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Ma F, Li Y, Zhang Y, Zhang Q, Li X, Cao Q, Ma H, Xie D, Zhang B, Yu J, Li X, Xie Q, Wan G, Guo M, Guo J, Yin J, Liu G. Effects of umami substances as taste enhancers on salt reduction in meat products: A review. Food Res Int 2024; 185:114248. [PMID: 38658067 DOI: 10.1016/j.foodres.2024.114248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024]
Abstract
Sodium is one of the essential additives in meat processing, but excessive sodium intake may increase risk of hypertension and cardiovascular disease. However, reducing salt content while preserving its preservative effect, organoleptic properties, and technological characteristics poses challenges. In this review, the mechanism of salt reduction of umami substances was introduced from the perspective of gustation-taste interaction, and the effects of the addition of traditional umami substances (amino acids, nucleotides, organic acids(OAs)) and natural umami ingredients (mushrooms, seaweeds, tomatoes, soybeans, tea, grains) on the sensory properties of the meat with reduced-salt contents were summarized. In addition, the impacts of taste enhancers on eating quality (color, sensory, textural characteristics, and water-holding capacity (WHC)), and processing quality (lipid oxidation, pH) of meat products (MP) and their related mechanisms were also discussed. Among them, natural umami ingredients exhibit distinct advantages over traditional umami substances in terms of enhancing quality and nutritional value. On the basis of salt reduction, natural umami ingredients improve the flavor, texture, WHC and antioxidant capacity. This comprehensive review may provide the food industry with a theoretical foundation for mitigating salt consumption through the utilization of umami substances and natural ingredients.
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Affiliation(s)
- Fang Ma
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China
| | - Yang Li
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China
| | - Yuanlv Zhang
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China
| | - Qian Zhang
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China
| | - Xiaoxue Li
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China
| | - Qingqing Cao
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China
| | - Haiyang Ma
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China
| | - Delang Xie
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China
| | - Bingbing Zhang
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China
| | - Jia Yu
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China
| | - Xiaojun Li
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China
| | - Qiwen Xie
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China
| | - Guoling Wan
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China
| | - Mei Guo
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China
| | - Jiajun Guo
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China
| | - Junjie Yin
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China
| | - Guishan Liu
- School of Food Science and Engineering, Ningxia University, Yinchuan, Ningxia 750021, China.
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Adams KP, Vosti SA, Somé JW, Tarini A, Becher E, Koudougou K, Engle-Stone R. Micronutrient-fortified bouillon as a strategy to improve the micronutrient adequacy of diets in Burkina Faso. Ann N Y Acad Sci 2024. [PMID: 38809659 DOI: 10.1111/nyas.15155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Bouillon is a promising candidate for fortification to complement existing large-scale food fortification (LSFF) programs. We used household dietary data from Burkina Faso to model potential contributions of bouillon fortified with vitamin A (40-250 μg/g bouillon), folic acid (20-120 μg/g), vitamin B12 (0.2-2 μg/g), iron (0.6-5 mg/g), and zinc (0.6-5 mg/g) for meeting micronutrient requirements of women of reproductive age (15-49 years; WRA) and children (6-59 months). Most households (82%) reported bouillon consumption, with higher proportions of resource-constrained (84-88%) and rural households (88%) consuming bouillon. Accounting for the contributions of existing LSFF, household diets were inadequate to meet the micronutrient requirements of many WRA and children, exceeding 90% and 60% inadequacy for vitamins A and B12, respectively. Modeling results showed bouillon fortification could reduce inadequacy by up to ∼30 percentage points (pp) for vitamin A, ∼26 pp for folate among WRA (∼11 pp among children), ∼38 pp for vitamin B12, and 11-13 pp for zinc, with comparable reductions across socioeconomic strata and urban and rural residence. Predicted reductions in iron inadequacy were <3 pp. These results suggest dietary micronutrient inadequacies are a concern in Burkina Faso, and fortified bouillon can make substantial contributions to reducing micronutrient inadequacies, including among resource-constrained and rural populations.
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Affiliation(s)
- Katherine P Adams
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA
| | - Stephen A Vosti
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California, USA
| | - Jérome W Somé
- Institut de Recherche en Sciences de la Santé, Centre National de Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | | | - Emily Becher
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA
| | | | - Reina Engle-Stone
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA
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Engle-Stone R, Wessells KR, Haskell MJ, Kumordzie SM, Arnold CD, Davis JN, Becher ER, Fuseini AD, Nyaaba KW, Tan X, Adams KP, Lietz G, Vosti SA, Adu-Afarwuah S. Effect of multiple micronutrient-fortified bouillon on micronutrient status among women and children in the Northern Region of Ghana: Protocol for the Condiment Micronutrient Innovation Trial (CoMIT), a community-based randomized controlled trial. PLoS One 2024; 19:e0302968. [PMID: 38709803 PMCID: PMC11073681 DOI: 10.1371/journal.pone.0302968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Micronutrient deficiencies are prevalent in West Africa, particularly among women of reproductive age (WRA) and young children. Bouillon is a promising food fortification vehicle due to its widespread consumption. This study aims to evaluate the impact of multiple micronutrient-fortified bouillon cubes, compared to control bouillon cubes (fortified with iodine only), on micronutrient status and hemoglobin concentrations among lactating and non-lactating WRA and young children in northern Ghana. METHODS This randomized, controlled doubly-masked trial will be conducted in the Kumbungu and Tolon districts in the Northern Region of Ghana, where prior data indicate multiple micronutrient deficiencies are common. Participants will be: 1) non-pregnant non-lactating WRA (15-49 y), 2) children 2-5 y, and 3) non-pregnant lactating women 4-18 months postpartum. Eligible participants will be randomly assigned to receive household rations of one of two types of bouillon cubes: 1) a multiple micronutrient-fortified bouillon cube containing vitamin A, folic acid, vitamin B12, iron, zinc, and iodine, or 2) a control cube containing iodine only. Each participant's household will receive a ration of bouillon cubes every 2 weeks, and households will be advised to prepare meals as usual, using the study-provided cubes. The trial duration will be 9 months for non-pregnant non-lactating WRA and children, and 3 months for lactating women. The primary outcomes will be changes in biomarkers of micronutrient status and hemoglobin among WRA and children and milk micronutrient concentrations among lactating women. Secondary outcomes will include change in prevalence of micronutrient deficiency and anemia; dietary intake of bouillon and micronutrients; inflammation, malaria, and morbidity symptoms; and child growth and development. DISCUSSION Evidence from this study will inform discussions about bouillon fortification in Ghana and West Africa. TRIAL REGISTRATION The trial was registered on ClinicalTrials.gov (NCT05178407) and the Pan-African Clinical Trial Registry (PACTR202206868437931). This manuscript reflects protocol version 4 (August 29, 2022).
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Affiliation(s)
- Reina Engle-Stone
- Department of Nutrition, University of California, Davis, California, United States of America
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - K Ryan Wessells
- Department of Nutrition, University of California, Davis, California, United States of America
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - Marjorie J. Haskell
- Department of Nutrition, University of California, Davis, California, United States of America
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - Sika M. Kumordzie
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - Charles D. Arnold
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - Jennie N. Davis
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - Emily R. Becher
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - Ahmed D. Fuseini
- Department of Food Science and Nutrition, University of Ghana, Legon, Ghana
| | - Kania W. Nyaaba
- Department of Food Science and Nutrition, University of Ghana, Legon, Ghana
| | - Xiuping Tan
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - Katherine P. Adams
- Department of Nutrition, University of California, Davis, California, United States of America
- Institute for Global Nutrition, University of California, Davis, California, United States of America
| | - Georg Lietz
- Institute of Cellular Medicine, Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Stephen A. Vosti
- Institute for Global Nutrition, University of California, Davis, California, United States of America
- Department of Agricultural and Resource Economics, University of California, Davis, California, United States of America
| | - Seth Adu-Afarwuah
- Department of Food Science and Nutrition, University of Ghana, Legon, Ghana
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Gafane-Matemane LF, Craig A, Kruger R, Alaofin OS, Ware LJ, Jones ESW, Kengne AP. Hypertension in sub-Saharan Africa: the current profile, recent advances, gaps, and priorities. J Hum Hypertens 2024:10.1038/s41371-024-00913-6. [PMID: 38698111 DOI: 10.1038/s41371-024-00913-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
Recent global and regional reports consistently confirm the high and increasing prevalence of hypertension in sub-Saharan Africa (SSA), with poor detection, treatment, and control rates. This narrative review summarises the burden of hypertension in SSA and recent findings from community-based hypertension management strategies. We further outline prominent risk factors according to recent data and associated underlying mechanisms for hypertension development. An extensive review of literature showed that most countries have reported on the prevalence of hypertension during 2017-2023, despite limitations linked to the lack of nationally representative studies, heterogeneity of sampling and data collection methods. Task-shifting approaches that assign roles to model patients and community health workers reported improved linkage to healthcare services and adherence to medication, with inconsistent findings on blood pressure (BP)-lowering effects over time. The regularly reported risk factors include unhealthy diet, sedentary lifestyle, increased adiposity and underweight, ageing, level of education, and/or income as well as psychosocial factors. Newer data on the pathophysiological mechanisms leading to hypertension and potential areas of intervention are reported from children and adults and include, among others, salt-handling and volume overload, endothelial function, BP dipping patterns and the role of human immunodeficiency virus . To conclude, significant strides have been made in data reporting from SSA on the burden of hypertension in the region as well as biomarker research to improve understanding and identification of areas of intervention. However, gaps remain on linkage between knowledge generation, translation, and implementation research. Coordinated studies addressing both discovery science and public health are crucial to curb hypertension development and improve management in SSA.
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Affiliation(s)
- Lebo F Gafane-Matemane
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa.
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa.
| | - Ashleigh Craig
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Soweto, 1864, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa
| | - Omotayo S Alaofin
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Soweto, 1864, South Africa
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University, Mthatha, South Africa
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Ge R, You S, Zheng D, Zhang Z, Cao Y, Chang J. Global, regional, and national temporal trends of diet-related ischemic stroke mortality and disability from 1990 to 2019. Int J Stroke 2024:17474930241237932. [PMID: 38415357 DOI: 10.1177/17474930241237932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Stroke is the second leading cause of death and the third leading cause of disability in the general population worldwide. However, the changing trend of ischemic stroke burden attributable to various dietary risk factors has not been fully revealed and may contribute to a better understanding of stroke epidemiology. AIMS Our article aimed to evaluate the temporal trend of diet-related ischemic stroke burden to inform future research and policy-making. METHODS This analysis was based on the data from the Global Burden of Disease (GBD) Study 2019 (spanning years 1990 to 2019), and we used the joinpoint regression to model temporal trends in diet-related ischemic stroke burden across countries and regions of the world during the study period. Six specific dietary factors known to influence stroke risk, including sodium, red meat, fiber, vegetables, whole grains, and fruits, were evaluated in the GBD study to determine their individual and joint impact on ischemic stroke. The changing trend was primarily measured by the average annual percent change (AAPC). Age-standardized rates (ASRs) of mortality and years lived with disability (YLD) per 100,000 population were used to evaluate disease burden. Finally, the socioeconomic background, which was quantified as sociodemographic index (SDI), and its association with diet-related ischemic stroke burden were also explored with the Pearson correlation coefficient. RESULTS During the study period, the ischemic stroke ASR of mortality attributable to overall dietary risk decreased by an average of 1.6% per year, while the ASR of YLD decreased by an average of 0.2% per year. High sodium diet was still a key driver of diet-related ischemic stroke, accounting for 8.4% and 11.0% of deaths and disabilities, respectively, in 2019. In addition, we found a negative association between temporal evolution of stroke burden and socioeconomic background (r = -0.6603 for mortality and r = -0.4224 for disability, P < 0.001), which suggested that the developing countries with weak social and economic foundation faced greater challenges from the ongoing burden of diet-related strokes compared with developed countries. CONCLUSIONS Our study found declining trends and revealed the current status of diet-related ischemic stroke mortality and disability. Interdisciplinary countermeasures involving the development of effective food policies, evidence-based guidelines, and public education are needed in the future to combat this global epidemic. DATA ACCESS STATEMENT The data used for analysis were open-access and can be obtained from https://vizhub.healthdata.org/gbd-results/.
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Affiliation(s)
- Rongguang Ge
- Department of Neurology and Clinical Research Center of Neurological Disease, Soochow Medical College, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shoujiang You
- Department of Neurology and Clinical Research Center of Neurological Disease, Soochow Medical College, The Second Affiliated Hospital of Soochow University, Suzhou, China
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Danni Zheng
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Zengli Zhang
- Department of Occupational and Environmental Health, School of Public Health, Soochow Medical College, Soochow University, Suzhou, China
| | - Yongjun Cao
- Department of Neurology and Clinical Research Center of Neurological Disease, Soochow Medical College, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jie Chang
- Department of Occupational and Environmental Health, School of Public Health, Soochow Medical College, Soochow University, Suzhou, China
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Davis JN, Kumordzie SM, Arnold CD, Wessells KR, Nyaaba KW, Adams KP, Tan XJ, Becher E, Vosti SA, Adu-Afarwuah S, Engle-Stone R. Consumption of Discretionary Salt and Salt from Bouillon among Households, Women, and Young Children in Northern Region, Ghana: A Mixed-Methods Study with the Condiment Micronutrient Innovation Trial (CoMIT) Project. Curr Dev Nutr 2024; 8:102088. [PMID: 38419834 PMCID: PMC10897853 DOI: 10.1016/j.cdnut.2024.102088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Background Information on salt consumption patterns is needed to inform the need for and design of salt reduction strategies. Objectives In northern Ghana, this study aimed to estimate household consumption of salt, including salt from bouillon, and compare (estimated) women and children's salt intake to global recommendations; to estimate the proportion of salt consumed from bouillon; and to identify factors, including knowledge, attitudes, and practices, associated with household salt consumption. Methods Employing mixed-methods methodology, we conducted a pilot survey (n = 369 households enrolled) and focus group discussions (FGDs; n = 20) in Tolon and Kumbungu districts (14 urban, 14 rural clusters) (clinicaltrials.gov registry: NCT04632771). Households reported purchases of discretionary salt (DS, "table salt") and bouillon cubes. DS and total salt (TS; DS+salt from bouillon) consumption for women (15-49 y) and children (2-5 y) were estimated using the Adult Male Equivalent method and compared with global recommendations (<5 g/d women; <3.75 g/d children). Women's salt intake was also predicted from urinary sodium excretion (INTERSALT equation). Associations between DS and TS consumption, as well as household and women's characteristics, were tested with minimally adjusted and multivariable linear mixed-effects models. Qualitative FGD themes were generated using the Framework Method. Results From household purchase data, estimated TS consumption exceeded global recommendations for 44% of children [median: 2.9 (IQR: 1.9, 5.2) g/d] and 60% of women [6.0 (4.0, 10.2) g/d]; 35% of children and 50% of women exceeded recommendations from DS alone. Bouillon contributed <25% of households' TS consumption. Few characteristics were associated with DS or TS consumption. Salient qualitative themes that shaped salt consumption behaviors included salt's ubiquity as a seasoning, key household members' influence on food procurement and preparation, and perceptions about health. Conclusions Purchase data suggest salt consumption among women and children exceeds recommendations, even when excluding salt from bouillon; food prepared outside the home likely further contributes. Salt reduction interventions may be warranted in this context.
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Affiliation(s)
- Jennie N Davis
- University of California, Department of Nutrition, Institute for Global Nutrition, Davis, CA, United States
| | - Sika M Kumordzie
- University of California, Department of Nutrition, Institute for Global Nutrition, Davis, CA, United States
| | - Charles D Arnold
- University of California, Department of Nutrition, Institute for Global Nutrition, Davis, CA, United States
| | - K Ryan Wessells
- University of California, Department of Nutrition, Institute for Global Nutrition, Davis, CA, United States
| | - Kania W Nyaaba
- University of Ghana, Department of Nutrition and Food Science, Legon, Accra, Ghana
| | - Katherine P Adams
- University of California, Department of Nutrition, Institute for Global Nutrition, Davis, CA, United States
| | - Xiuping Jenny Tan
- University of California, Department of Nutrition, Institute for Global Nutrition, Davis, CA, United States
| | - Emily Becher
- University of California, Department of Nutrition, Institute for Global Nutrition, Davis, CA, United States
| | - Stephen A Vosti
- University of California, Department of Agriculture and Resource Economics, Institute for Global Nutrition, Davis, CA, United States
| | - Seth Adu-Afarwuah
- University of Ghana, Department of Nutrition and Food Science, Legon, Accra, Ghana
| | - Reina Engle-Stone
- University of California, Department of Nutrition, Institute for Global Nutrition, Davis, CA, United States
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Matthias D, McDonald CM, Archer N, Engle-Stone R. The Role of Multiply-Fortified Table Salt and Bouillon in Food Systems Transformation. Nutrients 2022; 14:nu14050989. [PMID: 35267964 PMCID: PMC8912775 DOI: 10.3390/nu14050989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 01/09/2023] Open
Abstract
Our global food system lacks the critically needed micronutrients to meet the daily requirements of the most at-risk populations. Diets also continue to shift toward unhealthy foods, including the increased intake of salt. While most countries exceed the WHO’s recommended levels, sodium does play an essential physiological role. Table salt and other salt-containing condiments, such as bouillon, also have cultural importance, as they are used to enhance the flavor of foods cooked at home. Given their universal consumption across income classes and both urban and rural populations, these condiments are an integral part of the food system and should, therefore, be part of its transformation. Fortification of salt and salt-containing condiments can play a catalytic role in the delivery of population-wide nutritional and health benefits. With relatively consistent levels of intake across the population, these condiments hold high potential for delivering micronutrients beyond iodine while also reducing concerns related to high micronutrient intake, particularly so in countries where the industries are relatively consolidated. As a flexible and complementary strategy to an evolving food system, fortification levels can also be adjusted over time to ensure micronutrient delivery targets continue to be achieved as the system improves, whether through lower intakes of sodium in line with WHO recommendations, enhanced consumption of nutrient-dense foods, and/or broader adoption of biofortified crops. Future areas of innovation are required to realize this vision, including developing affordable salt substitutes to meet cost requirements of consumers in low-and middle-income countries, improving the stability and bioavailability of the micronutrients in condiments so that delivery targets can be reached without affecting sensory attributes, and the development of efficient systems for monitoring population intake and micronutrient status to inform fortification program design and management. Rather than being considered antithetical to the transformation, multiply-fortified salt and bouillon can strengthen our ability to meet the cultural, sensory, nutritional, and health needs of an evolving food system.
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Affiliation(s)
- Dipika Matthias
- Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
- Correspondence:
| | - Christine M. McDonald
- Departments of Pediatrics, and Epidemiology and Biostatistics, University of California, San Francisco, CA 94143, USA;
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA 95616, USA;
| | - Nicholas Archer
- CSIRO Health and Biosecurity, North Ryde, Sydney 2113, Australia;
| | - Reina Engle-Stone
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA 95616, USA;
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