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Background: In 2014, the World Food Programme added to an ongoing health and nutrition program named "Sante Nutritionnelle a Assise Communautaire dans la region de Kayes" (SNACK), the distribution of cash to mothers and/or lipid-based nutrient supplement (LNS) to children aged 6-23 mo, conditional upon attendance at community health centers (CHCs) during the first 1000 d of life. Objective: We evaluated the additional impact of the distribution of cash and/or LNS on mean height-for-age z scores (HAZ; primary outcome), stunting (HAZ < -2), and on intermediate outcomes along the program impact pathways. Methods: In a cluster-randomized controlled trial using a 2 x 2 factorial design, 76 CHCs were randomly assigned to deliver either SNACK, SNACK + Cash, SNACK + LNS, or SNACK + Cash + LNS. Cross-sectional surveys among 12- to 42-mo-old children and their mothers were conducted at baseline (2013, n = 5046) and at endline (2016, n = 5098). Results: Factorial analysis showed no interaction between cash and LNS treatments for HAZ, but found an antagonistic interaction for stunting (OR: 1.55; 95% CI: 1.05, 2.31; P = 0.03). There were no impacts of the cash, LNS, or cash + LNS treatments, compared with the SNACK alone, on either HAZ or stunting (treatment x time interaction). There were significant impacts of the LNS and cash + LNS treatments on attendance at =1 growth monitoring (GM) session (OR: 3.95; 95% CI: 1.69, 9.24; OR: 3.90; 95% CI: 1.73, 8.81, respectively) and half the expected sessions (OR: 4.72; 95% CI: 1.47, 15.17; OR: 5.25; 95% CI: 1.82, 15.11, respectively), mothers' knowledge on importance of GM (OR: 1.98; 95% CI: 1.16, 3.39; OR: 3.12; 95% CI: 1.60, 6.09, respectively), and, only for the LNS group, appropriate timing for complementary feeding (OR: 1.62; 95% CI: 1.09, 2.41). Conclusions: Implementation constraints and suboptimal participation in program activities may explain the lack of impact on child linear growth in this rural region of Mali.

International audience; Background: The popularity of nutrition-sensitive interventions calls for high-quality monitoring and evaluation tools. In this context, the Minimum Dietary Diversity for Women of Reproductive Age (MDD-W), validated as a proxy of micronutrient adequacy, does fill a gap. However, because it is a newly endorsed indicator, information on its linkages with other dimensions of food and nutrition security is still scarce. Objective: The objective of this study was to investigate whether the MDD-W is related to household food insecurity and farm production diversity. Methods: A cross-sectional survey on a representative sample of 5046 women of reproductive age was conducted in the region of Kayes, Mali, in 2013. Dietary diversity was assessed through qualitative 24-h recall, and MDD-W was computed. MDD-W equaled 1 if the women consumed at least 5 different food groups and 0 otherwise. Food insecurity was measured using the Household Food Insecurity Access Scale and the Household Hunger Scale (HHS), and a farm production diversity score (FPDS) was calculated based on a count of food crops/livestock groups produced. Logistic regressions were used to assess the relation between MDD-W and the indicators of household food security. Results: Only 27% of women reached the MDD-W. These women consumed animal source foods and/or vitamin A-rich vegetables and fruits more frequently than did other women. Women from extremely food insecure households (moderate to severe hunger according to the HHS) were less likely to reach the MDD-W (OR: 0.70; 95% CI: 0.50, 0.97). One more group in the FPDS increased the odds of attaining the MDD-W (OR: 1.12; 95% CI: 1.06, 1.18). Conclusion: In the rural region of Kayes, Mali, women's dietary diversity, as measured by the MDD-W, was associated with household-level food security indicators. This study was registered at ISRCTN.org as ISRCTN08435964.

Introduction: In many developing countries including Vietnam, data are lacking on vitamin D and calcium deficiencies whereas those deficiencies can play an important role in the development of bone health and possibly non-communicable diseases. The purpose of this study was to determine the overall prevalence of vitamin D and calcium deficiencies in women and young children and their nutritional related risk factors. Methods: A cross-sectional study conducted among 595 women of reproductive age and 532 children,5 years from 19 provinces of Vietnam. For each individual, data concerning daily diet, socioeconomic group, anthropometric status were obtained, and plasma concentrations of calcium and vitamin D were measured. Results: The prevalence of hypovitaminosis D status was very high, with the prevalence of vitamin D deficiency (25(OH) D, 30 nmol/L) and insufficiency (25(OH) D between 30-49.9 nmol/L) being 17% and 40% in women and 21% and 37% in children, respectively. Using more liberal cut-off of 75 nmol/L, approximately 90% of the women and children were classified as having hypovitaminosis D. Overweight/obese women had a 2 times lower risk (OR = 0.46, [0.24-0.90]) for vitamin D deficiency than non-overweight and non-obese women. No participant had severe calcium deficiency but moderate and mild hypocalcaemia (plasma calcium concentrations between 1.15-0.9 mmol/L for mild deficiency and between 0.9-0.8 mmol/L for moderate deficiency) affected respectively 14% and 83% of the women with 97% of the children having mild hypocalcaemia. Women and children consumed about 1% of the Institute of Medicine (IOM) recommended nutrient intake (RNI) for vitamin D and less than 43% of the RNI for calcium. Conclusion: Our study suggests that calcium and vitamin D deficiencies represent a major public health concern in Vietnam. Thus, actions to improve the vitamin D and calcium status of the Vietnamese population should be considered.

Background: The 2000 Vietnamese National Nutrition Survey showed that the population's dietary intake had improved since 1987. However, inequalities were found in food consumption between socioeconomic groups. As no national data exist on the prevalence of micronutrient deficiencies, a survey was conducted in 2010 to assess the micronutrient status of randomly selected 1526 women of reproductive age and 586 children aged 6-75 mo. Principal Findings: In women, according to international thresholds, prevalence of zinc deficiency (ZnD, 67.2 +/- 2.6%) and vitamin B12 deficiency (11.7 +/- 1.7%) represented public health problems, whereas prevalence of anemia (11.6 +/- 1.0%) and iron deficiency (ID, 13.7 +/- 1.1%) were considered low, and folate (= 23 kg/m(2) for Asian population) or underweight occurred in 20% of women respectively highlighting the double burden of malnutrition. In children, a similar pattern was observed for ZnD (51.9 +/- 3.5%), anemia (9.1 +/- 1.4%) and ID (12.9 +/- 1.5%) whereas prevalence of marginal vitamin A status was also high (47.3 +/- 2.2%). There was a significant effect of age on anemia and ID prevalence, with the youngest age group (6-17 mo) having the highest risk for anemia, ID, ZnD and marginal vitamin A status as compared to other groups. Moreover, the poorest groups of population had a higher risk for zinc, anemia and ID. Conclusion: The prevalence of anemia and ID in Vietnam has been markedly reduced over the last decade, but a large part of the population is still at risk for other deficiencies such as zinc, vitamin A, folate and vitamin B12 especially the youngest children aged 6-17 mo. Consequently specific interventions to improve food diversity and quality should be implemented, among them food fortification of staple foods and condiments and improvement of complementary feeding.

Ces dernières années, les modes de consommation alimentaires ont considérablement évolué, aussi bien au sein des sociétés occidentales qu'au sein des pays en développement. Propre à chacun, leur impact direct en Santé est indéniable. La compréhension des pratiques de consommation est donc naturellement au coeur des problématiques nutritionnelles actuelles. L'utilité d'identification de groupes de consommateurs n'est ainsi plus à démontrer ; mais aujourd'hui aucune classification ne fait consensus. C'est pourquoi il convient d'en proposer de nouvelles. S'affranchissant de tout a priori, l'approche non-supervisée s'impose à l'approche supervisée de façon évidente. D'autre part, si les méthodes hiérarchiques peuvent être envisagées, les méthodes non-hiérarchiques présentent l'avantage de donner des groupes distincts les uns des autres sans intégrer la notion de formation séquentielle (pas à pas) de ces groupes et laisser supposer que certains soient seulement le résultat de scissions de « sur-groupes ». Au contraire, les consommateurs peuvent être considérés simultanément. La méthode des cartes de Kohonen, particulièrement adaptée pour les problématiques de grandes dimensions comme les problématiques nutritionnelles, réunit ces deux conditions : elle est non-supervisée et non-hiérarchique. L'algorithme repose en effet sur un apprentissage non supervisé et elle est, de plus, caractérisée par l'association de réponses voisines. On la définit aussi comme une méthode d'auto-organisation. Appliquée à des bases de données nutritionnelles accessibles, les cartes de Kohonen ont permis de partitionner les consommateurs selon leurs habitudes alimentaires et de fait d'identifier des profils de consommateurs. La classification de Kohonen : un outil précieux dans la compréhension des problématiques nutritionnelles.