Effect of multiple micronutrient supplementation on survival of HIV-infected children in Uganda: a randomized, controlled trial

<p>Abstract</p> <p>Background</p> <p>Micronutrient deficiencies compromise the survival of HIV-infected children in low-income countries. We assessed the effect of multiple micronutrient supplementation on the mortality of HIV-infected children in Uganda.</p> <p>Methods</p> <p>In a randomized, controlled trial, 847 children aged one to five years and attending HIV clinics in Uganda were stratified by antiretroviral therapy (ART, n = 85 versus no ART, n = 762). The children were randomized to six months of either: twice the recommended dietary allowance of 14 micronutrients as the intervention arm (vitamins A, B₁, B₂, niacin, B₆, B₁₂, C, D and E, folate, zinc, copper, iodine and selenium); or the standard recommended dietary allowance of six multivitamins (vitamins A, D_2,B₁, B₂, C and niacin) as a comparative "standard-of-care" arm. Mortality was analyzed at 12 months of follow up using Kaplan Meier curves and the log rank test.</p> <p>Results</p> <p>Mortality at 12 months was 25 out of 426 (5.9%) children in the intervention arm and 28 out of 421 (6.7%) in the comparative arms: risk ratio 0.9 (95% CI 0.5 - 1.5). Two out of 85 (2.4%) children in the ART stratum died compared with 51 out of 762 (6.7%) in the non-ART stratum. Of those who died in the non-ART stratum, 25 of 383 (6.5%) were in the intervention arm and 26 of 379 (6.9%) in the comparative arm; risk ratio 1.0 (95% CI 0.6 - 1.6). There was no significant difference in survival at 12 months (p = 0.64, log rank test). In addition, there was no significant difference in mean weight-for-height at 12 months; 0.70 ± 1.43 (95% CI 0.52 - 0.88) for the intervention versus 0.59 ± 1.15 (95% CI 0.45 - 0.75) in the comparative arm. The mean CD4 cell count; 1024 ± 592 (95% CI 942 - 1107) versus 1060 ± 553 (95% CI 985 - 1136) was also similar between the two groups.</p> <p>Conclusions</p> <p>Twice the recommended dietary allowance of 14 micronutrients compared with a standard recommended dietary allowance of six multivitamins for six months was well tolerated, but it did not significantly alter mortality, growth or CD4 counts. Future intervention studies should carefully consider: (1) the composition and dosing of the supplements; and (2) the power needed to detect a difference between arms.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov Identifier: NCT00122941</p

Salt iodization for the elimination of iodine deficiency

French version available in IDRC Digital Library: Iodation du sel pour l'élimination de la carence en iod

Monitoring universal salt iodization programmes

French version available in IDRC Digital Library: Contrôles des programmes universels d'iodation du se

High participation in the Posyandu nutrition program improved children nutritional status

The objective of this research was to analyze nutritional status and food consumption of children participating in the Posyandu nutrition program. A total sample of 300 children under five years had been drawn. Sample was divided into two categories namely high participation and low participation in the Posyandu nutrition program. The sample was selected from two sub districts of Cianjur District, West Java. The districts were areas with a high proportion of poor people and many of them take the benefits of Posyandu nutrition program conducted by the government. The participation of children (under five years old) in visiting Posyandus was relatively good, namely, 92.4% (for the high participation group). However, for the low participation group, the number of participating children was relatively low (28.3%). The average consumption of energy for children under five years old was still below the recommended dietary allowance < 80% of RDA, whereas the protein consumption was already above the RDA. The prevalence of underweight, stunting, and wasting among children were respectively 30.0%, 43.7%, and 12.3%. The activities at Posyandus had a positive impact on the nutritional status of children under five years olds, measured in terms of weight for age (W/A) and weight for height (W/H). The more frequent the visit to Posyandus, the better the nutritional statuses would be

Why do adult women in Vietnam take iron tablets?

BACKGROUND: Conducting iron supplementation programs has been a major strategy to reduce iron deficiency anemia in pregnancy. However, only a few countries have reported improvements in the anemia rate at a national level. The strategies used for control of nutrition problems need regular review to maintain and improve their effectiveness. The objective of this study was to analyze the factors in compliance with taking iron tablets, where daily doses of iron (60 mg) and folic acid (400 μg) were distributed in rural Vietnamese communes. METHODS: A cross sectional survey was conducted in Nghe An province, Vietnam in January, 2003. The study population was adult women aged less than 35 years who delivered babies between August 1(st )2001 and December 1(st )2002 (n = 205), of which 159 took part in the study. Data for the study were collected from a series of workshops with community leaders, focus group discussions with community members and a questionnaire survey. RESULTS: Improvements in the rate of anemia was not given a high priority as one of the commune's needs, but the participants still made efforts to continue taking iron tablets. Two major factors motivated the participants to continue taking iron tablets; their experience of fewer spells of dizziness (50%), and their concern for the health of their newborn baby (54%). When examining the reasons for taking iron tablets for at least 5–9 months, the most important factor was identified as 'a frequent supply of iron tablets' (OR = 11.93, 95% CI: 4.33–32.85). CONCLUSION: The study found that multiple poor environmental risk factors discouraged women from taking iron tablets continuously. The availability (frequent supply) of iron tablets was the most effective way to help adult women to continue taking iron tablets

Iron deficiency anemia is not a rare problem among women of reproductive ages in Ethiopia: a community based cross sectional study

<p>Abstract</p> <p>Background</p> <p>In Ethiopia, the existence of iron deficiency anemia is controversial despite the fact that Ethiopia is one of the least developed in Africa with a high burden of nutrient deficiencies.</p> <p>Methods</p> <p>The first large nutrition study of a representative sample of women in Ethiopia was conducted from June to July 2005 and a systematically selected sub-sample of 970 of these subjects, 15 to 49 years old, were used in this analysis of nutritional anemia. Hemoglobin was measured from capillary blood using a portable HemoCue photometer. For serum ferritin, venous blood from antecubital veins was measured by an automated Elecsys 1020 using commercial kits. Diets were assessed via simplified food frequency questionnaire. The association of anemia to demographic and health variables was tested by chi-square and a stepwise backward logistic regression model was applied to test the significant associations observed in chi square tests.</p> <p>Results</p> <p>Mean hemoglobin ± SD was 11.5 ± 2.1 g/dL with a 29.4% prevalence of anemia. Mean serum ferritin was 58 ± 41.1 ug/L with a 32.1% prevalence of iron deficiency. The overall prevalence rate of iron deficiency anemia was 18.0%. Prevalence of anemia, iron deficiency, and iron deficiency anemia was highest among those 31-49 years old (p < 0.05). Intake of vegetables less than once a day and meat less than once a week was common and was associated with increased anemia (p = 0.001). Although the prevalence of anemia was slightly higher among women with parasitic infestation the difference was not significant (p = 0.9). Nonetheless, anemia was significantly higher in women with history of illness and the association was retained even when the variable was adjusted for its confounding effect in the logistic regression models (AOR = 0.3; 95%CI = 0.17 to 0.5) signifying that the most probable causes of anemia is nutrition related and to some extent chronic illnesses.</p> <p>Conclusion</p> <p>Moderate nutritional anemia in the form of iron deficiency anemia is a problem in Ethiopia and therefore, the need for improved supplementation to vulnerable groups is warranted to achieve the United Nation's Millennium Development Goals. Chronic illnesses are another important cause of anemia.</p

Micronutrient malnutrition and biofortification: recent advances and future perspectives

Micronutrients malnutrition is of great public health importance in several parts of the world, especially the developing and underdeveloped countries. It has been estimated that about 2 billion people, about one third of the world’s population, are deficient in one or more mineral elements. Although required in traces, these mineral elements are involved in many vital metabolic functions. Micronutrient deficiencies in humans can be remedied through food diversification, mineral supplementation, food fortification, and biofortification. Biofortification is the strategy of increasing the content of bioavailable nutrients in the edible parts of staple food crops for better human nutrition. Staple crops such as maize, rice, and wheat provide most of the calories for low-income families around the globe. However, staple crop-based diets fall far short in providing the required amounts of micronutrients and heavy reliance on staple food is the root cause of micronutrient malnutrition. Biofortification includes the enhanced uptake of such minerals from soils, their transport to edible plant parts, and improving the bioavailability of these minerals. International initiatives have recently released several plant cultivars with increased bioavailable micronutrient concentrations in their edible parts. The use of these biofortified cultivars is expected to mitigate micronutrient malnourishment in large populations especially in Africa. Crop breeding, genetic manipulation, and application of mineral fertilizers are the bases of biofortification strategies and have enormous potential to address micronutrient malnourishment. In this chapter, crop biofortification for zinc, iron, vitamin A, and iodine has been discussed. Biofortification is a proven strategy to combat micronutrient deficiency in large populations, particularly for those living in developing countries. However, to make it more effective, efficient, and acceptable for people, better planning, implementation, monitoring, and evaluation of biofortification programs are needed to produce cost-effective and socially acceptable biofortified food crops. Food safety, quality assurance, and legal framework also need to be considered while developing any biofortification strategy

Ethical and Sociocultural Considerations of Biofortified Crops: Ensuring Value and Sustainability for Public Health

This chapter highlights ethical considerations related to biofortified crops and provides insights on how planned and implemented biofortification interventions can take into account sociocultural aspects to improve public health. A literature review of ethical and sociocultural issues was performed, as well as an analysis of biofortification using a public health ethics framework. The research suggests that biofortification has clear public health goals and has promise toward meeting those goals. Where there is a need for more research is to better understand the impacts of biofortification programs on issues of self-determination, liberties, and food justice, the burdens and nonmaleficence to society can be minimized. This can be done through early involvement of the community in research and programmatic strategies. Distributive justice issues, such as ensuring fair access to seeds and foods for farmers and consumers, ought to be considered

Safe vitamin A dosage during pregnancy and lactation : recommendations and report of a consultation

French version available in IDRC Digital Library: Apports de sécurité en vitamine A pendant la grossesse et l'allaitement : recommandations et rapport d'une consultatio

Orange‐fleshed sweet potato (Ipomoea batatas) composite bread as a significant source of dietary vitamin A

Refining food recipes with orange‐fleshed sweet potato (OFSP) has the potential to improve dietary intake of vitamin A. The objectives of this study were to utilize OFSP in the development of two composite bread types and to assess their contribution to dietary intake of vitamin A using the dietary reference intake of lactating mothers. Two composite OFSP–wheat flour bread recipes—vita butter bread and vita tea bread—were developed by incorporating 46% OFSP puree in existing 100% wheat flour bread recipes consumed by Ghanaians. A paired‐preference test was used to profile the appearance, aroma, sweetness, and overall degree of liking of the vita butter bread and vita tea bread and their respective 100% wheat flour bread types. Weighed bread intake by lactating mothers (n = 50) was used to estimate the contribution to dietary vitamin A based on the trans β‐carotene content. The developed vita butter bread and vita tea bread were most preferred by at least 77% (p &lt; .05) of consumers (n = 310) for all the attributes considered. The average daily intake by the lactating mothers for vita butter bread was 247 g, and for vita tea bread was 196 g. The trans β‐carotene content of vita butter bread and vita tea bread were found to be 1.333 mg/100 g and 0.985 mg/100 g, respectively. The estimated trans‐β‐carotene intake was 3,293 μg/day (vita butter) and 1,931 μg/day (vita tea) based on the weighed bread intake, respectively, meeting 21% and 12% of the daily requirement (1,300 μg RAE/day) for lactating mothers, the life stage group with the highest vitamin A requirement. OFSP therefore could composite wheat flour to bake butter and tea bread, and will contribute to significant amount of dietary intake of vitamin A