Food and Nutrition Bulletin

The increasing rate of obesity among Kuwaiti adolescents is associated with immediate and long term-risks to their health and well-being.

To update data on the prevalence of overweight and obesity among Kuwaiti adolescents and to examine the relative contribution of selected lifestyle factors to overweight and obesity in this population.

The present study is part of the Arab Teens Lifestyle Study (ATLS). A total of 906 adolescents (463 boys and 443 girls) aged between 14 and 19 years were selected from Kuwaiti schools by a multistage stratified randomization process. A validated questionnaire was used to collect data on physical activity, sedentary lifestyle, and eating habits. The International Obesity Task Force (IOTF) cutoff values for adolescents under 18 years of age were used to define overweight and obesity. Total energy expenditure was calculated using metabolic equivalent-minutes per week. A general linear model was used to establish the proportion of the variance (expressed in partial eta squared) in excess weight attributable to differences in eating habits and physical activity.

The prevalence of overweight and obesity was 50.5% in boys and 46.5% in girls. Among boys, moderate and vigorous activities were found to be significantly negatively associated with overweight and obesity (p < .05), whereas in girls, only those with not less than moderate activities were negatively associated with overweight and obesity (p < .05). Sedentary behaviors, time spent watching television, and time spent working on the computer were not significantly associated with obesity in either sex. Consumption of breakfast, vegetables, and fast foods (boys and girls) and potatoes, cakes and doughnuts, and sweets (girls only) was significantly associated with overweight and obesity (p < .05). In general, the partial eta square explained by physical activity was less than 3.6% in boys compared with less than 1.0% in girls, and eating habits explained less than 1.8% in boys compared with 2.5% in girls.

Physical activity explains a greater proportion of variation in body mass index than do eating habits, particularly in boys. Eating habits explain a greater proportion of variation in body mass index than does physical activity in girls. Prospective studies are needed to clarify the relative effects of sedentary behaviors on overweight in adolescents.

The Chilean Ministry of Health has combated iron deficiency through the delivery of fortified milk by the National Complementary Feeding Program (NCFP).

To assess iron status and associations between biomarkers of iron status and serum C-reactive protein (CRP) in 218 beneficiaries of the NCFP aged 19 to 72 months in Santiago and Valparaiso, Chile.

Blood was collected from a cross-sectional representative sample. Iron status (measured by hemoglobin, zinc protoporphyrin, and serum ferritin levels) and inflammation (according to CRP level) were determined.

Serum CRP level was positively associated with serum ferritin and zinc protoporphyrin levels (r = 0.16 and r = 0.15; p = .0168 and p = .0290, respectively). Serum ferritin was higher among children with high CRP (> 10 mg/dL) than among those with low CRP (≤ 10 mg/dL) (p = .003). After adjustment for 10, 6, and 5 mg/L CRP, the prevalence of low serum ferritin changed from 56.4% without adjustment to 60.6%, 61.5%, and 42.7%, respectively, and the prevalence of high zinc protoporphyrin changed from 22.9% to 21.6%, 17.4%, and 17.9%, respectively. There were no differences between regions in biomarkers of iron status. There was no association between consumption of fortified milk and the prevalence of abnormal serum ferritin (< 15 μg/L) after adjustment for sex, age, and breastfeeding (OR, 1.00; 95% CI, 0.99 to 1.01; p = .288). After adjustment for 10 mg/L CRP, 5.5% were classified as having iron-deficiency anemia, 42.7% as having iron-deficiency erythropoiesis, 17.9% as having depleted iron stores, and 35.8% as having normal iron status.

CRP level was positively associated with serum ferritin and zinc protoporphyrin levels. Chilean children aged 19 to 72 months from Santiago and Valparaiso who were beneficiaries of the NCFP had a low prevalence of iron-deficiency anemia, a high prevalence of iron-deficiency erythropoiesis, and a moderate prevalence of depleted iron stores.

Food fortification has been increasingly recognized as a promising approach to prevent micronutrient deficiencies. The Fortification Rapid Assessment Tool (FRAT) was developed to assist public health program managers to acquire the information needed to implement an effective mass food fortification program. Multiple countries have conducted FRAT surveys, but information on results and experiences with the FRAT tool has been available only at the national level.

To summarize the findings of the FRAT surveys previously conducted in sub-Saharan Africa.

Surveys from 12 sub-Saharan African countries (Burkina Faso, Cameroon, Congo, Guinea, Malawi, Mali, Mauritania, Mozambique, Niger, Rwanda, Senegal, Uganda) were identified. Information on consumption patterns for wheat flour, vegetable oil, sugar, and bouillon cubes was reviewed and summarized.

Most surveys found that a moderate to high proportion of women reported consuming wheat flour (48% to 93%), vegetable oil (44% to 98%), sugar (55% to 99%), and bouillon cubes (79% to 99%) in the past 7 days, although consumption was more common and more frequent in urban areas than in rural areas. Similarly, the reported amounts consumed during the previous 24 hours were generally higher in urban settings.

The FRAT instrument has been successfully used in multiple countries, and the results obtained have helped in planning national food fortification programs. However, the recommended sampling scheme may need to be reconsidered, and the guidelines should be revised to clarify important aspects of fieldworker training, implementation, data analysis and interpretation, and reporting of the results.

Agriculture has the potential to have a bigger impact on nutrition status than it currently does. The pathways between agriculture and nutrition are well known. Yet the evidence on how to increase the impact of agriculture on nutrition is weak.

To outline some of the possible reasons for the weak evidentiary link between agriculture and income and to highlight some approaches to incentivizing agriculture to give nutrition a greater priority.

A review of literature reviews and other studies.

Agriculture does not have a strong poverty and nutrition impact culture, the statistical links between aggregate agriculture and nutrition data are weak, literature reviews to date have not been sufficiently clear on the quality of evidence admitted, and the evidence for the impact of biofortification on nutrition status is positive, but small. Some tools are proposed and described that may be helpful in raising the profile of nutrition outcomes, building nutrition outcomes into impact assessments of agriculture, measuring the commitment to undernutrition reduction, and helping to prioritize nutrition-relevant actions within agriculture. Leadership in agriculture and nutrition is also an understudied issue.

Agriculture has a vast potential to increase its impact on nutrition outcomes. We don't know if this potential is being fully realized as yet. I suspect it is not. Tools that help promote the visibility of nutrition within agriculture and the accountability of agriculture toward nutrition can possibly contribute to moving “from Nutrition Plus to Nutrition Driven” agriculture.

Nutritional requirements have been previously calculated for emergency-affected populations and are widely used for planning and assessing the nutritional adequacy of humanitarian food assistance. The Sphere Project is an interagency collaboration that defines minimum standards and indicators for humanitarian responses, including food and nutrition. It last published population nutritional requirements in 2004, but a revision was required due to the release of new Reference Nutrient Intakes (RNIs) by the World Health Organization and Food and Agriculture Organization (WHO/FAO).

To review and revise the list of specified nutrients and recalculate population requirements using RNIs published by WHO/FAO.

Review of published normative documents, consultation with experts and participants in the Sphere revision process, construction of a reference demographic profile, and calculation of population nutrient requirements for use in designing emergency general rations.

Twenty-one nutrients and energy were selected for inclusion, and a demographic profile was constructed to represent a typical beneficiary population. Compared with the previous version of the Sphere Handbook, population requirements for nine vitamins and minerals were found to have increased as a result of the new WHO/FAO RNIs.

The calculated requirements were adopted and published as part of the Sphere 2011 Handbook. The incorporation of these requirements into planning, monitoring, and evaluation practices for food assistance will help to ensure that populations receive appropriate nutritional support during crises.

The prevalence of vitamin D deficiency in Latin America and the Caribbean is unknown.

To examine the prevalence data available on vitamin D deficiency in Latin America and the Caribbean.

A systematic review was conducted in 2011. Studies using biochemical biomarkers and dietary intake estimation were included. Studies conducted in apparently healthy individuals, independently of age, latitude, skin pigmentation, and season of the year at the time of blood collection, were included.

A total of 243 studies were identified. The final number of selected studies was 28, including two National Health Surveys (Mexico and Argentina). There are studies that report the vitamin D status of specific subgroups conducted in Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, and Mexico. However, the small sample sizes in these studies and thus the low national representativeness of the reported data do not allow for an accurate assessment of vitamin D status at the regional level. In the majority of the countries with available data, we observed that vitamin D insufficiency was classified as a mild, moderate, or severe public health problem. The only country with a nationally representative sample was Mexico, which found 24%, 10%, 8%, and 10% prevalence rates of vitamin D insufficiency (25-hydroxyvitamin D < 50 nmol/L) in preschoolers, schoolchildren, adolescents, and adults, respectively. The prevalence of vitamin D deficiency (25-hydroxyvitamin D < 20 nmol/L) was less than 1% for all groups.

There is some indication that vitamin D insufficiency may be a public health problem in Latin America and the Caribbean, but the exact magnitude is currently unknown.

The effects of boiling and frying on the bioaccessibility of all-trans-β-carotene in biofortified BRS Jari cassava roots have not been investigated, although these are conventional methods of cassava preparation.

The aims of the present study were to investigate β-carotene micellarization efficiency of yellow-fleshed BRS Jari cassava roots after boiling and frying, as an indicator of the bioaccessibility of this carotenoid, and to apply fluorescence microscopy to investigate β-carotene in the emulsified fraction.

Uncooked, boiled, and fried cassava roots were digested in vitro for the evaluation, by reversed-phase high-performance liquid chromatography (HPLC), of the efficiency of micellarization of all-trans-β-carotene in BRS Jari cassava roots. Fluorescence microscopy of the micellar fraction was used to confirm the presence of β-carotene in the emulsified fraction and to observe the structure of the microemulsion from the boiled and fried cassava samples.

Fried cassava roots showed the highest (p < .05) micellarization efficiency for total carotenoids and all-trans-β-carotene (14.1 ± 2.25% and 14.37 ± 2.44%, respectively), compared with boiled and raw samples. Fluorescence microscopy showed that after in vitro digestion there were no carotenoid crystals in the micellar fraction, but rather that this fraction presented a biphasic system compatible with emulsified carotenoids, which was consistent with the expected high bioavailability of β-carotene in this fraction.

Increased emulsification and bioaccessibility of β-carotene from fried biofortified BRS Jari cassava roots compensates for chemical losses during preparation, indicating that this preparation is suitable for home use of BRS Jari cassava roots and might represent a relatively good food source of bioavailable provitamin A.

To reverse the trend of rising child obesity rates in many middle-income countries, recommendations include increasing fruit and vegetable consumption. Schools can positively impact children's eating behavior, and multicomponent interventions that include the curriculum, school food environments, and parental involvement are most effective.

To find out how fruits and vegetables feature in the dietary guidelines provided to schools, what specific schemes are available for providing these foods, the extent to which nutrition education is included in the curriculum, and how vegetables and fruits are procured in primary schools.

In 2008, a survey questionnaire previously validated and revised was sent electronically to national program managers and focal points for school feeding programs in 58 middle-income countries. The rationale was to obtain information relevant to the entire country from these key informants. The survey response rate was 46%. The information provided by 22 respondents in 18 countries was included in the current study. On average, respondents answered 88% of the questions analyzed in this paper. Of the respondents, 73% worked for the national authority responsible for school food programs, with 45% at the program coordinator or director level.

Few countries have any special fruit and vegetable schemes; implementation constraints include cost and lack of storage facilities. Although 11 of 18 countries have both nutrient-based guidelines and school food guidelines for meals, fruits and vegetables are often not adequately specified.

In some countries, nutrition education, special activities, school gardens, and parental participation are used to promote fruits and vegetables. Specific schemes are needed in some, together with school food guidelines that include fruits and vegetables.

The 2010 floods inundated one-fifth of Pakistan and affected more than 20 million people.

To characterize the impact of the floods and subsequent humanitarian response on household economy and food security.

A cross-sectional 80 × 20 cluster survey (n = 1,569 households) was conducted using probability proportional to size sampling in the four most flood-affected provinces 6 months after the floods. Analysis included both descriptive statistics and regression models, with receipt of food aid (in the first month), dietary quality, and household income at 6 months postflood as outcomes.

Need for food aid was nearly ubiquitous (98.9%); however, only half of the study population ever received food aid. Displacement was not a significant predictor of food aid receipt (OR, 1.28; 95% CI, 0.83 to 1.98); however urban location (OR, 2.78; 95% CI, 2.00 to 3.86) and damage to the home (OR, 2.73; 95% CI, 1.34 to 5.60) were significantly associated. Some of the hardest-hit groups, including both farmers and day laborers, were significantly less likely to receive food aid (p < .05). Additionally, receipt of food aid was not necessarily associated with improved household economy or food security; although households in internally displaced people (IDP) camps were more likely to receive food aid (OR, 2.78; 95% CI, 2.00 to 3.86), they were less likely to report same or improved dietary quality (OR, 0.63; 95% CI, 0.46 to 0.88) or income status (OR, 0.55; 95% CI, 0.35 to 0.86).

Food aid coverage following the 2010 floods was relatively low, and many of the most affected populations were less likely to receive aid, suggesting that targeting should be improved in future responses.

Cross-cultural validity of food security indicators is commonly presumed without questioning the suitability of generic indicators in different geographic settings. However, ethnic differences in the perception of, and reporting on, food insecurity, as well as variations in consumption patterns, may limit the comparability of results. Although research on correction factors for standardization of food security indicators is in process, so far no universal indicator has been identified.

The current paper considers the ability of the Food Consumption Score (FCS) developed by the World Food Programme in southern Africa in 1996 to meet the requirement of local cultural validity in a Laotian context. The analysis is based on research that seeks to identify options for correcting possible biases linked to cultural disparities.

Based on the results of a household survey conducted in different agroecological zones of Laos in 2009, the FCS was validated against a benchmark of calorie consumption. Changing the thresholds and excluding small amounts of food items consumed were tested as options to correct for biases caused by cultural disparities.

The FCS in its original form underestimates the food insecurity level in the surveyed villages. However, the closeness of fit of the FCS to the benchmark classification improves when small amounts of food items are excluded from the assessment.

Further research in different cultural settings is required to generate more insight into the extent to which universal thresholds can be applied to dietary diversity indicators with or without locally determined correction factors such as the exclusion of small amounts of food items.