Micronutrient Initiative

Ottawa, Canada

Micronutrient Initiative

Ottawa, Canada
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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.

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.

Gillespie S.,International Food Policy Research Institute | Haddad L.,Institute of Development Studies | Mannar V.,Micronutrient Initiative | Menon P.,International Food Policy Research Institute | Nisbett N.,Institute of Development Studies
The Lancet | Year: 2013

In the past 5 years, political discourse about the challenge of undernutrition has increased substantially at national and international levels and has led to stated commitments from many national governments, international organisations, and donors. The Scaling Up Nutrition movement has both driven, and been driven by, this developing momentum. Harmonisation has increased among stakeholders, with regard to their understanding of the main causes of malnutrition and to the various options for addressing it. The main challenges are to enhance and expand the quality and coverage of nutrition-specific interventions, and to maximise the nutrition sensitivity of more distal interventions, such as agriculture, social protection, and water and sanitation. But a crucial third level of action exists, which relates to the environments and processes that underpin and shape political and policy processes. We focus on this neglected level. We address several fundamental questions: how can enabling environments and processes be cultivated, sustained, and ultimately translated into results on the ground? How has high-level political momentum been generated? What needs to happen to turn this momentum into results? How can we ensure that high-quality, well-resourced interventions for nutrition are available to those who need them, and that agriculture, social protection, and water and sanitation systems and programmes are proactively reoriented to support nutrition goals? We use a six-cell framework to discuss the ways in which three domains (knowledge and evidence, politics and governance, and capacity and resources) are pivotal to create and sustain political momentum, and to translate momentum into results in high-burden countries. © 2013 Elsevier Ltd.

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.

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.

Horton S.,Wilfrid Laurier University | Wesley A.,Micronutrient Initiative | Venkatesh Mannar M.G.,Micronutrient Initiative
Food Policy | Year: 2011

Iron deficiency is very widespread, with adverse consequences for health and cognition. Iron supplementation is not popular for long-term use, and cereal fortification is not feasible where milling occurs locally. Double-fortified salt (DFS: using both iron and iodine) is an alternative. The study undertakes a literature survey to find the effect of DFS on hemoglobin, and then uses a previous algorithm to make calculations for India. The benefit:cost ratio was estimated as 2.4:1 if only the benefits to children and women were included, and between 4:1 and 5:1 if anemia levels for men also decreased. This is just a little lower than the median ratio estimated for iron fortification of cereal staples (6.7:1), for home fortification for children less than two (37:1), and for biofortification. - breeding for high iron - of cereals (high, but no exact figure available). Double-fortified salt is therefore a good alternative for improving iron status in populations where fortification of other staple foods does not achieve desired coverage. © 2011 Elsevier Ltd.

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.

Neufeld L.M.,Micronutrient Initiative | Cameron B.M.,Micronutrient Initiative
Journal of Nutrition | Year: 2012

Micronutrient deficiency remains a major public health problem in many countries worldwide with important consequences for the health of the population and child growth and development. The objective of this article is to review information that should be taken into consideration in identifying the need for and in designing micronutrient programs. We review information that could be used to identify nutritional need, including the prevalence of deficiency and evidence of inadequate dietary intake as well as potential data sources andsomestrengths and weakness of such data for program decision-making. We also review factors that might modify the potential impact of programs and that should therefore be taken into consideration in their design. For example, such factorsmay include access to formal and informal health systems, quality of health provider training, and behavior change communication and complementary or overlapping interventions. Nationally representative data on micronutrient deficiencies and dietary intake are most useful for identifying unmet needs. Although the burden of micronutrient deficiencies lies in low-income countries, few have detailed information on specific deficiencies beyond anemia, and nationally representative dietary intake data are scarce. Nationally representative data may still mask considerable within-country variability by geographic, economic, or ethnic group. Some efforts designed to promote coordination in nutrition programming within countries utilizing information on prevalence, intake, and program coverage and utilization are also reviewed. Improving the quality of such data and ensuring continual updates are vital to guide decision making and to ensure that programs can appropriately respond to needs. © 2012 American Society for Nutrition.

Harding K.B.,Micronutrient Initiative | Neufeld L.M.,Micronutrient Initiative
Advances in Nutrition | Year: 2012

WHO recommendations on iron supplementation for infants and young children in malaria-endemic areas changed dramatically from universal to targeted supplementation for iron-deficient children only, after a trial in a high malaria transmission area showed an increased risk of hospital admission and mortality among iron-replete children following iron and folic acid supplementation. Since this time, there has been much debate and little agreement among the nutrition research community on how to move forward, and country policy and program decision makers have been left with incomplete guidance on how to address young child iron deficiency and anemia in their countries. The focus of a recent symposium during the American Society for Nutrition annual meeting, held in Washington, DC, in April 2011, was on exploring options for addressing iron deficiency and anemia among infants and young children in malaria-endemic areas, now, with safe, effective, and feasible interventions that provide iron. Papers based on the invited presentations are included in this supplement. The first paper is a review of the relationship between iron and malaria. The second is an analysis of theoretical and practical considerations regarding the targeted approach of providing iron and includes results from field testing noninvasive screening devices. This is followed by a review of the safety of universal provision of iron through home-fortification products in malaria-endemic areas. The final papers provide a call to action by highlighting pending research issues (fourth paper) and feasible strategies to move programs forward (fifth paper). © 2012 American Society for Nutrition.

Neufeld L.M.,Micronutrient Initiative | Osendarp S.J.M.,Micronutrient Initiative
Nestle Nutrition Institute Workshop Series | Year: 2014

Stunting and wasting provide indicators of different nutritional deficiency problems, the causes of which are well established. Underweight based on weight-for-age cannot distinguish between these two and is therefore not useful to target programs and has limited value for tracking progress. Stunting reduces later school attainment and income as adults and increases the risk of obesity and noncommunicable diseases in later life. Globally, the estimated number of stunted children is decreasing, but is not on track to meet the goal of 100 million by 2025 (165 million), and there has been little change in the number of children suffering from wasting since 2004. Stunting and wasting provide excellent indicators of inequity. For example, from 1990 to 2010, the number of stunted children in Asia declined from 188.7 to 98.4 million, while in sub-Saharan Africa there was essentially no change in prevalence, and the number of stunted children increased from 45.7 to 55.8 million. Recent global development movements are recognizing the need for robust measures of trends in nutritional status of children, particularly during the critical first years of life. Such measures are needed to track progress and improve accountability, and should be aspirational to mobilize sufficient investment in nutrition. © 2014 Nestec Ltd., Vevey/S. Karger AG, Basel.

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