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This study estimates the prevalence of food insecurity, mental well-being, and their associations among immigrants and compares the food insecurity-mental well-being associations with nonimmigrants globally and by region.The Gallup World Poll data from 2014 to 2019 were analyzed in 2021. A total of 36,313 immigrants and 705,913 nonimmigrants were included. Food insecurity was measured by the Food Insecurity Experience Scale. Mental well-being was assessed using the Negative Experience Index and Positive Experience Index. A community attachment index was used to measure the living environment. Multilevel mixed-effect linear models were used to examine how the Negative Experience Index/Positive Experience Index was associated with food insecurity and the community attachment index in immigrants and nonimmigrants, adjusting for sociodemographic characteristics, survey years, and country fixed effects. The modifying effects of immigration status on food insecurity-mental well-being associations were tested.The weighted proportion of food insecurity among global immigrants was 38.6% during 2014-2019. In the pooled adjusted model, food insecurity was dose-responsively associated with greater Negative Experience Index and lower Positive Experience Index than the food-secure ref (p0.001 for trend). Similar dose-response associations were observed in nonimmigrants and in region-specific analyses. Community attachment marginally affected the food insecurity-mental well-being associations (all p≤0.001 for interaction). Immigration status significantly modified the food insecurity-mental well-being associations in all analyses (all p=0.01 for interaction), and immigrants experienced poorer mental well-being than nonimmigrants at the same level of community attachment and food insecurity.Food insecurity is prevalent and is associated with poor mental well-being in immigrants worldwide. Future interventions are needed to alleviate food insecurity and promote community attachment to improve mental health among immigrants, especially in Asian and Pacific countries.

Poor complementary feeding (CF) challenges early childhood growth. We examined the trends and influencing factors of CF practices among children aged 6-23 months in Côte d'Ivoire. Using data from Demographic and Health Surveys (DHS, 1994-2011) and Multiple Indicator Cluster Surveys (MICS, 2000-2016), the trends and predictors of World Health Organization-United Nations International Children's Emergency Fund CF indicators including the timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD) and minimum acceptable diet (MAD) were determined. Using 2016 MICS data, we applied multivariate logistic regression models to identify factors associated with CF indicators. Between 1994 and 2016, the mean proportion of children aged 6-8 months achieving INTRO was 56.9% and increased by about 25% points since 2006. Over 2011-2016, the proportion of children aged 6-23 months meeting MMF, MDD and MAD increased from 40.2% to 47.7%, 11.3% to 26.0% and 4.6% to 12.5%, respectively. Older children and those from urban households had higher odds of meeting MDD and MAD. Maternal TV watching was associated with higher odds of meeting MDD. The secondary or higher education levels of mothers significantly predicted higher odds of meeting INTRO and MDD. Currently, breastfeeding was also positively associated with odds of meeting MMF and MAD. Children from poorer households had lower odds of meeting MMF, MDD and MAD. Despite the improvements, CF practices remain suboptimal in Côte d'Ivoire. Influencing factors associated with CF were distributed across individual, household and community levels, calling for future programmes and policies to implement multi-level strategies to improve young children's diet in Côte d'Ivoire.

BackgroundIron deficiency (ID) and iron deficiency anemia (IDA) are highly-prevalent nutrient deficiencies and have been shown to have a range of negative effects on cognition and brain function. Human intervention studies including measures at three levels—blood, brain, and behavior—are rare and our objective was to model the relationships among measures at these three levels in school-going Indian adolescents.MethodsMale and female adolescents in rural India were screened for ID/IDA. Subjects consumed 2 meals/day for 6 months; half were randomly assigned to consume meals made from a standard grain (pearl millet) and half consumed meals made from an iron biofortified pearl millet (BPM). Prior to and then at the conclusion of the feeding trial, they completed a set of cognitive tests with concurrent electroencephalography (EEG).ResultsOverall, serum ferritin (sFt) levels improved over the course of the study. Ten of 21 possible measures of cognition showed improvements from baseline (BL) to endline (EL) that were larger for those consuming BPM than for those consuming the comparison pearl millet (CPM). Critically, the best model for the relationship between change in iron status and change in cognition had change in brain measures as a mediating factor, with both change in serum ferritin as a primary predictor and change in hemoglobin as a moderator.ConclusionsA dietary intervention involving a biofortified staple grain was shown to be efficacious in improving blood iron biomarkers, behavioral measures of cognition, and EEG measures of brain function. Modeling the relationships among these variables strongly suggests multiple mechanisms by which blood iron level affects brain function and cognition.Trial registrationRegistered at ClinicalTrials.gov,NCT02152150, 02 June 2014.

Background. Several recent genome-wide association studies suggested insomnia and anemia may share some common genetic components. We thus examined whether adults with anemia had higher odds of having insomnia relative to those without anemia in a cross-sectional study and a meta-analysis. Methods. Included in this cross-sectional study were 12,614 Chinese adults who participated in an ongoing cohort, the Kailuan Study. Anemia was defined as hemoglobin levels below 12.0 g/dL in women and 13.0 g/dL in men. Insomnia was assessed using the Chinese version of the Athens Insomnia Scale (AIS). A total AIS score ≥6 was considered insomnia. The association between anemia and insomnia was assessed using a logistic regression model, adjusting for potential confounders such as age, sex, chronic disease status, and plasma C-reactive protein concentrations. A meta-analysis was conducted using the fixed effects model to pool results from our study and three previously published cross-sectional studies on this topic in adult populations. Results. Individuals with anemia had greater odds of having insomnia (adjusted odds ratio [OR]: 1.32; 95% confidence interval [CI]: 1.03–1.70) compared with individuals without anemia. A significant association persisted after we excluded individuals with chronic inflammation, as suggested by C-reactive protein levels >1 mg/L (adjusted OR: 1.68; 95% CI: 1.22–2.32). The meta-analysis results, including 22,134 participants, also identified a positive association between anemia and insomnia (pooled OR: 1.39; 95% CI: 1.22–1.57). Conclusions. The presence of anemia was significantly associated with a higher likelihood of having insomnia in adults. Due to the nature of the cross-sectional study design, results should be interpreted with caution.

Summary Background Universal home fortification of complementary foods with iron-containing multiple micronutrient powders (MNPs) is a key intervention to prevent anaemia in young children in low-income and middle-income countries. However, evidence that MNPs might promote infection raises uncertainty about whether MNPs give net health benefits and are cost-effective. We aimed to determined country-specific net benefit or harm and cost-effectiveness of universal provision of MNPs to children aged 6 months. Methods We developed a microsimulation model to estimate net country-specific disability-adjusted life-years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to anaemia, malaria, and diarrhoea averted (or increased) by provision of a 6-month course of MNPs to children aged 6 months, compared with no intervention, who would be followed up for an additional 6 months (ie, to age 18 months). Anaemia prevalence was derived from Demographic and Health Surveys or similar national surveys, and malaria and diarrhoea incidence were sourced from the Global Burden of Disease Study. Programme and health-care costs were modelled to determine cost per DALY averted (US$). Additionally, we explored the effects of reduced MNP coverage in a sensitivity analysis. Findings 78 countries (46 countries in Africa, 20 in Asia or the Middle East, and 12 in Latin America) were included in the analysis, and we simulated 5 million children per country. 6 months of universal distribution of daily MNPs, assuming 100% coverage, produced a net benefit (DALYs averted) in 54 countries (24 in Africa, 19 in Asia and the Middle East, 11 in Latin America) and net harm in 24 countries (22 in Africa, one in Asia, and one in Latin America). MNP intervention provided a benefit on YLDs associated with anaemia, but these gains were attenuated and sometimes reversed by increases in YLLs associated with malaria and diarrhoea, reducing the benefits seen for DALYs. In the 54 countries where MNP provision was beneficial, the median benefit was 28·1 DALYs averted per 10 000 children receiving MNPs (IQR 20·6–40·4), and median cost per DALY averted was $3576 (IQR 2474–4918). DALY effects positively correlated with moderate and severe anaemia prevalence in Asia, the Middle East, and Latin America, but correlated inversely in Africa. Suboptimal coverage markedly reduced DALYs averted and cost-effectiveness. Interpretation Net health benefits of MNPs vary between countries, are highest where prevalence of moderate and severe anaemia is greatest but infection prevalence is smallest, and are ameliorated when coverage of the intervention is poor. Our data provide country-specific guidance to national policy makers. Funding International Union of Nutrition Sciences.

Food insecurity (FI) is a dynamic phenomenon, and its association with daily affect is unknown. We explored the association between daily FI and affect among low-income adults during a 2-seasonal-month period that covered days both pre- and during the COVID-19 pandemic. A total of 29 healthy low-income adults were recruited during fall in 2019 or 2020, 25 of whom were followed in winter in 2020 or 2021. Daily FI (measured once daily) and affect (measured 5 times daily) were collected over the 2nd−4th week in each month. Time-Varying-Effect-Models were used to estimate the association between daily FI and positive/negative affect (PA/NA). Overall, 902 person-days of daily-level data were collected. Daily FI was associated with lower PA in the 3rd and 4th week of fall and winter and with higher NA in the second half of winter months. Similar patterns of FI-affect relations were found pre- and during COVID-19 in the second half of a given month, while unique patterns of positive affect scores in the 2nd week and negative scores in the 1st week were only observed during COVID days. Our study supports a time-varying association between FI and affect in low-income adults. Future large studies are needed to verify the findings; ultimately, better understanding such associations may help identify, target, and intervene in food insecure adults to prevent adverse mental health outcomes.

Limited data exist regarding the relationship between socioeconomic risk factors and failure to thrive (FTT). Using data from the National Health and Nutrition Examination Survey (NHANES) from years 1999 to 2014, we sought to determine whether there was a higher prevalence of underweight (

Iron deficiency (ID) and iron deficiency anemia (IDA) are highly-prevalent nutrient deficiencies and have been shown to have a range of negative effects on cognition and brain function. Human intervention studies including measures at three levels-blood, brain, and behavior-are rare and our objective was to model the relationships among measures at these three levels in school-going Indian adolescents.Male and female adolescents in rural India were screened for ID/IDA. Subjects consumed 2 meals/day for 6 months; half were randomly assigned to consume meals made from a standard grain (pearl millet) and half consumed meals made from an iron biofortified pearl millet (BPM). Prior to and then at the conclusion of the feeding trial, they completed a set of cognitive tests with concurrent electroencephalography (EEG).Overall, serum ferritin (sFt) levels improved over the course of the study. Ten of 21 possible measures of cognition showed improvements from baseline (BL) to endline (EL) that were larger for those consuming BPM than for those consuming the comparison pearl millet (CPM). Critically, the best model for the relationship between change in iron status and change in cognition had change in brain measures as a mediating factor, with both change in serum ferritin as a primary predictor and change in hemoglobin as a moderator.A dietary intervention involving a biofortified staple grain was shown to be efficacious in improving blood iron biomarkers, behavioral measures of cognition, and EEG measures of brain function. Modeling the relationships among these variables strongly suggests multiple mechanisms by which blood iron level affects brain function and cognition.Registered at ClinicalTrials.gov, NCT02152150 , 02 June 2014.

The WHO recommends exclusive breastfeeding for the first 6 months of life. However, the transition of the infants' diet to partial breastfeeding with the addition of animal milks and/or solids typically occurs earlier than this. Here, we explored factors associated with the timing of an early transition to partial breastfeeding across seven sites of a birth cohort study in which twice weekly information on infant feeding practices was collected. Infant (size, sex, illness and temperament), maternal (age, education, parity and depressive symptoms), breastfeeding initiation practices (time of initiation, colostrum and pre‐lacteal feeding) and household factors (food security, crowding, assets, income and resources) were considered. Three consecutive caregiver reports of feeding animal milks and/or solids (over a 10‐day period) were characterized as a transition to partial breastfeeding, and Cox proportional hazard models with time (in days) to partial breastfeeding were used to evaluate associations with both fixed and time‐varying characteristics. Overall, 1470 infants were included in this analysis. Median age of transition to partial breastfeeding ranged from 59 days (South Africa and Tanzania) to 178 days (Bangladesh). Overall, higher weight‐for‐length z‐scores were associated with later transitions to partial breastfeeding, as were food insecurity, and infant cough in the past 30 days. Maternal depressive symptoms (evaluated amongst 1227 infants from six sites) were associated with an earlier transition to partial breastfeeding. Relative thinness or heaviness within each site was related to breastfeeding transitions, as opposed to absolute z‐scores. Further research is needed to understand relationships between local perceptions of infant body size and decisions about breastfeeding.

Background Environmental enteric dysfunction (EED) is thought to increase the risk of micronutrient deficiencies, but few studies adjust for dietary intakes and systemic inflammation. Objective We tested whether EED is associated with micronutrient deficiency risk independent of diet and systemic inflammation, and whether it mediates the relation between intake and micronutrient status. Methods Using data from 1283 children in the MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) birth cohort we evaluated the risk of anemia, low retinol, zinc, and ferritin, and high transferrin receptor (TfR) at 15 mo. We characterized gut inflammation and permeability by myeloperoxidase (MPO), neopterin (NEO), and α-1-antitrypsin (AAT) concentrations from asymptomatic fecal samples averaged from 9 to 15 mo, and averaged the lactulose:mannitol ratio z-score (LMZ) at 9 and 15 mo. Nutrient intakes from complementary foods were quantified monthly from 9 to 15 mo and densities were averaged for analyses. α-1-Acid glycoprotein at 15 mo characterized systemic inflammation. Relations between variables were modeled using a Bayesian network. Results A greater risk of anemia was associated with LMZ [1.15 (95% CI: 1.01, 1.31)] and MPO [1.16 (1.01, 1.34)]. A greater risk of low ferritin was associated with AAT [1.19 (1.03, 1.37)] and NEO [1.22 (1.04, 1.44)]. A greater risk of low retinol was associated with LMZ [1.24 (1.08, 1.45)]. However, MPO was associated with a lower risk of high transferrin receptor [0.86 (0.74, 0.98)], NEO with a lower risk of low retinol [0.75 (0.62, 0.89)], and AAT with a lower risk of low plasma zinc [0.83 (0.70, 0.99)]. Greater nutrient intake densities (vitamins A and B6, calcium, protein, and zinc) were negatively associated with EED. Inverse associations between nutrient densities and micronutrient deficiency largely disappeared after adjustment for EED, suggesting that EED mediates these associations. Conclusions EED is independently associated with an increased risk of low ferritin, low retinol, and anemia. Greater nutrient density from complementary foods may reduce EED, and the control of micronutrient deficiencies may require control of EED.

An adapted version of the Wechsler Preschool and Primary Scale of Intelligence—Third Edition (WPPSI-III) was administered to assess cognitive functioning among 1,253 5-year-old children from the Malnutrition and Enteric Disease (MAL-ED) study—an international, multisite study investigating multiple aspects of child development. In this study, the factor structure and invariance of the WPPSI-III were examined across seven international research sites located in Bangladesh, Brazil, India, Nepal, Pakistan, South Africa, and Tanzania. Using a multiple indicator multiple cause (MIMIC) modeling approach, the findings supported the validity of a fluid reasoning dimension (comprised of block design, matrix reasoning, and picture completion subscales) across each of the seven sites, although the scores were noninvariant. Accordingly, these scores are recommended for research purposes and understanding relationships between variables but not for mean comparisons or clinical purposes.

OBJECTIVES: To examine the trends and influencing factors of suboptimal complementary feeding (CF) practices among children aged 6–23 months in Niger using national data from 2000 to 2018. METHODS: Using data from the 2000 Multiple Indicator Cluster Survey, 2012 Demographic and Health Surveys (DHS), and 2018 Standardized Monitoring and Assessment of Relief and Transitions survey in Niger, the trends and predictors of WHO-UNICEF CF indicators including timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD) were estimated. Using the most completed data in CF and influencing factors (available from 2012 DHS), multilevel logistic regression models were applied to identify factors at the individual, household and community levels that were associated with meeting INTRO, MMF, MDD, and MAD. RESULTS: The weighted proportion of children aged 6–8 months meeting INTRO increased from 56.0% in 2000 to 84.4% in 2018. The weighted proportion of children meeting MMF (51.3% to 77.9%), MDD (9.8% to 14.2%), and MAD (5.6% to 10.9%) also increased between 2012 - 2018. At the individual level, children with mothers who were employed had higher odds of meeting all four indicators as compared to those whose mothers were unemployed. Older child age and maternal exposure to media were significantly associated with higher odds of meeting MMF, MDD, and MAD. Maternal education and child birth weight greater or smaller than average (reference) were positively associated with the odds of meeting MMF and MAD, and antenatal iron supplementation and currently breastfeeding were positively associated with the odds of achieving MDD and MAD. At the household level, the odds of meeting MMD and MAD were higher among children from wealthier households. At the community level, the odds of meeting INTRO and MMF were higher among children from communities with greater access to health services. CONCLUSIONS: Despite the improvement in CF practices since 2000, only 10% of children from 6–23 months received minimum acceptable diets. Factors associated with CF were distributed across individual, household and community levels, suggesting the need for multi-level strategies to improve child nutrition in Niger. FUNDING SOURCES: UNICEF West and Central Africa Regional Office (Grant # 43279190).

OBJECTIVES: Food insecurity is a dynamic phenomenon within a given month and across seasons. It remains unknown how food insecurity influences low-income adults’ day-to-day affective well-being, which is associated with long-term mental and physical health. In this pilot study, we explored the association between daily food insecurity and affect over a 2-month period (spanning 2 seasons) in a sample of low-income adults in Central Pennsylvania. METHODS: A total of 22 healthy low-income adults were recruited during the fall months (September, October, or November) in 2019, 18 of whom were also followed in the winter months (February or March) in 2020. Using an ecological momentary assessment framework administered on smart phones over a three-week-long wave (2nd – 4th week) in each survey month, daily food insecurity (once daily), and positive and negative affect (5 times daily) were collected. Time Varying Effect Models were used to estimate the association between levels of daily food insecurity and daily aggregated positive/negative affect as a function of study day, adjusting for gender, race/ethnicity, employment, and poverty status. RESULTS: A total of 713 person-days (84.9% of what was possible) of daily-level data was collected. Food insecurity was reported in 42.9% and 36.0% of participants in the fall and winter months, respectively. Greater daily food insecurity was associated with significantly lower positive affect scores in the 3rd week of the fall months (β ranged from −1.40 (95% CI −2.62, −0.18) to −3.17 (95% CI: −5.93, −0.42)) and in the 4th week of the winter months (β ranged from −2.24 (95% CI: −4.08, −0.39) to −2.84 (95% CI: −4.28, −1.40)). No consistent association was identified between daily food insecurity and negative affect. CONCLUSIONS: Daily food insecurity was associated with lower positive affect in the second half of the months in both fall and winter seasons. Future large observational studies should verify our study findings in order to better identify, target, and intervene in food insecure adults who are at-risk of adverse mental health outcomes. FUNDING SOURCES: The National Center for Advancing Translational Sciences, National Institutes of Health (UL1TR002014) and the Broadhurst Career Development Professorship for the Study of Health Promotion and Disease Prevention.

Background Significant rates of anxiety, depressive symptoms, and low quality of life (QoL) have been found among pregnant women in developed countries. These psychosocial disturbances have not been adequately assessed during pregnancy in many developing countries. Methods Women were recruited in their first trimester of pregnancy (n = 116) and followed through to their 2nd (n = 71) and 3rd (n = 71) trimesters. Questionnaires were used to collect data on anxiety symptoms (Beck Anxiety Inventory; BAI), depressive symptoms (Center for Epidemiological Studies-Depression Inventory; CES-D), and quality of life (RAND SF-36; QoL). Psychometric analyses were used to determine the reliability of the questionnaires in this context. The proportion of pregnant women with psychosocial disturbances at each trimester was determined. Repeated measures ANOVA were used to examine changes in psychosocial outcomes over time; and generalized estimating equation to determine if gestational age predicted the psychosocial outcomes whilst controlling for sociodemographic variables. Results Participants were aged 27.1 ± 5.2 years, on average. Psychometric analyses revealed a 4-factor solution for BAI (18 items), 1-factor solution for CES-D (13 items) and 4-factor solution for RAND SF-36 (26 items). The prevalence estimate of psychosocial disturbances was 34%, 10%, 2% (anxiety), 49%, 31%, 34% (depressive symptoms), and 46%, 37%, 59% (low QoL) for 1st, 2nd and 3rd trimesters, respectively. Gestational age and food insecurity were significant predictors of depressive symptoms, anxiety symptoms and QoL. Conclusions In this population of Ghanaian women, the levels of depressive symptoms and low QoL observed across pregnancy should be recognized as major public health problems and efforts to address these should be put in place. Addressing food insecurity may be a major step to solve not only the physical needs of the pregnant woman but also the psychological needs.

Background: Congenital cytomegalovirus (CMV) infection is the leading acquired cause of mental retardation, developmental delay and sensorineural deafness, yet a reliable assessment of the global disease burden is lacking. Therefore, we estimate the birth prevalence and annual new cases of congenital CMV (cCMV) worldwide. Methods: We performed a systematic literature review and meta-analysis to estimate the birth prevalence of cCMV by World Health Organization (WHO) region and World Bank income level using the MEDLINE/PubMed, Scopus, and Cochrane Database of Systematic Reviews databases PROSPERO (CRD42021224431). A random-effects model predicted the global birth prevalence of symptomatic and asymptomatic cCMV infections. We conducted meta-regression analysis to evaluate the association of sociodemographic characteristics, maternal seroprevalence, fetal HIV exposure, maternal age, malnutrition, and race/ethnicity with the prevalence of cCMV. We estimated trends of the prevalence over time. Findings: 77 articles were included, representative of all WHO regions, and each income level. The pooled birth prevalence of cCMV was highest in Africa (3.71%; 95% CI 2.40% - 5.28%) compared to the United States and Canada (0.85%; 95% CI 0.64% - 1.09%, p

BACKGROUND:Multiple factors constrain the trajectories of child cognitive development, but the drivers that differentiate the trajectories are unknown. We examine how multiple early life experiences differentiate patterns of cognitive development over the first 5 years of life in low-and middle-income settings.METHODS:Cognitive development of 835 children from the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) multisite observational cohort study was assessed at 6, 15, 24 (Bayley Scales of Infant and Toddler Development), and 60 months (Wechsler Preschool and Primary Scale of Intelligence). Markers of socioeconomic status, infection, illness, dietary intake and status, anthropometry, and maternal factors were also assessed. Trajectories of development were determined by latent class-mixed models, and factors associated with class membership were examined by discriminant analysis.RESULTS:Five trajectory groups of cognitive development are described. The variables that best discriminated between trajectories included presence of stimulating and learning resources in the home, emotional or verbal responsivity of caregiver and the safety of the home environment (especially at 24 and 60 months), proportion of days (0–24 months) for which the child had diarrhea, acute lower respiratory infection, fever or vomiting, maternal reasoning ability, mean nutrient densities of zinc and phytate, and total energy from complementary foods (9–24 months).CONCLUSIONS:A supporting and nurturing environment was the variable most strongly differentiating the most and least preferable trajectories of cognitive development. In addition, a higher quality diet promoted cognitive development while prolonged illness was indicative of less favorable patterns of development.

BackgroundWhile head circumference (HC) has been related to intracranial volume and brain size, its association with cognitive function remains unclear. We sought to understand the relationship among various biological and socioeconomic risk factors, HC and cognitive development.MethodsWe analysed data across resource-poor settings in Bangladesh, India, Nepal, Peru, South Africa and Tanzania from the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development longitudinal birth cohort study. Participating children were enrolled and followed up between 2009 and 2014. A final sample of 1210 children aged 0–24 months were included in the analyses. The main outcomes were HC for age Z-score and cognitive, gross motor and language scores from Bayley Scales of Infant Development-III tests. Length, weight and HC were measured monthly, and cognitive tests were administered at 6, 15 and 24 months of age. To disentangle the associations between risk factors and HC from linear growth and to distinguish the direct and indirect effects of these risk factors on cognitive function, we conducted mediation analysis using longitudinal models to account for all data measured during follow-up.ResultsAverage HC-for-age Z-score (HCAZ) was −0.54 (95% CI −0.47 to −0.62) near birth and −1.01 (95% CI −0.94 to −1.08) at 24 months. Children with higher enrolment weight (pConclusionsThe main risk factors associated with HC are similar to those associated with body length, and HC is not related to cognitive function.

OBJECTIVES: To assess the following relations in women of reproductive age: 1) food security (FS) and iron status, 2) iron status and depressive symptoms (DS), 3) FS and DS and if iron status mediates this relation. METHODS: From the NHANES 2005–2010 cycles, we included 2507 non-pregnant women (20–44 yrs) with complete data for iron biomarkers, DS (Patient Health Questionnaire-9), FS (Food Security Survey Module), BMI, and sociodemographic variables. Ferritin (Ft), transferrin receptor (TfR), body iron (BI) and hemoglobin (Hb) were used to classify iron sufficient (IS), ID, and ID anemic (IDA). Logistic regression models were run (entire sample and within poverty income ratio (PIR) categories). A mediation model was also run. Age, race/ethnicity, marital status, total number of people in the household, PIR, education level, health insurance, parity, BMI, welfare status, and antidepressant use were potential covariates. RESULTS: The prevalence of ID was 43% (Ft), 2% (TfR), 37% (BI) and of anemia, 9% (Hb); IDA ranged from 19–77%. In adjusted models: 1) those with food insecurity (FIS) were 2.58 times (95% CI: 1.53–4.35) more likely to be ID (TfR); those in the lowest PIR and with FIS were 1.46 (95% CI: 1.06–2.01) (Ft), 4.00 (1.80–8.88) (TfR), and 1.43 (1.06–1.93) (BI) times more likely to be ID; 2) ID in the lowest PIR were 2.84 (95% CI:1.24–6.51) times more likely to have higher DS; 3) those with low FS had increased risk for moderate and severe DS (2.17 (95% CI: 1.28–3.68) and 3.44 (95% CI: 1.55–7.63)), and for those with very low FS, the risk for mild, moderate, and severe DS was 2.26 (95% CI: 1.20–4.24), 3.10 (95% CI: 1.67–5.76), and 9.01 (95% CI: 4.87–16.64), respectively. Iron status did not mediate the relation between FS and DS. CONCLUSIONS: Women with FIS are at increased risk of ID and DS compared to FS women, and ID women are at increased risk of DS compared to IS women. However, iron status did not mediate the relation between FS and DS. These risks are higher in those with the lowest PIR. FUNDING SOURCES: Internal Penn State funds.

OBJECTIVES: 1) To describe the trends of complementary feeding since 2010; 2) to understand the factors influencing the sub-optimal feeding practices; and 3) to generate recommendations to inform future interventions. METHODS: Mixed methods study with an iterative, two phase design. Phase 1: quantitative data analysis of 13 key complementary feeding indicators reported in 68 national survey reports from 2010 to 2018. Phase 2: semi-structured qualitative interviews with 14 regional informants (UN, Government, NGO, and donor communities). We conducted a literature review of grey and peer-reviewed publications in 2010–2019 to contextualize the results. RESULTS: Phase 1. Across 24 WCAR countries, mean continued breastfeeding at 1y was 89%, but halved to 44% by 2y. Introduction of complementary foods occurred in 64% of children 6–8 mos. Minimum meal frequency in children 6–23 mos increased over time from 27% to 38% while minimum dietary diversity and minimum acceptable diet were stagnant (22% and 10%, respectively) since 2010. Intake of nutrient rich foods (vitamin A, animal source, iron-rich) were reported in about half of children, respectively. The proportion of children (only reported for

We examined the association between food insecurity (FIS) and micronutrient status among Ghanaian women planning to become pregnant. A cross-sectional analysis was completed of 95 women aged 18&ndash, 35 years, living in the Upper Manya Krobo District in the Eastern Region of Ghana. Questionnaires were administered to collect sociodemographic and food security data, weight and height were measured. Blood was drawn from an antecubital vein, one drop was used to assess hemoglobin via Hemocue. Zinc and copper were analyzed using flame atomic spectrophotometry while iron biomarkers, retinol and 25-hydroxyvitamin D were analyzed using ELISA, ultra-performance liquid chromatography and liquid chromatography-tandem mass spectrometry, respectively. Logistic regression models were used to determine the relationship between food insecurity (FIS) and micronutrient deficiencies. FIS was reported among 23% of the households, while micronutrient deficiencies ranged from 7&ndash, 28% irrespective of FIS status. Retinol concentrations were negatively associated with FIS (p = 0.043) after controlling for covariates, although levels were within the normal range in both groups. No statistically significant associations between FIS and micronutrient deficiencies were found. Among those with FIS, 59% were deficient in at least one nutrient with 18% deficient in two nutrients. Unmarried women were at higher risk of FIS (p = 0.017) than married women. FIS was associated with retinol concentrations but not other micronutrient biomarkers in Ghanaian women expecting to become pregnant in the next 6 months.

BACKGROUND Iron deficiency remains the most prevalent micronutrient deficiency globally, but few studies have examined how iron status relates to cognition in adolescents. Iron biofortification of staple food crops is being scaled up, yet it is unknown whether consuming biofortified crops can benefit cognition. Objective Our objective was to determine the efficacy of iron-biofortified pearl millet in improving attention and memory in Indian school-going adolescents. Methods A double-blind, randomized, intervention study was conducted in 140 Indian boys and girls, aged 12-16 y, who were assigned to consume iron-biofortified [Fe = 86 parts per million (ppm)] or conventional (Fe = 21-52 ppm) pearl millet. Hemoglobin, ferritin, and transferrin receptor (TfR) were measured and body iron (BI) was calculated at baseline and after 4 and 6 mo. Five measures of cognitive function were obtained at baseline and 6 mo: simple reaction time (SRT), Go/No-Go (GNG) task, Attentional Network Task (ANT), Composite Face Effect (CFE) task, and Cued Recognition Task (CRT). Intention-to-treat analysis was used. Results Daily iron intake from pearl millet was higher in those consuming biofortified compared with conventional pearl millet (19.6 compared with 4.8 mg/d). Effects on ferritin, TfR, and BI at 4 mo, and on TfR at 6 mo (all P

Importance: Congenital cytomegalovirus (cCMV) infection is the most common congenital infection and the leading acquired cause of developmental disabilities and sensorineural deafness, yet a reliable assessment of the infection burden is lacking. Objectives: To estimate the birth prevalence of cCMV in low- and middle-income countries (LMICs) and high-income countries (HICs), characterize the rate by screening methods, and delineate associated risk factors of the infection. Data Sources: MEDLINE/PubMed, Scopus, and Cochrane Database of Systematic Reviews databases were searched from January 1, 1960, to March 1, 2021, and a total of 1322 studies were identified. Study Selection: Studies that provided data on the prevalence of cCMV derived from universal screening of infants younger than 3 weeks were included. Targeted screening studies were excluded. Data Extraction and Synthesis: Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Extraction was performed independently by 3 reviewers. Quality was assessed using the Newcastle-Ottawa Scale for cohort studies. Random-effects meta-analysis was undertaken. Metaregression was conducted to evaluate the association of sociodemographic characteristics, maternal seroprevalence, population-level HIV prevalence, and screening methods with the prevalence of cCMV. Main Outcomes and Measures: Birth prevalence of cCMV ascertained through universal screening of infants younger than 3 weeks for CMV from urine, saliva, or blood samples. Results: Seventy-seven studies comprising 515646 infants met the inclusion criteria from countries representative of each World Bank income level. The estimated pooled overall prevalence of cCMV was 0.67% (95% CI, 0.54%-0.83%). The pooled birth prevalence of cCMV was 3-fold greater in LMICs (1.42%; 95% CI, 0.97%-2.08%; n = 23 studies) than in HICs (0.48%; 95% CI, 0.40%-0.59%, n = 54 studies). Screening methods with blood samples demonstrated lower rates of cCMV than urine or saliva samples (odds ratio [OR], 0.38; 95% CI, 0.23-0.66). Higher maternal CMV seroprevalence (OR, 1.19; 95% CI, 1.11-1.28), higher population-level HIV prevalence (OR, 1.22; 95% CI, 1.05-1.40), lower socioeconomic status (OR, 3.03; 95% CI, 2.05-4.47), and younger mean maternal age (OR, 0.85; 95% CI, 0.78-0.92, older age was associated with lower rates) were associated with higher rates of cCMV. Conclusions and Relevance: In this meta-analysis, LMICs appeared to incur the most significant infection burden. Lower rates of cCMV were reported by studies using only blood or serum as a screening method.. © 2021 American Medical Association. All rights reserved.

Characteristics of temperament have been shown to predict aspects of personality and psychopathology. Approach temperament (i.e., sensitivity, reactivity, and behavioral disposition toward reward stimuli) may be a particularly salient predictor of developmental outcomes (e.g., Nigg, 2006; Shiner & Caspi, 2003). However, there is little research on approach temperament among children from low- and middle-income nations. This study examined the validity of an adapted version of the Infant Temperament Scale across eight international sites with a focus on approach temperament. Our sample included 1,933 infants from eight study sites in low- and middle-income nations: Bangladesh, Brazil, India, Nepal, Peru, Pakistan, South Africa, and Tanzania. The Infant Temperament Scale was translated and administered as a structured interview to caregivers at each site. Exploratory and confirmatory factor analyses were used to examine the factor structure of the scale, and multiple indicator multiple cause (MIMIC)...

OBJECTIVES: Iron deficiency (ID)—a highly-prevalent nutritional deficiency—has been shown to have deleterious effects on measures of cognitive performance and brain activity. Many of these results are suggestive of the impact of ID on neurotransmitter regulation and myelination. A third critical potential effect of ID on brain function is at the level of brain energy expenditure, however to date there has not been any method for indirectly estimating the impact of ID on energy expenditure in humans in the context of cognitive work. METHODS: We report here a study comparing ID and iron sufficient (IS) college students in which simultaneous behavioral, electrophysiological (EEG), and metabolic data were collected in a task designed as a cognitive analog to standard physical exertion tasks. RESULTS: We show that increases in cognitive demands produced decrements in behavioral measures of performance, and increases in EEG and metabolic measures of work. Critically, we found that the magnitudes of those changes were directly related to iron levels. DISCUSSION: We find support for the idea that brain activity mediates the relationship between cognitive demands and energy expenditure, with ferritin and hemoglobin moderating those relationships in distinct ways. Finally, we show that levels of energy expenditure can be indirectly estimated by measures of EEG spectral power.

Background: Iron deficiency is a global public health concern and has implications on the health status of women in reproductive age. Objective: We hypothesized that improving iron intake with double fortified salt would improve food intake, resulting in higher energy, nutrient intakes, and weight indicators of female tea plantation workers. Methods: In this randomized double-masked study, the participants (n = 245) were assigned to receive salt double fortified with iron and iodine (DFS; treatment) or salt fortified with iodine (control) and followed for 7.5 to 9 months. Dietary intakes were measured at three time points, baseline, midpoint, and end line using (1) food frequency questionnaire, (2) 24-hour recall, and (3) weighed lunch intake. Anthropometric measures of height (cm), weight (kg), and mid-upper arm circumference (cm) were also recorded at three time points. Mixed-model repeated-measures approach was used to detect group differences across time. Results: Double fortified salt improved dietary iron intake in the treatment group compared to the control group ( P < .001). No other dietary or anthropometric differences could be attributed to treatment. Significant effect of time was observed in the intake frequency of major food groups and calcium, vitamin A and C ( P Conclusion: Addition of DFS in the diet improved dietary iron intake but did not affect the intake of energy, other nutrients, or nutritional status indicators. The improvement observed in the dietary iron intake demonstrates that fortification is an effective strategy to address iron deficiency in at-risk populations.

Background Academic success is a key determinant of future prospects for students. Cognitive functioning has been related to nutritional and physical factors. Here, we focus on iron status and aerobic fitness in young-adult female students given the high rate of iron deficiency and declines in fitness reported in this population. Objectives We sought to explore the combined effects of iron status and fitness on academic success and to determine whether these associations are mediated by cognitive performance. Methods Women (n = 105) aged 18-35 y were recruited for this cross-sectional study. Data were obtained for iron biomarkers, peak oxygen uptake (VO2peak), grade point average (GPA), performance on computerized attention and memory tasks, and motivation and parental occupation. We compared the GPA of groups 1) with low compared with normal iron status, 2) among different fitness levels, and 3) by using a combined iron status and fitness designation. Mediation analysis was applied to determine whether iron status and VO2peak influence GPA through attentional and mnemonic function. Results After controlling for age, parental occupation, and motivation, GPA was higher in women with normal compared with low ferritin (3.66 ± 0.06 compared with 3.39 ± 0.06; P = 0.01). In analyses of combined effects of iron status and fitness, GPA was higher in women with normal ferritin and higher fitness (3.70 ± 0.08) than in those with 1) low ferritin and lower fitness (3.36 ± 0.08; P = 0.02) and 2) low ferritin and higher fitness (3.44 ± 0.09; P = 0.04). Path analysis revealed that working memory mediated the association between VO2peak and GPA. Conclusions Low iron stores and low aerobic fitness may prevent female college students from achieving their full academic potential. Investigators should explore whether integrated lifestyle interventions targeting nutritional status and fitness can benefit cognitive function, academic success, and postgraduate prospects.

Considering the high burden of micronutrient deficiencies in Bangladeshi children, this analysis aimed to identify the factors associated with micronutrient deficiencies and association of plasma micronutrient concentration trajectories from 7 to 24 months with the concentrations at 60 months of age. Plasma samples were collected at 7, 15, 24, and 60 months of age, and hemoglobin, ferritin, zinc, and retinol concentrations of 155, 153, 154, and 155 children were measured, respectively. A generalized estimating equation was used to identify the factors associated with micronutrient deficiencies, while latent class growth modeling identified the trajectories of plasma micronutrients from 7 to 24 months and its association with the concentrations of micronutrients at 60 months was examined using multiple linear regression modeling. Early (AOR = 2.21, p &lt, 0.05) and late convalescence (AOR = 1.65, p &lt, 0.05) stage of an infection, low ferritin (AOR = 3.04, p &lt, 0.05), and low retinol (AOR = 2.07, p &lt, 0.05) were associated with increased anemia prevalence. Wasting at enrollment was associated with zinc deficiency (AOR = 1.8, p &lt, 0.05) and birth weight was associated with ferritin deficiency (AOR = 0.58, p &lt, 0.05). Treatment of drinking water was found protective against vitamin A deficiency (AOR = 0.57, p &lt, 0.05). Higher trajectories for ferritin and retinol during 7&ndash, 24 months were positively associated with plasma ferritin (&beta, = 13.72, p &lt, 0.05) and plasma retinol (&beta, = 3.99, p &lt, 0.05) at 60 months.

OBJECTIVES: To examine the association between iron status and mother-infant interactions in dyads from rural Bangladesh. METHODS: Maternal-infant interactions were assessed in dyads from a substudy nested within a randomized controlled trial in rural Bangladesh. Recorded interactions (10 minutes free-play; 2 minutes diapering) at baseline (BL) (infant age 6–18 mo; n = 116), midline (ML) (+ 3 mo; n = 324), and endline (EL) (+ 6 mo; n = 336) were coded per the Emotional Availability Scales (EAS; 4 maternal scales: sensitivity, structuring, non-intrusiveness, non-hostility; 2 child scales: responsiveness, involvement). Ferritin (Ft), transferrin receptor (TfR), and hemoglobin (Hb; in infants only) concentrations were measured at BL and EL. Group differences (categorized by iron status irrespective of intervention group) were assessed via ANCOVA (covariates: socioeconomic status, mean upper arm circumference, weight-for-age Z-score, child sex and age and maternal depressive symptoms (Center for Epidemiologic Studies Depression Scale) and reasoning abilities (Raven's Progressive Matrices)). Stepwise regressions were run to determine predictors of the EAS scores. RESULTS: Prevalence of iron deficiency (ID; Ft

OBJECTIVES: Poor complementary feeding practices pose a major challenge for early childhood growth and development in Côte d'Ivoire, where more than 20% children under five suffer from stunting. We aimed to examine the trends and risk factors of suboptimal complementary feeding among children aged 6–23 months in Côte d'Ivoire. METHODS: We estimated the country-level prevalence, trends, and risk factors of four complementary feeding indicators: introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). Data was extracted from Demographic and Health Surveys (1994 to 2011) and Multiple Indicator Cluster Surveys (2000–2016) to estimate the complementary feeding indicators for children between 6 to 23 months in Côte d'Ivoire. Multilevel logistic regression models were used to identify factors associated with these complementary feeding indicators in 2016. RESULTS: On average, 59.2% of children aged 6–8 months achieved INTRO between 1994–2016. In 2016, the proportion of children aged 6–8 months meeting INTRO was 65.5% showing an increase of around 15 percentage points from 2006. Between 2011 – 2016, the proportion of children aged 6–23 months meeting MMF, MDD, and MAD also increased from 40.2% to 47.7%, 11.3% to 26.0%, and 4.6% to 12.5%, respectively. Child age (MDD, MAD), maternal education (INTRO), and breastfeeding status (MMF, MAD) were significantly and positively associated with achieving at least one of the complementary feeding practices: INTRO, MMF, MDD, and MAD. Higher household wealth was significantly associated with greater odds of achieving all four complementary feeding criteria compared to poorer households CONCLUSIONS: Suboptimal complementary feeding practices remain a problem and disparities in complementary feeding still exist in Côte d'Ivoire. However, complementary feeding practices have improved in the past decade. Additional research is needed to understand the policy and programmatic efforts that may explain the promising trends of complementary feeding practices in Côte d'Ivoire. FUNDING SOURCES: UNICEF West and Central Africa Regional Office and Bill & Melinda Gates Foundation (Grant # 43279190).

OBJECTIVES: To 1) quantify the prevalence of iron deficiency (ID), iron deficiency anemia (IDA), and/or anemia in children in the Pennsylvania (PA) Foster Care System and 2) examine if a child's iron status is associated with the frequency of certain developmental and behavioral diagnoses. METHODS: Retrospective cohort Medicaid chart review of children, from 6 mos to 10 yrs of age, in the PA Foster Care System using the most recently available data (2010–2015), extracted from the Medicaid Analytic eXtract database. Data from ICD-9 and ICD-10 codes which capture iron status and anemia, along with 16 relevant behavioral and 10 relevant developmental diagnoses were extracted. ICD codes for ID, IDA, and anemia cannot be differentiated; therefore, we used ID/anemia as a group label. The prevalence of ID/anemia was calculated and the prevalence of developmental delays and behavioral impairments among those diagnosed with ID/anemia was compared to those who were not diagnosed with ID/anemia. Group differences were determined using Pearson's chi-squared tests. RESULTS: From 2010–2015, there were 50,311 children, ages 6 mos to 10 yrs, in the PA Foster Care System. Of these, 1,365 (2.7%) were diagnosed with ID/anemia. Specific delays in development (a category with several sub-diagnoses) were reported in 48% of children with ID/anemia and 19% of children without diagnosed ID/anemia (χ(2) = 679.42, p

A positive association between cardiorespiratory fitness (CRF) and cognitive function has been demonstrated mainly in children and older adults. Women attending college live in a cognitively demanding setting where optimal cognition matters but often experience declines in CRF. Our aim was to test whether CRF is associated with executive function in young adult women.Participants in this cross-sectional study included 120 healthy women age 18-35 yr in a university setting. Each woman completed a maximal treadmill-based exercise test to determine peak oxygen uptake (V˙O2peak), computerized tests of executive function, and questionnaires to assess motivation and other factors with potential to influence physical and cognitive performance.Overall CRF was excellent, with a sample mean V˙O2peak of 44.6 mL·min·kg. After adjusting for covariates, higher V˙O2peak was associated with better performance on attention (P0.01), learning/shifting (P0.01), working memory (P0.01), and problem-solving (P0.05) tasks. Likewise, when women were grouped according to the American College of Sports Medicine fitness classification, performance on executive function tasks was poorest in women with very poor or poor CRF. Women with superior CRF performed best on executive function tasks, and performance was intermediate in women with fair, good, or excellent CRF.The findings from this cross-sectional study suggest that optimal cognition is related to CRF in young adult women. Future studies are needed to test whether strategies to improve CRF are effective in improving cognitive function.

The duration of exclusive breastfeeding (EBF) is often defined as the time from birth to the first non-breast milk food/liquid fed (EBFLONG), or it is estimated by calculating the proportion of women at a given infant age who EBF in the previous 24 h (EBFDHS). Others have measured the total days or personal prevalence of EBF (EBFPREV), recognizing that although non-EBF days may occur, EBF can be re-initiated for extended periods. We compared breastfeeding metrics in the MAL-ED study; infants' breastfeeding trajectories were characterized from enrollment (median 7 days, IQR: 4, 12) to 180 days at eight sites. During twice-weekly surveillance, caretakers were queried about infant feeding the prior day. Overall, 101 833 visits and 356 764 child days of data were collected from 1957 infants. Median duration of EBFLONG was 33 days (95% CI: 32–36), compared to 49 days based on the EBFDHS. Median EBFPREV was 66 days (95% CI: 62–70). Differences were because of the return to EBF after a non-EBF period. The median number of returns to EBF was 2 (IQR: 1, 3). When mothers re-initiated EBF (second episode), infants gained an additional 18.8 days (SD: 25.1) of EBF, and gained 13.7 days (SD: 18.1) (third episode). In settings where women report short gaps in EBF, programmes should work with women to return to EBF. Interventions could positively influence the duration of these additional periods of EBF and their quantification should be considered in impact evaluation studies. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd