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Sharman A, Shaw JE, Shayanrad A, Shayesteh AA, Shengelia L, Shi Z, Shibuya K, Shimizu-Furusawa H, Shimony T, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Sidossis LS, Silitrari N, Silva AM, Silva CRDM, Silva DAS, Silva KS, Sim X, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skoblina EV, Skoblina NA, Slazhnyova T, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobek G, Sobngwi E, Sodemann M, Söderberg S, Soekatri MYE, Soemantri A, Sofat R, Solfrizzi V, Solovieva YV, Somi MH, Sonestedt E, Song Y, Soofi S, Sørensen TIA, Sørgjerd EP, Sossa Jérome C, Soto-Rojas VE, Soumaré A, Sousa-Poza A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spencer PR, Spinelli A, Spiroski I, Staessen JA, Stamm H, Stang A, Starc G, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Steinsbekk S, Stergiou GS, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, Suarez-Ortegón MF, Suebsamran P, Sugiyama M, Suka M, Sulo G, Sun CA, Sun L, Sund M, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Sweis NWG, Swinburn BA, Sy RG, Sylva RC, Szponar L, Tabone L, Tai ES, Takuro F, Tambalis KD, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanrygulyyeva M, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Taxová Braunerová R, Taylor A, Taylor J, Tchibindat F, Te Velde S, Tebar WR, Tell GS, Tello T, Tessema M, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thorand B, Thrift AG, Tichá Ľ, Timmermans EJ, Tjandrarini DH, Tjonneland A, Tolonen HK, Tolstrup JS, Tomaszewski M, Topbas M, Topór-Mądry R, Torheim LE, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Touloumi G, Traissac P, Tran TTH, Tremblay MS, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsigga M, Tsintavis P, Tsugane S, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Twig G, Tynelius P, Tzala E, Tzotzas T, Tzourio C, Udoji N, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Lippevelde W, Van Minh H, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Vargas LN, Varona-Pérez P, Vasan SK, Vasques DG, Vatasescu R, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Verloigne M, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Vik FN, Vilar M, Villalpando S, Vioque J, Viriyautsahakul N, Virtanen JK, Visser M, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Vollenweider P, Völzke H, Vourli G, Voutilainen A, Vrijheid M, Vrijkotte TGM, Vuletić S, Wade AN, Waldhör T, Walton J, Wambiya EOA, Wan Bebakar WM, Wan Mohamud WN, Wanderley Júnior RDS, Wang C, Wang H, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Wartha O, Weber A, Wedderkopp N, Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wichstrøm L, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wirth JP, Wojtyniak B, Woldeyohannes M, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan L, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, Yépez García M, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, Yotov Y, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Zeljkovic Vrkic T, Zeng Y, Zentai A, Zhang B, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zimmet P, Zins M, Zitt E, Zocalo Y, Zoghlami N, Zuñiga Cisneros J, Zuziak M, Ezzati M. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024; 403:1027-1050. [PMID: 38432237 PMCID: PMC7615769 DOI: 10.1016/s0140-6736(23)02750-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. METHODS We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). FINDINGS From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. INTERPRETATION The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. FUNDING UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.
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Rohner F, Wirth JP, Zeng W, Petry N, Donkor WES, Neufeld LM, Mkambula P, Groll S, Mbuya MN, Friesen VM. Global Coverage of Mandatory Large-Scale Food Fortification Programs: A Systematic Review and Meta-Analysis. Adv Nutr 2023; 14:1197-1210. [PMID: 37499980 PMCID: PMC10509437 DOI: 10.1016/j.advnut.2023.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/16/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023] Open
Abstract
Food fortification with micronutrients is widely implemented to reduce micronutrient deficiencies and related outcomes. Although many factors affect the success of fortification programs, high population coverage is needed to have a public health impact. We aimed to provide recent global coverage estimates of salt, wheat flour, vegetable oil, maize flour, rice, and sugar among countries with mandatory fortification legislation. The indicators were the proportion of households consuming the: food, fortifiable food (that is, industrially processed), fortified food (to any extent), and adequately fortified food (according to national or international standards). We estimated the number of individuals reached with fortified foods. We systematically retrieved and reviewed all applicable evidence from: published reports and articles from January 2010 to August 2021, survey lists/databases from key organizations, and reports/literature received from key informants. We analyzed data with R statistical package using random-effects meta-analysis models. An estimated 94.4% of households consumed salt, 78.4% consumed fortified salt (4.2 billion people), and 48.6% consumed adequately fortified salt in 64, 84, and 31 countries, respectively. Additionally, 77.4% of households consumed wheat flour, 61.6% consumed fortifiable wheat flour, and 47.1% consumed fortified wheat flour (66.2 million people) in 15, 8, and 10 countries, respectively, and 87.0% consumed vegetable oil, 86.7% consumed fortifiable oil, and 40.1% consumed fortified oil (123.9 million people) in 10, 7, and 5 countries, respectively. Data on adequately fortified wheat flour and vegetable oil and coverage indicators for maize flour, rice, and sugar were limited. There are major data gaps on fortification coverage for most foods except salt. All countries with mandatory fortification programs should generate and use more coverage data to assess program performance and adjust programs as needed to realize their potential to reduce micronutrient deficiencies (PROSPERO CRD42021269364).
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Affiliation(s)
| | | | - Wu Zeng
- GroundWork, Fläsch, Switzerland; Georgetown University, School of Health, Washington DC, United States
| | | | | | - Lynnette M Neufeld
- Food and Agriculture Organization of the United Nations (FAO; formerly GAIN)
| | - Penjani Mkambula
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Sydney Groll
- GroundWork, Fläsch, Switzerland; Georgetown University, School of Health, Washington DC, United States
| | - Mduduzi Nn Mbuya
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
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Siegal K, Musau K, Woodruff BA, Custer E, Vergari L, Anyango H, Donkor W, Kiprotich M, Rohner F, Wegmüller R. Factors associated with nutrition intervention adherence: Evidence from a cluster-randomised controlled trial in Kenya. Matern Child Nutr 2023; 19:e13467. [PMID: 36507550 PMCID: PMC10019062 DOI: 10.1111/mcn.13467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022]
Abstract
Nutrition experts point to the importance of a multipronged approach to address high stunting rates in rural areas. This can include nutrition-specific and -sensitive interventions, such as the provision of micronutrient powder, eggs, and chlorine, and nutrition training to improve feeding practices. In 2018, an agricultural nongovernmental organisation initiated a multipronged approach as part of a randomised trial. However, adherence to a programme with so many components can be challenging for participants. The aim of this study is to understand which factors are associated with high adherence in complex multifaceted nutrition-sensitive agricultural programmes. We used a mixed method approach in which we used bivariate and multivariable analyses to estimate the relationship between child and caregiver demographic factors with product adherence. We analyzed data from six focus groups and 120 feedback sessions on barriers to product adherence. We found that the age and sex of the child did not influence product adherence, but caregivers were more likely to adhere to all products if they were not the child's biological mother (most often grandmothers) (0.28 higher adherence score; p < 0.001) and if caregivers were older (0.34 higher adherence score, p < 0.001). A higher monthly training attendance, combining product distribution and interactive training, predicted stronger product adherence. Participants noted that adherence was supported by the early demonstration of positive results, regular reminders, interactive trainings, and the encouragement of family members. These findings underscore the importance of combining product distribution with training and include potentially targeting grandmothers and other caregivers who may demonstrate higher product adherence.
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Affiliation(s)
- Kim Siegal
- One Acre FundKakamegaKenya
- Present address:
Mathematica Policy ResearchWashingtonDistrict of ColumbiaUSA
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Siegal K, Musau K, Woodruff BA, Custer E, Vergari L, Anyango H, Donkor W, Kiprotich M, Rohner F, Wegmüller R. Cover Image. Matern Child Nutr 2023. [PMCID: PMC10019059 DOI: 10.1111/mcn.13510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Affiliation(s)
- Kim Siegal
- One Acre FundKakamegaKenya,Present address:
Mathematica Policy ResearchWashingtonDistrict of ColumbiaUSA
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Mishra A, Zhou B, Rodriguez-Martinez A, Bixby H, Singleton RK, Carrillo-Larco RM, Sheffer KE, Paciorek CJ, Bennett JE, Lhoste V, Iurilli MLC, Di Cesare M, Bentham J, Phelps NH, Sophiea MK, Stevens GA, Danaei G, Cowan MJ, Savin S, Riley LM, Gregg EW, Aekplakorn W, Ahmad NA, Baker JL, Chirita-Emandi A, Farzadfar F, Fink G, Heinen M, Ikeda N, Kengne AP, Khang YH, Laatikainen T, Laxmaiah A, Ma J, Monroy-Valle M, Mridha MK, Padez CP, Reynolds A, Sorić M, Starc G, Wirth JP, Abarca-Gómez L, Abdeen ZA, Abdrakhmanova S, Ghaffar SA, Abdul Rahim HF, Abdurrahmonova Z, Abu-Rmeileh NM, Garba JA, Acosta-Cazares B, Adam I, Adamczyk M, Adams RJ, Adu-Afarwuah S, Afsana K, Afzal S, Agbor VN, Agdeppa IA, Aghazadeh-Attari J, Aguenaou H, Aguilar-Salinas CA, Agyemang C, Ahmad MH, Ahmadi A, Ahmadi N, Ahmadi N, Ahmed I, Ahmed SH, Ahrens W, Aitmurzaeva G, Ajlouni K, Al-Hazzaa HM, Al-Lahou B, Al-Raddadi R, Al Hourani HM, Al Qaoud NM, Alarouj M, AlBuhairan F, AlDhukair S, Aldwairji MA, Alexius S, Ali MM, Alkandari A, Alkerwi A, Alkhatib BM, Allin K, Alvarez-Pedrerol M, Aly E, Amarapurkar DN, Etxezarreta PA, Amoah J, Amougou N, Amouyel P, Andersen LB, Anderssen SA, Androutsos O, Ängquist L, Anjana RM, Ansari-Moghaddam A, Anufrieva E, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Aseffa N, Aspelund T, Assah FK, Assembekov B, Assunção MCF, Aung MS, Auvinen J, Avdičová M, Avi S, Azevedo A, Azimi-Nezhad M, Azizi F, Azmin M, Babu BV, Jørgensen MB, Baharudin A, Bahijri S, Bakacs M, Balakrishna N, Balanova Y, Bamoshmoosh M, Banach M, Banegas JR, Baran J, Baran R, Barbagallo CM, Filho VB, Barceló A, Baretić M, Barkat A, Barnoya J, Barrera L, Barreto M, Barros AJD, Barros MVG, Bartosiewicz A, Basit A, Bastos JLD, Bata I, Batieha AM, Batista AP, Batista RL, Battakova Z, Baur LA, Bayauli PM, Beaglehole R, Bel-Serrat S, Belavendra A, Ben Romdhane H, Benedics J, Benet M, Rolandi GEB, Bere E, Bergh IH, Berhane Y, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Carrasola XB, Bettiol H, Beutel ME, Beybey AF, Bezerra J, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bi H, Bi Y, Bia D, Biasch K, Lele ECB, Bikbov MM, Bista B, Bjelica DJ, Bjerregaard AA, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Magnazu MB, Bo S, Bobak M, Boddy LM, Boehm BO, Boer JMA, Boggia JG, Bogova E, Boissonnet CP, Bojesen SE, Bonaccio M, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Bovet P, Boymatova K, Braeckevelt L, Braeckman L, Bragt MCE, Brajkovich I, Branca F, Breckenkamp J, Breda J, Brenner H, Brewster LM, Brian GR, Briceño Y, Brinduse L, Brito M, Brophy S, Brug J, Bruno G, Bugge A, Buntinx F, Buoncristiano M, Burazeri G, Burns C, de León AC, Cacciottolo J, Cai H, Caixeta RB, Cama T, Cameron C, Camolas J, Can G, Cândido APC, Cañete F, Capanzana MV, Čapková N, Capuano E, Capuano R, Capuano V, Cardol M, Cardoso VC, Carlsson AC, Carmuega E, Carvalho J, Casajús JA, Casanueva FF, Casas M, Celikcan E, Censi L, Cervantes‐Loaiza M, Cesar JA, Chamukuttan S, Chan A, Chan Q, Chaturvedi HK, Chaturvedi N, Rahim NCA, Chee ML, Chen CJ, Chen F, Chen H, Chen S, Chen Z, Cheng CY, Cheng YJ, Cheraghian B, Chetrit A, Chikova-Iscener E, Chinapaw MJM, Chinnock A, Chiolero A, Chiou ST, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cifkova R, Cilia M, Cinteza E, Cirillo M, Claessens F, Clarke J, Clays E, Cohen E, Compañ-Gabucio LM, Concin H, Confortin SC, Cooper C, Coppinger TC, Corpeleijn E, Cortés LY, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Cross AJ, Crujeiras AB, Cruz JJ, Csányi T, Csilla S, Cucu AM, Cui L, Cureau FV, Cuschieri S, Czenczek-Lewandowska E, D’Arrigo G, d’Orsi E, Dacica L, Dallongeville J, Damasceno A, Damsgaard CT, Dankner R, Dantoft TM, Dasgupta P, Dastgiri S, Dauchet L, Davletov K, de Assis MAA, De Backer G, De Bacquer D, De Curtis A, de Fragas Hinnig P, de Gaetano G, De Henauw S, De Miguel-Etayo P, de Oliveira PD, De Ridder D, De Ridder K, de Rooij SR, De Smedt D, Deepa M, Deev AD, DeGennaro V, Delisle H, Delpeuch F, Demarest S, Dennison E, Dereń K, Deschamps V, Dhimal M, Di Castelnuovo A, Dias-da-Costa JS, Díaz-Sánchez ME, Diaz A, Fernández PD, Ripollés MPD, Dika Z, Djalalinia S, Djordjic V, Do HTP, Dobson AJ, Dominguez L, Donati MB, Donfrancesco C, Dong G, Dong Y, Donoso SP, Döring A, Dorobantu M, Dorosty AR, Doua K, Dragano N, Drygas W, Duan JL, Duante CA, Duboz P, Duleva VL, Dulskiene V, Dumith SC, Dushpanova A, Dyussupova A, Dzerve V, Dziankowska-Zaborszczyk E, Echeverría G, Eddie R, Eftekhar E, Egbagbe EE, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ammari L, El Ati J, Eldemire-Shearer D, Eliasen M, Elliott P, Endevelt R, Engle-Stone R, Erasmus RT, Erbel R, Erem C, Ergor G, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Faeh D, Fakhradiyev I, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Sant’Angelo VF, Fattahi MR, Fawwad A, Fawzi WW, Feigl E, Felix-Redondo FJ, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari G, Ferrari M, Ferrario MM, Ferreccio C, Ferreira HS, Ferrer E, Ferrieres J, Figueiró TH, Fijalkowska A, Fisberg M, Fischer K, Foo LH, Forsner M, Fouad HM, Francis DK, do Carmo Franco M, Fras Z, Frontera G, Fuchs FD, Fuchs SC, Fujiati II, Fujita Y, Fumihiko M, Furdela V, Furusawa T, Gaciong Z, Gafencu M, Cuesta MG, Galbarczyk A, Galenkamp H, Galeone D, Galfo M, Galvano F, Gao J, Gao P, Garcia-de-la-Hera M, Mérida MJG, Solano MG, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gaya ACA, Gaya AR, Gazzinelli A, Gehring U, Geiger H, Geleijnse JM, George R, Ghaderi E, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Gialluisi A, Giampaoli S, Gianfagna F, Gieger C, Gill TK, Giovannelli J, Gironella G, Giwercman A, Gkiouras K, Glushkova N, Gluškova N, Godara R, Godos J, Gogen S, Goldberg M, Goltzman D, Gómez G, Gómez JHG, Gomez LF, Gómez SF, Gomula A, da Silva BGC, Gonçalves H, Gonçalves M, González-Alvarez AD, Gonzalez-Chica DA, González-Gil EM, Gonzalez-Gross M, González-Leon M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gottrand F, Graça AP, Graff-Iversen S, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregor RD, Gregório MJ, Grøholt EK, Grøntved A, Grosso G, Gruden G, Gu D, Guajardo V, Gualdi-Russo E, Guallar-Castillón P, Gualtieri A, Gudmundsson EF, Gudnason V, Guerrero R, Guessous I, Guimaraes AL, Gulliford MC, Gunnlaugsdottir J, Gunter MJ, Guo XH, Guo Y, Gupta PC, Gupta R, Gureje O, González EG, Gutierrez L, Gutzwiller F, Gwee X, Ha S, Hadaegh F, Hadjigeorgiou CA, Haghshenas R, Hakimi H, Halkjær J, Hambleton IR, Hamzeh B, Hanekom WA, Hange D, Hanif AAM, Hantunen S, Hao J, Hardman CM, Kumar RH, Lassen TH, Harooni J, Hashemi-Shahri SM, Hassapidou M, Hata J, Haugsgjerd T, Hayes AJ, He J, He Y, He Y, Heidinger-Felső R, Heier M, Hejgaard T, Hendriks ME, dos Santos Henrique R, Henriques A, Cadena LH, Herrala S, Herrera-Cuenca M, Herrera VM, Herter-Aeberli I, Herzig KH, Heshmat R, Hill AG, Ho SY, Ho SC, Hobbs M, Höfelmann DA, Holdsworth M, Homayounfar R, Homs C, Hopman WM, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Hu Y, Huerta JM, Huhtaniemi IT, Huiart L, Petrescu CH, Huisman M, Husseini A, Huu CN, Huybrechts I, Hwalla N, Hyska J, Iacoviello L, Iakupova EM, Ibarluzea JM, Ibrahim MM, Wong NI, Ikram MA, Iñiguez C, Iotova V, Irazola VE, Ishida T, Isiguzo GC, Islam M, Islam SMS, Islek D, Ivanova-Pandourska IY, Iwasaki M, Jääskeläinen T, Jackson RT, Jacobs JM, Jadoul M, Jafar T, Jallow B, James K, Jamil KM, Jamrozik K, Jansson A, Janszky I, Janus E, Jarani J, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jiang CQ, Jimenez RO, Jöckel KH, Joffres M, Jokelainen JJ, Jonas JB, Jonnagaddala J, Jørgensen T, Joshi P, Josipović J, Joukar F, Jóźwiak JJ, Judge DS, Juolevi A, Jurak G, Simina IJ, Juresa V, Kaaks R, Kaducu FO, Kafatos A, Kaj M, Kajantie EO, Kakutia N, Kállayová D, Kalmatayeva Z, Kalter-Leibovici O, Kameli Y, Kampmann FB, Kanala KR, Kannan S, Kapantais E, Karaglani E, Karakosta A, Kårhus LL, Karki KB, Katchunga PB, Katibeh M, Katz J, Katzmarzyk PT, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva GM, Kaze FF, Ke C, Keil U, Boker LK, Keinänen-Kiukaanniemi S, Kelishadi R, Kelleher C, Kemper HCG, Keramati M, Kerimkulova A, Kersting M, Key T, Khader YS, Khaledifar A, Khalili D, Khaw KT, Kheiri B, Kheradmand M, Khosravi A, Khouw IMSL, Kiechl-Kohlendorfer U, Kiechl SJ, Kiechl S, Killewo J, Kim HC, Kim J, Kindblom JM, Kingston A, Klakk H, Klimek M, Klimont J, Klumbiene J, Knoflach M, Koirala B, Kolle E, Kolsteren P, König J, Korpelainen R, Korrovits P, Korzycka M, Kos J, Koskinen S, Kouda K, Kovács É, Kovacs VA, Kovalskys I, Kowlessur S, Koziel S, Kratenova J, Kratzer W, Kriaucioniene V, Kriemler S, Kristensen PL, Krizan H, Kroker-Lobos MF, Krokstad S, Kromhout D, Kruger HS, Kruger R, Kryst Ł, Kubinova R, Kuciene R, Kujala UM, Kujundzic E, Kulaga Z, Kulimbet M, Kumar RK, Kunešová M, Kurjata P, Kusuma YS, Kutsenko V, Kuulasmaa K, Kyobutungi C, La QN, Laamiri FZ, Lachat C, Lackner KJ, Laid Y, Lall L, Lam TH, Jimenez ML, Landais E, Lanska V, Lappas G, Larijani B, Larissa SP, Latt TS, Laurenzi M, Lauria L, Lazo-Porras M, Le Coroller G, Le Nguyen Bao K, Le Port A, Le TD, Lee J, Lee J, Lee PH, Lehmann N, Lehtimäki T, Lemogoum D, Leskošek B, Leszczak J, Leth-Møller KB, Leung GM, Levitt NS, Li Y, Liivak M, Lilly CL, Lim C, Lim WY, Lima-Costa MF, Lin HH, Lin X, Lin YT, Lind L, Lingam V, Linkohr B, Linneberg A, Lissner L, Litwin M, Liu J, Liu L, Lo WC, Loit HM, Long KQ, Abril GL, Lopes L, Lopes MVV, Lopes O, Lopez-Garcia E, Lopez T, Lotufo PA, Lozano JE, Lukrafka JL, Luksiene D, Lundqvist A, Lunet N, Lunogelo C, Lustigová M, Łuszczki E, M’Buyamba-Kabangu JR, Ma G, Ma X, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Madsen AL, Maestre GE, Maggi S, Magliano DJ, Magnacca S, Magriplis E, Mahasampath G, Maire B, Majer M, Makdisse M, Mäki P, Malekzadeh F, Malekzadeh R, Malhotra R, Rao KM, Malyutina SK, Maniego LV, Manios Y, Manix MI, Mann JI, Mansour-Ghanaei F, Manyanga T, Manzato E, Marcil A, Margozzini P, Mariño J, Markaki A, Markey O, Ioannidou EM, Marques-Vidal P, Marques LP, Marrugat J, Martin-Prevel Y, Martin R, Martorell R, Martos E, Maruszczak K, Marventano S, Masala G, Mascarenhas LP, Masoodi SR, Mathiesen EB, Mathur P, Matijasevich A, Matłosz P, Matsha TE, Matsudo V, Mavrogianni C, Mazur A, Mbanya JCN, McFarlane SR, McGarvey ST, McKee M, McLachlan S, McLean RM, McLean SB, McNairy ML, McNulty BA, Benchekor SM, Medzioniene J, Mehdipour P, Mehlig K, Mehrparvar AH, Meirhaeghe A, Meisfjord J, Meisinger C, Melgarejo JD, Melkumova M, Mello J, Méndez F, Mendivil CO, Menezes AMB, Menon GR, Mensink GBM, Menzano MT, Meshram II, Meto DT, Mi J, Michaelsen KF, Michels N, Mikkel K, Miłkowska K, Miller JC, Milushkina O, Minderico CS, Mini GK, Miquel JF, Miranda JJ, Mirjalili MR, Mirkopoulou D, Mirrakhimov E, Mišigoj-Duraković M, Mistretta A, Mocanu V, Modesti PA, Moghaddam SS, Mohajer B, Mohamed MK, Mohamed SF, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Yusoff MFM, Mohebbi I, Mohebi F, Moitry M, Møllehave LT, Møller NC, Molnár D, Momenan A, Mondo CK, Montenegro Mendoza RA, Monterrubio-Flores E, Monyeki KDK, Moon JS, Moosazadeh M, Mopa HT, Moradpour F, Moreira LB, Morejon A, Moreno LA, Morey F, Morgan K, Morin SN, Mortensen EL, Moschonis G, Moslem A, Mossakowska M, Mostafa A, Mostafavi SA, Mota-Pinto A, Mota J, Motlagh ME, Motta J, Moura-dos-Santos MA, Movsesyan Y, Msyamboza KP, Mu TT, Muc M, Muca F, Mugoša B, Muiesan ML, Müller-Nurasyid M, Münzel T, Mursu J, Murtagh EM, Musa KI, Milanović SM, Musil V, Musinguzi G, Muyer MTMC, Nabipour I, Naderimagham S, Nagel G, Najafi F, Nakamura H, Nalecz H, Námešná J, Nang EEK, Nangia VB, Nankap M, Narake S, Nardone P, Naseri T, Nauck M, Neal WA, Nejatizadeh A, Nekkantti C, Nelis K, Nenko I, Neovius M, Nervi F, Ng TP, Nguyen CT, Nguyen ND, Nguyen QN, Ni MY, Nicolescu R, Nie P, Nieto-Martínez RE, Nikitin YP, Ning G, Ninomiya T, Nishi N, Nishtar S, Noale M, Noboa OA, Nogueira H, Nordendahl M, Nordestgaard BG, Noto D, Nowak-Szczepanska N, Nsour MA, Nuhoğlu I, Nunes B, Nurk E, Nuwaha F, Nyirenda M, O’Neill TW, O’Reilly D, Obreja G, Ochimana C, Ochoa-Avilés AM, Oda E, Odili AN, Oh K, Ohara K, Ohlsson C, Ohtsuka R, Olafsson Ö, Olinto MTA, Oliveira IO, Omar MA, Omar SM, Onat A, Ong SK, Onland-Moret NC, Ono LM, Ordunez P, Ornelas R, Ortiz AP, Ortiz PJ, Osler M, Osmond C, Ostojic SM, Ostovar A, Otero JA, Overvad K, Owusu-Dabo E, Paccaud FM, Pagkalos I, Pahomova E, de Paiva KM, Pająk A, Palloni A, Palmieri L, Pan WH, Panda-Jonas S, Pandey A, Panza F, Paoli M, Papadopoulou SK, Papandreou D, Pareja RG, Park SW, Park S, Parnell WR, Parsaeian M, Pascanu IM, Pasquet P, Patel ND, Pattussi M, Pavlyshyn H, Pechlaner R, Pećin I, Pednekar MS, Pedro JM, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peres MA, Pérez CM, Peterkova V, Peters A, Petersmann A, Petkeviciene J, Petrauskiene A, Kovtun OP, Pettenuzzo E, Peykari N, Pfeiffer N, Phall MC, Pham ST, Pichardo RN, Pierannunzio D, Pigeot I, Pikhart H, Pilav A, Pilotto L, Pistelli F, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Platonova AG, Poh BK, Pohlabeln H, Polka NS, Pop RM, Popovic SR, Porta M, Posch G, Poudyal A, Poulimeneas D, Pouraram H, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Price AJ, Price JF, Prista A, Providencia R, Puder JJ, Pudule I, Puiu M, Punab M, Qadir MS, Qasrawi RF, Qorbani M, Quintana HK, Quiroga-Padilla PJ, Bao TQ, Rach S, Radic I, Radisauskas R, Rahimikazerooni S, Rahman M, Rahman M, Raitakari O, Raj M, Rajabov T, Rakhmatulloev S, Rakovac I, Rao SR, Ramachandran A, Ramadan OPC, Ramires VV, Ramke J, Ramos E, Ramos R, Rampal L, Rampal S, Rangelova LS, Rarra V, Rascon-Pacheco RA, Rech CR, Redon J, Reganit PFM, Regecová V, Renner JDP, Repasy JA, Reuter CP, Revilla L, Rezaianzadeh A, Rho Y, Ribas-Barba L, Ribeiro R, Riboli E, Richter A, Rigo F, Rigotti A, Rinaldo N, Rinke de Wit TF, Rito AI, Ritti-Dias RM, Rivera JA, Roa RG, Robinson L, Robitaille C, Roccaldo R, Rodrigues D, Rodríguez-Artalejo F, del Cristo Rodriguez-Perez M, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Rohner F, Rojas-Martinez R, Rojroongwasinkul N, Romaguera D, Romeo EL, Rosario RV, Rosengren A, Rouse I, Rouzier V, Roy JGR, Ruano MH, Rubinstein A, Rühli FJ, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Moreno ER, Rusakova IA, Jonsson KR, Russo P, Rust P, Rutkowski M, Saamel M, Sabanayagam C, Sabbaghi H, Sacchini E, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saki N, Šalaj S, Salanave B, Martinez ES, Saleva C, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Samoutian M, Sánchez-Abanto J, Rodríguez IS, Sandjaja, Sans S, Marina LS, Santacruz E, Santos DA, Santos IS, Santos LC, Santos MP, Santos O, Santos R, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Savy M, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Rosario AS, Schargrodsky H, Schienkiewitz A, Schindler K, Schipf S, Schmidt CO, Schmidt IM, Schneider A, Schnohr P, Schöttker B, Schramm S, Schramm S, Schröder H, Schultsz C, Schulze MB, Schutte AE, Sebert S, Sedaghattalab M, Selamat R, Sember V, Sen A, Senbanjo IO, Sepanlou SG, Sequera G, Serra-Majem L, Servais J, Ševčíková Ľ, Shalnova S, Shamah-Levy T, Shamshirgaran SM, Shanthirani CS, Sharafkhah M, Sharma SK, Shaw JE, Shayanrad A, Shayesteh AA, Shengelia L, Shi Z, Shibuya K, Shimizu-Furusawa H, Shimony T, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Sidossis LS, Silitrari N, Silva AM, de Moura Silva CR, Silva DAS, Silva KS, Sim X, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skoblina NA, Skodje G, Slazhnyova T, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobek G, Sobngwi E, Sodemann M, Söderberg S, Soekatri MYE, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Sonestedt E, Song Y, Soofi S, Sørensen TIA, Sørgjerd EP, Jérome CS, Soto-Rojas VE, Soumaré A, Sousa-Poza A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spencer PR, Spinelli A, Spiroski I, Staessen JA, Stamm H, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, Suka M, Sun CA, Sun L, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Sweis NWG, Swinburn BA, Sy RG, Sylva RC, Szklo M, Szponar L, Tabone L, Tai ES, Tambalis KD, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanrygulyyeva M, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Braunerová RT, Taylor A, Taylor J, Tchibindat F, Te Velde S, Tebar WR, Tell GS, Tello T, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thorand B, Thuesen BH, Tichá Ľ, Timmermans EJ, Tjandrarini DH, Tjonneland A, Tolonen HK, Tolstrup JS, Topbas M, Topór-Mądry R, Torheim LE, Tormo MJ, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Touloumi G, Traissac P, Tran TTH, Tremblay MS, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tsao YH, Tshepo L, Tsigga M, Tsintavis P, Tsugane S, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Twig G, Tynelius P, Tzala E, Tzotzas T, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Lippevelde W, Van Minh H, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Vargas LN, Varona-Pérez P, Vasan SK, Vasques DG, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Verloigne M, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Vik FN, Vilar M, Villalpando S, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Vollenweider P, Völzke H, Voutilainen A, Vrijheid M, Vrijkotte TGM, Wade AN, Waldhör T, Walton J, Wambiya EOA, Bebakar WMW, Mohamud WNW, de Souza Wanderley Júnior R, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Weber A, Webster-Kerr K, Wedderkopp N, Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wojciech R, Wojtyniak B, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, García MY, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Vrkic TZ, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zins M, Zitt E, Zocalo Y, Zoghlami N, Cisneros JZ, Zuziak M, Bhutta ZA, Black RE, Ezzati M. Diminishing benefits of urban living for children and adolescents' growth and development. Nature 2023; 615:874-883. [PMID: 36991188 PMCID: PMC10060164 DOI: 10.1038/s41586-023-05772-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/30/2023] [Indexed: 03/31/2023]
Abstract
Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.
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Wirth JP, Zeng W, Petry N, Rohner F, Glenn S, Donkor WES, Wegmüller R, Boy E, Lividini K. The global burden of high fasting plasma glucose associated with zinc deficiency: Results of a systematic review and meta-analysis. PLOS Glob Public Health 2023; 3:e0001353. [PMID: 36963036 PMCID: PMC10022216 DOI: 10.1371/journal.pgph.0001353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/28/2023] [Indexed: 03/14/2023]
Abstract
Non-communicable diseases (NCDs) account for the largest share of the global disease burden, and increasing evidence shows that zinc deficiency (ZD) contributes to NCDs by inducing oxidative stress, insulin resistance, and impaired lipid metabolism. A systematic review and meta-analysis was conducted to determine whether ZD was associated with fasting plasma glucose (FPG), a key risk factor for NCDs. A random effects meta-analysis was conducted to determine the strength of the association in the form of an odds ratio (OR) and subsequently the population attributable risk (PAR) with population prevalences of high FPG. The disease burden from high FPG attributable to ZD was expressed as disability adjusted life years (DALYS). Data from seven studies were obtained as part of the systematic review. The meta-analysis shows a significant (p<0.01) inverse relationship between ZD and high FPG (OR = 2.34; 95% CI: 1.16, 4.72). Globally, the PAR of ZD's contribution to high FPG is 6.7%, with approximately 8.2 million high FPG DALYs attributable to ZD. Cardiovascular diseases, diabetes, and chronic kidney diseases account for more than 90% of the total DALYs. Total DALYs attributable to ZD are largest in the "Southeast Asia, East Asia, and Oceania" and "High Income" Super Regions. While the disease burden is highest among populous countries (e.g., China, India, USA), the population-standardized DALYs are highest among island nations, particularly island nations in the South Pacific and Caribbean. While ZD accounts for a small share of the high FPG disease burden, the total number of DALYs far surpasses other estimates of the disease burden attributable to ZD, which focus on diarrheal diseases in childhood. Zinc interventions are urgently needed to help address the increasing disease burden from NCDs, and the double burden of malnutrition.
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Affiliation(s)
| | - Wu Zeng
- GroundWork, Fläsch, Switzerland
- School of Health, Georgetown University, Washington, DC, United States of America
| | | | | | - Scott Glenn
- Institute for Health Metrics and Evaluation, Seattle, WA, United States of America
| | | | | | - Erick Boy
- Research Delivery & Impact Division/International Food Policy Research Institute (IFPRI), Washington, DC, United States of America
| | - Keith Lividini
- Research Delivery & Impact Division/International Food Policy Research Institute (IFPRI), Washington, DC, United States of America
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Stevens GA, Flores-Urrutia MC, Rogers LM, Paciorek CJ, Rohner F, Namaste S, Wirth JP. Associations between type of blood collection, analytical approach, mean haemoglobin and anaemia prevalence in population-based surveys: A systematic review and meta-analysis. J Glob Health 2022; 12:04088. [PMID: 36412108 PMCID: PMC9682214 DOI: 10.7189/jogh.12.04088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Previous studies have observed that haemoglobin concentrations can be affected by type of blood collection, analysis methods and device, and that near-in-time population-based surveys report substantially different anaemia prevalence. We investigated whether differences in mean haemoglobin or prevalence of anaemia between near-in-time surveys of the same population were associated with differences in type of blood collection or analytic approach to haemoglobin measurement. Methods We systematically identified pairs of population-based surveys that measured haemoglobin in the same population of women of reproductive age (WRA) or preschool-aged children (PSC). Surveys were matched on geographic coverage, urban/rural place of residence, inclusion of pregnant women, time of data collection (within 18 months), and, to the extent feasible, age range. Differences in anaemia prevalence were presented graphically. Random-effects meta-analysis and meta-regression of difference in mean haemoglobin were carried out, with subgroups defined by comparison of type of blood collection and analytic approach within each survey pair. Results We included 23 survey pairs from 17 countries for PSC and 17 survey pairs from 11 countries for WRA. Meta-regression indicates that surveys measuring haemoglobin with HemoCue® Hb 301 found higher haemoglobin concentrations than near-in-time surveys using HemoCue® Hb 201+ in non-pregnant women ((NPW); 5.8 g/L (95% confidence interval (CI) = 3.2-8.3) mean difference, n = 5 pairs) and PSC (4.3 g/L (1.4-7.2), n = 6). Surveys collecting venous blood found higher haemoglobin concentrations than near-in-time surveys collecting capillary blood in PSC (3.8 g/L (0.8-6.7), n = 8), but not NPW (0.4 g/L (-1.9-2.8), n = 9). Conclusions Because this study is observational, differences in haemoglobin concentrations in near-in-time surveys may be caused by other factors associated with choice of analytic approach or type of blood collected. The source or sources of differences should be clarified to improve use of surveys to prioritize and evaluate public health programs. Registration PROSPERO CRD42022296553.
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Affiliation(s)
- Gretchen A Stevens
- Independent Researcher, Los Angeles, California, USA,Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | | | - Lisa M Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | | | | | - Sorrel Namaste
- The DHS Program, ICF International, Rockville, Maryland, USA
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Davis JN, Williams A, Arnold CD, Rohner F, Wirth JP, Addo Y, Flores-Ayala RC, Oaks BM, Young MF, Suchdev PS, Engle-Stone R. The Relationship Between Ferritin and BMI is Mediated by Inflammation Among Women in Higher-Income Countries, But Not in Most Lower-Income Countries Nor Among Young Children: A Multi-Country Analysis. Curr Dev Nutr 2022; 6:nzac139. [PMID: 36475018 PMCID: PMC9718651 DOI: 10.1093/cdn/nzac139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 10/03/2023] Open
Abstract
Background In the presence of inflammation, the serum or plasma ferritin concentration ("ferritin" hereafter) transiently increases, confounding its interpretation as an iron status marker. The extent to which adiposity-related inflammation may influence ferritin interpretation is uncertain. Objectives We describe relationships between weight status, inflammation, and ferritin among nonpregnant women of reproductive age (WRA; 15-49 years) and preschool-age children (PSC; 6-59 months) with normal weight to overweight or obesity (OWOB) in differing geographic settings. Methods Cross-sectional data were separately analyzed from 18 surveys (WRA) and 25 surveys (PSC) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project, excluding observations with underweight, wasting, pregnancy, or malaria. Relationships were assessed between BMI (in WRA) or BMI-for-age z-score (BAZ; in PSC), inflammatory biomarkers of C-reactive protein (CRP) and/or α-1-acid glycoprotein (AGP), ferritin by linear regression, and potential mediation by CRP and/or AGP in relationships between BMI or BAZ and ferritin with structural equation modeling. Regression and mediation models accounted for complex survey designs. Results were grouped by World Bank income classifications. Results In 5 of 6 surveys among WRA from upper-middle and high-income countries, ferritin was significantly positively associated with BMI, and this relationship was partially (or fully, in the United States) mediated by CRP and/or AGP. Mediation was present in 4 of 12 surveys for WRA in low- and lower-middle income countries. Among PSC, ferritin was positively associated with CRP and/or AGP in all surveys, but there were no significant CRP- or AGP-mediated relationships between ferritin and BAZ, except a negative relationship in the Philippines. Conclusions Where having OWOB is common among WRA, measurements of inflammatory biomarkers and their uses in interpreting ferritin may improve iron status assessments. While these relationships were inconsistent among PSC, inflammation was common and should be measured to interpret iron status. Included Kenyan trial data are registered at clinicaltrials.gov as NCT01088958.
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Affiliation(s)
- Jennie N Davis
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
| | - Anne Williams
- University of Otago, Department of Human Nutrition, Dunedin, New Zealand
| | - Charles D Arnold
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
| | | | | | - Yaw Addo
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Chamblee, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rafael C Flores-Ayala
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Chamblee, GA, USA
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Melissa F Young
- Global Health Department, Emory University, Atlanta, GA, USA
| | - Parminder S Suchdev
- Department of Pediatrics and Global Health, Emory University, Atlanta, GA, USA
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reina Engle-Stone
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
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9
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Stevens GA, Paciorek CJ, Flores-Urrutia MC, Borghi E, Namaste S, Wirth JP, Suchdev PS, Ezzati M, Rohner F, Flaxman SR, Rogers LM. National, regional, and global estimates of anaemia by severity in women and children for 2000-19: a pooled analysis of population-representative data. Lancet Glob Health 2022; 10:e627-e639. [PMID: 35427520 PMCID: PMC9023869 DOI: 10.1016/s2214-109x(22)00084-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/23/2022] [Accepted: 02/21/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anaemia causes health and economic harms. The prevalence of anaemia in women aged 15-49 years, by pregnancy status, is indicator 2.2.3 of the UN Sustainable Development Goals, and the aim of halving the anaemia prevalence in women of reproductive age by 2030 is an extension of the 2025 global nutrition targets endorsed by the World Health Assembly (WHA). We aimed to estimate the prevalence of anaemia by severity for children aged 6-59 months, non-pregnant women aged 15-49 years, and pregnant women aged 15-49 years in 197 countries and territories and globally for the period 2000-19. METHODS For this pooled analysis of population-representative data, we collated 489 data sources on haemoglobin distribution in children and women from 133 countries, including 4·5 million haemoglobin measurements. Our data sources comprised health examination, nutrition, and household surveys, accessed as anonymised individual records or as summary statistics such as mean haemoglobin and anaemia prevalence. We used a Bayesian hierarchical mixture model to estimate haemoglobin distributions in each population and country-year. This model allowed for coherent estimation of mean haemoglobin and prevalence of anaemia by severity. FINDINGS Globally, in 2019, 40% (95% uncertainty interval [UI] 36-44) of children aged 6-59 months were anaemic, compared to 48% (45-51) in 2000. Globally, the prevalence of anaemia in non-pregnant women aged 15-49 years changed little between 2000 and 2019, from 31% (95% UI 28-34) to 30% (27-33), while in pregnant women aged 15-49 years it decreased from 41% (39-43) to 36% (34-39). In 2019, the prevalence of anaemia in children aged 6-59 months exceeded 70% in 11 countries and exceeded 50% in all women aged 15-49 years in ten countries. Globally in all populations and in most countries and regions, the prevalence of mild anaemia changed little, while moderate and severe anaemia declined in most populations and geographical locations, indicating a shift towards mild anaemia. INTERPRETATION Globally, regionally, and in nearly all countries, progress on anaemia in women aged 15-49 years is insufficient to meet the WHA global nutrition target to halve anaemia prevalence by 2030, and the prevalence of anaemia in children also remains high. A better understanding of the context-specific causes of anaemia and quality implementation of effective multisectoral actions to address these causes are needed. FUNDING USAID, US Centers for Disease Control and Prevention, and Bill & Melinda Gates Foundation.
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Affiliation(s)
- Gretchen A Stevens
- Independent researcher, Los Angeles, CA, USA; School of Public Health, Imperial College London, London, UK
| | | | | | - Elaine Borghi
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | | | | | - Parminder S Suchdev
- Department of Pediatrics and Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Majid Ezzati
- School of Public Health, Imperial College London, London, UK; Regional Institute for Population Studies, University of Ghana, Legon, Ghana
| | | | - Seth R Flaxman
- Department of Computer Science, University of Oxford, Oxford, UK
| | - Lisa M Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland.
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10
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Wegmüller R, Musau K, Vergari L, Custer E, Anyango H, Donkor WES, Kiprotich M, Siegal K, Petry N, Wirth JP, Lewycka S, Woodruff BA, Rohner F. Effectiveness of an integrated agriculture, nutrition-specific, and nutrition-sensitive program on child growth in Western Kenya: a cluster-randomized controlled trial. Am J Clin Nutr 2022; 116:446-459. [PMID: 35421217 PMCID: PMC9348977 DOI: 10.1093/ajcn/nqac098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Stunting rates remain unacceptably high in many regions, including sub-Saharan Africa. Agricultural programs have led to increased yields and household incomes but showed limited success in improving nutritional status. OBJECTIVES We assessed whether linear growth could be improved through a potentially scalable, integrated program adding nutrition-specific and nutrition-sensitive components to an existing agricultural program. METHODS In this cluster-randomized controlled trial in rural Western Kenya, we randomized children aged 6-35 months from farming families to an agricultural intervention without (control group) or with a bundle of interventions (intervention group), including distribution of micronutrient powders (MNP), poultry to increase egg consumption, seeds of greens and onions, and soap and chlorine solution, as well as provision of monthly behavior change trainings. The primary outcome was the change in height-for-age z-score (HAZ) over 2 years of follow-up. We assessed safety through active morbidity and passive adverse event monitoring. We conducted an intention-to-treat analysis, followed by per-protocol and prespecified subgroup analyses. RESULTS From March to April 2018, we enrolled 1927 children from 126 clusters (control, 942 children in 63 clusters; intervention, 985 children in 63 clusters). Data on HAZ were available for 1672 (86.6%) children after 2 years. Adherence was >80% for use of MNP, chlorine, and greens and receipt of soap, and ∼40% for egg and red onion consumption. The intention-to-treat analysis indicated a greater change in HAZ over 2 years in the intervention group (adjusted effect size, 0.11; 95% CI: 0.02-0.19). We found a slightly stronger effect in the per-protocol analysis (adjusted effect size, 0.15; 95% CI: 0.06-0.24). Dietary diversity and consumption of iron-rich foods were improved in the intervention group, and reported instances of fever, lower respiratory tract infections, and diarrheal episodes were lower in the intervention group. CONCLUSIONS This study found a modest improvement in linear growth, indicating the need for multiple, integrated interventions to achieve benefits. The trial was registered with clinicaltrials.gov as NCT03448484.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sonia Lewycka
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK,Oxford University Clinical Research Unit, Hanoi, Vietnam
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11
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Donkor WES, Mbai J, Sesay F, Ali SI, Woodruff BA, Hussein SM, Mohamud KM, Muse A, Mohamed WS, Mohamoud AM, Mohamud FM, Petry N, Galvin M, Wegmüller R, Rohner F, Katambo Y, Wirth JP. Risk factors of stunting and wasting in Somali pre-school age children: results from the 2019 Somalia micronutrient survey. BMC Public Health 2022; 22:264. [PMID: 35139826 PMCID: PMC8827289 DOI: 10.1186/s12889-021-12439-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stunting and wasting in children less than 5 years of age are two key indicators of child malnutrition. Reducing their prevalence is a priority of the global public health community and for Somalia, a country suffering complex humanitarian emergencies such as drought, flooding, conflict and large-scale displacements. METHODS Data from the nationally representative cross-sectional Somalia Micronutrient Survey (SMS 2019) on 1947 children were analyzed to assess the prevalence and potential risk factors of stunting and wasting. Bivariate and multivariable analyses were conducted separately for children 0-5 months and 6-59 months, and population attributable fractions were calculated using adjusted risk ratios produced by Poisson regression models. RESULTS Among the 1947 children, the prevalence of stunting and wasting were 17.2% (95% CI: 15.0, 19.6) and 11.0% (95% CI: 9.3, 12.9), respectively. Among children 6-59 months of age, those residing in severely food insecure households had a higher risk of stunting (adjusted risk ratio [aRR] 1.47; CI: 1.12, 1.93) compared to those in food secure households. This risk of stunting was also higher in children with inflammation (aRR 1.75; CI: 1.35, 2.25) and iron deficiency (ID) (aRR 2.09; CI: 1.58, 2.80). For wasting, a dose-response relationship was found with household wealth, with the risk of wasting increasing significantly as the household wealth quintile decreased. On the other hand, the risk of wasting was lower in iron-deficient children (aRR 0.69; CI: 0.49, 0.98) than in iron-replete children. Among children 0-5 months of age no variables remained statistically significantly associated with stunting in the multivariable analysis. Wasting, however, was more common in children with recent diarrhea (aRR 3.51; CI: 1.68, 7.36). CONCLUSIONS Nutritional status of children in Somalia may be improved by prevention of diarrhea and other infections and improvements in household food security.
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Affiliation(s)
| | | | | | | | | | | | | | - Ahmed Muse
- Department of Nutrition, Ministry of Health, Hargeisa, Somaliland
| | | | | | | | - Nicolai Petry
- GroundWork, Hintergasse 1, 7306, Fläsch, Switzerland
| | | | | | - Fabian Rohner
- GroundWork, Hintergasse 1, 7306, Fläsch, Switzerland
| | | | - James P Wirth
- GroundWork, Hintergasse 1, 7306, Fläsch, Switzerland.
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12
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Donkor WES, Adu-Afarwuah S, Wegmüller R, Bentil H, Petry N, Rohner F, Wirth JP. Complementary Feeding Indicators in Relation to Micronutrient Status of Ghanaian Children Aged 6-23 Months: Results from a National Survey. Life (Basel) 2021; 11:969. [PMID: 34575118 PMCID: PMC8468967 DOI: 10.3390/life11090969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Optimal complementary feeding is critical for adequate growth and development in infants and young children. The associations between complementary feeding and growth have been studied well, but less is known about the relationship between complementary feeding and micronutrient status. METHODS Using data from a national cross-sectional survey conducted in Ghana in 2017, we examined how multiple WHO-recommended complementary feeding indicators relate to anemia and the micronutrient status of children aged 6-23 months. RESULTS In total, 42%, 38%, and 14% of the children met the criteria for minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), respectively. In addition, 71% and 52% of the children consumed iron-rich foods and vitamin A-rich foods, respectively. The prevalence of anemia, iron deficiency (ID), iron deficiency anemia (IDA) and vitamin A deficiency (VAD) was 46%, 45%, 27%, and 10%, respectively. Inverse associations between MMF and socio-economic status were found, and MMF was associated with an increased risk of ID (55%; p < 0.013) and IDA (38%; p < 0.002). CONCLUSION The pathways connecting complementary feeding and micronutrient status are complex. Findings related to MMF should be further investigated to ensure that complementary feeding programs account for the potential practice of frequent feeding with nutrient-poor foods.
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Affiliation(s)
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon P.O. Box LG 25, Ghana; (S.A.-A.); (H.B.)
| | - Rita Wegmüller
- GroundWork, 7306 Fläsch, Switzerland; (R.W.); (N.P.); (F.R.); (J.P.W.)
| | - Helena Bentil
- Department of Nutrition and Food Science, University of Ghana, Legon P.O. Box LG 25, Ghana; (S.A.-A.); (H.B.)
| | - Nicolai Petry
- GroundWork, 7306 Fläsch, Switzerland; (R.W.); (N.P.); (F.R.); (J.P.W.)
| | - Fabian Rohner
- GroundWork, 7306 Fläsch, Switzerland; (R.W.); (N.P.); (F.R.); (J.P.W.)
| | - James P. Wirth
- GroundWork, 7306 Fläsch, Switzerland; (R.W.); (N.P.); (F.R.); (J.P.W.)
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13
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Wirth JP, Sesay F, Mbai J, Ali SI, Donkor WES, Woodruff BA, Pilane Z, Mohamud KM, Muse A, Yussuf HO, Mohamed WS, Veraguth R, Rezzi S, Williams TN, Mohamoud AM, Mohamud FM, Galvin M, Rohner F, Katambo Y, Petry N. Risk factors of anaemia and iron deficiency in Somali children and women: Findings from the 2019 Somalia Micronutrient Survey. Matern Child Nutr 2021; 18:e13254. [PMID: 34405549 PMCID: PMC8710091 DOI: 10.1111/mcn.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/24/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
There are limited data on the prevalence of anaemia and iron deficiency (ID) in Somalia. To address this data gap, Somalia's 2019 micronutrient survey assessed the prevalence of anaemia and ID in children (6–59 months) and non‐pregnant women of reproductive age (15–49 years). The survey also collected data on vitamin A deficiency, inflammation, malaria and other potential risk factors for anaemia and ID. Multivariable Poisson regressions models were used to identify the risk factors for anaemia and ID in children and women. Among children, the prevalence of anaemia and ID were 43.4% and 47.2%, respectively. Approximately 36% and 6% of anaemia were attributable to iron and vitamin A deficiencies, respectively, whereas household possession of soap was associated with approximately 11% fewer cases of anaemia. ID in children was associated with vitamin A deficiency and stunting, whereas inflammation was associated with iron sufficiency. Among women, 40.3% were anaemic, and 49.7% were iron deficient. In women, ID and number of births were significantly associated with anaemia in multivariate models, and approximately 42% of anaemia in women was attributable to ID. Increased parity was associated with ID, and incubation and early convalescent inflammation was associated with ID, whereas late convalescent inflammation was associated with iron sufficiency. ID is the main risk factor of anaemia in both women and children and contributed to a substantial portion of the anaemia cases. To tackle both anaemia and ID in Somalia, food assistance and micronutrient‐specific programmes (e.g. micronutrient powders and iron supplements) should be enhanced.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ahmed Muse
- Ministry of Health, Somaliland, Hargeisa, Somalia
| | | | - Warsame Said Mohamed
- Ministry of Health, Somaliland, Hargeisa, Somalia.,Ministry of Health, Puntland, Garowe, Somalia
| | | | - Serge Rezzi
- Swiss Vitamin Institute, Epalinges, Switzerland
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14
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Suri DJ, Wirth JP, Adu-Afarwuah S, Petry N, Rohner F, Sheftel J, Tanumihardjo SA. Inflammation Adjustments to Serum Retinol and Retinol-Binding Protein Improve Specificity but Reduce Sensitivity when Estimating Vitamin A Deficiency Compared with the Modified Relative Dose-Response Test in Ghanaian Children. Curr Dev Nutr 2021; 5:nzab098. [PMID: 34386690 PMCID: PMC8352745 DOI: 10.1093/cdn/nzab098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Serum retinol and retinol-binding protein (RBP) concentrations are commonly used biomarkers of vitamin A deficiency (VAD); however, evidence indicates that they are not always accurate, especially in populations with high exposure to inflammation. OBJECTIVE The aim was to assess sensitivity and specificity of serum retinol and RBP concentrations to predict VAD, with and without adjustment for inflammation (using categorical and regression-adjusted approaches), using the modified relative dose-response (MRDR) as the reference standard for liver reserves. METHODS This secondary analysis of diagnostic accuracy used inflammation and RBP data and analyzed serum retinol and MRDR from a subsample of women of reproductive age (n = 178) and preschool children (n = 166) in the cross-sectional 2017 Ghana Micronutrient Survey. RESULTS Inflammation (elevated C-reactive protein and/or α1-acid glycoprotein) was present in 41% of children and 16% of women. Among children, estimates of VAD prevalence were as follows: 7% (MRDR), 40% (serum retinol), 29% (categorical-adjusted serum retinol), 24% (RBP), 13% (categorical-adjusted RBP), and 7% (regression-adjusted RBP). Sensitivity (95% CI) ranged from 22.2% (2.81%, 60.0%; both adjusted RBPs) to 80.0% (44.4%, 97.5%; serum retinol), whereas specificity ranged from 63.3% (54.7%, 71.3%; serum retinol) to 93.5% (88.0%, 97.0%; regression-adjusted RBP). Among women, VAD prevalence ranged from 1% (RBP) to 4% (all others); sensitivity was 0% and specificity was >96% for all indicators. CONCLUSIONS Serum retinol and RBP had varying accuracy in estimating VAD, especially in children; adjustment for inflammation increased accuracy by increasing specificity at the expense of sensitivity. Effects of inflammation adjustment in the context of high inflammation and VAD prevalence need to be further explored. Especially in populations with high inflammation, the MRDR test should accompany serum retinol or RBP measurements in a subsample of subjects in population-based surveys. This trial was registered with the Open Science Framework registry (doi: 10.17605/OSF.IO/J7BP9).
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Affiliation(s)
- Devika J Suri
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana-Legon, Legon, Accra, Ghana
| | | | | | - Jesse Sheftel
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Sherry A Tanumihardjo
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
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15
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Whitfield KC, Smith TJ, Rohner F, Wieringa FT, Green TJ. Thiamine fortification strategies in low- and middle-income settings: a review. Ann N Y Acad Sci 2021; 1498:29-45. [PMID: 33496051 PMCID: PMC8451796 DOI: 10.1111/nyas.14565] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/30/2020] [Accepted: 01/09/2021] [Indexed: 12/13/2022]
Abstract
Thiamine (vitamin B1 ) is an essential micronutrient in energy metabolism and cognitive and neurological health. Thiamine deficiency disorders (TDDs) have a range of clinical presentations that result in various morbidities and can be fatal if not promptly recognized and treated, especially in infants. To intervene, thiamine intakes by breastfeeding mothers and others at risk of thiamine deficiency should be increased to ensure adequate thiamine intake. Although thiamine fortification programs have a long history in high-income countries, there are few mandatory fortification programs to address TDDs in low- and middle-income countries (LMICs), particularly in the regions of greatest concern, South and Southeast Asia. This review highlights essential aspects for consideration in the development of a mandatory fortification program in LMICs, including an overview of the data required to model fortification dosing schemes, available thiamine fortificants, and potential fortification vehicles, as well as identifies current knowledge gaps.
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Affiliation(s)
- Kyly C. Whitfield
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Taryn J. Smith
- Institute for Global NutritionUniversity of California DavisDavisCalifornia
| | | | - Frank T. Wieringa
- UMR‐95 QualiSud, French National Research Institute for Sustainable Development (IRD)CIRAD/IRD/University of Montpellier/SupAgro/University of Avignon/University of RéunionAvignonFrance
| | - Tim J. Green
- SAHMRI Women and KidsSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
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16
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Petry N, Rohner F, Phall MC, Jallow B, Ceesay AA, Sawo Y, Darboe MK, Barrow S, Sarr A, Ceesay PO, Fofana MN, Prentice AM, Wegmüller R, Wirth JP. Prevalence and co-existence of cardiometabolic risk factors and associations with nutrition-related and socioeconomic indicators in a national sample of Gambian women. Sci Rep 2021; 11:12057. [PMID: 34103653 PMCID: PMC8187481 DOI: 10.1038/s41598-021-91592-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/11/2021] [Indexed: 01/25/2023] Open
Abstract
Cardiovascular diseases (CVD) are on the rise in Sub-Saharan Africa, and a large proportion of the adult population is thought to suffer from at least one cardiometabolic risk factor. This study assessed cardiometabolic risk factors and the contribution of nutrition-related indicators in Gambian women. The prevalence and co-existence of diabetes (elevated glycated hemoglobin (HbA1c ≥ 6.5%) or prediabetes (HbA1c ≥ 5.7% to < 6.5%), hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg), obesity (body mass index (BMI) ≥ 30.0) and inflammation (C-reactive protein (CRP) > 3 mg/L or alpha-1-acid glycoprotein (AGP) > 1 g/L) and the contribution of nutrition related and socioeconomic indicators were measured in non-pregnant women 15-49 years of age in the Gambia using data from a nationally representative cross-sectional stratified survey. Nationally, 54.5% (95% CI: 47.4, 61.4) of 1407 women had elevated HbA1c. Of these, 14.9% were diabetic and 85.1% were prediabetic. Moreover, 20.8% (95% CI 17.8, 20.0) of 1685 women had hypertension, 11.1% (95% CI 9.0, 13.7) of 1651 were obese and 17.2% (95% CI 5.1, 19.6) of 1401 had inflammation. At least one of the aforementioned cardiometabolic risk factor was present in 68.3% (95% CI 63.0, 73.1) of women. Obesity increased the risk of hypertension (aRR 1.84; 95% CI 1.40, 2.41), diabetes (aRR 1.91; 95% CI 1.29, 2.84), elevated HbA1c (aRR 1.31; 95% CI 1.14, 1.51) and inflammation (aRR 3.47; 95% CI 2.61, 4.61). Inflammation increased the risk of hypertension (aRR 1.42; 95% CI 1.14, 1.78). Aging increased the risk of hypertension, obesity and inflammation. Further, inadequate sanitation increased the risk for diabetes (aRR 1.65; 95% CI 1.17, 2.34) and iron deficiency increased the risk of elevated HbA1c (aRR 1.21; 95% CI 1.09, 1.33). The high prevalence of cardiometabolic risk factors and their co-existence in Gambian women is concerning. Although controlling obesity seems to be key, multifaceted strategies to tackle the risk factors separately are warranted to reduce the prevalence or minimize the risk of CVD.
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Affiliation(s)
| | | | | | | | | | | | - Momodou K Darboe
- Medical Research Council Unit the Gambia at London, School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
| | | | | | | | | | - Andrew M Prentice
- Medical Research Council Unit the Gambia at London, School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
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17
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Petry N, Wirth JP, Adu-Afarwuah S, Wegmuller R, Woodruff BA, Tanumihardjo SA, Bentil H, Donkor WES, Williams TN, Shahab-Ferdows S, Selenje L, Mahama A, Steiner-Asiedu M, Rohner F. Risk factors for anaemia among Ghanaian women and children vary by population group and climate zone. Matern Child Nutr 2021; 17:e13076. [PMID: 32945623 PMCID: PMC7988882 DOI: 10.1111/mcn.13076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/27/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022]
Abstract
Anaemia has serious effects on human health and has multifactorial aetiologies. This study aimed to determine putative risk factors for anaemia in children 6-59 months and 15- to 49-year-old non-pregnant women living in Ghana. Data from a nationally representative cross-sectional survey were analysed for associations between anaemia and various anaemia risk factors. National and stratum-specific multivariable regressions were constructed separately for children and women to calculate the adjusted prevalence ratio (aPR) for anaemia of variables found to be statistically significantly associated with anaemia in bivariate analysis. Nationally, the aPR for anaemia was greater in children with iron deficiency (ID; aPR 2.20; 95% confidence interval [CI]: 1.88, 2.59), malaria parasitaemia (aPR 1.96; 95% CI: 1.65, 2.32), inflammation (aPR 1.26; 95% CI: 1.08, 1.46), vitamin A deficiency (VAD; aPR 1.38; 95% CI: 1.19, 1.60) and stunting (aPR 1.26; 95% CI: 1.09, 1.46). In women, ID (aPR 4.33; 95% CI: 3.42, 5.49), VAD (aPR 1.61; 95% CI: 1.24, 2.09) and inflammation (aPR 1.59; 95% CI: 1.20, 2.11) were associated with anaemia, whereas overweight and obese women had lower prevalence of anaemia (aPR 0.74; 95% CI: 0.56, 0.97). ID was associated with child anaemia in the Northern and Middle belts, but not in the Southern Belt; conversely, inflammation was associated with anaemia in both children and women in the Southern and Middle belts, but not in the Northern Belt. Anaemia control programmes should be region specific and aim at the prevention of ID, malaria and other drivers of inflammation as they are the main predictors of anaemia in Ghanaian children and women.
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Affiliation(s)
| | | | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | | | | | - Sherry A Tanumihardjo
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Helena Bentil
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - William E S Donkor
- GroundWork, Fläsch, Switzerland
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | | | - Setareh Shahab-Ferdows
- USDA Agricultural Research Service Western Human Nutrition Research Center, Davis, California, USA
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18
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Greffeuille V, Fortin S, Gibson R, Rohner F, Williams A, Young MF, Houghton L, Ou J, Dijkhuizen MA, Wirth JP, Lander RL, McDonald CM, Suchdev PS, Berger J, Wieringa FT. Associations between Zinc and Hemoglobin Concentrations in Preschool Children and Women of Reproductive Age: An Analysis of Representative Survey Data from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project. J Nutr 2021; 151:1277-1285. [PMID: 33693923 PMCID: PMC8454198 DOI: 10.1093/jn/nxaa444] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/23/2020] [Accepted: 12/17/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Anemia is a worldwide concern. Nutritional deficiencies and inflammation are considered main contributors, but zinc deficiency has only recently been associated with anemia. OBJECTIVES In this study we assessed associations between zinc status and hemoglobin (Hb) concentrations and anemia in preschool children 6-59 mo old (PSC) and nonpregnant women of reproductive age 15-49 y old (WRA) in population-based nutrition surveys. METHODS Cross-sectional data from 13 (PSC) and 12 (WRA) countries within the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project were used. Multivariable linear models were constructed that included zinc status (plasma/serum zinc concentrations), Hb concentrations and anemia, iron status, age, sex, and inflammation (C-reactive protein and α-1-acid glycoprotein). Zinc was adjusted for inflammation in PSC according to the BRINDA algorithm. RESULTS Data were available for 18,658 PSC and 22,633 WRA. Prevalence of anemia ranged from 7.5% to 73.7% and from 11.5% to 94.7% in PSC and WRA, respectively. Prevalence of zinc deficiency ranged from 9.2% to 78.4% in PSC and from 9.8% to 84.7% in WRA, with prevalence of zinc deficiency >20% in all countries except Azerbaijan (PSC), Ecuador (PSC), and the United Kingdom (WRA). Multivariable linear regression models showed that zinc concentrations were independently and positively associated with Hb concentrations in 7 of 13 countries for PSC and 5 of 12 countries for WRA. In the same models, ferritin concentration was also significantly associated with Hb among PSC and WRA in 9 and 10 countries, respectively. Zinc deficiency was significantly associated with anemia in PSC and WRA in 5 and 4 countries respectively. CONCLUSIONS Zinc deficiency was prevalent in most countries and associations between zinc and Hb in roughly half of the countries examined suggesting that strategies to combat zinc deficiency may help reduce anemia prevalence. More research on mechanisms by which zinc deficiency is associated with anemia and the reasons for the heterogeneity among countries is warranted.
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Affiliation(s)
- Valerie Greffeuille
- Alimentation, Nutrition, Sante (E6), Qualisud, Université Montpellier, Université Avignon, CIRAD, Institut Agro, IRD, Université de la Reunion, Montpellier, France
| | - Sonia Fortin
- Alimentation, Nutrition, Sante (E6), Qualisud, Université Montpellier, Université Avignon, CIRAD, Institut Agro, IRD, Université de la Reunion, Montpellier, France
| | - Rosalind Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand,South Australian Health and Medical Institute, Adelaide, Australia
| | | | - Anne Williams
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA,McKing Consulting Corporation, Atlanta, GA, USA
| | - Melissa F Young
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Lisa Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Jiangda Ou
- McKing Consulting Corporation, Atlanta, GA, USA
| | | | | | - Rebecca L Lander
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Christine M McDonald
- UCSF Benioff Children's Hospital Oakland, Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - Parminder S Suchdev
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA,Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Jacques Berger
- Alimentation, Nutrition, Sante (E6), Qualisud, Université Montpellier, Université Avignon, CIRAD, Institut Agro, IRD, Université de la Reunion, Montpellier, France
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19
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Cohee LM, Opondo C, Clarke SE, Halliday KE, Cano J, Shipper AG, Barger-Kamate B, Djimde A, Diarra S, Dokras A, Kamya MR, Lutumba P, Ly AB, Nankabirwa JI, Njagi JK, Maiga H, Maiteki-Sebuguzi C, Matangila J, Okello G, Rohner F, Roschnik N, Rouhani S, Sissoko MS, Staedke SG, Thera MA, Turner EL, Van Geertruyden JP, Zimmerman MB, Jukes MCH, Brooker SJ, Allen E, Laufer MK, Chico RM. Preventive malaria treatment among school-aged children in sub-Saharan Africa: a systematic review and meta-analyses. Lancet Glob Health 2020; 8:e1499-e1511. [PMID: 33222799 PMCID: PMC7721819 DOI: 10.1016/s2214-109x(20)30325-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 05/09/2020] [Accepted: 07/02/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The burden of malaria infection in sub-Saharan Africa among school-aged children aged 5-15 years is underappreciated and represents an important source of human-to-mosquito transmission of Plasmodium falciparum. Additional interventions are needed to control and eliminate malaria. We aimed to assess whether preventive treatment of malaria might be an effective means of reducing P falciparum infection and anaemia in school-aged children and lowering parasite transmission. METHODS In this systematic review and two meta-analyses, we searched the online databases PubMed, Embase, Cochrane CENTRAL, and Clinicaltrials.gov for intervention studies published between Jan 1, 1990, and Dec 14, 2018. We included randomised studies that assessed the effect of antimalarial treatment among asymptomatic school-aged children aged 5-15 years in sub-Saharan Africa on prevalence of P falciparum infection and anaemia, clinical malaria, and cognitive function. We first extracted data for a study-level meta-analysis, then contacted research groups to request data for an individual participant data meta-analysis. Outcomes of interest included prevalence of P falciparum infection detected by microscopy, anaemia (study defined values or haemoglobin less than age-adjusted and sex-adjusted values), clinical malaria (infection and symptoms on the basis of study-specific definitions) during follow-up, and code transmission test scores. We assessed effects by treatment type and duration of time protected, and explored effect modification by transmission setting. For study-level meta-analysis, we calculated risk ratios for binary outcomes and standardised mean differences for continuous outcomes and pooled outcomes using fixed-effect and random-effects models. We used a hierarchical generalised linear model for meta-analysis of individual participant data. This study is registered with PROSPERO, CRD42016030197. FINDINGS Of 628 studies identified, 13 were eligible for the study-level meta-analysis (n=16 309). Researchers from 11 studies contributed data on at least one outcome (n=15 658) for an individual participant data meta-analysis. Interventions and study designs were highly heterogeneous; overall risk of bias was low. In the study-level meta-analysis, treatment was associated with reductions in P falciparum prevalence (risk ratio [RR] 0·27, 95% CI 0·17-0·44), anaemia (0·77, 0·65-0·91), and clinical malaria (0·40, 0·28-0·56); results for cognitive outcomes are not presented because data were only available for three trials. In our individual participant data meta-analysis, we found treatment significantly decreased P falciparum prevalence (adjusted RR [ARR] 0·46, 95% CI 0·40-0·53; p<0·0001; 15 648 individuals; 11 studies), anaemia (ARR 0·85, 0·77-0·92; p<0·0001; 15 026 individuals; 11 studies), and subsequent clinical malaria (ARR 0·50, 0·39-0·60; p<0·0001; 1815 individuals; four studies) across transmission settings. We detected a marginal effect on cognitive function in children older than 10 years (adjusted mean difference in standardised test scores 0·36, 0·01-0·71; p=0·044; 3962 individuals; five studies) although we found no significant effect when combined across all ages. INTERPRETATION Preventive treatment of malaria among school-aged children significantly decreases P falciparum prevalence, anaemia, and risk of subsequent clinical malaria across transmission settings. Policy makers and programme managers should consider preventive treatment of malaria to protect this age group and advance the goal of malaria elimination, while weighing these benefits against potential risks of chemoprevention. FUNDING US National Institutes of Health and Burroughs Wellcome Fund/ASTMH Fellowship.
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Affiliation(s)
- Lauren M Cohee
- Center for Vaccine Development and Global Health, University of Maryland, Baltimore, MA, USA
| | - Charles Opondo
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Siân E Clarke
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Katherine E Halliday
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Jorge Cano
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrea G Shipper
- University of Maryland School of Medicine, and Health Sciences and Human Services Library, University of Maryland, Baltimore, MA, USA
| | | | - Abdoulaye Djimde
- Faculty of Medicine, Pharmacy, and Odnonto-Stomatology, Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Mali
| | | | - Aditi Dokras
- Department of Pediatrics, University of Maryland, Baltimore, MA, USA
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Pascal Lutumba
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Joaniter I Nankabirwa
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda
| | - J Kiambo Njagi
- National Malaria Control Programme, Ministry of Health, Nairobi, Kenya
| | - Hamma Maiga
- Faculty of Medicine, Pharmacy, and Odnonto-Stomatology, Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Mali
| | | | - Junior Matangila
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Democratic Republic of Congo; Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - George Okello
- Health Systems and Social Science Research Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Saba Rouhani
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Save the Children, Bamako, Mali
| | - Mahamadou S Sissoko
- Faculty of Medicine, Pharmacy, and Odnonto-Stomatology, Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Sarah G Staedke
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Mahamadou A Thera
- Faculty of Medicine, Pharmacy, and Odnonto-Stomatology, Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Elizabeth L Turner
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Michael B Zimmerman
- Institute of Food, Nutrition, and Health, Swiss Federal Institute of Technology, Zurich, Switzerland
| | | | | | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Miriam K Laufer
- Center for Vaccine Development and Global Health, University of Maryland, Baltimore, MA, USA
| | - R Matthew Chico
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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20
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Williams AM, Guo J, Addo OY, Ismaily S, Namaste SML, Oaks BM, Rohner F, Suchdev PS, Young MF, Flores-Ayala R, Engle-Stone R. Intraindividual double burden of overweight or obesity and micronutrient deficiencies or anemia among women of reproductive age in 17 population-based surveys. Am J Clin Nutr 2020; 112:468S-477S. [PMID: 32743649 PMCID: PMC7396267 DOI: 10.1093/ajcn/nqaa118] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rising prevalence of overweight/obesity (OWOB) alongside persistent micronutrient deficiencies suggests many women face concomitant OWOB and undernutrition. OBJECTIVES We aimed to 1) describe the prevalence of the double burden of malnutrition (DBM) among nonpregnant women of reproductive age, defined as intraindividual OWOB and either ≥1 micronutrient deficiency [micronutrient deficiency index (MDI) > 0; DBM-MDI] or anemia (DBM-anemia); 2) test whether the components of the DBM were independent; and 3) identify factors associated with DBM-MDI and DBM-anemia. METHODS With data from 17 national surveys spanning low- and middle-income countries (LMICs) and high-income countries from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project (n = 419 to n = 9029), we tested independence of over- and undernutrition using the Rao-Scott chi-square test and examined predictors of the DBM and its components using logistic regression for each survey. RESULTS Median DBM-MDI was 21.9% (range: 1.6%-39.2%); median DBM-anemia was 8.6% (range: 1.0%-18.6%). OWOB and micronutrient deficiencies or anemia were independent in most surveys. Where associations existed, OWOB was negatively associated with micronutrient deficiencies and anemia in LMICs. In 1 high-income country, OWOB women were more likely to experience micronutrient deficiencies and anemia. Age was consistently positively associated with OWOB and the DBM, whereas the associations with other sociodemographic characteristics varied. Higher socioeconomic status tended to be positively associated with OWOB and the DBM in LMICs, whereas in higher-income countries the association was reversed. CONCLUSIONS The independence of OWOB and micronutrient deficiencies or anemia within individuals suggests that these forms of over- and undernutrition may have unique etiologies. Decision-makers should still consider the prevalence, consequences, and etiology of the individual components of the DBM as programs move towards double-duty interventions aimed at addressing OWOB and undernutrition simultaneously.
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Affiliation(s)
| | - Junjie Guo
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - O Yaw Addo
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA,McKing Consulting Corporation, Atlanta, GA, USA
| | - Sanober Ismaily
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | | | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | | | - Parminder S Suchdev
- Department of Pediatrics, Emory University, Atlanta, GA, USA,Emory Global Health Institute, Atlanta, GA, USA,Division of Nutrition, Physical Activity and Obesity, US CDC, Atlanta, GA, USA
| | - Melissa F Young
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Rafael Flores-Ayala
- Division of Nutrition, Physical Activity and Obesity, US CDC, Atlanta, GA, USA
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21
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Petry N, Wirth JP, Friesen VM, Rohner F, Nkundineza A, Chanzu E, Tadesse KG, Gahutu JB, Neufeld LM, Birol E, Boy E, Mudyahoto B, Muzhingi T, Mbuya MNN. Assessing the Coverage of Biofortified Foods: Development and Testing of Methods and Indicators in Musanze, Rwanda. Curr Dev Nutr 2020; 4:nzaa107. [PMID: 32734133 PMCID: PMC7382634 DOI: 10.1093/cdn/nzaa107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Biofortification of staple crops has the potential to increase nutrient intakes and improve health outcomes. Despite program data on the number of farming households reached with and growing biofortified crops, information on the coverage of biofortified foods in the general population is often lacking. Such information is needed to ascertain potential for impact and identify bottlenecks to parts of the impact pathway. OBJECTIVES We aimed to develop and test methods and indicators for assessing household coverage of biofortified foods. METHODS To assess biofortification programs, 5 indicators of population-wide household coverage were developed, building on approaches previously used to assess large-scale food fortification programs. These were 1) consumption of the food; 2) awareness of the biofortified food; 3) availability of the biofortified food; 4) consumption of the biofortified food (ever); and 5) consumption of the biofortified food (current). To ensure that the indicators are applicable to different settings they were tested in a cross-sectional household-based cluster survey in rural and peri-urban areas in Musanze District, Rwanda where planting materials for iron-biofortified beans (IBs) and orange-fleshed sweet potatoes (OFSPs) were delivered. RESULTS Among the 242 households surveyed, consumption of beans and sweet potatoes was 99.2% and 96.3%, respectively. Awareness of IBs or OFSPs was 65.7% and 48.8%, and availability was 23.6% and 10.7%, respectively. Overall, 15.3% and 10.7% of households reported ever consuming IBs and OFSPs, and 10.4% and 2.1% of households were currently consuming these foods, respectively. The major bottlenecks to coverage of biofortified foods were awareness and availability. CONCLUSIONS These methods and indicators fill a gap in the availability of tools to assess coverage of biofortified foods, and the results of the survey highlight their utility for identifying bottlenecks. Further testing is warranted to confirm the generalizability of the coverage indicators and inform their operationalization when deployed in different settings.
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Affiliation(s)
| | | | | | | | | | | | | | - Jean B Gahutu
- College of Medicine Health Sciences, University of Rwanda, Kigali, Rwanda
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22
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Petry N, Al-Maamary SA, Woodruff BA, Alghannami S, Al-Shammakhi SM, Al-Ghammari IK, Tyler V, Rohner F, Wirth JP. National Prevalence of Micronutrient Deficiencies, Anaemia, Genetic Blood Disorders and Over- and Undernutrition in Omani Women of Reproductive Age and Preschool Children. Sultan Qaboos Univ Med J 2020; 20:e151-e164. [PMID: 32655907 PMCID: PMC7328830 DOI: 10.18295/squmj.2020.20.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/04/2019] [Accepted: 12/05/2019] [Indexed: 01/18/2023] Open
Abstract
A national cross-sectional survey was conducted to estimate the prevalence of anaemia, micronutrient deficiencies, haemoglobin disorders and over- and undernutrition in children and women of reproductive age in Oman. Wasting and stunting were found in 9.3% and 11.4% of children aged 0-59 months, respectively, while 4.2% were overweight or obese. In addition, 23.8% were anaemic and 10.2%, 9.5% and 10.6% had iron, vitamin A and vitamin D deficiencies, respectively. Sickle cell and β-thalassaemia genetic traits were present in 5.3% and 4.2% of children and 4.7% and 2.8% of women, respectively. Overall, 9.1% of Omani women were underweight and 59.2% were overweight or obese. The prevalence of anaemia was 27.8%, while iron, folate, vitamin B12 and vitamin D deficiencies affected 24.8%, 11.6%, 8.9% and 16.2%, respectively. Anaemia among both children and women and the prevalence of overweight and obesity in women are the most concerning nutritional problems in Oman.
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Affiliation(s)
- Nicolai Petry
- Department of Nutrition & Health, GroundWork LLC, Zurich, Switzerland
| | - Salima A Al-Maamary
- Department of Nutrition, Directorate General of Health Affairs, Ministry of Health, Muscat, Oman
| | | | - Samia Alghannami
- Department of Nutrition, Directorate General of Health Affairs, Ministry of Health, Muscat, Oman
| | - Saleh M Al-Shammakhi
- Department of Nutrition, Directorate General of Health Affairs, Ministry of Health, Muscat, Oman
| | - Ibtesam K Al-Ghammari
- Department of Nutrition, Directorate General of Health Affairs, Ministry of Health, Muscat, Oman
| | - Vilma Tyler
- Department of Health & Nutrition, United Nations International Children's Emergency Fund, Amman, Jordan
| | - Fabian Rohner
- Department of Nutrition & Health, GroundWork LLC, Zurich, Switzerland
| | - James P Wirth
- Department of Nutrition & Health, GroundWork LLC, Zurich, Switzerland
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23
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Suri D, Wirth J, Petry N, Rohner F, Adu-Afarwuah S, Sheftel J, Tanumihardjo S. Comparison of Serum Retinol and Retinol-Binding Protein with the Modified Relative Dose-Response Test in Estimating Vitamin A Deficiency Among Ghanaian Women and Children. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa053_118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
To evaluate the sensitivity and specificity of serum retinol (SR) and retinol-binding protein (RBP) in determining vitamin A deficiency (VAD) using the modified relative dose-response (MRDR) test as the reference.
Methods
Subjects included a subset of women and children participating in the Ghana Micronutrient Survey 2017. VAD was determined by the following cut-offs: SR or RBP < 0.7 mmol/L; MRDR ratio of 3,4-didehydroretinol to SR ³0.060. Sensitivity, specificity and the area-under-the-receiver operating characteristic (ROC) curve were calculated for unadjusted and inflammation-adjusted VAD cut-offs (based on C-reactive protein (CRP) and a1-acid-glycoprotein (AGP) for SR and RBP using the MRDR test as the reference.
Results
In 167 children and 178 women, inflammation (elevated CRP and/or elevated AGP) was present in 41% and 16%, respectively. Prevalence of VAD ranged, depending on the indicator used, from 7% (MRDR) to 40% (unadjusted SR) in children and 1% (RBP) to 4% (SR and MRDR) in women. Among children, sensitivity and specificity of unadjusted and adjusted SR and RBP were highly variable among the children. Highest sensitivity was achieved by unadjusted SR (80% of children with VAD correctly identified), while highest specificity was achieved by adjusted RBP (86% of children without VAD correctly identified). The best predictor of VAD in children compared with MRDR was adjusted SR, with a sensitivity of 78%, specificity of 73%, and an area under the ROC curve of 0.76. Among women, specificity was 97% for unadjusted and adjusted SR with an area under the ROC curve of 0.48; additional values could not be calculated due to lack of VAD cases.
Conclusions
SR and RBP were only moderately sensitive and specific for identifying VAD in children in Ghana. Low specificity—falsely identifying VAD—is especially problematic when populations are covered by one or more vitamin A interventions. Overlapping sources of preformed vitamin A can lead to hypervitaminosis, which may affect bone metabolism and growth. More accurate measures should be used in conjunction with SR and RBP for evaluating VAD especially in vulnerable populations.
Funding Sources
UNICEF, Canada's Ministry of Foreign Affairs, Trade and Development.
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Petry N, Wirth J, Friesen V, Rohner F, Nkundineza A, Chanzu E, Tadesse KG, Gahutu JB, Neufeld L, Birol E, Boy E, Mudyahoto B, Muzhingi T, Mbuya M. Assessing the Coverage of Biofortified Foods: Development and Testing of Methods and Indicators in Musanze, Rwanda. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa067_060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Biofortification is a promising approach to increase micronutrient intakes, especially among populations that are hard to reach with other interventions. Information on the coverage of biofortified foods is needed to ascertain potential for impact, understand program performance, and identify bottlenecks. In this study, we aimed to develop and test methods and indicators for assessing household coverage of biofortified foods.
Methods
We developed five recall-based indicators of household coverage to assess biofortification programs building on approaches previously used to assess targeted and large-scale food fortification programs. These were: 1) consumption of the food; 2) awareness of the biofortified food; 3) availability of the biofortified food; 4) consumption of the biofortified food (ever); and 5) consumption of the biofortified food (current). We tested these indicators in a cross-sectional, cluster, household survey in 20 rural and five peri-urban areas in Musanze, Rwanda where two biofortification programs, i.e., biofortified beans and orange fleshed sweet potatoes (OFSP), were implemented.
Results
Among the 242 households surveyed, consumption of beans and sweet potatoes was high (99% and 96%, respectively) while awareness of biofortified beans or OFSP was 66% and 49%, respectively, and availability was 24% and 11%, respectively. Overall, 15% and 11% of households had ever consumed biofortified beans and OFSP, respectively, and 10% and 2% of households were currently consuming them, respectively. The major bottlenecks to coverage were awareness and availability of the biofortified foods.
Conclusions
The proposed methods and indicators fill a gap in the availability of tools to assess biofortification program coverage and the results of the survey highlight their utility for assessing program performance and identifying bottlenecks. Further testing is warranted to confirm the generalizability of the coverage indicators and inform their operationalization when deployed in different contexts.
Funding Sources
Bill & Melinda Gates Foundation.
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Rohner F, Nizamov F, Petry N, Yuldasheva F, Ismailov S, Wegmüller R, Guo S, Wirth JP, Woodruff BA. Household Coverage with Adequately Iodized Salt and Iodine Status of Nonpregnant and Pregnant Women in Uzbekistan. Thyroid 2020; 30:898-907. [PMID: 32098586 PMCID: PMC7307690 DOI: 10.1089/thy.2019.0788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Globally, iodine deficiency has been drastically reduced since the introduction of salt iodization programs; nonetheless, many populations remain at-risk for iodine deficiency. This study aimed to assess the iodine status among women of reproductive age in Uzbekistan and to identify factors associated with iodine deficiency, including the availability of adequately iodized salt at the household level. Methods: A cross-sectional household survey was conducted to produce region-specific estimates of the household coverage with adequately iodized salt and iodine status among women for each of the 14 regions in Uzbekistan. Other information, such as socioeconomic status, lactation and pregnancy, residence, age, and consumption of iodine supplements, was also collected. Results: Overall, 36% of 3413 households had adequately iodized salt (iodine concentration >15 ppm [parts per million (mg I/kg salt)]), 20% had inadequately iodized salt (5-14 ppm), and 44% had salt without detectable iodine (<5 ppm). Adequate iodization was found in 33.2% of the 2626 salt samples taken from retail packages labeled as "iodized," 36.5% of the 96 samples taken from retail packages without mention of iodization, and 50.5% of the 674 samples without the original packaging (p < 0.001). The median urinary iodine concentration (UIC) of 140.9 μg/L (95% confidence interval [CI 132.4-150.7]) in nonpregnant nonlactating women indicated adequate iodine status, while for nonpregnant lactating and pregnant women, the median UIC of 112.9 μg/L [CI 99.3-128.4] and 117.3 μg/L [CI 101.8-139.9], respectively, indicated borderline adequacy. Significant differences in UIC (p < 0.001) were found between nonpregnant nonlactating women living in households with adequately iodized salt (UIC 208.9 μg/L), inadequately iodized salt (UIC 139.1 μg/L), and noniodized salt (UIC 89.9 μg/L). Conclusions: Coverage with adequately iodized salt is low in Uzbekistan, and women in households with poorly iodized salt have substantially worse iodine status; claims on packaging about salt iodization do not reflect salt iodine content. This highlights the importance and effectiveness of salt iodization and the need to strengthen this program in Uzbekistan.
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Affiliation(s)
- Fabian Rohner
- GroundWork, Fläsch, Switzerland
- Address correspondence to: Fabian Rohner, PhD, GroundWork, Hintergasse 1, Fläsch 7306, Switzerland
| | | | | | - Feruza Yuldasheva
- Scientific Epidemiological Laboratory for the Determination of Iodine in Urine and Salt, Republic Specialized Scientific Practical Medical Centre of Endocrinology, Tashkent, Uzbekistan
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Petry N, Nizamov F, Woodruff BA, Ishmakova R, Komilov J, Wegmüller R, Wirth JP, Arifdjanova D, Guo S, Rohner F. Risk Factors for Anemia and Micronutrient Deficiencies among Women of Reproductive Age-The Impact of the Wheat Flour Fortification Program in Uzbekistan. Nutrients 2020; 12:E714. [PMID: 32156021 PMCID: PMC7146397 DOI: 10.3390/nu12030714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 11/17/2022] Open
Abstract
Food fortification can be effective in reducing the prevalence of anemia and micronutrient deficiencies. This study assessed risk factors for-and the impact of the wheat flour program in Uzbekistan on-anemia, and iron and folate deficiency (FD) in non-pregnant women (NPW) of reproductive age. National data were analyzed for risk factors using multivariable regression. Additional iron intake from fortified flour was not associated with iron deficiency (ID) and did not result in a significantly different prevalence of anemia regardless of the levels, whereas women with additional folic acid intake had a lower relative risk (RR) of FD (RR: 0.67 [95% CI: 0.53, 0.85]). RR for anemia was greater in women with ID (RR: 4.7; 95% CI: 3.5, 6.5) and vitamin A insufficiency (VAI; RR 1.5; 95% CI: 1.3, 1.9). VAI (RR: 1.4 [95% CI: 1.3, 1.6]) and breastfeeding (RR: 1.1 [95% CI: 0.99, 1.2]) were associated with increased risk of ID, while being underweight reduced the risk (RR: 0.74 [95% CI: 0.58, 0.96]). Breastfeeding (RR: 1.2 [95% CI: 1.1, 1.4]) and inflammation (RR: 1.2 [95% CI: 1.0, 1.3]) increased risk of FD. FD results indicate that the fortification program had potential for impact, but requires higher coverage of adequately fortified wheat flour and a more bioavailable iron fortificant.
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Affiliation(s)
- Nicolai Petry
- GroundWork, 7306 Fläsch, Switzerland; (B.A.W.); (R.W.); (J.P.W.); (F.R.)
| | | | | | | | | | - Rita Wegmüller
- GroundWork, 7306 Fläsch, Switzerland; (B.A.W.); (R.W.); (J.P.W.); (F.R.)
| | - James P. Wirth
- GroundWork, 7306 Fläsch, Switzerland; (B.A.W.); (R.W.); (J.P.W.); (F.R.)
| | | | - Sufang Guo
- UNICEF, Tashkent 100029, Uzbekistan; (F.N.); (D.A.); (S.G.)
| | - Fabian Rohner
- GroundWork, 7306 Fläsch, Switzerland; (B.A.W.); (R.W.); (J.P.W.); (F.R.)
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Welch VA, Hossain A, Ghogomu E, Riddle A, Cousens S, Gaffey M, Arora P, Black R, Bundy D, Castro MC, Chen L, Dewidar O, Elliott A, Friis H, Hollingsworth TD, Horton S, King CH, Thi HL, Liu C, Rohner F, Rousham EK, Salam R, Sartono E, Steinmann P, Supali T, Tugwell P, Webb E, Wieringa F, Winnichagoon P, Yazdanbakhsh M, Bhutta ZA, Wells GA. Deworming children for soil-transmitted helminths in low and middle-income countries: systematic review and individual participant data network meta-analysis. J Dev Effect 2019; 11:288-306. [PMID: 32256965 PMCID: PMC7077355 DOI: 10.1080/19439342.2019.1691627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 06/11/2023]
Abstract
Intestinal parasites affect millions of children globally. We aimed to assess effects of deworming children on nutritional and cognitive outcomes across potential effect modifiers using individual participant data (IPD). We searched multiple databases to 27 March 2018, grey literature, and other sources. We included randomised and quasi randomised trials of deworming compared to placebo or other nutritional interventions with data on baseline infection. We used a random-effects network meta-analysis with IPD and assessed overall quality, following a pre-specified protocol. We received IPD from 19 trials of STH deworming. Overall risk of bias was low. There were no statistically significant subgroup effects across age, sex, nutritional status or infection intensity for each type of STH. These analyses showed that children with moderate or heavy intensity infections, deworming for STH may increase weight gain (very low certainty). The added value of this review is an exploration of effects on growth and cognition in children with moderate to heavy infections as well as replicating prior systematic review results of small effects at the population level. Policy implications are that complementary public health strategies need to be assessed and considered to achieve growth and cognition benefits for children in helminth endemic areas.
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Affiliation(s)
- Vivian Andrea Welch
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Alomgir Hossain
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Cardiovascular Research Methods, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), University of Ottawa, Ottawa, Ontario, Canada
| | - Elizabeth Ghogomu
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alison Riddle
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Cousens
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Michelle Gaffey
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Paul Arora
- Public Health Agency of Canada in the National Public Health Laboratory, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Robert Black
- Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD, USA
| | - Donald Bundy
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Li Chen
- Cardiovascular Research Methods, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Omar Dewidar
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alison Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Henrik Friis
- Department of Human Nutrition, University of Copenhagen, Frederiksberg, Denmark
| | - T. Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sue Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Huong Le Thi
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Chengfang Liu
- School of Advanced Agricultural Sciences (SAAS), China Center for Agricultural Policy (CCAP), Peking University, Beijing, China
| | | | - Emily K Rousham
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
| | - Rehana Salam
- South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
| | - Erliyani Sartono
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Taniawati Supali
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Peter Tugwell
- Center for Global Health, WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Emily Webb
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Franck Wieringa
- UMR204 Nutripass, Institute de Recherche pour le Développement, IRD/UM/SupAgro, Montpellier, France
| | - Pattanee Winnichagoon
- Community/International Nutrition, Institute of Nutrition, Mahidol University, Salaya, Thailand
| | - Maria Yazdanbakhsh
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Center of Excellence in Women and Child Health, Aga Khan University
| | - George A Wells
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Cardiovascular Research Methods, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Welch VA, Ghogomu E, Hossain A, Riddle A, Gaffey M, Arora P, Dewidar O, Salam R, Cousens S, Black R, Hollingsworth TD, Horton S, Tugwell P, Bundy D, Castro MC, Elliott A, Friis H, Le HT, Liu C, Rousham EK, Rohner F, King C, Sartono E, Supali T, Steinmann P, Webb E, Wieringa F, Winnichagoon P, Yazdanbakhsh M, Bhutta ZA, Wells G. Mass deworming for improving health and cognition of children in endemic helminth areas: A systematic review and individual participant data network meta-analysis. Campbell Syst Rev 2019; 15:e1058. [PMID: 37131850 PMCID: PMC8356492 DOI: 10.1002/cl2.1058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Soil transmitted (or intestinal) helminths and schistosomes affect millions of children worldwide. Objectives To use individual participant data network meta-analysis (NMA) to explore the effects of different types and frequency of deworming drugs on anaemia, cognition and growth across potential effect modifiers. Search Methods We developed a search strategy with an information scientist to search MEDLINE, CINAHL, LILACS, Embase, the Cochrane Library, Econlit, Internet Documents in Economics Access Service (IDEAS), Public Affairs Information Service (PAIS), Social Services Abstracts, Global Health CABI and CAB Abstracts up to March 27, 2018. We also searched grey literature, websites, contacted authors and screened references of relevant systematic reviews. Selection Criteria We included randomised and quasirandomised deworming trials in children for deworming compared to placebo or other interventions with data on baseline infection. Data Collection and Analysis We conducted NMA with individual participant data (IPD), using a frequentist approach for random-effects NMA. The covariates were: age, sex, weight, height, haemoglobin and infection intensity. The effect estimate chosen was the mean difference for the continuous outcome of interest. Results We received data from 19 randomized controlled trials with 31,945 participants. Overall risk of bias was low. There were no statistically significant subgroup effects across any of the potential effect modifiers. However, analyses showed that there may be greater effects on weight for moderate to heavily infected children (very low certainty evidence). Authors' Conclusions This analysis reinforces the case against mass deworming at a population-level, finding little effect on nutritional status or cognition. However, children with heavier intensity infections may benefit more. We urge the global community to adopt calls to make data available in open repositories to facilitate IPD analyses such as this, which aim to assess effects for the most vulnerable individuals.
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Affiliation(s)
- Vivian A. Welch
- Centre for Global HealthBruyère Research InstituteOttawaOntarioCanada
- School of EpidemiologyPublic Health and Preventive Medicine, University of OttawaOttawaOntarioCanada
| | | | - Alomgir Hossain
- Cardiovascular Research MethodsUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | - Alison Riddle
- School of EpidemiologyPublic Health and Preventive Medicine, University of OttawaOttawaOntarioCanada
| | - Michelle Gaffey
- Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Paul Arora
- Public Health Agency of Canada in the National Public Health Laboratory and Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Omar Dewidar
- Bruyère Research InstituteUniversity of OttawaOttawaOntarioCanada
| | - Rehana Salam
- South Australian Health and Medical Research InstituteUniversity of AdelaideAdelaideAustralia
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine (LSHTM)LondonUK
| | - Robert Black
- Department of International HealthJohns Hopkins School of Hygiene and Public HealthBaltimoreMaryland
| | - T. Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Sue Horton
- School of Public Health and Health SystemsUniversity of WaterlooWaterlooOntarioCanada
| | - Peter Tugwell
- School of EpidemiologyPublic Health and Preventive Medicine, University of OttawaOttawaOntarioCanada
- Center for Global Health, WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health EquityBruyère Research InstituteOttawaOntarioCanada
| | | | | | - Alison Elliott
- Medical Research Council/Uganda Virus Research InstituteLondon School of Hygiene and Tropical Medicine Uganda Research UnitEntebbeUganda
| | - Henrik Friis
- Department of Human NutritionUniversity of CopenhagenFrederiksbergDenmark
| | - Huong T. Le
- Institute for Preventive Medicine and Public HealthHanoi Medical UniversityHanoiVietnam
| | - Chengfang Liu
- School of Advanced Agricultural Sciences (SAAS)China Center for Agricultural Policy (CCAP), Peking UniversityBeijingChina
| | - Emily K. Rousham
- School of Sport, Exercise and Health SciencesLoughborough UniversityLeicestershireUK
| | | | - Charles King
- Department of PediatricsUniversity of CaliforniaLa JollaCalifornia
| | - Erliyani Sartono
- Department of ParasitologyLeiden University Medical CenterLeidenThe Netherlands
| | - Taniawati Supali
- Department Parasitology, Faculty of MedicineUniversitas IndonesiaJakartaIndonesia
| | - Peter Steinmann
- Swiss Tropical and Public Health InstituteUniversity of BaselBaselSwitzerland
| | - Emily Webb
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Franck Wieringa
- UMR204 NutripassInstitute de Recherche pour le DéveloppementMontpellierFrance
| | - Pattanee Winnichagoon
- Community/International Nutrition, Institute of NutritionMahidol UniversityNakhon PathomThailand
| | - Maria Yazdanbakhsh
- Department of ParasitologyLeiden University Medical CenterLeidenThe Netherlands
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Center of Excellence in Women and Child HealthAga Khan UniversityKarachiPakistan
| | - George Wells
- Cardiovascular Research MethodsUniversity of Ottawa Heart InstituteOttawaOntarioCanada
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Tumilowicz A, Habicht J, Mbuya MN, Beal T, Ntozini R, Rohner F, Pelto GH, Fisseha T, Haidar J, Assefa N, Wodajo HY, Wolde TT, Neufeld LM. Bottlenecks and predictors of coverage and adherence outcomes for a micronutrient powder program in Ethiopia. Matern Child Nutr 2019; 15:e12807. [PMID: 31622042 PMCID: PMC6856804 DOI: 10.1111/mcn.12807] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/28/2019] [Accepted: 02/18/2019] [Indexed: 01/23/2023]
Abstract
A theory-driven evaluation was conducted to assess performance of a trial to deliver micronutrient powder (MNP) through the Ethiopian Ministry of Health. We adapted an approach to coverage assessment, originally developed to identify bottlenecks in health service delivery, to examine sequential program outcomes and their correlates using cross-sectional survey data of caregivers of children 6-23 months (N = 1915). Separate multivariable Poisson regression models were used to estimate adjusted risk ratios of conceptually relevant determinants of coverage and adherence. Caregivers of children >11 months were more likely to have received MNP than caregivers of younger infants, yet children 12-17 months were 32% (P < 0.001) and children 18-23 months 38% (P < 0.001) less likely to have been fed MNP in the 14 days preceding the survey than children 6-11 months. Among caregivers who initiated feeding MNP, the most frequently reported reasons for discontinuing use were not obtaining additional supply (36.1%) and perceived child rejection of food with MNP (22.9%). For each additional time a caregiver met with frontline workers in the 3 months preceding the survey, they were 13% more likely to have recently fed MNP (P < 0.001). Caregivers' perception that MNP produced positive changes in children was associated with a 14% increase in the likelihood of having recently fed it (P < 0.001). These results emphasize the importance of counselling for MNP and infant and young child feeding for initial use and the importance of multiple contacts with frontline workers for continued use.
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Affiliation(s)
| | | | - Mduduzi N.N. Mbuya
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
- Global Alliance for Improved NutritionWashingtonDCUSA
| | - Ty Beal
- Global Alliance for Improved NutritionWashingtonDCUSA
- Department of Environmental Science and PolicyUniversity of CaliforniaDavisCaliforniaUSA
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
| | | | - Gretel H. Pelto
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Tezera Fisseha
- Institute for Education, Health and DevelopmentAddis AbabaEthiopia
| | - Jemal Haidar
- School of Public Health, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Nigussie Assefa
- School of Public Health, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | | | - Telahun Teka Wolde
- Health Services Quality DirectorateFederal Ministry of HealthAddis AbabaEthiopia
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Petry N, Jallow B, Sawo Y, Darboe MK, Barrow S, Sarr A, Ceesay PO, Fofana MN, Prentice AM, Wegmüller R, Rohner F, Phall MC, Wirth JP. Micronutrient Deficiencies, Nutritional Status and the Determinants of Anemia in Children 0-59 Months of Age and Non-Pregnant Women of Reproductive Age in The Gambia. Nutrients 2019; 11:E2275. [PMID: 31547543 PMCID: PMC6835426 DOI: 10.3390/nu11102275] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/12/2019] [Accepted: 09/18/2019] [Indexed: 11/16/2022] Open
Abstract
Data on micronutrient deficiency prevalence, nutrition status, and risk factors of anemia in The Gambia is scanty. To fill this data gap, a nationally representative cross-sectional survey was conducted on 1354 children (0-59 months), 1703 non-pregnant women (NPW; 15-49 years), and 158 pregnant women (PW). The survey assessed the prevalence of under and overnutrition, anemia, iron deficiency (ID), iron deficiency anemia (IDA), vitamin A deficiency (VAD), and urinary iodine concentration (UIC). Multivariate analysis was used to assess risk factors of anemia. Among children, prevalence of anemia, ID, IDA, and VAD was 50.4%, 59.0%, 38.2%, and 18.3%, respectively. Nearly 40% of anemia was attributable to ID. Prevalence of stunting, underweight, wasting, and small head circumference was 15.7%, 10.6%, 5.8%, and 7.4%, respectively. Among NPW, prevalence of anemia, ID, IDA and VAD was 50.9%, 41.4%, 28.0% and 1.8%, respectively. Anemia was significantly associated with ID and vitamin A insufficiency. Median UIC in NPW and PW was 143.1 µg/L and 113.5 ug/L, respectively. Overall, 18.3% of NPW were overweight, 11.1% obese, and 15.4% underweight. Anemia is mainly caused by ID and poses a severe public health problem. To tackle both anemia and ID, programs such as fortification or supplementation should be intensified.
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Affiliation(s)
| | | | | | - Momodou K Darboe
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia.
| | - Samba Barrow
- Gambia Bureau of Statistics, Banjul, The Gambia.
| | | | | | | | - Andrew M Prentice
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia.
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Kodish SR, Bio F, Oemcke R, Conteh J, Beauliere JM, Pyne-Bailey S, Rohner F, Ngnie-Teta I, Jalloh MB, Wirth JP. A qualitative study to understand how Ebola Virus Disease affected nutrition in Sierra Leone-A food value-chain framework for improving future response strategies. PLoS Negl Trop Dis 2019; 13:e0007645. [PMID: 31504036 PMCID: PMC6736239 DOI: 10.1371/journal.pntd.0007645] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/19/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study sought understand how the 2014-2016 EVD Virus Disease (EVD) outbreak impacted the nutrition sector in Sierra Leone and use findings for improving nutrition responses during future outbreaks of this magnitude. METHODOLOGY This qualitative study was iterative and emergent. In-depth interviews (n = 42) were conducted over two phases by purposively sampling both key informants (n = 21; government stakeholders, management staff from United Nations (UN) agencies and non-governmental organizations (NGO)), as well as community informants (n = 21; EVD survivors, health workers, community leaders) until data saturation. Multiple analysts collaborated in a team-based coding approach to identify key themes using Dedoose software. Findings are presented as both quotations and tables/figures. RESULTS The EVD outbreak effects and the related response strategies, especially movement restriction policies including 21-day quarantines, contributed to disruptions across the food value-chain in Sierra Leone. System-wide impacts were similar to those typically seen in large-scale disasters such as earthquakes. Participants described an array of direct and indirect effects on agricultural production and food storage and processing, as well as on distribution, transport, trade, and retailing. Secondary data were triangulated by interviews which described the aggregate negative effect of this outbreak on key pillars of food security, infant and young child feeding practices, and nutrition. During the humanitarian response, nutrition-specific interventions, including food assistance, were highly accepted, although sharing was reported. Despite EVD impacts across the entire food value-chain, nutrition-sensitive interventions were not central to the initial response as EVD containment and survival took priority. Culturally-appropriate social and behavior change communications were a critical response component for improving health, nutrition, and hygiene-related behaviors through community engagement. CONCLUSIONS Infectious diseases such as EVD have far-reaching effects that impact health and nutrition through interrelated pathways. In Sierra Leone, the entire food value-chain was broken to the extent that the system-wide damage was on par with that typically resulting from large natural disasters. A food value-chain approach, at minimum, offers a foundational framework from which to position nutrition preparedness and response efforts for outbreaks in similar resource constrained settings.
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Kodish S, Bio F, Oemcke R, Conteh J, Beauliere JM, Pyne-Bailey S, Rohner F, Teta IN, Jalloh M, Wirth J. A Qualitative Study Exploring Perceived Impacts of Ebola on Nutrition in Sierra Leone – a Food Value-chain Framework for Improving Future Response Strategies (OR21-07-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz034.or21-07-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
• to explore how and through what multi-level pathways the Ebola outbreak impacted the nutrition sector in Sierra Leone • to investigate the barriers and facilitating factors to implementing effective response strategies during the nutrition response • to develop an improved preparedness and nutrition response framework for consideration during future outbreaks of this nature.
Methods
This qualitative study had an iterative and emergent design. In-depth interviews (n = 42) were conducted over two phases by purposively sampling both key informants (n = 21; government stakeholders, management staff from United Nations agencies and non-governmental organizations (NGO), and informants (n = 21; community members, Ebola survivors, front-line workers) until data saturation was reached. Multiple analysts worked collaboratively in a team-based coding approach to identify key themes and sub-themes using Dedoose software. Findings are presented as both salient quotations and tables/figures to illustrate the results.
Results
The Ebola outbreak and related response strategies, especially movement restriction policies, disrupted nearly every aspect of the food value-chain in Sierra Leone. Through production, storage and processing, distribution, transport and trade, and retailing, salient themes emerged across interviews with Government, United Nations, and NGO stakeholders, as well as community-level participants about the serious effects of the outbreak on food and nutrition. Data suggest that the effects of the outbreak had an aggregate negative effect on key pillars of food security as well as infant and young child feeding practices. Food-based response efforts were highly accepted, although sharing and selling of food assistance was reported by front-line workers and community members alike.
Conclusions
Infectious diseases such as Ebola have far-reaching effects that are not just directly bio-medical in nature but also indirectly impacting health through the entire food value-chain from agriculture agricultural disruption to individual nutritional status. A food value-chain approach therefore may offer a viable framework from which to position nutrition preparedness and response efforts for infectious disease outbreaks in other similar food insecure settings.
Funding Sources
UNICEF West and Central Africa Regional Bureau.
Supporting Tables, Images and/or Graphs
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Wirth JP, Kitilya B, Petry N, PrayGod G, Veryser S, Mngara J, Zwahlen C, Wieringa F, Berger J, de Onis M, Rohner F, Becquey E. Growth Status, Inflammation, and Enteropathy in Young Children in Northern Tanzania. Am J Trop Med Hyg 2018; 100:192-201. [PMID: 30398137 DOI: 10.4269/ajtmh.17-0720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Recent evidence suggests that enteropathy of the gut due to environmental conditions (i.e., environmental enteropathy [EE]) in young children is negatively associated with linear growth. Using a case-control study design, we examined the potential determinants of stunting in stunted and non-stunted children 22-28 months of age. Potential determinants included inflammation biomarkers C-reactive protein, alpha-1-acid glycoprotein (AGP), and endotoxin-core antibody (EndoCAb) measured in serum samples; enteropathy markers alpha-1-antitrypsin, neopterin, myeloperoxidase (MPO) measured in stools samples; and demographic, health, feeding, and household characteristics. We also explored the determinants of EE by testing associations of composite EE scores and individual biomarkers with potential risk factors. Fifty-two percent of children (n = 310) were found to be stunted, and mean height-for-age Z scores (HAZ) were -1.22 (standard deviation [SD] ± 0.56) among non-stunted (control) children and -2.82 (SD ± 0.61) among stunted (case) children. Child HAZ was significantly (P < 0.05) and inversely associated with AGP, and child stunting was significantly positively associated (P < 0.05) with low dietary diversity, severe household hunger, and absence of soap in the household. Alpha-1-acid glycoprotein and EndoCAb concentrations were also significantly higher (P < 0.05) among children in households with no soap. Our study documented a seemingly localized cultural practice of young children (25%) being fed their dirty bathwater, which was associated with significantly higher concentrations of MPO (P < 0.05). Alpha-1-acid glycoprotein showed the most consistent associations with child growth and hygiene practices, but fecal EE biomarkers were not associated with child growth. The lack of retrospective data in our study may explain the null findings related to fecal EE biomarkers and child growth.
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Affiliation(s)
- James P Wirth
- GroundWork, Fläsch, Switzerland.,Unité Mixte de Recherche (UMR)-204, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, Montpellier, France
| | - Brenda Kitilya
- National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | | | - George PrayGod
- National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | | | - Julius Mngara
- National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | | | - Frank Wieringa
- Unité Mixte de Recherche (UMR)-204, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, Montpellier, France
| | - Jacques Berger
- Unité Mixte de Recherche (UMR)-204, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, Montpellier, France
| | | | | | - Elodie Becquey
- International Food Policy Research Institute (IFPRI), Dakar, Senegal
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Wirth JP, Rajabov T, Petry N, Woodruff BA, Shafique NB, Mustafa R, Tyler VQ, Rohner F. Micronutrient Deficiencies, Over- and Undernutrition, and Their Contribution to Anemia in Azerbaijani Preschool Children and Non-Pregnant Women of Reproductive Age. Nutrients 2018; 10:E1483. [PMID: 30314363 PMCID: PMC6213945 DOI: 10.3390/nu10101483] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 09/29/2018] [Accepted: 10/02/2018] [Indexed: 12/31/2022] Open
Abstract
Data on the nutritional situation and prevalence of micronutrient deficiencies in Azerbaijan are scarce, and knowledge about anemia risk factors is needed for national and regional policymakers. A nationally representative cross-sectional survey was conducted to assess the prevalence of micronutrient deficiencies, over- and undernutrition, and to disentangle determinants of anemia in children and women in Azerbaijan. The survey generated estimates of micronutrient deficiency and growth indicators for children aged 0⁻59 months of age (6⁻59 months for blood biomarkers) and non-pregnant women 15⁻49 years of age. Questionnaire data, anthropometric measurements, and blood samples were collected to assess the prevalence of under- and over-nutrition, anemia, iron deficiency, and iron deficiency anemia, in both groups. In children only, vitamin A deficiency and zinc deficiency were also assessed. In women only, folate and vitamin B12 deficiencies and vitamin A insufficiency were assessed. In total, 3926 household interviews were successfully completed with a response rate of 80.6%. In the 1455 children, infant and young child feeding practices were relatively poor overall; the prevalence of wasting and stunting were 3.1% and 18.0%, respectively; and 14.1% of children were overweight or obese. The prevalence of anemia was 24.2% in 6⁻59 months old children, the prevalence of iron deficiency was 15.0% in this age group, and the prevalence of iron deficiency anemia was 6.5%. Vitamin A deficiency was found in 8.0% of children, and zinc deficiency was found in 10.7%. Data from 3089 non-pregnant women 15⁻49 years of age showed that while undernutrition was scarce, 53% were overweight or obese, with increasing prevalence with increasing age. Anemia affected 38.2% of the women, iron deficiency 34.1% and iron deficiency anemia 23.8%. Vitamin A insufficiency was found in 10.5% of women. Folate and vitamin B12 deficiency were somewhat more common, with prevalence rates of 35.0% and 19.7%, respectively. The main risk factors for anemia in children were recent lower respiratory infection, inflammation and iron deficiency. In women, the main risk factors for anemia were iron deficiency and vitamin A insufficiency. Anemia is a public health problem in Azerbaijani children and women, and additional efforts are needed to reduce anemia in both groups.
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Affiliation(s)
| | | | | | | | | | | | - Vilma Qahoush Tyler
- UNICEF Regional Office for Middle East and North Africa, Amman 11821, Jordan.
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Kodish SR, Rohner F, Beauliere JM, Daffe M, Ayoya MA, Wirth JP, Ngnie-Teta I. Correction: Implications of the Ebola virus disease outbreak in Guinea: Qualitative findings to inform future health and nutrition-related responses. PLoS One 2018; 13:e0204675. [PMID: 30281637 PMCID: PMC6169907 DOI: 10.1371/journal.pone.0204675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Kodish SR, Rohner F, Beauliere JM, Daffe M, Ag Ayoya M, Wirth JP, Ngnie-Teta I. Implications of the Ebola virus disease outbreak in Guinea: Qualitative findings to inform future health and nutrition-related responses. PLoS One 2018; 13:e0202468. [PMID: 30138407 PMCID: PMC6107191 DOI: 10.1371/journal.pone.0202468] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/03/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Due to the close relationship between EVD and nutrition, the humanitarian community implemented various nutrition-specific and -sensitive interventions to stem the Ebola Virus Disease (EVD) outbreak in West Africa. Little, however, is known about stakeholder and community members' perspectives toward this response in Guinea. Therefore, we aimed to firstly understand how EVD may have influenced the nutrition situation; and secondly to assess the perceived acceptability and effectiveness of the nutrition response. MATERIALS AND METHODS Using 27 in-depth interviews conducted in April-May 2016, this descriptive, qualitative study had three iterative phases in an emergent design. Phase 1 explored the perceptions of 11 high-level policy and management staff. Phase 2 assessed the views of 16 community members, survivors, and front-line workers. Phase 3 compared the qualitative findings to relevant nutrition indicators from secondary data for final interpretations. A systematic, team-based coding approach using Dedoose software identified key themes during textual analysis. RESULTS Overall, several plausible pathways through an interrelated network of bio-social factors help describe EVD impacts on the nutrition situation of Guinea. At a basic level, complex social dimensions of health, response unpreparedness, and market disruptions were perceived to be major determinants affecting the nutrition situation, especially among IYC. At an underlying level, household food security was negatively impacted, along with weakened care-seeking practices, IYC feeding practices, and coping strategies. Consequently, treatment coverage for childhood illnesses and IYC diets were negatively impacted during the outbreak. In hindsight, most participants had positive perceptions toward the overall EVD response, but described salient considerations for improving upon this nutrition response during future outbreaks. DISCUSSION This study highlighted the complex web of inter-related factors through which EVD was perceived to impact the nutrition situation in Guinea. Considering the multi-level social and behavioral dimensions of health and nutrition is critical for effectively responding to infectious disease outbreaks.
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Karakochuk CD, Henderson AM, Samson KLI, Aljaadi AM, Devlin AM, Becquey E, Wirth JP, Rohner F. Comparison of a New Multiplex Immunoassay for Measurement of Ferritin, Soluble Transferrin Receptor, Retinol-Binding Protein, C-Reactive Protein and α¹-Acid-glycoprotein Concentrations against a Widely-Used s-ELISA Method. Diagnostics (Basel) 2018; 8:E13. [PMID: 29393894 PMCID: PMC5871996 DOI: 10.3390/diagnostics8010013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 01/26/2018] [Accepted: 01/31/2018] [Indexed: 01/30/2023] Open
Abstract
Recently, a multiplex ELISA (Quansys Biosciences) was developed that measures ferritin, soluble transferrin receptor (sTfR), retinol-binding protein (RBP), C-reactive protein (CRP), α¹-acid glycoprotein (AGP), thyroglobulin, and histidine-rich protein 2. Our primary aim was to conduct a method-comparison study to compare five biomarkers (ferritin, sTfR, RBP, CRP, and AGP) measured with the Quansys assay and a widely-used s-ELISA (VitMin Lab, Willstaett, Germany) with use of serum samples from 180 women and children from Burkina Faso, Cambodia, and Malaysia. Bias and concordance were used to describe the agreement in values measured by the two methods. We observed poor overall agreement between the methods, both with regard to biomarker concentrations and deficiency prevalence estimates. Several measurements were outside of the limit of detection with use of the Quansys ELISA (total n = 42 for ferritin, n = 2 for sTfR, n = 0 for AGP, n = 5 for CRP, n = 22 for RBP), limiting our ability to interpret assay findings. Although the Quansys ELISA has great potential to simplify laboratory analysis of key nutritional and inflammation biomarkers, there are some weaknesses in the procedures. Overall, we found poor comparability of results between methods. Besides addressing procedural issues, additional validation of the Quansys against a gold standard method is warranted for future research.
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Affiliation(s)
- Crystal D Karakochuk
- Food, Nutrition, and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
- BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.
| | - Amanda M Henderson
- BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.
- Department of Paediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada.
| | - Kaitlyn L I Samson
- Food, Nutrition, and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
- BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.
| | - Abeer M Aljaadi
- Food, Nutrition, and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
- BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.
| | - Angela M Devlin
- BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.
- Department of Paediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada.
| | - Elodie Becquey
- International Food Policy Research Institute, Washington, DC 20005, USA.
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Woodruff BA, Wirth JP, Ngnie-Teta I, Beaulière JM, Mamady D, Ayoya MA, Rohner F. Determinants of Stunting, Wasting, and Anemia in Guinean Preschool-Age Children: An Analysis of DHS Data From 1999, 2005, and 2012. Food Nutr Bull 2018; 39:39-53. [PMID: 29382224 DOI: 10.1177/0379572117743004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Wasting, stunting, and anemia are persistent and important forms of malnutrition in preschool-age children in the less developed world, in particular the Republic of Guinea, which was the site of a large outbreak of Ebola virus disease in 2014 to 2015. We analyzed data from 3 Demographic and Health Surveys done in Guinea in 1999, 2005, and 2012 to identify possible determinants of wasting, stunting, and anemia. All analyses, both bivariate and multivariate, were carried out separately for each of 3 age groups: less than 6 months, 6 to 23 months, and 24 to 59 months. Variables found statistically significantly associated with stunting, wasting, or anemia in bivariate analysis were placed in an age-specific logistic regression model for that outcome. Overall, anthropometric indices were available for 9228 children and hemoglobin concentrations were available for 5681 children. Logistic regression found relatively few variables associated with nutrition outcomes in children younger than 6 months. More variables were associated with nutrition outcomes in children aged 6 to 23 months. Such variables measured a wide variety of conditions, including estimated birth size, child health and nutritional status, child caring practices, mother's nutritional and health status, and household water source and sanitation. A similarly broad range of variables was statistically significantly associated with one or more nutrition outcomes in children aged 24 to 59 months. Few of the standard infant and young child feeding indicators were associated with any nutrition outcome. Improvement in the nutritional status of young children in Guinea may require a broad range of nutrition and health interventions.
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Namaste SML, Rohner F, Huang J, Bhushan NL, Flores-Ayala R, Kupka R, Mei Z, Rawat R, Williams AM, Raiten DJ, Northrop-Clewes CA, Suchdev PS. Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr 2017; 106:359S-371S. [PMID: 28615259 PMCID: PMC5490647 DOI: 10.3945/ajcn.116.141762] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: The accurate estimation of iron deficiency is important in planning and implementing interventions. Ferritin is recommended as the primary measure of iron status, but interpretability is challenging in settings with infection and inflammation.Objective: We assessed the relation between ferritin concentrations and inflammation and malaria in preschool children (PSC) (age range: 6-59 mo) and women of reproductive age (WRA) (age range: 15-49 y) and investigated adjustment algorithms to account for these effects.Design: Cross-sectional data from 15 surveys for PSC (n = 27,865) and 8 surveys for WRA (24,844), from the Biomarkers Reflecting the Inflammation and Nutritional Determinants of Anemia (BRINDA) project were analyzed individually and combined with the use of a meta-analysis. Several approaches were explored to estimate depleted iron stores (ferritin concentration <12 μg/L in PSC and <15 μg/L in WRA) in inflammation and malaria settings as follows: 1) increase ferritin-concentration cutoff to <30 μg/L; 2) exclude individuals with C-reactive protein (CRP) concentrations >5 mg/L or α-1-acid glycoprotein (AGP) concentrations >1 g/L; 3) apply arithmetic correction factors; and 4) use a regression correction approach.Results: Depleted iron-store estimates incrementally increased as CRP and AGP deciles decreased (4% compared with 30%, and 6% compared with 29% from highest compared with lowest CRP deciles for pooled PSC and WRA, respectively, with similar results for AGP). Depending on the approach used to adjust for inflammation (CRP plus AGP), the estimated prevalence of depleted iron stores increased by 7-25 and 2-8 absolute median percentage points for PSC and WRA, respectively, compared with unadjusted values. Adjustment for malaria in addition to CRP and AGP did not substantially change the estimated prevalence of depleted iron stores.Conclusions: Our results lend support for the use of internal regression correction to estimate the prevalence of depleted iron stores in regions with inflammation. This approach appears to mathematically reflect the linear relation of ferritin concentrations with acute-phase proteins. More research is warranted to validate the proposed approaches, but this study contributes to the evidence base to guide decisions about how and when to adjust ferritin for inflammation.
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Affiliation(s)
- Sorrel ML Namaste
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally, Arlington, VA;,Helen Keller International, Washington, DC
| | | | - Jin Huang
- Department of Oncology, Johns Hopkins University, Baltimore, MD
| | - Nivedita L Bhushan
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC
| | | | | | | | - Rahul Rawat
- Poverty Health and Nutrition Division, International Food Policy Research Institute, Dakar, Senegal
| | | | - Daniel J Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD; and
| | | | - Parminder S Suchdev
- Nutrition Branch, CDC, Atlanta, GA;,Emory University, Department of Pediatrics, Atlanta, GA
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Rohner F, Namaste SML, Larson LM, Addo OY, Mei Z, Suchdev PS, Williams AM, Sakr Ashour FA, Rawat R, Raiten DJ, Northrop-Clewes CA. Adjusting soluble transferrin receptor concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr 2017; 106:372S-382S. [PMID: 28615256 PMCID: PMC5490651 DOI: 10.3945/ajcn.116.142232] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Iron deficiency is thought to be one of the most prevalent micronutrient deficiencies globally, but an accurate assessment in populations who are frequently exposed to infections is impeded by the inflammatory response, which causes iron-biomarker alterations.Objectives: We assessed the relation between soluble transferrin receptor (sTfR) concentrations and inflammation and malaria in preschool children (PSC) (age range: 6-59 mo) and women of reproductive age (WRA) (age range: 15-49 y) and investigated adjustment algorithms to account for these effects.Design: Cross-sectional data from the Biomarkers Reflecting the Inflammation and Nutritional Determinants of Anemia (BRINDA) project from 11,913 PSC in 11 surveys and from 11,173 WRA in 7 surveys were analyzed individually and combined with the use of a meta-analysis. The following 3 adjustment approaches were compared with estimated iron-deficient erythropoiesis (sTfR concentration >8.3 mg/L): 1) the exclusion of individuals with C-reactive protein (CRP) concentrations >5 mg/L or α-1-acid glycoprotein (AGP) concentrations >1 g/L, 2) the application of arithmetic correction factors, and 3) the use of regression approaches.Results: The prevalence of elevated sTfR concentrations incrementally decreased as CRP and AGP deciles decreased for PSC and WRA, but the effect was more pronounced for AGP than for CRP. Depending on the approach used to adjust for inflammation, the estimated prevalence of iron-deficient erythropoiesis decreased by 4.4-14.6 and 0.3-9.5 percentage points in PSC and WRA, respectively, compared with unadjusted values. The correction-factor approach yielded a more modest reduction in the estimated prevalence of iron-deficient erythropoiesis than did the regression approach. Mostly, adjustment for malaria in addition to AGP did not significantly change the estimated prevalence of iron-deficient erythropoiesis.Conclusions: sTfR may be useful to assess iron-deficient erythropoiesis, but inflammation influences its interpretation, and adjustment of sTfR for inflammation and malaria should be considered. More research is warranted to evaluate the proposed approaches in different settings, but this study contributes to the evidence on how and when to adjust sTfR for inflammation and malaria.
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Affiliation(s)
| | - Sorrel ML Namaste
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally, Arlington, VA;,Helen Keller International, Washington, DC
| | | | | | | | | | | | | | - Rahul Rawat
- International Food Policy Research Institute, Washington, DC
| | - Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD; and
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Mei Z, Namaste SML, Serdula M, Suchdev PS, Rohner F, Flores-Ayala R, Addo OY, Raiten DJ. Adjusting total body iron for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr 2017; 106:383S-389S. [PMID: 28615255 PMCID: PMC5490648 DOI: 10.3945/ajcn.116.142307] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Total body iron (TBI) that is calculated from ferritin and soluble transferrin receptor (sTfR) allows for the evaluation of the full range of iron status from deficiency to excess. However, both ferritin and sTfR are affected by inflammation and malaria, which may require a statistical adjustment. TBI has been used to assess iron status in the United States, but its use worldwide and in settings with inflammation has been limited.Objective: We examine whether inflammation-adjusted ferritin and sTfR concentrations affect TBI values and the prevalence of low TBI (<0 mg/kg) in preschool children (PSC) (age range: 6-59 mo) and women of reproductive age (WRA) (age range: 15-49 y).Design: Cross-sectional data for PSC (8 surveys; n = 8413) and WRA (4 surveys; n = 4258) from the Biomarkers Reflecting the Inflammation and Nutritional Determinants of Anemia (BRINDA) project were analyzed individually and combined. TBI and the prevalence of low TBI were compared following 3 adjustment approaches for ferritin and sTfR: 1) the exclusion of individuals with inflammation (C-reactive protein concentration >5 mg/L or α-1-acid glycoprotein concentration >1 g/L), 2) the application of arithmetic correction factors, and 3) the use of regression correction.Results: Regardless of the method that was used to adjust ferritin and sTfR for inflammation, the adjusted mean TBI decreased in both PSC and WRA compared with unadjusted values. Subsequently, inflammation-adjusted TBI increased the prevalence of low TBI by a median of 4-14 percentage points (pps) in PSC and 1-3 pps in WRA compared with unadjusted TBI. The regression approach resulted in a greater median increase than was achieved with the exclusion or correction-factor approaches, and accounting for malaria in addition to inflammation did not have an added effect on the prevalence estimates.Conclusion: The prevalence of low TBI is underestimated if it is not adjusted by inflammation, particularly in children living in areas with a high prevalence of inflammation.
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Affiliation(s)
| | - Sorrel ML Namaste
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally, Arlington, VA;,Helen Keller International, Washington, DC
| | | | | | | | | | | | - Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD
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Engle-Stone R, Aaron GJ, Huang J, Wirth JP, Namaste SM, Williams AM, Peerson JM, Rohner F, Varadhan R, Addo OY, Temple V, Rayco-Solon P, Macdonald B, Suchdev PS. Predictors of anemia in preschool children: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr 2017; 106:402S-415S. [PMID: 28615260 PMCID: PMC5490650 DOI: 10.3945/ajcn.116.142323] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: A lack of information on the etiology of anemia has hampered the design and monitoring of anemia-control efforts.Objective: We aimed to evaluate predictors of anemia in preschool children (PSC) (age range: 6-59 mo) by country and infection-burden category.Design: Cross-sectional data from 16 surveys (n = 29,293) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project were analyzed separately and pooled by category of infection burden. We assessed relations between anemia (hemoglobin concentration <110 g/L) and severe anemia (hemoglobin concentration <70 g/L) and individual-level (age, anthropometric measures, micronutrient deficiencies, malaria, and inflammation) and household-level predictors; we also examined the proportion of anemia with concomitant iron deficiency (defined as an inflammation-adjusted ferritin concentration <12 μg/L). Countries were grouped into 4 categories on the basis of risk and burden of infectious disease, and a pooled multivariable logistic regression analysis was conducted for each group.Results: Iron deficiency, malaria, breastfeeding, stunting, underweight, inflammation, low socioeconomic status, and poor sanitation were each associated with anemia in >50% of surveys. Associations between breastfeeding and anemia were attenuated by controlling for child age, which was negatively associated with anemia. The most consistent predictors of severe anemia were malaria, poor sanitation, and underweight. In multivariable pooled models, child age, iron deficiency, and stunting independently predicted anemia and severe anemia. Inflammation was generally associated with anemia in the high- and very high-infection groups but not in the low- and medium-infection groups. In PSC with anemia, 50%, 30%, 55%, and 58% of children had concomitant iron deficiency in low-, medium-, high-, and very high-infection categories, respectively.Conclusions: Although causal inference is limited by cross-sectional survey data, results suggest anemia-control programs should address both iron deficiency and infections. The relative importance of factors that are associated with anemia varies by setting, and thus, country-specific data are needed to guide programs.
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Affiliation(s)
| | - Grant J Aaron
- Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Jin Huang
- Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins University, Baltimore, MD
| | | | - Sorrel Ml Namaste
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally, Arlington, VA
| | | | - Janet M Peerson
- Department of Nutrition, University of California, Davis, CA
| | | | - Ravi Varadhan
- Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins University, Baltimore, MD
| | - O Yaw Addo
- Department of Global Health, Rollins School of Public Health, Atlanta, GA
| | - Victor Temple
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Pura Rayco-Solon
- Department of Nutrition for Health and Development, WHO, Geneva, Switzerland
| | | | - Parminder S Suchdev
- Department of Pediatrics, Emory University, Atlanta, GA;
- Department of Global Health, Rollins School of Public Health, Atlanta, GA
- Nutrition Branch, CDC, Atlanta, GA
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Wirth JP, Woodruff BA, Engle-Stone R, Namaste SML, Temple VJ, Petry N, Macdonald B, Suchdev PS, Rohner F, Aaron GJ. Predictors of anemia in women of reproductive age: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr 2017; 106:416S-427S. [PMID: 28615262 PMCID: PMC5490645 DOI: 10.3945/ajcn.116.143073] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Anemia in women of reproductive age (WRA) (age range: 15-49 y) remains a public health problem globally, and reducing anemia in women by 50% by 2025 is a goal of the World Health Assembly.Objective: We assessed the associations between anemia and multiple proximal risk factors (e.g., iron and vitamin A deficiencies, inflammation, malaria, and body mass index) and distal risk factors (e.g., education status, household sanitation and hygiene, and urban or rural residence) in nonpregnant WRA.Design: Cross-sectional, nationally representative data from 10 surveys (n = 27,018) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project were analyzed individually and pooled by the infection burden and risk in the country. We examined the severity of anemia and measured the bivariate associations between anemia and factors at the country level and by infection burden, which we classified with the use of the national prevalences of malaria, HIV, schistosomiasis, sanitation, and water-quality indicators. Pooled multivariate logistic regression models were constructed for each infection-burden category to identify independent determinants of anemia (hemoglobin concertation <120 g/L).Results: Anemia prevalence was ∼40% in countries with a high infection burden and 12% and 7% in countries with moderate and low infection burdens, respectively. Iron deficiency was consistently associated with anemia in multivariate models, but the proportion of anemic women who were iron deficient was considerably lower in the high-infection group (35%) than in the moderate- and low-infection groups (65% and 71%, respectively). In the multivariate analysis, inflammation, vitamin A insufficiency, socioeconomic status, and age were also significantly associated with anemia, but malaria and vitamin B-12 and folate deficiencies were not.Conclusions: The contribution of iron deficiency to anemia varies according to a country's infection burden. Anemia-reduction programs for WRA can be improved by considering the underlying infection burden of the population and by assessing the overlap of micronutrient deficiencies and anemia.
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Affiliation(s)
| | | | | | - Sorrel ML Namaste
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally, Arlington, VA;,Helen Keller International, New York City, NY;,Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD
| | - Victor J Temple
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | | | | | - Parminder S Suchdev
- Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA; .,Department of Pediatrics, Emory University, Atlanta, GA; and
| | | | - Grant J Aaron
- Global Alliance for Improved Nutrition, Geneva, Switzerland
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Killilea DW, Rohner F, Ghosh S, Otoo GE, Smith L, Siekmann JH, King JC. Identification of a Hemolysis Threshold That Increases Plasma and Serum Zinc Concentration. J Nutr 2017; 147:1218-1225. [PMID: 28490675 PMCID: PMC5443468 DOI: 10.3945/jn.116.247171] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/19/2017] [Accepted: 03/28/2017] [Indexed: 12/20/2022] Open
Abstract
Background: Plasma or serum zinc concentration (PZC or SZC) is the primary measure of zinc status, but accurate sampling requires controlling for hemolysis to prevent leakage of zinc from erythrocytes. It is not established how much hemolysis can occur without changing PZC/SZC concentrations.Objective: This study determines a guideline for the level of hemolysis that can significantly elevate PZC/SZC.Methods: The effect of hemolysis on PZC/SZC was estimated by using standard hematologic variables and mineral content. The calculated hemolysis threshold was then compared with results from an in vitro study and a population survey. Hemolysis was assessed by hemoglobin and iron concentrations, direct spectrophotometry, and visual assessment of the plasma or serum. Zinc and iron concentrations were determined by inductively coupled plasma spectrometry.Results: A 5% increase in PZC/SZC was calculated to result from the lysis of 1.15% of the erythrocytes in whole blood, corresponding to ∼1 g hemoglobin/L added into the plasma or serum. Similarly, the addition of simulated hemolysate to control plasma in vitro caused a 5% increase in PZC when hemoglobin concentrations reached 1.18 ± 0.10 g/L. In addition, serum samples from a population nutritional survey were scored for hemolysis and analyzed for changes in SZC; samples with hemolysis in the range of 1-2.5 g hemoglobin/L showed an estimated increase in SZC of 6% compared with nonhemolyzed samples. Each approach indicated that a 5% increase in PZC/SZC occurs at ∼1 g hemoglobin/L in plasma or serum. This concentration of hemoglobin can be readily identified directly by chemical hemoglobin assays or indirectly by direct spectrophotometry or matching to a color scale.Conclusions: A threshold of 1 g hemoglobin/L is recommended for PZC/SZC measurements to avoid increases in zinc caused by hemolysis. The use of this threshold may improve zinc assessment for monitoring zinc status and nutritional interventions.
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Affiliation(s)
| | | | - Shibani Ghosh
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA; and
| | - Gloria E Otoo
- Department of Nutrition and Food Sciences, University of Ghana, Accra, Ghana
| | - Lauren Smith
- Children's Hospital Oakland Research Institute, Oakland, CA
| | | | - Janet C King
- Children's Hospital Oakland Research Institute, Oakland, CA
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Wirth JP, Petry N, Tanumihardjo SA, Rogers LM, McLean E, Greig A, Garrett GS, Klemm RDW, Rohner F. Vitamin A Supplementation Programs and Country-Level Evidence of Vitamin A Deficiency. Nutrients 2017; 9:nu9030190. [PMID: 28245571 PMCID: PMC5372853 DOI: 10.3390/nu9030190] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 12/15/2022] Open
Abstract
Vitamin A supplementation (VAS) programs targeted at children aged 6–59 months are implemented in many countries. By improving immune function, vitamin A (VA) reduces mortality associated with measles, diarrhea, and other illnesses. There is currently a debate regarding the relevance of VAS, but amidst the debate, researchers acknowledge that the majority of nationally-representative data on VA status is outdated. To address this data gap and contribute to the debate, we examined data from 82 countries implementing VAS programs, identified other VA programs, and assessed the recentness of national VA deficiency (VAD) data. We found that two-thirds of the countries explored either have no VAD data or data that were >10 years old (i.e., measured before 2006), which included twenty countries with VAS coverage ≥70%. Fifty-one VAS programs were implemented in parallel with at least one other VA intervention, and of these, 27 countries either had no VAD data or data collected in 2005 or earlier. To fill these gaps in VAD data, countries implementing VAS and other VA interventions should measure VA status in children at least every 10 years. At the same time, the coverage of VA interventions can also be measured. We identified three countries that have scaled down VAS, but given the lack of VA deficiency data, this would be a premature undertaking in most countries without appropriate status assessment. While the global debate about VAS is important, more attention should be directed towards individual countries where programmatic decisions are made.
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Affiliation(s)
| | | | - Sherry A Tanumihardjo
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA.
| | - Lisa M Rogers
- Department of Nutrition for Health and Development, World Health Organization, 1207 Geneva, Switzerland.
| | - Erin McLean
- UNICEF Headquarters, New York, NY 10017, USA.
| | - Alison Greig
- Infant and Young Child Nutrition, Micronutrient Initiative, Ottawa, ON K2P 2K3, Canada.
| | - Greg S Garrett
- Global Alliance for Improved Nutrition, 1202 Geneva, Switzerland.
| | - Rolf D W Klemm
- Helen Keller International, New York, NY 10010, USA.
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Leyvraz M, Rohner F, Konan AG, Esso LJCE, Woodruff BA, Norte A, Adiko AF, Bonfoh B, Aaron GJ. High Awareness but Low Coverage of a Locally Produced Fortified Complementary Food in Abidjan, Côte d'Ivoire: Findings from a Cross-Sectional Survey. PLoS One 2016; 11:e0166295. [PMID: 27824917 PMCID: PMC5100976 DOI: 10.1371/journal.pone.0166295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 10/26/2016] [Indexed: 11/18/2022] Open
Abstract
Poor complementary feeding practices among infants and young children in Côte d’Ivoire are major contributing factors to the country’s high burden of malnutrition. As part of a broad effort to address this issue, an affordable, nutritious, and locally produced fortified complementary food product was launched in the Côte d’Ivoire in 2011. The objective of the current research was to assess various levels of coverage of the program and to identify coverage barriers. A cross-sectional household survey was conducted among caregivers of children less than 2-years of age living in Abidjan, Côte d’Ivoire. Four measures of coverage were assessed: “message coverage” (i.e., has the caregiver ever heard of the product?), “contact coverage” (i.e., has the caregiver ever fed the child the product?), “partial coverage” (i.e., has the caregiver fed the child the product in the previous month?), and “effective coverage” (i.e., has the caregiver fed the child the product in the previous 7 days?). A total of 1,113 caregivers with children between 0 and 23 months of age were interviewed. Results showed high message coverage (85.0%), moderate contact coverage (37.8%), and poor partial and effective coverages (8.8% and 4.6%, respectively). Product awareness was lower among caregivers from poorer households, but partial and effective coverages were comparable in both poor and non-poor groups. Infant and young child feeding (IYCF) practices were generally poor and did not appear to have improved since previous assessments. In conclusion, the results from the present study indicate that availability on the market and high awareness among the target population is not sufficient to achieve high and effective coverage. With market-based delivery models, significant efforts are needed to improve demand. Moreover, given the high prevalence of malnutrition and poor IYCF practices, additional modes of delivering IYCF interventions and improving IYCF practices should be considered.
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Affiliation(s)
- Magali Leyvraz
- Global Alliance for Improved Nutrition, Geneva, Switzerland
- * E-mail:
| | | | - Amoin G. Konan
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
| | - Lasme J. C. E. Esso
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
| | | | | | - Adiko F. Adiko
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Grant J. Aaron
- Global Alliance for Improved Nutrition, Geneva, Switzerland
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47
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Petry N, Olofin I, Hurrell RF, Boy E, Wirth JP, Moursi M, Donahue Angel M, Rohner F. The Proportion of Anemia Associated with Iron Deficiency in Low, Medium, and High Human Development Index Countries: A Systematic Analysis of National Surveys. Nutrients 2016; 8:nu8110693. [PMID: 27827838 PMCID: PMC5133080 DOI: 10.3390/nu8110693] [Citation(s) in RCA: 234] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/26/2016] [Accepted: 10/28/2016] [Indexed: 11/16/2022] Open
Abstract
Iron deficiency is commonly assumed to cause half of all cases of anemias, with hereditary blood disorders and infections such as hookworm and malaria being the other major causes. In countries ranked as low, medium, and high by the Human Development Index, we conducted a systematic review of nationally representative surveys that reported the prevalence of iron deficiency, iron deficiency anemia, and anemia among pre-school children and non-pregnant women of reproductive age. Using random effects meta-analyses techniques, data from 23 countries for pre-school children and non-pregnant women of reproductive age was pooled, and the proportion of anemia attributable to iron deficiency was estimated by region, inflammation exposure, anemia prevalence, and urban/rural setting. For pre-school children and non-pregnant women of reproductive age, the proportion of anemia associated with iron deficiency was 25.0% (95% CI: 18.0, 32.0) and 37.0% (95% CI: 28.0, 46.0), respectively. The proportion of anemia associated with iron deficiency was lower in countries where anemia prevalence was >40%, especially in rural populations (14% for pre-school children; 16% for non-pregnant women of reproductive age), and in countries with very high inflammation exposure (20% for pre-school children; 25% for non-pregnant women of reproductive age). Despite large heterogeneity, our analyses suggest that the proportion of anemia associated with iron deficiency is lower than the previously assumed 50% in countries with low, medium, or high Human Development Index ranking. Anemia-reduction strategies and programs should be based on an analysis of country-specific data, as iron deficiency may not always be the key determinant of anemia.
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Affiliation(s)
| | - Ibironke Olofin
- GroundWork, Fläsch 7306, Switzerland.
- Department of Epidemiology; Harvard School of Public Health, Boston, MA 02115, USA.
| | - Richard F Hurrell
- Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich 8092, Switzerland.
| | - Erick Boy
- Harvest Plus, International Food Policy Research Institute, Washington, DC 20006, USA.
| | | | - Mourad Moursi
- Harvest Plus, International Food Policy Research Institute, Washington, DC 20006, USA.
| | - Moira Donahue Angel
- Harvest Plus, International Food Policy Research Institute, Washington, DC 20006, USA.
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48
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Rohner F, Leyvraz M, Konan AG, Esso LJCE, Wirth JP, Norte A, Adiko AF, Bonfoh B, Aaron GJ. The Potential of Food Fortification to Add Micronutrients in Young Children and Women of Reproductive Age - Findings from a Cross-Sectional Survey in Abidjan, Côte d'Ivoire. PLoS One 2016; 11:e0158552. [PMID: 27384762 PMCID: PMC4934880 DOI: 10.1371/journal.pone.0158552] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/19/2016] [Indexed: 11/18/2022] Open
Abstract
Poor micronutrient intakes are a major contributing factor to the high burden of micronutrient deficiencies in Côte d'Ivoire. Large-scale food fortification is considered a cost-effective approach to deliver micronutrients, and fortification of salt (iodine), wheat flour (iron and folic acid), and vegetable oil (vitamin A) is mandatory in Côte d'Ivoire. A cross-sectional survey on households with at least one child 6-23 months was conducted to update coverage figures with adequately fortified food vehicles in Abidjan, the capital of and largest urban community in Côte d'Ivoire, and to evaluate whether additional iron and vitamin A intake is sufficient to bear the potential to reduce micronutrient malnutrition. Information on demographics and food consumption was collected, along with samples of salt and oil. Wheat flour was sampled from bakeries and retailers residing in the selected clusters. In Abidjan, 86% and 97% of salt and vegetable oil samples, respectively, were adequately fortified, while only 32% of wheat flour samples were adequately fortified, but all samples contained some added iron. There were no major differences in additional vitamin A and iron intake between poor and non-poor households. For vitamin A in oil, the additional percentage of the recommended nutrient intake was 27% and 40% for children 6-23 months and women of reproductive age, respectively, while for iron from wheat flour, only 13% and 19% could be covered. Compared to previous estimates, coverage has remained stable for salt and wheat flour, but improved for vegetable oil. Fortification of vegetable oil clearly provides a meaningful additional amount of vitamin A. This is not currently the case for iron, due to the low fortification levels. Iron levels in wheat flour should be increased and monitored, and additional vehicles should be explored to add iron to the Ivorian diet.
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Affiliation(s)
| | - Magali Leyvraz
- Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Amoin G. Konan
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
| | - Lasme J. C. E. Esso
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
| | | | | | - Adiko F. Adiko
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Grant J. Aaron
- Global Alliance for Improved Nutrition, Geneva, Switzerland
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Woodruff BA, Wirth JP, Bailes A, Matji J, Timmer A, Rohner F. Determinants of stunting reduction in Ethiopia 2000 - 2011. Matern Child Nutr 2016; 13. [PMID: 27161654 DOI: 10.1111/mcn.12307] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/30/2016] [Accepted: 02/01/2016] [Indexed: 01/21/2023]
Abstract
The prevalence of stunting in Ethiopia declined from 57% in 2000 to 44% in 2011, yet the factors producing this change are not fully understood. Data on 23,999 children 0-59 months of age from three Demographic and Health Surveys (DHS) from 2000, 2005, and 2011 were analyzed to assess the trends in stunting prevalence, mean height-for-age z-scores (HAZ) and the associations between potential factors and HAZ. Associations were determined separately using three separate generalized linear models for children age less than 6 months, 6-23 months, and 24-59 months of age. Significant variables were then analyzed to determine if they showed an overall trend between the 2000 and 2011 surveys. In children < 6 months of age, only mother's height was both a significant predictor of HAZ and showed a progressive, albeit non-significant, increase from 2000 to 2011. In children 6-23 months of age, only mother's use of modern contraception showed substantial changes in a direction consistent with improving HAZ, but improvements in maternal nutrition status were observed from 2000 to 2005. For children 24-59 months of age a consistent and progressive change is seen in child's diarrhea, fever, mother's education, and the occurrence of open defecation. Our analysis demonstrated that factors associated with HAZ vary by child's age and the dominant livelihood practice in the community. Variables that could have contributed to the decline of stunting in Ethiopia in children less than 5 years of age include markers of child health, mother's nutritional status, mother's educational level, and environmental hygiene.
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Affiliation(s)
| | - James P Wirth
- GroundWork, Crans-près-Céligny, Switzerland.,Institute of Research for Development (IRD), UMR Nutripass IRD-UM2-UM1, Montpellier, France
| | - Adam Bailes
- UNICEF Ethiopia, Nutrition and Food Security Section, Addis Ababa, Ethiopia
| | - Joan Matji
- UNICEF Ethiopia, Nutrition and Food Security Section, Addis Ababa, Ethiopia
| | - Arnold Timmer
- UNICEF Ethiopia, Nutrition and Food Security Section, Addis Ababa, Ethiopia
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50
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Wirth JP, Rohner F, Woodruff BA, Chiwile F, Yankson H, Koroma AS, Russel F, Sesay F, Dominguez E, Petry N, Shahab-Ferdows S, de Onis M, Hodges MH. Anemia, Micronutrient Deficiencies, and Malaria in Children and Women in Sierra Leone Prior to the Ebola Outbreak - Findings of a Cross-Sectional Study. PLoS One 2016; 11:e0155031. [PMID: 27163254 PMCID: PMC4862671 DOI: 10.1371/journal.pone.0155031] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/25/2016] [Indexed: 12/15/2022] Open
Abstract
To identify the factors associated with anemia and to document the severity of micronutrient deficiencies, malaria and inflammation, a nationally representative cross-sectional survey was conducted. A three-stage sampling procedure was used to randomly select children <5 years of age and adult women from households in two strata (urban and rural). Household and individual data were collected, and blood samples from children and women were used to measure the prevalence of malaria, inflammation, and deficiencies of iron, vitamin A, folate, and vitamin B12. 839 children and 945 non-pregnant women were included in the survey. In children, the prevalence rates of anemia (76.3%; 95% CI: 71.8, 80.4), malaria (52.6%; 95% CI: 46.0, 59.0), and acute and chronic inflammation (72.6%; 95% CI: 67.5, 77.1) were high. However, the prevalence of vitamin A deficiency (17.4%; 95% CI: 13.9, 21.6) was moderate, and the prevalence of iron deficiency (5.2%; 95% CI: 3.3, 8.1) and iron-deficiency anemia (3.8%; 95% CI: 2.5, 5.8) were low. Malaria and inflammation were associated with anemia, yet they explained only 25% of the population-attributable risk. In women, 44.8% (95% CI: 40.1, 49.5), 35.1% (95% CI: 30.1, 40.4), and 23.6% (95% CI: 20.4, 27.3) were affected by anemia, malaria, or inflammation, respectively. The prevalence rates of iron deficiency (8.3%; 95% CI: 6.2, 11.1), iron-deficiency anemia (6.1%; 95% CI: 4.4, 8.6), vitamin A deficiency (2.1%; 95% CI: 1.1, 3.1) and vitamin B12 deficiency (0.5%; 95% CI: 0.2, 1.4) were low, while folate deficiency was high (79.2%; 95% CI: 74.1, 83.5). Iron deficiency, malaria, and inflammation were significantly associated with anemia, but explained only 25% of cases of anemia. Anemia in children and women is a severe public health problem in Sierra Leone. Since malaria and inflammation only contributed to 25% of anemia, other causes of anemia, such as hemoglobinopathies, should also be explored.
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Affiliation(s)
| | | | | | | | | | | | - Feimata Russel
- Ministry of Health and Sanitation, Freetown, Sierra Leone
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