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Background: Early growth and body composition may influence risk of obesity and health in adulthood. Few studies have examined how undernutrition is associated with body composition in early life.Objective: We assessed stunting and wasting as correlates of body composition in young Kenyan children.Methods: Nested in a randomized controlled nutrition trial, this longitudinal study assessed fat and fat-free mass (FM, FFM) using deuterium dilution technique among children at age 6 and 15 months. Cross-sectional and longitudinal associations between z-score categories of length-for-age Z (LAZ) or weight-for-length Z (WLZ) and FM, FFM, fat mass index (FMI), fat-free mass index (FFMI), triceps and subscapular skinfolds were analyzed by linear mixed models.Results: Among 499 children enrolled, breastfeeding declined from 99% to 87%, stunting increased from 13% to 32% and wasting remained at 2-3% between 6 and 15 months. Compared to LAZ >0, stunted children had 1.12 (95% CI: 0.88;1.36, P <0.001) kg lower FFM at 6 months increasing to 1.59 (95% CI: 1.25;1.94, P <0.001) kg at 15 months, corresponding to differences of 18% and 17%, respectively. When analysing FFMI, the deficit in FFM tended to be less than proportional to children's height at 6 months (P ≤0.060), but not at 15 months (P >0.40). Stunting was associated with 0.28 (95% CI: 0.09;0.47, P =0.004) kg lower FM at 6 months. The difference lost significance at 15 months, and stunting was not associated with FMI at any time point. Lower WLZ was generally associated with lower FM, FFM, FMI and FFMI at 6 and 15 months. Differences in FFM, but not FM, increased with time, while FFMI differences did not change and FMI differences generally decreased with time.Conclusions: Overall, low LAZ and WHZ among young Kenyan children is associated with reduced lean tissue, which may have long-term health consequences.Trial reg

Background: Few studies have evaluated the body composition (BC) of adults who suffered from severe acute malnutrition (SAM) during childhood, a population at risk of long-term noncommunicable diseases. Objective: We performed an observational cohort study to evaluate BC in a group of young adults aged 11–30 y after nutritional rehabilitation for SAM, in the Democratic Republic of the Congo (DRC). Methods: We evaluated 151 adults in eastern DRC who were treated for SAM during childhood between 1988 and 2007. They were compared with 120 aged- and sex-matched control adults living in the same community who had not been exposed to malnutrition as children. The main variables of interest were the different compartments of adult BC (fat-free mass [FFM], fat mass [FM], and 2 indices of height-normalized BC: FFM index [FFMI] and FM index [FMI]) measured by deuterium dilution. Results: The mean age in both groups was 23 y, and females represented 49% and 56% of the exposed and nonexposed groups, respectively. SAM-exposed males had lower mean ± SD weight (53.6 ± 6.4 compared with 56.4 ± 7.9 kg, P = 0.029) and lower height (159.9 ± 6.6 compared with 163.6 ± 6.7 cm, P = 0.003) compared to unexposed males. SAM-exposed subjects had less FFM (–1.56 kg [–2.93, –0.20]; P = 0.024) but this observation was more marked in males (45.4 ± 5.4 compared with 48.2 ± 6.9 kg, P = 0.01) than in females. No differences in FM were noted between SAM-exposed and unexposed subjects. Adjusting for height, FFMI and FMI showed no difference between SAM-exposed and unexposed in either sex. Conclusion: SAM during childhood is associated with reduced FFM in adulthood which is probably due to a shorter height.

Background: Few studies have evaluated the body composition (BC) of adults who suffered from severe acute malnutrition (SAM) during childhood, a population at risk of long-Term noncommunicable diseases. Objective: We performed an observational cohort study to evaluate BC in a group of young adults aged 11-30 y after nutritional rehabilitation for SAM, in the Democratic Republic of the Congo (DRC). Methods: We evaluated 151 adults in eastern DRC who were treated for SAM during childhood between 1988 and 2007. They were compared with 120 aged-and sex-matched control adults living in the same community who had not been exposed to malnutrition as children. The main variables of interest were the different compartments of adult BC (fat-free mass [FFM], fat mass [FM], and 2 indices of height-normalized BC: FFM index [FFMI] and FM index [FMI]) measured by deuterium dilution. Results: The mean age in both groups was 23 y, and females represented 49% and 56% of the exposed and nonexposed groups, respectively. SAM-exposed males had lower mean ± SD weight (53.6 ± 6.4 compared with 56.4 ± 7.9 kg, P = 0.029) and lower height (159.9 ± 6.6 compared with 163.6 ± 6.7 cm, P = 0.003) compared to unexposed males. SAM-exposed subjects had less FFM (-1.56 kg [-2.93,-0.20]; P = 0.024) but this observation was more marked in males (45.4 ± 5.4 compared with 48.2 ± 6.9 kg, P = 0.01) than in females. No differences in FM were noted between SAM-exposed and unexposed subjects. Adjusting for height, FFMI and FMI showed no difference between SAM-exposed and unexposed in either sex. Conclusion: SAM during childhood is associated with reduced FFM in adulthood which is probably due to a shorter height., SCOPUS: ar.j, info:eu-repo/semantics/published

Severe and moderate acute malnutrition are among the leading causes of mortality among children in low- and middle-income countries. There is strong evidence that growth assessed anthropometrically from conception to 2 years of age marks later risk of ill-health. This is central to the concept of the developmental origins of adult disease and is presumed to be related to modification of developmental processes during critical "window(s)" of vulnerability. Interventions to treat acute malnutrition have resulted in dramatic increase in the number of affected children surviving. Ensuring that these children thrive to fulfil their full physical and cognitive potential is a new challenge. Integral to this challenge is the need to be able to measure how earlier insults relate to the ability to survive and thrive to productive adulthood. Despite its obvious value, routine anthropometry does not adequately indicate how earlier adverse exposures affect more refined aspects of growth. Anthropometry is inadequate for predicting how disruption of healthy growth might modulate risk of disease, or any subsequent interventions correct this risk. A clear characterisation of healthy child growth is needed for determining which component best predicts later outcomes. The extent to which postnatal acute malnutrition is a consequence of maternal factors acting pre-conception or in-utero and their relationship to postnatal health and long-term risk of non-communicable diseases is not clear. Body composition measurement has significant untapped potential allowing us to translate and better understand the relationship between early insults and interventions on early growth in the short-term and long-term health outcomes.

The impact of quality complementary food products on infant growth and body composition has not been adequately investigated. This study evaluated the effect on fat-free mass (FFM) accrual, linear growth and iron status of locally produced complementary food products comparing to a standard product. In a randomized, double-blind trial, 499 infants at 6 mo received 9 monthly rations of: 1) WinFood Classic (WFC) comprising germinated amaranth (71%), maize (10.4%), small fish (3%) and edible termites (10%); 2) WinFood Lite (WFL) comprising germinated amaranth (82.5%), maize (10.2%) and multi-micronutrient premix; or 3) fortified Corn-soy blend plus (CSB+). Primary outcomes were changes in FFM, length, and plasma ferritin and transferrin receptors (TfR). FFM was determined using deuterium dilution. Analysis was by intention-to-treat, based on available cases. Compared to CSB+, there were no differences in change from 6 to 15 mo in FFM for WFC 0.0 kg, (95% CI:-0.30, 0.29) and WFL 0.03 kg, (95% CI:-0.25, 0.32) and length change for WFC -0.3 cm (95% CI:-0.9, 0.4) and WFL -0.3 cm (95% CI:-0.9, 0.3). TfR increased in WFC group 3.3 mg/L (95% CI: 1.7, 4.9) and WFL group 1.7 mg/L (95% CI: 0.1, 3.4) compared to CSB+. Compared to the increase in Hb in CSB+ group, there was a reduction in Hb in WFC of -0.9 g/dl (95 %CI:-1.3,-0.5) and a lower increase in WFL -0.4 g/dl (95 %CI:-0.8, 0.0). In conclusion, the tested WinFoods had the same effect on FFM and length as CSB+, while Hb and iron status decreased, suggesting inhibited iron bioavailability from the amaranth-based WinFoods.

Because edible insects provide nutritional and environmental benefits, there is a focus on establishing and optimizing the insect production sector and developing the value chain. However, little is known about consumers' reactions to insects as food. This paper provides a first insight into consumers' preferences for termite-based food products (TBFPs) using data from a choice experiment survey in Kenya. A novel feature of this paper is that it investigates the combined effects of product-related and contextual attributes, as well as consumer attitudes on preferences for TBFPs. In addition, the paper focuses on the extent to which preferences may be affected depending on the meal formats, i.e. whether the termites are introduced either as whole insects or as a processed component in a typical daily meal. The results suggest that consumers prefer TBFPs with high nutritional value and especially when they are recommended by officials. Results further indicate that affirmative recommendations are particularly important for the processed TBFP, and consumers prefer to buy this type of product in kiosks or supermarkets than at local marketplaces. Despite a considerable degree of preference heterogeneity, most consumers react positively to whole as well as processed termites. Therefore, the introduction of TBFPs is likely to succeed regardless of whether the termites are processed or not, although introducing the processed product may require further information and quality assurances to alleviate perceived food risks., Because edible insects provide nutritional and environmental benefits, there is a focus on establishing and optimizing the insect production sector and developing the value chain. However, little is known about consumers' reactions to insects as food. This paper provides a first insight into consumers' preferences for termite-based food products (TBFPs) using data from a choice experiment survey in Kenya. A novel feature of this paper is that it investigates the combined effects of product-related and contextual attributes, as well as consumer attitudes on preferences for TBFPs. In addition, the paper focuses on the extent to which preferences may be affected depending on the meal formats, i.e. whether the termites are introduced either as whole insects or as a processed component in a typical daily meal. The results suggest that consumers prefer TBFPs with high nutritional value and especially when they are recommended by officials. Results further indicate that affirmative recommendations are particularly important for the processed TBFP, and consumers prefer to buy this type of product in kiosks or supermarkets than at local marketplaces. Despite a considerable degree of preference heterogeneity, most consumers react positively to whole as well as processed termites. Therefore, the introduction of TBFPs is likely to succeed regardless of whether the termites are processed or not, although introducing the processed product may require further information and quality assurances to alleviate perceived food risks.

Edible insects are receiving substantial attention because of their potential as a significant future food source of high nutritional value and with important environmental benefits. As a result, there is a focus on the supply side to establish and optimize the insect production sector and develop the value chain. However, as the ultimate success of a product development depends on consumers' product judgement and acceptance, acquiring information about potential demand is of paramount importance for policy advice. In this paper, we aim to give a first insight into the potential demand for termite-based food products (TBFPs) in Kenya. We assess the demand in terms of consumer preferences and willingness to pay using a stated choice experiment method. A novel feature of this paper is that it focuses on how the termites should be presented and introduced, either as whole or processed, in a typical daily meal in order to increase consumer acceptance. Results from the latent class model reveal that consumers prefer and are willing to pay more for TBFPs with high nutritional value and when they are recommended by officials. In addition, results show that high to a very high food safety control levels of the TBFPs are valued positively by most consumers., Edible insects are receiving substantial attention because of their potential as a significant future food source of high nutritional value and with important environmental benefits. As a result, there is a focus on the supply side to establish and optimize the insect production sector and develop the value chain. However, as the ultimate success of a product development depends on consumers' product judgement and acceptance, acquiring information about potential demand is of paramount importance for policy advice. In this paper, we aim to give a first insight into the potential demand for termite-based food products (TBFPs) in Kenya. We assess the demand in terms of consumer preferences and willingness to pay using a stated choice experiment method. A novel feature of this paper is that it focuses on how the termites should be presented and introduced, either as whole or processed, in a typical daily meal in order to increase consumer acceptance. Results from the latent class model reveal that consumers prefer and are willing to pay more for TBFPs with high nutritional value and when they are recommended by officials. In addition, results show that high to a very high food safety control levels of the TBFPs are valued positively by most consumers.

BACKGROUND: Researchers face myriad challenges in the design and implementation of randomized, controlled trials. Apart from summaries on limitations, these challenges are rarely documented in detail to inform future research projects.OBJECTIVE: To describe methodological challenges encountered during randomized, controlled trials (WinFood Study) designed to assess the efficacy of locally produced complementary foods based on traditional animal-source foods (edible termites and spiders) to support growth and nutritional status in Kenyan and Cambodian infants.METHODS: In a randomized, controlled design, infants received WinFood or corn-soy blend (CSB) for 9 months from 6 to 15 months of age. Lean mass accrual and blood nutrition indicators (lipid profile, iron and zinc status) were measured cross-sectionally at 9 and 15 months of age, respectively. Lean mass was determined by measuring deuterium oxide enrichment in saliva samples following a standard dose of deuterium solution (0.5 g/kg body weight) to infants. Blood nutrition indicators were determined following the drawing of 3 mL of blood by venipuncture.RESULTS: Challenges included rapid depletion of food rations, high rate of loss to follow-up, delayed ethical approval, lack of local food-processing capacity, low capacity among staff to draw blood, and lack of laboratory capacity to perform both deuterium oxide and micronutrient status measurements. Spillage of deuterium oxide solution during dosing was a major challenge in the Kenya context. A high rate of morbidity among infants made some assessments very difficult, especially drawing of blood and saliva samples.CONCLUSIONS: The challenges were largely contextual. Improvement of local laboratory capacity, training of staff and sensitization of the communities and the Ethics Review Committee are highly recommended.

Community-based Management of Acute Malnutrition using ready-to-use therapeutic food (RUTF) has revolutionised the treatment of severe acute malnutrition (SAM). However, 25% milk content in standard peanut-based RUTF (P-RUTF) makes it too expensive. The effectiveness of milk-free RUTF has not been reported hitherto. This non-blinded, parallel group, cluster randomised, controlled, equivalence trial that compares the effectiveness of a milk-free soy-maize-sorghum-based RUTF (SMS-RUTF) with P-RUTF in treatment of children with SAM, closes the gap. A statistician randomly assigned health centres (HC) either to the SMS-RUTF (n=12; 824 enrolled) or P-RUTF (n=12; 1103 enrolled) arms. All SAM children admitted at the participating HCs were enrolled. All the outcomes were measured at individual level. Recovery rate was the primary outcome. The recovery rates for SMS-RUTF and P-RUTF were 53.3% and 60.8% for the intention-to-treat (ITT) analysis and 77.9% and 81.8% for per protocol (PP) analyses, respectively. The corresponding adjusted risk difference (ARD) and 95% confidence interval, were -7.6% (-14.9, 0.6%) and -3.5% (-9,6. 2.7%) for ITT (P=0.034) and PP analyses (P=0.257), respectively. An unanticipated interaction (interaction P<0.001 for ITT analyses and 0.0683 for PP analyses) between the study arm and age group was observed. The ARDs were -10.0 (-17.7 to -2.3)% for ITT (P=0.013) and -4.7 (-10.0 to 0.7) for PP (P=0.083) analyses for the <24 months age group and 2.1 (-10.3,14.6)% for ITT (P=0.726) and -0.6 (-16.1, 14.5) for PP (P=0.939) for the ≥24 months age group. In conclusion, the study did not confirm our hypothesis of equivalence between SMS-RUTF and P-RUTF in SAM management., SCOPUS: ar.j, FLWIN, info:eu-repo/semantics/published

The diversity of traditional foods in Kisumu West District of Western Kenya was assessed with an aim to identify the foods with a potential for complementary feeding. Leaves were the most consumed plant part amongst vegetables, while a few fruits were consumed together with their seeds. Amaranthus cruentus L. was found to be consumed as a leafy vegetable while another variety, Amaranthus hybridus L. was found to be consumed as a grain. Four species of winged termites, a grasshopper, black ant and dagaa fish were also identified. Twelve of the traditional foods were found to be associated with nutritional and health benefits as perceived by the locals. Traditional food processing methods such as boiling, fermentation and sun drying were identified. Thus exploitation of the species possessing nutrient, health and processing benefits needs to be explored in complementary feeding.

We assessed acceptability of two flours and porridges of complementary foods based on germinated grain amaranth and maize with or without edible termites and dagaa small fish named "Winfood Classic" (WFC) and "Winfood Lite" (WFL), respectively, compared to Corn Soy Blend Plus (CSB+) among mothers and young children. A total of 57 children consumed each of the three foods on separate days with one­day washout between foods. Each food was considered acceptable if the child consumed at least 75% of the serving. Most mothers preferred WFLflour and porridge (63.2% and 70.2%, respectively) compared to WFC (24.4% and 10.5%) and CSB+ (12.3% and 19.3%). Children consuming at least 75% of served porridge were 43%, 19.6% and 21% for WFL, WFC and CSB+, respectively. No adverse effects were observed for all the foods throughout the study period and follow up lasting 4 weeks. All foods were acceptable and can be further developed and be tested for efficacy.

Background: Lipid-based ready-to-use foods are currently used for infant feeding, but their potential effect on breast-milk intake is not well documented. Objective: The objective was to assess the breast-milk intake of 9-10-mo-old infants given either a ready-to-use complementary food (RUCF) paste or a standard corn-soy blend (UNIMIX) porridge in South Kivu, Democratic Republic of Congo. Design: Infants were randomly assigned at 6 mo of age to receive either RUCF (n = 700) or UNIMIX (n = 700) for 6 mo. Breast-milk intake was measured at 9-10 mo in a subsample of 58 infants (29 from each group). Mothers received a dose of ≈30 g deuterium oxide. Predose and postdose saliva samples were collected from both mothers and infants over 2 wk. Breast-milk intake (g/d) was measured from saliva samples by using infrared spectroscopy. Results: Mean (±SD) breast-milk intake was not significantly (P = 0.69) different between the 2 groups: RUCF (705 ± 236 g/d) and UNIMIX (678 ± 285 g/d). Mean (±SD) nonmilk oral water intakes were 338.3 ± 251.1 and 336.4 ± 227.2 g/d for RUCF and UNIMIX, respectively (P = 0.98). Conclusions: No differences in breast-milk intake were observed between infants consuming either RUCF or UNIMIX. The deuterium-dose-to-the- mother dilution technique is an affordable technique that we recommend for periodic evaluation of breast-milk intake in resource-poor settings. This trial is registered at controlled-trials.com as ISRCTN20267635. © 2011 American Society for Nutrition., SCOPUS: ar.j, info:eu-repo/semantics/published