Food and Nutrition Bulletin

Published by SAGE Publications
Online ISSN: 1564-8265
Print ISSN: 0379-5721
Between 2002 and 2004, the Institute of Nutrition of Central America and Panama (INCAP), in collaboration with Emory University, the International Food Policy Research Institute (IFPRI), and the University of Pennsylvania, re-surveyed young Guatemalan adults who had, as children, been participants in a nutrition supplementation trial conducted by INCAP between 1969 and 1977. This "Human Capital Study 2002-04" complements and extends data obtained in previous studies by collecting new information on measures of physical health and well-being, schooling and cognitive ability, wealth, consumption and economic productivity, and marriage and fertility histories. This paper describes the study domains and data collection procedures. Among 2,393 members of the original sample, 1,856 (77%) were targets for enrollment. Response rates varied by gender, current place of residence, and domain of data collection, with 80% of males and 89% of females completing at least one data collection instrument. Attrition was not random and appears to be associated with a number of initial characteristics of individuals and their households that should be controlled for in future analyses. We conclude that data collection was successful and data quality is high, facilitating the successful undertaking of our planned investigation of important study hypotheses.
Infant and young child feeding indicators among children 0 to 23 months of age in India, 2005-06 Indicator Size of subsample (weighted) n (weighted) Rate (%) 95% CI
Univariate and multivariate analyses of the risks of being bottle-fed and of not being exclusively breastfed, India 2005−06
In India, poor feeding practices in early childhood contribute to the burden of malnutrition and infant and child mortality. To estimate infant and young child feeding indicators and determinants of selected feeding practices in India. The sample consisted of 20,108 children aged 0 to 23 months from the National Family Health Survey India 2005-06. Selected indicators were examined against a set of variables using univariate and multivariate analyses. Only 23.5% of mothers initiated breastfeeding within the first hour after birth, 99.2% had ever breastfed their infant, 89.8% were currently breastfeeding, and 14.8% were currently bottle-feeding. Among infants under 6 months of age, 46.4% were exclusively breastfed, and 56.7% of those aged 6 to 9 months received complementary foods. The risk factors for not exclusively breastfeeding were higher household wealth index quintiles (OR for richest = 2.03), delivery in a health facility (OR = 1.35), and living in the Northern region. Higher numbers of antenatal care visits were associated with increased rates of exclusive breastfeeding (OR for 2 7 antenatal visits = 0.58). The rates of timely initiation of breastfeeding were higher among women who were better educated (OR for secondary education or above = 0.79), were working (OR = 0.79), made more antenatal clinic visits (OR for 2 7 antenatal visits = 0.48), and were exposed to the radio (OR = 0.76). The rates were lower in women who were delivered by cesarean section (OR = 2.52). The risk factors for bottle-feeding included cesarean delivery (OR = 1.44), higher household wealth index quintiles (OR = 3.06), working by the mother (OR = 1.29), higher maternal education level (OR = 1.32), urban residence (OR = 1.46), and absence of postnatal examination (OR = 1.24). The rates of timely complementary feeding were higher for mothers who had more antenatal visits (OR = 0.57), and for those who watched television (OR = 0.75). Revitalization of the Baby Friendly Hospital Initiative in health facilities is recommended. Targeted interventions may be necessary to improve infant feeding practices in mothers who reside in urban areas, are more educated, and are from wealthier households.
From 2006 to 2008, there were sharp increases in the prices of major food commodities globally, including maize, rice, and wheat. Few studies have contributed empirical evidence of the nutritional impacts of this food price crisis. To assess changes in energy intake in response to food price shocks and in relation to calorie adequacy levels in seven Latin American countries. Data were drawn from nationally representative household budget surveys. The quadratic almost ideal demand system (QUAIDS) model characterized change patterns in consumption for six food groups and one nonfood group under two scenarios: actual change in food prices by country, and standardized 10% increase in prices across all countries. Energy intakes before and after the crisis were determined once calories were assigned to food items from the ProPAN and US Department of Agriculture food composition databases. Energy intakes were reduced by 8.0% (range, 0.95% to 15.1%) from precrisis levels across all countries. Ecuador and Panama were the worst affected, followed by Haiti and Nicaragua. There was a consistent, direct relationship between wealth quintile and change in energy intake. Rural areas were affected to the same extent as or a greater extent than urban areas. High positive increases in calorie consumption were found in the richest wealth quintile, exceeding 10% of previous levels in five countries. Policies and programs targeting the poorest households in both rural and urban areas may be needed to offset the energy deficits associated with food price increases. More research is needed on the effect of food prices and micronutrient nutrition.
By 2000, the global track record on universal salt iodization (USI) indicated 26% access to adequately iodized salt in the Central and Eastern Europe, Commonwealth of Independent States (CEE/ CIS) Region. Aimed at extracting lessons learned, this study examined experiences, achievements, and outcomes of USI strategies in CEE/CIS countries during the subsequent decade. Information from the design, timing, execution, outputs, multi-sector management and results of actions by national stakeholders yielded 20 country summaries. Analysis across countries used a LogFrame Analysis typical for public nutrition development. By 2009, USI strategies had reached the target and population iodine nutrition shown adequate levels in 9 countries, while in 6 others, USI was close and/or population iodine status showed only minor imperfection. True USI, i.e., iodization of salt destined both for the food industry and the household, had been made mandatory in 13 of these 15 countries. In the Balkan area, USI and iodine nutrition advanced more than in CIS. Of the 20 sample countries, 17 (85%) had exceeded the mark of 50% adequate access, while the overall regional score reached 55% by 2010. Experience from this region suggests that strong partnership collaboration, a new concept in post-Soviet societies, was a major success factor. Voluntary iodization or focusing on household salt alone was less likely conducive for success. Achieving optimum iodine nutrition required the setting of proper iodine standard Weak political leadership insistence in the Russian Federation and Ukraine to embrace USI is the main factor why the region remains behind in the global progress.
Biomarkers of iron and inflammation status in children aged 12 to 18 months in 2009 (n = 320) 
Iron status in 2009 after fortification (n = 308). NIDA, non-iron-deficiency anemia; IDA, iron-deficiency anemia; IDWA, iron deficiency without anemia; DIS, depleted iron stores; NIS, normal iron status. Error bars represent 95% confidence intervals 
Iron deficiency is the most prevalent nutritional deficiency in the world, primarily affecting infants, young children, and women of childbearing age. To evaluate the impact of the National Complementary Feeding Program (NCFP) on anemia and iron status in Chilean children aged 11 to 18 months. Two studies were performed. The first study was performed at one public outpatient health center in Santiago, using data collected in 1999 (n = 128) and 2000 (n = 125), before and after the national introduction of iron-fortified milk. Subsequently, a study of a representative sample (n = 320) from the two most populated areas of the country was performed in 2009. One year after fortification, the prevalence of anemia was 9%; significantly lower (p < .001) than the 27% prevalence observed 1 year before. Ten years after fortification, 14% of children were anemic and 77% of children with anemia (12% of all children) suffered from iron-deficiency anemia. In 2009, 11% of children consuming iron-fortified milk delivered by the NCFP (73%) were anemic, significantly lower (p = .028) than the 21% prevalence of anemia observed in children without consumption. Consumption of iron-fortified milk was positively associated with hemoglobin concentration (r = 0.28, p = .022) and was associated with a lower prevalence of anemia after adjusting for confounding factors (odds ratio, 0.50; 95% CI, 0.26 to 0.96). In Chile, the NCFP has had an impact on the reduction of anemia and improved the iron status of children aged 11 to 18 months. Increasing the consumption of this iron-fortified milk could enhance the impact of the NCFP.
In medical investigation there is a need for non-invasive methods. Moreover, patients ask for easy methods that are simple to perform and medical doctors demand reliable techniques. With the advent of stable isotopes a new area of tracer technology became available. In gastroenterology, 13CO2 breath tests are used which fulfill all the conditions needed in modern clinical research and investigation.
The 13C-mixed triacylglycerol (MTG) breath test is used to measure intraluminal fat digestion. In normal digestion 20% to 40% of the ingested 13C label is recovered in breath CO2. We aimed to identify the proportions of ingested label excreted in stool as well as breath following ingestion of 13C-MTG by children with impaired exocrine pancreatic function and healthy controls. 13C enrichment of breath samples was measured by continuous flow isotope ratio mass spectrometry (IRMS) and the cumulative percent dose recovered (cPDR) in 10 hours was calculated. Total 13C of a fecal fat extract from each stool was measured by combustion-IRMS, and 13C enrichment and concentration of the tert.-butyldimethylsilyl (TBDMS) derivative of octanoic acid was measured by gas chromatography-mass spectrometry (GC/MS) after hydrolysis of the fat extract. Stool 5-day cPDR was calculated. Mean breath cPDR was 33% for children with cystic fibrosis and 45% for controls. Mean cPDR in stool by combustion-IRMS and GC/MS, respectively, was 0.7% and 0.3% for children with cystic fibrosis and 1.4 and 4.2% for controls.
13C-breath tests are widely applied as a tool to investigate metabolic processes and infectious diseases, but most of them have not yet entered into clinical practice. In order to promote the introduction of more 13C-breath tests into clinical routine application we evaluated the tests so far known with respect to some reasonable criteria, which are valued by one of three marks. The sum sigma of these marks is assumed as a measure of the total value of the respective 13C-breath test. In this way we arrived at 10 tests with sigma value of 10 or more points which seem to have an especially high potential to successfully enter into clinical practice. This is particularly true for the 13C-breath tests with urea, aminopyrine, acetate, galactose, caffeine, octanoic acid, and phenylalanine as substrates. Measures are proposed for promoting the clinical application of such tests.
Stable isotope labeled compounds are widely used as diagnostic probes in medicine. These diagnostic stable isotope probes are now being expanded in their scope, to provide precise indications of the presence or absence of etiologically significant change in metabolism due to a specific disease. This concept exploits a labeled tracer probe that is a specifically designed substrate of a "gateway" enzyme in a discrete metabolic pathway, whose turnover can be measured by monitoring unidirectional precursor product mass flow. An example of such a probe is the 13C-urea breath test, where labeled urea is given to patients with H. pylori infection. Another example of this kind of probe is used to study the tripeptide glutathione (glu-cys-gly, GSH), which is the most abundant cellular thiol, and protects cells from the toxic effects of reactive oxygen species. Within the gamma glutamyl cycle, 5-oxoproline (L-pyroglutamic acid) is a metabolite generated during GSH catabolism, and is metabolized to glutamic acid by 5-oxoprolinase. This enzyme can also utilize the substrate L-2-oxothiazolidone-4-carboxylate (OTC), to generate intracellular cysteine, which is beneficial to the cell. Thus, labeled (13C) OTC would, under enzymatic attack yield cysteine and 13CO2, and can thus track the state and capacity of glutathione metabolism. Similarly, stable isotope labeled probes can be used to track the activity of the rate of homocysteine clearance, lymphocyte CD26, and liver CYP (cytochrome P450) enzyme activity. In the future, these applications should be able to titrate, in vivo, the characteristics of various specific enzyme systems in the body and their response to stress or infection as well as to treatment regimes.
Benzo(alpha)pyrene (BP) and 7,12--dimethylbenz(alpha) anthracene (DMBA) are potent carcinogens for mammals, which are able to affect the normal metabolic processes. The influence both of BP and DMBA to the transport rate of individual 14C labeled amino acids (14C-lysine; 14C-valine; 14C-leucine or 14C-tyrosine) in yeast Saccharomyces cerevisiae strain A3 were studied by introducing about one microCi (37 kBq) of individual 14C labeled amino acid into 30 ml liquid ethanol media that contained BP (0.001% v/v) or DMBA (0.001% v/v), then followed by inoculating a known concentration of yeast suspension in such a manner to get the initial optical density (OD) of new cultures were about 0.10. Uptake rates were determined at certain intervals after inoculation, using a liquid scintillation counter. The results show that BP had the tendency to increase the uptake rate while DMBA showed a reversed effect on the use of amino acids. It was also found that tyrosine was absorbed faster than valine as well as leucine and this was different with the result reported by the former investigators.
In Bangladesh, pervasive poverty has kept generations of families from sending their children to school, and without education, their children's future will be a distressing echo of their own. Many children from poor families in Bangladesh do not attend school either because their families cannot afford books and other school materials, or because the children contribute to their family's livelihood and cannot be spared. In some areas, there is also a lack of schools. Among those who enter primary school, only about 40 percent of them complete it. The great success of the Food for Education (FFE) program of the Government of Bangladesh has led to larger classes, but do these crowded classrooms crowd out learning?
PROGRESA transfers to beneficiary households from November 1998 to October 1999 
Together with 16 other Millennium Development Goals, the global community has committed itself to halving by 2015 the proportion of the world's population that lives in poverty and suffers from hunger. While the goals of reducing poverty and hunger may seem intertwined, a review of the existing literature suggests this may not be the case. This paper contributes to this debate, using an analysis based on the impact of Mexico's Programa de Educación, Salud y Alimentación (PROGRESA).
Prevalence of anemia among pregnant women
Prevalence of anemia among adolescent girls
Nutritional anemia is one of India's major public health problems. The prevalence of anemia ranges from 33% to 89% among pregnant women and is more than 60% among adolescent girls. Under the anemia prevention and control program of the Government of India, iron and folic acid tablets are distributed to pregnant women, but no such program exists for adolescent girls. To assess the status of anemia among pregnant women and adolescent girls from 16 districts of 11 states of India. A two-stage random sampling method was used to select 30 clusters on the basis of probability proportional to size. Anemia was diagnosed by estimating the hemoglobin concentration in the blood with the use of the indirect cyanmethemoglobin method. The survey data showed that 84.9% of pregnant women (n = 6,923) were anemic (hemoglobin < 110 g/L); 13.1% had severe anemia (hemoglobin < 70 g/L), and 60.1% had moderate anemia (hemoglobin > or = 70 to 100 g/L). Among adolescent girls (n = 4,337)from 16 districts, the overall prevalence of anemia (defined as hemoglobin < 120 g/L) was 90.1%, with 7.1% having severe anemia (hemoglobin < 70 g/L). Any intervention strategy for this population must address not only the problem of iron deficiency, but also deficiencies of other micronutrients, such as B12 and folic acid and other possible causal factors.
The objective of this review is to examine the degree of variation that exists in the achieved height of preadolescent and adolescent children across populations experiencing favorable conditions that support linear growth. Fifty-three population groups were identified that reported mean heights for economically privileged populations from all major continents. Graphic representation of the heights for these populations indicates that the mean height of preadolescent children differs by 3 to 5 cm, whereas population means begin to diverge from the National Center for Health Statistics/World Health Organization (NCHS/WHO) reference at puberty, with most non-European populations falling to approximately 5 cm below the reference and northern European populations exceeding the reference by a similar amount. We conclude that the evidence for limited interpopulation variation in the height of preadolescents supports consideration of a single growth reference for children up to puberty, but the uncertainty of the causes of the divergence in achieved height during puberty requires further research in order to establish an appropriate adolescent growth reference.
Serum ferritin and zinc protoporphyrin concentrations within groups defined by binary CRP levels (n = 218) 
The Chilean Ministry of Health has combated iron deficiency through the delivery of fortified milk by the National Complementary Feeding Program (NCFP). To assess iron status and associations between biomarkers of iron status and serum C-reactive protein (CRP) in 218 beneficiaries of the NCFP aged 19 to 72 months in Santiago and Valparaiso, Chile. Blood was collected from a cross-sectional representative sample. Iron status (measured by hemoglobin, zinc protoporphyrin, and serum ferritin levels) and inflammation (according to CRP level) were determined. Serum CRP level was positively associated with serum ferritin and zinc protoporphyrin levels (r = 0.16 and r = 0.15; p = .0168 and p = .0290, respectively). Serum ferritin was higher among children with high CRP (> 10 mg/dL) than among those with low CRP (< or = 10 mg/dL) (p = .003). After adjustment for 10, 6, and 5 mg/L CRP, the prevalence of low serum ferritin changed from 56.4% without adjustment to 60.6%, 61.5%, and 42.7%, respectively, and the prevalence of high zinc protoporphyrin changed from 22.9% to 21.6%, 17.4%, and 17.9%, respectively. There were no differences between regions in biomarkers of iron status. There was no association between consumption of fortified milk and the prevalence of abnormal serum ferritin (< 15 microg/L) after adjustment for sex, age, and breastfeeding (OR, 1.00; 95% CI, 0.99 to 1.01; p = .288). After adjustment for 10 mg/L CRP, 5.5% were classified as having iron-deficiency anemia, 42.7% as having iron-deficiency erythropoiesis, 17.9% as having depleted iron stores, and 35.8% as having normal iron status. CONCLUSIONS. CRP level was positively associated with: serum ferritin and zinc protoporphyrin levels. Chilean children aged 19 to 72 months from Santiago and Valparaiso who were beneficiaries of the NCFP had a low prevalence of iron-deficiency anemia, a high prevalence of iron-deficiency erythropoiesis, and a moderate prevalence of depleted iron stores.
Trends in anemia prevalence among children aged 1.5 to 5 years in Chile 
In 1974/75, the prevalence of anemia in Chilean preschoolers was 18.8%. Since 2000, the Chilean Ministry of Health has combated anemia through the delivery of iron-fortified milk by the National Complementary Feeding Program (NCFP). To determine the prevalence of anemia in children aged 19 to 72 months who are beneficiaries of the NCFP. A cross-sectional representative sample of 224 beneficiaries of the NCFP aged 19 to 72 months from the Santiago and Valparaiso regions was recruited. The mean (+/- SD) hemoglobin concentration was 12.3 +/- 1.0 g/dL. Four percent of all children studied were anemic. In simple linear regression analysis, it was observed that hemoglobin concentration was positively correlated with age (r = 0.23, p = .001). There was no association between hemoglobin concentration and duration of breastfeeding (r = -0.12, p = .175). The prevalence of anemia among the 69% of children consuming iron-fortified milk delivered by NCFP was 2.6%, as compared with 7.1% among children not consuming iron-fortified milk (p = 0.227). Consumption of iron-fortified milk did not show a positive significant relationship with hemoglobin concentration (r = 0.063, p = .529). Similarly, multiple logistic regression did not show an association between consumption of fortified milk and anemia, after adjusting for sex, age, and breastfeeding (p = .150; OR = 0.98; 95% CI, 0.95 to 0.10). In 2009 anemia was not a public health problem in Chilean children aged 19 to 72 months from Santiago and Valparaiso.
We discuss food-consumption patterns in Central West Africa from 1961 to 2000 and some implications for combating malnutrition. The availability of food in the region improved in the 1960s, declined sharply in the 1970s and the early 1980s, and has shown a modest positive trend since the mid-1980s. Notwithstanding obvious progress over the past decades and in the region as a whole, food availability today remains below the required levels for large parts of the population and appears unstable over time, particularly in the Sahelian zone. On average, diets in this zone contain fewer than 2,200 kcal, compared with almost 2,500 kcal in the coastal zone. Conversely, protein deficiency is more common in the coastal zone, where a typical diet contains only 45 g of protein, compared with 60 g in the Sahelian zone. Furthermore, consumption is showing a dietary shift toward cereals, while yield growth lags far behind population growth. The associated import dependency and pressure on land seem to gain significance regardless of the region's agro-ecological capacity to increase and to substitute cereal imports for locally produced food. Moreover, food consumption appears responsive to income changes (calorie-income elasticity ranges from 0.25 to 0.62), while, in turn, it has a significant impact on nutritional outcomes (stunting-calorie elasticity of -1.42). We conclude that combating malnutrition requires first broad-spectrum income growth, and next specific policies that promote the yield and the contribution to diets of nutritious food produced within the region.
In this note, we calculate and describe proxy measures that account for variation in standard of living across subjects in the Institute of Nutrition of Central America and Panama (INCAP) Longitudinal Study (1969-77), at the time of the original intervention. Using principal components analysis, we construct two linear indices from an array of household consumer durable goods and housing characteristics, measured at the nuclear family level in the 1975 cross-sectional census. The two indices perform well on three dimensions. First, they are internally coherent in that average ownership and quality of housing characteristics increase with the principal component score. Second, they are robust in that the different approaches yield similar results, for example, in classifying nuclear families into tertiles. And third, they are consistent in that they yield results similar to scores constructed by previous researchers. The indices can be used as background controls in analyses of the INCAP Longitudinal Study (1969-77) data and subsequent follow-up studies, including the Human Capital Study 2002-04. Several articles presented in this supplement to the Food and Nutrition Bulletin used the 1975 index.
This paper examines how nutrition has been used to raise humanitarian relief resources through the United Nations appeals process, from 1992 to early 2009. Recent calls for "nutrition safety nets" as a response to the world food price crisis reflect a growing recognition of nutrition as a key element in crisis management, not simply as a metric of how bad things have become. The evolution in thinking about the role of nutrition in emergency programming is reflected in changes in how nutrition has been conceptualized and presented in the consolidated appeals process. Based on a desk review, supported by key informant interviews, the paper highlights important changes that include an increasing distinction that separates nutrition from food, water, and health; the importance of synergies across sectors; increased emphasis on "essential packages" of inputs and services versus stand-alone activities; the importance of technical rigor in food and nutrition assessment and surveys; the need for technical competency and capacity in the design and management of nutrition interventions; and the importance of planning for long-term change even in delivering a short-term response. There has also been growing emphasis on specificity in objectives--a trend linked to demand for more accountability across the humanitarian system. Enhanced emergency preparedness will require further capacity building and improved systems for surveillance and data management. Without more systematic, targeted attention to pre-crisis malnutrition, the resources needed to tackle nutrition problems during emergencies will continue to grow.
In 1993, the State Council of China announced the policy to virtually eliminate iodine-deficiency disorders (IDD) by 2000 and adopted universal salt iodization (USI) as the national strategy. Biennial province-based monitoring from 1995 onward aimed at capturing the use and iodine content of household salt, along with urinary iodine concentrations among schoolchildren from the same households. This paper reports on the progress made in China toward the goal of virtually eliminating iodine-deficiency disorders on the basis of 85 population-representative surveys in China's provinces during 1995--99. The percentage of households using adequately iodized salt (iodine > or = 20 mg/kg) increased from 43.1 % in 1995, to 82.2% in 1997, to 89.0% in 1999. In 1999, at least 90% of the households in 15 (48%) of the 31 provinces used adequately iodized salt, and a median urinary iodine concentration of less than 100 microg/L in children was reported in only one province. Across provinces, the median urinary iodine concentrations in children were positively correlated in each survey year with the median household salt iodine contents (combined r(s) = 0.74, p < .001) and with the proportions of households using adequately iodized salt (combined r(s) = 0.81, p <.001). Also in each survey year, the percentage of children with urinary iodine concentrations of at least 300 microg/L was correlated (combined r(s) = 0.69, p < .001) with the proportion of households using salt with iodine content of at least 40 mg/kg. The median urinary iodine concentration in children had reached 300 microg/L or more in 13 provinces (42%) by 1999. In a little more than five years, then, China has achieved outstanding progress toward the goal of virtual elimination of IDD through USI. Policy recommendations include improvement of quality assurance by salt manufacturers, along with a modest reduction in the mandated salt iodization levels.
Since universal salt iodization (USI) was implemented in Shenzhen, China, in 1996, evaluation of the time trend of USI to indicate the control of iodine-deficiency disorders has not been performed. To assess the time trend of median urinary iodine and total goiter rates from 1997 to 2011. Probability-proportionate-to-size sampling was employed in the surveillance of iodine-deficiency disorders, for which schoolchildren aged 8 to 10 years were randomly selected from five districts of the city during each iodine-deficiency disorders survey. Urinary iodine content and thyroid size were measured by ammonium persulfate oxidation and B ultrasound, respectively. The coverage of iodized salt increased from 73.2% in 1997 to more than 90% in 2011. The median urinary iodine of children aged 8 to 10 years varied between 207.1 and 278.8 microg/L; these levels were above the urinary iodine level in 1995. The proportion of urine samples with iodine content above 300 microg/L was 45.6% in 1997 and decreased to 20.8% in 2011, indicating excessive consumption of iodine by the children. The goiter rate among children dropped from 10.8% in 1997 to 1.3% in 2011; both values were lower than the goiter rate in 1995, indicating that the spread of endemic goiter was under control. Preliminary elimination of iodine-deficiency disorders was achieved by USI in Shenzhen. Nevertheless, some problems still existed, such as over-iodization. To clarify the causes of excessive urinary iodine content, the various sources of iodine from the diet need to be investigated in the future.
Poor feeding practices in early childhood contribute to the burden of childhood malnutrition and morbidity. To estimate the key indicators of breastfeeding and complementary feeding and the determinants of selected feeding practices in Sri Lanka. The sample consisted of 1127 children aged 0 to 23 months from the Sri Lanka Demographic and Health Survey 2000. The key infant feeding indicators were estimated and selected indicators were examined against a set of individual-, household-, and community-level variables using univariate and multivariate analyses. Breastfeeding was initiated within the first hour after birth in 56.3% of infants, 99.7% had ever been breastfed, 85.0% were currently being breastfed, and 27.2% were being bottle-fed. Of infants under 6 months of age, 60.6% were fully breastfed, and of those aged 6 to 9 months, 93.4% received complementary foods. The likelihood of not initiating breastfeeding within the first hour after birth was higher for mothers who underwent cesarean delivery (OR = 3.23) and those who were not visited by a Public Health Midwife at home during pregnancy (OR = 1.81). The rate of full breastfeeding was significantly lower among mothers who did not receive postnatal home visits by a Public Health Midwife. Bottlefeeding rates were higher among infants whose mothers had ever been employed (OR = 1.86), lived in a metropolitan area (OR = 3.99), or lived in the South-Central Hill country (OR = 3.11) and were lower among infants of mothers with secondary education (OR = 0.27). Infants from the urban (OR = 8.06) and tea estate (OR = 12.63) sectors were less likely to receive timely complementary feeding than rural infants. Antenatal and postnatal contacts with Public Health Midwives were associated with improved breastfeeding practices. Breastfeeding promotion strategies should specifically focus on the estate and urban or metropolitan communities.
Overweight and obesity are among the most prevalent nutritional problems in developed and developing countries. In this descriptive study, we attempted to determine the prevalence of overweight and obesity in Iranian adolescent girls attending high school in Tabriz. A sample of 1,650 (final study group, 1,518) high-school girls aged 14 to 20 years was selected by stepwise random sampling from five districts of Tabriz. Overweight and obesity were defined according to body mass index (BMI) percentiles from the First National Health and Nutrition Examination Survey (NHANES I) and the International Obesity Task Force (IOTF) BMI cutoffs. According to the NHANES I criteria, 14.6% of the study subjects were overweight or obese. Overweight and obesity was seen in 11. 1% and 3.6% of the students, respectively. By the IOTF cutoffs, 14% of the subjects were overweight or obese. Overweight and obesity were seen in 10.1% and 3.9% of the students, respectively. Of the study subjects, 8% had a BMI below the 15th percentile of NHANES I, an indicator of underweight. The prevalence of overweight and obesity in Tabriz high-school girls is higher than in many, but not all, parts of Iran, but lower than in some neighboring countries such as Saudi Arabia. In this age group, in addition to overweight and obesity, underweight (BMI < or = 15th percentile) is also present.
A project for universal salt iodation with potassium iodate and wheat flour fortification with a vitamin-mineral premix was implemented in Azerbaijan, Kazakhstan, Kyrgyzstan, Mongolia, Tajikistan, and Uzbekistan between 2002 and 2007. To determine the potential effectiveness of the food fortification programs in improving the micronutrient status of selected families in a sentinel population in each country. An area was selected in each country in a sentinel population expected to have early access to iodated salt and fortified wheat flour. Within this area, an average of 40 families with a woman of reproductive age and two children between 2 and 15 years old were sampled at baseline. All the rounds of the study were carried out in women and children in the same households. Hemoglobin, serum ferritin, folic acid, and urinary iodine excretion were analyzed at baseline, one year, and three years later. In the third round in 2007 significant increases were observed in the average levels of blood hemoglobin, serum ferritin and folic acid, and urinary iodine. Corresponding decreases in the prevalence of anemia and increases in serum ferritin levels, folic acid, and iodine were found. Salt and wheat flour fortification resulted in a significant improvement in the micronutrient status of children and women living in sentinel households in the countries participating in the Asian Development Bank project. Sentinel studies were a cost-effective way of determining potential national effectiveness.
Iodine deficiency is a global public health problem, and estimates of the extent of the problem were last produced in 2003. To provide updated global estimates of the magnitude of iodine deficiency in 2007, to assess progress since 2003, and to provide information on gaps in the data available. Recently published, nationally representative data on urinary iodine (UI) in school-age children collected between 1997 and 2006 were used to update country estimates of iodine nutrition. These estimates, alongside the 2003 estimates for the remaining countries without new data, were used to generate updated global and regional estimates of iodine nutrition. The median UI was used to classify countries according to the public health significance of their iodine nutrition status. Progress was measured by comparing current prevalence figures with those from 2003. The data available for pregnant women by year of survey were also assessed. New UI data in school-age children were available for 41 countries, representing 45.4% of the world's school-age children. These data, along with previous country estimates for 89 countries, are the basis for the estimates and represent 91.1% of this population group. An estimated 31.5% of school-age children (266 million) have insufficient iodine intake. In the general population, 2 billion people have insufficient iodine intake. The number of countries where iodine deficiency is a public health problem is 47. Progress has been made: 12 countries have progressed to optimal iodine status, and the percentage ofschool-age children at risk of iodine deficiency has decreased by 5%. However, iodine intake is more than adequate, or even excessive, in 34 countries: an increase from 27 in 2003. There are insufficient data to estimate the global prevalence of iodine deficiency in pregnant women. Global progress in controlling iodine deficiency has been made since 2003, but efforts need to be accelerated in order to eliminate this debilitating health issue that affects almost one in three individuals globally. Surveillance systems need to be strengthened to monitor both low and excessive intakes of iodine.
Vitamin A deficiency is a public health problem in most developing countries. The technological challenges associated with the measurement of serum retinol have limited the epidemiologic assessment of vitamin A deficiency. The combination of retinol-binding protein (RBP) enzyme immunoassay and dried blood spots offers a rapid, inexpensive, and reliable tool for the population-level assessment of vitamin A deficiency in resource-poor settings. To report on the application of RBP enzyme immunoassay and dried blood spots to assess serum retinol concentrations as an indicator of vitamin A status in the Uganda Demographic and Health Survey 2006. A total of 5,642 capillary blood spot samples were collected by fingerprick onto filter paper cards from women (15-49 years) and children (6-59 months) in a representative probability sample of 9,864 households between May and October 2006. The cards were dried, packed individually with desiccant, and kept at 4 degrees C in a portable refrigerator in the field and at -20 degrees C in the laboratory. Prior to analysis, the RBP enzyme immunoassay was optimized with the use of matched serum and dried blood spots. The correlation between RBP values determined by matching serum and dried blood spots was excellent (r = 0.79, p < .00001). The prevalence of vitamin A deficiency in women (RBP < 1.24 micromol/L) and children (RBP < 0.825 micromol/L) was 19.4% and 20.4%, respectively. The combination of RBP enzyme immunoassay and dried blood spots is a simple, reliable, and cost-effective tool for the estimation of vitamin A deficiency in population-level surveys in resource-poor settings.
Means and 95% confidence intervals (CI) of the characteristics of children under 2 years of age who participated in the Brazilian National Survey on Demography and the Health of Women and Children (PNDS 2006) 
Vitamin A deficiency is prevalent among infants, primarily in undeveloped communities, compromising immune system competence and raising morbidity and mortality rates. Understanding the risk factors associated with vitamin A deficiency is essential to create informed health policies. To identify and quantify risk factors for vitamin A deficiency in a probabilistic sample of children under 2 years of age participating in a national survey in Brazil and to provide a comprehensive risk factor model to inform health strategies and policies. We analyzed data from a cross-sectional study of 1,436 children from the 2006 Brazilian National Survey on Demography and the Health of Women and Children. Vitamin A deficiency was defined as retinol levels below 0.70 μg/dL. The prevalence of vitamin A deficiency was estimated at 16.1% (95% CI, 12.7 to 20.2). The Poisson regression model identified three risk factors for vitamin A deficiency: urban residence (prevalence ratio [PR] = 1.47, p = .023), no consumption of animal meat within the past week (PR = 1.41, p = .031), and a mother older than 25 years (PR = 1.31, p = .048). Strategies to control infant vitamin A deficiency should include health promotion and nutrition education for families from all socioeconomic levels. Improvements in lifestyle quality, based on adequate food consumption by all infants, must be achieved by communities, especially in urban areas and for older mothers.
Members of the Infant and Young Child Nutrition (IYCN) Working Group of the Ten Year Strategy for the Reduction of Vitamin and Mineral Deficiencies and several guests and speakers participated in a workshop in Geneva on 10 October 2008. The workshop had two broad objectives. The first objective was to review the evidence base for maternal and IYCN actions and explore how to integrate action throughout the window of opportunity from the prenatal period through the first 2 years of life. The second objective was to discuss the development of the Maternal, Infant, and Young Child Nutrition (MIYCN) Network in relation to the IYCN Working Group's role and structure. The speakers identified a spectrum of efforts needed to improve maternal, infant, and young child nutrition. The group decided to continue discussion on initiating a structure for an MIYCN Network to enhance collaboration.
Map of the survey area and the most flood-affected districts 
The 2010 floods inundated one-fifth of Pakistan and affected more than 20 million people. To characterize the impact of the floods and subsequent humanitarian response on household economy and food security. A cross-sectional 80 x 20 cluster survey (n = 1,569 households) was conducted using probability proportional to size sampling in the four most flood-affected provinces 6 months after the floods. Analysis included both descriptive statistics and regression models, with receipt of food aid (in the first month), dietary quality, and household income at 6 months postflood as outcomes. Need for food aid was nearly ubiquitous (98.9%); however, only half of the study population ever received food aid. Displacement was not a significant predictor of food aid receipt (OR, 1.28; 95% CI, 0.83 to 1.98); however urban location (OR, 2.78; 95% CI, 2.00 to 3.86) and damage to the home (OR, 2.73; 95% CI, 1.34 to 5.60) were significantly associated. Some of the hardest-hit groups, including both farmers and day laborers, were significantly less likely to receive food aid (p < .05). Additionally, receipt of food aid was not necessarily associated with improved household economy or food security; although households in internally displaced people (IDP) camps were more likely to receive food aid (OR, 2.78; 95% CI, 2.00 to 3.86), they were less likely to report same or improved dietary quality (OR, 0.63; 95% CI, 0.46 to 0.88) or income status (OR, 0.55; 95% CI, 0.35 to 0.86). Food aid coverage following the 2010 floods was relatively low, and many of the most affected populations were less likely to receive aid, suggesting that targeting should be improved in future responses.
Micronutrient powders (MNP) reduce anemia and improve iron status in children aged 6 to 23 months. Little is known about home fortification interventions in low-income and middle-income countries. To describe highlights of the Global Assessment of Home Fortification Interventions 2011, new directions, and needed policy and programmatic guidance. A cross-sectional survey ofhomefortification interventions was conducted. Staff at UNICEF and regional focal points at Home Fortification Technical Advisory Group partner agencies sent questionnaires to representatives in 152 low-income and middle-income countries. Included interventions met the following criteria: they were for prevention and used MNP lipid-based nutrient supplements (LNS), or complementary food supplements (CFS); one recommended mode of use was mixing into food; they were implemented or planning to start within 12 months; and research interventions were directly linked to programs. This study identified 63 implemented interventions (36 countries) and 28 planned interventions (21 countries), including 34 implemented interventions (22 countries) and 25 planned interventions (20 countries) that used MNP These interventions were expected to reach 17.2 million people in 2011, including 14.1 million participants in MNP interventions. Among implemented interventions, 16% distributed nationally. Most interventions used integrated approaches targeting young children. Recently, there was increasing expansion of interventions in Africa. The main challenges identified were monitoring and evaluation, adherence, product funding, and procurement. Home fortification interventions, especially those that use MNP, are increasing and scaling up rapidly in regions with widespread problems of micronutrient deficiencies and stunting. Home fortification interventions contribute to global initiatives to reduce undernutrition.
Nutrients specified in normative documents for emergency-affected populations since 2000 
Population demographic profile used for calcula- tion of minimum mean population requirements 
Nutritional requirements have been previously calculated for emergency-affected populations and are widely used for planning and assessing the nutritional adequacy of humanitarian food assistance. The Sphere Project is an interagency collaboration that defines minimum standards and indicators for humanitarian responses, including food and nutrition. It last published population nutritional requirements in 2004, but a revision was required due to the release of new Reference Nutrient Intakes (RNIs) by the World Health Organization and Food and Agriculture Organization (WHO/FAO). To review and revise the list of specified nutrients and recalculate population requirements using RNIs published by WHO/FAO. Review of published normative documents, consultation with experts and participants in the Sphere revision process, construction of a reference demographic profile, and calculation of population nutrient requirements for use in designing emergency general rations. Twenty-one nutrients and energy were selected for inclusion, and a demographic profile was constructed to represent a typical beneficiary population. Compared with the previous version of the Sphere Handbook, population requirements for nine vitamins and minerals were found to have increased as a result of the new WHO/FAO RNIs. The calculated requirements were adopted and published as part of the Sphere 2011 Handbook. The incorporation of these requirements into planning, monitoring, and evaluation practices for food assistance will help to ensure that populations receive appropriate nutritional support during crises.
Micronutrient deficiencies continue to constitute a major burden of disease, particularly in Africa and South Asia. Programs to address micronutrient deficiencies have been increasing in number, type, and scale in recent years, creating an ever-growing need to understand their combined coverage levels, costs, and impacts so as to more effectively combat deficiencies, avoid putting individuals at risk for excess intakes, and ensure the efficient use of public health resources. To analyze combinations of the two current programs--sugar fortification and Child Health Week (CHW)--together with four prospective programs--vegetable oil fortification, wheat flour fortification, maize meal fortification, and biofortified vitamin A maize--to identify Zambia's optimal vitamin A portfolio. Combining program cost estimates and 30-year Zambian food demand projections, together with the Zambian 2005 Living Conditions Monitoring Survey, the annual costs, coverage, impact, and cost-effectiveness of 62 Zambian portfolios were modeled for the period from 2013 to 2042. Optimal portfolios are identified for each of five alternative criteria: average cost-effectiveness, incremental cost-effectiveness, coverage maximization, health impact maximization, and affordability. The most likely scenario is identified to be one that starts with the current portfolio and takes into account all five criteria. Starting with CHW and sugar fortification, it phases in vitamin A maize, oil, wheat flour, and maize meal (in that order) to eventually include all six individual interventions. Combining cost and Household Consumption and Expenditure Survey (HCES) data provides a powerful evidence-generating tool with which to understand how individual micronutrient programs interact and to quantify the tradeoffs involved in selecting alternative program portfolios.
Classification of complementary food supplements
Fortified blended food mixtures provided by organizations implementing supplementary feeding programs for children with moderate acute malnutrition
Other foods provided to moderately malnourished children 
Reducing child malnutrition requires nutritious food, breastfeeding, improved hygiene, health services, and (prenatal) care. Poverty and food insecurity seriously constrain the accessibility of nutritious diets that have high protein quality, adequate micronutrient content and bioavailability, macrominerals and essential fatty acids, low antinutrient content, and high nutrient density. Diets based largely on plant sources with few animal-source and fortified foods do not meet these requirements and need to be improved by processing (dehulling, germinating, fermenting), fortification, and adding animal-source foods, e.g., milk, or other specific nutrients. Options include using specially formulated foods (fortified blended foods, commercial infant cereals, or ready-to-use foods [RUFs; pastes, compressed bars, or biscuits]) or complementary food supplements (micronutrient powders or powdered complementary food supplements containing micronutrients, protein, amino acids, and/or enzymes or lipid-based nutrient supplements (120 to 250 kcal/day), typically containing milk powder, high-quality vegetable oil, peanut paste, sugar, and micronutrients. Most supplementary feeding programs for moderately malnourished children supply fortified blended foods, such as corn-soy blend, with oil and sugar, which have shortcomings, including too many antinutrients, no milk (important for growth), suboptimal micronutrient content, high bulk, and high viscosity. Thus, for feeding young or malnourished children, fortified blended foods need to be improved or replaced. Based on success with ready-to-use therapeutic foods (RUTFs) for treating severe acute malnutrition, modifying these recipes is also considered. Commodities for reducing child malnutrition should be chosen on the basis of nutritional needs, program circumstances, availability of commodities, and likelihood of impact. Data are urgently required to compare the impact of new or modified commodities with that of current fortified blended foods and of RUTF developed for treating severe acute malnutrition.
The benefits of food fortification depend on the proportion of the population that uses the fortified food (coverage), the amount of the food being consumed, and the additional content of micronutrients in the food. Coverage and amounts consumed can be determined by 24-hour recall or Food Frequency Questionnaires (FFQs). However, these methods are rarely applied. Secondary analysis of data from Household Consumption and Expenditures Surveys (HCES) can be used for these purposes; however, such data analysis has not been validated. To compare the results of HCES and 24-hour recall for estimating the consumption profile of potential fortification vehicles in Uganda. Food intake estimates for 24- to 59-month-old children and 15- to 49-year-old women derived from a one-day 24-hour recall carried out in Uganda (Kampala, North, and Southwest) were compared with data from two HCES (2006, nationwide, and 2008, coupled with the 24-hour recall). The analyzed foods were vegetable oil, sugar, wheat flour, maize flour, and rice. Food consumption estimates calculated from HCES may be less accurate than estimates derived by 24-hour recall. Nevertheless, the HCES results are sensitive enough to differentiate consumption patterns among population strata. In Uganda, HCES predicted proportion of the population that consumes the foods, and approximated intakes of main food vehicles by the "observed" consumers (those who reported using the foods), although estimates for the latter were lower for wheat flour and rice. HCES data offer the basic information needed to provide a rationale for, and help design, food fortification programs. Individual intake surveys are still needed, however, to assess intrahousehold use of foods.
Action is needed to reduce the burden of micronutrient malnutrition in developing countries, and because low-income populations are vulnerable to deficiencies of multiple micronutrients, we need to move beyond approaches that comprise only single nutrients. The normal and evolutionary manner in which to consume nutrients is in the context of foods, both snacks and meals. Spreads are high-viscosity-fat products prepared by mixing dried powdered ingredients with a vegetable fat chosen for its viscosity. Spreads are not traditionally used for feeding infants or young children and were initially proposed as a way to treat children recovering from severe malnutrition. In preparation for the International Research Group on Infant Supplementation (IRIS) III intervention, a sequel to the IRIS I study (which was the focus of a workshop in Lima, Peru, from May 30-June 1, 2001), the feasibility of preparing a FOODlet for feeding infants and young children was explored. Within the spectrum of intervention tools for micronutrient supplementation, tablets are a pharmaceutical form, fortified spreads are a food, and sprinkles are an intermediate approach. The issues still to be discussed and resolved with regard to creating such a spread include its specific micronutrient formulation, the capacity of young children to consume the required amounts (from either the FOODlet alone or the FOODlet mixed with other foods), the iron content and overall antioxidant protection of the spread matrix and its vitamins, potential allergenicity of proteins, and the economic implications of using such a FOODlet in low-income societies.
Composition of complementary food supplements and corn-soy blend Nutrient Nutributter a (per 20 g) Foodlets (per one dose) b Sprinkles (per one dose) c CSB d (per 100 g) 
Foods included for each region, 90% of maximum amount consumed in grams in each region (90% max.), and costs used in linear programming runs 
Cost comparisons of diets including Nutributter, Sprinkles, Foodlets or corn-soy blend (US$) 
The age range from 6 to 24 months is a critical period when malnutrition and infection are particularly common in developing countries. For breastfed children a set of recommendations in the form of 10 Guiding Principles was recently issued regarding complementary feeding within this age range. Many of these Guiding Principles can also be applied to nonbreastfed children (Nos. 3 4 6 and 10). Others however need to be revised for nonbreastfed infants. This document will cover appropriate feeding of nonbreastfed children from 6 to 24 months of age with a focus on developing-country populations. The Guiding Principles that will be addressed include No. 5 (amount of food needed) No. 7 (meal frequency and energy density) No. 8 (nutrient content of foods) and No. 9 (use of vitamin-mineral supplements or fortified products). To address Nos. 8 and 9 linear programming (LP) techniques were used to develop diets that can meet nutrient requirements within this age range. (excerpt)
Key characteristics of the 24-hour recall surveys reviewed 
Cost of conducting a 24-hour recall survey on a "typical" Household Consumption and Expenditures Survey (HCES) sample of 8,500 househods (assuming a one-round, 24-hour recall survey) 
Parameters for calculating the quantity of each survey input for conducting a two-round, 24-hour recall survey of 480 households (with no blood or food analyses) 
The technical and resource demands of the most precise dietary assessment methods, 24-hour recall and observed-weighed food records, have proven impractical for most low- and middle-income countries, leaving nutrition policymakers with a woefully inadequate evidence base and compromising nutrition program effectiveness. To better understand the relative costs of informing food and nutrition policy-making using two different data sources: 24-hour recall survey data and Household Consumption and Expenditures Survey (HCES) data. A comparative analysis of the costs of designing, implementing, and analyzing a 24-hour recall survey and the cost of secondary analysis of HCES data. The cost of conducting a 24-hour recall survey with a sample of the size typical of HCES would be roughly 75 times higher than the cost of analyzing the HCES data. Although the 24-hour recall method is undoubtedly more precise, it has become self-evident that the practical choice for most countries is not between these two surveys, but between having data from less precise, but much more readily available and affordable HCES or having no nationally representative data. In the light of growing concerns about inappropriate fortification policies developed without data, there is an urgent need to begin working to strengthen HCES to provide more precise food and nutrition data. The best way forward is not likely to rest with one data source or another, but with the development of an eclectic approach that exploits the strengths and weaknesses of alternative surveys and uses them to complement one another.
Sample sizes of the 2008 Uganda 24-hour recall survey (24HR) and the 2006 Uganda Household Consumption and Expenditures Survey (HCES) by target group and region 
Energy intake among women of reproductive age and children 24-59 months of age by region and data source 
Individual dietary intake data are important for informing national nutrition policy but are rarely available. National Household Consumption and Expenditures Surveys (HCES) may be an alternative method, but there is no evidence to assess their relative performance. To compare HCES-based estimates of the nutrient density of foods consumed by Ugandan women (15 to 49 years of age) and children (24 to 59 months of age) with estimates based on 24-hour recall. The 52 food items of the Uganda 2006 HCES were matched with nutrient content of foods in a 2008 24-hour recall survey, which were used to refine the HCES-based estimates of nutrient intakes. Two methods were used to match the surveys'food items. Model 1 identified the four or five most commonly consumed foods from the 24-hour recall survey and calculated their unweighted average nutrient contents. Model 2 used the nutrient contents of the single most consumed food from the 24-hour recall. For each model, 14 estimates of nutrient densities of the diet were made and 84 differences were compared. Models 1 and 2 were not significantly different. Of the model 2 HCES-24-hour recall comparisons, 67 (80%) did not find a significant difference. No significant differences were found for protein, fat, fiber, iron, thiamin, riboflavin, and vitamin B6 intakes. HCES overestimated intakes of vitamins C and B12 and underestimated intakes of vitamin A,folate, niacin, calcium, and zinc in at least one of the groups. The HCES-based estimates are a relatively good proxy for 24-hour recall measures of nutrient density of the diet. Further work is needed to ascertain nutrient adequacy using this method in several countries.
The 1997 Demographic and Health Survey in Mozambique shows that 47% of girls 15 to 19 years old living in Manica province (west-central Mozambique) are pregnant or have already had a child. A recent survey also shows that 45% of girls 10 to 18 years old attending school are anemic. Strategies are needed to build iron stores before pregnancy and to control seasonal and chronic iron deficiency and anemia in school-aged girls. To assess the program effectiveness of two school-based weekly iron and folic acid (IFA) supplementation regimes (5-month supplementation vs. 8-month supplementation) in girls 10 to 18 years old attending school in Manica province. Twelve schools were included in the study. Schools were ordered by descending mean hemoglobin concentration, and assigned alternately to study group 5 (six schools; 5-month supplementation) or study group 8 (six schools; 8-month supplementation). In both study groups, the weekly supplement contained 60 mg of elemental iron and 400 microg of folic acid. All girls received a single dose of mebendazol (500 mg) twice--once at the beginning of the study (T0) and once six months later (T6). Supplementation was implemented and supervised by the teachers of the schools included in the study. Between T0 and T3, girls in study group 8 received IFA supplements weekly whereas girls in study group 5 did not. Between T3 and T8, all girls in both groups received weekly IFA supplements. At T0, mean hemoglobin concentration and anemia prevalence were comparable in study groups 8 and 5 (125.3 +/- 12.6 g/L vs. 123.8 +/- 12.8 g/L; 28% vs. 29%, respectively). At T3, the mean hemoglobin concentration in study group 8 was significantly higher (126.3 +/- 14.3 g/L vs. 121.5 g/dL +/- 11.9 g/L, p < .001) and the prevalence of anemia was lower (28% vs. 35%, p = .076) than in study group 5. At T8, after an additional 5-month supplementation period in both study groups, mean hemoglobin concentration and anemia prevalence in study groups 8 and 5 were not significantly different (126.5 +/- 12.6 g/L vs. 124.9 +/- 12.3 g/L; 23% vs. 27%, respectively). In Manica Province, school-based weekly IFA supplementation is a feasible and effective intervention to prevent seasonal drops in hemoglobin concentration and increases in anemia prevalence. Short supplementation periods can have an important impact on girls' hematological status. However, the size of girls' hematological response in this study was significantly lower that that observed in studies with similar population groups, initial anemia prevalence, supplement dosing, and/or supplementation regime.
Selected tests of physical fitness 
Commonly used methods for the assessment of pattern and/or level of physical activity (PA) and energy expendi- ture (EE)
Selected surveys of physical activity.
Recent estimates of physical activity and inactivity in several countries: Global School-Based Student Health Survey, children 13-15 years of age [22]
Concepts related to energy expenditure, physical activity and physical fitness, and methods of assessment are briefly considered. Variation in energy expenditure, physical activity, and physical fitness associated with age and sex during childhood and adolescence and relationships between physical activity and physical fitness in children and adolescents are reviewed. Implications of undernutrition and obesity for physical activity and physical fitness, and secular changes in physical activity and physical fitness, are briefly highlighted. The review concludes with specific recommendations for and limitations of inclusion of indicators of physical activity and fitness in the construction of an International Growth Standard for Preadolescent and Adolescent Children.
Characteristics of the women (N = 100) 
Mean nutrient intakes presented as percentages of US Dietary Reference Intakes (US DRIs) for young women (N = 100). Error bars indicate SDs. Broken line represents 100% of the US DRI. Absolute mean intakes appear to the right of the bars 
Anemia and iron deficiency are significant public health problems in India, particularly among women and children. Recent figures suggest that nearly 50% of young Indian women are anemic. Few studies have comprehensively assessed etiologic factors contributing to anemia and iron deficiency in India. Hence, this study assessed the relative importance of various factors contributing to these problems in young women of low socioeconomic status in Bangalore, India. A random sample of 100 nonpregnant, nonlactating women 18 to 35 years of age, selected from among 511 women living in a poor urban settlement, participated in this study. Data were obtained on demography, socioeconomic status, anthropometry, three-day dietary intake, blood hemoglobin, hemoglobinopathies, serum ferritin, serum C-reactive protein, and stool parasites. The prevalence rates of anemia and iron deficiency were 39% and 62%, respectively; 95% of the anemic women were iron deficient. The mean dietary iron intake was 9.5 mg per day, predominantly from the consumption of cereals, pulses, and vegetables (77%). The estimated bioavailability of nonheme iron in this diet was 2.8%. Dietary intakes were suboptimal for several nutrients. Blood hemoglobin was significantly correlated with dietary intake of fat, riboflavin, milk and yogurt, and coffee. Serum ferritin was significantly correlated with intake of niacin, vitamin B12, and selenium. Parasitic infestation was low. An inadequate intake of dietary iron, its poor bioavailability, and concurrent inadequate intake of dietary micronutrients appear to be the primary factors responsible for the high prevalence of anemia and iron deficiency in this population.
Mean ± SD height, weight, anthropometric indices, and cardiovascular risk factors in different age groups 
It is unknown whether the waist circumference (WC) or the waist-to-hip ratio (WHR) is a better predictor of cardiovascular risk factors at different ages. To compare WC and WHR as predictors of cardiovascular risk factors and to determine the prevalence of some cardiovascular risk factors in overweight and obese adult women at different ages. In this clinical cross-sectional study, 714 overweight and obese women aged 20 to 70 years who were referred to two nutrition clinics in Sistan and Baluchestan province, Islamic Republic of Iran, were studied. The subjects were classified into three groups, 20 to < 35, 35 to < 50, and > or = 50 years of age. Anthropometric indices were measured according to the standard protocol. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and TC/HDL-C ratios were enzymatically determined. Older subjects (> or = 50 years old) had significantly higher values of body mass index (BMI), WC, TC, TG, and LDL-C than those in the two younger age classes. The prevalence rates of obesity, high WC, high WHR, high TC, high TG, high LDL-C, and high TC/ HDL-C ratios were higher in the older subjects. After adjustment for age and BMI, multiple linear regression showed that WC was significantly related to TC and TG in the 20- to < 35-year-old group and to TG in the 35- to < 50-year-old group. In the older participants, WHR was significantly related to TG. The prevalence of cardiovascular risk factors increases with age. In clinical practice, WC is a better index for predicting some cardiovascular risk factors in younger and middle-aged women; however, for older women, WHR is better.
Breastfeeding indicators among children 0 to 35 months of age, Bangladesh 2004
Univariate and multivariate analyses of the risks of not receiving timely initiation of breastfeeding and not being given timely complementary foods, Bangladesh 2004
Background: Childhood undernutrition and mortality are high in Nepal, and therefore interventions on infant and young child feeding practices deserve high priority. Objective: To estimate infant and young child feeding indicators and the determinants of selected feeding practices. Methods: The sample consisted of 1906 children aged O to 23 months from the Demographic and Health Survey 2006. Selected indicators were examined against a set of variables using univariate and multivariate analyses. Results: Breastfeeding was initiated within the first hour after birth in 35.4% of children, 99.5% were ever breastfed, 98.1% were currently breastfed, and 3.5% were bottle-fed. The rate of exclusive breastfeeding among infants under 6 months of age was 53.1%, and the rate of timely complementary feeding among those 6 to 9 months of age was 74.7%. Mothers who made antenatal clinic visits were at a higher risk for no exclusive breastfeeding than those who made no visits. Mothers who lived in the mountains were more likely to initiate breastfeeding within 1 hour after birth and to introduce complementary feeding at 6 to 9 months of age, but less likely to exclusively breastfeed. Cesarean deliveries were associated with delay in timely initiation of breastfeeding. Higher rates of complementary feeding at 6 to 9 months were also associated with mothers with better education and those above 35 years of age. Risk factors for bottle-feeding included living in urban areas and births attended by trained health personnel. Conclusions: Most breastfeeding indicators in Nepal are below the expected levels to achieve a substantial reduction in child mortality. Breastfeeding promotion strategies should specifically target mothers who have more contact with the health care delivery system, while programs targeting the entire community should be continued.
Top-cited authors
Judith Kimiywe
  • Kenyatta University
Rajwinder Harika
Afework Mulugeta
  • Mekelle University
Mieke Faber
  • South African Medical Research Council
Ans Eilander
  • Unilever