Saskia J. M. Osendarp

Sharply higher rates of iron deficiency in obese Mexican women and children are predicted by obesity-related inflammation rather than by differences in dietary iron intake

BACKGROUNDnObese individuals may be at increased risk of iron deficiency (ID), but it is unclear whether this is due to poor dietary iron intakes or to adiposity-related inflammation.nnnOBJECTIVEnThe aim of this study was to examine the relations between body mass index (BMI), dietary iron, and dietary factors affecting iron bioavailability, iron status, and inflammation [C-reactive protein (CRP)] in a transition country where obesity and ID are common.nnnDESIGNnData from the 1999 Mexican Nutrition Survey, which included 1174 children (aged 5-12 y) and 621 nonpregnant women (aged 18-50 y), were analyzed.nnnRESULTSnThe prevalence of obesity was 25.3% in women and 3.5% in children. The prevalence of ID was significantly (P < 0.05) higher in obese women and children compared with normal-weight subjects [odds ratios (95% CIs): 1.92 (1.23, 3.01) and 3.96 (1.34, 11.67) for women and children, respectively]. Despite similar dietary iron intakes in the 2 groups, serum iron concentrations were lower in obese women than in normal-weight women (62.6 ± 29.5 compared with 72.4 ± 34.6 μg/dL; P = 0.014), and total-iron-binding capacity was higher in obese children than in normal-weight children (399 ± 51 compared with 360 ± 48 μg/dL; P < 0.001). CRP concentrations in obese women and children were 4 times those of their normal-weight counterparts (P < 0.05). CRP but not iron intake was a strong negative predictor of iron status, independently of BMI (P < 0.05).nnnCONCLUSIONSnThe risk of ID in obese Mexican women and children was 2-4 times that of normal-weight individuals at similar dietary iron intakes. This increased risk of ID may be due to the effects of obesity-related inflammation on dietary iron absorption. Thus, ID control efforts in Mexico may be hampered by increasing rates of adiposity in women and children.

Essential fats: how do they affect growth and development of infants and young children in developing countries? A literature review.

Omega-3 and omega-6 fatty acids, particularly docosahexaenoic acid (DHA), are known to play an essential role in the development of the brain and retina. Intakes in pregnancy and early life affect growth and cognitive performance later in childhood. However, total fat intake, alpha-linolenic acid (ALA) and DHA intakes are often low among pregnant and lactating women, infants and young children in developing countries. As breast milk is one of the best sources of ALA and DHA, breastfed infants are less likely to be at risk of insufficient intakes than those not breastfed. Enhancing intake of ALA through plant food products (soy beans and oil, canola oil, and foods containing these products such as lipid-based nutrient supplements) has been shown to be feasible. However, because of the low conversion rates of ALA to DHA, it may be more efficient to increase DHA status through increasing fish consumption or DHA fortification, but these approaches may be more costly. In addition, breastfeeding up to 2 years and beyond is recommended to ensure an adequate essential fat intake in early life. Data from developing countries have shown that a higher omega-3 fatty acid intake or supplementation during pregnancy may result in small improvements in birthweight, length and gestational age based on two randomized controlled trials and one cross-sectional study. More rigorous randomized controlled trials are needed to confirm this effect. Limited data from developing countries suggest that ALA or DHA supplementation during lactation and in infants may be beneficial for growth and development of young children 6-24 months of age in these settings. These benefits are more pronounced in undernourished children. However, there is no evidence for improvements in growth following omega-3 fatty acid supplementation in children >2 years of age.

Current information and Asian perspectives on long-chain polyunsaturated fatty acids in pregnancy, lactation, and infancy: systematic review and practice recommendations from an early nutrition academy workshop

The Early Nutrition Academy supported a systematic review of human studies on the roles of pre- and postnatal long-chain polyunsaturated fatty acids (LC-PUFA) published from 2008 to 2013 and an expert workshop that reviewed the information and developed recommendations, considering particularly Asian populations. An increased supply of n-3 LC-PUFA during pregnancy reduces the risk of preterm birth before 34 weeks of gestation. Pregnant women should achieve an additional supply ≥200 mg docosahexaenic acid (DHA)/day, usually achieving a total intake ≥300 mg DHA/day. Higher intakes (600-800 mg DHA/day) may provide greater protection against early preterm birth. Some studies indicate beneficial effects of pre- and postnatal DHA supply on child neurodevelopment and allergy risk. Breast-feeding is the best choice for infants. Breast-feeding women should get ≥200 mg DHA/day to achieve a human milk DHA content of ∼0.3% fatty acids. Infant formula for term infants should contain DHA and arachidonic acid (AA) to provide 100 mg DHA/day and 140 mg AA/day. A supply of 100 mg DHA/day should continue during the second half of infancy. We do not provide quantitative advice on AA levels in follow-on formula fed after the introduction of complimentary feeding due to a lack of sufficient data and considerable variation in the AA amounts provided by complimentary foods. Reasonable intakes for very-low-birth weight infants are 18-60 mg/kg/day DHA and 18-45 mg/kg/day AA, while higher intakes (55-60 mg/kg/day DHA, ∼1% fatty acids; 35-45 mg/kg/day AA, ∼0.6-0.75%) appear preferable. Research on the requirements and effects of LC-PUFA during pregnancy, lactation, and early childhood should continue.

Essential fats for future health. Proceedings of the 9 th Unilever Nutrition Symposium, 26-27 May 2010

The 9th Unilever Nutrition Symposium entitled ‘Essential fats for future health’, held on 26–27 May 2010, aimed to review the dietary recommendations for essential fatty acids (EFA); discuss the scientific evidence for the roles of EFA in cognition, immune function and cardiovascular health; and to identify opportunities for joint efforts by industry, academia, governmental and non-governmental organizations to effectively improve health behaviour. This paper summarizes the main conclusions of the presentations given at the symposium. Linoleic acid (LA) and α-linolenic acid (ALA) are EFA that cannot by synthesized by the human body. Docosahexaenoic acid (DHA) is considered as conditionally essential because of its limited formation from ALA in the human body and its critical role in early normal retinal and brain development and, jointly with eicosapentaenoic acid (EPA), in prevention of cardiovascular disease (CVD). Some evidence for possible beneficial roles of n-3 fatty acids for immune function and adult cognitive function is emerging. A higher consumption of polyunsaturated fatty acids (PUFA; >10%E), including LA, ALA and at least 250–500u2009mg per day of EPA+DHA, is recommended for prevention of coronary heart disease (CHD). Two dietary interventions suggest that EFA may affect CVD risk factors in children similarly as in adults. To ensure an adequate EFA intake of the population, including children, public health authorities should develop clear messages based on current science; ensure availability of healthy, palatable foods; and collaborate with scientists, the food industry, schools, hospitals, health-care providers and communities to encourage consumers to make healthy choices.

Dietary intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in children - a workshop report.

There is controversy whether children should have a dietary supply of preformed long-chain polyunsaturated n-3 fatty acids EPA and DHA. The aims of the workshop were to review evidence for a possible benefit of a preformed EPA and/or DHA supply, of data required to set desirable intakes for children aged 2-12 years, and of research priorities. The authors concluded that EPA and DHA intakes per kg body weight may often be low in 2- to 12-year-old children, relative to intakes per kg body weight of breast-fed infants and adult intakes, but reliable data are scarce. Little information is available that increasing dietary intakes of EPA or DHA in children has benefits to physical or mental function or other health endpoints. Studies addressing EPA and DHA intakes and tissue status among groups of children with different dietary habits, and measures of relevant development and health endpoints, are needed for developing potential advice on desirable intakes of EPA and/or DHA in children. At this time it appears prudent to advise that dietary intakes in childhood are consistent with future eating patterns supporting adult health, such as prevention of metabolic disorders and CVD, supporting immune function, and reproductive health. In conclusion, the available information relating dietary EPA and DHA intakes in children aged 2-12 years to growth, development and health is insufficient to derive dietary intake recommendations for EPA and DHA. Adequately designed studies addressing dietary intakes, measures of status and relevant functional or health effects across this age group are needed.

Case study on iron in mental development - in memory of John Beard (1947-2009)

Iron deficiency (ID) anemia is associated with poor neurocognitive development in infants and children. Depending on the stage of development at the time of deficiency, these adverse effects may be reversible. Recent investigations using sensitive measurements have confirmed that the deposition of iron in the brain varies according to brain region and age, and that dopamine-dependent behaviors are among the core deficits in ID. Dr John Beard (1947-2009) has been one of the leading scientists and pioneers in the area of iron and child development. His legacy to this area of science will grow through the continuation of his work by his co-workers and colleagues.

Dietary and nutritional change in India: implications for strategies, policies, and interventions

Despite the global transition to overnutrition, stunting affected approximately 159 million children worldwide in 2014, while an estimated 50 million children were wasted. India is an important front in the fight against malnutrition and is grappling with the coexistence of undernutrition, overnutrition, and micronutrient deficiencies. This report summarizes discussions on trends in malnutrition in India, its evolution in the context of economic growth, intrahousehold aspects, infant and young child feeding practices, womens status, maternal nutrition, and nutrition policymaking. The discussion focuses on a review of trends in malnutrition and dietary intakes in India in the context of economic change over the past four decades, identification of household dynamics affecting food choices and their consequences for family nutritional status in India, and effective malnutrition prevention and treatment interventions and programs in India and associated policy challenges.

Socio‐cultural and economic determinants and consequences of adolescent undernutrition and micronutrient deficiencies in LLMICs: a systematic narrative review

Adolescent undernutrition is a persisting public health problem in low and lower middle income countries (LLMICs). Nutritional trajectories are complexly interrelated with socio‐cultural and economic (SCE) trajectories. However, a synthesis of the SCE determinants or consequences of undernutrition in adolescents is lacking. We undertook a narrative review of published literature to provide a narrative overview of the SCE determinants and consequences associated with undernutrition among adolescents in LLMICs. We identified 98 articles from PubMed, SCOPUS, and CAB‐Abstracts on determinants and consequences of undernutrition as defined by stunting, underweight, thinness, and micronutrient deficiencies. At the individual level, significant determinants included age, sex, birth order, religion, ethnicity, educational and literacy level, working status, and marital status. At the household level, parental education and occupation, household size and composition, income, socioeconomic status, and resources were associated with undernutrition. Only a few determinants at the community/environmental level, including residence, sanitation, school type, and seasonality, were identified. The consequences of adolescent undernutrition were mostly related to education and cognition. This review underscores the importance of the broad range of context‐specific SCE factors at several levels that influence adolescent nutritional status and shows that further research on SCE consequences of undernutrition is needed.

Effectiveness of a Program Intervention with Reduced-Iron Multiple Micronutrient Powders on Iron Status, Morbidity and Growth in Young Children in Ethiopia

Despite the potential for improving iron status and child growth in low- and middle-income settings, concerns on the safety of high iron dosages of Micronutrient Powders (MNP currently limit their applicability in programs. We examined the effectiveness and risks of an integrated complementary feeding program with low iron dose (6 mg/serving) MNP among 6–23-month-old Ethiopian children using a quasi-experimental study design comparing children from five intervention districts (n = 1172) to those from four matched non-intervention districts (n = 1137). Haemoglobin concentrations increased in intervention and decreased in non-intervention children (group-difference +3.17 g/L), but without improvement in iron stores. Intervention children were 2.31 times more likely to have diarrhoea and 2.08 times more likely to have common cold and flu, but these differences decreased towards the end of the intervention. At end line, intervention children had higher mean Height-for-Age Zscore (HAZ) and a 51% reduced odds of being stunted compared to non-intervention children. MNP with low iron dose, when provided combined with other Infant and Young Child Feeding (IYCF) interventions, marginally improved haemoglobin status and resulted in a remarkable improvement in linear growth in 6–23-month-old children. These benefits likely outweigh the relatively small increase in the risk of diarrhoea.

Agro-ecological zone and farm diversity are factors associated with haemoglobin and anaemia among rural school-aged children and adolescents in Ghana

Abstract Understanding contextual risk factors for haemoglobin (Hb) status and anaemia of rural school‐aged children (SAC) and adolescents is critical in developing appropriate interventions to prevent anaemia. We analysed secondary data from the baseline of an impact evaluation of the Ghana School Feeding Programme to determine the severity of anaemia and contextual factors associated with anaemia and Hb status among rural SAC (6–9 years; n = 323) and adolescents (10–17 years; n = 319) in Ghana. We used regression models with variable selection based on backward elimination in our analyses. The mean Hb was 113.8 ± 13.1 g/L, and the overall prevalence of anaemia was 52.3%, being 55.1% and 49.5% among SAC and adolescents, respectively. We identified childs age (β = 2.21, P < 0.001); farm diversity score (β = 0.59, P = 0.036); and agro‐ecological zone (P trend <0.001) as the main predictors of Hb of SAC. Household asset index (P trend = 0.042) and agro‐ecological zone (P trend <0.001) were predictors of Hb in adolescents. Agro‐ecological zone and age were predictors of anaemia, but the effect of age was only significant for girls and not boys (prevalence odds ratio [POR] = 1.35, 95% CI [1.04, 1.76] vs. POR = 1.14, 95% CI [0.88, 1.46]). SAC in households with maize stock were less likely to be anaemic (POR = 0.55, 95% CI [0.32, 0.97]). Household dietary diversity score (β = 0.59, P = 0.033) was associated with Hb status for the full sample only. Anaemia is a severe public health problem among SAC and adolescents in rural Ghana irrespective of sex. Farm diversity score, availability of maize stock in the household, household asset index, and agro‐ecological zone were the main predictors of Hb and anaemia among the rural SAC and adolescents.