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Werner ER, Arnold CD, Caswell BL, Iannotti LL, Maleta KM, Stewart CP. Associations of fish and meat intake with iron and anaemia in Malawian children. Matern Child Nutr 2024; 20:e13622. [PMID: 38217291 PMCID: PMC10981481 DOI: 10.1111/mcn.13622] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/15/2024]
Abstract
Animal flesh foods are rich in bioavailable iron but infrequently consumed by young children. We aimed to determine whether flesh food intake was associated with iron and anaemia status among 585 Malawian infants enroled in a 6-month egg-feeding trial. The percentage of days of small fish, large fish and meat consumption were assessed through weekly 7-day animal-source food screeners. Grams of intake were assessed through 24-h recalls conducted at 6-9, 9-12 and 12-15 months of age. Plasma ferritin, soluble transferrin receptor (sTfR) and haemoglobin concentrations were measured at 6-9 and 12-15 months of age. Iron biomarkers were adjusted for inflammation during analysis. At enrolment, each flesh food category was consumed by <5% of children in the past 24 h. Over the next 6 months, small fish, large fish and meat were consumed on 25%, 8% and 6% of days, respectively, with mean usual intakes of <5 g/day. More frequent small fish consumption was associated with lower sTfR (geometric mean ratio [95% CI]: 0.98 mg/L [0.96, 1.00] per 10 percentage point difference) but not ferritin (1.03 µg/L [0.98, 1.07]) or haemoglobin (1.01 g/dL [1.00, 1.01]). Large fish consumption was associated with higher anaemia (prevalence ratio [95% CI]: 1.09 [1.01, 1.19]) and lower iron deficiency (0.96 [0.93, 1.00]) prevalence. Gram intakes of flesh food categories were not associated with any iron or anaemia indicators. Small fish were a primary contributor to flesh food intake in this cohort of Malawian children, although usual portions were small. Fish was associated with modest improvements to iron status, but meat was too infrequent to be associated with anaemia and iron deficiency.
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Affiliation(s)
- E. Rochelle Werner
- Institute for Global NutritionUniversity of California, DavisDavisCaliforniaUSA
- Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - Charles D. Arnold
- Institute for Global NutritionUniversity of California, DavisDavisCaliforniaUSA
| | - Bess L. Caswell
- Institute for Global NutritionUniversity of California, DavisDavisCaliforniaUSA
- U.S. Department of AgricultureWestern Human Nutrition Research CenterDavisCaliforniaUSA
| | - Lora L. Iannotti
- E3 Nutrition LabWashington University in St. LouisSt. LouisMissouriUSA
| | - Kenneth M. Maleta
- School of Global and Public HealthKamuzu University of Health SciencesBlantyreMalawi
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Beckner AG, Arnold CD, Bragg MG, Caswell BL, Chen Z, Cox K, DeBolt MC, George M, Maleta K, Stewart C, Oakes LM, Prado E. Examining infants' visual paired comparison performance in the US and rural Malawi. Dev Sci 2023:e13439. [PMID: 37653622 PMCID: PMC10986336 DOI: 10.1111/desc.13439] [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: 08/30/2022] [Revised: 07/22/2023] [Accepted: 07/30/2023] [Indexed: 09/02/2023]
Abstract
Measures of attention and memory were evaluated in 6- to 9-month-old infants from two diverse contexts. One sample consisted of African infants residing in rural Malawi (N = 228, 118 girls, 110 boys). The other sample consisted of racially diverse infants residing in suburban California (N = 48, 24 girls, 24 boys). Infants were tested in an eye-tracking version of the visual paired comparison procedure and were shown racially familiar faces. The eye tracking data were parsed into individual looks, revealing that both groups of infants showed significant memory performance. However, how a look was operationally defined impacted some-but not other-measures of infant VPC performance. RESEARCH HIGHLIGHTS: In both the US and Malawi, 6- to 9-month-old infants showed evidence of memory for faces they had previously viewed during a familiarization period. Infant age was associated with peak look duration and memory performance in both contexts. Different operational definitions of a look yielded consistent findings for peak look duration and novelty preference scores-but not shift rate. Operationalization of look-defined measures is an important consideration for studies of infants in different cultural contexts.
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Affiliation(s)
- Aaron G. Beckner
- College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Charles D. Arnold
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, California, USA
| | - Megan G. Bragg
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, California, USA
| | - Bess L. Caswell
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, California, USA
| | - Zhijun Chen
- Department of Psychology and Center for Mind and Brain, University of California, Davis, California, USA
| | - Katherine Cox
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, California, USA
| | - Michaela C. DeBolt
- Department of Psychology and Center for Mind and Brain, University of California, Davis, California, USA
| | - Matthews George
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Kenneth Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Christine Stewart
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, California, USA
| | - Lisa M. Oakes
- Department of Psychology and Center for Mind and Brain, University of California, Davis, California, USA
| | - Elizabeth Prado
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, California, USA
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Perez-Plazola M, Diaz J, Stewart CP, Arnold CD, Caswell BL, Lutter CK, Werner ER, Maleta K, Turner J, Prathibha P, Liu X, Gyimah E, Iannotti L. Plasma mineral status after a six-month intervention providing one egg per day to young Malawian children: a randomized controlled trial. Sci Rep 2023; 13:6698. [PMID: 37095119 PMCID: PMC10125967 DOI: 10.1038/s41598-023-33114-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 04/07/2023] [Indexed: 04/26/2023] Open
Abstract
Mineral deficiencies are common in children living in low-resource areas. Eggs are a rich source of essential nutrients and have been shown to improve growth in young children, although little is known about their impact on mineral status. Children aged 6-9 months (n = 660) were randomized to receive either one egg/day for 6-months or no intervention. Anthropometric data, dietary recalls, and venous blood were collected at baseline and 6-months follow-up. Quantification of plasma minerals (n = 387) was done using inductively coupled plasma-mass spectroscopy. Difference-in-difference mean plasma mineral concentrations was determined from baseline and follow-up values and assessed between groups by intention-to-treat using ANCOVA regression models. Prevalence of zinc deficiency was 57.4% at baseline and 60.5% at follow-up. Mean difference (MD) of plasma magnesium, selenium, copper, and zinc levels were not different between groups. Plasma iron concentrations were significantly lower in the intervention compared to the control group (MD = - 9.29; 95% CI: - 15.95, - 2.64). Zinc deficiency was widely prevalent in this population. Mineral deficiencies were not addressed with the egg intervention. Further interventions are needed to improve the mineral status of young children.
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Affiliation(s)
| | - Jenna Diaz
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, Campus, Box 8208, St. Louis, MO, 63110, USA.
| | - Christine P Stewart
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, USA
| | - Charles D Arnold
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, USA
| | - Bess L Caswell
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, USA
- Western Human Nutrition Research Center, U.S. Department of Agriculture, Agricultural Research Service,, Davis, USA
| | - Chessa K Lutter
- International Development Group, RTI International US, Triangle Park, USA
| | - E Rochelle Werner
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, USA
| | - Kenneth Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Jay Turner
- Division of Engineering Education Energy, Environmental Energy and Chemical Engineering, Washington University in St. Louis, St. Louis, USA
| | - Pradeep Prathibha
- Division of Engineering Education Energy, Environmental Energy and Chemical Engineering, Washington University in St. Louis, St. Louis, USA
| | - Xuan Liu
- Division of Engineering Education Energy, Environmental Energy and Chemical Engineering, Washington University in St. Louis, St. Louis, USA
| | - Emmanuel Gyimah
- Institute for Public Health, Washington University in St. Louis, St. Louis, USA
| | - Lora Iannotti
- Institute for Public Health, Washington University in St. Louis, St. Louis, USA
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Bragg MG, Prado EL, Caswell BL, Arnold CD, George M, Oakes LM, Beckner AG, DeBolt MC, Bennett BJ, Maleta KM, Stewart CP. The association between plasma choline, growth and neurodevelopment among Malawian children aged 6-15 months enroled in an egg intervention trial. Matern Child Nutr 2023; 19:e13471. [PMID: 36567549 PMCID: PMC10019050 DOI: 10.1111/mcn.13471] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022]
Abstract
Choline is an essential micronutrient that may influence growth and development; however, few studies have examined postnatal choline status and children's growth and development in low- and middle-income countries. The aim of this observational analysis was to examine associations of plasma choline with growth and development among Malawian children aged 6-15 months enrolled in an egg intervention trial. Plasma choline and related metabolites (betaine, dimethylglycine and trimethylamine N-oxide) were measured at baseline and 6-month follow-up, along with anthropometric (length, weight, head circumference) and developmental assessments (the Malawi Developmental Assessment Tool [MDAT], the Infant Orienting with Attention task [IOWA], a visual paired comparison [VPC] task and an elicited imitation [EI] task). In cross-sectional covariate-adjusted models, each 1 SD higher plasma choline was associated with lower length-for-age z-score (-0.09 SD [95% confidence interval, CI -0.17 to -0.01]), slower IOWA response time (8.84 ms [1.66-16.03]) and faster processing speed on the VPC task (-203.5 ms [-366.2 to -40.7]). In predictive models, baseline plasma choline was negatively associated with MDAT fine motor z-score at 6-month follow-up (-0.13 SD [-0.22 to -0.04]). There were no other significant associations of plasma choline with child measures. Similarly, associations of choline metabolites with growth and development were null except higher trimethylamine N-oxide was associated with slower information processing on the VPC task and higher memory scores on the EI task. In this cohort of children with low dietary choline intake, we conclude that there were no strong or consistent associations between plasma choline and growth and development.
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Affiliation(s)
- Megan G. Bragg
- Department of NutritionUniversity of California DavisDavisCaliforniaUSA
- AJ Drexel Autism InstituteDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | | | - Bess L. Caswell
- USDA Western Human Nutrition Research CenterDavisCaliforniaUSA
| | - Charles D. Arnold
- Department of NutritionUniversity of California DavisDavisCaliforniaUSA
| | - Matthews George
- School of Public Health and Family MedicineKamuzu University of Health SciencesBlantyreMalawi
| | - Lisa M. Oakes
- Center for Mind and BrainUniversity of California DavisDavisCaliforniaUSA
| | - Aaron G. Beckner
- Center for Mind and BrainUniversity of California DavisDavisCaliforniaUSA
| | - Michaela C. DeBolt
- Center for Mind and BrainUniversity of California DavisDavisCaliforniaUSA
| | | | - Kenneth M. Maleta
- School of Public Health and Family MedicineKamuzu University of Health SciencesBlantyreMalawi
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Werner ER, Haskell MJ, Arnold CD, Caswell BL, Iannotti LL, Lutter CK, Maleta KM, Stewart CP. The Effects of One Egg Per Day on Vitamin A Status Among Young Malawian Children: A Secondary Analysis of a Randomized Controlled Trial. Curr Dev Nutr 2023; 7:100053. [PMID: 37181936 PMCID: PMC10111603 DOI: 10.1016/j.cdnut.2023.100053] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 02/24/2023] Open
Abstract
Background Vitamin A deficiency (VAD) is common in populations with limited dietary diversity and access to vitamin A-rich foods. Objectives This analysis aimed to determine the impact of supplementing children's diets with 1 egg/d on the concentration of plasma retinol and RBP and the prevalence of VAD. Methods Children age 6-9 mo living in the Mangochi district of Malawi were individually randomly assigned to receive 1 egg/d for 6 mo (n = 331) or continue their usual diet (n = 329) in the Mazira trial (clinicaltrials.gov; NCT03385252). This secondary analysis measured plasma retinol by HPLC and RBP, CRP, and α-1-acid glycoprotein (AGP) by ELISA techniques at enrollment and 6 mo follow-up. Retinol and RBP were adjusted for inflammation, and mean concentrations were compared between groups using linear regression models. In addition, prevalence ratios of VAD (retinol <0.7 μmol/L) were compared between groups using log-binomial or modified Poisson regression models. Results After 6 mo of study participation, 489 were assessed for retinol (egg: n = 238; control: n = 251), and 575 (egg: n = 281; control: n = 294) were assessed for RBP. Prevalence of inflammation (CRP >5 mg/L or AGP >1 g/L: 62%) and inflammation-adjusted VAD (7%) at enrollment did not differ between groups. At follow-up, the egg intervention group did not differ from the control in inflammation-adjusted retinol [geometric mean (95% CI); egg: 1.10 μmol/L (1.07, 1.13); control: 1.08 (1.05, 1.12)], RBP [egg: 0.99 μmol/L (0.96, 1.02); control: 0.97 (0.94, 1.00)], or prevalence of VAD [egg: 6%; control: 3%; prevalence ratio: 1.87 (0.83, 4.24)]. Conclusions Provision of 1 egg/d did not impact VAD, plasma retinol, or RBP among young children in rural Malawi, where the prevalence of VAD was low. Curr Dev Nutr 2023;x:xx.This trial was registered at [clinicaltrials.gov] as [NCT03385252].
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Affiliation(s)
- E Rochelle Werner
- Institute for Global Nutrition, University of California, Davis, Davis, CA, United States
| | - Marjorie J Haskell
- Institute for Global Nutrition, University of California, Davis, Davis, CA, United States
| | - Charles D Arnold
- Institute for Global Nutrition, University of California, Davis, Davis, CA, United States
| | - Bess L Caswell
- Institute for Global Nutrition, University of California, Davis, Davis, CA, United States
- Western Human Nutrition Research Center, US Department of Agriculture, Davis, CA, United States
| | - Lora L Iannotti
- E3 Nutrition Lab, Washington University in St Louis, St Louis, MO, United States
| | | | - Kenneth M Maleta
- School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Christine P Stewart
- Institute for Global Nutrition, University of California, Davis, Davis, CA, United States
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Werner ER, Arnold CD, Caswell BL, Iannotti LL, Lutter CK, Maleta KM, Stewart CP. The Effects of 1 Egg per Day on Iron and Anemia Status among Young Malawian Children: A Secondary Analysis of a Randomized Controlled Trial. Curr Dev Nutr 2022; 6:nzac094. [PMID: 35755939 PMCID: PMC9213210 DOI: 10.1093/cdn/nzac094] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/04/2022] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022] Open
Abstract
Background Young children with diets lacking diversity with low consumption of animal source foods are at risk of iron deficiency anemia (IDA). Objectives Our objectives were to determine the impact of supplementing diets with 1 egg/d on 1) plasma ferritin, soluble transferrin receptor (sTfR), body iron index (BII), and hemoglobin concentrations and 2) the prevalence of iron deficiency (ID), anemia, and IDA. Methods Malawian 6-9-mo-old infants in the Mazira trial (clinicaltrials.gov; NCT03385252) were individually randomly assigned to receive 1 egg/d for 6 mo (n = 331) or continue their usual diet (n = 329). In this secondary analysis, hemoglobin, plasma ferritin, sTfR, C-reactive protein (CRP), and α-1-acid glycoprotein (AGP) were measured at enrollment and 6-mo follow-up. Iron biomarkers were corrected for inflammation. Ferritin, sTfR, BII, and hemoglobin were compared between groups using linear regression. Prevalence ratios (PRs) for anemia (hemoglobin <11 g/dL) and ID (ferritin <12 µg/L, sTfR >8.3 mg/L, or BII <0 mg/kg) between groups were compared using log binomial or modified Poisson regression. Results A total of 585 children were included in this analysis (Egg: n = 286; Control: n = 299). At enrollment, the total prevalence of anemia was 61% and did not differ between groups. At 6-mo follow-up, groups did not differ in geometric mean concentration of hemoglobin [mean (95% CI); Egg: 10.9 (10.7, 11.1) g/dL; Control: 11.1 (10.9, 11.2) g/dL] and inflammation-adjusted ferritin [Egg: 6.52 (5.98, 7.10) µg/L; Control: 6.82 (6.27, 7.42) µg/L], sTfR [Egg: 11.34 (10.92, 11.78) mg/L; Control: 11.46 (11.04, 11.89) mg/L] or BII [Egg: 0.07 (0.06, 0.09) mg/kg; Control: 0.07 (0.05, 0.08) mg/kg]. There were also no group differences in anemia [Egg: 46%; Control 40%; PR: 1.15 (95% CI: 0.96, 1.38)], ID [PR: 0.99 (0.94, 1.05)], or IDA [PR: 1.12 (0.92, 1.36)]. Conclusions Providing eggs daily for 6 mo did not affect iron status or anemia prevalence in this context. Other interventions are needed to address the high prevalence of ID and anemia among young Malawian children. This trial is registered at http://www.clinicaltrials.gov as NCT03385252.
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Affiliation(s)
- E Rochelle Werner
- Institute for Global Nutrition, University of California, Davis, CA, USA
| | - Charles D Arnold
- Institute for Global Nutrition, University of California, Davis, CA, USA
| | - Bess L Caswell
- Institute for Global Nutrition, University of California, Davis, CA, USA
- Western Human Nutrition Research Center, US Department of Agriculture, Davis, CA, USA
| | - Lora L Iannotti
- E3 Nutrition Lab, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Kenneth M Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
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Bragg MG, Prado EL, Arnold CD, Zyba SJ, Maleta KM, Caswell BL, Bennett BJ, Iannotti LL, Lutter CK, Stewart CP. Plasma Choline Concentration Was Not Increased After a 6-Month Egg Intervention in 6-9-Month-Old Malawian Children: Results from a Randomized Controlled Trial. Curr Dev Nutr 2022; 6:nzab150. [PMID: 35233478 PMCID: PMC8881212 DOI: 10.1093/cdn/nzab150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/04/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Eggs are a rich source of choline, an essential nutrient important for child growth and development. In a randomized trial of 1 egg/d in young children in Ecuador, an egg intervention led to significant improvements in growth, which were partially mediated by increased plasma choline concentration. A similar trial in Malawi (clinicaltrials.gov: NCT03385252) found little improvement in child growth or development. OBJECTIVES We aimed to evaluate the effect of 1 egg/d for 6 mo on plasma choline concentrations in Malawian children enrolled in a randomized trial. METHODS Infants aged 6-9 mo in rural Malawi were randomly assigned to receive 1 egg/d (n = 331) or serve as a nonintervention control (n = 329) for 6 mo. Anthropometric, developmental, and dietary data were collected at baseline and 6-mo follow-up, along with a blood draw. Plasma choline, betaine, dimethylglycine, trimethylamine N-oxide (TMAO), and DHA were measured at both time points using ultrahigh performance liquid chromatography-tandem MS (n = 200 per group). Linear regression analysis was used to determine the difference in plasma choline and related metabolites between groups after 6 mo of intervention. RESULTS Plasma choline, betaine, dimethylglycine, and DHA concentrations did not differ between groups at 6-mo follow-up. Plasma TMAO was significantly (26%; 95% CI: 7%, 48%) higher in the egg intervention group in a fully adjusted model. CONCLUSIONS Provision of 1 egg/d for 6 mo did not result in increases in plasma choline or related metabolites, except TMAO. This could partially explain the lack of effect on growth and development. Additional interventions are needed to improve choline status, growth, and development in this population.
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Affiliation(s)
- Megan G Bragg
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Elizabeth L Prado
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Charles D Arnold
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Sarah J Zyba
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Kenneth M Maleta
- School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Bess L Caswell
- USDA Western Human Nutrition Research Center, Davis, CA, USA
| | - Brian J Bennett
- USDA Western Human Nutrition Research Center, Davis, CA, USA
| | - Lora L Iannotti
- Brown School, Institute for Public Health, Washington University in St Louis, St Louis, MO, USA
| | | | - Christine P Stewart
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, CA, USA
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Caswell BL, Arnold CD, Lutter CK, Iannotti LL, Chipatala R, Werner ER, Maleta KM, Stewart CP. Impacts of an egg intervention on nutrient adequacy among young Malawian children. Matern Child Nutr 2021; 17:e13196. [PMID: 33974324 PMCID: PMC8189245 DOI: 10.1111/mcn.13196] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023]
Abstract
Eggs are a rich source of multiple nutrients that support child growth and development. Provision of eggs as a complementary food may improve dietary adequacy among young children at risk for undernutrition. Our objective was to test the impact of an egg intervention on the adequacy of total nutrient intakes and micronutrient density among 6- to 15-month-old Malawian children. Children 6 to 9 months old, living in Mangochi District, Malawi, were randomly assigned to the intervention group (n = 331) receiving an egg per day or a control group (n = 329) consuming their usual diet. Dietary intakes of macronutrients, vitamins and minerals were assessed using 24-h recalls at baseline, 3-month midline and 6-month endline, with repeat recalls in a subsample. Usual nutrient intake and micronutrient density distributions were modelled to estimate group means and prevalence of inadequacy. Group differences at midline and endline were tested using unequal variance t tests with bootstrapped standard errors. The egg intervention resulted in higher intakes of fat and protein and lower intakes of carbohydrates. The egg group had lower prevalence of inadequacy for selenium, vitamin A, riboflavin, vitamin B5 , vitamin B12 and choline. Micronutrient density inadequacy was lower in the egg group for vitamin A and choline at midline and endline, riboflavin at midline and vitamin B5 at endline. Inadequacy of nutrient intakes or density remained highly prevalent in both groups for multiple micronutrients. Though the egg intervention increased intakes of protein and several micronutrients, total intakes and micronutrient density of multiple micronutrients remained far below recommendations.
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Affiliation(s)
- Bess L. Caswell
- Department of NutritionUniversity of California, DavisDavisCaliforniaUSA
| | - Charles D. Arnold
- Department of NutritionUniversity of California, DavisDavisCaliforniaUSA
| | - Chessa K. Lutter
- Food and Nutrition DivisionRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Lora L. Iannotti
- Institute for Public HealthBrown School at Washington University in Saint LouisSt. LouisMissouriUSA
| | - Raphael Chipatala
- Institute for Public HealthBrown School at Washington University in Saint LouisSt. LouisMissouriUSA
| | | | - Kenneth M. Maleta
- School of Public Health and Family MedicineUniversity of Malawi College of MedicineBlantyreMalawi
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Lutter CK, Caswell BL, Arnold CD, Iannotti LL, Maleta K, Chipatala R, Prado EL, Stewart CP. Impacts of an egg complementary feeding trial on energy intake and dietary diversity in Malawi. Maternal & Child Nutrition 2021; 17:e13055. [PMID: 33128502 PMCID: PMC7729770 DOI: 10.1111/mcn.13055] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/19/2020] [Accepted: 06/16/2020] [Indexed: 01/17/2023]
Abstract
Complementary feeding diets in low- and middle-income countries are generally inadequate to meet requirements for growth and development. Food-based interventions may prevent nutrient inadequacies provided that they do not displace other nutrient-rich foods. We conducted a randomized controlled trial in rural Malawi in which 660 children aged 6 to 9 months were provided an egg a day for 6 months or assigned to a control group. Dietary intake of complementary foods and drinks was assessed at baseline, 3-month midline and 6-month endline visits using a tablet-based multipass 24-h recall. Up to two repeat recalls were collected at each time point in a subsample of 100 children per treatment group. At midline and endline, usual energy intake from eggs was about 30 kcal/day higher in the egg group compared with controls (p < 0.0001). Compared with controls, children in the egg group were over nine times more likely to consume eggs at midline and endline. There was a comparable, but nonsignificant, greater total usual energy intake from complementary foods of 30 kcal/day at midline (p = 0.128) and 36 kcal/day at endline (p = 0.087). There also was a displacement of 7 kcal/day in legumes and nuts in children at endline (p = 0.059). At midline and endline, more than 80% of children in the egg group consumed a minimally diverse diet compared with 53% at midline and 60% at endline in the control group. This study illustrates that mothers in the egg group fed eggs to young children on a regular basis without substantial displacement of other complementary foods.
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Affiliation(s)
- Chessa K Lutter
- RTI International, Washington, DC, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Bess L Caswell
- Department of Nutrition, University of California Davis, Davis, California, USA
| | - Charles D Arnold
- Department of Nutrition, University of California Davis, Davis, California, USA
| | - Lora L Iannotti
- Brown School, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kenneth Maleta
- School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Raphael Chipatala
- School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Elizabeth L Prado
- Department of Nutrition, University of California Davis, Davis, California, USA
| | - Christine P Stewart
- Department of Nutrition, University of California Davis, Davis, California, USA
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French CD, Arsenault JE, Arnold CD, Haile D, Luo H, Dodd KW, Vosti SA, Slupsky CM, Engle-Stone R, French CD, Arsenault JE, Arnold CD, Haile D, Wiesmann D, Martin-Prevel Y, Brouwer ID, Daniels MC, Nyström CD, Löf M, Ndjebayi A, Palacios C, Prapkree L, Palmer A, Caswell BL, Hn Brown K, Lietz G, Haskell M, Miller J. Within-Person Variation in Nutrient Intakes across Populations and Settings: Implications for the Use of External Estimates in Modeling Usual Nutrient Intake Distributions. Adv Nutr 2020; 12:429-451. [PMID: 33063105 PMCID: PMC8262514 DOI: 10.1093/advances/nmaa114] [Citation(s) in RCA: 12] [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: 05/26/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 12/22/2022] Open
Abstract
Determining the proportion of a population at risk of inadequate or excessive nutrient intake is a crucial step in planning and managing nutrition intervention programs. Multiple days of 24-h dietary intake data per subject allow for adjustment of modeled usual nutrient intake distributions for the proportion of total variance in intake attributable to within-individual variation (WIV:total). When only single-day dietary data are available, an external adjustment factor can be used; however, WIV:total may vary by population, and use of incorrect WIV:total ratios may influence the accuracy of prevalence estimates and subsequent program impacts. WIV:total values were compiled from publications and from reanalyses of existing datasets to describe variation in WIV:total across populations and settings. The potential impact of variation in external WIV:total on estimates of prevalence of inadequacy was assessed through simulation analyses using the National Cancer Institute 1-d method. WIV:total values were extracted from 40 publications from 24 countries, and additional values were calculated from 15 datasets from 12 nations. Wide variation in WIV:total (from 0.02 to 1.00) was observed in publications and reanalyses. Few patterns by population characteristics were apparent, but WIV:total varied by age in children (< vs. >1 y) and between rural and urban settings. Simulation analyses indicated that estimates of the prevalence of inadequate intake are sensitive to the selected ratio in some cases. Selection of an external WIV:total estimate should consider comparability between the reference and primary studies with regard to population characteristics, study design, and statistical methods. Given wide variation in observed ratios with few discernible patterns, the collection of ≥2 days of intake data in at least a representative subsample in population dietary studies is strongly encouraged. In the case of single-day dietary studies, sensitivity analyses are recommended to determine the robustness of prevalence estimates to changes in the variance ratio.
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Affiliation(s)
| | - Joanne E Arsenault
- Intake–Center for Dietary Assessment, FHI
Solutions, Washington, DC, USA
| | - Charles D Arnold
- Institute for Global Nutrition, University of
California, Davis, CA, USA
| | - Demewoz Haile
- Department of Nutrition, University of
California, Davis, Davis, CA, USA,Institute for Global Nutrition, University of
California, Davis, CA, USA
| | - Hanqi Luo
- Department of Nutrition, University of
California, Davis, Davis, CA, USA,Institute for Global Nutrition, University of
California, Davis, CA, USA
| | - Kevin W Dodd
- National Cancer Institute, National Institutes of
Health, Rockville, MD, USA
| | - Stephen A Vosti
- Department of Agricultural and Resource Economics, University
of California, Davis, CA, USA
| | - Carolyn M Slupsky
- Department of Nutrition, University of
California, Davis, Davis, CA, USA,Department of Food Science and Technology, University of
California, Davis, Davis, CA, USA
| | - Reina Engle-Stone
- Department of Nutrition, University of
California, Davis, Davis, CA, USA,Institute for Global Nutrition, University of
California, Davis, CA, USA
| | - The Variance Components of Nutrient Intakes Data Working Group Engle-StoneReinaFrenchCaitlin DArsenaultJoanne EArnoldCharles DHaileDemewozWiesmannDorisIndependent ConsultantMartin-PrevelYvesNutripass, University of Montpellier, Institut de
Recherche pour le Développement, Montpellier
SupAgro, Montpellier, FranceBrouwerInge DDivision of Human Nutrition and Health, Wageningen
University, Wageningen, NetherlandsDanielsMelissa CDepartment of Nutrition, University of North
Carolina, Chapel Hill, NC, USANyströmChristine DelisleDepartment of Biosciences and Nutrition,
Karolinska Institutet, Stockholm, SwedenLöfMarieDepartment of Biosciences and Nutrition,
Karolinska Institutet, Stockholm, SwedenNdjebayiAlexHelen Keller International,
Yaoundé, CameroonPalaciosCristinaDepartment of Dietetics and Nutrition, Florida
International University, Miami, FL, USAPrapkreeLukkamolDepartment of Dietetics and Nutrition, Florida
International University, Miami, FL, USAPalmerAmandaDepartment of International Health, Johns Hopkins
Bloomberg School of Public Health, Baltimore,
MD, USACaswellBess LDepartment of Nutrition and Institute for Global
Nutrition, University of California, Davis,
Davis, CA, USAHn BrownKennethDepartment of Nutrition and Institute for Global
Nutrition, University of California, Davis,
Davis, CA, USALietzGeorgnHuman Nutrition Research Centre, Population Health
Sciences Institute, Newcastle University,
Newcastle upon Tyne, UKHaskellMarjorienDepartment of Nutrition and Institute for Global
Nutrition, University of California, Davis,
Davis, CA, USAMillerJodyDepartment of Nutrition and Institute for Global
Nutrition, University of California, Davis,
Davis, CA, USA
| | | | | | | | | | | | - Yves Martin-Prevel
- Nutripass, University of Montpellier, Institut de Recherche pour le Développement, Montpellier SupAgro, Montpellier, France
| | - Inge D Brouwer
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Melissa C Daniels
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
| | | | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | | | - Cristina Palacios
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Lukkamol Prapkree
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Amanda Palmer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bess L Caswell
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
| | - Kenneth Hn Brown
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
| | - Georgn Lietz
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Marjorien Haskell
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
| | - Jody Miller
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
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Prado EL, Maleta K, Caswell BL, George M, Oakes LM, DeBolt MC, Bragg MG, Arnold CD, Iannotti LL, Lutter CK, Stewart CP. Early Child Development Outcomes of a Randomized Trial Providing 1 Egg Per Day to Children Age 6 to 15 Months in Malawi. J Nutr 2020; 150:1933-1942. [PMID: 32286620 PMCID: PMC7330477 DOI: 10.1093/jn/nxaa088] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Received: 11/20/2019] [Revised: 01/27/2020] [Accepted: 03/11/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Eggs are a rich source of nutrients important for brain development, including choline, riboflavin, vitamins B-6 and B-12, folate, zinc, protein, and DHA. OBJECTIVE Our objective was to evaluate the effect of the consumption of 1 egg per day over a 6-mo period on child development. METHODS In the Mazira Project randomized controlled trial, 660 children aged 6-9 mo were randomly allocated into an intervention or control group. Eggs were provided to intervention households during twice-weekly home visits for 6 mo. Control households were visited at the same frequency. At enrollment, blinded assessors administered the Malawi Developmental Assessment Tool (MDAT), and 2 eye-tracking tasks using a Tobii-Pro X2-60 eye tracker: a visual paired comparison memory task and an Infant Orienting with Attention task. At endline, 6-mo later, blinded assessors administered the MDAT and eye-tracking tasks plus an additional elicited imitation memory task. RESULTS At endline, intervention and control groups did not significantly differ in any developmental score, with the exception that a smaller percentage of children were delayed in fine motor development in the intervention group (10.6%) compared with the control group (16.5%; prevalence ratio: 0.59, 95% CI: 0.38-0.91). Among 10 prespecified effect modifiers for the 8 primary developmental outcomes, we found 7 significant interactions demonstrating a consistent pattern that children who were less vulnerable, for example, those with higher household wealth and maternal education, showed positive effects of the intervention. Given multiple hypothesis testing, some findings may have been due to chance. CONCLUSION The provision of 1 egg per day had no overall effect on child development in this population of children, however, some benefits may be seen among children in less vulnerable circumstances. This trial was registered at clinicaltrials.gov as NCT03385252.
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Affiliation(s)
| | - Kenneth Maleta
- School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Bess L Caswell
- Department of Nutrition and Institute for Global Nutrition, University of California Davis, Davis, CA, USA
| | - Matthews George
- School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Lisa M Oakes
- Department of Psychology and Center for Mind and Brain, University of California Davis, Davis, CA, USA
| | - Michaela C DeBolt
- Department of Psychology and Center for Mind and Brain, University of California Davis, Davis, CA, USA
| | - Megan G Bragg
- Department of Nutrition and Institute for Global Nutrition, University of California Davis, Davis, CA, USA
| | - Charles D Arnold
- Department of Nutrition and Institute for Global Nutrition, University of California Davis, Davis, CA, USA
| | - Lora L Iannotti
- Brown School, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Chessa K Lutter
- RTI International, Washington DC, School of Public Health, University of Maryland, College Park, MD, USA
| | - Christine P Stewart
- Department of Nutrition and Institute for Global Nutrition, University of California Davis, Davis, CA, USA
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Henjum S, Caswell BL, Terragni L. "I Feel like I'm Eating Rice 24 Hours a Day, 7 Days a Week": Dietary Diversity among Asylum Seekers Living in Norway. Nutrients 2019; 11:E2293. [PMID: 31561439 PMCID: PMC6835806 DOI: 10.3390/nu11102293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/11/2019] [Accepted: 09/18/2019] [Indexed: 11/25/2022] Open
Abstract
Food insecurity is widespread among asylum seekers resettled in Western countries. Limited information exists on the quality of food intake in this population. The aim of this study was to investigate dietary quality among asylum seekers living in Norwegian reception centers. This study has a cross-sectional research design. Dietary intake was assessed through a qualitative 24-hour dietary recall, and the dietary diversity score (DDS) was calculated. This study was conducted in eight Norwegian reception centers. A total of 205 adult asylum seekers (131 men and 74 women) participated in the study. The asylum seekers ate on average two meals per day, and one-third ate their first meal after noon. Mean (SD) DDS was 4.0 (1.6) and 2/3 had low dietary diversity, eating from fewer than five food groups. Women had a significantly higher mean DDS (4.5) than men (3.8) (β (95% CI): 0.47 (0.00, 0.95) and a higher consumption of vegetables and fruits. The longer the period of residence in Norway, the higher the DDS, β (95% CI): 0.01 (0.00, 0.02). The asylum seekers' inadequate dietary intake reveals new forms of poverty and social exclusion in Europe. An inadequate dietary intake may increase the magnitude of difficulty involved in the settlement process and contribute to poorer health.
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Affiliation(s)
- Sigrun Henjum
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, 0130 Oslo, Norway.
| | - Bess L Caswell
- Department of Nutrition, University of California, Davis, CA 95616, USA.
| | - Laura Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, 0130 Oslo, Norway.
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13
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Caswell BL, Talegawkar SA, Siamusantu W, West KP, Palmer AC. A 10-Food Group Dietary Diversity Score Outperforms a 7-Food Group Score in Characterizing Seasonal Variability and Micronutrient Adequacy in Rural Zambian Children. J Nutr 2018; 148:131-139. [PMID: 29378046 DOI: 10.1093/jn/nxx011] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 07/14/2017] [Accepted: 10/02/2017] [Indexed: 11/12/2022] Open
Abstract
Background Dietary diversity scores and dichotomous indicators derived from them are widely used to assess dietary quality, and specific scoring methods have been recommended for women and 6- to 23-mo-old children. However, there is no specific score recommended for older children and the effect of seasonal dietary changes on score performance is not well documented. Objective We assessed performance of 2 recommended dietary diversity scores as indicators of dietary quality over 3 seasons. Methods We conducted 7 repeat 24-h dietary recalls among 4- to 8-y-old rural Zambian children (n = 200) over 6 mo. Dietary diversity was assessed using a 7-food group score for assessing infant and young child feeding (DDS-IYCF) and a 10-food group score for use among women of reproductive age (DDS-W). Micronutrient intake adequacy was described by mean probability of adequacy (MPA) over 11 micronutrients. Longitudinal models were fit to test the association between each score and MPA overall and by season. Receiver operating characteristic (ROC) curves were used to describe indicator performance of each score. Results Mean ± SE scores were 4.11 ± 0.03 for DDS-IYCF and 4.39 ± 0.03 for DDS-W. Both scores varied by season, but DDS-W better reflected seasonal dietary changes. Across seasons, MPA increased 1-6 percentage points/unit increase in DDS-IYCF or 1-10 percentage points for DDS-W (P < 0.05). Score performance as a predictor of MPA > 0.75 was moderate, with area under the ROC curve values by season ranging from 0.63 to 0.77 for DDS-IYCF and from 0.66 to 0.72 for DDS-W. Conclusions DDS-W performed better than DDS-IYCF in characterizing seasonal variability and micronutrient adequacy among rural Zambian children.
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Affiliation(s)
- Bess L Caswell
- The Johns Hopkins Bloomberg School of Public Health Center for Human Nutrition, Baltimore, MD
| | - Sameera A Talegawkar
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | | | - Keith P West
- The Johns Hopkins Bloomberg School of Public Health Center for Human Nutrition, Baltimore, MD
| | - Amanda C Palmer
- The Johns Hopkins Bloomberg School of Public Health Center for Human Nutrition, Baltimore, MD
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14
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Na M, Caswell BL, Talegawkar SA, Palmer A. Monthly food insecurity assessment in rural mkushi district, Zambia: a longitudinal analysis. BMC Public Health 2017; 17:260. [PMID: 28302099 PMCID: PMC5353779 DOI: 10.1186/s12889-017-4176-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/11/2016] [Accepted: 03/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background Perception-based scales are widely used for household food insecurity (HFI) assessment but were only recently added in national surveys. The frequency of assessments needed to characterize dynamics in HFI over time is largely unknown. The study aims to examine longitudinal changes in monthly reported HFI at both population- and household-level. Methods A total of 157 households in rural Mkushi District whose children were enrolled in the non-intervened arm of an efficacy trial of biofortified maize were included in the analysis. HFI was assessed by a validated 8-item perception-based Likert scale on a monthly basis from October 2012 to March 2013 (6 visits), characterizing mostly the lean season. An HFI index was created by summing scores over the Likert scale, with a possible range of 0–32. The Wilcoxon matched signed-ranks test was used to compare distribution of HFI index between visits. A random effect model was fit to quantify the sources of variance in indices at household level. Results The median [IQR] HFI index was 4.5 [2, 8], 5 [1, 8], 4 [1, 7], 4 [1, 6], 3 [1, 7] and 4 [1, 6] at the six monthly visits, respectively. HFI index was significantly higher in visit 1 and 2 than visit 3–6 and on average the index decreased by 0.25 points per visit. Within- and between-household variance in the index were 10.6 and 8.8, respectively. Conclusions The small change in mean monthly HFI index over a single lean season indicated that a seasonal HFI measure may be sufficient for monitoring purposes at population level. Yet, higher variation within households suggests that repeated assessments may be required to avoid risk of misclassification at household level and to target households with the greatest risk of food insecurity.
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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, USA
| | - Bess L Caswell
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sameera A Talegawkar
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Amanda Palmer
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Na M, Gross AL, Wu LSF, Caswell BL, Talegawkar SA, Palmer AC. Internal validity of the Food Access Survey Tool in assessing household food insecurity in rural Zambia. Food Secur 2016. [DOI: 10.1007/s12571-016-0573-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Caswell BL, Talegawkar SA, Dyer B, Siamusantu W, Klemm RDW, Palmer AC. Assessing Child Nutrient Intakes Using a Tablet-Based 24-Hour Recall Tool in Rural Zambia. Food Nutr Bull 2015; 36:467-80. [PMID: 26487637 DOI: 10.1177/0379572115612631] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 11/17/2022]
Abstract
BACKGROUND Detailed dietary intake data in low-income populations are needed for research and program evaluation. However, collection of such data by paper-based 24-hour recall imposes substantial demands for staff time and expertise, training, materials, and data entry. OBJECTIVE To describe our development and use of a tablet-based 24-hour recall tool for conducting dietary intake surveys in remote settings. METHODS We designed a 24-hour recall tool using Open Data Kit software on an Android tablet platform. The tool contains a list of local foods, questions on portion size, cooking method, ingredients, and food source and prompts to guide interviewers. We used this tool to interview caregivers on dietary intakes of children participating in an efficacy trial of provitamin A-biofortified maize conducted in Mkushi, a rural district in central Zambia. Participants were children aged 4 to 8 years not yet enrolled in school (n = 938). Dietary intake data were converted to nutrient intakes using local food composition and recipe tables. RESULTS We developed a tablet-based 24-hour recall tool and used it to collect dietary data among 928 children. The majority of foods consumed were maize, leafy vegetable, or small fish dishes. Median daily energy intake was 6416 kJ (1469 kcal). CONCLUSIONS Food and nutrient intakes assessed using the tablet-based tool were consistent with those reported in prior research. The tool was easily used by interviewers without prior nutrition training or computing experience. Challenges remain to improve programming, but the tool is an innovation that enables efficient collection of 24-hour recall data in remote settings.
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Affiliation(s)
- Bess L Caswell
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sameera A Talegawkar
- Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - Brian Dyer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Rolf D W Klemm
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda C Palmer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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