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Neufeld L.M.,Micronutrient Initiative | Laraia B.,University of California at Berkeley | Ramakrishnan U.,Emory University | Garcia-Guerra A.,Instituto Nacional Of Salud Publica | Fernald L.C.H.,University of California at Berkeley
Nutrition and Diabetes | Year: 2013

OBJECTIVE: Standard approaches have found that rapid growth during the first 2 years of life is a risk factor for overweight in later childhood. Our objective was to test whether growth velocity, independent of concurrent size, was associated with overweight using a nonlinear random-effects model that allows for enhanced specifications and estimations. METHODS: Longitudinal data from a birth cohort in Mexico (n=586) were used to estimate growth trajectories over 0-24 months for body mass index (BMI), length and weight using the SuperImposition by Translation and Rotation (SITAR) models. The SITAR models use a nonlinear random-effects model to estimate an average growth curve for BMI, length and weight and each participant's deviation from this curve on three dimensions-size, velocity and timing of peak velocity. We used logistic regression to estimate the association between overweight status at 7-9 years and size, velocity and timing of BMI, length and weight trajectories during 0-24 months. We tested whether any association between velocity and overweight varied by relative size during 0-24 months or birth weight. RESULTS: SITAR models explained the majority of the variance in BMI (73%), height (86%) and weight (85%) between 0-24 months. When analyzed individually, relative BMI/length/weight (size) and BMI/length/weight velocity during 0-24 months were each associated with increased odds of overweight in late childhood. Associations for timing of peak velocity varied by anthropometric measure. However, in the mutually adjusted models, only relative BMI/length/weight (size) remained statistically significant. We found no evidence that any association between velocity and overweight varied by size during 0-24 months or birth weight. CONCLUSIONS: After mutual adjustment, size during 0-24 months of life (as opposed to birth size), but not velocity or timing of peak velocity, was most consistently associated with overweight in later childhood. © 2013 Macmillan Publishers Limited All rights reserved. Source

Hackett K.M.,University of Toronto | Mukta U.S.,Research and Evaluation Division RED | Jalal C.S.B.,Micronutrient Initiative | Sellen D.W.,University of Toronto
Maternal and Child Nutrition | Year: 2015

Improved infant and young child feeding (IYCF) practices have the potential to improve child health and development outcomes in poorly resourced communities. In Bangladesh, approximately 60% of rural girls become mothers before the age of 18, but most interventions to improve IYCF practices target older mothers. We investigated the knowledge, attitudes and perceptions regarding IYCF among adolescent girls and young women aged 15-23 years old in two rural regions in north-west Bangladesh and identified the main points of concordance with, or mismatch to, key international IYCF recommendations. We compared qualitative data collected during interviews and focus groups with participants who were unmarried, married without a child and married with at least one child, and stratified by region. Qualitative indicators of concordance with international recommendations suggest that IYCF knowledge of participants was limited, irrespective of marriage or maternity. Young mothers in our study were no more knowledgeable about feeding practices than their nulliparous peers. Some participants were well aware of an IYCF recommendation (e.g. to exclusively breastfeed for 6 months), but their interpretation of the recommendation deviated from the intended public health message. Notions of insufficient or 'spoiled' breast milk, gender-based biases in feeding intentions and understandings of infant needs, and generational shifts in feeding practices were commonly reported. Conclusions are that female adolescence is a window of opportunity for improving health outcomes among future children, and increased investment in early education of adolescent girls regarding safe IYCF may be an effective strategy to promote and support improved infant feeding practices. © 2012 Blackwell Publishing Ltd. Source

Harika R.K.,Unilever | Eilander A.,Unilever | Alssema M.,Unilever | Osendarp S.J.M.,Micronutrient Initiative | And 2 more authors.
Annals of Nutrition and Metabolism | Year: 2013

Aim: To systematically review data from different countries on population intakes of total fat, saturated fatty acids (SFA) and polyunsaturated fatty acids (PUFA), and to compare these to recommendations from the Food and Agriculture Organization of the United Nations/the World Health Organization (FAO/WHO). Methods: Data from national dietary surveys or population studies published from 1995 were searched via MEDLINE, Web of Science and websites of national public health institutes. Results: Fatty acid intake data from 40 countries were included. Total fat intake ranged from 11.1 to 46.2 percent of energy intake (% E), SFA from 2.9 to 20.9% E and PUFA from 2.8 to 11.3% E. The mean intakes met the recommendation for total fat (20-35% E), SFA (<10% E) and PUFA (6-11% E) in 25, 11 and 20 countries, respectively. SFA intake correlated with total fat intake (r = 0.76, p < 0.01) but not with PUFA intake (r = 0.03, p = 0.84). Twenty-seven countries provided data on the distribution of fatty acids intake. In 18 of 27 countries, more than 50% of the population had SFA intakes >10% E and in 13 of 27 countries, the majority of the population had PUFA intakes <6% E. Conclusions: In many countries, the fatty acids intake of adults does not meet the levels that are recommended to prevent chronic diseases. The relation between SFA and PUFA intakes shows that lower intakes of SFA in the populations are not accompanied by higher intakes of PUFA, as is recommended for preventing coronary heart disease. © 2013 S. Karger AG, Basel. Source

Brown K.H.,University of California at Davis | Hambidge K.M.,Section of Nutrition | Ranum P.,Micronutrient Initiative
Food and Nutrition Bulletin | Year: 2010

Background: Zinc fortification is recommended as an appropriate strategy to enhance population zinc status, but guidelines are needed on the appropriate types and levels of zinc fortification of cereal flours for mass fortification programs. Objective: To review available information on the scientific rationale, efficacy, and effectiveness of zinc fortification programs, and to develop guidelines on appropriate levels of fortification of cereal flours, based on simulations of the amount of zinc absorbed under different dietary conditions and information on possible adverse effects. Methods: Systematic review of scientific literature and application of an existing prediction equation to estimate zinc absorption. Results: Previously completed research demonstrates that zinc intake and absorption are increased when zinc-fortified foods are consumed, but little information is, as yet, available on the biologic impact of large-scale fortification programs. Studies suggest that there are no disadvantages of the recommended ranges of zinc fortification with regard to the sensory properties of zincfortified foods, and most research indicates that there are no adverse effects of zinc fortification on the utilization of other minerals. Conclusions: Zinc fortification of cereal flour is a safe and appropriate strategy for enhancing the zinc status of population subgroups who consume adequate amounts of fortified cereal flour, although additional information is needed to confirm the efficacy and effectiveness of large-scale zinc fortification programs to control zinc deficiency. The appropriate level of fortification depends on the population subgroup, their usual amount of flour intake, the degree of milling and fermentation that is practiced, and the usual intakes of zinc and phytate from other food sources. Fortification recommendations are presented for different dietary scenarios. Source

Johnson Q.W.,Training and Technical Support Group | Wesley A.S.,Micronutrient Initiative
Food and Nutrition Bulletin | Year: 2010

Background: Cereal flour fortification has been identified as an effective mass fortification intervention as part of a national public health strategy to overcome micronutrient deficiencies and improve the health status of populations, especially women and children. Objective: The effectiveness of cereal flour fortification programs requires the use of micronutrient premixes that provide the desired health benefits. Method: The Miller's Best/Enhanced Practices for Flour Fortification at the flour mill has been developed to provide specific guidance to millers and government officials to ensure that flour fortification practices are carried out in a way that results in the anticipated public health impact. Results: The paper provides information specific to the use of micronutrient premixes, feeders, the fortification process, and quality control systems to ensure that both minimum and enhanced practices can be followed by the millers. Conclusions: Guidelines for basic and best/enhanced practices to be followed for each stage of the flour fortification process at the flour mill are presented. The paper is designed to be a companion to the Recommended Practices for the Production and Procurement of Premix used in Cereal Fortification Programs and supplementary to existing food quality manuals and systems, such as Good Manufacturing Practices, Food Quality Systems, and Hazard Analysis and Critical Control Points. Other stakeholders involved in flour fortification programs have the responsibility to follow best practices of their own to ensure optimum effectiveness. Source

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