Food and Nutrition Bulletin

Anemia in pregnancy remains a major problem in nearly all developing and many industrialized countries. In Mali, the subpopulation prevalence and etiology of anemia during pregnancy are largely unknown.

To examine the prevalence and likely etiologies of anemia in pregnancy in a poor urban population in Bamako, Mali.

Pregnant women (n = 190) were selected randomly. Hemoglobin, serum iron, and total iron-binding capacity were measured; blood smears were examined for Plasmodium falciparum malaria; and single stool and urine samples were examined for Schistosoma haematobium and hookworm. Gynecologic examinations were performed and interviews conducted to qualitatively assess food consumption and other socioeconomic characteristics. Associations among mild, moderate, and severe anemia; iron and parasite status; erythrocyte sedimentation rates; and the presence of abnormal vaginal discharge were evaluated. Differences in hemoglobin and serum iron concentrations, total iron-binding capacity, and anemia were compared according to trimester of pregnancy and between infected and noninfected women. The relative and attributable risks of anemia were calculated, and adjusted odds ratios for anemia and low serum iron were estimated by multivariate logistic regression.

Of the 131 women for whom complete data were available, 47% had hemoglobin concentrations below 110 g/L; 13% had serum iron concentrations below 12 μmol/L; none had transferrin saturation values below 16%; 11%, 23%, and 8% harbored P. falciparum, S. haematobium, and hookworm, respectively; and 82% had an abnormal vaginal discharge. Food restrictions were reported by 45% of the women. Abnormal vaginal discharge correlated significantly with anemia (Pearson χ² = 62.4; p < .01). Univariate and multivariate analyses found that infections were strongly associated with and predictive of anemia.

Our data suggest that infections and food accessibility contribute to the high rates of anemia during pregnancy in Mali.

Mild deficiencies and excesses of iodine have deleterious effects in both females and males. The iodine status of the population after implementation of the universal salt iodization program in Sri Lanka is not known.

This cross-sectional study was carried out to assess the iodine status of pregnant women and female adolescents, with urinary iodine concentration used as the measure of outcome.

The participants were 100 women in the first trimester of pregnancy and 99 female adolescents in Kuliyapitiya, Kurunegala District, North-Western Province, Sri Lanka. The urinary iodine concentration was measured in a casual urine sample from each subject. The iodate contents of salt samples collected from households of the adolescents participating in the study were also measured.

The median urinary iodine concentration of 185.0 μg/L and the prevalence of values under 50 μg/L of only 1% among the pregnant women indicate adequate iodine intake and optimal iodine nutrition. The median urinary iodine concentration (213.1 μg/L) among female adolescents indicates a more than adequate iodine intake and a risk of iodine-induced hyperthyroidism. Approximately 8% and 4% of the adolescents and pregnant women, respectively, had urinary iodine concentrations in the range of mild iodine deficiency (51 to 100 μg/L). More than half of the adolescents (56%) and 39% of the pregnant women had urinary iodine concentrations higher than optimal. The median iodine content in salt samples was 12.7 ppm. Only 20.2% of the samples were adequately iodized, and 10.1% of the samples had very high iodine levels.

Female adolescents and pregnant women had no iodine deficiency, but a considerable proportion of them, especially female adolescents, were at risk for iodine-induced hyperthyroidism. There is thus a need for proper monitoring of the salt iodization program to achieve acceptable iodine status.

Soy sauces are available in different types and grades, which allows them to reach consumers of all socioeconomic groups. Ferric sodium ethylenediaminetetraacetic acid (NaFeEDTA) has been used for iron fortification of soy sauces in some countries, however, its high cost may make it unattractive to policymakers and industry.

We evaluated the feasibility of using more economical iron sources for iron fortification, with soy sauce of various types and grades used as a vehicle.

Seven iron sources were tested for their feasibility for fortification of four types of soy sauce: naturally fermented in the traditional style, naturally fermented according to large-scale industrial formulas 1 and 5, and chemically hydrolyzed at 5 mg per serving (15 mL, per Thailand's food labeling regulations). Either citric acid or sodium citrate was added at 0.1% as a chelator.

Five iron sources—ferrous sulfate, NaFeEDTA, ferric ammonium citrate, ferrous lactate, and ferrous gluconate—did not significantly affect the sensory qualities of the product over a period of 3 months (p > .05). Ferrous fumarate and ferrous bisglycinate caused unacceptable precipitation. Less than 3% of 260 and 306 commonly cooked foods out of 871 and 772 preparations using soy sauces fortified with NaFeEDTA and ferrous sulfate, respectively, were found to be different from normal with regard to sensory qualities. The cost of fortification was US 0.22 cents to US 3.28 cents per bottle (700 mL).

Both naturally fermented and chemically hydrolyzed soy sauces could be fortified with all five iron sources. Ferrous sulfate is the most appropriate source because of its low cost and acceptable sensory characteristics. Soy sauce is a promising vehicle for iron fortification, however, the bioavailability of iron in the products examined here needs to be evaluated under normal use conditions.

The development of low-cost, high-protein food supplements for weaning infants from local and readily available raw materials is a constant challenge for developing countries.

To formulate, develop, and assess the nutritive value, acceptability, and keeping quality of sorghum-based staple dried flakes as instant weaning foods.

Weaning blends composed of 42% sorghum supplemented with 20% legumes, 10% oil seeds, and 28% additives (sugar, oil, skim milk powder, and vanillin) were prepared according to FAO/WHO/UNU recommendations and processed in a twin-roller drum dryer. The effects of fermentation and of the addition of malt on the nutritive value and functional properties of the blends were investigated.

The blends were found to contain 16.6% to 19.3% protein, 68.7% to 72.7% carbohydrate, 0.9% to 1.3% fiber, and 405.8 to 413.2 kcal of energy per 100 g. The iron content of the blends ranged from 5.3 to 9.1 mg/100 g, and the calcium content ranged from 150 to 220 mg/100 g. All blends reconstituted well and formed a soft paste when stirred with hot or cold water.

The water-holding capacity, wettability, and bulk density were within the ranges of corresponding values of commercial weaning foods. Sensory attributes, viscosity values, and in vitro digestibility varied among the blends, whereas lysing content improved considerably (p ≤ .05) for all blends. All blends had similar keeping quality, with no signs of spoilage or development of off-flavors or colors after 10 months of storage. Most blends remained free of aflatoxins.

Legumes and oil seeds can be effectively used in sorghum-based weaning foods as an acceptable protein and mineral supplement.

Weight-for-age is a commonly used indicator of the health of children and communities. We determined the accuracy of health volunteers' weight measurements in a nutrition project in Vietnam.

To report the accuracy of the volunteers' weight measurements and to assess the likely effect of any inaccuracies.

Save the Children /USA trained health volunteers to weigh children (6–36 months old) every other month from December 1999 to August 2000. Trained researchers randomly rechecked 257 weights (range, 24–114 per session). We computed nondirectional and directional differences between the weights measured by volunteers and those measured by researchers.

The weights recorded by volunteers were lower than those recorded by researchers by an average of 30 g (p < .05). Almost all of the error occurred during the first weighing session, at which the average weight recorded by volunteers was 280 g below that recorded by researchers (p = .01). The error at subsequent weighings was minimal (< 20 g below reference at each session).

One-time directional error suggests bias. Perhaps some communities (or families) influenced the volunteers to report weights lower than those actually observed to justify the programmatic food supplements or to give the impression at subsequent weighings that the level of malnutrition had been successfully reduced from that at the first session. Careful supervision of measurements of weight at baseline is essential.

Overweight and obesity have reached epidemic proportions in Arabian oil-rich countries and are threatening to become a global epidemic. Excess weight has a great impact on the health and quality of life of individuals. However, prevalence of underweight in the developing world has shown a decline during the last decade.

The aim of this cross-sectional study was to determine the prevalence of underweight, overweight, and obesity, as measured by body-mass index, in a representative sample of adolescents aged 12 to 17 years in the State of Qatar.

Qatari schoolchildren (n = 3,923) from 30 schools in urban and semiurban districts responded to a sociodemographic questionnaire. Body-mass index was calculated and the prevalence of overweight and obesity was determined on the basis of cutoff points of the International Obesity Task Force (IOTF) values (above the 85th and 95th percentiles, respectively, for overweight and obesity). Underweight was defined on the basis of CDC (Centers for Disease Control and Prevention) less than 5th percentile of BMI for age.

The final sample consisted of 1,968 boys and 1,955 girls. The prevalence of underweight, overweight, and obesity was 8.6%, 28.6%, and 7.9%, respectively, among adolescent boys and 5.8%, 18.9%, and 4.7% among girls. The prevalence of underweight was highest at 16 years of age among boys (10.5%) and at 17 years among girls (8.9%). The prevalence of obesity was highest at 12 years of age among boys (11.7%) and at 13 years among girls (6.4%). The 95th percentile curve for boys was above the IOTF standard curve; the 95th percentile curve for girls was below the IOTF curve.

Adolescents living in the State of Qatar are at high risk for overweight and obesity. There is a need to establish a national program for the prevention and treatment of obesity and related complications.