Search

Background Linear catch-up growth after treatment of severe acute malnutrition (SAM) is low, and little is known about the association between ponderal and subsequent linear growth. Objective The study assessed the association of weight-for-height z -score (WHZ) gain with subsequent linear growth during SAM treatment and examined its modifiers. Methods This was a prospective study, nested in a trial (ISRCTN16454889), among 6–59-mo-old children treated for SAM in Uganda. Weight, total length (TL), and knee-heel length (KHL) were measured at admission, weekly during inpatient therapeutic care (ITC), at discharge, and fortnightly during outpatient therapeutic care (OTC) for 8 wk. Linear regression was used to assess the association between WHZ gain during ITC and linear growth during OTC. Results Of 400 children, 327 were discharged to OTC and 290 were followed up for 8 wk. Mean WHZ gains were 0.45 in ITC and 1.24 in OTC, whereas mean height-for-age z -score (HAZ) declined by 0.41 during ITC and increased by 0.14 during OTC. WHZ gain during ITC was positively associated with HAZ, TL, and KHL gains during OTC [regression coefficients (β) (95% CI): 0.12 (0.09, 0.15) z -score; 3.1 (2.4, 3.8) mm and 0.5 (0.1, 0.7) mm, respectively]. The regression coefficients were highest for the middle tertile of WHZ gain with respect to HAZ and TL. Admission diarrhea and low plasma citrulline reduced the association between WHZ gain during ITC and HAZ and TL gain during OTC (P  < 0.001). In contrast, pneumonia (P  = 0.051) and elevated plasma C-reactive protein (P  < 0.001) increased the association with TL gain, but reduced the association with KHL gain (P  < 0.001). Conclusions Among children admitted with SAM, considerable WHZ gain during ITC was followed by very modest linear catch-up growth during OTC, with no indication of a WHZ gain threshold, above which linear growth was higher. To optimize linear growth in these children, early treatment of infections and conditions affecting the gut may be necessary. [ABSTRACT FROM AUTHOR]

Background Serum insulin-like growth factor 1 (sIGF-1) is an important growth factor in childhood. However, studies on sIGF-1 among children from low-income countries are few, and the role of body composition is unknown. Objectives To assess the associations of anthropometry, body composition, inflammation, and breastfeeding with sIGF-1 among children with moderate acute malnutrition (MAM). Methods A cross-sectional study based on admission data from 6- to 23-mo-old children with MAM participating in a nutrition intervention trial (Treatfood) in Burkina Faso. Linear regression analysis was used to identify correlates of sIGF-1. Results Among 1546 children, the median (IQR) sIGF-1 was 12 (8.2–18.3) ng/mL. sIGF-1 was highest at 6 mo, with a nadir ∼10–11 mo, and higher in girls than boys. Length-for-age z score (LAZ), weight-for-length z score (WLZ), and midupper arm circumference were positively associated with sIGF-1 (P  ≤ 0.001). Fat-free mass (FFM) was also positively associated, as sIGF-1 increased 1.5 (95% CI: 0.5, 2.5) ng/mL for each 1-kg increase in FFM. However, the association disappeared after adjustment for height. Elevated serum C-reactive protein and α1-acid glycoprotein were negatively associated with sIGF-1 (P  ≤ 0.001), as was fever (P  < 0.001) but not a positive malaria test per se (P  = 0.15). Children never breastfed had lower sIGF-1 (–5.1; 95% CI: –9.8, –0.3). Conclusions LAZ and WLZ were positively and inflammation negatively associated with sIGF-1. As all children were moderately malnourished and many had inflammation, this probably explains the very low median sIGF-1. The association of FFM with sIGF-1 was fully explained by height. There was a marked age pattern, with a nadir in late infancy, confirming findings from smaller studies from well-nourished populations. There is a need for prospective studies to disentangle the role of sIGF-1 in growth and health. This trial was registered at https://www.isrctn.com as ISRCTN42569496. [ABSTRACT FROM AUTHOR]

Stunting is associated with cognitive impairment and later chronic disease. Previous trials to prevent stunting have had little effect, and no trials seem to have provided larger amounts of energy and high-quality proteins to already stunted children. We aimed to assess the effects of milk protein (MP) and whey permeate (WP) in large-quantity lipid-based nutrient supplements (LNS-LQ), among stunted children, on linear growth and child development. This was a randomized, double-blind, 2-by-2 factorial trial. Stunted children aged 12–59 mo from eastern Uganda (n  = 750) were randomly assigned to receive 100 g LNS-LQ with or without MP and WP (n  = 4 × 150) or no supplement (n  = 150) for 3 mo. The primary outcomes were change in knee-heel and total length. Secondary outcomes included child development, body composition, anthropometry, and hemoglobin. Micronutrient status, intestinal function, and microbiota were also assessed. Our findings will contribute to an understanding of the role of milk ingredients and LNS in linear catch-up growth. This trial was registered at www.isrctn.com as ISRCTN13093195. [ABSTRACT FROM AUTHOR]

Change in hydration is common in children with severe acute malnutrition (SAM) including during treatment, but is difficult to assess. We investigated the utility of bio-electrical impedance vector analysis (BIVA), a quick non-invasive method, for indexing hydration during treatment. We studied 350 children 0·5–14 years of age with SAM (mid-upper arm circumference <11·0 cm or weight-for-height <70% of median, and/or nutritional oedema) admitted to a hospital nutrition unit, but excluded medically unstable patients. Weight, height (H), resistance (R), reactance (Xc) and phase angle (PA) were measured and oedema assessed. Similar data were collected from 120 healthy infants and preschool/school children for comparison. Means of height-adjusted vectors (R/H, Xc/H) from SAM children were interpreted using tolerance and confidence ellipses of corresponding parameters from the healthy children. SAM children with oedema were less wasted than those without (p < 0·001), but had BIVA parameters that differed more from those of healthy children (P < 0·05) than those non-oedematous. Initially, both oedematous and non-oedematous SAM children had mean vectors outside the reference 95% tolerance ellipse. During treatment, mean vectors migrated differently in the two SAM groups, indicating fluid loss in oedematous patients, and tissue accretion in non-oedematous patients. At admission, R/H was lower (oedematous) or higher (non-oedematous) among children who died than those who exited the hospital alive. BIVA can be used in children with SAM to distinguish tissue-vs. hydration-related weight changes during treatment, and also identify children at high risk of death enabling early clinical interventions. [ABSTRACT FROM AUTHOR]

Treatment of children with uncomplicated severe acute malnutrition (SAM) is based on ready-to-use therapeutic foods (RUTF) and aims for quick regain of lost body tissues while providing sufficient micronutrients to restore diminished body stores. Little evidence exists on the success of the treatment to establish normal micronutrient status. We aimed to assess the changes in vitamin A and iron status of children treated for SAM with RUTF, and explore the effect of a reduced RUTF dose. We collected blood samples from children 6–59 months old with SAM included in a randomised trial at admission to and discharge from treatment and analysed haemoglobin (Hb) and serum concentrations of retinol binding protein (RBP), ferritin (SF), soluble transferrin receptor (sTfR), C-reactive protein (CRP) and α1-acid glycoprotein (AGP). SF, sTfR and RBP were adjusted for inflammation (CRP and AGP) prior to analysis using internal regression coefficients. Vitamin A deficiency (VAD) was defined as RBP < 0.7 μmol/l, anaemia as Hb < 110 g/l, storage iron deficiency (sID) as SF < 12 μg/l, tissue iron deficiency (tID) as sTfR > 8.3 mg/l and iron deficiency anaemia (IDA) as both anaemia and sID. Linear and logistic mixed models were fitted including research team and study site as random effects and adjusting for sex, age and outcome at admission. Children included in the study (n = 801) were on average 13 months of age at admission to treatment and the median treatment duration was 56 days [IQR: 35; 91] in both arms. Vitamin A and iron status markers did not differ between trial arms at admission or at discharge. Only Hb was 1.7 g/l lower (95% CI −0.3, 3.7; p = 0.088) in the reduced dose arm compared to the standard dose, at recovery. Mean concentrations of all biomarkers improved from admission to discharge: Hb increased by 12% or 11.6 g/l (95% CI 10.2, 13.0), RBP increased by 13% or 0.12 μmol/l (95% CI 0.09, 0.15), SF increased by 36% or 4.4 μg/l (95% CI 3.1, 5.7) and sTfR decreased by 16% or 1.5 mg/l (95% CI 1.0, 1.9). However, at discharge, micronutrient deficiencies were still common, as 9% had VAD, 55% had anaemia, 35% had sID, 41% had tID and 21% had IDA. Reduced dose of RUTF did not result in poorer vitamin A and iron status of children. Only haemoglobin seemed slightly lower at recovery among children treated with the reduced dose. While improvement was observed, the vitamin A and iron status remained sub-optimal among children treated successfully for SAM with RUTF. There is a need to reconsider RUTF fortification levels or test other potential strategies in order to fully restore the micronutrient status of children treated for SAM. • Severe acute malnutrition (SAM) is treated with ready-to-use therapeutic foods (RUTF). • RUTF are supposed to restore normal micronutrient status during treatment. • We show that by anthropometric recovery 9% and 35% are still vitamin A and iron deficient. • RUTF nutrient content should be revised. • Post-discharge intervention strategies could be tested to reduce deficiencies. [ABSTRACT FROM AUTHOR]

Treatment of children with uncomplicated severe acute malnutrition (SAM) is based on ready-to-use therapeutic foods (RUTF) prescribed based on body weight and administered at home. Treatment performance is typically monitored through weight gain. We previously reported that a reduced dose of RUTF resulted in weight gain velocity similar to standard dose. Here we investigate the change in body composition of children treated for SAM and compare it to community controls, and describe the effect of a reduced RUTF dose on body composition at recovery. Body composition was measured via bio-electrical impedance analysis at admission and recovery among a sub-group of children with SAM participating in a clinical trial and receiving a reduced or a standard dose of RUTF. Non-malnourished children were measured to represent community controls. Linear mixed regression models were fitted. We obtained body composition data from 452 children at admission, 259 at recovery and 97 community controls. During SAM treatment the average weight increased by 1.20 kg of which 0.55 kg (45%) was fat-free mass (FFM) and 0.67 kg (55%) was fat mass (FM). At recovery, children treated for SAM had 1.27 kg lower weight, 0.38 kg lower FFM, and 0.90 kg lower FM compared to community controls. However, their fat-free mass index (FFMI) was not different from community controls (Δ0.2 kg/m2; 95% CI −0.1, 0.4). No differences were observed in FFM, FM or fat mass index (FMI) between the study arms at recovery. However, FFMI was 0.35 kg/m2 higher at recovery with the reduced compared to standard dose (p = 0.007) due to slightly lower height (Δ0.22 cm; p = 0.25) and higher FFM (Δ0.11 kg; p = 0.078) in the reduced dose group. Almost half of the weight gain during SAM treatment was FFM. Compared to community controls, children recovered from SAM had a lower FM while their height-adjusted FFM was similar. There was no evidence of a differential effect of a reduced RUTF dose on the tissue accretion of treated children when compared to standard treatment. • Severe acute malnutrition (SAM) is treated with ready-to-use therapeutic foods (RUTF). • Recovery from SAM is monitored in terms of weight gain. • The type of tissue gained during treatment is poorly known. • In this study, about 1/2 of the weight gained was fat free mass. • At recovery, treated children remained deficient particularly in fat mass. [ABSTRACT FROM AUTHOR]

Background Both impaired and accelerated postnatal growth have been associated with adult risks of obesity and cardiometabolic diseases, like type 2 diabetes and cardiovascular disease. However, the timing of the onset of cardiometabolic changes and the specific growth trajectories linking early growth with later disease risks are not well understood. Objectives The aim of this study was to identify distinct trajectories of BMI growth from 0 to 5 y and examine their associations with body composition and markers of cardiometabolic risk at age 5 y. Methods In a prospective birth cohort study of 453 healthy and term Ethiopian children with BMIs assessed a median of 9 times during follow-up, we identified subgroups of distinct BMI trajectories in early childhood using latent class trajectory modeling. Associations of the identified growth trajectories with cardiometabolic markers and body composition at 5 y were analyzed using multiple linear regression analyses in 4 adjustment models for each outcome. Results We identified 4 heterogeneous BMI growth trajectories: stable low BMI (19.2%), normal BMI (48.8%), rapid catch-up to high BMI (17.9%), and slow catch-up to high BMI (14.1%). Compared with the normal BMI trajectory, children in the rapid catch-up to high BMI trajectory had higher triglycerides (TGs) (range of β-coefficients in Models 1–4: 19–21%), C-peptides (23–25%), fat masses (0.48–0.60 kg), and fat-free masses (0.50–0.77 kg) across the 4 adjustment models. Children in the stable low BMI trajectory had lower LDL cholesterol concentrations (0.14–0.17 mmol/L), HDL cholesterol concentrations (0.05–0.09 mmol/L), fat masses (0.60–0.64 kg), and fat-free masses (0.35–0.49 kg), but higher TGs (11–13%). Conclusions The development of obesity and cardiometabolic risks may be established already in early childhood; thus, our data provide a further basis for timely interventions targeted at young children from low-income countries with unfavorable growth patterns. The birth cohort was registered at ISRCTN as ISRCTN46718296. [ABSTRACT FROM AUTHOR]

Background: Fetal and early life growth is associated with adult risk of obesity and cardiometabolic disease. However, little is known about the relative importance of birth weight and successive periods of weight gain on markers of cardiometabolic risk in childhood in low-income populations.Objectives: The objective was to study associations of birth weight and weight gain velocities in selected age intervals from birth to 60 mo with height, fat-free mass (FFM), and markers of adiposity and cardiometabolic risk at 60 mo.Methods: In a prospective cohort study of 375 Ethiopian children aged 60 mo, we estimated individual weight gain velocities in the periods between birth and 3, 6, 24, 48, and 60 mo using linear-spline mixed-effects modeling. Subsequently, we analyzed associations of birth weight, weight gain velocities, and current weight with height, FFM, and markers of adiposity and cardiometabolic risk.Results: Weight gain from 48 to 60 mo and weight at 60 mo rather than birth weight were the strongest correlates of insulin, C-peptide, HOMA-IR, blood pressure, height, FFM, waist circumference, and fat mass at 60 mo. For instance, 1 SD higher (1 SD = 50 g/mo) weight accretion from 48 to 60 mo was associated with a higher insulin of 23.3% (95% CI: 9.6%, 38.8%), C-peptide of 11.4% (2.7%, 20.8%), systolic blood pressure of 1.4 mm Hg (0.6, 2.3 mm Hg), fat mass of 0.72 kg (0.59, 0.85 kg), and FFM of 0.70 kg (0.56, 0.85 kg). Weight gain from 0 to 3 mo was positively associated with LDL cholesterol, systolic blood pressure, height, and the body composition indices, and weight gain from 24 to 48 mo was inversely associated with blood glucose.Conclusions: In 60-mo-old Ethiopian urban children, weight gain and weight after 48 mo rather than weight at birth may represent a sensitive period for variations in markers of adiposity and glucose metabolism. The birth cohort is registered at https://www.isrctn.com/ as ISRCTN46718296. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between body composition-specifically fat mass (FM) and fat-free mass (FFM)-in early infancy, and mental health outcomes in early childhood.Study Design: In the Infant Anthropometry and Body Composition birth cohort study from Ethiopia, body composition was measured at birth and 1.5, 2.5, 3.5, 4.5, and 6 months of age. Mental health was assessed at 5 years of age using the approved Amharic version of the Strengths and Difficulties Questionnaire (SDQ), a parent report scale covering 4 different domains providing a total difficulties score. The associations of FM or FFM at birth as well as during early infancy, with SDQ score at 5 years of age were examined using multiple linear regression analyses.Results: At 5 years of age, the mean ± SD for SDQ score was 10.4 ± 5.8. FM at birth was positively and FFM negatively associated with SDQ score. For each kg increase in FM at birth, the SDQ score at 5 years was 5.7 points higher (β = 5.7; 95% CI, 1.4-10.0). In contrast, for each kilogram increase in FFM at birth, the SDQ score was 3.9 points lower (β = -3.9; 95% CI, -7.0 to -0.8). Neither FM nor FFM accretion rate during early infancy were associated with SDQ score at 5 years of age.Conclusions: Fetal rather than infant body composition was associated with SDQ score at 5 years of age. Greater FFM accretion during fetal life may have contributed to more optimal neurobehavioral development during early life. However, the potential mechanisms underlying the observed associations need further investigation. [ABSTRACT FROM AUTHOR]

The impact of freshwater fish consumption on the status of long-chain n-3 fatty acids (n-3 LCPUFA) in infants in landlocked, low-income populations is unknown. We used secondary data from a randomized, single-blinded, controlled trial to evaluate the impact of daily consumption of complementary food products with small amounts of freshwater fish on whole blood n-3 LCPUFA in Cambodian infants. Infants (n = 419), received daily, one of four food products for 9 months. Two products contained freshwater fish: WinFood (10% fish by dry weight) and WinFood-L (12% fish by dry weight), while two products were non-fish-based: corn-soy blends (CSB+ and CSB++). Whole blood fatty acids and breastfeeding status were assessed at baseline and endline of the intervention. The WinFood products contributed to an estimated maximum intake of 86.5 mg/day n-3 LCPUFA. There was no difference in whole blood n-3 LCPUFA among the four intervention groups or between the fish-based and the non-fish-based groups (p ≥ 0.142). At endline, 71% of the children were still breastfed. Interaction analyses indicated a lower ratio of n-6/n-3 PUFA in non-breastfed infants in the WinFood groups compared to the CSB groups (p interaction   = 0.026). Thus, a high intake of n-3 LCPUFA from breastmilk may have blurred a potential impact of small amounts of freshwater fish effect on n-3 LCPUFA status in Cambodian infants. [ABSTRACT FROM AUTHOR]

Summary Introduction Despite expanding use of bio-impedance (BI), little is known about its pathophysiologic significance and biological correlates Objective Determine correlations of BI parameters with anthropometry and biomarkers of electrolyte homeostasis, inflammation and liver function in children with severe acute malnutrition (SAM). Methods We studied Ethiopian children with SAM (mid-arm circumference <11·0 cm or weight-for-height <70% of the NCHS growth reference median and/or nutritional oedema) at hospitalization. Impedance (Z, Ohm), resistance (R, Ohm), reactance (Xc, Ohm) and phase angle (PA, degree) were measured at 50 kHz. R and Xc were height-indexed. Anthropometric Z-scores were calculated. Serum phosphate, Ca, Na, K, Mg, alkaline phosphatase, bilirubin, α1-acid glycoprotein, albumin and haemoglobin were measured. Healthy children were used for BI comparison. Correlates of BI were established using forward selection after comparing models using likelihood ratio test. Results The sample comprised 55 children with SAM (age 36 ± 24 months; 60% males; 72.7% oedematous) and 80 healthy control children (age 28 ± 15 months; 47.5% males). Oedematous children had the lowest BI parameters compared with reference and non-oedematous children. Similarly, they had lower serum albumin, K and alkaline phosphatase levels than non-oedematous children. Oedema was independent negative correlate of R, Xc and PA. Serum albumin level and weight-for-height Z-score were positive correlates of R, whereas serum calcium and Cl levels were positive correlates of Xc. MUAC correlated positively with PA. Conclusion Nutritional oedema explained the divergence of BI parameters from normality. Soft tissue mass, serum albumin, Ca and Cl accounted for variability of BI parameters in children with SAM. [ABSTRACT FROM AUTHOR]

Background: We have previously shown that fat-free mass (FFM) at birth is associated with height at 2 y of age in Ethiopian children. However, to our knowledge, the relation between changes in body composition during early infancy and later linear growth has not been studied.Objective: This study examined the associations of early infancy fat mass (FM) and FFM accretion with linear growth from 1 to 5 y of age in Ethiopian children.Methods: In the infant Anthropometry and Body Composition (iABC) study, a prospective cohort study was carried out in children in Jimma, Ethiopia, followed from birth to 5 y of age. FM and FFM were measured ≤6 times from birth to 6 mo by using air-displacement plethysmography. Linear mixed-effects models were used to identify associations between standardized FM and FFM accretion rates during early infancy and linear growth from 1 to 5 y of age. Standardized accretion rates were obtained by dividing FM and FFM accretion by their respective SD.Results: FFM accretion from 0 to 6 mo of age was positively associated with length at 1 y (β = 0.64; 95% CI: 0.19, 1.09; P = 0.005) and linear growth from 1 to 5 y (β = 0.63; 95% CI: 0.19, 1.07; P = 0.005). The strongest association with FFM accretion was observed at 1 y. The association with linear growth from 1 to 5 y was mainly engendered by the 1-y association. FM accretion from 0 to 4 mo was positively associated with linear growth from 1 to 5 y (β = 0.45; 95% CI: 0.02, 0.88; P = 0.038) in the fully adjusted model.Conclusions: In Ethiopian children, FFM accretion was associated with linear growth at 1 y and no clear additional longitudinal effect from 1 to 5 y was observed. FM accretion showed a weak association from 1 to 5 y. This trial was registered at www.controlled-trials.com as ISRCTN46718296. [ABSTRACT FROM AUTHOR]

Background: Children with moderate acute malnutrition (MAM) are treated with lipid-based nutrient supplements (LNSs) or corn-soy blends (CSBs) but little is known about the impact of these supplements on hemoglobin, iron status, and inflammation. Objective: The objective of this study was to investigate the impact of supplementary foods for treatment of MAM on hemoglobin, iron status, inflammation, and malaria. Design: A randomized 2 × 2 × 3 factorial trial was conducted in Burkina Faso. Children aged 6-23 mo with MAM received 500 kcal/d as LNS or CSB, containing either dehulled soy (DS) or soy isolate (SI) and different quantities of dry skimmed milk (0%, 20% or 50% of total protein) for 12 wk. The trial was double-blind with regard to quality of soy and quantity of milk, but not matrix (CSB compared to LNS). Hemoglobin, serum ferritin (SF), serum soluble transferrin receptor (sTfR), serum C-reactive protein (CRP), serum a1-acid glycoprotein (AGP), and malaria antigens were measured at inclusion and after supplementation. Results: Between September 2013 and August 2014, 1609 children were enrolled. Among these, 61 (3.8%) were lost to follow-up. During the 12-wk supplementation period, prevalence of anemia, low SF adjusted for inflammation (SFAI), elevated sTfR, and iron-deficiency anemia decreased by 16.9, 8.7, 12.6 and 10.5 percentage points. Children who received LNS compared to CSB had higher hemoglobin (2 g/L; 95% CI: 1, 4 g/L), SFAI (4.2 µg/L; 95% CI: 2.9, 5.5 µg/L), and CRP (0.8 mg/L; 95% CI: 0.4, 1.2 mg/L) and lower sTfR (-0.9 mg/L, 95% CI: -1.3, -0.6 mg/L) after the intervention. Replacing DS with SI or increasing milk content did not affect hemoglobin, SFAI, sTfR, or CRP. Conclusion: Supplementation with LNS compared to CSB led to better hemoglobin and iron status, but overall prevalence of anemia remained high. The higher concentrations of acute-phase proteins in children who received LNSs requires further investigation. [ABSTRACT FROM AUTHOR]

Objective: To assess the levels of physical activity among young children with moderate acute malnutrition and to identify clinical, biochemical, anthropometric, and sociodemographic correlates of physical activity.Study Design: In a cross-sectional study, 1609 children aged 6-23 months wore a triaxial accelerometer (ActiGraph GT3x+; ActiGraph, Pensacola, Florida) for 6 consecutive days, from which total physical activity were determined. Data on morbidity were collected based by history and physical examination, and serum C-reactive protein and α1-acid glycoprotein were measured.Results: A total of 1544 (96%) children had physical activity measured, of whom 1498 (97%) completed 6 consecutive days of physical activity recording with a daily median wear time of 24 hours. The mean (±SD) total physical activity was 707 (±180) vector magnitude counts per minute (cpm). Age was negatively correlated with physical activity; compared with children below 12 months of age, those 12-17 months of age, and 18-23 months of age had 51 (95% CI, 26; 75) and 106 (95% CI, 71; 141) cpm lower physical activity, respectively. Fever and malaria were associated with 49 (95% CI, 27; 70) and 44 (95% CI, 27; 61) cpm lower activity, respectively. Elevated serum C-reactive protein and α1-acid glycoprotein were both negative correlates of physical activity, and hemoglobin was a positive correlate.Conclusions: Physical activity declines with age in children with moderate acute malnutrition and is also inversely related to infection and inflammatory status. Future studies are needed to ascertain cause and effect of these associations.Trial Registration: Controlled-Trials.com: ISRCTN42569496. [ABSTRACT FROM AUTHOR]

Background: Children who receive in-hospital treatment of severe acute malnutrition often have high mortality rates, and the reasons are not well understood. Objective: We assessed risk factors for death in children who were treated for malnutrition in a hospital. Design: In a prospective observational study of 120 children who were receiving in-hospital treatment of severe acute malnutrition in Uganda with therapeutic formulas F-75 and F-100, we collected data on symptoms, clinical findings, plasma markers of refeeding syndrome (electrolytes and phosphate), and acute phase reactants, and recorded the nutritional therapy given in hospital. Results: Seventeen children (14%) died. Clinical risk factors for death were the presence of oral thrush (HR: 5.0; 95% CI: 1.6, 15.2), a caretaker-reported severity of illness on a visual analog scale (HR: 1.7; 95% CI: 1.1, 2.6), impaired consciousness (HR: 16.7; 95% CI: 3.1, 90.4), and a capillary refill time >2 s (HR: 3.9; 95% CI: 1.4, 11.3). HIV infection was not associated with mortality (HR: 3.0; 95% CI: 0.7, 12.4), which was most likely due to low power. Biochemical risk factors were a plasma C-reactive protein concentration >15 mg/L on admission and low plasma phosphate that was measured on day 2 (HR: 8.7; 95% CI: 2.5, 30.1), particularly in edematous children. The replacement of F-75 with unfortified rice porridge to ameliorate diarrhea was associated with a higher risk of death, particularly if given during the first 2 d (HR: 5.0; 95% CI: 1.9, 13.3), which was an association that remained after adjustment for potential confounders (HR: 69.5; 95% CI: 7.0, 694.6). Conclusions: Refeeding syndrome may occur in children who are treated for malnutrition, even with moderately low plasma phosphate, and, in particular, in children with edematous malnutrition. The replacement of F-75 with unfortified rice porridge is associated with increased risk of death, which is possibly mediated by lowering plasma phosphate. The identified clinical risk factors may potentially improve the triage of children with malnutrition. This trial was registered at www.isrctn.com as ISRCTN55092738. [ABSTRACT FROM AUTHOR]

Background: Biomarkers of iron status are affected by inflammation. In order to interpret them in individuals with inflammation, the use of correction factors (CFs) has been proposed.Objective: The objective of this study was to investigate the use of regression models as an alternative to the CF approach.Methods: Morbidity data were collected during clinical examinations with morbidity recalls in a cross-sectional study in children aged 6-23 mo with moderate acute malnutrition. C-reactive protein (CRP), α1-acid glycoprotein (AGP), serum ferritin (SF), and soluble transferrin receptor (sTfR) were measured in serum. Generalized additive, quadratic, and linear models were used to model the relation between SF and sTfR as outcomes and CRP and AGP as categorical variables (model 1; equivalent to the CF approach), CRP and AGP as continuous variables (model 2), or CRP and AGP as continuous variables and morbidity covariates (model 3) as predictors. The predictive performance of the models was compared with the use of 10-fold crossvalidation and quantified with the use of root mean square errors (RMSEs). SF and sTfR were adjusted with the use of regression coefficients from linear models.Results: Crossvalidation revealed no advantage to using generalized additive or quadratic models over linear models in terms of the RMSE. Linear model 3 performed better than models 2 and 1. Furthermore, we found no difference in CFs for adjusting SF and those from a previous meta-analysis. Adjustment of SF and sTfR with the use of the best-performing model led to a 17% point increase and <1% point decrease, respectively, in estimated prevalence of iron deficiency.Conclusion: Regression analysis is an alternative to adjust SF and may be preferable in research settings, because it can take morbidity and severity of inflammation into account. In clinical settings, the CF approach may be more practical. There is no benefit from adjusting sTfR. This trial was registered at www.controlled-trials.com as ISRCTN42569496. [ABSTRACT FROM AUTHOR]

Introduction: health systems in low-income settings are not sufficiently reaching the poor, and global disparities in reproductive health persist. The frequency and quality of health education during antenatal care is often low. Further studies are needed on how to improve the performance of health systems in low income settings to improve maternal and child health. Objectives: to assess the effectiveness of a participatory antenatal care intervention on health behaviours and to illuminate how the different socioeconomic groups responded to the intervention in Jimma, Ethiopia. Setting, intervention and measurements: an intervention was designed participatorily and comprised trainings, supervisions, equipment, health education material, and adaption of guidelines. It was implemented at public facilities. Household surveys, before (2008) and after (2010) intervention, were conducted amongst all women who had given birth within the previous 12 months. The effect of the intervention was assessed by comparing the change in health behaviours (number of antenatal visits, health facility delivery, breast feeding, preventive infant health check, and infant immunisation) from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression. Results: on the basis of 1357 women included before and 2262 after the intervention, there were positive effects of the intervention on breast feeding practices (OR 3.0, 95% CI: 1.4; 3.6) and preventive infant health check (OR 2.4, 95% CI: 1.5; 3.5). There was no effect on infant immunisation coverage and negative effect on number of antenatal visits. The effect on various outcomes was modified by maternal education, and results indicate increased health facility delivery (OR 2.4, 95% CI: 0.8; 6.9) and breast feeding practices (OR 18.2, 95% CI: 5.2;63.6) among women with no education. Key conclusions and implications for practice: the facility based intervention improved some, but not all health behaviours. The improvements indicated amongst the most disadvantaged antenatal care attendants in breast feeding and health facility delivery are encouraging and underline the need to scale up priority of antenatal care in the effort to reduce maternal and child health inequity. [ABSTRACT FROM AUTHOR]

Summary Background & objectives Restoration of body composition indicates successful management of severe acute malnutrition (SAM). Bioimpedance (BI) index (height 2 /resistance) is used to predict total body water (TBW) but its performance in SAM, especially with oedema, requires further investigation. Subjects/Methods Children with SAM (mid-arm circumference <11.0 cm or weight-for-height <70% of median of NCHS reference and/or nutritional oedema) admitted to Jimma University Hospital were included. Tetrapolar-whole-body impedance (Z), resistance (R) and reactance (Xc) were measured at 50 and 200 kHzs. Pre- and post-deuterium dose saliva samples were analysed using isotope-ratio mass spectrometry. TBW was regressed on H 2 /Z. Xc and R were height (H)-indexed, and Xc/H plotted against R/H. Results Thirty five children (16 non-oedematous and 19 oedematous) with median (interquartile range) age of 42 (26–54) months were studied. Height-for-age z-score (mean ± SD) was low in both non-oedematous (−3.9 ± 2.8) and oedematous (−3.6 ± 1.7) children. Oedematous children had lower BI parameters than non-oedematous (p < 0.001) and hence higher H 2 /Z for a given amount of TBW. At both 50 and 200 kHz, association between H 2 /Z and TBW was stronger in non-oedematous children than oedematous (60% higher coefficient of determination and 20% lower standard error of estimate). Intercepts and regression estimates at 50 and 200 kHz were similar, in both oedematous and non-oedematous children. Conclusions In children with oedematous SAM, BI index was weak in predicting TBW. Moreover, predicted TBWs at 200 kHz and 50 kHz did not differ and hence BI measurement at 50 kHz is still practical for TBW estimation. [ABSTRACT FROM AUTHOR]

Background: Children treated for severe acute malnutrition (SAM) are at risk of refeeding hypophosphatemia. Therapeutic diets have only recently become fortified with phosphorus to meet United Nations (UN) specifications, but to our knowledge no studies have investigated the effect. Objective: The aim was to assess concentrations and correlates of plasma phosphate (P-phosphate) at admission and during treatment and to identify correlates of changes in P-phosphate. Design: This was a prospective observational study in 6- to 59-mo-old children admitted for treatment of SAM to Mulago Hospital, Uganda. P-phosphate was measured at admission, on the second day of treatment with a therapeutic formula containing 75 kcal/100 mL and 560 mg phosphorus/L (F-75, Nutriset), at the start of the transition to a therapeutic formula containing 100 kcal/100 mL and 579 mg phosphorus/L (F-100; Nutriset), at day 2 of transition, and at discharge. Results: Among 120 children, mean ± SD P-phosphate at admission was 1.04 ± 0.31 mmol/L and increased by 0.43 (95% CI: 0.35, 0.52) mmol/L during the first 2 d and more slowly toward discharge. Most (79%) children experienced their lowest P-phosphate concentration at admission, and none developed severe hypophosphatemia. P-phosphate was lowest in children with edema and with elevated C-reactive protein, and a lower increase was seen with increasing caretaker-reported severity of illness. Partially or fully replacing F-75 with rice porridge (i.e., a local practice to reduce diarrhea) during the first 2 d of stabilization was associated with a 0.34-mmol/L (95% CI: 0.18, 0.50 mmol/L) lower increase in P-phosphate during the same first 2 d. Conclusions: F-75, which complies with UN specifications and provides 73 mg phosphorus ⋅ kg-1 ⋅ d-1 (130 mL ⋅ kg-1 ⋅ d-1), seems to prevent refeeding hypophosphatemia in children with SAM. Replacing this formula with rice porridge during the first days of treatment to manage diarrhea may have an adverse effect on P-phosphate concentrations. This study was registered at http://www.isrctn.com as ISRCTN55092738. [ABSTRACT FROM AUTHOR]

Background: The management of children with moderate acute malnutrition (MAM) is based on food supplementation in outpatient programs. When midupper arm circumference (MUAC) is used as the sole admission criterion, it is common practice to exclude children with lengths <67 cm from treatment. The WHO calls for research to determine the treatment effect among children with MAM included by MUAC and aged ≥6 mo with lengths <67 cm. Objective: We hypothesized that among children given supplementary feeding based on an MUAC of 115-124 mm as the sole criterion, there would be no difference in growth rate between children <67 cm and those ≥67 cm in length at program admission. Design: This was an observational study nested in a randomized trial that investigated the effectiveness of new formulations of corn-soy blend and lipid-based nutrient supplements. Children aged 6-23 mo were included if their MUAC was between 115 and 124 mm but with a weight-for-height z score (WHZ) ≥-2. This cohort was divided into 2 groups by length at admission: <67 cm ("short") and ≥67 cm ("long"). Linear mixed-effects models and regression models were used to compare gains in weight and MUAC while adjusting for intervention, season, sex, age, and site. Results: Weight-gain velocity (expressed as g ⋅ kg-1 ⋅ d-1) and MUAC-gain velocity (expressed as 0.01 mm ⋅ cm-1 ⋅ d-1) were not different between short and long children. Weight-gain velocity was slightly higher in the shortest quartile of length (P = 0.03), whereas there was no effect modification by stunting across length quartiles (P = 0.32). Conclusions: We found no evidence of a difference in percentage of weight gain or weight-gain velocity during supplementary feeding in short or long children aged 6-23 mo. We recommend a policy change to include children <67 cm in supplementary feeding programs if their MUAC is between 115 and 124 mm and their WHZ is ≥-2. This could benefit millions of children currently excluded from supplementary feeding. This trial was registered at www.controlled-trials.com as ISRCTN42569496. [ABSTRACT FROM AUTHOR]

Background: A midupper arm circumference (MUAC) <115 mm and weight-for-height z score (WHZ) or weight-for-length z score (WLZ) less than −3, all of which are recommended to identify severe wasting in children, often identify different children. The reasons behind this poor agreement are not well understood. Objective: We investigated the association between these 2 anthropometric indexes and body composition to help understand why they identify different children as wasted. Design: We analyzed weight, length, MUAC, fat-mass (FM), and fat-free mass (FFM) data from 2470 measurements from 595 healthy Ethiopian infants obtained at birth and at 1.5, 2.5, 3.5, 4.5, and 6 mo of age. We derived WLZs by using 2006 WHO growth standards. We derived length-adjusted FM and FFM values as unexplained residuals after regressing each FM and FFM against length. We used a correlation analysis to assess associations between length, FFM, and FM (adjusted and nonadjusted for length) and the MUAC and WLZ and a multivariable regression analysis to assess the independent variability of length and length-adjusted FM and FFM with either the MUAC or the WLZ as the outcome. Results: At all ages, length showed consistently strong positive correlations with the MUAC but not with the WLZ. Adjustment for length reduced observed correlation coefficients of FM and FFM with the MUAC but increased those for the WLZ. At all ages, both length-adjusted FM and FFM showed an independent association with the WLZ and MUAC with higher regression coefficients for the WLZ. Conversely, length showed greater regression coefficients for the MUAC. At all ages, the MUAC was shown to be more influenced than was the WLZ by the FM variability relative to the FFM variability. Conclusions: The MUAC and WLZ have different associations with body composition, and length influences these associations differently. Our results suggest that the WLZ is a good marker of tissue masses independent of length. The MUAC acts more as a composite index of poor growth indexing jointly tissue masses and length. This trial was registered at www.controlled-trials.com as ISRCTN46718296. [ABSTRACT FROM AUTHOR]

Background: Poor nutritional quality of complementary foods often limits growth. Animal source foods, such as milk or meat, are often unaffordable. Local affordable alternatives are needed. Objective: We evaluate the efficacy of 2 newly developed, rice-based complementary food products: WinFood (WF) with small fish and edible spiders and WinFood-Lite (WF-L) fortified with small fish, against 2 existing fortified corn-soy blend products, CSB+ (purely plant based) and CSB++ (8% dried skimmed milk). Design: In total, 419 infants aged 6 mo were enrolled in this randomized, single-blinded study for 9 mo, designed primarily to assess increments in fat-free mass by a deuterium dilution technique and change in plasma ferritin and soluble transferrin receptor. Secondary endpoints were changes in anthropometric variables, including kneeheel length. Data were analyzed by the intention-to-treat approach. Results: There was no difference in fat-free mass increment in WF or WF-L compared with CSB+ [WF: +0.04 kg (95% CI: 20.20, 0.28 kg); WF-L: +0.14 kg (95% CI: 20.10, 0.38 kg)] or CSB++ [WF: 20.03 kg (95% CI: 20.27, 0.21 kg); WF-L: +0.07 kg (95% CI: 20.18, 0.31 kg)] and no effect on iron status. The 1.7-mm (95% CI: 20.1, 3.5 mm) greater increase in knee-heel length in WF-L than in CSB+ was not significant. Conclusions: No difference was found between the locally produced products (WF and WF-L) and the CSBs. Micronutrient fortification may be necessary, and small fish may be an affordable alternative to milk to improve complementary foods. The dietary role of edible spiders needs to be further explored. This trial was registered at controlled-trials.com as ISRCTN19918531. Am J Clin Nutr 2015;101:742-51. [ABSTRACT FROM AUTHOR]

Late Palaeocene to Early Eocene shales are widely distributed in Siri Canyon located in the Danish-Norwegian Basin. Geochemical study on the Late Paleocene-Early Eocene shales has revealed a common provenance of intermediate rocks, and the Rogaland anorthosite complex located in the southwestern Norway is supposed to provide the source materials. The litho-components of Late Paleocene shales were exposed to intermediate-strong weathering, and a decrease of weathering degree that probably accompanied with a shift to less oxic depositional environment was observed for the Lower Eocene shales. The change could be related to continental rift that associated with the opening of North Atlantic rifting zone at ∼56 Ma. Spatially, there is little elemental variability among the shales from different oil fields, except distinct lower Na contents in shales from the Cecilie field. The transformation of smectite to illite at greater deepth in Cecilie filed may release more Na which acts as an interlayer cation in the smectite. [ABSTRACT FROM AUTHOR]

Background: Micronutrients play an important role in immune function. To our knowledge, there have been no comprehensive studies on the role of micronutrient supplementation in children with tuberculosis. Objective: We assessed the effect of micronutrient supplementation in children treated with antituberculosis therapy (ATT). Design: A randomized, double-blind, placebo-controlled trial that used a 2 X 2 factorial design was undertaken at 2 teaching hospitals in Delhi. Children with newly diagnosed intrathoracic tuberculosis were enrolled, and they received ATT together with daily supplementation for 6 mo with either zinc alone, micronutrients without zinc, micro-nutrients in combination with zinc, or a placebo. Main outcomes were weight gain and an improvement in a chest X-ray (CXR) lesion assessed at 6 mo of treatment. Results: A total of 403 children were enrolled and randomly assigned. A microbiological diagnosis of tuberculosis was confirmed in 179 children (44.4%). The median (95% CI) increase in weight-for-age z score at 6 mo was not significantly different between subjects who received micronutrients [0.75 (0.66, 0.84)] and those who did not receive micronutrients [0.76 (0.67, 0.85)] and between subjects who received zinc [0.76 (0.68, 0.85)] and those who did not receive zinc [0.75 (0.66, 0.83)]. An improvement in CXR was observed in 285 children, but there was no difference between those receiving zinc and no zinc or between those receiving micronutrients and no micronutrients after 6 mo of ATT. However, children who received micronutrients had a faster gain in height over 6 mo than did those who did not receive micronutrients (height-for-age z score Δ = 0.08; P = 0.014). Conclusions: Micronutrient supplementation did not modify the weight gain or clearance of lesions on CXR in children with intrathoracic tuberculosis. However, micronutrient supplementation during treatment may improve height gain in children with intrathoracic tuberculosis. This trial was registered at clinicaltrials.gov as NCT00801606. [ABSTRACT FROM AUTHOR]

Objective: To assess physical activity at admission and during recovery from severe acute malnutrition. Study design: Ethiopian children who were admitted with severe acute malnutrition received a clinical examination each week to monitor their recovery during rehabilitation. Using accelerometry (24 h/d for 5 consecutive days) at admission and again after 10 days of rehabilitation, we assessed the level and changes of physical activity. Results: Among 13 children included, the mean (SD) age was 31.1 months (15.5). At baseline, the day-night activity difference was relatively small, whereas the level of activity had substantially increased at follow-up. The diurnal mean acceleration level was significantly greater at follow-up for wrist (1158.8 vs 541.4 counts per minute, P = .003) but not hip movements (204.1 vs 141.5, P = .261). During daytime (6 a.m. to 10 p.m.), hip activity increased by 38% from baseline to follow-up (eB 1.38, 95% CI 1.17-1.62), and wrist activity more than doubled (eB 2.50, 95% CI 2.17-2.87). Conclusion: The level of physical activity among children with severe acute malnutrition is very low but increases rapidly during recovery. Accelerometry may be a useful approach in the recovery phase as an indicator of early improvement. [Copyright &y& Elsevier]

Highlights: [•] The Ordovician Khabour Formation is the oldest exposed rock unit in Iraq. [•] Its sandstones are characterized silica cementation. [•] Five quartz cement phases are recognized by using SEM-CL. [•] Biogenic silica, pressure solution and hydrothermal fluids were major sources for successive quartz cement phases. [Copyright &y& Elsevier]

Background: Data on body composition in infancy may improve the understanding of the relation between variability in fetal and infant growth and disease risk through the life course. Although new assessment techniques have recently become available, body composition is rarely described in infants from low-income settings. Objective: The aim of this study was to provide reference data for fat mass (FM) and fat-free mass (FFM) from birth to the age of 6 mo from an urban African population. Design: We conducted a prospective cohort study among infants from Jimma, Ethiopia. FM and FFM were measured at birth and at 1.5, 2.5, 3.5, 4.5, and 6 mo of age with air-displacement plethysmography (ADP) validated against a stable isotope method in a subsample. Reference charts and reference tables with z scores and percentiles for FM, FFM, FM index (FMI; in kg/m²), and FFM index (FFMI: in kg/m²) were constructed with the lambda-mu-sigma method. Results: Body composition growth charts were based on a total of 2026 measurements of body composition obtained from 378 infants. FM and FMI gain progressed in a logarithmic-shaped curve and variation increased with increasing age, whereas FFM increased in an almost linear manner with a minor deceleration at around 3 mo of age. The FFMI curve showed a very modest exponential increase with age. Conclusions: By presenting z scores and centile reference charts for an apparently healthy urban Ethiopian infant population, this study represents a first step toward providing reference data on FM and FFM for an urban African context, which is important for future clinical care and research. This study was registered at www.controlled-trials.com as ISRCTN46718296. [ABSTRACT FROM AUTHOR]

Underweight is common among tuberculosis (TB) patients. However, there is little information on determinants of body composition at TB treatment initiation in high-TB-burdened countries. This study aimed to determine factors associated with body composition at commencement of TB treatment in Mwanza, Tanzania. A cross-sectional study was conducted from 2007 to 2008 among newly diagnosed TB patients. Fat and fat-free mass were determined using a deuterium dilution technique and fat and fat-free mass indices were computed. Correlates were assessed using multiple regression analysis. A total of 201 pulmonary TB patients were recruited; of these, 37.8% (76) were female, 51.7% (104) were HIV infected, 65.3% (126) had sputum-positive TB, and 24.4% (49) were current smokers. In multiple regressions analysis, males had a 2.2-kg/m² [(95% Cl = 1.6, 2.9); P < 0.00011 lower fat mass index but 1.5 kg/m² [(95% Cl = 0.9, 2.0); P < 0.00011 higher fat-free mass index compared with females. Sputum-positive TB was associated with a lower fat mass index among HIV-uninfected patients [-1.4 kg (95% Cl = -2.5, -0.4); P= 0.006] but not among HIV-infected patients (P-interaction = 0.09). Current smokers had a 0.7-kg/m² [(95% Cl = 0.02, 1.5); P = 0.045] lower fat mass index, but smoking did not affect fat-free mass. High socioeconomic status (SES) was associated with higher fat as well as fat-free mass. HIV infection, cluster of differentiation 4 count, and antiretroviral therapy were not correlates. Sex, smoking, and SES were associated with body composition of TB patients at treatment commencement. Prospective studies are needed to determine the role of these factors on weight gain, functional recovery, and survival during and after treatment. [ABSTRACT FROM AUTHOR]

Vitamin A deficiencies in pregnancy may impair the health of the mother and the growth, development, and later health of her offspring. However, the understanding of the variability of micronutrient status markers during pregnancy is limited. We measured serum retinol and β-carotene and the acute phase proteins C-reactive protein (CRP) and α1-antichymotrypsin (ACT) in 738 pregnant women in a cross-sectional study in Guinea-Bissau, West Africa. Gestational age ranged from 7 to 42 wk (mean ± SD = 23 ± 7 wk). The serum retinol concentration was 1.03 ± 0.33 μmol/L (mean ± SD) whereas serum β-carotene was 1.40 (0.85, 2.13) μmol/L [median (25, 75 percentile)]. Vitamin A deficiency (serum retinol <0.70 μmol/L) was observed in 13.8% of individuals. Serum CRP was elevated (>3 mg/L) in 51.6% of individuals and ACT (>0.3 g/L) in 66.3%. Gestational age >20 wk (β = -0.11; P < 0.001) as well as elevated serum CRP (β = -0.16; P < 0.001) and ACT (β = -0.80; P = 0.004) were associated with lower serum retinol. Based on this large cross-sectional study, we suggest that serum retinol and its conventional cutoff may be underestimating the vitamin A status in late pregnancy and in populations with high prevalence of infections. However, prospective cohort studies measuring the serum concentration of retinol during and after pregnancy and inflammation are needed to describe the physiological behavior of serum retinol and thereby to improve the assessment of vitamin A status. [ABSTRACT FROM AUTHOR]

Undernutrition is common among tuberculosis (TB) patients. The objective of this study was to assess the effect of multi- micronutrient supplementation during TB treatment on weight, body composition, and handgrip strength. A total of 865 patients with smear-positive IPTB+) or-negative IPTB-) pulmonary TB were randomly allocated to receive a daily biscuit with or without multi-micronutrients for 60 d during the intensive phase of TB treatment. Weight, arm fat area, arm muscle area, and handgrip strength were assessed at baseline and after 2 and 5 mo. At 2 mo, the multi-micronutrient supplementation led to a higher handgrip gain (1.22 kg; 95% CI = 0.50, 1.94; P= 0.0011 but had no effects on other outcomes. The effects of multi- micronutrient supplementation were modified by HIV infection (P-interaction = 0.002). Among HIV- patients, multi- micronutrient supplementation increased weight gain by 590 g (95% Cl = -40, 1210; P = 0.07) and handgrip strength by 1.6 kg (95% Cl = 0.78, 2.47; P< 0.0011, whereas among HIV+ patients, it reduced weight gain by 1440 g (95% Cl = 290, 2590; P= 0.0021 and had no effect on handgrip strength 10.07 kg; 95% Cl = -1.30, 1.46; P= 0.91). The reduced weight gain among HIV+ patients receiving multi-micronutrient supplementation seemed to be explained by a higher proportion of patients reporting fever. At 5 mo, the effects on weight were sustained, whereas there was no effect on handgrip strength. In conclusion, multi- micronutrient supplementation given as a biscuit is beneficial among HIV- PTB patients and may be recommended to TB programs. More research is needed to develop an effective supplement for HIV+ PTB patients. [ABSTRACT FROM AUTHOR]

Abstract: The Maastrichtian Pab Formation in the southern part of Pakistan is composed of fine- to very coarse-grained texturally mature quartz arenite and subordinate sublitharenite varieties. The sandstones have undergone intense and complex diagenetic episodes due to burial and uplift. Diagenetic modifications were dependent mainly on the clastic composition of sandstone, burial depth and thrust tectonics. Diagenetic events identified include compaction, precipitation of calcite, quartz, clay minerals and iron oxide/hydroxide, dissolution and alteration of unstable clastic grains as feldspar and volcaniclithic fragments as well as tectonically induced grain fracturing. The unstable clastic grains like feldspar and lithic volcanic fragments suffered considerable alteration to kaolinite and chlorite. Dissolution and alteration of feldspar and volcanic lithic fragments and pressure solution were the main sources of quartz cements. Mechanical compaction and authigenic cements like calcite, quartz and iron oxide/hydroxide reduced the primary porosity, whereas dissolution of clastic grains and cements has produced secondary porosity. Chlorite coatings on clastic grains have prevented quartz cementation. Coarse-grained, thick bedded packages of fluviodeltaic, shelf delta lobe and submarine channels facies have higher average porosity than fine-grained, thin bedded and bioturbated sandstone of deeper shelf and abyssal plain environments and these facies are concluded to be possible future hydrocarbon prospects. [Copyright &y& Elsevier]

Abstract: The standard closed circuit comminution process commonly employed in industrial vertical roller mills has been analyzed to determine the influence of typical abrasive minerals on wear rates. With the main focus on raw mixes used in cement plants, synthetic mixtures imitating were prepared. Using statistical planning, a total of 10 tests were carried out with two different limestones and one type of quartz sand. The size distributions were kept constant and only the mixing ratios were varied. It appears from the investigation that mixtures consisting of minerals with different grindabilities result in an increased concentration of abrasive particles in the grinding bed . The present study shows that the quartz concentration in the grinding bed is determining the wear rate. [Copyright &y& Elsevier]

Abstract: The Hermod sand of the Stine Segments, Siri Field, Danish North Sea, displays large permeability variations (1–600mD). These permeability variations represent horizontal layering in the reservoir, largely formed by diagenetic processes. They have a significant impact on reservoir performance, because horizontal producers in fairly thin reservoirs (∼30m) are protected against bottom-water influx and can produce water-free for long periods of time. This paper presents the results of a detailed multidisciplinary study where the observed variation in permeability can be explained by two main diagenetic phases: silica, as opal cement and microquartz, and berthierine, a serpentine mineral that is closely related to chlorite. Opal/microquartz and berthierine cements dominate in separate parts of the reservoir bodies. Opal/microquartz cemented sands have high permeability (typically 500–600mD). Berthierine cement has a different growth pattern in the oil and water zones, resulting in intermediate permeability in the oil zone (typically 50–100mD) and very low permeability in the water zone (typically 1–10mD). [Copyright &y& Elsevier]

Vitamin D is essential to immune function, but little is known about the vitamin D status in equatorial populations. A cross-sectional study was conducted among pulmonary tuberculosis (PTB) patients in Mwanza, Tanzania to identify the predictors of their vitamin D status. Data on sociodemography, season, and intake of food, alcohol, tobacco, and soil were collected, anthropometric measurements taken, and serum α1-antichymotrypsin (ACT), ferritin and soluble transferrin receptor (sTfR), and serum 25-hydroxy-(ergocalciferol + cholecalciferol) [25(OH)D] determined. Of the 655 patients studied, 79.7% 1508/637) were culture-positive (PTB+l and 47.2% HIV infected. Mean serum ACT, an acute phase reactant, was 0.73 ± 0.25 g/L with 69.2% >0.6 g/L. Mean serum 25(OH(D was 86.6 ± 32.9 nmol/L, with 41.2% <75 nmol/L. Serum 25(OH)D was highest during the harvest season, May to July, compared with the remaining year. Single subjects had lower (10.4 (95% Cl 4.0; 16.9) nmol/L] serum 25(OH)D concentrations than married subjects and PTB+ patients had concentrations lower 18.2 (95% Cl 1.5; 14.9) nmol/L] than PTB-patients. Serum 25(OH)D increased with consumption of a large freshwater fish but not of small dried fish or other foods. BMI and serum TfR were positive predictors of serum 25(OH)D, whereas neither elevated serum ACT nor HIV were predictors. In conclusion, serum 25(OH)D is a valid measure of vitamin D status during the acute phase response. The lower concentrations in PTB+ patients may reflect lower sun exposure or increased utilization. The health consequences of hypovitaminosis D in low-income equatorial populations, at risk for both infectious and chronic diseases, should be studied. [ABSTRACT FROM AUTHOR]

Fortified blended foods (FBF), especially corn soy blend, are used as food aid for millions of people worldwide, especially malnourished individuals and vulnerable groups. There are only a few studies evaluating the effect of FBF on health outcomes, and the potential negative effect of antinutrients has not been examined. Different lines of evidence suggest that dairy proteins have beneficial effects on vulnerable groups. Here we review the evidence on the effects of adding whey or skimmed milk powder to FBF used for malnourished infants and young children or people living with HIV or AIDS. Adding whey or skimmed milk powder to FBF improves the protein quality, allowing a reduction in total amount of protein, which could have potential metabolic advantages. It also allows for a reduced content of soy and cereal and thereby a reduction of potential antinutrients. It is possible that adding milk could improve weight gain, linear growth, and recovery from malnutrition, but this needs to be confirmed. Bioactive factors in whey might have beneficial effects on the immune system and muscle synthesis, but evidence from vulnerable groups is lacking. Milk proteins will improve flavor, which is important for acceptability in vulnerable groups. The most important disadvantage is a considerable increase in price. Adding 10-15% milk powder would double the price, which means that such a product should be used only in well-defined vulnerable groups with special needs. The potential beneficial effects of adding milk protein and lack of evidence in vulnerable groups call for randomized intervention studies. [ABSTRACT FROM AUTHOR]

Iron deficiency is widespread in sub-Saharan Africa, but its predictors are not fully understood. We conducted a cross-sectional study among adults around Lake Victoria to describe iron status and asses the role of dietary and infectious predictors. Linear regression analyses were used to assess the role of infections and intake of meat, fish, fruit/vegetables, alcoholic beverages, and soil on hemoglobin and serum ferritin, while controlling for elevated serum alpha(1)-antichymotrypsin (ACT). Among 1498 participants, the mean age was 33.3 (14-87) y with 53.9% females. More than one-half ate fish daily, 6% ate fruit/vegetables daily, and only 11% ate meat weekly. One-third consumed alcoholic beverages and one-fifth of females consumed soil. Hookworm (80.3%), Schistosoma mansoni (64.7%), and HIV (7.3%) infection were common. Anemia was found in 48.2% of females (<120 g/L hemoglobin) and 40.1% of males (<130 g/L hemoglobin), and 22.3% of females and 7.0% of males had depleted iron stores (serum ferritin <12 microg/L). In multivariate analyses, alcoholic beverage consumption and HIV were positive, whereas soil eating and hookworm infection were negative predictors of serum ferritin. Alcoholic beverage consumption was a positive predictor of hemoglobin, and soil eating, HIV, and hookworm infection were negative predictors. Intakes of meat, fish, and fruit or vegetables were not predictors. Elevated serum ACT was a predictor of both hemoglobin and serum ferritin. Anemia and depleted iron stores were common, whereas iron overload was rare. In conclusion, the associations between alcoholic beverage intake and hemoglobin and iron status suggest that alcoholic beverages may contain micronutrients essential to erythropoiesis. The role of alcoholic beverage intake and other determinants of hemoglobin and iron status in low-income populations needs to be better elucidated. [ABSTRACT FROM AUTHOR]

Abstract: Elemental geochemistry of 1131 sandstone samples has been used to characterise five Palaeogene sandstone members in a system of density flow deposits within an incised submarine canyon, Danish North Sea. Diagenetic overprinting has complicated the use of most main and trace elements, but a group of “heavy mineral bound” elements with low mobility (Ti, Y, Zr, Nb and Th) has proved highly potential for correlation. The individual sandstone members exhibit very consistent relations between the “heavy mineral elements” along the canyon and, based on Zr/Ti plots, two families of sandstone members can be distinguished. The families are recognised on variations in inclination and intersection of linear regression lines which are related to subtle variations in provenance/source area. The inclination is believed to be controlled by the detrital heavy mineral (HM) suite and composition, whereas the intersections are controlled by the background contribution, such as HM inclusions in detrital rock forming minerals, e.g. quartz and/or feldspar, as well as substituted and/or adhered elements in glauconite. The correlation pattern has been used to suggest a re-interpretation of the stratigraphic relation of some of the sands. [Copyright &y& Elsevier]