Realistic Food-Based Approaches Alone May Not Ensure Dietary Adequacy for Women and Young Children in South-East Asia

Managing nutrition-biodiversity trade-offs on coral reefs

Coral reefs support an incredible abundance and diversity of fish species, with reef-associated fisheries providing important sources of income, food, and dietary micronutrients to millions of people across the tropics. However, the rapid degradation of the world's coral reefs and the decline in their biodiversity may limit their capacity to supply nutritious and affordable seafood while meeting conservation goals for sustainability. Here, we conduct a global-scale analysis of how the nutritional quality of reef fish assemblages (nutritional contribution to the recommended daily intake of calcium, iron, and zinc contained in an average 100 g fish on the reef) relates to key environmental, socioeconomic, and ecological conditions, including two key metrics of fish biodiversity. Our global analysis of more than 1,600 tropical reefs reveals that fish trophic composition is a more important driver of micronutrient concentrations than socioeconomic and environmental conditions. Specifically, micronutrient density increases as the relative biomass of herbivores and detritivores increases at lower overall biomass or under high human pressure. This suggests that the provision of essential micronutrients can be maintained or even increase where fish biomass decreases, reinforcing the need for policies that ensure sustainable fishing, and that these micronutrients are retained locally for nutrition. Furthermore, we found a negative association between micronutrient density and two metrics of fish biodiversity, revealing an important nutrition-biodiversity trade-off. Protecting reefs with high levels of biodiversity maintains key ecosystem functions, whereas sustainable fisheries management in locations with high micronutrient density could sustain the essential supply of micronutrients to coastal human communities.

Small Fish Big Impact: Improving Nutrition during Pregnancy and Lactation, and Empowerment for Marginalized Women

Undernutrition and micronutrient deficiencies such as anemia are considered significant public health challenges in Bangladesh, which enhancing fish consumption is a well-established food-based intervention to address these. This paper documents the establishment of community-based fish chutney production and reports the impact of its consumption on mid-upper arm circumference (MUAC) and hemoglobin (Hb) levels among targeted 150 pregnant and lactating women (PLW) in rural Bangladesh. A fish chutney was developed using locally available ingredients followed by a series of laboratory tests, including nutrient composition, shelf-life and food safety. A community-based fish chutney production process was designed to: (1) supply locally available ingredients for processing; (2) establish two fish drying sites; (3) initiate a community-based production site; and (4) distribute fish chutney to PLW for one year by six women nutrition field facilitators. Then a pre- and post-intervention study was designed for a selected 150 PLW to receive 30 g of fish chutney daily for 12 months. Differences in mean MUAC and Hb levels pre- and post-consumption were analyzed using one-way analysis of variance. Consumption of 30 g of fish-chutney resulted in significant increases of the mean values of Hb levels and MUAC among the targeted PLW.

Food pattern modeling to inform global guidance on complementary feeding of infants

Nutrient needs are difficult to meet during infancy due to high nutrient requirements and the small quantities of food consumed. Guidelines to support food choice decisions are critical to promoting optimal infant health, growth and development and food pattern modeling can be used to inform guideline development. We employed the Optifood modeling system to determine if unfortified complementary foods could meet 13 nutrient targets for breastfed infants (6-11 months), and to describe food patterns that met, or came as close as possible to meeting targets. We also examined the impacts of eliminating food groups, increasing starchy staple foods or adding sentinel unhealthy foods. We collated a global food list from dietary studies in 37 countries and used this list to develop nutrient values for a set of 35 food subgroups. We analyzed infant dietary intakes from studies in eight countries to inform maximum quantities and frequencies of consumption for these subgroups in weekly food patterns. We found that unfortified foods could meet targets for most infants for 12 nutrients, but not for iron. For the smallest and youngest infants, with the lowest energy intakes, there were additional deficits for minerals. Best-case food patterns that met targets or came as close as possible to meeting targets included ample amounts of diverse vegetables, diverse plant- and animal-source protein foods, small amounts of whole grain foods and dairy and no refined grains or added fats or sugar. There were nutrient deficits if animal-source foods or vegetables were eliminated or if unhealthy foods were included.

Enhancing child dietary diversity through cooking demonstration and nutritional education in rural Lao PDR

BACKGROUND

Efforts to prevent malnutrition in children under five are crucial for both short-term and long-term impact, especially in resource-constrained low- and middle-income countries, where ensuring minimal food diversity remains an urgent challenge. Our organization implemented initiatives to improve dietary diversity among children under five in rural areas of Lao People's Democratic Republic (Lao PDR).

METHODS

We carried out educational and awareness programs directed at caregivers of children aged 6-59 months. These programs were delivered by healthcare professionals and trained community volunteers in specific areas of Xaybouathong District, Khammouane Province. To evaluate the impact of our interventions, we conducted surveys both at the beginning and end of the project. We designated the Individual Dietary Diversity Score IDDS as the objective variable, serving as an indicator of child dietary diversity. Using sociodemographic and economic indicators as explanatory variables, we assessed the impact of the intervention through multivariate analysis with a generalized linear model as well as a bivariate analysis.

RESULTS

The comparison between 210 children at baseline and 205 children at endline revealed a significant increase in IDDS among children aged 6-23 months (from 3.36 to 4.22) and children aged 24-59 months (from 3.29 to 3.83). Multivariate analysis indicated a significant association between the intervention effect (baseline vs. endline) and the village of residence. Furthermore, significant improvements were observed in each food group that constitute IDDS, including vegetables and fruits, eggs, and legumes and nuts.

CONCLUSIONS

Even in resource-limited settings, such as rural areas of Lao PDR, it is possible to improve child dietary diversity through educational approaches that encourage the utilization of locally available foods.

Benchmarking the nutrient composition and labelling practices of dry or instant cereals for older infants and young children across seven Southeast Asian countries

In Southeast Asia, the increasing availability of commercially produced complementary foods (CPCF), including dry or instant cereals (CPCF cereals), has been noted, however, concerns exist around their nutrient profile and labelling practices. This 2021 study assessed the nutrient composition, labelling practices, and micronutrient content of CPCF cereals sold in the capital cities of seven Southeast Asian countries: Phnom Penh (Cambodia), Jakarta (Indonesia), Manila (Philippines), Bangkok (Thailand), Vientiane (Lao PDR), Hanoi (Vietnam), and Kuala Lumpur (Malaysia). The study adapted a nutrient profiling model from the WHO Regional Office for Europe to determine the proportion of products suitable for promotion for older infants and young children. Micronutrient content of fortified CPCF cereals was assessed against fortification levels specified in the Codex Alimentarius guideline for formulated complementary foods. Of the 484 products assessed, 184 (38.0%) met all nutrient composition requirements. Around one-third of CPCF cereals contained added sugars and/or sweeteners (37.2%) and high levels of sodium (28.9%). None of the CPCF cereals met all labelling requirements, primarily due to the presence of inappropriate claims on the labels. Most fortified CPCF cereals contained adequate amounts of critical micronutrients, such as calcium, iron, zinc, vitamin A, and vitamin D. However, rates of fortification varied across the seven countries, and almost a third (30.8%) of CPCF cereals were not fortified with any micronutrients. To support the appropriate promotion of CPCF in the region, Southeast Asian countries need to strengthen and enforce national binding legal measures, including national standards for the composition, labelling, and fortification of CPCF cereals.

Exploring the potential of meeting adolescent girls' nutrient needs in urban Colombia using food-based recommendations

During adolescence, many young people gain greater food choice agency but also become increasingly exposed and susceptible to environmental pressures that influence their food choices. This coincides with increased nutritional needs, especially for girls. In urban Colombia, adolescent diets are often high in undesirable foods and low in nutritious foods, contributing to overweight and micronutrient deficiencies. This study aimed to explore the potential of improving diet quality using food-based recommendations (FBRs) within the parameters of local food systems and adolescents' existing dietary patterns to inform context-specific programmatic responses to malnutrition. We applied linear programming analysis to dietary data from 13- to 20-year-old girls in Medellin to identify problem nutrients, local micronutrient sources, and promising FBRs. Iron and, to a lesser extent, calcium targets were difficult to meet using optimized diets based on local foods, especially for 13- to 17-year-olds. High habitual consumption of foods with excessive salt, fat, or sugar provided >5% of micronutrients in optimized diets. Otherwise, significant micronutrient sources included legumes, meat, dairy, bread, potatoes, and fruit. FBRs met targets for 10 micronutrients but only 32%-39% recommended nutrient intake for iron. FBRs, including occasionally consumed foods and supplements, met all intake targets for less cost, indicating a need to increase access to nutrient-dense products.

Locally relevant food-based recommendations could increase iron and calcium intake for adolescent girls in Vietnam

Unhealthy eating habits are common among adolescents in Vietnam, where transitioning food environments increasingly offer energy-dense micronutrient-poor foods. Successful behavior change approaches must be feasible and acceptable, promoting local foods that are available, accessible, and preferred. Yet, few studies have investigated the potential of food-based approaches for adolescents. We used linear programming to identify problem nutrients, local nutrient sources, and realistic food-based recommendations (FBRs) to improve nutrient intake among girls 16-22 years in Thai Nguyen, Vietnam. We then identified a reduced set of FBRs to prioritize the most critical micronutrient gaps. Calcium and iron targets could not be met in any realistic diet modeling scenario. The best set of FBRs included seven recommendations which could meet intake targets for 9 of 11 modeled micronutrients. The best reduced set of three FBRs targeting iron and calcium only-although more feasible for behavior change-was less effective at improving intake of these nutrients since fewer foods were recommended. Given the difficulty of meeting calcium and iron targets using local foods within acceptable dietary patterns, additional interventions, such as supplementation, staple food fortification, or increasing the availability of affordable calcium- and iron-rich foods, may be necessary to promote dietary adequacy for adolescent girls.

Effectiveness of locally produced ready to use supplementary food on hemoglobin, anthropometrics, and plasma micronutrients concentrations of 6 to 23 months age children: a non-randomized community-based trial from Pakistan

Background

Micronutrient deficiencies including vitamin A, vitamin D, and zinc are highly prevalent in children below 5 years of age in low and -middle-income countries. We aimed to evaluate the effectiveness of ready-to-use Lipid-based Nutrient Supplement-Medium Quantity (LNS-MQ) local name "Wawa-mum" on plasma micronutrient status, hemoglobin concentration and anthropometric measurements.

Methods

A community-based non-randomized trial was conducted in the Kurram district of Khyber Pakhtunkhwa from January 2018 to June 2019. A total of 110 children aged 6 to 23 months old were recruited and allocated to the intervention and control arm of the study. A total of 57 children in the intervention arm received a daily ration of 50 g of Wawa-mum, for one year. To assess the impact of the intervention on primary outcome measures, i.e., serum vitamin A, D concentration, plasma zinc, and hemoglobin concentration. Blood samples were collected at baseline and after one year following the intervention. The vitamins concentration in serum were assessed using Enzyme-Linked Immunosorbent Assay (ELISA) and plasma zinc by atomic absorption spectrometry. The hemoglobin concentration was measured by an automated hematology analyzer. A 24-h dietary recall interview was used to assess the nutrient intake adequacy. Multivariate Linear regression models were used to analyze the outcomes while controlling for potential confounders.

Results

In the intervention arm, children had on average 6.2 μg/dL (95% CI 3.0-9.3, value of p<0.001) increase in the serum vitamin A concentration, 8.1 ng/mL (95% CI 1.3-14.9, value of p 0.02) increase in serum vitamin D concentration and 49.0 μg/dL (95% CI 33.5-64.5, value of p<0.001) increase in the plasma zinc concentration, and 2.7 g/dL (95% CI 2.0-3.3, value of p<0.001) increase in hemoglobin concentration while adjusted for covariates. An addition, length-for-age z-score (LAZ), weight-for-length z-score (WLZ), weight-for-age z-score (WAZ), and prevalence of undernutrition including stunting, wasting, and underweight were calculated as a secondary outcome to investigate the impact of micronutrients on growth parameters, that has been improved significantly after receiving the Wawa-mum.

Conclusion

Wawa-mum (LNS-MQ) is an effective intervention to improve the micronutrient status, hemoglobin concentration, and growth parameters in 6 to 23 months children, which can be scaled up in the existing health system to address the alarming rates of under nutrition in Pakistan and other developing countries.

Clinical trial registration

https://doi.org/10.1186/ISRCTN94319790, ISRCTN94319790.

Exploring the Complementarity of Fortification and Dietary Diversification to Combat Micronutrient Deficiencies: A Scoping Review

Achieving a balanced and diverse diet remains a challenge for many people, contributing to an ongoing burden of micronutrient deficiencies, particularly in low-income settings. Fortification or dietary diversification are common food-based approaches. We conducted a scoping review to: 1) find evidence on whether combined food-based strategies are more effective than single strategies, and 2) understand how strategies implemented together could complement each other to achieve optimal nutritional impact on populations. Peer-reviewed articles selected (n = 21) included interventions or observational studies (n = 13) and reviews (n = 8). We found little evidence of an added nutritional impact. On the other hand, it is apparent that fortification and dietary diversification target different types of settings (urban compared with rural) and foods (that is, low priced compared with highly priced). Further research is needed to understand the complementarity of these approaches and establish evidence of the effectiveness of combined strategies to foster policy adoption.

Essential Minerals and Metabolic Adaptation of Immune Cells

Modern lifestyles deviated considerably from the ancestral routines towards major shifts in diets and increased sedentarism. The trace elements status of the human body is no longer adequately supported by micronutrient-inferior farmed meats and crop commodities produced by the existing agricultural food systems. This is particular evident in the increased obesogenic adipogenesis and low-grade inflammation that fails to resolve with time. The metabolically restrictive environment of the inflamed tissues drives activation and proliferation of transient and resident populations of immune cells in favor of pro-inflammatory phenotypes, as well as a part of the enhanced autoimmune response. As different stages of the immune activation and resolution depend on the availability of specific minerals to maintain the structural integrity of skin and mucus membranes, activation and migration of immune cells, activation of the complement system, and the release of pro-inflammatory cytokines and chemokines, this review discusses recent advances in our understanding of the contribution of select minerals in optimizing the responses of innate and adaptive immune outcomes. An abbreviated view on the absorption, transport, and delivery of minerals to the body tissues as related to metabolic adaptation is considered.

Small pelagic fish supply abundant and affordable micronutrients to low- and middle-income countries

Wild-caught fish provide an irreplaceable source of essential nutrients in food-insecure places. Fishers catch thousands of species, yet the diversity of aquatic foods is often categorized homogeneously as 'fish', obscuring an understanding of which species supply affordable, nutritious and abundant food. Here, we use catch, economic and nutrient data on 2,348 species to identify the most affordable and nutritious fish in 39 low- and middle-income countries. We find that a 100 g portion of fish cost between 10 and 30% of the cheapest daily diet, with small pelagic fish (herring, sardine, anchovy) being the cheapest nutritious fish in 72% of countries. In sub-Saharan Africa, where nutrient deficiencies are rising, <20% of small pelagic catch would meet recommended dietary fish intakes for all children (6 months to 4 years old) living near to water bodies. Nutrition-sensitive policies that ensure local supplies and promote consumption of wild-caught fish could help address nutrient deficiencies in vulnerable populations.

Mathematical modeling to inform the development of national guidelines on infant feeding in Thailand

The development of national dietary guidelines promoting healthy food choices is a public health priority in Thailand. In developing the recent national complementary feeding guidelines (CFGs) for 6- to 12-month-old children, mathematical modeling was used to inform decisions. Model parameters were derived from nationally representative dietary data and analyzed for 11 micronutrients by age group, using linear programming analysis in Optifood. Models were run to identify micronutrients whose nutrient reference values could not be met using local foods as consumed (problem nutrients), evaluate the original 2012 Thai CFGs, and predict the nutritional benefits of a specific fortified complementary food. The results identified three problem nutrients (iron, calcium, and zinc), which, for 9- to 11-month-olds, were reduced to one when the fortified food was modeled. The number of servings/week of vegetables and meat, fish or eggs were higher, and of oil and fruit were lower, in the modeled nutritionally best rather than observed diets (medians). When modeled, the original Thai CFGs were not feasible because the energy constraint was exceeded; hence, in revising them, the recommended number of servings/week of oil and fruit were reduced. This study demonstrates the advantages of using mathematical modeling, when revising national CFGs, to evaluate and improve them.

Phytochemicals of Avocado Residues as Potential Acetylcholinesterase Inhibitors, Antioxidants, and Neuroprotective Agents

Avocado (Persea americana) is a widely consumed fruit and a rich source of nutrients and phytochemicals. Its industrial processing generates peels and seeds which represent 30% of the fruit. Environmental issues related to these wastes are rapidly increasing and likely to double, according to expected avocado production. Therefore, this work aimed to evaluate the potential of hexane and ethanolic peel (PEL-H, PEL-ET) and seed (SED-H, SED-ET) extracts from avocado as sources of neuroprotective compounds. Minerals, total phenol (TPC), total flavonoid (TF), and lipid contents were determined by absorption spectroscopy and gas chromatography. In addition, phytochemicals were putatively identified by paper spray mass spectrometry (PSMS). The extracts were good sources of Ca, Mg, Fe, Zn, ω-6 linoleic acid, and flavonoids. Moreover, fifty-five metabolites were detected in the extracts, consisting mainly of phenolic acids, flavonoids, and alkaloids. The in vitro antioxidant capacity (FRAP and DPPH), acetylcholinesterase inhibition, and in vivo neuroprotective capacity were evaluated. PEL-ET was the best acetylcholinesterase inhibitor, with no significant difference (p > 0.05) compared to the control eserine, and it showed neither preventive nor regenerative effect in the neuroprotection assay. SED-ET demonstrated a significant protective effect compared to the control, suggesting neuroprotection against rotenone-induced neurological damage.

Household-level consumption data can be redistributed for individual-level Optifood diet modeling: analysis from four countries

A barrier to using Optifood linear programming (LP), which identifies nutrient gaps and supports population-specific food-based recommendation (FBR) development, is the requirement for dietary intake data. We investigated whether Household Consumption and Expenditure Surveys (HCESs) could be used instead of individual-level 24-h recalls (24HRs). The 24HR data from 12- to 23-month-old breastfeeding children in rural Kenya, Uganda, Guatemala, and Bangladesh were paired with HCES food consumption data from similar areas (n = 8) and time periods. HCES food intakes (g/week) were estimated using adult male equivalents, adjusted for breastfeeding. Paired HCES- and 24HR-defined LP inputs and outputs were compared using percentage agreement. Mean overall percentage agreements were 42%, 63%, and 80%, for food, food subgroup, and food-group model parameters, respectively. HCES food lists were on average 1.3 times longer than 24HR. Similar nutrient gaps (77-100% agreement), food sources of nutrients (71-100% agreement), and FBRs (80-100% agreement) were identified. The results suggest that HCES data can be used in Optifood analyses for 12- to 23-month-old children, despite recognized challenges of using it to estimate dietary intakes of young children compared with older age groups. Further analyses, however, are required for different age groups and locations to confirm expectations that it would perform equally well.

Dried small fish provide nutrient densities important for the first 1000 days

Inadequate nutrient intakes are prevalent among many populations in sub-Saharan Africa and increasing fish consumption among pregnant/lactating women and children is one strategy to improve diets and address nutrient deficiencies. We report the nutrient content of two fish-based recipes-fish powder and fish chutney-that contain dried small fish available in local markets in Zambia. The contribution of a serving of each recipe to the recommended daily intakes of iron, zinc, calcium and docosahexaenoic acid (DHA) for pregnant/lactating women and children 6-24 months was calculated because these nutrients are commonly deficient in African diets. We found that one 10-g serving of fish powder provides 20% or more of the daily calcium recommendation and 37% or more of the daily DHA recommendation for both pregnant/lactating women and children. A 30-g serving of fish chutney provides over 40% of the daily calcium recommendation for pregnant women and over 50% for lactating women. Additionally, we investigated the nutrient density (nutrients per kilocalorie) of the fish powder and compared it with the nutrient density of a small-quantity lipid-based nutrient supplement plus (SQ-LNS-plus). SQ-LNS-plus is designed to enhance children's diets by providing micronutrients and DHA. Fish powder is similar to SQ-LNS-plus in iron and zinc density and even higher in calcium and DHA density. Consuming dried small fish as part of a daily meal can be a viable strategy for combatting nutrient deficiencies in the first 1000 days.

Energy Content and Nutrient Profiles of Frequently Consumed Meals in Singapore

Singapore is a multi-ethnic country with a great variety of traditional ethnic cuisines. In this modern society where there is an increasing prevalence of obesity, it is important to know the nutritional content and energy density of our foods. However, there have been little data on the nutritional content of our local foods. The energy density and nutrient content of 45 commonly consumed meals by three ethnic groups in Singapore (Chinese, Malay, and Indian) were assessed in this study. Chinese, Malay, and Indian cuisines had an average energy density of 661, 652, and 723 kJ/100 g, respectively. Moreover, the macronutrient content is different between the different ethnic groups. Compared to Chinese and Malay cuisines, Indian cuisine contained lower protein but higher fat and carbohydrate content (p = 0.03). From the mineral analysis of the ethnic foods, we found out that Chinese cuisines contain significantly higher sodium (average of 238 mg/100 g) than Malay cuisines (p = 0.006) and Indian cuisines (p = 0.03). Knowing the caloric density and nutrition content of local ethnic foods may aid hawkers and government officials in developing healthier options to tackle Singapore's obesity epidemic.

Scoping review of nutrition intervention and dietary assessment studies in Khmer populations living in Cambodia

BACKGROUND

This scoping review aims to describe the body of nutrition intervention and dietary assessment research undertaken with Khmer populations in Cambodia, as well as summarise the nutrition knowledge base and highlight priority areas for future research.

METHODS

Five databases and the grey literature were searched, following PRISMA-ScR guidelines. Studies involving dietary assessment or nutrition interventions published after 1992 were identified using specific search terms and extracted to a customised data extraction table for categorisation and analysis. Study participants were Khmer people of any age and gender, living in rural or urban Cambodia.

RESULTS

Of the 100 included studies, 58 were dietary assessment only studies, 24 were nutrition interventions only, and 18 studies involved both assessment of intake and an intervention. Sixty-eight percent of study populations were mothers and young children, of which 52 studies focused on children aged under 5 years. Nineteen interventions involved supplementation and six trialled fortification of rice or fish sauce. Anaemia was the most common nutrition condition studied (n = 17), followed by malnutrition (n = 15) and malnutrition risk factors (n = 11). General nutrition status was explored in 25 studies, and individual micronutrients that were studied included iron (n = 27), zinc (n = 6), vitamin A (n = 4) and thiamine (n = 3).

CONCLUSIONS

Diet-related research in Khmer populations in Cambodia has predominantly focused on dietary assessment or evaluation of interventions aimed at reducing malnutrition and resolving micronutrient deficiencies. Areas identified as emerging needs included non-communicable diseases, the ageing population and non-iron deficiency anaemia.

The Role of Micronutrients in Ageing Asia: What Can Be Implemented with the Existing Insights

Life expectancy as a measure of population health does not reflect years of healthy life. The average life expectancy in the Asia-Pacific region has more than doubled since 1900 and is now above 70 years. In the Asia-Pacific region, the proportion of aged people in the population is expected to double between 2017 and 2050. Increased life expectancy leads to an increase in non-communicable diseases, which consequently affects quality of life. Suboptimal nutritional status is a contributing factor to the prevalence and severity of non-communicable diseases, including cardiovascular, cognitive, musculoskeletal, immune, metabolic and ophthalmological functions. We have reviewed the published literature on nutrition and healthy ageing as it applies to the Asia-Pacific region, focusing on vitamins, minerals/trace elements and omega-3 fatty acids. Optimal nutritional status needs to start before a senior age is reached and before the consequences of the disease process are irreversible. Based on the nutritional status and health issues in the senior age in the region, micronutrients of particular importance are vitamins A, D, E, C, B-12, zinc and omega-3 fatty acids. The present paper substantiates the creation of micronutrient guidelines and proposes actions to support the achievement of optimal nutritional status as contribution to healthy ageing for Asia-Pacific populations.

Use of Linear Programming to Develop Complementary Feeding Recommendations to Improve Nutrient Adequacy and Dietary Diversity Among Breastfed Children in the Rural Philippines

BACKGROUND

Lack of dietary diversity in complementary feeding contributes to nutrient gaps leading to undernutrition. Food-based strategies have been successfully used to enrich the complementary diets of infants and young children. However, context-specific recommendations based on an objective diet optimization are needed to formulate sound and practical nutritional guidelines.

OBJECTIVES

The present study aimed to identify problem nutrients in complementary diets and formulate complementary feeding recommendations (CFRs) using linear programming analysis for children aged 6 to 23 months in the rural Philippines.

METHODS

A cross-sectional survey was conducted in the municipality of Mercedes, Philippines. Dietary intakes of breastfed children 6 to 8, 9 to 11, and 12 to 23 months of age (n = 297) were assessed using a multipass 24-hour recall method with 7-day food consumption frequency. A linear programming tool was used to identify the recommended nutrient intakes that could not be met within the existing local food patterns and develop CFRs that would best fulfill nutrient adequacy for 11 modeled micronutrients.

RESULTS

Problem nutrients in the current diets were iron and calcium in any age-group, zinc for 6 to 8 and 9 to 11 months old, and thiamine and folate for 12 to 23 months old children. Adoption of CFRs with 4 to 5 food groups in the diet would ensure the adequacy of 7 to 8 nutrients, depending on the age-group.

CONCLUSION

Within the boundaries of local dietary patterns, adequacy for most nutrients could be achieved by promoting realistic servings of nutrient-dense foods and food groups. The linear programming results provide an evidence-based strategy in designing interventions to improve the quality of Filipino complementary diets.

The impact of feeding experiences during infancy on later child eating behaviours

PURPOSE OF REVIEW

Individual differences in appetite and eating behaviours appear early in infancy. This review synthesizes recent research investigating the impact of feeding experiences during infancy on later appetite and energy intake regulation, and appraises the consistency and longevity of any effects.

RECENT FINDINGS

Three themes of early feeding experiences were identified; breastfeeding, infants' first foods and caregivers' feeding practices. Recent findings suggest that breastfeeding alone is unlikely to promote better regulation of food intake later in childhood. It remains unclear whether the method of first food introduction (e.g., baby-led weaning vs traditional spoon feeding), or types of food introduced (e.g. ultra-processed foods), affect later child eating self-regulation. Randomised controlled trials (RCTs) on receiving guidance for responsive feeding showed some benefits; lower child body mass index z-scores in toddlerhood, parents reported less likelihood to pressure their child to eat or use food as a reward and lower emotional eating in the child.

SUMMARY

There is little consistent new evidence for the lasting impact of any one specific infant feeding experience on later eating self-regulation. More RCTs using observed and measured behaviours, with longer follow-ups of children's eating behaviours, and those conducted across different populations are warranted.

Local Foods Can Increase Adequacy of Nutrients Other than Iron in Young Urban Egyptian Women: Results from Diet Modeling Analyses

BACKGROUND

Nutrition transition and recent changes in lifestyle in Middle Eastern countries have resulted in the double burden of malnutrition. In Egypt, 88% of urban women are overweight or obese and 50% are iron deficient. Their energy, sugar, and sodium intakes are excessive, while intakes of iron, vitamin D, and folate are insufficient.

OBJECTIVE

This study aimed to formulate dietary advice based on locally consumed and affordable foods and determine the need for fortified products to meet the nutrient requirements of urban Egyptian women.

METHODS

Food intakes were assessed using a 4-d food diary collected from 130 urban Egyptian women aged 19-30 y. Food prices were collected from modern and traditional markets to calculate diet cost. Population-based linear and goal programming analyses (Optifood tool) were used to identify "limiting nutrients" and to assess whether locally consumed foods (i.e., consumed by >5% of women) could theoretically improve nutrient adequacy at an affordable cost (i.e., less than or equal to the mean diet cost), while meeting recommendations for SFAs, sugars, and sodium. The potential of hypothetical fortified foods for improving intakes of micronutrients was also assessed.

RESULTS

Iron was the most limiting nutrient. Daily consumption of fruits, vegetables, milk or yogurt, meat/fish/eggs, and tahini (sesame paste) were likely to improve nutrient adequacy for 11 out of 12 micronutrients modeled. Among fortified foods tested, iron-fortified rice, milk, water, bread, or yogurt increased the minimized iron content of the modeled diet from 40% to >60% of the iron recommendation.

CONCLUSIONS

A set of dietary advice based on locally consumed foods, if put into practice, can theoretically meet requirements for most nutrients, except for iron for which adequacy is harder to achieve without fortified products. The acceptability of the dietary changes modeled needs evaluation before promoting them to young Egyptian women.

Energy Density and Nutrient Contents of Selective Chinese New Year Snacks

BACKGROUND

In this study, the energy density and nutrient contents of thirty Chinese New Year (CNY) snacks commonly consumed in the Asian region during the CNY festive season were measured.

METHODS

Calorie Answer™, Gas Chromatography-Mass Spectrometry (GC-MS) and Inductively coupled plasma-mass spectrometry (ICP-MS) were the main methods applied in this study.

RESULTS

All snacks showed high energy density (kJ/100 g) and the nutrient content, including macro-and micronutrients of these snacks were remarkably different. The most abundant minerals in these snacks include sodium, magnesium, potassium, and calcium. Palmitic (C16:0), oleic (C18:1) and linoleic (C18:2) acids were the main fatty acids and trans-fat was only identified in Butter cookies.

CONCLUSIONS

This study provides a large database on macro- and micronutrient contents in CNY snacks consumed in the Asian region that has not been previously reported. Our results indicate that the snacks were generally energy-dense and nutrient-poor. This study provides necessary information to enable the reformulation of snacks with lower saturated fat and sodium content. It is also a source of information for consumers to select healthier snacks.

Equity implications of rice fortification: a modelling study from Nepal

Objective:

To model the potential impact and equity impact of fortifying rice on nutritional adequacy of different subpopulations in Nepal.

Design:

Using 24-h dietary recall data and a household consumption survey, we estimated: rice intakes; probability of adequacy (PA) of eight micronutrients commonly fortified in rice (vitamin A, niacin (B₃), pyridoxine (B₆), cobalamin (B₁₂), thiamin (B₁), folate (B₉), Fe and Zn) plus riboflavin (B₂), vitamin C and Ca and mean probability of adequacy (MPA) of these micronutrients. We modelled: no fortification; fortification of purchased rice, averaged across all households and in rice-buying households only. We compared adequacy increases between population subgroups.

Setting:

(i) Dhanusha and Mahottari districts of Nepal (24-h recall) and (ii) all agro-ecological zones of Nepal (consumption data).

Participants:

(i) Pregnant women (n 128), mothers-in-law and male household heads; (ii) households (n 4360).

Results:

Unfortified diets were especially inadequate in vitamins B₁₂, A, B_9, Zn and Fe. Fortification of purchased rice in rice-purchasing households increased PA > 0·9 for thiamin, niacin, B₆, folate and Zn, but B₁₂ and Fe remained inadequate even after fortification (PA range 0·3–0·9). Pregnant women’s increases exceeded men’s for thiamin, niacin, B₆, folate and MPA; men had larger gains in vitamin A, B₁₂ and Zn. Adequacy improved more in the hills (coefficient 0·08 (95 % CI 0·05, 0·10)) and mountains (coefficient 0·07 (95 % CI 0·01, 0·14)) but less in rural areas (coefficient −0·05 (95 % CI −0·09, −0·01)).

Conclusions:

Consumption of purchased fortified rice improves adequacy and gender equity of nutrient intake, especially in non-rice-growing areas.

Guidelines for Complementary Feeding of Infants in the Asia Pacific Region: APACPH Public Health Nutrition Group

Good nutrition in the first "1000 days," including breastfeeding and appropriate complementary foods, prepares for a healthy childhood and adult life, also contributes to the prevention of the double burden of malnutrition. Exclusive breastfeeding provides all required nutrients until an infant is around 6 months of age when complementary foods are needed. A literature review was undertaken of complementary foods in the Asia Pacific region. The foods being used at present are often of low nutrient density may provide insufficient amounts of some critical nutrients, and generally the variety is limited. Guidelines for complementary feeding are provided to assist in education and in public health planning.

Effectiveness of a locally produced ready-to-use supplementary food in preventing growth faltering for children under 2 years in Cambodia: a cluster randomised controlled trial

This cluster randomised controlled trial tested the effectiveness of a locally produced, fish-based, ready-to-use supplementary food (RUSF) to prevent growth faltering (decline in z-scores). Cambodian infants (n= 485), aged 6 to 11 months, were randomised by site to receive the RUSF, Corn-Soy Blend++ (CSB++), micronutrient powders (MNP), or no supplement (control). The intervention was for 6 months. In unadjusted analysis, the control group had statistically significantly decreased weight-for-age z-scores (WAZ; -0.02, 95%CI = -0.03 - -0.01, P= 0.001) and height-for-age z-scores (HAZ; -0.07, 95%CI = -0.09 - -0.05, P < 0.001), and increased mid-upper arm-circumference (MUAC; 0.02cm, 95%CI = 0.01 - 0.04, P = 0.010), but no statistically significant change in weight-for-height z-scores (WHZ). The RUSF group did not differ significantly from the control for WAZ, HAZ or WHZ (in other words, WAZ and HAZ decreased and WHZ did not change), but had increased MUAC in comparison to the control (0.04cm, 95%CI = 0.01 - 0.06, P = 0.008). There were no statistically significant differences between the RUSF group and the CSB++ or MNP groups with respect to WAZ, HAZ, WHZ or MUAC. Interestingly, in adjusted analysis, low consumers of RUSF had increased WAZ, WHZ and MUAC (0.03, 95%CI = 0.01-0.06, P = 0.006; 0.04, 95%CI = 0.01-0.08, P = 0.026; and 0.05cm, 95%CI = 0.02-0.09, P = 0.004, respectively) compared with the control. The novel RUSF, particularly in small quantities, protected against ponderal growth faltering, but the improvements were of limited clinical significance.

Development and testing of locally-produced ready-to-use therapeutic and supplementary foods (RUTFs and RUSFs) in Cambodia: lessons learned

Background

Rates of childhood undernutrition are persistently high in Cambodia. Existing ready-to-use supplementary and therapeutic foods (RUSFs and RUTFs) have had limited acceptance and effectiveness. Therefore, our project developed and trialled a locally-produced, multiple micronutrient fortified lipid-based nutrient supplement (LNS) with therapeutic and supplementary versions. This ready-to-use food (RUF) is innovative in that, unlike many RUFs, it contains fish instead of milk. Development began in 2013 and the RUF was finalised in 2015. From 2015 until the present, both the RUTF and the RUSF versions were trialled for acceptability and effectiveness.

Methods

This paper draws on project implementation records and semi-structured interviews to describe the partnership between the Cambodian Ministries of Health and Agriculture, Forestry and Fisheries, UNICEF, the French National Research Institute for Sustainable Development (IRD), universities, and Vissot factory. It discusses the project implementation and lessons learned from the development and trialling process, and insights into positioning nutrition on the health agenda in low and middle-income countries.

Results

The lessons learned relate to the importance of project planning, management, and documentation in order to seize opportunities in the research, policy, advocacy, and programming environment while ensuring adequate day-to-day project administration and resourcing.

Conclusions

We conclude that projects such as ours, that collaborate to develop and test novel, locally-produced RUTFs and RUSFs, offer an exciting opportunity to respond to both local programmatic and broader research needs.

Problem Nutrients in Adolescent Girls With Anemia Versus Nonanemic Adolescent Girls and the Optimized Food-Based Recommendations to Meet Adequacy of These Nutrients in Adolescent School Girls in East Java, Indonesia

BACKGROUND

Inadequate intake of micronutrients in adolescence leads to high risk of nutritional anemia contributing to the intergenerational cycle of malnutrition.

OBJECTIVE

To compare problem nutrients in diet of girls with anemia and nonanemic girls and develop food-based recommendation (FBR) to prevent anemia (hemoglobin <12.0 g/dL) and micronutrient deficiencies among adolescent schoolgirls.

METHODS

Screening for anemia was conducted among 355 adolescent schoolgirls aged 15 to 18 years in East Java, Indonesia. Food consumption patterns were assessed from 69 girls with anemia and 78 nonanemic girls aged 15 to 18 years using two 24-hour dietary recalls and 5-day food records. Weighing is used to obtain food portion sizes. Linear Programming (LP) approach using Optifood was used to identify problem nutrient(s) and formulate FBRs.

RESULTS

Iron and calcium were problem nutrients among nonanemic girls, while iron, calcium, folate, and vitamin A were problem nutrients among anemic girls. Milk and liver were potential nutrient-dense foods identified to fill the nutrient gaps. Six FBRs would ensure the dietary adequacy for 9 of 12 nutrients except for iron, folate, and calcium.

CONCLUSIONS

Anemic girls had more problem nutrients compared to their nonanemic counterparts. The FBRs developed using LP can meet adequacy of most nutrients except iron, folate, and calcium. Nutrient gap identified from LP analysis suggests that it is advisable to add a mixture of weekly iron and folate supplement for adolescent girls in order to meet adequacy of iron and folate to prevent anemia.