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

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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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

British Journal Of Nutrition ◽

10.1017/s0007114516002063 ◽

2016 ◽

Vol 116 (S1) ◽

pp. S8-S15 ◽

Cited By ~ 7

Author(s):

Umi Fahmida ◽

Otte Santika

Keyword(s):

Complementary Feeding ◽

Economic Status ◽

Portion Size ◽

Cross Sectional Survey ◽

Fortified Foods ◽

West Java ◽

Cross Sectional ◽

Nutrient Adequacy ◽

Food Pattern ◽

Poor Access

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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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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Farmer Decision-Making on the Concept of Coexistence: A Comparative Analysis between Organic and Biotech Farmers in the Philippines

Agriculture ◽

10.3390/agriculture11090857 ◽

2021 ◽

Vol 11 (9) ◽

pp. 857

Author(s):

Clarisse Mendoza Gonzalvo ◽

Wilson Jr. Florendo Aala ◽

Keshav Lall Maharjan

Keyword(s):

Decision Making ◽

The Philippines ◽

Environmental Conservation ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Internal Factors ◽

Organic Farmers ◽

Farmer Decision Making ◽

Decision Making Processes ◽

Farmer Groups

Farmer perspectives are relevant for understanding agricultural issues and formulating policies. In this study, we conducted a cross-sectional survey on 70 Filipino farmers (i.e., 35 organic and 35 biotech) to understand farmers’ perspectives regarding coexisting farming methods. Internal response variables were tested to verify the type of decision-making processes being undertaken by biotech and organic farmers. Our results showed that a non-linear decision-making process, similar to the Stimulus–Organism–Response Model, was present for both farmer groups. The study also found that biotech farmers were more influenced by internal factors (e.g., consumer resources) than organic farmers, who rely more on external influences (e.g., culture and social interactions), in connection to their coexistence perspective. The presence of “maverick executives” within the organic farmers gives traction to the notion that coexistence can help empower farmers in choosing what farming method is most suitable to their needs. Our data can also provide insights to policymakers in terms of surveying farmer perspectives to balance farmer needs, primarily in yield and income security, with the national agricultural agenda centered on environmental conservation. Thus, farmer perspectives should be considered alongside ongoing studies and debates on coexistence.

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Dietary intakes and body mass indices of non-pregnant, non-lactating (NPNL) women from the Coastal and Guinea savannah zones of Ghana

African Journal of Food, Agriculture, Nutrition and Development ◽

10.18697/ajfand.49.enam11 ◽

2012 ◽

Vol 12 (49) ◽

pp. 5843-5861

Author(s):

GY Kobati ◽

◽

A Lartey ◽

GS Marquis ◽

EK Colecraft ◽

...

Keyword(s):

Body Mass ◽

Coastal Zone ◽

Formal Education ◽

Maternal Nutrition ◽

Dietary Intakes ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Dietary Recall ◽

Working Day ◽

Savannah Zone

Adequate maternal nutrition prior to pregnancy is important for maternal health and favourable pregnancy outcomes. However, information on the dietary intakes of NonPregnant, Non-Lactating (NPNL) women in Ghana is lacking. A cross-sectional survey was undertaken to compare the dietary intakes of NPNL women of children aged 2 to 5 years who are either living in the Coastal (n=79) or Guinea Savannah (n=89) zones. Data were collected using various methods namely interviewer administered socio-demographic questionnaire, 24hr dietary recall records, with data collected on one working and one non-working day within a week, and a 1-week food frequency questionnaire. Body mass index was derived from height and weight measurements. Women in the Coastal Savannah zone had significantly (p=0.05) more formal education (3.9 ± 2.5 years) and earned a higher (p<0.001) weekly income (Gh¢ 6.8 ± 2.7) than women in the Guinea Savannah zone with educational level and incomes of 2.2±1.6 years and Gh¢ 3.9±2.4 respectively. More women in the Coastal zone had significantly (p<0.05) fewer births and were heads of their households. Cereal-based foods were consumed daily by all women during the two-day observation period. Fish was the predominant animal source food in the diet in both zones. Significantly (p<0.05) more women in the Guinea Savannah zone did not meet their Estimated Average Requirements (EAR) for protein (81%), vitamin A (94.4%), and vitamin C (72%) compared to women in the Coastal zone (44%, 22%, and 31% respectively).The diets of both groups of women were low in calcium. Generally, women in the Coastal zone had a significantly (p<0.001) higher BMI (24.2 ± 4.6 kg/m2) than their counterparts in the Guinea Savannah zone (21.3± 2.4 kg/m2).The overall quality of dietary intakes and nutritional status of women in the Guinea Savannah zone was poorer than that of Coastal women. Dietary deficiencies are also present in NPNL women in Ghana. Efforts are needed to improve diet quality and to increase access to resources especially for women in the Guinea Savannah zone of Ghana.

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Impact of school lunch type on nutritional quality of English children’s diets

Public Health Nutrition ◽

10.1017/s1368980015000853 ◽

2015 ◽

Vol 19 (1) ◽

pp. 36-45 ◽

Cited By ~ 20

Author(s):

Charlotte EL Evans ◽

Vera Mandl ◽

Meaghan S Christian ◽

Janet E Cade

Keyword(s):

Primary Schools ◽

Dietary Intakes ◽

Evaluation Tool ◽

Food Diary ◽

School Lunches ◽

Cross Sectional Survey ◽

Cross Sectional ◽

School Meal ◽

Food Standards ◽

Quality Diet

AbstractObjectiveNutrient and food standards exist for school lunches in English primary schools although packed lunches brought from home are not regulated. The aim of the present study was to determine nutritional and dietary differences by lunch type.DesignA cross-sectional survey was carried out in 2007 assessing diet using the Child and Diet Evaluation Tool (CADET), a validated 24 h estimated food diary. The data were analysed to determine nutritional and dietary intakes over the whole day by school meal type: school meals and packed lunches.SettingFifty-four primary schools across England.SubjectsChildren (n 2709) aged 6–8 years.ResultsChildren having a packed lunch consumed on average 11·0 g more total sugars (95 % CI 6·6, 15·3 g) and 101 mg more Na (95 % CI 29, 173 mg) over the whole day. Conversely, children having a school meal consumed, on average, 4·0 g more protein (95 % CI 2·3, 5·7 g), 0·9 g more fibre (NSP; 95 % CI 0·5, 1·3 g) and 0·4 mg more Zn (95 % CI 0·1, 0·6 mg). There was no difference in daily energy intake by lunch type. Children having a packed lunch were more likely to consume snacks and sweetened drinks; while children having a school meal were more likely to consume different types of vegetables and drink water over the whole day.ConclusionsCompared with children having a school meal, children taking a packed lunch to school consumed a lower-quality diet over the whole day, including higher levels of sugar and Na and fewer vegetables. These findings support the introduction of policies that increase school meal uptake.

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Concerning Impact of Decreasing Infant Cereal Consumption on Essential Nutrient Intakes of Breastfed Babies: Feeding Infants and Toddlers Study (FITS) 2016 (P11-064-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.p11-064-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Kristen Finn ◽

Brian Kineman ◽

Ryan Carvalho

Keyword(s):

Infant Formula ◽

Nutrient Intakes ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Dietary Recall ◽

Breastfed Infants ◽

Funding Sources ◽

Calcium Phosphorus ◽

Dietary Nutrient ◽

Essential Nutrient

Abstract Objectives Infant cereal consumption among 6–11.9 month old infants has declined from 72% in 2002 to 52% in 2016. This is especially concerning for breastfed infants since infant cereal is a top source of iron and other key nutrients. The purpose of this study is to determine how infant cereal consumption impacts nutrient intakes of breastfed infants. Methods FITS 2016 is a cross sectional survey of caregivers across the U.S. assessing food and nutrient intakes. A 24 hour dietary recall was administered to caregivers of children aged 0–47.9 months (n = 3235). For this analysis, only infants aged 6–11.9 months who were either breastfed (no infant formula provided, n = 296) or mixed fed (breastmilk and infant formula provided, n = 102) were included. If any amount of infant cereal was consumed, the infant was considered a cereal user. Dietary supplements were excluded to determine usual nutrient intakes from diet only. Infants were categorized as a breastfed cereal user, breastfed non-user, mixed fed cereal user, or mixed fed non-user. The percentage of infants with dietary nutrient intakes below the adequate intake (AI) or estimated average requirement (EAR) were analyzed for significant differences between cereal users and non-users among breastfed and mixed fed infants using paired T-tests. Results Among breastfed infants, a significantly higher percentage of cereal users had intakes above the EAR or AI level for iron, vitamin C, thiamine, riboflavin, niacin, vitamin B6, folate, vitamin B12, calcium, phosphorus, magnesium, vitamin A, zinc, potassium, and choline compared to non-users (See Figure 1). Among mixed fed infants, a significantly higher percentage of cereal users had intakes above the EAR or AI level for iron, magnesium, and choline (See Figure 2). Most infants had inadequate intakes of vitamin D. Conclusions Breastfed and mixed fed infants who consume infant cereal are more likely to have adequate intakes of iron, choline, and magnesium than their non-infant cereal consuming counterparts. Among breastfed infants, infant cereal consumers are also more likely to consume adequate amounts of 12 other nutrients compared to non-users. Infant cereal is a source of many key nutrients and is an important complementary food, especially for breastfed infants. Funding Sources Nestlé Research Center, Switzerland. Supporting Tables, Images and/or Graphs

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Molecular identification of Ancylostoma ceylanicum in the Philippines

Parasitology ◽

10.1017/s0031182020001547 ◽

2020 ◽

Vol 147 (14) ◽

pp. 1718-1722

Author(s):

Oyime P. Aula ◽

Donald P. McManus ◽

Kosala G. Weerakoon ◽

Remigio Olveda ◽

Allen G. Ross ◽

...

Keyword(s):

Molecular Diagnostics ◽

The Philippines ◽

Schistosomiasis Japonica ◽

Cross Sectional Survey ◽

Ancylostoma Ceylanicum ◽

Cross Sectional ◽

Multifaceted Approach ◽

Stool Samples ◽

Health Relevance ◽

Polymerase Chain

AbstractHookworms are some of the most widespread of the soil-transmitted helminths (STH) with an estimated 438.9 million people infected. Until relatively recently Ancylostoma ceylanicum was regarded as a rare cause of hookworm infection in humans, with little public health relevance. However, recent advances in molecular diagnostics have revealed a much higher prevalence of this zoonotic hookworm than previously thought, particularly in Asia. This study examined the prevalence of STH and A. ceylanicum in the municipalities of Palapag and Laoang in the Philippines utilizing real-time polymerase chain reaction (PCR) on stool samples previously collected as part of a cross-sectional survey of schistosomiasis japonica. Prevalence of hookworm in humans was high with 52.8% (n = 228/432) individuals positive for any hookworm, 34.5% (n = 149/432) infected with Necator americanus, and 29.6% (n = 128/432) with Ancylostoma spp; of these, 34 were PCR-positive for A. ceylanicum. Considering dogs, 12 (n = 33) were PCR-positive for A. ceylanicum. This is the first study to utilize molecular diagnostics to identify A. ceylanicum in the Philippines with both humans and dogs infected. Control and elimination of this zoonotic hookworm will require a multifaceted approach including chemotherapy of humans, identification of animal reservoirs, improvements in health infrastructure, and health education to help prevent infection.

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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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Prices, Availability and Affordability of Medicines with Value-Added Tax Exemption: A Cross-Sectional Survey in the Philippines

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17145242 ◽

2020 ◽

Vol 17 (14) ◽

pp. 5242 ◽

Cited By ~ 1

Author(s):

Krizzia Lambojon ◽

Jie Chang ◽

Amna Saeed ◽

Khezar Hayat ◽

Pengchao Li ◽

...

Keyword(s):

Value Added ◽

Access To Medicines ◽

The Philippines ◽

Unit Price ◽

World Health ◽

Value Added Tax ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Universal Healthcare ◽

Health Organization

Background: Developing countries, such as the Philippines, started implementing policies to improve access to medicines, which is a vital step toward universal healthcare coverage. This study aimed to evaluate the prices, availability and affordability of prescribed medicines for diabetes, hypercholesterolemia and hypertension with the exemption of 12% value-added tax in the Philippines. Methods: The prices and availability of 50 medicines were collected in August 2019 from 36 public and 42 private medicine outlets in six regions of the Philippines, following a modified methodology developed by the World Health Organization and Health Action International. Availability is reported as the percentage of outlets in which the surveyed medicine was found at the time of visit. Medicine prices are expressed as median unit prices (MUPs) in Philippine Peso. Affordability is calculated based on the number of days’ wages required for the lowest-paid unskilled government worker to purchase a monthly treatment. Results: The mean availability of surveyed medicines was low in both public and private sectors, with 1.3% for originator brands (OBs) and 25.0% for lowest-priced generics (LPGs) in public outlets, and 34.7% and 35.4% in private outlets, respectively. The MUP of medicines were higher in private outlets, and OBs have higher unit price compared to the generic equivalents. Treatments with OBs were unaffordable, except for gliclazide, but the affordability of most LPGs is generally good. Conclusion: Access to medicines in both sectors was affected by low availability. High prices of OBs influenced the affordability of medicines even with tax exemption. A review of policies and regulations should be initiated for a better access to medicines in the Philippines.

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