Breast-milk iodine concentration declines over the first 6 mo postpartum in iodine-deficient women.

BACKGROUND: Little is known about the iodine status of lactating mothers and their infants during the first 6 mo postpartum or, if deficient, the amount of supplemental iodine required to improve status. OBJECTIVE: The objective was to determine maternal and infant iodine status and the breast-milk iodine concentration (BMIC) over the first 6 mo of breastfeeding. DESIGN: A randomized, double-blind, placebo-controlled supplementation trial was conducted in lactating women who received placebo (n = 56), 75 μg I/d (n = 27), or 150 μg I/d (n = 26) after their infants' birth until 24 wk postpartum. Maternal and infant urine samples and breast-milk samples were collected at 1, 2, 4, 8, 12, 16, 20, and 24 wk. Maternal serum thyrotropin and free thyroxine concentrations were measured at 24 wk. RESULTS: Over 24 wk, the median urinary iodine concentration (UIC) of unsupplemented women and their infants ranged from 20 to 41 μg/L and 34 to 49 μg/L, respectively, which indicated iodine deficiency (ie, UIC < 100 μg/L). Mean maternal UIC was 2.1-2.4 times higher in supplemented than in unsupplemented women (P < 0.001) but did not differ significantly between the 2 supplemented groups. BMIC in the placebo group decreased by 40% over 24 wk (P < 0.001) and was 1.3 times and 1.7 times higher in women supplemented with 75 μg I/d (P = 0.030) and 150 μg I/d (P < 0.001), respectively, than in unsupplemented women. Thyrotropin and free thyroxine did not differ significantly between groups. CONCLUSION: BMIC decreased in the first 6 mo in these iodine-deficient lactating women; supplementation with 75 or 150 μg I/d increased the BMIC but was insufficient to ensure adequate iodine status in women or their infants. The study was registered with the Australian New Zealand Clinical Trials Registry as ACTRN12605000345684

Environmental enteric dysfunction and child stunting

In 2017, an estimated 1 in every 4 (23%) children aged < 5 years were stunted worldwide. With slow progress in stunting reduction in many regions and the realization that a large proportion of stunting is not due to insufficient diet or diarrhea alone, it remains that other factors must explain continued growth faltering. Environmental enteric dysfunction (EED), a subclinical state of intestinal inflammation, can occur in infants across the developing world and is proposed as an immediate causal factor connecting poor sanitation and stunting. A result of chronic pathogen exposure, EED presents multiple causal pathways, and as such the scope and sensitivity of traditional water, sanitation, and hygiene (WASH) interventions have possibly been unsubstantial. Although the definite pathogenesis of EED and the mechanism by which stunting occurs are yet to be defined, this paper reviews the existing literature surrounding the proposed pathology and transmission of EED in infants and considerations for nutrition and WASH interventions to improve linear growth worldwide

Sanitation, human rights, and disaster management

Purpose The purpose of this paper is to link debates around the international law on human rights and disaster management with the evolving debate around the human right to sanitation, in order to explore the extent to which states are obliged to account for sanitation in their disaster management efforts. Design/methodology/approach The paper is based on analysis of existing laws and policy relating to human rights, sanitation and disaster management. It further draws upon relevant academic literature. Findings The paper concludes that, while limitations exist, states have legal obligations to provide sanitation to persons affected by a disaster. It is further argued that a human rights-based approach to sanitation, if respected, can assist in strengthening disaster management efforts, while focusing on the persons who need it the most. Research limitations/implications The analysis in this paper focuses on the obligations of states for people on their territory. Due to space limitations, it does not examine the complex issues relating to enforcement mechanisms available to disaster victims. Originality/value This is the first scholarly work directly linking the debates around international human rights law and disaster management, with human rights obligations in relation to sanitation. The clarification of obligation in relation to sanitation can assist in advocacy and planning, as well as in ensuring accountability and responsibility for human rights breaches in the disaster context

Leveraging agriculture for nutrition in South Asia and East Africa: examining the enabling environment through stakeholder perceptions

South Asia and sub-Saharan Africa are the two regions of the world with the highest concentration of undernutrition. The majority of the nutritionally vulnerable populations in both regions is dependent in some way upon agriculture as a primary source of livelihood. The agriculture sector and wider agri-food system is considered to be central to sustained progress in reducing undernutrition – and yet not enough is known about how to unleash this potential. Recent scoping assessments have also revealed a paucity of information on wider political, institutional and policy-related challenges relating to the agriculture-nutrition nexus globally. Contextualized research into policy processes and the political economy of agriculture and nutrition is needed to better characterize “enabling environments” for agriculture to benefit nutrition, and how these environments can be shaped and sustained. This study aims to contribute to filling this gap, by drawing upon evidence from a set of case studies in South Asia (India, Bangladesh and Pakistan) and eastern Africa (Ethiopia, Uganda and Kenya). In synthesizing results across countries, while recognizing important nuance and detail, we conclude by highlighting four key issues to be addressed. First, improving knowledge and perception of undernutrition and its links to agriculture, on the part of agricultural policymakers and programme managers. Second, generating system-wide incentives for decisions and actions to become more pro-nutrition. Third, developing transparent systems of accountability for nutrition-relevant action throughout the agriculture sector, through linking timely and actionable data and evidence with incentives. And fourth, cultivating and strengthening leadership and capacities at different levels, underpinned by adequate financing.UK AidDepartment for International Development (DFID

Association between wasting and food insecurity among children under five years: findings from Nepal demographic health survey 2016

Background Wasting is a consequence of food insecurity, inappropriate dietary practices, and inadequate caring and feeding practices. The present study assessed association between wasting and household food insecurity among under 5 years old children, along with other socio-demographic characteristics. Methods This study is a secondary analysis of the Nepal Demographic and Health Survey 2016. The survey is cross-sectional in design with use of standardized tools. The sampling frame used is an updated version of the frame from the 2011 National Population and Housing Census. The participants were children under 5 years of age (n = 2414). Logistic regression was carried out to identify the odds of being wasted for children belonging to different levels of food insecure households using odds ratio and 95% confidence intervals. Results The prevalence of wasting increased with the level of food insecurity, from mild (9.4%) to moderate (10.8%) and to severe (11.3%). The highest proportions of wasted children were in Province 2 (14.3%), from rural areas (10.1%), born to mothers with no education (12.4%) and from a richer quintile (11.3%). Children belonging to severe food insecure households had 1.36 (95%CI 0.72–2.57) adjusted odds of being wasted and those belonging to mild food insecure and moderately food insecure households had 0.98 (95%CI 0.64-1.49) and 1.13 (95%CI 0.65–1.97) odds of being wasted respectively. Province 1 (AOR 2.06, 95%CI 1.01–4.19) and Province 2 (AOR 2.45, 95%CI 1.22–4.95) were significantly associated with wasting. Conclusion Considering the increment in childhood wasting as per level of food insecurity, an integrated intervention should be developed in Nepal that, 1. addresses improving knowledge and behavior of community people with respect to diet and nutrition; 2. reduce the problem of food insecurity through agricultural interventions

Dietary Factors Modulate Helicobacter-associated Gastric Cancer in Rodent Models

Since its discovery in 1982, the global importance of Helicobacter pylori–induced disease, particularly in developing countries, remains high. The use of rodent models, particularly mice, and the unanticipated usefulness of the gerbil to study H. pylori pathogenesis have been used extensively to study the interactions of the host, the pathogen, and the environmental conditions influencing the outcome of persistent H. pylori infection. Dietary factors in humans are increasingly recognized as being important factors in modulating progression and severity of H. pylori–induced gastric cancer. Studies using rodent models to verify and help explain mechanisms whereby various dietary ingredients impact disease outcome should continue to be extremely productive.National Institutes of Health (U.S.) (P01CA028842)National Institutes of Health (U.S.) (P01CA026731)National Institutes of Health (U.S.) (P30ES002109