Systematic review of the treatment of moderate acute malnutrition using food products.

There is currently a lack of international guidance on the most appropriate treatment for moderate acute malnutrition (MAM), and discrepancies in national treatment guidelines exist. We aimed to explore whether food interventions are effective for MAM children 6-59 months old and whether they result in better outcomes compared with no treatment or management with nutrition counselling. A systematic literature search was conducted in October 2018, identifying studies that compared treating MAM children with food products versus management with counselling or no intervention. A total of 673 abstracts were screened, 101 full texts were read, and one study was identified that met our inclusion criteria. After broadening the criteria to include micronutrients in the control group and enrolment based on out-dated anthropometric criteria, 11 studies were identified for inclusion. Seven of these found food products to be superior for anthropometric outcomes compared with counselling and/or micronutrient supplementation; two of the studies found no significant benefit of a food product intervention; and two studies were inconclusive. Hence, the majority of studies in this review found that food products resulted in greater anthropometric gains than counselling or micronutrient interventions. This was especially true if the supplementary food provided was of suitable quality and provided for an adequate duration. Improving quality of and adherence to counselling may improve its effectiveness, particularly in food secure contexts. There is currently a paucity of comparable studies on this topic as well as a lack of studies that include important functional outcomes beyond anthropometric proxies

Monitoring and evaluation design of Malawi's Right Foods at the Right Time nutrition program

Abstract Child stunting is a public health problem in Malawi. In 2014, the Government of Malawi launched the Right Foods at the Right Time (RFRT) program in Ntchisi district delivering nutrition social and behavior change communication, a small-quantity lipid-based nutrient supplement to children 6–23 months, and nutrition sensitive activities. Monitoring and evaluation (M&E) systems are key aspects of successful program implementation. We describe these and the methodology for an impact evaluation that was conducted for this program. Two monitoring systems using traditional and electronic platforms were established to register and track program delivery and processes including number of eligible beneficiaries, worker performance, program participation, and to monitor input, output, and outcome indicators. The impact evaluation used comparative cross-sectional and longitudinal designs to assess impact on anthropometric and infant and young child feeding outcomes. Three cross-sectional surveys (base-, mid-, and end-line) and two longitudinal cohorts of children followed in 6-month intervals from 6 to 24 months of age, were conducted in sampled households in the program and a neighboring comparison district. Additional M&E included qualitative studies, a process evaluation, and a cost-effectiveness study. The current paper describes lessons from this program's M&E, and demonstrates how multiple implementation research activities can inform course-correction and program scale-up

Strengths and limitations of computer assisted telephone interviews (CATI) for nutrition data collection in rural Kenya.

Despite progress in fighting undernutrition, Africa has the highest rates of undernutrition globally, exacerbated by drought and conflict. Mobile phones are emerging as a tool for rapid, cost effective data collection at scale in Africa, as mobile phone subscriptions and phone ownership increase at the highest rates globally. To assess the feasibility and biases of collecting nutrition data via computer assisted telephone interviews (CATI) to mobile phones, we measured Minimum Dietary Diversity for Women (MDD-W) and Minimum Acceptable Diet for Infants and Young Children (MAD) using a one-week test-retest study on 1,821 households in Kenya. Accuracy and bias were assessed by comparing individual scores and population prevalence of undernutrition collected via CATI with data collected via traditional face-to-face (F2F) surveys. We were able to reach 75% (n = 1366) of study participants via CATI. Women's reported nutrition scores did not change with mode for MDD-W, but children's nutrition scores were significantly higher when measured via CATI for both the dietary diversity (mean increase of 0.45 food groups, 95% confidence interval 0.34-0.56) and meal frequency (mean increase of 0.75 meals per day, 95% confidence interval 0.53-0.96) components of MAD. This resulted in a 17% higher inferred prevalence of adequate diets for infants and young children via CATI. Women without mobile-phone access were younger and had fewer assets than women with access, but only marginally lower dietary diversity, resulting in a small non-coverage bias of 1-7% due to exclusion of participants without mobile phones. Thus, collecting nutrition data from rural women in Africa with mobile phones may result in 0% (no change) to as much as 25% higher nutrition estimates than collecting that information in face-to-face interviews

Har kokosfett gynnsamma effekter på blodkolesterol hos friska vuxna? - en systematisk översiktsartikel

Sahlgrenska Akademin vid Göteborgs universitet Avdelningen för invärtesmedicin och klinisk nutrition Sammanfattning Titel: Har kokosfett gynnsamma effekter på blodkolesterol hos friska vuxna? - en systematisk översiktsartikel Författare: Arghanoon Farhikhtah och Eddie Grahn Handledare: Lena Hulthén Examinator: Frode Slinde Linje: Dietistprogrammet, 180/240 hp Typ av arbete: Examensarbete, 15 hp Datum: 2013-05-23 Bakgrund Kokosfett har fått mycket uppmärksamhet för sina påstådda positiva hälsoeffekter. Fettsammansättningen i kokos består av cirka 90 % mättade fettsyror. Mättat fett påverkar kolesterolhalten i blodet. Kolesterol kan mätas genom totalkolesterol (TC), Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), Very Low Density Lipoprotein (VLDL) och kvoten mellan LDL och HDL. Forskning har gjorts på enskilda fettsyror från kokosfett och resultat på gynnsamma hälsoeffekter har visats. Det är dock viktigt att belysa att slutsatser baserade på studier gjorda på enskilda fettsyror kan skilja sig från kokosfett i helhet. Syfte Syftet med denna översiktsartikel var att undersöka hur en kost rik på kokosfett påverkar kolesterolhalten i blodet gällande TC, LDL, HDL och LDL/HDL-kvoten. Sökväg Databaserna PubMed och Scopus användes i litteratursökningsprocessen för att få fram lämpliga artiklar. Sökord av betydelse för översiktsartikelns frågeställning användes. Urvalskriterier RCT, CCT och kohortstudier från 1990 och framåt som undersökte kokosfett vs. andra fetter eller kokosfett vs. placebo inkluderades. Studier med gravida kvinnor samt deltagare som använde läkemedel som påverkade blodfettsmetabolismen eller studier på enskilda fettsyror exkluderades. Datainsamling och analys Ett urval av adekvat material gjordes och tre studier valdes, två RCT och en CCT. Studiekvalitén samt graden av effektmåttens evidensstyrka bedömdes utifrån Granskningsmall för randomiserade studier, Granskningsmall för observationsstudier och icke-randomiserade kontrollerade studier och Sammanfattande Evidensformulär. Resultat Testdieterna rika på kokosfett (SFA-kost) gav signifikant högre TC- och LDL-nivåer jämfört med testdieterna rika på HUFA (tistelolja, sojabönsolja eller HUFA-mix). Endast en studie visade på signifikant högre nivåer av HDL i gruppen som helhet efter en kost med kokosfett. TC och LDL var signifikant högre med smör som testfett jämfört med kokosfett (SFA vs. SFA). LDL/HDLkvoten var lägre efter en HUFA-diet jämfört med SFA-dieterna. Slutsats Kokosfett som det dominerande fettet i kosten ger en signifikant ökning av TC och LDL, något som idag anses vara ofördelaktigt gällande blodkolesterolhalten relaterat till hälsan. Effekten på HDL skiljer sig åt mellan studierna. LDL/HDL-kvoten är högre när man jämför en kost rik på kokosfett med en kost rik på HUFA. Evidensstyrkan för kokosfettets påverkan på TC, LDL och HDL bedöms vara måttlig (+++) och för LDL/HDL-kvoten låg (++).Sahlgrenska Academy at University of Gothenburg Department of Internal Medicine and Clinical Nutrition Abstract Title: Does coconut fat have beneficial effects on blood cholesterol in healthy adults? - a systematic review Author: Arghanoon Farhikhtah and Eddie Grahn Supervisor: Lena Hulthén Examiner: Frode Slinde Programme: Dietician study programme, 180/240 ECTS Type of paper: Examination paper, 15 ECTS Date: May 23, 2013 Background Coconut fat has gained a lot of attention for its claimed beneficial effects concerning health. Its fat content is made up of approximately 90% saturated fatty acids. The intake of saturated fats affects blood cholesterol levels. Cholesterol can be measured through total cholesterol (TC), Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), Very Low Density Lipoprotein (VLDL) and LDL/HDL ratio. Research has been done on single fatty acids from coconut fat and positive results regarding health have been reached. However it is important to elucidate that conclusions based on studies made on single fatty acids may differ from coconut fat as a whole. Objective The aim of this systematic review was to investigate how a diet rich in coconut fat would affect blood cholesterol levels when it came to TC, LDL, HDL and the LDL/HDL-ratio. Search strategy The databases PubMed and Scopus were used in the literary search process for relevant articles. Search words of importance for the systematic reviews’ research question were applied. Selection criteria RCT, CCT and cohort studies from 1990 to present, both investigating coconut fat vs. other fats as well as coconut fat vs. placebo were considered. Studies including pregnant women, participants using drugs that influenced blood lipid metabolism or studies on single fatty acids were excluded. Data collection and analysis Appropriate materials were selected and three final studies were chosen, two RCT and one CCT. The study quality and the strength of evidence of the endpoints were based upon the validation template Granskningsmall för randomiserade studier, Granskningsmall för observationsstudier och icke-randomiserade kontrollerade studier and Sammanfattande Evidensformulär. Main results The test diets rich in coconut fat (SFA diets) led to significantly higher TC and LDL levels compared to diets rich in HUFA (safflower oil, soya-bean oil or a HUFA mix). Only one study showed significantly higher HDL levels in all its subjects after a coconut fat diet. TC and LDL were significantly higher on a butter diet compared to a coconut fat diet (SFA versus SFA). The LDL/HDL ratio was lower after the HUFA mix diet compared to the SFA diets. Conclusions Coconut fat as the main fat in the diet significantly increases TC and LDL levels, which is today not considered beneficial regarding blood cholesterol in relation to health. The outcomes on HDL levels however differ between the studies. The LDL/HDL ratio is higher when comparing coconut fat diets with a HUFA diet. The strength of evidence regarding coconut fat’s effect on TC, LDL and HDL is measured mediate-high (+++) and for LDL/HDL ratio low (++)

Minimum Acceptable Diet Survey

Test-Retest of data collection mode on dietary diversity data (via the Minimum Acceptable Diet for Infants and Young Children indicator) and poverty data (via the Progress Out of Poverty Index) for children aged 6-23.99 months in Kenya. Modes tested were face-to-face interviewing and computer assisted telephone interviewing (CATI). Data were collected in November and December 2016

Minimum Dietary Diversity for Women Survey

Test-Retest of data collection mode on dietary diversity data (via the Minimum Dietary Diversity for Women indicator) and poverty data (via the Progress Out of Poverty Index) for women of reproductive age (15-49 years) in Kenya. Modes tested were face-to-face interviews and computer assisted telephone interviews (CATI). Data were collected in November and December 2016