Food and Nutrition Bulletin

The effectiveness of nutrition education and unsupervised daily iron supplementation on iron status was studied in adolescent schoolgirls of low socio-economic status. Baseline knowledge, attitudes, and practices related to nutrition and iron status were assessed in 915 girls attending schools in an urban and a rural area of Sri Lanka. Girls in intervention schools received nutrition education and ferrous sulphate or a placebo and were requested to take one tablet per day. Subjects in control schools did not receive any intervention. All subjects were reassessed after 10 weeks. Educational intervention resulted in significant increases in knowledge of nutrition and in iron status among girls in both areas. Good compliance was noted with both iron supplements and the placebo. Iron status was more improved in the groups receiving iron supplementation than in the groups receiving education only, indicating the effectiveness of unsupervised supplementation when combined with nutrition education. The short-term sustainability of intervention was higher in the rural area than in the urban area.

In many parts of the world, people suffer from different micronutrient deficiencies due to the same aetiology of micronutrient deficiency and physiological interactions between the micronutrient metabolisms. To reduce and alleviate micronutrient deficiencies, supplementation programmes for different micronutrients are often implemented simultaneously. Since operational strategies and distribution systems can be similar for each micronutrient, efforts and resources are duplicated and cost-effectiveness is therefore reduced. Widespread micronutrient deficiencies in populations have a deep-rooted causality within the life cycle of people. They are strongly associated with poverty and are passed from one generation to the next. Recently, multi-micronutrient supplementation has been suggested to break this vicious circle of micronutrient deficiencies within the life cycle. However, several technical and scientific aspects have to be considered for the implementation of a multi-micronutrient supplementation programme.

Iron deficiency is the world's most common nutritional disorder and is predominantly responsible for anaemia in human populations. Its management and control involve iron supplementation and fortification of foods and, in developing countries, the control of parasitic infections as well. It is also important to formulate food-based strategies to improve the bioavailability of dietary iron, for example, by promoting culturally acceptable changes in food choices, processing, and preservation. These require sound scientific data from nutritional research and the participation of women scientists who are familiar with the local and sociocultural preferences of the target communities. Research has shown that the major effects of processing on iron availability are associated with the separation, dehulling, and cooking procedures. The magnitude of losses varies with the food type and processing technique. Blanching and homogenization of vegetables may account for up to 28% and 40% of soluble iron loss, respectively. Moreover, the traditional practice of adding kanwa (an alkaline salt) to soften beans and to impart a green colour to vegetables during cooking results in reduced iron availability. In contrast, germination and fermentation have been shown to enhance the availability of iron from foods. Thus, traditional-food processing methods, such as fermentation, should be encouraged, actively promoted, and preserved.

Urban–rural comparisons of childhood undernutrition suggest that urban populations are better off than rural populations. However, these comparisons could mask the large differentials that exist between socio-economic groups in urban areas. Data from the Demographic and Health Surveys for 11 countries from three regions were used to test the hypothesis that intra-urban differentials in child stunting are greater than intra-rural differentials, and that the prevalence of stunting among the urban and the rural poor is equally high. A socio-economic status (SES) index based on household assets, housing quality, and availability of services was created separately for rural and urban areas of each country, using principal components analysis. Odds ratios (OR) were computed to estimate the magnitude of differentials in stunting (height-for-age Z scores < −2) between urban and rural areas and between the lowest and highest SES quintiles within areas. The prevalence of stunting was lower in urban than in rural areas for all countries, but rural–urban odds ratios were relatively small (< 3.3). As hypothesized, the gap between low and high SES was markedly larger in urban (median OR, 4) than rural (median OR, 1.8) areas, and differentials were statistically significant (interaction between area and SES in logistic regression) in all but three countries. Within-urban ORs as high as 10 were found in Peru and the Dominican Republic, whereas within-rural ORs were smaller than 3.5, except in Brazil. In most countries, stunting in the poorest urban quintile was almost the same as that among poor rural dwellers. Thus, malnutrition in urban areas continues to be of concern, and effective targeting of nutrition programmes to the poorest segments of the urban population will be critical to their success and cost-effectiveness.

The prevalence of low birthweight (LBW) and its possible risk factors in Ahvaz, Iran, were determined in 10 health centres and 3 main hospitals in the city from 876 randomly selected mother-infant files. The variables included maternal pre-pregnancy and pre-labour weight, infant weight, maternal haemoglobin level, pregnancy history, and socio-economic status. The rate of LBW was 7.3%. LBW was significantly related to pre-pregnancy maternal weight, weight gain during pregnancy, maternal haemoglobin level, and mother's literacy (p < .05). Mothers given iron supplements starting at four months of pregnancy had elevated haemoglobin levels (p < .0001). Evidence is provided that educating young mothers can reduce the rate of LBW.

An adverse lipid profile is a major risk factor for atherosclerosis. This study evaluated the lipid profiles of 683 schoolchildren aged 10 to 13 years. The prevalence of both high LDL and high total cholesterol levels was significantly (p < .001) higher in private schoolchildren than in public schoolchildren. There were no significant differences in the prevalence of high triglyceride levels among the schoolchildren. Mean total cholesterol and LDL cholesterol levels were significantly higher in children whose parents had completed over 11 years of schooling. Private schoolchildren were more sedentary and tended to have a more atherogenic diet. Our data suggest that prevention programmes in primary schools are required to decrease the prevalence of cardiovascular risk factors, including abnormal lipid profiles.

Iron deficiency is the most prevalent nutritional problem in the world. We determined the prevalence of iron deficiency, anaemia, and iron-deficiency anaemia in 652 high-school students (340 girls and 312 boys) who were selected by stepwise random sampling from 16 high schools in Jolfa, East Azerbaijan. Iron deficiency was defined as having transferrin saturation and/or serum ferritin values below normal. Anaemia was defined as having haemoglobin levels below normal. Iron-deficiency anaemia was taken to be the combination of both. The prevalences of iron deficiency, anaemia, and iron-deficiency anaemia were 60.7%, 12.6%, and 11.5%, respectively. The respective prevalences of these conditions were 66.5%, 13.6%, and 13% in girls and 54.5%, 11.6%, and 10.3% in boys. The prevalences of these conditions were higher among 15- and 16-year-old boys than among girls. Among boys, age was inversely related to the prevalence of iron deficiency (r = −0.88, p < .05) and anaemia (r = −0.79, p < .07). Among girls, age was directly related to the prevalence of anaemia (r = 0.96, p<.001) and iron-deficiency anaemia (r = 0.99, p < .001).

A nutritional survey was conducted on 150 female college students (75 boarders and 75 day scholars) aged 18 to 23 years at the Punjab Agricultural University in Ludhiana, India. The mean weight, mid-upper-arm circumference, and triceps skinfold thickness were below normal, but the mean height and body fat were in the normal range. The body mass index showed that 50% of the subjects were normal, 21% were low normal weight, and 21% had a mild energy deficiency. The average daily consumptions of energy and of iron were 1,776 ± 22 kcal and 14.5 ± 0.2 mg, respectively; both were inadequate. The daily total energy expenditure was 1,824 ± 9 kcal, yielding a negative energy balance of 48 ± 10 kcal/day. The average haemoglobin and serum ferritin levels were below normal, while serum iron was in the low normal range. Low iron intake and haemoglobin levels confirmed an unsatisfactory iron status of the subjects. The combined deficiency of energy and iron appeared to have a worse effect on physical fitness than energy or iron deficiency alone.

Focus group discussions and interviewer-administered questionnaires assessed the knowledge, attitudes, and practices of rural dwellers relating to iodine-deficiency disorders. The iodine content of salt was measured at the household and retail levels, and the iodine nutritional status of school-aged children (6–12 years) was assessed by measuring urinary iodine concentrations. The analyses showed a high level of ignorance about the causes and consequences of iodine deficiency, iodine as a nutrient, and iodized salt and its purpose. In a goitre endemic area of south-eastern Nigeria, only 47% of the household samples and 48% of the retail salt samples were iodized to a level above 30 ppm, whereas 34% of the household samples and 19% of the retail samples had no iodine. These findings could be attributable to the methods of salt handling and storage in the area. Among children, 90% had moderate to severe iodine deficiency, 10% were mildly iodine deficient, and none had normal iodine levels according to urinary iodine excretion. The findings suggest a high level of iodine deficiency and the urgent need for information, education, and communication in the study area.

This study used locally available raw materials to enrich the contents of provitamin A (β-carotene) and other nutrients in a maize-based traditional complementary food for infants and pre-school children in Benue State, Nigeria. Fermented maize, dehulled soya bean, and sliced mango mesocarp were dried in a mobile wooden solar cabinet dryer (65°–70°C) to a moisture level of 8% to 10%. The dried products were milled separately. Blends containing different proportions of the flours were prepared to determine the most appropriate blend for preparing porridge, which was tested by sensory evaluation. The most appropriate blend consisted of 55% maize, 25% soya bean, and 20% mango flour (blend B). Its β-carotene content was 233 μg/100 g. The β-carotene contents of other blends were 199 μg/100g for 60% maize, 25% soya bean, and 15% mango (blend C), and 158 μg/100 g for 70% maize and 30% soya bean (blend A), whereas that of traditional maize akamu was 67 μg/100 g. The provitamin A retention percentages were 89% for blend A, 92% for blend B, 91% for blend C, and 88% for akamu. A healthy, well-fed infant 6 to 11 months of age is expected to consume 200 to 300 ml of the porridge, which provides 13 to 20 μg of retinol activity, compared with 1 to 2 μg of retinol activity expected from akamu. The porridge prepared with blend B was organoleptically acceptable. Detailed nutrient composition, including essential amino acids, was determined.

To determine if double-fortified salt improved the haemoglobin levels and productivity of tea pickers, a double-blind, randomized, placebo-controlled trial was conducted on 793 tea pickers. The subjects in the experimental households (n = 385) received salt fortified with iron and iodine, and the subjects in the control households (n = 408) received common unfortified salt. Fingerprick blood analysis for haemoglobin by the cyanmethaemoglobin method was performed three times during a period of one year. The productivity data were also analysed for 450 tea pickers. At the end of the year, their average haemoglobin level had increased from 8.9 to 10.2 g/dl and their corresponding picking average had increased from 24.8 kg to 26.2 kg, which could increase annual tea production by 330 tonnes.

A nutritional study was conducted on 150 female college students aged 18 to 23 at the Punjab Agricultural University, Ludhiana, India, to evaluate the effectiveness of “MSU Nutriguide: Asian Indian Foods,” a computer programme for assessing nutrient intakes and total energy expenditure (TEE) of the Indian population. A non-significant difference between analysed and calculated values for energy, protein, iron, and ascorbic acid revealed that the intake of the nutrients calculated with the MSU Nutriguide was a correct assessment in most of the subjects. TEE estimation by MSU Nutriguide gives values based on age, height, weight, and four levels of physical activity (sleeping and light, moderate, and heavy activity), whereas prediction equations are based on the body weight of each subject and a single level of activity. Therefore, MSU Nutriguide can be efficiently used to assess the TEE of people in India.

The present community-based study of 2,700 children in three governorates of Upper Egypt revealed that stunting was present among 35.7% of the total sample. It was more prevalent in Menia (39.4%), followed by Assiut (38%), and Sohag (29.9%) governorates. Underweight was observed in 30.4% of all pre-schoolers (Menia 28.6%, Sohag 27.1%, and Assiut 25.7%). The prevalence of wasting in the whole sample was 9.2% (Assiut 10.8%, Sohag 9.3%, and Menia 7.6%). Protein–energy malnutrition (PEM) was usually higher in rural than in urban sites and higher in girls than in boys, with the second year of life showing the highest prevalence. Low socioeconomic level and high morbidity load were associated with increased risk of all PEM indicators. Integrated programmes are needed to improve socio-economic conditions and infant-feeding practices.