Publications (13)45.23 Total impact
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Article: Home gardening is associated with Filipino preschool children's dietary diversity.
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ABSTRACT: Dietary diversification through home gardening is a sustainable strategy that can address multiple micronutrient deficiencies. This cross-sectional study aimed to determine the association between home gardening and the dietary diversity of preschool-aged children. Households with children aged 2 to 5 years (n=200) were surveyed from Baras and Angono in the province of Rizal, Philippines in January 2008. Food security was determined based on the US Department of Agriculture Food Security Questionnaire. Dietary diversity score was based on the number of unique food groups consumed during the past 24 hours. The Student t test was performed to compare means between groups (households with gardens vs households without gardens) whereas proportions between groups were compared using Pearson's χ(2) analyses. Multiple linear regression was performed to model the adjusted regression coefficients for the quantitative outcome variables by exposure variable. Around 52.5% of children were from households with a fruit and/or vegetable garden. Children from households with gardens had higher dietary diversity scores whether using the all-inclusive dietary diversity score (6.12 vs 5.62; P=0.040) or applying a 10-g minimum intake for each food group (5.89 vs 5.37; P=0.044) compared with children who lived in homes without a garden. Children from households with gardens were significantly more likely to eat vegetables more frequently (χ(2)=9.06; P=0.029). The presence or absence of a garden was not significantly associated with food security. Having a home garden was positively associated with the child's diet diversity and with frequency of vegetable consumption. Households without gardens may benefit from interventions promoting gardens as a means to improve diet quality.Journal of the American Dietetic Association 05/2011; 111(5):711-5. · 3.59 Impact Factor -
Article: Efficacy of pandesal baked from wheat flour fortified with iron and vitamin a in improving the iron and anthropometric status of anemic schoolchildren in the Philippines.
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ABSTRACT: To determine the efficacy of pandesal baked from wheat flour fortified with iron, with or without vitamin A (VA), in improving anemic schoolchildren's iron and anthropometric status. Anemic 6- to 12-year-old Filipino children (n = 250) received two 60 g pandesal daily for 8 months. They were randomized into 1 of 4 groups: (1) iron-fortified (with hydrogen-reduced iron at 80 mg/kg, electrolytic iron at 80 mg/kg, or ferrous fumarate at 40 mg/kg), (2) iron and VA-fortified, (3) VA-fortified (at 490 RE/100 g), and (4) nonfortified flour. Hemoglobin (Hb) and zinc protoporphyrin (ZnPP) concentrations and weight and height were determined before and after intervention. Analyses of variance and chi-square and multiple regression analyses were performed. Mean Hb increased by 1.3 g/dL (p < 0.001) and mean ZnPP decreased by 24.4 micromol/mol (p < 0.001) after 8 months. Anemia decreased to 26% and iron deficiency decreased from 58% to 12%. After controls were applied for baseline concentration, age, and gender, Hb concentration at post intervention was significantly higher in the Iron + VA group than in the nonfortified group (coefficient = 0.37; p = 0.034). The odds of being iron deficient at post intervention were significantly lower in the Iron group than in the nonfortified group after controls were applied for age, gender, and baseline prevalence (coefficient = 0.12; p = 0.006). None of the 3 fortified groups had significantly different weight-for-age z-score, body mass index-for-age z-score, or height-for-age z-score compared with the nonfortified group after controls were applied for baseline z-scores, age, and gender. Our study shows that in a non-malaria-endemic area, iron fortification of flour significantly reduced the prevalence of iron deficiency among anemic schoolchildren, and double fortification with iron and VA significantly improved Hb status.Journal of the American College of Nutrition 10/2009; 28(5):591-600. · 2.29 Impact Factor -
Article: Effectiveness of a redesigned iron supplementation delivery system for pregnant women in Negros Occidental, Philippines.
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ABSTRACT: To determine the effectiveness of a redesigned Fe supplementation delivery system (ISDS) in improving Hb concentrations and compliance among pregnant women. A controlled before and after study design was used. Interviews and Hb measurements of randomly selected pregnant women in both treatment areas were conducted at baseline and after 6 months. The redesigned ISDS, reached by consensus based on the surveys and focus group discussions, involved the health workers in spot mapping and clustering; Fe tablets' distribution, monitoring and promotion; and counselling of pregnant women. Negros Occidental and Negros Oriental, Philippines. In total, 1180 pregnant women given Fe/folic acid tablets daily through the redesigned ISDS in the experimental areas and the existing ISDS in the control areas. There were significantly more anaemic pregnant women in the experimental than in the control area at baseline (50.7 v. 37.3%; P = 0.001). However, at endline, the anaemia prevalence rate in the experimental area was comparable to that of the control (35.6 v. 33.1%; P = 0.530). Also, the mean Hb concentration increased significantly in the experimental area by 0.5 g/dl (P = 0.002). An increase in the actual number of prenatal visits/trimester in the experimental area was observed (from 0.99 to 1.66; P < 0.0001). Pregnant women in the experimental area were four times more likely to take Fe tablets (OR = 3.79; P < 0.001) and sixteen times more likely to being monitored for Fe intake (OR = 16.86; P < 0.001) compared to the control. The redesigned ISDS was effective in improving the Hb concentration and health-related behaviour of pregnant women.Public Health Nutrition 09/2008; 12(7):932-40. · 2.17 Impact Factor -
Article: Determinants of anemia among preschool children in the Philippines.
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ABSTRACT: Our objective was to identify the determinants of anemia among rural Filipino children aged 12-71 months. A cross-sectional survey was conducted among 2090 preschool children from 8 rural villages in Cebu, an area non-endemic for malaria and schistosomiasis. Hemoglobin (Hb) concentration was determined using a HemoCue hemoglobinometer and zinc protoporphyrin (ZPP) concentration was measured with a hematofluorometer. A 3-day non-consecutive 24-hour food recall interview with the child's primary caregiver was done to estimate the child's dietary intake. Stool analysis for presence of soil-transmitted helminths was performed through a concentration technique. A separate interview on household socio-economic status with the child's primary caregiver was conducted. Mean Hb concentration was 12.0 g/dL (SD 1.3). 16.1% were anemic. Age and sex had a significant interaction in their effect on Hb concentration. Females had higher Hb concentration between 12 to 23 months of age. Hb levels equalize between the 2 genders at around 24 months and increase with similar increments until 71 months of age. All dietary parameters improved Hb concentration with increasing intake. In the multiple regression, however, only the index for bioavailable iron and vitamin C intakes remained independent factors. None of the helminths or combination of helminths had significant effects on Hb concentration. Among the socio-economic variables, maternal educational attainment and water supply were significant independent factors. Mean ZPP concentration was 72.07 (SD 46.45) and 30.8% were iron deficient. As with Hb concentration, age and sex had a significant interaction in their effect on ZPP concentration, with females having lower ZPP levels before 24 months of age. Bioavailable iron (animal iron + 0.3*plant iron) had a significant effect on ZPP concentration at levels of at least 15% of the iron requirement. This was seen even after controlling for multivitamin supplementation. The control of anemia among preschoolers can be achieved through a combination of various nutritional interventions such as micronutrient supplementation, food fortification and nutrition education. Our findings emphasize the importance of a multi-sectoral approach to nutritional problems--the importance of empowering women (through engagement and education) and of maintaining a healthy physical environment (water and sanitation) are often peripheral concerns of nutritionists. Our study highlights the importance of supporting initiatives that address these issues not only for their core benefit, but also for the potential benefit to nutrition.Journal of the American College of Nutrition 05/2008; 27(2):229-43. · 2.29 Impact Factor -
Article: Relationships of body mass index with serum carotenoids, tocopherols and retinol at steady-state and in response to a carotenoid-rich vegetable diet intervention in Filipino schoolchildren.
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ABSTRACT: In marginally nourished children, information is scarce regarding the circulating concentrations of carotenoids and tocopherols, and physiological factors influencing their circulating levels. We determined the serum concentrations of carotenoids, tocopherols and retinol at steady state and in response to a 9-week vegetable diet intervention in 9-12-year-old girls (n=54) and boys (n=65) in rural Philippines. We determined cross-sectional relationships of BMI (body mass index) with serum micronutrient levels, and whether BMI is a determinant of serum carotenoid responses to the ingestion of carotenoid-rich vegetables. We measured dietary nutrient intakes and assessed inflammation by measurement of serum C-reactive protein levels. The children had low serum concentrations of carotenoids, tocopherols and retinol as compared with published values for similar-aged children in the U.S.A. The low serum retinol levels can be ascribed to inadequate diets and were not the result of confounding due to inflammation. Significant inverse correlations of BMI and serum all-trans-beta-carotene, 13-cis-beta-carotene, alpha-carotene, lutein, zeaxanthin and alpha-tocopherol (but not beta-cryptoxanthin, lycopene and retinol) were observed among girls at baseline. The dietary intervention markedly enhanced the serum concentrations of all carotenoids. Changes in serum all-trans-beta-carotene and alpha-carotene (but not changes in lutein, zeaxanthin and beta-cryptoxanthin) in response to the dietary intervention were inversely associated with BMI in girls and boys. Thus, in Filipino school-aged children, BMI is inversely related to the steady-state serum concentrations of certain carotenoids and vitamin E, but not vitamin A, and is a determinant of serum beta- and alpha-carotene responses, but not xanthophyll responses, to the ingestion of carotenoid-rich vegetable meals.Bioscience Reports 05/2008; 28(2):97-106. · 2.38 Impact Factor -
Article: Stability of iodine in iodized fresh and aged salt exposed to simulated market conditions.
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ABSTRACT: The salt iodization law of the Philippines required that iodized salt sold at retail not be exposed to direct sunlight, high temperature and relative humidity, and contamination with moisture and dust from the environment. However, because the majority of local consumers buy salt displayed in open heaps, it was suggested that iodized salt should be sold in the same manner for greater accessibility and availability. Objective. We aimed to provide evidence on the stability of iodine in local aged and fresh salt iodized at 100 ppm iodine and exposed to various market and storage conditions. Samples of salt in open heaps and repacked salt were exposed for 4 weeks, and salt packed in woven polypropylene bags was stored for 6 months. The iodine content of the salt was determined by the iodometric titration method, and the moisture content was determined by the oven-drying method. For all types of exposed salt, iodine levels were above 60 ppm after the end of the study (4 weeks). Within each salt type, losses were greater for open-heap salt than for repacked salt. The greatest drop in moisture content occurred in the first week for most types of salt and exposure combinations. Moisture content was linearly correlated with iodine content. Iodine levels in stored salt remained above 60 ppm even after 6 months. Iodized salt is able to retain iodine above the recommended levels despite exposure to an open environment and use of ordinary packaging materials while being sold at retail and kept in storage.Food and nutrition bulletin 01/2008; 28(4):412-8. · 1.92 Impact Factor -
Article: Carotene-rich plant foods ingested with minimal dietary fat enhance the total-body vitamin A pool size in Filipino schoolchildren as assessed by stable-isotope-dilution methodology.
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ABSTRACT: Strategies for improving the vitamin A status of vulnerable populations are needed. We studied the influence of the amounts of dietary fat on the effectiveness of carotene-rich plant foods in improving vitamin A status. Schoolchildren aged 9-12 y were fed standardized meals 3 times/d, 5 d/wk, for 9 wk. The meals provided 4.2 mg provitamin A carotenoids/d (mainly beta-carotene) from yellow and green leafy vegetables [carrots, pechay (bok choy), squash, and kangkong (swamp cabbage)] and 7, 15, or 29 g fat/d (2.4, 5, or 10 g fat/meal) in groups A, B, and C (n = 39, 39, and 38, respectively). Other self-selected foods eaten were recorded daily. Before and after the intervention, total-body vitamin A pool sizes and liver vitamin A concentrations were measured with the deuterated-retinol-dilution method; serum retinol and carotenoid concentrations were measured by HPLC. Similar increases in mean serum beta-carotene (5-fold), alpha-carotene (19-fold), and beta-cryptoxanthin (2-fold) concentrations; total-body vitamin A pool size (2-fold); and liver vitamin A (2-fold) concentrations were observed after 9 wk in the 3 study groups; mean serum retinol concentrations did not change significantly. The total daily beta-carotene intake from study meals plus self-selected foods was similar between the 3 groups and was 14 times the usual intake; total fat intake was 0.9, 1.4, or 2.0 times the usual intake in groups A, B, and C, respectively. The overall prevalence of low liver vitamin A (<0.07 mumol/g) decreased from 35% to 7%. Carotene-rich yellow and green leafy vegetables, when ingested with minimal fat, enhance serum carotenoids and the total-body vitamin A pool size and can restore low liver vitamin A concentrations to normal concentrations.American Journal of Clinical Nutrition 04/2007; 85(4):1041-9. · 6.67 Impact Factor -
Article: Good governance for nutrition in the Philippines: elements, experiences, and lessons learned.
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ABSTRACT: Malnutrition is a multifactorial problem that needs a multisectoral solution. This article reviews the role of good governance in nutrition programs, citing the Philippines as an example. In the Philippines, these efforts are reflected in the partnership between the public and private sectors in the establishment of the country's capability in research, policy-making, and program implementation. The establishment of the different public institutions engaged in research and policy-making is discussed, highlighting the role of political will through legislation. The evolving tasks of the nutrition program are discussed by citing the tasks in two eras. In the 1970s, the challenges were limited national nutrition data, man-power, tools, and health infrastructure. The public and private institutions were able to respond by legislating national nutrition surveys and dedicated nutrition workers in each village. The challenges in the current era are improved implementation of health programs, given the devolution of health services, and the gathering of an evidence base to further strengthen and refine the strategies of supplementation, fortification, breastfeeding, and food security. In responding to these challenges, multisectoral solutions and collaboration are critical in providing an evidence base to formulate policy. The role of the private sector, with the Nutrition Center of the Philippines used as an example, is that of a supportive and collaborative partner in good governance. Finally, the lessons learned from the past decades of implementing a national nutrition program, given changes in political and economic circumstances, are summarized.Food and nutrition bulletin 01/2007; 27(4):343-52. · 1.92 Impact Factor -
Article: Implementing preventive iron-folic acid supplementation among women of reproductive age in some Western Pacific countries: possibilities and challenges.
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ABSTRACT: Lack of effective implementation mechanisms is identified as a major obstacle in the prevention and control of iron-deficiency anemia. This paper discusses experiences gained from implementing iron-folic acid supplementation in the Philippines, Vietnam, and Cambodia. The understanding of contextual elements is proposed as a foundation for planning interventions. Moreover, it is suggested that a social marketing framework should provide a way of thinking about how to influence related behaviors. The application of a social marketing framework applied using a "5 P's" approach: public relations and collaboration, product, price, place, and promotion, is described, as well as enabling factors (possibilities) and inhibiting factors (challenges) of this approach. Although a program to improve iron nutrition among women of reproductive age may not be simple to implement, it is essential to enhancing health, human development, and economic advancement in developing countries.Nutrition Reviews 01/2006; 63(12 Pt 2):S81-6. · 4.47 Impact Factor -
Article: Maternal vitamin B-6 and folate status and risk of oral cleft birth defects in the Philippines.
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ABSTRACT: Vitamin deficiencies induce oral clefts in animal experiments, but the role of specific nutrients in human oral clefts is uncertain. Associations between maternal vitamin B-6 and folate status and risk of nonsyndromic cleft lip, with or without cleft palate (CL/P), were examined in case-control studies at two sites in the Philippines--Negros Occidental and Davao. Cases were mothers of affected children and control mothers were those who had no children with oral clefts. The risk of having a CL/P-affected child increased with increasing tertile of vitamin B-6 deficiency in both Negros Occidental and Davao (odds ratios [ORs] and 95% confidence intervals [CIs] for sites combined = 1.0 [reference], OR, 2.94; 95% CI, 1.51-5.73; OR, 4.98; 95% CI, 2.56-9.67). Poor B-6 status had a stronger association with CL/P among mothers with lower versus higher plasma folate levels. Increasing tertiles of plasma folate were marginally associated with an increased risk of clefts in both sites combined (1.0 [reference]; OR, 1.58; 95% CI, 0.93-2.68; OR, 1.59; 95% CI, 0.94-2.70). Increasing tertiles of erythrocyte folate were associated with a decreased risk of CL/P in Negros Occidental (1.0 [reference]; OR, 0.34; 95% CI, 0.13-0.90; OR, 0.46; 95% CI, 0.20-1.09) and an increased risk in Davao (1.0 [reference]; OR, 1.23; 95% CI, 0.54-2.81; OR, 4.85; 95% CI, 2.24-10.50). The inconsistent associations between folate status and CL/P risk appeared to be a result of statistical interaction between folate, vitamin B-6, and case-control status that produced different results in study areas of higher versus lower prevalence of vitamin B-6 deficiency. Poor maternal vitamin B-6 status was consistently associated with an increased risk of CL/P at two sites in the Philippines. Folate-CL/P associations were inconsistent and may be related to the vitamin B-6 status or other characteristics of the populations under study.Birth Defects Research Part A Clinical and Molecular Teratology 08/2004; 70(7):464-71. · 2.27 Impact Factor -
Article: Dietary vitamin A intakes of Filipino elders with adequate or low liver vitamin A concentrations as assessed by the deuterated-retinol-dilution method: implications for dietary requirements.
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ABSTRACT: The vitamin A requirements of elderly humans have not been studied. In a cross-sectional study of 60-88-y-old men (n = 31) and women (n = 31) in rural Philippines, we assessed the dietary intakes of elders with adequate (> or = 0.07 micromol/g) or low (< 0.07 micromol/g) liver vitamin A concentrations to estimate vitamin A requirements for this age group. Total-body vitamin A was assessed by the deuterated-retinol-dilution technique; liver vitamin A concentrations were assessed by assuming that liver weight is 2.4% of body weight and that, in this marginally nourished population, 70% of total-body vitamin A is in the liver; serum retinol was measured by HPLC; and dietary intakes were assessed with 3 nonconsecutive 24-h dietary recalls. The mean vitamin A intake + 2 SDs of subjects with adequate liver vitamin A concentrations was used to estimate an acceptable or sufficient vitamin A intake value for elders. The mean (+/- SD) vitamin A intakes of the men and women with adequate vitamin A in liver were 135 +/- 86 and 134 +/- 104 microg retinol activity equivalents (RAE)/d, respectively; intakes of the men and women with low vitamin A in liver were 75 +/- 53 and 60 +/- 27 microg RAE/d, respectively. Total-body vitamin A or liver vitamin A but not serum retinol correlated with dietary RAE, preformed vitamin A, beta-carotene, fat, and protein. An estimated acceptable or sufficient dietary vitamin A intake associated with adequate liver vitamin A concentrations in elders is 6.45 microg RAE/kg body wt; for a reference 76-kg man and a 61-kg woman, these values are approximately 500 and 400 microg RAE/d, respectively. The dietary vitamin A intakes of elders with adequate or low liver vitamin A concentrations as estimated by use of the deuterated-retinol-dilution technique are useful for assessing vitamin A requirements.American Journal of Clinical Nutrition 04/2004; 79(4):633-41. · 6.67 Impact Factor -
Article: Effect of a multiple-micronutrient-fortified fruit powder beverage on the nutrition status, physical fitness, and cognitive performance of schoolchildren in the Philippines.
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ABSTRACT: This study aimed to determine the effect of a multiple-micronutrient-fortified beverage on the micronutrient status, physical fitness, and cognitive performance of schoolchildren. The study was a randomized, double-blind, placebo-controlled trial of schoolchildren assigned to receive either the fortified or nonfortified beverage with or without anthelmintic therapy. Data on hemoglobin level, urinary iodine excretion (UIE) level, physical fitness, and cognitive performance were collected at baseline and at 16 weeks post-intervention. The fortified beverage significantly improved iron status among the subjects that had hemoglobin levels < 11 g/dl at baseline. The proportion of children who remained moderately to severely anemic was significantly lower among those given the fortified beverage. In the groups that received the fortified product, the median UIE level increased, whereas among those who received the placebo beverage, the median UIE level was reduced significantly. Iron- and/or iodine-deficient subjects who received the fortified beverage showed significant improvements in fitness (post-exercise reduction of heart rate) and cognitive performance (nonverbal mental ability score). The study showed that consumption of a multiple-micronutrient-fortified beverage for 16 weeks had significant effects on iron status, iodine status, physical fitness, and cognitive performance among iron- and/or iodine-deficient Filipino schoolchildren. Anthelmintic therapy improved iron status of anemic children and iodine status of the iron-adequate children at baseline but it had no effect on physical fitness and cognitive performance. The results from the clinical study showed that a multiple-micronutrient-fortified beverage could play an important role in preventing and controlling micronutrient deficiencies.Food and nutrition bulletin 12/2003; 24(4 Suppl):S129-40. · 1.92 Impact Factor -
Article: Quantitative assessment of total body stores of vitamin A in adults with the use of a 3-d deuterated-retinol-dilution procedure.
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ABSTRACT: The conventional deuterated-retinol-dilution (DRD) technique provides a quantitative estimate of total body stores of vitamin A in humans. The procedure requires equilibration of serum deuterated retinol with nondeuterated retinol after administration of an oral dose of deuterated vitamin A. Equilibration takes approximately 3 wk to complete. Our goal was to develop a predictive mathematical formula for quantitative assessment of total body stores of vitamin A in adults by using a procedure that takes less time to perform because serum isotope equilibration is not required, so that blood drawing can be done 3 d, instead of approximately 3 wk, after isotope dosing. Ratios of serum deuterated to nondeuterated retinol (D:H retinol) were determined in Filipino adults (n = 68) 3 and 20 d after an oral dose of 0.015 mmol [(2)H(4)]retinyl acetate and in Guatemalan adults (n = 15) 3 and 21 d after a 0.030-mmol dose. D:H retinol values 20 or 21 d after the isotope dose were used in a mathematical formula to obtain quantitative estimates of total body stores of vitamin A that were then correlated with serum D:H retinol values 3 d after the isotope dose. The relation between these variables was nonlinear and was described by the following equation: total body stores of vitamin A (in mmol retinol) = 0.00468 x 10(37(isotope dose in mmol))/D:H retinol in serum 3 d after the isotope dose. A 3-d DRD technique could be used for quantitative assessment of total body stores of vitamin A; this technique takes less time than does the conventional DRD technique.American Journal of Clinical Nutrition 04/2003; 77(3):694-9. · 6.67 Impact Factor
Top co-authors
Top Journals
Institutions
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2008
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University of Massachusetts Boston
Boston, MA, USA
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2007
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Tufts University
Boston, GA, USA
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2006
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Mahidol University
Bangkok, Bangkok, Thailand
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2004
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Utah State University
- Department of Nutrition, Dietetics and Food Sciences
Logan, OH, USA
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