Haemoglobin status of adult non-pregnant Kazakh women living in Kzyl-Orda region, Kazakhstan.

OBJECTIVE: To estimate the prevalence of anaemia among adult non-pregnant women in the Kzyl-Orda region of Kazakhstan, and to determine the association between haemoglobin concentration and anthropometric, socioeconomic, reproductive and dietary factors. DESIGN: A cross-sectional study using a randomly selected sample. Subjects were interviewed, and finger-prick blood samples and anthropometric measurements were collected. Associations between haemoglobin concentration and anthropometric and questionnaire data were evaluated by sequential linear regression analysis. SETTING: Health centres in Kazalinsk, Djalagash and Zhanakorgan districts of Kzyl-Orda region, Kazakhstan. SUBJECTS: Three-thousand six-hundred and twenty-five non-pregnant women aged 18-45 y randomly selected from health centre records. RESULTS: Iron deficiency anaemia, as reflected by low haemoglobin levels (Hb<12 g/dl), was detected in 40.2% of the total sample. There was a significant curvilinear relationship between haemoglobin concentration and age, with the nadir of the curve in the 30-40 y age-group. Haemoglobin concentration was found to be positively associated with body mass index (BMI) and socioeconomic factors. Significant negative associations were found between haemoglobin concentration and duration of menses, use of the intra-uterine contraceptive device and the consumption of tea. CONCLUSIONS: This study demonstrates that iron deficiency anaemia is present at considerable levels among adult women living in Kzyl-Orda region, Kazakhstan, and provides important baseline information for future research and public health interventions. SPONSORSHIP: Funding was provided by the United States Agency for International Development, Office of Nutrition, the United Kingdom Department for International Development, and the Polden-Puckham Trust

Effectiveness of the National Program of Complementary Feeding for older adults in Chile on vitamin B12 status in older adults; secondary outcome analysis from the CENEX Study (ISRCTN48153354).

BACKGROUND: Older people are at increased risk of vitamin B12 deficiency and the provision of fortified foods may be an effective way to ensure good vitamin B12 status in later life. AIM: To evaluate the effectiveness of a vitamin B12 fortified food provided by a national program of complementary food for older people on plasma vitamin B12 levels. SUBJECTS AND METHODS: A random sub-sample of 351 subjects aged 65-67 y from a large cluster randomised controlled trial provided blood samples at baseline and after 24 months of intervention. The intervention arm (10 clusters 186 participants) received a vitamin B12 fortified food designed to deliver 1.4 μg/day, while the control arm did not receive complementary food (10 clusters, 165 participants). Serum vitamin B12 and folate levels determined by radioimmunoassay were used to estimate the effect of intervention on vitamin B12 levels, adjusting for baseline levels and sex. RESULTS: Attrition at 24 months was 16.7% and 23.6% in the intervention and control arms respectively (p = 0.07). Over 24 months of intervention, mean (95% CI) serum vitamin B12 decreased from 392 (359-425) pmol/dL to 357 (300-414) pmol/dL (p < 0.07) in the intervention arm and from 395 (350-440) pmol/dL to 351 (308-395) pmol/dL in the control arm. There was no significant effect of the intervention on folate status. DISCUSSION: Our findings suggest that foods fortified with 1.4 μg/daily vitamin B12 as provided by Chile's national programme for older people are insufficient to ensure adequate vitamin B12 levels in this population. Chile has a long and successful experience with nutrition intervention programs; however, the country's changing demographic and nutritional profiles require a constant adjustment of the programs

Projected health effects of realistic dietary changes to address freshwater constraints in India : a modelling study

Acknowledgements This study forms part of the Sustainable and Healthy Diets in India project supported by the Wellcome Trust's Our Planet, Our Health programme (grant number 103932). LA's PhD is funded by the Leverhulme Centre for Integrative Research on Agriculture and Health. SA is supported by a Wellcome Trust Capacity Strengthening Strategic Award-Extension phase (grant number WT084754/Z/08/A). We would like to thank Zaid Chalabi (London School of Hygiene & Tropical Medicine) for providing valuable guidance on the modelling methods.Peer reviewedPublisher PD

Dietary patterns and non-communicable disease risk in Indian adults : secondary analysis of Indian Migration Study data

Acknowledgements The authors thank the IMS study team members and field staff involved in the generation and processing of IMS data. Financial support: This study forms part of the Sustainable and Healthy Diets in India (SAHDI) project supported by the Wellcome Trust ‘Our Planet, Our Health’ programme (grant number 103932). The Wellcome Trust had no role in the design, analysis or writing of this article. The IMS was funded by Wellcome Trust (grant number GR070797MF). L.A.’s PhD studentship is funded by the Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH).Peer reviewedPublisher PD

Is there an association of vitamin B12 status with neurological function in older people? A systematic review.

Low vitamin B12 status is common in older people; however, its public health significance in terms of neurological manifestations remains unclear. The present systematic review evaluated the association of vitamin B12 status with neurological function and clinically relevant neurological outcomes in adults aged 50+ years. A systematic search of nine bibliographic databases (up to March 2013) identified twelve published articles describing two longitudinal and ten cross-sectional analyses. The included study populations ranged in size (n 28-2287) and mean/median age (range 65-81 years). Studies reported various neurological outcomes: nerve function; clinically measured signs and symptoms of nerve function; self-reported neurological symptoms. Studies were assessed for risk of bias, and results were synthesised qualitatively. Among the general population groups of older people, one longitudinal study reported no association, and four of seven cross-sectional studies reported limited evidence of an association of vitamin B12 status with some, but not all, neurological outcomes. Among groups with clinical and/or biochemical evidence of low vitamin B12 status, one longitudinal study reported an association of vitamin B12 status with some, but not all, neurological outcomes and three cross-sectional analyses reported no association. Overall, there is limited evidence from observational studies to suggest an association of vitamin B12 status with neurological function in older people. The heterogeneity and quality of the evidence base preclude more definitive conclusions, and further high-quality research is needed to better inform understanding of public health significance in terms of neurological function of vitamin B12 status in older people

Global dietary quality, undernutrition and non-communicable disease: a longitudinal modelling study

OBJECTIVES: To determine the relationship between global dietary energy availability and dietary quality, and nutrition-related health outcomes. // DESIGN: A worldwide longitudinal modelling study using country-level data. Data on total dietary energy availability and dietary energy from 10 distinct food groups (as a proxy for dietary quality) were obtained from the FAO Food Balance Sheets database. Indicators of development were abstracted from the World Bank's World Development Indicators database. Data on nutrition and health outcomes were taken from the WHO mortality database and major cross-country analyses. We investigated associations of energy availability from food groups and health and nutrition outcomes in the combined data set using mixed effects models, while adjusting for measures of development. // POPULATION: 124 countries over the period 1980–2009. // MAIN OUTCOME MEASURES: Prevalence of stunting in children under 5 years and mortality rate from ischaemic heart disease (IHD) in adults aged 55+ years. // RESULTS: From 1980 to 2009, global dietary energy availability increased, and rates of child stunting and adult IHD mortality declined. After adjustment for measures of development, increased total dietary energy availability was significantly associated with reduced stunting rates (−0.84% per 100 kcal increase in energy, 95% CI −0.97 to −0.72) and non-significantly associated with increased IHD mortality rates (by 4.2 deaths per 100 000/100 kcal increase, 95% CI −1.85 to 10.2). Further analysis demonstrated that the changing availability of energy from food groups (particularly fruit, vegetables, starchy roots, meat, dairy and sugar) was important in explaining the associations with health outcomes. // CONCLUSIONS: Our study has demonstrated that by combining large, publicly available data sets, important patterns underlying trends in diet-related health can be uncovered. These associations remain even after accounting for measures of development over a 30-year period. Further work and joined-up multisectoral thinking will be required to translate these patterns into policies that can improve nutrition and health outcomes globally

Interventions in Agriculture for Nutrition Outcomes: A Systematic Review Focused on South Asia

Research on the potential impact of interventions in agriculture on nutrition outcomes is of particular relevance in South Asia where agriculture-related activities are a major source of livelihoods for large sections of society and where the population suffers from one of the highest global burdens of malnutrition in all its forms. This systematic review aims to assess the strength of the available evidence that agricultural interventions have an impact on intermediate and final nutrition outcomes in India, Bangladesh, Nepal, Pakistan and Afghanistan. We searched five literature databases and reference lists of previous systematic reviews to identify peer-reviewed studies published between 2012 and 2017, detailing impacts of household- or farm-level agricultural interventions on nutritional outcomes in South Asia. We identified six intervention studies (reported in nine papers) conducted in Bangladesh (two studies), India (two studies) and Nepal (two studies). The majority of studies examined the impact of provision of seed, plants and training to increase home garden fruit and vegetable production with or without integrated poultry provision and training. Other studies evaluated the impact of livestock or aquaculture provision and training. Study designs and quality were mixed; heterogeneity across studies precluded formal meta-analysis. Interventions had a positive impact on intermediate outcomes on the pathway from agricultural intervention to nutritional or health status including dietary quality and dietary diversity of households and individuals (reported in seven papers). The evidence on the impact on final nutritional outcomes was mixed: one paper reported that home gardens with poultry reduced the odds of anaemia but there was no convincing evidence of an impact of agricultural interventions on child anthropometric measurement (reported in four papers). In recent years, the Leveraging Agriculture for Nutrition in South Asia (LANSA) research programme consortium has significantly expanded research on agricultural interventions for nutrition outcomes by conducting and commissioning a suite of formative and feasibility studies that have extended both the range and geographic location of interventions under study. This expanding body of research should, in the future, enable the identification of cost-effective interventions to enhance the impact of agricultural interventions sustainably to improve nutrition outcomes especially in women and children in South Asia