J.M.A. van Raaij

WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6-9-year-old children.

What is already known about this subject Overweight and obesity prevalence estimates among children based on International Obesity Task Force definitions are substantially lower than estimates based on World Health Organization definitions. Presence of a north–south gradient with the highest level of overweight found in southern European countries. Intercountry comparisons of overweight and obesity in primary‐school children in Europe based on measured data lack a similar data collection protocol.

Impact of iron supplementation and deworming on growth performance in preschool Beninese children

Objective: To assess the effects of iron and deworming on linear growth performance of preschoolers.Design: Three-month randomized, double-blind and placebo-controlled trial. The children were allocated to four treatments: iron (60 mg elemental iron/day)+albendazole (200 mg/day for 3 consecutive days, repeated 1 month later), iron+albendazole-placebo, albendazole+iron-placebo or placebos. The supplementation was supervised.Subjects: A group of 177 children aged 3–5 y was selected from low-income households in a rural area in southern Bénin. A complete data set was analysed for 140 subjects. Many children were stunted (58% had height-for-age Z-score <−2), none were wasted (2% had weight-for-height Z-score <−2) and 76% were anemic (Hb<110 g/l).Main outcome measures: Anthropometric parameters, hemoglobin and eggs per gram feces.Results: No significant difference in changes in anthropometric parameters was observed between study groups, and also not in a sub-sample of stunted and anemic subjects. Changes in hemoglobin were highest in the iron-treated subjects at the end of the 3-month intervention period (P=0.032). The difference between the iron and the placebo groups remained significant even 7 months later (P=0.022). The difference was 5 g/l in both periods. Ascaris lumbricoides and hookworm infections decreased significantly in albendazole-treated subjects (P<0.05).Conclusions: In addition to recurrent parasitic infection burden, the children may have multiple micronutrient deficiencies. Therefore, it may be interesting to study appetite and food intake of young toddlers in relation to health and linear growth performance in poor environments.Sponsorship: The Nestlé Foundation (Lausanne, Switzerland).European Journal of Clinical Nutrition (2001) 55, 223–228

The effect of a micronutrient-fortified complementary food on micronutrient status, growth and development of 6- to 12-month-old disadvantaged urban South African infants

The study was conducted to look at the effectiveness of a multimicronutrient-fortified complementary food on the micronutrient status, linear growth and psychomotor development of 6- to 12-month-old infants from a black urban disadvantaged community in the Western Cape, South Africa. The study was designed as an intervention study. In both the experimental and control groups, serum retinol concentration showed a decline over the intervention period of 6 months. The decline was less pronounced in the experimental group. This resulted in a significantly (P<005) higher serum retinol concentration at 12 months in the experimental group (26.8±5.8 μg/dl) compared with the control group (21.4±5 μg/dl). Serum iron concentration also declined over the intervention period. The decline was less pronounced in the experimental group. No difference was observed in haemoglobin levels between the groups at 12 months. Serum zinc concentration did not differ significantly between the two groups at follow up. Weight gain over the 6 months period did not differ significantly between the experimental (2.1±0.9 kg) and control groups (2.1±1.2 kg). There was no difference in linear growth between the experimental (10.0±1.5 cm) and control group (10.1±2.1 cm) at the end of the follow-up period. Weight and length at 6 months significantly predicted weight and length at 12 months. No difference was observed in psychomotor developmental scores between the two groups after 6 months of intervention. Introducing a multimicronutrient-fortified complementary food into the diet of 6- to 12-month-old infants seemed to have an arresting effect on declining serum retinol and iron concentration in the experimental group. No benefit was observed in serum zinc concentration, linear growth and psychomotor development.

Validity and reproducibility of resting metabolic rate measurements in rural Bangladeshi women: comparison of measurements obtained by Medgem™ and by Deltatrac™ device

Objective:To assess reproducibility and validity of resting metabolic rate (RMR) of Bangladeshi women as measured with the MedGem device and using the Deltatrac metabolic monitor as a reference; and (2) to evaluate the FAO/WHO/UNU basal metabolic rate (BMR)-prediction equations.Design:In each of two sessions, resting oxygen consumption was measured in triplicate by MedGem and in triplicate by Deltatrac device.Setting:Matlab area, the rural field research area of the Centre for Health and Population Research, Bangladesh (ICDDR,B).Subjects:A total of 37 nonpregnant, nonlactating women, aged 27.6±4.5 y, BMI 20.8±3.1 kg/m2 participated.Results:The difference in oxygen consumption by MedGem and Deltatrac device was significantly level dependent. Within-subject within-session variations (expressed as CV) were 9.0 and 3.0% (P<0.01) and within-subject between-session variations were 8.2 and 4.5% (P<0.01) for MedGem and Deltatrac, respectively. Mean RMR measured by Deltatrac (5.17±0.51 MJ/day) was not significantly different from the BMR predicted by the FAO/WHO/UNU equations (5.16±0.42 MJ/day) in the second session and only 0.19 MJ/day higher than predicted in the first session (P<0.05).Conclusion:Reproducibility and validity of the MedGem device was poor compared to the Deltatrac reference method. The FAO/WHO/UNU BMR-prediction equations give a good estimation of the BMR of rural, nonpregnant, nonlactating Bangladeshi women of 18–35 y.Sponsorship:Wageningen University (The Netherlands) and ICDDR,B (Bangladesh).

Energy stress during pregnancy and lactation: consequences for maternal nutrition in rural Bangladesh

Objective: To assess the relationship of energy stress during pregnancy and lactation to maternal body stores in marginally nourished rural Bangladeshi women.Subjects and methods: Two-hundred and fifty-two women were followed from 5–7 months of pregnancy until 6 months postpartum. Energy intake was estimated during pregnancy and at 1, 3 and 6 month(s) postpartum using 24 h dietary recall. Body weight was measured on enrollment, another once or twice during pregnancy, and at 1, 3 and 6 month(s) postpartum. The weekly rates of pregnancy weight gain and postpartum weight changes were determined. Weight and length of the infants were measured at birth and at approximately 1, 3 and 6 month(s).Results: Maternal energy intake at 5–7 months of gestation was 1464±416 kcal/day (mean±s.d.). Women gained a mean of 200 g/week or a total of 4 kg during the second half of pregnancy. An analysis of maternal weight showed no indication of accrual of fat stores during pregnancy. Dietary energy during lactation exceeded the intake during pregnancy by 248–354 kcal/day. Mothers lost an estimated average of 1 kg of weight during the first 6 months of lactation. The mean (±s.d.) birth weight was 2.55±0.38 kg, and the prevalence of low birth weight (<2500 g) was 48%. Infants exhibited some catch-up growth only during the first 3 months but overall growth during the first 6 months did not change from their relative status at birth when compared with NCHS reference.Conclusion: These rural Bangladeshi women failed to gain sufficient weight during the last half of pregnancy to maintain body weight during lactation when the energy demand is high. Poor growth of their primarily breastfed infants raises concern about the adequacy of lactation in this community.

Exposure and effectiveness of phytosterol/-stanol-enriched margarines.

Background:Studies on effectiveness of phytosterol/-stanol-enriched margarines in the community have received low priority. For postlaunch monitoring purposes including risk–benefit analyses, it is needed to investigate both exposure and effectiveness of these margarines.Objective:To study the use and effectiveness of phytosterol/-stanol-enriched margarine.Design, setting and subjects:The study population consisted of 2379 subjects that participated in a community intervention study (‘Hartslag Limburg’) aged 28–76 years. In 1998 and 2003, blood samples for total and high-density lipoprotein (HDL) cholesterol were obtained. A general questionnaire and food frequency questionnaire (FFQ) were administered. From 1999 onwards, phytosterol/-stanol-enriched margarines were introduced on the Dutch market. On the basis of 2003 data, subjects were classified in users of (a) phytosterol/-stanol-enriched margarine, (b) cholesterol-lowering drugs, (c) the combination (both enriched margarine and drugs) and (d) neither enriched margarines nor cholesterol-lowering drugs.Results:Mean (±s.d.) daily intake of phytosterol-enriched margarine (n=99) and phytostanol-enriched margarine (n=16) was 14±9 g. From 1998 to 2003, total serum cholesterol concentration changed significantly different among the four groups: in the combination users −2.04±1.50 mmol/l (−29%), in cholesterol-lowering drug users −1.09±1.17 mmol/l (−17%), in the enriched margarine users −0.24±0.75 mmol/l (−4%) and in non-users +0.10±0.72 mmol/l (+2%)(P<0.05).Conclusion:Recommended doses are not consumed, but phytosterol/-stanol-enriched margarines can modestly reduce serum total cholesterol in the community. These margarines cannot equal the effect of cholesterol-lowering drugs, but may act additively. Further investigation of the health effects that may occur during simultaneous cholesterol lowering drugs and phytosterol-or –stanol-enriched margarines usage is important, as well as community education about the cholesterol lowering foods and drugs.Sponsorship:Netherlands Organization for Health Research and Development (ZonMW) (data collection of Hartslag Limburg and further data- analyses).

Seasonal variation in food pattern but not in energy and nutrient intakes of rural Beninese school-aged children

BACKGROUND Inadequate energy and nutrient intakes are a major nutritional problem in developing countries. A recent study in Beninese school-aged children in different seasons revealed a high prevalence of stunting and poor iron status that might be related to the food pattern. OBJECTIVE To analyse the food pattern and resulting energy and nutrient intakes of rural Beninese school-aged children in relation to season and school attendance. SUBJECTS AND METHODS The study was performed in northern Benin in eighty randomly selected children aged 6-8 years. Dietary intake was assessed using observed weighed records. Food, energy and nutrient intakes were measured in post- and pre-harvest seasons. Complete food consumption data sets were available for seventy-five children. RESULTS Food pattern showed seasonal variations. Cereals, roots and tubers were the main staple foods. Contributions of animal products to the diet were very small. The food pattern was not different for either boys v. girls or for children attending v. not attending school. Median daily energy intakes were 5.0 and 5.3 MJ in the post- and pre-harvest season, respectively. Only fat and vitamin C showed seasonal differences (P < 0.05). Energy and nutrient intakes were different for boys and girls but, unexpectedly, not for children attending v. not attending school. CONCLUSIONS Seasonal variations in food pattern did not result in seasonality in energy and nutrient intakes. Because the childrens diet was low in animal products, protein, fat and vitamin C and high in fibre, the absorption of fat, fat-soluble vitamins, carotenoids, Fe and Zn might be low. Fe and Zn bioavailability from such a diet needs further investigation.

Short-Term Micronutrient Supplementation Reduces the Duration of Pneumonia and Diarrheal Episodes in HIV-Infected Children

The duration of pneumonia and of diarrhea is reported to be longer in HIV-infected than in uninfected children. We assessed the effect of a multi-micronutrient supplement on the duration of hospitalization in HIV-infected children. In a double-blind, randomized trial, HIV-infected children (4-24 mo) who were hospitalized with diarrhea or pneumonia were enrolled (n = 118) and given a daily dose of a multi-micronutrient supplement (containing vitamins A, B complex, C, D, E, and folic acid, as well as copper, iron, and zinc at levels based on recommended daily allowances) or a placebo until discharge from the hospital. Childrens weights and heights were measured after enrollment and micronutrient concentrations were measured before discharge. On recovery from diarrhea or pneumonia, the children were discharged and the duration of hospitalization was noted. Anthropometric indices and micronutrient concentrations did not differ between children who received supplements and those who received placebos. Overall, the duration of hospitalization was shorter (P < 0.05) among children who were receiving supplements (7.3 +/- 3.9 d) (mean +/- SD) than in children who were receiving placebos (9.0 +/- 4.9); this was independent of admission diagnosis. In children admitted with diarrhea, the duration of hospitalization was 1.6 d (19%) shorter among children receiving supplements than in those receiving placebos, and hospitalization for pneumonia was 1.9 d (20%) shorter among children receiving supplements. Short-term multi-micronutrient supplementation significantly reduced the duration of pneumonia or diarrhea in HIV-infected children who were not yet receiving antiretroviral therapy and who remained alive during hospitalization.

No substantial reduction of the thermic effect of a meal during pregnancy in well-nourished Dutch women

To investigate changes in the thermic effect of a meal (TEM) during pregnancy, metabolic rate was measured in the fasting state and during the first 180 min after consumption of a standardized test meal in twenty-seven women before, and in each trimester of pregnancy. Resting metabolic rate (RMR) showed a steady increase over pregnancy: values in weeks 24 and 35 of pregnancy were significantly higher than the prepregnancy baseline (Tukeys studentized range test). The pattern of changes of postprandial metabolic rate (PPMR) was similar to that of RMR. Consequently TEM, calculated as PPMR minus RMR, did not change over pregnancy; mean TEM values (kJ/180 min) before and in weeks 13, 24 and 35 of pregnancy were 117.3 (SD 19.4), 116.4 (SD 23.7), 111.6 (SD 24.4) and 111.5 (SD 26.7) respectively. We consider changes in TEM of less than 15% to be of little importance physiologically. If true changes in TEM over pregnancy are 15% or more we would have had a 90% chance of observing significant changes in TEM in the present study, given the number of subjects and the methods used. Therefore, we conclude that no substantial reduction in TEM occurs during pregnancy.

Consuming a diet complying with front-of-pack label criteria may reduce cholesterol levels: a modeling study.

Background/Objectives:Front-of-pack nutrition labels can help consumers to make healthier choices and stimulate healthier product development. This is the first modeling study to investigate the potential impact on cholesterol levels of consuming a diet consisting of products that comply with the criteria for a ‘healthier choice logo’.Subjects/Methods:National food consumption and food composition data were used to estimate the nutrient intake of the Dutch adult population (18–70 years) before and after replacing foods that did not comply with the Choices front-of-pack label criteria. Different scenarios were established. The difference in cholesterol levels in the Dutch population was assessed before and after replacement by means of equations from meta-analyses that calculate how blood lipids change when diet composition changes.Results:After replacing non-complying products with products, which comply with the labels criteria (maximum scenario), saturated fatty acids median intake reduced from 14.5 to 9.8 en%. Trans-fatty acids reduced from 0.95 to 0.57 en%. The average predicted changes in low-density lipoprotein and total cholesterol levels were −0.25 and −0.31 mmol/l, respectively. Because high-density lipoprotein (HDL) cholesterol levels reduced as well (−0.05 mmol/l), overall, the result was a slightly positive change in the total cholesterol/HDL ratio (−0.03).Conclusions:Our findings suggest that the consumption of foods complying with the criteria for a front-of-pack label could contribute moderately to cardiovascular risk reduction via influencing blood lipids. These findings were independent of other potential effects on related health outcomes.