food aid programming products, program implementation, cost-effectiveness, and interagency processes. Trials are underway to harmonize the areas of multisectoral nutrition programming and gather more evidence on the effects of dairy ingredients in food aid products.
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Affiliation(s)
- Nina Schlossman
- Global Food & Nutrition Inc., Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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18
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Suri DJ, Moorthy D, Rosenberg IH. The Role of Dairy in Effectiveness and Cost of Treatment of Children With Moderate Acute Malnutrition: A Narrative Review. Food Nutr Bull 2016; 37:176-85. [PMID: 26936209 DOI: 10.1177/0379572116633327] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dairy is recommended in specially formulated supplementary foods to treat children with moderate acute malnutrition (MAM) but with limited evidence and added cost. OBJECTIVE Review studies of ready-to-use foods (RUFs) versus fortified blended foods (FBFs) to determine whether inclusion of dairy modifies the comparative effectiveness and cost. METHODS We reviewed literature comparing FBF and RUF in treatment of MAM among children younger than 5 years in developing countries. Outcomes of recovery from MAM, weight, and length gain were compared among treatment categories: FBF with dairy (FBF+), FBF without dairy (FBF-), RUF with dairy (RUF+), and RUF without dairy (RUF-). Supplement cost was compared per 500 kcal. RESULTS Eight studies were included. Rations were heterogeneous in energy and type of dairy. Overall, RUF+, RUF-, and FBF+ performed similarly, with higher recovery and weight gain compared with FBF-. RUF+ had higher recovery (in 5 of 6 comparisons), weight gain (4 of 4), and length gain (1 of 4) versus FBF-. The RUF+ had higher recovery (1 of 2) versus FBF+, with no other differences. The RUF- versus FBF+ had no differences (0 of 2). The RUF- had higher recovery (1 of 2), weight gain (2 of 2) versus FBF-. Four studies reported supplement costs, which averaged US$0.15 (FBF-), US$0.18 (FBF+), US$0.18 (RUF-), and US$0.37 (RUF+) per 500 kcal. CONCLUSIONS There is a consistent benefit of FBF that include dairy in treatment of children with MAM. Benefits of dairy in RUF require further investigation. Evidence from rigorous quantitative analysis of existing data, cost-effectiveness, and prospective trials will be essential in determining policy on treatment for children with MAM.
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Affiliation(s)
- Devika J Suri
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA Department of Nutritional Sciences, University of Wisconsin, Madison, WI, USA
| | - Denish Moorthy
- Strengthening Partnerships, Results and Innovations in Nutrition Globally (SPRING) Project, Arlington, VA, USA
| | - Irwin H Rosenberg
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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