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This study, which covered all the ten provinces of Zambia, aimed at assessing the Iodine Deficiency prevalence, and access to adequately iodised salt in the country. It was carried out in 2011 and entailed determining the urinary iodine concentration (UIC) among 1, 283 school children from 30 selected schools and the amount of iodine in 875 salt samples collected from the households of the children. The iodine concentration was also determined in salt samples collected from 365 salt traders near the selected schools. Each of the salt traders was requested to complete a questionnaire. In addition, a questionnaire was administered to 75 teachers from the selected schools. The Urinary Iodine Concentration (UIC) was assayed by the Sandell-Kolthoff reaction, after digesting the urine with Ammonium Persulfate at 100[degrees]C. The iodine concentration in the salt was determined using the quantitative titrimetric method. The data for the UIC and salt iodine plus data from questionnaires were analysed using Excel and Statistical Package for Social Sciences version 15 (SPSS 15). The median urinary iodine concentration (MUIC) was 248.5[micro]g/l and the Interquartile Range (IQR) was 145 - 380 [micro]g/L. These results indicated that Iodine Deficiency was not of public health concern among children in Zambia at the time of this study. However, the proportion of households with access to adequately iodised salt (15-40 ppm iodine) was 53%, which is below the recommended target of 90% or more household coverage. Results from questionnaires indicated that the challenges faced by the Zambian Government in attaining Universal Salt Iodisation (USI) include: (i) lack of sustainability of local salt iodisation in local salt producing areas, (ii) weak enforcement of the law on salt iodisation, (iii) poor packaging and storage of salt by traders and households, (iv) limited knowledge of the link between lack of iodine in salt and iodine deficiency, and (v) relatively high cost of imported iodised salt in local salt producing areas. Key words: Iodized, Salt, Iodine Deficiency, Universal Salt Iodisation, Zambia, INTRODUCTION Iodine is present in the body in trace amounts, mainly in the thyroid gland. Its main role is in the biosynthesis of thyroid hormones. When the body does not [...]

Background: Malaria causes anemia by destruction of red blood cells and inhibition of erythropoiesis., Objective: We assessed whether the magnitude of the malaria-specific effect on anemia differs by age, during low and high malaria seasons., Method: In rural Zambian children participating in a pro-vitamin A efficacy trial, we estimated differences in the prevalence of anemia (defined as hemoglobin < 110 g/L for children < 60 months. and < 115 g/L in older children) by malaria status and assessed malaria-age interactions. Regression models (with anemia as the outcome) were used to model malaria-age interaction in both the low and high malaria seasons, controlling for potential confounders., Results: Average age was 68 months at baseline ( n  = 820 children). In the low malaria season, anemia prevalence was 29% in malaria-negative children and 54% in malaria-positive children ( p  < 0.001), with no malaria-age interactions ( p  = 0.44). In the high malaria season, anemia prevalence was 41% in malaria-negative children and 54% in malaria-positive children ( p  < 0.001), with significant malaria-age interactions ( p  = 0.02 for anemia). Age-stratified prevalence of anemia in malaria positive versus negative children was 67.0% versus 37.1% (in children < 60 months); 57.0% versus 37.2% (in 60-69 months.); 46.8% versus 37.2% (in 70-79 months.); 37.0% versus 37.3% (in 80-89 months) and 28.0% versus 37.4% (in 90+ months)., Conclusions: Malarial anemia is most severe in younger children, especially when transmission is intense. Anemia control programs must prioritize this vulnerable group., Competing Interests: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported., (© 2021 The Authors. eJHaem published by British Society for Haematology and John Wiley & Sons Ltd.)

This study, which covered all the ten provinces of Zambia, aimed at assessing the Iodine Deficiency prevalence, and access to adequately iodised salt in the country. It was carried out in 2011 and entailed determining the urinary iodine concentration (UIC) among 1, 283 school children from 30 selected schools and the amount of iodine in 875 salt samples collected from the households of the children. The iodine concentration was also determined in salt samples collected from 365 salt traders near the selected schools. Each of the salt traders was requested to complete a questionnaire. In addition, a questionnaire was administered to 75 teachers from the selected schools. The Urinary Iodine Concentration (UIC) was assayed by the Sandell-Kolthoff reaction, after digesting the urine with Ammonium Persulfate at 100°C. The iodine concentration in the salt was determined using the quantitative titrimetric method. The data for the UIC and salt iodine plus data from questionnaires were analysed using Excel and Statistical Package for Social Sciences version 15 (SPSS 15). The median urinary iodine concentration (MUIC) was 248.5μg/l and the Interquartile Range (IQR) was 145 - 380 μg/L. These results indicated that Iodine Deficiency was not of public health concern among children in Zambia at the time of this study. However, the proportion of households with access to adequately iodised salt (15-40 ppm iodine) was 53%, which is below the recommended target of 90% or more household coverage. Results from questionnaires indicated that the challenges faced by the Zambian Government in attaining Universal Salt Iodisation (USI) include: (i) lack of sustainability of local salt iodisation in local salt producing areas, (ii) weak enforcement of the law on salt iodisation, (iii) poor packaging and storage of salt by traders and households, (iv) limited knowledge of the link between lack of iodine in salt and iodine deficiency, and (v) relatively high cost of imported iodised salt in local salt producing areas. [ABSTRACT FROM AUTHOR]

Estimates of the components of nutrient intake variation are needed for modelling distributions of usual intake or predicting the usual intake of individuals. Season is a potential source of variation in nutrient intakes in addition to within- and between-person variation, particularly in low- or middle-income countries. We aimed to describe seasonal variation in nutrient intakes and estimate within-person, between-person and other major components of intake variance among Zambian children. Children from rural villages and peri-urban towns in Mkushi District, Zambia aged 4-8 years were enrolled in the non-intervened arm of a randomised controlled trial of pro-vitamin A carotenoid biofortified maize (n 200). Up to seven 24-h dietary recalls per child were obtained at monthly intervals over a 6-month period covering the late post-harvest (August-October), early lean (November-January) and late lean (February-April) seasons (2012-2013). Nutrient intakes varied significantly by season. For energy and most nutrients, intakes were highest in the early lean season and lower in the late post-harvest and late lean seasons. Season and recall on a market day had the strongest effects on nutrient intakes among covariates examined. Unadjusted within- to between-person variance ratios ranged from 4·5 to 31·3. In components of variance models, season accounted for 3-20 % of nutrient intake variance. Particularly in rural settings in low- and middle-income countries, where availability of locally grown, nutrient-rich foods may vary seasonally, studies should include replicates across seasons to more precisely estimate long-term usual intakes.

Objective: To estimate the burden of anemia attributable to malaria, inflammation, and deficiency of iron or vitamin A during low and high malaria seasons among Zambian children., Study Design: From a cohort of children (n = 820), 4-8 years of age participating in a randomized controlled trial of pro-vitamin A, we estimated attributable fractions for anemia (hemoglobin of <110 or 115 g/L, by age) owing to current malaria or inflammation (C-reactive protein of >5 mg/L, or α-1 acid glycoprotein of >1 g/L, or both), and current or prior iron deficiency (ID; defined as low ferritin [<12 or 15 μg/L for age <5 or >5 years] or functional ID [soluble transferrin receptor of >8.3 mg/L] or both) and vitamin A deficiency (retinol of <0.7 μmol/L), during low and high malaria seasons, using multivariate logistic regression. Serum ferritin, soluble transferrin receptor, and retinol were adjusted for inflammation., Results: The burden of anemia independently associated with current malaria, inflammation, ID, and vitamin A deficiency in the low malaria season were 12% (P < .001), 6% (P = .005), 14% (P = .001), and 2% (P = .07), respectively, and 32% (P < .001), 15% (P < .001), 10% (P = .06), and 2% (P = .06), respectively, in the high malaria season. In both seasons, functional ID was independently associated with more anemia (approximately 11%) than low ferritin (approximately 4%). Anemia and ID in the low malaria season, accounted for 20% (P < .001) and 4% (P = .095) of the anemia in the subsequent high malaria season., Conclusions: Anemia in this population is strongly linked to malaria, inflammation, and functional ID, and to a lesser extent, low iron stores. Integrated control strategies are needed., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Impairments in visual function have been well characterized in vitamin A deficiency. However, eye function may also be sensitive to other nutrient deficiencies., Objective: We examined associations between visual function-characterized by pupillary threshold or pupillary responsiveness-and nutritional status in Zambian children., Methods: We used digital pupillometry to measure visual responses to calibrated light stimuli (-2.9 to 0.1 log cd/m2) among dark-adapted children aged 4-8 y (n = 542). We defined pupillary threshold as the first light stimulus at which pupil diameter decreased by ≥10% and considered a pupillary threshold ≥-0.9 log cd/m2 as impaired. Pupillary responsiveness was defined by absolute percentage of change in pupil diameter from pre- to poststimulus. We tested associations between these measures and serum concentrations of retinol, β-carotene, ferritin, soluble transferrin receptor, and hemoglobin (Hb <11.0 or 11.5 g/dL were used to define anemia, depending on age), as well as anthropometric indexes, with the use multilevel mixed-effects models., Results: Pupillary threshold was correlated only with serum retinol (r = 0.12, P < 0.05). The strongest correlates of pupillary responsiveness were Hb (r = -0.16, P < 0.01), height-for-age z score (r = 0.14, P < 0.05), weight-for-age z score (r = 0.14, P < 0.05), and soluble transferrin receptor (r = 0.12, P < 0.05). In multivariate models, anemia was positively associated with pupillary responsiveness (β = 2.99; 95% CI: 1.26, 4.72)., Conclusions: In this marginally nourished population, we found positive correlations between vitamin A status, iron status, or anthropometric indexes and visual function. Hb was negatively associated with visual function, with greater pupillary responsiveness among anemic children. We posit that this may signal altered parasympathetic activity, possibly driven by infection. Future studies should consider a broader range of indicators to better characterize the relation between nutrition and visual function. This trial was registered at clinicaltrials.gov as NCT01695148.

Biofortified maize, designed as an intervention strategy to prevent vitamin A deficiency, can provide upwards of 15 μg β-carotene per g dry weight. Some varieties also have elevated concentrations of other carotenoids. We conducted a cluster randomized, controlled feeding trial in rural Zambia to test the impact of daily consumption of biofortified maize over a 6-month period on vitamin A status. Serum concentrations of retinol and carotenoids were assessed by high-performance liquid chromatography. Data on circulating carotenoids by intervention group in 679 children are reported here. As previously shown, consumption of this β-carotene-rich maize significantly improved serum β-carotene concentrations (0.273 vs. 0.147 μmol/L, p < 0.001, in this subset of children). Here we show significant increases in α-carotene, β-cryptoxanthin, and zeaxanthin (p < 0.001). There was no impact on lutein or lycopene concentrations. Consumption of biofortified maize can have broader implications beyond the control of vitamin A deficiency (Trial registration: NCT01695148).

Background: Dietary diversity scores and dichotomous indicators derived from them are widely used to assess dietary quality, and specific scoring methods have been recommended for women and 6- to 23-mo-old children. However, there is no specific score recommended for older children and the effect of seasonal dietary changes on score performance is not well documented., Objective: We assessed performance of 2 recommended dietary diversity scores as indicators of dietary quality over 3 seasons., Methods: We conducted 7 repeat 24-h dietary recalls among 4- to 8-y-old rural Zambian children (n = 200) over 6 mo. Dietary diversity was assessed using a 7-food group score for assessing infant and young child feeding (DDS-IYCF) and a 10-food group score for use among women of reproductive age (DDS-W). Micronutrient intake adequacy was described by mean probability of adequacy (MPA) over 11 micronutrients. Longitudinal models were fit to test the association between each score and MPA overall and by season. Receiver operating characteristic (ROC) curves were used to describe indicator performance of each score., Results: Mean ± SE scores were 4.11 ± 0.03 for DDS-IYCF and 4.39 ± 0.03 for DDS-W. Both scores varied by season, but DDS-W better reflected seasonal dietary changes. Across seasons, MPA increased 1-6 percentage points/unit increase in DDS-IYCF or 1-10 percentage points for DDS-W (P < 0.05). Score performance as a predictor of MPA > 0.75 was moderate, with area under the ROC curve values by season ranging from 0.63 to 0.77 for DDS-IYCF and from 0.66 to 0.72 for DDS-W., Conclusions: DDS-W performed better than DDS-IYCF in characterizing seasonal variability and micronutrient adequacy among rural Zambian children., (© 2018 American Society for Nutrition. All rights reserved.)

Inadequate nutrient intakes put children at risk for impaired growth and development. We described diet, usual intakes of energy and macro- and micronutrients and prevalence of nutrient intake adequacies among 4-8-year-old Zambian children. Children not yet in school and living in Mkushi District, Central Province, Zambia were enrolled into an efficacy trial of pro-vitamin A biofortified maize. Children in the non-intervened arm were included in this analysis (n 202). Dietary intake data were collected by tablet-based 24-h recall on a monthly basis over the 6-month trial. Observed nutrient intakes were derived from reported food quantities, standard recipes and food composition tables. Usual nutrient intake distributions were modelled based on observed intakes. Prevalence of inadequacy was estimated by comparing the usual nutrient intake distribution to the nutrient requirement distribution. Frequency and quantity of consumption of commonly reported foods were described and key sources of energy and nutrients were identified. Median usual energy intake was 6422 kJ/d (1535 kcal/d). Most childrens' macronutrient intakes fell within recommended ranges (74-98 %). Estimated prevalences of inadequate intakes of Fe, folate, vitamin B12 and Ca were 25, 57, 76 and >99 %, respectively. Estimated prevalences of inadequacy for other micronutrients were low (0·1-2·2 %). Commonly consumed foods included maize, vegetable oil, tomatoes, rape leaves and small fish (>0·6 servings/d), whereas meat, eggs or dairy were rarely eaten (<0·2 servings/d). These findings suggest that the heavily plant-based diet of rural Zambian children provides inadequate Ca, folate, vitamin B12 and Fe to meet recommended nutrient intakes.

Inflammation-induced hyporetinolemia (IIH), a reduction in serum retinol (SR) during inflammation, may bias population estimates of vitamin A deficiency (VAD). The optimal adjustment for IIH depends on the type and extent of inflammation. In rural Zambian children (4-8 years, N = 886), we compared three models for defining inflammation: α-1-acid glycoprotein (AGP) only (inflammation present if > 1 g/L or normal if otherwise), C-reactive protein (CRP) only (moderate inflammation, 5-15 mg/L; high inflammation, > 15 mg/L; or normal if otherwise) and a combined model using both AGP and CRP to delineate stages of infectious episode. Models were compared with respect to 1) the variance in SR explained and 2) comparability of inflammation-adjusted VAD estimated in low and high malaria seasons. Linear regression was used to estimate the variance in SR explained by each model and in estimating the adjustment factors used in generating adjusted VAD (retinol < 0.7 μmol/L). The variance in SR explained were 2% (AGP-only), 11% (CRP-only), and 11% (AGP-CRP) in the low malaria season; and 2% (AGP-only), 15% (CRP-only), and 12% (AGP-CRP) in the high malaria season. Adjusted VAD estimates in the low and high malaria seasons differed significantly for the AGP (8.2 versus 13.1%) and combined (5.5 versus 9.1%) models but not the CRP-only model (6.1 versus 6.3%). In the multivariate regression, a decline in SR was observed with rising CRP (but not AGP), in both malaria seasons (slope = -0.06; P < 0.001). In this malaria endemic setting, CRP alone, as opposed to CRP and AGP, emerged as the most appropriate model for quantifying IIH.

Objective: In 4- to 8-year-old Zambian children (n = 744), we evaluated the effects of adjusting for inflammation (α1-acid glycoprotein >1 g/l), with or without additional adjustment for malaria, on prevalence estimates of iron deficiency (ID) and iron deficiency anaemia (IDA) during low malaria (LowM) and high malaria (HighM) transmission seasons., Methods: To estimate adjustment factors, children were classified as: (i) reference (malaria negative without inflammation), (ii) inflammation without malaria (I), (iii) malaria without inflammation (M) and (iv) inflammation with malaria (IM). We estimated the unadjusted ID or IDA prevalence, and then adjusted for inflammation alone (ID I or IDA I ) or inflammation and malaria (ID IM or IDA IM )., Results: Mean ferritin was 38 (reference), 45 (I), 43 (M) and 54 μg/l (IM) in LowM, increasing to 44, 56, 96 and 167 μg/l, respectively, in HighM. Corresponding mean sTfR was 6.4, 6.9, 7.9 and 8.4 mg/l in LowM, increasing to 8.2, 9.2. 8.7 and 9.7 mg/l in HighM. Ferritin-based ID, ID I and ID IM were 7.8%, 8.7% or 9.1%, respectively, in LowM and 4.6%, 10.0% or 11.7%, respectively, in HighM. Corresponding soluble transferrin receptor (sTfR)-based estimates were 27.0%, 24.1% and 19.1%, respectively, in LowM, increasing to 53.6%, 46.5% and 45.3%, respectively, in HighM. Additional adjustment for malaria resulted in a ~1- to 2-percentage point change in IDA, depending on biomarker and season., Conclusions: In this population, malaria substantially increased ferritin and sTfR concentrations, with modest effects on ID and IDA prevalence estimates., (© 2017 John Wiley & Sons Ltd.)

Background: Higher iron stores, defined by serum ferritin (SF) concentration, may increase malaria risk. Objective: We evaluated the association between SF assessed during low malaria season and the risk of malaria during high malaria season, controlling for inflammation. Methods: Data for this prospective study were collected from children aged 4-8 y ( n = 745) participating in a biofortified maize efficacy trial in rural Zambia. All malaria cases were treated at baseline (September 2012). We used baseline SF and malaria status indicated by positive microscopy at endline (March 2013) to define exposure and outcome, respectively. Iron status was defined as deficient (corrected or uncorrected SF <12 or <15 μg/L, depending on age <5 or ≥5 y, respectively), moderate (<75 μg/L, excluding deficient), or high (≥75 μg/L). We used a modified Poisson regression to model the risk of malaria in the high transmission seasons (endline) as a function of iron status assessed in the low malaria seasons (baseline). Results: We observed an age-dependent, positive dose-response association between ferritin in the low malaria season and malaria incidence during the high malaria season in younger children. In children aged <6 y (but not older children), we observed a relative increase in malaria risk in the moderate iron status [incidence rate ratio (IRR) with SF: 1.56; 95% CI: 0.64, 3.86; IRR with inflammation-corrected SF: 1.92; 95% CI: 0.75, 4.93] and high iron status (IRR with SF: 2.66; 95% CI: 1.10, 6.43; or IRR with corrected SF: 2.93; 95% CI: 1.17, 7.33) categories compared with the deficient iron status category. The relative increase in malaria risk for children with high iron status was statistically significant only among those with a concurrently normal serum soluble transferrin receptor concentration (<8.3 mg/L; IRR: 1.97; 95% CI: 1.20, 7.37). Conclusions: Iron adequacy in 4- to 8-y-old children in rural Zambia was associated with increased malaria risk. Our findings underscore the need to integrate iron interventions with malaria control programs. This trial was registered at clinicaltrials.gov as NCT01695148., Competing Interests: Author disclosures: MAB, KJS, CLC, JC, NK, MA, WS, WJM, KPW, and ACP, no conflicts of interest. The views expressed do not necessarily reflect those of HarvestPlus., (© 2017 American Society for Nutrition.)

Background: Impaired dark adaptation is an early functional indicator of vitamin A deficiency that may be prevented by regular dietary intake of foods containing provitamin A carotenoids., Objective: We tested the impact of provitamin A carotenoid-biofortified maize consumption (∼15 μg β-carotene/g) on dark adaptation in Zambian children., Methods: We used a cluster-randomized trial of children aged 4-8 y (n = 1024) in Mkushi District, Zambia, and compared the regular consumption (2 meals/d, 6 d/wk for 6 mo) of biofortified orange maize (OM) to white maize (WM). The primary outcome was the serum retinol response. In a random sample (n = 542), we used a digital pupillometer to test pre- and postintervention responses to graded light stimuli (-2.9 to 0.1 log cd/m 2 ) in a dark-adapted state., Results: At baseline, 11.7% of the children had serum retinol <0.7 μmol/L, 14.4% had impaired dark adaptation (pupillary threshold ≥ -1.11 log cd/m 2 ), and 2.3% had night blindness. The mean ± SD pupillary responsiveness to light stimuli was poorer at baseline in the OM group (16.1% ± 6.6%) than the WM group (18.1% ± 6.4%) (P = 0.02) but did not differ at follow-up (OM: 17.6% ± 6.5%; WM: 18.3% ± 6.5%). Among children with serum retinol <1.05 μmol/L at baseline, there was greater improvement in pupillary responsiveness in the OM group (2.2%; 95% CI: 0.1%, 4.3%) than the WM group (0.2%; 95% CI: -1.1%, 1.5%; P = 0.01), but there were no differences in children with adequate baseline status. We found no effect of treatment on pupillary threshold or night blindness., Conclusions: The regular consumption of provitamin A carotenoid-biofortified maize increased pupillary responsiveness among children with marginal or deficient vitamin A status, providing evidence of a functional benefit to consuming this biofortified crop. This trial was registered at clinicaltrials.gov as NCT01695148., (© 2016 American Society for Nutrition.)

Background: Vitamin A deficiency remains a nutritional concern in sub-Saharan Africa. Conventionally bred maize hybrids with high provitamin A carotenoid concentrations may have the potential to improve vitamin A status in maize-consuming populations., Objective: We evaluated the efficacy of regular provitamin A carotenoid-biofortified "orange" maizemeal (∼15 μg β-carotene/g) consumption in improving vitamin A status and reducing vitamin A deficiency in children., Design: This was a cluster-randomized controlled trial in the rural farming district of Mkushi, Zambia. All 4- to 8-y-old children in an ∼400-km(2) area were identified and grouped by proximity into clusters of ∼15-25 children. We randomly assigned clusters to 1) orange maizemeal (n = 25), 2) white maizemeal (n = 25), or 3) a parallel, nonintervention group (n = 14). Children in intervention clusters (n = 1024) received 200 g maizemeal for 6 d/wk over 6 mo; the maizemeal was prepared according to standardized recipes and served in cluster-level kitchens. Staff recorded attendance and leftovers. We collected venous blood before and after the intervention to measure serum retinol, β-carotene, C-reactive protein, and α1-acid glycoprotein., Results: Intervention groups were comparable at baseline, and vitamin A status was better than anticipated (12.1% deficient on the basis of serum retinol <0.7 μmol/L). Although attendance at meals did not differ (85%), median daily maize intake was higher in white (154 g/d) than in orange (142 g/d) maizemeal clusters. At follow-up, mean serum β-carotene was 0.14 μmol/L (95% CI: 0.09, 0.20 μmol/L) higher in orange maizemeal clusters (P < 0.001), but mean serum retinol (1.00 ± 0.33 μmol/L overall) and deficiency prevalence (17.1% overall) did not differ between arms., Conclusion: In this marginally nourished population, regular biofortified maizemeal consumption increased serum β-carotene concentrations but did not improve serum retinol. This trial was registered at clinicaltrials.gov as NCT01695148., (© 2016 American Society for Nutrition.)

Objective: To determine the prevalence of vitamin A deficiency, infection and adequacy of vitamin A intakes among Zambian children, and the contribution of dietary vitamin A and infection to vitamin A status.Design: A cross-sectional survey of vitamin A intakes by the 24 h recall method, vitamin A status by plasma retinol and the modified relative dose-response test, and infection by acute-phase proteins.Setting: Rural communities in Central and Eastern Provinces of Zambia.Subjects: Children 2-5 years of age.Results: The prevalence of vitamin A deficiency was 56 % by plasma retinol, 48 % with infection-adjusted plasma retinol and 22 % by the modified relative dose-response test. The majority of children (61 %) had a current infection. Vitamin A intakes were relatively high (331 to 585 μg retinol activity equivalents/d in the harvest/early post-harvest and late post-harvest seasons, respectively) and the prevalence of inadequate intakes was <1 % when compared with the Estimated Average Requirement (210 and 275 μg retinol activity equivalents/d for children aged 1-3 and 4-8 years, respectively). Elevated α-1-acid glycoprotein was negatively associated with plasma retinol (P < 0·0 0 1) and vitamin A intake was positively associated with plasma retinol (P < 0·05), but only when estimated assuming a 26:1 retinol equivalence for provitamin A from green and yellow vegetables.Conclusions: Infection and vitamin A intakes were significant determinants of plasma retinol. We cannot conclude which indicator more accurately represents the true vitamin A status of the population. Reasons for the persistent high prevalence of vitamin A deficiency in the presence of adequate vitamin A intakes are unclear, but the high rates of infection may play a role. [ABSTRACT FROM AUTHOR]

Background: Vitamin A deficiency is associated with poor health outcomes related to reproduction, growth, vision, and immunity. Biofortification of staple crops is a novel strategy for combating vitamin A deficiency in high-risk populations where staple food intakes are high. African populations are proposed beneficiaries of maize (Zea mays) biofortified with provitamin A carotenoids, often called "orange maize" because of its distinctive deep yellow-orange kernels. The color facilitates ready recognition but presents a cultural challenge to maize-consuming populations, including those in much of Africa, who traditionally eat white varieties.Objective: This study explores the intake patterns of, as well as adaptation to, traditional foods made with provitamin A-biofortified maize compared with white maize in rural Zambian children 3 to 5 years of age (n = 189) during a 3-month feeding trial.Methods: The subjects were fed a breakfast of maize porridge (sweet mush), a lunch of maize nshima (stiff mush) with various side dishes, and an afternoon snack based on a 6-day rotating menu. The trial was conducted in 2010. The orange maize used in the trial came from three different sources. O1 maize was from the 2009 harvest and was stored in a freezer until use in 2010. O2 maize was also from the 2009 harvest and was stored in a cold room until 2010. O3 ("fresh") maize was from the 2010 harvest and was fed immediately after harvest in week 9 of the study and then stored in a freezer until milling for the final four weeks.Results: Consumption of menu items, except snacks, was influenced by week (p < .0084). The intakes of porridge and nshima made with orange maize equaled those of porridge and nshima made with white maize from week 2 onward. The intakes of porridge and nshima prepared from O1 and O2 did not differ, but intakes became significantly higher when meals made from O3 were introduced (p < .014 for porridge and p < or = .013 for nshima).Conclusions: These results demonstrate quick adaptation to orange maize, a preference for recently harvested maize, and an optimistic outlook for similar adaptation patterns in other biofortified-maize target countries. [ABSTRACT FROM AUTHOR]

Background: Detailed dietary intake data in low-income populations are needed for research and program evaluation. However, collection of such data by paper-based 24-hour recall imposes substantial demands for staff time and expertise, training, materials, and data entry., Objective: To describe our development and use of a tablet-based 24-hour recall tool for conducting dietary intake surveys in remote settings., Methods: We designed a 24-hour recall tool using Open Data Kit software on an Android tablet platform. The tool contains a list of local foods, questions on portion size, cooking method, ingredients, and food source and prompts to guide interviewers. We used this tool to interview caregivers on dietary intakes of children participating in an efficacy trial of provitamin A-biofortified maize conducted in Mkushi, a rural district in central Zambia. Participants were children aged 4 to 8 years not yet enrolled in school (n = 938). Dietary intake data were converted to nutrient intakes using local food composition and recipe tables., Results: We developed a tablet-based 24-hour recall tool and used it to collect dietary data among 928 children. The majority of foods consumed were maize, leafy vegetable, or small fish dishes. Median daily energy intake was 6416 kJ (1469 kcal)., Conclusions: Food and nutrient intakes assessed using the tablet-based tool were consistent with those reported in prior research. The tool was easily used by interviewers without prior nutrition training or computing experience. Challenges remain to improve programming, but the tool is an innovation that enables efficient collection of 24-hour recall data in remote settings., (© The Author(s) 2015.)

Introduction: Vitamin A (VA) cannot be made in the human body and thus foods rich in VA are the only sources of vitamin A for the body. However, ensuring availability in adequate amount of foods rich in VA remains a challenge, mainly in low-income counties including Ethiopia. In addition, children from the poorest and less educated families of same country have disproportionately limited consumptions of foods rich in VA. Therefore, the present study aimed assessing the wealth related inequality in vitamin A consumption (VAC) and decompose it to the various contributing factors. Methods: This study was conducted using the 2019 Ethiopian demographic and health survey data on a weighted sample of 1,497 children of age 6–23 months in Ethiopia. The wealth related inequality in VAC was quantified using concentration index and plotted using concentration curve. The Wagstaff decomposition analysis was performed to assess the relative contributions of each explanatory variable to the inequalities in the overall concentration index of VAC. Result: The overall Wagstaff normalized concentration index (C) analyses of the wealth-related inequality in consumption of foods rich in VA among children aged 6–23 months was [C = 0.25; 95% C: 0.15, 0.35]. Further decomposition of the C by the explanatory variables reported the following contributions; primary level of women's education (7.2%), secondary and above (17.8%), having ANC visit during pregnancy (62.1%), delivery at a health institution (26.53%), living in the metropolis (13.7%), central region (34.2%), child age 18–23 months (4.7%) contributed to the observed wealth related inequality in the consumption of foods rich in vitamin A in Ethiopia. Conclusion: We found pro-rich wealth-related inequality in VAC among children of age 6–23 months in Ethiopia. Additionally, maternal education, region, ANC visit, and place of delivery were the significant contributors of wealth-related inequality of VAC. Nutritional related interventions should prioritise children from poorer households and less educated mothers. Moreover, enhancing access to ANC and health facilities delivery services through education, advocacy, and campaign programs is highly recommended in the study setting. [ABSTRACT FROM AUTHOR]

The successful translation of biofortified orange maize (BOM) to a staple household food is dependent on farmers' ability to cultivate and subsequently utilize it. In this study, we assessed farmers' allocation of their land to the cultivation of BOM and conventional white maize (CWM) varieties in districts where the AFIKEPO Nutrition Program is implemented in Malawi. The results showed that farmers were skeptical of allocating more land to the cultivation of BOM. CWM was allocated significantly more land (1.75 ± 0.51 acres) than BOM (1.12 ± 0.32 acres) (p < 0.001) in all districts. More farmers (87.9%) allocated less than 1 acre to BOM cultivation. The cost of seeds did not explain the preference for CWM, as the price of seeds in Malawi Kwacha was similar for both maize types (p = 0.742). Consequently, the average number of bags (50 kg maize grains/bag) harvested was significantly lower (mean: 6.48 ± 8.27 bags; median: 4 bags) for BOM than for CWM (mean: 23.11 ± 20.54 bags; median: 17 bags). Interestingly, BOM was found to be more resistant to weevils during post-harvest storage, suggesting the potential for improved food and nutrition security for households. The knowledge of high grain resistance to weevils did not influence farmers to cultivate more BOM. This has the potential to negatively affect maize biofortification as an effective strategy to alleviate vitamin A deficiency (VAD) in developing countries. Farmers should be sensitized to identify the benefits of BOM so that they are willing to purchase seeds and grow BOM on a larger scale. Coupled with its higher resistance to storage weevils, superior taste, and nutrient content, the continued cultivation and consumption of BOM has the potential to contribute to the achievement of both food and nutrition security within communities. [ABSTRACT FROM AUTHOR]

Child Health Weeks (CHWs) are semi-annual, campaign-style, facility- and outreach-based events that provide a package of high-impact nutrition and health services to under-five children. Since 1999, 30% of the 85 countries that regularly implement campaign-style vitamin A supplementation programmes have transformed their programmes into CHW. Using data drawn from districts' budget, expenditures and salary documents, UNICEF's CHW planning and budgeting tool and a special purposive survey, an economic analysis of the June 2010 CHW's provision of measles, vitamin A and deworming was conducted using activity-based costing combined with an ingredients approach. Total CHW costs were estimated to be US$5.7 million per round. Measles accounted for 57%, deworming 22% and vitamin A 21% of total costs. The cost per child was US$0.46. The additional supplies and personnel required to include measles increased total costs by 42%, but reduced the average costs of providing vitamin A and deworming alone, manifesting economies of scope. The average costs of covering larger, more urban populations was less than the cost of covering smaller, more dispersed populations. Provincial-level costs per child served were determined primarily by the number of service sites, not the number of children treated. Reliance on volunteers to provide 60% of CHW manpower enables expanding coverage, shortening the duration of CHWs and reduces costs by one-third. With costs of $1093 per life saved and $45 per disability-adjusted life-year saved, WHO criteria classify Zambia's CHWs as 'very cost-effective'. The continued need for CHWs is discussed.

Background: Women's Dietary Diversity Score (WDDS) is an indicator of dietary diversity, a key component of diet quality in women of reproductive age (WRA). Limited information is available regarding its applicability in other population groups. Objective: To examine the ability of the Minimum Dietary Diversity for Women (MDD-W) of 5-food groups cutoff to predict micronutrient adequacy in men and women 15 to 65 years old from 8 Latin American countries. Methods: We used a 24-hour recall from 9216 participants in the Latin American Study on Nutrition and Health (ELANS) to determine Dietary Diversity Score (DDS) based on the consumption of 10 food groups. The Mean Probability of Adequacy (MPA) was associated with DDS for the overall sample, for men, WRA, and women of nonreproductive age (WNRA). Sensitivity and specificity analyses were performed to determine if the 5-food groups cutoff point for MDD can be used to correctly identify men, WRA, and WNRA with adequate micronutrient adequacy (MPA ≥ 0.70). Results: We found a mean DDS of 4.78 ± 1.33 and an MPA of 0.64 ± 0.16, with 59% of participants showing a diverse diet (DDS ≥ 5). The 5-food groups-cutoff point showed a better balance between sensitivity and specificity predicting an MPA ≥0.70 in men, WRA, and WNRA. MPA was significantly associated with DDS in WRA and for men and WNRA, as well. Conclusion: The 5-food group MDD, originally intended to be used in WRA, performed equally well in predicting MPA ≥0.70 in men, WRA, and WNRA, and can be used as a proxy of micronutrient adequacy in Latin American population. Plain language title: Assessment of the FAO Minimum Dietary Diversity Index to Estimate Micronutrients Intake in Urban Cities of 8 Latin America Countries Plain language summary: The Women's Dietary Diversity Score (WDDS) proposed by the Food and Agriculture Organization is an indicator that measures the variety of foods consumed by women of reproductive age (WRA), and it has been reported in several studies that the more diverse the diet, the greater the probability of meeting micronutrients requirements. This indicator has not been validated in other population, but few studies have been conducted in the Latin American region. So, we aimed to investigate whether the Minimum Dietary Diversity for Women (MDD-W) established for WRA could also predict sufficient micronutrient intake in men and women aged 15 to 65 years in the Latin American population. To accomplish this objective, we used data from the Latin American Study of Nutrition and Health (Estudio Latino Americano de Nutrición y Salud—ELANS) that collected dietary data from 24-h recalls from 9216 participants and analyzed the association between DDS and the Mean Probability of Adequacy (MPA). Additionally, we determined if the MDD cutoff point could correctly identify individuals with appropriate vitamin and mineral intake. We found that the overall mean DDS was 4.78 ± 1.33, the MPA was 0.64 ± 0.16, and approximately 59% of participants had a diverse diet. The MDD of 5-food groups cutoff point was demonstrated to be useful in predicting sufficient micronutrient intake for men, WRA, and women over 50 years. Respondents with a DDS ≥5 had higher micronutrient adequacy. These findings suggest that DDS can serve as a proxy for assessing micronutrient adequacy in urban populations beyond WRA. The effect of promoting diverse diets on micronutrient adequacy as part of intervention programs can be captured by the DDS in urban Latin American populations. [ABSTRACT FROM AUTHOR]

This study evaluated the effectiveness of nutrition behavioural change communication interventions and food consumption behaviours and demand for nutritious foods in Makoni district, Zimbabwe. The study employed an observational and cross-sectional design using mixed—methods. The population was smallholder farmers' households with children six to twenty-four months old. Secondary data was obtained from the main intervention reports. The total sample size of this project comprised of five personnel participating in the implementation of the intervention for key informant interviews; forty participants for the in-depth interviews; and a total of 81 participants for eight focus group discussions. Participants indicated that the Livelihoods and Food Security Programme intervention successfully increased their nutrition knowledge, enhanced their ability to diversify crop production, and improved their access to varied foods, including some new crops. Local markets had little influence on the demand for nutritious foods by the intervention population. The interventions were effective in stimulating demand for diverse and nutritious foods in Makoni District. [ABSTRACT FROM AUTHOR]

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Objective: To evaluate the acceptability of traditional Zambian dishes fortified with Complementary Food for Africa+Dried Fish Powder (ComFA+Fish), a locally sourced protein/micronutrient blend designed to impact nutrient deficiencies among infants and young children (IYC) and improve pregnancy and birth outcomes among women of reproductive age (WRA). Design: During two sensory panels, caregivers evaluated: (1) the acceptability of four ComFA+Fish dishes for household consumption, including fortified chibwabwa fisashi, savory Kapenta chutney, fortified complementary maize porridge and fortified bean-vegetable soup and (2) whether their IYC found the fortified complementary maize porridge acceptable. Setting: Lake Kariba, Southern Province, Zambia. Participants: Women of reproductive age (n 42) and their IYC aged 6–11 months (n 16) and 12–23 months (n 26) were recruited from fishing villages in Gwembe, Siavonga and Sinazongwe District. Results: A majority of caregivers extremely liked/liked the: (1) fortified chibwabwa fisashi's sensory attributes (94·7 %), convenience (92·8 %) and overall acceptability (100 %); (2) savory Kapenta chutney's sensory attributes (81·8 %), convenience (92·8 %) and overall acceptability (100 %); (3) fortified complementary porridge's sensory attributes (83·5 %), convenience (90·5 %) and overall acceptability (88·1 %) and (4) fortified bean-vegetable soup's sensory attributes (66·8 %), convenience (87·5 %) and overall acceptability (87·5 %). Further, a majority of caregivers evaluated the fortified complementary porridge as highly acceptable to their IYC. Conclusions: Results suggest that ComFA+Fish is strategically well placed to fill nutritional gaps among IYC and WRA in Zambia and has the potential to be scaled across sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Access to and availability of various food sources is not an issue in rural communities. However, there is no guarantee that households are not affected by nutritional inadequacy, which is still a problem in most underdeveloped nations. A mixed-methods study was conducted to determine the HDDS through the snowballing method for the last 12 months' food groups-and-sources and the 48-h diet recall. Ninety-eight households in two rural communities surrounding Sikwafta (zone one) and Malu'u (zone two) participated in the interview between April and May 2019. The results were then analyzed through SPSS and QDA MINER. The aim is to analyze the household dietary patterns of the communities between the two zones. The study also hypothesizes that the dietary pattern of households has not changed. Results showed that a total of nine food groups were consumed: grain, white roots, tubers, plantains, oils/fats (95.90%), condiments (83.70%), and meat/poultry/sea foods (77.60%). The majority of the food consumed comes from the gardens, followed by other food sources, which make up the average HDDS of five. A correlation analysis found a statistically significant relationship between HDDS and total meal (0.504*), with no relationships between demographics. When comparing 48-h food sources-and-groups to the previous year, there was little to no difference in accessibility and availability. This implies that the majority of households are likely to achieve their nutritional needs within the parameters of their dietary trend. Even though households have adequate access to food, there is a significant need to improve their nutritional needs, even if they consume the average amount of the required food groups. [ABSTRACT FROM AUTHOR]

Key Message: The suppression of the HYD-1 gene by a TILLING approach increases the amount of β-carotene in durum wheat kernel. Vitamin A deficiency is a major public health problem that affects numerous countries in the world. As humans are not able to synthesize vitamin A, it must be daily assimilated along with other micro- and macronutrients through the diet. Durum wheat is an important crop for Mediterranean countries and provides a discrete amount of nutrients, such as carbohydrates and proteins, but it is deficient in some essential micronutrients, including provitamin A. In the present work, a targeting induced local lesions in genomes strategy has been undertaken to obtain durum wheat genotypes biofortified in provitamin A. In detail, we focused on the suppression of the β-carotene hydroxylase 1 (HYD1) genes, encoding enzymes involved in the redirection of β-carotene toward the synthesis of the downstream xanthophylls (neoxanthin, violaxanthin and zeaxanthin). Expression analysis of genes involved in carotenoid biosynthesis revealed a reduction of the abundance of HYD1 transcripts greater than 50% in mutant grain compared to the control. The biochemical profiling of carotenoid in the wheat mutant genotypes highlighted a significant increase of more than 70% of β-carotene compared to the wild-type sibling lines, with no change in lutein, α-carotene and zeaxanthin content. This study sheds new light on the molecular mechanism governing carotenoid biosynthesis in durum wheat and provides new genotypes that represent a good genetic resource for future breeding programs focused on the provitamin A biofortification through non-transgenic approaches., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: To enable easy assessment of oral frailty; that is, an overlapping slight decline in multifaceted oral function, in any setting, we developed the oral frailty five‐item checklist (OF‐5), and examined its predictive validity for increased risks of physical frailty, physical disability and mortality among community‐dwelling older adults. Methods: This population‐based cohort study randomly selected 2044 residents in Kashiwa, Japan, with no long‐term care needs. Baseline data were collected in 2012, and follow‐up data were collected in 2013, 2014, 2016, 2018 and 2021. The OF‐5 includes five measures: fewer teeth, difficulty in chewing, difficulty in swallowing, dry mouth and low articulatory oral motor skills. Physical frailty was defined according to the Cardiovascular Health Study criteria. Physical disability and mortality determined from the long‐term care insurance receipt database were followed for 9 years. Results: Of 2031 eligible participants (mean age 73.1 ± 5.6 years; 51.1% women), 39.3% individuals with ≥2 OF‐5 points had significantly increased prevalence and new‐onset rate of physical frailty. After adjusting for potential confounders, oral frailty, defined as ≥2 OF‐5 points, was associated with increased risks of physical disability (adjusted hazard ratio 1.40; 95% confidence interval 1.14–1.72) and mortality (adjusted hazard ratio 1.44; 95% confidence interval 1.11–1.87). The highest adjusted hazard ratios were observed in older adults with coexisting physical and oral frailty. Conclusions: The OF‐5 showed strong predictive validity for physical frailty, physical disability and mortality in Japanese older adults. This assessment tool can be implemented in various settings and foster comprehensive prevention through interprofessional collaboration. Geriatr Gerontol Int 2023; 23: 651–659. [ABSTRACT FROM AUTHOR]

This article presents the evolution of the biofortification program in Nigeria over the last decade and the role of interdisciplinary research in informing cost-effective, efficient, and inclusive development; implementation; and scaling of this program. Launched in 2011 to improve Nigeria's food systems to deliver accessible and affordable nutrients through commonly consumed staples, the Nigeria biofortification program was implemented through an effective partnership between the CGIAR and public, private, and civil society sectors at federal, state, and local levels. By the end of 2021, several biofortified varieties of Nigeria's 2 main staples, namely cassava and maize, were officially released for production by smallholders, with several biofortified varieties of other key staples (including pearl millet, rice, and sorghum) either under testing or in the release pipeline. In 2021, the program was estimated to benefit 13 million Nigerians consuming biofortified cassava and maize varieties. The evidence on the nutritional impact, consumer and farmer acceptance, and cost-effective scalability of biofortified crops documented by the program resulted in the integration of biofortified crops in several key national public policies and social protection programs; private seed and food company products/investments, as well as in humanitarian aid. [ABSTRACT FROM AUTHOR]

Proline betaine (Pro-B) has been identified as a biomarker of dietary citrus intake, yet gaps remain in its validation as a quantitative predictor of intake during various physiological states. This study quantified sources of within-individual variation (WIV) in urinary Pro-B concentration during pregnancy and assessed its correlation with the reported usual intake of citrus fruit and juice. Pro-B concentrations were determined by 1H-NMR spectroscopy in spot and 24-h urine specimens (n = 255) collected throughout pregnancy from women participating in the MARBLES cohort study. Adjusted linear or log mixed effects models quantified WIV and tested potential temporal predictors of continuous or elevated Pro-B concentration. Pearson or Spearman correlations assessed the relationship between averaged repeated biomarker measures and usual citrus intake reported by food frequency questionnaires. The proportion of variance in urinary Pro-B attributable to WIV ranged from 0.69 to 0.74 in unadjusted and adjusted models. Citrus season was a significant predictor of Pro-B in most analyses (e.g., adjusted β [95% CI]: 0.52 [0.16, 0.88] for non-normalized Pro-B), while gestational age predicted only non-normalized Pro-B (adjusted β [95% CI]: −0.093 [−0.18, −0.0038]). Moderate correlations (rs of 0.40 to 0.42) were found between reported usual citrus intake and averaged repeated biomarker measurements, which were stronger compared to using a single measurement. Given the high degree of WIV observed in urinary Pro-B, multiple samples per participant are likely needed to assess associations between citrus consumption and health outcomes. [ABSTRACT FROM AUTHOR]

The shortage of diversified diets in lactating postpartum mothers is a severe problem in developing countries. The promotion of diverse diets is important to improving micronutrient nourishment and adequate energy intake for lactating mothers. To date, there is limited evidence regarding inadequate dietary diversity practices among lactating postpartum mothers in Gambella region. The study is aimed to determine inadequate dietary diversity practice and associated factors among lactating postpartum mothers in Gambella city, southwest Ethiopia. Mixed methods were employed on 407 randomly selected lactating postpartum mothers and 15 purposively selected key informants from February 28 to March 24, 2021. A pre-tested questionnaire and interview guide were used for data collection. Data were analyzed using Statistical Package for the Social Sciences version 21 software. Binary logistic regression models were used to determine the associated factors of dietary diversity. Qualitative data were analyzed manually through a thematic approach. The prevalence of inadequate dietary diversity practice was 60.2%. Having no education (AOR = 3.74, 95% CI: 1.18, 11.88), employed women(AOR = 0.37, 95% CI: 0.18, 0.75), meal frequency < 3 meals (AOR = 2.92, 95% CI: 1.04, 8.71), time taken to market > 30 min (AOR = 4.20, 95% CI: 2.01, 8.76), not received nutrition education (AOR = 2.0, 95% CI:1.09, 3.68), having home gardening (AOR = 0.32, 95% CI: 0.18, 0.57) and having big animals (AOR = 0.12, 95% CI: 0.05, 0.29) were significant factors of inadequate dietary diversity practice. Diet habits, food taboos, low social status of women in ownership of household assets, low family support, order of feeding, child preference for resource distribution in a polygamous family, and health care provider's advice were the main mentioned reasons for inadequate dietary diversity practices. The prevalence of inadequate dietary diversity practices were high compared to previous studies. Having no education, employed women, meal frequency < 3 meals, time taken to market > 30 min, not receiving nutrition education, having a home garden, and having big animals were significant factors of inadequate dietary diversity practice. Nutrition intervention focused on nutrition education to increase meal frequency should be provided for lactating postpartum mothers to improve inadequate dietary diversity practices. [ABSTRACT FROM AUTHOR]

Purpose: Vitamin A deficiency (VAD) remains a significant contributor to childhood morbidity and mortality in developing countries; therefore, the implementation of sustainable and cost-effective approaches to control VAD is of utmost pertinence. This study aims to investigate the efficacy of red palm olein (RPO)-enriched biscuit supplementation in improving vitamin A, haematological, iron, and inflammatory status among vitamin A-deficient schoolchildren., Methods: We conducted a double-blinded, randomised controlled trial involving 651 rural primary schoolchildren (8-12 years) with VAD in Malaysia. The schoolchildren were randomised to receive either RPO-enriched biscuits (experimental group, n = 334) or palm olein-enriched biscuits (control group, n = 317) for 6-month duration., Results: Significant improvements in retinol and retinol-binding protein 4 levels were observed in both groups after supplementation (P < 0.001). The improvement in retinol levels were similar across groups among subjects with confirmed VAD (P = 0.40). Among those with marginal VAD, greater improvement in retinol levels was recorded in the control group (P < 0.001) but lacked clinical significance. The levels of α- and β-carotenes, haematological parameters (haemoglobin, packed cell volume, mean corpuscular volume and mean corpuscular haemoglobin) and iron enhanced more significantly in the experimental group (P < 0.05). The significant reduction in the prevalence of microcytic anaemia (- 21.8%) and high inflammation (- 8.1%) was only observed in the experimental group., Conclusion: The supplementation of RPO-enriched biscuits enhanced levels of provitamin A carotenes, iron, and erythropoiesis, and exhibited anti-inflammatory effects. Therefore, the incorporation of RPO into National Nutritional Intervention Programs may be a potential measure to improve the health status of vitamin A-deficient children, among various other interventions., Clinical Trial Registration: ClinicalTrials.gov (NCT03256123)., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Carotenoids were synthesized in the plant cells involved in photosynthesis and photo-protection. In humans, carotenoids are essential as dietary antioxidants and vitamin A precursors. Brassica crops are the major sources of nutritionally important dietary carotenoids. Recent studies have unraveled the major genetic components in the carotenoid metabolic pathway in Brassica, including the identification of key factors that directly participate or regulate carotenoid biosynthesis. However, recent genetic advances and the complexity of the mechanism and regulation of Brassica carotenoid accumulation have not been reviewed. Herein, we reviewed the recent progress regarding Brassica carotenoids from the perspective of forward genetics, discussed biotechnological implications and provided new perspectives on how to transfer the knowledge of carotenoid research in Brassica to the crop breeding process. [ABSTRACT FROM AUTHOR]

Background and Aims. Poor diets and subsequent malnutrition are among the greatest current societal challenges triggering immense health and economic burden especially among populations that are forcibly displaced. It is indispensable to establish the dietary patterns of any population, especially in displaced populations, in order to develop and effectively implement interventions for the specific population. Methods. A cross-sectional study was conducted to assess dietary practices and nutrient adequacy of 307 internally displaced pupils aged between 5 and 15 years in the West Region of Cameroon. Pretested, structured interviewer questionnaires were used to collect data on the demographic and socioeconomic status of the children and their caregivers, the nutrition knowledge of caregivers, the dietary practices of the children, dietary diversity, their food sources, and coping strategies that were used during food shortage. SPSS version 23 was used to analyze the data. The dietary diversity of the children was assessed at the individual level using FAO method of assessing women's dietary diversity score. Results. Out of the total 307 children, 148 (48.2%) were boys and 159 (51.8%) were girls. During food shortages, most of the mothers/caregivers (72%) used borrowing as the main auxiliary food source and others (28%) used food as payment for work or begging. A majority of the children (56%) usually ate only two times in a day. Most of the children were of unacceptable or low dietary diversity (66.2%). The most frequently consumed food group was cereals as it was eaten by 21% of the children, seven or more times per week; meanwhile, the least was animal products with only 3% of the children consuming it seven or more times weekly. Their diets were energy-deficient (1640.5 ± 1.64 kcal) and unbalanced with daily inadequate protein (18.45 ± 1.13 g), vitamin A (470.27 ± 1.38 μg), and iron (4.02 ± 0.08 mg) intake. The nutrition knowledge of the mothers/caregivers was poor as less than half (41%) of them had an acceptable nutrition knowledge. Conclusion. The high prevalence of poor dietary patterns and poor nutrition knowledge imposes the necessity of developing nutritional interventions and education strategies aimed at promoting healthy eating habits in the children. [ABSTRACT FROM AUTHOR]

Vitamin A deficiency (VAD) is one of the significant hidden hunger challenges in sub-Saharan Africa (SSA), and children are the most vulnerable group. Therefore, there is a need for interventions to reduce this deficiency. Provitamin A biofortified maize (PVABM) has the potential to reduce VAD for the vulnerable groups of SSA. The study investigated the possibility of incorporating provitamin A biofortified maize into smallholder farming systems and assessed the acceptability of typical PVABM meals for household consumption. Using a quantitative approach, a crosssectional study design was conducted in Bulwer local municipality of Sisonke district and Mhlathuze local municipality of uThungulu district, KwaZulu-Natal province, South Africa. A total of 233 smallholder farmers were interviewed using semi-structured interviews and focus group discussions. The sensory evaluation was done with 72 smallholder farmers assessing the sensory attributes of typical meals such as steamed mealies (ifutho) and crumbled maize meal (uphuthu) produced by PVABM and common maize. Knowledge about PVABM and the average household income highly influenced (p < 0.05) the farmers’ likeliness to accept and incorporate PVABM into their farming systems. About 82% (Bulwer) and 83% (Mhlathuze) of farmers from the areas were willing to incorporate PVABM in their farming systems, and they had positive perceptions about the success of the varieties in their systems. Farmers already growing yellow maize were more willing to integrate PVABM. Sensory evaluation showed that PVABM foods (uphuthu and ifutho) were accepted for consumption and the farmers expressed the willingness to consume PVABM in their diets for nutrient improvement. The response showed that the taste of ifutho was acceptable for both PVABM (52.8%) and white maize (52.8%). The colour of PVABM ifutho was acceptable (50%) and white maize (44.4%), and the aroma was good for PVABM (58.3%) and very good for white maize (44.4%). Overall, both maize sensory attributes were rated as acceptable. The study indicated that farmers could accept PVABM into farming systems and it can be consumed at the household level. [ABSTRACT FROM AUTHOR]

Background: Currently, 30% of the total energy intake in the Mexican diet comes from ultra‐processed foods. Although its consumption is associated with high intakes of added sugar and saturated fats and low intakes of dietary fibre, there is no evidence regarding its association with dietary diversity and micronutrient intake. The present study evaluated the association between ultra‐processed foods consumption with dietary diversity and micronutrient intake in Mexico. Methods: Ultra‐processed foods items were identified in a 24‐h recall from a sample of 10,087 participants aged ≥ 1 year. The minimum dietary diversity (MDD) was established by using the Food and Agriculture Organization 10 food group indicators with unprocessed, minimally processed and processed foods. The study conducted multiple linear regression models to evaluate the association between quintiles of energy contribution of ultra‐processed foods with dietary diversity and micronutrient intake. Results: A high consumption of ultra‐processed foods was associated with a low dietary diversity and micronutrients intake. The association between ultra‐processed foods and MDD was not linear (47.1%, 57.1%, 52.5%, 45.0% and 28.0% of participants achieved the MDD). On the other hand, the association was linear and negatively associated with: niacin, pantothenic acid, pyridoxine, folate, vitamin B12, vitamin C, vitamin E, zinc, calcium, magnesium, potassium and phosphorus (p < 0.05). Conclusions: These findings are relevant in the context of the double burden of malnutrition currently faced in Mexico. Increasing dietary diversity and micronutrient intake is essential by discouraging ultra‐processed foods consumption. However, other strategies are also needed to promote the dietary diversity and increase the consumption of unprocessed and minimally processed foods. Highlights: A high consumption of ultra‐processed foods was associated with a low dietary diversity and micronutrients intake.These findings are relevant in the context of the double burden of malnutrition currently faced in Mexico. A decrease in the consumption of ultra‐processed foods is essential to achieve the goal of dietary diversity and micronutrient recommendations. [ABSTRACT FROM AUTHOR]

Micronutrient malnutrition has affected over two billion people worldwide and continues to be a health risk. A growing human population, poverty, and the prevalence of low dietary diversity are jointly responsible for malnutrition, particularly in developing nations. Inadequate bioavailability of key micronutrients, such as iron (Fe), zinc (Zn), and vitamin A, can be improved through agronomic and/or genetic interventions. The Consultative Group on International Agricultural Research prioritizes developing biofortified food crops that are rich in minerals and vitamins through the HarvestPlus initiative on biofortification. The objective of this review is to provide an overview of biofortified food crops along with evidence supporting their acceptability and adoption. Between 2004 and 2019, 242 biofortified varieties belonging to 11 major crops were released in 30 countries across Asia, Africa, and Latin America. These conventionally bred biofortified crops include Fe‐enriched beans, pearl millet, and cowpea; Zn‐enriched rice, wheat, and maize; both Fe‐ and Zn‐enriched lentil and sorghum; and varieties with improved vitamin A in orange‐fleshed sweet potato, maize, cassava, and banana/plantain. In addition to ongoing efforts, breeding innovations, such as speed breeding and CRISPR‐based gene editing technologies, will be necessary for the next decade to reach two billion people with biofortified crops. [ABSTRACT FROM AUTHOR]

Background: Malaria‐endemic areas are not spared from the impact of coronavirus disease 2019 (COVID-19), leading to co-infection scenarios where overlapping symptoms impose serious diagnostic challenges. Current knowledge on Plasmodium spp. and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co‐infection in pregnant women remains limited, especially in Latin America, where Plasmodium vivax infection is highly prevalent. Methods: This is a case series of five pregnant women with P. vivax and SARS-CoV-2 co-infection hospitalized in two main malaria referral centers of the Capital District and Bolivar state, Venezuela between March 13, 2020 and December 31, 2021. Results: Clinical and laboratory data from five pregnant women with a mean age of 22 years were analyzed; three of them were in the third trimester of pregnancy. Comorbidities included obesity in two cases, hypertension in one, and asthma in one. Three out of five patients had severe to critical COVID-19 disease. Dry cough, fever, chills, and headache were the most frequent symptoms reported. Laboratory analyses showed elevated aspartate/alanine aminotransferase and creatinine levels, thrombocytopenia, and severe anemia as the most relevant abnormalities. The mean period between symptom onset and a positive molecular test for SARS-CoV-2 infection or positive microscopy for Plasmodium spp. was 4.8 ± 2.5 days and 2.8 ± 1.6 days, respectively. The mean hospital stay was 5.4 ± 7 days. Three women recovered and were discharged from the hospital. Two women died, one from cerebral malaria and one from respiratory failure. Three adverse fetal outcomes were registered, two miscarriages and one stillbirth. Conclusion: This study documented a predominance of severe/critical COVID-19 disease and a high proportion of adverse maternal–fetal outcomes among pregnant women with malaria and COVID-19 co-infection. More comprehensive prospective cohort studies are warranted to explore the risk factors, management challenges, and clinical outcomes of pregnant women with this co-infection. [ABSTRACT FROM AUTHOR]

Adequate nutrition during childhood is vital for proper growth and development. However, nutrient intakes of Filipino school-age children are shown to be inadequate. This study assessed the nutrient intakes among school-age children from districts with the highest malnutrition rate in Davao City, Philippines. Using 3-day food records, dietary intake data were collected from a representative sample of 165 schoolchildren (aged 10-12 years) from six public schools in Poblacion, Paquibato, and Marilog districts. The nutrient intakes were calculated from the indicated food quantities, and the USDA food composition table was used as the primary database. These were compared with the 2015 Philippine Dietary Reference Intake values. Intake of total energy (102.56%), protein (165.11%), and some micronutrients reached the required amounts. On the other hand, inadequacies in several nutrients were identified: lipid intake was 49.01% of the recommended level, carbohydrate at 91.68%, dietary fiber at 53.16%, vitamin C at 54.98%, folate at 67.69%, vitamin E at 43.48%, vitamin D (IU) at 89.20%, calcium at 48.93%, and iron at 53.70%. Excess intakes of sodium (683.07%) and vitamin B12 (520.74%) were also reported. These findings suggest the need for targeted intervention programs that address nutrient inadequacies among Filipino school-age children. [ABSTRACT FROM AUTHOR]

Breeding maize with high contents of zinc, iron and provitamin A (PVA) could be effective in mitigating micronutrient deficiency in developing countries with a high reliance on maize-based diets. Information on the mode of inheritance of zinc, iron, PVA and grain yield (GY) would facilitate the development of varieties with enhanced contents of these nutrients. Twenty-four yellow to orange maize inbred lines and their 96 F1 hybrids generated using North Carolina Design II, were evaluated alongside four checks for two years at two locations in Nigeria. The effects of environment, hybrid and inbred line were significant for GY and contents of zinc, iron and PVA. The GY, and contents of zinc, iron and PVA of the hybrids ranged from 1.49 to 6.05 t ha−1, 22.51 to 33.33 mg kg−1, 20.04 to 29.65 mg kg−1 and 3.55 to 15.28 µg g−1, respectively. Additive gene effects controlled the accumulation of PVA and Fe, whereas both additive and non-additive gene effects controlled the inheritance of Zn and GY. Inbred lines with high general combining ability for GY and single or multiple micronutrients were identified, and could be used to develop hybrids and synthetics that combine high GY with high micronutrient content. Six hybrids combined high GY with high contents of all three micronutrients, and are recommended for further evaluation and possible release. Our study revealed the feasibility of enriching maize with multiple micronutrients without compromising grain yield. [ABSTRACT FROM AUTHOR]

Genotype assessment across various environments is a basic condition for developing stable and superior genotypes for sustainable maize production in the South-East of the DR Congo. Therefore, this research’s objectives were to identify the performance of newly developed provitamin A maize genotypes in various environments, and to recommend high-performing and stable genotypes for broader adaptation. Eight provitamin A maize genotypes, including one commercial variety, were planted at three sites during two consecutive cropping seasons (2020/2021 and 2021/2022) forming six environments. All genotypes in six environments were planted in a randomized complete block design containing three replications. Two stability analysis approaches, GGE biplot and Eberhart and Russell method are widely used to identify high yielding and stable genotypes. The combined analysis of variance revealed that G and E as well as their interaction (GEI) have significantly affected the emergence rate, cob’s insertion height, days to anthesis and silking, cob length, cob grain weight and grain yield. Average grain yield varied from 8.30 t/ha for PVAH-7L to 9.41 t/ha for PVAH-1L. The Eberhart and Russell method and the CV identified PVAH-1L, PVAH-4L, PVAH-7L and PVAH-6L as the most stable genotypes, but could not reliably identify the high yielding genotypes. On the other hand, the GGE biplot reliably and graphically showed the stable and high-yielding genotypes (PVAH-1L > PVAH-6L) as well as the low-yielding genotypes (PVAH-7 > PVAH-4L). In additional, the GGE biplot showed that L’shi21 was the best test environment for selecting high performing and stable provitamin A maize genotype. The results of this study indicate that PVAH-1L and PVAH-6L are the stable, high-yielding provitamin A maize genotypes in the South-East of the Democratic Republic of the Congo and should be disseminated in this region. [ABSTRACT FROM AUTHOR]

Helminthiases cause significant health deficiencies among children. Mass administration of anthelminthic drugs has had significant results to counter these effects. We assessed the effects on and determinants of treatment coverage of community-directed treatment among children in Zambia, using cross-sectional survey data, and using chi-square test and multilevel mixed-effects model. Of 1,416 children, 51.5% were males and 48.5% were females, while 52.7%, were school-age, and 47.3% were preschool-age. Overall treatment coverage was 53.7% (95% confidence interval (CI) 51.1, 56.4). More preschool-age children were treated compared to school-age ones, 65.2% versus 43.4%, P < 0.001. Similarly, more children under community-directed intervention were treated compared to regular mass drug administration (65.2% versus 51.1 %, P < 0.001). Treatment among school-age participants was associated with being male (Adjusted Odds Ratio (AOR 1.83, 95%CI 1.23–2.72), receiving community-directed treatment (AOR 5.53; 95%CI 3.41–8.97), and shorter distance to health facility (AOR 2.20; 95%CI 1.36–3.56). Among preschool-aged participants, treatment was associated with being residents of Siavonga district (AOR 0.03; 95%CI 0.01–0.04) and shorter distance to health facility (AOR 0.35; 95%CI 0.21–0.59). Community-directed treatment can be used to increase treatment coverage, thereby contribute to 2030 vision of ending epidemics of neglected tropical diseases. [ABSTRACT FROM AUTHOR]

Undernutrition is prevalent in developing regions, particularly sub-Saharan Africa (SSA), especially among children under five. Biofortification of staple crops and using indigenous and traditional crops could be an affordable and sustainable strategy together with other existing strategies to reduce undernutrition. This study aimed to determine the effect of adding bambara groundnut (BGN) on the physical quality, nutritional composition and consumer acceptability of a provitamin A-biofortified maize (PVABM) complementary instant porridge. The PVABM flour was substituted with flour of either red or brown BGN variety at 0, 10, 20 and 30% (w/w) levels. The composite flours were used to make an instantized complementary porridge. The physical quality (texture, color, water absorption capacity (WAC), solubility index (SI) and swelling volume (SV)) of the grains and the composite complementary instant porridges were assessed. Nutritional analysis was conducted using standard AOAC methods. A 55-member consumer panel evaluated the acceptability of the porridge samples using a nine-point hedonic scale. The firmness, WAC, SI and SV decreased with increasing concentration of flour of either of the BGN varieties. The decrease in SV would positively affect the porridge quality as nutrient density and viscosity decreased. The protein, fat, fiber and total mineral (ash) content of the porridges increased with an increase in either BGN variety. There was no significant difference (p > 0.05) in the overall acceptability of the BGN–PVABM composite porridge samples and the porridge without BGN (control). The improved nutritional composition and positive consumer acceptability of BGN–PVABM are encouraging as consumption could contribute to the alleviation of nutrient deficiencies, including protein-energy malnutrition and mineral deficiencies, especially in SSA. [ABSTRACT FROM AUTHOR]

Background: School health and nutrition programmes improve the health and nutritional status of learners, yet their implementation status in Zambia remains unknown. This study aimed to explore the implementation of school health and nutrition programme in one of the districts in Zambia. Methods: This was a descriptive, cross-sectional study conducted in Lusaka district, in 2015. The participating schools, including only state schools in Lusaka district were selected using stratified sampling method. Community and privately owned schools were not included. Herein, 40 school health and nutrition programme coordinators completed a questionnaire based on the guidelines provided by the Ministry of Education. Quantitative data were analysed via Microsoft Excel and Stata. The data obtained from open-ended questions were subjected to content analysis with prominent themes generated. Results: A School health and nutrition programme was observed in 42.5% (n=17) of the schools, but with no significant differences (P=0.601) between the urban and peri-urban ones. Due to insufficient funds and lack of supervision, only some of the recommended activities were implemented, such as school gardens, deworming, vitamin A and iron supplementation, and health education. The schools implementing school health and nutrition activities noted positive changes such as improvement in school attendance, pass rate, and a reduction in diarrhoea and bilharzia among their learners. Conclusion: School health and nutrition programme was implemented by less than half of the schools, still only partially. The effective implementation of the school health and nutrition programme is crucial to improve the health and nutritional status of learners. This necessitates that the Ministry of Education consistently follow up on school health and nutrition implementation. [ABSTRACT FROM AUTHOR]

Background: Iron status is considered as a continuum from an iron deficiency with anaemia, without anaemia, varying amounts of stored iron to iron overload. The burden of Plasmodium falciparum infections is typically high among school-aged children (SAC). Nonetheless, SAC are often less likely to be covered by malaria interventions, making them a group with an untreated reservoir of parasite transmission. This study aimed to assess the effects of asymptomatic and clinical malaria infections on biochemical markers of iron status among SAC in Malawi. Methods: Data from the 2015–2016 Malawi Micronutrient Survey (MNS) was used and multivariable logistic regression models using a generalized estimating equation to account for the complex cluster survey design were constructed. Blood samples of 684 children aged 5 to 14 years old were evaluated for clinical and asymptomatic malaria infections. Furthermore, blood samples were used to estimate haemoglobin (Hb), serum ferritin (SF) and, soluble transferrin receptors (sTfR) concentrations. Results: Of the 684 SAC analysed, approximately 42% had asymptomatic malaria, while 41.0% had clinical malaria. Anaemia (low Hb levels), iron deficiency (low SF concentration), and functional iron deficiency (high sTfR levels) were found in 20%, 5%, and 30% of the children, respectively. School-aged children with asymptomatic malaria had increased odds of being anaemic (adjusted odds ratio [aOR]: 3.71, 95% confidence interval [CI]: 2.29–5.99) and increased levels of sTfR (aOR: 3.00, 95% CI 2.01–4.47). Similarly, SAC with clinical malaria had increased odds of being anaemic (aOR: 3.54, 95% CI 2.19–5.72) and increased levels of sTfR (aOR: 3.02, 95% CI 2.02–4.52). Conclusions: Both asymptomatic and clinical malaria were independent risk factors for anaemia and functional iron deficiency (FID). The notion that asymptomatic and clinical malaria were associated with both anaemia and FID underscores the need for public health programmers to consider adding mass screening and treatment for malaria to existing school-based health programmes. [ABSTRACT FROM AUTHOR]

Objective: We wanted to identify factors related to dietary behavioural change among impoverished pregnant women in the face of nutrition education and counselling, describing what creates an enabling environment and barriers for dietary change.Design: We used qualitative data from a cluster-randomised maternal education trial and conducted a thematic analysis using a social ecological framework to describe the factors that influenced dietary adherence.Setting: Mangochi district in rural Malawi.Participants: We interviewed ten pregnant women and conducted four sets of focus group discussions with twenty-two significant family members (husbands and mothers-in-law) and twelve counsellors.Results: The participants' experiences showed that the main barriers of adherence to the intervention were taste, affordability and poverty. The use of powders and one-pot dishes, inclusion of both women and significant family members and a harmonisation with local food practices enabled adherence to the intervention. We found it crucial to focus the dietary education and counselling intervention on locally available ingredients and food processing methods.Conclusions: Use of contextualised food-based solutions to combat maternal malnutrition was observed to be relatively cheap and sustainable. However, there is need for more research on local foods used as nutrition supplements. We suggest that investments need to be directed not only to nutrition education and counselling but also to the enabling factors that enhance adherence. The original cluster-randomised controlled trial was registered with Clinical trials.gov ID: NCT03136393. [ABSTRACT FROM AUTHOR]

We aimed to investigate dietary vitamin A (DVA) intake, serum vitamin A (SVA) concentrations, and breast milk vitamin A (BMVA) concentrations of urban lactating Chinese women and explore the associated factors. We recruited 326 lactating women from ten cities in China and collected their dietary information, blood samples, and breast milk samples. SVA and BMVA were assessed with high-performance liquid chromatography. Mann–Whitney U tests, Kruskal–Wallis H tests, Chi-square tests, Spearman correlation tests, and multiple regression analyses were conducted. The median (25th, 75th) of DVA, SVA and BMVA were 372.36 (209.12, 619.78) μg RAE/day, 1.99 (1.71, 2.35) μmol/L, and 1.67 (1.13, 2.15) μmol/L, respectively. Only 3.1% of lactating women met the recommended nutrient intake of Vitamin A (VA), and 20.6% had a BMVA level below 1.05 μmol/L. Compared to underweight or normal weight women, overweight or obese lactating women had lower DVA and BMVA but higher SVA (p = 0.022; p = 0.030; p = 0.003). Multiparous women had a higher risk of inadequate BMVA (p = 0.023) than primiparous women. SVA and BMVA were positively associated with DVA, especially for lactating women not using VA supplements (β = 0.174, 95%CI = 0.025, 0.324, p = 0.022; β = 0.501, 95%CI = 0.208, 0.795, p = 0.001). There was no association between SVA and BMVA (β = 0.165, 95%CI = −0.037, 0.366, p = 0.109). In conclusion, VA nutritional status among Chinese urban lactating women needs more attention, especially for those who are obese, overweight, or higher parity. Increased DVA may contribute to increased BMVA. [ABSTRACT FROM AUTHOR]