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

Consumption of food away from home in low- and middle-income countries: a systematic scoping review

Consumption of food away from home represents an increasing share of people’s food consumption worldwide, although the percentage of food intake that is consumed away from home varies among countries and among individuals. Previous systematic reviews have reported that, overall, consumption away from home negatively affects an individual’s diet and nutritional status. However, these reviews have mainly focused on high-income countries, leaving a gap in knowledge and data for people in low- and middle-income countries (LMICs). The present review aimed to describe trends in the consumption of food away from home in an apparently healthy population in low- and middle-income countries (LMICs) and to investigate any associations between this behavior and diet quality, nutritional status, and health outcomes

Estimation of food portion sizes in women of childbearing age and young children in Ouagadougou (Burkina Faso) using a food photography atlas and salted replicas: Comparison with weighed records.

Quantitative assessment of foods consumed when using 24-hour dietary recall requires accurate tools to estimate portion sizes. Therefore, we developed a food portion photography atlas with age-appropriate portion sizes for 11 foods frequently consumed by young children (sizes for 6-11-month- and for 12-23-month-old children) and women of childbearing age in Ouagadougou, Burkina Faso capital. We then compared the accuracy and precision of portion estimation with this atlas and with salted replicas relative to weighed records (the reference). After weighing, we randomly assigned food portions to 67 women and their children. The next day, women estimated the served portions and leftovers by recall using the atlas and then salted replicas (n = 1156 measurements, ranging from 19 to 113 for each food). For most food types, the portions estimated with the atlas and salted replicas were positively correlated and showed good concordance with the weighed records. However, accuracy and precision varied in function of the estimation method, food type, and age group. The mean crude differences ranged from -28 to +12g (with errors in absolute values from 24 to 69%) for children, and from -32 to +44g (errors from 17 to 56%) for women. The atlas-based method showed the lowest Lin's concordances (coefficients of 0.1 to 0.2) for the leafy vegetable dish, meat, and fish in 12-23-month-old children. Bland-Altman plots indicated that the salted replicas allowed estimating the consumed portions with fewer errors than the photographic atlas (56 to 91% vs 46 to 79% between the limits of ±50%). Our study highlights that mothers have difficulties in perceiving the quantities of food consumed by their children. Our findings also indicate that the food atlas could be used in food consumption surveys when salted replicas are not available for all food types

The cost and cost efficiency of conducting a 24-h dietary recall using INDDEX24, a mobile dietary assessment platform, compared with pen-and-paper interview in Viet Nam and Burkina Faso

The INDDEX24 Dietary Assessment Platform (INDDEX24) was developed to facilitate the collection of 24-h dietary recall (24HR) data. Alongside validation studies in Viet Nam and Burkina Faso in 2019-2020, we conducted activity-based costing studies to estimate the cost of conducting a 24HR among women of reproductive age using INDDEX24 compared with the pen-and-paper interview (PAPI) approach. We also modelled alternative scenarios in which: (1) 25-75 % of dietary reference data were borrowed from the INDDEX24 Global Food Matters Database (FMDB); (2) all study personnel were locally based and (3) national-scale surveys. In the primary analysis, in Viet Nam, the 24HR cost US 111 004 (755/respondent, n 147) using INDDEX24 and 120 483 (820/respondent, n 147) using PAPI. In Burkina Faso, the 24HR cost 78 105 (539/respondent, n 145) using INDDEX24 and 79 465 (544/respondent, n 146) using PAPI. In modelled scenarios, borrowing dietary reference data from the FMDB decreased the cost of INDDEX24 by 17-34 % (Viet Nam) and 5-15 % (Burkina Faso). With all locally based personnel, INDDEX24 cost more than PAPI ($498 v.$448 per respondent in Viet Nam and $456 v.$410 in Burkina Faso). However, at national scales (n 4376, Viet Nam; n 6500, Burkina Faso) using all locally based personnel, INDDEX24 was more cost-efficient ($109 v.$137 per respondent in Viet Nam and $123 v.$148 in Burkina Faso). In two countries and under most circumstances, INDDEX24 was less expensive than PAPI. Higher INDDEX24 survey preparation costs (including purchasing equipment) were more than offset by higher PAPI data entry, cleaning and processing costs. INDDEX24 may facilitate cost-efficient dietary data collection

Estimation of food portion sizes in women of childbearing age and young children in Ouagadougou (Burkina Faso) using a food photography atlas and salted replicas: comparison with weighed records

International audienceQuantitative assessment of foods consumed when using 24-hour dietary recall requires accurate tools to estimate portion sizes. Therefore, we developed a food portion photography atlas with age-appropriate portion sizes for 11 foods frequently consumed by young children (sizes for 6-11-month- and for 12-23-month-old children) and women of childbearing age in Ouagadougou, Burkina Faso capital. We then compared the accuracy and precision of portion estimation with this atlas and with salted replicas relative to weighed records (the reference). After weighing, we randomly assigned food portions to 67 women and their children. The next day, women estimated the served portions and leftovers by recall using the atlas and then salted replicas (n = 1156 measurements, ranging from 19 to 113 for each food). For most food types, the portions estimated with the atlas and salted replicas were positively correlated and showed good concordance with the weighed records. However, accuracy and precision varied in function of the estimation method, food type, and age group. The mean crude differences ranged from -28 to +12g (with errors in absolute values from 24 to 69%) for children, and from -32 to +44g (errors from 17 to 56%) for women. The atlas-based method showed the lowest Lin’s concordances (coefficients of 0.1 to 0.2) for the leafy vegetable dish, meat, and fish in 12-23-month-old children. Bland-Altman plots indicated that the salted replicas allowed estimating the consumed portions with fewer errors than the photographic atlas (56 to 91% vs 46 to 79% between the limits of ±50%). Our study highlights that mothers have difficulties in perceiving the quantities of food consumed by their children. Our findings also indicate that the food atlas could be used in food consumption surveys when salted replicas are not available for all food types

Small-quantity lipid-based nutrient supplements, with or without added zinc, do not cause excessive fat deposition in Burkinabe children : results from a cluster-randomized community trial

Purpose Public health interventions to address stunting and wasting should be evaluated for possibly contributing to obesity risk. The present study tested the hypothesis that small-quantity lipid-based nutrient supplements (SQ-LNS) might increase fat deposition, and that additional zinc provided via SQ-LNS or in the form of dispersible tablets would increase fat-free mass (FFM) accretion. Methods Using a two-stage, cluster-randomized trial design, 34 communities were randomly assigned to the intervention cohort (IC) or non-intervention cohort (NIC), and family compounds within the IC were randomly assigned to receive different amounts of zinc (0, 5 or 10 mg zinc) incorporated in SQ-LNS or 5 mg zinc in the form of dispersible tablets along with treatment for diarrhea, malaria and fever. Body composition was assessed in a subset of IC (n = 201) and NIC (n = 74) children at 9 and 18 months using the deuterium dilution method. A mixed linear model was used to examine average change in FFM and % fat mass (%FM) among intervention groups and by cohort. Results Children in the IC had significantly greater change in FFM (Mean (95% Confidence Interval)) (1.57 (1.49, 1.64) kg) compared to the NIC (1.35 (1.23, 1.46) kg; p = 0.005). There were no significant differences in the change in %FM between the NIC and IC or among the intervention groups. Conclusion SQ-LNS, along with morbidity treatment increased weight gain and FFM in young children from 9 to 18 months of age without increasing FM deposition. Additional zinc supplementation did not affect changes in FFM or %FM

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.

BackgroundWe assessed the effects of providing a package of interventions including small-quantity lipid-based nutrient supplements (SQ-LNS) containing 0, 5 or 10&nbsp;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).MethodsUsing 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&nbsp;g SQ-LNS/d containing 0, 5 or 10&nbsp;mg zinc, 6&nbsp;mg of iron and 400&nbsp;μg 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.ResultsAt baseline, 35% of children had low adjusted pZC (&lt;65&nbsp;μg/dL), 93% were anemic (Hb &lt;110&nbsp;g/L), 25% had low adjusted pF (&lt;12&nbsp;μg/L), 90% had high adjusted sTfR (&gt;8.3&nbsp;mg/L) and 47% had low adjusted RBP (&lt;0.94&nbsp;μmol/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 &lt; 0.001), but no difference in pZC. Mean adjusted RBP was greater at 18 months in IC vs. NIC (0.94&nbsp;μmol/L vs. 0.86&nbsp;μmol/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&nbsp;mg zinc had a significantly lower mean pF at 18 months compared to children who received SQ-LNS with 5&nbsp;mg zinc (p = 0.034).ConclusionsSQ-LNS regardless of zinc amount and source provided along with illness treatment improved indicators of iron and vitamin A status, but not pZC.Trial registrationNCT00944281 (July 21, 2009)

Validation of the INDDEX24 mobile app v. a pen-and-paper 24-hour dietary recall using the weighed food record as a benchmark in Burkina Faso

Effective nutrition policies require timely, accurate individual dietary consumption data; collection of such information has been hampered by cost and complexity of dietary surveys and lag in producing results. The objective of this work was to assess accuracy and cost-effectiveness of a streamlined, tablet-based dietary data collection platform for 24-hour individual dietary recalls (24HR) administered using INDDEX24 platform v. a pen-and-paper interview(PAPI) questionnaire, with weighed food record (WFR) as a benchmark. This cross-sectional comparative study included women 18-49 years old from rural Burkina Faso (n 116 INDDEX24; n 115 PAPI). A WFR was conducted; the following day, a 24HR was administered by different interviewers. Food consumption data were converted into nutrient intakes. Validity of 24HR estimates of nutrient and food group consumption was based on comparison with WFR using equivalence tests (group level) and percentages of participants within ranges of percentage error (individual level). Both modalities performed comparably estimating consumption of macro- and micronutrients, food groups and quantities (modalities' divergence from WFR not significantly different). Accuracy of both modalities was acceptable (equivalence to WFR significant at P &lt; 0·05) at group level for macronutrients, less so for micronutrients and individual-level consumption (percentage within ±20 % for WFR, 17-45 % for macronutrients, 5-17 % for micronutrients). INDDEX24 was more cost-effective than PAPI based on superior accuracy of a composite nutrient intake measure (but not gram amount or item count) due to lower time and personnel costs. INDDEX24 for 24HR dietary surveys linked to dietary reference data shows comparable accuracy to PAPI at lower cost