Development of complementary feeding recommendations for 12–23-month-old children from low and middle socio-economic status in West Java, Indonesia: contribution of fortified foods towards meeting the nutrient requirement

AbstractInadequate nutrient intake as part of a complementary feeding diet is attributable to poor feeding practices and poor access to nutritious foods. Household socio-economic situation (SES) has an influence on food expenditure and access to locally available, nutrient-dense foods and fortified foods. This study aimed to develop and compare complementary feeding recommendations (CFR) for 12–23-month-old children in different SES and evaluate the contribution of fortified foods in meeting nutrient requirements. A cross-sectional survey was conducted in low and medium SES households (n 114/group) in urban Bandung district, West Java province, Indonesia. Food pattern, portion size and affordability were assessed, and CFR were developed for the low SES (LSES) and middle SES (MSES) using a linear programming (LP) approach; two models – with and without fortified foods – were run using LP, and the contribution of fortified foods in the final CFR was identified. Milk products, fortified biscuits and manufactured infant cereals were the most locally available and consumed fortified foods in the market. With the inclusion of fortified foods, problem nutrients were thiamin in LSES and folate and thiamin in MSES groups. Without fortified foods, more problem nutrients were identified in LSES, that is, Ca, Fe, Zn, niacin and thiamin. As MSES consumed more fortified foods, removing fortified foods was not possible, because most of the micronutrient-dense foods were removed from their food basket. There were comparable nutrient adequacy and problem nutrients between LSES and MSES when fortified foods were included. Exclusion of fortified foods in LSES was associated with more problem nutrients in the complementary feeding diet.

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Evaluating Interventions With Special Fortified Products and Complementary Feeding Recommendations to Best Achieve the Nutrient Adequacy in Filipino Complementary Diets

Current Developments in Nutrition ◽

10.1093/cdn/nzab045_049 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 667-667

Author(s):

Karen Kay Mejos ◽

Jayashree Arcot ◽

Maria Socorro Ignacio ◽

Rohan Jayasuriya

Keyword(s):

Complementary Feeding ◽

The Philippines ◽

Dietary Intakes ◽

Cross Sectional Survey ◽

Fortified Foods ◽

Cross Sectional ◽

Nutrient Adequacy ◽

Funding Sources ◽

Micronutrient Powder ◽

Filipino Children

Abstract Objectives The objective of this study was to predict the intervention scenarios that best fulfil the nutrient adequacy in Filipino complementary diets in rural settings using linear programming (LP) analyses of special fortified foods, alone or in combination with complementary feeding recommendations (CFRs). Methods A cross-sectional survey was conducted in the municipality of Mercedes, Camarines Norte Province. Dietary intakes of breastfed children 6–8, 9–11 and 12–23 months of age (n = 297) were assessed using a multi-pass 24-hour recall method with 7-day food consumption frequency. Optifood, an LP tool was used to formulate age-specific CFRs and determine the extent to which special fortified foods, namely micronutrient powder (MNP), small-quantity lipid-based nutrient supplements (LNS-SQ) and fortified blended food with micronutrient powder (FBF + MNP), can contribute towards nutrient adequacy in complementary diets. Results LP analyses show that for 6–8 and 9–11-month-old infants, requirements for iron will be difficult to meet even with four serves of MNP per week, while for 9–11 and 12–23-month-old young children, calcium adequacy would remain a challenge even with daily serves of LNS-SQ per week. Adequacy for 11 modelled micronutrients could only be achieved if CFRs that modify current dietary patterns were fully adopted along with supplementation of LNS-SQ 5–7 times per week. Conclusions Adoption of food-based CFRs with special fortified products is necessary to best fulfil the gaps of essential micronutrients in the diets of rural Filipino children aged 6–23 months. The findings provide insight into the current program in the Philippines. The MNP supplementation with the usual ration of MNP 3 to 4 times per week would not be sufficient to ensure adequacy for iron in 6–8 and 9–11-month-old infants unless the frequency is increased to 5 times per week. Empirical intervention studies are needed to confirm the LP simulations and feasibility of the CFRs. Funding Sources The authors received no funding for this work.

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Use of Linear Programming to Develop Complementary Feeding Recommendations to Improve Nutrient Adequacy and Dietary Diversity Among Breastfed Children in the Rural Philippines

Food and Nutrition Bulletin ◽

10.1177/0379572121998125 ◽

2021 ◽

pp. 037957212199812

Author(s):

Karen Kay Mejos ◽

Maria Socorro Ignacio ◽

Rohan Jayasuriya ◽

Jayashree Arcot

Keyword(s):

Linear Programming ◽

Complementary Feeding ◽

Dietary Diversity ◽

Age Group ◽

Dietary Intakes ◽

Food Groups ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Nutrient Adequacy ◽

Programming Tool

Background: Lack of dietary diversity in complementary feeding contributes to nutrient gaps leading to undernutrition. Food-based strategies have been successfully used to enrich the complementary diets of infants and young children. However, context-specific recommendations based on an objective diet optimization is needed to formulate sound and practical nutritional guidelines. Objectives: The present study aimed to identify problem nutrients in complementary diets and formulate complementary feeding recommendations (CFRs) using linear programming analysis for children aged 6 to 23 months in the rural Philippines. Methods: A cross-sectional survey was conducted in the municipality of Mercedes, Philippines. Dietary intakes of breastfed children 6 to 8, 9 to 11, and 12 to 23 months of age (n = 297) were assessed using a multipass 24-hour recall method with 7-day food consumption frequency. A linear programming tool was used to identify the recommended nutrient intakes that could not be met within the existing local food patterns and develop CFRs that would best fulfil nutrient adequacy for 11 modelled micronutrients. Results: Problem nutrients in the current diets were iron and calcium in any age-group, zinc for 6 to 8 and 9 to 11 months old, and thiamine and folate for 12 to 23 months old children. Adoption of CFRs with 4 to 5 food groups in the diet would ensure the adequacy of 7 to 8 nutrients, depending on the age-group. Conclusion: Within the boundaries of local dietary patterns, adequacy for most nutrients could be achieved by promoting realistic servings of nutrient-dense foods and food groups. The linear programming results provide an evidence-based strategy in designing interventions to improve the quality of Filipino complementary diets.

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AWARENESS ABOUT INDOOR AIR POLLUTION IN GENERAL POPULATION OF RAWALPINDI AND ISLAMABAD

Pakistan Journal of Public Health ◽

10.32413/pjph.v8i2.118 ◽

2018 ◽

Vol 8 (2) ◽

pp. 80-83

Author(s):

Nadia Tariq ◽

Tamkeen Jaffry ◽

Rahma Fiaz ◽

Abdul Majid Rajput ◽

Sadaf Khalid

Keyword(s):

Air Pollution ◽

General Population ◽

Indoor Air ◽

Indoor Air Pollution ◽

Economic Status ◽

Educational Status ◽

Epidemiological Studies ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Significant Difference

Background: Indoor air pollutants are increasingly being associated with respiratory illnesses leading to high degree of morbidity and mortality. There are not sufficient epidemiological studies from Pakistan which assess level of awareness of indoor air pollution resulting in respiratory diseases in population. Methods: This cross sectional survey was carried out on general population of Rawalpindi/Islamabad. Sample size was 223 study subjects selected by non-probability convenient sampling. Knowledge of the study subjects was determined with regard to indoor air pollution, its effects on health and different sources of indoor air pollution with the help of a questionnaire. The influence of age, gender, educational status and socio economic status on the level of awareness was also analyzed. Results: Out of total 223 participants, 115 were males and108 females. Participants aware of indoor air pollution were 91.5% and adequate awareness about its sources was 80.7%. Those who knew indoor air pollution is detrimental to health were 95.1%. Awareness about building construction dust as source of indoor air pollution was maximum (84.8%). There was significant difference in awareness among participants with different monthly incomes and educational status and also between males and females. Conclusion: This study concludes that general population of Rawalpindi/Islamabad has fairly good awareness about sources of indoor air pollution. Use of harmful material causing indoor air pollution should be limited or substituted with better ones where possible.

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Health Literacy is Associated with Health Behaviors in Students from Vocational Education and Training Schools: A Danish Population-Based Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17020671 ◽

2020 ◽

Vol 17 (2) ◽

pp. 671 ◽

Cited By ~ 3

Author(s):

Charlotte Demant Klinker ◽

Anna Aaby ◽

Lene Winther Ringgaard ◽

Anneke Vang Hjort ◽

Melanie Hawkins ◽

...

Keyword(s):

Health Literacy ◽

Health Behavior ◽

Vocational Education ◽

Economic Status ◽

Education And Training ◽

Vocational Education And Training ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Scale Scores ◽

And Training

Health literacy has been identified as an important and changeable intermediary determinant of health equity. Vocational education and training (VET) schools are a relevant setting for health behavior interventions seeking to diminish health inequities because many VET students come from low socio-economic status backgrounds. This study examines VET students’ health literacy and its association with health behavior based on a cross-sectional survey among 6119 students from 58 VET schools in Denmark in 2019. Two scales from the Health Literacy Questionnaire was used to assess domains of health literacy. Data were analyzed using Anova and logistic regression. The study population consisted of 43.4% female, and mean age was 24.2 years (range 15.8–64.0). The health literacy domain ‘Actively managing my health’ mean was 2.51, SD 0.66, and ‘Appraisal of health information’ mean was 2.37, SD 0.65. For both domains, being female, older age, attending the VET educational program Care-health-pedagogy, and higher self-rated health were associated with higher scale scores. In the adjusted analyses, lower scale scores were associated with less frequent breakfast, daily smoking, high-risk alcohol behavior and moderate-to-low physical activity. Our results show that low health literacy is associated with unhealthy behaviors in this population. Our results support and inform health literacy research and practice in educational institutions and services.

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Essential Medicines at the National Level: The Global Asthma Network’s Essential Asthma Medicines Survey 2014

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16040605 ◽

2019 ◽

Vol 16 (4) ◽

pp. 605 ◽

Cited By ~ 4

Author(s):

Karen Bissell ◽

Philippa Ellwood ◽

Eamon Ellwood ◽

Chen-Yuan Chiang ◽

Guy Marks ◽

...

Keyword(s):

Inhaled Corticosteroids ◽

Communicable Disease ◽

Action Plan ◽

National Level ◽

Essential Medicines ◽

World Health ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Middle Income ◽

Poor Access

Patients with asthma need uninterrupted supplies of affordable, quality-assured essential medicines. However, access in many low- and middle-income countries (LMICs) is limited. The World Health Organization (WHO) Non-Communicable Disease (NCD) Global Action Plan 2013–2020 sets an 80% target for essential NCD medicines’ availability. Poor access is partly due to medicines not being included on the national Essential Medicines Lists (EML) and/or National Reimbursement Lists (NRL) which guide the provision of free/subsidised medicines. We aimed to determine how many countries have essential asthma medicines on their EML and NRL, which essential asthma medicines, and whether surveys might monitor progress. A cross-sectional survey in 2013–2015 of Global Asthma Network principal investigators generated 111/120 (93%) responses—41 high-income countries and territories (HICs); 70 LMICs. Patients in HICs with NRL are best served (91% HICs included ICS (inhaled corticosteroids) and salbutamol). Patients in the 24 (34%) LMICs with no NRL and the 14 (30%) LMICs with an NRL, however no ICS are likely to have very poor access to affordable, quality-assured ICS. Many LMICs do not have essential asthma medicines on their EML or NRL. Technical guidance and advocacy for policy change is required. Improving access to these medicines will improve the health system’s capacity to address NCDs.

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Effectiveness of mobile produce markets in increasing access and affordability of fruits and vegetables among low-income seniors

Public Health Nutrition ◽

10.1017/s1368980020002931 ◽

2020 ◽

Vol 23 (17) ◽

pp. 3226-3235

Author(s):

Reece Lyerly ◽

Pasquale Rummo ◽

Sarah Amin ◽

Whitney Evans ◽

Eliza Dexter Cohen ◽

...

Keyword(s):

Rhode Island ◽

Low Income ◽

Fruits And Vegetables ◽

Economic Status ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Assistance Program ◽

Logistic Regression Models ◽

Populations At Risk ◽

Nutrition Assistance

AbstractObjective:Mobile produce markets (MPM) offering Supplemental Nutrition Assistance Program (SNAP) incentive programmes have the potential to provide accessible and affordable fruits and vegetables (FV) to populations at risk of food insecurity. The objective of this study is to characterise the customer base of an MPM and describe their participation at twelve market sites serving low-income seniors.Design:In 2018, customers from an MPM in Rhode Island (RI) participated in a cross-sectional survey (n 330; 68 % response rate), which measured dietary patterns, food security and food shopping behaviours. We compared the shopping habits and market experiences of customers who currently received SNAP benefits with those who did not currently receive SNAP benefits.Setting:An MPM in RI which offers a 50 % discount for FV purchased with SNAP benefits.Participants:This study describes current market customers at twelve market sites serving low-income seniors.Results:Market customers were mostly low-income, female, over the age of 50 years and Hispanic/Latino. Most customers received SNAP benefits, and almost half were food insecure. In addition, three quarters of SNAP customers reported their SNAP benefits last longer since shopping at the markets. Mixed logistic regression models indicated that SNAP customers were more likely to report buying and eating more FV than non-SNAP customers.Conclusions:MPM are critical resources of affordable produce and have been successful in improving access to FV among individuals of low socio-economic status in RI. This case study can inform policy and programme recommendations for MPM and SNAP incentive programmes.

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Patterns and predictors of food texture introduction in French children aged 4–36 months

British Journal Of Nutrition ◽

10.1017/s0007114518002386 ◽

2018 ◽

Vol 120 (9) ◽

pp. 1065-1077 ◽

Cited By ~ 9

Author(s):

Lauriane Demonteil ◽

Eléa Ksiazek ◽

Agnès Marduel ◽

Marion Dusoulier ◽

Hugo Weenen ◽

...

Keyword(s):

Complementary Feeding ◽

Eating Habits ◽

First Year ◽

Age Classes ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Food Texture ◽

Second Year ◽

Almost All ◽

Linear Regressions

AbstractThe aims of this study were to describe which and when food textures are offered to children between 4 and 36 months in France and to identify the associated factors. An online cross-sectional survey was designed, including questions about 188 food texture combinations representing three texture levels: purées (T1), soft small pieces (T2) and hard/large pieces and double textures (T3). Mothers indicated which combinations they already offered to their child. A food texture exposure score (TextExp) was calculated for all of the texture levels combined and for each texture level separately. Associations between TextExp and maternal and child characteristics and feeding practices were explored by multiple linear regressions, per age class. Answers from 2999 mothers living in France, mostly educated and primiparous, were analysed. Over the first year, children were mainly exposed to purées. Soft and small pieces were slowly introduced between 6 and 22 months, whereas hard/large pieces were mainly introduced from 13 months onwards. TextExp was positively associated with children’s number of teeth and ability to eat alone with their finger or a fork. For almost all age classes, TextExp was higher in children introduced to complementary feeding earlier, lower for children who were offered only commercial baby foods and higher for those who were offered only home-made/non-specific foods during the second year. Our study shows that until 12 months of age the majority of French children were exposed to pieces to a small extent. It provides new insights to further understand the development of texture acceptance during a key period for the development of eating habits.

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Dietary Sources and Nutrient Adequacy Potential of Local Foods among Children (6–23 Months) in Urban Slums of West Oromia (Ethiopia)

Journal of Nutrition and Metabolism ◽

10.1155/2020/1787065 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12

Author(s):

Wondu Garoma Berra

Keyword(s):

Vitamin A ◽

Vitamin C ◽

Substantial Improvement ◽

Model Parameters ◽

Local Foods ◽

Dietary Intakes ◽

Analysis Model ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Nutrient Adequacy

Background. Identifying the combination of local foods that optimize nutrient intake is challenging. This study addressed how local foods could be rationally combined to provide basic nutritional needs, while limiting the use of commercial foods among children in Ethiopia. Methods. A cross-sectional survey was carried out to estimate dietary intakes of 396 children (6–23 months of age) using 24-hour recall and WDR. Anthropometrics (weight and height) of the children was taken to calibrate energy and protein requirements to body sizes during ProPAN analysis. Model parameters were defined using dietary and market-survey data. ProPAN (2.0), SAS (9.2), and NutriSurvey for Windows were used for data analysis. Results. Age-specific optimal combinations of local foods that achieve nutrient adequacy set by the WHO/FAO (≥70% RDA) for 9 nutrients were successfully generated. Overall, the percentage of children consuming ≥ EAR for most nutrients obtained from median servings was 54.3%, 89.9%, 61.8%, 12.9%, 85.6%, 79.7%, and 34.2% for energy, protein, iron, zinc, vitamin A, vitamin C, and calcium, respectively. The percentage of RDA was 46.3% for zinc, 56.7% for vitamin A, 24.3% for vitamin C, and 40% for calcium among infants (6–11 months), whereas the respective percentage of RDA was 78.1% for zinc, 100% for vitamin A, 43.3% for vitamin C, and 50% for calcium in older children (12–23 months of age). However, careful combination of local foods, slightly complimented by commercial foods, has shown substantial improvement in nutrient adequacy, ensuring ≥99% RDA for all target nutrients. Conclusions. Careful combinations of local foods have the potential to achieve optimum dietary intakes of essential nutrients. However, minimal consideration of commercial foods has been inevitable, especially for infants aged 6–11 months.

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Exposure to Messages on Risk Factors for Noncommunicable Diseases in a Rural Province of Vietnam

BioMed Research International ◽

10.1155/2019/7962947 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Bich Diep Pham ◽

Bao Giang Kim ◽

Thi Thu Huyen Nguyen ◽

Van Minh Hoang

Keyword(s):

Risk Factors ◽

Economic Status ◽

Intervention Programs ◽

Noncommunicable Diseases ◽

Cluster Sampling ◽

Poisson Regression Model ◽

Sources Of Information ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Factors Associated

Background. Providing messages on risk factors for noncommunicable diseases (NCDs) plays an important role in preventing disease. Objectives. This study investigated how often adults living in a rural area in northern Vietnam heard about risks factor for NCD and where they obtained that information. Methods. A cross-sectional survey was conducted using a multistage stratified cluster sampling to recruit 2970 participants. Data analyses were adjusted for all variables in a two-level multilevel Poisson regression model. Results. Overall, 77% of respondents had heard about NCDs, while 38.3 to 50% had been exposed to messages on risk factors of NCDs in the last month. Television, radio, and friends/neighbors were the most common sources of information. Most people exposed information no more than one or two sources. Factors associated with exposure to messages about risk were occupation, age group, education, and economic status. Conclusion. Intervention programs should focus on providing information primarily through television, considering influencing factors as well ensuring that messages reach target audiences.

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