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Hazel EA, Erchick DJ, Katz J, Lee ACC, Diaz M, Wu LSF, West KP, Shamim AA, Christian P, Ali H, Baqui AH, Saha SK, Ahmed S, Roy AD, Silveira MF, Buffarini R, Shapiro R, Zash R, Kolsteren P, Lachat C, Huybregts L, Roberfroid D, Zhu Z, Zeng L, Gebreyesus SH, Tesfamariam K, Adu-Afarwuah S, Dewey KG, Gyaase S, Poku-Asante K, Boamah Kaali E, Jack D, Ravilla T, Tielsch J, Taneja S, Chowdhury R, Ashorn P, Maleta K, Ashorn U, Mangani C, Mullany LC, Khatry SK, Ramokolo V, Zembe-Mkabile W, Fawzi WW, Wang D, Schmiegelow C, Minja D, Msemo OA, Lusingu JPA, Smith ER, Masanja H, Mongkolchati A, Keentupthai P, Kakuru A, Kajubi R, Semrau K, Hamer DH, Manasyan A, Pry JM, Chasekwa B, Humphrey J, Black RE. Neonatal mortality risk of vulnerable newborns by fine stratum of gestational age and birthweight for 230 679 live births in nine low- and middle-income countries, 2000-2017. BJOG 2024. [PMID: 38228570 DOI: 10.1111/1471-0528.17743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/29/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To describe the mortality risks by fine strata of gestational age and birthweight among 230 679 live births in nine low- and middle-income countries (LMICs) from 2000 to 2017. DESIGN Descriptive multi-country secondary data analysis. SETTING Nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America. POPULATION Liveborn infants from 15 population-based cohorts. METHODS Subnational, population-based studies with high-quality birth outcome data were invited to join the Vulnerable Newborn Measurement Collaboration. All studies included birthweight, gestational age measured by ultrasound or last menstrual period, infant sex and neonatal survival. We defined adequate birthweight as 2500-3999 g (reference category), macrosomia as ≥4000 g, moderate low as 1500-2499 g and very low birthweight as <1500 g. We analysed fine strata classifications of preterm, term and post-term: ≥42+0 , 39+0 -41+6 (reference category), 37+0 -38+6 , 34+0 -36+6 ,34+0 -36+6 ,32+0 -33+6 , 30+0 -31+6 , 28+0 -29+6 and less than 28 weeks. MAIN OUTCOME MEASURES Median and interquartile ranges by study for neonatal mortality rates (NMR) and relative risks (RR). We also performed meta-analysis for the relative mortality risks with 95% confidence intervals (CIs) by the fine categories, stratified by regional study setting (sub-Saharan Africa and Southern Asia) and study-level NMR (≤25 versus >25 neonatal deaths per 1000 live births). RESULTS We found a dose-response relationship between lower gestational ages and birthweights with increasing neonatal mortality risks. The highest NMR and RR were among preterm babies born at <28 weeks (median NMR 359.2 per 1000 live births; RR 18.0, 95% CI 8.6-37.6) and very low birthweight (462.8 per 1000 live births; RR 43.4, 95% CI 29.5-63.9). We found no statistically significant neonatal mortality risk for macrosomia (RR 1.1, 95% CI 0.6-3.0) but a statistically significant risk for all preterm babies, post-term babies (RR 1.3, 95% CI 1.1-1.5) and babies born at 370 -386 weeks (RR 1.2, 95% CI 1.0-1.4). There were no statistically significant differences by region or underlying neonatal mortality. CONCLUSIONS In addition to tracking vulnerable newborn types, monitoring finer categories of birthweight and gestational age will allow for better understanding of the predictors, interventions and health outcomes for vulnerable newborns. It is imperative that all newborns from live births and stillbirths have an accurate recorded weight and gestational age to track maternal and neonatal health and optimise prevention and care of vulnerable newborns.
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Affiliation(s)
- Elizabeth A Hazel
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel J Erchick
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanne Katz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne C C Lee
- Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Diaz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lee S F Wu
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keith P West
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Parul Christian
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hasmot Ali
- JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh
| | - Abdullah H Baqui
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Mariângela F Silveira
- Post-Graduate Program in Epidemiology-Federal University of Pelotas, Pelotas, Brazil
| | - Romina Buffarini
- Post-Graduate Program in Epidemiology-Federal University of Pelotas, Pelotas, Brazil
| | - Roger Shapiro
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca Zash
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Dominique Roberfroid
- Namur University, Namur, Belgium
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - Zhonghai Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Seifu H Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kokeb Tesfamariam
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Kathryn G Dewey
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA
| | | | | | - Ellen Boamah Kaali
- Kintampo Health Research Centre, Kintampo, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Darby Jack
- Columbia University's Mailman School of Public Health, New York, New York, USA
| | | | - James Tielsch
- George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Per Ashorn
- Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Kenneth Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ulla Ashorn
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Charles Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Luke C Mullany
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Vundli Ramokolo
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Wanga Zembe-Mkabile
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- College Graduate of Studies, University of South Africa, Pretoria, South Africa
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA
| | - Christentze Schmiegelow
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Minja
- National Institute of Medical Research, Tanga, Tanzania
| | | | | | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
| | | | | | - Paniya Keentupthai
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani, Thailand
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Richard Kajubi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Katherine Semrau
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Albert Manasyan
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jake M Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean Humphrey
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert E Black
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Anwar A, Ali AM, Yadav UN, Huda MN, Rizwan AAM, Parray AA, Sarma H, Halima O, Saha N, Shuvo SD, Mondal PK, Shamim AA, Mistry SK. Promotion of livelihood opportunities to address food insecurity in Rohingya refugee camps of Bangladesh. Glob Public Health 2024; 19:2295446. [PMID: 38118127 DOI: 10.1080/17441692.2023.2295446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/11/2023] [Indexed: 12/22/2023]
Abstract
The world is facing a tremendous problem in the form of food insecurity that is posing a great challenge to achieving sustainable development goal 2 of creating a hunger-free world. Refugees and displaced populations are particularly vulnerable to food insecurity and malnutrition, who lack any productive assets and depend on aid. Rohingya refugees, displaced from Myanmar and took refuge in Cox's Bazar, Bangladesh, live in a crowded unhealthy environment and are severely vulnerable to food insecurity and malnutrition. In our recent study, we found that only 21.6% of the households in Rohingya refugee camps had acceptable food security status. Interestingly, this study further revealed that acceptable food security status was significantly higher among the households that had some additional income aside from aid, compared to those relying on aid alone. This shows the importance of promoting livelihood opportunities to improve food security status among the camp dwellers. In this paper, we presented our views on promoting livelihood opportunities to address the overwhelming food insecurity crisis among the Rohingya refugees in Bangladesh.
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Affiliation(s)
- Afsana Anwar
- Rohingya Response Crisis, World Vision Bangladesh, Cox's Bazar, Bangladesh
| | | | - Uday Narayan Yadav
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Md Nazmul Huda
- ARCED Foundation, Dhaka, Bangladesh
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | | | - Ateeb Ahmad Parray
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MA, USA
| | - Haribondhu Sarma
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Oumma Halima
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| | - Nobonita Saha
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| | - Suvasish Das Shuvo
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, Bangladesh
| | | | - Abu Ahmed Shamim
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sabuj Kanti Mistry
- ARCED Foundation, Dhaka, Bangladesh
- School of Population Health, University of New South Wales, Sydney, Australia
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
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Shaheen N, Shamim AA, Choudhury SR, Sarwar S, Ashraf MM, Bahar N, Al Mamun MA, Sobhan SMM, Abedin MJ, Karim MR, Amin MR, Alim A. Commonly consumed processed packaged foods in Bangladesh are unhealthy and their nutrient contents are not in conformity with the label declaration. Food Sci Nutr 2024; 12:481-493. [PMID: 38268880 PMCID: PMC10804074 DOI: 10.1002/fsn3.3772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/22/2023] [Accepted: 10/04/2023] [Indexed: 01/26/2024] Open
Abstract
The present study was undertaken to identify the major nutrient content in processed foods commonly consumed in Bangladesh, their label conformity healthiness, and percent daily nutrient contribution. Twenty-four nationally representative composite samples were analyzed using AOAC and other standard methods. Results were compared with label information using a restrictive approach and EU tolerance guidelines. The healthiness of the products was evaluated in terms of the Health Star Rating (HSR) scheme and the UK traffic light labeling system. Among the analyzed samples, fried pulse, chanachur, lozenge, and fried peas had the highest amount of protein, fat, carbohydrates, and dietary fiber, respectively. Biscuits and milk chocolate had high levels of trans fatty acids (TFA) and saturated fatty acids (SFA). It was observed that around half of the products lacked information about saturated fatty acid (46%), followed by total dietary fiber and trans-fat (38% each). Other information was missing in one-fifth of the products, namely protein (17%), total fat (17%), available carbohydrate (17%), energy (17%), sugar (21%), and salt (21%). Label compliance analysis according to the restrictive approach revealed that none of the products accurately reported the salt, sugar, saturated fat, and trans fat content on the label. According to the EU tolerance guideline, approximately half of the products had protein (58%), fat (54%), and carbohydrate (42%) levels that fell within the EU tolerance limit. However, only around one-third of the samples had sugar (21%), salt (38%), and saturated fat (33%) levels that met the EU tolerance limit. In terms of healthiness analysis, according to the HSR, the range of stars was between 0.5 and 2.5 of the foods where fried peas got the highest rating (2.5 stars), while in terms of the UK traffic light system, none of the samples got all green signals. The lozenge got green lights for fat, SFA, and salt contents. It was also found that consumption of 100 g of fried peas or pulse would exceed the acceptable daily limit of salt, sugar, and SFA compared to the daily maximum allowable intake for the 2000 kcal diet recommended by the WHO. However, according to the serving size, biscuits were major contributors of TFA, sugar, and SFA, whereas fried pulse was a key contributor of sodium/salt. Proper regulatory actions should be introduced to promote healthy processed foods with user-friendly front-of-the-pack labeling and monitor their quality to prevent non-communicable diseases (NCDs).
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Affiliation(s)
- Nazma Shaheen
- Institute of Nutrition and Food ScienceUniversity of DhakaDhakaBangladesh
| | - Abu Ahmed Shamim
- National Heart Foundation Hospital & Research InstituteDhakaBangladesh
- Center for Non‐communicable Diseases and Nutrition, BRAC James P Grant of School of Public HealthBRAC UniversityDhakaBangladesh
| | | | - Sneha Sarwar
- Institute of Nutrition and Food ScienceUniversity of DhakaDhakaBangladesh
- National Heart Foundation Hospital & Research InstituteDhakaBangladesh
| | | | - Nisarga Bahar
- Institute of Nutrition and Food ScienceUniversity of DhakaDhakaBangladesh
- National Heart Foundation Hospital & Research InstituteDhakaBangladesh
| | | | | | - Md Joynul Abedin
- Institute of Nutrition and Food ScienceUniversity of DhakaDhakaBangladesh
| | - Md Rizwanul Karim
- Non‐Communicable Disease Control (NCDC) ProgrammeDirectorate General of Health Services (DGHS)DhakaBangladesh
| | - Mohammad Robed Amin
- Non‐Communicable Disease Control (NCDC) ProgrammeDirectorate General of Health Services (DGHS)DhakaBangladesh
| | - Abdul Alim
- Non‐Communicable Disease Control (NCDC) ProgrammeDirectorate General of Health Services (DGHS)DhakaBangladesh
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4
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Shamim AA, Hossain MM, Akter F, Urmy NJ, Hanif AAM, Hasan M, Khan MSA, Ullah MA, Bulbul MMI, Mridha MK. Unhealthy Foods and Sugar-Sweetened Beverages Consumption Among Bangladeshi Adolescents and Their Sociodemographic Determinants: Findings From a Nationally Representative Cross-Sectional Study. Cureus 2023; 15:e41262. [PMID: 37529825 PMCID: PMC10390030 DOI: 10.7759/cureus.41262] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Consumption of savory crispy or fried snacks (SCFS), sugary snacks (SS), and sugar-sweetened beverages (SSB) is associated with an increased prevalence of obesity and noncommunicable diseases. We aimed to estimate the consumption of SCFS, SS, and SSB among adolescent males and females in Bangladesh and to report the factors associated with their consumption using data from a nationwide cross-sectional survey. METHODS We interviewed 4,907 adolescent males and 4,865 females for the seven-day recall on intake of SCFS, SS, and SSB from 82 randomly selected clusters from rural, non-slum urban, and slum areas. Sociodemographic and anthropometry data were also collected. RESULTS Consumption of SCFS, SS, and SSB for ≥7 times per week was reported by 11.6%, 28.9%, and 25.6% of the males and 4.9%, 24.8%, and 20.7% of the females, respectively. The weekly mean frequency of SCFS, SS, and SSB intake increased after adjustment for potential confounders among females with higher maternal education and for SCFS and SSB among males with the highest level of father's education. Increased intake of SS and SSB for both males and females was associated with dwelling in a female-headed household. SCFS intake was higher among both males and females from the richest households. Nutritional status, both overweight and obesity, and underweight, was not associated with a more frequent intake of SCFS and SS among males and females; however, a lower frequency of intake of SSB was observed among overweight and obese males. Screen time (television viewing: none, up to 1 hour, and more than 1 hour) was not associated with consumption of SCFS and SSB among both males and females. CONCLUSION Consumption of unhealthy snacks and drinks is high among adolescents in Bangladesh and needs to be addressed through policy and program measures to abate the epidemic of obesity and associated NCD.
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Affiliation(s)
- Abu Ahmed Shamim
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BGD
| | - Md Mokbul Hossain
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BGD
| | - Fahmida Akter
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BGD
| | - Nushrat Jahan Urmy
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BGD
| | - Abu Abdullah Mohammad Hanif
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BGD
| | - Mehedi Hasan
- James P Grant School of Public Health, BRAC University, Dhaka, BGD
| | - Md Showkat Ali Khan
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BGD
| | - Mohammad Aman Ullah
- Ministry of Health and Family Welfare, Bangladesh, National Nutrition Services (NNS), Dhaka, BGD
| | - Md Mafizul I Bulbul
- Ministry of Health and Family Welfare, Bangladesh, National Nutrition Services, Dhaka, BGD
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BGD
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5
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Hazel EA, Erchick DJ, Katz J, Lee ACC, Diaz M, Wu LSF, West KP, Shamim AA, Christian P, Ali H, Baqui AH, Saha SK, Ahmed S, Roy AD, Silveira MF, Buffarini R, Shapiro R, Zash R, Kolsteren P, Lachat C, Huybregts L, Roberfroid D, Zhu Z, Zeng L, Gebreyesus SH, Tesfamariam K, Adu-Afarwuah S, Dewey KG, Gyaase S, Poku-Asante K, Boamah Kaali E, Jack D, Ravilla T, Tielsch J, Taneja S, Chowdhury R, Ashorn P, Maleta K, Ashorn U, Mangani C, Mullany LC, Khatry SK, Ramokolo V, Zembe-Mkabile W, Fawzi WW, Wang D, Schmiegelow C, Minja D, Msemo OA, Lusingu JPA, Smith ER, Masanja H, Mongkolchati A, Keentupthai P, Kakuru A, Kajubi R, Semrau K, Hamer DH, Manasyan A, Pry JM, Chasekwa B, Humphrey J, Black RE. Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017. BJOG 2023. [PMID: 37156238 DOI: 10.1111/1471-0528.17518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE We aimed to understand the mortality risks of vulnerable newborns (defined as preterm and/or born weighing smaller or larger compared to a standard population), in low- and middle-income countries (LMICs). DESIGN Descriptive multi-country, secondary analysis of individual-level study data of babies born since 2000. SETTING Sixteen subnational, population-based studies from nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America. POPULATION Live birth neonates. METHODS We categorically defined five vulnerable newborn types based on size (large- or appropriate- or small-for-gestational age [LGA, AGA, SGA]), and term (T) and preterm (PT): T + LGA, T + SGA, PT + LGA, PT + AGA, and PT + SGA, with T + AGA (reference). A 10-type definition included low birthweight (LBW) and non-LBW, and a four-type definition collapsed AGA/LGA into one category. We performed imputation for missing birthweights in 13 of the studies. MAIN OUTCOME MEASURES Median and interquartile ranges by study for the prevalence, mortality rates and relative mortality risks for the four, six and ten type classification. RESULTS There were 238 203 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.6, interquartile range [IQR] 2.0-2.9), PT + LGA (median RR 7.3, IQR 2.3-10.4), PT + AGA (median RR 6.0, IQR 4.4-13.2) and PT + SGA (median RR 10.4, IQR 8.6-13.9). T + SGA, PT + LGA and PT + AGA babies who were LBW, had higher risk compared with non-LBW babies. CONCLUSIONS Small and/or preterm babies in LIMCs have a considerably increased mortality risk compared with babies born at term and larger. This classification system may advance the understanding of the social determinants and biomedical risk factors along with improved treatment that is critical for newborn health.
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Affiliation(s)
- Elizabeth A Hazel
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel J Erchick
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanne Katz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne C C Lee
- Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Diaz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lee S F Wu
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keith P West
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Parul Christian
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hasmot Ali
- JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Mariângela F Silveira
- Post-Graduate Program in Epidemiology - Federal University of Pelotas, Pelotas, Brazil
| | - Romina Buffarini
- Post-Graduate Program in Epidemiology - Federal University of Pelotas, Pelotas, Brazil
| | - Roger Shapiro
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca Zash
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Dominique Roberfroid
- Namur University, Namur, Belgium
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - Zhonghai Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Seifu H Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kokeb Tesfamariam
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Kathryn G Dewey
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA
| | | | | | - Ellen Boamah Kaali
- Kintampo Health Research Centre, Kintampo, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Darby Jack
- Columbia University's Mailman School of Public Health, New York, New York, USA
| | | | - James Tielsch
- George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Per Ashorn
- Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Kenneth Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ulla Ashorn
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Charles Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Luke C Mullany
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Vundli Ramokolo
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Wanga Zembe-Mkabile
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- South African Research Chair in Social Policy at College Graduate of Studies, University of South Africa, Pretoria, South Africa
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Minja
- National Institute of Medical Research, Tanga, Tanzania
| | | | | | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
| | | | | | - Paniya Keentupthai
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani, Thailand
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Richard Kajubi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Katherine Semrau
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Albert Manasyan
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jake M Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean Humphrey
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert E Black
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Rahman S, Saha N, Sarwar S, Shamim AA, Shaheen N. Corrigendum: J Water Health (2022) 20 (11): 1644-1653: Can guava (Psidium guajava) leaf extracts develop an indigenous, simplified tool for a semi-quantitative assessment of iron in groundwater? Sabuktagin Rahman, Nobonita Saha, Sneha Sarwar, Abu Ahmed Shamim, Nazma Shaheen. J Water Health 2022; 20:1762. [PMID: 36573680 DOI: 10.2166/wh.2022.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Sabuktagin Rahman
- Department of Nutrition and Food Engineering, Faculty of Allied Health Science, Daffodil International University, Ashulia, Dhaka 1341, Bangladesh
| | - Nobonita Saha
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka 1000, Bangladesh
| | - Sneha Sarwar
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka 1000, Bangladesh
| | - Abu Ahmed Shamim
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Nazma Shaheen
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka 1000, Bangladesh
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Rahman S, Saha N, Sarwar S, Shamim AA, Shaheen N. Can guava (Psidium guajava) leaf extracts develop an indigenous, simplified tool for a semi-quantitative assessment of iron in groundwater? J Water Health 2022; 20:1644-1653. [PMID: 36448614 DOI: 10.2166/wh.2022.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Iron present in the drinking groundwater is attributed to the low burden of iron deficiency (ID) in Bangladesh. The supplemental anemia prevention strategies involving iron need a cautious approach due to the excess load of iron and the side effects. The present pilot study examined the potential of the guava leaf extracts to use as a natural reagent for the assessment of iron in groundwater. Eighteen households with the drinking source of groundwater were randomly selected. Guava leaves were crushed and the shreds of the leaves were mixed with the water sample. Changes of water color were photographed. Five groups were identified - 'whitish', 'shades of pink', 'shades of purple', 'light black' and the 'frank black'. The iron concentration was measured by a test kit device. Each color group was assigned a number on the ordinal scale 1-5. Statistical correlation and agreements were performed between the methods. The positive correlation (Kendall's tau b: 0.89, p < 0.000) and the agreements (Kappa: 0.77, p < 0.000; rho_c: 0.73, p < 0.000) were observed. Guava leaf extracts may standardize an indigenous tool for a semi-quantitative measurement of groundwater iron content. Validation of the tool thus may aid in the design and evaluation of the iron supplementation and fortification programs.
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Affiliation(s)
- Sabuktagin Rahman
- Department of Nutrition and Food Engineering, Faculty of Allied Health Science, Daffodil International University, Ashulia, Dhaka 1341, Bangladesh E-mail:
| | - Nobonita Saha
- Department of Nutrition and Food Engineering, Faculty of Allied Health Science, Daffodil International University, Ashulia, Dhaka 1341, Bangladesh E-mail:
| | - Sneha Sarwar
- Department of Nutrition and Food Engineering, Faculty of Allied Health Science, Daffodil International University, Ashulia, Dhaka 1341, Bangladesh E-mail:
| | - Abu Ahmed Shamim
- Department of Nutrition and Food Engineering, Faculty of Allied Health Science, Daffodil International University, Ashulia, Dhaka 1341, Bangladesh E-mail:
| | - Nazma Shaheen
- Department of Nutrition and Food Engineering, Faculty of Allied Health Science, Daffodil International University, Ashulia, Dhaka 1341, Bangladesh E-mail:
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Merrill R, de Pee S, Ahmed T, Kramer K, Hossain N, Choudhury N, Schumacher B, Steiger G, Minhas S, Shamim AA, Shaikh S, Fuli R, Christian P. Design, development, and local production of lipid-based nutritional supplements to enhance the complementary feeding diet: A model for collaboration for a feeding trial in Bangladesh. Gates Open Res 2022; 6:122. [DOI: 10.12688/gatesopenres.13673.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Lipid-based nutrient supplements (LNS) are effective for treating childhood wasting and for preventing stunting, wasting, and anemia, but large-scale production and programmatic use are a barrier. Locally-developed and produced LNS may be more affordable and reduce logistical procurement and importation hurdles, while promoting private sector engagement and partnership. Methods: In northwestern Bangladesh, we conducted a community-based trial of complementary food supplementation to test its efficacy to reduce childhood stunting. Two locally-developed, small-quantity LNS (20g/day, rice-lentil and chick-pea based) were designed, developed first at small scale in the ‘kitchen’ laboratory under controlled conditions, followed by taking them to a local food manufacturer for larger production for the study. We describe here the partnership, required expertise and capacity, experiences, and lessons learned that made this uniquely complex undertaking possible Results: Key steps in the journey included addressing the dynamics of clear communication between partners, executing on carefully assigned tasks and roles, correcting course when needed, and maintaining timeliness and roadmaps. Knowledge of food science and technology was key in solving many food-production challenges that were encountered in taking the laboratory recipe to the factory. Factory production was established and had to meet quality and hygiene criteria set for young children. Conclusions: We provide documentation of this experience as a model to describe the various steps and considerations and what is entailed in local LNS production. We highlight the importance of a well-conceived collaboration with clear roles that created a ‘win-win’ situation for all partners for achieving common goals, establishing improved technology at the factory, and building new capacity to produce such products for children in a low resource setting. Key words: micronutrient, lipid-based nutrient supplements, maternal and child, malnutrition, multiagency collaboration
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Shakya E, Na M, Shaikh S, Wu L, Shamim AA, Ali H, Schulze K, Labrique A, Christian P, West K. Mid-Gestation Weight Gain Predicts Greater Newborn Size in Rural Bangladesh but the Effect Size Varies by Maternal Nutritional Status and Season. Curr Dev Nutr 2022. [PMCID: PMC9193684 DOI: 10.1093/cdn/nzac060.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Assess association between mid-gestation weight gain and birth size by maternal nutritional status and season.
Methods
During an antenatal micronutrient trial in 2008–12, 14,801 rural Bangladeshi mothers were measured for wt (kg) and ht (cm) < 12 wk gestation [median (IQR): 9 (7–10) wk] and at 32 (32–33) wk, with single, term (37–42 wk gestational age, GA) newborns measured for wt < 72 hours of birth (BW, kg). Mid-gestation rate of wt gain (GWG) per wk was calculated as the difference between maternal wt measures divided by interval length in wk. Initially, BW was modeled as a function of GWG, adjusted for maternal age, body mass index (BMI), parity, height, newborn sex, GA at birth, birth month and wealth index to yield adjusted increments in BW (in kg) per kg of GWG (β^). This outcome was then analyzed and compared between mothers with low (<18.5 kg/m2, n = 4008) vs normal (18.5–24.9, n = 4770) BMI, across seasons of birth [Sep-Nov (season 1, post-monsoon), Dec-Feb (2, winter) and Mar-May (3, hot/dry) and Jun-Aug (4, monsoon)], and between mothers by BMI in each season of birth.
Results
46% of mothers had a BMI < 18.5 and 53% were < 150 cm in ht. Mean GWG per wk was 0.28 kg for thin, and 0.21 kg for normal BMI mothers. Overall, BW was positively associated with GWG per wk [β^ = 0.87 kg; 95% CI: 0.80–0.94], being greater for mothers of low [β^ = 0.84: 0.74–0.94] vs normal [0.68: 0.59–0.77] 1st trimester BMI, and varying by season (β^1 = 0.74, β^2 = 1.06, β^3 = 0.86 and β^4 = 0.78, with 95% CI excluding the average (0.87) for seasons 1 and 2). Comparing β^i between mothers with low vs normal BMI, GWG per wk was associated with a (a) lower mean BW increment in season 1 (0.59 vs 0.82 kg), (b) comparable BW increment in season 2 (β^2 = 1.08 vs 0.99 kg), (c) greater BW increment in season 3 (β^3 = 1 vs 0.68 kg) and the largest incremental difference in season 4 (β^4 = 0.99 vs 0.56 kg) when 95% CIs were exclusive.
Conclusions
Birth weight increased with rate of mid-gestation wt gain, especially for thin vs normal wt mothers. Season of birth modified the association, most clearly during monsoon when food is more secure, aligning with mid-gestation intervals spanning the winter season. Maternal nutritional status and season may alter efficiencies of materno-fetal nutrient/energy transfer reflected by birth weight.
Funding Sources
The Gates Foundation (GH614), Sight and Life and Broadhurst Career Development Professorship.
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Affiliation(s)
| | - Muzi Na
- The Pennsylvania State University
| | | | - Lee Wu
- Johns Hopkins Bloomberg School of Public Health
| | | | | | | | | | | | - Keith West
- Johns Hopkins Bloomberg School of Public Health
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Kang Y, Wu LSF, Shaikh S, Ali H, Shamim AA, Christian P, Labrique A, West KP. Birth anthropometry predicts neonatal and infant mortality in rural Bangladesh: a focus on circumferential measurements. Am J Clin Nutr 2022; 115:1334-1343. [PMID: 35021206 PMCID: PMC9071409 DOI: 10.1093/ajcn/nqab432] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/29/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Low birth weight predicts risk of infant death. However, several birth measurements may be equally predictive, for which cutoffs and associated risks are less explored. OBJECTIVES We assessed and optimized population cutoffs of birth length, weight, and midupper arm circumference (MUAC), head circumference (HC), and chest circumference (CC) for predicting neonatal (≤28 d) and infant (≤365 d) mortality in northwest Bangladesh. METHODS Among 28,026 singletons born in an antenatal micronutrient supplement trial, 21,174 received anthropometry ≤72 h after birth, among whom 583 died in infancy. Optimization for predicting mortality for each measurement was guided by the Youden Index (sensitivity + specificity - 1). Relative risk ratios (RRRs) and positive predictive values (PPVs) were calculated across cutoff ranges for individual and any pair of measurements. RESULTS Optimal cutoffs, harmonized to 100-g or 0.5-cm readings, for neonatal and infant mortality were 44.5 cm for length, 2200 g for weight, 9.0 cm for MUAC, 31.0 cm for HC, and 28.5 cm for CC, below which all predicted mortality. However, a CC <28.5 cm, alone and combined with HC <31.0 cm, yielded the highest RRR [9.68 (95% CI: 7.84, 11.94) and 15.74 (95% CI: 12.54, 19.75), respectively] and PPV (11.3% and 10.7%) for neonatal mortality and highest RRR [6.02 (95% CI: 5.15, 7.02) and 9.19 (95% CI: 7.72, 10.95)] and PPV (16.3% and 14.5%) for infant mortality. Pairs of measurements revealed a higher RRR for neonatal and infant mortality than individual measurements of any one pair, although the ranges of PPV remained comparable. CONCLUSIONS In Bangladesh, multiple birth measurements alone or in combination, particularly chest circumference, predict neonatal and infant mortality.
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Affiliation(s)
- Yunhee Kang
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lee Shu Fune Wu
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Hasmot Ali
- The JiVitA Project, Gaibandha, Bangladesh
| | - Abu Ahmed Shamim
- The JiVitA Project, Gaibandha, Bangladesh
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alain Labrique
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Roy A, Hossain MM, Hanif AAM, Khan MSA, Hasan M, Hossaine M, Shamim AA, Ullah MA, Sarkar SK, Rahman SMM, Bulbul MMI, Mitra DK, Mridha MK. Prevalence of Infant and Young Child Feeding Practices and Differences in Estimates of Minimum Dietary Diversity Using 2008 and 2021 Definitions: Evidence from Bangladesh. Curr Dev Nutr 2022; 6:nzac026. [PMID: 35415389 PMCID: PMC8992578 DOI: 10.1093/cdn/nzac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/28/2022] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Infant and young child feeding (IYCF) practices directly impact the health of <2-y-old children. Minimum dietary diversity (MDD) is an IYCF indicator to assess feeding practices of children aged 6-23 mo. The definition of MDD has recently been updated by the WHO and UNICEF, substituting "≥4 out of 7 food groups" (MDD-7FG) with "≥5 out of 8 food groups" (MDD-8FG). Objectives The goals of this study were to estimate the prevalence of IYCF indicators and identify the implications of the change in the prevalence of MDD at the national and regional levels of Bangladesh. Methods This study used data from the National Food Security and Nutrition Surveillance 2018-2019 round. A total of 1992 children aged 0-23 mo were included in this analysis. IYCF indicators and MDD were calculated according to the WHO-UNICEF guidelines. The difference between the prevalence of MDD-7FG and MDD-8FG is presented as percentage points. Results The prevalence of early initiation of breastfeeding was 43.8%, and exclusive breastfeeding was 56.2%. Approximately 55% of children maintained MDD (MDD-7FG), 48% received minimum meal frequency, and 28% received a minimum acceptable diet. Compared with MDD-7FG, the prevalence of MDD-8FG was lower among 6-23-mo-old children. The difference between MDD prevalence (MDD-8FG vs. MDD-7FG) was high for boys (44.0% vs. 53.2%), children aged 12-23 mo (53.4% vs. 63.4%), in urban areas (30.2% vs. 42.4%), in the Dhaka administrative division (42.0% vs. 56.3%), among uneducated mothers (37.1% vs. 47.1%), in households with ≤4 members (44.3% vs. 55%), and for middle-class households (40.3% vs. 57.6%). Conclusions The new method led to a decrease in the prevalence of MDD in Bangladesh. As the country prepares to implement the new indicator, it is critical to disseminate the new knowledge and its positive implication for improved child feeding and nutrition.
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Affiliation(s)
- Abhijeet Roy
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abu Abdullah Mohammad Hanif
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Showkat Ali Khan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mehedi Hasan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Moyazzam Hossaine
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abu Ahmed Shamim
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mohammad Aman Ullah
- National Nutrition Services (NNS), Institute of Public Health Nutrition (IPHN), Dhaka, Bangladesh
| | - Samir Kanti Sarkar
- National Nutrition Services (NNS), Institute of Public Health Nutrition (IPHN), Dhaka, Bangladesh
| | - S M Mustafizur Rahman
- National Nutrition Services (NNS), Institute of Public Health Nutrition (IPHN), Dhaka, Bangladesh
| | - Md Mofijul Islam Bulbul
- National Nutrition Services (NNS), Institute of Public Health Nutrition (IPHN), Dhaka, Bangladesh
| | | | - Malay Kanti Mridha
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Akter F, Hossain MM, Shamim AA, Khan MSA, Hasan M, Hanif AAM, Hossaine M, Urmy NJ, Ullah MA, Sarker SK, Rahman SMM, Mitra DK, Bulbul MMI, Mridha MK. Prevalence and socio-economic determinants of inadequate dietary diversity among adolescent girls and boys in Bangladesh: findings from a nationwide cross-sectional survey. J Nutr Sci 2021; 10:e103. [PMID: 35059184 PMCID: PMC8727722 DOI: 10.1017/jns.2021.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 01/05/2023] Open
Abstract
Malnutrition among adolescents is often associated with inadequate dietary diversity (DD). We aimed to explore the prevalence of inadequate DD and its socio-economic determinants among adolescent girls and boys in Bangladesh. A cross-sectional survey was conducted during the 2018-19 round of national nutrition surveillance in Bangladesh. Univariate and multivariable logistic regression was performed to identify the determinants of inadequate DD among adolescent girls and boys separately. This population-based survey covered eighty-two rural, non-slum urban and slum clusters from all divisions of Bangladesh. A total of 4865 adolescent girls and 4907 adolescent boys were interviewed. The overall prevalence of inadequate DD was higher among girls (55⋅4 %) than the boys (50⋅6 %). Moreover, compared to boys, the prevalence of inadequate DD was higher among the girls for almost all socio-economic categories. Poor educational attainment, poor maternal education, female-headed household, household food insecurity and poor household wealth were associated with increased chances of having inadequate DD in both sexes. In conclusion, more than half of the Bangladeshi adolescent girls and boys consumed an inadequately diversified diet. The socio-economic determinants of inadequate DD should be addressed through context-specific multisectoral interventions.
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Affiliation(s)
- Fahmida Akter
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abu Ahmed Shamim
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Showkat Ali Khan
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mehedi Hasan
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abu Abdullah Mohammad Hanif
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Moyazzam Hossaine
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Nushrat Jahan Urmy
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mohammad Aman Ullah
- National Nutrition Services, Institute of Public Health Nutrition, Dhaka, Bangladesh
| | - Samir Kanti Sarker
- National Nutrition Services, Institute of Public Health Nutrition, Dhaka, Bangladesh
| | | | - Dipak Kumar Mitra
- Department of Public Health, North South University, Dhaka, Bangladesh
| | | | - Malay Kanti Mridha
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Mistry SK, Das Gupta R, Alam S, Kaur K, Shamim AA, Puthussery S. Gestational diabetes mellitus (GDM) and adverse pregnancy outcome in South Asia: A systematic review. Endocrinol Diabetes Metab 2021; 4:e00285. [PMID: 34505412 PMCID: PMC8502223 DOI: 10.1002/edm2.285] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/07/2021] [Accepted: 06/19/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The prevalence of gestational diabetes mellitus (GDM) is increasing in developing countries including the South Asian Nations. The current study aimed to examine the association of GDM with adverse pregnancy outcomes from foetal and maternal perspectives in South Asia. METHODS A systematic review was conducted including primary studies published since January 2020 from South Asian countries. Following electronic databases were searched to locate the articles: MEDLINE, EMBASE and EMCARE. Data were extracted using a customized extraction tool and methodological quality of the included studies was assessed using modified Effective Public Health Practice Project (EPHPP) quality assessment tool. Narrative synthesis was performed as statistical pooling was not possible due to the heterogeneous nature of the studies. RESULTS Eight studies were included in the review. Overall, the review found a positive correlation between GDM and adverse foetal outcomes such as macrosomia, neonatal hyperglycaemia, intrauterine growth retardation (IUGR), stillbirths and low birthweight (LBW), but the findings were not conclusive. GDM was also positively associated with preeclampsia but the association between GDM and C-section delivery was not conclusive. CONCLUSION Policymakers, public health practitioners and researchers in South Asia should take in to account the link between GDM and adverse pregnancy outcomes while designing interventions to promote maternal health in South Asia. Researchers should focus on conducting longitudinal studies in future to clearly understand the epidemiology and pathobiology of this issue.
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Affiliation(s)
- Sabuj Kanti Mistry
- BRAC James P Grant School of Public HealthBRAC UniversityDhakaBangladesh
- Centre for Primary Health Care and EquityUNSWSydneyNSWAustralia
| | - Rajat Das Gupta
- BRAC James P Grant School of Public HealthBRAC UniversityDhakaBangladesh
| | - Sabiha Alam
- Institute of Nutrition and Food ScienceUniversity of DhakaDhakaBangladesh
| | | | - Abu Ahmed Shamim
- BRAC James P Grant School of Public HealthBRAC UniversityDhakaBangladesh
| | - Shuby Puthussery
- Maternal and Child Health Research CentreInstitute for Health ResearchUniversity of BedfordshireLutonUK
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Hanif AAM, Hasan M, Khan MSA, Hossain MM, Shamim AA, Mitra DK, Hossaine M, Ullah MA, Sarker SK, Rahman SMM, Bulbul MMI, Mridha MK. Prevalence and associated factors of insufficient physical activity among elderly people in Bangladesh: a nationally representative cross-sectional study. BMJ Open Sport Exerc Med 2021; 7:e001135. [PMID: 34567786 PMCID: PMC8438863 DOI: 10.1136/bmjsem-2021-001135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Insufficient physical activity (IPA) is a crucial risk factor for non-communicable diseases (NCDs). The elderly population has a higher likelihood of suffering from NCDs. We aimed to estimate the prevalence of and factors associated with IPA among the elderly people in Bangladesh. METHODS We analysed data from the Bangladesh Food Security and Nutrition Surveillance round 2018-2019, collected from 82 rural, non-slum urban and slum clusters selected using multistage cluster sampling. IPA was defined as <150 min of moderate intensity or <75 min of vigorous intensity or equivalent in a typical week. The weighted prevalence of IPA was estimated by gender and across different variables. Crude and adjusted prevalence ratios were calculated using Poisson regression with robust variance. RESULTS The weighted prevalence of IPA among elderly people was 38.4%, with a slightly higher prevalence in women (39.7% vs 37.3%). Factors associated with higher prevalence of IPA in both sexes were-higher age, living in non-slum urban areas, unemployed or homemaker, not currently married, sedentary behaviour and self-reported hypertension. Further, >10 years of education, inadequate fruits and vegetable consumption, self-reported asthma and higher waist circumference among men; and higher household income and self-reported diabetes among women were associated with a higher prevalence of IPA. CONCLUSIONS IPA is highly prevalent among Bangladeshi elderly men and women. Sedentary behaviour, inadequate fruits and vegetable consumption and higher waist circumference were the modifiable factors of IPA. Evidence from this study can guide the development of appropriate interventions to promote healthy ageing in Bangladesh.
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Affiliation(s)
- Abu Abdullah Mohammad Hanif
- Centre for Non-Communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Mehedi Hasan
- Centre for Non-Communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Md Showkat Ali Khan
- Centre for Non-Communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-Communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Abu Ahmed Shamim
- Centre for Non-Communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Dipak Kumar Mitra
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Moyazzam Hossaine
- Centre for Non-Communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Mohammad Aman Ullah
- National Nutrition Services (NNS), Government of Bangladesh Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Samir Kanti Sarker
- National Nutrition Services (NNS), Government of Bangladesh Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - S M Mustafizur Rahman
- National Nutrition Services (NNS), Government of Bangladesh Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Md Mofijul Islam Bulbul
- National Nutrition Services (NNS), Government of Bangladesh Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Malay Kanti Mridha
- Centre for Non-Communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
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15
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Gurung S, Schulze KJ, Shamim AA, Shaikh S, Ali H, Wu LSF, Udomkesmalee E, Eggersdorfer M, Kraemer K, Labrique A, Jr. KW, Christian P. Chronic Vitamin E Deficiency in Rural Bangladeshi Women. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab045_030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Vitamin E deficiency (VED) appears to be common in rural areas of South Asia, with prevalence of ≥ 50% reported among women of reproductive age. Long term deficiency may impart neurological damage, but little information exists about persistence of VED. We provide initial estimates of chronic VED (CVED) in women of reproductive age living in Gaibandha District, a typical rural setting in NW Bangladesh.
Methods
We assessed α-tocopherol concentrations by HPLC in early pregnancy and 3-month postpartum (PP) plasma samples of women participating in biochemical sub-studies of JiVitA-1 (n = 2,319), a cluster-randomized, placebo-controlled, weekly vitamin A or β-carotene supplementation trial from 2001–7, and JiVitA-3 (N = 2,073), a cluster-randomized, daily multiple micronutrient (MMS) versus iron-folic acid (IFA) supplementation trial from 2008–12. VED was conventionally defined by an α-tocopherol concentration < 12 μmol/L and CVED as α-tocopherol < 12 μmol/L at both early pregnancy and postpartum assessments, an interval spanning a median (IQR) of 9.4 (2.8) months.
Results
Across both trials combined (N = 4,392), the mean ± SD plasma α-tocopherol concentration and prevalence of VED in early pregnancy and at 3 months post-partum was 11.28 ± 4.07 and 10.86 ± 4.41 μmol/L, and 53.5% and 42.2%, respectively. In JiVitA-3, the post-partum prevalence of VED among women not previously receiving MMS (containing 15 mg of vitamin E as all-rac-α-tocopheryl acetate) was 57.5% (vs 42.5% among MMS recipients, p < 0.001). The prevalence of CVED among women in both trials combined was 32.0% (34.45% in JiVitA-1 and 26.65% in JiVitA-3, IFA group only). Across a maternal age range of 11–43 [median: 20 (IQR: 8) years, risk of CVED decreased comparably per year of age in the JiVitA-1 [OR = 0.94 (95% CI: 0.93–0.95)] and JiVitA-3 [OR = 0.93 (95% CI:0.92–0.95)] trials.
Conclusions
In rural NW Bangladesh, where over half of women enter pregnancy vitamin E-deficient, about one-third are also deficient postpartum, ∼10 months later, providing a provisional estimate of chronic maternal vitamin E deficiency in a South Asian setting.
Funding Sources
Bill & Melinda Gates Foundation (Grant GH614, OPP1141435) and US Agency for International Development (AID (HRN-A-00–97-00015–00).
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Affiliation(s)
- Sabi Gurung
- Johns Hopkins Bloomberg School of Public Health
| | - Kerry Jean Schulze
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Department of International Health
| | | | - Saijuddin Shaikh
- The JiVitA Project and Dept of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Hasmot Ali
- The JiVitA Project and Dept of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Lee S-F Wu
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | | | | | - Klaus Kraemer
- Sight and Life Global Nutrition Research Institute, Dept of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Alain Labrique
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Keith West Jr.
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Parul Christian
- Center for Human Nutrition, JiVitA Project, Department of International Health, Johns Hopkins Bloomberg School of Public Health
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16
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Mridha MK, Hossain MM, Khan MSA, Hanif AAM, Hasan M, Hossaine M, Shamim AA, Ullah MA, Rahman SMM, Sarker SK, Bulbul MMI, Mitra DK. Nutrition and Health Status of Elderly People in Bangladesh: Evidence From a Nationwide Survey. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab033_039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Though Bangladesh is passing through demographic, epidemiologic and nutritional transitions, national estimates on nutrition and health status of the elderly population are largely unknown. We aimed to determine the status of selected health and nutrition indicators among the elderly population in Bangladesh.
Methods
For the first time in Bangladesh, we included elderly population (≥60 years old females and males) as a separate population group in the national food security and nutrition surveillance round 2018–2019. We collected data on dietary diversity, nutritional status,
behavioral risk factors of non-communicable diseases, blood pressure, and self-reported chronic diseases from 4,818 elderly people (48% female) living in 82 clusters (57 rural, 15 non-slums urban, and 10 slums) randomly selected from eight administrative division of Bangladesh.
Results
Majority (59% in rural, 53% in non-slum urban, and 69% in slums) of elderly people were consuming an inadequately diverse (4 or less food groups out of 10) diet. Overall, 89% of elderly people were malnourished (20%) or at risk of malnutrition (69%). The highest prevalence of malnutrition was in Mymensingh division (37%) followed by Sylhet division (27%). The prevalence of obesity was 5%, 16%, and 11%, in rural, non-slum urban, and slums, respectively. The national prevalence of smoking, smokeless tobacco consumption, physical inactivity was 18%, 52%, and 38%, respectively. There was a high burden of hypertension (49% in rural, 53% in non-slum urban, and 39% in slums). Overall, 16% of elderly people had heart diseases, 14% had chronic respiratory diseases, 3% had kidney diseases, 9% had diabetes, 8% had stroke, 0.5% had cancer and 1.4% had mental health problems.
Conclusions
The government of Bangladesh should design and implement health and nutrition programs among the elderly population. The regional differences in the prevalence of health and nutrition indicators should be considered while designing such programs.
Funding Sources
Ministry of Health and Family Welfare, Government of Bangladesh
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Affiliation(s)
- Malay Kanti Mridha
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Md Mokbul Hossain
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | | | - Abu abdullah Mohammad Hanif
- Centre For Non-Communicable Diseases And Nutrition, BRAC James P Grant School of Public Health, BRAC University, Bangladesh
| | - Mehedi Hasan
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | | | - Abu Ahmed Shamim
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
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17
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Hanif AAM, Hossain MM, Hasan M, Shamim AA, Mridha MK. Prevalence of Iodine Insufficiency Is High Among Pregnant and Lactating Women in Northern Bangladesh Three Decades After Initiating Mandatory Salt Iodization. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab053_030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Optimum Iodine status during pregnancy and lactation is crucial for normal fetal growth and child development. We assessed the urinary iodine concentration of pregnant and lactating women to determine their iodine status and measured salt iodine from their households.
Methods
We collected spot urine samples and corresponding household salt samples from 80 pregnant women (37 and 43 second and third-trimester women, respectively) and 49 lactating women (with children <6 months). Urinary iodine was determined by manual digestion with ammonium persulfate followed by Sandell-Kolthoff Reaction using 96 multi-well plates and a micro-plate reader at 405 nm. The iodine content in salt was measured by iodometric titration method. Samples were analyzed at the icddr, b Immunology, Nutrition, and Toxicology Laboratory, Dhaka, Bangladesh.
Results
The median [IQR] UIC in the second-trimester women, third-trimester women, and lactating women was 90.6[41.9–171.5] mcg/L, 67.9[24.2–144.5] mcg/L, and 74.7[48.1–134.8] mcg/L, respectively. More than three-quarters of pregnant women (73% of the second-trimester women and 79% of the third-trimester women) and more than half of the lactating mothers (57%) were below the WHO recommended cut-offs. Only 42% of the household salts were adequately iodized. A moderate positive linear relationship was found between urinary and household salt iodine content (r = 0.51, P < 0.0001).
Conclusions
Even with mandatory salt iodization policy in Bangladesh for about three decades, the iodine insufficiency among pregnant and lactating women is widespread and needs to be improved through ensuring the availability of adequately iodized salt or supplement.
Funding Sources
ETH Zurich, Switzerland.
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Affiliation(s)
- Abu abdullah Mohammad Hanif
- Centre For Non-Communicable Diseases And Nutrition, BRAC James P Grant School of Public Health, BRAC University, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Mehedi Hasan
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Abu Ahmed Shamim
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Malay Kanti Mridha
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
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18
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Roy A, Hossain MM, Khan MSA, Hanif AAM, Hasan M, Hossaine M, Shamim AA, Ullah MA, Sarker SK, Rahman SMM, Bulbul MMI, Mitra DK, Mridha MK. Differences in Estimates of Minimum Dietary Diversity by Using the New and Old Definition: Evidence From Bangladesh. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab046_105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Minimum Dietary Diversity (MDD) is an indicator to assess feeding practices of children aged 6–23 months. The WHO and UNICEF have recently revised the definition of MDD, replacing ‘≥4 out of 7 food groups (MDD-7FG)’ with ‘≥5 out of 8 food groups (MDD-8FG)’. In the new definition, breast milk was considered as a separate food group. We aimed to estimate the implications of this change on the prevalence of MDD at the national and regional levels of Bangladesh.
Methods
We analyzed data from the national food security and nutrition surveillance round 2018–2019. MDD was defined and calculated according to the WHO-UNICEF guidelines. The prevalence of MDD-7FG and MDD-8FG was estimated and stratified by gender, age groups, place of residence, division, and wealth index. The difference between the prevalence between MDD-7FG and MDD-8FG was presented as percentages.
Results
Compared to the older definition, the overall prevalence of MDD was lower among 6 to 23 months old children in Bangladesh (46.2% vs. 54.7%). The absolute percentage point difference between the estimates (MDD-8FG vs. MDD-7FG) was higher among the boys (44.0% vs. 53.2%), 12–23 months aged old children (53.4% vs. 63.4%), children living in the non-slum urban areas (30.2% vs. 42.4%) and Dhaka division (42.0% vs. 56.3%), and among the children of middle-class families (40.3% vs. 57.6%).
Conclusions
The new definition and the inclusion of breast milk intake as a new food group led to a decrease in the prevalence of minimum dietary diversity in Bangladesh. The country program needs to emphasize the continuation of breastfeeding until two years of age of the children. Moreover, the changes in the definition of MDD and the resultant consequence should be kept in mind while performing trend analysis of dietary diversity in Bangladesh and elsewhere.
Funding Sources
Ministry of Health and Family Welfare, Government of Bangladesh.
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Affiliation(s)
- Abhijeet Roy
- BRAC James P Grant School of Public Health, BRAC University, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | | | - Abu abdullah Mohammad Hanif
- Centre For Non-Communicable Diseases And Nutrition, BRAC James P Grant School of Public Health, BRAC University, Bangladesh
| | - Mehedi Hasan
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | | | - Abu Ahmed Shamim
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | | | | | | | | | | | - Malay Kanti Mridha
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
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19
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Hanif AAM, Hasan M, Khan MSA, Hossain MM, Shamim AA, Hossaine M, Ullah MA, Sarker SK, Rahman SMM, Bulbul MMI, Mitra DK, Mridha MK. Ten-years cardiovascular risk among Bangladeshi population using non-laboratory-based risk chart of the World Health Organization: Findings from a nationally representative survey. PLoS One 2021; 16:e0251967. [PMID: 34038457 PMCID: PMC8153482 DOI: 10.1371/journal.pone.0251967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/06/2021] [Indexed: 11/18/2022] Open
Abstract
The World Health Organization (WHO) has recently developed a non-laboratory based cardiovascular disease (CVD) risk chart considering the parameters age, sex, current smoking status, systolic blood pressure, and body mass index. Using the chart, we estimated the 10-years CVD risk among the Bangladeshi population aged 40–74 years. We analyzed data from a nationally representative survey conducted in 2018–19. The survey enrolled participants from 82 clusters (57 rural, 15 non-slum urban, and 10 slums) selected by multistage cluster sampling. Using the non-laboratory-based CVD risk chart of the World Health Organization (WHO), we categorized the participants into 5 risk groups: very low (<5%), low (5% to <10%), moderate (10% to <20%), high (20% to <30%) and very high (> = 30%) risk. We performed descriptive analyses to report the distribution of CVD risk and carried out univariable and multivariable logistic regression to identify factors associated with elevated CVD risk (> = 10% CVD risk). Of the 7,381 participants, 46.0% were female. The median age (IQR) was 59.0 (48.0–64.7) years. Overall, the prevalence of very low, low, moderate, high, and very high CVD risk was 34.7%, 37.8%, 25.9%, 1.6%, and 0.1%, respectively. Elevated CVD risk (> = 10%) was associated with poor education, currently unmarried, insufficient physical inactivity, smokeless tobacco use, and self-reported diabetes in both sexes, higher household income, and higher sedentary time among males, and slum-dwelling and non-Muslim religions among females. One in every four Bangladeshi adults had elevated levels of CVD risk, and males are at higher risk of occurring CVD events. Non-laboratory-based risk prediction charts can be effectively used in low resource settings. The government of Bangladesh and other developing countries should train the primary health care workers on the use of WHO non-laboratory-based CVD risk charts, especially in settings where laboratory tests are not available.
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Affiliation(s)
- Abu Abdullah Mohammad Hanif
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mehedi Hasan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Showkat Ali Khan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md. Mokbul Hossain
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abu Ahmed Shamim
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Moyazzam Hossaine
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mohammad Aman Ullah
- National Nutrition Services (NNS), Institute of Public Health Nutrition (IPHN), Dhaka, Bangladesh
| | - Samir Kanti Sarker
- National Nutrition Services (NNS), Institute of Public Health Nutrition (IPHN), Dhaka, Bangladesh
| | - S. M Mustafizur Rahman
- National Nutrition Services (NNS), Institute of Public Health Nutrition (IPHN), Dhaka, Bangladesh
| | - Md Mofijul Islam Bulbul
- National Nutrition Services (NNS), Institute of Public Health Nutrition (IPHN), Dhaka, Bangladesh
| | | | - Malay Kanti Mridha
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- * E-mail:
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20
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Feng C, Li R, Shamim AA, Ullah MB, Li M, Dev R, Wang Y, Zhao T, Liao J, Du Z, Ling Y, Lai Y, Hao Y. High-resolution mapping of reproductive tract infections among women of childbearing age in Bangladesh: a spatial-temporal analysis of the demographic and health survey. BMC Public Health 2021; 21:342. [PMID: 33579253 PMCID: PMC7881647 DOI: 10.1186/s12889-021-10360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reproductive tract infections (RTIs) have become major but silent public health problems devastating women's lives in Bangladesh. Accurately and precisely identifying high-risk areas of RTIs through high-resolution risk maps is meaningful for resource-limited settings. METHODS We obtained data reported with RTI symptoms by women of childbearing age in the years 2007, 2011 and 2014 from Bangladesh Demographic and Health Survey. High-spatial Environmental, socio-economic and demographic layers were downloaded from different open-access data sources. We applied Bayesian spatial-temporal models to identify important influencing factors and to estimate the infection risk at 5 km spatial resolution across survey years in Bangladesh. RESULTS We estimated that in Bangladesh, there were approximate 11.1% (95% Bayesian credible interval, BCI: 10.5-11.7%), 13.9% (95% BCI: 13.3-14.5%) and 13.4% (95% BCI: 12.8-14.0%) of women of childbearing age reported with RTI symptoms in 2007, 2011 and 2014, respectively. The risk of most areas shows an obvious increase from 2007 to 2011, then became stable between 2011 and 2014. High risk areas were identified in the southern coastal areas, the western Rajshahi Division, the middle of Khulna Division, and the southwestern Chittagong Division in 2014. The prevalence of Rajshahi and Nawabganj District were increasing during all the survey years. CONCLUSION The high-resolution risk maps of RTIs we produced can guide the control strategies targeted to priority areas cost-effectively. More than one eighth of women of childbearing age reported symptoms suggesting RTIs and the risk of RTIs varies in different geographical area, urging the government to pay more attention to the worrying situation of female RTIs in the country.
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Affiliation(s)
- Chenyang Feng
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Department of Information, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Ruixue Li
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Department of Information, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Abu Ahmed Shamim
- James P Grant School of public Health, BRAC University, Dhaka, Bangladesh
| | - Md Barkat Ullah
- Department of Nutrition, University of California Davis, California, USA
| | - Mengjie Li
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Rubee Dev
- Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal
| | - Yijing Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Tingting Zhao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jing Liao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Zhicheng Du
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yuheng Ling
- CNRS UMR 6240, Universite de Corse Pascal Paoli, 20250, Corti, France
| | - Yingsi Lai
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China. .,Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China.
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
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21
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Hanif AAM, Shamim AA, Hossain MM, Hasan M, Khan MSA, Hossaine M, Ullah MA, Sarker SK, Rahman SMM, Mitra DK, Mridha MK. Gender-specific prevalence and associated factors of hypertension among elderly Bangladeshi people: findings from a nationally representative cross-sectional survey. BMJ Open 2021; 11:e038326. [PMID: 33478960 PMCID: PMC7825269 DOI: 10.1136/bmjopen-2020-038326] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE We aimed to estimate the gender-specific prevalence and associated factors of hypertension among elderly people in Bangladesh. DESIGN AND METHOD We analysed data from the food security and nutrition surveillance round 2018-2019. The multistage cluster sampling method was used to select the study population. Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg and/or having a history of hypertension. We carried out the descriptive analysis, bivariate and multivariable logistic regression to report the weighted prevalence of hypertension as well as crude and adjusted ORs with 95% CI. A p value<0.05 was considered statistically significant. SETTING The study was conducted in 82 clusters (57 rural, 15 non-slum urban and 10 slums) in all eight administrative divisions of Bangladesh. PARTICIPANTS A total of 2482 males and 2335 females aged ≥60 years were included in this analysis. RESULTS The weighted prevalence of hypertension was 42% and 56% among males and females, respectively. The prevalence was higher among females across all sociodemographic, behavioural and clinical strata. Factors associated with higher odds of hypertension (adjusted OR (AOR) (95% CI) for males and females, respectively) were age ≥70 years (1.32 (1.09, 1.60) and 1.40 (1.15, 1.71)); insufficient physical activity (1.50 (1.25, 1.81) and 1.38 (1.15, 1.67)); higher waist circumference (2.76 (2.22, 3.43) and 2.20 (1.82, 2.67)); and self-reported diabetes (1.36 (1.02, 1.82) and 1.82 (1.35, 2.45)). Additionally, living in slums decreased (0.71 (0.52, 0.96)) and education >10 years increased odds of hypertension (1.83 (1.38, 2.44)) among males. CONCLUSION In Bangladesh, half of the elderly persons were hypertensive, with a higher prevalence in females. In both sexes, odds of hypertension was higher among persons with older age (≥70 years), insufficient physical activity, higher waist circumference and self-reported diabetes. The Ministry of Health of Bangladesh should consider these findings while designing and implementing health programmes for elderly population.
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Affiliation(s)
- Abu Abdullah Mohammad Hanif
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abu Ahmed Shamim
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mehedi Hasan
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Showkat Ali Khan
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Moyazzam Hossaine
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mohammad Aman Ullah
- National Nutrition Services (NNS), Directorate General of Health Services, Government of Bangladesh, Dhaka, Bangladesh
| | - Samir Kanti Sarker
- National Nutrition Services (NNS), Directorate General of Health Services, Government of Bangladesh, Dhaka, Bangladesh
| | - S M Mustafizur Rahman
- National Nutrition Services (NNS), Directorate General of Health Services, Government of Bangladesh, Dhaka, Bangladesh
| | - Dipak K Mitra
- Public Health, North South University, Dhaka, Bangladesh
| | - Malay Kanti Mridha
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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22
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Mridha MK, Hossain MM, Khan MSA, Hanif AAM, Hasan M, Mitra D, Hossaine M, Ullah MA, Sarker SK, Rahman SMM, Bulbul MMI, Shamim AA. Prevalence and associated factors of depression among adolescent boys and girls in Bangladesh: findings from a nationwide survey. BMJ Open 2021; 11:e038954. [PMID: 33455924 PMCID: PMC7813352 DOI: 10.1136/bmjopen-2020-038954] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To assess the prevalence of and factors associated with depression among adolescent boys and girls. DESIGN We conducted a nationwide cross-sectional study. SETTING This study was carried out in 82 randomly selected clusters (57 rural, 15 non-slum urban and 10 slums) from eight divisions of Bangladesh. PARTICIPANTS We interviewed 4907 adolescent boys and 4949 adolescent girls. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was 'any depression' and the secondary outcome measures were types of depression: no or minimal, mild, moderate, moderately severe and severe. RESULTS The overall prevalence of no or minimal, mild, moderate, moderately severe and severe depression was 75.5%, 17.9%, 5,4%, 1.1% and 0.1%, respectively. Across most of the sociodemographic, lifestyle and anthropometric strata, the prevalence of any depression was higher among adolescent girls. In both sexes, depression was associated with higher age, higher maternal education, paternal occupation e.g., business, absence of a 6-9-year-old member in the household, food insecurity, household consumption of unfortified oil, household use of non-iodised salt, insufficient physical activity (adjusted odds ratio, AOR: 1.24 for boys, 1.44 for girls) and increased television viewing time e.g., ≥121 minute/day (AOR: 1.95 for boys, 1.99 for girls). Only among boys, depression was also associated with higher paternal education e.g., complete secondary and above (AOR: 1.42), absence of another adolescent member in the household (AOR: 1.34), household use of solid biomass fuel (AOR: 1.39), use of any tobacco products (AOR: 2.17), and consumption of processed food (AOR: 1.24). Only among girls, non-slum urban residence, Muslim religion, and household size ≤4 were also associated with depression. CONCLUSION The prevalence of depression among adolescent boys and girls is high in Bangladesh. In most sociodemographic, lifestyle and anthropometric strata, the prevalence is higher among girls. In this age group, depression is associated with a number of sociodemographic and lyfestyle factors. The government of Bangladesh should consider these findings while integrating adolescent mental health in the existing and future programmes.
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Affiliation(s)
- Malay Kanti Mridha
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Showkat Ali Khan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abu Abdullah Mohammad Hanif
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mehedi Hasan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Dipak Mitra
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Moyazzam Hossaine
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mohammad Aman Ullah
- National Nutrition Services (NNS), Directorate General of Health Services, Dhaka, Bangladesh
| | - Samir Kanti Sarker
- National Nutrition Services (NNS), Directorate General of Health Services, Dhaka, Bangladesh
| | - S M Mustafizur Rahman
- National Nutrition Services (NNS), Directorate General of Health Services, Dhaka, Bangladesh
| | - Md M Islam Bulbul
- National Nutrition Services (NNS), Directorate General of Health Services, Dhaka, Bangladesh
| | - Abu Ahmed Shamim
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Urmy NJ, Hossain MM, Shamim AA, Khan MSA, Hanif AAM, Hasan M, Akter F, Mitra DK, Hossaine M, Ullah MA, Sarker SK, Rahman SM, Bulbul MMI, Mridha MK. Noncommunicable Disease Risk Factors Among Adolescent Boys and Girls in Bangladesh: Evidence From a National Survey. Osong Public Health Res Perspect 2021; 11:351-364. [PMID: 33403198 PMCID: PMC7752145 DOI: 10.24171/j.phrp.2020.11.6.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives To assess the prevalence of noncommunicable disease (NCD) risk factors and the factors associated with the coexistence of multiple risk factors (≥ 2 risk factors) among adolescent boys and girls in Bangladesh. Methods Data on selected NCD risk factors collected from face to face interviews of 4,907 boys and 4,865 girls in the national Nutrition Surveillance round 2018-2019, was used. Descriptive analysis and multivariable logistic regression were performed. Results The prevalence of insufficient fruit and vegetable intake, inadequate physical activity, tobacco use, and being overweight/obese was 90.72%, 29.03%, 4.57%, and 6.04%, respectively among boys; and 94.32%, 50.33%, 0.43%, and 8.03%, respectively among girls. Multiple risk factors were present among 34.87% of boys and 51.74% of girls. Younger age (p < 0.001), non-slum urban (p < 0.001) and slum residence (p < 0.001), higher paternal education (p = 0.001), and depression (p < 0.001) were associated with the coexistence of multiple risk factors in both boys and girls. Additionally, higher maternal education (p < 0.001) and richest wealth quintile (p = 0.023) were associated with the coexistence of multiple risk factors in girls. Conclusion The government should integrate specific services into the existing health and non-health programs which are aimed at reducing the burden of NCD risk factors.
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Affiliation(s)
- Nushrat Jahan Urmy
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Abu Ahmed Shamim
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Md Showkat Ali Khan
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Abu Abdullah Mohammad Hanif
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Mehedi Hasan
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Fahmida Akter
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Dipak Kumar Mitra
- Department of Public Health, North South University, Bashundhara, Dhaka, Bangladesh
| | - Moyazzam Hossaine
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Mohammad Aman Ullah
- National Nutrition Services, Directorate General of Health Services, Government of Bangladesh, Bangladesh
| | - Samir Kanti Sarker
- National Nutrition Services, Directorate General of Health Services, Government of Bangladesh, Bangladesh
| | - Sm Mustafizur Rahman
- National Nutrition Services, Directorate General of Health Services, Government of Bangladesh, Bangladesh
| | - Md Mofijul Islam Bulbul
- National Nutrition Services, Directorate General of Health Services, Government of Bangladesh, Bangladesh
| | - Malay Kanti Mridha
- Centre for Non-Communicable Disease and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
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Chowdhury ZT, Hurley KM, Campbell RK, Shaikh S, Shamim AA, Mehra S, Christian P. Novel Method for Estimating Nutrient Intakes Using a Semistructured 24-Hour Diet Recall for Infants and Young Children in Rural Bangladesh. Curr Dev Nutr 2020; 4:nzaa123. [PMID: 32875267 PMCID: PMC7447588 DOI: 10.1093/cdn/nzaa123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nutrient-level intakes from home-prepared complementary foods are rarely estimated among infants and young children in low-income settings. The major constraints are related to lack of standard recipes and ingredients and portion sizes. OBJECTIVES This article describes the feasibility, applicability, and validity of a post hoc qualitative methodology to estimate nutrient intakes in children using 24-h dietary recall. METHODS Semistructured, interviewer-administered caregiver 24-h diet recalls were conducted to assess food intake among children participating in a randomized trial of complementary food supplementation at ages 6, 9, 12, 15, 18, and 24 mo in rural Bangladesh. At the end of the diet data collection, focus group discussions with mothers (n = 6) and cooking activities (n = 5) were conducted to obtain standard recipes (and ingredients) and portion sizes for reported foods given at different ages. Nutrient intakes were calculated for children in the control group (n = 1438), and convergent validity of the data was tested by examining the association of energy and protein intakes with child age and socioeconomic status (SES). RESULTS Focus group discussions generated standardized recipes for 21 commonly consumed mixed dishes being fed to children. These recipes were cooked, and portion sizes of standardized measures used in 24-h recalls were quantified in grams. For discrete foods, we quantified women's perceptions of "small," "medium," and "large" in grams. Across all ages, food groups consumed consisted mostly of staples, with the most common being rice, potatoes, and biscuits. Using portion size data and recipe ingredients, the 24-h dietary data, and Bangladeshi food composition tables, we successfully estimated nutrient intakes in children. Convergent validity analysis showed that energy and protein intakes were strongly associated with age and SES (both P < 0.001). CONCLUSIONS We demonstrated the use of a validated, qualitative methodology for estimating nutrient intakes in young children from complementary foods in undernourished contexts. This trial was registered at clinicaltrials.gov as NCT01562379.
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Affiliation(s)
- Zaynah T Chowdhury
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kristen M Hurley
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca K Campbell
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saijuddin Shaikh
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- JiVitA Project, Gaibandha, Bangladesh
| | | | - Sucheta Mehra
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Parul Christian
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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25
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Schulze KJ, Gernand AD, Khan AZ, Wu LSF, Mehra S, Shaikh S, Ali H, Shamim AA, Sungpuag P, Udomkesmalee E, Labrique AB, West KP, Christian P. Newborn micronutrient status biomarkers in a cluster-randomized trial of antenatal multiple micronutrient compared with iron folic acid supplementation in rural Bangladesh. Am J Clin Nutr 2020; 112:1328-1337. [PMID: 32844185 PMCID: PMC7657323 DOI: 10.1093/ajcn/nqaa223] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 07/16/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Daily antenatal multiple micronutrient (MM) compared with iron folic acid (IFA) supplementation from early pregnancy improved birth outcomes and maternal micronutrient status in rural Bangladesh, but effects on newborn status are unknown. OBJECTIVE We examined cord blood micronutrient biomarkers in relation to antenatal MM and IFA supplementation and maternal gestational micronutrient status in rural Bangladeshi newborns. DESIGN In a double-blinded, cluster-randomized trial of antenatal IFA or MM (with the same IFA content), we analyzed cord blood plasma from 333 singleton births, and corresponding maternal plasma at 32.5 ± 2.6 wk of gestation, for ferritin (iron stores), folate, cobalamin (vitamin B-12), retinol (vitamin A), 25-hydroxyvitamin D [25(OH)D, vitamin D status], α-tocopherol (vitamin E), zinc, thyroglobulin, and free thyroxine (iodine status). Intervention effects and associations were determined using linear regression, exploring maternal status as a mediator of intervention effects on cord biomarkers. RESULTS The MM intervention increased cord ferritin (mean: +12.4%; 95% CI: 1.3, 24.6%), 25(OH)D (mean: +14.7%; 95% CI: 4.8, 25.6%), and zinc (mean: +5.8%; 95% CI: 1.0, 10.8%). Cord folate (mean: +26.8%; 95% CI: 19.6, 34.5%), cobalamin (mean: +31.3%; 95% CI: 24.6, 38.3%), 25(OH)D (mean: +26.7%; 95% CI: 23.2, 30.3%), α-tocopherol (mean: +8.7%; 95% CI: 3.6, 13.7%), zinc (mean: +2.3%; 95% CI: 0.5, 4.2%), thyroglobulin (mean: +20.1%; 95% CI: 9.0, 32.2%) and thyroxine (mean: +1.5%; 95% CI: 0.0, 3.0%) increased per 1-SD increment in maternal status (all P < 0.05); ferritin and retinol changed by +2.0%; 95% CI: -8.9, 14.3%; P = 0.72; and +3.5%; 95% CI: -0.4, 7.3%; P = 0.07, respectively. Ferritin, folate, cobalamin, zinc, and thyroglobulin averaged 1.57-6.75 times higher and retinol, α-tocopherol, and 25(OH)D 0.30-0.84 times lower in cord than maternal plasma, suggesting preferential maternal-fetal transfer of iron, folate, cobalamin, and zinc; limited transfer of fat-soluble vitamins; and high fetal iodine demand. CONCLUSIONS Antenatal MM supplementation increased newborn ferritin, 25(OH)D, and zinc, while maternal and newborn folate, vitamins B-12, D, and E, zinc, and iodine biomarkers were positively related. Despite limited effects of MM, better maternal micronutrient status was associated with improved micronutrient status of Bangladeshi newborns. This trial was registered at clinicaltrials.gov as NCT00860470.
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Affiliation(s)
| | - Alison D Gernand
- Present address for ADG: Department of Nutritional Sciences, The Pennsylvania State University, 224 Chandlee Lab, University Park, PA 16802, USA
| | - Afreen Zaman Khan
- Present address for AZK: Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Lee S-F Wu
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sucheta Mehra
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saijuddin Shaikh
- The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh
| | - Hasmot Ali
- The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh
| | - Abu Ahmed Shamim
- Present address for AAS: BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | | | - Alain B Labrique
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Hur J, West KP, Shamim AA, Rashid M, Labrique AB, Wu LS, Ali H, Ullah B, Schulze KJ, Klemm RD, Christian P. Thinness and fecundability: Time to pregnancy after adolescent marriage in rural Bangladesh. Matern Child Nutr 2020; 16:e12985. [PMID: 32207581 PMCID: PMC7296800 DOI: 10.1111/mcn.12985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 02/05/2020] [Accepted: 02/18/2020] [Indexed: 01/22/2023]
Abstract
Undernutrition may affect fecundability, but few studies have quantified this relationship. In rural Bangladesh, where newlywed couples face strong pressures to become pregnant, we assessed fecundability, estimated by time to pregnancy (TTP), and its association with preconceptional thinness among nulligravid, newlywed female adolescents. During 2001-2002, 5,516 newlywed women aged 12-19 years participated in a home-based, 5-weekly surveillance system for 5-6 years to enrol pregnant women into an antenatal vitamin A or β-carotene supplementation trial. Thinness was defined as a left mid-upper arm circumference (MUAC) ≤21.5 versus >21.5 cm. At each visit, staff obtained a monthly history of menstruation. Report of amenorrhea prompted a human chorionic gonadotropin urine test to confirm pregnancy. We derived hazard ratios (with 95% confidence intervals [CI]) for pregnancy and Kaplan-Meier curves for TTP. Ages of women at marriage and pregnancy detection (mean ± standard deviation) were 15.3 ± 1.9 and 17.0 ± 1.9 years, respectively. A total of 82.7% of thinner and 87.3% of better nourished women became pregnant. The unadjusted and multivariable relative hazard of ever becoming pregnant was 0.84 (95% CI [0.78, 0.89]) and 0.86 (95% CI [0.81, 0.92]), respectively, and TTP was 12 weeks longer (median [95% CI]: 63 [58-68] vs. 51 [49-54]) in women whose MUAC was ≤21.5 versus >21.5 cm. In rural Bangladesh, thin adolescent newlywed girls have a lower probability of becoming pregnant and experience a longer time to pregnancy.
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Affiliation(s)
- Jinhee Hur
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | - Keith P. West
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | | | | | - Alain B. Labrique
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | - Lee S.F. Wu
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | | | - Barkat Ullah
- Department of NutritionUniversity of California, DavisDavisCalifornia
| | - Kerry J. Schulze
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | - Rolf D.W. Klemm
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | - Parul Christian
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
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27
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Shaikh S, Campbell RK, Mehra S, Kabir A, Schulze KJ, Wu L, Ali H, Shamim AA, West KP, Christian P. Supplementation with Fortified Lipid-Based and Blended Complementary Foods has Variable Impact on Body Composition Among Rural Bangladeshi Children: A Cluster-Randomized Controlled Trial. J Nutr 2020; 150:1924-1932. [PMID: 32240304 PMCID: PMC7330466 DOI: 10.1093/jn/nxaa061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/26/2019] [Accepted: 02/24/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Complementary food supplementation enhances linear growth and may affect body composition in children. OBJECTIVE We aimed to determine the effect of complementary food supplements provided from the age of 6 to 18 mo on fat-free mass (FFM) and fat mass (FM) gain among children in rural Bangladesh. METHODS In an unblinded, cluster-randomized, controlled trial we tested the effects of 4 complementary food supplements for 1 y [chickpea, rice lentil, Plumpy'doz, and wheat-soy-blend++ (WSB++)] compared with no supplements on linear growth. Body composition was estimated using weight-length-based, age- and sex-specific equations at 6, 9, 12, 15, and 18 mo and postintervention aged 24 mo. Generalized estimating equations (GEEs) were applied to estimate the effect of each complementary food on mean FFM and FM from 9 to 18 and 24 mo compared with the control, adjusting for baseline measures. Sex interactions were also explored. RESULTS In total, 3592 (65.9% of enrolled) children completed all anthropometric assessments. Estimated FFM and FM (mean ± SD) were 5.3 ± 0.6 kg and 1.4 ± 0.4 kg, respectively, at the age of 6 mo. Mean ± SE FFM and FM from 9 to 18 mo were 75.4 ± 14.0 g and 32.9 ± 7.1 g, and 61.0 ± 16.6 g and 30.0 ± 8.4 g, higher with Plumpy'doz and chickpea foods, respectively, than the control (P < 0.001). Estimated FFM was 41.5 ± 16.6 g higher in rice-lentil-fed versus control (P < 0.05) children. WSB++ had no impact on FFM or FM. A group-sex interaction (P < 0.1) was apparent with Plumpy'doz and rice-lentil foods, with girls involved in the intervention having higher estimated FFM and FM than control girls compared with no significant effect in boys. At 24 mo, FFM and FM remained higher only in girls eating Plumpy'doz compared with the controls (P < 0.01). CONCLUSIONS In this randomized trial, supplementation effected small shifts in apparent body composition in rural Bangladeshi children. Where seen, FFM increments were twice that of FM, in proportion to these compartments, and more pronounced in girls. FFM increased in line with reported improvements in length. This trial was registered at clinicaltrials.gov as NCT01562379.
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Affiliation(s)
| | - Rebecca K Campbell
- Center for Human Nutrition, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sucheta Mehra
- Center for Human Nutrition, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alamgir Kabir
- International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Kerry J Schulze
- Center for Human Nutrition, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lee Wu
- Center for Human Nutrition, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hasmot Ali
- The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh,Center for Human Nutrition, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abu Ahmed Shamim
- James P Grant School of Public Health, Bangladesh Rural Advancement Committee (BRAC), University, Dhaka, Bangladesh
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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28
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Hanif AAM, Shamim AA, Hossain MM, Hasan M, Hossaine M, Ullah MA, Sarker SK, Rahman SMM, Mitra DK, Haque ME, Mridha M. Elderly Women Are Disproportionately Vulnerable to Hypertension in Bangladesh: Evidence from the National Nutrition Surveillance Study. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa040_030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Bangladesh has a dearth of information on the prevalence and factors associated with hypertension among elderlies. We assessed the prevalence, sex differences in prevalence, and factors associated with hypertension in the most recent national nutrition surveillance round (2018–19).
Methods
We analyzed data of 4817 elderlies (≥60 years) from 82 clusters (57 rural, 15 urban and 10 slum) selected by multistage cluster sampling. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or having a history of hypertension. We analyzed data using Stata 15.0.
Results
The weighted prevalence of hypertension was 42%, and 56% for elderly males, and females, respectively; and was higher among females for many socio-demographic, behavioural and anthropetric variables including age 70 + years (58% vs. 46%); high waist circumference (69% vs. 65%); diabetes (69% vs. 65%); living in rural (55% vs. 41%), urban (63% vs. 45%) and slum (50% vs. 30%) area; Muslim (56% vs. 42%); insufficient physical activity (60% vs 52%); and inadequate fruits/vegetables intake (56% vs. 43%). Among females, the factors associated with hypertension were age 70 + years (AOR: 1.40, 95% CI: 1.15–1.71), waist circumference ≥80 cm (AOR: 2.20, 95% CI: 1.82–2.67), diabetes (AOR: 1.82, 95% CI: 1.35–2.45), and inadequate physical activity (AOR: 1.38, 95% CI: 1.15–1.67). Among males, these factors were age 70 + years (AOR: 1.32, 95% CI: 1.09–1.60), waist circumference ≥90 cm (AOR: 2.76, 95% CI: 2.22–3.43), diabetes (AOR: 1.36, 95% CI: 1.02–1.82), slum-dwelling (AOR: 0.71, 95% CI: 0.52–0.96), > 10 years of education (AOR: 1.83; 95% CI: 1.38, 2.44), inadequate physical activity (AOR: 1.50, 95% CI: 1.25–1.81), and current smoking (AOR: 0.74; 95% CI: 0.61, 0.89). In both males and females, fruits and vegetables intake was not assicaited with hypertension.
Conclusions
In Bangladesh, the elderly female population is disproportionately affected by hypertension. They were found having a consistent pattern of higher prevalence of hypertension for many socio-demographic, behavioral, and anthropometric variables. The ministry of health of Bangladesh should consider this disproportionately high prevalence of hypertension among elderly females while designing and implementing health programs.
Funding Sources
Ministry of Health and Family Welfare, Bangladesh.
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Affiliation(s)
- Abu Abdullah Mohammad Hanif
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Abu Ahmed Shamim
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Md Mokbul Hossain
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Mehedi Hasan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Moyazzam Hossaine
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Mohammad Aman Ullah
- Institute of Public Health Nutrition, Ministry of Health and Family Welfare, Government of Bangladesh
| | - Samir Kanti Sarker
- Institute of Public Health Nutrition, Ministry of Health and Family Welfare, Government of Bangladesh
| | - S M Mustafizur Rahman
- National Nutrition Services, Institute of Public Health Nutrition, Ministry of Health and Family Welfare, Government of Bangladesh
| | | | | | - Malay Mridha
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
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29
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Mridha M, Shamim AA, Hossain MM, Hasan M, Hanif AAM, Hossaine M, Ullah MA, Sarker SK, Rahman SMM, Mitra DK, Haque ME. Dietary Practices of Men in Bangladesh: Evidence from the National Nutrition Surveillance. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa046_049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Bangladesh has a paucity of information about the dietary practices of adult men. In the recently completed round of the national nutrition surveillance (NNS 2018–2019), we explored the dietary practices of adult men and factors associated with insufficient dietary diversity (IDD) and insufficient intake of fruits and vegetables.
Methods
In the NNS, between October 2018 and 2019, we collected data from from 82 clusters (57 rural, 15 non-slum urban, and 10 slums) selected using multistage cluster sampling. In these clusters we interviewed and took physical measurements of 4904 20–59 years old men (3471 in rural, 832 in urban, and 601 in slum). We used minimum dietary diversity for women (MDD-W) questionnaire to collect dietary data. IDD was defined as consumption of < 5 food groups out of 10 food groups, and insufficient fruits and vegetables intake was defined as consumption of < 5 servings of fruits and vegetables in the past 24 hours.
Results
The prevalence of IDD was 53% (54% in rural, 42% in non-slum urban, and 56% in slum areas) among the adult men. In the past 24 hours, 73% consumed meat/fish/poultry, 28% consumed eggs, and 22% consumed dairy products. The consumption of dark green leafy vegetables, vitamin A rich fuits and vegetables, other vegetables, other fruits was 34%, 22%, 73%, and 37%, respectively. Among the respondents, 27% had savory snacks, 52% had sweets, and 75% had sugary drinks. The prevalence of insufficient fruits and vegetables intake was 86% (83% in rural, 92% in non-slum urban and 93% in slum areas). IDD was associated with education (partial secondary education: Adjusted odds ratio (AOR) 0.67, P < 0.001; ≥10 years of schooling: AOR 0.48, P < 0.001), and sufficient intake of fruits and vegetables (AOR 0.82, P = 0.022). On the other hand, insufficient fruits and vegetables intake was associated with IDD (AOR 1.23, P = 0.014), hypertension (AOR 0.77, P = 0.020) and adequate physical activity (AOR 0.46, P < 0.001).
Conclusions
More than half of the men aged 20–59 years consume an inadequately diversified diet in Bangladesh and 86% had insufficient intake of fruits and vegetables. This study identified a number of factors associated with IDD, and insufficient intake of fruits and vegetables. The government of Bangladesh should address them while developing interventions to improve nutrition.
Funding Sources
Ministry of Health and Family Welfare, Bangladesh.
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Affiliation(s)
- Malay Mridha
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Abu Ahmed Shamim
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Md Mokbul Hossain
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Mehedi Hasan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Abu Abdullah Mohammad Hanif
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Moyazzam Hossaine
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Mohammad Aman Ullah
- Institute of Public Health Nutrition, Ministry of Health and Family Welfare, Government of Bangladesh
| | - Samir Kanti Sarker
- Institute of Public Health Nutrition, Ministry of Health and Family Welfare, Government of Bangladesh
| | - S M Mustafizur Rahman
- National Nutrition Services, Institute of Public Health Nutrition, Ministry of Health and Family Welfare, Government of Bangladesh
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Akter F, Hossain MM, Shamim AA, Hasan M, Hanif AAM, Hossaine M, Ullah MA, Sarker SK, Rahman SMM, Mitra DK, Haque ME, Mridha M. Inadequate Dietary Diversity and Its Determinants Among Adolescent Girls and Boys: Evidence from the National Nutrition Surveillance Study in Bangladesh. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa046_002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Bangladesh is experiencing triple burden of malnutrition among adolescents, which may be associated with inadequate dietary diversity (IDD). In the recently completed round of the national nutrition surveillance (NNS 2018–2019), we explored the prevalence of IDD and its determinants among adolescent girls and boys.
Methods
A total of 4808 adolescent girls and 4761 adolescent boys were interviewed. We used minimum dietary diversity for women (MDD-W) questionnaire to collect dietary data. IDD was defined as consumption of <5 food groups out of 10 food groups in the past 24 hours. Bivariate and multivariable logistic regression were performed to identify risk factors for IDD among adolescent girls and boys.
Results
The prevalence of IDD was 55.5% and 50.6% among the adolescent girls and boys. Prevalence of IDD decreased with an increase of educational attainment among girls (no education 77.8% and grade 10 completed education 49.2%) and boys (no education 68.2% and grade 10 completed education 44.2%). The prevalence of IDD in slum, urban and rural areas was 66.4%, 55.6%, and 51.9% among girls and 61.4%, 50.5% and 52.6% among boys, respectively. Prevalence of IDD was lowest among the richest wealth quintile (girls: 45.4% and boys: 43.1%). Among adolescent girls education (e.g., for grade 10 completed, AOR: 3.42, P = 0.002), marital status (AOR: 1.24, P = 0.046), processed food consumption (AOR: 1.66, P < 0.001), television viewing time (e. g. for ≤60 min/day, AOR: 1.37, P < 0.001), and sex of household head (AOR: 0.81, P = 0.003) were significantly associated with IDD. Among the adolescent boys age (AOR: 0.82, P = 0.024), education (e.g., for grade 10 completed, AOR: 2.36, P < 0.001), sex of household heads (AOR: 0.80, P = 0.002), livestock ownership (AOR: 1.22, P = 0.012), fruits and vegetable consumption (AOR: 1.38, P = 0.004), processed food intake (AOR: 1.74, P < 0.001), physical activity (AOR: 0.76, P = 0.001), and television viewing time (e. g. for ≤60 min/day, AOR: 1.19, P = 0.021) were significantly associated with IDD.
Conclusions
About more than half of the adolescent girls and boys consume inadequately diversified diet in Bangladesh. The study identified a number of factors associated with IDD, which should be addressed through comprehensive and sustainable public health interventions.
Funding Sources
Ministry of Health and Family Welfare, Bangladesh.
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Affiliation(s)
- Fahmida Akter
- BRAC James P Grant School Of Public Health, BRAC University, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Abu Ahmed Shamim
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Mehedi Hasan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Abu Abdullah Mohammad Hanif
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Moyazzam Hossaine
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Mohammad Aman Ullah
- Institute of Public Health Nutrition, Ministry of Health and Family Welfare, Government of Bangladesh
| | - Samir Kanti Sarker
- Institute of Public Health Nutrition, Ministry of Health and Family Welfare, Government of Bangladesh
| | - S M Mustafizur Rahman
- National Nutrition Services, Institute of Public Health Nutrition, Ministry of Health and Family Welfare, Government of Bangladesh
| | | | | | - Malay Mridha
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
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Hasan H, Shamim AA, Hossain MM, Hanif AAM, Hossaine M, Ullah MA, Sarker SK, Rahman SMM, Mitra DK, Haque ME, Mridha M. Double Burden of Malnutrition Among Elderly People in Bangladesh: Evidence from the National Nutrition Surveillance Study. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa053_045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Double burden of malnutrition (DBM), referred as the coexistence of undernutrition and overnutrition, is an evolving public health concern. There is a paucity of data about DBM among elderly people in Bangladesh. In the recently completed round of the national nutrition surveillance (NNS 2018–2019), we assessed the prevalence and determinants of DBM among elderly people.
Methods
In the NNS, we collected data from 30,005 persons in 6 population groups from 82 clusters (57 rural, 15 non-slum urban, and 10 slums) selected using multistage cluster sampling. We collected socio-demographic, life-style and anthropometric data from 4817 respondents aged >60 years. Underweight was defined as body mass index (BMI) <18.5 kg/m2 and overweight/obesity as BMI ≥ 23 kg/m2.
Results
The weighted prevalence of underweight was 26.8%, and was higher among elderly aged ≥70 years (34.4%), male (28.5%), non-diabetic (28.5%), rural residents (27.1%) and with inadequate fruits and vegetables consumption (27.1%). The weighted prevalence of overweight was 27.0%, and was higher among elderly aged 60–69 years (29.8%), female (30.8), diabetic (51.0%), urban residents (48.2%), with poor physical activity (31.3%), and with inadequate fruits and vegetables consumption (27.4%). As education and wealth status increased, the prevalence of underweight decreased and the prevalence of overweight and obesity increased. In multivariable logistic regression, male gender (AOR: 1.33, 95% CI: 1.18,1.51), being non-diabetic (AOR: 1.50, 95% CI: 1.23,1.82), having no education (AOR: 1.73, 95% CI: 1.35,2.22), and having adequate physical activity (AOR: 1.19, 95% CI: 1.05,1.35) were associated with underweight. However, urban residency (AOR: 1.73, 95% CI: 1.41,2.12), 60–69 years age (AOR: 1.59, 95% CI: 1.36,1.85), being female (AOR: 1.81, 95% CI: 1.56,2.10), having diabetes (AOR: 2.52, 95% CI:2.07,3.08), being Muslim (AOR: 1.25, 95% CI: 1.04,1.53), and having inadequate physical activity (AOR: 1.36, 95% CI: 1.18,1.57) were associated with overweight.
Conclusions
The overall prevalence of undernutrition and overnutrition is very high among elderly population in Bangladesh. The government together with national and international organizations should implement population-based interventions to prevent and control DBM.
Funding Sources
Ministry of Health and Family Welfare, Bangladesh.
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Affiliation(s)
- Hasan Hasan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Abu Ahmed Shamim
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Md Mokbul Hossain
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Abu Abdullah Mohammad Hanif
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Moyazzam Hossaine
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Mohammad Aman Ullah
- Institute of Public Health Nutrition, Ministry of Health and Family Welfare, Government of Bangladesh
| | - Samir Kanti Sarker
- Institute of Public Health Nutrition, Ministry of Health and Family Welfare, Government of Bangladesh
| | - S M Mustafizur Rahman
- National Nutrition Services, Institute of Public Health Nutrition, Ministry of Health and Family Welfare, Government of Bangladesh
| | | | | | - Malay Mridha
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
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Hossain MM, Shamim AA, Hasan M, Hanif AAM, Hossaine M, Ullah MA, Sarker SK, Rahman SMM, Mitra DK, Haque ME, Mridha M. Prevalence of and Factors Associated with Insufficient Physical Activity Among Adolescents: Evidence from the National Nutrition Surveillance Study. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa066_010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
The World Health Organization (WHO) set a target of 15% relative reduction of the prevalence of insufficient physical activity (IPA) by 2025 among adolescents and adults globally. In Bangladesh, there is no national estimates of the prevalence of IPA among adolescents. In the recently completed round of the national nutrition surveillance (NNS 2018–2019), we aimed to estimate the prevalence and risk factors associated with IPA among adolescent girls and boys.
Methods
NNS was conducted in 57 rural, 15 urban and 10 slum clusters selected using multistage cluster sampling. In these clusters, we collected data from 4732 adolescent girls and 4761 adolescent boys. We used Global Physical Activity Questionnaire to collect physical activity (PA) data. The WHO recommended cut off points for IPA (5–17 years: <300 minutes of moderate to vigorous-intensity PA weekly; 18–19 years: <150 minutes of moderate intensity PA weekly or <75 minutes of vigorous-intensity PA weekly) were used to estimate the prevalence of IPA. Bivariate and multivariable logistic regression were performed to identify factors associated with IPA.
Results
Prevalence of IPA among girls and boys were 50.6% and 29.4%, respectively and the prevalence was significantly higher among early adolescents (10–14 years) than late adolescents in both boys and girls. The IPA prevalence was the highest among the adolescents living in non-slum urban areas (girls: 77.9% and boys: 64.6%). The IPA prevalence in slum areas was 36.6% for girls and 34.0% for boys; and in rural areas was 50.0% for girls and 28.2% for boys. For both girls and boys, age group, occupation and >6 hours of sitting per day were associated with IPA. Place of residence, consumption of fruits and vegetables, education and paternal occupation were associated with IPA only among the boys. On the other hand, maternal and paternal education and overweight/obesity were associated with IPA only among the girls.
Conclusions
One in every two adolescent girls and one in every three adolescent boys do not meet the WHO recommended level of PA in Bangladesh. This study identified several modifiable factors associated with IPA among adolescent boys and girls and these factors should be addressed through comprehensive public health interventions in order to improve adolescent health in Bangladesh.
Funding Sources
Ministry of Health and Family Welfare, Bangladesh.
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Affiliation(s)
- Md Mokbul Hossain
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Abu Ahmed Shamim
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Mehedi Hasan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Abu Abdullah Mohammad Hanif
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Moyazzam Hossaine
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
| | - Mohammad Aman Ullah
- Institute of Public Health Nutrition, Ministry of Health and Family Welfare, Government of Bangladesh
| | - Samir Kanti Sarker
- Institute of Public Health Nutrition, Ministry of Health and Family Welfare, Government of Bangladesh
| | - S M Mustafizur Rahman
- National Nutrition Services, Institute of Public Health Nutrition, Ministry of Health and Family Welfare, Government of Bangladesh
| | | | | | - Malay Mridha
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University
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Schulze KJ, Mehra S, Shaikh S, Ali H, Shamim AA, Wu LSF, Mitra M, Arguello MA, Kmush B, Sungpuag P, Udomkesmelee E, Merrill R, Klemm RDW, Ullah B, Labrique AB, West KP, Christian P. Antenatal Multiple Micronutrient Supplementation Compared to Iron-Folic Acid Affects Micronutrient Status but Does Not Eliminate Deficiencies in a Randomized Controlled Trial Among Pregnant Women of Rural Bangladesh. J Nutr 2019; 149:1260-1270. [PMID: 31006806 PMCID: PMC6602890 DOI: 10.1093/jn/nxz046] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/15/2019] [Accepted: 02/25/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Antenatal multiple micronutrient (MM) supplementation improves birth outcomes relative to iron-folic acid (IFA) in developing countries, but limited data exist on its impact on pregnancy micronutrient status. OBJECTIVE We assessed the efficacy of a daily MM (15 nutrients) compared with IFA supplement, each providing approximately 1 RDA of nutrients and given beginning at pregnancy ascertainment, on late pregnancy micronutrient status of women in rural Bangladesh. Secondarily, we explored other contributors to pregnancy micronutrient status. METHODS Within a double-masked trial (JiVitA-3) among 44,500 pregnant women, micronutrient status indicators were assessed in n = 1526 women, allocated by cluster to receive daily MM (n = 749) or IFA (n = 777), at 10 wk (baseline: before supplementation) and 32 wk (during supplementation) gestation. Efficacy of MM supplementation on micronutrient status indicators at 32 wk was assessed, controlling for baseline status and other covariates (e.g., inflammation and season), in regression models. RESULTS Baseline status was comparable by intervention. Prevalence of deficiency among all participants was as follows: anemia, 20.6%; iron by ferritin, 4.0%; iron by transferrin receptor, 4.7%; folate, 2.5%; vitamin B-12, 35.4%; vitamin A, 6.7%; vitamin E, 57.7%; vitamin D, 64.0%; zinc, 13.4%; and iodine, 2.6%. At 32 wk gestation, vitamin B-12, A, and D and zinc status indicators were 3.7-13.7% higher, and ferritin, γ-tocopherol, and thyroglobulin indicators were 8.7-16.6% lower, for the MM group compared with the IFA group, with a 15-38% lower prevalence of deficiencies of vitamins B-12, A, and D and zinc (all P < 0.05). However, indicators typically suggested worsening status during pregnancy, even with supplementation, and baseline status or other covariates were more strongly associated with late pregnancy indicators than was MM supplementation. CONCLUSIONS Rural Bangladeshi women commonly entered pregnancy deficient in micronutrients other than iron and folic acid. Supplementation with MM improved micronutrient status, although deficiencies persisted. Preconception supplementation or higher nutrient doses may be warranted to support nutritional demands of pregnancy in undernourished populations. This trial was registered at clinicaltrials.gov as NCT00860470.
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Affiliation(s)
- Kerry J Schulze
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Address correspondence to KJS (e-mail: )
| | - Sucheta Mehra
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Saijuddin Shaikh
- The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh
| | - Hasmot Ali
- The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh
| | - Abu Ahmed Shamim
- The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh
| | - Lee S-F Wu
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Maithilee Mitra
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Margia A Arguello
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Brittany Kmush
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Rebecca Merrill
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rolf D W Klemm
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Barkat Ullah
- The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh
| | - Alain B Labrique
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Surkan PJ, Strobino DM, Mehra S, Shamim AA, Rashid M, Wu LSF, Ali H, Ullah B, Labrique AB, Klemm RDW, West KP, Christian P. Unintended pregnancy is a risk factor for depressive symptoms among socio-economically disadvantaged women in rural Bangladesh. BMC Pregnancy Childbirth 2018; 18:490. [PMID: 30545325 PMCID: PMC6292066 DOI: 10.1186/s12884-018-2097-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/19/2018] [Indexed: 01/09/2023] Open
Abstract
Background Little is known about the relation between unwanted pregnancy and intention discordance and maternal mental health in low-income countries. The study aim was to evaluate maternal and paternal pregnancy intentions (and intention discordance) in relation to perinatal depressive symptoms among rural Bangladeshi women. Methods Data come from a population-based, community trial of married rural Bangladeshi women aged 13–44. We examined pregnancy intentions among couples and pregnancy-intention discordance, as reported by women at enrollment soon after pregnancy ascertainment, in relation to depressive symptoms in the third trimester of pregnancy (N = 14,629) and six months postpartum (N = 31,422). We calculated crude and adjusted risk ratios for prenatal and postnatal depressive symptoms by pregnancy intentions. Results In multivariable analyses, women with unwanted pregnancies were at higher risk of prenatal (Adj. RR = 1.60, 95% CI: 1.37–1.87) and postnatal depressive symptoms (Adj. RR = 1.32, 95% CI: 1.21–1.44) than women with wanted pregnancies. Women who perceived their husbands did not want the pregnancy also were at higher risk for prenatal (Adj. RR = 1.42, 95% CI: 1.22–1.65) and postnatal depressive symptoms (Adj. RR = 1.30, 95% CI: 1.19–1.41). Both parents not wanting the pregnancy was associated with prenatal and postnatal depressive symptoms (Adj. RR = 1.34, 95% CI: 1.19–1.52; Adj. RR = 1.13, 95% CI: 1.06–1.21, respectively), compared to when both parents wanted it. Adjusting for socio-demographic and pregnancy intention variables simultaneously, maternal intentions and pregnancy discordance were significantly related to prenatal depressive symptoms, and perception of paternal pregnancy unwantedness and couple pregnancy discordance, with postnatal depressive symptoms. Conclusions Maternal, paternal and discordant couple pregnancy intentions, as perceived by rural Bangladeshi women, are important risk factors for perinatal maternal depressive symptoms.
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Affiliation(s)
- Pamela J Surkan
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Room E2519, Baltimore, MD, 21205-2179, USA. .,Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205-2179, USA.
| | - Donna M Strobino
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205-2179, USA
| | - Sucheta Mehra
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Room E2519, Baltimore, MD, 21205-2179, USA
| | - Abu Ahmed Shamim
- The JiVitA Project, Johns Hopkins University in Bangladesh, Gaibandha, Bangladesh
| | - Mahbubur Rashid
- The JiVitA Project, Johns Hopkins University in Bangladesh, Gaibandha, Bangladesh
| | - Lee Shu-Fune Wu
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Room E2519, Baltimore, MD, 21205-2179, USA
| | - Hasmot Ali
- The JiVitA Project, Johns Hopkins University in Bangladesh, Gaibandha, Bangladesh
| | - Barkat Ullah
- The JiVitA Project, Johns Hopkins University in Bangladesh, Gaibandha, Bangladesh
| | - Alain B Labrique
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Room E2519, Baltimore, MD, 21205-2179, USA
| | - Rolf D W Klemm
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Room E2519, Baltimore, MD, 21205-2179, USA
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Room E2519, Baltimore, MD, 21205-2179, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Room E2519, Baltimore, MD, 21205-2179, USA
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Campbell RK, Hurley KM, Shamim AA, Shaikh S, Chowdhury ZT, Mehra S, Wu L, Christian P. Complementary Food Supplements Increase Dietary Nutrient Adequacy and Do Not Replace Home Food Consumption in Children 6-18 Months Old in a Randomized Controlled Trial in Rural Bangladesh. J Nutr 2018; 148:1484-1492. [PMID: 30184222 DOI: 10.1093/jn/nxy136] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 06/05/2018] [Indexed: 01/24/2023] Open
Abstract
Background Inadequate complementary feeding is common in low- and middle-income countries, contributing to growth deficits. Complementary food supplements (CFSs) aim to fill dietary gaps, but few CFS studies have measured nutrient intake. In a community-based, randomized CFS trial in Bangladesh, we previously reported poor dietary diversity in 6-18-mo-old participants. Objective We investigated, in a secondary analysis in the same trial, micronutrient intake adequacy in supplemented compared with control-arm children. Methods At age 6 mo, children were assigned to 1 y of child-feeding counseling for mothers (control) or counseling plus 1 of 4 CFS formulations. Mothers were administered quantitative past 24-h diet questionnaires for their children at ages 6, 9, 12, 15, and 18 mo. Nutrient intakes were estimated with local recipes and food composition tables assuming average age-specific breastmilk intake. Adequacy was evaluated relative to estimated average requirements or adequate intakes. Multivariate analysis of variance and generalized estimating equation (GEE) regression models estimated the effect of each CFS on nutrient adequacy. GEE models tested dietary predictors of nutrient adequacy in the control arm. Results A total of 25,964 dietary modules across 5 interviews were completed. Nutrient adequacy from home foods combined with assumed breastmilk intake was low. Only 5 of 16 micronutrients were adequately consumed by >60% of children at 18 mo of age. Daily CFSs did not affect energy-adjusted micronutrient intake from home foods at any follow-up age (P > 0.05). CFSs increased the mean adequacy ratio for all micronutrients (P < 0.001 at all ages), to ≥1 for 14 of 16 micronutrients at 18 mo. Dietary diversity predicted adequate iron, zinc and calcium intake at 15 mo in unsupplemented controls. Conclusions Home foods did not meet the estimated micronutrient needs of 9-18-mo-old children in rural Bangladesh. Daily supplementation with fortified complementary foods filled many micronutrient intake gaps and did not displace home foods. Previously, CFSs were shown to also improve linear growth and reduce stunting in this cohort. Findings support the need for CFSs in similar settings to promote nutritional well being and growth. This trial was registered at clinicaltrials.gov as NCT01562379.
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Affiliation(s)
- Rebecca K Campbell
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kristen M Hurley
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Abu Ahmed Shamim
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Saijuddin Shaikh
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Zaynah T Chowdhury
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sucheta Mehra
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lee Wu
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Kabir A, Rahman MJ, Shamim AA, Klemm RDW, Labrique AB, Rashid M, Christian P, West KP. Identifying maternal and infant factors associated with newborn size in rural Bangladesh by partial least squares (PLS) regression analysis. PLoS One 2017; 12:e0189677. [PMID: 29261760 PMCID: PMC5738092 DOI: 10.1371/journal.pone.0189677] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 11/30/2017] [Indexed: 11/19/2022] Open
Abstract
Birth weight, length and circumferences of the head, chest and arm are key measures of newborn size and health in developing countries. We assessed maternal socio-demographic factors associated with multiple measures of newborn size in a large rural population in Bangladesh using partial least squares (PLS) regression method. PLS regression, combining features from principal component analysis and multiple linear regression, is a multivariate technique with an ability to handle multicollinearity while simultaneously handling multiple dependent variables. We analyzed maternal and infant data from singletons (n = 14,506) born during a double-masked, cluster-randomized, placebo-controlled maternal vitamin A or β-carotene supplementation trial in rural northwest Bangladesh. PLS regression results identified numerous maternal factors (parity, age, early pregnancy MUAC, living standard index, years of education, number of antenatal care visits, preterm delivery and infant sex) significantly (p<0.001) associated with newborn size. Among them, preterm delivery had the largest negative influence on newborn size (Standardized β = -0.29 − -0.19; p<0.001). Scatter plots of the scores of first two PLS components also revealed an interaction between newborn sex and preterm delivery on birth size. PLS regression was found to be more parsimonious than both ordinary least squares regression and principal component regression. It also provided more stable estimates than the ordinary least squares regression and provided the effect measure of the covariates with greater accuracy as it accounts for the correlation among the covariates and outcomes. Therefore, PLS regression is recommended when either there are multiple outcome measurements in the same study, or the covariates are correlated, or both situations exist in a dataset.
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Affiliation(s)
- Alamgir Kabir
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
- The JiVitA Maternal and Child Health and Nutrition Research Project of Johns Hopkins University, Gaibandha, Bangladesh
- * E-mail:
| | | | - Abu Ahmed Shamim
- The JiVitA Maternal and Child Health and Nutrition Research Project of Johns Hopkins University, Gaibandha, Bangladesh
- Helen Keller International, Dhaka, Bangladesh
| | - Rolf D. W. Klemm
- Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Helen Keller International, New York, New York, United States of America
| | - Alain B. Labrique
- Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mahbubur Rashid
- The JiVitA Maternal and Child Health and Nutrition Research Project of Johns Hopkins University, Gaibandha, Bangladesh
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- The Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Keith P. West
- Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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Ali H, Hamadani J, Mehra S, Tofail F, Hasan MI, Shaikh S, Shamim AA, Wu LSF, West KP, Christian P. Effect of maternal antenatal and newborn supplementation with vitamin A on cognitive development of school-aged children in rural Bangladesh: a follow-up of a placebo-controlled, randomized trial. Am J Clin Nutr 2017; 106:77-87. [PMID: 28490513 DOI: 10.3945/ajcn.116.134478] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 04/07/2017] [Indexed: 11/14/2022] Open
Abstract
Background: The impact of early vitamin A supplementation on neurodevelopmental function has not been adequately studied. In rural Bangladesh we examined cognitive and motor function and scholastic achievement in a cohort of children who were exposed to vitamin A in utero or at birth.Objective: The aim of this study was to examine independent and combined effects of antenatal and newborn supplementation with vitamin A on the cognitive function of children at 8 y of age.Design: A cohort of rural Bangladeshi children from 2 previous double-blind, placebo-controlled cluster-randomized trials were revisited at age 8 y between February 2013 and June 2014. Data on sociodemographic, social, and physical conditions; schooling; child care behavior; anthropometric measures; and cognitive function were collected with the use of various psychometric assessment tools.Results: Among 11,950 children from the parent trial who were last known to be alive, a subset of 1803 children balanced by treatment group in a selected contiguous study area were re-enrolled and 1613 (89%) provided consent for assessments. Of these, 1577 (87%) children had a complete cognitive evaluation. All groups were highly comparable on baseline variables collected in the previous trials and factors measured at re-enrollment. Overall, there was no impact of either maternal or newborn supplementation with vitamin A on intelligence, memory, and motor function. Compared with placebo, children who received both interventions had significantly better performance in reading, spelling, and math computation, with increased mean (95% CI) scores of 8.0 (2.2, 13.8), 6.8 (1.9, 11.7), and 4.8 (0.6, 9.0), respectively.Conclusions: General intelligence or memory and motor functions were not affected by antenatal or newborn supplementation with vitamin A. Scholastic performance and aspects of executive function improved when both interventions were provided. These trials were registered at clinicaltrials.gov as NCT00198822 and NCT00128557.
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Affiliation(s)
- Hasmot Ali
- The JiVitA Project, Johns Hopkins University Bangladesh, Paschim Para, Gaibandha, Bangladesh; .,Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jena Hamadani
- Child Development Unit, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sucheta Mehra
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Fahmida Tofail
- Child Development Unit, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Imrul Hasan
- Child Development Unit, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Saijuddin Shaikh
- The JiVitA Project, Johns Hopkins University Bangladesh, Paschim Para, Gaibandha, Bangladesh.,Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Lee S-F Wu
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Keith P West
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Parul Christian
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Bill & Melinda Gates Foundation, Seattle, WA
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Chowdhury ZT, Hurley K, Campbell RK, Shaikh S, Shamim AA, Mehra S, Christian P. Quantification and Validation of a Semi‐Structured 24‐ Hour Diet Recall for Infants and Young Children in Rural Bangladesh. FASEB J 2017. [DOI: 10.1096/fasebj.31.1_supplement.639.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Kristen Hurley
- Center for Human NutritionJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Saijuddin Shaikh
- JiVitA ProjectGaibandhaBangladesh
- Center for Human NutritionJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Sucheta Mehra
- Center for Human NutritionJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
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Sundaram ME, Ali H, Mehra S, Shamim AA, Ullah B, Rashid M, Shaikh S, Christian P, Klemm RDW, West KP, Labrique A. Early newborn ritual foods correlate with delayed breastfeeding initiation in rural Bangladesh. Int Breastfeed J 2016; 11:31. [PMID: 27980605 PMCID: PMC5143457 DOI: 10.1186/s13006-016-0090-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 11/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background Early and exclusive breastfeeding may improve neonatal survival in low resource settings, but suboptimal breastfeeding still exists in areas with high infant mortality. Prelacteal feeding, the practice of giving a non-breastmilk food as a neonate’s first food, has been associated with suboptimal breastfeeding practices. We examined the association of feeding a non-breastmilk food in the first three days of life (early neonatal food, or ENF) with time from birth to initiation of breastfeeding among 25,286 Bangladeshi mother-neonate pairs, in a secondary analysis of a randomized controlled trial in northwestern rural Bangladesh conducted from 2001–2007. Methods Trained interviewers assessed the demographic characteristics during pregnancy. At three months postpartum, the interviewers visited participants again and retrospectively assessed demographic and breastfeeding characteristics surrounding the birth. We assessed the relationship between ENF and time to initiation of breastfeeding in hours in both unadjusted and adjusted linear regression analyses. We also calculated reverse cumulative distribution curves for time to initiation of breastfeeding and analyses were stratified by an infant’s ability to breastfeed normally at birth. Results The mean ± SD time from birth to initiation of breastfeeding was 30.6 ± 27.9 hours. Only 2,535 (10.0%) of women reported initiating breastfeeding in the first hour after birth and 10,207 (40.4%) reported initiating breastfeeding in the first 12 hours after birth. In adjusted linear regression analyses, feeding ENF was associated with a significant increase in time, in hours, to breastfeeding initiation both among children not able to breastfeed at birth (37.4; 95% CI 33.3, 41.5) and among children able to breastfeed at birth (13.3; 95% CI 12.7, 14.0). Conclusions Feeding ENF was strongly associated with delayed initiation of breastfeeding, even after adjusting for other related factors and stratifying on the neonate’s ability to suckle normally after birth. More research is needed to understand the impact of these findings on optimal breastfeeding in this setting. It is possible that ENF feeding and the ability to breastfeed immediately after birth are interrelated in their respective associations to suboptimal breastfeeding initiation. This study in a large population representative of other populations in rural South Asia, demonstrates significantly longer times to breastfeeding initiation than previously appreciated, with a possible important role of ENF feeding. Trial registration The randomized controlled trial on which this analysis is based, “Impact of Maternal Vitamin A or Beta-Carotene Supplementation on Maternal and Infant Mortality in Bangladesh”, was registered with ClinicalTrials.gov as trial number ID GHS-A-00-03-00019-00 and identifier NCT00198822. The identifier was first received September 12, 2005 (retrospectively registered). The first participant was enrolled in August 2001. Electronic supplementary material The online version of this article (doi:10.1186/s13006-016-0090-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria E Sundaram
- Department of Environmental Health, University of Minnesota School of Public Health, Minneapolis, MN USA
| | - Hasmot Ali
- The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh
| | - Sucheta Mehra
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Abu Ahmed Shamim
- The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh ; SHIKHA Project, FHI 360, Durham, NC USA
| | - Barkat Ullah
- International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mahbubur Rashid
- The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh
| | - Saijuddin Shaikh
- The JiVitA Maternal and Child Health and Nutrition Research Project, Gaibandha, Bangladesh
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Rolf D W Klemm
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Alain Labrique
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Campbell RK, Hurley KM, Shamim AA, Shaikh S, Chowdhury ZT, Mehra S, de Pee S, Ahmed T, West KP, Christian P. Effect of complementary food supplementation on breastfeeding and home diet in rural Bangladeshi children. Am J Clin Nutr 2016; 104:1450-1458. [PMID: 27680994 PMCID: PMC5081719 DOI: 10.3945/ajcn.116.135509] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 08/26/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Complementary food supplements (CFSs) can enhance growth where stunting is common, but substitution for the usual diet may reduce observed benefits. OBJECTIVE We aimed to characterize dietary diversity from home foods in a CFS efficacy trial and determine whether supplementation reduced breastfeeding frequency or displaced home foods. DESIGN In a cluster-randomized controlled trial in rural Bangladesh, children (n = 5499) received, for 1 y starting at age 6 mo, periodic child feeding counseling for mothers (control) or counseling plus 1 of 4 CFSs fed as a daily snack. Breastfeeding status and past 24-h diet were assessed at enrollment and every 3 mo thereafter until 18 mo of age. A 7-food group dietary diversity score (DDS) was calculated from home foods only, and a DDS ≥4 constituted minimum dietary diversity (MDD). RESULTS Most children (97%) were breastfed through 18 mo of age, and 24-h breastfeeding frequency did not differ by supplementation group. Child dietary diversity was low; only 51% of children met the MDD by 18 mo. Rice, potatoes, and biscuits (cookies) were the most frequently consumed foods, whereas the legumes, dairy, eggs, and vitamin A-rich fruit and vegetable food groups were each consumed by <50% of children. The odds of meeting the MDD through the consumption of home foods were equal or greater in the supplemented groups compared with the control group at all ages. High socioeconomic status and any maternal education were associated with increased odds of MDD at age 18 mo, whereas child sex and household food security were not associated with MDD. CONCLUSIONS In a setting where daily complementary food supplementation improved linear growth, there was no evidence that supplementation displaced breastfeeding or home foods, and the supplementation may have improved dietary diversity. Pathways by which supplementation with fortified foods may enhance dietary diversity, such as an improved appetite and increased body size, need elucidation. This trial was registered at clinicaltrials.gov as NCT01562379.
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Affiliation(s)
- Rebecca K Campbell
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kristen M Hurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Saijuddin Shaikh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Zaynah T Chowdhury
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sucheta Mehra
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Saskia de Pee
- Nutrition Division, United Nations World Food Program, Rome, Italy
| | - Tahmeed Ahmed
- Center for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Keith P West
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
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Christian P, Kim J, Mehra S, Shaikh S, Ali H, Shamim AA, Wu L, Klemm R, Labrique AB, West KP. Effects of prenatal multiple micronutrient supplementation on growth and cognition through 2 y of age in rural Bangladesh: the JiVitA-3 Trial. Am J Clin Nutr 2016; 104:1175-1182. [PMID: 27604769 DOI: 10.3945/ajcn.116.135178] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 08/04/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Childhood undernutrition may have prenatal origins, and the impact of prenatal interventions on postnatal growth is not well known. OBJECTIVE We assessed the effects of prenatal multiple micronutrient (MM) supplementation on child growth and cognitive development. DESIGN In a cluster-randomized controlled trial in rural Bangladesh, prenatal MM supplementation compared with iron-folic acid (IFA) supplementation was examined for its impact on growth assessed longitudinally from birth up to 24 mo of age (n = 8529) and, in a subsample (n = 734), on cognitive function at 24 mo of age by use of the Bayley scales of infant and toddler development-third edition test. RESULTS Prevalence of stunting at birth [length for age z score (LAZ): <-2] was 31.9% in the MM and 35.7% in the IFA groups (P < 0.001); however, LAZ increased during the first 3-4 mo in both groups. With the use of a linear random-effects model, prenatal MM-exposed children sustained a higher mean predicted LAZ of ∼0.10 at 1 and 3 mo and 0.06 at 6 mo of age compared with children in the IFA group. Supplementation reduced the prevalence of stunting at 1 (RR: 0.95; 95% CI: 0.92, 0.98) and 3 (RR: 0.91; 95% CI: 0.88, 0.94) mo of age. Differences between groups were absent by 6, 12, and 24 mo of age, when nearly 50% of children had stunted growth. Ponderal and linear growth velocities were somewhat slower from 3 to 12 mo of age in the MM group than in the IFA group, but not from 12 to 24 mo of age. There was no difference between groups on composite scores of cognition, language, and motor performance at 24 mo of age. CONCLUSIONS In this Bangladeshi trial, maternal pre- and postnatal MM supplementation resulted in improvements in LAZ and reduction in stunting through 3 mo of age, but not thereafter and had no impact on cognitive and motor function at 2 y. This trial was registered at clinicaltrials.gov as NCT000860470.
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Affiliation(s)
- Parul Christian
- Departments of International Health and Bill & Melinda Gates Foundation, Seattle, WA
| | - Jeongyong Kim
- Biostatistics, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | | | - Saijuddin Shaikh
- Departments of International Health and JiVitA Maternal and Child Health & Nutrition Research Project, Gaibandha, Bangladesh; and
| | - Hasmot Ali
- Departments of International Health and JiVitA Maternal and Child Health & Nutrition Research Project, Gaibandha, Bangladesh; and
| | - Abu Ahmed Shamim
- Departments of International Health and Biostatistics, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | - Lee Wu
- Departments of International Health and
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Na M, Mehra S, Christian P, Ali H, Shaikh S, Shamim AA, Labrique AB, Klemm RD, Wu LS, West KP. Maternal Dietary Diversity Decreases with Household Food Insecurity in Rural Bangladesh: A Longitudinal Analysis. J Nutr 2016; 146:2109-2116. [PMID: 27581578 DOI: 10.3945/jn.116.234229] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/02/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Household food insecurity (HFI) can lead to a poor diet and malnutrition. Yet, little is known about the extent to which maternal diet covaries with food insecurity during pregnancy and lactation. OBJECTIVE Longitudinal associations between HFI and maternal dietary diversity from early pregnancy to 3 mo postpartum were examined in rural Bangladesh. METHODS We repeatedly assessed dietary intake by using a 7-d food-frequency questionnaire in the first and third trimesters of pregnancy and at 3 mo postpartum among 14,600 women enrolled into an antenatal micronutrient supplementation trial. Maternal dietary diversity score (DDS) was constructed as the sum of 10 food groups reportedly consumed at each assessment. Households were classified at 6 mo postpartum as being food secure or having mild, moderate, or severe HFI on the basis of a 9-item standard scale. Generalized estimating equations were used to estimate the longitudinal relation between HFI status and DDS and the likelihood of individual food-group consumption, adjusting for confounders at the maternal and household levels. RESULTS The DDS decreased with progressively worse HFI, an association best explained by a derived household wealth index. Compared with women from food-secure households, women of mild, moderate, and severe HFI were less likely, in a dose-response fashion, to have consumed dairy products [adjusted ORs (95% CIs): 0.73 (0.69, 0.78), 0.62 (0.58, 0.66), and 0.52 (0.48, 0.55), respectively], eggs [0.81 (0.76, 0.85), 0.73 (0.68, 0.77), and 0.61 (0.57, 0.65)], meat [0.83 (0.79, 0.88), 0.73 (0.69, 0.78), and 0.60 (0.56, 0.64)], fish [0.87 (0.80, 0.94), 0.76 (0.70, 0.83), and 0.59 (0.54, 0.65)], legumes and nuts [0.88 (0.83, 0.93), 0.81 (0.76, 0.87), and 0.79 (0.74, 0.85)], and yellow and orange fruit and vegetables [0.85 (0.80, 0.91), 0.78 (0.73, 0.84), and 0.72 (0.67, 0.78)]. Neither intakes of dark-green leafy vegetables nor of vegetable oil were associated with HFI status. CONCLUSION Antenatal and postnatal maternal dietary diversity, especially intakes of animal-source foods, fruit, and vegetables, declined with worsening food insecurity in rural Bangladesh.
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Affiliation(s)
- Muzi Na
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sucheta Mehra
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Hasmot Ali
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; JiVitA Project of Johns Hopkins University, Gaibandha, Bangladesh; and
| | - Saijuddin Shaikh
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; JiVitA Project of Johns Hopkins University, Gaibandha, Bangladesh; and
| | - Abu Ahmed Shamim
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; JiVitA Project of Johns Hopkins University, Gaibandha, Bangladesh; and
| | - Alain B Labrique
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rolf Dw Klemm
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Helen Keller International, Washington, DC
| | - Lee Sf Wu
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
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Chowdhury ZT, Hurley KM, Jahan M, Shaikh S, Mehra S, Ali H, Shamim AA, Christian P. Non‐Responsive Feeding Behaviors are Negatively Associated with Growth and Dietary Diversity at 24 months in Rural Bangladesh. FASEB J 2016. [DOI: 10.1096/fasebj.30.1_supplement.432.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Zaynah T Chowdhury
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Kristen M Hurley
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Saijuddin Shaikh
- JiVitA ProjectGaibandhaBangladesh
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Sucheta Mehra
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Hasmot Ali
- JiVitA ProjectGaibandhaBangladesh
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Parul Christian
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
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Shamim AA, Mashreky SR, Ferdous T, Tegenfeldt K, Roy S, Rahman AKMF, Rashid I, Haque R, Rahman Z, Hossen K, Siddiquee SR, Rahman M, Sanghvi TG, Shaheen N. Pregnant Women Diet Quality and Its Sociodemographic Determinants in Southwestern Bangladesh. Food Nutr Bull 2016; 37:14-26. [DOI: 10.1177/0379572116632137] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Diet diversity of pregnant women is associated with nutrition sufficiency, micronutrient adequacy, and pregnancy outcomes. However, the sociodemographic determinants of diet diversity among pregnant women in low-income countries are not well studied. Objective: The analysis was undertaken to study the determinants of high dietary diversity and consumption of micronutrient-rich foods by pregnant women from rural Bangladesh. Methods: Pregnant women (508) were randomly selected from southwestern Bangladesh and interviewed to collect data about diet and sociodemographic characteristics. A 24-hour recall was used to collect information about diet. Diet diversity score was calculated for 9 major food groups. All analyses were conducted using STATA SE 12. Result: The overall mean diet diversity score was low at 4.28 and was significantly high among pregnant women who have higher educational achievement, whose husbands’ occupation was business, who live in households of 4 or more family members, and who were dwelling in a house with more than 1 room. Highest gap on knowledge and consumption was reported for 3 food groups including dairy foods, eggs, and dark green leafy vegetables. Consumption of dairy and eggs was lower among women from low socioeconomic status, but no significant association was found between sociodemographic characteristics and consumption of leafy vegetables. Conclusion: Our analysis has shown that diet quality of pregnant women was poor and intake of micronutrient-rich foods was low despite having knowledge about the importance of these foods, underscoring the need for promoting the diet quality in developing countries through behavior change communication programs.
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Affiliation(s)
| | - Saidur Rahman Mashreky
- Center for Injury Prevention, Health Development and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | | | | | | | - A. K. M. Fazlur Rahman
- Center for Injury Prevention, Health Development and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | | | | | - Zakia Rahman
- Center for Injury Prevention, Health Development and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Kabir Hossen
- Center for Injury Prevention, Health Development and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | | | | | | | - Nazma Shaheen
- Institute of Nutrition and Food Science, Dhaka University, Dhaka, Bangladesh
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Gernand AD, Schulze KJ, Nanayakkara-Bind A, Arguello M, Shamim AA, Ali H, Wu L, West KP, Christian P. Effects of Prenatal Multiple Micronutrient Supplementation on Fetal Growth Factors: A Cluster-Randomized, Controlled Trial in Rural Bangladesh. PLoS One 2015; 10:e0137269. [PMID: 26431336 PMCID: PMC4591978 DOI: 10.1371/journal.pone.0137269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 08/15/2015] [Indexed: 11/19/2022] Open
Abstract
Prenatal multiple micronutrient (MM) supplementation improves birth weight through increased fetal growth and gestational age, but whether maternal or fetal growth factors are involved is unclear. Our objective was to examine the effect of prenatal MM supplementation on intrauterine growth factors and the associations between growth factors and birth outcomes in a rural setting in Bangladesh. In a double-blind, cluster-randomized, controlled trial of MM vs. iron and folic acid (IFA) supplementation, we measured placental growth hormone (PGH) at 10 weeks and PGH and human placental lactogen (hPL) at 32 weeks gestation in maternal plasma (n = 396) and insulin, insulin-like growth factor-1 (IGF-1), and IGF binding protein-1 (IGFBP-1) in cord plasma (n = 325). Birth size and gestational age were also assessed. Early pregnancy mean (SD) BMI was 19.5 (2.4) kg/m2 and birth weight was 2.68 (0.41) kg. There was no effect of MM on concentrations of maternal hPL or PGH, or cord insulin, IGF-1, or IGFBP-1. However, among pregnancies of female offspring, hPL concentration was higher by 1.1 mg/L in the third trimester (95% CI: 0.2, 2.0 mg/L; p = 0.09 for interaction); and among women with height <145 cm, insulin was higher by 59% (95% CI: 3, 115%; p = 0.05 for interaction) in the MM vs. IFA group. Maternal hPL and cord blood insulin and IGF-1 were positively, and IGFBP-1 was negatively, associated with birth weight z score and other measures of birth size (all p<0.05). IGF-1 was inversely associated with gestational age (p<0.05), but other growth factors were not associated with gestational age or preterm birth. Prenatal MM supplementation had no overall impact on intrauterine growth factors. MM supplementation altered some growth factors differentially by maternal early pregnancy nutritional status and sex of the offspring, but this should be examined in other studies.
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Affiliation(s)
- Alison D. Gernand
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, United States of America
| | - Kerry J. Schulze
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Ashika Nanayakkara-Bind
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Margia Arguello
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | - Hasmot Ali
- The JiVitA Project, Gaibandha, Bangladesh
| | - Lee Wu
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Keith P. West
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Parul Christian
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
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Christian P, Shaikh S, Shamim AA, Mehra S, Wu L, Mitra M, Ali H, Merrill RD, Choudhury N, Parveen M, Fuli RD, Hossain MI, Islam MM, Klemm R, Schulze K, Labrique A, de Pee S, Ahmed T, West KP. Effect of fortified complementary food supplementation on child growth in rural Bangladesh: a cluster-randomized trial. Int J Epidemiol 2015; 44:1862-76. [PMID: 26275453 PMCID: PMC4689999 DOI: 10.1093/ije/dyv155] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2015] [Indexed: 12/15/2022] Open
Abstract
Background: Growth faltering in the first 2 years of life is high in South Asia where prevalence of stunting is estimated at 40–50%. Although nutrition counselling has shown modest benefits, few intervention trials of food supplementation exist showing improvements in growth and prevention of stunting. Methods: A cluster-randomized controlled trial was conducted in rural Bangladesh to test the effect of two local, ready-to-use foods (chickpea and rice-lentil based) and a fortified blended food (wheat-soy-blend++, WSB++) compared with Plumpy’doz, all with nutrition counselling vs nutrition counselling alone (control) on outcomes of linear growth (length and length-for-age z-score, LAZ), stunting (LAZ < −2), weight-for-length z-score (WLZ) and wasting (WLZ < −2) in children 6–18 months of age. Children (n = 5536) were enrolled at 6 months of age and, in the food groups, provided with one of the allocated supplements daily for a year. Results: Growth deceleration occurred from 6 to 18 months of age but deceleration in LAZ was lower (by 0.02–0.04/month) in the Plumpy’doz (P = 0.02), rice-lentil (< 0.01), and chickpea (< 0.01) groups relative to control, whereas WLZ decline was lower only in Plumpy’doz and chickpea groups. WSB++ did not impact on these outcomes. The prevalence of stunting was 44% at 18 months in the control group, but lower by 5–6% (P ≤ 0.01) in those receiving Plumpy’doz and chickpea. Mean length and LAZ at 18 months were higher by 0.27–0.30 cm and 0.07–0.10 (all P < 0.05), respectively, in all four food groups relative to the control. Conclusions: In rural Bangladesh, small amounts of daily fortified complementary foods, provided for a year in addition to nutrition counselling, modestly increased linear growth and reduced stunting at 18 months of age.
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Affiliation(s)
- Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,
| | - Saijuddin Shaikh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, JiVitA Project, Gaibandha, Bangladesh
| | | | - Sucheta Mehra
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lee Wu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maithilee Mitra
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hasmot Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, JiVitA Project, Gaibandha, Bangladesh
| | - Rebecca D Merrill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nuzhat Choudhury
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Monira Parveen
- United Nations World Food Programme, IDB Bhaban, Dhaka, Bangladesh and
| | - Rachel D Fuli
- United Nations World Food Programme, IDB Bhaban, Dhaka, Bangladesh and
| | - Md Iqbal Hossain
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Md Munirul Islam
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Rolf Klemm
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kerry Schulze
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saskia de Pee
- Office of Nutrition Advisor, United Nations World Food Programme, Rome, Italy
| | - Tahmeed Ahmed
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Keith P West
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Sikder SS, Labrique AB, Craig IM, Wakil MA, Shamim AA, Ali H, Mehra S, Wu L, Shaikh S, West KP, Christian P. Patterns and determinants of care seeking for obstetric complications in rural northwest Bangladesh: analysis from a prospective cohort study. BMC Health Serv Res 2015; 15:166. [PMID: 25985774 PMCID: PMC4459664 DOI: 10.1186/s12913-015-0832-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 03/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In communities with low rates of institutional delivery, little data exist on care-seeking behavior for potentially life-threatening obstetric complications. In this analysis, we sought to describe care-seeking patterns for self-reported complications and near misses in rural Bangladesh and to identify factors associated with care seeking for these conditions. METHODS Utilizing data from a community-randomized controlled trial enrolling 42,214 pregnant women between 2007 and 2011, we used multivariable multinomial logistic regression to explore the association of demographic and socioeconomic factors, perceived need, and service availability with care seeking for obstetric complications or near misses. We also used multivariable multinomial logistic regression to analyze the factors associated with care seeking by type of obstetric complication (eclampsia, sepsis, hemorrhage, and obstructed labor). RESULTS Out of 9,576 women with data on care seeking for obstetric complications, 77% sought any care, with 29% (n = 2,150) visiting at least one formal provider and 70% (n = 5,149) visiting informal providers only. The proportion of women seeking at least one formal provider was highest among women reporting eclampsia (57%), followed by hemorrhage (28%), obstructed labor (22%), and sepsis (17%) (p < 0.001). In multivariable analyses, socioeconomic factors such as living in a household from the highest wealth quartile (Relative Risk Ratio of 1.49; 95% CI of [1.33-1.73]), women's literacy (RRR of 1.21; 95% CI of [1.05-1.42]), and women's employment (RRR of 1.10; 95% CI of [1.01-1.18]) were significantly associated with care seeking from formal providers. Service factors including living less than 10 kilometers from a health facility (RRR of 1.16; 95% CI of [1.05-1.28]) and facility availability of comprehensive obstetric services (RRR of 1.25; 95% CI of 1.04-1.36) were also significantly associated with seeking care from formal providers. CONCLUSIONS While the majority of women reporting obstetric complications sought care, less than a third visited health facilities. Improvements in socioeconomic factors such as maternal literacy, coupled with improved geographic access and service availability, may increase care seeking from formal facilities. Enhancing community awareness on symptoms of hemorrhage, sepsis, and obstructed labor and their consequences may promote care seeking for obstetric complications in rural Bangladesh. TRIAL REGISTRATION TRIAL REGISTRATION NUMBER NCT00860470 .
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Affiliation(s)
- Shegufta S Sikder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Alain B Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Ian M Craig
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Abu Ahmed Shamim
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Hasmot Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Sucheta Mehra
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Lee Wu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Saijuddin Shaikh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Keith P West
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Shamim AA, Schulze K, Merrill RD, Kabir A, Christian P, Shaikh S, Wu L, Ali H, Labrique AB, Mehra S, Klemm RDW, Rashid M, Sungpuag P, Udomkesmalee E, West KP. First-trimester plasma tocopherols are associated with risk of miscarriage in rural Bangladesh. Am J Clin Nutr 2015; 101:294-301. [PMID: 25646326 DOI: 10.3945/ajcn.114.094920] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Tocopherols were discovered for their role in animal reproduction, but little is known about the contribution of deficiencies of vitamin E to human pregnancy loss. OBJECTIVE We sought to determine whether higher first-trimester concentrations of α-tocopherol and γ-tocopherol were associated with reduced odds of miscarriage (pregnancy losses <24 wk of gestation) in women in rural Bangladesh. DESIGN A case-cohort study in 1605 pregnant Bangladeshi women [median (IQR) gestational age: 10 wk (8-13 wk)] who participated in a placebo-controlled vitamin A- or β-carotene-supplementation trial was done to assess ORs of miscarriage in women with low α-tocopherol (<12.0 μmol/L) and γ-tocopherol (<0.81 μmol/L; upper tertile cutoff of the γ-tocopherol distribution in women who did not miscarry). RESULTS In all women, plasma α- and γ-tocopherol concentrations were low [median (IQR): 10.04 μmol/L (8.07-12.35 μmol/L) and 0.66 μmol/L (0.50-0.95 μmol/L), respectively]. In a logistic regression analysis that was adjusted for cholesterol and the other tocopherol, low α-tocopherol was associated with an OR of 1.83 (95% CI: 1.04, 3.20), whereas a low γ-tocopherol concentration was associated with an OR of 0.62 (95% CI: 0.41, 0.93) for miscarriage. Subgroup analyses revealed that opposing ORs were evident only in women with BMI (in kg/m(2)) ≥18.5 and serum ferritin concentration ≤150 μg/L, although low BMI and elevated ferritin conferred stronger risk of miscarriage. CONCLUSIONS In pregnant women in rural Bangladesh, low plasma α-tocopherol was associated with increased risk of miscarriage, and low γ-tocopherol was associated with decreased risk of miscarriage. Maternal vitamin E status in the first trimester may influence risk of early pregnancy loss. The JiVitA-1 study, from which data for this report were derived, was registered at clinicaltrials.gov as NCT00198822.
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Affiliation(s)
- Abu Ahmed Shamim
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Kerry Schulze
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Rebecca D Merrill
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Alamgir Kabir
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Parul Christian
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Saijuddin Shaikh
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Lee Wu
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Hasmot Ali
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Alain B Labrique
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Sucheta Mehra
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Rolf D W Klemm
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Mahbubur Rashid
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Pongtorn Sungpuag
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Emorn Udomkesmalee
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
| | - Keith P West
- From the Center for Human Nutrition, Department of International Health, Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD (AAS, KS, RDM, PC, SS, LW, HA, ABL, SM, RDWK, and KPW); The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh (AAS, AK, SS, HA, and MR); and the Institute of Nutrition, Mahidol University, Bangkok, Thailand (PS and EU)
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West KP, Shamim AA, Mehra S, Labrique AB, Ali H, Shaikh S, Klemm RDW, Wu LSF, Mitra M, Haque R, Hanif AAM, Massie AB, Merrill RD, Schulze KJ, Christian P. Effect of maternal multiple micronutrient vs iron-folic acid supplementation on infant mortality and adverse birth outcomes in rural Bangladesh: the JiVitA-3 randomized trial. JAMA 2014; 312:2649-58. [PMID: 25536256 DOI: 10.1001/jama.2014.16819] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Maternal micronutrient deficiencies may adversely affect fetal and infant health, yet there is insufficient evidence of effects on these outcomes to guide antenatal micronutrient supplementation in South Asia. OBJECTIVE To assess effects of antenatal multiple micronutrient vs iron-folic acid supplementation on 6-month infant mortality and adverse birth outcomes. DESIGN, SETTING, AND PARTICIPANTS Cluster randomized, double-masked trial in Bangladesh, with pregnancy surveillance starting December 4, 2007, and recruitment on January 11, 2008. Six-month infant follow-up ended August 30, 2012. Surveillance included 127,282 women; 44,567 became pregnant and were included in the analysis and delivered 28,516 live-born infants. Median gestation at enrollment was 9 weeks (interquartile range, 7-12). INTERVENTIONS Women were provided supplements containing 15 micronutrients or iron-folic acid alone, taken daily from early pregnancy to 12 weeks postpartum. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause infant mortality through 6 months (180 days). Prespecified secondary outcomes in this analysis included stillbirth, preterm birth (<37 weeks), and low birth weight (<2500 g). To maintain overall significance of α = .05, a Bonferroni-corrected α = .01 was calculated to evaluate statistical significance of primary and 4 secondary risk outcomes (.05/5). RESULTS Among the 22,405 pregnancies in the multiple micronutrient group and the 22,162 pregnancies in the iron-folic acid group, there were 14,374 and 14,142 live-born infants, respectively, included in the analysis. At 6 months, multiple micronutrients did not significantly reduce infant mortality; there were 764 deaths (54.0 per 1000 live births) in the iron-folic acid group and 741 deaths (51.6 per 1000 live births) in the multiple micronutrient group (relative risk [RR], 0.95; 95% CI, 0.86-1.06). Multiple micronutrient supplementation resulted in a non-statistically significant reduction in stillbirths (43.1 vs 48.2 per 1000 births; RR, 0.89; 95% CI, 0.81-0.99; P = .02) and significant reductions in preterm births (18.6 vs 21.8 per 100 live births; RR, 0.85; 95% CI, 0.80-0.91; P < .001) and low birth weight (40.2 vs 45.7 per 100 live births; RR, 0.88; 95% CI, 0.85-0.91; P < .001). CONCLUSIONS AND RELEVANCE In Bangladesh, antenatal multiple micronutrient compared with iron-folic acid supplementation did not reduce all-cause infant mortality to age 6 months but resulted in a non-statistically significant reduction in stillbirths and significant reductions in preterm births and low birth weight. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00860470.
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Affiliation(s)
- Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Abu Ahmed Shamim
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland2The JiVitA Project, Gaibandha, Bangladesh
| | - Sucheta Mehra
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alain B Labrique
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hasmot Ali
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland2The JiVitA Project, Gaibandha, Bangladesh
| | - Saijuddin Shaikh
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland2The JiVitA Project, Gaibandha, Bangladesh
| | - Rolf D W Klemm
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lee S-F Wu
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maithilee Mitra
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Allan B Massie
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland3Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Kerry J Schulze
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Islam MZ, Shamim AA, Ahmed A, Akhtaruzzaman M, Kärkkäinen M, Lamberg-Allardt C. Effect of vitamin D, calcium and multiple micronutrients supplementation on lipid profile in pre-menopausal Bangladeshi garment factory workers with hypovitaminosis D. J Health Popul Nutr 2014; 32:687-695. [PMID: 25895202 PMCID: PMC4438699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Elevated total cholesterol and low-density lipoprotein cholesterol in sera are both well-known risk factors of coronary heart disease. Adequate vitamin D status is important for optimal function of many organs and tissues of our body. There is continuing controversy about the effect of adequate vitamin D consumption on serum lipids and lipoproteins. The present study assessed the effect of vitamin D, calcium and multiple micronutrients supplementation on the lipid profile in Bangladeshi young female garment factory workers who have hypovitaminosis D. This placebo-controlled intervention trial conducted over a period of one year randomly assigned a total of 200 apparently healthy subjects aged 16-36 years to 4 groups. The subjects received daily supplements of 400 IU of vitamin D (VD group) or 400 IU of vitamin D+600 mg of calcium lactate (VD-Ca group), or multiple micronutrients with 400 IU of vitamin-D+600 mg of calcium lactate (MMN-VD-Ca group), or the group consuming placebo (PL group). Serum concentrations of lipid and lipoprotein, 25-hydroxyvitamin D (25OHD) and intact parathyroid hormone (iPTH) were measured at baseline and after one year of follow-up. No significant changes in the serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), LDL-C/HDL-C ratio were observed in the supplemented groups compared to the placebo group. Supplementation had a positive effect (p<0.05) on very low-density-lipoprotein cholesterol (VLDL-C) and triacylglycerol (TAG). A negative correlation between changes in serum iPTH and HDL-C was observed, which indicated that subjects with the greatest decline in S-iPTH had the greatest increase in HDL-C. The results suggest that consumption of adequate vitamin D with calcium or MMN for one-year may have no impact on serum lipid profile in the subjects studied. Longer-term clinical trials with different doses of supplemental vitamin D are warranted in evaluating the effect of intervention.
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Affiliation(s)
- Md. Zahirul Islam
- Calcium Research Unit, Department of Food and Environmental Sciences (Nutrition), PO Box 66, 00014, University of Helsinki, Finland
- Food Security Nutritional Surveillance Project (FSNSP), BRAC Institute of Global Health, BRAC University, icddr,b Main Building, Level 6, Mohakhali, Dhaka 1212, Bangladesh
| | - Abu Ahmed Shamim
- Calcium Research Unit, Department of Food and Environmental Sciences (Nutrition), PO Box 66, 00014, University of Helsinki, Finland
| | - Abu Ahmed
- Calcium Research Unit, Department of Food and Environmental Sciences (Nutrition), PO Box 66, 00014, University of Helsinki, Finland
| | | | - Merja Kärkkäinen
- Calcium Research Unit, Department of Food and Environmental Sciences (Nutrition), PO Box 66, 00014, University of Helsinki, Finland
| | - Christel Lamberg-Allardt
- Calcium Research Unit, Department of Food and Environmental Sciences (Nutrition), PO Box 66, 00014, University of Helsinki, Finland
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