Robert F. Houser

Coexistence of maternal central adiposity and child stunting in Mexico

Objective:To assess the coexistence of maternal adiposity and child stunting (CS) in Mexico, estimate its national prevalence and identify the associated socio-demographic factors.Methods:A secondary analysis from the Mexican Nutrition Survey 1999, a nationally representative survey, was conducted. Mother and children subsamples were matched and a total of 6225 mother/child pairs were obtained. Stunting was defined as height-for-age z-scores <−2.0. Maternal body mass index (BMI) was classified according to World Health Organization recommended cutoff points. Waist-to-hip ratio (WHR) was calculated by dividing waist by hip circumferences. Logistic regression models were fitted to explore the coexistence of CS and maternal central adiposity (MCA) (WHR⩾0.85) while controlling for biological and socio-demographic factors.Results:A total of 5974 pairs had complete information. MCA coexisted with CS in 6.2% of the mother/child pairs. The phenomenon was more prevalent in rural locations, in the south region and among indigenous families (14.5, 12.5 and 23.9%). After controlling for child age and maternal BMI, a 78% increase in the likelihood of CS was related to maternal WHR ⩾0.85 (odds ratio (OR)=1.78, 95% confidence interval (CI)=1.53, 2.10). After controlling for maternal height, the magnitude of the OR decreased (OR=1.33, 95%CI=1.13, 1.57), but remained significant. Therefore, it is suggested that women with a WHR ∼1 have had twice the probability of having a stunted child as those with a WHR of 0.65.Conclusion:Although MCA and CS are two conditions frequently regarded as result of opposite determinants, our observation suggests that this is not necessarily the case, particularly in populations undergoing the nutrition transition. MCA was associated not only to chronic diseases, but also to child stunting.

Obesity in HIV-Infection: Dietary Correlates

Objective: To describe the prevalence of obesity among a cohort of individuals living with HIV infection, and to determine differences in dietary intake among those subjects who are normal weight, overweight, and obese. Design: A cross-sectional study among participants enrolled in the Nutrition for Healthy Living (NFHL) study. Setting: Eligible participants included HIV-positive adults living in the greater Boston, MA and Providence, RI, areas. Subjects and Measures of Outcome: In total, 321 (265 males, 56 females) subjects were studied. Body composition measurements, demographic and health data, and fasting blood samples were analyzed. Dietary intake was assessed by three-day food records. Statistical analyses were performed using Statistical Package for Social Science (SPSS). Results: 13% of males and 29% females were found to be obese. Energy intake per kilogram decreased by body mass index (BMI) category for both men and women (p <0.05). Although not different between groups, mean total fat and saturated fat intakes were above recommendations for both men and women in all BMI categories, while total grams dietary fiber decreased as BMI increased. Individuals in all BMI groups had micronutrient intakes below the Dietary Reference Intakes. Serum markers of insulin resistance were significantly different by BMI category among men and women, as well as triglycerides and total cholesterol for the males. Conclusions: Obesity and diet in individuals living with HIV-infection needs to be addressed, as quality of dietary intake may have future implications regarding cardiovascular disease, metabolic syndrome, and other health risks associated with overweight and obesity.

Yoruba toddlers’ engagement in errands and cognitive performance on the Yoruba Mental Subscale

Responsibility training is an essential component of child-rearing practices in several African societies. To inculcate responsibility, caregivers allocate their children household duties and send them on errands; these include (but are not limited to) fetching objects and purchasing items. Such errands foster the acquisition of cognitive, social, and economic competencies. In this paper, the relationship between the types of errands engaged in by Yoruba toddlers of southwest Nigeria and cognitive performance using an adapted version of the Bayley Mental Scales of Development, referred to as the Yoruba Mental Subscale, is examined. Findings revealed that children who engaged in purchasing items and retrieving specific objects for the caregiver had a significantly higher performance on the Yoruba Mental Subscale compared to children who did not engage in such errands. With regard to performance on the Bayley Mental Scales, findings revealed no significant association with the errands examined. The implications of these findings for cross-cultural research and early childhood education are discussed.

The role of modeling processes in the "Knee Deep in the Big Muddy" phenomenon.

Abstract Entrapping conflicts are characterized by the tendency for individuals to make increasing commitments to some failing course of action, in large part to justify the appropriateness of previous investments made in that situation. It has been suggested that (1) these dilemmas frequently arise in organizational settings, and (2) whether decision makers escalate their commitment or withdraw from a failing course of action can be affected by a variety of factors. The present four experiments were designed to determine if an individuals degree of entrapment (i.e., tendency to escalate) may be affected by the behavior of a model in a similar situation. In Experiments 1–3, considerable generality was obtained for the proposition that decision makers in entrapping conflicts can be directly influenced by a model. Individuals who witnessed an entrapped model became significantly more entrapped than those who did not. This effect was obtained (1) for subjects and models of both sexes, (2) on measures of both process and outcome, (3) across two different experimental procedures, and (4) when the model was viewed either during or before the time that subjects were called upon to make their decisions. Experiments 3 and 4 delineated several limiting conditions of the modeling-entrapment relationship. Participants did not invest more of their resources in the presence than in the absence of an entrapped model if the model expressed regret rather than pleasure about his behavior. In fact, under such conditions a significant “reverse modeling” effect was obtained, in which subjects became less entrapped in the presence of the entrapped model. The modeling-entrapment relationship was also significantly reduced when the model was unlikable and unintelligent, and thus not an appropriate person for comparison. Theoretical and practical implications are discussed, including the possibility that models may be skillfully employed to help decision makers stop “throwing good money after bad.”

Community-Level Micronutrient Fortification of School Lunch Meals Improved Vitamin A, Folate, and Iron Status of Schoolchildren in Himalayan Villages of India

Anemia and micronutrient deficiencies are common among Indian schoolchildren. We assessed the effectiveness of micronutrient fortification of meals cooked and fortified at school on anemia and micronutrient status of schoolchildren in Himalayan villages of India. In this placebo-controlled, cluster-randomized study, 499 schoolchildren (6-10 y) received either multiple micronutrients (treatment group) or placebo (control group) as part of school meals (6 d/wk) for 8 mo. Both groups were dewormed at the beginning of the study. The micronutrient premix provided 10 mg iron, 375 microg vitamin A, 4.2 mg zinc, 225 microg folic acid, and 1.35 microg vitamin B-12 for each child per day (approximately 75% recommended dietary allowance). Blood samples drawn before and after the intervention were analyzed for hemoglobin, ferritin, retinol, zinc, folate, and vitamin B-12. Baseline prevalence of anemia (37%), iron deficiency anemia (10%), low serum ferritin (24%), retinol (56%), zinc (74%), folate (68%), and vitamin B-12 (17%) did not differ between groups. Postintervention, fewer in the treatment group had lower serum retinol [odds ratio (OR) (95% CI): 0.57 (0.33-0.97)] and folate [OR (95% CI): 0.47 (0.26-0.84)] than the control group. The serum vitamin B-12 concentration decreased in both groups, but the magnitude of change was less in the treatment than in the control group (P < 0.05). Total body iron (TBI) increased in both groups; however, the change was greater in the treatment than in the control group (P < 0.05). Micronutrient fortification of school meals by trained school personnel was effective in improving vitamin A, folate, and TBI status while also reducing the magnitude of a decrease in vitamin B-12 status.

Dietary Supplement Use Pattern of U.S. Adult Population in the 2007–2008 National Health and Nutrition Examination Survey (NHANES)

Data from the 2007–2008 National Health and Nutrition Examination Survey (NHANES) suggested that nearly half of U.S. adults aged 20 to 69 reported taking at least one dietary supplement in the past month. Logistic regression showed that the following factors were independently associated with a greater likelihood of supplement use: being female, older, white, having higher level of education, non-SNAP participation, and living in a food-secure household. To compare nutrient intakes between supplement users and non-supplement users, daily intakes of eight nutrients were examined. When considering nutrients from food, supplement users tended to consume greater amounts of vitamin A, vitamin C, vitamin E, folic acid, calcium, and iron; meanwhile there was no association between supplement use and daily intakes of vitamin B12 and zinc from food sources only. Including nutrients from daily supplement use, supplement users consumed greater amounts of all eight nutrients.

Socioeconomic disparities and the familial coexistence of child stunting and maternal overweight in Guatemala.

The double burden of malnutrition, defined here as households with a stunted child and an overweight mother (SCOM), is a growing problem in Guatemala. We explored the magnitude of SCOM and the identification of socio-economic factors associated with this malnutrition duality. From the 2000 Living Standards Measurement Study from Guatemala, we obtained a sample of 2492 households with pairs of children 6-60 months and their mothers (18-49 years) and estimated the prevalence of SCOM. Economic characteristics of this sample were assessed with the Concentration Index (CI). Results revealed higher prevalence of child stunting, but a lower prevalence of maternal overweight among the poor compared to the rich households. Economic inequality in child stunting was greater than economic inequality in maternal overweight (CI=-0.22 vs. +0.14). SCOM pairs were more prevalent among the poor and middle SES groups as compared to the rich households. A multivariate logistic regression model showed that SCOM was more likely to occur in households from the middle consumption quintile than in those from the first quintile (odds ratio=1.7). The findings reported here add new insights into the complex phenomenon observed in households with both extremes of the malnutrition continuum, and support the need for the identification of economic, social and biological interventions aimed at, on the one hand, the prevention of this duality of the malnutrition in those households where it is still non-existent, and on the other hand, to deter or correct the economic, social and biological environments where those mother-child dyads are already affected by such phenomena.

Nutritional status of primary schoolchildren in Garhwali Himalayan villages of India.

Background Anemia and micronutrient deficiencies are common among Indian schoolchildren. However, past studies have narrowly focused on only a few micronutrients and have not carefully evaluated the association between sociodemographic factors and nutritional status of schoolchildren. Objective To assess the nutritional status of schioolchildren in Himalayan villages of India and to determine the relationships between their nutritional status, intestinal helminth infection, and sociodemographic characteristics. Methods A random sample of 499 children 6 to 10 years of age from 20 public primary schools was selected. Household sociodemographic data and morbidity data on children were collected through interviews with their caretakers. Height and weight were measured, and venous blood was drawn for assessment of hemoglobin, serum ferritin, soluble transferrin receptor, retinol, zinc, folic acid, vitamin B12, and C-reactive protein. Stool samples were analyzed for parasitic infections. Results Underweight, stunting, and wasting were present in 60.9%, 56.1%, and 12.2% of schoolchildren, respectively. Anemia, iron-deficiency anemia, and low serum concentrations of ferritin, zinc, retinol, folate, and vitamin B12 were found in 36.7%, 10.2%, 24.1%, 57.1%, 56.1%, 67.9%, and 17.4% of the children, respectively. One-fifth of the children had intestinal parasites. Being underweight was associated with lower household wealth (p < .05). Helminth infection was associated with stunting, anemia, and low serum retinol (p < .05). Living at higher altitude was associated with low serum levels of ferritin, retinol, and vitamin B12. There were no associations between any sociodemographic variables and serum zinc or folate. Conclusions Growth impairment and micronutrient deficiencies are prevalent among schoolchildren in Himalayan villages of India.

Daily Use of Sprinkles Micronutrient Powder for 2 Months Reduces Anemia among Children 6 to 36 Months of Age in the Kyrgyz Republic: A Cluster-Randomized Trial

Background Iron-deficiency anemia is widespread among young children in the Kyrgyz Republic, and there is an urgent need to identify an effective intervention to address this significant public health problem. Objective To test the effectiveness of a 2-month intervention with daily home fortification of complementary food using micronutrient powder (Sprinkles) in reducing anemia among children 6 to 36 months of age in the Kyrgyz Republic. Methods In this cluster-randomized, community-based effectiveness trial conducted in three regions of the Kyrgyz Republic, 24 clusters of children aged 6 to 36 months were randomly assigned to two groups. The intervention group (12 clusters, n = 1,103) received 60 sachets of micronutrient powder (12.5 mg elemental iron), which were taken as one sachet daily for 2 months. The control group (12 clusters, n = 1,090) did not receive micronutrient powder until after the study period. Blood hemoglobin concentration was assessed at the start and end of the intervention. Results From baseline to follow-up, the mean hemoglobin concentration in the intervention group increased by 7 g/L, whereas it decreased by 2 g/L in the control group (p < .001). The prevalence of anemia (hemoglobin < 110 g/L) in the intervention group decreased from 72% at baseline to 52% at follow-up, whereas it increased from 72% to 75% in the control group (p < .001). Compliance with the intervention was high, with children consuming on average 45 of the 60 sachets given. Conclusions A course of 60 Sprinkles micronutrient powder sachets taken daily for 2 months is effective in improving hemoglobin levels and reducing the prevalence of anemia among young children in the Kyrgyz Republic.

“He said, she said”: who should speak for households about experiences of food insecurity in Bangladesh?

This paper examines the extent to which males and females from the same household respond differently to household food insecurity questions, and explores the reasons for these differences and the impact for measurement. The data derive from the 2001–2003 Bangladesh Food Insecurity Measurement and Validation Study. Male and female enumerators administered the food insecurity questionnaire to women and men in the same household during three survey rounds and debriefed a subsample of men and women regarding their response discrepancies. The rate of discordance in male-female responses to individual items was examined using contingency tables. Potential explanations for the discordance were informed by the joint respondent debriefing. These hypotheses were assessed through an examination of response patterns. To assess the impact of discordance on measurement, female and male responses to a scale of 13 food insecurity items were compared and the degree of differential classification was assessed. On average the rate of discordance was 15%, but it ranged for particular items from less than 1% to upwards of 53%. Item content interacted with gender to produce discordance; women and men seemed to respond differently due to separate spheres of responsibility within the same household, power imbalances influencing intra-household food allocation, and because men seemed to take more psychological responsibility for ensuring the household food supply. Nearly one-third of households were classified in a different food security category using female versus male responses to the items. The results suggest that the household food insecurity construct is not as useful in places like Bangladesh where certain food insecurity-related manifestations are not collectively or similarly shared by members of the same living space. Individual-level measures of food insecurity are needed to complement household data, along with surveys that allow for proportionate representation of potentially vulnerable individuals with different demographic characteristics across the population.