1
|
Gomez MG, Arynchyna-Smith A, Ghotme KA, Garcia R, Johnson WD, Boop FA, Park KB, Caceres A, Pardo Vargas RA, Ayala R, Ibbotson G, Sheneman N, Peterson DB, Öcal E, Nyalundja AD, La Fuente J, Khan T, Hobart-Porter L, Moser RP, Ahmed YS, El Abbadi N, Woodrow S, Sundell K, Osendarp SJM, Martinez H, Blount JP, Rosseau GL. Global Neurosurgery at the 76th World Health Assembly (2023): First Neurosurgery-Driven Resolution Calls for Micronutrient Fortification to Prevent Spina Bifida. World Neurosurg 2024; 185:135-140. [PMID: 38266995 DOI: 10.1016/j.wneu.2024.01.089] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
Since 2018, a neurosurgery delegation has been actively engaged and consistently present at the World Health Assembly. Recognizing the growing impact of neurosurgical diseases, the neurosurgery delegation participated in the 76th World Health Assembly in May 2023, advocating for timely, safe, and affordable global neurosurgical care. The delegation focused on forging new collaborations, strengthening the World Health Organization-World Federation of Neurosurgical Societies official relations, and actively supporting resolutions that impact the neurosurgical patients. However, there is a long advocacy journey ahead to address unmet neurosurgical needs. Patient-centered advocacy is an inherent task of our profession and the essence of the Global Neurosurgery Bogota Declaration of 2016. The highlight of the 76th World Health Assembly was the adoption of the first neurosurgery-driven resolution calling for micronutrient fortification to prevent spina bifida and other micronutrient deficiencies. For the last 4 years, the Global Alliance for Prevention of Spina Bifida, a group spearheaded by neurosurgeons, advocated for spina bifida prevention. This Alliance collaborated with many stakeholders, notably, the Colombian government to promote the resolution: "Accelerating efforts for preventing micronutrient deficiencies and their consequences, including spina bifida and other neural tube defects, through safe and effective food fortification." This is a proud milestone for the neurosurgical profession. There are many strategies available for neurosurgeons, when working together with elected leaders, other stakeholders, and allied professionals, to implement initiatives that can prevent future cases of spina bifida and other neurological disorders and reduce the burden of neurosurgical disease.
Collapse
Affiliation(s)
- Martina Gonzalez Gomez
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anastasia Arynchyna-Smith
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kemel A Ghotme
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia; Department of Neurosurgery, Pediatric Neurosurgery, Fundacion Santa Fe de Bogota, Bogota, Colombia.
| | - Roxanna Garcia
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Walter D Johnson
- Department of Surgery and Neurosurgery, Department of Global Health, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Frederick A Boop
- Department of Neurosurgery, St Jude Global Program, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Adrian Caceres
- Department of Pediatric Neurosurgery, Children's National Hospital, San Jose, Costa Rica
| | - Rosa A Pardo Vargas
- Genetics Section and Neonatology Unit, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Ruben Ayala
- Operation Smile Inc., Virginia Beach, Virginia, USA
| | | | - Natalie Sheneman
- Global Alliance for Surgical, Obstetric, Trauma and Anaesthesia Care (The G4 Alliance), Chicago, Illinois, USA
| | - Daniel B Peterson
- Global Alliance for Surgical, Obstetric, Trauma and Anaesthesia Care (The G4 Alliance), Chicago, Illinois, USA
| | - Eylem Öcal
- Department of Neurosurgery, University of Arkansas for Medical Sciences Medical Center, Little Rock, Arkansas, USA
| | - Arsene Daniel Nyalundja
- Center for Tropical Diseases and Global Health (CTDGH), Catholic University of Bukavu, South-Kivu, Democratic Republic of Congo; Research Department, Université Catholique de Bukavu, South-Kivu, Democratic Republic of Congo; Association of Future African Neurosurgeons, Yaoundé, Cameroon
| | - Jesus La Fuente
- Department of Neurosurgery, Sacred Heart Hospital, Barcelona, Spain
| | - Tariq Khan
- Department of Neurosurgery, Northwest School of Medicine, Peshawar, Pakistan
| | - Laura Hobart-Porter
- Pediatric Physical Medicine and Rehabilitation, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Richard P Moser
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Najia El Abbadi
- Department of Neurosurgery, Hospital Ibn Sina, Rabat, Morroco
| | - Sarah Woodrow
- Department of Neurological Surgery, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Kristin Sundell
- Global Alliance for Improved Nutrition, Washington DC, Northwest Washington, USA
| | | | - Homero Martinez
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gail L Rosseau
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA; Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia; Department of Neurosurgery, Pediatric Neurosurgery, Fundacion Santa Fe de Bogota, Bogota, Colombia
| |
Collapse
|
2
|
Rodas-Moya S, Giudici FM, Owolabi A, Samuel F, Kodish SR, Lachat C, Abreu TC, van het Hof KH, Osendarp SJM, Brouwer ID, Feskens EJM, Melse-Boonstra A. A generic theory of change-based framework with core indicators for monitoring the effectiveness of large-scale food fortification programs in low- and middle-income countries. Front Nutr 2023; 10:1163273. [PMID: 37426192 PMCID: PMC10324612 DOI: 10.3389/fnut.2023.1163273] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/17/2023] [Indexed: 07/11/2023] Open
Abstract
Large-scale food fortification (LSFF) programs are widely implemented in low- and middle-income countries (LMIC) to alleviate micronutrient deficiencies. However, these programs may not achieve the desired impact due to poor design or bottlenecks in program implementation. Monitoring and evaluation (M&E) frameworks and a set of agreed indicators can help to benchmark progress and to strengthen the evidence-base of effectiveness in a standardized way. We aimed to formulate recommendations towards core indicators for evaluating the effectiveness of LSFF programs with their associated metrics, methods, and tools (IMMT). For this, we used a multi-method iterative approach, including a mapping review of the literature, semi-structured interviews with international experts, compilation of a generic Theory of Change (ToC) framework for LSFF program delivery, and selection of IMMT for M&E of LSFF programs at key stages along the ToC delivery framework. Lastly, we conducted exploratory, qualitative interviews with key informants in Nigeria to explore experiences and perceptions related to the implementation of LSFF programs in Nigeria's context, and their opinion towards the proposed set of core IMMT. The literature search resulted in 14 published and 15 grey literature documents, from which we extracted a total of 41 indicators. Based on the available literature and interviews with international experts, we mapped a ToC delivery framework and selected nine core indicators at the output, outcome and impact level for M&E of the effectiveness of LSFF programs. Key informants in Nigeria revealed that the main bottlenecks for implementation of the proposed IMMT are related to the lack of technical capacity, equipment, laboratory infrastructure, and financial resources. In conclusion, we propose a set of nine core indicators for enabling comprehensive M&E of the effectiveness of LSFF programs in LMIC. This proposed set of core indicators can be used for further evaluation, harmonization and integration in national and international protocols for M&E of LSFF programs.
Collapse
Affiliation(s)
- Santiago Rodas-Moya
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
| | - Francesca M. Giudici
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
| | - Adedotun Owolabi
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
| | - Folake Samuel
- Department of Human Nutrition and Dietetics, College of Medicine, Faculty of Public Health, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Stephen R. Kodish
- Department of Nutritional Sciences and Biobehavioral Health, Pennsylvania State University, University Park, PA, United States
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Taymara C. Abreu
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Karin H. van het Hof
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
| | - Saskia J. M. Osendarp
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
- The Micronutrient Forum, Washington, DC, United States
| | - Inge D. Brouwer
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
| | - Edith J. M. Feskens
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
| | - Alida Melse-Boonstra
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
| |
Collapse
|
3
|
Manger MS, Brown KH, Osendarp SJM, Atkin RA, McDonald CM. Barriers to and Enablers of the Inclusion of Micronutrient Biomarkers in National Surveys and Surveillance Systems in Low- and Middle-Income Countries. Nutrients 2022; 14:nu14102009. [PMID: 35631149 PMCID: PMC9145664 DOI: 10.3390/nu14102009] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
Including biomarkers of micronutrient status in existing or planned national surveys or surveillance systems is a critical step in improving capacity to promote, design, monitor, and evaluate micronutrient policies and programs. We aimed to identify the barriers to and enablers of the inclusion of micronutrient biomarker assessment in national surveys and surveillance systems, to identify the main challenges faced during the survey process, and to review experiences using existing platforms for micronutrient surveys. We conducted a series of key informant interviews with in-country and external representatives from six countries where national-level data on micronutrient status were collected in the past 5 years: Cambodia, Pakistan, Malawi, Uganda, Ghana, and Uzbekistan. Micronutrients associated with specific public health programs were always prioritized for inclusion in the survey. If funding, time, and/or logistics allowed, other considered micronutrients were also included. The most important and frequently reported barrier to inclusion of a more comprehensive panel of micronutrient biomarkers was inadequate funding to cover the laboratory analysis cost for all micronutrients considered at the planning stage. Government support and commitment was stressed as the most important enabling factor by all key informants. Advocacy for funding for micronutrient status assessment is needed.
Collapse
Affiliation(s)
- Mari S. Manger
- International Zinc Nutrition Consultative Group, University of California, San Francisco, CA 94143, USA;
- Correspondence:
| | - Kenneth H. Brown
- Department of Nutrition, Institute for Global Nutrition, University of California Davis, Davis, CA 95616, USA;
| | | | - Reed A. Atkin
- Micronutrient Forum, Washington, DC 20005, USA; (S.J.M.O.); (R.A.A.)
| | - Christine M. McDonald
- International Zinc Nutrition Consultative Group, University of California, San Francisco, CA 94143, USA;
- Departments of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, CA 94143, USA
| |
Collapse
|
4
|
Samuel A, Osendarp SJM, Feskens EJM, Lelisa A, Adish A, Kebede A, Brouwer ID. Gender differences in nutritional status and determinants among infants (6–11 m): a cross-sectional study in two regions in Ethiopia. BMC Public Health 2022; 22:401. [PMID: 35219315 PMCID: PMC8881837 DOI: 10.1186/s12889-022-12772-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
A limited number of studies suggest that boys may have a higher risk of stunting than girls in low-income countries. Little is known about the causes of these gender differences. The objective of the study was to assess gender differences in nutritional status and its determinants among infants in Ethiopia.
Methods
We analyzed data for 2036 children (6–11 months old) collected as the baseline for a multiple micronutrient powders effectiveness study in two regions of Ethiopia in March–April 2015. Child, mother, and household characteristics were investigated as determinants of stunting and wasting. Multiple logistic regression models were used separately for boys and girls to check for gender differences while adjusting for confounders. The study is registered at http://www.clinicaltrials.gov/ with the clinical trials identifier of NCT02479815.
Results
Stunting and wasting prevalence is significantly higher among boys compared to girls, 18.7 vs 10.7% and 7.9 vs 5.4%, respectively. Untimely initiation of breastfeeding, not-exclusive breastfeeding at the age of 6 months, region of residence, and low maternal education are significant predictors of stunting in boys. Untimely introduction to complementary food and low consumption of legumes/nuts are significant predictors of stunting in both boys and girls, and low egg consumption only in girls. Region of residence and age of the mother are significant determinants of wasting in both sexes. Analysis of interaction terms for stunting, however, shows no differences in predictors between boys and girls; only for untimely initiation of breastfeeding do the results for boys (OR 1.46; 95%CI 1.02,2.08) and girls (OR 0.88; 95%CI 0.55,1.41) tend to be different (p = 0.12).
Conclusion
In Ethiopia, boys are more malnourished than girls. Exclusive breastfeeding and adequate dietary diversity of complementary feeding are important determinants of stunting in boys and girls. There are no clear gender interactions for the main determinants of stunting and wasting. These findings suggest that appropriate gender-sensitive guidance on optimum infant and young child feeding practices is needed.
Collapse
|
5
|
Brown KH, Atkin R, Gorstein J, Osendarp SJM. Comments on article by Pullakhandam et al: Reference cut-offs to define low serum zinc concentrations in healthy 1-19 year old Indian children and adolescents. Eur J Clin Nutr 2022; 76:1204-1205. [PMID: 35804149 PMCID: PMC9352568 DOI: 10.1038/s41430-022-01174-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/06/2022] [Accepted: 05/26/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Kenneth H. Brown
- grid.27860.3b0000 0004 1936 9684Department of Nutrition and Institute for Global Nutrition, University of California Davis, Davis, CA USA ,The Micronutrient Forum, Washington DC, USA
| | - Reed Atkin
- The Micronutrient Forum, Washington DC, USA
| | - Jonathan Gorstein
- grid.418309.70000 0000 8990 8592The Bill & Melinda Gates Foundation, Seattle, WA USA ,grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
| | | |
Collapse
|
6
|
Hess SY, McLain AC, Frongillo EA, Afshin A, Kassebaum NJ, Osendarp SJM, Atkin R, Rawat R, Brown KH. Challenges for Estimating the Global Prevalence of Micronutrient Deficiencies and Related Disease Burden: A Case Study of the Global Burden of Disease Study. Curr Dev Nutr 2021; 5:nzab141. [PMID: 34993390 PMCID: PMC8728001 DOI: 10.1093/cdn/nzab141] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/05/2021] [Accepted: 11/16/2021] [Indexed: 11/12/2022] Open
Abstract
Information on the prevalence of micronutrient deficiencies is needed to determine related disease burden; underpin evidence-based advocacy; and design, deliver, and monitor safe, effective interventions. Assessing the global prevalence of deficiency requires a valid micronutrient status biomarker with an appropriate cutoff to define deficiency and relevant data from representative surveys across multiple locations and years. The Global Burden of Disease Study includes prevalence estimates for iodine, iron, zinc, and vitamin A deficiencies, for which recommended biomarkers and appropriate deficiency cutoffs exist. Because representative survey data are lacking, only retinol concentration is used to model vitamin A deficiency, and proxy indicators are used for the other micronutrients (goiter for iodine, hemoglobin for iron, and dietary food adequacy for zinc). Because of data limitations, complex statistical modeling is required to produce current estimates, relying on assumptions and proxies that likely understate the extent of micronutrient deficiencies and the consequent global health burden.
Collapse
Affiliation(s)
- Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Alexander C McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Ashkan Afshin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicholas J Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Reed Atkin
- The Micronutrient Forum, Washington, DC, USA
| | - Rahul Rawat
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Kenneth H Brown
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis
, Davis, CA, USA
| |
Collapse
|
7
|
Brown KH, Moore SE, Hess SY, McDonald CM, Jones KS, Meadows SR, Manger MS, Coates J, Alayon S, Osendarp SJM. Increasing the availability and utilization of reliable data on population micronutrient (MN) status globally: the MN Data Generation Initiative. Am J Clin Nutr 2021; 114:862-870. [PMID: 34036318 PMCID: PMC8408880 DOI: 10.1093/ajcn/nqab173] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 03/18/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
Micronutrient (MN) deficiencies can produce a broad array of adverse health and functional outcomes. Young, preschool children and women of reproductive age in low- and middle-income countries are most affected by these deficiencies, but the true magnitude of the problems and their related disease burdens remain uncertain because of the dearth of reliable biomarker information on population MN status. The reasons for this lack of information include a limited understanding by policy makers of the importance of MNs for human health and the usefulness of information on MN status for program planning and management; insufficient professional capacity to advocate for this information and design and implement related MN status surveys; high costs and logistical constraints involved in specimen collection, transport, storage, and laboratory analyses; poor access to adequately equipped and staffed laboratories to complete the analyses reliably; and inadequate capacity to interpret and apply this information for public health program design and evaluation. This report describes the current situation with regard to data availability, the reasons for the lack of relevant information, and the steps needed to correct this situation, including implementation of a multi-component MN Data Generation Initiative to advocate for critical data collection and provide related technical assistance, laboratory services, professional training, and financial support.
Collapse
Affiliation(s)
- Kenneth H Brown
- Department of Nutrition and Institute for Global Nutrition, University of California Davis, Davis, CA, USA
| | - Sophie E Moore
- Department of Women's and Children's Health, Kings College London, London, United Kingdom
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Sonja Y Hess
- Department of Nutrition and Institute for Global Nutrition, University of California Davis, Davis, CA, USA
| | - Christine M McDonald
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, CA, USA
- International Zinc Nutrition Consultative Group, San Francisco, CA, USA
| | - Kerry S Jones
- National Institute for Health Research Biomedical Research Centre Nutritional Biomarker Laboratory, Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Sarah R Meadows
- National Institute for Health Research Biomedical Research Centre Nutritional Biomarker Laboratory, Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Mari S Manger
- International Zinc Nutrition Consultative Group, San Francisco, CA, USA
| | - Jennifer Coates
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Silvia Alayon
- United States Agency for International Development Advancing Nutrition, Arlington, VA, USA
- Save the Children, Washington, DC, USA
| | | |
Collapse
|
8
|
Azupogo F, Abizari AR, Osendarp SJM, Feskens EJ, Brouwer ID. Ten2Twenty-Ghana: Study Design and Methods for an Innovative Randomized Controlled Trial with Multiple-Micronutrient-Fortified Biscuits among Adolescent Girls in Northeastern Ghana. Curr Dev Nutr 2021; 5:nzaa184. [PMID: 33604499 PMCID: PMC7880270 DOI: 10.1093/cdn/nzaa184] [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: 10/28/2020] [Revised: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 02/04/2023] Open
Abstract
Investing in adolescent girls' nutrition is vital for health and for breaking the intergenerational cycle of malnutrition and deprivation, but limited knowledge on the type, timing, and efficacy of interventions delays progress. We describe the design of a 26-wk randomized placebo-controlled trial with multiple-micronutrient-fortified biscuits (MMBs) among adolescent girls in northeastern Ghana. Apparently healthy, premenarche (n = 312) and postmenarche (n = 309) girls (10-17 y) were randomly assigned to receive the following for 5 d/wk: 1) MMBs (fortified with 11 vitamins and 7 minerals) or 2) unfortified biscuits. Data included plasma micronutrient status, anthropometry, body composition, cognitive function, psychosocial health, fertility, dietary intake, and sociodemographic and socioeconomic covariates, complemented with in-depth interviews (n = 30) and 4 focus group discussions. We hypothesized an increase in plasma ferritin and retinol-binding protein with a resultant increase in hemoglobin, cognition, vertical height, and psychosocial health. Our study seeks to investigate the efficacy and optimal timing of a multiple-micronutrient food intervention program for adolescent girls. The RCT was registered prospectively with the Netherlands Clinical Trials Register (NL7487).
Collapse
Affiliation(s)
- Fusta Azupogo
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
- Department of Family and Consumer Sciences, Faculty of Agriculture, Food, and Consumer Sciences, University for Development Studies, Tamale, Ghana
| | - Abdul-Razak Abizari
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Saskia J M Osendarp
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
- Micronutrient Forum, Washington, DC, USA
| | - Edith J Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Inge D Brouwer
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| |
Collapse
|
9
|
Samuel A, Brouwer ID, Pamungkas NP, Terra T, Lelisa A, Kebede A, Osendarp SJM. Determinants of adherence to micronutrient powder use among young children in Ethiopia. Matern Child Nutr 2020; 17:e13111. [PMID: 33169528 PMCID: PMC7988858 DOI: 10.1111/mcn.13111] [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] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/15/2020] [Accepted: 10/25/2020] [Indexed: 11/28/2022]
Abstract
In Ethiopia, home fortification of complementary foods with micronutrient powders (MNPs) was introduced in 2015 as a new approach to improve micronutrient intakes. The objective of this study was to assess factors associated with intake adherence and drivers for correct MNP use over time to inform scale‐up of MNP interventions. Mixed methods including questionnaires, interviews and focus group discussions were used. Participants, 1,185 children (6–11 months), received bimonthly 30 MNP sachets for 8 months, with instruction to consume 15 sachets/month, that is, a sachet every other day and maximum of one sachet per day. Adherence to distribution (if child receives ≥14 sachets/month) and adherence to instruction (if child receives exactly 15[±1] sachets/month) were assessed monthly by counting used sachets. Factors associated with adherence were examined using generalized estimating equations. Adherence fluctuated over time, an average of 58% adherence to distribution and 28% for adherence to instruction. Average MNP consumption was 79% out of the total sachets provided. Factors positively associated with adherence included ease of use (instruction), child liking MNP and support from community (distribution and instruction) and mother's age >25 years (distribution). Distance to health post, knowledge of correct use (OR = 0.74, 95% CI = 0.66–0.81), perceived negative effects (OR = 0.73, 95% CI = 0.54–0.99) and living in Southern Nations, Nationalities and People Region (OR = 0.59, 95% CI = 0.52–0.67) were inversely associated with adherence to distribution. Free MNP provision, trust in the government and field staff played a role in successful implementation. MNP is promising to be scaled‐up, by taking into account factors that positively and negatively determine adherence.
Collapse
Affiliation(s)
- Aregash Samuel
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Inge D Brouwer
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Nindya P Pamungkas
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Tosca Terra
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Azeb Lelisa
- Nutrition International, Ethiopia, C/O Ethiopia-Canada Cooperation Office (CIDA-ECCO), Addis Ababa, Ethiopia
| | - Amha Kebede
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Saskia J M Osendarp
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| |
Collapse
|
10
|
Affiliation(s)
| | - Kenneth H Brown
- Micronutrient Forum, Washington, DC 20005-3915, USA; Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA, USA
| | - Lynnette M Neufeld
- Global Alliance for Improved Nutrition, Geneva, Switzerland; Micronutrient Forum, Washington, DC 20005-3915, USA
| | - Emorn Udomkesmalee
- Institute of Nutrition, Mahidol University, Salaya, Nakhon Pathom, Thailand; Micronutrient Forum, Washington, DC 20005-3915, USA
| | - Sophie E Moore
- Micronutrient Forum, Washington, DC 20005-3915, USA; Department of Women and Children's Health, King's College London, London, UK; Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| |
Collapse
|
11
|
Bourassa MW, Osendarp SJM, Adu-Afarwuah S, Ahmed S, Ajello C, Bergeron G, Black R, Christian P, Cousens S, de Pee S, Dewey KG, Arifeen SE, Engle-Stone R, Fleet A, Gernand AD, Hoddinott J, Klemm R, Kraemer K, Kupka R, McLean E, Moore SE, Neufeld LM, Persson LÅ, Rasmussen KM, Shankar AH, Smith E, Sudfeld CR, Udomkesmalee E, Vosti SA. Antenatal multiple micronutrient supplementation: call to action for change in recommendation. Ann N Y Acad Sci 2019; 1465:5-7. [PMID: 31691295 PMCID: PMC7053381 DOI: 10.1111/nyas.14271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/18/2019] [Indexed: 01/22/2023]
Affiliation(s)
| | | | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Saima Ahmed
- The New York Academy of Sciences, New York, New York
| | - Clayton Ajello
- The Vitamin Angels Alliance, Inc., Santa Barbara, California
| | | | - Robert Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Parul Christian
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Bill & Melinda Gates Foundation, Seattle, Washington
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saskia de Pee
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands.,UN World Food Programme, Rome, Italy.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Kathryn G Dewey
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Reina Engle-Stone
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California
| | | | - Alison D Gernand
- The Pennsylvania State University, University Park, Pennsylvania
| | - John Hoddinott
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Rolf Klemm
- The Vitamin Angels Alliance, Inc., Santa Barbara, California.,Helen Keller International, Baltimore, Maryland
| | | | | | | | - Sophie E Moore
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | | | - Lars-Åke Persson
- London School of Hygiene and Tropical Medicine, Addis Ababa, Ethiopia
| | | | - Anuraj H Shankar
- Summit Institute of Development, Mataram, Indonesia.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Emily Smith
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Departments of Global Health, and Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, D.C
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California
| |
Collapse
|
12
|
Samuel A, Osendarp SJM, Ferguson E, Borgonjen K, Alvarado BM, Neufeld LM, Adish A, Kebede A, Brouwer ID. Identifying Dietary Strategies to Improve Nutrient Adequacy among Ethiopian Infants and Young Children Using Linear Modelling. Nutrients 2019; 11:E1416. [PMID: 31238506 PMCID: PMC6627485 DOI: 10.3390/nu11061416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 05/18/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022] Open
Abstract
Nutrient adequacy of young children's diet and best possible strategies to improve nutrient adequacy were assessed. Data from the Ethiopian National Food Consumption Survey were analysed using Optifood (software for linear programming) to identify nutrient gaps in diets for children (6-8, 9-11 and 12-23 months), and to formulate feasible Food-Based Dietary Recommendations (FBDRs) in four regions which differ in culture and food practices. Alternative interventions including a local complementary food, micronutrient powders (MNPs), Small quantity Lipid-based Nutrient Supplement (Sq-LNS) and combinations of these were modelled in combination with the formulated FBDRs to compare their relative contributions. Risk of inadequate and excess nutrient intakes was simulated using the Estimated Average Requirement cut-point method and the full probability approach. Optimized local diets did not provide adequate zinc in all regions and age groups, iron for infants <12 months of age in all regions, and calcium, niacin, thiamine, folate, vitamin B12 and B6 in some regions and age-groups. The set of regional FBDRs, considerably different for four regions, increased nutrient adequacy but some nutrients remained sub-optimal. Combination of regional FBDRs with daily MNP supplementation for 6-12 months of age and every other day for 12-23 months of age, closed the identified nutrient gaps without leading to a substantial increase in the risk of excess intakes.
Collapse
Affiliation(s)
- Aregash Samuel
- Ethiopian Public Health Institute (EPHI), Gulele Sub City, Addis Ababa, Ethiopia.
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
| | - Saskia J M Osendarp
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
- Nutrition International (NI), Ottawa, ON K2P2K3, Canada.
| | - Elaine Ferguson
- London School of Hygiene and Tropical Medicine (LSHTM), London WC1E 7HT, UK.
| | - Karin Borgonjen
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
| | - Brenda M Alvarado
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
| | - Lynnette M Neufeld
- Global Alliance for Improved Nutrition (GAIN), 1202 Geneva, Switzerland.
| | - Abdulaziz Adish
- Nutrition International (NI), Nifas Silk Lafto Sub City, Kebele 04, Addis Ababa, Ethiopia.
| | - Amha Kebede
- Ethiopian Public Health Institute (EPHI), Gulele Sub City, Addis Ababa, Ethiopia.
| | - Inge D Brouwer
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
| |
Collapse
|
13
|
Lanou HB, Osendarp SJM, Argaw A, De Polnay K, Ouédraogo C, Kouanda S, Kolsteren P. Micronutrient powder supplements combined with nutrition education marginally improve growth amongst children aged 6-23 months in rural Burkina Faso: A cluster randomized controlled trial. Matern Child Nutr 2019; 15:e12820. [PMID: 30941887 DOI: 10.1111/mcn.12820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 03/07/2019] [Accepted: 03/19/2019] [Indexed: 01/18/2023]
Abstract
Micronutrients powder (MNP) can prevent anaemia amongst children 6-23 months old. However, evidence of an effect on growth is limited and concerns about the safety of iron-containing MNP interventions limits their applicability. In a cluster randomized controlled intervention, we evaluated the effectiveness of a nutritional package including counselling and provision of MNP to improve the nutritional status of children aged 6-23 months and the effect of sustained use of MNP on morbidity in a malaria-endemic area. Child feeding practises and nutritional status were assessed through cross-sectional surveys. Biweekly morbidity surveillance and anthropometry measurements were carried out in a nested cohort study. No significant differences in the prevalence of wasting (-0.7% [-6.8, 5.3] points; p = .805), stunting (+4.6% [-2.9, 12.0] points; p = .201), or mean length-for-age z-score and weight-for-length z-score scores were found between study groups. The proportion of children with a minimum dietary diversity score and those with a minimum acceptable diet significantly increased in the intervention group compared with the control by 6.5% points (p = .043) and 5.8% points (p = .037), respectively. There were no significant differences in the risk of diarrhoea (RR: 1.68, 95% CI [0.94, 3.08]), fever (RR: 1.20 [0.82, 1.77]), and malaria (RR: 0.68 [0.37, 1.26]) between study groups. In the nested study, the rate of linear growth was higher in the intervention than in the control group by 0.013 SD/month (p = .027). In a programmatic intervention, MNP and nutrition education marginally improved child feeding practises and growth, without increasing morbidity from malaria or fever.
Collapse
Affiliation(s)
- Hermann B Lanou
- Ministry of Higher Education, Scientific Research and Innovation, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso.,Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | | | - Alemayehu Argaw
- Nutrition International, Ottawa, Ontario, Canada.,Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.,Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Kirrily De Polnay
- Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Seni Kouanda
- Ministry of Higher Education, Scientific Research and Innovation, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Patrick Kolsteren
- Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| |
Collapse
|
14
|
Bourassa MW, Osendarp SJM, Adu-Afarwuah S, Ahmed S, Ajello C, Bergeron G, Black R, Christian P, Cousens S, de Pee S, Dewey KG, Arifeen SE, Engle-Stone R, Fleet A, Gernand AD, Hoddinott J, Klemm R, Kraemer K, Kupka R, McLean E, Moore SE, Neufeld LM, Persson LÅ, Rasmussen KM, Shankar AH, Smith E, Sudfeld CR, Udomkesmalee E, Vosti SA. Review of the evidence regarding the use of antenatal multiple micronutrient supplementation in low- and middle-income countries. Ann N Y Acad Sci 2019; 1444:6-21. [PMID: 31134643 PMCID: PMC6852202 DOI: 10.1111/nyas.14121] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 03/04/2019] [Revised: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 12/22/2022]
Abstract
Inadequate micronutrient intakes are relatively common in low- and middle-income countries (LMICs), especially among pregnant women, who have increased micronutrient requirements. This can lead to an increase in adverse pregnancy and birth outcomes. This review presents the conclusions of a task force that set out to assess the prevalence of inadequate micronutrient intakes and adverse birth outcomes in LMICs; the data from trials comparing multiple micronutrient supplements (MMS) that contain iron and folic acid (IFA) with IFA supplements alone; the risks of reaching the upper intake levels with MMS; and the cost-effectiveness of MMS compared with IFA. Recent meta-analyses demonstrate that MMS can reduce the risks of preterm birth, low birth weight, and small for gestational age in comparison with IFA alone. An individual-participant data meta-analysis also revealed even greater benefits for anemic and underweight women and female infants. Importantly, there was no increased risk of harm for the pregnant women or their infants with MMS. These data suggest that countries with inadequate micronutrient intakes should consider supplementing pregnant women with MMS as a cost-effective method to reduce the risk of adverse birth outcomes.
Collapse
Affiliation(s)
| | - Saskia J M Osendarp
- Osendarp Nutrition, Berkel & Rodenrijs, the Netherlands.,Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Saima Ahmed
- The New York Academy of Sciences, New York, New York
| | - Clayton Ajello
- The Vitamin Angels Alliance, Inc., Santa Barbara, California
| | | | - Robert Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Parul Christian
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Bill & Melinda Gates Foundation, Seattle, Washington
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saskia de Pee
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands.,UN World Food Programme, Rome, Italy.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, California
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Reina Engle-Stone
- Department of Nutrition, University of California, Davis, Davis, California
| | | | | | - John Hoddinott
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Rolf Klemm
- The Vitamin Angels Alliance, Inc., Santa Barbara, California.,Helen Keller International, Baltimore, Maryland
| | | | | | | | - Sophie E Moore
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | | | - Lars-Åke Persson
- London School of Hygiene and Tropical Medicine, Addis Ababa, Ethiopia
| | | | - Anuraj H Shankar
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Summit Institute of Development, Mataram, Indonesia
| | - Emily Smith
- Bill & Melinda Gates Foundation, Seattle, Washington.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Stephen A Vosti
- Department of Nutrition, University of California, Davis, Davis, California
| |
Collapse
|
15
|
Smuts CM, Matsungo TM, Malan L, Kruger HS, Rothman M, Kvalsvig JD, Covic N, Joosten K, Osendarp SJM, Bruins MJ, Frenken LGJ, Lombard CJ, Faber M. Effect of small-quantity lipid-based nutrient supplements on growth, psychomotor development, iron status, and morbidity among 6- to 12-mo-old infants in South Africa: a randomized controlled trial. Am J Clin Nutr 2019; 109:55-68. [PMID: 30649163 PMCID: PMC6358035 DOI: 10.1093/ajcn/nqy282] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 04/09/2018] [Accepted: 09/18/2018] [Indexed: 01/14/2023] Open
Abstract
Background Evidence on the effect of small-quantity lipid-based nutrient supplements (SQ-LNSs) on early child growth and development is mixed. Objective This study assessed the effect of daily consumption of 2 different SQ-LNS formulations on linear growth (primary outcome), psychomotor development, iron status (secondary outcomes), and morbidity in infants from age 6 to 12 mo within the context of a maize-based complementary diet. Methods Infants (n = 750) were randomly assigned to receive SQ-LNS, SQ-LNS-plus, or no supplement. Both SQ-LNS products contained micronutrients and essential fatty acids. SQ-LNS-plus contained, in addition, docosahexaenoic acid, arachidonic acid (important for brain and eye development), lysine (limiting amino acid in maize), phytase (enhances iron absorption), and other nutrients. Infants' weight and length were measured bimonthly. At age 6 and 12 mo, psychomotor development using the Kilifi Developmental Inventory and South African Parent Rating Scale and hemoglobin, plasma ferritin, C-reactive protein, and α1-acid glycoprotein were assessed. WHO Motor Milestone outcomes, adherence, and morbidity were monitored weekly through home visits. Primary analysis was by intention-to-treat, comparing each SQ-LNS group with the control. Results SQ-LNS-plus had a positive effect on length-for-age zscore at age 8 mo (mean difference: 0.11; 95% CI: 0.01, 0.22; P = 0.032) and 10 mo (0.16; 95% CI: 0.04, 0.27; P = 0.008) but not at 12 mo (0.09; 95% CI: -0.02, 0.21; P = 0.115), locomotor development score (2.05; 95% CI: 0.72, 3.38; P = 0.003), and Parent Rating Score (1.10; 95% CI: 0.14, 2.07; P = 0.025), but no effect for weight-for-age zscore. Both SQ-LNS (P = 0.027) and SQ-LNS-plus (P = 0.005) improved hemoglobin concentration and reduced the risk of anemia, iron deficiency, and iron-deficiency anemia. Both SQ-LNS products reduced longitudinal prevalence of fever, coughing, and wheezing but increased incidence and longitudinal prevalence of diarrhea, vomiting, and rash/sores. Conclusions Point-of-use fortification with SQ-LNS-plus showed an early transient effect on linear growth and improved locomotor development. Both SQ-LNS products had positive impacts on anemia and iron status. This trial was registered at clinicaltrials.gov as NCT01845610.
Collapse
Affiliation(s)
- Cornelius M Smuts
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa,Address correspondence to CMS (e-mail: )
| | - Tonderayi M Matsungo
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Linda Malan
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Herculina S Kruger
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Marinel Rothman
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Jane D Kvalsvig
- Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Namukolo Covic
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Karen Joosten
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | | | | | | | - Carl J Lombard
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa,Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Mieke Faber
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa,Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, South Africa
| |
Collapse
|
16
|
Azupogo F, Aurino E, Gelli A, Bosompem KM, Ayi I, Osendarp SJM, Brouwer ID, Folson G. Agro-ecological zone and farm diversity are factors associated with haemoglobin and anaemia among rural school-aged children and adolescents in Ghana. Matern Child Nutr 2019; 15:e12643. [PMID: 30047257 PMCID: PMC7198936 DOI: 10.1111/mcn.12643] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 01/28/2023]
Abstract
Understanding contextual risk factors for haemoglobin (Hb) status and anaemia of rural school-aged children (SAC) and adolescents is critical in developing appropriate interventions to prevent anaemia. We analysed secondary data from the baseline of an impact evaluation of the Ghana School Feeding Programme to determine the severity of anaemia and contextual factors associated with anaemia and Hb status among rural SAC (6-9 years; n = 323) and adolescents (10-17 years; n = 319) in Ghana. We used regression models with variable selection based on backward elimination in our analyses. The mean Hb was 113.8 ± 13.1 g/L, and the overall prevalence of anaemia was 52.3%, being 55.1% and 49.5% among SAC and adolescents, respectively. We identified child's age (β = 2.21, P < 0.001); farm diversity score (β = 0.59, P = 0.036); and agro-ecological zone (P trend <0.001) as the main predictors of Hb of SAC. Household asset index (P trend = 0.042) and agro-ecological zone (P trend <0.001) were predictors of Hb in adolescents. Agro-ecological zone and age were predictors of anaemia, but the effect of age was only significant for girls and not boys (prevalence odds ratio [POR] = 1.35, 95% CI [1.04, 1.76] vs. POR = 1.14, 95% CI [0.88, 1.46]). SAC in households with maize stock were less likely to be anaemic (POR = 0.55, 95% CI [0.32, 0.97]). Household dietary diversity score (β = 0.59, P = 0.033) was associated with Hb status for the full sample only. Anaemia is a severe public health problem among SAC and adolescents in rural Ghana irrespective of sex. Farm diversity score, availability of maize stock in the household, household asset index, and agro-ecological zone were the main predictors of Hb and anaemia among the rural SAC and adolescents.
Collapse
Affiliation(s)
- Fusta Azupogo
- Division of Human NutritionWageningen UniversityWageningenThe Netherlands
- Department of Family and Consumer Sciences, Faculty of AgricultureUniversity for Development StudiesTamaleGhana
| | - Elisabetta Aurino
- Centre for Health Economics and Policy Innovation, Department of ManagementImperial College Business School, Imperial College LondonLondonUK
| | - Aulo Gelli
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of Columbia
| | - Kwabena M. Bosompem
- Noguchi Memorial Institute for Medical Research (NMIMR), College of Health SciencesUniversity of GhanaLegonGreater Accra RegionGhana
| | - Irene Ayi
- Noguchi Memorial Institute for Medical Research (NMIMR), College of Health SciencesUniversity of GhanaLegonGreater Accra RegionGhana
| | | | - Inge D. Brouwer
- Division of Human NutritionWageningen UniversityWageningenThe Netherlands
| | - Gloria Folson
- Noguchi Memorial Institute for Medical Research (NMIMR), College of Health SciencesUniversity of GhanaLegonGreater Accra RegionGhana
| |
Collapse
|
17
|
Osendarp SJM, Martinez H, Garrett GS, Neufeld LM, De-Regil LM, Vossenaar M, Darnton-Hill I. Large-Scale Food Fortification and Biofortification in Low- and Middle-Income Countries: A Review of Programs, Trends, Challenges, and Evidence Gaps. Food Nutr Bull 2018; 39:315-331. [PMID: 29793357 PMCID: PMC7473077 DOI: 10.1177/0379572118774229] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [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] [Indexed: 01/02/2023]
Abstract
BACKGROUND Food fortification and biofortification are well-established strategies to address micronutrient deficiencies in vulnerable populations. However, the effectiveness of fortification programs is not only determined by the biological efficacy of the fortified foods but also by effective and sustainable implementation, which requires continual monitoring, quality assurance and control, and corrective measures to ensure high compliance. OBJECTIVE To provide an overview of efficacy, effectiveness, economics of food fortification and biofortification, and status of and challenges faced by large-scale food fortification programs in low- and middle-income countries (LMIC). METHODS A literature review of PubMed publications in English from 2000 to 2017, as well as gray literature, targeting nongovernmental organizations whose work focuses on this topic, complemented by national reports and a "snowball" process of citation searching. The article describes remaining technical challenges, barriers, and evidence gap and prioritizes recommendations and next steps to further accelerate progress and potential of impact. RESULTS The review identifies and highlights essential components of successful programs. It also points out issues that determine poor program performance, including lack of adequate monitoring and enforcement and poor compliance with standards by industry. CONCLUSIONS In the last 17 years, large-scale food fortification initiatives have been reaching increasingly larger segments of populations in LMIC. Large-scale food fortification and biofortification should be part of other nutrition-specific and nutrition-sensitive efforts to prevent and control micronutrient deficiencies. There are remaining technical and food system challenges, especially in relation to improving coverage and quality of delivery and measuring progress of national programs.
Collapse
Affiliation(s)
- Saskia J. M. Osendarp
- Osendarp Nutrition, Berkel & Rodenrijs, the Netherlands
- Micronutrient Forum, Ottawa, Ontario, Canada
| | - Homero Martinez
- Micronutrient Forum, Ottawa, Ontario, Canada
- Nutrition International, Ottawa, Ontario, Canada
| | - Greg S. Garrett
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | | | | | | | - Ian Darnton-Hill
- Institute of Obesity, Nutrition and Exercise, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Friedman School of Nutrition Science and Policy, Tufts University, MA, USA
| |
Collapse
|
18
|
Sako B, Leerlooijer JN, Lelisa A, Hailemariam A, Brouwer ID, Tucker Brown A, Osendarp SJM. Exploring barriers and enablers for scaling up a community-based grain bank intervention for improved infant and young child feeding in Ethiopia: A qualitative process evaluation. Matern Child Nutr 2017; 14:e12551. [PMID: 29063698 PMCID: PMC5901006 DOI: 10.1111/mcn.12551] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 09/21/2017] [Accepted: 09/27/2017] [Indexed: 11/28/2022]
Abstract
Child malnutrition remains high in Ethiopia, and inadequate complementary feeding is a contributing factor. In this context, a community‐based intervention was designed to provide locally made complementary food for children 6–23 months, using a bartering system, in four Ethiopian regions. After a pilot phase, the intervention was scaled up from 8 to 180 localities. We conducted a process evaluation to determine enablers and barriers for the scaling up of this intervention. Eight study sites were selected to perform 52 key informant interviews and 31 focus group discussions with purposely selected informants. For analysis, we used a framework describing six elements of successful scaling up: socio‐political context, attributes of the intervention, attributes of the implementers, appropriate delivery strategy, the adopting community, and use of research to inform the scale‐up process. A strong political will, alignment of the intervention with national priorities, and integration with the health care system were instrumental in the scaling up. The participatory approach in decision‐making reinforced ownership at community level, and training about complementary feeding motivated mothers and women's groups to participate. However, the management of the complex intervention, limited human resources, and lack of incentives for female volunteers proved challenging. In the bartering model, the barter rate was accepted, but the bartering was hindered by unavailability of cereals and limited financial and material resources to contribute, threatening the project's sustainability. Scaling up strategies for nutrition interventions require sufficient time, thorough planning, and assessment of the community's capacity to contribute human, financial, and material resources.
Collapse
Affiliation(s)
- Binta Sako
- Independent Consultant, Brussels, Belgium
| | | | - Azeb Lelisa
- Nutrition International, Addis Ababa, Ethiopia
| | | | | | | | - Saskia J M Osendarp
- Wageningen University, Wageningen, The Netherlands.,Nutrition International, Ottawa, Ontario, Canada
| |
Collapse
|
19
|
Neufeld LM, Osendarp SJM, Gonzalez W. Fortification of Complementary Foods: A Review of Products and Program Delivery. Nestle Nutr Inst Workshop Ser 2017; 87:115-129. [PMID: 28315892 DOI: 10.1159/000449210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Fortified complementary foods (FCF) and home fortificants - single-sachet micronutrient powders (MNP) or small-quantity lipid-based nutrient supplements (SQ-LNS) to be added to a child's food immediately before consumption - have been shown to be efficacious to improve the micronutrient status and some functional outcomes in children 6-23 months of age. The objective of this chapter is to describe and discuss the latest advances related to the composition and delivery of FCF products, including home and commercial fortification. For FCF and MNPs, there is guidance to ensure that products are safe and aligned with recommendations. Impact, however, can be achieved only if adequate attention is paid to program design and implementation, including the choice of the delivery platform, and ensuring availability, accessibility, acceptability, coverage, and utilization by the target population. Well-targeted programs such as social protection programs, health services, community-based vendors (referred to as market based), child health weeks, and emergency programs have all been used as delivery platforms for FCF and MNPs. To date, guidance for formulation and programmatic experience with the distribution of SQ-LNS is limited. An in-depth understanding of the local context and culture, and the design and implementation of program components, including behavior change interventions that respond to those, can increase program coverage and product utilization. Using rigorous process evaluation would permit to adapt programs to increase their potential for impact, strengthen the evidence related to how programs work, and allow the development of program guidance to increase effective implementation.
Collapse
|
20
|
Osendarp SJM, Broersen B, van Liere MJ, De-Regil LM, Bahirathan L, Klassen E, Neufeld LM. Complementary Feeding Diets Made of Local Foods Can Be Optimized, but Additional Interventions Will Be Needed to Meet Iron and Zinc Requirements in 6- to 23-Month-Old Children in Low- and Middle-Income Countries. Food Nutr Bull 2016; 37:544-570. [DOI: 10.1177/0379572116655239] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The question whether diets composed of local foods can meet recommended nutrient intakes in children aged 6 to 23 months living in low- and middle-income countries is contested. Objective: To review evidence of studies evaluating whether (1) macro- and micronutrient requirements of children aged 6 to 23 months from low- and middle-income countries are met by the consumption of locally available foods (“observed intake”) and (2) nutrient requirements can be met when the use of local foods is optimized, using modeling techniques (“modeled intake”). Methods: Twenty-three articles were included after conducting a systematic literature search. To allow for comparisons between studies, findings of 15 observed intake studies were compared against their contribution to a standardized recommended nutrient intake from complementary foods. For studies with data on intake distribution, %< estimated average requirements were calculated. Results: Data from the observed intake studies indicate that children aged 6 to 23 months meet requirements of protein, while diets are inadequate in calcium, iron, and zinc. Also for energy, vitamin A, thiamin, riboflavin, niacin, folate, and vitamin C, children did not always fulfill their requirements. Very few studies reported on vitamin B6, B12, and magnesium, and no conclusions can be drawn for these nutrients. When diets are optimized using modeling techniques, most of these nutrient requirements can be met, with the exception of iron and zinc and in some settings calcium, folate, and B vitamins. Conclusion: Our findings suggest that optimizing the use of local foods in diets of children aged 6 to 23 months can improve nutrient intakes; however, additional cost-effective strategies are needed to ensure adequate intakes of iron and zinc.
Collapse
Affiliation(s)
- Saskia J. M. Osendarp
- The Micronutrient Initiative, Ottawa, Ontario, Canada
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Britt Broersen
- The Micronutrient Initiative, Ottawa, Ontario, Canada
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | | | | | | | - Eva Klassen
- The Micronutrient Initiative, Ottawa, Ontario, Canada
| | | |
Collapse
|
21
|
Roche ML, Sako B, Osendarp SJM, Adish AA, Tolossa AL. Community-based grain banks using local foods for improved infant and young child feeding in Ethiopia. Matern Child Nutr 2015; 13. [PMID: 26663813 DOI: 10.1111/mcn.12219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 08/11/2015] [Accepted: 08/18/2015] [Indexed: 01/22/2023]
Abstract
The first thousand days of a child's life are critical for ensuring adequate nutrition to enable optimal health, development and growth. Inadequate infant and young child feeding (IYCF) practices likely contribute to Ethiopia's concerning malnutrition situation. Development partners in four regions of Ethiopia implemented community production of complementary food with women's groups processing local grains and legumes at grain banks to improve availability, accessibility, dietary diversity and timely introduction of complementary foods. The objective of this study was to establish the acceptability, perceived impact, feasibility and required inputs to sustain local grain bank interventions to improve IYCF. A subsidized barter system was used by mothers in the rural communities, and flour was sold in the semi-urban context. Purposive sampling guided the qualitative study design and selection of project stakeholders. A total of 51 key informant interviews and 33 focus group discussions (n = 237) were conducted. The grain bank flour was valued for its perceived diverse local ingredients; while the project was perceived as creating labour savings for women. The grain bank flour offered the potential to contribute to improved IYCF; however, further dietary modification or fortification is needed to improve the micronutrient content. Dependence upon external inputs to subsidize the barter model and the reliance on volunteer labour from women's groups in the rural context are the greatest risks to sustainability. This intervention illustrates how integrated agricultural and health interventions leveraging local production can appeal to diverse stakeholders as an acceptable approach to improve IYCF.
Collapse
Affiliation(s)
| | - Binta Sako
- Independent Consultant, Ottawa, Ontario, Canada
| | | | | | | |
Collapse
|
22
|
Koletzko B, Boey CCM, Campoy C, Carlson SE, Chang N, Guillermo-Tuazon MA, Joshi S, Prell C, Quak SH, Sjarif DR, Su Y, Supapannachart S, Yamashiro Y, Osendarp SJM. Current information and Asian perspectives on long-chain polyunsaturated fatty acids in pregnancy, lactation, and infancy: systematic review and practice recommendations from an early nutrition academy workshop. Ann Nutr Metab 2014; 65:49-80. [PMID: 25227906 DOI: 10.1159/000365767] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/30/2014] [Indexed: 11/19/2022]
Abstract
The Early Nutrition Academy supported a systematic review of human studies on the roles of pre- and postnatal long-chain polyunsaturated fatty acids (LC-PUFA) published from 2008 to 2013 and an expert workshop that reviewed the information and developed recommendations, considering particularly Asian populations. An increased supply of n-3 LC-PUFA during pregnancy reduces the risk of preterm birth before 34 weeks of gestation. Pregnant women should achieve an additional supply ≥200 mg docosahexaenic acid (DHA)/day, usually achieving a total intake ≥300 mg DHA/day. Higher intakes (600-800 mg DHA/day) may provide greater protection against early preterm birth. Some studies indicate beneficial effects of pre- and postnatal DHA supply on child neurodevelopment and allergy risk. Breast-feeding is the best choice for infants. Breast-feeding women should get ≥200 mg DHA/day to achieve a human milk DHA content of ∼0.3% fatty acids. Infant formula for term infants should contain DHA and arachidonic acid (AA) to provide 100 mg DHA/day and 140 mg AA/day. A supply of 100 mg DHA/day should continue during the second half of infancy. We do not provide quantitative advice on AA levels in follow-on formula fed after the introduction of complimentary feeding due to a lack of sufficient data and considerable variation in the AA amounts provided by complimentary foods. Reasonable intakes for very-low-birth weight infants are 18-60 mg/kg/day DHA and 18-45 mg/kg/day AA, while higher intakes (55-60 mg/kg/day DHA, ∼1% fatty acids; 35-45 mg/kg/day AA, ∼0.6-0.75%) appear preferable. Research on the requirements and effects of LC-PUFA during pregnancy, lactation, and early childhood should continue. © 2014 S. Karger AG, Basel.
Collapse
Affiliation(s)
- Berthold Koletzko
- Early Nutrition Academy, Dr. von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Neufeld LM, Osendarp SJM. Global, regional and country trends in underweight and stunting as indicators of nutrition and health of populations. Nestle Nutr Inst Workshop Ser 2014; 78:11-9. [PMID: 24504202 DOI: 10.1159/000354930] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Stunting and wasting provide indicators of different nutritional deficiency problems, the causes of which are well established. Underweight based on weight-for-age cannot distinguish between these two and is therefore not useful to target programs and has limited value for tracking progress. Stunting reduces later school attainment and income as adults and increases the risk of obesity and noncommunicable diseases in later life. Globally, the estimated number of stunted children is decreasing, but is not on track to meet the goal of 100 million by 2025 (165 million), and there has been little change in the number of children suffering from wasting since 2004. Stunting and wasting provide excellent indicators of inequity. For example, from 1990 to 2010, the number of stunted children in Asia declined from 188.7 to 98.4 million, while in sub-Saharan Africa there was essentially no change in prevalence, and the number of stunted children increased from 45.7 to 55.8 million. Recent global development movements are recognizing the need for robust measures of trends in nutritional status of children, particularly during the critical first years of life. Such measures are needed to track progress and improve accountability, and should be aspirational to mobilize sufficient investment in nutrition.
Collapse
Affiliation(s)
- L M Neufeld
- Micronutrient Initiative, Ottawa, ON, Canada
| | | |
Collapse
|
24
|
Harika RK, Eilander A, Alssema M, Osendarp SJM, Zock PL. Intake of fatty acids in general populations worldwide does not meet dietary recommendations to prevent coronary heart disease: a systematic review of data from 40 countries. Ann Nutr Metab 2013; 63:229-38. [PMID: 24192557 DOI: 10.1159/000355437] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 08/30/2013] [Indexed: 11/19/2022]
Abstract
AIM To systematically review data from different countries on population intakes of total fat, saturated fatty acids (SFA) and polyunsaturated fatty acids (PUFA), and to compare these to recommendations from the Food and Agriculture Organization of the United Nations/the World Health Organization (FAO/WHO). METHODS Data from national dietary surveys or population studies published from 1995 were searched via MEDLINE, Web of Science and websites of national public health institutes. RESULTS Fatty acid intake data from 40 countries were included. Total fat intake ranged from 11.1 to 46.2 percent of energy intake (% E), SFA from 2.9 to 20.9% E and PUFA from 2.8 to 11.3% E. The mean intakes met the recommendation for total fat (20-35% E), SFA (<10% E) and PUFA (6-11% E) in 25, 11 and 20 countries, respectively. SFA intake correlated with total fat intake (r = 0.76, p < 0.01) but not with PUFA intake (r = 0.03, p = 0.84). Twenty-seven countries provided data on the distribution of fatty acids intake. In 18 of 27 countries, more than 50% of the population had SFA intakes >10% E and in 13 of 27 countries, the majority of the population had PUFA intakes <6% E. CONCLUSIONS In many countries, the fatty acids intake of adults does not meet the levels that are recommended to prevent chronic diseases. The relation between SFA and PUFA intakes shows that lower intakes of SFA in the populations are not accompanied by higher intakes of PUFA, as is recommended for preventing coronary heart disease.
Collapse
|
25
|
Thomas T, Eilander A, Muthayya S, McKay S, Thankachan P, Theis W, Gandhe A, Osendarp SJM, Kurpad AV. The effect of a 1-year multiple micronutrient or n-3 fatty acid fortified food intervention on morbidity in Indian school children. Eur J Clin Nutr 2011; 66:452-8. [PMID: 22009072 DOI: 10.1038/ejcn.2011.178] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Few studies have shown that supplementation with micronutrients (MNs) or n-3 fatty acids may have health benefits such as reduced morbidity in schoolchildren. The effect of a combination of these nutrients has never been investigated. This study aimed to determine the effect of a combination of two different doses of MN and n-3 fatty acids on morbidity in schoolchildren in Bangalore, India. SUBJECTS/METHODS In all 598 children (6-10 years) received foods fortified with either high (100% recommended dietary allowance) or low (15% recommended dietary allowance) MN, combined with either high (900 mg α-linolenic acid (ALA) plus 100 mg docosahexaenoic acid) or low (140 mg ALA) n-3 fatty acids for 1 year. Morbidity was measured by weekly self-reports using a structured questionnaire. Poisson regression analyses of episodes/child/year and duration/episode adjusted for age and sex were performed on clusters of symptoms, including upper and lower respiratory tract infections (URTI and LRTI), gastrointestinal complaints (GI) and general symptoms of illness to observe MN and n-3 fatty acid treatment effects. RESULTS Children consuming high n-3 fatty acids had significantly fewer episodes of URTI/child/year (relative risk (RR)=0.88, 95% confidence interval (CI): 0.79, 0.97) and significantly shorter duration/episode of URTI (RR=0.81, 95% CI: 0.78, 0.85), LRTI (RR=0.91, 95% CI: 0.85, 0.97), GI complaints (RR=0.79, 95% CI: 0.74, 0.85) and general symptoms (RR=0.90, 95% CI: 0.82, 0.98) compared with children who received low n-3 fatty acid intervention. The high MN intervention reduced the duration of general symptoms (RR=0.89, 95% CI: 0.82, 0.98). CONCLUSION Although n-3 fatty acids may be beneficial for reducing illness in Indian schoolchildren, more research is needed to confirm presence of combined effect with MN.
Collapse
Affiliation(s)
- T Thomas
- Epidemiology and Biostatistics Unit, St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Huffman SL, Harika RK, Eilander A, Osendarp SJM. Essential fats: how do they affect growth and development of infants and young children in developing countries? A literature review. Matern Child Nutr 2011; 7 Suppl 3:44-65. [PMID: 21929635 PMCID: PMC6860654 DOI: 10.1111/j.1740-8709.2011.00356.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Omega-3 and omega-6 fatty acids, particularly docosahexaenoic acid (DHA), are known to play an essential role in the development of the brain and retina. Intakes in pregnancy and early life affect growth and cognitive performance later in childhood. However, total fat intake, alpha-linolenic acid (ALA) and DHA intakes are often low among pregnant and lactating women, infants and young children in developing countries. As breast milk is one of the best sources of ALA and DHA, breastfed infants are less likely to be at risk of insufficient intakes than those not breastfed. Enhancing intake of ALA through plant food products (soy beans and oil, canola oil, and foods containing these products such as lipid-based nutrient supplements) has been shown to be feasible. However, because of the low conversion rates of ALA to DHA, it may be more efficient to increase DHA status through increasing fish consumption or DHA fortification, but these approaches may be more costly. In addition, breastfeeding up to 2 years and beyond is recommended to ensure an adequate essential fat intake in early life. Data from developing countries have shown that a higher omega-3 fatty acid intake or supplementation during pregnancy may result in small improvements in birthweight, length and gestational age based on two randomized controlled trials and one cross-sectional study. More rigorous randomized controlled trials are needed to confirm this effect. Limited data from developing countries suggest that ALA or DHA supplementation during lactation and in infants may be beneficial for growth and development of young children 6-24 months of age in these settings. These benefits are more pronounced in undernourished children. However, there is no evidence for improvements in growth following omega-3 fatty acid supplementation in children >2 years of age.
Collapse
Affiliation(s)
- Sandra L Huffman
- Department of Nutrition and Program in International and Community Nutrition, University of California Davis, Davis, California 95616, USA.
| | | | | | | |
Collapse
|
27
|
Calder PC, Dangour AD, Diekman C, Eilander A, Koletzko B, Meijer GW, Mozaffarian D, Niinikoski H, Osendarp SJM, Pietinen P, Schuit J, Uauy R. Essential fats for future health. Proceedings of the 9th Unilever Nutrition Symposium, 26-27 May 2010. Eur J Clin Nutr 2011; 64 Suppl 4:S1-13. [PMID: 21119686 DOI: 10.1038/ejcn.2010.242] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The 9th Unilever Nutrition Symposium entitled 'Essential fats for future health', held on 26-27 May 2010, aimed to review the dietary recommendations for essential fatty acids (EFA); discuss the scientific evidence for the roles of EFA in cognition, immune function and cardiovascular health; and to identify opportunities for joint efforts by industry, academia, governmental and non-governmental organizations to effectively improve health behaviour. This paper summarizes the main conclusions of the presentations given at the symposium. Linoleic acid (LA) and α-linolenic acid (ALA) are EFA that cannot by synthesized by the human body. Docosahexaenoic acid (DHA) is considered as conditionally essential because of its limited formation from ALA in the human body and its critical role in early normal retinal and brain development and, jointly with eicosapentaenoic acid (EPA), in prevention of cardiovascular disease (CVD). Some evidence for possible beneficial roles of n-3 fatty acids for immune function and adult cognitive function is emerging. A higher consumption of polyunsaturated fatty acids (PUFA; >10%E), including LA, ALA and at least 250-500 mg per day of EPA+DHA, is recommended for prevention of coronary heart disease (CHD). Two dietary interventions suggest that EFA may affect CVD risk factors in children similarly as in adults. To ensure an adequate EFA intake of the population, including children, public health authorities should develop clear messages based on current science; ensure availability of healthy, palatable foods; and collaborate with scientists, the food industry, schools, hospitals, health-care providers and communities to encourage consumers to make healthy choices.
Collapse
Affiliation(s)
- P C Calder
- Institute of Human Nutrition, School of Medicine, University of Southampton, Southampton, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Iron deficiency (ID) anemia is associated with poor neurocognitive development in infants and children. Depending on the stage of development at the time of deficiency, these adverse effects may be reversible. Recent investigations using sensitive measurements have confirmed that the deposition of iron in the brain varies according to brain region and age, and that dopamine-dependent behaviors are among the core deficits in ID. Dr John Beard (1947-2009) has been one of the leading scientists and pioneers in the area of iron and child development. His legacy to this area of science will grow through the continuation of his work by his co-workers and colleagues.
Collapse
|
29
|
Muthayya S, Eilander A, Transler C, Thomas T, van der Knaap HCM, Srinivasan K, van Klinken BJW, Osendarp SJM, Kurpad AV. Effect of fortification with multiple micronutrients and n-3 fatty acids on growth and cognitive performance in Indian schoolchildren: the CHAMPION (Children's Health and Mental Performance Influenced by Optimal Nutrition) Study. Am J Clin Nutr 2009; 89:1766-75. [PMID: 19369376 DOI: 10.3945/ajcn.2008.26993] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [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
BACKGROUND Fortification with multiple micronutrients has been shown to improve growth and cognitive performance among children in developing countries, but it is unknown whether higher concentrations are more effective than lower concentrations. OBJECTIVE We compared the effect of 2 different concentrations of a combination of micronutrients and n-3 (omega-3) fatty acids on indicators of growth and cognitive performance in low-income, marginally nourished schoolchildren in Bangalore, India. DESIGN In a 2-by-2 factorial, double-blind, randomized controlled trial, 598 children aged 6-10 y were individually allocated to 1 of 4 intervention groups to receive foods fortified with either 100% or 15% of the Recommended Dietary Allowance of micronutrients in combination with either 900 mg alpha-linolenic acid plus 100 mg docosahexaenoic acid or 140 mg alpha-linolenic acid for 12 mo. Anthropometric and biochemical assessments were performed at baseline and 12 mo. Cognitive performance was measured at baseline and at 6 and 12 mo. RESULTS The high micronutrient treatment significantly improved linear growth at 12 mo (0.19 cm; 0.01, 0.36) and short-term memory at 6 mo (0.11 SD; 0.01, 0.20) and was less beneficial on fluid reasoning at 6 (-0.10 SD; -0.17, -0.03) and 12 (-0.12 SD; -0.20, -0.04) mo than was the low micronutrient treatment, whereas no differences were observed on weight, retrieval ability, cognitive speediness, and overall cognitive performance. No significant differences were found between the n-3 treatments. CONCLUSIONS The high micronutrient treatment was more beneficial for linear growth than was the low micronutrient treatment. However, with some small differential effects, higher micronutrient concentrations were as effective as lower concentrations on cognitive performance. This trial was registered at clinicaltrials.gov as NCT00467909.
Collapse
Affiliation(s)
- Sumithra Muthayya
- Division of Nutrition, St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Osendarp SJM, Baghurst KI, Bryan J, Calvaresi E, Hughes D, Hussaini M, Karyadi SJM, van Klinken BJW, van der Knaap HCM, Lukito W, Mikarsa W, Transler C, Wilson C. Effect of a 12-mo micronutrient intervention on learning and memory in well-nourished and marginally nourished school-aged children: 2 parallel, randomized, placebo-controlled studies in Australia and Indonesia. Am J Clin Nutr 2007; 86:1082-93. [PMID: 17921387 DOI: 10.1093/ajcn/86.4.1082] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [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
BACKGROUND Little is known about the combined effect of micronutrients and essential fatty acids on cognitive function in school-aged children. OBJECTIVE We assessed the effect of micronutrients, long-chain n-3 fatty acids, or both on indicators of cognitive performance in well-nourished and marginally nourished school-aged children. DESIGN Two 2-by-2 factorial randomized controlled double-blind trials were performed home-based in Adelaide, South Australia, and at 6 primary schools in Jakarta, Indonesia. A total of 396 children (aged 6-10 y) in Australia and 384 children in Indonesia were randomly allocated to receive a drink with a micronutrient mix (iron, zinc, folate, and vitamins A, B-6, B-12, and C), with docosahexanoic acid (DHA, 88 mg/d) and eicosapentaenoic acid (EPA, 22 mg/d), or with both or placebo 6 d/wk for 12 mo. Biochemical indicators were determined at baseline and 12 mo. Cognitive performance was measured at baseline, 6 mo, and 12 mo. RESULTS The micronutrient treatment significantly improved plasma micronutrient concentrations in Australian and Indonesian children. DHA+EPA treatment increased plasma DHA and total plasma n-3 fatty acids in both countries. The micronutrient treatment resulted in significant increases in scores on tests representing verbal learning and memory in Australia (estimated effect size: 0.23; 95% CI: 0.01, 0.46). A similar effect was observed among Indonesian girls (estimated effect size: 0.32; 95% CI: -0.01, 0.64). No effects were found on tests measuring general intelligence or attention. No effects of DHA+EPA on the factors of cognitive tests were observed. CONCLUSION In well-nourished school-aged children, fortification with multiple micronutrients can result in improvements in verbal learning and memory.
Collapse
Affiliation(s)
- Saskia J M Osendarp
- Unilever Food and Health Research Institute (UFHRI), Unilever R&D, Olivier van Noortlaan 120, 3133 AT Vlaardingen, Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Osendarp SJM, Prabhakar H, Fuchs GJ, van Raaij JMA, Mahmud H, Tofail F, Santosham M, Black RE. Immunization with the heptavalent pneumococcal conjugate vaccine in Bangladeshi infants and effects of zinc supplementation. Vaccine 2007; 25:3347-54. [PMID: 17289221 DOI: 10.1016/j.vaccine.2007.01.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Accepted: 01/02/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Zinc deficiency is known to impair immunologic functions. However, the effect of zinc supplementation on immune response to polysaccharide vaccines is not known. OBJECTIVE To determine the immunogenicity of the heptavalent Pneumococcal protein conjugate (PNC) vaccine in poor Bangladeshi infants and to assess the effect of zinc supplementation on immune response to the PNC vaccine. DESIGN We immunized a sub-cohort of 241 infants who had previously received three doses of a Hib conjugate vaccine with three doses of the heptavalent PNC vaccine at 4 weeks intervals beginning at 18+/-1 weeks of age. The infants were supplemented with daily 5 mg zinc or placebo from 4 to 33 weeks of age. Response to each of the seven PNC serotypes were assessed at 4, 24 and 33 weeks of age. RESULTS After three doses of PNC, at 29 weeks of age, geometric mean titres for the pneumococcal serotypes ranged from 3.68 to 13.34 microg/ml. Titres were significantly higher for infants who had received PNC compared to infants who had only received DTP-Hib. Zinc supplementation resulted in higher titres for serotype 9V (4.09 microg/ml; [95% CI: 3.27; 5.10] and 3.33 microg/ml; [95% CI: 2.79; 3.96] for zinc and placebo group, respectively; p<0.05) after three doses but had no effect on other serotypes. CONCLUSIONS A heptavalent PNC vaccine proved to be safe and immunogenic in Bangladeshi infants. Zinc supplementation enhanced the immune response to only one of the serotypes (9V). However, there was no effect on other serotypes.
Collapse
|
32
|
Osendarp SJM, Fuchs GJ, van Raaij JMA, Mahmud H, Tofail F, Black RE, Prabhakar H, Santosham M. The effect of zinc supplementation during pregnancy on immune response to Hib and BCG vaccines in Bangladesh. J Trop Pediatr 2006; 52:316-23. [PMID: 16621858 DOI: 10.1093/tropej/fml012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
An essential role for zinc in development of the fetal immune system has been documented. However, the effect of antenatal zinc supplementation on infants' postnatal immune response to vaccinations is unknown. The objective of this study was to evaluate the effect of zinc supplementation during pregnancy on immune response to the Bacillus Calmette-Guerin (BCG) vaccine and the Haemophilus influenzae type b (Hib) component of the combined diphtheria, tetanus toxoid and pertussis (DTP)-Haemophilus influenzae type-b (Hib)- conjugate vaccine in poor Bangladeshi infants. We immunized 405 infants whose mothers were supplemented daily with 30 mg elemental zinc or placebo beginning at 12-16 weeks gestation with the standard BCG vaccine at birth. A subcohort of 203 infants were in addition immunized at 1-month intervals with three doses of DTP-Hib vaccine starting at 9 weeks of age. The delayed hypersensitivity (PPD) skin test was performed in 345 infants at 24 weeks of age. Hib polysaccharide (PRP) antibodies were assessed for 91 infants at 4 and 24 weeks of age. In infants born with low birth weight (LBW) a lower proportion of negative responses to PPD skin test were observed in the zinc (66.2%) compared to placebo (78.5%) group (p = 0.07). No differences were observed in normal birth weight infants. There were no differences in proportion of infants above the protective thresholds for anti-PRP antibodies between zinc (81%) and placebo (89%) group. Geometric mean PRP antibody titres at 4 and 24 weeks of age were not different between groups. Zinc supplementation during pregnancy did not enhance immune response to Hib-conjugate vaccine but there was a suggestion of improved delayed hypersensitivity immune responses to BCG-vaccine in Bangladeshi LBW infants.
Collapse
|
33
|
Kimmons JE, Dewey KG, Haque E, Chakraborty J, Osendarp SJM, Brown KH. Low nutrient intakes among infants in rural Bangladesh are attributable to low intake and micronutrient density of complementary foods. J Nutr 2005; 135:444-51. [PMID: 15735076 DOI: 10.1093/jn/135.3.444] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We assessed the adequacy of nutrient intakes of 135 rural Bangladeshi breast-fed infants 6-12 mo of age and examined nutritional trade-offs due to possible displacement of breast milk by complementary foods. Observers completed 12-h daytime measurements of breast milk and complementary food intakes; data for the previous 12 h were obtained from maternal recall, yielding estimates of total 24-h intakes. On average, infants were mildly wasted (mean +/- SD weight-for-length Z-score = -0.92 +/- 0.88) and moderately stunted (length-for-age Z-score = -1.49 +/- 0.96). Total energy intakes at 6-8 and 9-12 mo were 88 and 86% of absolute energy requirements (kJ/d), 106 and 105% of requirements per kg body weight, and 97 and 94% of requirements per kg median weight-for-length, respectively. Breast milk contributed 78% of energy intake at 6-8 mo and 75% at 9-12 mo. Mean meal frequency and energy density of complementary foods were generally consistent with recommendations, but only small amounts of food were offered. Nevertheless, only 72% of the food energy offered was consumed. Total energy intake was positively correlated with meal frequency, quantity consumed per meal, and energy intake from breast milk, but not with energy density of complementary foods. Energy intake from complementary foods was inversely related to energy intake from breast milk. The diets fell short of recommended intakes for numerous vitamins and minerals. We conclude that although greater intakes of complementary foods were associated with higher total energy intake, micronutrient intake remained low due to the low micronutrient density of the complementary foods consumed and the partial displacement of breast milk.
Collapse
Affiliation(s)
- Joel E Kimmons
- Program in International Nutrition, Department of Nutrition, University of California, Davis, CA, USA
| | | | | | | | | | | |
Collapse
|
34
|
Kimmons JE, Dewey KG, Haque E, Chakraborty J, Osendarp SJM, Brown KH. Behavior-change trials to assess the feasibility of improving complementary feeding practices and micronutrient intake of infants in rural Bangladesh. Food Nutr Bull 2004; 25:228-38. [PMID: 15460266 DOI: 10.1177/156482650402500302] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study used simple rapid-assessment techniques to test the feasibility of increasing the consumption of complementary foods by infants by asking mothers to increase meal quantity or frequency or by altering the viscosity/energy density of the food. The feasibility of using micronutrient supplements either added directly to food or administered as liquid drops was also examined. The study was conducted in rural Bangladesh and involved four separate short-term behavioral change trials. Depending on the trial, fieldworkers recruited 30 to 45 infants 6 to 12 months of age. Following recommendations to increase the amount of food provided to infants, the mean intakes from single meals increased from 40 +/- 23 g on day 1 to 64 +/- 30 g on day 7 (p < 0.05). In a second trial, the mean meal frequency increased from 2.2 +/- 1.3 on day 1 to 4.1 +/- 1.3 on day 7 (p < 0.05). Provision of high-energy-density diets, prepared by decreasing viscosity with alpha-amylase or by hand-mashing rice and dhal into a paste before feeding, increased single-meal energy consumption from 54 +/- 35 kcal to 79 +/- 52 kcal or 75 +/- 37 kcal (p < 0.05), respectively. Both types of micronutrient supplements were well accepted and used according to recommendations. In conclusion, it was possible to change short-term child-feeding behaviors to promote increased food intake, mealfrequency, energy density, and micronutrient consumption. Because each of these interventions lasted for only about 1 week, however, the long-term sustainability of these changes is not known. Moreover, the effect of increased feeding of complementary foods on intakes of breastmilk and total daily consumption of energy and nutrients requires further study.
Collapse
Affiliation(s)
- Joel E Kimmons
- International Nutrition, Department of Nutrition, University of California, Davis, California, USA
| | | | | | | | | | | |
Collapse
|
35
|
Abstract
Maternal zinc deficiency during pregnancy has been related to adverse pregnancy outcomes. Most studies in which pregnant women have been supplemented with zinc to examine effects on pregnancy outcome have been carried out in industrialized countries and the results have been inconclusive. This review discusses preliminary findings of eight randomized, controlled intervention trials performed recently in less-developed countries. It is based on evidence presented by investigators and discussed during a workshop held in Wageningen, The Netherlands in June 2001. Preliminary findings from these studies indicate maternal zinc supplementation has a beneficial effect on neonatal immune status, early neonatal morbidity and infant infections. With respect to labor and delivery complications, gestational age at birth, maternal zinc status and health and fetal neurobehavioral development, evidence is conflicting and more research is required. Data currently available do not support the hypothesis that maternal zinc supplementation promotes intrauterine growth. Thus despite the emerging evidence for a positive effect of zinc on some outcomes of pregnancy, the workshop concluded that the full results of studies carried out need to be known and that more research is required to determine the benefits of large-scale introduction of zinc supplementation of pregnant women in less-developed countries.
Collapse
Affiliation(s)
- Saskia J M Osendarp
- Division of Human Nutrition and Epidemiology, Wageningen University, The Netherlands
| | | | | |
Collapse
|
36
|
Osendarp SJM, Santosham M, Black RE, Wahed MA, van Raaij JMA, Fuchs GJ. Effect of zinc supplementation between 1 and 6 mo of life on growth and morbidity of Bangladeshi infants in urban slums. Am J Clin Nutr 2002; 76:1401-8. [PMID: 12450909 DOI: 10.1093/ajcn/76.6.1401] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evidence for an effect of zinc supplementation on growth and morbidity in very young infants in developing countries is scarce and inconsistent. OBJECTIVE We assessed the effect of zinc supplementation on growth and morbidity in poor Bangladeshi infants aged 4-24 wk. DESIGN Infants from Dhaka slums were enrolled at 4 wk of age and randomly assigned to receive 5 mg elemental Zn/d (n = 152) or placebo (n = 149) until 24 wk of age. They were followed weekly for information on compliance and morbidity; anthropometric measurements were performed monthly. Serum zinc was assessed at baseline and at 24 wk of age. RESULTS At 24 wk of age, serum zinc concentrations were higher in the zinc than in the placebo group (13.3 +/- 3.8 and 10.7 +/- 2.9 micro mol/L, respectively; P < 0.001). Significantly greater weight gains were observed in the zinc than in the placebo group for 43 infants who were zinc deficient (< 9.18 micro mol/L) at baseline (3.15 +/- 0.77 and 2.66 +/- 0.80 kg, respectively; P < 0.04). In the other infants, no significant differences were observed in mean weight and length gains during the study period. Zinc-deficient infants showed a reduced risk of incidence of acute lower respiratory infection after zinc supplementation (relative risk: 0.30; 95% CI: 0.10, 0.92); among the non-zinc-deficient infants there were no significant differences between treatment groups. CONCLUSIONS Zinc-deficient Bangladeshi infants showed improvements in growth rate and a reduced incidence of acute lower respiratory infection after zinc supplementation. In infants with serum zinc concentrations > 9.18 micro mol/L, supplementation improved only biochemical zinc status.
Collapse
Affiliation(s)
- Saskia J M Osendarp
- International Center for Diarrhoeal Disease Research, Bangladesh (ICDDR,B): Centre for Health and Population Research, Dhaka, Bangladesh.
| | | | | | | | | | | |
Collapse
|
37
|
Hamadani JD, Fuchs GJ, Osendarp SJM, Huda SN, Grantham-McGregor SM. Zinc supplementation during pregnancy and effects on mental development and behaviour of infants: a follow-up study. Lancet 2002; 360:290-4. [PMID: 12147372 DOI: 10.1016/s0140-6736(02)09551-x] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Zinc deficiency is widely prevalent in developing countries. Zinc supplements given to Bangladeshi pregnant women have been shown to reduce infants' infectious disease morbidity. We assessed these infants at age 13 months to establish the effect of antenatal zinc supplementation on infant development and behaviour. METHODS The study originally consisted of 559 pregnant women who were randomly allocated to zinc (30 mg daily) or placebo (cellulose) from 4 months' gestation to delivery. The effect of zinc supplementation on pregnancy outcome and on infant growth and morbidity in the first 6 months was assessed. We then randomly selected a subsample of 168 infants from 383 who completed the study at 6 months. When babies in this subsample reached age 13 months, we assessed mental development with Bayley scales of infant development-II, rated behaviour on a modified version of Wolke's scales, and measured weight and height. FINDINGS When we controlled for differences between tested and non-tested participants, infants in the placebo group had higher scores on mental development index (regression coefficient=3.3, SE 1.6, 95% CI 0.2-6.5, p=0.04) and psychomotor development index (5.1, 2.4, 0.2-9.9, p=0.04) than those in the zinc-supplemented group. Zinc supplementation had no significant effect on behaviour or growth. The children's nutritional status was poor, and weight-for-age at testing was strongly related to developmental levels, which accounted for some of the treatment effect. INTERPRETATION Prenatal supplementation with zinc alone in poor women from Bangladesh does not seem to confer benefit on infants' mental development. Such treatment should be considered with caution.
Collapse
Affiliation(s)
- Jena D Hamadani
- Centre for Health and Population Research, International Centre for Diarrhoeal Disease Research, Bangladesh
| | | | | | | | | |
Collapse
|