Iodine status of young Burkinabe children receiving small-quantity lipid-based nutrient supplements and iodised salt : a cluster-randomised trial

The objective of the present study was to assess the impact of providing small-quantity lipid-based nutrient supplements (SQ-LNS) on the I status of young Burkinabe children. In total, thirty-four communities were assigned to intervention (IC) or non-intervention cohorts (NIC). IC children were randomly assigned to receive 20 g lipid-based nutrient supplements (LNS)/d containing 90 mu g I with 0 or 10 mg Zn from 9 to 18 months of age, and NIC children received no SQ-LNS. All the children were exposed to iodised salt through the national salt iodization programme. Spot urinary iodine (UI), thyroid-stimulating hormone (TSH) and total thyroxine (T-4) in dried blood spots as well as plasma thyroglobulin (Tg) concentrations were assessed at 9 and 18 months of age among 123 IC and fifty-six NIC children. At baseline and at 18 months, UI, TSH and T-4 did not differ between cohorts. Tg concentration was higher in the NIC v. IC at baseline, but this difference did not persist at 18 months of age. In both cohorts combined, the geometric mean of UI was 339.2 (95 % CI 298.6, 385.2) mu g/l, TSH 0.8 (95 % CI 0.7, 0.8) mU/l, T-4 118 (95 % CI 114, 122) nmol/l and Tg 26.0 (95 % CI 24.3, 27.7) mu g/l at 18 months of age. None of the children had elevated TSH at 18 months of age. Marginally more children in NIC (8.9 %) had low T-4 (15 ppm). A reduction of SQ-LNS I content could be considered in settings with similarly successful salt iodisation programmes

Small-quantity lipid-based nutrient supplements containing different amounts of zinc along with diarrhea and malaria treatment increase iron and vitamin A status and reduce anemia prevalence, but do not affect zinc status in young Burkinabe children : a cluster-randomized trial

Background: We assessed the effects of providing a package of interventions including small-quantity lipid-based nutrient supplements (SQ-LNS) containing 0, 5 or 10 mg zinc and illness treatment to Burkinabe children from 9 to 18 months of age, on biomarkers of zinc, iron and vitamin A status at 18 months and compared with a non-intervention cohort (NIC). Methods: Using a two-stage cluster randomized trial design, communities were randomly assigned to the intervention cohort (IC) or NIC, and extended family compounds within the IC were randomly assigned to different treatment groups. IC children (n = 2435) were provided with 20 g SQ-LNS/d containing 0, 5 or 10 mg zinc, 6 mg of iron and 400 mu g of vitamin A along with malaria and diarrhea treatment. NIC children (n = 785) did not receive the intervention package. At 9 and 18 months, hemoglobin (Hb), zinc, iron and vitamin A status were assessed in a sub-group (n = 404). Plasma concentrations of zinc (pZC), ferritin (pF), soluble transferrin receptor (sTfR) and retinol-binding protein (RBP) were adjusted for inflammation. Results: At baseline, 35% of children had low adjusted pZC ( 8.3 mg/L) and 47% had low adjusted RBP (< 0.94 mu mol/L), with no group-wise differences. Compared with the NIC, at 18 months IC children had significantly lower anemia prevalence (74 vs. 92%, p = 0.001) and lower iron deficiency prevalence (13% vs. 32% low adjusted pF and 41% vs. 71% high adjusted sTfR, p < 0.001), but no difference in pZC. Mean adjusted RBP was greater at 18 months in IC vs. NIC (0.94 mu mol/L vs. 0.86 mu mol/L, p = 0.015), but the prevalence of low RBP remained high in both cohorts. Within the IC, different amounts of zinc had no effect on the prevalence of low pZC or indicators of vitamin A deficiency, whereas children who received SQ-LNS with 10 mg zinc had a significantly lower mean pF at 18 months compared to children who received SQ-LNS with 5 mg zinc (p = 0.034). Conclusions: SQ-LNS regardless of zinc amount and source provided along with illness treatment improved indicators of iron and vitamin A status, but not pZC

Influence of feeding Mediterranean food industry by-products and forages to Awassi sheep on physicochemical properties of milk, yoghurt and cheese

Feeding agro-industrial by-products and unconventional forages, rich in potentially anti-nutritional factors, may influence the quality of the raw milk and the dairy products prepared therefrom. The aim of the present study was to determine side-effects on physicochemical properties of milk, yoghurt and cheese of feeding diets where one third were feeds either rich in lipids (tomato pomace and olive cake) or phenols (olive leaves and lentil straw) or electrolytes (Atriplex leaves). The diets, including a control diet, were designed to be isoenergetic and isonitrogenous. They were fed in amounts of 2 5 kg dry matter/day per head during 50 days to 6×10 multiparous fat-tailed Awassi ewes. Milk samples were analysed for various physicochemical traits and fatty acid composition on days 0, 24, 36 and 48. Three times, milk pooled by group was processed to yoghurt and non-aged farmer-type cheese, which were analysed for their gross and fatty acid composition and texture, and were subjected to sensory evaluation. Feeding olive cake and tomato pomace reduced milk casein, but increased proportions of monounsaturated fatty acids. There were some variations in minerals among test diets but, contrary to expectations, Atriplex did not increase milk sodium. The nutritional composition of yoghurt and cheese was not varied much by the test feeds, except for some changes in fatty acid profile similar to the milk. Yoghurt firmness declined with all test diets, but texture score tended to be lower only for olive cake and leaf diets relative to control. Cheese firmness was increased by feeding the Atriplex leaf and olive cake diets which was also reflected in the texture scores. No off-flavours were reported. Possible reasons for effects on the dairy products are discussed. In conclusion, the feeds investigated had certain effects on the physicochemical properties of dairy products, but these were neither very systematic nor large thus not prohibiting their use in Mediterranean sheep milk production system

Small-quantity lipid-based nutrient supplements, regardless of their zinc content, increase growth and reduce the prevalence of stunting and wasting in young Burkinabe children : a cluster-randomized trial

Small-quantity lipid-based nutrient supplements (SQ-LNS) are promising home fortification products, but the optimal zinc level needed to improve growth and reduce morbidity is uncertain. We aimed to assess the impact of providing SQ-LNS with varied amounts of zinc, along with illness treatment, on zinc-related outcomes compared with standard care. In a placebo-controlled, cluster-randomized trial, 34 communities were stratified to intervention (IC) or nonintervention cohorts (NIC). 2435 eligible IC children were randomly assigned to one of four groups: 1) SQ-LNS without zinc, placebo tablet; 2) SQ-LNS containing 5mg zinc, placebo tablet; 3) SQ-LNS containing 10mg zinc, placebo tablet; or 4) SQ-LNS without zinc and 5mg zinc tablet from 9-18 months of age. During weekly morbidity surveillance, oral rehydration salts were provided for reported diarrhea and antimalarial therapy for confirmed malaria. Children in NIC (n = 785) did not receive SQ-LNS, tablets, illness surveillance or treatment. At 9 and 18 months, length, weight and hemoglobin were measured in all children. Reported adherence was 97 +/- 6% for SQ-LNS and tablets. Mean baseline hemoglobin was 89 +/- 15g/L. At 18 months, change in hemoglobin was greater in IC than NIC (+8 vs -1g/L, p<0.0001), but 79.1% of IC were still anemic (vs. 91.1% in NIC). Final plasma zinc concentration did not differ by group. During the 9-month observation period, the incidence of diarrhea was 1.10 +/- 1.03 and of malaria 0.54 +/- 0.50 episodes per 100 child-days, and did not differ by group. Length at 18 months was significantly greater in IC compared to NIC (77.7 +/- 3.0 vs. 76.9 +/- 3.4cm; p<0.001) and stunting prevalence was significantly lower in IC (29.3%) than NIC (39.3%; p<0.0001), but did not differ by intervention group within IC. Wasting prevalence was also significantly lower in IC (8.7%) than in NIC (13.5%; p = 0.0003). Providing SQ-LNS daily with or without zinc, along with malaria and diarrhea treatment, significantly increased growth and reduced stunting, wasting and anemia prevalence in young children

Mycotoxin exposure assessments in a multi-center European validation study by 24-hour dietary recall and biological fluid sampling

The European Food Consumption Validation (EFCOVAL) project includes 600 men and women from Belgium, the Czech Republic, France, the Netherlands, and Norway, who had given serum and 24-hour urine samples, and completed 24-hour dietary recall (24-HDR) interviews. Consumption, according to 24-HDR, was matched against the European Food Safety Authority (EFSA) databases of mycotoxin contaminations, via the FoodEx1 standard classifications, producing an indirect external estimate of dietary mycotoxin exposure. Direct, internal measurements of dietary mycotoxin exposure were made in serum and urine by ultra-performance liquid chromatography coupled to tandem mass spectrometry. For the first time, mycotoxin exposures were thoroughly compared between two 24-HDRs, and two 24-hour urine samples collected during the same days covered by the 24-HDRs. These measurements were compared to a single-time point serum measurement to investigate evidence of chronic mycotoxin exposure. According to 24-HDR data, all 600 individuals were exposed to between 4 and 34 mycotoxins, whereof 10 found to exceed the tolerable daily intake. Correlations were observed between two time points, and significant correlations were observed between concentrations in serum and urine. However, only acetyldeoxynivalenol, ochratoxin A, and sterigmatocystin were found to have significant positive correlations between 24-HDR exposures and serum, while aflatoxin G1 and G2, HT-2 toxin, and deoxynivalenol were associated between concurrent 24-HDR and 24-hour urine. Substantial agreements on quantitative levels between serum and urine were observed for the groups Type B Trichothecenes and Zearalenone. Further research is required to bridge the interpretation of external and internal exposure estimates of the individual on a time scale of hours. Additionally, metabolomic profiling of dietary mycotoxin exposures could help with a comprehensive assessment of single time-point exposures, but also with the identification of chronic exposure biomarkers. Such detailed characterization informs population exposure assessments, and aids in the interpretation of epidemiological health outcomes related to multi-mycotoxin exposure

Assessment of the performance of malaria rapid diagnostic test in acutely malnourished children under five years of age in Nanoro - Burkina Faso

The interaction of malaria with malnutrition is complex. In areas where malnutrition among children is prevalent, management of malaria is not standardized. In Burkina Faso, malaria treatment is prescribed after positive malaria rapid diagnostic test (RDT) or thick blood smears confirmation regardless of the nutritional status of the child. The study aims to assess the performance of malaria RDT in acute malnourished children under five years of age. A descriptive cross-sectional study was carried out from June 1st to August 31th 2014 in the health district of Nanoro in Burkina Faso. The study involved the children less than 5 years of age who were admitted for acute malnutrition and tested for malaria using RDT. The diagnostic values were then assessed for their agreement with the gold standard of the World Health Organization (thick blood smears) using Cohen-Kappa coefficient. In total, RDT and thick blood smear results were obtained from 131 children (aged 1-59 months). RDT was positive in 87 tested children (66.4%), while the thick smear indicated that only 47 were infected by malaria (35.9%) and Cohen kappa coefficient was 0.44. The sensitivity, specificity, positive predictive value and negative predictive value of RDT for malaria compared to microscopy were respectively 100% (95% CI: 92.5 - 100), 52.4% (95% CI: 51.1 - 52.9), 54% (95% CI: 43 - 64.8), 100% (95% CI: 92.5 - 100). Their timeliness was 8 min (± 3.47 min). Using malaria RDT in acutely malnourished children results in high number of false positive

Differing growth responses to nutritional supplements in neighboring health districts of Burkina Faso are likely due to benefits of small-quantity lipid-based nutrient supplements (LNS)

Background : Of two community-based trials among young children in neighboring health districts of Burkina Faso, one found that small-quantity lipid-based nutrient supplements (LNS) increased child growth compared with a non-intervention control group, but zinc supplementation did not in the second study. Objectives : We explored whether the disparate growth outcomes were associated with differences in intervention components, household demographic variables, and/or children's morbidity. Methods : Children in the LNS study received 20g LNS daily containing different amounts of zinc (LNS). Children in the zinc supplementation study received different zinc supplementation regimens (Z-Suppl). Children in both studies were visited weekly for morbidity surveillance. Free malaria and diarrhea treatment was provided by the field worker in the LNS study, and by a village-based community-health worker in the zinc study. Anthropometric assessments were repeated every 13-16 weeks. For the present analyses, study intervals of the two studies were matched by child age and month of enrollment. The changes in length-for-age z-score (LAZ) per interval were compared between LNS and Z-Suppl groups using mixed model ANOVA or ANCOVA. Covariates were added to the model in blocks, and adjusted differences between group means were estimated. Results : Mean ages at enrollment of LNS (n = 1716) and Z-Suppl (n = 1720) were 9.4 +/- 0.4 and 10.1 +/- 2.7 months, respectively. The age-adjusted change in mean LAZ per interval declined less with LNS (-0.07 +/- 0.44) versus Z-Suppl (-0.21 +/- 0.43; p<0.0001). There was a significant group by interval interaction with the greatest difference found in 9-12 month old children (p<0.0001). Adjusting for demographic characteristics and morbidity did not reduce the observed differences by type of intervention, even though the morbidity burden was greater in the LNS group. Conclusions : Greater average physical growth in children who received LNS could not be explained by known cross-trial differences in baseline characteristics or morbidity burden, implying that the observed difference in growth response was partly due to LNS

Effect of zinc added to a daily small-quantity lipid-based nutrient supplement on diarrhoea, malaria, fever and respiratory infections in young children in rural Burkina Faso : a cluster-randomised trial

Objective: Preventive zinc supplementation in the form of tablets or syrup reduces the incidence of diarrhoea and acute lower respiratory tract infections (RTI), but its effect on malaria is inconsistent. When zinc is administered with other micronutrients or foods, its effect is also uncertain. We assessed the effects of different amounts and sources of zinc on the frequency of diarrhoea, malaria, fever and RTI in young children. Design, setting and populations: This community-based, double-blind, placebo-controlled, cluster-randomised trial of 2435 children 9 months of age was carried out between April 2010 and July 2012 in rural southwestern Burkina Faso. Interventions: Participants were randomly assigned at the concession level to receive daily 1 of 4 interventions for 9 months: (1) 20 g small-quantity lipid-based nutrient supplement (SQ-LNS) without zinc and placebo tablet, (2) 20 g SQ-LNS with 5 mg zinc and placebo tablet, (3) 20 g SQ-LNS with 10 mg zinc and placebo tablet or (4) 20 g SQ-LNS without zinc and 5 mg zinc tablet. Participants were visited weekly in their homes for morbidity surveillance for 9 months, and those with uncomplicated diarrhoea and malaria received treatment from the study field workers in the community. Main outcomes: Incidence and longitudinal prevalence of diarrhoea, malaria, fever, and lower and upper RTI by intervention group. Results: The incidence of diarrhoea, malaria and fever was 1.10 (+/- 1.03 SD), 0.61 (+/- 0.66 SD) and 1.49 (+/- 1.12 SD) episodes per 100 child-days at risk, respectively, and did not differ by intervention group (p=0.589, p=0.856 and p=0.830, respectively). The longitudinal prevalence of acute lower RTI (0.1%; 95% IC 0.1-0.2%) and of upper RTI (7.8%; 95% IC 7.1-8.4%) did not differ among groups (p=0.234 and p=0.501, respectively). Conclusions: Inclusion of 5 or 10 mg zinc in SQ-LNS and provision of 5 mg zinc dispersible tablet along with SQ-LNS had no impact on the incidence of diarrhoea, malaria and fever or the longitudinal prevalence of RTI compared with SQ-LNS without zinc in this population