Effectiveness of the National Program of Complementary Feeding for older adults in Chile on vitamin B12 status in older adults; secondary outcome analysis from the CENEX Study (ISRCTN48153354).

BACKGROUND: Older people are at increased risk of vitamin B12 deficiency and the provision of fortified foods may be an effective way to ensure good vitamin B12 status in later life. AIM: To evaluate the effectiveness of a vitamin B12 fortified food provided by a national program of complementary food for older people on plasma vitamin B12 levels. SUBJECTS AND METHODS: A random sub-sample of 351 subjects aged 65-67 y from a large cluster randomised controlled trial provided blood samples at baseline and after 24 months of intervention. The intervention arm (10 clusters 186 participants) received a vitamin B12 fortified food designed to deliver 1.4 μg/day, while the control arm did not receive complementary food (10 clusters, 165 participants). Serum vitamin B12 and folate levels determined by radioimmunoassay were used to estimate the effect of intervention on vitamin B12 levels, adjusting for baseline levels and sex. RESULTS: Attrition at 24 months was 16.7% and 23.6% in the intervention and control arms respectively (p = 0.07). Over 24 months of intervention, mean (95% CI) serum vitamin B12 decreased from 392 (359-425) pmol/dL to 357 (300-414) pmol/dL (p < 0.07) in the intervention arm and from 395 (350-440) pmol/dL to 351 (308-395) pmol/dL in the control arm. There was no significant effect of the intervention on folate status. DISCUSSION: Our findings suggest that foods fortified with 1.4 μg/daily vitamin B12 as provided by Chile's national programme for older people are insufficient to ensure adequate vitamin B12 levels in this population. Chile has a long and successful experience with nutrition intervention programs; however, the country's changing demographic and nutritional profiles require a constant adjustment of the programs

Is there an association of vitamin B12 status with neurological function in older people? A systematic review.

Low vitamin B12 status is common in older people; however, its public health significance in terms of neurological manifestations remains unclear. The present systematic review evaluated the association of vitamin B12 status with neurological function and clinically relevant neurological outcomes in adults aged 50+ years. A systematic search of nine bibliographic databases (up to March 2013) identified twelve published articles describing two longitudinal and ten cross-sectional analyses. The included study populations ranged in size (n 28-2287) and mean/median age (range 65-81 years). Studies reported various neurological outcomes: nerve function; clinically measured signs and symptoms of nerve function; self-reported neurological symptoms. Studies were assessed for risk of bias, and results were synthesised qualitatively. Among the general population groups of older people, one longitudinal study reported no association, and four of seven cross-sectional studies reported limited evidence of an association of vitamin B12 status with some, but not all, neurological outcomes. Among groups with clinical and/or biochemical evidence of low vitamin B12 status, one longitudinal study reported an association of vitamin B12 status with some, but not all, neurological outcomes and three cross-sectional analyses reported no association. Overall, there is limited evidence from observational studies to suggest an association of vitamin B12 status with neurological function in older people. The heterogeneity and quality of the evidence base preclude more definitive conclusions, and further high-quality research is needed to better inform understanding of public health significance in terms of neurological function of vitamin B12 status in older people

Interventions in Agriculture for Nutrition Outcomes: A Systematic Review Focused on South Asia

Research on the potential impact of interventions in agriculture on nutrition outcomes is of particular relevance in South Asia where agriculture-related activities are a major source of livelihoods for large sections of society and where the population suffers from one of the highest global burdens of malnutrition in all its forms. This systematic review aims to assess the strength of the available evidence that agricultural interventions have an impact on intermediate and final nutrition outcomes in India, Bangladesh, Nepal, Pakistan and Afghanistan. We searched five literature databases and reference lists of previous systematic reviews to identify peer-reviewed studies published between 2012 and 2017, detailing impacts of household- or farm-level agricultural interventions on nutritional outcomes in South Asia. We identified six intervention studies (reported in nine papers) conducted in Bangladesh (two studies), India (two studies) and Nepal (two studies). The majority of studies examined the impact of provision of seed, plants and training to increase home garden fruit and vegetable production with or without integrated poultry provision and training. Other studies evaluated the impact of livestock or aquaculture provision and training. Study designs and quality were mixed; heterogeneity across studies precluded formal meta-analysis. Interventions had a positive impact on intermediate outcomes on the pathway from agricultural intervention to nutritional or health status including dietary quality and dietary diversity of households and individuals (reported in seven papers). The evidence on the impact on final nutritional outcomes was mixed: one paper reported that home gardens with poultry reduced the odds of anaemia but there was no convincing evidence of an impact of agricultural interventions on child anthropometric measurement (reported in four papers). In recent years, the Leveraging Agriculture for Nutrition in South Asia (LANSA) research programme consortium has significantly expanded research on agricultural interventions for nutrition outcomes by conducting and commissioning a suite of formative and feasibility studies that have extended both the range and geographic location of interventions under study. This expanding body of research should, in the future, enable the identification of cost-effective interventions to enhance the impact of agricultural interventions sustainably to improve nutrition outcomes especially in women and children in South Asia

Estimating the Relationship between Food Prices and Food Consumption—Methods Matter

Concerns about the growing prevalence of obesity worldwide have led researchers and policy makers to investigate the potential health impact of fiscal policies such as taxes on unhealthy foods. A common instrument used to measure the relationship between food prices and food consumption is the price elasticity of demand. Using meta-regression analysis we assessed how differences in methodological approaches to estimating demand affected food price elasticities. Most methodological differences had a statistically significant impact on elasticity estimates, which stresses the importance of using meta-estimates or testing the sensitivity of simulation outcomes to a range of elasticity parameters before drawing policy conclusions

Dietary patterns in India: a systematic review.

Dietary patterns analysis is an emerging area of research. Identifying distinct patterns within a large dietary survey can give a more accurate representation of what people are eating. Furthermore, it allows researchers to analyse relationships between non-communicable diseases (NCD) and complete diets rather than individual food items or nutrients. However, few such studies have been conducted in developing countries including India, where the population has a high burden of diabetes and CVD. We undertook a systematic review of published and grey literature exploring dietary patterns and relationships with diet-related NCD in India. We identified eight studies, including eleven separate models of dietary patterns. Most dietary patterns were vegetarian with a predominance of fruit, vegetables and pulses, as well as cereals; dietary patterns based on high-fat, high-sugar foods and more meat were also identified. There was large variability between regions in dietary patterns, and there was some evidence of change in diets over time, although no evidence of different diets by sex or age was found. Consumers of high-fat dietary patterns were more likely to have greater BMI, and a dietary pattern high in sweets and snacks was associated with greater risk of diabetes compared with a traditional diet high in rice and pulses, but other relationships with NCD risk factors were less clear. This review shows that dietary pattern analyses can be highly valuable in assessing variability in national diets and diet-disease relationships. However, to date, most studies in India are limited by data and methodological shortcomings

Projected health effects of realistic dietary changes to address freshwater constraints in India : a modelling study

Acknowledgements This study forms part of the Sustainable and Healthy Diets in India project supported by the Wellcome Trust's Our Planet, Our Health programme (grant number 103932). LA's PhD is funded by the Leverhulme Centre for Integrative Research on Agriculture and Health. SA is supported by a Wellcome Trust Capacity Strengthening Strategic Award-Extension phase (grant number WT084754/Z/08/A). We would like to thank Zaid Chalabi (London School of Hygiene & Tropical Medicine) for providing valuable guidance on the modelling methods.Peer reviewedPublisher PD