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Start Over Author "Hess, Sonja Y." Journal american journal of clinical nutrition
16 results on '"Hess, Sonja Y."'

1. Increasing the availability and utilization of reliable data on population micronutrient (MN) status globally: the MN Data Generation Initiative

Author

Brown, Kenneth H, Moore, Sophie E, Hess, Sonja Y, McDonald, Christine M, Jones, Kerry S, Meadows, Sarah R, Manger, Mari S, Coates, Jennifer, Alayon, Silvia, and Osendarp, Saskia JM

Subjects
Biomedical and Clinical Sciences, Nutrition and Dietetics, Clinical Sciences, Pediatric, Clinical Research, Prevention, Health Services, Generic health relevance, Good Health and Well Being, Databases, Factual, Global Health, Humans, Micronutrients, Nutritional Status, Population Surveillance, vitamin deficiency, mineral deficiency, nutrition biomarkers, nutritional status assessment, nutrition surveys, laboratory quality assurance, Engineering, Medical and Health Sciences, Nutrition & Dietetics, Clinical sciences, Nutrition and dietetics
Abstract

Micronutrient (MN) deficiencies can produce a broad array of adverse health and functional outcomes. Young, preschool children and women of reproductive age in low- and middle-income countries are most affected by these deficiencies, but the true magnitude of the problems and their related disease burdens remain uncertain because of the dearth of reliable biomarker information on population MN status. The reasons for this lack of information include a limited understanding by policy makers of the importance of MNs for human health and the usefulness of information on MN status for program planning and management; insufficient professional capacity to advocate for this information and design and implement related MN status surveys; high costs and logistical constraints involved in specimen collection, transport, storage, and laboratory analyses; poor access to adequately equipped and staffed laboratories to complete the analyses reliably; and inadequate capacity to interpret and apply this information for public health program design and evaluation. This report describes the current situation with regard to data availability, the reasons for the lack of relevant information, and the steps needed to correct this situation, including implementation of a multi-component MN Data Generation Initiative to advocate for critical data collection and provide related technical assistance, laboratory services, professional training, and financial support.

Published
2021

2. Adjusting plasma or serum zinc concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project

Author

McDonald, Christine M, Suchdev, Parminder S, Krebs, Nancy F, Hess, Sonja Y, Wessells, K Ryan, Ismaily, Sanober, Rahman, Sabuktagin, Wieringa, Frank T, Williams, Anne M, Brown, Kenneth H, and King, Janet C

Subjects
Nutrition, Adolescent, Adult, Anemia, Biomarkers, C-Reactive Protein, Child, Child, Preschool, Cross-Sectional Studies, Female, Humans, Infant, Male, Middle Aged, Nutritional Status, Orosomucoid, Young Adult, Zinc, zinc, inflammation, micronutrients, nutritional assessment, undernutrition, Engineering, Medical and Health Sciences, Nutrition & Dietetics
Abstract

BackgroundThe accurate estimation of zinc deficiency at the population level is important, as it guides the design, targeting, and evaluation of nutrition interventions. Plasma or serum zinc concentration (PZC) is recommended to estimate zinc nutritional status; however, concentrations may decrease in the presence of inflammation.ObjectivesWe aimed to assess the relation between PZC and inflammation in preschool children (PSC; 6-59 mo) and nonpregnant women of reproductive age (WRA; 15-49 y), and to compare different inflammation adjustment approaches, if adjustment is warranted.MethodsCross-sectional data from 13 nationally representative surveys (18,859 PSC, 22,695 WRA) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project were analyzed. Correlation and decile analyses were conducted, and the following 3 adjustment methods were compared if a consistent negative association between PZC and C-reactive protein (CRP) or α-1-acid glycoprotein (AGP) was observed: 1) exclude individuals with CRP > 5 mg/L or AGP > 1 g/L; 2) apply arithmetic correction factors; and 3) use the BRINDA regression correction (RC) approach.ResultsIn 6 of 12 PSC surveys, the estimated prevalence of zinc deficiency increased with increasing CRP deciles, and to a lesser extent, with increasing AGP deciles. In WRA, the association of PZC with CRP and AGP was weak and inconsistent. In the 6 PSC surveys in which adjustment methods were compared, application of RC reduced the estimated prevalence of zinc deficiency by a median of 11 (range: 4-18) percentage points, compared with the unadjusted prevalence.ConclusionsRelations between PZC and inflammatory markers were inconsistent, suggesting that correlation and decile analyses should be conducted before applying any inflammation adjustments. In populations of PSC that exhibit a significant negative association between PZC and CRP or AGP, application of the RC approach is supported. At this time, there is insufficient evidence to warrant inflammation adjustment in WRA.

Published
2020

3. Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials.

Author

Dewey, Kathryn G, Arnold, Charles D, Wessells, K Ryan, Prado, Elizabeth L, Abbeddou, Souheila, Adu-Afarwuah, Seth, Ali, Hasmot, Arnold, Benjamin F, Ashorn, Per, Ashorn, Ulla, Ashraf, Sania, Becquey, Elodie, Brown, Kenneth H, Christian, Parul, Colford, John M, Dulience, Sherlie J L, Fernald, Lia C H, Galasso, Emanuela, Hallamaa, Lotta, and Hess, Sonja Y

Subjects
META-analysis, CONFIDENCE intervals, SYSTEMATIC reviews, DIETARY supplements, WASTING syndrome, QUALITY assurance, MALNUTRITION, DESCRIPTIVE statistics, GROWTH disorders, LIPIDS, CHILDREN
Abstract

Background Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting. Objectives We aimed to identify the effect of SQ-LNSs on prevalence of severe wasting (weight-for-length z score < −3) and severe stunting (length-for-age z score < −3). Methods We conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6–24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons. Results SQ-LNS provision led to a relative reduction of 31% in severe wasting [prevalence ratio (PR): 0.69; 95% CI: 0.55, 0.86; n  = 34,373] and 17% in severe stunting (PR: 0.83; 95% CI: 0.78, 0.90; n  = 36,795) at endline. Results were similar in most of the sensitivity analyses but somewhat attenuated when comparisons using passive control arms were excluded (PR: 0.74; 95% CI: 0.57, 0.96; n  = 26,327 for severe wasting and PR: 0.88; 95% CI: 0.81, 0.95; n  = 28,742 for severe stunting). Study-level characteristics generally did not significantly modify the effects of SQ-LNSs, but results suggested greater effects of SQ-LNSs in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation. Conclusions Including SQ-LNSs in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting. This meta-analysis was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592. [ABSTRACT FROM AUTHOR]

Published
2022
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4. Child malnutrition and mortality among families not utilizing adequately iodized salt in Indonesia

Author

Semba, Richard D., de Pee, Saskia, Hess, Sonja Y., Sun, Kai, Sari, Mayang, and Bloem, Martin W.

Subjects
Children -- Health aspects, Iodine deficiency diseases -- Care and treatment, Iodine deficiency diseases -- Prevention, Iodine deficiency diseases -- Research, Iodized salt -- Health aspects, Iodized salt -- Research, Food/cooking/nutrition, Health
Abstract

Background: Salt iodization is the main strategy for reducing iodine deficiency disorders worldwide. Characteristics of families not using iodized salt need to be known to expand coverage. Objective: The objective was to determine whether families who do not use iodized salt have a higher prevalence of child malnutrition and mortality and to identify factors associated with not using iodized salt. Design: Use of adequately iodized salt ([greater than or equal to] 30 ppm), measured by rapid test kits, was assessed between January 1999 and September 2003 in 145 522 and 445 546 families in urban slums and rural areas, respectively, in Indonesia. Results: Adequately iodized salt was used by 66.6% and 67.2% of families from urban slums and rural areas, respectively. Among families who used adequately iodized salt, mortality in neonates, infants, and children aged Conclusion: In Indonesia, nonuse of adequately iodized salt is associated with a higher prevalence of child malnutrition and mortality in neonates, infants, and children aged KEY WORDS Children, iodized salt, mortality, Indonesia

Published
2008

5. Comparison of the efficacy of wheat-based snacks fortified with ferrous sulfate, electrolytic iron, or hydrogen-reduced elemental iron: randomized, double-blind, controlled trial in Thai women

Author

Zimmermann, Michael B., Winichagoon, Pattanee, Gowachirapant, Sueppong, Hess, Sonja Y., Harrington, Mary, Chavasit, Visith, Lynch, Sean R., and Hurrell, Richard F.

Subjects
Elemental diet -- Nutritional aspects, Elemental diet -- Health aspects, Iron in the body -- Health aspects, Women -- Health aspects, Women -- Research, Food/cooking/nutrition, Health
Abstract

Background: Although elemental iron powders are widely used to fortify cereal products, little data exist on their efficacy in humans. Objective: We compared the efficacy of wheat-based snacks fortified with ferrous sulfate, electrolytic iron, or hydrogen-reduced iron in Thai women with low iron stores. Design: A double-blind intervention was conducted in 18-50-y-old women (n = 330) randomly assigned into 4 groups to receive either no fortification iron or 12 mg Fe/d for 6 d/wk for 35 wk as ferrous sulfate, electrolytic iron, or hydrogen-reduced iron in a baked, wheat-flour--based snack. Snacks were not consumed with meals, and consumption was monitored. At baseline, 20 wk, and 35 wk, hemoglobin status and iron were measured and the groups were compared. Results: Between baseline and 35 wk, geometric mean serum ferritin (SF) increased significantly in all 3 groups receiving iron (P < 0.01), and geometric mean serum transferrin receptor (TfR) decreased significantly in the groups receiving ferrous sulfate and electrolytic iron (P < 0.05). Calculated mean ([+ or -]SD) body iron stores increased from 1.5 [+ or -]2.8 to 5.4 [+ or -] 2.9 mg/kg in the ferrous sulfate group, from 1.5 [+ or -] 3.5 to 4.4 [+ or -] 3.6 mg/kg in the electrolytic iron group, and from 1.3 [+ or -]3.2 to 3.2 [+ or -]4.3 mg/kg in the hydrogen-reduced iron group (P < 0.01 for all 3 groups) but did not change significantly in the control group. Conclusions: Ferrous sulfate, electrolytic iron, and hydrogenreduced iron, fortified into wheat-based snacks, significantly improved iron status. On the basis of the change in body iron stores during the 35-wk study, the relative efficacy of the electrolytic and hydrogen-reduced iron compared with ferrous sulfate was 77% and 49%, respectively. KEY WORDS: Elemental iron, electrolytic iron, hydrogenreduced iron, iron fortification, Thailand

Published
2005

6. High thyroid volume in children with excess dietary iodine intakes

Author

Zimmermann, Michael B., Ito, Yoshiya, Hess, Sonja Y., Fujieda, Kenji, and Molinari, Luciano

Subjects
Thyroid diseases -- Risk factors, Iodine in the body -- Health aspects, Food/cooking/nutrition, Health
Abstract

Background: There are few data on the adverse effects of chronic exposure to high iodine intakes, particularly in children. Objective: The objective of the study was to ascertain whether high dietary intakes of iodine in children result in high thyroid volume (Tvol), a high risk of goiter, or both. Design: In an international sample of 6-12-y-old children (n = 3319) from 5 continents with iodine intakes ranging from adequate to excessive, Tvol was measured by ultrasound, and the urinary iodine (UI) concentration was measured. Regressions were done on Tvol and goiter including age, body surface area, sex, and UI concentration as covariates. Results: The median UI concentration ranged from 115 [micro] g/L in central Switzerland to 728 [micro]g/L in coastal Hokkaido, Japan. In the entire sample, 31% of children had UT concentrations >300 [micro]g/L, and 11% had UI concentrations >500 [micro]g/L; in coastal Hokkaido, 59% had UI concentrations >500 [micro]g/L, and 39% had UI concentrations > 1000 [micro]g/L. In coastal Hokkaido, the mean age- and body surface area-adjusted Tvol was [approximately equal to] 2-fold the mean Tvol from the other sites combined (P < 0.0001), and there was a positive correlation between log(UI concentration) and log(Tvol) (r = 0.24, P < 0.0001). In the combined sample, after adjustment for age, sex, and body surface area, log(Tvol) began to rise at a log(UI concentration) >2.7. which, when transformed back to the linear scale, corresponded to a UI concentration of [approximately equal to] 500 [micro]g/L. Conclusions: Chronic iodine intakes approximately twice those recommended--indicated by UI concentrations in the range of 300-500 [micro]g/L--do not increase Tvol in children. However, UI concentrations [greater than or equal to] 500 [micro]g/L are associated with increasing Tvol, which reflects the adverse effects of chronic iodine excess. KEY WORDS Thyroid volume, goiter, children, urinary iodine, excess iodine

Published
2005

7. Serum transferrin receptor and zinc protoporphyrin as indicators of iron status in African children

Author

Zimmermann, Michael B., Molinari, Luciano, Staubli-Asobayire, Franziska, Hess, Sonja Y., Chaouki, Noureddine, Adou, Pierre, and Hurrell, Richard F.

Subjects
Africa -- Health aspects, Iron deficiency anemia -- Research, Iron deficiency anemia -- Diagnosis, Teenagers, Youth, Transferrin, Children, Food/cooking/nutrition, Health
Abstract

Background: Although transferrin receptor (TfR) and zinc proto-porphyrin (ZnPP) are often used to define iron status in school-age children in developing countries, the diagnostic cutoffs for this age group are uncertain. Objective: The objective was to determine the sensitivity and specificity of TfR and ZnPP in predicting iron deficiency in black and white children in Africa. Design: Hemoglobin, C-reactive protein (CRP), serum ferritin (SF), TfR, and ZnPP were measured in children in Cote d'Ivoire and Morocco. We excluded children with elevated CRP and then used receiver operating characteristic (ROC) curves to evaluate TfR and ZnPP alone and in combination in screening for iron deficiency, defined as an SF concentration < 15 [micro]g/L, and iron deficiency anemia (IDA), defined as an SF concentration Results: The sample included 2814 children aged 5-15 y. The sensitivity and specificity of TfR and ZnPP were limited by considerable overlap between iron-sufficient, nonanemic children and those with IDA. On the basis of ROC curves, we identified diagnostic cutoffs for TfR and ZnPP that achieved specificities and sensitivities of [approximately equal to] 60-80%. Separate cutoffs for Cote d'Ivoire and Morocco gave the best performance; the cutoffs for both TfR and ZnPP were higher in Cote d'Ivoire. Moreover, a comparison of nonanemic, iron-sufficient subjects showed that Ivorian children had significantly higher TfR and ZnPP concentrations than did Moroccan children (P < 0.01). Conclusions: New diagnostic cutoffs for TfR and ZnPP. based on ROC curve analyses, may improve the performance of these indexes in defining iron status in children. Significant ethnic differences in TfR and ZnPP suggest that separate cutoffs may be needed for black and white children. KEY WORDS Iron, iron deficiency, hemoglobin, zinc proto-porphyrin, transferrin receptor, serum ferritin, receiver operating characteristic curve, school children, anemia

Published
2005

8. New reference values for thyroid volume by ultrasound in iodine-sufficient schoolchildren: a World Health Organization/Nutrition for Health and Development Iodine Deficiency Study Group Report

Author

Zimmermann, Michael B, Hess, Sonja Y, Molinari, Luciano, de Benoist, Bruno, Delange, Francois, Braverman, Lewis E, Fujieda, Kenji, Ito, Yoshiya, Jooste, Pieter L, Moosa, Khairya, Pearce, Elizabeth N, Pretell, Eduardo A, and Shishiba, Yoshimasa

Subjects
Iodine deficiency diseases -- Care and treatment, Children -- Health aspects, Ultrasonic waves -- Health aspects, Ultrasonic waves -- Usage, Food/cooking/nutrition, Health
Abstract

Background: Goiter prevalence in school-age children is an indicator of the severity of iodine deficiency disorders (IDDs) in a population. In areas of mild-to-moderate IDDs, measurement of thyroid volume (Tvol) by ultrasound is preferable to palpation for grading goiter, but interpretation requires reference criteria from iodine-sufficient children. Objective: The study aim was to establish international reference values for Tvol by ultrasound in 6-12-y-old children that could be used to define goiter in the context of IDD monitoring. Design: Tvol was measured by ultrasound in 6-12-y-old children living in areas of long-term iodine sufficiency in North and South America, central Europe, the eastern Mediterranean, Africa, and the western Pacific. Measurements were made by 2 experienced examiners using validated techniques. Data were log transformed, used to calculate percentiles on the basis of the Gaussian distribution, and then transformed back to the linear scale. Age- and body surface area (BSA)-specific 97th percentiles for Tvol were calculated for boys and girls. Results: The sample included 3529 children evenly divided between boys and girls at each year [bar]x [+ or -] SD age: 9.3 [+ or -] 1.9 y). The range of median urinary iodine concentrations for the 6 study sites was 118-288 [micro]g/L. There were significant differences in age- and BSA-adjusted mean Tvols between sites, which suggests that population-specific references in countries with long-standing iodine sufficiency may be more accurate than is a single international reference. However, overall differences in age- and BSA-adjusted Tvols between sites were modest relative to the population and measurement variability, which supports the use of a single, site-independent set of references. Conclusion: These new international reference values for Tvol by ultrasound can be used for goiter screening in the context of IDD monitoring. KEY WORDS Thyroid volume, children, international reference, ultrasound, iodine, goiter

Published
2004

9. Thyroid size and goiter prevalence after introduction of iodized salt: a 5-y prospective study in schoolchildren in Cote d'Ivoire

Author

Zimmermann, Michael B, Hess, Sonja Y, Adou, Pierre, Toresanni, Toni, Wegmuller, Rita, and Hurrell, Richard F

Subjects
Children -- Food and nutrition, Goiter -- Prevention, Goiter -- Care and treatment, Iodine deficiency diseases -- Care and treatment, Iodine deficiency diseases -- Prevention, Food/cooking/nutrition, Health
Abstract

Background: The long-term goal of salt iodization is elimination of iodine deficiency and reduction of the goiter rate to Objective: We described the time course and pattern of changes in thyroid size and goiter rate in response to the introduction of iodized salt in an area of severe endemic goiter. Design: In a 5-y prospective study, we measured thyroid size by ultrasonography and urinary iodine and thyroid hormone concentrations in schoolchildren 6 mo before the introduction of iodized salt and annually for 4 y thereafter. Results: Four years after the introduction of iodized salt and normalization of the median urinary iodine concentration, mean thyroid size had decreased 56% (P < 0.0001). However, 29% of the children remained goitrous, with a significant age shift in the distribution of goiter. At baseline, the goiter rate was significantly higher in younger (age: 5-9 y) than in older (age: 10-14 y) children (P < 0.0001). At 2, 3, and 4 y after salt iodization, the goiter rate was significantly higher in the older than in the younger children (at 4 y: 52% compared with 19%), and the difference increased with time (P < 0.0001). Conclusion: The goiter rate in school-aged children may remain sharply elevated for up to 4 y after successful introduction of iodized salt, primarily because of persistent goiter in older children. KEY WORDS Iodine, iron, deficiency, anemia, goiter, thyroid, iodized salt, prospective, children Cote d'Ivoire

Published
2003

10. Treatment of iron deficiency in goitrous children improves the efficacy of iodized salt in Cote d'Ivoire

Author

Hess, Sonja Y, Zimmermann, Michael B, Adou, Pierre, Torresani, Toni, and Hurrell, Richard F

Subjects
Iron deficiency anemia in children -- Care and treatment, Goiter -- Health aspects, Iodized salt -- Health aspects, Food/cooking/nutrition, Health
Abstract

Background: In many developing countries, children are at high risk of both goiter and iron deficiency anemia. Iron deficiency adversely affects thyroid metabolism and may reduce the efficacy of iodine prophylaxis in areas of endemic goiter. Objective: The aim of this study was to determine whether iron supplementation in goitrous, iron-deficient children would improve their response to iodized salt. Design: We conducted a randomized, double-blind, placebo-controlled trial in 5-14-y-old children in Cote d'Ivoire. Goitrous, iron-deficient children (n = 166) consuming iodized salt (10-30 mg I/kg salt at the household level) were supplemented with either iron (60 mg Fe/d, 4 d/wk for 16 wk) or placebo. At 0, 1, 6, 12, and 20 wk, we measured hemoglobin, serum ferritin, serum transferrin receptor, whole-blood zinc protoporphyrin, thyrotropin, thyroxine, urinary iodine, and thyroid gland volume (by ultrasonography). Results: Hemoglobin and iron status at 20 wk were significantly better after iron treatment than after placebo (P < 0.05). At 20 wk, the mean reduction in thyroid size in the iron-treated group was nearly twice that in the placebo group ([bar]x [+ or -] SD percentage change in thyroid volume from baseline: -22.8 [+ or -] 10.7% compared with -12.7 [+ or -] 10.1%; P < 0.01). At 20 wk, goiter prevalence was 43% in the iron-treated group compared with 62% in the placebo group (P < 0.02). There were no significant differences between groups in whole-blood thyrotropin or serum thyroxine at baseline or during the intervention. Conclusions: Iron supplementation improves the efficacy of iodized salt in goitrous children with iron deficiency. A high prevalence of iron deficiency among children in areas of endemic goiter may reduce the effectiveness of iodine prophylaxis. Am J Clin Nutr 2002;75:743-8. KEY WORDS Iodine, iron, deficiency, anemia, goiter, iodized oil, iodized salt, children, Cote d'Ivoire

Published
2002

11. Testing metal, proving mettle—findings from the 2016–2018 India Comprehensive National Nutrition Survey regarding the prevalence of low serum zinc concentrations among children and adolescents, and their implications for public health.

Author

Brown, Kenneth H, McDonald, Christine M, Wessells, K Ryan, and Hess, Sonja Y

Subjects
PUBLIC health, SEX distribution, ZINC, GROWTH disorders, CHILDREN, ADOLESCENCE
Abstract

The authors comment on a study published within the issue which reported on the prevalence of low serum zinc concentrations among children and adolescents in India. Topics covered include the risk factors for low SZC identified by the study, the limitations of the study, and the implications of the study findings for public health.

Published
2021
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12. Plasma zinc concentration responds to short-term zinc supplementation, but not zinc fortification, in young children in Senegal1,2.

Author

Lo, Nafissatou Ba, Aaron, Grant J, Hess, Sonja Y, Dossou, Nicole Idohou, Guiro, Amadou Tidiane, Wade, Salimata, and Brown, Kenneth H

Abstract

BACKGROUND: Simple, low-cost methods are needed to evaluate the effect of zinc-fortification programs. Plasma zinc concentration is a useful biomarker of zinc intake from supplementation, but responses to zinc fortification are inconsistent. OBJECTIVE: The objective was to compare the change in plasma zinc concentrations in young children who received zinc from either a liquid supplement or a zinc-fortified complementary food. DESIGN: A double-blind intervention trial was conducted in 137 young Senegalese children aged 9-17 mo who were randomly assigned to receive one of the following treatments for 15 d: 1) 30 g dry weight of an iron-fortified cereal porridge and a liquid multivitamin supplement without zinc (control group), 2) the same porridge and multivitamin supplement with 6 mg Zn added to the supplement dose (ZnSuppl group), or 3) the same porridge with added zinc to provide 6 mg Zn per 25 g dry weight of porridge and multivitamin without zinc (ZnFort group). RESULTS: Mean (±SD) plasma zinc concentration ([mu]g/dL) increased by 4.7 ± 1.6 (P = 0.004) in the ZnSuppl group, which was significantly greater (P = 0.009) than the mean change in the control group (-1.0 ± 1.6; P = 0.51) and in the ZnFort group (-1.8 ± 1.7; P = 0.29). The latter 2 groups did not differ from each other (P = 0.99). CONCLUSIONS: Plasma zinc concentration increased in children who received daily zinc supplementation for 15 d but not in those who received a zinc-fortified complementary food containing a similar amount of zinc. Additional longer-term studies are needed to assess the effect of zinc-fortification programs on zinc-related functional outcomes and the usefulness of plasma zinc as a biomarker of program effect. This trial was registered at www.clinicaltrials.gov as study NCT0094398. [ABSTRACT FROM AUTHOR]

Published
2011
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13. Plasma zinc concentration responds to short-term zinc supplementation, but not zinc fortification, in young children in Senegal.

Author

Nafissatou Ba Lo, Aaron, Grant J., Hess, Sonja Y., Dossou, Nicole Idohou, Guiro, Amadou Tidiane, Wade, Salimata, and Brown, Kenneth H.

Subjects
ZINC, DIETARY supplements, CHILDREN'S health, DIET therapy
Abstract

Background: Simple, low-cost methods are needed to evaluate the effect of zinc-fortification programs. Plasma zinc concentration is a useful biomarker of zinc intake from supplementation, but responses to zinc fortification are inconsistent. Objective: The objective was to compare the change in plasma zinc concentrations in young children who received zinc from either a liquid supplement or a zinc-fortified complementary food. Design: A double-blind intervention trial was conducted in 137 young Senegalese children aged 9-17 mo who were randomly assigned to receive one of the following treatments for 15 d: 1) 30 g dry weight of an iron-fortified cereal porridge and a liquid multivitamin supplement without zinc (control group), 2) the same porridge and multivitamin supplement with 6 mg Zn added to the supplement dose (ZnSuppl group), or 3) the same porridge with added zinc to provide 6 mg Zn per 25 g dry weight of porridge and multivitamin without zinc (ZnFort group). Results: Mean (±SD) plasma zinc concentration (μg/dL) increased by 4.7 ± 1.6 (P = 0.004) in the ZnSuppl group, which was significantly greater (P = 0.009) than the mean change in the control group (-1.0 ± 1.6; P = 0.51) and in the ZnFort group (-1.8 ± 1.7; P = 0.29). The latter 2 groups did not differ from each other (P = 0.99). Conclusions: Plasma zinc concentration increased in children who received daily zinc supplementation for 15 d but not in those who received a zinc-fortified complementary food containing a similar amount of zinc. Additional longer-term studies are needed to assess the effect of zinc-fortification programs on zinc-related functional outcomes and the usefulness of plasma zinc as a biomarker of program effect. This trial was registered at www.clinicaltrials.gov as study NCT0094398. [ABSTRACT FROM AUTHOR]

Published
2011
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14. Small-quantity lipid-based nutrient supplements for children age 6–24 months: a systematic review and individual participant data meta-analysis of effects on developmental outcomes and effect modifiers.

Author

Prado, Elizabeth L, Arnold, Charles D, Wessells, K Ryan, Stewart, Christine P, Abbeddou, Souheila, Adu-Afarwuah, Seth, Arnold, Benjamin F, Ashorn, Ulla, Ashorn, Per, Becquey, Elodie, Brown, Kenneth H, Chandna, Jaya, Christian, Parul, Dentz, Holly N, Dulience, Sherlie J L, Fernald, Lia C H, Galasso, Emanuela, Hallamaa, Lotta, Hess, Sonja Y, and Huybregts, Lieven

Subjects
EXECUTIVE function, META-analysis, CONFIDENCE intervals, CHILD development, SYSTEMATIC reviews, DIETARY supplements, LANGUAGE acquisition, DESCRIPTIVE statistics, DISEASE prevalence, EMOTIONS, LIPIDS, MOTOR ability
Abstract

Background Small-quantity (SQ) lipid-based nutrient supplements (LNSs) provide many nutrients needed for brain development. Objectives We aimed to generate pooled estimates of the effect of SQ-LNSs on developmental outcomes (language, social-emotional, motor, and executive function), and to identify study-level and individual-level modifiers of these effects. Methods We conducted a 2-stage meta-analysis of individual participant data from 14 intervention against control group comparisons in 13 randomized trials of SQ-LNSs provided to children age 6–24 mo (total n  = 30,024). Results In 11–13 intervention against control group comparisons (n  = 23,588–24,561), SQ-LNSs increased mean language (mean difference: 0.07 SD; 95% CI: 0.04, 0.10 SD), social-emotional (0.08; 0.05, 0.11 SD), and motor scores (0.08; 95% CI: 0.05, 0.11 SD) and reduced the prevalence of children in the lowest decile of these scores by 16% (prevalence ratio: 0.84; 95% CI: 0.76, 0.92), 19% (0.81; 95% CI: 0.74, 0.89), and 16% (0.84; 95% CI: 0.76, 0.92), respectively. SQ-LNSs also increased the prevalence of children walking without support at 12 mo by 9% (1.09; 95% CI: 1.05, 1.14). Effects of SQ-LNSs on language, social-emotional, and motor outcomes were larger among study populations with a higher stunting burden (≥35%) (mean difference: 0.11–0.13 SD; 8–9 comparisons). At the individual level, greater effects of SQ-LNSs were found on language among children who were acutely malnourished (mean difference: 0.31) at baseline; on language (0.12), motor (0.11), and executive function (0.06) among children in households with lower socioeconomic status; and on motor development among later-born children (0.11), children of older mothers (0.10), and children of mothers with lower education (0.11). Conclusions Child SQ-LNSs can be expected to result in modest developmental gains, which would be analogous to 1–1.5 IQ points on an IQ test, particularly in populations with a high child stunting burden. Certain groups of children who experience higher-risk environments have greater potential to benefit from SQ-LNSs in developmental outcomes. This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020159971. [ABSTRACT FROM AUTHOR]

Published
2021
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15. Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child anemia and micronutrient status: an individual participant data meta-analysis of randomized controlled trials.

Author

Wessells, K Ryan, Arnold, Charles D, Stewart, Christine P, Prado, Elizabeth L, Abbeddou, Souheila, Adu-Afarwuah, Seth, Arnold, Benjamin F, Ashorn, Per, Ashorn, Ulla, Becquey, Elodie, Brown, Kenneth H, Byrd, Kendra A, Campbell, Rebecca K, Christian, Parul, Fernald, Lia C H, Fan, Yue-Mei, Galasso, Emanuela, Hess, Sonja Y, Huybregts, Lieven, and Jorgensen, Josh M

Subjects
ANEMIA prevention, META-analysis, INFLAMMATION, IRON, DIETARY supplements, VITAMIN A deficiency, DESCRIPTIVE statistics, DISEASE prevalence, VITAMIN A, MICRONUTRIENTS, NUTRITIONAL status, LIPIDS, CHILDREN
Abstract

Background Small-quantity lipid-based nutrient supplements (SQ-LNSs) have been shown to reduce the prevalence of child anemia and iron deficiency, but effects on other micronutrients are less well known. Identifying subgroups who benefit most from SQ-LNSs could support improved program design. Objectives We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child hemoglobin (Hb), anemia, and inflammation-adjusted micronutrient status outcomes. Methods We conducted a 2-stage meta-analysis of individual participant data from 13 randomized controlled trials of SQ-LNSs provided to children 6–24 mo of age (n  = 15,946). We generated study-specific and subgroup estimates of SQ-LNSs compared with control, and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine potential study-level effect modifiers. Results SQ-LNS provision decreased the prevalence of anemia (Hb < 110 g/L) by 16% (relative reduction), iron deficiency (plasma ferritin < 12 µg/L) by 56%, and iron deficiency anemia (IDA; Hb < 110 g/L and plasma ferritin <12 µg/L) by 64%. We observed positive effects of SQ-LNSs on hematological and iron status outcomes within all subgroups of the study- and individual-level effect modifiers, but effects were larger in certain subgroups. For example, effects of SQ-LNSs on anemia and iron status were greater in trials that provided SQ-LNSs for >12 mo and provided 9 (as opposed to <9) mg Fe/d, and among later-born (than among first-born) children. There was no effect of SQ-LNSs on plasma zinc or retinol, but there was a 7% increase in plasma retinol-binding protein (RBP) and a 56% reduction in vitamin A deficiency (RBP < 0.70 µmol/L), with little evidence of effect modification by individual-level characteristics. Conclusions SQ-LNSs can substantially reduce the prevalence of anemia, iron deficiency, and IDA among children across a range of individual, population, and study design characteristics. Policy-makers and program planners should consider SQ-LNSs within intervention packages to prevent anemia and iron deficiency. This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020156663. [ABSTRACT FROM AUTHOR]

Published
2021
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16. Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child growth: an individual participant data meta-analysis of randomized controlled trials.

Author

Dewey KG, Wessells KR, Arnold CD, Prado EL, Abbeddou S, Adu-Afarwuah S, Ali H, Arnold BF, Ashorn P, Ashorn U, Ashraf S, Becquey E, Bendabenda J, Brown KH, Christian P, Colford JM, Dulience SJL, Fernald LCH, Galasso E, Hallamaa L, Hess SY, Humphrey JH, Huybregts L, Iannotti LL, Jannat K, Lartey A, Le Port A, Leroy JL, Luby SP, Maleta K, Matias SL, Mbuya MNN, Mridha MK, Nkhoma M, Null C, Paul RR, Okronipa H, Ouédraogo JB, Pickering AJ, Prendergast AJ, Ruel M, Shaikh S, Weber AM, Wolff P, Zongrone A, and Stewart CP

Subjects
Africa South of the Sahara epidemiology, Bangladesh epidemiology, Child, Preschool, Effect Modifier, Epidemiologic, Female, Haiti epidemiology, Humans, Infant, Male, Randomized Controlled Trials as Topic, Child Development drug effects, Child Nutrition Disorders epidemiology, Dietary Supplements, Infant Nutritional Physiological Phenomena, Lipids administration & dosage, Nutritional Status
Abstract

Background: Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child stunting and wasting. Identification of subgroups who benefit most from SQ-LNSs may facilitate program design., Objectives: We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child growth outcomes., Methods: We conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 37,066). We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons., Results: SQ-LNS provision decreased stunting (length-for-age z score < -2) by 12% (relative reduction), wasting [weight-for-length (WLZ) z score < -2] by 14%, low midupper arm circumference (MUAC) (<125 mm or MUAC-for-age z score < -2) by 18%, acute malnutrition (WLZ < -2 or MUAC < 125 mm) by 14%, underweight (weight-for-age z score < -2) by 13%, and small head size (head circumference-for-age z score < -2) by 9%. Effects of SQ-LNSs generally did not differ by study-level characteristics including region, stunting burden, malaria prevalence, sanitation, water quality, duration of supplementation, frequency of contact, or average compliance with SQ-LNS. Effects of SQ-LNSs on stunting, wasting, low MUAC, and small head size were greater among girls than among boys; effects on stunting, underweight, and low MUAC were greater among later-born (than among firstborn) children; and effects on wasting and acute malnutrition were greater among children in households with improved (as opposed to unimproved) sanitation., Conclusions: The positive impact of SQ-LNSs on growth is apparent across a variety of study-level contexts. Policy-makers and program planners should consider including SQ-LNSs in packages of interventions to prevent both stunting and wasting.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Published
2021
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