Age-Appropriate Feeding Practices in Cambodia and the Possible Influence on the Growth of the Children:A Longitudinal Study

Age-appropriate feeding practice (ADF) during early childhood are vital for optimal nutrition. This longitudinal study determined the effect of selected risk factors and ADF, as described by the National Nutritional Recommendations, on linear and ponderal growth of children below 24 months of age. Weight and length measures were used to calculate z-scores of anthropometric measures by WHO standards. The prevalence of stunting increased from 13.2% to 32.4% over time, while prevalence of wasting remained stable (14.5%). At first visit, 43% of children of all ages complied with ADF criteria, a proportion which decreased to 7.1% in follow-up. The quality of feeding practices for children above 12 months of age was the poorest, where at the last visit, only 6% complied with the criteria for ADF. The linear mixed-effect models found the association between ADF and ponderal growth to be significant (weight-for-height estimate: 0.05 SD). In Cambodia, Ratanakiri province, ADF was the second largest determinant for ponderal growth. We recommend province specific public health actions. For children above 6 months, the quantity of food given needs to be increased, followed by the meal frequency. Mothers’ educational level, improved sanitation, and drinking water quality were among strongest predictors of a child’s growth

Multi-micronutrient-fortified biscuits decreased the prevalence of anaemia and improved iron status, whereas weekly iron supplementation only improved iron status in Vietnamese school children

In Vietnam, nutrition interventions do not target school children despite a high prevalence of micronutrient deficiencies. The present randomised, placebo-controlled study evaluated the impact of providing school children (n 403) with daily multiple micronutrient-fortified biscuits (FB) or a weekly Fe supplement (SUP) on anaemia and Fe deficiency. Micronutrient status was assessed by concentrations of Hb, and plasma ferritin (PF), transferrin receptor (TfR), Zn and retinol. After 6 months of intervention, children receiving FB or SUP had a significantly better Fe status when compared with the control children (C), indicated by higher PF (FB: geometric mean 36·9 (95% CI 28·0, 55·4) μg/l; SUP: geometric mean 46·0 (95% CI 33·0, 71·7) μg/l; C: geometric mean 34·4 (95% CI 15·2, 51·2) μg/l; P<0·001) and lower TfR concentrations (FB: geometric mean 5·7 (95% CI 4·8, 6·52) mg/l; SUP: geometric mean 5·5 (95% CI 4·9, 6·2) mg/l; C: geometric mean 5·9 (95% CI 5·1, 7·1) mg/l; P=0·007). Consequently, body Fe was higher in children receiving FB (mean 5·6 (sd 2·2)mg/kg body weight) and SUP (mean 6·1 (sd 2·5)mg/kg body weight) compared with the C group (mean 4·2 (sd 3·3)mg/kg body weight, P<0·001). However, anaemia prevalence was significantly lower only in the FB group (1·0%) compared with the C group (10·4%, P=0·006), with the SUP group being intermediate (7·4%). Children receiving FB had better weight-for-height Z-scores after the intervention than children receiving the SUP (P=0·009). Vitamin A deficiency at baseline modified the intervention effect, with higher Hb concentrations in vitamin A-deficient children receiving FB but not in those receiving the SUP. This indicates that vitamin A deficiency is implicated in the high prevalence of anaemia in Vietnamese school children, and that interventions should take other deficiencies besides Fe into account to improve Hb concentrations. Provision of biscuits fortified with multiple micronutrients is effective in reducing anaemia prevalence in school childre

High prevalence of vitamin D deficiency in Cambodian women:A common deficiency in a sunny country

Recent studies have shown that in spite of being generally close to the equator; vitamin D deficiency is common in South East Asian countries. In order to quantify micronutrient status for women and children in Cambodia; a nationally-representative survey was conducted in 2014 linked to the Cambodian Demographic Health Survey. The countrywide median of 25(OH) D was, respectively, 64.9 and 91.1 nmol/L for mothers and children. Based on The Endocrine Society cutoffs (>50<75 nmol/L = insufficiency; <= 50 nmol/L = deficiency); 64.6% of mothers and 34.8% of their children had plasma vitamin D concentrations indicating insufficiency or deficiency. For deficiency alone, 29% of the mothers were found to be vitamin D deficient, but only 13.4% of children. Children who live in urban areas had a 43% higher rate of vitamin D insufficiency versus those who live in rural areas (OR; 1.434; 95% CI: 1.007; 2.041). However, such differences were not observed in their mothers. The high prevalence of vitamin D deficiency is likely in part due to lifestyle choices, including sun avoidance, increasingly predominant indoor work, and covered transport. These survey findings support the need for a broader national Cambodian study incorporating testing of adult men, adolescents and the elderly, and encompassing other parameters such as skeletal health. However, the data presented in this study already show significant deficiencies which need to be addressed and we discuss the benefit of establishing nationally-mandated food fortification programs to enhance the intake of vitamin D

The high prevalence of anemia in Cambodian children and women cannot be satisfactorily explained by nutritional deficiencies or hemoglobin disorders

Background: Anemia is highly prevalent in Cambodian women and children, but data on causes of anemia are scarce. We performed a national micronutrient survey in children and women that was linked to the Cambodian Demographic Health Survey 2014 (CDHS-2014) to assess the prevalence of micronutrient deficiency, hemoglobin disorders and intestinal parasite infection. Methods: One-sixth of households from the CDHS-2014 were selected for a follow-up visit for the micronutrient survey. Households were visited from two weeks to two months after the CDHS-2014 visit. Data on micronutrient status were available for 1512 subjects (792 children and 720 women). Results: Anemia was found in 43% of the women and 53% of the children. Hemoglobin disorders affected &gt;50% of the population, with Hemoglobin-E the most prevalent disorder. Deficiencies of iron (ferritin &lt; 15 g/L), vitamin A (retinol-binding-protein (RBP) &lt; 0.70 mol/L) or vitamin B12 (&lt;150 pmol/L) were not prevalent in the women (&lt;5% for all), whereas 17.8% of the women had low concentrations of folic acid (&lt;10 nmol/L). In the children, the prevalence of iron, vitamin A, vitamin B12 or folic acid deficiency was &lt;10%. Zinc deficiency, hookworm infection and hemoglobinopathy were significantly associated with anemia in children, whereas in the women none of the factors was significantly associated with anemia. Iron deficiency anemia (IDA) was more prevalent in children &lt;2 years, but in older children and women, the prevalence of IDA was &lt;5%. The most prevalent, preventable causes of anemia were hookworm infection and zinc and folic acid deficiency. Over 40% of the anemia was not caused by nutritional factors. Conclusion: The very high prevalence of anemia in Cambodian women and children cannot be explained solely by micronutrient deficiencies and hemoglobin disorders. Micronutrient interventions to improve anemia prevalence are likely to have limited impact in the Cambodian setting. The focus of current interventions to reduce the high prevalence of anemia in children and women should be broadened to include zinc and folic acid as well as effective anti-hookworm measures

Child-Sensitive WASH Composite Score and the Nutritional Status in Cambodian Children.

Progress in health has occurred in the past decades in Cambodia, in terms of health service access and interventions, but several indicators, including the prevalence of malnourished children, remain alarming. The causes of undernutrition are often linked to inadequate access to water, sanitation and hygiene services but limited evidence exists on the direct association between poor WASH practices and children's' nutritional statuses. This study investigates the relationship between water, sanitation and hygiene practices, defined as the child-sensitive composite score, and the nutritional status of children under five years old, measured as the weight-for-height z-score, mid-upper arm circumference or height-for-age z-score in six districts of Cambodia. The analysis used data from a longitudinal study, comprising extensive data collection on anthropometry, health, nutrition, WASH, and cognitive development. Chronological trends in wasting and stunting were described cross-sectionally, whereas the effect of WASH practices on the nutritional status of children over up to three consecutive study visits was examined with a linear mixed-effects model. The prevalence of wasting decreased during the study while stunting prevalence increased. A small, but significant, association was found between the WASH child-sensitive composite scores and the wasting child anthropometry indicators: weight-for-height z-score or mid-upper arm circumference. Evidence for an association with height-for-age z-score, detecting stunted children, was found when the independent variable was quantified according to global, but not national, guidelines. This study reinforces discordant existing evidence towards a direct association between WASH practices and children's nutritional status, suggesting the need to align nutrition and WASH programmes

Micronutrient Deficits Are Still Public Health Issues among Women and Young Children in Vietnam

Background: The 2000 Vietnamese National Nutrition Survey showed that the population’s dietary intake had improved since 1987. However, inequalities were found in food consumption between socioeconomic groups. As no national data exist on the prevalence of micronutrient deficiencies, a survey was conducted in 2010 to assess the micronutrient status of randomly selected 1526 women of reproductive age and 586 children aged 6–75 mo. Principal Findings: In women, according to international thresholds, prevalence of zinc deficiency (ZnD, 67.262.6%) and vitamin B12 deficiency (11.761.7%) represented public health problems, whereas prevalence of anemia (11.661.0%) and iron deficiency (ID, 13.761.1%) were considered low, and folate (,3%) and vitamin A (VAD,,2%) deficiencies were considered negligible. However, many women had marginal folate (25.1%) and vitamin A status (13.6%). Moreover, overweight (BMI$23 kg/m 2 for Asian population) or underweight occurred in 20 % of women respectively highlighting the double burden of malnutrition. In children, a similar pattern was observed for ZnD (51.963.5%), anemia (9.161.4%) and ID (12.961.5%) whereas prevalence of marginal vitamin A status was also high (47.362.2%). There was a significant effect of age on anemia and ID prevalence, with the youngest age group (6–17 mo) having the highest risk for anemia, ID, ZnD and marginal vitamin A status as compared to other groups. Moreover, the poorest groups of population had a higher risk for zinc, anemia and ID

Les carences en micronutriments : de l'épidémiologie à une stratégie d'enrichissement des aliments : étude de cas au Vietnam

Contexte: L'enrichissement des aliments est une stratégie efficace pour lutter contre les carences en micronutriments. Toutefois, il existe de nombreuses étapes critiques, tels que l'évaluation des besoins de la population, l'obtention de l'appui du gouvernement et de l'industrie, le choix du véhicule alimentaire, la sélection des bons micronutriments (s) et son dosage, et enfin le suivi. Objectif: Cette thèse évalue et de discute les défis de l'enrichissement des aliments au Vietnam. Méthodologie: Les méthodes suivantes ont été utilisées: une étude transversale, une enquête sur la consommation, une étude d'impact, une étude de stabilité, une étude coût-conséquences, deux revues de littérature, une étude de validation, et les leçons tirées de programmes d'enrichissement financés par GAIN. Résultats: Les carences en micronutriments chez les femmes et les enfants au Vietnam sont encore très répandues et se chevauchent souvent. Bien qu'il n'y ait pas de consensus sur le meilleur indicateur pour déterminer le statut en zinc, la prévalence du déficit en zinc semble être élevée par example. De nombreuses initiatives d'enrichissement ont montré que le soutien du gouvernement et de l'industrie est essentiel pour réussir. Le gouvernement vietnamien a reconnu la nécessité de lutter contre les carences en micronutriments. Les véhicules appropriés pour l'enrichissement des aliments au Vietnam sont les huiles végétales et le riz, ainsi que la sauce de poisson, la sauce soja, les bouillons cubes et les aliments de complément. Cependant, il y a des questions qui doivent être soigneusement étudiés, tels que le niveau de peroxyde dans l'huile, la présence d'inhibiteurs de l'absorption du fer, ou le risque de sédimentation dans les sauces. Lors de l'ajout de micronutriments aux aliments, des facteurs tels que les coûts, la qualité et la sécurité doivent être pris en considération. Enfin, l'enrichissement doit être soigneusement surveillés pour s'assurer de la qualité et de surveiller les effets sur la santé de la population. Conclusion: Avant que la fortification des aliments puisse être mise en œuvre et être efficace au Vietnam, une série de défis devront être surmontés.Background: Food fortification is an effective strategy to combat micronutrient deficiencies. However, there are many critical steps, such as assessing the population's needs, obtaining support from the government and industries, choosing the food vehicle, selecting the right micronutrient(s) and the dosage and finally monitoring. Objective: The overall objective of this thesis is to assess and discuss the challenges of food fortification in Vietnam. Methodology: The following methods were used: a cross-sectional study, a consumption survey, an impact study, a stability study, a cost-implication study, two literature reviews, a validation study, and lessons learned from GAIN funded fortification programs. Results: Micronutrient deficiencies in women and children in Vietnam are still widespread and often overlap. Although there is no consensus on which indicator is best to use to determine zinc status, zinc deficiency prevalence seems to be high. Numerous fortification initiatives have shown that the support from the government and the industry is essential in order to be successful. The Vietnamese government has recognized the need to fight micronutrient deficiencies. Suitable food vehicles for fortification in Vietnam are vegetable oil and rice, as well as fish sauce, soy sauce, wheat flour and possibly flavoring powders and complementary foods. However, there are issues that need to be carefully studied, such as the peroxide level in the oil, the presence of absorption inhibitors in the flour, or the risk of sedimentation in sauces. When adding micronutrients to foods, factors such as costs, quality and safety need to be considered. Finally, fortification needs to be carefully monitored to assure quality and to supervise the effect on the population's health. Conclusion: Before food fortification can be implemented and be effective in Vietnam, a series of challenges will need to be overcome

Beyond Effectiveness—The Adversities of Implementing a Fortification Program. A Case Study on the Quality of Iron Fortification of Fish and Soy Sauce in Cambodia

Fortification of fish and soy sauces is a cost-effective strategy to deliver and increase iron intake in the Cambodian diet, as both are widely consumed by the entire population. In order to qualify as fortified sauces recognized by international regulations, iron content must be between 230 and 460 mg/L, whilst nitrogen and salt should contain no less than 10 g/L and 200 g/L respectively. This survey aims to analyze the progress of the fortification program. Through a better understanding of its obstacles and successes, the paper will then consider approaches to strengthen the program. Two hundred and fifty two samples were collected from 186 plants and 66 markets in various provinces. They were then analyzed for iron, nitrogen and salt content. The study demonstrates that 74% of fortified fish and soy sauces comply with Cambodian regulations on iron content. 87% and 53.6% of the collected samples do not have adequate level of nitrogen and salt content, respectively. The paper will discuss additional efforts that need to be implemented to ensure the sustainability of the project, including the need to: (i) comply with International Codex; (ii) adopt mandatory legislation; and (iii) ensure enforcement

Les carences en micronutriments (de l'épidémiologie à une stratégie d'enrichissement des aliments)

Contexte: L'enrichissement des aliments est une stratégie efficace pour lutter contre les carences en micronutriments. Toutefois, il existe de nombreuses étapes critiques, tels que l'évaluation des besoins de la population, l'obtention de l'appui du gouvernement et de l'industrie, le choix du véhicule alimentaire, la sélection des bons micronutriments (s) et son dosage, et enfin le suivi. Objectif: Cette thèse évalue et de discute les défis de l'enrichissement des aliments au Vietnam. Méthodologie: Les méthodes suivantes ont été utilisées: une étude transversale, une enquête sur la consommation, une étude d'impact, une étude de stabilité, une étude coût-conséquences, deux revues de littérature, une étude de validation, et les leçons tirées de programmes d'enrichissement financés par GAIN. Résultats: Les carences en micronutriments chez les femmes et les enfants au Vietnam sont encore très répandues et se chevauchent souvent. Bien qu'il n'y ait pas de consensus sur le meilleur indicateur pour déterminer le statut en zinc, la prévalence du déficit en zinc semble être élevée par example. De nombreuses initiatives d'enrichissement ont montré que le soutien du gouvernement et de l'industrie est essentiel pour réussir. Le gouvernement vietnamien a reconnu la nécessité de lutter contre les carences en micronutriments. Les véhicules appropriés pour l'enrichissement des aliments au Vietnam sont les huiles végétales et le riz, ainsi que la sauce de poisson, la sauce soja, les bouillons cubes et les aliments de complément. Cependant, il y a des questions qui doivent être soigneusement étudiés, tels que le niveau de peroxyde dans l'huile, la présence d'inhibiteurs de l'absorption du fer, ou le risque de sédimentation dans les sauces. Lors de l'ajout de micronutriments aux aliments, des facteurs tels que les coûts, la qualité et la sécurité doivent être pris en considération. Enfin, l'enrichissement doit être soigneusement surveillés pour s'assurer de la qualité et de surveiller les effets sur la santé de la population. Conclusion: Avant que la fortification des aliments puisse être mise en œuvre et être efficace au Vietnam, une série de défis devront être surmontés.Background: Food fortification is an effective strategy to combat micronutrient deficiencies. However, there are many critical steps, such as assessing the population's needs, obtaining support from the government and industries, choosing the food vehicle, selecting the right micronutrient(s) and the dosage and finally monitoring. Objective: The overall objective of this thesis is to assess and discuss the challenges of food fortification in Vietnam. Methodology: The following methods were used: a cross-sectional study, a consumption survey, an impact study, a stability study, a cost-implication study, two literature reviews, a validation study, and lessons learned from GAIN funded fortification programs. Results: Micronutrient deficiencies in women and children in Vietnam are still widespread and often overlap. Although there is no consensus on which indicator is best to use to determine zinc status, zinc deficiency prevalence seems to be high. Numerous fortification initiatives have shown that the support from the government and the industry is essential in order to be successful. The Vietnamese government has recognized the need to fight micronutrient deficiencies. Suitable food vehicles for fortification in Vietnam are vegetable oil and rice, as well as fish sauce, soy sauce, wheat flour and possibly flavoring powders and complementary foods. However, there are issues that need to be carefully studied, such as the peroxide level in the oil, the presence of absorption inhibitors in the flour, or the risk of sedimentation in sauces. When adding micronutrients to foods, factors such as costs, quality and safety need to be considered. Finally, fortification needs to be carefully monitored to assure quality and to supervise the effect on the population's health. Conclusion: Before food fortification can be implemented and be effective in Vietnam, a series of challenges will need to be overcome.MONTPELLIER-BU Sciences (341722106) / SudocSudocFranceF