Ana M Palacios’s research while affiliated with University of Texas at Austin and other places

The main objective of this study was to evaluate the impact of a community‐based nutrition intervention using a fortified corn and soy premix on the reduction of anemia and improvement in hemoglobin concentrations in 6 to 76 month old children that live in Santa Cruz Muluá, a rural community in Retalhuleu, Guatemala. The children were provided a daily serving of an atole, Chispuditos®, fortified with 21 vitamins and minerals containing 12 mg iron via iron glycinate, 0.5 mg pyridoxine, 160 mg folic acid, 0.9 mcg vitamin B12, and 40 mg vitamin C. Children were screened and invited to participate in the nutrition program if they had height‐for‐age Z score (HAZ) <‐1SD and if parents agreed to participate and signed an informed consent. A total of 588 children were identified and received a daily portion of 18.75g of dry product that was mixed with either milk or water and consumed as a beverage. Hemoglobin concentrations were determined prior to and after 6 months of receiving the nutritional intervention. At baseline, close to half of the children suffered from anemia (43.3%), and after 6 months the prevalence of anemia decreased to 36.7%, p<0.001. Furthermore, mean hemoglobin concentrations significantly improved from 10.8 g/dL to 11.4g/dL, p<0.001. A mild but non‐significant improvement was observed in mean HAZ (−2.38 to −2.31SD, p=0.293) and mean weight‐for‐height Z scores (−0.10 to −0.07, p=0.680). Chispuditos, a well‐accepted and culturally appropriate method of providing micronutrients to children at risk of developing micronutrient deficiencies in this community in Retalhuleu, Guatemala, has proven effective in reducing anemia and improving hemoglobin concentrations in this population within 6 months. Support or Funding Information This project is sponsored by The Mathile Institute for the Advancement of Human Nutrition

A corn and soy atole fortified with 21 vitamins and minerals, including higher levels of iron and zinc than other locally available options, has been provided to children from 6–84 months of age attending 6 Sociedad Protectora del Niño day care centers in Guatemala since August of 2013. Trained staff prepared and fed the children one serving consisting of 18.75g (~one tablespoon) of dry product mixed with 8 oz of water, brought to a boil and served as a warm beverage 5 days per week throughout the year. The objectives of this study were to assess the changes in mean height for age Z‐scores (HAZ) and hemoglobin (Hb) after 21 months of intervention, and to quantify the amount of atole consumed by the children on two different non‐consecutive days. Children were followed‐up for anthropometry and Hb every 6 months. To evaluate the amount of atole that children consumed, a waste study was performed in 3 randomly selected nurseries, on two non‐consecutive days, using graduated cylinders and food scales to measure the amount of atole prepared and not consumed. Multivariate mixed model analyses were performed to evaluate changes over time in Z‐scores and Hb. Mean Hb improved on average of 0.5g/dL throughout the intervention (t=11.43, df=1761.15, p<0.001). Mean HAZ improved significantly in those children with HAZ<‐2 SD at baseline, showing an average monthly increase of ~0.03 SD, (t=6.15, df=1324, p<0.001) over the course of the intervention. The waste study indicated that children consumed 98.5% of the served beverage/day. This micronutrient intervention is effective in improving Hb concentrations and a significant effect in the improvement in HAZ among stunted children was also noted. The product is highly acceptable to children, making this fortified atole a good alternative to address chronic undernutrition in similar institutions in Guatemala and other Central American countries where atole consumption is a common habit and practice. Support or Funding Information This program was sponsored by The Mathile Institute for the Advancement of Human Nutrition

Many country complementary feeding guidelines do not promote introduction to animal source foods such as eggs and dairy until a child is at least 12 months. To our knowledge, there is no evidence that supports that restricting diets after 4 to 6 months of age will prevent allergies (Halken, 2001) and allergic sensitization to food and inhalant allergens are associated with late introduction of some solid foods (Paton, 2012, Nwaru 2010). The objective of this study is to assess whether reported egg or dairy consumption at 6 to 9 months of age was associated with allergy‐like symptoms and/or allergic reactions in the rural province of Cotopaxi, Ecuador. Primary caretakers of recruited participants were asked whether infants had any known food allergies prior to enrollment. Data were collected in a survey as part of a randomized controlled trial that evaluated the efficacy of daily egg consumption on the nutrient status of 169 infants 6 to 9 months of age. A multivariate logistic regression analysis was used to ascertain whether any of the following symptoms: skin rash, fever, nasal discharge, cough, and difficulty breathing/wheezing/panting, could be predicted by consumption of egg, cow's milk and other dairy products after controlling for sex, parental unemployment and undernutrition (SD<‐2 for either LAZ, WAZ or WHZ). We examined all available socio‐economic, demographic, environmental and nutrition factors in the models. A total 169 infants were recruited; 66 reported to have consumed eggs, 80 yogurt, 27 milk, and 53 other dairy products in the previous 24 hours. There were no reported allergies to milk, eggs or food products during screening or enrollment to the study, and no observed allergic reactions to eggs or dairy were identified during the trial. No significant associations were found between milk, dairy or egg consumption reported in the previous 24 hours with the following symptoms: rash, cough, and fever also reported in the previous 24 hours. After controlling for sex, parental unemployment and undernutrition, we observed that children who reported egg consumption were less likely to report difficulty breathing/wheezing/panting in the previous 24 hours, OR: 0.27 (0.09–0.86), p=0.035. Similarly, and after controlling for sex, undernutrition and parental unemployment, those children who reported yogurt consumption were less likely to report nasal discharge, OR:0.36 (0.18–0.74), p=0.034. We found no evidence to suggest allergic reactions to eggs, milk or dairy products in these infants. Furthermore, reported consumption of eggs and yogurt were associated with a lower prevalence of respiratory tract symptoms suggesting a protective effect in children from these ages in this cross‐sectional analysis. Further research is warranted to investigate whether introduction to eggs and dairy products at or after 6 months of age could influence respiratory tract symptoms in infants. Support or Funding Information Research sponsored by The Mathile Institute for the Advancement of Human Nutrition.

Since 2010, six Guatemala City Municipal Nurseries were provided a 21 micronutrient fortified corn and soy beverage that contains chelated forms of zinc (9mg) and iron (12mg) to address micronutrient deficiencies among children ages 6 to 84 months that attend the daycare centers for 5 days/week. The main objective of this study was to carry out a four‐year longitudinal analysis of the nutritional status of stunted children that have attended the nurseries. A total of 491 children with stunting (height‐for‐age Z scores (HAZ) <‐2SD) at enrollment were identified. Height and weight measurements were collected at the beginning and before the end of every school year. Hemoglobin (Hb) was assessed in a subsample of individuals at the beginning and before the end of the school year for the first year, and in subsequent years only at the end of the school year; concentrations were adjusted for an elevation of 1500m. A multivariate mixed model analysis was performed to evaluate the relationship between time of intervention and HAZ, and Hb concentrations. To assess prevalence of stunting and anemia across time, a multivariate generalized linear mixed model was performed. We observed that mean HAZ score (baseline HAZ=−2.54SD) improved over time by 0.02 SD per month (F=609.56, df=1, 1159.16 p<0.001) after controlling for sex; and on average, the odds of having stunting decreased by ~11% for every month the child received the nutrition intervention, OR=0.89 95% CI (0.88–0.91), p<0.001, controlling for sex. For those stunted children with anemia at baseline, the odds of having anemia decreased on average by 11% for every month of receiving the nutritional intervention, OR: 0.89, 95% CI (0.85–0.93), p<0.001. We also observed a significant increase in mean Hb concentrations (F=81.59, df=1, 102.00, p<0.001) in anemic children at baseline (mean Hb=10.45g/dL) and the next measurement after ten months (12.30g/dL). The Hb concentrations were maintained within normal ranges (≥11.60g/dL) in all subsequent measurements. This analysis demonstrates that the nutrition program at the Guatemala City Municipal nurseries is effective in reducing the prevalence of stunting and anemia, and in improving mean HAZ and Hb concentrations in stunted children from 6 to 84 months of age. Support or Funding Information This research was sponsored in part by the Mathile Institute for the Advancement of Human Nutrition.